Main Diseases
MENINGITIS
Useful information on the symptoms, vaccine and treatment of viral and bacterial meningitis.
Meningitis is inflammation of the membranes (meninges) covering the brain and the spinal cord, a form of blood poisoning). Although the most common causes are infection (either bacterial or viral), chemical agents and even tumour cells may cause meningitis. The major bacteria that cause meningitis are Streptococcus pneumoniae, Haemophilusinfluenzae, staphylococcus and meningococcus. Meningitis is a serious illness which can be fatal or cause long term damage to the brain and nerves
The classical symptoms of meningitis are headache, neck stiffness and photophobia (the trio are called "meningism"). An altered level of consciousness or other neurological deficits may be present depending on the severity of the disease. A lumbar puncture to obtain cerebrospinal fluid (CSF) is usually indicated to determine the cause and direct appropriate treatment.
Meningitis is a medical emergency, being a condition with a high mortality rate if untreated. The cause is most commonly a bacterial infection sensitive to antibiotics. Patients with suspected meningitis should optimally initially have a CT scan to help determine if there is a raised intracranial pressure that might cause a serious or fatal brain herniation during lumbar puncture. If there are no signs of elevated central nervous system pressure demonstrated on the CT scan, a lumbar puncture procedure is performed to obtain cerebrospinal fluid for microscopic examination, chemical analysis, and bacterial cultures.
Broad spectrum antibiotics should be urgently started before the culture results are available. If lumbar puncture can not be performed because of raised intracranial pressure (likely due to edema or concomitant brain abscess), a broad spectrum intravenous antibiotic should be started immediately (this is often a third generation cephalosporin). When cerebrospinal fluid gram stain, or blood or CSF culture and sensitivity results, are available, the empiric treatment can be refined by switching to more specific antibiotics. In children (but not in adults) the administration of steroids helps reduce the incidence of deafness following meningitis.
Infection of the meninges usually originates through spread from infection of the neighbouring structures (which include the sinuses and mastoid cells of ear). These should be investigated when diagnosis of meningitis is confirmed or suspected.
Convulsions are a known complication of meningitis and are treated with appropriate anti-seizure drugs such as phenytoin
POLIO
Useful information on the background, symptoms and treatment of polio plus advice on the polio childhood vaccine.
Polio (Poliomyelitis) is a virus which attacks the nerve tissues in the brain and spinal cord that can sometimes cause paralysis. It is caused by a virus called poliovirus (PV), which enters the body through the mouth, infecting the intestinal lining. It may proceed to the blood stream and into the central nervous system causing paralysis and muscle weakness.
The effects of a polio infection have been recorded since prehistory. Egyptian paintings and carvings depict otherwise healthy people with withered limbs, walking with canes at a young age, etc. The Roman emperor Claudius was stricken as a child; he walked with a limp for the rest of his life. United States president Franklin Delano Roosevelt contracted polio in 1921 and was paralysed from the waist down for the rest of his life as a result.
Polio may be spread through contact with faeces, mucus, saliva of an infected person or through airborne particles.
The first effective polio vaccine was developed by Jonas Salk, and inoculations of children against polio began in Pittsburgh, Pennsylvania on February 23, 1954. Through mass immunisation, the disease was wiped out, although it recently has re-appeared in Haiti, where political strife and poverty have interfered with vaccination efforts.
Young children who contract polio are likely to suffer only mild symptoms, and as a result they may become permanently immune to the disease. The incubation period varies between three and twenty one days. Hence inhabitants of areas with better sanitation may actually be more susceptible to polio because fewer people have the disease as young children. People who have survived polio sometimes develop additional symptoms, notably muscle weakness, decades later; these symptoms are called post-polio syndrome.
In 1988, the World Health Organisation passed a resolution to eradicate polio by 2000. The current plan calls for a stop of spreading the virus by 2005. Most remaining polio infections are located in two areas: the Indian sub-continent and Nigeria. Eradication efforts in the Indian sub-continent have met with a large measure of success. The Indian Government started the Plus-Polio Campaign to get rid of Polio. Most families allowed their children to take the vaccine. Some Muslim families refused due to false rumours that the vaccine causes sterility in boys.If polio is eradicated it will be the second disease to eradicated. The first one was smallpox.
