Envenomation Of Causus Maculatus

New York, Scholium International, 1983. 2. Minton SA Venom Diseases. Springfield, IL, Thomas, 1974. 3. Swaroop S, Grab B Snakebite mortality in the world. Bull WHO 10 35, 1954. 4. Gutierrez JM, Rucavado A Snake venom metalloproteinases Their role in the pathogenesis of local tissue damage. Biochimie 82 841, 2000. 5. Rosenberg P Pharmacology of phospholipase A2 from snake venoms. In Lee CY (ed) Snake Venoms. Handbook of Experimental Pharmacology, Vol. 52....

References

Stephenson LS, Latham MC, Ottesen EA Global malnutrition. Parasitology 121 S5-S22, 2000. 2. West KP Extent of vitamin A deficiency among preschool children and women of reproductive age. J Nutr 132 2857S-2866S, 2002. 3. Stoltzfus RJ Defining iron-deficiency anemia in public health terms A time for reflection. J Nutr 131 565S-567S, 2001. 4. International Zinc Nutrition Consultative Group (IZiNCG) Technical Document 1. Assessment of the risk of zinc deficiency in populations and options for its...

Treatment And Prognosis

Because of known drug-resistant strains of M. leprae, especially to dapsone and rifampin, monotherapy with any antileprotic is proscribed.96,97 The type of antibacterial multidrug therapeutic (MDT) regimen employed is usually based on the WHO simplified classification of the disease, that is, PB or MB, and utilizes the WHO recommended combination of drugs,98-100 as follows Single lesion regimen Some clinicians treat patients who have only a single skin lesion with a single dose combination of...

Principles of Control of Infectious Disease Outbreaks

Control measures can focus on reservoirs (slaughter of infected animals and vaccination). Some pathogens have a human reservoir, and control measures are not as simple and require effective treatment, vaccines, or difficult behavioral changes.1,110 One safeguard against transmission is keeping water and food supplies free of pathogens. Immunization plays an extremely important role in a relatively few diseases, and herd immunity principles apply. For some diseases, immunity wanes with age, and...

Treatment Of Systemic Nematodes

Diethylcarbamazine is the drug of choice for several systemic filarial nematode infections, including those caused by Wuchereria bancrofti, Brugia malayi, Brugia timori, and Loa loa, and for people with tropical pulmonary eosinophilia19,20 (see Table 13-1). Diethylcarbamazine is not directly toxic to microfilariae but promotes the host's killing of microfilariae of these species and also promotes damage or killing of adult worms. It can be used prophylactically to prevent L. loa infections in...

Aids And Tuberculosis In Haiti Josephs Story

On the afternoon of March 17, 2003, four men appeared at the public clinic in Lascahobas, Haiti, each carrying a leg of a makeshift stretcher. (The Lascahobas clinic in Central Haiti is a recent partnership between the nonprofit organization Partners in Health Zanmi Lasante and the Haitian Ministry of Health. It is rural Haiti's second full-service AIDS clinic and also provides a range of other health services.) On the stretcher lay a young man, eyes closed, seemingly unaware of the 5-mile...

Acute Q Fever

Self-limited illness is the most common manifestation of Q fever. In areas where Q fever is endemic, 12 or more of the population have antibodies to C. burnetii, and most of these infections are subclinical or undiagnosed. A study from the south of Spain found that 108 of 505 adults (21 ) who had fever for more than 1 week and less than 3 weeks had Q fever. All of these patients had normal chest radiographs. This illness is more severe than the self-limited febrile illness. The major...

Agent

Y. pestis is a nonmotile, nonsporulating, gram-negative coccobacillus in the family Enterobacteriaceae.4,14 It is microaerophilic, oxidase- and urease-negative, non-lactose-fermenting, and biochemically unreactive. The organism is nonfastidious and is highly infective to laboratory rodents. Y. pestis grows slowly but well on a wide variety of common media (e.g., brain-heart infusion broth, sheep blood agar, chocolate agar, and MacConkey agar). Routine specimens can be safely handled under BSL-2...

