William C. Oliver, Jr., MD

• Professor
• Department of Anesthesiology
• College of Medicine
• Mayo Clinic
• Rochester, Minnesota

No plague vaccine is available in the United States translational medicine cheap olanzapine master card, but research for such a vaccine continues medications safe during breastfeeding purchase generic olanzapine pills. Prevention A June 2010 report from the Center for Biosecurity at the University of Pittsburgh Medical Center stated that from 2008 through 2010 symptoms zithromax cheap olanzapine online amex, government spending to support biodefense programs increased treatment notes order cheapest olanzapine and olanzapine. Bioterrorism prevention and intervention are top priorities medications used for anxiety cheap 7.5 mg olanzapine visa, according to Department of Health and Human Services secretary Kathleen Sebelius medications 512 buy olanzapine 7.5mg line, who, in early 2010, announced a new national health security strategy of focusing resources on first-responder teams and front-line health care. On October 7, the National Institute of Allergy and Infectious Diseases announced its investment of $68 million in research projects for the development of vaccines to protect against biological terror. These projects include those looking into a needle-free dengue vaccine, an orally administered anthrax vaccine, and an anthrax vaccine administered with an adjuvant to stimulate the immune system. Impact Because there have been few incidents of bioterrorism, there is little historical data on its impact. However, scientific predictions about likely effects on populations have led to response strategies and to investment in prevention and detection technologies. Wild birds have adapted to urban environmental settings, increasing the risk of domestic infections. Even though infections may be spread from birds to humans, a resulting human illness is rare. Newborns, young children, and immunocompromised persons are at greatest risk for disease transmission. However, domestic birds such as farm chickens and ducks may become sick and spread the disease through saliva or droppings. Typically, the avian flu is spread to pigs and other animals that can contract both bird and human flu strains. The bird and human flu strains combine to form a new mutant strain to which humans are susceptible. More severe symptoms include eye infection and pneumonia and other respiratory difficulties. The risk for mortality is high because humans have no immunity to the avian flu strains. More than one-half of all persons who have been diagnosed with the avian flu have died. Certain antiviral medications are effective, but the seasonal influenza vaccine cannot protect against avian flu. West Nile Virus West Nile virus is a flavivirus that is spread by a mosquito that first bites an infected bird and then, newly infected, bites a human. West Nile virus was first documented in the United States in 1999, and it spread rapidly. Symptoms may be mild, with a rash, muscle weakness, and flulike symptoms, or they may be more severe, with meningitis, encephalitis, or a lack of cognitive clarity. Although the virus is not as prevalent in the human population now as it was during the original outbreak, West Nile virus remains a subject of medical research. Scientists continue to work on identifying the types of birds that carry the Salem Health Isolating and observing arboviruses (viruses transmitted by arthropod vectors) is key to understanding disease reservoirs and transmission patterns. The disease is rare in humans; only a few hundred cases are reported each year in the United States. Veterinarians, pet-store employees, and bird owners between the age of thirty and sixty years are at greatest risk; the disease is rarely reported in children. Rarely, the presentation is more severe and includes pneumonia, infection of the heart, hepatitis, and death. Baby chicks and ducklings often have the bacterium Salmonella in their intestines, hence they shed it in their droppings. Humans may develop salmonellosis either by holding the bird or by touching a contaminated object. Children are at greatest risk because of their improper handwashing technique and because of their tendency to put their fingers in their mouths after petting birds. Persons who are immunocompromised, elderly, or pregnant should avoid touching birds, especially chicks and ducklings. Salmonellosis results in diarrhea, fever, stomach pain, and other flulike symptoms within a few days of exposure. The fungi Cryptococcus neoformans, which causes the disease, is found in soil droppings or in roosts, such as in attics and on ledges. Infections are usually asymptomatic or mild and include flulike symptoms, a cough, and a skin rash. In more severe forms, infection in the lungs may spread to the central nervous system and cause brain damage or become fatal. Histoplasmosis, a disease transmitted to humans commonly from pigeons, starlings, blackbirds, and bats, is caused by the fungus Histoplasma capsulatum. Humans may contract the disease by inhaling air near affected soil, near roosts that have been maintained for several years, or near droppings (from bats). Construction workers, gardeners, and those in other outdoor occupations are at highest risk because of the disruption of soil at work sites. Young children, the elderly, and persons with lung disease are at greatest risk for these more significant symptoms. Impact Perhaps the greatest impact to global public health and the world economy can be found in the experiences of the bird flu pandemic of 1997. For example, government officials in Hong Kong who feared outbreaks and a significant number of deaths had ordered the slaughter of all poultry in that region (about 1. The virus spread rapidly to other Asian countries, and with bird migration, the disease spread to Europe. Continuing research into vaccines and proper education about bird handling and care are vital to reducing the amount of human infections and preventing avian-disease-related pandemics. However, a balance should exist between preserving the wild and domestic bird populations and protecting humans. Also considers human health, agricultural concerns, and the potential effect on wild bird populations. Examines the history of the bird flu and its possible future effects on global health. A biology text examining disease vectors, including bats and wild and domestic birds. A detailed description of the health risks to birds, other animals, and humans from avian-related infectious diseases. Salem Health Symptoms If symptoms do appear, they are generally mild (respiratory infection or fever). However, in immunocompromised persons, symptoms can be severe