MMA Quickinfo

Chickenpox

2008-02-17T08:12:00.000-08:00

What is it?
Chickenpox is a highly contagious infection and is generally a disease of childhood.

How do you get it?
It spreads by inhalation of infective droplets or contact with lesions after 10-20 days.

What are the signs and symptoms?
Fever and malaise are mild in children and more marked in adults. Fluid-filled lesions, quickly rupturing to form small ulcers, may appear first in the mouth and throat. The rash begins prominently on the face, scalp, and trunk, and later involves the extremities. Pimples change in a few hours to vesicles (fluid-filled lesions) that eventually form crusts. New lesions may erupt for 1-5 days, so that all stages of the eruption are usually present simultaneously. The crusts slough in 7-14 days. The lesions are superficial and elliptical, with slightly serrated borders.

How do you diagnose it?
Diagnosis is usually made clinically, from its signs and symptoms.

What are its complications?
Pneumonia is more common in adults (especially smokers, and pregnant women) than in children and may result in acute respiratory distress syndrome (ARDS). Ischemic strokes have been recognized in the wake of chickenpox. Hepatitis occurs in a small percentage of chickenpox patients. Encephalitis is infrequent may be life-threatening. Secondary bacterial infections are common. Pitted scars are frequent sequelae. Reye's syndrome also complicates chickenpox, usually in childhood, and is associated with aspirin therapy.

When contracted during the first or second trimesters of pregnancy, chickenpox carries a very small risk of congenital malformations. If a mother develops chickenpox within 5 days after delivery, the newborn is at risk for disseminated disease and should receive varicella-zoster immune globulin (VZIG).

What can you do at home?
Patients should be isolated until primary crusts have disappeared and kept at bed rest until they are fever free. The skin should be kept clean. Paracetamol can be used to control fever.

How do you treat it?
Hospitalized patients with chickenpox should be isolated, and caregivers should wear gowns, gloves, and masks when in contact with them. Itching can be relieved with medications.

Acyclovir is an antiviral agent that can be used in chickenpox. It reduces the severity and shorten the duration of chickenpox in adults and in children. Acyclovir, if given in the first 72 hours of zoster, reduces the number of days of fever and the maximum number of lesions.

How do you prevent it?
Patients with active chickenpox should be separated from non-chickenpox infected people. They should stay away from work when active vesicles are present, typically from the tenth day after onset through the twenty-first day. A vaccine against chickenpox is also available.

Chikungunya

2008-02-17T08:10:00.002-08:00

What is it?
It is an infection caused by Chikungunya virus, which is an Alphavirus.

How do you get it?
The virus is transmitted by Aedes mosquito when it bites an uninfected person after biting an infected person.

What are it’s signs and symptoms?
Following the transmission of the virus, the newly infected person may show no signs of the illness for about 2 to 4 days. This is called the incubation period. In patients with chikungunya, after the incubation period, there is a sudden onset of fever and severe joint pains, accompanied by chills, flushed face, headache, muscular pain, backache, and difficulty looking at bright objects.
Joint pains are in multiple joints, involving different joints at different times, and mostly involve the small joints.
Skin rashes, typically on the trunk and limbs, occur usually during the second to fifth day of illness. The clinical picture resembles that of dengue fever, with which chikungunya is often confused. Most infections are probably asymptomatic. Joint pains may last several months. Although mild hemorrhagic manifestations have been reported; Chikungunya virus is not a cause of severe hemorrhagic disease.

How do you diagnose it?
Diagnosis is clinical, from the patient’s signs and symptoms. Investigations are usually not required to make the diagnosis and initiate management. Blood tests may be required if the illness need to be differentiated from Dengue Fever.

What is safe home care?
The patient should be given bed rest, plenty of oral fluids; not just plain water and Paracetamol for fever. Mild exercises in the morning will help relieve the pain.

