Swine Influenza (H1N1) Diseases

CONTENTS:-
What is Swine Influenza(H1N1):
What exactly is swine flu?
How bad is this strain?
How is the virus transmitted ?
How can we kill the virus ?
How can we prevent getting the virus ?
How can we diagnose Swine Flu in human ?
What are the symptoms of Swine in Human?
Can a vaccine be created ?
Swine Influenza in India:
Flu surveillance in India:
Human studies area:
Prevention in humans:
Is there a vaccine against this new H1N1 virus ?
Treatment In swine:
Treatment In humans:





What is Swine Influenza(H1N1):

Swine influenza is common in pigs in the mid western United States, Mexico, Canada, South America, Europe, UK, Sweden, and Italy, Kenya, Mainland China, Taiwan, Japan and othe Asia. It’s thought that novel influenza A swine flu spreads in the same way that regular seasonal influenza viruses spread; mainly through the fever, coughing, headache and sneezes of people who are sick with the virus.
Swine influenza (swine flu, hog flu, and pig flu) refers to the influenza caused by those strains of influenza virus that are usually infect pigs and called swine influenza virus (SIV).

Transmission of swine influenza from pigs to humans is not common. People who's work with pigs, specially people with intense exposures, are at risk of catching swine flu. There will be more cases, more hospitalization and more deaths associated with this new virus. These strains of swine flu can pass from human to human. In humans, the symptoms of swine flu are similar to those of influenza and of influenza-like illness in general, namely chills, fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort.

The 2009 flu outbreak in humans that is widely known as "swine flu" This strain of influenza virus is unique. These new strain of influenza A virus subtype H1N1 that was produced by re assortment from one strain of human influenza virus, one strain of avian influenza virus, and two separate strains of swine influenza. because it is a combination of genes from swine, bird, and human influenza viruses. The origin of this new strain is unknown, and the World Organization for Animal Health that this strain has not been isolated in pigs. Infected individuals report flu-like symptoms of fever, aches and pains, sore throats, coughing, and trouble breathing. It passes with apparent ease from human to human, an ability attributed to an as-yet unidentified mutation. Some people have also reported diarrhea and vomiting.

influenza A(H1N1):
H1N1 is a new influenza (flu) virus first seen in the United States in April 2009. It is called "novel" H1N1 because the virus has never been identified before and is new. Novel H1N1 was initially called "swine flu" by health officials because many of the genes are similar to some flu viruses that pigs in North America can get. However, further study showed that this new virus contains genes from flu viruses that circulate in pigs in Europe and Asia as well as genes from birds and humans. Scientists call this a "quadruple re assortant" influenza virus.

Influenza A virus subtype H1N1, also known as A(H1N1), is a subtype of influenza virus A and the most common cause of influenza (flu) in humans. Some strains of H1N1 are endemic in humans, including the strain(s) responsible for the 1918 flu pandemic which killed 50–100 million people worldwide. Less virulent H1N1 strains still exist in the wild today, worldwide, causing a small fraction of all influenza-like illness and a large fraction of all seasonal influenza. H1N1 strains caused roughly half of all flu infections in 2006. Other strains of H1N1 are endemic in pigs and in birds.

In March and April 2009, hundreds of laboratory-confirmed infections and a number of deaths were caused by an outbreak of a new strain of H1N1..
Top


What exactly is swine flu?
Swine influenza is a highly contagious respiratory disease that emanates from pigs. Pigs are unique because these animals accommodate influenza virus from two other major hosts: humans and birds. Swine flu is a type A influenza virus.
Type A influenza viruses are sub-typed according to 1) their respective Hemagglutinin (H), which is a surface protein that allows the virus to attach to host cells and 2) a viral surface associated neuraminidase (N), which allows the virus to enter the host cell. All influenza A subtypes have been identified from birds. The current swine flu is type A subtype H1N1. Top


How bad is this strain?
This strain is unique for several reasons. First, as previously mentioned, the combination of avian and human influenza gene sequences is worrisome because of the possible species jumping of the avian virus to that of humans. Second, the H is sufficiently different from the current vaccine strain H such that humans will have little or no protection. Third, unlike the H5N1 bird influenza virus, this current swine influenza virus is effectively passed from human to human and has made its debut well in advanced of the typical influenza season typically kills 36,000 people in the United States. However, it is still too early to tell the full extent of the current viral infection.
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How is the virus transmitted ?
Influenza spreads primarily through aerosolization (coughing and sneezing) and direct contact by touching contaminated surfaces. Although the virus requires a living cell to survive/thrive, influenza virus has been shown to persist on surfaces like tabletops for up to 24 hours. The virus is not transmitted by eating cooked pork products. Top


How can we kill the virus?
Like many viruses, influenza is very heat sensitive. Furthermore, influenza is an envelope virus, which means the genetic material (RNA) is contained within a membrane. Once the membrane is compromised, the viral RNA genome is subject to degradation and thus the virus cannot replicate/survive. There are a number of hand hygiene products that are available that disrupt viral membranes. Additionally, drugs such as Tamiflu (an inhibitor of the viral N) are very effective against the current circulating virus. The antiviral drug Amantadine (an inhibitor of the viral proton pump) has been shown to be ineffective against the current circulating swine influenza. Top


How can we prevent getting the virus?
Covering the nose and mouth with a surgical mask can be of some help but good hand hygiene, staying away from sick individuals and avoiding crowds will also help greatly. Top


How can we diagnose Swine Flu in human?
In human, Swine Flu is usually transmitted through the Respiratory Tract. Droplets of infected body fluids may carry flu when people cough or sneeze. Therefore, a respiratory specimen generally needs to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, especially children may shed virus for 10 days or longer. The collected specimen is then sent to the identified laboratories in the country for confirmation.
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Who is at risk?
Typically, the very young and the very old tend to be at greatest risk, but for two very different reasons. In small children, the immune system is very alert and when activated in response to entities such as an influenza virus, literally goes into overdrive creating a cytokine storm. The result is extensive damage in the lungs akin to drowning in one's own fluids. In the elderly, the immune system is not as alert and does not go into an overdrive as it does with young hosts. Due to aging a compromised immune system gives rise to secondary bacterial infections such as pneumonia. TOP


What are the symptoms of Swine in Human?
It takes about 4 (four) days for the onset of symptoms when a person is infected. The symptoms are usually:-
1. Coughing and sneezing
2. Headache and Body ache
3. Fever and chills
4. Sometimes vomiting and diarrhea
Severe cases of Flu that leads to death are normally seen in very young and very old people whose immune systems are too weak to fight off the virus. Top


Can a vaccine be created ?
Creating a vaccine is no trivial issue. A vaccine can be created, but to make the number of doses needed to protect the entire community may take a minimum of 6-9 months with the participation of large pharmaceutical firms.

Now that the pandemic alert level is phase 5 imminent pandemic, what should I do?

Pandemic implies that the virus is widespread. It does not necessarily mean that the virus is extremely virulent. However, since the verdict is still out with regard to the current virus, the bottom line is:

• Wash your hands frequently.
• Stay away from those who are ill.
• Avoid large crowds of people.
• Wash hands thoroughly with soap and warm water
• Use hand sanitizer regularly
• Cough and sneeze in your arm or sleeve and refrain from any close contact with your colleagues if you suspect you may be sick
• Get your annual flu shot
• Keep doing what you normally do, but stay home if sick
• Talk to a health professional if you experience flu-like symptoms: fever, cough, runny nose, sore throat, body aches, fatigue and lack of appetite.

Swine Influenza in India:
NEW DELHI: Even as the government claims that India is now better prepared to deal with influenza A(H1N1) outbreak than it was four years ago, three persons are being kept under observation here and two in Koch Of the three admitted to the Delhi hospitals, one had volunteered to get himself tested. Two of them had arrived from the United States and the other from Germany. The two in Kochi had visited the U.S., Europe, and came to India via Dubai.

Although influenza is not a new nor rare disease, the virus is constantly drifting due to changes in the viral H gene as well as reassortment changes arising from genomic mixing thus presenting differently to all hosts yearly. However, there are precautionary measures that one can take to decrease the risk of exposure.
Top


Flu surveillance in India:
India has stepped up its effort of swine flu monitoring by directing screening of passengers at all ports and international air ports. Surveillance at border road posts has also beefed up, as five more people – all Indians – arriving from abroad have reported suspected flu symptoms.

However, Joint Secretary in the health ministry Vineet Chawdhry on Monday informed that there is no laboratory confirmed human death.

Samples of suspected patients have been sent to both the National Institute of Communicable Diseases (New Delhi) and National Institute of Virology (NIV), Pune for tests, he informed.

Cabinet Secretary K.M. Chandrasekhar held a video conference with Chief Secretaries of 17 States and reviewed the preparedness of the States. And the Director General of Health Services held a meeting with Director of Health Services of States/Union Territories and discussed technical aspects, including surveillance at Airports, ports and community; laboratory support; sample collection and transportation, clinical management, risk communication etc.

So far, all suspected samples have been tested negative and India is in better place as far as the spread of swine flu is concerned.


Influenza A:
Swine influenza is known to be caused by influenza A subtypes H1N1,H3N2,and H2N3.pigs, three influenza A virus subtypes (H1N1, H3N2, and H1N2) are the most common strains worldwide.[14] In the United States, the H1N1 subtype was exclusively prevalent among swine populations before 1998; however, since late August 1998, H3N2 subtypes have been isolated from pigs. As of 2004, H3N2 virus isolates in US swine and turkey stocks were triple reassortants, containing genes from human (HA, NA, and PB1), swine (NS, NP, and M), and avian (PB2 and PA) lineages.


History:
Swine influenzas epidemics are actually caused by several strains, spreading across swines populations with more or less visible symptoms. The Swine influenzas are likely to have exists for thousands of years, probably millions, coevolving together with swine immune system as a traditional arms race opposing them too. In human farms, swine influenzas are likely to have caused difficulties since the beginning of swine taming, in terms of productivity, as well as in term of rare interspecies virus transmissions. That's only in recent centuries, and especially in recent decades, that humans got the knowledge need to record, study, understand and soon create vaccines and look at the genetic code of swine flus. The first isolation occurring in 1930. The swine flus have been mainly an economic concern, especially within intensive pig farms (pork industry) which increasingly looked for ways to keep their herds alive, healthy, and growing faster. Top


Human studies area:
The influenza virus constantly changes form, thereby eluding the protective antibodies that target populations (swine, avian or human) may have developed in response to previous exposures to influenza or to influenza vaccines. Every two or three years the virus undergoes minor changes. But at intervals of roughly a decade, after the bulk of the world's population has developed some level of resistance to these minor changes, it undergoes a major change that enables it to easily infect populations around the world, often infecting hundreds of millions of people whose antibody defenses are unable to resist it. The influenza virus has also been known to change form over a much shorter period of time. For instance, during the Spanish flu pandemic, the initial wave of the disease was relatively mild, while the second wave of the disease a year later was highly lethal. Top


Prevention:
Prevention of swine influenza has three components: prevention in swine, prevention of transmission to humans, and prevention of its spread among humans.