and include interstitial nephritis and narrowed ureters following kidney transplant; hemorrhagic cystitis following bone marrow transplant; increased risk of bladder cancer; encephalitis (swelling of the brain); retinitis (swelling of the retina); and pneumonitis (swelling of the lungs). In the severe cases seen in immunocompromised persons, decreasing immunosuppression therapy is the principle treatment. Leflunomide is frequently used because it has both immunosuppressive and antiviral properties. Quinolone antibiotics (such as ciprofloxacin) and intravenous immunoglobulin are also used. Additional treatments, such as pain medication, bladder irrigation, or hyperhydration, may be necessary. It is known, however, that the virus is spread from person to person (not from an animal source), possibly through saliva, air, cough, blood, needles, blood transfusions, sexual contact, pregnancy, or organ transplant. It is likely they had the infection but had symptoms that were flulike (leading many, possibly, to believe they had the flu). However, the virus can be reactivated if the immune system is compromised (weakened). A long-term illness, such as diabetes or acquired immunodeficiency syndrome, may weaken the immune system. Anti-rejection medications taken by organ transplant patients may also weaken the immune system. These molds produce conidia (asexual spores), which can become airborne and cause infection through inhalation. Most dimorphic fungi (such as Blastomyces, Coccidioides, Paracoccidioides, and Histoplasma) are also considered endemic fungi because each of them is found primarily in a particular region of the world. For Blastomyces, the vast majority of cases are seen in certain regions of North America and Africa, although cases are seen worldwide. In the United States, areas endemic for Blastomyces are the central and southeast states, especially along the Mississippi and Ohio rivers and the upper Great Lakes region. In highly endemic areas, mean annual incidence rates can be as high as 40 per 100,000 persons. Studies using molecular techniques to detect Blastomyces in endemic areas have generally failed to find it. Therefore, transmission occurs only through environmental sources; humanto-human or animal-to-human cases have not been reported. Pathogenicity and Clinical Significance Blastomycosis begins as a lung infection after inhalation of the Blastomyces conidia. After lodging in the lungs, the conidia germinate into the yeast form of the fungus. This change provides Blastomyces a distinct advantage for infection, as yeastlike cells are much more resistant to phagocytosis than are filamentous mold forms. Virulence factors are also produced in the yeast but not mold form of Blastomyces. The infection can then disseminate through the blood and lymphatics to other organs. The inflammatory immune response results in macrophage recruitment and, ultimately, granuloma formation. In most immunocompetent people, the innate immune system (especially the action of alveolar Blastomyces Category: Pathogen Transmission route: Inhalation Definition Blastomyces is a pathogenic, dimorphic, endemic soil fungus that causes a respiratory infection known as blastomycosis. The size, shape, and arrangement of cells are often very different between the sexual and asexual morphological forms of the same fungus. The sexual form of any fungus is called the teleomorph, in contrast to the asexual morphological form, called the anamorph. Ajellomyces dermatitidis is the teleomorph stage and is the official name of the fungus. Blastomyces is one of only a few dimorphic fungi that can cause serious disease in humans. Infection by Blastomyces is called blastomycosis and has been recognized since the nineteenth century. While most fungi are always either molds or yeastlike cells, dimorphic fungi can grow as either yeastlike cells or as filamentous forms (molds). Studies of epidemic exposures indicates that about 50 percent of people exposed to Blastomyces develop no symptoms (are asymptomatic). If symptoms do appear, they include a dry cough, chest pain, hoarseness, and a low-grade fever. The symptoms may take several months to appear after the initial inhalation of the conidia. Because blastomycosis symptoms are similar to those of many other diseases, such as tuberculosis, acute pneumonia, histoplasmosis, and even influenza, diagnosis is often delayed or missed. Pneumonia is the most frequent symptom of blastomycosis, and, except in rare cases of skin infection, the lungs are the site of first infection. Infection of skin, bone, prostate, and the central nervous system are also seen in blastomycosis. If the primary pulmonary infection does not resolve, severe progressive (chronic) blastomycosis can result. Chronic illness may resemble tuberculosis or lung cancer, with symptoms of low-grade fever, a productive cough, night sweats, and weight loss. Blastomycosis can disseminate and spread infection to the skin, bones, urogenital tract, prostate, and the central nervous system. Dissemination outside the respiratory tract occurs more often in those who are immunocompromised and in persons with chronic pulmonary illness. In these cases, although the initial infection is resolved, live Blastomyces remains inside the host and are capable of causing secondary infection. Immunocompromised persons are at much higher risk for developing severe Blastomyces infections. Among people with human immunodeficiency virus infection or with acquired immunodeficiency syndrome, mortality rates for blastomycosis of 30 to 40 percent have been reported. Minimizing morbidity and mortality from blastomycosis depends primarily on early recognition and appropriate treatment of the disease. Drug Susceptibility the in vitro drug susceptibility of Blastomyces, like many fungi, correlates poorly with treatment efficacy. That is, antifungal agents that may work well in the Salem Health laboratory do not always work well in clinical cases. The primary antifungal drugs for treating Blastomyces infection are amphotericin B, itraconazole, flucanazole, ketoconazole. Amphotericin B has historically been the most effective antifungal for severe blastomycosis (especially in children). However, while effective, amphotericin B has many deleterious side effects and must be administered intravenously. Liposomal formulations of amphotericin B have with significantly less toxicity, and anecdotal reports suggest they may be effective against Blastomyces. The azole class of antifungals is an equally effective and less toxic alternative to amphotericin B for treating mild-to-moderate blastomycosis. Azoles used to treat blastomycosis include itraconazole, flucanazole, and ketoconazole.

