Upper Respiratory Tract Infection Ebook
Rhinitis medicamentosa is a chronic congestive condition associated with prolonged overdosage of local nasal medications. The condition is caused by nasal obstruction which is relieved initially by medications. The relief is short lived causing the patient to reuse nasal medications. Eventually, the nasal medications cause nasal membranes to swell rather than constrict (rebound effect). a. Description. Nasal polyps are growths of mucous membrane. These growths hang down from the posterior wall of the nasal septum. Called polyps, these growths look like bluish-white tumors. As they get bigger, they may fill the nasopharynx. The cause of nasal polyps is thought to be chronic irritation such as nasal rhinitis.
The common cold, with runny nose, mild fever, cough, often sore throat, and sometimes diarrhea is a frequent but not a serious problem in children. Treat with lots of liquids. Give acetaminophen or perhaps aspirin (see p. 379). Let children who want to stay in bed do so. Good food and lots of fruit help children avoid colds and get well quickly. Penicillin, tetracycline, and other antibiotics do no good for the common cold or 'flu'. Injections are not needed for colds.
Allergic rhinitis that is seasonal consists of symptoms that present after exposure and sensitization of pollens. Allergic rhinitis that is perennial occurs year-round because of allergens that the patient is exposed to on a continual basis. Risk Factors Etiology. Approximately 5-9 of children will develop seasonal allergic rhinitis, and it is rare before the age of 5 years. The pathophysiology stems from the inhalation of spores, pollens, and animal and mite antigens that are deposited on the nasal mucosa. IgE is produced and stimulates the release of mast cells. Diagnostic Tests. The diagnosis is made on clinical grounds. However, a nasal smear of patients with allergic rhinitis may be overabundant with eosinophils. In addition, a family history of asthma or eczema may be obtained. Treatment. The patient should avoid the allergen. Antihistamines and decongestants are useful in treating allergic rhinitis, especially if seasonal. Cromolyn nasal solution is useful in both...
In most of the cases discussed so far the host becomes infected when epithelial cells and or lymphoid cells at a body surface become infected. Some infections (e.g. common cold, rotavirus) remain limited to these tissues, while others (e.g. measles, polio, HIV) cross the epithelial surface and spread to other organs and tissues.
Common cold viruses and rotaviruses might infect other epithelial cells lining the respiratory tract and the intestinal tract, respectively. Most adjacent animal cells are separated from each other only by their plasma membranes, providing opportunities for direct cell-to-cell spread for some viruses.
Inspect the external nose and look for redness, edema, lumps, tumors, or poor alignment. A patient with red nostrils may blow the nose frequently because of allergies or infectious rhinitis. Dilated, engorged blood vessels of the nose may indicate either that the patient is outside in all kinds of weather much of the time or that he is an alcoholic. A person with a bulbous, discolored nose may have rosacea (a chronic inflammatory disorder similar to acne).
Types A and B are responsible for epidemics. Type C is a sporadic cause of upper respiratory tract infections. and nasal congestion and cough may last 4-10 days. These viruses are less common in younger children, who have laryngotracheitis, bronchiolitis, bronchitis, and upper respiratory tract infections as a result of infection.
Gross Pathology Pathologic features seen if neonatal disease is left untreated include syphilitic chondritis and rhinitis (causes saddle-nose deformity), pathologic fractures, bowing of the tibia (saber shin), V-shaped incisors (Hutchinson's teeth), multicuspid molars (mulberrymolars), interstitial keratitis, and deafness.
Klebsiella pneumoniae (Friedlander's bacillus) is isolated with some frequency from the upper respiratory and intestinal tracts of normal individuals and is responsible for approximately 2 percent of the bacterial pneumonias. Pulmonary infections are characterized by extensive hemorrhagic consolidation of the lobes. The fatality rate is high in untreated cases. Klebsiella species are frequently isolated from various upper respiratory tract infections, although their presence, in many instances, is probably that of secondary invaders. The organisms have definitely been responsible for suppurative abscesses of the other visceral tissue.
