Brucellosis has been recognized in humans since the XX century; however it has existed since ancient times. A Scottish microbiologist David Bruce was first to establish the relationship between the bacteria and disease in 1887. Alternative names for the condition include Bang’s disease, Crimean fever, Malta fever, Gibraltar fever, and Mediterranean fever. Most of these names were given in connection with the location of disease. Another popular name undulant fever originates from the wave-like nature of the symptoms.

Human brucellosis is found worldwide and its annual occurrence rate is 500,000 cases. The high-risk areas include South and Central America, the Mediterranean Basin, Eastern Europe, Africa, Asia, the Middle East, and the Caribbean. Although the incidence of brucellosis has been reduced recently through vaccination, it still remains the most common zoonosis.

Causes and transmission

Brucellosis is caused by bacteria of the genus Brucella, in particular B. abortus (infects cattle and bison), B. melitensis (sheep and goats), B.canis (dogs), and B. suis (pigs). B. melitensis causes most cases of infection and is most often found in Spain, Greece, India, and Latin America. B. suis is the most common type seen in the US.

This disease is a contagious zoonosis, which most often spreads to people via dairy products, such as unpasteurized milk, butter and cheese, and meat from an infected animal. More rarely the bacteria can spread through direct contact with infected animals and their secretions, and through the air. For these reason farmers, laboratory workers, veterinarians, butchers and slaughterhouse are at increased risk of getting brucellosis.

Transmission from mother to a child and from human to human through sexual contact and blood transfusion is also possible.

Brucellosis signs and symptoms

Brucellosis symptoms may develop within days or months after the exposure to the bacteria. The infection usually causes signs and symptoms similar to those of other febrile diseases, including:

- Fever with chills

- Increased sweating
- Muscular pain
- Weakness and fatigue
- Dizziness
- Loss of appetite
- Weight loss
- Back pain
- Abdominal pain
- Swollen lymph nodes

- Headache

The symptoms may last from a couple of weeks to several months. They may disappear for some period and then return in some weeks or even months. For this reason brucellosis is also referred to as undulant fever.

Brucellosis may become chronic with symptoms lasting for years. Chronic brucellosis may cause complications in almost any part of the body, including heart, nervous system, and reproductive system. Possible complications include arthritis and spondylitis, endocarditis and myocarditis, epididymo-orchitis, hepatitis, and infection of the central nervous system.
The severity of the symptoms usually depends on what type of Brucella you are infected with. B.abortus and B.canis usually cause mild to moderate symptoms, but the first is more likely to develop chronic symptoms. B. suis may cause abscesses in different organs. B. melitensis is the most dangerous type. It may cause severe symptoms and lead to disability.

Diagnosis and treatment

Since brucellosis often resembles the flu, it can be hard to identify. The diagnosis is usually confirmed by testing blood sample for brucella bacteria or for antibodies to the bacteria. Additional tests include X-rays (to reveal changes in joints), CT-scan or MRI (to identify inflammation), echocardiography (to check the heart for signs of infection), and cerebrospinal fluid culture (to reveal other infections). Differential diagnoses include bronchitis, endocarditis, pneumonia, tuberculosis, and some other conditions.

Brucellosis is usually treated with antibiotics, such as doxycycline, rifampin, tetracycline, aminoglycosides streptomycin, and gentamicin. Sometimes more than one antibiotic is prescribed. Most commonly rifampin and doxycycline is a treatment of choice.

The treatment is aimed at relieving the symptoms and preventing complications. The treatment usually lasts for at least six weeks, but the symptoms may not go away even after a few months.

In general, if treated properly and in timely manner, the prognosis for brucellosis is excellent. However, the disease returns in about 10% of cases. The mortality rate is less than 2%. Death is most commonly caused by endocarditis.

Prevention of brucellosis in humans

There is no vaccine against brucellosis in humans, but you can reduce the risk of getting the infection by taking the following precautions:

- Avoid undercooked meat. The meat should be cooked at 145-165 F. Proper cooking will also destroy other bacteria such as salmonella. When in a restaurant, order meat at least medium-well.
- Avoid unpasteurized dairy products, including milk, cheese, ice-cream, and butter.
- When travelling to high-risk areas, avoid dairy products and meat from street vendors.
- Wear barrier precautions (gloves, masks, goggles, etc.) when handling animals’ tissues.
- Vaccinate animals.