If started early medications knowledge buy olanzapine with paypal, an antitoxin can stop the paralysis from progressing and may shorten the duration of symptoms symptoms food poisoning buy olanzapine 7.5 mg amex. Recovery occurs after the body produces new nerve fibers medicine 257 purchase olanzapine 2.5 mg overnight delivery, a process that may take weeks or months medications with weight loss side effects buy discount olanzapine 2.5 mg. Methods to eliminate the toxin include enemas medications mobic buy 5mg olanzapine with visa, suctioning of stomach contents medical treatment olanzapine 5 mg mastercard, and medication to stimulate vomiting. One should wash contaminated clothing and surfaces with a bleach solution, or the surfaces and clothing should be left untouched for days. Medical staff have been instructed to report all cases to public health officials. Prevention and Outcomes Antitoxin could be given after a known release of the toxin, but there are limited supplies of antitoxin. In the event of a terrorism attack, the antitoxin likely would be given at the first signs of illness. Laboratory workers and military personnel can receive a toxoid vaccine to prevent the disease by building immunity. The botulinum antitoxin is available from the Centers for Disease Control and Prevention through state and local health departments. The success of an attack would depend on its secrecy, the size of the toxin particle, and weather conditions at the time of release. Persons who are aware of an attack should prepare to cover their mouth and nose with clothing or a handkerchief. Experts predict that some of the released toxin could live in dry, cool air for up to two days. Committee on Advances in Technology and the Prevention of Their Application to Next Generation Biowarfare Threats. Food that may be contaminated with the toxin include home-canned goods, sausage, other meat products, seafood, canned vegetables, and honey. Unlike adults and older children, infants become sick from toxin produced by bacteria growing in their own intestines. Third, and rarely in the United States, a wound can become infected with bacteria. Risk Factors Risk factors for botulism include eating improperly canned foods and (rarely) using intravenous drugs. Symptoms Symptoms begin in the face and eyes and progress down both sides of the body. If the disease is left untreated, muscles in the arms, legs, and torso, and those used in breathing, become paralyzed. Symptoms in adults can range from mild to severe and include muscle weakness, dizziness, double or blurred vision, droopy eyelids, trouble swallowing, dry mouth, sore throat, slurred speech, difficulty breathing, and constipation. In babies, the symptoms include constipation, not eating or sucking, little energy, poor muscle tone, and a feeble cry. When food is the cause of botulism, symptoms usually start within thirty-six hours of eating the contaminated food. Some people notice symptoms within a few hours, but others may not develop symptoms for several days. When a wound is the cause of botulism, symptoms start within four to fourteen days. Blood, stool, and Botulism Category: Diseases and conditions Anatomy or system affected: All Definition Botulism is a potentially deadly illness that is caused by a toxin produced by the bacterium Clostridium botulinum. This bacterium is found in the soil and at the bottom of streams, lakes, and oceans. If available, samples of questionable food may also be tested for the toxin and bacteria. Treatment aims to maintain adequate oxygen supply, which may require a ventilator and close monitoring in an intensive care unit. If treatment begins early, an antitoxin can stop the paralysis from progressing and may shorten the duration of symptoms. Methods to eliminate the toxin include enemas, suctioning of stomach contents, medication to stimulate vomiting, surgery to clean a wound, and antibiotics to treat a wound infection. Prevention and Outcomes Strategies to prevent botulism include the following: Avoid feeding honey to children who are younger than one year of age; refrigerate oils that contain garlic or herbs; bake potatoes without foil (if potatoes are wrapped in foil, keep them hot until served or refrigerate them); avoid tasting foods that appear spoiled; avoid eating food from a can that is bulging; boil home-canned foods for ten to twenty minutes before eating; practice good hygiene when canning; seek medical care for wounds and return to the doctor if the wounds look infected (exhibits redness, warmth, pus, or tenderness); and avoid injecting illicit drugs. All antibody types are specific for only one pathogen and do not attack irrelevant or commensal (good) organisms. Oligosaccharides (chains of sugars) and mucins (large molecules made of protein and carbohydrates) are able to clump together with invading bacteria, making them harmless. White blood cells (leukocytes) are abundant in breast milk; most notably in colostrum, the milky fluid that precedes the flow of milk. Neutrophils, macrophages, and lymphocytes are all present and play a role in protecting the infant from disease. Infection Transmission Few organisms are passed readily by breast milk to cause clinical infection, and it may be difficult to accurately determine the mode of transmission, because breast-feeding requires close contact between mother and infant. Some infections that are spread during the breast-feeding period pass by other means, such as airborne droplets or skin contact. Three viruses can be transmitted through breast milk and are of greatest clinical concern. It is thought that transmission occurs through exposure to small amounts of virus for several feedings each day during the prolonged period of breast-feeding. Most women are infected before becoming pregnant and develop antibodies that cross the placenta to protect the growing fetus and breastfeeding infant. However, if the woman experiences primary infection during pregnancy or breastfeeding, inadequate immune resources and infection can result. It is composed of milk-producing mammary glands and lactiferous ducts that carry milk to the nipple, which is surrounded by fatty tissue. It has been known for some time that breast-fed infants contract fewer infections than those who are formulafed, but only lately have experts come to understand and identify the specific immune components that are transferred to the infant in breast milk. Breast milk also contains microorganisms, a few of which can be passed to the infant, leading to infection and clinical disease. Rarely, the considerable benefits of breast-feeding must be weighed against the risk of transmitting infection. Mastitis (infection of the breast tissue) is commonly seen between one and three months of delivery and may cause pain, fever, and malaise in the mother, which makes care of the newborn difficult. In almost all cases, it is recommended that a woman with mastitis continue to breast-feed. During pregnancy immunoglobulins cross the placenta to help protect the fetus from infections. All five major antibody types-IgG, IgA, IgM, IgD, and IgE-have been found in human breast milk and are active when ingested by the nursing infant. Some infections, including having gonorrhea, group B strep, syphilis, or tuberculosis, could lead to an interruption of breast-feeding for a brief time, while the mother or the mother and infant begin antimicrobial therapy. This condition may lead to a localized, minor infection or a more serious deep-breast abscess. Symptoms include tenderness and swelling of the breast, fever, chills, and other flulike symptoms. Prevention includes good hygiene and handwashing and proper breast-feeding technique to avoid cracked nipples. Most women with mastitis should continue to breast-feed; doing so does not harm the