Illness of pigs was largely due to respiratory disease and included a loud and distinctive cough and neurologic symptoms. The nature of the disease depended on the age of the pig. In sows and boars, symptoms of acute febrile respiratory illness predominated. Neurologic symptoms, when present, included spasms, seizures, head pressing, and pharyngeal muscle paralysis. Abortions occurred in diseased pregnant sows. In suckling pigs, mortality was higher, and the symptoms were a combination of respiratory and neurologic disease.13 In pigs, respiratory tract involvement was the most common feature at postmortem examination. Giant cell pneumonia was present with multi-nucleated syncytial cells in the lung. NiV antigen was identified in the giant cells, the epithelial lining, the necrotic areas of the upper and lower respiratory tract, and renal tubular cells.50,51
Inherited differences in the shape of the upper airways, and diminished elastic content of the tissues with age. Allergies, infection, respiratory irritants, and smoking can cause swelling of these tissues. Alcohol and some drugs can cause the muscles of the throat to relax. Lying on the back can cause the tongue and other throat tissue to be pulled back by gravity. Large tonsils and adenoids may constrict the size of the throat. Nasal congestion may force more mouth breathing. Even depression, stress, or anxiety can cause changes in blood flow to the nose, causing swelling.
The respiratory tract infections caused by HPIV-1 and HPIV-3 may be limited to the upper respiratory tract, causing colds, or may also involve the lower respiratory tract, causing bronchopneumonia, bronchiolitis, or bronchitis. These viruses are widespread around the world and are an important cause of lower respiratory tract disease in
Concurrent studies also took increasing note that kwashiorkor, the most severe form of protein energy malnutrition, was often preceded by an infection such as acute diarrheal disease,19 measles,20 or chicken pox.21 Prospective birth cohort studies revealed that breast-fed children in impoverished settings grew in parallel to children in industrialized settings. However, when weaning foods were introduced and the incidence of both diarrhea and respiratory illness increased, growth faltering occurred. Even asymptomatic gastrointestinal infections led to growth faltering.5 Measured observations of children during infectious disease episodes showed that common infections led to anorexia, nutrient malabsorption, micronutrient wasting, and growth deficits.22-27 Diverse infections often occurred at a rate that continually delayed the ability of a child to achieve adequate catch-up in nutritional status or linear growth, and the child entered a cycle of infections and worsening nutritional...
The answer is a Fauci 14e pp 14511455 Massive lifethreatening hemoptysis is 100 cc of blood in 24 h The most common
The answer is d. (Fauci, 14 e, pp 194-197.) The most common cause of chronic cough in adults is postnasal drip due to sinusitis or rhinitis (allergic, vasomotor, irritant, perennial nonallergic). Patients typically complain of having to clear their throats or a feeling of something dripping in the back of their throats. Physical examination reveals muco-purulent secretions and a cobblestone appearance to the mucosa. Asthma is more of an episodic disease with wheezing, but occasionally patients complain of only cough. Gastroesophageal reflux disease (GERD) must be considered in patients who complain of heartburn or regurgitation. Other causes of chronic cough include bronchitis, congestive heart failure, and use of angiotensin converting enzyme (ACE) inhibitors.
Cold sore blisters, also called herpes labialis (figure 1-8), are often associated with colds, trauma, fatigue, fevers, and prolonged exposure to the sun and the wind. The common site of occurrence is on the lips at the border with the skin of the face (called the vermilion border). The lesions usually consist of clusters of small vesicles that, in the early stage, contain a clear, transparent fluid. After a few hours, the vesicles rupture and form a crust or scab. The disease is self-limiting and usually disappears in 10 to 14 days. The individual is infective until complete healing has occurred.