Complications and Unusual Manifestations

Intestinal perforation occurs in about 3 of hospitalized patients. It usually occurs during the third week of illness, but can happen during the first week.64,79 The patient with perforation has the usual symptoms of typhoid fever and complains of severe abdominal pain that is often localized to the right lower quandrant, but may be diffuse. Bowel sounds are absent in 50 of cases. About 75 of patients will have guarding, rebound tenderness, and rigidity, particularly in the right lower...

Disease

In communities with endemic trachoma, the disease often has inapparent or gradual onset. Initially, trachoma presents as conjunctivitis characterized by the formation of lymphoid follicles in the subconjunctival tissue and inflammatory infiltration (papillary hypertrophy) of the conjunctiva (Fig. 47-1). In children under 2 years of age, the papillary reaction with inflammatory thickening of the conjunctiva may be the predominant sign, and follicles may not be a prominent sign. The disease...

Treatment

A patient with generalized tetanus or neonatal tetanus requires the facilities and the expertise of an intensive care unit (ICU) to survive. A review of 335 consecutive tetanus patients revealed that survival drastically improved after the development of ICUs (44 mortality vs. 15 ) and that the major improvement came from prevention of death due to respiratory failure.66 The mainstays of treatment include (1) neutralizing existing toxin before it enters the nervous system, (2) inhibiting...

Other Enteric Clostridium Infections Clostridium perfringens

Clostridium perfringens type C has been the cause of both sporadic and epidemic cases of necrotizing enteritis. Clinical entities such as Darmbrand (bowel gangrene) in postwar Germany during the 1940s and pigbel97 in the Papua New Guinea highlands have been attributed to this organism, which elicits alpha and beta toxins capable of causing the enteritis. Poor nutrition and episodic dietary indulgence have been associated with these entities, with investigators suggesting that a low level of...

Treatment Of Ectoparasitic Diseases

The major ectoparasites of humans, lice and scabies, are treated with malathion, permethrin, or alternative drugs (Table 13-9 Box 13-6). Table 13-9 Treatment of Ectoparasites Lice infestation (Pediculus humanus, P. capitis, Phthirus pubis)a Drug of choice 0.5 Malathionb or 1 Permethrinc Alternative Pyrethrins with piperonyl butoxidec Scabies (Sarcoptes scabiei) Drug of choice Alternatives 5 Permethrin Ivermectin4'1 or 10 Crotamiton For infestation of eyelashes with E pubis lice, use petrolatum...

Pathogenesis And Immunity

As stated previously, meningococcal disease is exclusive to humans. The meningococcal carrier state is fundamental to the development of invasive disease.2,4,9,10 Approximately 6 of the population develops nasopharyngeal colonization with N. meningitidis yearly. Nasopharyngeal carriage rates vary markedly with age and the population under study but are approximately 5 to 15 , rising from 0.5 in children 3 to 48 months old to approximately 20 to 40 in young adults. Carriage persists for weeks to...

Introduction Definition

Plague in humans is a severe febrile illness caused by the gram-negative bacillus, Yersinia pestis. Historically, it is synonymous with catastrophic epidemics. Y. pestis is maintained in nature as a zoonotic infection of rodents and their fleas in scattered foci in large areas of Asia, Africa, and the Americas. It is an incidental infection of humans and mammals other than rodents. Humans acquire infection most often by the bite of rodent fleas, occasionally by handling or ingesting infected...

Species Diversity And Focality In The Tropics

Viruses, parasites, fungi, and bacteria have evolved with their reservoirs from ancestral forms. The evolution of plants and animals in the tropics has generated high species diversity in many taxa. It follows that microorganisms also are diverse in the tropics because each has evolved with specific reservoir hosts. The more diverse the hosts, the more diverse will be the infectious agents. This diversity is also accompanied by focal-ity, an increased degree of spatial localization. Of course,...

Clinical Manifestations

It is useful to stratify the different clinical presentations of brucellosis due to B. melitensis.45 However, it is less helpful in the evaluation of patients with B. abortus or B. suis infections, because chronic or recurring forms are infrequent. Acute Form (Classical Febrile Brucellosis) In acute B. melitensis infections, patients typically present with evening fever (100 F or greater), with profuse or patchy sweating, malaise, headache, and weight loss (3 to 10 kg in 1 to 2 weeks). Half of...