infant. For those few circumstances where disease transmission is of concern, more work is needed to develop vaccines and other interventions. Bronchiolitis Category: Diseases and conditions Anatomy or system affected: Lungs, respiratory system Infectious Diseases and Conditions Definition Bronchiolitis is most often a childhood disease that affects the lungs. As a result, a thick fluid called mucus collects in the airways, making it difficult for air to flow freely in the lungs. Droplets of moisture are released into the air, and an uninfected person can become infected by breathing that air. Risk Factors Bronchiolitis can affect anyone, but it most often strikes children under the age of two years, especially between three and six months of age, and most often during the winter months. Adults most at risk are those who are immunocompromised or are exposed to toxic fumes. Children most at risk are those who were never breast-fed or were born prematurely, those exposed to tobacco smoke, those who are often in groups of children (as in day care), and those who are living in crowded conditions. During the first two to three days, the child will probably have a runny or stuffy nose and a slight fever. During the next two to three days, the symptoms will increase to include a cough (dry), fever, sneezing, rash, red eyes, fast rate of breathing, difficulty breathing, wheezing (making a whistling noise during breathing), bluish color in the skin (especially around the lips or nails), poor feeding, and restlessness. This may help to reduce swelling and mucus in the airways, but there is limited evidence showing their benefits. The doctor will check for dehydration and pneumonia and will make sure the child is getting enough oxygen. One should consult a doctor if the sick child is vomiting and cannot keep liquids down; is breathing fast (more than forty breaths in one minute); has bluish skin, especially around the lips or on the fingertips; has to sit up to breathe; was born prematurely or has a history of heart disease; or appears dehydrated. Prevention and Outcomes Bronchiolitis can spread easily from one person to another. To prevent giving the infection to others, children should be kept home until they are no longer sick. Family members should wash their hands before touching a baby or after being in contact with an infected child. Bronchitis Category: Diseases and conditions Anatomy or system affected: Lungs, respiratory system, throat Also known as: Lower respiratory tract infection, upper respiratory tract infection Definition the bronchi are air passages of the lungs. The different types of bronchitis are acute bronchitis (a sudden onset of symptoms) that lasts a short time. Another type is chronic bronchitis, a long-term, serious condition that causes obstruction and erosion of the lungs. Another type is asthmatic bronchitis, which occurs in people with asthma and during an asthma attack. Causes Bronchi inflammation may be caused by bacterial and viral infections, smoking (cigarettes or marijuana), and inhalation of respiratory irritants such as ammonia, chlorine, minerals, or vegetable dusts, usually in work settings. Risk Factors Risk factors for bronchitis include smoking, exposure to secondhand smoke, contact with a person infected Infectious Diseases and Conditions with bronchitis, viral upper-respiratory-tract infection (cold or influenza), asthma, chronic sinusitis, occupational exposures to respiratory inhalants, smog (in susceptible persons), enlarged tonsils or adenoids (or both), and malnutrition. In acute bronchitis, the symptoms are runny nose; malaise; slight fever; back and muscle pain; sore throat; a cough, initially dry, that produces mucus that may be thick, yellow, green, or blood-streaked; and wheezing. In chronic bronchitis, the symptoms include a cough that brings up yellow-green mucus, often worse in the morning; difficulty breathing; bluish tint to lips and skin (in severe cases); and swelling of the feet (in end-stage cases). However, the following may be recommended for severe or questionable cases: a blood test; chest X rays, to rule out pneumonia, which is a complication of bronchitis; pulse oximetry, to measure the amount of oxygen in the blood; and a bronchoscopy to obtain sputum for a culture. For chronic bronchitis, tests may include a blood test; chest X rays; pulmonary function tests or spirometry (to evaluate lung function); sputum culture; arterial blood gas (to test for levels of oxygen, carbon dioxide, and acid in the blood); pulse oximetry; and a bronchoscopy to obtain sputum for a culture. Treatment and Therapy For acute bronchitis, treatment is aimed at relieving the symptoms. Treatment includes aspirin or acetaminophen to treat pain and fever, expectorants or cough suppressants, increased fluid intake, cool-mist humidification, and herbs and supplements (pelargonium sidoides extract may help resolve symptoms in persons with acute bronchitis). There are some concerns about the safety of overthe-counter cough and cold products. Treatment may include oral antibiotics and bronchodilators, particularly clarithromycin. A study found that shorter antibiotic treatment (five days or less) is as effective as longer treatment (more than five days). Treatment for chronic bronchitis also includes bronchodilators, oral or intravenous corticosteroid medications, inhaled bronchodilators or corticosteroids, expectorants to loosen secretions, mucolytics, supplemental oxygen, cool-mist humidification, lung reduction surgery (removal of the most damaged part of the lungs, in severe cases), and lung transplant (in end-stage cases). Prevention and Outcomes To reduce the chance of getting bronchitis, one should stop smoking, avoid passive (secondhand) smoke, avoid exposure to respiratory irritants, and avoid contact with people who have bronchitis. Salem Health A photomicrograph of the bacterium Brucella melitensis, initially named Micrococcus melitensis. Each of the ten species has a different host range and has some metabolic differences. With the exception of microti, they are slow-growing in culture, often taking several days to weeks to show growth. Nutritionally, they are considered to be fastidious and require several vitamins and amino acids. Both abortus and melitensis grow best when erythritol is added to the medium as a carbon source. They are considered facultative intracellular parasites and can survive for long periods in soil and water. They have worldwide distribution and reservoirs in several domestic and nondomestic mammal species. Studies with microti suggest that, in addition to its normal vole reservoir, soil could serve as a reservoir for this species. In their animal reservoirs, there is often a high concentration of bacteria in the reproductive organs; these bacteria are transferred during sex, by licking of the external genitalia, and by contact with the placenta and fluids released during birth.