RUBELLA
Rubella (also known as German Measles) is a disease caused by the Rubella virus. The virus usually enters the body through the nose or throat. The disease can last 1-5 days, but has a long incubation period of 14 to 21 days. Children recover more quickly than adults.
Symptoms of rubella include:
- swollen glands fever
- rash
- flaking, dry skin
- inflammation of the eyes
- nasal congestion
- joint pain and swelling
- pain in the testicles
Rubella can affect anyone of any age and is generally a mild disease. However if a woman contracts rubella in the first eight to ten weeks of pregnancy the effects on her unborn baby can be very serious, including deafness, blindness, heart, problems or brain damage.
Fewer cases of rubella occur since a vaccine became available in 1969. Most people are vaccinated against rubella as children at 12-15 months of age. A second dose is required before age 11. Symptoms are usually treated with acetaminophen until the disease has run its course.
Rubella (also known as German Measles) is a disease caused by the Rubella virus. The virus usually enters the body through the nose or throat. The disease can last 1-5 days, but has a long incubation period of 14 to 21 days. Children recover more quickly than adults.
Symptoms of rubella include:
- swollen glands fever
- rash
- flaking, dry skin
- inflammation of the eyes
- nasal congestion
- joint pain and swelling
- pain in the testicles
Rubella can affect anyone of any age and is generally a mild disease. However if a woman contracts rubella in the first eight to ten weeks of pregnancy the effects on her unborn baby can be very serious, including deafness, blindness, heart, problems or brain damage.
Fewer cases of rubella occur since a vaccine became available in 1969. Most people are vaccinated against rubella as children at 12-15 months of age. A second dose is required before age 11. Symptoms are usually treated with acetaminophen until the disease has run its course
FEVER
Facts on Fever in Children
Fever remains the most common concern prompting parents to present their child to the emergency department. Fever has traditionally been defined as a rectal temperature over 100.4 F or 38 C. Temperatures measured at other body sites are usually lower.
Fever itself is not life-threatening unless it is extremely and persistently high, such as greater than 107 F (41.6 C) when measured rectally. Risk factors for worrisome fevers include age under 2 years (infants and toddlers) or recurrent fevers lasting more than one week. Fever may indicate the presence of a serious illness, but usually, a fever is caused by a common infection, most of which are not serious. The part of the brain called the hypothalamus controls body temperature. The hypothalamus increases the body's temperature as a way to fight the infection. However, many conditions other than infections may cause a fever.
Causes of fever in Children include
- bacterial infections, such as scarlet fever, or rarely, rheumatic fever (both related to "strep throat");
- viral infections, like influenza (the "flu");
- medications;
- illicit drugs;
- illnesses related to heat exposure;
- allergies;
- rarely, inflammatory diseases, juvenile rheumatoid arthritis
Signs and symptoms of a fever may be obvious or subtle. The younger the child, the more subtle the symptoms.
Infants may show the following symptoms:
-
- be irritable,
- be fussy,
- be lethargic,
- be quiet,
- feel warm or hot,
- not feed normally,
- cry,
- breathe rapidly,
- exhibit changes in sleeping or eating habits
- haveseizures
-
- feeling hotter or colder than others in the room who feel comfortable,
- body aches,
- a headache,
- sleeping more or having difficulty sleeping,
- poor appetite.
Picture of a child with fever and high temperature
Fever remains the most common concern prompting parents to present their child to the emergency department. Fever has traditionally been defined as a rectal temperature over 100.4 F or 38 C. Temperatures measured at other body sites are usually lower. The threshold for defining a fever does vary significantly among different individuals since body temperatures can vary by as much as 1 F. Low-grade fevers are usually considered less than 102.2 F (39 C).
Fever itself is not life-threatening unless it is extremely and persistently high, such as greater than 107 F (41.6 C) when measured rectally. Risk factors for worrisome fevers include age under 2 years (infants and toddlers) or recurrent fevers lasting more than one week. Fever may indicate the presence of a serious illness, but usually, a fever is caused by a common infection, most of which are not serious. The part of the brain called the hypothalamus controls body temperature. The hypothalamus increases the body's temperature as a way to fight the infection. However, many conditions other than infections may cause a fever.