Geographic Barriers To Spread Of Agents

Tropical infectious diseases are limited by geographic barriers such as oceans, rivers, mountain ranges, or deserts. Rift Valley fever is an excellent example. This mosquito-borne viral agent is indigenous to sub-Saharan Africa and is believed to have as its reservoir Aedes mosquitoes that maintain the virus in mosquito eggs between periods of rain. The eggs are deposited in dambos (depressions) in East African pastures. After periods of heavy rain, the eggs hatch and the adult mosquito,...

Tb Patience With 76kg Is Expected To Take How Many Dose Of Drugs

Modern TB treatment is based on the use of potent short-course, multiple-drug regimens that sterilize the sputum rapidly. TB treatment is divided into two phases the initial intensive phase lasting 1 or 2 months that kills the rapidly dividing, rapidly metabolizing organisms, followed by a 4- to 6-month continuation phase that kills the remaining slowly metabolizing organisms. The most useful first-line drugs for TB treatment include isoniazid, rifampicin, ethambutol, pyrazinamide, and...

Edward T Ryan Megan Murray

Epidemiology is the science of investigating the occurrence, causes, and prevention of disease in human populations. Epidemiologic tools may be used to estimate disease frequency, uncover or confirm associations between risk factors and disease occurrence, and define the impact of preventive and curative measures to combat disease. As one of the primary disciplines of the field of public health, epidemiology is of great importance to human health worldwide, especially in the developing world. A...

Info

Symptomatic urethritis Comparison of oral and intramuscular single-dose therapy. Sex Transm Dis 22 145-148, 1995. 138. Jaschek G, Gaydos CA, Welsh LE, et al Direct detection of Chlamydia trachomatis in urine specimens from symptomatic and asymptomatic men by using a rapid polymerase chain reaction assay. J Clin Microbiol 31 1209-1212, 1993. 139. Batteiger BE, Jones RB Chlamydial infections. Infect Dis Clin North Am 1 55-81, 1987. Centers for Disease Control and Prevention Increases in...

Ornithodoros Hermsii Borrelia

Except for the louse-borne agent Borrelia recurrentis, Borrelia species are transmitted by ticks.14 The vectors of tick-borne relapsing fever are argasid ticks of the genus Ornithodoros. Ornithodoros ticks pass through more than one nymphal stage between the larval and adult stages Figure 45-1 shows several sizes of Ornithodoros turicatae. Most species of argasid ticks feed on a single or a very limited number of types of animal. Ornithodoros ticks are noted for their longevity, up to 15 to 20...

Prevention Of Infectionrelated Malignancies

Each carcinogenic pathogen has unique features that may facilitate or frustrate efforts to control or prevent the associated cancers. Prevention at the primary level that is, by blocking an initial infection may be accomplished in the case of hepatitis B by immunization of infants with a recombinant DNA or plasma-derived vaccine. Such vaccine has already proved effective in protecting inoculated children against chronic carriage and hepatocellular carcinoma.38,40 In Taiwan, an intensive...

Evolution of Virulence

The traditional view assumes that natural selection would favor evolution toward a benign coexistence between host and parasite.18,19 In other words, virulence was considered an artifact of recent associations between parasites and their hosts. At the logical end, the relationship would become that of commensalism or mutualism. However, this model does not explain epidemiologic observations that in some cases challenge the traditional view. A modern view of evolution of virulence focuses on the...

Localized Disease

Undermined Edges

This form develops as a single, usually movable, nodule in the subcutaneous tissue and lower dermis (Fig. 37-2). Nodules are firm, may attain a diameter up to 2 to 4 cm, and though sometimes pruritic, are not painful. This stage often is observed in African patients, and because of the firmness, in the Kikongo language the disease is called mputa matadi, or rock-hard lesion. Microscopically, there is contiguous coagulation necrosis of the lower dermis and panniculus and sometimes the fascia....

Tab Valgancyclovir 900 Mg Bd 15 Days

A decrease in ATV levels is expected EFV no change Dose Recommend ATV r 300 100 mg each given once daily with food EFV standard Levels NVP no effect EFV AUC 4- 22 *Several drug interaction studies have been completed with saquinavir given as Invirase or Fortovase. Results from studies conducted with Invirase may not be applicable to Fortovase. Study conducted with Invirase. From U.S. Department of Health and Human Services Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults...