For rash they used red-oak bark and alum. Goose grease and sorghum, or honey, was a standard remedy for croup, backed up with turpentine and brown sugar. Sassafras tea was given in the spring and fall as a blood medicine. Adults' colds were doctored with horsemint tea and tea from the roots of broom sedge. For eruptions and impure blood, spice-wood tea was given. Wine was made from the berries of the elder bush. For diarrhoea, roots ofblackberry and blackberry cordial and so, also, was a tea made from the leaves ofthe rose geranium. Mutton suet, sweet gum and the buds ofthe balm of Gilead was a standard salve for all cuts and sores. Balsam cucumber was widely used as a tonic, and was considered a specific remedy in burns. Catnip, elecampane, and comfrey root andpennyroyal were in every good housewife's pantry, in which, also, was the indispensable string or red peppers, a bag of sage leaves and of 'balm.' Calamus root for colic in babies was a common dose. The best known standard...
A 24-year-old woman with a history of allergic rhinitis is involved in an automobile accident and sustains a splenic laceration. She undergoes abdominal surgery and is then transfused with four units of blood of the appropriate ABO and Rh type. As the transfusion progresses, she becomes rapidly hypotensive and develops airway edema, consistent with anaphylaxis. Which of the following pre-existing conditions best accounts for these symptoms
The answer is b. (Fauci, 14 e, p 1544.) IgA nephropathy (Berger's) is the most commonly encountered form of focal glomerulonephritis worldwide, and patients will often have microhematuria. It may follow an upper respiratory tract infection or physical exertion. Bladder cancer is a common cause of asymptomatic microhematuria but is usually found in patients over the age of 50. Risk factors for bladder neoplasia include aniline, rubber, other organic solvents, industrial dyes, and tobacco use. Minimal change disease almost always presents with severe proteinuria, and erythrocyte casts are not seen in rhabdomyolysis. Patients with Alport syndrome have the nephritic syndrome and hearing loss.
A 40-year-old male smoker presents with a history of chronic cough. He has had symptoms of an upper respiratory illness for a few months since visiting family in Arizona. Physical exam is normal. CXR is shown below in Fig. 1. The next step in management should be A 34-year-old woman, a recent immigrant from Eastern Europe, is seen with complaints of vague chest discomfort after an upper respiratory tract infection. She is not a smoker and gives a history of BCG vaccination when she was an infant. Physical examination is normal. PPD is 10-mm induration and induced sputum for acid-fast bacilli is negative. CXR is shown in Fig. 2.
Interestingly, a similar clinical picture has been observed in human infants treated with neem seed oil. Sinniah and Baskaran (1981) report a series of 13 babies ages 21 days to 2 years who had been given 5 to 30 ml of neem seed oil by their parents as a treatment for minor illnesses, such as vomiting, fever, or upper respiratory tract infections. Within V2 to 4V2 hours, the children developed drowsiness, tachypnea, and metabolic acidosis, followed by recurrent generalised seizures. Interestingly, hypoglycemia was not observed. Two of the babies died (one of these was also diagnosed with a streptococcal meningitis), one became developmentally delayed and suffered from recurrent fits, but the other 10 all made a good recovery. Acute hepatotoxicity with fatty infiltration was seen in one fatal case who had a liver biopsy. This pattern of illness has been likened to Reye's syndrome. Others have reported similar cases (Simpson and Lim, 1935 Lai et al., 1990).
In the setting of an upper respiratory illness or viral exanthem, blood cultures are drawn which are reported as positive for N. meningitidis, often after discharge. Occult bacteremia with recovery in the absence of antimicrobial therapy is rare, but serum concentrations of bacteria in children are often low, from 22 to 325 organisms per milliliter of blood in
Parainfluenza virus is the predominant cause of croup. However, adenovirus, respiratory syncytial, influenza, and measles viruses have also been implicated. Other family members may have a mild respiratory illness, i.e., cold symptoms. Presentation. The child with viral croup is usually between 3 months and 5 years. The patient may have a slightly elevated temperature and a mild respiratory illness, i.e., cold symptoms. These cold symptoms may be present for several days before the patient exhibits a brassy, barking cough.
Three common health problems for which people too often request medicines they do not need are (1) the common cold, (2) minor cough, and (3) diarrhea. The common cold is best treated by resting, drinking lots of liquids, and at the most taking aspirin. Penicillin, tetracycline, and other antibiotics do not help at all (see p. 163).
