AMOEBIASIS,

or Amebiasis, Entamoeba histolytica. Likewise amoebiasis is sometimes incorrectly used to refer to infection with other amoebae, but strictly speaking it should be reserved for Entamoeba histolytica infection. o Dientamoeba fragilis, which causes Dientamoebiasis o Entamoeba dispar o Entamoeba hartmanni o Entamoeba coli o Entamoeba moshkovskii o Endolimax nana and o Iodamoeba butschlii. A gastrointestinal infection that may or may not be symptomatic and can remain latent in an infected person for several years. Symptoms can range from mild diarrhea to dysentery with blood and mucus in the stool. Severe amoebiasis infections (known as invasive or fulminant amoebiasis) occur in two major forms. Invasion of the intestinal lining causes amoebic dysentery or amoebic colitis. If the parasite reaches the bloodstream it can spread through the body, most frequently ending up in the liver where it causes amoebic liver abscesses. Liver abscesses can occur without previous development of amoebic dysentery. Transmission- fecaloral route, but it can also be transmitted indirectly through contact with dirty hands or objects as well as by anal-oral contact.

commonly this means the liver, as this is where blood from the intestine reaches first, but they can end up almost anywhere. Treatment- E. histolytica infections occur in both the intestine and (in people with symptoms) in tissue of the intestine and/or liver. As a result, two different classes of drugs are needed to treat the infection, one for each location. Such anti-amoebic drugs are known as amoebicides.

Complications: HEPATIC AMOEBIASIS includes subdiaphragmatic abscess, perforation of diaphgram to pericardium and pleural cavity, perforation to abdominal cavital (amoebic peritonitis) and perforation of skin (amoebic cutis). PULMONARY AMOEBIASIS can occur from hepatic lesion by haemotagenous spread and also by perforation of pleural cavity and lung. It can cause lung abscess, pulmono pleural fistula, empyema lung and broncho pleural fistula. It can also reach brain through blood vessel and cause amoebic brain abscess and amoebic meningoencephalitis. CUTANEOUS AMOEBIASIS can also occur skin around site of colostomy wound, perianal region, region overlying visceral lesion and at the site of drainage of liver abscess. UROGENITAL TRACT AMOEBIASIS derived from intestinal lesion can cause amoebic vulvovaginitis (May's disease), rectovesicle fistula and rectovaginal fistula.

Prevention: Wash hands thoroughly with soap and hot running water for at least 10 seconds after using the toilet or changing a baby's diaper, and before handling food. Clean bathrooms and toilets often; pay particular attention to toilet seats and taps. Avoid sharing towels or face washers. Avoid raw vegetables when in endemic areas, as they may have been fertilized using human feces. Boil water or treat with iodine tablets. Avoid eating Street Foods especially in public places where others are sharing sauces in one container Symptoms take from a few days to a few weeks to develop and manifest themselves, but usually it is about two to four weeks. Symptoms can range from mild diarrhoea to dysentery with blood and mucus. The blood comes from amoebae invading the lining of the intestine. In about 10% of invasive cases the amoebae enter the bloodstream and may travel to other organs in the body. Most

ANTHRAX

is an acute disease caused by the bacterium Bacillus anthracis. Anthrax commonly infects wild and domesticated herbivorous mammals that ingest or inhale the spores while grazing. Ingestion is thought to be the most common route by which herbivores contract anthrax. Carnivores living in the same environment may become infected by consuming infected animals. Diseased animals can spread anthrax to humans, either by direct contact (e.g., inoculation of infected blood to broken skin) or by consumption of a diseased animal's flesh. Signs and symptoms: Pulmonary- Respiratory infection in humans initially presents with cold or flu-like symptoms for several days, followed by severe (and often fatal) respiratory collapse.

Gastrointestinal- Gastrointestinal infection in humans is most often caused by eating anthrax-infected meat and is characterized by serious gastrointestinal difficulty, vomiting of blood, severe diarrhea, acute inflammation of the intestinal tract, and loss of appetite. Some lesions have been found in the intestines and in the mouth and throat. Cutaneous- Cutaneous (on the skin) anthrax infection in humans shows up as a boil-like skin lesion that eventually forms an ulcer with a black center (eschar). The black eschar often shows up as a large, painless necrotic ulcer (beginning as an irritating and itchy skin lesion or blister that is dark and usually concentrated as a black dot, somewhat resembling bread mold) at the site of infection. In general, cutaneous infections form within the site of spore penetration between 2 and 5 days after exposure. Unlike bruises or most other lesions, cutaneous anthrax infections normally do not cause pain Exposure: Occupational exposure to infected animals or their products (such as skin, wool, and meat) is the usual pathway of exposure for humans. Workers who are exposed to dead animals and animal products are at the highest risk, especially in countries where anthrax is more common Diagnosis: Other than Gram stain of specimens, there are no specific direct identification techniques for identification of Bacillus species in clinical material. These organisms are Gram-positive but with age can be Gramvariable to Gram-negative Prevention: An anthrax vaccine (BioThrax or Anthrax Vaccine Adsorbed) licensed by the U.S. Food and Drug Administration (FDA) and produced from one non-virulent strain of the anthrax bacterium was formerly administered in a six-dose primary series at 0, 2, 4 weeks and 6, 12, 18 months, with annual boosters to maintain immunity. On December 11, 2008, the FDA approved omitting the week 2 dose, resulting in the currently recommended five-dose series. Treatment: Anthrax cannot be spread directly from person to person, but a peoples clothing and body may be contaminated with anthrax spores. Effective decontamination of people can be accomplished by a thorough wash-down with antimicrobial effective soap and water. Waste water should be treated with bleach or other anti-microbial agent. Effective decontamination of articles

