Kimberly A. Pilkinton, MD, MPH

• Assistant Professor
• Scott & White Memorial Hospital and Clinic
• Texas A&M University System Health Science Center College
• of Medicine
• Assistant Program Director, Obstetrics and Gynecology Residency
• Program
• Director, Division of Education for Department of Obstetrics
• and Gynecology
• Department of Obstetrics and Gynecology
• Temple, Texas

The pentastomids symptoms xanax buy cheap albenza 400mg online, or tongue-worms medications bipolar albenza 400mg with mastercard, are parasites of reptilian respiratory systems professional english medicine buy albenza master card. As adults treatment 3 degree heart block effective 400mg albenza, most pentastomids medications zolpidem cheap 400 mg albenza with visa, of which there are approximately sixty species medications reactions best 400mg albenza, live in the lungs of snakes, lizards, and crocodilians. Visceral pentastomiasis occurs in humans when pentastomid eggs are consumed with the meat Salem Health of reptiles or by accidental ingestion of feces or body secretions. Nymphs develop in various internal organs, causing damage to the spleen, liver, lungs, eyes, and mesentery. Pentastomiasis cases have been reported in many parts of the world, including Africa, Malaysia, the Philippines, Java, and China. Prevention and Outcomes the most straightforward way to avoid bacterial and fungal infections from reptiles is good handwashing technique. Children and adults should wash hands and any other body parts exposed to reptiles immediately after any contact. Sensible precautions for those who keep reptiles include not allowing the animals to have free range of living quarters, keeping water dishes and aquariums clean and disinfected, and not washing animals and their artificial habitats in the kitchen sink, bathtubs, or showers, unless these areas are completely disinfected after use. In countries where pentastomids are a problem, good hygiene is again the primary preventive measure, although this may be difficult in areas in which people do not have access to soap, disinfectants, and clean water. In those cultures in which the eating of reptiles is common, one should thoroughly cook the meat at a temperature high enough to kill parasitic organisms. Provides a summary of Salmonella cases transmitted by turtles in several state outbreaks. Includes more than one thousand color photographs of reptile species with an emphasis on anatomy and histology. A classic work Infectious Diseases and Conditions focusing on the parasites of humans and domestic animals. A good introduction to zoonotic diseases, including those caused by reptiles, in humans. Droplets containing pathogens and respiratory mucus are too large to remain in the air for long and quickly settle on nearby surfaces, where the pathogens can survive up to three hours. Bacterial diseases commonly transmitted by droplet transmission are bacterial meningitis, strep throat, tuberculosis, and whooping cough (pertussis). Viral diseases transmitted by droplet transmission include the common cold, influenza, mumps, measles, rubella (German measles), and chickenpox. These pathogens thrive in the warm, moist environment of the upper respiratory tract. In cases of influenza, a person can infect others beginning one full day before the onset of symptoms and up to one week after symptoms appear. In cases of measles, 90 percent of unvaccinated or immunocompromised persons living with an infected person will become infected. Human rhinovirus, which causes the common cold, is the most common infective virus, perhaps because of its minimal size; less common infective viruses are ten times larger. Respiratory Hygiene "Respiratory hygiene" is a term coined by the Centers for Disease Control and Prevention to describe measures that can be taken to decrease the risk of spreading respiratory pathogens. A minimum of three feet of space should be maintained between an infected person and others. When it is necessary to work within three feet of another person, the infected person should wear a disposable medical-procedure mask. Persons not wearing a mask should cough or sneeze into tissues, dispose of the tissues promptly, and wash their hands with antiseptic soap or an alcohol-based hand sanitizer. Hands should be washed with soap for a minimum of fifteen seconds in warm water and then dried with a disposable towel or a heated blower. Hand sanitizer should not be used on hands that are visibly soiled because it may not reach all pathogens effectively. Respiratory route of transmission Category: Transmission Also known as: Aerosol transmission, droplet contact, droplet transmission Definition In the respiratory route of transmission, a sick person who coughs or sneezes emits airborne droplets of respiratory secretions that contain pathogens (bacteria or viruses). These droplets may be breathed in by another person, who can then become infected. An August, 2009, observational study by medical students at Otago University in Wellington, New Zealand, found that 1 in 77 people covered sneezes and coughs with the arm, while 1 in 30 people used a tissue or handkerchief. Most of the people observed sneezing and coughing in public still covered their mouth with their hands. News reports showed people wearing disposable medical masks in schools and businesses and when using public transportation. The mortality rate of nearly 10 percent and the more than twelve thousand flu-related deaths in the United States alone prompted funding for research into the respiratory transmission of diseases, particularly the transmission of viruses. The use of alcohol-based hand sanitizers has become more common, and people are learning to cover their coughs and sneezes with something other than their hands. Nasal sprays of live attenuated virus are alternatives to vaccines of killed virus. Treatment with the antiviral drugs Tamiflu (oseltamivir) or Relenza (zanamivir) is recommended for people with influenza who require hospitalization. A discussion of viral and bacterial triggers of coughing and the appropriate treatments to reduce pathogenic spread. Discusses how the observation of hospitalized patients led to the determination of the incubation period of this then-new strain of flu. Discusses research into the mechanisms of respiratory transmission, including particle size, mucous properties, and relative air humidity. Examines how the practice of epidemiology using the Internet and Web is shaping how people view emerging infections and global health. Although these infections can happen at any age, they occur most commonly and are usually most severe in infants, young children, and the elderly. The contagious virus most often enters the body from touching the mouth, nose, or eyes. Virus shedding (contagiousness) usually lasts for three to eight days, but may last up to four weeks. Risk factors include exposure to a person infected with the virus or an object contaminated with the virus; premature birth; problems with the heart, lungs, or immune system; present or recent treatment with chemotherapy; having had an organ or bone marrow transplant; and having problems associated with muscle weakness. In most cases, the infection is not severe; almost all children contract the virus by two years of age, and for most it simply presents as a cold. Young children, the elderly, and people with chronic diseases are more likely to have severe symptoms. Symptoms commonly include a runny or stuffy nose, sore throat, mild cough, headache, low-grade fever, and discharge from the eyes. Chest x-rays may be used to check for telltale signs of bronchiolitis, while blood tests may be conducted to check white blood cell counts or to determine if any antigens are present. Other lab tests called antigen detection assays are commonly done using secretions from the nose. Treatment and Therapy Mild infections such as colds do not need special treatment. The goal of any treatment is to ease symptoms so that the patient feels more comfortable while the body fights the virus. For symptom relief, one should drink increased amounts of liquids, especially water and fruit juice, to help keep nasal fluid thin and easy to clear; use a cool-mist vaporizer to humidify the air, which may help reduce coughing and soothe irritated breathing passages; use saline (salt water) nose drops to loosen mucus in the nose; and use nonaspirin antipyretic medication, such as acetaminophen, as needed to reduce fever. Such infections include pneumonia and bronchiolitis and may require treatment in a hospital. Retroviral infections Category: Diseases and