Churg-Strauss syndrome, named for Jakob Churg, a Polish-American pathologist (19101966) and Lotte Strauss, an American pathologist (1913-1985), has an incidence of about 3 per million. The typical patient is usually male and in the fifth decade of life. Classically the syndrome is a triad of rhinitis and asthma, eosinophilia, and systemic vasculitis. Because of its makeup, there are a number of theories about the underlying pathophysiology. It may be a progression of an allergic phenomenon, or a primary vasculitis that has an asthmatic component due to the involvement of eosinophils.
Everybody gets colds and 'flu from time to time, and these, like other illnesses, can affect the control of your diabetes. The most likely result is that your blood glucose level will rise, so you need to make frequent checks to test whether this is happening, especially if you are on insulin. Because any illness can be potentially dangerous for people with diabetes, it is essential that you speak with your doctor and get specific instructions about self-care during sick days. You will need to know how often you should monitor your blood glucose when you are sick, when you will need to take more or less of your insulin or diabetes medication, and which over-the-counter medications are safe for you to use. By getting all the important information before you get sick, you will be prepared to take good care of yourself when, and if, it happens.
An 8yearold child has repeated episodes of nosebleeds Past history family history and physical examination are
The most common cause of epistaxis is as a result of picking the nose. Trauma, foreign bodies, and inflammation (from recurrent URI, sinusitis, and allergic rhinitis) can also cause nosebleeds. Rarely, vascular anomalies or bleeding disorders may be responsible. Epistaxis is rare outside of childhood. Juvenile nasopharyngeal angiofibroma should be considered in pubertal boys with profuse bleeding and an associated nasal mass. Foreign bodies may cause nosebleeds and are characterized by profuse, purulent, unilateral nasal drainage.
The answer is b. (Fauci, 14 e, p 1158.) Mucormycosis is a rare fungal disease limited to persons with preexisting illness and may be seen in poorly controlled diabetic patients. Patients present with fever, nasal congestion, sinus pain, diplopia, and coma. Physical examination may reveal a necrotic nasal turbinate, reduced ocular motion, proptosis, and blindness. CT scan or MRI will reveal the extent of sinus involvement prior to surgery.
C. trachomatis is also recognized as a significant cause of neonatal pneumonia.30 Following an incubation period of 2 weeks to 3 months, infants with C. trachomatis pneumonia develop rhinitis which is often accompanied by conjunctivitis. They are usually afebrile, tachypneic, occasionally apneic, and develop a staccato cough. Chest radiography reveals hyper-inflation with diffuse interstitial infiltrates. Laboratory investigations frequently reveal eosinophilia and hypergammaglobulinemia, particularly associated with an elevation of immunoglobulin M (IgM) levels. In the majority of cases, the infection is mild and either resolves spontaneously or after a short course of anti-chlamy-dial therapy. Unfortunately, a minority of infants requires intensive therapy, and their subsequent ability to withstand respiratory infections may be impaired.31 Neonatal chlamy-dial infections of the middle ear, vagina, and rectum have also been documented.32
Chronic allergic ocular disease encompasses several disorders, such as seasonal atopic conjunctivitis, perennial atopic conjunctivitis, atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) 7 . Seasonal atopic conjunctivitis (SAC) is a time-limited disease and in most cases conjunctivitis is only one manifestation of additional allergic reactions (rhinitis, hay fever or a hay fever like symptomatology, and in severe cases conjunctivitis is associated with different forms of pulmonary affection). Atopic keratoconjunctivitis is a severe, bilateral, ocular allergic disease affecting adults. A familial history for atopy and an association with systemic atopic dermatitis are common. Symptoms commonly include itching, burning, and tearing. Signs include involvement of mainly upper conjunctiva in the form of a papillary conjunctivitis. The corneal epithelium reveals mild to moderate inflammatory changes that can result in scarring and neovasculariza-tion leading to...