can be accomplished by boiling contaminated articles in water for 30 minutes or longer. Chlorine bleach is ineffective in destroying spores and vegetative cells on surfaces, though formaldehyde is effective. Burning clothing is very effective in destroying spores. After decontamination, there is no need to immunize, treat or isolate contacts of person ill with anthrax unless they were also exposed to the same source of infection. Antibiotics- Treatment for anthrax infection and other bacterial infections includes large doses of intravenous and oral antibiotics, such as fluoroquinolones like ciprofloxacin, or doxycycline, erythromycin, vancomycin or penicillin. FDA-approved agents include ciprofloxacin, doxycycline and penicillin

CHOLERA is an infection of the small

intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhoea and vomiting.It can also lead to death in some cases, and the cause is unsanitary water or sewage. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces of an infected but asymptomatic person. The severity of the diarrhea and vomiting can lead to rapid dehydration and electrolyte imbalance and death in some cases. The primary treatment is with oral rehydration solution (ORS) to replace water and electrolytes, and if this is not tolerated or doesn't provides quick enough treatment, intravenous fluids can also be used. Antibiotics are beneficial in those with severe disease to shorten the duration and severity. Worldwide it affects 35 million people and causes 100,000130,000 deaths a year as of 2010. Cholera was one of the earliest infections to be studied by epidemiological methods. The primary symptoms of cholera are profuse painless diarrhea and vomiting of clear fluid.These symptoms usually start suddenly, one to five days after ingestion of the bacteria.The diarrhea is frequently described as "rice water" in nature and may have a fishy odor. An untreated person with cholera may produce 1020 litres of diarrhea a day with fatal results. For every symptomatic person there are 3 to 100 people who get the infection but remain asymptomatic. If the severe diarrhea and vomiting are not aggressively treated it can, within hours, result in life-threatening dehydration and electrolyte imbalances. The typical symptoms of dehydration include low blood pressure, poor

skin turgor (wrinkled hands), sunken eyes, and a rapid pulse. Diagnosis- A rapid dip-stick test is available to determine the presence of V. cholerae. In those that test positive, further testing should be done to determine antibiotic resistance. In epidemic situations, a clinical diagnosis may be made by taking a history and doing a brief examination. Treatment is usually started without or before confirmation by laboratory analysis. Stool and swab samples collected in the acute stage of the disease, before antibiotics have been administered, are the most useful specimens for laboratory diagnosis. If an epidemic of cholera is suspected, the most common causative agent is Vibrio cholerae O1. If V. cholerae serogroup O1 is not isolated, the laboratory should test for V. cholerae O139. Prevention Sterilization: Proper disposal and treatment of infected fecal waste water produced by cholera victims and all contaminated materials (e.g. clothing, bedding, etc.) is essential. Sewage: antibacterial treatment of general sewage by chlorine, ozone, ultraviolet light or other effective treatment before it enters the waterways or underground water supplies helps prevent undiagnosed patients from inadvertently spreading the disease. Sources: Warnings about possible cholera contamination should be posted around contaminated water sources with directions on how to decontaminate the water (boiling, chlorination etc.) for possible use. Water purification: All water used for drinking, washing, or cooking should be sterilized by either boiling, chlorination, ozone water treatment, ultraviolet light sterilization (. Public health education and adherence to appropriate sanitation practices are of primary importance to help prevent and control transmission of cholera and other diseases. Treatment: Fluids- In most cases, cholera can be successfully treated with oral rehydration therapy (ORT), which is highly effective, safe, and simple to administer. Rice-based solutions are preferred to glucosebased ones due to greater efficiency. In severe cases with significant dehydration, intravenous rehydration may be necessary. Ringer's lactate is the preferred solution, often with added potassium

Electrolytes- As there frequently is initially acidosis, the potassium level may be normal, even though large losses have occurred. As the dehydration is corrected, potassium levels may decrease rapidly, and thus need to be replaced. Antibiotics- Antibiotic treatments for one to three days shorten the course of the disease and reduce the severity of the symptoms. People will recover without them, however, if sufficient hydration is maintained. Doxycycline is typically used first line, although some strains of V. cholerae have shown resistance. Testing for resistance during an outbreak can help determine appropriate future choices.Other antibiotics that have been proven effective include cotrimoxazole, erythromycin, tetracycline, chloramphenicol, and furazolidone. Fluoroquinolones, such as norfloxacin, also may be used, but resistance has been reported.