These articles can be used for informational purposes only. To get an accurate diagnosis consult your doctor!

Cheilitis is a medical condition causing inflammation of the lip. In cheilitis lips usually appear dry, scaly, and sensitive. Small cracks, redness and swelling may occur. There are several types of lip inflammation that may be caused by many conditions, including:

- Iron deficiency anemia
- Megaloblastic anemia (caused by Vitamin B12 deficiency)
- Oral candidiasis (a condition causing creamy whitish lesions on the longue and inner cheeks)
- Allergy
- Taking retinoids, high doses of vitamin A, chemotherapeutic agents, lithium, and some other medications
- High fever or dehydration
- Environmental conditions (such as cold weather)

Types of cheilitis

Cheilitis is divided into several types:

- Exfoliative cheilitis is a chronic inflammatory condition in which the lips are covered with crusts.

- Actinic cheilitis is a counterpart of actinic keratosis (rough raised area on the skin). This condition is also referred to as actinic cheilosis.

- Allergic contact cheilitis is characterized by edema, dryness, and crusting of the lip.

- Angular cheilitis is an inflammation at the corner of the mouth (at the labial commissure). It often occurs bilaterally.

- Cheilitis glandularis is characterized by eversion and swelling of the lower lip.

- Plasma cell cheilitis is characterized by red erosive plaques.

Symptoms of actinic cheilitis

Actinic cheilitis is more common in males and in individuals with a history of prolonged sun exposure. This condition is characterized by thickening and whitish discoloration of the lips. The lesions are usually painless.

This condition may also cause the loss of the border between the lip and the skin (also known as vermillion border). http://t1.gstatic.com/images?q=tbn:ANd9GcT8oD3DxIIanJfO34IbE7ChQKdZiMrHj2vDYr6MG_RnJYX7PjyO
The lip often becomes scaly and indurated. Other symptoms may include:

- Dry and cracked lips
- Scaly or crusty bumps on the lip

- Red, pale or discolored lips

- Puff lips

Causes and risk factors

Actinic cheilitis is caused by persistent exposure to ultraviolet radiation. For this reason, it is also referred to as solar cheilitis, sailor’s lip or farmer’s lip. It most commonly affects the lower lip. Risk factors for developing the condition include:

- Being a man of 50 or older
- Light complexion and fair skin
- Working outdoors (farmers, constructional workers)
- Smoking or tobacco use
- Poor oral hygiene
- Lip irritation due to chemical or physical factors
- Ill-fitting dentures

Actinic cheilitis is a premalignant condition because in about 10% of all cases it develops into squamous cell carcinoma (cancer of epithelial cells).

Diagnosis and treatment

In most cases no special tests are required to diagnose actinic cheilitis. If precancerous condition is suspected, then a skin biopsy may be performed.

It is very important to initiate the treatment as soon as possible, as actinic cheilitis may develop into carcinoma. There is no way to determine if inflammation will progress into carcinoma.

Actinic cheilitis may be treated in several ways depending on the symptoms severity. The treatment is aimed at healing the lesions. Treatment options include:

- Fluorouracil (5-fluorouracil) is an effective treatment for diffuse, but minor cases. It works by blocking DNA synthesis. The treatment usually lasts for about two-four weeks.
- Imiquimod (immune response modifier) causes tumor cells to die.
- Scalpel vermillionectomy (lip shave procedure) and carbon dioxide laser vaporization are used to treat recurring lesions. Carbon dioxide laser is used to ablate the vermillion border, and shave vermillionectomy involves the removal of a part of the vermillion ridge by shaving. The effectiveness of these procedures is very high and healing time is short.
- Electrosurgery and cryosurgery are effective options for small lesions. Electrosurgery involves the application of electric current to tissue and requires local anesthesia. Cryosurgery involves the application of liquid nitrogen to destroy abnormal cells. This procedure is performed without anesthesia and may be quite painful.
- Photo-dynamic surgery (irradiation of the lesions with a laser or special light)
- Chemical peel (using of a chemical solution that causes the skin to peel off) has not proved to be an effective option and the success rate is as low as 30%.