Prevention in humans?

Swine can be infected by both avian and human influenza strains of influenza, and therefore are hosts where the antigenic shifts can occur that create new influenza strains.

The transmission from swine to human is believed to occur mainly in swine farms where farmers are in close contact with live pigs. Although strains of swine influenza are usually not able to infect humans this may occasionally happen, so farmers and veterinarians are encouraged to use a face mask when dealing with infected animals. The use of vaccines on swine to prevent their infection is a major method of limiting swine to human transmission. Risk factors that may contribute to swine-to-human transmission include smoking and not wearing gloves when working with sick animals. Top


Is there a vaccine against this new H1N1 virus?
At this time, there is no vaccine for novel H1N1 flu. The seasonal influenza vaccine does not provide protection against this new H1N1 flu. This makes ordinary precautions, such as covering coughs and washing hands, all the more important.
Should I keep my child home from school as a precaution?

Parents do not need to keep otherwise healthy children home from school unless directed to do so by local school and health officials.

Children who are ill should not attend school. Monitor your child for influenza-like symptoms and keep them home if they are sick. Symptoms include fever, cough, body aches, runny or stuffy nose, sore throat, headache, chills and fatigue. Novel H1N1 can also cause nausea, vomiting or diarrhea. You may want to contact their health care provider, particularly if symptoms are severe. Be sure to tell your health care provider if you have recently traveled, especially to states in the U.S. or to other countries where H1N1 flu has been confirmed. Your health care provider will determine whether influenza testing or treatment is needed.
Should I ask my health care provider for a prescription anti-flu drug?

Antiviral drugs are usually used to treat people who are at risk for developing life-threatening complications from the flu. There is no reason to routinely ask for one of these drugs to keep at home, or to take them just as a precaution. Over-use could result in limited supplies for those who need it most. In addition, over-use of antiviral drugs has been known to lead to flu viruses becoming resistant to the drugs. All drugs, including antivirals, can cause side effects and should only be used when necessary under the direction of a health care provider.
Can I get H1N1 flu from eating or preparing pork?

H1N1 influenza viruses are not spread by food. You cannot get H1N1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.Top


Treatment In swine:
As swine influenza is not usually fatal to pigs, little treatment is required; instead veterinary efforts are focused on preventing the spread of the virus throughout the farm, or to other farms. Vaccination and animal management techniques are most important in these efforts. Modern pork industry also largely make use of antibiotic, which have no effect against influenza itself, but keep bacterias away, preventing pneumonia and other bacterial infections to affect their influenza-weakened herds.Top


Treatment In humans:
If a person becomes sick with swine flu, antiviral drugs can make the illness milder and make the patient feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms). Beside antivirals, palliative care, at home or in the hospitals, focuses on controlling fevers and maintaining fluid balance. The U.S. Centers for Disease Control and Prevention recommends the use of Tamiflu (oseltamivir) or Relenza (zanamivir) for the treatment and/or prevention of infection with swine influenza viruses, however, the majority of people infected with the virus make a full recovery without requiring medical attention or antiviral drugs. The virus isolates in the 2009 outbreak have been found resistant to amantadine and rimantadine.

In the U.S., on April 27, 2009, the FDA issued Emergency Use Authorizations to make available Relenza and Tamiflu antiviral drugs to treat the swine influenza virus in cases for which they are currently unapproved. The agency issued these EUAs to allow treatment of patients younger than the current approval allows and to allow the widespread distribution of the drugs, including by non-licensed volunteers. Top


By: Raj

Diseases And Information

Diseases Name:

Bacterial Infections:

• Acinetobacter
• Actinomycosis
• Anthrax
• Bacteroides Infection
• Bartonellosis
• Botulism
• Brucellosis
• Burkholderia
• Campylobacter Infections
• Cardiobacterium
• Corynebacterium Infections
• * Ehrlichiosis
• * Enterobacter Infections
• * Enterococcal Infections
• * Escherichia Coli Infections
• * HACEK Group Infections
• * Haemophilus Influenzae Infections
• * Klebsiella Infections
• * Leptospirosis
• * Listeria Monocytogenes
• * Meningococcal Infections
• * Meningococcemia
• * Moraxella Catarrhalis Infections
• * Morganella Infections
• * Mycoplasma Infections
• * Nocardiosis
• * Pasteurella Multocida Infection
• * Peptostreptococcus Infection
• * Plague
• * Propionibacterium Infections
• * Proteus Infections
• * Providencia Infections
• * Pseudomonas Aeruginosa Infections
• * Pseudotuberculosis (Yersinia)
• Q Fever
• Relapsing Fever
• Rhodococcus equi
• Rickettsialpox
• Rocky Mountain Spotted Fever
• Sepsis, Bacterial
• Serratia
• Staphylococcal Infections
• Stenotrophomonas Maltophilia
• Streptococcus Group A Infections
• Streptococcus Group B Infections
• Streptococcus Group D Infections
• Trench Fever
• Treponematosis (Endemic Syphilis)
• Typhoid Fever
• Typhus
• Vibrio Infections
• Yersinia Enterocolitica

Bone and Joint Infections:

* Pott Disease (Tuberculous Spondylitis)
* Septic Arthritis


Cardiovascular Infections:

CNS Infections:

* Brain Abscess
* California Encephalitis
* Cysticercosis
* Eastern Equine Encephalitis
* Japanese Encephalitis
* Meningitis
* Naegleria Infection
* St. Louis Encephalitis
* Tetanus
* Venezuelan Encephalitis
* West Nile Encephalitis
* Western Equine Encephalitis


Fungal Infections:

* Candidiasis
* Coccidioidomycosis (Infectious Diseases)
* Cryptococcosis
* Mucormycosis
* Paracoccidioidomycosis
* Pneumocystis (carinii) jiroveci Pneumonia
* Sporotrichosis
* Trichosporon Infections
* Zygomycosis


Gastrointestinal Tract and Intra-abdominal Infections:

* Bacterial Overgrowth Syndrome
* Cholera
* Cyclospora
* Pseudomembranous Colitis
* Salmonellosis
* Strongyloidiasis
* Yellow Fever

Genitourinary Tract Infections:

* Urinary Tract Infection, Females
* Urinary Tract Infection, Males

HEENT Infections:

* Herpangina
* Pharyngitis, Bacterial
* Pharyngitis, Viral
* Rhinocerebral Mucormycosis
* Rhinosporidiosis
* Sinusitis, Acute
* Sinusitis, Chronic

Lower Respiratory Tract Infections:

* Avian Influenza
* Hantavirus Pulmonary Syndrome
* Human Metapneumovirus
* Legionnaires Disease
* Nosocomial Pneumonia
* Nursing Home Acquired Pneumonia
* Pneumococcal Infections
* Pneumonia, Community-Acquired
* Psittacosis
* Severe Acute Respiratory Syndrome (SARS)
* Tularemia


Mycobacterial Infections:

* Miliary Tuberculosis
* Mycobacterium Avium-Intracellulare
* Mycobacterium Chelonae
* Mycobacterium Fortuitum
* Mycobacterium Gordonae
* Mycobacterium Haemophilum
* Mycobacterium Kansasii
* Mycobacterium Marinum
* Mycobacterium Xenopi
* Tuberculosis


Parasitic Infections:

* Acanthamoeba
* African Trypanosomiasis (Sleeping Sickness)
* Amebiasis
* Ascariasis
* Babesiosis
* Balantidiasis
* Chagas Disease (American Trypanosomiasis)
* Cryptosporidiosis
* Diphyllobothriasis
* Dipylidiasis
* Dirofilariasis
* Echinococcosis
* Echinococcosis Hydatid Cyst
* Filariasis
* Hookworms
* Intestinal Flukes
* Isosporiasis
* Leishmaniasis
* Malaria
* Microsporidiosis
* Nematode Infections
* Onchocerciasis
* Pinworm
* Sarcosporidiosis
* Schistosomiasis
* Toxocariasis
* Toxoplasmosis
* Trematode Infection
* Trichinosis
* Trichomoniasis
* Tungiasis


Sexually Transmitted Diseases:

* Chancroid
* Chlamydial Genitourinary Infections
* Gonococcal Infections
* Lymphogranuloma Venereum (LGV)
* Papillomavirus
* Syphilis
* Ureaplasma Infection


Skin and Soft-Tissue Infections:

* Bacillary Angiomatosis
* Burn Wound Infections
* Catscratch Disease
* Cellulitis
* Clostridial Gas Gangrene
* Diabetic Foot Infections
* Eosinophilic Folliculitis
* Epidural Abscess
* Erythema Multiforme (Stevens-Johnson Syndrome)
* Gas Gangrene
* Hand-Foot-and-Mouth Disease
* Human Bite Infections
* Impetigo
* Leprosy
* Mediterranean Spotted Fever
* Molluscum Contagiosum
* Mycetoma
* Pediculosis
* Pinta
* Pityriasis
* Toxic Epidermal Necrolysis
* Yaws


Special Topics:

* Bacterial Infections and Pregnancy
* Chronic Fatigue Syndrome
* Fever of Unknown Origin
* Intravenous-to-Oral Switch Therapy
* Viral Infections and Pregnancy


Viral Infections:

* Adenoviruses
* Arenaviruses
* Coxsackieviruses
* Cytomegalovirus
* Dengue Fever
* Ebola Virus
* Echoviruses
* Enteroviruses
* Herpes B
* Herpes Simplex
* Herpes Zoster
* Human Herpesvirus Type 6
* Human Papillomavirus
* Human T-Cell Lymphotrophic Viruses
* Infectious Mononucleosis
* Influenza
* Kuru
* Lymphocytic Choriomeningitis
* Norwalk Virus
* Orbivirus
* Parainfluenza Virus
* Parapoxviruses
* Picornavirus-Overview
* Poxviruses
* Rabies
* Reoviruses
* Rhinoviruses
* Smallpox
* H1N1 Influenza (Swine Flu)
* Vaccinia
* Varicella-Zoster Virus