How do you treat it?
There is no specific treatment for Chikungunya virus. Anti-inflammatory drugs may relieve joint pains. The severe joint pains may last several months, however, it usually reduces in intensity over a few weeks.

How do you prevent it?
Prevention depends on mosquito control and decreasing mosquito exposure.

Dengue

2008-02-17T08:10:00.001-08:00

What is it?
It is an infection caused by the Dengue Virus, which is an Flavivirus.

How do you get it?
The virus is transmitted by Aedes aegypti mosquito when it bites an uninfected person after biting an infected person.

What are it’s signs and symptoms?
Following the transmission of the virus, the newly infected person may show no signs of the illness for about 3 to 14 days. This is called the incubation period. In many, the infection is so mild that no apparent signs or symptoms are seen. In those who are symptomatic, the illness can range from a mild non-specific viral illness to a severe illness causing haemorrhagic complications.
The Classical form is mostly seen in adults and older children. In the young child the illness is usually mild.
The usual signs and symptoms are: sudden onset fever, headache, chills, eye pain, bodyaches, muscular and joint pains. A rash may be seen over the trunk around the 3rd to 5th day of illness. Nausea, vomiting, lymph node enlargement, anorexia, constipation, and altered taste sensation are common. Occasionally, petechiae (bleeding under the skin) are seen on the feet, legs, hands, arm pit, and palate late in the illness. The illness generally lasts 5 to 7 days, after which recovery is complete, although convalescence may be prolonged.
Decrease in white cell count with a relative increase in lymphocytes and decrease in platelets may occur. Liver enzyme levels may be elevated, and bleeding manifestations may occur. Neurologic manifestations such as encephalopathy and seizures may occur during the disease's febrile stage.

How do you diagnose it?
Diagnosis of dengue infections should be based on clinical signs and symptoms and on epidemiologic information such as travel history. Laboratory testing is useful only for confirmation of the clinical diagnosis.

What is safe home care?
Fever may be initially managed at home with oral Paracetamol. The patient should be given bed rest, plenty of oral fluids; not just plain water. If the patient becomes acutely unwell especially with altered conscious state and or cold hands and feet; urgent care should be sought.
Certain pain relieving medications (Ibuprofen and diclofenac) are not routinely recommended and can be potentially dangerous.

How do you treat it?
There is no specific treatment for Dengue fever. Anti-viral medications have not been seen to be effective. Management consists of supportive fluid therapy and close monitoring for progress of disease and complications.

How do you prevent it?
Prevention depends on mosquito control and decreasing mosquito exposure.

DENGUE HAEMORRHAGIC FEVER

Dengue hemorrhagic fever (DHF) is a severe form of dengue infection that is most commonly observed in children younger than 15 years. Although the risk of DHF is higher in patients are being infected a second time, it also occurs in patients who have primary infections.

Signs and symptoms:
DHF is characterized by sudden onset of fever, usually lasting 2 to 7 days, and nonspecific signs and symptoms. The critical stage of DHF occurs between 24 hours before and 24 hours after the patient's temperature falls to or below normal. During this time, bleeding manifestations usually occur, and signs of circulatory failure may appear. The patient may become restless or lethargic, experience acute abdominal pain, and have cold extremities and decreased urine output, usually on or after the third day of illness.
Clinical laboratory tests at this time will show low platelet counts, a low serum total protein level, a low albumin level, and a rise in hematocrit. Another indication of vascular leakage is pleural effusion (collection of fluid in the space just outside the lungs).
Loss of intravascular volume may result in hypovolemia, shock, and death if not corrected. The most common bleeding manifestations are bleeding under the skin, but bleeding from the nose, bleeding gums, gastrointestinal bleeding, and blood in urine may occur.

Treatment:
There is no vaccine for dengue/DHF. Treatment is supportive. Currently, disease prevention depends exclusively on mosquito control and personal protective measures such as mosquito repellents.