conditions Anatomy or system affected: All Definition A retroviral infection is a disease state caused by a retrovirus that incorporates into a host cell. Retroviruses are associated with a variety of diseases, including malignancies, immunodeficiencies, and neurologic disorders. There are seven genera of retroviruses divided into two categories, simple and complex. Other examples of common retroviruses include human T-cell leukemia virus, Raus sarcoma virus in chickens, and murine and feline leukemia viruses in mice and cats. Infectious Diseases and Conditions Retroviruses also exist among other host species, ranging from plants to invertebrates, fish, birds, and many mammalian species. Causes the cause of an infection in general is the detrimental colonization of a host organism by a foreign pathogenic species. These foreign organisms can interfere with the normal functioning of the host cell, which can lead to chronic wounds, illness, and death. More specifically, viral infections, for example, are caused by viral particles, which are not considered organisms because they lack metabolism and reproduction (when no host cell is present). At some point, the viral particles leave this quiescent stage and become pathogenic, causing a disease state. Risk Factors Because retroviral infection in humans is caused by the incorporation of viral particles into a human host cell, the risk factor for this type of infection is exhibited by the secretion of fluids containing the virus from one person to another. The primary factors contributing to this spread of viral particles include transmission through sexual intercourse, blood transfusion, or contaminated needles, and transmission by a woman to her fetus or newborn. Chronic retroviral infection, also common, involves a primary infection that can lead to recurring infections. Once retroviruses are incorporated into host cells, the host immune system is compromised, which further exasperates the risk of future infections. Thus, low immune response has been a major factor in developing a high risk for chronic retroviral disease. Symptoms Because of the severe weakening of the normal functioning host cell after retroviral infection, most symptoms reflect the loss of function of these cells. These symptoms include chronic fatigue, continuous weight loss, low-grade or spiking fever, night sweats and chills, and chronic body aches and pain. Typically, retroviral infections are systemic, involving many different parts of the body; therefore, symptoms tend to include many organ systems. Screening and Diagnosis Infection by a retrovirus is generally detected by the presence of specific antibodies to the virus, because antibodies to viruses persist for life. This test is nearly as accurate as a blood test, and because it does not involve a needle stick, it is favored by many persons. Nonnucleoside reverse transcriptase inhibitors inhibit the virility of retroviruses and cause cell death. Prevention and Outcomes the best way to prevent infection by a retrovirus is to avoid contact with that virus. The author provides a detailed account of virus structure and replication and of the basis for disease pathology. A minimum of nine endogenous retroviruses are present in vertebrate genomes, accounting for approximately 1 percent of the human genome, and they appear latent, with no effect on the hosts. Exogenous retroviruses, which are passed among vertebrates through blood and bodily secretions, can be more pathogenic. All seven genera of the two subfamilies of retroviruses share the same mode of replication and basic virion structure, and they spread through host cells rapidly. Retroviruses consist of a lipid envelope that surrounds a spherical and electrondense protein core, or capsid. Immature viral particles are then released from the infected host cell to spread throughout the body. Retroviruses can evolve rapidly and repeatedly on the basis of selective needs, resulting from immune attacks or administered drugs. Because retroviruses can change the host genome, they also can develop oncogenes in the body. Because retroviral genomes have the ability to change and adapt to outside pressures rapidly and efficiently, drug susceptibility varies by viral strain and by particular infected host, and it depends on immune system attacks and on treatments administered to the host. If, after twenty days on a regimen, viral load is not lowered to undetectable levels, the regimen is considered ineffective and can lead to virologic failure without a change of therapy. A thorough discussion of retroviral families and pathogenicity, with descriptions of the resultant diseases. A textbook discussion on retrovirus transmission that is particularly focused on transmission among children. To do this, it Infectious Diseases and Conditions uses an enzyme called reverse transcriptase. Treatment and Therapy the goals of treatment are to kill the strep bacteria, treat the inflammation caused by the rheumatic fever, and prevent future cases of rheumatic fever. Treatment includes medication to treat the strep infection (such as penicillin or other antibiotics, including erythromycin and azithromycin). The patient may have to be on bed rest or restricted activity for a period of time. Prevention and Outcomes One should treat strep throat with antibiotics promptly to help prevent the onset of rheumatic fever. Persons with a sore throat and fever that last more than twenty-four hours should consult a doctor. Rheumatic Fever in America and Britain: A Biological, Epidemiological, and Medical History. Rheumatic fever Category: Diseases and conditions Anatomy or system affected: All Definition Rheumatic fever is an inflammatory condition. The most severe complication is rheumatic heart disease, which may permanently damage the heart valves, which affect the flow of blood to and from the heart. Often, the symptoms of valve damage appear ten to thirty years after the initial event.

J Japanese encephalitis Category: Diseases and conditions Anatomy or system affected: Brain symptoms 2 order albenza 400 mg on-line, central nervous system Definition Japanese encephalitis is a mosquito-borne virus that leads to swelling of the brain medications similar to vyvanse purchase generic albenza line. It can affect the central nervous system and cause severe complications medicine hat jobs purchase albenza 400 mg with visa, even death medicine in balance albenza 400 mg low price. Causes Japanese encephalitis is caused by the bite of a mosquito infected with the virus treatment arthritis purchase albenza australia. Risk Factors the factors that increase the chance of being exposed to Japanese encephalitis include living or traveling in certain rural parts of Asia medications joint pain albenza 400mg cheap. According to the Centers for Disease Control and Prevention, outbreaks of Japanese encephalitis have occurred in China, Korea, Japan, Taiwan, and Thailand. Other countries that still have periodic epidemics include Vietnam, Cambodia, Myanmar, India, Nepal, and Malaysia. Also, laboratory workers who might be exposed to the virus are at high risk for developing Japanese encephalitis. Symptoms Symptoms of Japanese encephalitis, which usually appear five to fifteen days after the bite of an infected mosquito, include agitation, brain damage, chills, coma, confusion, convulsions (especially in infants), fever, headache, nausea, neck stiffness, paralysis, tiredness, tremors, and vomiting. Treatment and Therapy Because there is no specific treatment for Japanese encephalitis, care is concentrated on treating specific symptoms and complications. Prevention and Outcomes A Japanese encephalitis vaccine is recommended for people who live or travel in certain rural parts of Asia and for laboratory workers who are at risk of exposure to the virus. The fungus that causes jock itch most often results from wearing wet, damp, or unlaundered clothing (such as underwear or an athletic supporter); sharing towels that are infected with jock itch fungus; and infrequent showering, especially after exercising or perspiring heavily from work. Risk Factors Risk factors for jock itch include hot, humid conditions; heavy perspiration; obesity; tight clothing; wearing clothes, especially underwear or athletic supporters, that have not been cleaned; changing underwear infrequently; infrequent showering; sharing towels or clothing with other people; using public showers or locker rooms; and having an immune system disorder. Symptoms Jock itch causes a chafed, itchy, sometimes painful rash in the groin, upper inner thigh, or buttock. The