Ecology As A Factor In Distribution

Many of the tropical diseases are zoonoses that is, transmissible in nature from vertebrate animals to humans. The zoonoses are highly sensitive to climatic and other ecological influences. May's classification of infectious diseases1 has greatly enhanced our conceptual thinking and is fundamental to understanding the basis for the distribution of infectious agents. The term agent is used here to mean the infectious entity, including viruses, bacteria, fungi, and parasites. May proposed that...

Diseases

The incubation period of South American bartonellosis is considered to be 21 days (from Carrion's experimental case) with a range of 1 to 30 weeks and a mean of 2 months. The two clinical forms of the disease Oroya fever and verruga peruana may occur sequentially, sometimes with an intervening clinically silent period, or either form may occur alone.7,10,26-28,53,54 The usual gradual onset of systemic symptoms of malaise, somnolence, anorexia, myalgia, headache, pain in the back and...

Specific Antibiotics

Prior to the emergence of drug-resistant strains of S. Typhi, chloramphenicol was the most effective and widely used antibiotic for treating typhoid fever patients and the standard against which all other antibiotics were judged. It produces defervescence and relief of symptoms in most patients within 3 to 4 days, reduced the pre-antibiotic era case-fatality rates of 10 to 15 to 1 to 4 , and cures approximately 90 of patients with chloramphenicol-sensitive strains.87,107 Most studies have shown...

Major Histocompatibility Complex

The major histocompatibility complex (MHC), also designated HLA for human leukocyte antigen, is expressed on the surfaces of a large variety of cells and is translated from a region of highly polymorphic genes.1-3 A number of very elegant studies in mice led to the MHC's being recognized as responsible for immune responses, and the region to which these genes mapped was called the Ir region for immune response genes.35 These genes were subsequently shown to be necessary for activation of helper...

Hypothesis Testing

When designing a study, researchers should first state the hypothesis that they want to test. For example, we hypothesize that drug A is effective in treating salmonellosis. The hypothesis should be stated before data are collected. A common pitfall of studies is to first collect data and then to analyze data for comparisons that reach statistical significance. Such a fishing expedition may uncover real differences, but may also uncover differences related to chance alone.1 A placebo-controlled...

Neurolathyrism

Consumption of the vegetables khesari (Lathyrus sativus), found in India, China, Ethiopia, and Nepal, can cause a devastating disease known as neurolathyrism.53 Khesari is a readily accessible food source in developing countries because it needs no irrigation, fertilizers, or pesticides, and its seeds are high in protein.54 Consumption of bread or other products produced from this crop can result in toxicity. A neurotoxic amino acid, P-N-oxalyamino-L-alanine (BOAA), has been implicated in...

Soft Tissue Infections

Erysipelas is caused exclusively by S. pyogenes and is characterized by the abrupt onset of fiery-red swelling of the face or extremities.17 Distinctive features are well-defined margins, particularly along the nasolabial fold a scarlet or salmon-red color rapid progression and intense pain. Flaccid bullae filled with clear fluid may develop during the second to third day of illness, yet extension to deeper soft tissues, bacteremia, and shock occur only rarely. Surgical debridement is rarely...

Staphylococcal Toxic Shock Syndrome

Toxic shock syndrome associated with S. aureus infections was originally referred to as TSS,48 though in this chapter this syndrome is designated Staph TSS to distinguish it from Strep TSS. Between 77 and 93 of cases of Staph TSS have occurred in females and the vast majority (> 90 ) of these women were white and 15 to 19 years of age.49-54 The incidence of Staph TSS was highest in 1980 and ranged from 2.4 to 16 per 100,000 population.52,53,55-58 Because most of these studies were performed...

Indirect Damage

Damage to the host may also develop as a consequence of immune reactions to the infectious agents. One scheme for classifying immunopathologic responses divides the reactions into four types based on the elements of the immune response involved.98 Type I reactions involve elements of strong Th2 responses that lead to increased IgE, eosinophilia, and eosinophil and mast cell activation. Adverse reactions of this type include the development of urticaria (with several helminthic parasites), the...

