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Lower Respiratory Tract Infection

The lower respiratory tract is located beneath the vocal cords. Lower respiratory tract infection is always referred to pneumonia but it can also refer to other illnesses like acute bronchitis and lung abscess. Symptoms include weakness, shortness of breath, coughing, high fever and fatigue.

Infection in the lower respiratory tract is far more serious than upper respiratory tract infection. There are different diseases associated with lower respiratory tract. The first line treatment for this infection is antibiotics but these are not prescribed for viral infections. It is important to have the right kind of medication based on the bacteria involved to ensure treatment success and to avoid bacterial resistance. M. catarrhalis and haemophilus influenzae are thought to be common in both chronic bronchitis exacerbation and community-acquired pneumonia.

Classification

· Bronchitis

Lower Respiratory Tract InfectionBronchitis is classified as either acute or chronic. Acute bronchitis is an acute viral or bacterial infection of the large airways in people who are healthy without recurrent disease history. Viral infection is mostly the cause therefore, antibiotic use is not indicated. Some use antibiotics as treatment for viral bronchitis but its effects are not that beneficial compared to the side effects it may exhibit such as increased resistance, nausea and vomiting, and cost of treatment. Beta 2 agonist is sometimes used to relieve cough in acute bronchitis.

· Pneumonia

Pneumonia occurs in different situations and the treatment depends on the severity. It is classified as community-acquired or hospital-acquired depending on where the patient has acquired the infection. Pneumonia is life-threatening especially to immunocompromised and elderly patients. It is treated with antibiotics. Pneumococcal bacteria like Streptococcus pneumoniae are the common cause of pneumonia which accounts to 2/3 of the cases. It is a dangerous type of infection with over 25% of mortality rate. Treatment and management include causative-agent identification, pain relievers for chest pain, oxygen, physiotherapy, bronchodilators, and hydration. The patient should be assessed for complications like lung abscess and emphysema.

Antibiotic of Choice

It is important to base the antibiotic of choice on the sensitivity test and isolated bacteria because of increasing bacteria resistant to antibiotics and traditional treatments are now becoming less effective.

In children, procaine penicillin and amoxicillin are found to have greater effect compared to cotrimoxazole for community-acquired pneumonia. In hospitals, penicillin and gentamicin are found to be effective than chloramphenicol. Oral amoxicillin has similar results with penicillins that are injectable. In children with severe pneumonia, oral antibiotics are as effective with injectible once without the need to experience injection pain, high cost and risk for infection. Amoxicillin is the first line drug for community acquired pneumonia while intravenous azithromycin is the first line drug if there is a risk of death. Ticarcillin and gentamicin with clavunalic acid is given intravenously in severe cases of hospital acquired pneumonia.

Non-Pharmalogical Treatment

Increased fluid intake is usually advised by doctors to patients having lower respiratory tract infection. Also, rest will allow conservation of energy, for the body to fight infection. In some types of pneumonia, physiotherapy is indicated if appropriate.

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Skin Infection Treatment

There are many various soft tissue and skin infections which varies from mild to severe. Determining if the infection only has a local response or has a systemic involvement is an important factor in treating and diagnosing a skin infection.

Topical Antibiotics

Topical antibiotics are recognized to be very effective for superficial skin infection treatment like in dermatitis and impetigo. Infected traumatic lesions such as lacerations, abrasions, and suture wounds are also treated by topical antibiotics.

Topical antibiotics are preferred in treating such infections because they are as potent with systemic antibiotics, the systemic toxicity is decreased, decreased bacterial resistance, its antibacterial agent is highly concentrated, and it is versatile.

Examples of Topical Antibiotics:

Skin Infection Treatment· Neomycin

· Mupirocin

· Bacitracin

· Polymyxin

Systemic Antibiotics

Skin infections accompanied by hypothermia or fever, hypotension or tachycardia, indicates that further diagnostic test is needed. These tests include drug susceptibility and blood culture, complete blood count, bicarbonate, creatinine, C-reactive protein levels and creatinine phosphokinase. Severe and complicated soft tissue infection indicates necrotizing infection presence and surgical evaluation is needed. These conditions include:

· Pain that is not proportion to physical findings

· Violaceous bullae

· Skin sloughing

· Cutaneous hemorrhage

· Skin anesthesia

· Gas in the tissue

· Rapid progression

Examples of systemic antibiotics for complicated skin infection treatment:

· Clindamycin

· Penicillin

· Cephalexin

· Doxycycline

· Dicloxacillin

· Minocycline

· Vancomycin

· Trimethoprim-sulfamethoxazole

Prophylactic Antibiotics

An inhaled Staphylococcus aureus predisposes to infection. Topical antibiotics applied in the nose for nasal carriers prevent infection caused by S. Aureus. The most effective topical agent is Mupirocin for reducing S. aureus carriage.