For others, allowing the body to self-heal meant bolstering the immune system. For example, in talking about how she treats her husband's colds, Laura said, I'll give him Echinacea or suggest he use some vitamin C or garlic to boost his immune system. Lindsay also believes in the value of strengthening the immune system to allow the body to heal itself I wanted to find if there was a way that I could strengthen my own body constitution so that it could fight off the infections more. So when I'm starting to feel sick, hopefully my immune system will kick whatever it is off sooner.
It has been known for some time that the onset of type 1 diabetes in children and young people is more likely to occur at certain times of the year when lots of coughs and colds are circulating. Some viruses, such as mumps and Coxsackie, are known to have the potential to damage the pancreas, bringing on diabetes. As far as individual patients are concerned, however, it is very rare that doctors can link the onset of their diabetes with a specific bout of infection. A possible explanation for this is that the infection may have begun a process that only comes to light many years later.
Examples of prescriptions include one where animal parts were mixed in wine to procure an abortion rub a mixture of lizard's liver, skin of the cicada locust and wine on to the navel. Or the flesh of a pit viper was prepared by placing the snake in a gallon of wine then burying the sealed jar under a horse's stall for one year. The resultant liquid was a cure for apoplexy, fistula, stomach pain, heart pain, colic, haemorrhoids, worms, flatulence and bleeding from the bowel. Alcoholism could be cured by donkey's placenta mixed in wine, the liver of a black cat in wine for malaria, and to cure a bad cold an owl was smothered to death, plucked and boiled, its bones charred and taken with wine (Read 1931-7).
Cocaine is a white, crystalline alkaloid derived from the leaves of the South American coca plant. It has the composition of C17H21NO4. The usual form is cocaine hydrochloride, a powder which may be inhaled or sniffed but is poorly absorbed and cannot be smoked. It is irritant and gives chronic rhinitis or even nasal ulceration. It is a mucous membrane anaesthetic, hence its application in clinical medicine. It produces rapid euphoria and alertness, which last for up to 90 min, and is addictive.
A 20-year-old male presents with a runny nose, nasal congestion, sore throat, headache, and sneezing. Colds occur 2-3 times a year in the average person in the United States the peak incidence is in the winter months. Rhinoviruses account for the majority of viral URls, followed by coronaviruses. Spread occurs by respiratory droplets and direct contact. Q QiS p.198
Rhinoviruses are the most common agents causing upper respiratory tract infections in humans. Most children have had at least one rhinovirus infection by the age of 2 years, and in adults rhinoviruses account for about 50 of common colds. Rhinoviruses replicate in the epithelium of the upper respiratory tract, where the temperature is around 33-35 C. For at least some human rhinoviruses the optimum temperature for replication is in this range, though many human rhinoviruses are able to replicate at 37 C and some of these are probably responsible for disease in the lower respiratory tract.
Upper respiratory infections (URI), or the common cold, are caused by rhinoviruses, parainfluenza viruses, respiratory syncytial viruses, and coronaviruses. Children are the major reservoirs. The incubation period is 2-5 days. Transmission is by large droplets, small aerosol particles, or secretions. Symptoms include fever, nasal congestion, rhinorrhea, sneezing, pharyngitis, and malaise. Most symptoms resolve by 5-7 days. Treatment is not necessary. Complications include otitis media, sinusitis, and pneumonia.
The patient usually has a history of upper respiratory tract infection, rhinnorhea, and sneezing. In addition, the patient develops fever of 38.5 -39 C and gradually develops respiratory distress evidenced by tachypnea, wheezing, and cough. The patient may have difficulty feeding because of the rate of breathing. Mild cases resolve in 1-3 days. However, in severe cases the course is lengthened.
Calcitonin can be provided in two forms. Nasal congestion and rhinitis are the most significant side effects of the nasal form. The injectable formulation has gastrointestinal side effects and is less convenient than the nasal preparation. The increase in bone density observed by this therapy is significantly less than that achieved by bisphosphonates or estrogen and maybe limited to the spine. Nonetheless, it still has recognized value in reducing risk of fracture.