PINWORM INFECTION or ENTEROBIASIS is a human parasitic

disease and one of the most common childhood parasitic worm infections in the developed world.It is caused by infestation with the parasitic roundworm Enterobius vermicularis, commonly called the human pinworm. Infection usually occurs through the ingestion of pinworm eggs, either through contaminated hands, food, or less commonly, water. The chief symptom is itching in the anal area. The incubation time from ingestion of eggs to the first appearance of new eggs around the anus is 4 to 6 weeks. Signs and symptoms Pinworms seen around a person's anus. One third of individuals with pinworm infection are totally asymptomatic. The main symptoms are pruritus ani and perineal pruritus, i.e., itching in and around the anus and around the perineum. The itching occurs mainly during the night, Both the migrating females and the clumps of eggs are irritating, but the mechanisms causing the intense pruritus have not been explained. The intensity of the itching varies, and it can be described as tickling, crawling sensations, or even acute pain. The itching leads to continuously scratching the area around the anus, which can further results in tearing of the skin and complications such as secondary bacterial infections, including bacterial dermatitis (i.e., skin inflammation) and folliculitis (i.e., hair follicle inflammation).General symptoms are insomnia (i.e., persistent difficulties to sleep) and restlessness. A considerable proportion of

children suffer from anorexia (i.e., loss of appetite), weight loss, irritability, emotional instability, and enuresis (i.e., inability to control urination). Pinworms cannot damage the skin, and they do not normally migrate through tissues. However, in women they may move onto the vulva and into the vagina, from there moving to external orifice of the uterus, and onwards to the uterine cavity, fallopian tubes, ovaries, and peritoneal cavity. This can cause vulvovaginitis, i.e. an inflammation of the vulva and vagina. This causes vaginal discharge and pruritus vulvae, i.e., itchiness of the vulva. The pinworms can also enter the urethra, and presumably, they carry intestinal bacteria with them. Preventative action revolves around personal hygiene and the cleanliness of the living quarters.The main measures are keeping fingernails short, and washing and scrubbing hands and fingers carefully, especially after defecation and before meals. Under ideal conditions, bed covers, sleeping garments, and hand towels should be changed daily. Simple laundering of clothes and linen disinfects them. Children should wear gloves while asleep, and the bedroom floor should be kept clean. Food should be covered to limit contamination with dust-borne parasite eggs. Household detergents have little effect on the viability of pinworm eggs, and cleaning the bathroom with a damp cloth moistened with an antibacterial agent or bleach will merely spread the viable eggs. Similarly, shaking clothes and bed linen will detach and spread the eggs. Treatment The benzimidazole compounds albendazole (brand names e.g., Albenza, Eskazole, Zentel and Andazol) and mebendazole (brand names e.g., Ovex, Vermox, Antiox and Pripsen) are the most effective. They work by inhibiting the microtubule function in the pinworm adults, causing glycogen depletion, thereby effectively starving the parasite. A single 100 milligram dose of mebendazole with one repetition after a week, is considered the safest, and is usually effective with cure rate of 96%. Mebendazole has no serious side effects, although abdominal pain and diarrhea have been reported. Pyrantel pamoate (also called pyrantel embonate, brand names e.g., Reese's Pinworm Medicine, Pin-X, Combantrin, Anthel, Helmintox, and Helmex) kills adult pinworms through neuromuscular blockade, and is considered as effective as the benzimidazole compounds. Other medications are piperazine, which causes flaccid paralysis in the adult

pinworms, and pyrvinium pamoate (also called pyrvinium embonate), which works by inhibiting oxygen uptake of the adult pinworms. Pinworms located in the genitourinary system (in this case, female genital area) may require other drug treatments.

GONORRHEA (also colloquially known as

the clap is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain. In both men and women if gonorrhea is left untreated, it may spread locally causing epididymitis or pelvic inflammatory disease or throughout the body, affecting joints and heart valves. Treatment is commonly with ceftriaxone as antibiotic resistance has developed to many previously used medications. Signs and symptoms Half of women with gonorrhea are asymptomatic while others have vaginal discharge, lower abdominal pain or pain with intercourse. Most men who are infected have symptoms such as urethritis associated with burning with urination and discharge from the penis. The incubation period is 2 to 30 days with most symptoms occurring between 46 days after being infected. Diagnosis Traditionally, gonorrhea was diagnosed with gram stain and culture Prevention While the only sure way of preventing gonorrhea is abstaining from sexual intercourse, the risk of infection can be reduced significantly by using condoms correctly and by having a mutually monogamous relationship with an uninfected person. Treatment : Penicillin entered mass production in 1944 and revolutionized the treatment of several venereal diseases. Gonorrhea if left untreated may last for weeks or months with higher risks of complications. As of 2010 injectable ceftriaxone appears to be one of the few effective antibiotics. Because of increasing

rates of antibiotic resistance local susceptibility patterns need to be taken into account when deciding on treatment. Many antibiotics that were once effective including penicillin, tetracycline and fluoroquinolones are no longer recommended because of high rates of resistance. Cases of resistance to ceftriaxone have been reported but are still rare.

circulation (leading to confusion and coma due to hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding). This may become life-threatening and occasionally requires a liver transplant. Chronic Chronic hepatitis often leads to nonspecific symptoms such as malaise, tiredness and weakness, and often leads to no symptoms at all. It is commonly identified on blood tests performed either for screening or to evaluate nonspecific symptoms. The occurrence of jaundice indicates advanced liver damage. On physical examination there may be enlargement of the liver. Extensive damage and scarring of liver (i.e. cirrhosis) leads to weight loss, easy bruising and bleeding tendencies, peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the abdominal cavity). Eventually, cirrhosis may lead to various complications: esophageal varices (enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction). Acne, abnormal menstruation, lung scarring, inflammation of the thyroid gland and kidneys may be present in women with autoimmune hepatitis. Causes Acute Viral hepatitis: o Hepatitis A, B, C, D, and E. o Yellow fever o KIs-V o adenoviruses Non-viral infection o toxoplasma o Leptospira o Q fever o rocky mountain spotted fever Alcohol Toxins: Amanita toxin in mushrooms, carbon tetrachloride, asafetida Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many others (see longer list below). Ischemic hepatitis (circulatory insufficiency) Pregnancy Auto immune conditions, e.g., Systemic Lupus Erythematosus (SLE)