Basic Information:

Warning signs of pregnancy complications If one or more of these symptoms occur call your physician immediately, or call the labor and delivery department of your hospital:

Uterine contractions that feel like your womb is tightening (baby balling up)
Menstrual-like cramps that may come and go or are constant Abdominal cramps with or without diarrhea Low back aches that come and go or are constant Pelvic pressure which feels like the baby is pushing down on your vagina Change in vaginal discharge or a discharge that becomes mucousy,
watery or slightly bloody Vaginal discharge that has a "fishy" or foul odor Vaginal irritation or itching that is severe Urinary changes:
increased urgency or feeling of need to urinate; decreased amount of urine; concentrated urine with strong or foul odor;

pain or burning with urination Excessive swelling of feet, legs, hands (rings are tight) or face (especially around eyes) Frequent or severe headaches, dizziness, or confusion (inability to think clearly) Visual changes:

blurring or seeing spots before the eyes Steady back or abdominal pain or nausea after the end of the first trimester Decrease in fetal movement after 20 to 24 weeks into gestation period
Listening to your body Treatment of minor discomforts1,2

Moms-to-be sometimes have minor discomforts associated with their pregnancies. Here are some strategies for managing those discomforts:

Strategies for managing nausea and vomiting: Eat crackers, melba toast or dry cereal on awakening (before getting out of bed) and at other times when nauseated. Eat frequent small meals. Drink fluids such as flat, sugar-sweetened soft drinks and clear juices (between meals, not with) and avoid excessive fluids at time if nauseated - make up for lost fluids later.

Avoid caffeinated tea and coffee (always avoid caffeine).
Avoid food odors that make you feel ill.
Limit intake of high-fat foods.
Avoid skipping meals.
Extreme hunger can cause nausea.

Strategies for managing heartburn:
Eat small, low-fat meals and eat slowly.
Snack on crackers, toast or fruit as needed.
Drink fluids between meals, not with them.
Avoid spicy foods.
Eat slowly and chew thoroughly.
Avoid lying down 1 to 2 hours after eating, especially before going to bed.
Avoid bending over immediately after eating. S
leeping with head elevated may relieve symptoms.
Wear loose-fitting clothing.

Strategies for managing constipation:

Drink six to eight glasses of fluid daily;
warm or hot fluids are helpful upon awakening.
Eat high-fiber cereals, whole grains, fruit, vegetables and legumes.
Engage in physical activities, such as walking.
Do not take laxatives unless recommended by your provider.
Stop what you are doing and immediately get to a toilet at the first urge to defecate.

Strategies for managing frequent urination:

Limit fluid intake two hours before bedtime.
Do not cut down on daily fluid intake; redistribute it.
Call your physician if experiencing pain or burning when going to the bathroom.

Strategies for managing nasal stuffiness:

Try using a humidifier. Use normal saline nose drops.

Strategies for managing vaginal discharge:
Wear pads.
Refer to physician if discharge becomes yellow, has a foul odor or causes burning or itching. Urinary Tract Infections [UTI] can cause preterm labor.
Do not douche.

Strategies for managing fatigue and stress:
Prioritize your commitments. Eliminate non-essential "duties."
Get help from your spouse, or another family member.
Relax your housekeeping standards.
Plan ahead for errands and group them if you can.
If possible, rest with feet up at lunch and/or breaktime.
Reduce the noise in your environment.
If certain activities make you tense or frustrated, try to change or avoid these events.
Know your physical and intellectual rhythms and take advantage of them (e.g. if you are a morning person, do your difficult jobs then).
Avoid rushing by planning a little extra time for everything.
Don't over-schedule yourself.
Be realistic.
Learn to say no.
Be assertive.
Avoid or reduce entertainment that causes you to feel tense.
Try not to make too many changes at once, if possible. Even changes for the better cause stress. For example, don't start new job, move to a new house and start school all in the same year.

Exercise regularly within your physician-established guidelines.
Eliminate caffeine and nicotine.
Eat a well-balanced diet. Get adequate sleep.
You may want to try meditation, deep breathing, visualization or a similar technique. Make time for fun - whatever you enjoy.
Develop a support network.
If you feel like crying, do.

Uterine palpation procedure (Braxton-Hicks)You may experience irregular, non-painful uterine contractions.
These contractions, also known as Braxton-Hicks contractions, are a normal occurrence. They begin during the first trimester and increase in frequency, duration and intensity as pregnancy progresses.
The contractility of uterine muscle increases in pregnancy.
Near term, strong Braxton-Hicks contractions are often difficult to distinguish from the contractions of true labor. The acceptable number of contractions in a one-hour time frame is determined by your physician. Be sure to discuss Braxton-Hicks contractions during a physician visit. Keep a clock or watch with easily readable numbers and a second hand available at bedside. Uterine contraction is a gradual tightening of the uterine muscle which lasts at least 35 seconds from beginning to end. When they occur, you need to monitor the uterine palpation through the following steps:
Empty your bladder.
Lie on your left side or in a comfortable position.
Place the heel of both hands just above your hipbone on both left and right sides.
Allow the palm of your hand and fingers to lie over the uterine abdominal area.
Be aware of any tightening of the uterus.
Time this tightening from the beginning, through the crescendo (when uterus is very hard) and the decreased tightening. When the uterus is no longer tight the contraction is completed. Count the number of times this occurs in one hour. If there are greater than the allowable number of contractions drink two (2) 12 oz. glasses of water, empty your bladder, lie on left side only and begin to palpate again for one hour. If contractions remain above threshold which has been established by your doctor after second hour of palpation, call your obstetrician immediately. Your palpation program should be done as instructed by your obstetrician. Top



DETAILS:

Bacterial Infections:

Bacteria are living things that have only one cell. Under a microscope, they look like balls, rods or spirals. They are so small that a line of 1,000 could fit across a pencil eraser. Most bacteria won't hurt you - less than 1 percent makes people sick. Many are helpful. Some bacteria help to digest food, destroy disease-causing cells and give the body needed vitamins. Bacteria are also used in making healthy foods like yogurt and cheese.

But infectious bacteria can make you ill. They reproduce quickly in your body. Many give off chemicals called toxins, which can damage tissue and make you sick. Examples of bacteria that cause infections include Streptococcus, Staphylococcus, and E. coli.

Antibiotics are the usual treatment. When you take antibiotics, follow the directions carefully. Each time you take antibiotics, you increase the chances that bacteria in your body will learn to resist them. Later, you could get or spread an infection that those antibiotics cannot cure.

Some bacteria are harmless. Your skin, mouth, bowels and other places are filled with them. Many are even necessary to your survival because they help digest food or keep infectious organisms at bay. Cows could not digest grass without bacteria in their stomachs. The troublemakers are the ones that are able to make harmful chemicals that act like acids or poisons. Botulism, for instance, is caused by a bacterial poison. Pus, for the most part, is the body's response to illness. It's a collection of white cells that the body recruits for an area of infection. At other times, bacteria are so irritating to your system that your own body's defenses go overboard and attack not only the bacteria but also the tissues that host them.

How do bacteria work?

Bacteria don't grow bigger. Instead, they multiply by dividing. Each bacterium splits into two every few minutes, hours or days, depending on the species. Under ideal conditions, they can increase exponentially, producing millions from a single organism in a short time. Not requiring sex to multiply frees them from a great number of complications. But in order to exchange genetic material, they indulge in two types of conjugal relationships. Occasionally two bacteria get together and simply trade genes. At other times viruses act as messengers, transporting bits of genetic material from one organism to the other in a process called transduction. This is how most antibiotic resistance is transferred, and it is also how a great deal of genetic engineering takes place in modern molecular biology laboratories. We have learned from our enemies.

How do I know I have a bacterial infection?

Bacterial infection usually makes you noticeably sick, whether it's an infected ingrown toenail or bloody diarrhea. Sometimes, however, they produce very little awareness but still can go on to cause immense trouble. Sexually transmitted disease, for instance, can be very subtle and can leave you infertile before you know what hit you. Even if an infection is obvious, it often takes a modern laboratory to identify the exact germ and, more important, tell the doctor what to use to treat it. Most bacteria can be grown in the laboratory and tested for their reaction to different antibiotics. This is why the doctor wants to collect a specimen from your infection, wherever it is.

Many infections produce inflammation, a process generated mostly by your immune system, which appears as redness from an increased blood supply, swelling from fluid accumulating in the tissues, pain from nerve irritation, and heat, both localized warmth and generalized fever.

How do antibiotics work?

Because bacteria are complete life forms, they perform many chemical processes to stay alive. They must manufacture their structural elements, digest and assimilate nutrients, replicate themselves as they multiply and protect themselves from hostile elements in their environment. Antibiotics hinder these processes.

Some can kill bacteria by interrupting a vital process. Others merely slow them down or stop them from multiplying until your body's immune system can kill them. Each class of antibiotics - penicillins, cephalosporins, tetracyclines, aminoglycosides, quinolones, macrolides - targets a specific bacterial process. In turn, bacteria develop the ability to disable each class of antibiotics by targeting its particular susceptibility, usually by producing a chemical that inactivates it. Some bacteria are then able to transfer that ability, as a piece of genetic information, to other bacteria by transduction - "cross-pollinating," if you will. Top



Acinetobacter Disease:

Acinetobacter is a Gram-negative genus of Bacteria belonging to the Gammaproteobacteria. Non-motile, Acinetobacter species are oxidase-negative, and occur in pairs under magnification. They are important soil organisms where they contribute to the mineralisation of, for example, aromatic compounds. Acinetobacter are a key source of infection in debilitated patients in the hospital.

Natural habitat:

Acinetobacter spp are widely distributed in nature. They are able to survive on various surfaces (both moist and dry) in the hospital environment, thereby being an important source of infection in debilitated patients. Occasional strains are isolated from foodstuffs and some are able to survive on various medical equipment and even on healthy human skin.

What is Acinetobacter?

Acinetobacter is a group of bacteria commonly found in soil and water. It can also be found on the skin of healthy people, especially healthcare personnel. While there are many types or “species” of Acinetobacter and all can cause human disease, Acinetobacter baumannii accounts for about 80% of reported infections.

Outbreaks of Acinetobacter infections typically occur in intensive care units and healthcare settings housing very ill patients. Acinetobacter infections rarely occur outside of healthcare settings.

What are the symptoms of Acinetobacter infection?