These treatment options help destroy and remove the damaged skin. Some of these procedures may be associated with pain and edema. In rare cases the disease may recur after the treatment.

Prevention

To prevent actinic cheilitis you should avoid or limit exposure to sunlight. Wearing a wide-brimmed hat and applying protecting lip balm can help prevent inflammation. Consult your GP is you notice any signs of the disease.

These articles can be used for informational purposes only. To get an accurate diagnosis consult your doctor!

Also known as scarlatina, scarlet fever causes fever and a scarlet rash. Although the condition was once considered a life-threatening disease, nowadays it is effectively treated with antibiotics.

Causes and transmission

Scarlet fever is caused by streptococcal bacteria (Group A strep., also responsible for sore throat). This bacteria release toxins that cause the rash and red tongue.

Scarlatina is a highly contagious disease. Infection is usually spread by inhalation of droplets, released when an infected person sneezes or coughs. For this reason scarlet fever spreads more easily between people in close contact, such as classmates or family members. The infection may be also caught by touching the skin of a person infected with a streptococcal skin infection or by sharing personal items, such as towels and kitchen utensils.

The incubation period lasts from two to four days, meaning that the first symptoms usually appear 2-4 days after exposure to the bacteria.

Scarlet fever symptoms

In 15%-20% of children scarlet fever may pass asymptomatic. It may happen if a patient is not susceptible to the toxins produced by streptococcal bacteria. However people who do not show any symptoms are known as carriers and still can spread the infection.

In most cases the following symptoms develop:

- Sore throat
- Fever of 101F or higher (38.3 C) and chills
- Red “strawberry” tongue. The tongue is often covered with white or yellowish coating.

- Red rash. The rash usually appears 12-72 hours after the fever. Scarlatina features bright red rash that typically starts on the face and then covers most of the body. The rash feels like sandpaper and blanches upon pressure. It usually fades by the sixth-seventh day of the infection. As the rash fades, the skin around the fingers and toes may peel.

- Pastia lines. Red lines may appear on the folds of skin around elbows, knees, neck, and groin. The lines are darker than the surrounding rash.

- Red face. The face may appear red with a clear area around the mouth.

- Swollen glands in the neck
- Difficulty swallowing
- Body aches
- Abdominal pain
- Headache
- Loss of appetite
- Nausea and vomiting

Complications

If left untreated, scarlatina may spread to other parts of the body, including tonsils, the skin, the blood, middle ear, and sinuses. Complications may include:

- Otitis media (ear infection)
- Adenitis (gland inflammation)
- Kidney and/or liver damage
- Pneumonia
- Meningitis
- Sinusitis
- Osteomyelitis (bone marrow inflammation)

In rare cases scarlet fever can cause rheumatic fever, which is a severe condition affecting heart, nervous system, and joints.

Diagnosis and tests

To diagnose scarlet fever the doctor will perform a physical exam, during which he will examine the condition of the child’s throat and tongue, assess the rash appearance, and feel the lymph nodes. If scarlatina is suspected, the doctor will take a throat swab to determine strep bacteria. Sometimes a blood test is also done to confirm the infection.

Differential diagnosis includes Far East scarlet-like fever which has similar clinical presentation.

Treatment

Most mild cases of scarlatina go away in about seven days without treatment. However it is recommended to undergo course of medical treatment to prevent complications and to improve the recovery.

Scarlet fever is effectively treated with antibiotics. Most commonly penicillin is used, but in case of penicillin allergy, erythromycin or clindamycin may be prescribed. Patients are no longer infectious after using antibiotics for 24 hours. Still it is very important to complete the full course of treatment, otherwise the infection may not be eradicated and the risk of complications may increase. The treatment course usually lasts for 10 day. A patient should stay at home at least 24 hours after the initiation of treatment.