HEPATITIS (plural hepatitides) is a medical

condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar (), the root being hepat- (-), meaning liver, and suffix -itis, meaning "inflammation" (c. 1727) The condition can be self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis. Hepatitis may occur with limited or no symptoms, but often leads to jaundice, anorexia (poor appetite) and malaise. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide, but it can also be due to toxins (notably alcohol, certain medications, some industrial organic solvents and plants), other infections and autoimmune diseases. Signs and symptoms Acute Initial features are of nonspecific flu-like symptoms, common to almost all acute viral infections and may include malaise, muscle and joint aches, fever, nausea or vomiting, diarrhea, and headache. More specific symptoms, which can be present in acute hepatitis from any cause, are: profound loss of appetite, aversion to smoking among smokers, dark urine, yellowing of the eyes and skin (i.e., jaundice) and abdominal discomfort. Physical findings are usually minimal, apart from jaundice in a third and tender hepatomegaly (swelling of the liver) in about 10%. Some exhibit lymphadenopathy (enlarged lymph nodes, in 5%) or splenomegaly (enlargement of the spleen, in 5%). Acute viral hepatitis is more likely to be asymptomatic in younger people. Symptomatic individuals may present after convalescent stage of 7 to 10 days, with the total illness lasting 2 to 6 weeks. A small proportion of people with acute hepatitis progress to acute liver failure, in which the liver is unable to clear harmful substances from the

Metabolic diseases, e.g., Wilson's disease

Chronic Viral hepatitis: Hepatitis B with or without hepatitis D, hepatitis C (neither hepatitis A nor hepatitis E causes chronic hepatitis) Autoimmune o Autoimmune hepatitis Alcohol Drugs o methyldopa o nitrofurantoin o isoniazid o ketoconazole Non-alcoholic steatohepatitis Heredity o Wilson's disease o alpha 1-antitrypsin deficiency Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic hepatitis Alcoholic hepatitis Ethanol, mostly in alcoholic beverages, is a significant cause of hepatitis. Usually alcoholic hepatitis comes after a period of increased alcohol consumption. Alcoholic hepatitis is characterized by a variable constellation of symptoms, which may include feeling unwell, enlargement of the liver, development of fluid in the abdomen ascites, and modest elevation of liver blood tests. Alcoholic hepatitis can vary from mild with only liver test elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and liver failure. Severe cases are characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both categories is 50% within 30 days of onset. Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption. Alcoholic hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic hepatitis by itself does not lead to cirrhosis, but cirrhosis is more common in patients with long term alcohol consumption. Patients who drink alcohol to excess are also more often than others found to have hepatitis C. The combination of hepatitis C and alcohol consumption accelerates the development of cirrhosis. Drug induced A large number of drugs can cause hepatitis:

Agomelatine (antidepressant) Allopurinol Amitriptyline (antidepressant) Amiodarone (antiarrhythmic) Atomoxetine

[8]

Azathioprine[9] Halothane (a specific type of anesthetic gas) Hormonal contraceptives Ibuprofen and indomethacin (NSAIDs)

Isoniazid (INH), rifampicin, and pyrazinamide (tuberculosis-specific antibiotics) Ketoconazole (antifungal) Loratadine (antihistamine) Methotrexate (immune suppressant) Methyldopa (antihypertensive) Minocycline (tetracycline antibiotic) Nifedipine (antihypertensive) Nitrofurantoin (antibiotic)

Paracetamol (acetaminophen in the United States) can cause hepatitis when taken in an overdose. The severity of liver damage may be limited by prompt administration of acetylcysteine.

Phenytoin and valproic acid (antiepileptics)

Troglitazone (antidiabetic, withdrawn in 2000 for causing hepatitis) Zidovudine (antiretroviral i.e., against HIV) Some herbs and nutritional supplements

The clinical course of drug-induced hepatitis is quite variable, depending on the drug and the patient's tendency to react to the drug. For example, halothane hepatitis can range from mild to fatal as can INH-induced hepatitis. Hormonal contraception can cause structural changes in the liver. Amiodarone hepatitis can be untreatable since the long half life of the drug (up to 60 days) means that there is no effective way to stop exposure to the drug. Statins can cause elevations of liver function blood tests normally without indicating an underlying hepatitis. Lastly, human variability is such that any drug can be a cause of hepatitis. Other toxins Other Toxins can cause hepatitis: Amatoxin-containing mushrooms, including the Death Cap (Amanita phalloides), the Destroying Angel (Amanita ocreata), and some species of Galerina. A portion of a single mushroom can be enough to be lethal (10 mg or less of -amanitin). White phosphorus, an industrial toxin and war chemical. Carbon tetrachloride ("tetra", a dry cleaning agent), chloroform, and trichloroethylene, all chlorinated hydrocarbons, cause steatohepatitis (hepatitis with fatty liver).