rash is usually red, tan, or brown; usually defined clearly at the edges; and often slightly scaly. Jock itch Category: Diseases and conditions Anatomy or system affected: Skin Also known as: Tinea cruris Definition Jock itch is a fungal infection of the skin on the groin, upper inner thighs, or buttocks. Causes Jock itch is caused by common fungal organisms that grow best in warm, moist areas. If uncertain of the diagnosis, one should contact a doctor, who will ask about symptoms and medical history and perform a physical exam. Testing usually consists of a skin scraping that can be viewed under a microscope or cultured. Treatment and Therapy Over-the-counter antifungal creams can usually treat jock itch. In severe or persistent cases, a doctor may prescribe stronger creams or oral medication. If the rash does not resolve within a month of treatment, one should contact the doctor. Antifungal creams for jock itch include miconazole, clotrimazole, econazole, oxiconazole (Oxistat), ketoconazole, terbinafine (Lamisil), tolnaftate, ciclopirox (Penlac), haloprogin (Halotex), naftifine (Naftin), and undecylenic acid. While all these medications can effectively treat jock itch, terbinafine may lead to a more rapid cure than some of the others. Tolnaftate and undecylenic acid may be less effective than some of the other medications, but as generics, they are generally among the least expensive treatments available. One should follow the instructions given on the package or by the pharmacist or physician. In some cases, over-the-counter antifungal creams may not work or effectively treat the rash. This symptom may indicate that the rash could be secondarily infected with bacteria. If the doctor confirms that it is infected, he or she may prescribe an antibiotic. Salem Health Prevention and Outcomes To help prevent jock itch and its recurrence, one should shower regularly and shower soon after exercising or perspiring heavily. After showering, one should dry the groin area thoroughly and apply absorbent powder to help keep the groin area dry; wear loose-fitting, breathable clothing; wear cotton underwear; avoid wearing clothing that chafes the groin; always launder clothing, such as underwear and athletic supporters; avoid sharing towels or clothing with others; avoid wearing wet swimsuits for long periods of time; and avoid storing damp clothing in a locker or in a gym bag. It commonly manifests as a series of lesions under the skin and in the lining of the mouth, nose, and throat. The skin form may cause edema, especially of the legs, because of lymphatic blockage. In persons who have received a transplant, an effective treatment is to reduce the level of immune suppressive drugs already being taken by the transplant recipient. Surgery is possible when only a few small lesions are present, and often, the doctor will order cryosurgery. Intralesion injection of chemotherapy agents, such as vinblastine, has also been used. When widespread lesions are present, systemic chemotherapy can be employed with liposomal anthracyclines (doxorubicin or daunorubicin). Other agents (bleomycin, etoposide, vincristine, vinblastine, paclitaxel, and vinorelbine) may also be used. Preventive methods include maintaining a strong and healthy immune system, practicing safer sex (such as using condoms during sexual intercourse) or abstaining from sex, and avoiding intravenous drug use, especially if it involves using shared needles. All arteries are affected, including coronary arteries, which send blood to the heart muscle. Other symptoms include swollen lymph glands, redness and irritation of the whites of the eyes, and peeling skin. There are no tests that screen for the disease, so diagnosis comes after other diseases are ruled out. A doctor will order blood and urine tests and may order an echocardiography, which is the most useful tool to monitor potential coronary artery abnormalities. For example, aspirin may be helpful in treating an associated high fever, especially in children, who must begin an aspirin regimen as soon as they exhibit a high fever. The goal is to lower the fever and inflammation as quickly as possible to prevent heart damage. An immune protein called gammaglobulin, which is given intravenously (through a vein), helps lower the risk of coronary problems. About 25 percent of children develop heart disease if treatment is delayed or not prescribed. Doctors and scientists continue to study the long-term implications of this disease. Kawasaki Disease: A Bibliography, Medical Dictionary, and Annotated Research Guide to Internet References. Keratitis Category: Diseases and conditions Anatomy or system affected: Eyes, vision Definition Keratitis is the inflammation of the cornea. There are many forms of keratitis, including acanthamoeba, dendritic, diffuse lamellar, disciform, exposure, filamentary, fungal, herpetic, microbial, neurotrophic, punctate, rosacea, sclerosing, and superficial punctate. The physical examination involves an assessment of visual acuity, a thorough external examination, and slit-lamp biomicroscopy. Smears and cultures can be useful in cases that involve a corneal infiltrate, that are chronic in nature or unresponsive to traditional broad spectrum antibiotic therapy, or that have clinical features that indicate amebic, fungal, or mycobacterial keratitis. Treatment and Therapy Some of the common agents used to treat bacterial keratitis include cefazolin, tobramycin, gentamicin, fluoroquinolones (such as besifloxacin, ciprofloxacin, gatifloxacin, levofloxacin, and moxifloxacin), ceftazidime, ceftriaxone, amikacin, carithromycin, azithromycin, sulfacetamide, and trimethoprim/sulfamethoxazole. Alternative delivery forms such as ointments and collagen shields can be used to enhance drug delivery of the chosen antibiotic. Severe cases of keratitis can benefit from a loading dose (every five to fifteen minutes for the first one to three hours) followed by frequent administration (every thirty to sixty minutes). Patients suffering from keratitis sicca are frequently treated with one or more of the following agents: artificial tears, cyclosporine, corticosteroids, or systemic omega-3 fatty acids. One should be educated in proper contact lens care and about the risks associated with overnight wear of contact lenses. Ocular surface disease should be treated with agents such as artificial tears or cyclosporine. Contact lens solution containing Fusarium colonies caused an outbreak of keratitis in 2006. Causes Causative organisms involved in keratitis include bacteria, fungi, viruses, and acanthamoeba. Bacterial species that have frequently been associated withthis disease include Staphylococcus aureus, S. Risk Factors the following are some of the more important factors that can increase the likelihood of developing keratitis: contact lens wear, previous ocular surgery, ocular trauma, ocular surface disease, corneal epithelial abnormalities, and systemic conditions such as diabetes and malnourishment. Symptoms the typical symptoms of keratitis include blurred vision, photophobia, ocular pain, foreign body sensation, redness, tearing, and discharge. Screening and Diagnosis A detailed medical history is critical to achieve an accurate diagnosis. Salem Health affinity is reported to be ten to one hundred times greater than that seen with erythromycin. Like macrolides, ketolides exhibit bacteriostatic activity, although bactericidal activity has been achieved at higher levels. Susceptible and Nonsusceptible Organisms Ketolides were introduced as an alternative to macrolides in the treatment of respiratory tract infections. The increasing use of macrolides (including azithromycin, erythromycin, and clarithromycin) and the subsequent resistance to macrolide antibiotics, coupled with increasing resistance to other antibiotics such as beta-lactams, has highlighted the need for new antibiotics to treat these resistant strains. Common bacteria responsible for respiratory infections against which ketolides are active include nonresistant and resistant gram-positive aerobic bacteria (Streptococcus pneumoniae, S. Gram-negative bacteria against which ketolides are active include Haemophilus influenzae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumoniae, Mycoplasma pneumoniae, Neisseria species, Bordetella pertussis, and Ureaplasma urealyticum. Organisms against which ketolides are not active include Pseudomonas aeruginosa, Enterobacteriacae, and Clostridium difficile. Telithromycin is approved for the treatment of mildto-moderate community acquired pneumonia caused by susceptible strains of S. Telithromycin