Causes of fever in Children include
- bacterial infections, such as scarlet fever, or rarely, rheumatic fever (both related to "strep throat");
- viral infections, like influenza (the "flu");
- medications;
- illicit drugs;
- illnesses related to heat exposure;
- allergies;
- rarely, inflammatory diseases, like juvenile rheumatoid arthritis.
Signs and symptoms of a fever may be obvious or subtle. The younger the child, the more subtle the symptoms.
- Infants may
- be irritable,
- be fussy,
- be lethargic,
- be quiet,
- feel warm or hot,
- not feed normally,
- cry,
- breathe rapidly,
- exhibit changes in sleeping or eating habits,
- haveseizures.
- Verbal children may complain of
- feeling hotter or colder than others in the room who feel comfortable,
- body aches,
- a headache,
- sleeping more or having difficulty sleeping,
- poor appetite.
Call a child's doctor if any of the following are present with fever.
- The child is younger than 6 months of age (regardless of prematurity).
- One is unable to control the fever.
- One suspects a child may become dehydrated from vomiting, diarrhea, or not drinking (for example, the child has sunken eyes, dry diapers, tented skin, cannot be roused, etc.).
- The child has been to a doctor but is now getting worse or new symptoms or signs have developed.
Although you may have done your best to care for your child, sometimes it is smart to take your child to the emergency department. The child's doctor may meet you there, or the child may be evaluated and treated by the emergency doctor.
Take a child to an emergency clinic when any of the following happen:
- One suspects the child is dehydrated.
- A seizure occurs.
- The child has a purple or red rash.
- A change in consciousness occurs.
- The child's breathing is shallow, rapid, or difficult.
- The child is younger than 2 months of age.
- The child has a headache that will not go away.
- The child continues to vomit.
- The child has complex medical problems or takes prescription medications on a chronic basis (for example, medications prescribed for more than two weeks' duration).
MALARIA
Malaria is a life-threatening mosquito-borne blood disease.
Five types of Plasmodium parasite can infect humans. These occur in different parts of the world. Some cause a more severe type of malaria than others.
Once an infected mosquito bites a human, the parasites multiply in the host's liver before infecting and destroying red blood cells.
Doctors divide malaria symptoms into two categories: Uncomplicated and severe malaria.
Uncomplicated malaria
Malaria is passed on by the Anopheles mosquito.
A doctor would give this diagnosis when symptoms are present, but no symptoms occur that suggest severe infection or dysfunction of the vital organs.
This form can become severe malaria without treatment, or if the host has poor or no immunity.
Symptoms of uncomplicated malaria typically last 6 to 10 hours and recur every second day.
Some strains of the parasite can have a longer cycle or cause mixed symptoms.
As symptoms resemble those of flu, they may remain undiagnosed or misdiagnosed in areas where malaria is less common.
In uncomplicated malaria, symptoms progress as follows, through cold, hot, and sweating stages:
- a sensation of cold with shivering
- fever, headaches, and vomiting
- seizures sometimes occur in younger people with the disease
- sweats, followed by a return to normal temperature, with tiredness
In areas where malaria is common, many people recognize the symptoms as malaria and treat themselves without visiting a doctor.
Severe malaria
In severe malaria, clinical or laboratory evidence shows signs of vital organ dysfunction.
Symptoms of severe malaria include:
- fever and chills
- impaired consciousness
- prostration, or adopting a prone position
- multiple convulsions
- deep breathing and respiratory distress
- abnormal bleeding and signs of anemia
- clinical jaundice and evidence of vital organ dysfunction
Severe malaria can be fatal without treatment.
Treatment aims to eliminate the Plasmodium parasite from the bloodstream.
Those without symptoms may be treated for infection to reduce the risk of disease transmission in the surrounding population.
Practitioners often combine ACT with a partner drug. ACT aims to reduce the number of parasites within the first 3 days of infection, while the partner drugs eliminate the rest.
Expanding access to ACT treatment worldwide has helped reduce the impact of malaria, but the disease is becoming increasingly resistant to the effects of ACT.
In places where malaria is resistant to ACT, treatment must contain an effective partner drug.
The WHO has warned that no alternatives to artemisinin are likely to become available for several years.
There are several ways to keep malaria at bay.