 Cylindrospermopsin, a toxin from the cyanobacterium Cylindrospermopsis raciborskii and other cyanobacteria. Metabolic disorders Some metabolic disorders cause different forms of hepatitis. Hemochromatosis (due to iron accumulation) and Wilson's disease (copper accumulation) can cause liver inflammation and necrosis. Non-alcoholic steatohepatitis (NASH) is effectively a consequence of metabolic syndrome. Obstructive "Obstructive jaundice" is the term used to describe jaundice due to obstruction of the bile duct (by gallstones or external obstruction by cancer). If longstanding, it leads to destruction and inflammation of liver tissue. Autoimmune Anomalous presentation of human leukocyte antigen (HLA) class II on the surface of hepatocytes, possibly due to genetic predisposition or acute liver infection; causes a cell-mediated immune response against the body's own liver, resulting in autoimmune hepatitis. Alpha 1-antitrypsin deficiency In severe cases of alpha 1-antitrypsin deficiency (A1AD), the accumulated protein in the endoplasmic reticulum causes liver cell damage and inflammation. Non-alcoholic fatty liver disease Non-alcoholic fatty liver disease (NAFLD) is the occurrence of fatty liver in people who have no history of alcohol use. It is most commonly associated with obesity (80% of all obese people have fatty liver). It is more common in women. Severe NAFLD leads to inflammation, a state referred to as non-alcoholic steatohepatitis (NASH), which on biopsy of the liver resembles alcoholic hepatitis (with fat droplets and inflammatory cells, but usually no Mallory bodies).

infiltration of the liver is medical imaging, including such ultrasound, computed tomography (CT), or magnetic resonance (MRI). However, imaging cannot readily identify inflammation in the liver. Therefore, the differentiation between steatosis and NASH often requires a liver biopsy. It can also be difficult to distinguish NASH from alcoholic hepatitis when the patient has a history of alcohol consumption. Sometimes in such cases a trial of abstinence from alcohol along with followup blood tests and a repeated liver biopsy are required. NASH is becoming recognized as the most important cause of liver disease second only to hepatitis C in numbers of patients going on to cirrhosis. Ischemic hepatitis Ischemic hepatitis is caused by decreased circulation to the liver cells. Usually this is due to decreased blood pressure (or shock), leading to the equivalent term "shock liver". Patients with ischemic hepatitis are usually very ill due to the underlying cause of shock. Rarely, ischemic hepatitis can be caused by local problems with the blood vessels that supply oxygen to the liver (such as thrombosis, or clotting of the hepatic artery which partially supplies blood to liver cells). Blood testing of a person with ischemic hepatitis will show very high levels of transaminase enzymes (AST and ALT), which may exceed 1000 U/L. The elevation in these blood tests is usually transient (lasting 7 to 10 days). It is rare that liver function will be affected by ischemic hepatitis. Hepatitis A is caused by eating food and drinking water infected with a virus called HAV. It can also be caused by anal-oral contact during sex. While it can cause swelling and inflammation in the liver, it doesn't lead to chronic, or life long, disease. Almost everyone who gets hepatitis A has a full recovery. Hepatitis B is caused by the virus HBV. It is spread by contact with an infected person's blood, semen, or other body fluid. And, it is a sexually transmitted disease (STD). You can get hepatitis B by: Having unprotected sex (not using a condom) with an infected person. Sharing drug needles (for illegal drugs like heroin and cocaine or legal drugs like vitamins and steroids).

The diagnosis depends on medical history, physical exam, blood tests, radiological imaging and sometimes a liver biopsy. The initial evaluation to identify the presence of fatty

 Getting a tattoo or body piercing with dirty (unsterile) needles and tools that were used on someone else. Getting pricked with a needle that has infected blood on it (health care workers can get hepatitis B this way). Sharing a toothbrush, razor, or other personal items with an infected person. An infected woman can give hepatitis B to her baby at birth or through her breast milk. Through a bite from another person.

disorders based on the site of infection. Oral herpes, the visible symptoms of which are colloquially called cold sores or fever blisters, infects the face and mouth. Oral herpes is the most common form of infection. Genital herpes, known simply as herpes, is the second most common form of herpes. Signs and symptoms HSV infection causes several distinct medical disorders. Common infection of the skin or mucosa may affect the face and mouth (orofacial herpes), genitalia (genital herpes), or hands (herpetic whitlow). More serious disorders occur when the virus infects and damages the eye (herpes keratitis), or invades the central nervous system, damaging the brain (herpes encephalitis). Patients with immature or suppressed immune systems, such as newborns, transplant recipients, or AIDS patients are prone to severe complications from HSV infections. HSV infection has also been associated with cognitive deficits of bipolar disorder, and Alzheimer's disease, although this is often dependent on the genetics of the infected person.

With hepatitis B, the liver also swells. Hepatitis B can be a serious infection that can cause liver damage, which may result in cancer. Some people are not able to get rid of the virus, which makes the infection chronic, or life long. Blood banks test all donated blood for hepatitis B, greatly reducing the risk for getting the virus from blood transfusions or blood products. Hepatitis C is caused by the virus HCV. It is spread the same way as hepatitis B, through contact with an infected person's blood, semen, or body fluid (see above). Like hepatitis B, hepatitis C causes swelling of the liver and can cause liver damage that can lead to cancer. Most people who have hepatitis C develop a chronic infection. This may lead to a scarring of the liver, called cirrhosis. Blood banks test all donated blood for hepatitis C, greatly reducing the risk for getting the virus from blood transfusions or blood products. Hepatitis D is caused by the virus HDV. You can only get hepatitis D if you are already infected with hepatitis B. It is spread through contact with infected blood, dirty needles that have HDV on them, and unprotected sex (not using a condom) with a person infected with HDV. Hepatitis D causes swelling of the liver. Hepatitis E is caused by the virus HEV. You get hepatitis E by drinking water infected with the virus. This type of hepatitis doesn't often occur in the U.S. It causes swelling of the liver, but no longterm damage. It can also be spread through oralanal contact.