Acinetobacter causes a variety of diseases, ranging from pneumonia to serious blood or wound infections and the symptoms vary depending on the disease. Typical symptoms of pneumonia could include fever, chills, or cough. Acinetobacter may also “colonize” or live in a patient without causing infection or symptoms, especially in tracheostomy sites or open wounds.

How do people get Acinetobacter infection?

Acinetobacter poses very little risk to healthy people. However, people who have weakened immune systems, chronic lung disease, or diabetes may be more susceptible to infections with Acinetobacter.Hospitalized patients, especially very ill patients on a ventilator, those with a prolonged hospital stay, or those who have open wounds, are also at greater risk for Acinetobacter infection. Acinetobactercan be spread to susceptible persons by person-to-person contact, contact with contaminated surfaces, or exposure in the environment.

How is Acinetobacter infection treated?

Acinetobacter is often resistant to many commonly prescribed antibiotics. Decisions on treatment of infections with Acinetobacter should be made on a case-by-case basis by a healthcare provider. Acinetobacter infection typically occurs in very ill patients and can either cause or contribute to death in these patients.

What should I do to prevent the spread of Acinetobacter infection to others?

Acinetobacter can live on the skin and may survive in the environment for several days. Careful attention to infection control procedures such as hand hygiene and environmental cleaning can reduce the risk of transmission. For more information on infection control practices and hand hygiene, see Hand Hygiene in Healthcare Settings and Guideline for Isolation Precautions in Hospitals. Top



Actinomycosis Disease:

Actinomycosis is a rare infectious bacterial disease of humans generally caused by Actinomyces israelii, A gerencseriae and Propionibacterium propionicus, though the condition is likely to be polymicrobial.

Actinomycosis occurs rather frequently in cattle as a disease called lumpy jaw. This name refers to the large abscesses that grow on the head and neck of the infected animal. It can also affect humans, swine, horses, and dogs, rarely wild animals and sheep. See Actinomycosis in animals.

Signs and symptoms:

The disease is characterized by the formation of painful abscesses in the mouth, lungs,[2] or digestive organs, actinomycosis abscesses grow larger as the disease progresses, often over a period of months. In severe cases, the abscesses may penetrate the surrounding bone and muscle to the skin, where they break open and leak large amounts of pus. The purulent leakage via sinus cavities contains 'sulfur granules' which are not actually sulfur containing but look like them. These granules contain progeny bacteria. The affected person generally has recently had dental work, poor oral hygiene, radiation therapy causing local tissue damage of oral mucosa, or periodontal disease, all of which predispose the person to developing actinomycosis.

Causes:

Actinomycosis is primarily caused by any of several members of the bacterial genus Actinomyces. These bacteria are generally anaerobes.[3] Actinomyces spp. normally live in the small spaces between the teeth and gums, causing infection only when they can multiply freely in anoxic environments. They are normal commensals in the caecum, thus abdominal actinomycosis can happen following appendicectomy. The three most common sites of infection are decayed teeth, the lungs, and the intestines. It is important to note that actinomycosis doesn't occur in isolation of other bacteria. This infection depends on other bacteria (gram positive, gram negative, and cocci) to aid in invasion of tissue.

Treatment:

Actinomyces bacteria are generally sensitive to penicillin, which is frequently used to treat actinomycosis. If the person is allergic to penicillin, then doxycyclin is used. If the person is allergic to doxycyclin, then penicillin is used. Top



Anthrax Disease:

Anthrax is an acute disease caused by Bacillus anthracis. It affects both humans and animals and most forms of the disease are highly lethal. There are effective vaccines against anthrax, and some forms of the disease respond well to antibiotic treatment.

Like many other members of the genus Bacillus, Bacillus anthracis can form dormant spores that are able to survive in harsh conditions for extremely long periods of time - even decades or centuries. Such spores can be found on all continents, even Antarctica. When spores are inhaled, ingested, or come into contact with a skin lesion on a host they may reactivate and multiply rapidly.

Anthrax commonly infects wild and domesticated herbivorous mammals which ingest or inhale the spores while browsing - in fact, ingestion is thought to be the most common route by which herbivores contract anthrax. Carnivores living in the same environment may become infected by consuming infected animals. Diseased animals can spread anthrax to humans, either by direct contact (e.g. inoculation of infected blood to broken skin) or consumption of diseased animals' flesh.

Anthrax spores can be produced in vitro and used as a biological weapon. Anthrax does not spread directly from one infected animal or person to another, but spores can be transported by clothing or shoes and the body of an animal that died of anthrax can also be a source of anthrax spores.

Mode of infection:

Anthrax can enter the human body through the intestines (ingestion), lungs (inhalation), or skin (cutaneous) and causes distinct clinical symptoms based on its site of entry. An infected human will generally be quarantined. However, anthrax does not usually spread from an infected human to a noninfected human. But if the disease is fatal the person’s body and its mass of anthrax bacilli becomes a potential source of infection to others and special precautions should be used to prevent further contamination. Inhalational anthrax, if left untreated until obvious symptoms occur, may be fatal.

Anthrax can be contracted in laboratory accidents or by handling infected animals or their wool or hides. It has also been used in biological warfare agents and by terrorists to intentionally infect humans, as occurred in, for example, the 2001 anthrax attacks.

Treatment and prevention:

The most effective form of prevention is vaccination against infection but this must be done well in advance of exposure to the bacillus, and does not protect indefinitely.
The name anthrax comes from anthrakitis, the Greek word for anthracite (coal), in reference to the black skin lesions victims develop in a cutaneous skin infection.

Anthrax vaccines:

An FDA-licensed vaccine, produced from one non-virulent strain of the anthrax bacterium, is manufactured by BioPort Corporation, subsidiary of Emergent BioSolutions. The trade name is BioThrax, although it is commonly called Anthrax Vaccine Adsorbed (AVA). It is administered in a six-dose primary series at 0,2,4 weeks and 6,12,18 months; annual booster injections are required thereafter to maintain immunity.

Unlike the West, the Soviets developed and used a live spore anthrax vaccine, known as the STI vaccine, produced in Tbilisi, Georgia. Its serious side effects restrict use to healthy adults. Top



Bacteroides Infection:

This article describes infections caused by the Bacteroides fragilis group and other anaerobic gram-negative bacilli (AGNB) that were previously included in the Bacteroides genus but are now included in the Prevotella and Porphyromonas genera. Infections due to AGNB are common, yet the specific identification of AGNB in these infections is difficult.

Bacteroides species are anaerobic bacteria that are predominant components of the bacterial florae of mucous membranes1 and are therefore a common cause of endogenous infections. Bacteroides infections can develop in all body sites, including the CNS, the head, the neck, the chest, the abdomen, the pelvis, the skin, and the soft tissues. Inadequate therapy against these anaerobic bacteria may lead to clinical failure.

Significance to man :

* Anaerobic production of butyrate (by for example, Bacteroides spp), as well as acetate and propionate provides about 70% of the energy supply of the colonic enterocytes!
* Bacteroides plays a key role in enterohepatic bile acid recirculation, and bile acid biotransformation.
* Bacteroides also probably compete with pathogenic micro-organisms for colonic resources - diminishing the food supply and receptor sites for agents such as Salmonellae and Shigellae, and making the environment unfavourable by deconjugating bile salts and changing the pH.
* Some vitamin K may be produced (menaquione, vitamin K2) - its relevance is unclear.

Features:

• An obligate anaerobic Gram-negative microorganism, a bit smaller than E coli (about 0.6 µm by 1.5 to 4.5 µm); the ends of the bacilli are rounded.
• Grows well on blood agar (anaerobically);
• May have large vacuoles resembling spores! B. fragilis does NOT form spores.
• Enormous capsule, NO cell membrane endotoxin.
• G+C 42% (40-48 for Bacteroides);
• Contain HMP shunt enzymes; membranes contain sphingolipids; possess menaquiones; peptidoglycan contains meso-diaminopimelic acid.
• Some B. fragilis possess superoxide dismutase and are more oxygen tolerant as a result; the organism has 29 other oxygen-induced proteins.

Treatment:

Treatment should be predicated by appropriate resuscitative measures, and drainage of abscesses as soon as is possible. Antibiotics include:

1. Metronidazole / Chloramphenicol / Carbapenems (active against 99%+) Metronidazole is probably the drug of choice.
2. Beta lactam + Beta lactamase inhibitor (active against 95%+) {resistance more common with other Bacteroides than with B fragilis}.
3. Clindamycin resistance may be increasing (while susceptibility to beta-lactams may even be greater, for unexplained reasons)
4. Susceptibility of B. fragilis to moxalactam, ceftriaxone, and clarithromycin is around 70-84%, and to cefoperazone, cefotaxime, ceftazidime, sparfloxacin, etc under 70%.

The Wadsworth Anaerobe Laboratory has comprehensive tables of susceptibility for Gram negative anaerobes.

DO NOT USE 'Fourth generation' cephalosporins ; there is also inherent resistance to aminoglycosides. When tetracycines were first used, they were effective against Bacteroides, which is now almost universally resistant! For B. fragilis, cefoxitin resistance is about 3-6%, with far higher resistance rates in other Bacteroides species. Penicillin resistance is over 50%. Top



Bartonellosis Disease:

Bartonellosis is an infectious disease produced by bacteria of the genus Bartonella. Bartonella species cause diseases such as Carrion´s disease, Trench fever, and Cat scratch disease, and other recognized diseases, such as bacillary angiomatosis, peliosis hepatis, chronic bacteremia, endocarditis, chronic lymphadenopathy, and neurological disorders.

Bartonella (formerly known as Rochalimaea) is a genus of Gram-negative bacteria. Facultative intracellular parasites, Bartonella species can infect healthy people but are considered especially important as opportunistic pathogens. Bartonella are transmitted by insect vectors such as ticks, fleas, sand flies and mosquitoes. At least eight Bartonella species or subspecies are known to infect humans. In June 2007, a new species under the genus, called Bartonella melophagi, was discovered. This is the sixth species known to infect humans, and the ninth species and subspecies, overall, known to infect humans.

Treatment :

Treatment is dependent on which strain of Bartonella is found in a given patient. While Bartonella species are susceptible to a number of standard antibiotics in vitro—macrolides and tetracycline, for example—the efficacy of antibiotic treatment in immunocompetent individuals is uncertain. Immunocompromised patients should be treated with antibiotics because they are particularly susceptible to systemic disease and bacteremia. Drugs of particular effectiveness include trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and rifampin; B. henselae is generally resistant to penicillin, amoxicillin, and nafcillin. Top



What is Botulism Disease?