Topical Treatment Options

The different types of skin infections and different bacterial pathogens need a lot of therapeutic options. Antibacterial topical agents are versatile and extremely important in antimicrobial therapy. These topical agents treat surgical and traumatic wounds, multiple skin infections and for prophylaxis used to prevent infection.

The topical antibacterial agents

· Hydrogen peroxide

Hydrogen peroxide acts by damaging the DNA of the bacteria. It is used in minor wounds and intact skin with limited bacterial activity but it can be harmful for the healing process.

· Chlorhexidine

The mechanism of action of chlorhexidine is by disrupting the cytoplasmic membranes of the bacteria. It is often used in hand washes, surgical hand scrubs, and preoperative skin operation. It remains active for a long time after application.

· Triclosan

Triclosan’s mechanism of action is by disrupting the bacterial membrane through lipid synthesis blockage. It is used in products such as detergents, soaps, cutting boards and toothpastes. It is resistant to strains of E. coli.

· Iodophors

It destroys the mibrobial DNA and protein. To reach full efficacy, it should have two minutes of skin contact. It is usually used in preoperative skin preparation. It is effective against Enterococcus species and MRSA. Adverse reactions are not common but it may cause metabolic acidosis and contact dermatitis in prolonged use.

· Benzoyl Peroxide

It is a broad-spectrum bactericidal. It is used to treat acne vulgaris. It is effective in different kinds of microorganisms which include Staphylococcus capitis, Propionibacterium, avidum, Staphylococcus Epidermidis and Propionibacterium acne.

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Throat Infection Remedies

The leading causes of throat infection are:

· Viral Infections like flu or colds are often accompanied with fever, muscle aches and runny nose. Viral infections have no cure but its symptoms are treatable. It disappears within a few days.

· Bacterial Infections like strep throat caused by Streptococcus bacteria is similar with viral infections but it’s long lasting and more severe. It is often accompanied by stomach ache, headache and swollen neck glands. It is treated with antibiotics because permanent kidney and heart damage may result. Bacteria culture is the only way to determine the cause of sore throat.

Other causes:

Throat Infection Remedies· Acid reflux

· Smoking

· Allergies

· Dry air with mouth open at night while sleeping

· Throat abuse like shouting, coughing and singing

· Mouth breathing

· Infected tonsils

· Cancer or polyps

· Food allergy

A sore throat is often minor but an annoying and disturbing ailment or it could be a sign of a serious illness. If you have a sore throat lasting for more than 2 to 3 days, you need to see a doctor. If you are only experiencing mild sore throat with allergy, there are home remedies which can work alone or with your medicine.

Home Remedies

· Your nasal passages should be clear. Doctors believe that sore throats are caused by dry throat and post nasal drip when sleeping with mouth open. Decongestants may help with post nasal drips. Saline nasal spray also helps with easy breathing.

· Take it easy and rest. If you have the kind of sore throat that doesn’t need medication, resting is the best way to recovery.

· Gargle with saltwater. Gargle by adding ½ teaspoon salt into a cup of warm water. It reduces phlegm and inflammation. Gargle every 3 to 4 hours.

· Gargle with Listerine. Gargle using Listerine mouthwash. Don’t share cups if the Listerine is not yours. Instead, pour into another cup and gargle.

· Drink Cider Vinegar. You will be needing 1 tablespoon of honey, 1 table spoon of vinegar and 8 ounces of hot water. Mix all ingredients and sip slowly. You can use it as often as you desire. For gargling, you will need 1 teaspoon salt, ½ cup vinegar and 1 cup of warm water. Dissolve salt in the vinegar and mix into the water. Gargle as necessary or every 15 minutes.