Condition

Description

Herpetic gingivostomatitis is often Herpetic the initial presentation during the gingivostomati first herpes infection. It is of tis greater severity than herpes labialis which is often the subsequent presentations. nfection occurs when the virus Herpes labialis comes into contact with oral mucosa or abraded skin. When symptomatic, the typical manifestation of a primary HSV-1 or HSV-2 genital infection is clusters of inflamed papules and vesicles on the outer surface of the genitals resembling cold sores. Herpes whitlow is a painful infection that typically affects the fingers or thumbs. Occasionally infection occurs on the toes or on the nail cuticle. Individuals that participate in contact sports such as wrestling, rugby, and soccer sometimes acquire a condition caused by HSV-

Herpes genitalis

Herpetic whitlow

HERPES SIMPLEX (Ancient Greek:

- herpes, lit. "creeping") is a viral disease caused by both Herpes simplex virus type 1 (HSV1) and type 2 (HSV-2). Infection with the herpes virus is categorized into one of several distinct

Herpes gladiatorum

acquire a condition caused by HSV1 known as herpes gladiatorum, scrumpox, wrestlers herpes, or mat herpes, which presents as skin ulceration on the face, ears, and neck. Symptoms include fever, headache, sore throat and swollen glands. It occasionally affects the eyes or eyelids. Primary infection typically presents Herpetic as swelling of the conjunctiva and keratoconjunct eyelids (blepharoconjunctivitis), ivitis accompanied by small white itchy lesions on the surface of the cornea. A herpetic infection of the brain that is thought to be caused by the retrograde transmission of virus from a peripheral site on the face following HSV-1 reactivation, along the trigeminal nerve axon, to the brain. HSV is the most common cause of viral encephalitis. When infecting the brain, the virus shows a preference for the temporal lobe. HSV-2 is the most common cause of Mollaret's meningitis, a type of recurrent viral meningitis. Neonatal HSV infection is a rare but serious condition, usually caused by vertical transmission of HSV (type 1 or 2) from mother to newborn.

immune function (e.g. HIV/AIDS, immunosuppression in solid organ transplants). Laboratory tests include: culture of the virus, direct fluorescent antibody (DFA) studies to detect virus, skin biopsy, and polymerase chain reaction (PCR) to test for presence of viral DNA. Treatment- There is no method to eradicate herpes virus from the body, but antiviral medications can reduce the frequency, duration, and severity of outbreaks. Analgesics such as ibuprofen and acetaminophen can reduce pain and fever. Topical anesthetic treatments such as prilocaine, lidocaine, benzocaine or tetracaine can also relieve itching and pain Antiviral The antiviral medication acyclovir. There are several antivirals that are effective for treating herpes including: aciclovir (acyclovir), valaciclovir (valacyclovir), famciclovir, and penciclovir. A number of topical antivirals are effective for herpes labialis including acyclovir, penciclovir, and docosanol. Certain dietary supplements and alternative remedies are claimed to be beneficial in the treatment of herpes. There is however insufficient evidence to support use of many of these compounds including echinacea, eleuthero, Llysine, zinc, bee products and aloe vera.

Herpesviral encephalitis

Herpesviral meningitis

Neonatal herpes simplex

In patients with a weakened immune system, herpes simplex During can cause unusual lesions in the immunodeficie skin. One of the most striking is the ncy appearance of clean linear erosions in skin creases, with the appearance of a knife cut. Herpetic sycosis Herpetic sycosis is a recurrent or initial herpes simplex infection affecting primarily the hair follicle Infection with herpesvirus in patients with chronic atopic dermatitis may result in spread of herpes simples throughout the
eczematous areas.

HOOKWORM INFECTION
There are many species of hookworms that infect mammals. The most important, at least from the human standpoint, are the human hookworms, Ancylostoma duodenale and Necator americanus, which infect an estimated 15-20% of the world's population. larvae infect humans by burrowing through the skin (for example, through bare feet), and migrating through the blood system to the lungs. From here they pass to the throat, where they are swallowed, and move down to the intestine. The adult worms feed in the intestine by attaching themselves to the lining with sharp "teeth". Here they produce eggs, which are then passed out with the feces. Juveniles (larvae) of the dog and cat hookworms (A. caninum and A. braziliense, respectively) can

Eczema herpeticum Herpes esophagitis

Symptoms may include painful swallowing (odynophagia) and difficulty swallowing (dysphagia). It is often associated with impaired

infect humans, but the juvenile worms will not mature into adult worms. Rather, the juveniles remain in the skin where they continue to migrate for weeks (or even months in some instances) until killed by the host's inflammatory response. This causes local intense itching and results in a condition known as "cutaneous" or "dermal larval migrans" or "creeping eruption." Hence the importance of not allowing dogs and cats to defecate indiscriminately.

