INFECTIOUS DISEASES







AMIBIASIS

It is sometimes weeks, even months after the stay in a country where amoebiasis exists in an endemic way, that can appear dysentria, particular diarrhea which characterizes the disease: the stools are numerous but not bulky: they are watery, afecales, contain mucus and a little blood. The patient suffers from diffuse abdominal pain but has no fever.

The diagnosis is confirmed by the detection in the stool (coproculture) of hematophagous amoebae as well as by endoscopy (rectoscopy) which finds ulceration in hard nail stroke the rectal mucosa.

When the intestinal amebiasis has been significant, chronic colitis may persist despite the complete eradication of the parasite by anti-amoebic drugs. Its treatment is that of a common colitis (antipasmodics).

This parasitosis occurs especially in tropical countries when hygienic conditions are poor. It can however be contracted on all continents, including Europe. It is transmitted by the faecal-oral route from dirty hands, vegetables, fruits, water contaminated by amoebas emitted with the stools of the sick.

Prevention is based on the following measures:

- avoid raw vegetables, fruits that you do not peel yourself, sorbets, homemade ice cream, molluscs and undercooked meat;

- drink only mineral or previously boiled water; water can also be disinfected. It is convenient to drink infusions.

Hepatic amebiasis:

The occurrence of a fever at 39 ° C, pain in the hepatic region, a sharp acceleration in the rate of sedimentation, an increase in the number of white blood cells makes fear of liver damage. Ultrasound or CT will look for the formation of a liver abscess which would modify the treatment.

Copyright photo : This image comes from the archive of Josef Reischig and is part of the 384 pictures kindly donated by the authorship heirs under CC BY SA 3.0 license as a part of Wikimedia Czech Republic's GLAM initiative.

Bibliography : Prescott, Microbiologie, De Boeck, 2010 p. 1012-1014.

ANGINA

ANGINA

You complain of fever and sore throat when swallowing: it is probably a sore throat. That is to say of an iflammation of the tonsils.

You must consult your doctor, because if angina is a very regularly benign disease, there are cases where the use of antibiotics is imperative.

The role of your doctor is to confirm the diagnosis, which is easy: it is enough for him to examine the throat. Then, he will have to propose a treatment the choice of which requires an examination and a rigorous reflection: study of the antecedents, appearance of the tonsils, presence of banal or worrying nodes, conservation or alteration of the general state.

Red or white sore throat requires the prescription of an anti-streptococcal antibiotic treatment (penicillin or erythromycin). Indeed, streptococcus is often responsible for this type of this type of angina. Strep throat will most often heal without antibiotic treatment, like most tonsillitis, but streptococcus has the property of making a toxin responsible for rheumatic fever, or acute glomerulonephritis. These diseases occur fifteen days after the angina has healed.

Anti-biotic anti-streptococcal treatment is started at the start of the signs, then continued at a sufficient dose for eight days to avoid the risk of streptococcal compilations.

This finding justifies the systematic anti-streptococcal treatment of all white or red sore throat (especially in children after two or three years and in adolescents up to the age of twenty). Proof of streptococcal infection requires a throat swab and two blood tests ten days apart. the cost of these examinations and the time limits imposed by bacteriological analysis techniques and serology often mean treating without proof. But it is thanks to systematic antibiotic therapy that rheumatic fever and acute glomerulonephritis of streptococcal origin have practically disappeared.

This attitude must of course be nuanced. Your doctor will recognize among the tonsillitis that he is called to treat:

- those requiring urgent surgical treatment: this is the case of the phlegmon of the tonsil. This complication is indicated by a trismus (difficulty in opening the mouth) and the examination notes the bulging of the pillar of an amygdala; the presence of a phlegmon imposes its surgical incision and subsequently the removal of the tonsils;

- those requiring urgent medical treatment: this is particularly the case for angina from diphtheria, acute leukemia; these two diseases are the subject of a specific study;

- those that do not require antibiotic treatment: red sore throat accompanied by diffuse redness of the pharynx, a clear nasal discharge, and sometimes a dry cough bringing back a clean sputum, is likely to be viral ; rest, fever and pain medication are sufficient, especially in children under two years of age and in adults. Angina from infectious mononucleosis does not require the use of antibiotic therapy either;

- there is a special case: it is that of caseous cryptic tonsillitis. It is not a bacterial angina: white spots appear periodically on the tonsils without any movement of fever. Caseous cryptic tonsillitis often causes bad breath and only requires cleaning with a water jet, similar to that used for dental hygiene. The removal of the tonsils is unnecessary in this case.

Copyright photo : Par James Heilman, MD — Travail personnel, CC BY-SA 3.0,

ANGUILLULOSIS

It is a very frequent parasitosis in tropical areas; Aboriginal cases have been described, however. The patient complains of alternating diarrhea and constipation, as well as abdominal pain similar to that of an ulcer, infection of the vesicle or the appendix.

The presence of hives and an increase in the number of certain white blood cells, eosinophils, suggests the diagnosis of anguillulosis. This is confirmed by coproculture and parasitological examination of the stool which isolates worms. Antiparasitic drugs cure the infection.

The worm is present in water and mud breathed out by already infected stools. It enters the body through the skin. Self-infections are possible.

We must therefore remember the need to wash your hands after each bowel movement, to cut your short nails in endemic areas; do not bathe in fresh, stagnant water, do not walk barefoot on damp ground. Watch out for the ford.

Always seek and treat this disease in the slightest doubt in individuals who have stayed in endemic areas, and should be treated with corticosteroids or immunosuppressants: indeed, these treatments promote the appearance of a severe form of disease in infected patients.