Vaccination
Advice for travelers
While malaria is not endemic, travel to many countries around the world entails a risk.
The Centers for Disease Control advise travelers to take the following precautions:
- find out what the risk of malaria is in the country and city or region they are visiting
- ask their doctor what medications they should use to prevent infection in that region
- obtain antimalarial drugs before leaving home, to avoid the risk of buying counterfeit drugs while abroad
- consider the risk for individual travelers, including children, older people, pregnant women, and the existing medical conditions of any travelers
- ensure they will have access to preventative tools, many of which are available to purchase online, including insect repellants, insecticides, pre-treated bed nets, and appropriate clothing
- be aware of the symptoms of malaria
In emergency situations, local health authorities in some countries may carry out "fogging," or spraying areas with pesticides similar to those used in household.
While away, travelers should, where possible, avoid situations that increase the risk of being bitten by mosquitoes. Precautions include taking an air-conditioned room, not camping by stagnant water, and wearing clothes that cover the body at times when mosquitoes are most likely to be around.
For a year after returning home, the traveler may be susceptible to symptoms of malaria. Donating blood may also not be possible for some time.
Seek medical attention for suspected symptoms of malaria as early as possible.
TYPHOID
Typhoid is a bacterial infection that can lead to a high fever, diarrhea, and vomiting. It can be fatal. It is caused by the bacteria Salmonella typhi.
The infection is often passed on through contaminated food and drinking water, and it is more prevalent in places where handwashing is less frequent. It can also be passed on by carriers who do not know they carry the bacteria.
If typhoid is caught early, it can be successfully treated with antibiotics; if it is not treated, typhoid can befatal
Symptoms normally begin between 6 and 30 days after exposure to the bacteria.
The two major symptoms of typhoid are fever and rash. Typhoid fever is particularly high, gradually increasing over several days up to 104 degrees Fahrenheit, or 39 to 40 degrees Celsius.
The rash, which does not affect every patient, consists of rose-colored spots, particularly on the neck and abdomen.
Other symptoms can include:
- weakness
- abdominal pain
- constipation
- headaches
Rarely, symptoms might include confusion, diarrhea, and vomiting, but this is not normally severe.
In serious, untreated cases, the bowel can become perforated. This can lead to peritonitis, an infection of the tissue that lines the inside of the abdomen, which has been reported as fatal in between 5 and 62 percent of cases.
Another infection, paratyphoid, is caused by Salmonella enterica. It has similar symptoms to typhoid, but it is less likely to be fatal.
Everything you need to know about cholera
Travelers should also be aware of another bacterial infection: Cholera
The only effective treatment for typhoid is antibiotics. The most commonly used are ciprofloxacin (for non-pregnant adults) and ceftriaxone.
Other than antibiotics, it is important to rehydrate by drinking adequate water.
In more severe cases, where the bowel has become perforated, surgery may be required.
Countries with less access to clean water and washing facilities typically have a higher number of typhoid cases.
Vaccination
If traveling to an area where typhoid is prevalent, vaccination is recommended.
Before traveling to a high-risk area, getting vaccinated against typhoid fever is recommended.
This can be achieved by oral medication or a one-off injection:
- Oral: a live, attenuated vaccine. Consists of 4 tablets, one to be taken every second day, the last of which is taken 1 week before travel.
- Shot, an inactivated vaccine, administered 2 weeks before travel.
Vaccines are not 100 percent effective and caution should still be exercised when eating and drinking.
Vaccination should not be started if the individual is currently ill or if they are under 6 years of age. Anyone with HIV should not take the live, oral dose.
There are two types of typhoid vaccine available, but a more powerful vaccine is still needed. The live, oral version of the vaccine is the strongest of the two. After 3 years, it still protects individuals from infection 73 percent of the time. However, this vaccine has more side effects.
Even when the symptoms of typhoid have passed, it is still possible to be carrying the bacteria.
This makes it hard to stamp out the disease, because carriers whose symptoms have finished may be less careful when washing food or interacting with others.
Typhoid is spread by contact and ingestion of infected human feces. This can happen through an infected water source or when handling food.
The following are some general rules to follow when traveling to help minimize the chance of typhoid infection:
- Drink bottled water, preferably carbonated.
- If bottled water cannot be sourced, ensure water is heated on a rolling boil for at least one minute before consuming.