The protein deficiency also can result in significantly delayed physical development in children. In its most progressive state can result in death. Diagnosis and Tests: The presence of hookworms can be demonstrated by finding the characteristic eggs in the feces; the eggs can not, however, be differentiated to species. Treatment and Prevention:

There are three pathological phases to hookworm infections: Cutaneous or invasive phase: When larvae initially penetrate the skin they can cause irritation and itching and if they fail to locate a blood capillary they can wander through the skin causing a condition known as cutaneous larval migrans, leaving a track visualized under the skin by the presence of the host inflammatory reaction. Pulmonary phase: This occurs during the period when the larvae are bursting out of the capillaries in the lungs into the alveolar spaces. This causes local haemorrhaging at the site. This is rarely symptomatic, except when there is a heavy infection, when it can result in pneumonitis, and can also cause a cough and a sore throat. Intestinal phase: Adult worms are usually restricted to the anterior third of the small intestine, but where infections are very heavy they can occupy the whole length of the small intestine. The worms clamp onto the mucosa abrading the surface and sucking the blood. Proteolytic enzymes from the dorsal pharyngeal gland are released into the buccal cavity which aid in digestion.

The drug of choice for the treatment of hookworm disease is mebendazole which is effective against both species, and in addition, will remove the intestinal worm Ascaris also, if present. The drug is very efficient, requiring only a single dose and is inexpensive -- the "perfect drug". However, treatment requires more than giving the anthelmintic, the patient should also receive dietary supplements to improve their general level of health, in particular iron supplementation is very important. Topical treatment with thiabendazole ointment is very effective in controlling dermal larval migrans. Complications The mouthparts of hookworms are modified into cutting plates. Attachment of hookworms to the host's small intestine causes hemorrhages, and the hookworms feed on the host's blood. Hookworm disease can have devastating effects on humans, particularly children, due to the loss of excessive amounts of blood. Heavy hookworm infections can account for as much as 200ml of blood loss per day.

KISSING DISEASE -Infectious

mononucleosis (IM; also known as EBV infectious mononucleosis or glandular fever or Pfeiffer's disease or Filatov's disease and sometimes colloquially as the kissing disease from its oral transmission or simply as mono in North America and as glandular fever in other English-speaking countries) is an infectious, widespread viral disease caused by the EpsteinBarr virus (EBV), one type of herpes virus. Main symptoms: The classical symptoms of mononucleosis are a sore throat, fever, fatigue, malaise, pharyngeal inflammation, vomiting, petechiae and loss of appetite. Common signs include lymphadenopathy (enlarged lymph nodes),

Signs and Symptoms The most common effect from hookworm infections is the varying degrees of anemia, depending on the level of the infection and the nutritional state of the patient. Patients also can suffer from protein deficiency which manifests as dry hair, skin and edema, but protein loss can have far-reaching effects including reduced immunocompetence and reduced ability to produce gama globulin (Antibody). The infection is particularly severe in children, and the development of a pot belly, as a result of the edema, is a common symptom of the infection.

splenomegaly (enlarged spleen), hepatitis (refers to inflammation of hepatocytescells in the liver) and hemolysis (the bursting of red blood cells). Often, if symptoms are not apparent in the first two days of possible viral infection, then mononucleosis is not present. Older adults are less likely to have a sore throat or lymphadenopathy, but are instead more likely to present with hepatomegaly (enlargement of the liver) and jaundice. Rarer signs and symptoms include thrombocytopenia (lower levels of platelets), with or without pancytopenia (lower levels of all types of blood cells), splenic rupture, splenic hemorrhage, upper airway obstruction, pericarditis and pneumonitis. Another rare manifestation of mononucleosis is erythema multiform.

Pediculosis may be divided into the following types: Pediculosis capitis (Head lice infestation) Pediculosis corporis (Pediculosis vestimenti, Vagabond's disease) Pediculosis pubis (Crabs) Head-lice infestation is most frequent on children aged 310 and their families. Females are more frequently infested than males. Head lice are spread through direct head-to-head contact with an infested person. Diagnosis To diagnose infestation, the entire scalp should be combed thoroughly with a louse comb and the teeth of the comb should be examined for the presence of living lice after each time the comb passes through the hair. The use of a louse comb is the most effective way to detect living lice. The most characteristic symptom of infestation is pruritus (itching) on the head which normally intensifies 3 to 4 weeks after the initial infestation. The bite reaction is very mild and it can be rarely seen between the hairs. The most common symptom of lice infestation is itching. Excessive scratching of the infested areas can cause sores, which may become infected. In addition, body lice can be a vector for louse-borne typhus, louseborne relapsing fever or trench fever. Body louse (Pediculus humanus humanus, sometimes called Pediculus humanus corporisis a louse which infests humans and is adapted to lay eggs in clothing, rather than at the base of hairs, and is thus of recent evolutionary origin. Pediculosis is a more serious threat due to possible contagion of diseases such as typhus. The pubic or crab louse (Pthirus pubis) is a parasitic insect which spends its entire life on human hair and feeds exclusively on blood. Humans are the only known host of this parasite, although it is more closely related to the louse parasites in other primate species, than are human head or body lice which probably evolved from it as the "original" louse infestation of humans.