The tibial nerve supplies the muscles and skin of the back of the leg and the plantar surfaces of the foot and toes 94 medications that can cause glaucoma cheap olanzapine 2.5mg visa. One of its branches symptoms of breast cancer effective 5 mg olanzapine, the sural nerve medicine keri hilson lyrics cheap 7.5mg olanzapine overnight delivery, supplies the heel treatment of diabetes discount olanzapine 7.5mg, the ankle and the dorsum of the foot medications rapid atrial fibrillation purchase olanzapine 5 mg with visa. The common fibular nerve supplies the muscles and skin of the front of the leg and the dorsal aspects of the foot and of the toes treatment 5th toe fracture cheap olanzapine master card. Clinical: Immobilisation, caused by a plaster cast or prolonged decubitus with the legs crossed, leads to compression of the common fibular nerve at the level of the fibular neck. This results in the steppage gait (foot drop with the foot hanging and the toes pointing down on walking) and also in a partial sensory loss in the anterolateral aspect of the thigh and anterior aspect of the instep. Physiological: the distribution of each nerve allows one to visualise the segment it supplies. The dermatome corresponds to the cutaneous area supplied by the same spinal nerve. Compression of the lateral femoral cutaneous nerve by tight clothing causes pain over a racquet-shaped area in the lateral aspect of the leg, known as meralgia paraesthetica or lateral femoral cutaneous neuropathy. The motor nerves are the oculomotor, trochlear, abducens, accessory and hypoglossal nerves. The vagus nerve is also an important component of the parasympathetic nervous system. The optic, ophthalmic, abducens, oculomotor, trochlear and a branch of the trigeminal all contribute to vision. The other branches of the trigeminal-the maxillary and the mandibular nerves-control mastication and also supply the face and the cranium. The facial nerve serves the sense of taste and supplies the muscles of facial expression. The glossopharyngeal nerve contains sensory and motor fibres for the muscles of the tongue, the tonsils and the pharynx and takes part in swallowing and reflex vomiting. The vagus nerve supplies the smooth muscles and/or the secretory glands of the pharynx, larynx, trachea, bronchi, heart, oesophagus, stomach, intestine, exocrine pancreas, gall bladder and bile duct, spleen, kidneys and ureters and the blood vessels of the thoracic and abdominal cavities. By innervating the muscles of the tongue and those surrounding the hyoid bone, the hypoglossal nerve takes part in swallowing and phonation. Clinical: Some fibres of the glossopharyngeal nerve carry nerve impulses from the carotid sinus and play a role in the control of arterial blood pressure. Mandibular nerve Comments Anatomical: the trigeminal nerve is a large mixed cranial nerve containing both sensory and motor fibres. Physiological: the trigeminal nerve is the main sensory nerve of the face and of the cranium. Its sensory fibres carry impulses from the pain, temperature and touch receptors in the nasal and buccal cavities and in the teeth. The ophthalmic nerve, a sensory nerve, supplies the nasal mucosa, the lacrimal gland, the conjunctiva and the eyelid, the forehead and the scalp. The maxillary nerve, also a sensory nerve, supplies the cheek, the upper gums and teeth and the lower eyelid. The mandibular nerve, a mixed nerve, is both motor and sensory and supplies the lower teeth and gums, the external acoustic meatus and the tympanum, the lower lip, the chin, the mandible and the tongue. Clinical: the occurrence of acute, paroxysmal, recurring and disabling pains in the face suggest a lesion of the trigeminal nerve, a trigeminal neuralgia. Common carotid artery Trachea Aortic arch Pulmonary trunk Heart Stomach Diaphragm Right pulmonary artery Right bronchus Cardiac plexus Oesophagus Vagus nerve Comments Anatomical: the vagus nerve is the 10th cranial nerve. It is mixed, containing both sensory and motor fibres, which run along the neck and through the thorax and the abdomen. It contains parasympathetic fibres and is an important component of the parasympathetic nervous system. Physiological: the vagus supplies motor and sensory fibres to the oropharyngolaryngeal region, the soft palate, the pharynx and the larynx and controls the vegetative activities of the cardiorespiratory organs (the heart, the thoracic and abdominal blood vessels, the lungs, the trachea and the bronchi), the alimentary system (the oesophagus, the stomach, the intestine, the exocrine pancreas, the gall bladder and the bile ducts), the spleen and the kidneys and ureters. Clinical: Stimulation of the vagus results in constriction of the bronchi, increased production of saliva and digestive juices and activation of the smooth muscle of the alimentary tract. Superior cervical ganglion Coeliac ganglion Superior mesenteric ganglion Inferior mesenteric ganglion Dilator pupillae muscle Salivary glands Buccal and nasal mucosae Skeletal blood vessels Heart Coronary arteries 11. Trachea and bronchi Stomach Liver Spleen Suprarenal medulla Colon and small intestine Kidney Bladder Sex organs and external genitalia Comments Anatomical: Pre- and postganglionic neurones take part in the transmission of nerve impulses of the sympathetic system. The preganglionic neurones lie in the thoracic and lumbar segments of the spinal cord. Their cell bodies are located in the grey matter, and their nerve fibres leave the spinal cord via the anterior root to reach a prevertebral ganglion. The postganglionic neurones have their cell bodies in a ganglion and, from there, they send their fibres to the target organ or tissue. Chains of sympathetic ganglia extend from the neck to the sacrum on either side of the vertebral bodies. As they leave the spinal cord, the fibres of the preganglionic neurones synapse with the cell bodies of the nearby postganglionic neurones. Physiological: Stimulation of the sympathetic nervous system produces dilation of the pupils, vasodilation in the coronary arterial system, bronchodilation, relaxation of the smooth muscle of the bladder, ejaculation in men, inhibition of mucus secretion of salivary glands in the buccal and nasal mucosae and urine formation in the kidney; reduced gastric and intestinal peristalsis; contraction of the heart, the spleen and the sphincters of the colon, the small intestine and the bladder; enhancement of blood coagulation, hepatic glycogenesis and glandular secretion in the sex organs. Thus, it allows the body to face situations of excitement, nervous tension or emotional upset. Ciliary ganglion Pterygopalatine ganglion Submandibular ganglion Optic ganglion Iris Lacrimal gland Salivary glands-submandibular, sublingual and parotid 8. Trachea and bronchi Stomach Liver and gall bladder Pancreas Kidney Small intestine Large intestine Bladder Sex organs and external genitalia Comments Anatomical: Two neurones are needed to transmit the nerve impulse to the affected organ. Acetylcholine is the neurotransmitter released by preganglionic fibres in the sympathetic ganglia; noradrenaline is the neurotransmitter released in the effector organs of the sympathetic nervous system. Physiological: Stimulation of the parasympathetic nervous system causes contraction of the pupils, the trachea and bronchi and the bladder wall; erection; relaxation of the vesical and intestinal sphincters; a drop in the frequency and force of the heartbeat; enhanced secretion of tears, saliva, gastric and pancreatic juices, bile and urine; enhanced digestion and gastric and intestinal peristalsis. The overall effect of its activation is to allow digestion and restorative processes in the body to take place in peace and quiet. Clinical: Vasovagal syncope, associated with bradycardia and hypotension, with possible loss of consciousness, is due to overactivity of the parasympathetic nervous system in certain circumstances, such as prolonged standing, exposure to confined spaces, severe pain and the sight of blood. Incus Stapes Semicircular canal Vestibulocochlear nerve Cochlea Auditory (pharyngotympanic or eustachian) tube 7. Tympanic membrane External acoustic meatus Lobule Helix Auricle Temporal bone Malleus Comments Anatomical: the ear is made up of three separate parts-the external ear, the middle ear and the internal ear. The external ear consists of the auricle and the external acoustic meatus, made up of fibrocartilage and osteocartilage, respectively. The middle ear consists of the tympanic membrane, which separates the external acoustic meatus from the tympanic cavity; the three ossicles, the malleus (or hammer), the incus (or anvil) and the stapes (or