carries a black-box warning that it should not be used in persons with myasthenia gravis because of reports of fatal and life-threatening respiratory failure. To slow the growth of resistant microorganisms, ketolides Ketolide antibiotics Category: Treatment Definition Ketolide antibiotics are semisynthetic derivates of erythromycin A and members of the macrolide class of antibiotics. The binding Infectious Diseases and Conditions should be reserved for persons in whom susceptible strains are known or presumed. Impact In an era of increasing antibiotic use and increasing patterns of resistance, antibiotics with the ability to target microorganisms that are resistant to older antibiotics are critical. Respiratory tract infections are a time and health burden on both patients and the medical system. Antibiotics such as ketolides provide an additional tool for practitioners to combat resistant bacteria. They also balance the water and electrolyte content in the blood by filtering salt and water. Causes Kidney infection may be caused by, most commonly, a bladder infection that was not treated or inadequately treated; conditions that slow the flow of urine from the bladder, such as an enlarged prostate or kidney stones; having a cystoscopy done to examine the bladder; surgery of the urinary tract; use of a catheter to drain urine from the bladder; and, rarely, bacteria from another part of the body that has entered the kidneys. Risk Factors the factors that increase the chance of developing kidney infection include sexual activity; pregnancy; diabetes; birth disorder of the urinary tract, including vesicoureteral reflux; blockage of the urinary tract, including tumors, an enlarged prostate gland, kidney stones, or a catheter or stent placed in the urinary tract; polycystic kidneys; sickle cell anemia; previous kidney transplant; and a weakened immune system. Symptoms Symptoms include pain in the abdomen, lower back, side, or groin; frequent urination; urgent urination that produces only a small amount of urine; sensation of a full bladder, even after urination; burning pain with urination; fever and chills; nausea and vomiting; pus and blood in the urine; and loss of appetite. Other preventive measures are to practice good hygiene, to urinate when the need arises, and to take showers rather than baths. Women should wipe from the front to the back after using the toilet, should urinate before and after having sex, and should avoid douches and genital deodorant sprays. If the infection does not go away after treatment or if the person has had several kidney infections, other tests might be ordered to see if there are problems with the kidney, ureters, and bladder. If the infection is not treated correctly or is left untreated, the condition can lead to septicemia (a blood infection that has spread throughout the body), chronic infection, scarring of the kidney, or permanent kidney damage. In some cases, the infected person may need to be hospitalized and may need to receive antibiotics intravenously. The second criterion states that the pathogen must be isolated from the diseased person and cultivated in the laboratory. The third criterion states that the cultivated pathogen must cause the disease in a healthy person after inoculation. The fourth criterion states that the pathogen must be isolated again from the infected person and identified as identical to the original isolate. Certain pathogens and fastidious microorganisms have complex and unusual growth requirements and can survive only within living host cells. Numerous pathogens infect a specific species only while others become transformed in vitro. Some infectious diseases have unclear origins while others cause multiple disease conditions. Many infections develop from the combined effects of several different microorganisms.

Diarrheal diseases medications starting with p 400mg albenza overnight delivery, which are the third leading cause of death in the world medicine 7253 pill order albenza with a visa, are most often spread by fecal-oral transmission treatment 4 pimples order cheapest albenza and albenza. Two of the most important are typhoid fever (Salmonella typhi) and cholera (Vibrio cholerae) medicine for bronchitis generic albenza 400 mg overnight delivery. These life-threatening bacterial illnesses are most often spread through contaminated water symptoms bone cancer cheap albenza online. Water purification methods have nearly eliminated these diseases in many countries medications 24 purchase albenza 400mg otc, yet they remain a serious threat in many areas of the world. Outbreaks of intestinal illnesses, including those on cruise ships, are often caused by viruses (norovirus and rotavirus) Salem Health that are spread through food by infected food handlers. Fecal contamination of food is the most common source of infection by the hepatitis A virus. Cryptosporidium parvum, Entamoeba histolytica, and Giardia intestinalis (also known as G. While rare in areas with good sanitation, these illnesses are still extremely common worldwide. Some pathogens are so sensitive to the environment outside the human body that they cannot survive long enough to be transmitted by casual contact. These organisms must be transmitted from one person to another directly-through the exchange of body fluids during sexual contact, blood transfusion, birth, or breastfeeding. Bacterial infections that are transmitted through sexual contact include syphilis (Treponema pallidum), gonorrhea (Neisseria gonorrhoeae), and chlamydia (Chlamydia trachomatis). Other pathogens are transmitted directly through contact with the skin, often entering through a wound or break in the skin. Antibiotic-resistant forms of staph infections are now common among athletes and are spread during contact sports and in locker rooms. Prevention Public sanitation programs have had a profound impact on the incidence of contagious diseases in developed countries. Public health measures to prevent the spread of waterborne and food-borne illnesses are generally quite effective. These measures include water purification and sewage treatment, waste removal, and enforcement of regulations to promote food safety during production and preparation. A dramatic example of an effective public health program comes from data on typhoid fever in Philadelphia during the early twentieth century. This result is a heartening reminder that the spread of contagious diseases can be controlled. Vaccination is the most effective method of preventing a variety of contagious diseases. Recent innovations in molecular biology have enabled the development of new vaccines that provide coverage against more diseases. Despite the availability of a range of vaccines, many adults in developed countries are not effectively immunized. In some cases, this is because immunity from their childhood vaccines has faded or may not have been very effective to begin with. In other cases, adults may not be aware that new vaccines are available or that they need to be immunized against different organisms as they age. Vaccination rates for children and adults in developing countries are low because of financial barriers and a lack of infrastructure. Sexually transmitted diseases can be prevented by using condoms during intercourse. Handwashing is an effective way to avoid infection by organisms that are spread through respiratory and oral-fecal routes. One should wash his or her hands before and after handling food, after using the toilet or changing diapers, after sneezing or coughing, and before and after treating a wound. A disinfectant that destroys pathogenic organisms, such as 95 percent isopropyl alcohol, should be used occasionally in kitchens and bathrooms. One should avoid antibacterial soaps, however, because they are not more effective at killing bacteria than regular soap and can lead to the development of drug-resistant bacteria. Impact Contagious diseases have been intimately associated with human life throughout history. These diseases continue to cause suffering, disability, and economic hardship for millions of people in both developed and developing nations. Widespread contagious illnesses can be so costly that they hamper the economic development and political stability of developing nations. Most infected persons, however, are not highly infectious outside conditions in which there is a high likelihood of other people handling their body fluids. For example, during the 2003 outbreak, infected persons had flown on several airliners without infecting other passengers. In contrast, certain other people appeared