Medications: In terms of pharmacotherapies,

non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be used to reduce fever and pain. Prednisone, a corticosteroid, is commonly used as an anti-inflammatory to reduce symptoms of pharyngeal pain, odynophagia, or enlarged tonsils, although its use remains controversial due to the rather limited benefit and the potential of side effects. Serious complications are uncommon, occurring in less than 5% of cases: CNS: Meningitis, encephalitis, hemiplegia, Guillain-Barr syndrome, and transverse myelitis. EBV infection has also been proposed as a risk factor for the development of multiple sclerosis (MS)but this has not been confirmed. Hematologic: Hemolytic anemia (direct Coombs test is positive) and various cytopenias; Bleeding (caused by thrombocytopenia Mild jaundice Hepatitis (rare) Upper airway obstruction (tonsillar hypertrophy) (rare) Fulminant disease course (immunocompromised patients)

Splenic rupture (rare) Myocarditis and pericarditis (rare)

EXANTHEMA SUBITUM (meaning sudden rash), also referred to as ROSEOLA INFANTUM (or rose rash of infants), sixth
disease (as the sixth rash-causing childhood disease) and (confusingly) baby measles, or three-

PEDICULOSIS

day fever, is a disease of children, generally under two years old, although it has been known to occur in eighteen year olds, whose manifestations are usually limited to a transient rash ("exanthem") that occurs following a fever of about three day's duration. Clinical features: Typically the disease affects a child between six months and two years of age, and begins with a sudden high fever (3940 C; 102.2-104 F). This can cause, in rare cases, febrile convulsions (also known as febrile seizures or "fever fits") due to the sudden rise in body temperature, but in many cases the child appears normal. After a few days the fever subsides, and just as the child appears to be recovering, a red rash appears. This usually begins on the trunk, spreading to the legs and neck. The rash is not itchy and may last 1 to 2 days. In contrast, a child suffering from measles would usually appear more infirm, with symptoms of conjunctivitis and a cough, and their rash would affect the face and last for several days. Liver dysfunction can occur in rare cases. Vaccines and treatment: There is no specific vaccine against or treatment for exanthema subitum, and most children with the disease are not seriously ill. A child with fever should be given plenty of fluids to drink. Paracetamol/acetaminophen or ibuprofen could be given to reduce their temperature (but never aspirin, due to the risk of Reye's Syndrome. It is likely that many children acquire exanthema subitum "subclinically"; in other words, they show no outward sign of the disease. Others may be debilitated enough that a doctor's opinion is required to confirm the diagnosis, and particularly to rule out other more serious infections, such as meningitis or measles. In case of febrile seizures, medical advice is essential.

Bright red tongue with a "strawberry" appearance Characteristic rash, which: is fine, red, and rough-textured; it blanches upon pressure. appears 1248 hours after the fever. generally starts on the chest, armpits, and behind the ears. spares the face (although some circumoral pallor is characteristic). is worse in the skin folds. These Pastia lines (where the rash runs together in the armpits and groin) appear and can persist after the rash is gone. may spread to cover the uvula. The rash begins to fade three to four days after onset and desquamation (peeling) begins. "This phase begins with flakes peeling from the face. Peeling from the palms and around the fingers occurs about a week later. Peeling also occurs in axilla, groin, and tips of the fingers and toes. Diagnosis of scarlet fever is clinical. The blood test shows marked leukocytosis with neutrophilia and conservated or increased eosinophils, high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (both indications of inflammation), and elevation of antistreptolysin O titer. Blood culture is rarely positive, but the streptococci can usually be demonstrated in throat culture. The complications of scarlet fever include septic complications due to spread of streptococcus in blood and immune-mediated complications due to an aberrant immune response. Septic complicationstoday rareinclude ear and sinus infection, streptococcal pneumonia, empyema thoracis, meningitis and full-blown sepsis, upon which the condition may be called malignant scarlet fever. Immune complications include acute glomerulonephritis, rheumatic fever and erythema nodosum. The secondary scarlatinous disease, or secondary malignant syndrome of scarlet fever, includes renewed fever, renewed angina, septic ear, nose, and throat complications and kidney infection or rheumatic fever and is seen around the eighteenth day of untreated scarlet fever. The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps, and it may itch. The

SCARLET FEVER is a disease caused by

exotoxin released by Streptococcus pyogenes. Once a major cause of death, it is now effectively treated with antibiotics. Symptoms It is characterized by: Sore throat Fever

rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks (on very dark skin, the streaks may appear darker than the rest of the skin). Areas of rash usually turn white (or paler brown, with dark complected skin) when pressed on. By the sixth day of the infection, the rash usually fades, but the affected skin may begin to peel. Usually there are other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever at or above 101 F (38.3 C), and swollen glands in the neck. Scarlet fever can also occur with a low fever. The tonsils and back of the throat may be covered with a whitish coating, or appear red, swollen, and dotted with whitish or yellowish specks of pus. Early in the infection, the tongue may have a whitish or yellowish coating. Also, an infected person may have chills, body aches, nausea, vomiting, and loss of appetite.

Treatment Other than the occurrence of the diarrhea, the treatment and course of scarlet fever are no different from those of any strep throat. In case of penicillin allergy, clindamycin or erythromycin can be used with success. Patients should no longer be infectious after taking antibiotics for 24 hours. People who have been exposed to scarlet fever should be watched carefully for a full week for symptoms, especially if aged 3 to young adult. It is very important to be tested (throat culture) and if positive, seek treatment.