Diabetes

2008-02-17T08:09:00.001-08:00

Name and magnitude of the problem:
Diabetes Mellitus. This metabolic disease which is manifests with hyperglycemia comprising mainly of 2 types, type 1 DM and type 2 DM. The former is characterized by a distinct autoimmune process which leads to an absolute deficiency of insulin whereas the latter and the more common type 2 DM is characterized by a predominant initial insulin resistance and a strong hereditary component. At the turn of the new millennium the prevalence of DM was estimated to be 0.19% in people <20>20 years old. In individuals >65 years the prevalence of DM was 20.1%. More alarmingly the incidence seems to be increasing for both types of DM.

How one contracts the illness:
Exact cause of DM is unknown, but most likely a combination of genetic predisposition, viral infection, lifestyle, nutrition and diet, obesity, autoimmune disorders, and exposure to toxic agents have a role to play in different magnitudes in different types of DM.

Signs and symptoms:
The most characteristic symptoms are polyuria (increased urination), polydipsia (increased thirst), polyphagia (increased eating) and rapid weight loss. Some may present with generalized weakness, fatigue, dehydration, non-healing wounds, increased susceptibility to infections or even with acute complications such as ketoacidosis. A large population also presents with chronic complications of long standing DM of which they were not aware of previously. These complications include visual problems, renal impairment, neuropathies, adverse cardiac events etc …

How it is diagnosed:
Symptomatic patient (ie: symptoms such as polyuria, polydipsia, and weight loss) associated with random plasma glucose >11.1mmol/L (200 mg/dL) can be diagnosed as DM. Fasting plasma glucose (FPG) > 7.0 mmol/L (126 mg/dL) also warrants the diagnosis of DM.
There is also a current concept of pre diabetes which includes impaired fasting glucose (IFG) and impaired glucose tolerance both are associated with risk of progression to DM as well as increased cardiovascular adverse outcomes.
Impaired fasting glucose (IFG) is defined as plasma glucose (FPG) >5.6 mmol/L (100 mg/dL) but <7.0>

How it is treated:
The main two modalities of treatment are orally taken medication and insulin injection. Along with these its imperative that a diabetic diet and a regular exercise regimen be followed.

Important considerations:
Since one of the main complications of uncontrolled diabetes is cardiovascular adverse effects its important that other risk factors such as hypertension, dyslipidemias etc be optimally managed.

What can you do?
The most important first step is early detection and control and thus as soon as symptoms consistent with DM are noted medical attention should be sought. Also adherence to the exercise program, diabetic diet as well as medications is extremely important especially given the fact that this is a long standing chronic disease.

Hand Foot & Mouth Disease

2008-02-17T08:08:00.000-08:00

What is it?
Hand-foot-and-mouth disease is a mild, enteroviral disease characterized by a fever vesicular eruption in the mouth and over the hands and feet. It occurs most frequently in children younger than age 5.

How do you get it?
An uninfected child gets the illness when respiratory droplets from an infected child are inhaled. Respiratory droplets are formed during coughing, sneezing and during speech. The virus also gets transmitted when spit or sputum contaminated objects (Eg: Toys) are handled by an uninfected child. Stool contamination (feco-oral) of food and drinking water has also been documented as a transmission route.

What are it’s signs and symptoms?
After an incubation period of 3 to 6 days druing which the newly infected child remains well, the illness begins with mild fever ranging from 38° to 39° C, decreased appetite, malaise, and, often, a sore mouth. Within 1 or 2 days vesicular lesions appear in the oral cavity, most frequently on the inside of the cheeks and the tongue, but also on the inside of the lips, gums, and hard palate. In the majority of preschool children, but in only some of the infected adults, the oral lesions are accompanied by vesicular skin lesions, most often on the hands and feet and on the fingers and toes, but not infrequently on the palms and soles. Less often, lesions occur on the buttocks or more proximally on the extremities, and rarely on the genitalia. They are generally 3 to 7 mm in diameter and surrounded by a narrow zone of redness. They range from 2 or 3 to 30 or more.