Here are some other steps that may help reduce discomfort and improve the recovery:

- Use ibuprofen or acetaminophen to treat fever and throat pain
- Use calamine lotion to relieve itching
- Prevent dehydration by taking enough fluids
- Gargle salty water to relieve the throat pain
- Prevent overheating and shivering
- Use air-humidifier to prevent throat irritation
- Use lozenges to ease the throat pain
- Have foods that can sooth the throat, such as warm soups and ice pops
- Avoid irritants that can irritate the throat, such as cleaning agents and cigarette smoke

Prevention

Currently there is no vaccine available to prevent scarlet fever. George and Gladys Dick developed a vaccine in 1924 but it was discontinued due to inefficiency after the introduction of antibiotics.

The risk of developing scarlet fever, as well as any other infection, may be eliminating by practicing the following healthy habits:

- Avoid sharing food and kitchen utensils with other people
- Wash your hands regularly
- Cover your mouth/nose when coughing/squeezing
- Teach your child to follow these hygienic habits
- Avoid any contacts with infected people.

These articles can be used for informational purposes only. To get an accurate diagnosis consult your doctor!

Meningitis is a life-threatening disease, which is considered a medical emergency.

Meningitis causes and types

The most common causes of inflammation are bacterial and viral infections. There are several types of meningitis depending on its cause:

- Viral meningitis is usually caused by enteroviruses (a group of RNA viruses that typically spreads to the nervous system from the gastrointestinal tract). It is more likely to occur in the end of the summer or at the beginning of the autumn. This form of the inflammation usually causes mild symptoms and often clears on its own. There are some other viruses that may lead to viral meningitis, such as herpes simplex virus, West Nile virus, Varicella zoster and others.
- Bacterial meningitis, which is also referred to as purulent meningitis, may be caused by different bacteria, among which are the following:

– Streptococcus pneumoniae is one of common causes of brain inflammation that may affect people of any age. It also causes ear and lung infections.
– Neisseria meningitides usually spreads from upper respiratory tract and is known to be highly contagious.
– Haemophilus influenza used to be the most common cause of meningitis in children, but now its incidence decreased as a vaccine against this bacterium is available.
– Listeria monocytogenes is especially dangerous for infants, pregnant women, and people with suppressed immune system.
– Mycobacterium tuberculosis may cause tuberculous meningitis, especially in areas where tuberculosis is common.
Bacterium often gets to the meninges via the bloodstream, but it may also directly invade the brain.

- Fungal meningitis may be caused by Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, Candida, and some other fungals.
- There are also several non-infectious causes of meninges inflammation, which include spread of tumor or cancer and allergic reaction to certain drugs (usually NSAIDs and antibiotics).

Risk factors

Meningitis is more likely to affect younger children. People with suppressed immune system or recent skull trauma are prone to different bacteria that may cause brain inflammation. Among other risk factors are living in crowded places (such as college campuses) and suffering from certain infections.

Symptoms

As it was mentioned above, viral meninges inflammation is often mild and may cause no symptoms. However, purulent meningitis usually causes a range of severe symptoms, among which are:
- Severe headache
- Neck stiffness, namely nuchal rigidity characterized by inability to bend the neck forward

- High fever
- Altered mental status.

These are the most typical symptoms; however, a patient may experience only several of them. Other less frequent symptoms include:

- Photophobia (extreme sensitivity to light)
- Phonophobia (sensitivity to loud noise)
- Anxiety
- Bulging fontanelles in infants

- Poor feeding in infants
- Cold extremities
- Skin color changes
- Seizures
- Vomiting and nausea
- Rapid breathing and fast heart rate.

Without proper treatment meningitis may cause severe complications and lead to permanent brain damage and neurological disorders, such as blindness, hearing loss, paralysis, behavioral and mental alteration, and memory and speech difficulty.

Diagnosis and treatment

In order to diagnose purulent meningitis, a doctor does a lumbar puncture (the procedure of taking spinal fluid for testing). Some other tests may be needed, such as CT scan, chest X-ray, and blood culture.

Since purulent meningitis is caused by bacteria, it should be treated with antibiotics. The choice of antibiotics depends on the bacterium that caused the inflammation. Treatment should be started as soon as the disorder is suspected, without waiting for the confirmation on the diagnosis. If at this point the exact bacterium is not determined yet, doctor should use broad-spectrum antibiotic or antibiotic against bacteria that are especially spread in this particular area. Here are some common antibiotics used for meningitis treatment: cefotaxime, ceftriaxone, vancomycin, and chloramphenicol.