to be "super spreaders," a pattern often seen in other viral infections. This virus infected mostly children and immunocompromised persons with mild upper respiratory symptoms and serious lower respiratory symptoms, including bronchiolitis and croup. Because of the high mutability of these viruses, the development of specific vaccines is unlikely. Infection can range from mild to severe in humans, manifesting as respiratory tract illnesses, enteric infections in infants and, in rare cases, neurological syndromes. Around the crown, viral spikes in the envelope glycoprotein bind to host surface glycoproteins to activate the virus. Persons with severe lung inflammation may need high doses of steroids, and those persons whose lungs have sustained damage may need mechanical ventilation for breathing support. Lessons about vaccines can be learned by looking at work done with the transmissible gastroenteritis virus, a virus that is deadly to pigs. Studies have shown that vaccinating the sow confers passive immunity on the piglets, a strategy that can have implications for human coronavirus vaccine. Causes Coronavirus is the underlying cause of a variety of illnesses that affect the respiratory system, the gastrointestinal system, and, in rare cases, the neurological system. Infections with the virus are often seasonal in nature, with more occurring in winter. Contact with contaminated droplets from sneezing and coughing and direct contact by touching contaminated objects, such as surfaces and tissues, may transmit the virus from person to person. The virus may live six to nine hours, and the live virus has been found in the stool of people diagnosed Coronaviruses with classic halo-like appearance. The virus can affect humans, cattle, pigs, rodents, cats, dogs, and birds, but there is no evidence of animal and bird variations infecting humans. Risk Factors Risk factors for coronavirus infection are exposure to an infected person through kissing and sharing living spaces and contact with droplets or contaminated surfaces containing the virus. The severity of the infection increases if a person is immunocompromised (less able to fight infections because of a weakened immune system). Symptoms Coronavirus infection that leads to the common cold comes with symptoms of fatigue, a scratchythroat, sneezing, nasal congestion, and a runny nose. Blood work may include blood chemistries and a complete blood count to determine if white blood cell counts, lymphocytes, and platelets are low. Treatment and Therapy In the absence of fever, symptoms may be treated with over-the-counter medications, plenty of fluids, and rest. Antibiotics, antiviral medications, and high doses of steroids to decrease lung inflammation may be prescribed. In severe cases, the patient may need oxygen, breathing support with a respirator, and hospitalization. Prevention and Outcomes the best prevention against coronavirus infection is to limit contact with infected persons. Hand hygiene, including handwashing or cleaning hands with an Salem Health alcohol-based hand sanitizer, is an important part of prevention. Infected persons should cough or sneeze into tissue or into the arm to minimize droplets and airborne particles. Because coronavirus is contagious, one should not share food and drink, utensils, or personal supplies. Household areas, including door knobs, counter tops, and other surfaces, should be cleaned with disinfectant. Corynebacterium Category: Pathogen Transmission route: Direct contact, ingestion, inhalation Infectious Diseases and Conditions Definition Corynebacterium is a gram-positive, non-spore-forming rod with a characteristic club-shaped appearance and worldwide distribution. Along with the Mycobacteria and Nocardia, they produce characteristic long-chain mycolic acids that can be used in their taxonomy. Their metabolism is varied, with both aerobic and facultatively anaerobic members of the genus. The bacteria are fastidious, and all strains require biotin and most require several other supplements. They are usually grown under an enriched carbon dioxide atmosphere and grow slowly, even on complex-enriched culture media. The rods are pleiomorphic, some having clubshaped ends (the Greek word koryne means "club"), and often show incomplete separation during cell division. The incomplete separation is caused by a characteristic "snapping" cell division, which leads to their peculiar cell wall. During cell division, the plasma membrane divides normally, but the cell wall may only partially separate, forming V- and other odd-shaped assemblages of two or more cells. The genomes of three species have been sequenced and contain a single circular chromosome of about 2. Pathogenicity and Clinical Significance Diphtheriae is the most important corynebacterial pathogen of humans and causes diphtheria. This disease is an upper respiratory infection with a characteristic pseudomembrane that covers parts of the pharynx and adjacent areas. Diphtheriae to epithelial cells at the site of infection, causing them to produce the fibrin-based pseudomembrane. The toxin can also be disseminated to many other areas of the body, leading to possible organ failure. Only those strains with an integrated lysogenic phage that carries the gene for the diphtheria toxin are able to produce the toxin. The disease severity is often a consequence of the strain of diphtheriae that causes the infection, because different strains grow at different rates and produce different amounts of diphtheria toxin. The toxin regulatory gene (DtxR), located on the bacterial chromosome, also affects toxin levels. Diphtheriae also can cause cutaneous diphtheria, a skin infection, if it enters a break in the skin. Nonpathogenic Corynebacterium are often referred to as diphtheroids, however, many of them can be opportunistic pathogens, especially in the elderly, the immune compromised, and those with prosthetic devices. Bovis and ulcerans have been isolated from skin ulcers, and bovis and pyogenes have caused systemic bacteremia. Corynebacteria that have been isolated from other infections include xerosis, jeikeium, striatum, and pseudodiphtheriticum. Many other diphtheroids, found as commensal organisms on healthy persons, might become pathogenic under the right circumstances. The antibiotics of choice are penicillin and erythromycin, administered for fourteen days. Antibiotic susceptibility of the diphtheroids varies, but penicillins, erythromycin, and rifampin are usually good choices. Volume 5 of this multivolume work describes Corynebacterium and its relatives in detail. This text outlines many common bacteria and describes their natural history, pathogenicity, and other characteristics. Salem Health Definition Cowpox is an extremely rare zoonotic disease in humans, acquired from direct contact with an infected cow or other mammalian host. It is a skin disease that results in a rash and ulceration, but no long-term effects. Edward Jenner, observing that milkmaids who had had cowpox never were infected with smallpox, used biological material from a cowpox lesion as the basis of the first successful vaccination in 1796. Because the two viruses have similar antigenic sites, antibodies produced against the cowpox virus provide immunity to smallpox. In modern times, inoculation with the related vaccinia virus is used as the smallpox vaccination agent, providing cross-immunity to cowpox. Although found in cattle, from which it derives its name, the cowpox virus has many mammalian reservoirs, including wild rodents such as mice and voles, and cats. The virus also has been found in zoo animals, particularly feline species and elephants. Cowpox is found primarily in the United Kingdom and the former western states of the Soviet Union and adjacent areas of north and central Asia. Risk Factors Infection can occur only through a break in the skin in direct contact with a cowpox lesion, especially from cats. Only one reported case of systemic involvement and death has been reported, and this occurred in an immune-compromised person. Symptoms At the site of infection, which is usually the hands, the normal symptoms is a rash followed by a pustular blister that then ulcerates, scabs over, and leaves a scar. Swollen nodes, slight fever, Cowpox Category: Diseases and conditions Anatomy or system affected: Skin Infectious Diseases and Conditions chills, loss of appetite, headache, and muscle aching may occur. Screening and Diagnosis Because cowpox is so rare, a physician will often misdiagnose the condition as bullous impetigo and treat it with antibiotics, which are ineffective.