How do you diagnose it?
Diagnosis is clinical, from the symptoms and signs.Blood tests are not required.

Home care:
Patient should be given bed-rest, plenty of oral fluids (not just plain water) and Paracetamol for the fever. In addition, patient’s with this disease should be kept separate from individuals without the disease.

How do you treat it?
Treatment is supportive. The lesions usually resolve in 1 week even without any treatment. Treatment mostly targets reducing discomfort while the body clears the infection by itself.

Mumps

2008-02-17T08:04:00.000-08:00

What is it?
Mumps is a paramyxoviral disease causing painful swelling of the salivary glands and, less commonly, of the testes, brain and its coverings, pancreas, and ovaries. Most patients are children. . Infectivity occurs via saliva and urine and precedes the symptoms by about 1 day and is maximal for 3 days but may last a week.

Clinical features:
The incubation period is 14-21 days. Up to one-third of affected individuals have subclinical infection.Those who do show evidence of the illness usually present with tender swollen parotid gland (the saliva producing gland situated near the angle of the jaw on either side of the face) tenderness (tenderness at the angle of the jaw) accompanying facial swelling.
Usually, one parotid gland enlarges a couple of days prior to the other, but unilateral parotid gland involvement can occur. Difficulty and pain in opening the mouth may result from the parotid gland inflammation. The parotid glands return to normal size within a week. Involvement of other salivary glands in conjunction with the parotids occurs in some of the cases.

Fever and malaise are variable and are often minimal in young children. High fever usually accompanies inflammation of the testes and coverings of the brain. Neck stiffness, headache, and lethargy suggest inflammation of the coverings of the brain. Testicular swelling and tenderness denote its inflammation, which is the most common extra-salivary gland manifestation of mumps in adults, but sterility is rare. Upper abdominal pain, nausea, and vomiting suggest inflammation of the pancreas. Lower abdominal pain and ovarian enlargement suggest inflammation of the ovaries, but the diagnosis may be difficult to make.

Complications:
Other manifestations of the disease are less common than inflammation of the salivary glands. These usually follow the inflammation of the salivary glands, but may precede it or occur without salivary gland involvement and include inflammation of the coverings of the brain, testes, pancreas, ovaries, thyroid gland, liver, kidneys and heart, decreased platelet counts in the blood and joint pains.

How is it diagnosed?
Diagnosis of simple cases is clinical. Blood tests are not routinely required. In complicated cases, investigations help to identify other organs involved.

Treatment:
The patient should be isolated until swelling subsides and kept at bed rest during the febrile period. Treatment of patients with mumps is largely supportive, although anti-inflammatory agents may be useful in cases of severe inflammation of the testes or joints.

Prevention:
Mumps vaccine is safe and highly effective. It is recommended for routine immunization for children over age 1 year, either alone or in combination with other virus vaccines (eg, in MMR vaccine). A second dose is recommended for children prior to starting school. It should not be given to pregnant women or to individuals with decreased immunity.

Hyperemesis

2008-02-17T07:57:00.000-08:00

What is it?
Nausea and Vomiting in the first 3 months of pregnancy is called morning sickness. This maybe experienced by 50% of pregnant women.
About 1-2% of these women may experience severe form of this which when is called Hyperemesis Gravidarum. The concern of over hyperemesis is that it can lead to derangements in body’s fluid and electrolytes (body’s mineral) content, weight loss and liver damage. This may affect growth of the baby.

What are the causes?
The cause is not fully understood, but maybe hormone related. It is commonly seen in multiple pregnancies ( twins or more) and is also seen in abnormal pregnancies like molar pregnancy.

What are the signs and symptoms?
Excessive vomiting – may or may not be related to eating, weight loss, dehydration and weakness. These are all related to the loss of nutrients and minerals in the vomitus. In very severe cases the mineral and electrolyte imbalance may be severe enough to require hospitalised care.