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. There are three main kinds of botulism. Foodborne botulism is caused by eating foods that contain the botulism toxin. Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum. Infant botulism is caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin. All forms of botulism can be fatal and are considered medical emergencies. Foodborne botulism can be especially dangerous because many people can be poisoned by eating a contaminated food.


What are the symptoms of botulism?

The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days.

How is botulism diagnosed?

Physicians may consider the diagnosis if the patient's history and physical examination suggest botulism. However, these clues are usually not enough to allow a diagnosis of botulism. Other diseases such as Guillain-Barré syndrome, stroke, and myasthenia gravis can appear similar to botulism, and special tests may be needed to exclude these other conditions. These tests may include a brain scan, spinal fluid examination, nerve conduction test (electromyography, or EMG), and a tensilon test for myasthenia gravis. The most direct way to confirm the diagnosis is to demonstrate the botulinum toxin in the patient's serum or stool by injecting serum or stool into mice and looking for signs of botulism. The bacteria can also be isolated from the stool of persons with foodborne and infant botulism. These tests can be performed at some state health department laboratories and at CDC.

How can botulism be treated?

The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated with an equine antitoxin which blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria followed by administration of appropriate antibiotics. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism. A human-derived antitoxin is used to treat cases of infant botulism and is available from the California Department of Public Health.

How can botulism be prevented?

Botulism can be prevented. Foodborne botulism has often been from home-canned foods with low acid content, such as asparagus, green beans, beets and corn. However, outbreaks of botulism from more unusual sources such as chopped garlic in oil, chile peppers, tomatoes, carrot juice, improperly handled baked potatoes wrapped in aluminum foil, and home-canned or fermented fish. Persons who do home canning should follow strict hygienic procedures to reduce contamination of foods. Oils infused with garlic or herbs should be refrigerated. Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated. Because the botulism toxin is destroyed by high temperatures, persons who eat home-canned foods should consider boiling the food for 10 minutes before eating it to ensure safety. Instructions on safe home canning can be obtained from county extension services or from the US Department of Agriculture. Because honey can contain spores of Clostridium botulinum and this has been a source of infection for infants, children less than 12 months old should not be fed honey. Honey is safe for persons 1 year of age and older. Wound botulism can be prevented by promptly seeking medical care for infected wounds and by not using injectable street drugs. Top



What is Brucellosis?

Brucellosis is an infectious disease caused by the bacteria of the genus Brucella. These bacteria are primarily passed among animals, and they cause disease in many different vertebrates. Various Brucella species affect sheep, goats, cattle, deer, elk, pigs, dogs, and several other animals. Humans become infected by coming in contact with animals or animal products that are contaminated with these bacteria. In humans brucellosis can cause a range of symptoms that are similar to the flu and may include fever, sweats, headaches, back pains, and physical weakness. Severe infections of the central nervous systems or lining of the heart may occur. Brucellosis can also cause long-lasting or chronic symptoms that include recurrent fevers, joint pain, and fatigue.

Can brucellosis be spread from person to person?

Direct person-to-person spread of brucellosis is extremely rare. Mothers who are breast-feeding may transmit the infection to their infants. Sexual transmission has also been reported. For both sexual and breast-feeding transmission, if the infant or person at risk is treated for brucellosis, their risk of becoming infected will probably be eliminated within 3 days. Although uncommon, transmission may also occur via contaminated tissue transplantation.

Is there a way to prevent infection?

Yes. Do not consume unpasteurized milk, cheese, or ice cream while traveling. If you are not sure that the dairy product is pasteurized, don't eat it. Hunters and animal herdsman should use rubber gloves when handling viscera of animals. There is no vaccine available for humans.


Recommendations for Risk Assessment, Post-Exposure Prophylaxis and Follow-up of Laboratory Personnel Exposed to Pathogenic Brucella Species.

How common is brucellosis?

Brucellosis is not very common in the United States, where100 to 200 cases occur each year. But brucellosis can be very common in countries where animal disease control programs have not reduced the amount of disease among animals.

Where is brucellosis usually found?

Although brucellosis can be found worldwide, it is more common in countries that do not have good standardized and effective public health and domestic animal health programs. Areas currently listed as high risk are the Mediterranean Basin (Portugal, Spain, Southern France, Italy, Greece, Turkey, North Africa), South and Central America, Eastern Europe, Asia, Africa, the Caribbean, and the Middle East. Unpasteurized cheeses, sometimes called "village cheeses," from these areas may represent a particular risk for tourists.


How is brucellosis transmitted to humans, and who is likely to become infected?

Humans are generally infected in one of three ways: eating or drinking something that is contaminated with Brucella, breathing in the organism (inhalation), or having the bacteria enter the body through skin wounds. The most common way to be infected is by eating or drinking contaminated milk products. When sheep, goats, cows, or camels are infected, their milk is contaminated with the bacteria. If the milk is not pasteurized, these bacteria can be transmitted to persons who drink the milk or eat cheeses made it. Inhalation of Brucella organisms is not a common route of infection, but it can be a significant hazard for people in certain occupations, such as those working in laboratories where the organism is cultured. Inhalation is often responsible for a significant percentage of cases in abattoir employees. Contamination of skin wounds may be a problem for persons working in slaughterhouses or meat packing plants or for veterinarians. Hunters may be infected through skin wounds or by accidentally ingesting the bacteria after cleaning deer, elk, moose, or wild pigs that they have killed.


Can brucellosis be spread from person to person?

Direct person-to-person spread of brucellosis is extremely rare. Mothers who are breast-feeding may transmit the infection to their infants. Sexual transmission has also been reported. For both sexual and breast-feeding transmission, if the infant or person at risk is treated for brucellosis, their risk of becoming infected will probably be eliminated within 3 days. Although uncommon, transmission may also occur via contaminated tissue transplantation.

Is there a way to prevent infection?

Yes. Do not consume unpasteurized milk, cheese, or ice cream while traveling. If you are not sure that the dairy product is pasteurized, don't eat it. Hunters and animal herdsman should use rubber gloves when handling viscera of animals. There is no vaccine available for humans.


How is brucellosis diagnosed?

Brucellosis is diagnosed in a laboratory by finding Brucella organisms in samples of blood or bone marrow. Also, blood tests can be done to detect antibodies against the bacteria. If this method is used, two blood samples should be collected 2 weeks apart.

Is there a treatment for brucellosis?

Yes, but treatment can be difficult. Doctors can prescribe effective antibiotics. Usually, doxycycline and rifampin are used in combination for 6 weeks to prevent reoccuring infection. Depending on the timing of treatment and severity of illness, recovery may take a few weeks to several months. Mortality is low and is usually associated with endocarditis. Top



What is melioidosis Disease(Burkholderia)?

Melioidosis, also called Whitmore's disease, is an infectious disease caused by the bacterium Burkholderia pseudomallei. Melioidosis is clinically and pathologically similar to glanders disease, but the ecology and epidemiology of melioidosis are different from glanders. Melioidosis is predominately a disease of tropical climates, especially in Southeast Asia where it is endemic. The bacteria causing melioidosis are found in contaminated water and soil and are spread to humans and animals through direct contact with the contaminated source. Glanders is contracted by humans from infected domestic animals.

How is melioidosis transmitted and who can get it?

Besides humans, many animal species are susceptible to melioidosis. These include sheep, goats, horses, swine, cattle, dogs, and cats. Transmission occurs by direct contact with contaminated soil and surface waters. In Southeast Asia, the organism has been repeatedly isolated from agriculture fields, with infection occurring primarily during the rainy season. Humans and animals are believed to acquire the infection by inhalation of dust, ingestion of contaminated water, and contact with contaminated soil especially through skin abrasions, and for military troops, by contamination of war wounds. Person-to-person transmission can occur. There is one report of transmission to a sister with diabetes who was the caretaker for her brother who had chronic melioidosis. Two cases of sexual transmission have been reported. Transmission in both cases was preceded by a clinical history of chronic prostatitis in the source patient.

What are the symptoms of melioidosis?

Illness from melioidosis can be categorized as acute or localized infection, acute pulmonary infection, acute bloodstream infection, and chronic suppurative infection. Inapparent infections are also possible. The incubation period (time between exposure and appearance of clinical symptoms) is not clearly defined, but may range from 2 days to many years.

Acute, localized infection: This form of infection is generally localized as a nodule and results from inoculation through a break in the skin. The acute form of melioidosis can produce fever and general muscle aches, and may progress rapidly to infect the bloodstream.

Pulmonary infection: This form of the disease can produce a clinical picture of mild bronchitis to severe pneumonia. The onset of pulmonary melioidosis is typically accompanied by a high fever, headache, anorexia, and general muscle soreness. Chest pain is common, but a nonproductive or productive cough with normal sputum is the hallmark of this form of melioidosis.

Acute bloodstream infection: Patients with underlying illness such as HIV, renal failure, and diabetes are affected by this type of the disease, which usually results in septic shock. The symptoms of the bloodstream infection vary depending on the site of original infection, but they generally include respiratory distress, severe headache, fever, diarrhea, development of pus-filled lesions on the skin, muscle tenderness, and disorientation. This is typically an infection of short duration, and abscesses will be found throughout the body.

How is melioidosis diagnosed?

Melioidosis is diagnosed by isolating Burkholderia pseudomallei from the blood, urine, sputum, or skin lesions. Detecting and measuring antibodies to the bacteria in the blood is another means of diagnosis. Top



What is campylobacteriosis Disease?

Campylobacteriosis is an infectious disease caused by bacteria of the genus Campylobacter. Most people who become ill with campylobacteriosis get diarrhea, cramping, abdominal pain, and fever within two to five days after exposure to the organism. The diarrhea may be bloody and can be accompanied by nausea and vomiting. The illness typically lasts one week. Some infected persons do not have any symptoms. In persons with compromised immune systems, Campylobacter occasionally spreads to the bloodstream and causes a serious life-threatening infection.

How is the infection diagnosed?

Many different kinds of infections can cause diarrhea and bloody diarrhea. Campylobacter infection is diagnosed when a culture of a stool specimen yields the organism.

How can campylobacteriosis be treated?

Almost all persons infected with Campylobacter recover without any specific treatment. Patients should drink extra fluids as long as the diarrhea lasts. In more severe cases, antibiotics such as erythromycin or a fluoroquinolone can be used, and can shorten the duration of symptoms if given early in the illness. Your doctor will decide whether antibiotics are necessary.