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Parabaslids also have a prominent Golgi body (or Golgi apparatus) called the parabasal body that is involved in protein synthesis medicine xalatan buy albenza 400 mg mastercard. Parabasalids also have an undulating membrane thought to be involved in locomotion medicine 4h2 pill buy albenza 400mg on line. Many digest cellulose in the guts of termites and ruminants treatment quadriceps strain buy discount albenza 400mg on line, while others treatment quality assurance unit order albenza toronto, such as Trichomonas spp medicine gabapentin order albenza 400 mg. The euglenoid kinetoplastids have a single large mitochondrion with discoid inner membranes medications voltaren generic albenza 400mg. Alveolates are recognized by their alveoli, the membrane-bound vesicles just inside the plasma membrane. Among the heterotrophic dinoflagellates are no important human pathogens, although many photosynthetic dinoflagellates produce toxins that can affect humans and other animals. All apicomplexans, formerly called sporozoa, are nonmotile parasites, contain a modified plastid called the apicoplast, produce spores, and have sexual reproduction. The most prevalent protistan disease of humans, malaria, is caused by the apicomplexan Plasmodium spp. All ciliates, as the name implies, have cilia, either on the entire surface or clustered in tufts or rings. They also have two types of nuclei, macronuclei and micronuclei, and reproduce both sexually and asexually. Amebozoans all have lobe- or tube-like pseudopodia for locomotion and lack cilia or flagella at any stage of the life cycle. Most cannot reproduce Protozoa classification and types Category: Pathogen Definition Protozoa are members of an informal grouping of simple, usually unicellular, heterotrophic phyla that share similar characteristics. Classification Traditionally, the kingdom Protista (also known as Protoctista) is made up of simple eukaryotic organisms that do not fit neatly into any of the other kingdoms. Often its members are more closely related to members of other kingdoms than to each other. For many years, this kingdom has been informally divided into three subgroups: the algae, which are photoautotrophs; the protozoa, which are ingestive heterotrophs; and the fungus-like protists, which are absorptive heterotrophs. These informal groupings sometimes break down, as among the euglenids and dinoflagellates, in which there are species that are photoautotrophs, species that are either absorptive or ingestive heterotrophs, and species that can switch between autotrophy and heterotrophy. Most taxonomists agree that the kingdom Protista is artificial (not monophyletic) and should be split into multiple kingdoms. Like the taxonomy of the protists in general, the taxonomy of the protozoa is continually changing, as more species are subjected to rigorous cytochemical and genomic analysis. All protozoa are nucleated and are considered to be eukaryotic, although some may show both eukaryotic and prokaryotic characteristics. The normal classification hierarchy that starts with kingdom is often not used with Protista. The species are simply placed in taxa according to possible evolutionary and biochemical similarities without labeling the taxa. Characteristics and Habitat Protists can live in fresh- or marine-aquatic habitats, in damp soil, or in other organisms such as parasitic or commensal organisms. All can reproduce asexually, while some, like the alveolates, can also reproduce sexually. The nucleus has a prominent nucleolar region called the endosome, and many can produce resting stages called cysts. Gymnamebas, like Amoeba proteus, are free-living, unicellular amoeba that produce multiple pseudopods. They cause a number of diseases in humans and exact a huge toll on the peoples of developing countries. Toxoplasma gondii can be transmitted to humans through cat feces and can cause toxoplasmosis. Entamoeba hystolytica is the only major amebic pathogen in humans and causes amebic dysentery. Although written for middle-school students, this book provides good coverage for all general readers studying the basics of protozoa. A middle- and Salem Health high-school-level book with broad coverage of protozoa. Protozoan diseases Category: Diseases and conditions Anatomy or system affected: All Definition the protozoa are a large and diverse group of oftenpathogenic organisms that can cause a wide range of diseases in humans. Traditionally, these organisms have been described as single-celled eukaryotic microorganisms, but newer ultrastructural information challenges this uniform classification. The protozoan Giardia lamblia, for example, has been found to lack mitochondria and may be a transitional organism somewhere between the prokaryotic bacteria and eukaryotic protozoa. These diseases may best be classified by their mode of transmission, the most common of which are enteric, sexual, and arthropodal. Causes Enteric transmission is generally associated with intestinal illness in humans. From top left: Giardia muris, Centropyxis aculeata, Perdidinium willei, Blepharisma japonica, Desmarella moniliformis, Chaos carolinense. Diseases caused by these groups begin with the ingestion of contaminated water or with fecal-oral transmission. Sexually transmitted Trichomonas vaginalis infection is the most common type of pathogenic protozoan disease. Arthropod-borne protozoa include the parasitic flagellate Trypanosoma, which is transmitted by the tsetse fly and causes trypanosomiasis. Malaria, the leading cause of death in tropical countries, is caused by four species of the protozoan Plasmodium and is transmitted by mosquitoes. Infection with the protozoan Leishmania is caused by the bite of an infected sandfly. Risk Factors Risk factors for enteric transmission of protozoa are poor sanitary conditions and living or traveling to parts of the world where these conditions are endemic. Giardiasis is more common in children than in adults and may be concentrated in child day-care centers. Pregnant women who are exposed to cat feces, undercooked meat, or unpasteurized milk are at increased risk for fetal transmission of toxoplasmosis. People with weakened immune systems are at higher risk from all the sporeforming protozoa. The risk factor for tickborne babesiosis is living in areas where ticks are common. In the United States, this includes the coastal areas of New England and New Jersey and the Upper Midwest. The risk of being infected with Plasmodium, Leishmania, or Trypanosoma is directly related to living or traveling in tropical or subtropical parts of the world where these organisms are endemic. Symptoms Symptoms of protozoan diseases vary greatly and can range from mild to severe. Protozoan diseases that are transmitted by contaminated water or oralfecal transmission and cause intestinal illness commonly lead to nausea, bloating, anorexia, weight loss, abdominal pain, diarrhea, colitis, and dysentery. Toxoplasmosis infection may cause symptoms of fever, body aches, headache, fatigue, and adenopathy. Infants infected with toxoplasmosis may be born with symptoms including seizures, jaundice, hepato or splenomegaly, and eye infection. Common symptoms of arthropod-borne protozoan diseases include fever, chills, sweats, headache, myalgia, fatigue, anorexia, and weight loss. The visceral form of leishmaniasis causes symptoms similar to other arthropod-borne diseases. The cutaneous form of leishmaniasis causes symptoms that include skin bumps or nodules that may ulcerate and scab. Salem Health Trichomoniasis causes symptoms of copious, watery, vaginal discharge. Vulvovaginal irritation may be accompanied by dysuria, dyspareunia, and abdominal pain. For all protozoa-related intestinal diseases, identification of the organism in a stool sample is the definitive method of confirming the diagnosis. Other laboratory studies that may help in diagnosis include enzyme-linked immunosorbent assay antibody detection, electron microscopy, and polymerase chain reaction. Diagnosis of arthropod-borne diseases frequently relies on serology, detection of underlying anemia, and identification of protozoa in blood or in a blood smear. Trichomoniasis is frequently diagnosed by doing a wet mount of vaginal secretions. Immunoflourescent antibody staining and culture are more sensitive, but they could delay diagnosis. Skin scrapings from cutaneous leishmaniasis may be examined microscopically or may be cultured for diagnosis. Treatment and Therapy Treatment for most protozoan diseases requires specific antiprotozoal medication. In cases of intestinal protozoa causing dehydration, intravenous rehydration therapy is an important aspect of treatment. Some medications used in the treatment of intestinal protozoan infections include