· Horseradish cocktail is a Russian cure for sore throat. You need 1 tablespoon of horseradish, 1 teaspoon of honey and 1 teaspoon of ground cloves. Mix in warm water and drink slowly.

· Use citrus. Mix 1 tablespoon of honey and lemon juice in a cup of warm water.

· You may drink a tablet of acetaminophen or ibuprofen to relieve sore throat pain.

· Try eating a juice bar. It is soothing for a hot throat. Let the small pieces melt in your mouth. Sucking it makes the throat irritated even more.

· Drinking hot liquids if you’re not good with gargling. Hot coffee, tea or lemonade may help soothe the pain.

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Kidney Infection

Pyelonephritis or kidney infection is a type of UTI or urinary tract infection that usually begins in the bladder or urethra and travels up to the kidneys. Kidney infections require immediate medical attention because if it is not properly treated, the infection may damage the kidney permanently or it can spread to the bloodstream and cause an infection that is life-threatening. Hospitalization and consumption of antibiotics are included in the kidney infection treatment.

Sign and Symptoms

Kidney Infection· Back, flank or groin pain

· Fever

· Abdominal pain

· Strong and persistent urgency to urinate

· Frequent urination

· Pain and burning sensation when urinating

· Hematuria or blood or pus in the urine.

Causes

A kidney infection usually occurs when bacteria enter the urethra and into the urinary tract and multiply. An existing bacterial infection anywhere in the body may also spread through the bloodstream and into the kidneys though this route to cause kidney infection is rare, it still can happen in some circumstances. Kidney infection may also result after a kidney surgery but these cases are rare.

Risk Factors

· Female Anatomy

Kidney infection in women are greater than in men because the urethra of females are shorter than males, thus, bacteria travels fast from outside of the body into the bladder in females resulting to infection. The closeness of the urethra to vagina to anus also creates an easy access for the bacteria for bladder entry. When the bacteria reach the bladder, it spreads in the kidneys.

· Urinary Tract Obstruction

Anything that disrupts the urine flow reduces the emptying ability of the bladder upon urinating. Obstructions may include structural abnormalities, kidney stones, and enlarged prostate gland in men, increases the risk of kidney infection.

· Immuncompromised Patients

Diabetes, cancer, HIV or any disease that weakens the immune system increases kidney infection risk.

· Damage to Bladder Nerves

Spinal cord or nerve damage blocks the sensation of bladder infection making you unaware of an ongoing or advancing kidney infection.

· The Urine flows in the wrong way

Vesicoureteral reflux is a condition where in the urine in small amounts flows back from your bladder up to the kidney and ureters. People who have this condition have recurrent kidney conditions during childhood and in adulthood as well.

Diagnosis

The signs and symptoms are the determinant of kidney infection such as upper back pain and fever. If your doctor suspects a kidney infection, he/she will let your urine examined by laboratory staff to determine any bacteria, pus and blood in your urine.

Treatment

· Antibiotics

The kidney infection first line treatment is antibiotics. The kind of drug and duration of taking it depends on the severity of the infection and the kind of bacteria found. After few days of treatment, the signs and symptoms begin to disappear but it is a must to continue the medication as long as the doctor orders it.

· Recurrent Kidney Infection Treatment

Recurring of kidney infections frequently makes your doctor to recommend you to another specialist to identify the underlying cause. The usual cause of recurrent kidney infection is structural deformity which is usually corrected through surgery.

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Hepatitis

Hepatitis is an inflammation of the liver caused by a bacteria, virus or exposure to hepatotoxins or certain medications.

The treatment goals include resting the inflamed liver to reduce metabolic demands and increasing the blood supply, thus promoting cellular regeneration and preventing complications.

Types of Viral Hepatitis

Hepatitis · Hepatitis A virus or infectious hepatitis

It is formerly known as infections hepatitis and is commonly seen during the fall and early winter. The individuals at risk are young children, individuals who are in institutionalized settings and the health care personnel.

Transmission is through oral-fecal route, person to person contact, eating of contaminated fruits, vegetables or uncooked shellfish.

· Hepatitis B virus or serum hepatitis

Hepatitis B is non-seasonal and it affects all age groups. The individuals at risk are drug addicts, clients undergoing long-term hemodyialysis and health care personnel.