How do people get infected with this germ?

Campylobacteriosis usually occurs in single, sporadic cases, but it can also occur in outbreaks, when a number of people become ill at one time. Most cases of campylobacteriosis are associated with eating raw or undercooked poultry meat or from cross-contamination of other foods by these items. Infants may get the infection by contact with poultry packages in shopping carts. Outbreaks of Campylobacter are usually associated with unpasteurized milk or contaminated water. Animals can also be infected, and some people have acquired their infection from contact with the stool of an ill dog or cat. The organism is not usually spread from one person to another, but this can happen if the infected person is producing a large volume of diarrhea.

What can be done to prevent Campylobacter infection?

Some simple food handling practices can help prevent Campylobacter infections.

* Cook all poultry products thoroughly. Make sure that the meat is cooked throughout (no longer pink) and any juices run clear. All poultry should be cooked to reach a minimum internal temperature of 165 °F.
* If you are served undercooked poultry in a restaurant, send it back for further cooking.
* Wash hands with soap before preparing food
* Wash hands with soap after handling raw foods of animal origin and before touching anything else.
* Prevent cross-contamination in the kitchen by using separate cutting boards for foods of animal origin and other foods and by carefully cleaning all cutting boards, countertops, and utensils with soap and hot water after preparing raw food of animal origin.
* Avoid consuming unpasteurized milk and untreated surface water.
* Make sure that persons with diarrhea, especially children, wash their hands carefully and frequently with soap to reduce the risk of spreading the infection.
* Wash hands with soap after contact with pet feces



Cardiobacterium disease:

Further Inpatient Care:

* Native valve endocarditis should be treated for 4 weeks. Prosthetic valve endocarditis requires 6 weeks of treatment.

Further Outpatient Care:

* Patients with C hominis endocarditis can be treated in an outpatient setting but should remain on intravenous antimicrobial therapy for the duration of treatment.
* Risks of embolic complications may arise during therapy.
* Patients should be continuously and carefully monitored and should have prompt access to medical care, including cardiac surgery, in the event of complications.

Prevention:

* Antibiotic prophylaxis given prior to dental procedures is primarily directed at Streptococcus viridans but should also help prevent infection due to HACEK bacteria.2

Complications:

* Mycotic aneurysm
* Embolization


Corynebacterium Infections:

A common genus of aerobic and facultative, anaerobic, gram-positive, nonmotile, rod-shaped curved bacilli that includes many species. The most common pathogenic species are C. acnes, commonly found in acne lesions, and C. diphtheriae, the cause of diphtheria. Nondiptherial corynebacteria have been recognized as pathogenic, especially in immunocompromised patients. The most common infection with these organisms is bacteremia in association with infections involving devices such as heart valves, catheters, and neurologic shunts
a genus of bacteria of the family corynebacteriaceae. They are gram-positive and show a variety of morphologies. They are short, slightly curved rods, sometimes club-shaped. Likely to be grouped into angled and palisade arrays of cells. The type species is Corynebacterium diphtheriae, the cause of diphtheria in humans.

Corynebacterium is a genus of Gram-positive, aerobic or facultatively anaerobic, non-motile, non-sporulated, rod-shaped actinobacteria. Most do not cause disease, but are part of normal human skin flora. Corynebacteria are a diverse group found in a range of different ecological niches such as soil, vegetables, sewage, skin, and cheese smear. Some, such as Corynebacterium diphtheriae, are important pathogens while others, such as Corynebacterium glutamicum, are of immense industrial importance. The term diphtheroids is used to represent Corynebacteria that are non-pathogenic for example, excluding Corynebacterium diptheriae.

IDENTIFYING CHARACTERISITCS:

• Most species are motile, but some are non-motile.
• Aerobic or faculative anaerobic.
• Non-spore forming.
• Chemoorganotrophs, mixed fermentative and respiratory metabolism.
• Non acid-fast.
• When dividing, cells tend to "snap apart" forming sharp angles that look like 'Chinese letters'.
• Storage granules common, staining shows refracticle granules in cells.

Prevention Information:

Mortality rates are highest at the extremes of age and in insufficiently immunized persons. However, even partial immunization confers a reduced risk of severe disease. Death usually occurs within the first week, either from asphyxia or heart disease.
Immunity to diphtheria waxes in the absence of booster injections of toxoid or natural infection. Therefore, persons traveling to endemic areas should receive booster injections. At one time, diphtheria immunization was considered lapsed if more than 4 years had elapsed since the last booster. This estimate is probably still relevant for persons traveling to high-risk areas, particularly those in high-risk jobs, such as medical personnel. Otherwise, the routine recommendation is currently for booster injections every 10 years. Annual updates are made each year by the CDC. A complete Adult Immunization Schedule is available from the CDC's National Immunization Program.

TAXONOMIC DESCRIPTION:

The genus Corynebacterium consists of procaryotic bacteria that are true bacteria and heterotrophic. Human and animal pathogens, plant pathogens, and non-pathogens are the three different types of corynebacteria. Each type has its own characterisitics. Human and animal pathogens are generally non-motile and mostly anaerobic. They are Gram positive and have slightly curved rods with irregular segments. Snapping division causes a picket fence arrangement of the rods that is a notable characteristic of this type. The most notable pathogen is Corynebacterium diphtheria. Isolated on blood tellurite agar (e.g. Tinsdale Medium), Corynebacterium grows well on blood agar with the addition of potassium tellurite, which inhibits the growth of normal flora in the throat. Corynebacterium colonies turn a distinctive grey-black: tellurite diffuses into the bacterial cells and is reduced to tellurium metal which precipitates within the cell.



Q Fever Disease:

Q fever is a zoonotic disease caused by Coxiella burnetii, a species of bacteria that is distributed globally. In 1999, Q fever became a notifiable disease in the United States but reporting is not required in many other countries. Because the disease is underreported, scientists cannot reliably assess how many cases of Q fever have actually occurred worldwide. Many human infections are inapparent.

Cattle, sheep, and goats are the primary reservoirs of C. burnetii. Infection has been noted in a wide variety of other animals, including other species of livestock and in domesticated pets. Coxiella burnetii does not usually cause clinical disease in these animals, although abortion in goats and sheep has been linked to C. burnetii infection. Organisms are excreted in milk, urine, and feces of infected animals. Most importantly, during birthing the organisms are shed in high numbers within the amniotic fluids and the placenta. The organisms are resistant to heat, drying, and many common disinfectants. These features enable the bacteria to survive for long periods in the environment. Infection of humans usually occurs by inhalation of these organisms from air that contains airborne barnyard dust contaminated by dried placental material, birth fluids, and excreta of infected herd animals. Humans are often very susceptible to the disease, and very few organisms may be required to cause infection.


Signs and Symptoms in Humans:

Only about one-half of all people infected with C. burnetii show signs of clinical illness. Most acute cases of Q fever begin with sudden onset of one or more of the following: high fevers (up to 104-105° F), severe headache, general malaise, myalgia, confusion, sore throat, chills, sweats, non-productive cough, nausea, vomiting, diarrhea, abdominal pain, and chest pain. Fever usually lasts for 1 to 2 weeks. Weight loss can occur and persist for some time. Thirty to fifty percent of patients with a symptomatic infection will develop pneumonia. Additionally, a majority of patients have abnormal results on liver function tests and some will develop hepatitis. In general, most patients will recover to good health within several months without any treatment. Only 1%-2% of people with acute Q fever die of the disease.

Chronic Q fever, characterized by infection that persists for more than 6 months is uncommon but is a much more serious disease. Patients who have had acute Q fever may develop the chronic form as soon as 1 year or as long as 20 years after initial infection. A serious complication of chronic Q fever is endocarditis, generally involving the aortic heart valves, less commonly the mitral valve. Most patients who develop chronic Q fever have pre-existing valvular heart disease or have a history of vascular graft. Transplant recipients, patients with cancer, and those with chronic kidney disease are also at risk of developing chronic Q fever. As many as 65% of persons with chronic Q fever may die of the disease.

The incubation period for Q fever varies depending on the number of organisms that initially infect the patient. Infection with greater numbers of organisms will result in shorter incubation periods. Most patients become ill within 2-3 weeks after exposure. Those who recover fully from infection may possess lifelong immunity against re-infection.


Diagnosis:

Because the signs and symptoms of Q fever are not specific to this disease, it is difficult to make an accurate diagnosis without appropriate laboratory testing. Results from some types of routine laboratory tests in the appropriate clinical and epidemiologic settings may suggest a diagnosis of Q fever. For example, a platelet count may be suggestive because persons with Q fever may show a transient thrombocytopenia. Confirming a diagnosis of Q fever requires serologic testing to detect the presence of antibodies to Coxiella burnetii antigens. In most laboratories, the indirect immunofluorescence assay (IFA) is the most dependable and widely used method. Coxiella burnetii may also be identified in infected tissues by using immunohistochemical staining and DNA detection methods.

Coxiella burnetii exists in two antigenic phases called phase I and phase II. This antigenic difference is important in diagnosis. In acute cases of Q fever, the antibody level to phase II is usually higher than that to phase I, often by several orders of magnitude, and generally is first detected during the second week of illness. In chronic Q fever, the reverse situation is true. Antibodies to phase I antigens of C. burnetii generally require longer to appear and indicate continued exposure to the bacteria. Thus, high levels of antibody to phase I in later specimens in combination with constant or falling levels of phase II antibodies and other signs of inflammatory disease suggest chronic Q fever. Antibodies to phase I and II antigens have been known to persist for months or years after initial infection.

Recent studies have shown that greater accuracy in the diagnosis of Q fever can be achieved by looking at specific levels of classes of antibodies other than IgG, namely IgA and IgM. Combined detection of IgM and IgA in addition to IgG improves the specificity of the assays and provides better accuracy in diagnosis. IgM levels are helpful in the determination of a recent infection. In acute Q fever, patients will have IgG antibodies to phase II and IgM antibodies to phases I and II. Increased IgG and IgA antibodies to phase I are often indicative of Q fever endocarditis.

Treatment:

Doxycycline is the treatment of choice for acute Q fever. Antibiotic treatment is most effective when initiated within the first 3 days of illness. A dose of 100 mg of doxycycline taken orally twice daily for 15-21 days is a frequently prescribed therapy. Quinolone antibiotics have demonstrated good in vitro activity against C. burnetii and may be considered by the physician. Therapy should be started again if the disease relapses.