stirrup); the mastoid bone and the eustachian tube, which connects the tympanic cavity to the nasopharynx. The internal ear is made up of the bony and the membranous labyrinths, consisting of the cochlea and the vestibule. Physiological: the ear is the auditory organ responding to sound, which is due to air vibration. The external ear picks up the sound waves and transmits them to the middle ear as they are amplified by the vibrations of the tympanic membrane. The middle ear then transmits the sound vibrations towards the internal ear, mobilising the auditory ossicles, the perilymph and the endolymph. Clinical: the clinical signs and symptoms of dysfunction of the ear include pain, ringing in the ear, partial or total (unilateral or bilateral, acute or chronic) hearing loss, otorrhoea (leakage of blood, pus or cerebrospinal fluid) and vertigo. Malleus (hammer) Incus (anvil) Head Body Oval window of the vestibule Stapes (stirrup) Handle of the malleus Tympanic membrane Comments Anatomical: the three ossicles-the malleus (hammer), incus (anvil) and stapes (stirrup)-are the auditory ossicles of the middle ear. Held in place by their ligaments, they are linked by joints and operate as a unit. The handle of the malleus is in contact with the tympanic membrane, and its head is linked to the incus (the intermediate ossicle). The incus is linked to the stapes (the third ossicle), which is attached to the oval window of the vestibule. Physiological: the vibrations of the membrane are transmitted to the three ossicles. The movements of the stapes (the third ossicle) generate across the oval window of the vestibule fluid waves in the perilymph of the scala vestibuli, which are transmitted to the cochlear duct. Clinical: the auditory threshold is at 0 decibels (dB), and the pain threshold is at 130 dB. Signs and symptoms of acute otitis media include fever, earache, partial hearing loss, sometimes with purulent discharge. Ampulla of the anterior semicircular canal Vestibular nerve Cochlear nerve Cochlea Cochlear duct Vestibule Saccule Utricle Posterior semicircular canal (membranous) Lateral semicircular canal (membranous) Temporal bone Anterior semicircular canal (membranous) Comments Anatomical: the internal ear consists of two parts, the bony labyrinth and the membranous labyrinth, and three regions-the vestibule containing the utricle and the saccule, the semicircular canals lying in the three planes of space, and the cochlea. The bony labyrinth contains the membranous labyrinth, which floats in the perilymph and is filled with endolymph. The cochlear duct is the part of the membranous labyrinth at which the ciliated cochlear cells give rise to the auditory receptors in the organ of Corti. By transforming fluid waves into electrical signals, the internal ear plays in a role in hearing. The utricle and the saccule, which form part of the vestibule, along with the semicircular canals, are responsible for the maintenance of balance. Clinical: A lesion of the internal ear can cause sensorineural deafness and balance problems. An isolated and brief attack of vertigo, caused by the circular movement of the head, is typical of benign paroxysmal positional vertigo. Scala vestibuli (perilymph) Cochlear duct (endolymph) Hair cell Tectorial membrane Spiral organ Basilar membrane Scala tympani (perilymph) Vestibulocochlear nerve, cochlear part Comments Anatomical: the cochlea, shaped like the shell of a snail, is made up of the scala vestibuli, the cochlear duct and the scala tympani. The cochlear duct contains the hair cells carrying the auditory receptors, which make up the spiral organ of Corti. The scala tympani and the scala vestibuli contain a fluid known as perilymph, whereas the cochlear duct contains endolymph. The auditory receptors are the dendrites of the sensory nerves that cluster to form the cochlear part of the vestibulocochlear nerve. Clinical: A change in the position of the head provokes a movement in the perilymph and endolymph, which will set in motion the stereocilia of the hair cells and stimulate the sensory receptors. Balance is maintained by an antagonism between the two ears, with an increase in the vestibular activity in one ear and a decrease in the other ear. Oval window of vestibule Scala vestibuli Cochlear duct Basilar membrane and spiral organ of Corti Scala tympani Round window of cochlea Auditory (eustachian) tube Tympanic membrane Chain of auditory ossicles Comments Physiological: In the external ear, the auricle picks up the sound waves from the air and transmits them to the middle ear by causing the tympanic membrane to produce vibrations and amplify them. The middle ear then transmits these vibrations to the inner ear via the mechanical motion of the ossicles. The motion of the last ossicle (the stapes), acting across the oval window, generates fluid waves in the perilymph of the scala vestibuli, which are reflected towards the cochlear duct. The waves produced in the endolymph then cause the basilar membrane to vibrate and stimulate the receptors of the hair cells of the spiral organ. Sounds of different frequencies stimulate the basilar membrane at different points. The nerve impulses thus produced are then transmitted to the brain via the auditory portion of the vestibulocochlear nerve. Clinical: the amplitude of a sound wave is measured by its frequency in hertz (Hz). Exposure to a loud noise can damage the hair cells of the spiral organ of Corti and cause deafness, especially if it is of long duration. Ciliary body Suspensory ligament of lens Iris Lens Cornea Anterior chamber Posterior chamber Scleral venous sinus (canal of Schlemm) 9. Vitreous body Retina Sclera Choroid Macula Optic nerve Optic disc Retinal vein Retinal artery Comments Anatomical: the eye lies in the orbital cavity and is made up of an outer coat, internal structures and adnexal structures. The outer coat consists of three layers-a fibrous external layer composed of the sclera (the white of the eye), which is continuous with the cornea, an intermediate vascular layer containing the choroid (the vascular layer of the eye), and continuous with the ciliary body and the iris, and an inner nervous layer made up of the retina, which lies between the choroid and the vitreous body. The internal structure of the eye consists of the lens, the aqueous humour and the vitreous body. The adnexal structures of the eye comprise the eyelids, the conjunctiva, the lacrimal glands, the lacrimal ducts and the oculomotor muscles. The eye is supplied by the ciliary arteries and the central retinal artery and vein, and it is innervated by the optic nerve. The sclera gives the eye its shape and provides sites of attachment for the ocular muscles. The rays of light penetrate the eye at the level of the pupil and are refracted by the cornea, which allows them to reach the retina. The role of the retina is to transform light energy into electrical energy, which is then transmitted to the brain via the optic nerve. Clinical: Monocular vision-using one eye-is possible but is associated with a reduced ability to judge distances in space and see the world properly in three dimensions. Choroid Pupil Ciliary body Iris, with circular and meridional fibres of the ciliary muscle Comments Anatomical: the choroid lines most of the internal surface of the sclera. The iris is a coloured ring containing the pigmented cells in the anterior part of the eye; it divides the eye into the anterior and posterior chambers, both of which contain the aqueous humour. It consists of two layers of smooth muscle and encloses the centrally located pupil. The ciliary body secretes the aqueous humour, and its muscle fibres control the size and thickness of the lens. Stimulation of the oculomotor nerve causes the ciliary muscle to contract and produce accommodation.