Transmission is through blood or body fluid contact, contact with infected blood products, infected semen or saliva, contaminated needles, sexual contact and blood or body fluids contact at birth.

· Hepatitis C virus or non-A, non-B hepatitis or posttranfusion hepatitis

It occurs year-round and it can also occur at any age group. Infection is common among drug abusers and is the major cause of post transfusion hepatitis. Individuals at risk are parenteral drug users, clients receiving frequent transfusions and health care personnel.

· Hepatitis D virus or delta agent hepatitis

Hepatitis D is common in the Mediterranean and Middle East areas. Hepatitis D occurs with hepatitis B and may cause infection only in the presence of active Hepatitis B virus infection.

Transmission is the same with hepatitis B virus through contact with blood and blood products.

· Hepatitis E virus or epidemic non-A, non-B hepatitis

Hepatitis E is a waterborne virus. It is prevalent in areas where sewage disposal is inadequate or where communal bathing in contaminated rivers are practiced. The risk of infection is the same with Hepatitis A virus. The individuals at risk are travellers to countries that have high incidence of Hepatitis E such as India, Burma, Afghanistan, Algeria and Mexico.

· Hepatitis G virus or non-A, non-B, non-C hepatitis

In Hepatitis G, autoantibodies are absent. It has been found in some blood donors, IV drug users, hemodialysis patients and patients with haemophilia.

Stages of Viral Hepatitis

· Preicteric Stage

It is the first stage of hepatitis preceding the appearance of jaundice.

· Icteric Stage

It is the second stage of hepatitis which includes jaundice appearance and associated symptoms such as increased bilirubin levels, dark or tea-colored urine and clay-colored stools

· Posticteric Stage

The convalescent stage in which the jaundice decreases and the color of the urine and stool return to normal

Signs and Symptoms

· Preicteric Stage

· Flulike symptoms: fatigue and malaise

· Nausea and vomiting, anorexia, diarrhea

· Headache, polyarthritis and muscle pains

· Increased serum bilirubin and enzyme levels

· Icteric Stage

· Jaundice

· Pruritus

· Brown-colored urine

· Lighter-colored urine

· Decrease in preicteric stage symptoms

· Post icteric stage

· Increased levels in energy

· Subsiding of pain

· Minimal to absent gastrointestinal symptoms

· Serum bilirubin and enzyme levels returned to normal

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Intestinal Infection (Gastroenteritis)

Gastroenteritis is gastrointestinal tract inflammation involving the stomach and small intestines which results to acute diarrhea. Transmission is through consumption of contaminated food and water. The infection is usually caused by viral infection and sometimes bacterial infection, parasites, toxins and it may be an adverse reaction to medication or diet. Gastroenteritis kills five to eight thousand people worldwide per year because of inadequate treatment. It is the leading cause of death in infants and in children.

Classification

Gastroenteritis is caused by different viruses and bacteria.

· Bacterial Gastroenteritis

Intestinal Infection (Gastroenteritis)In patients with diarrhea, the most common cause is Pseudomembranous colitis which is treated with antibiotics. It is important to distinguish between viral and bacterial cause especially if a child is admitted in the hospital because viruses are not treated with antibiotics. Bacteria Campylobacter, Shigella and parasites like Giardia are treated with antibiotics. An example of bacterial gastroenteritis is Traveller’s diarrhea.

· Viral Gastroenteritis

Norovirus, rotavirus, astrovirus and adenovirus are some of the viruses causing viral gastroenteritis. Viral gastroenteritis is self-limiting. Infected children usually develop full recovery in a few days. Viruses don’t respond to antibiotics. Children who are admitted in the hospital because of viral gastroenteritis are tested for rotavirus A for data surveillance purposes to determine the effects of rotavirus vaccination program.

Signs and Symptoms

Gastroenteritis symptoms usually include spasms or stomach pain, vomiting and or diarrhea, with upper small bowel non-inflammatory bowel infection or inflammatory infection in the colon. Gastroenteritis is usually acute in onset and self-limiting which usually last for one to six days.

Other symptoms include nausea and vomiting, loss of appetite, diarrhea, headaches, fever, abdominal pain, flatulence, bloody stools or dysentery which suggest amoeba, Salmonella, Campylobacter, shigella, and E. coli strains infection, weakness and fainting, and heartburn.