Vector Control

One can either kill vectors, or avoid their contact by various means, to prevent vector-borne diseases. Note that holometabolous insects have at least two different strategies for their control. One can perform larvicide or adulticide. Insecticides or other control agents will have to be delivered to different sites in the case of most holometabolous insects, depending on whether larvae or adults are being controlled. Malaria control is an example of holometabolous insect control. Malaria is...

Infections That Cause Cancer

Many infectious agents have been posited to cause cancer. The IARC biannually reviews epidemiologic and basic science information on putative cancer-causing agents. It then classifies these agents as definite, probable, possible, or unlikely causes of cancer. To date, they have carried out extensive evaluations of liver flukes, schistosomes, H. pylori, hepatitis viruses, human herpesvirus 8 (HHV-8), HPV, HTLV, human immunodeficiency virus (HIV), and Epstein-Barr virus (EBV Table 12-1). Table...

Nutritioninfection Interactions Paradigms And Principles

In summarizing the experimental data for the interaction between malnutrition and infection in 1968, Scrimshaw et al. delineated three possible effects that may occur to varying degrees depending on the infectious agent and on the hosts' nutritional status synergistic, antagonistic, or no effect.5 The first, synergistic, occurs when the interaction of the infectious agent and nutritional deficiency results in a more adverse clinical outcome than the simple additive combination of the two...

Serologic and Immunologic Diagnostic Methods

Although a variety of serologic methods have been used in the past to detect antibodies, the indirect immunofluores-cence method, first developed by Bernkopf and then by McComb and Nichols, has been simplified and standardized in an indirect microimmunofluorescence MIF test by Wang and associates.38 At present, this is the most commonly used test for evaluation of host response to trachoma or to oculo-genital C. trachomatis agents. For LGV, the complement fixation CF test can be used, although...

Epidemiology

Once the microorganism had been isolated, it was characterized and diagnostic reagents became available. In 1981, 5 years after the initial outbreak, England and colleagues6 reported on the first 1000 cases of sporadic Legionnaires' disease in the United States. The authors noted that most cases occurred during June to October 71 of patients were male, and 88 were white. During the 2 weeks before onset of this illness, 37 had traveled overnight, 29 had visited a hospital, and 5 had been...

Antifungal Drugs

The therapeutic armamentarium against fungi is expanding Table 14-3 . For many years, amphotericin B was the only Primary Agents Against Mycobacterium tuberculosis Isoniazid PO or IM, 5 mg kg day 10-20 mg kg day for children max. 300 mg day for adults and children Rifampin PO or IV, 10-20 mg kg day to 600 mg day Pyrazinamide PO 15-30 mg kg day to 1.5-2.5 g day Ethambutol Myambutol PO, 15-25 mg kg day Streptomycin IM 15 mg kg day 20-30 mg kg day for children Capreomycin Capastar IM 15 mg kg day...

Snake Venom And The Venom Apparatus

Snake venoms, produced in modified salivary glands in the upper jaw and injected through hollow or grooved fangs, are some of the most complex naturally occurring toxins known. Most contain a mixture of proteins including enzymes , low-molecular-weight nonenzymatic polypeptides, metallic ions, and other substances that continue to be researched.1 To avoid underestimating the potential of any particular snake's venom, one must recognize the complexity of these toxins and anticipate multisystemic...

Treatment Of Intestinal Nematodes

The benzimidazoles, albendazole and mebendazole, have broad spectra of activities against intestinal nematodes, including Ascaris lumbricoides, Trichuris trichiura, Ancylostoma duode-nale, Necator americanus, Enterobius vermicularis, and others Table 13-1 . Albendazole is particularly attractive because of its pharmacokinetics. It is effective in the treatment of most intestinal helminth infections when administered as a single dose, and it has been used successfully in mass treatment programs...

Treatment Of Cestodes And Trematodes

Among the platyhelminths, praziquantel is active against adult cestodes tapeworms in the human intestinal tract Table 13-2 and most trematodes that infect humans Table 13-3 .24,25 The principal exception is Fasciola hepatica, which responds to the veterinary fasciolide, triclabendazole, and to bithionol.26,27 Both albendazole and praziquantel kill cysticerci of Taenia solium in the central nervous system CNS and can be used in the treatment of neurocysticercosis.28,29 Corticosteroids are often...