Copyrigth photo : public domain

Bibliography : Advances in Parasitology by David Rollinson,J. Russell Stothard (Series Editor)

ASCARIDIOSIS

This parasitosis is rife in hot countries, but it is not uncommon in the West.

Man is contaminated by ingesting vegetables and fruits soiled by roundworm eggs. In the patient's digestive tract, the eggs release larvae which join the lungs. This is the first phase of the infection, similar to atypical bronchitis. The patient complains of itching, hives, chest pain; sometimes latous reports a bloody expectoration. The chest x-ray shows unusual opacities during bronchitis, which are all the more unusual as they are fleeting, the worm continuing its migration. The hemogram prescribed by your doctor will discover an increase in polynuclear eosinophils, suggestive of parasitosis.

During the second phase, ascaris goes up the respiratory tract, is swallowed, then enters the digestive tract where it causes abdominal pain, accelerated transit, weight loss with decreased appetite and fatigue. The diagnosis is then easily affirmed by coproculture and parasitological examination of the stools which isolate eggs or adult worms, resembling earthworms. The effective anti-parasite treatment is well tolerated.

The disease is transmitted through stool. Hands should be washed after each bowel movement. In hot countries, wash fruits and vegetables eaten raw with previously sterilized water.

Copyright photo : Par CDC Division of Parasitic Diseaseshttp://www.dpd.cdc.gov/dpdx/HTML/ImageLibrary/Ascariasis_il.htmhttp://www.dpd.cdc.gov/dpdx/images/ParasiteImages/A-F/Ascariasis/Ascaris_female.jpgOriginally uploaded to en:wikipedia, Domaine public

Bibliography : Parasitologie et mycologie médicales - Guide des analyses et des pratiques diagnostiques: Guides Des Analyses&Prat Diagn

BOTULISM

It is food poisoning caused by the toxin of an anaerobic Gram-positive bacillus Clostridium botulinum.

Clostridium botulinum is present in the soil, water and organism of many animals and produces spores that resist boiling and the storage methods (salt, vinegar, smoking) used in the manufacture of family preserves. These spores secrete an extremely powerful toxin which inhibits the secretion of acetylcholine involved in the transmission of nerve impulses, thus causing paralysis when ingesting food containing the toxin. Botulism has also occurred in consumers of industrial preserves (vegetables, fish).

The illness begins a few hours to 5 days after eating contaminated food. The first signs are often vision disturbances (paralysis, diplopia, pseudo-presbyopia) and mydriasis (abnormal and persistent dilation of the pupil). They are accompanied by an intense dryness of the mouth, with a difficulty in swallowing which can evoke an angina. Serious forms can appear with paralysis of the limbs, even respiratory muscles, cardiac disorders, and even sudden death.

The diagnosis is based on the identification of the toxin in the food in question.

The treatment is purely symptomatic and often requires hospitalization with monitoring of swallowing, breathing and heart condition. The injection of anti botulinum serum is sometimes recommended. The disease generally regresses slowly, within a few weeks.

It is based on scrupulous respect for the rules of food preparation and slaughter of animals. Doubtful preserves (domed lid, suspicious odor) must be excluded from consumption. Sterilizing canned food for 1.5 hours at 120 ° C is an effective hygiene measure because it destroys spores.

Copyright photo : Par Herbert L. Fred, MD and Hendrik A. van Dijk

Bibliography : W. H. Barker, Botulism, Cambridge, Cambridge University Press, 1993, 1176 p.(ISBN 0-521-33286-9), p. 623-625

DIPHTERIA

Diphtheria is an infection caused by the bacteria Corynebacterium diphtheriae. Signs and symptoms usually start 2 to 5 days after exposure and range from mild to severe. Symptoms often appear gradually, it is first of all a sore throat and fever. In severe cases, the bacteria produce a poison (toxin) that causes a thick gray or white spot at the back of the throat. This can block the airways making it difficult to breathe or swallow and can also cause a raucous cough. The neck may swell in part due to swollen lymph nodes.

The toxin can also enter the bloodstream causing complications including inflammation and damage to the heart muscle, inflammation of the nerves, kidney problems and bleeding problems due to low blood platelet counts. Damage to the heart muscle can cause an abnormal heart rate and inflammation of the nerves can cause paralysis.

Diphtheria is easily spread between people through direct contact or through air, with respiratory droplets emitted when a person coughs or sneezes. The disease can also be spread through contact with contaminated clothing or objects.

The clinical diagnosis of diphtheria is generally based on the presence of a grayish membrane covering the throat. Although laboratory confirmation of suspected cases is recommended, treatment should be started immediately.

Diphtheria infection is treated with the administration of a diphtheria antitoxin by intravenous or intramuscular injection. Antibiotics are also given to kill the bacteria and toxin production, and to prevent transmission to other people.

All children should be vaccinated against diphtheria. The 3 primary doses administered during infancy are the basis for acquiring lifelong immunity against the disease. In addition, immunization programs should ensure that 3 booster doses of diphtheria toxoid are administered during childhood and adolescence. Regardless of their age, people who are unvaccinated or partially vaccinated against diphtheria should receive the doses necessary to complete the vaccination series.

The recent outbreaks of diphtheria in several countries are a sign of insufficient immunization coverage, demonstrating the importance of maintaining high coverage in childhood immunization programs. Unvaccinated people are at risk regardless of the context. It is estimated that 86% of the world's children receive the 3 recommended doses of the diphtheria toxoid vaccine, the remaining 14% being either unvaccinated or partially vaccinated.

Copyright photo : This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #5325.

Bibliography : La Pratique de la Sérothérapie Et Les Traitements Nouveaux de la Diphtérie de  Henri Gillet

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