Viral diarreha in children causes frequent stools that are watery. A diarrhea with stains of blood may indicate bacterial colitis. Bile can be vomited in some cases.

Diagnosis

Diagnosis of Gastroenteritis is based on symptoms, physical examination, and complete medical history. A medical history should be accurate to determine the existence or non-existence of similar symptoms with the available friends and family members. Physician usually asks questions about the frequency, duration, and bowel movement description or if vomiting is experienced.

If simple gastroenteritis is experienced, no specific diagnostic test is done. However, if symptoms presented include bloody stools, fever and persistent diarrhea for two weeks, the stool is examined for Clostridium difficile and other cultures for Shigella, Salmonella, E. coli and Campylobacter.

Treatment

Usually, gastroenteritis is a self-limiting condition where in pharmacological therapy is not needed. To replace the fluids and electrolytes lost is the objective of the treatment. In children with mild to moderate dehydration, oral rehydration is done. Ondansetron and Metoclopramide are also helpful in children.

Rehydration is the primary treatment for children experiencing gastroenteritis to replenish the water loss. Oral rehydration therapy is done but in cases where the patient becomes unconscious, intravenous fluids are rendered. Oral rehydration salts are also recommended.

Medications for bacterial gastroenteritis include anti-emetics to stop the vomiting, antibiotics and sometimes antimotility drugs but it is usually discouraged in patients with bloody diarrhea.

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Gonorrhea

Gonorrhoea, also referred as “the clap” is a sexually transmitted disease caused by the bacteria Neisseria gonorrhoeae, also called as Gonococcus. In United States, the incidence of Gonorrhea is second to Chlamydia among the sexually transmitted diseases (STD). If Gonorrhea is not treated, it can spread to the different body parts including the heart valves and joints. It is not spread through sharing bathrooms or toilets.

Signs and Symptoms

Some people are asymptomatic or no presented symptoms for life time in 30% to 60% of infected people.

GonorrheaIn males, symptoms of gonorrhea include penile yellowish discharge with painful, frequent urination. The symptoms develop after 2 to 30 days of infection. Only a little percentage in men is asymptomatic. The symptoms may spread to the seminal vesicles, prostate and epididymis which usually cause fever and pain. Untreated gonorrhea may lead to sterility. The common presentation of men having gonorrhea is pain upon urination, copious, thick, and urethral pus discharge. The urethral meatus is also reddened upon examination. Ascending infection may happen involving the testicles, epididymis and prostate gland. Swelling and scrotal pain are the symptoms for this kind of infection.

In females, gonorrhea is sometimes asymptomatic or too mild to be ignored. Women usually complains of dysuria or difficulty in urination, vaginal discharge, projectile urination, menstrual bleeding but not in the cycle, or bleeding after intercourse. The cervix may appear normal or with inflammation with pus. Early symptoms include vaginal discharge, lower abdomen discomfort, genital irritation, abnormal bleeding and dysuria. Untreated gonorrhea in women may spread to the fallopian tubes, uterus and ovaries causing PID or pelvic inflammatory disease.

Cause

Gonorrhea is caused by Neisseria gonorrhoeae. It is transmitted through oral, vaginal and anal sex. Transmission is rare with the use of safe sex. The period of incubation is two to thirty days with symptoms appearing in the 4th to 6thday after the infection. Men having sex with men have a higher risk though getting it from infected women through vaginal sex is also high with 20% risk. Women have 60% to 80% risk having vaginal sex with an infected man. Infected pregnant mothers can transmit the disease to their newborn. The condition is called opthalmia neonatorum.

Treament

Antibiotics are used to treat gonorrhea which includes:

· 2g amoxicillin plus 1g probenecid orally

· 2 to 3g ampicillin plus 1g probenecid orally

· 2g azithromycin orally

· 400mg cefixime orally

· 500 mg cefotaxime by intramascular injection

· 2g cefoxitin by intramascular injection plus 1g probenecid orally

· 400mg cefpodoxime orally

· 125 to 250 mg ceftriaxone by intramuscular injection

· 500 ciprofloxacin orally

· 250mg levofloxacin orally

· 400mg ofloxacin orally

· 2g spectinomycin by intramuscular injection

Neiserria gonorrhea has high resistance in tetracyclines all over the world. Tetracyclines are now considered as infective against gonorrhea. In pregnant women, flouroquinolones like levofloxacin, ciprofloxacin and ofloxacin are not to be use. It is important to check your sexual partner for gonorrhea to prevent spread and from being reinfected. If you are infected with both gonorrhea and Chlamydia, the doctor will prescribe azithromycin and doxycyline as treatment for both diseases.