Disks if different antibiotics are placed within the colonies of bacteria Streptococcus (causes sore throat) Staphylococcus (causes boils) Salmonella typhosa (causes typhoid fever) Spirochaeta (causes syphilis) Bacteriology involves the use of cultures to identify types of bacteria and to develop and test antibiotics medications and mothers milk 2014 cheap olanzapine 7.5 mg on line. Pathogenic bacteria include Streptococcus symptoms 6dpo cheap olanzapine 2.5mg visa, Staphylococcus treatment goals for anxiety olanzapine 5mg low price, Salmonella symptoms nausea fatigue 7.5mg olanzapine free shipping, and the spirochetes treatment of pneumonia buy olanzapine 5mg low price. Predictably medications without doctors prescription order discount olanzapine, a few years following the introduction of antibiotics into the human bacteriological milieu, acquired drug resistance emerged in several bacterial species. Driven by natural selection in an environment rife with broad-spectrum antibiotics, antimicrobial resistance among many species of pathogenic bacteria has grown alarmingly prevalent, with many organisms exhibiting resistance to multiple antibiotics. Many common bacterial pathogens exhibit significant levels of antibiotic resistance. Once found primarily in health care settings, antibiotic-resistant strains of common bacterial pathogens are increasingly common in community- acquired infections. Therapeutic Bacteria the normal bacterial flora of the human gastrointestinal tract perform beneficial functions, including breaking down plant-derived carbohydrates and synthesizing vitamin K and certain B-complex vitamins. Additionally, normal gut flora compete with potentially pathogenic bacteria, including S. Building on observations of the beneficial functions of normal intestinal flora, bacteriologists and health care professionals are exploring the potential uses of probiotics for a variety of gastrointestinal and other medical disorders. Probiotics, according to the Food and Agriculture Organization of the United Nations and the World Health Organization, are live microorganisms that, when administrated in adequate amounts, confer a health benefit on the host. Large-scale, controlled clinical trials of various probiotic formulations for specific indications and ongoing bacteriologic research help clarify the potential role of bacteria as therapeutic agents. Impact the relationship between bacteria and human health remains dynamic, as bacterial species evolve and biomedical discoveries open new possibilities for interrupting pathogenicity and utilizing these ubiquitous organisms to promote health. Infectious disease text with referenced discussion of the epidemiology, pathogenesis, microbiology, and antimicrobial resistance of nosocomial (hospital acquired) infections associated with intravascular devices. Infectious disease text with referenced information on bacterial classification, virulence factors, pathogenicity, and evolution. Infectious disease text with referenced discussion of the epidemiology, pathogenesis, microbiology, and antimicrobial resistance of health-care-acquired pneumonia. Review of the uses, mechanisms of action, and clinical evidence of three therapeutic, probiotic formulations. Review of clinical research data supporting the use of probiotics for the prevention and management of infectious diarrhea and possible applications of genetically engineered probiotics. Case-history-based essay on the selective pressures and emergence of antimicrobial resistance among three common bacterial pathogens. Salem Health Balantidiasis Category: Diseases and conditions Anatomy or system affected: Gastrointestinal system, intestines, stomach Also known as: Balantidiosis Definition Balantidiasis is an infectious gastrointestinal illness caused by the protozoan parasite Balantidium coli, a single-celled microbial organism that also infects pigs, rodents, horses, sheep, and goats. The organism secretes a substance that breaks down the intestinal mucosa, causing ulceration and various other gastrointestinal symptoms. Risk Factors Balantidiasis occurs throughout the world but is most prevalent in locations where exposure to animal excrement is common, such as facilities where pigs or other infected animals are raised, slaughtered, or prepared as food. Living or working in such environments and poor sanitary conditions increase the risk of infection. Persons with impaired immunity or who are generally unwell because of malnutrition, cancer, or alcoholism are more likely than healthy persons to manifest symptoms. Balantidiasis can cause gastrointestinal disease ranging from mild fever and stomach pain to severe diarrhea, vomiting, weight loss, and dehydration. Rarely, patients with balantidiasis develop a tear (perforation) in the lining of the intestines or develop pneumonia or inflammation of the lymph nodes. Treatment and Therapy Balantidiasis is treated with the antibiotic medications tetracycline and metronidazole, together with intravenous fluids for patients who are dehydrated. Prevention and Outcomes Balantidiasis can be prevented by practicing good hygiene, especially when preparing food, and by avoiding environments where potentially infectious animals are handled. Bartonella infections Category: Diseases and conditions Anatomy or system affected: All Also known as: Bacillary angiomatosis, bacteremia, bartonellosis, cat scratch fever, endocarditis, Oroya fever, trench fever, urban trench fever Definition the bacterium Bartonella is a member of the family Bartonellaceae. Twenty-four species of Bartonella have been identified, ten of which cause infectious diseases in humans. Bartonella infections include Oroya fever, cat scratch fever, trench fever, endocarditis, bacteremia, and bacillary angiomatosis. Causes Bartonella infection is caused by Bartonella bacteria entering the body of humans and other mammals by the bites of fleas, sandflies, and ticks or by animal bites or scratches. The bacteria travel through the bloodstream and cause infections that can be mild or lifethreatening, involve different body systems and organs, and present in different ways. Today, some of these same factors occur in homeless populations, leading to the reemergence of infection. Also, researchers have determined that veterinary and animal shelter staff and animal groomers and trainers are at an increased risk for Bartonella infection because of daily exposure to animals, animal feces, and parasites. Symptoms Symptoms of Bartonella infection depend on the bacteria involved and on the degree of infection. One of the most common infections, Oroya fever, has initial symptoms of fever, jaundice, and anemia. Once Oroya fever has progressed from the acute to chronic phase, infected persons develop verruga peruana (Peruvian warts), which are blood-filled warts. Trench fever may present with symptoms of high fever, severe headache, eye pain, and muscle pain in the back and shins. Screening and Diagnosis Screening and diagnosis of Bartonella infection relies on epidemiologic data for an affected population and confirmation by laboratory evaluation. Because of the wide range of presenting symptoms and organ involvement, diagnosis is most commonly made using polymerase chain reaction testing and serology to detect antibodies. The Centers for Disease Control and Prevention recommends an immunofluorescent antibody assay. Treatment and Therapy Persons with otherwise healthy immune systems often do not receive treatment for mild or moderate Bartonella