- Be wary of eating anything that has been handled by someone else.
- Avoid eating at street food stands, and only eat food that is still hot.
- Do not have ice in drinks.
- Avoid raw fruit and vegetables, peel fruit yourself, and do not eat the peel.
DIARRHEA
Diarrhea is one of the most common health complaints. It can range from a mild, temporary condition, to a potentially life-threatening one.
Globally, an estimated 2 billion cases of diarrheal disease occur each year, and 1.9 million children under the age of 5 years, mostly in developing countries, die from diarrhea.
Diarrhea is characterized by abnormally loose or watery stools.
Some people frequently pass stools, but they are of normal consistency. This is not diarrhea. Similarly, breastfed babies often pass loose, pasty stools. This is normal. It is not diarrhea.
Fast facts on diarrhea
- Most cases of diarrhea are caused by bacteria, viruses, or parasites
- Inflammatory bowel diseases (IBD) including Crohn's disease and ulcerative colitis can cause chronic diarrhea
- Antidiarrheal medications can reduce diarrheal output and zinc supplement is effective in children
- Some nutritional and probiotic interventions may help prevent diarrhea
Correcting dehydration is the priority of diarrhea treatment.
Most cases of diarrhea are caused by an infection in the gastrointestinal tract. The microbes responsible for this infection include:
- bacteria
- viruses
- parasites
Some cases of chronic diarrhea are called "functional" because a clear cause cannot be found. In the developed world, irritable bowel syndrome (IBS) is the most common cause of functional diarrhea.
IBS is a complex of symptoms. There is cramping abdominal pain and altered bowel habits, including diarrhea, constipation, or both.
Inflammatory bowel disease (IBD) is another cause of chronic diarrhea. It is a term used to describe either ulcerative colitis or Crohn's disease. There is often blood in the stool in both conditions.
Other major causes of chronic diarrhea include:
- Microscopic colitis: This is a persistent diarrhea that usually affects older adults, often during the night.
- Malabsorptive and maldigestive diarrhea: The first is caused by impaired nutrient absorption, the second by impaired digestive function. Celiac disease is one example.
- Chronic infections: A history of travel or antibiotic use can be clues to chronic diarrhea. Various bacteria and parasites can be the cause.
- Drug-induced diarrhea: Laxatives and other drugs, including antibiotics, can trigger diarrhea.
- Endocrine causes: Sometimes hormonal factors cause diarrhea, for example, in the case of Addison disease and carcinoid tumors.
- Cancer causes: Neoplastic diarrhea is associated with a number of gut cancers.
Mild cases of acute diarrhea may resolve without treatment. Persistent or chronic diarrhea will be diagnosed and any underlying causes will be treated in addition to the symptoms of diarrhea.
Dehydration
For all cases of diarrhea, rehydration is key:
- Fluids can be replaced by simply drinking more fluids, or they can be received intravenously in severe cases. Children and older people are more vulnerable to dehydration.
- Oral rehydration solution or salts (ORS) refers to water that contains salt and glucose. It is absorbed by the small intestine to replace the water and electrolytes lost in the stools.
- Oral rehydration products, such as Oralyte and Rehydralyte, are available commercially. Zinc supplementation may reduce the severity and duration of diarrhea in children.
Antidiarrheal medication
Over-the-counter (OTC) antidiarrheal medicines are also available:
- Loperamide, or Imodium, is an antimotility drug that reduces stool passage. Loperamide and Imodium are both available to purchase over-the-counter or online.
- Bismuth subsalicylate, for example, Pepto-Bismol, reduces diarrheal stool output in adults and children. It can also be used to prevent traveler's diarrhea. The can be bought online as well as over-the-counter.
There is some concern that antidiarrheal medications could prolong bacterial infection by reducing the removal of pathogens through stools.
Antibiotics are only used to treat diarrhea caused by a bacterial infection. If the cause is a certain medication, switching to another drug might be possible.
- Sip on clear, still liquids such as fruit juice without added sugar.
- After each loose stool, replace lost fluids with at least one cup of liquid.
- Do most of the drinking between, not during meals.
- Consume high-potassium foods and liquids, such as diluted fruit juices, potatoes without the skin, and bananas.