What is the treatment?
Your doctor will rule out other causes of excessive vomiting and will make an assessment of your condition. The condition may require hospitalization based on the severity.
Medications may be started to reduce nausea and vomiting.
Management is based on improve hydration and replacement of electrolytes lost and adequate nutrition.

Seizures

2008-02-17T07:55:00.000-08:00

Name and magnitude of the problem:
Seizures are a temporary neurologic event that results from some abnormality in the central nervous system (CNS). Epilepsy describes a condition where there is a tendency in an individual to have recurrent seizures due to a chronic underlying process. 5-10% of all populations are expected to experience at least one seizure. The incidence of epilepsy is 5-10 in 1000.

How one contracts the illness:
There are many causes of seizures; some of these are obvious (eg. Head injury, drug toxicity or withdrawal, high fever, stroke) while others need extensive investigations to diagnose (eg. Electrolyte or metabolic derangements, CNS tumors, genetic predisposition, infective causes, drugs that lower the threshold for seizures …). A lot of the time a specific cause of the ailment cannot be found with any degree of certainty.

Signs and symptoms:
Seizures present with many varied physical presentations. There can be differences in the characteristic features, severity of manifestations, durations and level of consciousness. Some generalized seizures start with a prodrome which may include lethargy, depression, irritability, jerking of limbs, headache etc … The actual seizure may consist of loss of consciousness, partial or full body muscle spasm or contraction, unresponsive staring, apnea or cessation of breathing, a cry or blue coloring of the lips/nose etc… The seizure maybe accompanied or followed by bowel or bladder incontinence, deep coma, confusion or deep sleep.

How it is diagnosed:
A good description or witnessing of the seizure in most cases is enough to make a diagnosis of seizures. EEG can be useful during the seizure if it can be recorded during the episode and sometimes even when taken between seizures. Neuroimaging can be useful to delineate the exact cause of the seizure. Similarly some blood tests may also assist in ascertaining the cause.

How it is treated:
There are many medications that are used to treat seizures. They have to be taken regularly and advice followed diligently when discontinuation is being considered. Uncommonly surgical treatment is also used in specific conditions.

Important considerations:
Seizures can be life threatening or may result in permanent disability due to damage to the brain. Thus all preventive measures possible should be taken in situations or in patients prone to develop seizures.

What can you do?
The most important action to be taken is to ensure that the patient does not suffer an injury during the seizure. There is no need to physically restrain the patient other than to achieve this. Do not try to give any food or drink to the patient during or just after the seizure. Try to bring the patient to medical attention as soon as possible.

Stroke

2008-02-17T07:32:00.000-08:00

Name and magnitude of the problem:
Stroke (cerebrovascular accident). This is a very common ailment affecting millions each year. It leaves more than half the affected disabled requiring years of rehabilitation efforts.

How one contracts the illness:
A stroke occurs when there is a disruption of the cerebral blood flow to the brain. It results in either temporary or permanent neurologic deficits. There are two major categories of stroke. Ischemic stroke (cerebral infarction) accounts for 80% of all strokes and results from embolic obstruction or thrombosis of a vessel supplying a part of the brain. Hemorrhagic stroke, the other 20% of strokes, results from bleeding either into the subarachnoid space or the parenchyma of the brain.

Signs and symptoms:
Patient manifestations vary according to location affected. It may range from sudden onset of loss of power of one whole side of the body to a short lived mild weakness of one limb which lasts only about 5minutes. Some other manifestations include paresthesias; loss of vision in part of the visual field; hemisensory deficits; swallowing difficulties; aphasia (inability to produce or understand speech), severe headache, sudden loss of consciousness etc …

How it is diagnosed:
Diagnosis can be made with some degree of certainty after taking history and in some cases neurological examination. It can be established by neuroimaging.