iodoquinol, paromomycin, metronidazole, tinidazole, quinacrine, furazolidone, tetracycline, nitazoxanide, and trimethoprim/sulfamethoxazole. Toxoplasmosis may be treated with the antimalarial medication pyrimethamine and the antibiotic sulfadiazine. Infectious Diseases and Conditions Prevention and Outcomes It is not possible to completely prevent the wide spectrum of protozoan diseases. The best hope for prevention is through education and through public heath efforts to provide safe water supplies. Arthropod-borne protozoal diseases may be prevented by avoiding endemic areas, by wearing protective clothing, by using insecticides, by sleeping in screened areas, and, in the case of malaria, by taking medications to prevent infection. Chapter 35 of this classic reference text gives a complete review of the most common types of protozoan diseases. Pseudomonas Category: Pathogen Transmission route: Direct contact, inhalation Definition Pseudomonas is a member of the group of pseudomonads, which are gram-negative, rod-shaped, obligately aerobic, bacilli that include similar organisms in the genus Burkholderia. Natural Habitat and Features the pseudomonads are commonly found in soil or water, where they play a significant role in the degradation of organic material. In humans, they are part of the normal skin flora and are found in intestinal and respiratory passages; they are generally considered to be harmless saprotrophs. Pseudomonads are distinguished from the enteric bacteria, which they physically resemble (as strictly aerobic and with a nonfermentative metabolism) and because they use the enzyme cytochrome oxidase in their respiratory pathways. Some species also produce the greenish pigment pyoverdin, which fluoresces in the presence of ultraviolet light. Pathogenicity and Clinical Significance Pseudomonas is considered a harmless organism in healthy persons. However, in persons with compromised immune systems, it becomes an opportunistic pathogen. It also becomes a pathogen if introduced into areas of the body that are generally sterile. Under these conditions, the production of pigments by the bacterium results in a bluish-green pus. Infections may be difficult to treat because the organism frequently exhibits resistance to antibiotics. The infection in adults has the potential to become severe, while in infants the danger significantly increases as the organism may pass into the bloodstream. Urinary tract infections too are not uncommon under these conditions, and as many as 15 percent of such nosocomial infections are caused by Pseudomonas. A variety of factors are involved in the pathogenic properties of Pseudomonas once it is introduced into the body. Pili, protein extensions on the cell surface, allow the bacterium to attach to tissues. Once the bacterium has begun to colonize, it secretes several types of enzymes that are damaging to the host. These enzymes include an elastase, which is particularly damaging to respiratory epithelium; a cytotoxin, which can damage or kill white blood cells; and several hemolysins, which can break down red blood cells. The result is a potentially systemic disease, as the toxin may be released into the bloodstream. The pigments produced by many Pseudomonas strains may also contribute to the potential virulence of the organism. Pyocyanin, a bluish pigment, impairs the normal functions of respiratory cilia and may also damage white blood cells. Persons with underlying respiratory disease, such as those with compromised immune systems, chronic lung diseases, or cystic fibrosis, are at particular risk of P. Because these infections are often caused by strains that produce mucoid layers on Salem Health the bacterial cell surface, they are difficult to treat. Bacteremia and the dissemination of Pseudomonas may spread the organism to the heart (causing endocarditis) and to the central nervous system (causing meningitis). Untreated middle- or inner-ear infections have the potential to develop into meningitis. An infection of the eye, keratitis, is less common but may become severe if the immune system has been compromised. Drug Susceptibility Pseudomonas is naturally resistant to most common antibiotics, largely because of its own efflux pumps, which efficiently prevent internalization of such drugs, and because of the type of outer membrane it produces on the surface of the cell. These plasmids may also be passed to other bacteria, spreading the danger of antibiotic resistance.

People can also protect themselves with thorough handwashing after defecation treatment goals for depression order online albenza, after coming into contact with feces medications names discount albenza 400mg free shipping, before preparing food medications 230 discount albenza 400mg online, and before feeding children medications mexico buy albenza 400 mg. The Durokal and Shanchol vaccines are administered orally symptoms 8 months pregnant buy albenza with paypal, offering ease of administration and freedom from the risks of needle-borne infection medicine for nausea discount albenza 400mg otc. The vaccines must be administered in two doses, between seven days and six weeks apart. Persons in areas of the world in which cholera is prevalent should receive booster shots every six months. They provide temporary protection while safe water and improved sanitation are secured. Cholera vaccine Category: Prevention Definition Cholera vaccine can offer up to two years protection for more than 50 percent of the treated population against the sometimes fatal disease cholera. The disease is caused by eating food or water contaminated by the Vibrio cholerae bacterium. Cholera has multiplied during the first decade of the twenty-first century because increased numbers of people are moving from areas at high risk for cholera to other regions, at a pace too fast for local governments and health authorities to provide safe water and sanitation. However, many countries have not been able to use them because of high cost, limited supply, and logistical problems in providing two doses. The majority of reported cases, however, involve healthy males with an outdoor hobby or occupation such as agricultural work. Symptoms Chromoblastomycosis initially begins with small, painless, sometimes itchy, bumps on lower extremities at the site of implantation. Satellite lesions may develop on other areas (hands, arms, buttocks, ears, face, and breasts) and coalesce to form a large cauliflower-like rash that gradually covers the extremities. In severe cases, complications can arise; these include elephantiasis and secondary bacterial infections that result in lymphatic stasis (lymph fluid retention) and sepsis (bloodstream infection). Screening and Diagnosis Chromoblastomycosis is a long-term fungal infection of the skin, sometimes confused with blastomycosis, lobomycosis, paracoccidioidomycosis, or sporotrichosis. Primary care physicians should consult with an infectious disease specialist or pathologist for early diagnosis and treatment. Diagnosis involves isolation, microscopic examination, morphological testing, and culture of infected specimens for characteristic brown-colored, round, thick-walled, sclerotic bodies. These sclerotic bodies resemble copper pennies and are characteristic of the dematiaceous fungi responsible for chromoblastomycosis. Depending on the extent and severity of the disease, treatment includes surgical excision, heat, electric current, cryosurgery, and antifungal therapy. Chromoblastomycosis Category: Diseases and conditions Anatomy or system affected: Skin Definition Chromoblastomycosis is a chronic fungal infection of the skin caused by a group of dematiaceous, or darkly pigmented, fungi found in soil and decaying vegetation. The incidence of the disease is higher in barefooted rural populations of tropical and subtropical areas of Africa and South America. This type of infection usually affects the limbs, especially the lower extremities, where the skin is broken. Infection occurs when the fungus istraumatically implanted under the skin through minor injuries such as a cut with a splinter, thorn, or other plant debris. Infected persons rarely seek medical care because the trauma often goes unnoticed and because the progression of the disease is slow. Infectious Diseases and Conditions Prevention and Outcomes the etiologic agents of chromoblastomycosis are everywhere. The best form of prevention is to avoid walking barefoot in wooded areas, especially where the fungus is prevalent. Symptoms last a minimum of six months and are severe enough to interfere with daily activities. Primarily uppermiddle-class women in their thirties and forties were seeking help for their symptoms. Doctors continue to report seeing the syndrome in people of all ages, races and ethnicities, and social and economic classes. A virus attacked my bronchial