Fungal and viral inflammations are treated with antifungals (such as flucytosine or amphotericin B) and antivirals (such as aciclovir) correspondingly.

Other medications may be used to manage certain symptoms, such as seizures and brain swelling. In addition to medication treatment intravenous fluids may be used.

Early treatment is of great importance in case of meningitis, as without treatment it is almost always fatal. Besides, early treatment may help prevent neurological disorders and other complications.

Prevention

The best way to reduce the risk of brain inflammation is to prevent bacterial infections that may cause it. This can be done by practicing proper personal hygiene and following some other recommendations, namely:

- To wash your hands regularly
- To maintain good health and immune system (by doing exercises, having enough rest, eating health food)
- To avoid contacts with infected people

Besides there is a number of vaccines that help prevent different bacteria. These are Hib, pneumococcal conjugate and polysaccharide vaccines (PCV7 and PPSV), meningococcal conjugate vaccine (MCV4), and some others.

These articles can be used for informational purposes only. To get an accurate diagnosis consult your doctor!

Streptococcal infection primary affects the tonsils and sometimes the larynx. Tonsils are two lymphoid tissues in the throat located on each side of the root of the tongue, and larynx is a hollow muscular organ which forms an air passage to the lungs and holds the vocal cords.

Strep throat is a widespread disease and is common cause of sore throat in children.

Causes of streptococcal pharyngitis

The disease is caused by Streptococcus pyogenes, or group A streptococcal infection, which is also responsible for some skin infections.

This infection is highly contagious and usually transmits through airborne droplets released by infected people when coughing, sneezing, or talking. However, some people may pass the bacteria in their throat without developing any symptoms and infect other people even without knowing it.

In rare cases the infection may be transmitted through contaminated food.

Crowding is considered a risk factor for strep throat, that’s why it often spreads in schools and similar establishments. For this reason the infection easily spreads among family members.

The disease is more common in children of 5-15 years of age, but it may affect people of any age. People are more likely to catch the infection in early spring and later autumn.

Strep throat symptoms

The first signs of the infection usually appear 1-3 days after the contact with infected person. The common symptoms of strep throat in adults include:

- sore throat;
- scratchy throat;
- high fever (may be higher than 38° C or 100° F);
- tonsillar exudate (white pus or pus-containing patches on the tonsils);

- enlarged lymph nodes in the neck;
- swollen tonsils;

- difficulty swallowing or breathing.

Less common symptoms may include the following:

- headache;
- runny nose;
- conjunctivitis, or eyes inflammation;
- muscle pain;
- abdominal pain;
- rash;
- loss of appetite;
- nausea and vomiting (is more likely to occur in children);
- petechie (red spots) on the soft palate.

If untreated, strep throat may cause complications such as kidney inflammation, glomerulonephritis, mastoiditis, scarlet fever, and rheumatic fever. Streptococcal infection may spread throughout the body and affect the skin, blood, or middle ear.

Diagnosis and treatment

The diagnosis of streptococcal infection is made on the basis of physical examination and some lab tests. Thus, strep throat is suspected if physical examination reveals enlarged lymph nodes, petechie, and/or tonsillar exudate. Fever and absence of cough are also important signs of streptococcal pharyngitis. The diagnosis may be confirmed with tests, such as throat culture (a sample is rubbed with a swab over the tonsils or back of the throat), rapid antigen test (it allows to detect the bacterium in just a few minutes), or rapid DNA test.

Differential diagnoses may include viral sore throat and infectious mononucleosis.

Mild pharyngitis may not need treatment, as it is likely to resolve within a few days. However, medication treatment is still preferable, as it prevents complications, reduces the duration of the disease, reduces contagiousness of infection, and eases its symptoms.

The treatment of choice for strep throat is antibiotics. The most common drugs used are penicillin and amoxicillin. Sometimes cephalexin, azithromycin, clarithromycin, or erythromycin may be used as an alternative, if a patient is allergic to penicillin. Antibiotics significantly reduce the duration of symptoms to one or two days, and you/your child may return to work/school 24 hours after treatment initiation, however it is very important to finish the prescribed course of antibiotics, which usually lasts for about 10 days.