Chronic Q fever endocarditis is much more difficult to treat effectively and often requires the use of multiple drugs. Two different treatment protocols have been evaluated: 1) doxycycline in combination with quinolones for at least 4 years and 2) doxycycline in combination with hydroxychloroquine for 1.5 to 3 years. The second therapy leads to fewer relapses, but requires routine eye exams to detect accumulation of chloroquine. Surgery to remove damaged valves may be required for some cases of C. burnetii endocarditis.


Prevention:

In the United States, Q fever outbreaks have resulted mainly from occupational exposure involving veterinarians, meat processing plant workers, sheep and dairy workers, livestock farmers, and researchers at facilities housing sheep. Prevention and control efforts should be directed primarily toward these groups and environments.

The following measures should be used in the prevention and control of Q fever:

* Educate the public on sources of infection.

* Appropriately dispose of placenta, birth products, fetal membranes, and aborted fetuses at facilities housing sheep and goats.

* Restrict access to barns and laboratories used in housing potentially infected animals.

* Use only pasteurized milk and milk products.

* Use appropriate procedures for bagging, autoclaving, and washing of laboratory clothing.

* Vaccinate (where possible) individuals engaged in research with pregnant sheep or live C. burnetii.

* Quarantine imported animals.

* Ensure that holding facilities for sheep should be located away from populated areas. Animals should be routinely tested for antibodies to C. burnetii, and measures should be implemented to prevent airflow to other occupied areas.

* Counsel persons at highest risk for developing chronic Q fever, especially persons with pre-existing cardiac valvular disease or individuals with vascular grafts.

A vaccine for Q fever has been developed and has successfully protected humans in occupational settings in Australia. However, this vaccine is not commercially available in the United States. Persons wishing to be vaccinated should first have a skin test to determine a history of previous exposure. Individuals who have previously been exposed to C. burnetii should not receive the vaccine because severe reactions, localized to the area of the injected vaccine, may occur. A vaccine for use in animals has also been developed, but it is not available in the United States.



Relapsing fever:

Relapsing fever (synonym: typhinia) is an infection caused by certain bacteria in the genus Borrelia. It is a vector-borne disease that is transmitted through louse or soft-bodied tick bites.

Infection:

Louse-borne relapsing fever
Tick-borne Relapsing Fever

Borrelia recurrentis is the only agent of louse-borne disease. Pediculus humanus, is the specific vector. Louse-borne relapsing fever is more severe than the tick-borne variety.

Louse-borne relapsing fever occurs in epidemics amid poor living conditions, famine and war in the developing world;[4] it is currently prevalent in Ethiopia and Sudan.
Other relapsing infections are acquired from other Borrelia species, such as Borrelia hermsii or Borrelia parkeri, which can be spread from rodents, and serve as a reservoir for the infection, via a tick vector. Borrelia hermsii and Borrelia recurrentis cause very similar diseases although the disease associated with Borrelia hermsii has more relapses and is responsible for more fatalities, while the disease caused by B. recurrentis has longer febrile and afebrile intervals and a longer incubation period.

Treatment:

Antibiotics of the tetracycline class are most effective, but may induce a Jarisch-Herxheimer reaction, which occurs in over 50% of patients. This reaction produces apprehension, diaphoresis, fever, tachycardia, and tachypnea with an initial pressor response followed rapidly by hypotension. Recent studies have shown that tumor necrosis factor-alpha (TNF-alpha) may be partly responsible for the reaction.



Trench Fever:

Trench fever is a moderately serious disease transmitted by body lice. It infected armies in Flanders, France, Poland, Galicia, Italy, Salonika, Macedonia, Mesopotamia, and Egypt in World War and the German army in Russia during World War II. From 1915 to 1918 between one-fifth and one-third of all British troops reported ill had trench fever while about one-fifth of ill German and Austrian troops had the disease. The disease persists among the homeless. Outbreaks have been documented, for example, in Seattle and Baltimore in the United States among injection drug users and in Marseille, France, and Burundi.

Trench fever is also called Wolhynia fever, shin bone fever, quintan fever, five-day fever, Meuse fever.

The disease is caused by the bacterium Bartonella quintana found in the stomach walls of the body louse. Bartonella quintana is closely related to Bartonella henselae, the agent of cat scratch fever.

Symptoms:

The disease is classically a five-day fever of the relapsing type, rarely with a continuous course instead. The incubation period is relatively long, at about two weeks. The onset of symptoms is usually sudden with high fever, severe headache, pain on moving the eyeballs, soreness of the muscles of the legs and back, and frequently hyperaesthesia of the shins. The initial fever is usually followed in a few days by a single, short rise but there may be many relapses between periods without fever. The most constant symptom is pain in the legs. Recovery takes a month or more. Lethal cases are rare, but in a few cases "the persistent fever might lead to heart failure". After effects may include neurasthenia, cardiac disturbances and myalgia.

Treatment:

Tetracycline-group antibiotics (doxycycline, tetracycline) are commonly used. Chloramphenicol is an alternative medication recommended under circumstances that render tetracycline derivates usage undesirable (such as severe liver malfunction, kidney deficiency, in children under nine years and pregnant women). The drug is administered for seven to ten days.

The treatment for bacillary angiomatosis is erythromycin given for three to four months.



Typhoid Fever:

How is typhoid fever spread?

Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers , recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S. Typhi in their feces.

You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding S. Typhi or if sewage contaminated with S. Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage.

Once S. Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. The body reacts with fever and other signs and symptoms.

How can you avoid typhoid fever?

Two basic actions can protect you from typhoid fever:

1. Avoid risky foods and drinks.
2. Get vaccinated against typhoid fever.

It may surprise you, but watching what you eat and drink when you travel is as important as being vaccinated. This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers' diarrhea, cholera, dysentery, and
hepatitis A.

Getting vaccinated:

If you are traveling to a country where typhoid is common, you should consider being vaccinated against typhoid. Visit a doctor or travel clinic to discuss your vaccination options.

Remember that you will need to complete your vaccination at least 1 week before you travel so that the vaccine has time to take effect. Typhoid vaccines lose effectiveness after several years; if you were vaccinated in the past, check with your doctor to see if it is time for a booster vaccination. Taking antibiotics will not prevent typhoid fever; they only help treat it.

What are the signs and symptoms of typhoid fever?

Persons with typhoid fever usually have a sustained fever as high as 103° to 104° F (39° to 40° C). They may also feel weak, or have stomach pains, headache, or loss of appetite. In some cases, patients have a rash of flat, rose-colored spots. The only way to know for sure if an illness is typhoid fever is to have samples of stool or blood tested for the presence of S. Typhi .

What do you do if you think you have typhoid fever?

If you suspect you have typhoid fever, see a doctor immediately. If you are traveling in a foreign country, you can usually call the U.S. consulate for a list of recommended doctors.

You will probably be given an antibiotic to treat the disease. Three commonly prescribed antibiotics are ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Persons given antibiotics usually begin to feel better within 2 to 3 days, and deaths rarely occur. However, persons who do not get treatment may continue to have fever for weeks or months, and as many as 20% may die from complications of the infection.

Typhoid fever's danger doesn't end when symptoms disappear:

Even if your symptoms seem to go away, you may still be carrying S. Typhi . If so, the illness could return, or you could pass the disease to other people. In fact, if you work at a job where you handle food or care for small children, you may be barred legally from going back to work until a doctor has determined that you no longer carry any typhoid bacteria.

If you are being treated for typhoid fever, it is important to do the following:

Keep taking the prescribed antibiotics for as long as the doctor has asked you to take them.
Wash your hands carefully with soap and water after using the bathroom, and do not prepare or serve food for other people. This will lower the chance that you will pass the infection on to someone else.

Vibrio Infections:

Vibrio vulnificus is a bacterium in the same family as those that cause cholera. It normally lives in warm seawater and is part of a group of vibrios that are called "halophilic" because they require salt.

What type of illness does vulnificus cause?

Vibrio vulnificus can cause disease in those who eat contaminated seafood or have an open wound that is exposed to seawater. Among healthy people, ingestion of V. vulnificus can cause vomiting, diarrhea, and abdominal pain. In immunocompromised persons, particularly those with chronic liver disease, Vibrio vulnificus can infect the bloodstream, causing a severe and life-threatening illness characterized by fever and chills, decreased blood pressure (septic shock), and blistering skin lesions. Vibrio vulnificus bloodstream infections are fatal about 50% of the time.

Vibrio vulnificus can cause an infection of the skin when open wounds are exposed to warm seawater; these infections may lead to skin breakdown and ulceration. Persons who are immunocompromised are at higher risk for invasion of the organism into the bloodstream and potentially fatal complications.

Some tips for preventing Vibrio vulnificus infections, particularly among immunocompromised patients, including those with underlying liver disease:

* Do not eat raw oysters or other raw shellfish.
* Cook shellfish (oysters, clams, mussels) thoroughly.
* For shellfish in the shell, either a) boil until the shells open and continue boiling for 5 more minutes, or b) steam until the shells open and then continue cooking for 9 more minutes. Do not eat those shellfish that do not open during cooking. Boil shucked oysters at least 3 minutes, or fry them in oil at least 10 minutes at 375°F.
* Avoid cross-contamination of cooked seafood and other foods with raw seafood and juices from raw seafood.
* Eat shellfish promptly after cooking and refrigerate leftovers.
* Avoid exposure of open wounds or broken skin to warm salt or brackish water, or to raw shellfish harvested from such waters.
* Wear protective clothing (e.g., gloves) when handling raw shellfish.

How can Vibrio vulnificus infection be diagnosed?

Vibrio vulnificus infection Is diagnosed by stool, wound, or blood cultures. Notifying the laboratory when this infection is suspected helps because a special growth medium should be used to increase the diagnostic yield. Doctors should have a high suspicion for this organism when patients present with gastrointestinal illness, fever, or shock following the ingestion of raw seafood, especially oysters, or with a wound infection after exposure to seawater.

How is V. vulnificus infection treated?

If V. vulnificus is suspected, treatment should be initiated immediately because antibiotics improve survival. Aggressive attention should be given to the wound site; amputation of the infected limb is sometimes necessary. Clinical trials for the management of V. vulnificus infection have not been conducted. The antibiotic recommendations below come from documents published by infectious disease experts; they are based on case reports and animal models.