area and it was swollen shut, making it extremely difficult to breathe. Eventually my breathing got better, but I felt that the life was drained out of me. Aside from tremendous fatigue, I have blurred vision, dizziness, and pain (in my connective tissue, not my joints), mostly in my breast bone and hips. Then my cousin went to Toronto and found a magazine article on chronic fatigue syndrome and told me about it. I have to watch overexertion, even something like walking into a grocery store and trying to do the aisles. Some people are so desperate that they spend a fortune on all kinds of "treatments. I was ready to fire her after that, but she sent a very sincere letter of apology, stating that she had no right to say that. First, go to a doctor who knows about the disease and will do the appropriate diagnosis. However, perhaps this personality type increases the risk only after exposure to new mental stresses or to viral infections. Sometimes it develops more gradually, with no clear illness or other event noted as a starting point. Screening tests are usually given to people without current symptoms, but who may be at high risk for certain diseases or conditions. Additional tests may include Lyme disease antibody, cytomegalovirus titer, a test for mononucleosis (heterophile test), and tests for Candida, viral hepatitis, and human immunodeficiency virus infection. A personality assessment can help to determine coping abilities and to identify any coexisting affective disorders, such as depression, panic disorder, or other anxiety disorders. Ideally, treatment will be based on a combination of therapies and approaches, including lifestyle changes, medications, and alternative and complementary therapies. However, one can take the following preventive measures: Eat a balanced diet and exercise regularly and avoid the use of the following Salem Health drugs because the y are known to cause fatigue: hypnotics, blood pressure medications, antidepressants, seizure medications, antihistamines, beta-blockers, and tranquilizers. Chronic Fatigue Syndrome, Fibromyalgia, and Other Invisible Illnesses: the Comprehensive Guide. Adult flukes, which can live for more than twenty years, are 10 to 25 millimeters (mm) long and 3 to 5 mm wide. Risk Factors the greatest risk factor for contracting clonorchiasis is eating uncooked or undercooked fresh-water fish or crayfish imported from the Far East. Fish from this region should be thoroughly cooked to avoid the liver fluke infection. Clonorchiasis is in turn a known risk factor for the development of cholangiocarcinoma, a neoplasm of the biliary duct system. Higher-level infections can cause fever, chills, abdominal pain, nausea, diarrhea, mild jaundice, and eosinophilia. Severe fluke infestation may cause stenosis of the bile ducts and develop into cholangiohepatitis and liver failure. In long-standing infections, cholangitis, choletithiasis, pancreatitis, and cholangiocarcinoma can develop. Abdominal X rays, computed tomography scans, and sonographic assessments may be used to identify diffuse dilatation of small intrahepatic ducts or thickening of the bile duct walls. Treatment and Therapy the drugs of choice for treating clonorchiasis are praziquantel or albendazole. Albendazole inhibits metabolism in the cells of the fluke, causing immobilization and death. In most cases, only a single dose of either drug is necessary, but for severe infections, longer-term treatment may be required. Clonorchiasis Category: Diseases and conditions Anatomy or system affected: Gastrointestinal system, intestines, liver, stomach Definition Clonorchiasis is an infection of the biliary ducts of the liver caused by the parasite Clonorchis sinensis, also known as Opisthorchis sinensis. Infection with this liver fluke (trematode) is endemic to Asia, particularly in Korea, Japan, Taiwan, China, and Vietnam, but is introduced occasionally in other countries such as the United States through contaminated food imported from Asia. Immature flukes are released into the duodenum and ascend the common biliary tract through the ampulla of Vater. The flukes mature to adults in approximately one month and reside in the small- and medium-size intrahepatic ducts. Salem Health Further studies have revealed eggs in the feces of Chinese bodies buried 4,000 years ago. The mature flukes have both male and female reproductive organs termed hermaphroditic. Eggs pass out of humans, dogs, cats, swine, rats, or other mammals in feces and can contaminate fresh water. The eggs have an operculum or cap which opens upon entering the water, releasing miracidia which penetrate snails. After further development in the gut of the snail, tadpolelike cercaria are released into the water and infiltrate the scales of fish becoming encysted under the scales or in the muscle of the fish. Humans and other mammals become infected by eating raw, undercooked, or preserved fish. After about one week the ingested cysts develop into mature flukes in the duodenal portion of the small intestine. The flukes then migrate through the ampulla of Vater into the common bile duct to become attached somewhere in the biliary tree. The fluke has a ventral sucker which is used for attachment to the biliary epithelium and an oral sucker for nourishment from bile. These flukes may live up to 30 years and can produce as many as 4,000 eggs per day. It is estimated that 35 million people may be infected with nearly half being from China. The protein demands of the large Asian population have resulted in an increasing amount of fish grown in ponds. The ponds are fertilized using night soil (human feces) to enhance the growth of plants and algae which are eaten by the fish. Light cooking, freezing, or salting will not kill the encysted parasite and the fish will remain infective. Pathogenicity and Clinical Significance When humans become infected with this flatworm, the disease is called clonorchiasis. The acute stage may produce fever, abdominal pain, hepatomegaly, urticaria, or eosinophilia and may be mistaken for hepatitis. The chronic stage can be manifested by right upper quadrant abdominal discomfort, anorexia, or weight loss and is sometimes confused with Clonorchis sinesis Category: Pathogen Transmission route: Ingestion Definition Clonorchis sinesis was first discovered in 1874 when flukes were observed upon opening the bile duct of a Chinese carpenter at the time of autopsy in India. The global epidemiology of clonorchiasis and its relationship with cholangiocarcinoma. Longstanding infection is associated with the development of cholangiocarcinoma which is nearly always fatal. Studies have estimated that 25-35 cases of this cancer will develop in every 100,000 persons infected. Worldwide, this rough estimate would suggest about 10,000 cases of cholangiocarcinoma resulting from clonorchiasis. In the United States and other countries outside of Asia, clonorchiasis is found in immigrants and in people who consume infected fish from endemic areas. Drug Susceptibility Infection is usually diagnosed by finding the small (28 micron) eggs in the stool when examined under the microscope. Occasionally, when the patient is misdiagnosed and undergoes surgery for gallbladder disease, infection is realized when flukes are encountered by the surgeon exploring the common bile duct. Successful treatment can be easily accomplished by taking the oral drug praziquantel. Treatment not only cures the patient of clonorchiasis, but also avoids the increased risk of cholangiocarcinoma. Clostridium Category: Pathogen Transmission route: Blood, ingestion, inhalation Definition Clostridium is a gram-positive, rod-shaped, spore forming, chiefly anaerobic bacteria that can produce lethal toxins. There are approximately 134 species, 25 to 30 of which are infectious to animals and humans. It is also found as normal microbial flora in the gastrointestinal tract and in the vagina. It is saprophytic in nature, playing an important role in the degradation of organic materials. Most Clostridium species are obligate anaerobes, but a few can grow in the air at atmospheric pressure. Because Clostridium cannot use molecular oxygen as a final electron acceptor, it generates energy solely by fermentation. Clostridium can be seen microscopically, appearing pink to red when stained for gram-positive bacteria. Clostridium grown on agar will appear as a series of flat, round colonies and demonstrate hemolysis. Most Clostridium species are benign to humans, and some play an essential biological role in degrading biological molecules. Pathogenicity and Clinical Significance Clostridium infections range from mild food poisoning to life-threatening septic shock. All these methods of infection are rare; in general, only foodborne and intestinal colonization in infants is fatal if not treated properly.