Introduction

Typhoid fever is an acute systemic illness caused by infection with Salmonella enterica subspecies enterica serotype Typhi. It is characterized by 1 prolonged fever, 2 sustained bacteremia without endothelial or endocardial involvement, and 3 bacterial invasion of and multiplication within the mononuclear phagocytic cells of the liver, spleen, lymph nodes, and Peyer's patches. Paratyphoid fever is a pathologically and clinically similar, but generally milder, illness that is caused by many...

Tetanolysin Binding To Lipid Vesicles

In Edsall G ed Proceedings of the Fourth International Conference on Tetanus Dakar, Senegal. Lyon, France, Fondation Merieux, 1975, pp 19-20. 2. Summary of notifiable disease, 1988. MMWR 38 39, 1989. 3. Tetanus United States, 1982-1984. MMWR 34 601-611, 1985. 4. Schofield F Selective primary health care Strategies for control of disease in the developing world. 22. Tetanus A preventable problem. Rev Infect Dis 8 144-156, 1986. 5. Cvjetanovic B, Grab B, Uemura K, et al...

Prevention And Control

In developing countries, H. pylori recurrence after successful treatment occurs at rates 10 to 20 times higher than in developed countries. In addition, bacterial counts of H. pylori in gastric biopsies taken in recurrence are similar to those in biopsies taken prior to treatment. The high reinfection rate and lack of change in the H. pylori bacterial counts suggest there is little natural immunity after infection. The rapid recurrence of H. pylori infection in some areas means that its...

Diagnosis

A diagnosis of specific infection of the genital tract caused by C. trachomatis is totally dependent on the results of laboratory investigations. Isolation of C. trachomatis from clinical specimens has been the reference standard against which all other laboratory tests have been evaluated. However, culture of C. trachomatis requires laboratories with the capacity to perform either egg inoculations or cell culture since these bacteria are obligate intracellular pathogens. Successful isolation...

Manchineel

The manchineel tree Hippomane mancinella is an evergreen found in the West Indies, Central America, the Bahamas, South America, and the west coast of Africa. It is found in coastal regions because of an ability to thrive in a saline environment. The tree grows to 20 to 40 ft in height, has a trunk 1 or 2 ft in diameter, and is covered by smooth gray bark.48 Manchineel trees produce a round yellow-green fruit known as guavas. Manchineels have been described as the most toxic tree on the North...

Active Chronic Gastritis

Chronic gastritis refers to the histological presence of mononuclear cells lymphocytes and plasma cells in the gastric mucosa. Histologic chronic gastritis is associated very closely with H. pylori and there are few patients with this finding who do not have the organism.45 There is also a variable amount of neutrophilic infiltration of the mucosa, typically invading the necks of mucous glands. This latter appearance gives the name active or acute to the typical histologic appearance of active...

Diagnosis And Differential Diagnosis

The diagnosis of tetanus is primarily clinical. A clinical picture of trismus, muscle rigidity, stimulus-induced tetany, and a history of a wound or injury within the last 3 weeks is highly suggestive of generalized tetanus. Likewise, a newborn with a poor suck and increased muscle rigidity and spasms, in the setting of poor umbilical hygiene and a mother with no immunization history, likely has neonatal tetanus. EMG may demonstrate findings consistent with increased excitability of the motor...

Tbrf

LB, Lyme borreliosis LBRF, louse-borne relapsing fever TBRF, tick-borne relapsing fever. Primary reservoir for maintenance of species in nature. Borrelia burgdorferi probably invaded Europe and I. ricinus ticks from its North American origin. Borrelia recurrentis probably originated in Palearctic or Afro-Tropical regions. LB, Lyme borreliosis LBRF, louse-borne relapsing fever TBRF, tick-borne relapsing fever. Primary reservoir for maintenance of species in nature. Borrelia burgdorferi probably...

Vector Life Cycle Strategies

Rhodnius Prolixus

Most blood-sucking arthropods are oviparous, with the exception of some Diptera including the tsetse , which are ovoviviparous the egg hatches within the uterus and the larva feeds on secretions produced by milk glands . Two basically different growth strategies are observed those having complete metamorphosis holometabolous Fig. 8-1 and those having incomplete metamorphosis hemimetabolous Fig. 8-2 . Holometabolous insects follow the model of the butterfly, the caterpillar being very different...