Adenoviruses were first isolated as causal agents for adenoid inflammation in children respiratory infection by adenovirus generally results in common cold symptoms. Close to 50 different serotypes of adenovirus have been described, of which serotype 5 is the most commonly used for vector construction. Adenoviruses are nonenveloped, regular icosahedrons that are 65-80 nm in diameter. Twelve fibers extend from the core of the virus, and these fibers consist of a shaft and a terminal knob. The terminal knob contains the domain that is recognized by the coxackie adenovirus receptor (CAR). Adenoviruses contain some 36 kb of linear DNA flanked by two inverted terminal repeats. The left inverted terminal repeat partially overlaps with the sequence that is necessary to package the DNA into the virion. Upon infection of a host cell by adenovirus, the DNA is unpackaged, and early transcription is initiated. The first and essential transcripts derive from the E1A region. The E1A proteins...
Three weeks after an upper respiratory illness, a 25-year-old male develops weakness of his arms and legs over several days. On physical exam he is tachypneic, with shallow respirations and symmetric muscle weakness in both arms and legs. There is no obvious sensory deficit, but motor reflexes cannot be elicited. The most likely diagnosis is
On investigation, it was found that many of the deer mice were persistently infected with a virus that was excreted in their urine, droppings and saliva. Humans exposed to these materials were becoming infected and developing the respiratory illness. The virus was characterized as a new hantavirus and the disease was called hantavirus pulmonary syndrome.
Inhibitor of TRPV1 and to this end much work is being carried out to develop novel inhibitors 104 . Interestingly, capsaicin-sensitive nerve stimulation in subjects with active allergic rhinitis produces reproducible and dose-dependent leucocyte influx, albumin leakage and glandular secretion. These results provide in vivo evidence for the occurrence of neurogenic inflammation in the human upper airway with active allergic disease and may therefore suggest the therapeutic utility of TRPV1 antagonists in the management of this disease 105 . In addition, the treatment of persistent cough is a facet of airway diseases that is sorely in need of effective treatments and a TRPV1 inhibitor may prove extremely effective against cough induced by, for example, gastroesophageal acid reflux 106 , as well as that associated with asthma and other airways diseases as described.
Epistaxis, bleeding from the nose, may be either a primary disorder or a problem caused by another health condition. Nose bleeds in adults usually originate in the posterior septum and can be severe. Usually, a nose bleed occurs as a result of external or internal trauma for example, a blow to the nose, nose picking, or insertion of foreign objects. Nose bleeds can also be caused by polyps (growths in the nasal cavity), acute or chronic infections such as sinusitis or rhinitis, or inhalation of chemicals that irritate the nasal mucosa. Factors which increase the possibility of nose bleeds include
The answers are 2-1 a, 2-2 d. (Behrman, 16 e, pp 1285-1287. McMillan, 3 e, pp 1214-1216. Rudolph, 20 e, pp 672-677.) Of the choices given, bronchiolitis is the most likely, although asthma, pertussis, and bronchopneumonia can present similarly. The family history of upper respiratory infections, the previous upper respiratory illness in the patient, and the signs of intrathoracic airway obstruction make the diagnosis of bronchiolitis more likely. Viral croup, epiglottitis, and diphtheria are not reasonable choices because there are no signs of extrathoracic airway obstruction. 2-15. The answer is b. (Adams, 6 e, pp 180-182.) The term cluster headache refers to the tendency of these headaches to cluster in time. They may be distinctly seasonal, but the triggering event is unknown. The pain of cluster headache is usually described as originating in the eye and spreading over the temporal area as the headache evolves. In contrast to migraine, men are more often affected...
The answer is b. (Raoult, p 250.) Coronaviruses, discovered in 1965, are thought to be a major agent of the common cold, especially in older children and adults. The virion is known to contain RNA, but other elements of its structure are unclear. At 34 C, viral multiplication is profuse however, infectivity is greatly reduced at higher temperatures or following extended incubation. 14. The answer is d. (Levinson, p 239.) Echoviruses were discovered accidentally during studies on poliomyelitis. They were named enteric cytopath-ogenic human orphan (ECHO) viruses because, at the time, they had not been linked to human disease and thus were considered orphans. Echoviruses now are known to infect the intestinal tract of humans they also can cause aseptic meningitis, febrile illnesses, and the common cold. Echoviruses range in size from 24 to 30 nm in diameter and contain a core of RNA. 28. The answer is d. (Levinson, pp 239-240.) Rhinovirus is a major cause of the common cold. The...