How it is treated:
If patient presents within 3 hours to a center experienced in thrombolysis of stroke patients clot lysis using thrombolytics is the treatment of choice in selected patients. In ischemic strokes aspirin or other anti-platelet drugs are instituted early on. Most cases do not require any treatment other than supportive care, including physiotherapy, use of proper feeding techniques, prevention of deep vein thrombosis etc…

Important considerations:
Since one of the main risk factors of strokes is hypertension, it should be aggressively treated as soon as detected. Creating awareness regarding need and benefits of adequate control of hypertension will go a long way in decreasing the incidence of this disease of high morbidity and mortality.

What can you do?
Once stroke is suspected medical attention should be sought immediately since the 1st 24hours are most critical period. Due attention should be also given to proper feeding techniques as lot of the time deterioration of patient is not due to stroke per se, but due to aspiration of food into the respiratory airways. Physiotherapy on a continued basis is imperative for the proper recovery of the patient which may take from 3-6 months- or as long as 2yrs in some cases.

Dysmenorrhoea (Painful periods)

2008-02-17T07:31:00.000-08:00

What is it?
Pain during period is called Dysmenorrhoea. In some women this can be very severe affecting day to day life.

What causes it?
In some cases there is an identifiable cause while in other it is not so. When there is no apparent cause in the womb it is called Primary dysmenorrhoea. This is the commonest type and is seen in teenagers and women in their early 20’s. Where there is a disease of the womb causing the pain, it is called Secondary dysmenorrhoea. It is seen in women around their third and fourth decade of life.

What are the reasons for the pain?
The reason is not clearly known. It thought that it maybe due to a build up of chemicals/hormones during periods which causes excessive squeezing of muscles of the womb resulting in reduces blood to the womb. In some women the womb maybe extra sensitive to this chemical causing pain. In secondary dysmenorrhoea various different gynecological conditions like fibroids , ovarian cyst , endometriosis are the causes of pain.

What are the symptoms?
Pain is the primary complaint. It usually starts with the bleeding but sometimes may start a day or so earlier. The pain usually lasts 12-24 hrs but sometimes may last 3-4 days. It is commonly seen that the intensity of pain reduces as the woman increases in age. It some it completely disappears after a pregnancy.

Pain in secondary dysmenorrhoea is very varied according to the underlying cause.

What is the treatment?
Warmth – warm bath or a hot water bottle against lower abdomen maybe soothing to some.
Pain killers – There are many under different names for sale. Some of the common over-the-counter medications used are Panadol, Ponstan and Brufen. All medications should be ideally used under the guidance of your doctor.
Contraceptive pill (combined pill)– this reduces the chemical substance related to pain during periods.
Treatment of secondary dysmenorrohoea is the treatment of the disease.

Vaginal Thrush

2008-02-17T07:28:00.000-08:00

What is it?
Thrush is in an infection caused by a yeast called Candida. Candida is normally found on the skin and around the vagina. But its number increases when the immune system of the patient is low and presents as an infection.

What are the symptoms?
Discharge (white curd-like, sometimes watery).
Redness, itching , discomfort in and around the vagina.
Painful in some cases.
It does not harm the baby if the woman is pregnant and does not spread to the womb.

How and why does one get it?
The cause is usually not known. It is thought that sometime due to loss of natural defense around vagina in some conditions like pregnancy, diabetes or with use of antibiotics the yeast gets an opportunity to flourish and cause an infection. Other immuno-deficiency states can also lead to thrush.

What is the Treatment?
When the discharge is troublesome, consult your gynecologist to have it diagnosed. Not all discharges are Thrush. You may or may not require a laboratory test to confirm the infection. A test may involve taking a swab of the discharge and sending to the laboratory. Results usually take 48hours to be reported.

There are various creams for local application (around the itchy area) and vaginal pessaries (for insertion into the vagina) that can be used to control the infection.