- Consume high-sodium foods and liquids, such as broths, soups, sports drinks, and salted crackers.
Other advice from the nutritionists is to:
- eat foods high in soluble fiber, such as banana, oatmeal and rice, as these help thicken the stool
- limit foods that may make diarrhea worse, such as creamy, fried, and sugary foods
Foods and drinks that might make the diarrhea worse include:
- sugar-free gum, mints, sweet cherries, and prunes
- caffeinated drinks and medication
- fructose in high amounts, from fruit juices, grapes, honey, dates, nuts, figs, soft drinks, and prunes
- lactose in dairy products
- magnesium
- olestra, or Olean, a fat substitute
In children they reduce diarrheal illness by day 1.
Probiotics are available in capsules, tablets, powders, and liquids.
Symptoms
Symptoms of diarrhea can include bloating, thirst, and weight loss.
Diarrhea refers to watery stools, but it may be accompanied by other symptoms.
These include:
- stomach pain
- abdominal cramps
- bloating
- thirst
- weight loss
- fever
Diarrhea is a symptom of other conditions, some of which can be serious.
Other possible symptoms are:
- blood or pus in the stools
- persistent vomiting
- dehydration
If these accompany diarrhea, or if the diarrhea is chronic, it may indicate a more serious illness.
Complications
Two potentially serious complications of diarrhea are:
- dehydration, with acute or chronic diarrhea
- malabsorption, with chronic diarrhea
Diarrhea can also be a sign of a wide range of underlying chronic conditions. These conditions need to be diagnosed treated to prevent further problems.
Tests and diagnosis
Parasites or their eggs can be seen under a microscope.
The doctor will ask about the symptoms and about any current medications, past medical history, and other medical conditions.
They will also ask:
- when the problem started
- how frequent the stools are
- whether blood is present in the stool
- whether there has been vomiting
- whether the stools are watery, mucus- or pus-filled, and how much stool there is
The doctor will also look for signs of dehydration.
Severe dehydration can be fatal if treatment with rehydration therapy is not given urgently.
Tests for diarrhea
Most cases of diarrhea resolve without treatment, and a doctor will often be able to diagnose the problem without tests.
However, in more severe cases, a stool test may be needed, especially if the patient is very young or old.
Further tests may also be recommended if the patient:
- has signs of fever or dehydration
- has stools with blood or pus
- has severe pain
- has low blood pressure
- has a weakened immune system
- has recently traveled to places outside Western Europe, North America, Australia, and New Zealand
- has recently received antibiotics or been in hospital
- has diarrhea persisting for more than 1 week
If a person has chronic or persistent diarrhea, the doctor will order tests according to the suspected underlying cause.
These may include the following investigations:
- Full blood count: Anemia or a raised platelet count will suggest inflammation.
- Liver function tests: This will include testing albumin levels.
- Tests for malabsorption: These will check the absorption of calcium, vitamin B-12, and folate. They will also assess iron status and thyroid function.
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): Raised levels may indicate inflammatory bowel disease (IBD).
- Testing for antibodies: This may detect celiac disease.
Diarrhea often resolves without specialist medical treatment, but sometimes it is important to seek a doctor's help.
Infants under 1 year should see a doctor if they have had 6 bouts of diarrhea or 3 bouts of vomiting within 24 hours.
Children over 1 year should see a doctor if they have had 6 episodes or more of diarrhea in 24 hours, or if there is diarrhea and vomiting at the same time.
It is important to seek medical help in the following cases:
- persistent vomiting
- persistent diarrhea
- dehydration
- significant weight loss
- pus in the stool
- blood in the stool, which may turn the stool black
Anyone who experiences diarrhea after surgery, after spending time in hospital, or after using antibiotics, should seek medical assistance.
Adults whose sleep is persistently disturbed by diarrhea may be able to get help to solve this problem.
Prevention
The following can help prevent diarrhea:
- clean and safe drinking water
- good sanitation systems, for example, waste water and sewage
- good hygiene practices, including handwashing with soap after defecation, after cleaning a child who has defecated, after disposing of a child's stool, before preparing food, and before eating
- breastfeeding for the first 6 months of life
- education on the spread of infection
There is evidence that interventions from public health bodies to promote hand washing can cut diarrhea rates by about one-third.