The primary manifestations of asthma include wheezing, dyspnea, a prolonged expiratory phase of respiration, accessory muscle use, and retractions. The patient may have abdominal pain from use of the abdominal muscles. The liver and spleen may be palpable secondary to hyperinflation. Because asthma is a reversible respiratory illness, clubbing is not seen.
A 6-month-old infant presents to the physician with a 3-day history of upper respiratory tract infection, wheezy cough, and dyspnea. On physical examination, the patient has a temperature of 39 C, respirations of 60 breaths min, alae nasi flare, and accessory muscle usage. The patient appears to be air hungry, and the oxygen saturation is 92 .
There are two totally different polar types of leprosy (Rabello Jr, 1938) lepromatous leprosy (LL), and tuberculoid leprosy (TT) as well as two groups of cases indeterminate (I) and borderline (BL, BB, BT). Lepromatous leprosy is the progressive, systemic type, relatively transmissible, and it does not resolve spontaneously. It affects the skin and mucosae as diffusely infiltrating nodules. It also affects peripheral nerves and all organs and systems except the central nervous system. It is characterized by depressed cellular immunity that manifests as a negative lepromin skin test (Mitsuda's test) at three weeks the humoral response is normal. Lepromatous leprosy has two clinical forms nodular and diffuse. The nodular form is characterized by nodules, erythematous infiltrating plaques and hypopigmentation (Fig. 21.1). In the mucosa there is a lepromatous rhinitis that is associated with perforation of the cartilaginous nasal septum causing the so-called saddle nose. There is partial...
Penicillin works only against certain types of infections. Use of penicillin for sprains, bruises, or any pain or fever is a great mistake. As a general rule, injuries that do not break the skin, even if they make large bruises, have no danger of infection they do not need to be treated with penicillin or any other antibiotic. Neither penicillin nor other antibiotics helps colds (see p. 163).
Many patients have a history of a recent viral upper respiratory tract infection or varicella. Concomitant use of aspirin is also related to development of Reye syndrome and elimination of aspirin use in children has led to a decrease in the incidence of Reye syndrome. The peak age for Reye syndrome is 6 years with a range of 4-12 years.
Human breast milk is the preferred food for full-term babies. It offers several advantages to both mother and infant. Breast milk is premixed at the right temperature and concentration. Breast milk has immunologic factors such as IgA, lactoglobulin, and maternal macrophages, which protect the infant from infections. Breast-fecfbabies have a lower incidence of upper respiratory tract infections and otitis media than their formula-fed counterparts. Breast milk also decreases the incidence of allergic diseases. Maternal advantages to breast feeding include a more rapid return to prepregnancy weight and faster uterine regression. Breast feeding also promotes maternal-infant bonding.
Immunity acquired naturally is called active immunity. An individual can have the disease, recover, and become permanently immune. Measles, chickenpox, whooping cough, scarlet fever, typhoid fever, Rocky Mountain spotted fever, and diphtheria are examples of such diseases. The person has chickenpox, recovers, and has a permanent immunity to chickenpox. There are other diseases which an individual can have and recover from but not develop a lasting immunity. The group of infections called the common cold, influenza, gonorrhea, septic sore throat, and some types of pneumonia are examples. A person can have a cold, recover, and get another cold.
Colds, flu, measles, mumps, chickenpox, infantile paralysis, virus diarrhea cure certain illnesses caused by bacteria. Antibiotics have no effect on illnesses caused by most viruses, such as colds, flu, mumps, chickenpox, etc. Do not treat virus infections with antibiotics. They will not help and may be harmful (see Antibiotics, p. 55).