infection, but severely infected persons or those with compromised immune systems may be treated Salem Health with a course of oral or intravenous antibiotic drugs such as erythromycin, doxycycline, and azithromycin. Prevention and Outcomes Animals and household pets represent a large reservoir for many types of Bartonella bacteria that may infect humans. The Diagnosis, Treatment, and Prevention of "Bartonella": Atypical "Bartonella" Treatment Failures and Forty Hypothetical Physical Exam Findings. Bat species are ancient; their genome contains conserved information likely to be shared by many mammalian species. Thus, cellular receptors recognized by bat viruses may be homologous and identical to receptors conserved in many other mammalian species. In this state of lowered metabolism, pathogens may remain latent and depressed immune systems may fail to clear them from their systems. As bats are flying mammals, their range is large, increasing the probability of transmission of pathogens over a large area. Some bats migrate, some as far as eight hundred miles, increasing the range for dispersal of pathogens significantly. Bats often rest en masse in caves, in colonies that often run in the millions, often including more than one species. In addition, bats use echolocation and make high-pitched sounds that are emitted with great pressure, resulting in aerosolization of droplets from their respiratory tracts. A bat with a latent infection could continue in a carrier state and transmit pathogens for decades. This may contribute to the apparent capability of bats to carry pathogens in a subclinical state for long periods. Bats transmit rabies, a type of viral encephalitis that is nearly 100 percent fatal once signs have set in. A number of different bat species propagate their own rabies variant, and genetic sequencing identifies specific strains. Globally, the number of rabies cases caused by exposure to bats is negligible in comparison with those transmitted by dogs and terrestrial wildlife. Nonetheless, in developed nations where dog rabies has been eradicated, bat rabies make up an increasing proportion of cases. In addition, many rabies infections occur in persons who have no known history of exposure. In South America, vampire bats transmit rabies to humans and domestic animals during their normal feeding behavior. A genus of the family Rhadoviridae, which includes rabies, lyssavirus also causes severe Bats and infectious disease Category: Transmission Definition Bats are flying mammals belonging to the order Chiroptera (meaning "hand-wing"). The order is one of the most widespread on Earth, inhabiting all continents except Antarctica. The genome of many species is highly conserved, meaning the species has not changed significantly over time. In addition to being the only mammal that flies, bats also have a highly specialized sensory specialization of echolocation. Bats are relatively small, but because they fly, they can inhabit large ranges; some migrate hundreds of miles. They also tend to spend a great deal of time living in large, multispecies colonies at densities as high as three hundred bats per square foot. Zoonotic Disease Historically, bats have been associated with disease and danger to humans, perhaps in part because some bats are hematophagous (blood-eating). Bats do transmit rabies to both humans and domestic animals (even more so if they are hematophagous), but their contribution to the transmission of rabies is relatively small worldwide. Bats have become a concern because they are increasingly associated with the emergence of previously unknown viruses. Also, newly recognized strains of lyssavirus and new paramyxoviruses arose from virus reservoirs in bats. In addition, bats are potential sources of bacterial and fungal pathogens such as histoplasmosis. Research continues to isolate previously unknown viruses from bats, although most are not dangerous to humans. Between 1996 and 1998, a novel lyssavirus was isolated from a flying fox in New South Wales, Australia; two women died of the virus after exposure to sick bats. The disease was caused by a coronavirus that was isolated from masked palm civets and raccoon dogs, but, ultimately, the origin of the virus was believed to be in Chinese horseshoe bats. Flying foxes were implicated as sources for another novel pathogen, the paramyxoviruses known as hendra virus and nipah virus (a family of viruses that includes measles, rinderpest, and canine distemper viruses), which emerged to cause outbreaks of acute respiratory syndromes respectively in horses and humans in Hendra, Australia, and in pigs and humans in Malaysia from 1994 to 2004. The diseases were often fatal, killing 105 of 265 people in Malaysia and resulting in the culling (slaughter) of more than one million pigs. Nipah virus also has been found in flying foxes in Bangladesh, India, and Cambodia. The disease has occurred as localized outbreaks in Africa and has been exported to Europe and North America with nonhuman primates. Humans exposed to dust from large bat colonies may contract the pulmonary infection known as fungal histoplasmosis. The disease is generally mild, flulike, and self-limiting, but it can be severe if exposure is significant or is suffered by immunocompromised persons. As effective insectivores, bats save millions of dollars in damage to crops and probably prevent more vectorborne diseases in humans than they cause. A comprehensive review of bat natural history and a survey of emerging viral pathogens associated with bats. An introduction and general look at emerging diseases and human factors increasing exposures to potential pathogens. A report of the emergence of a novel lyssavirus and related outbreaks from 1996 through 1999. The syndrome is more prevalent in nations of the Mediterranean and the East, and it first appears in persons who are between twenty and forty years of age. Multiple causes have been proposed, however, including viral and bacterial infection, autoimmune response, and genetic predisposition. Men are affected twice as frequently as women and often have more severe symptoms. Primary symptoms include recurrent ulcers on the skin, genitals, and in the mouth. Other manifestations include inflammation of the tissues of the eye (uveitis, glaucoma), hearing loss, arthritis, neurological impairment, increased allergic response (pathergy), and the formation of blood clots (thrombosis). Corticosteroids, which are used to treat many symptoms, may be applied topically to areas of skin and mouth ulceration, administered as eye drops, injected into the joints for arthritis symptoms, and administered intravenously or in pill form for the treatment of systemic (widespread) inflammation. Antiviral medicines such as acyclovir or valcyclovir may be used if the cause is linked to a viral infection. Steroids may be used alone, or in combination with an antiviral drug, to decrease inflammation of the nerve. In rare cases, surgery may be used to widen the bony corridor where the nerve passes through to the face. Physical therapy may be ordered by the doctor to keep the facial muscles in shape during the disease. Because the affected eye may not close completely, lubricating drops or ointments and eye protection may be used. Helpful preventive measures are careful handwashing, avoiding contact with sick people, and practicing safer sex. The eye on the affected side may not close, and normal facial movements are difficult.

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