* Culture of wound or hemorrhagic bullae is recommended, and all V. vulnificus isolates should be forwarded to a public health laboratory
* Blood cultures are recommended if the patient is febrile, has hemorrhagic bullae, or has any signs of sepsis
* Antibiotic therapy:
Doxycycline (100 mg PO/IV twice a day for 7-14 days) and a third-generation cephalosporin (e.g.,ceftazidime 1-2 g IV/IM every eight hours) is generally recommended
A single agent regimen with a fluoroquinolone such as levofloxacin, ciprofloxacin or gatifloxacin, has been reported to be at least as effective in an animal model as combination drug regimens with doxycycline and a cephalosporin
Children, in whom doxycycline and fluoroquinolones are contraindicated, can be treated with trimethoprim-sulfamethoxazole plus an aminoglycoside
Necrotic tissue should be debrided; severe cases may require fasciotomy or limb amputation

What can be done to improve the safety of oysters?

Although oysters can be harvested legally only from waters free from fecal contamination, even legally harvested oysters can be contaminated with V. vulnificus because the bacterium is naturally present in marine environments. V. vulnificus does not alter the appearance, taste, or odor of oysters. Timely, voluntary reporting of V. vulnificus infections to CDC and to regional offices of the Food and Drug Administration (FDA) will help collaborative efforts to improve investigation of these infections. Regional FDA specialists with expert knowledge about shellfish assist state officials with tracebacks of shellfish and, when notified rapidly about cases, arez able to sample harvest waters to discover possible sources of infection and to close oyster beds when problems are identified. Ongoing research may help us to predict environmental or other factors that increase the chance that oysters carry pathogens.


Bone and Joint Infections:

Bones and the fluid and tissues of joints can become infected. Such infections include osteomyelitis and infectious arthritis.Infections of bones and joints are serious problems. A bacterial injection of a joint can cause a severe and potentially destructive form of arthritis, often referred to as septic arthritis. Treatment of Bone infections(osteomyelitis) and septic joint infections(arthritis) may require antibiotics and sometimes surgery.

septic arthritis:-

• Infectious arthritis is infection in the fluid and tissues of a joint usually caused by bacteria, A septic joint in an infection of bacteria within the joint space. but sometimes caused by viruses or fungi. A joint is the connection of two bones. The knee, hip, and shoulder are all joints, and when a bacterial infection occurs in that joint, it is called a septic joint.
• Bacteria or sometimes viruses or fungi may spread through the bloodstream or from nearby infected tissue to a joint, causing infection. After than causes, Pain, swelling, and fever usually develop within hours or a couple of days.
• Joint fluid is withdrawn in a needle and tested. Antibiotics are begun immediately.
• Septic arthritis develops when bacteria spread from a source of infection through the bloodstream to a joint or the joint is directly infected by traumatic penetration or surgical procedures.

Symptoms:

The joints most commonly infected are the knee, shoulder, wrist, hip, elbow, and the joints of the fingers. Most bacterial, fungal, and mycobacterial infections affect only one joint or, occasionally, several joints. For example, the bacteria that cause Lyme disease most often infect knee joints. Gonococcal bacteria and viruses can infect a few or many joints at the same time.
The infected joint usually becomes red and warm, and moving or touching it is very painful. Fluid collects in the infected joint, causing it to swell and stiffen. Symptoms also include fever and chills. Less dramatic symptoms (such as less pain and a lower fever) usually occur in people with chronic infectious arthritis that is caused by mycobacteria or fungi.

Diagnosis

Usually, a sample of joint fluid is removed with a needle as soon as possible. It is examined for white blood cells and tested for bacteria and other organisms.
A doctor usually orders blood tests because bacteria from joint infections often appear in the bloodstream. Sputum, spinal fluid, and urine may also be tested for bacteria to help determine the source of infection.

Prognosis and Treatment:

Braces and supports can help compensate for injured joint and can help support weak muscles. There are many types of braces and supports that can be purchased and it is important to understand the appropriate treatment in order to best help your condition. Because an infected joint can be destroyed within days or sometimes within hours without prompt treatment, Casts are used for treatment of many types of fractures as well as for post-surgical immobilization. Caring for a cast is an important part of treatment. antibiotics must be started as soon as an infection is suspected, even before the laboratory has identified the infecting organism.Casts are used for treatment of many types of fractures as well as for post-surgical immobilization. Caring for a cast is an important part of treatment.
Antibiotics that kill the most likely bacteria are given until the infecting organism is identified, usually within 48 hours of testing the joint fluid. Common medications used to treat orthopedic conditions include nonsteroidal anti-inflammatory medications (e.g. Motrin, Aleve, Naprosyn, Celebrex), Glucosamine, and others. Antibiotics are given by vein (intravenously) at first, to ensure that enough of the drug reaches the infected joint. If the antibiotics are effective against the infecting bacteria, improvement usually occurs within 48 hours. Injections are a frequently used to administer medications for orthopedic conditions. Treatment generally requires intravenous or intramuscular antibiotics to deliver the greatest amount of antibiotic to the affected joint. Oral medication may be used in selected situations.
The most commonly used injection is cortisone; a medication that is easily given with few side effects. As soon as the doctor receives the laboratory results, the antibiotic may be changed depending on the sensitivity of the particular bacteria to specific antibiotics. Surgery is used for treatment of many orthopedic problems. In some cases, surgery is recommended as an initial treatment, but most often surgery is used when other treatments fail to relieve symptoms. Patients with purulent arthritis generally require joint drainage. The drainage sometimes can be performed in the clinician's office while in other cases it is done in an operating room.

Bone, Joint, and Muscle Disorders:

• Autoimmune Disorders of Connective Tissue
• Muscle, Bursa, and Tendon Disorders
• Biology of the Musculoskeletal System
• Muscular Dystrophies and Related Disorders
• Osteonecrosis
• Osteoporosis
• Bone and Joint Infections
• Bone and Joint Tumors
• Paget's Disease of Bone
• Symptoms and Diagnosis of Musculoskeletal Disorders
• Foot Problems
• Vasculitic Disorders
• Gout and Pseudogout
• Hand Disorders
• Joint Disorders

Cardiovascular Infections:

* Infective Endocarditis
* Myocardial Abscess
* Rheumatic Fever

Before antibiotic therapy is initiated, multiple blood cultures, MUST be obtained in any patient in whom infective endocarditis is suspected. Coronary heart disease is caused by atherosclerosis, the narrowing of the coronary arteries due to fatty build ups of plaque. While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis. It's likely to produce chest pain(angina pectoris), heart attack or both.invasion and growth of microorganisms in the cardiovascular system, may be clinically inapparent or result in local cellular injury.
Coronary heart disease is caused by atherosclerosis, the narrowing of the coronary arteries due to fatty build ups of plaque. Cardiovascular diseases include coronary heart disease, cerebrovascular disease, raised hypertension, peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure.cardiovascular diseases refers to the class of diseases that involve the heart or blood vessels. Coronary heart disease is caused by atherosclerosis, the narrowing of the coronary arteries due to fatty build ups of plaque. It's likely to produce angina pectoris (chest pain), heart attack or both. It's likely to produce angina pectoris, heart attack or both.
These conditions have similar causes, mechanisms, and treatments. In practice, cardiovascular disease is treated by cardiologists, thoracic surgeons, vascular surgeons, neurologists, and interventional radiologists, depending on the organ system that is being treated. The major causes of cardiovascular disease are tobacco use, physical inactivity, and an unhealthy diet.


Symptoms of Cardiovascular Diseases:

• Chest pain.
• Pressure or a squeezing sensation.
• Especially after excretion Pain in your arms, jaw, or back, and especially the left shoulder.
• Shortness of breath or difficulty catching your breath.
• Body Dizziness or a feeling of light headiness.
• Sudden severe headaches.
• Bluing of the lips.
• Faster or Abnormal heartbeats.
• A sensation that your heart is skipping beats, Nausea, Fatigue.
• Confusion, lack of balance or difficulty talking.
• Coldness in the extremities.
• Sudden numbness of the face or arms.
• Heart and brain, as well as in the legs, pelvis, or arms.
• Disease of the blood vessels.
• A heart attack or stroke may be the first warning of underlying disease.
• Angina can be described as a discomfort.
• Heaviness, pressure, aching, burning, fullness, squeezing or painful feeling in your chest.
• Women are more likely to have shortness of breath, nausea, vomiting, and back or jaw pain.
• The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most often on one side of the body.
• Mistaken for indigestion or heartburn.
• People experiencing these symptoms should seek medical care immediately.

Treatment of Cardiovascular Diseases:

• Treatment obviously depends on the severity of cardiovascular diseases at presentation and any safety considerations.
• Many of the treatment modalities for cardiovascular disease are similar irrespective of whether diabetes is present or not.
• Unlike many other chronic medical conditions.
• Some are used for specific purposes, whereas others are useful for a range of cardiovascular diseases.
• However specific issues related to diabetes include the difficulty of diagnosing silent. cardiovascular disease.
• The stem cells are first collected from a patient’s bone marrow.
• Cardiovascular disease is treatable and reversible, even after a long history of disease.
• Circumstances, individuals may not be able to take one type of medication and will be prescribed something else to serve the same function.
• The traditional approach is medication and surgery, but several published studies indicate.
• The need for the aggressive management of all risk factors.
• Proceeding with surgery.
• Pharmaceutical drugs.
• The type of treatment will certainly depend on where in the world the patient is taken ill,
• Extracted from the hipbone then implanted back into the body days later.
• Treatment is primarily focused on diet and stress reduction.
• Insulin therapy to achieve blood glucose control when a heart attack occurs.
• Prior to re-implantation of the cells, the bone marrow is processed in one of our labs, where the quantity and quality of the stem cells is also checked.
• CostsImmediate treatment following an MI is required to minimise further damage to the heart cells and restore blood circulation.
• Medications are available to treat many of the symptoms and slow the progression of cardiovascular diseases.

These re-injected stem cells have the potential to transform into multiple types of cells and are capable of regenerating damaged tissue. Our innovative stem cell treatments use the self-healing potential of each patient’s own body to stimulate regeneration or repair.

Rheumatic fever:

Rheumatic fever is also related Cardiovascular Diseases.

Rheumatic fever is an inflammatory disease that can develop two to three weeks after as a complication of untreated or poorly treated strep throat. A streptococcal infection. Strep throat is caused by infection with group A streptococcus bacteria.It is believed to be caused by antibody cross-reactivity and can involve the heart, joints, skin, and brain.

Acute rheumatic fever commonly appears in children ages 5 through 15, with only 20% of first time attacks occurring in adults. Recurring episodes of rheumatic fever most often affect people when they are about 25 to 35 years of age.



Thanks,
Raj