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Fungal Skin Infection

Fungal skin infection is a skin infection caused by fungus. Excessive growth of harmless fungus and other types of fungus causes fungal skin infection symptoms. These skin infections can be treated easily.

Fungus in skin affects your skin because it lives in the keratin, a protein that composes your hair, skin and nails. Fungal skin infections are categorized into two groups depending on the organism type involved. The name of the infection is derived in the body part where it confides.

Types of Fungal Skin Infections

Dermatophyte Infections

Dermatophyte is a type of fungi that causes skin, nails and hair infection. This type of infection is common affecting 2 in 10 people. Dermatophyte infection includes:

Fungal Skin Infection · Athlete’s Foot (Tinea mannum and Tinea pedis)

25 in 100 adults experiences athlete’s foot in their lives. This is caused by a combination of bacteria and fungi causing the skin to itch, scaly, dry and red especially between the toes. It may also cause blisters and cracked skin.

A person usually gets athlete’s foot from contaminated swimming pools, saunas and showers. If you happen to touch a contaminated area without washing your hand, it spreads to your hands. This is called as Tinea mannum. The creases on the palms and sides of the fingers are usually affected.

· Nail Infections

Fungal infection in the nails is termed as Onychomycosis. The ringworm in the nails is called Tinea unguium. This is a common infection. The infection causes your nails to become thickened, malformed and crumbled.

· Groin Rinworm (Tinea Cruris)

This is known as “jock itch” because it is common in young men usually affecting people active in sports. It causes red rash and itch in the surrounding area and the groin itself. It is common in men who sweat a lot. Infection is spread through scratching in your feet with athlete’s foot and spreads to the groin.

· Body Ringworm (Tinea corporis)

The ringworm affects the abdomen and limbs causing red flat or raised patches which spreads and grows.

· Scalp Ringworm Tinea Capitis)

It is common in young children especially in African-Caribbean origin living in urban areas. It causes inflammation and hair loss on the affected area. You can develop this without symptoms and spread it to others.

Yeast Infections

· Intertrigo

Intertrigo is a type of yeast infection in the skin folds caused by Candida albicans living in your digestive system and in the skin. It can be seen in areas where skin touched such as in groin, armpits, and under heavy breasts. It is itchy, sore with scales and spots.

· Thrush

Thrush affects the mouth and tongue, also caused by Candida albicans. Vagina, folded skin and other moist areas may be affected as well. It causes white vaginal discharge and itch in adults.

It also affects men which causes painful red rash on the penis’ head or glans. Newborns are also affected called as oral thrush. White patches are commonly mistaken as milk from breast or formula milk. It is not serious but babies who develop throat thrush usually have difficulty in feeding.

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Sinus Infection

Sinusitis or sinus infection is the inflammation of the sinuses and passages of the nose. Sinus infection causes pressure in the eyes, cheek area, and nose, on a side of the head or headache. A person with sinusitis experiences cough, bad breath, fever, nasal congestion and nasal secretions. It is categorized as acute and chronic.

The sinuses have defences that have capability in fighting virus and bacteria.

Acute sinusitis last less than 8 weeks or 3 times every year with episodes lasting for ten days or less. Medications are always effective on acute sinusitis. Chronis sinusitis last more than 8 weeks and recurs 4 times a year with symptoms lasting for 20 days of more.

Causes

Sinus InfectionAfter a viral infection, sinusitis usually follows. Pollutants or allergens may also cause acute sinusitis. Viral infection destructs the sinuses lining cells which lead to inflammation. This causes the lining to thicken causing obstruction to the nasal passages. This disrupts the bacteria removal process that is normally present in the passages. The bacteria start to multiply and invade the sinus lining and cause the symptoms of sinus infection. Pollutants and allergens have the same effect.

Streptococcus pneumonia, Moraxella catarrhalis and Haemophilus influenza are the bacteria that cause sinus infection. They are also involved in the development of chronic sinusitis.

In people with weak immune system, fungi can also be the cause of chronic sinusitis.

Signs and Symptoms

· Mucus drips behind the nose down the throat sometimes accompanied by a sore throat. This is called as postnasal drip.

· Pressure or pain around the corner of the eye, cheek bone and upper teeth.

· Headache

· Pain when straining, coughing or lying on back

· Fever

· Visual disturbances like double vision if the pressure is extended in the brain

· Pain worsens with flu colds or allergy

Diagnosis

Assessment of medical history and physical examination is the basis of diagnosis. It is important to distinguish sinusitis from a common cold or upper respiratory tract infection. Sinusitis that is caused by bacteria is treated with antibiotics. Therefore, it is important to identify viral from bacterial cause. Over treatment of viral infection with antibiotics is dangerous.

Diagnosing of sinus infection doesn’t require any test but if a test if required, CT scan is usually done. CT scan can clearly show the nasal passages, paranasal sinuses and surrounding structures. A CT scan indicating sinus infection presents any of these conditions:

· Air or fluid levels in 1 or more sinuses

· Complete blockage to one or more sinuses

· Thickening of the sinuses inner lining

· Mucosal thickening may also occur in people without sinusitis symptoms. Findings in the CT scan must be coordinated with physical examination results of the patient to rule out sinusititis.

Ultrasound is a non-invasive diagnostic tool. It is reliable, fast and less expensive compared to CT scan though the results are not that detailed. But ultrasound is accepted for sinus infection diagnosis by medical professionals especially with nose, ear and throat physicians.

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Infectious Biological Warfare Agents

Anthrax

Anthrax is a warfare agent that can cause mass destruction and fatality. The disease is caused by Bacillus anthracis and can be contracted through the digestive system, abrasions in the skin, or inhalation through the lungs.

Transmission

Anthrax is transmitted by direct contact with bacteria and spores. The spores are dormant encapsulated bacteria that become active when they enter a living host. There is no person to person spread.

· Skin

AnthraxThe spores enter the skin through cuts and abrasions and are contacted by handling the contaminated animal skin products. The infection starts with an itchy bump, like a mosquito bite that progresses to a small liquid-filled sac. The sac becomes painless ulcer with an area of black, dead tissue in the middle. The toxins destroy the surrounding tissue.

· Gastrointestinal

The infection occurs following the ingestion of contaminated, undercooked meat. The symptoms begin with nausea, loss of appetite and vomiting. The disease progresses to severe abdominal pain, vomiting of blood and severe diarrhea.

· Inhalation

The infection is caused by the inhalation of bacterial spores, which multiply in the alveoli. The disease begins with the same symptoms as the flu, including fever, muscle aches and fatigue. Symptoms suddenly develop and become more severe with the development of breathing problems and shock. The toxins cause hemorrhage and destruction of lung tissue.

The infection is carried to the lymph node, and then spreads to the rest of the body by way of the blood and lymph. The high levels of toxins lead to shock and death. In the lungs, anthrax can cause build up of fluid, tissue decay and death if untreated.

Diagnosis and Treatment

A blood test is available to detect anthrax. The DNA is magnified from the blood sample and matches it to anthrax DNA.

Anthrax is treated with ciprofloxacin, doxycycline or penicillin. Although, there is a vaccine, it is limited in availability.

Botulism

Botulism is a serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum and the infected person may die in 24 hours.

The spore is found in the soil and can spread through the air or food or via contaminated food. Botulism is not spread from person to person.

Signs and Symptoms

· Diarrhea

· Abdominal pain, nausea and vomiting

· Double vision, blurred vision

· Drooping eyelids

· Difficulty speaking of swallowing

· Dry mouth

· Muscle weakness

Botulism can progress to paralysis of the arms, legs, trunk or respiratory muscles wherein mechanical ventilation is necessary.

Treatment

If diagnosed early, food-borne and wound botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood. Other treatments include induction of vomiting, enemas and penicillin. There is no vaccine available.

Medical Disaster Plan

External disasters occur in the community, and victims will be brought to the health care facility for care. When the health care agency is notified of a disaster, the medical health team will follow the guidelines specified in the disaster plan of the agency.

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