In addition to antibiotics, analgesics such as NSAIDs, or nonsteroidal anti-inflammatory drugs (such as ibuprofen) or paracetamol may be used for management of sore throat and some other symptoms. Note that aspirin should not be given to children as it increases the risk of Reye’s syndrome, which is a life-threatening metabolic disorder.

There are some more tips and recommendations that will help you to relieve symptoms during the treatment:

- Have enough rest;
- Drink plenty of liquids (it is especially beneficial to drink tea with lemon or honey and ginger ale);
- Avoid spicy or acidic foods and drinks that may irritate your throat, especially orange and grapefruit juices;
- Gargle with warm salty water;
- Take lozenges;
- Eat soothing food, such as warm soups, mashed potatoes, apple sauces, and smoothies.

Prevention

Although strep throat is a highly contagious disease, there are some recommendations that will help you reduce the risk of getting the infection:

- Wash your hands regularly and explain to your children the importance of proper personal hygiene;
- Don’t share personal objects (such as cups, spoons, and other kitchen utensils), foods or drinks with other people.

If you have already got streptococcal pharyngitis, you can prevent it further spread by:

- Staying isolated at home during the first 24 hours after the initiation of treatment;
- Changing your toothbrush after the treatment has been started;
- Covering mouth when coughing or sneezing.

These articles can be used for informational purposes only. To get an accurate diagnosis consult your doctor!

Causes of toxoplasmosis

Toxoplasma is a parasitic spore-forming protozoan and toxoplasmosis is caused by the protozoan Toxoplasma gondii.

It was first isolated in 1908 by Nicolle & Manceaux, who named it later in 1909. The primary host of Toxoplasma gondii is cats, however almost any warm-blooded animal may be infected. There are several ways of toxoplasmas transmission:

- Through eating undercooked infected meet (usually pork or lamb) or drinking contaminated water;
- Through eating contaminated vegetables and fruit;
- Through drinking unpasteurized milk;
- Through contact with feces of infected cat (while cleaning a litter box or working in the garden);
- Through contact with contaminated meat or surfaces (such as knives, cutting boards, and other utensils);
- From infected soil;
- From mother to fetus;
- While organ transplantation or transfusion.

Toxoplasma gondii is one of the most common parasites and is found throughout the world.

Signs and symptoms

In most people the parasite causes no symptoms and people may even not know they are infected. Asymptomatic form of the infection is also known as latent toxoplasmosis. Some people may develop mild flu-like symptoms, including:

- Fever;
- Headache;
- Pain in muscles;
- Swollen lymph nodes; http://aapnews.aappublications.org/content/31/10/16.1/embed/graphic-1.gif
- Fatigue.

However, people with suppressed immune system (for example, due to HIV/AIDS, chemotherapy, and organ transplant) are more likely to develop severe symptoms, such as:

- Confusion;
- Severe headache;
- Lack of coordination;
- Seizures;
- Pain in chest;
- Blurred vision or eye inflammation;

- Brain damage (encephalitis);
- Lung problems.

Healthy people normally recover well, while in people with weakened immune system toxoplasmosis is a potentially fatal disease. Encephalitis is the most dangerous complication of toxoplasmosis and the most common death cause.

Toxoplasmosis during pregnancy

Toxoplasmosis is especially dangerous if transmitted to a child before the birth. This form of the infection is known as congenital toxoplasmosis. The fetus is at higher risk during the third trimester. The born babies may develop the following problems:

- Seizures;
- Diarrhea or vomiting;
- Swollen lymph nodes;
- Jaundice (yellowing of the skin and/or whites of the eyes);

- Enlarges liver;
- Enlarged spleen;
- Eye infections;
- Hearing loss;
- Retinochoroiditis;
- Hydrocephalus (fluid accumulation in the brain).

These signs usually do not develop right after the birth, but may occur in the teens or even in adulthood. In rare cases toxoplasmosis may lead to stillbirth or miscarriage.

Diagnosis and treatment

Toxoplasmosis is rather difficult to diagnose, as its symptoms are similar to those of other more common diseases, such as flu or mononucleosis. To confirm the diagnosis toxoplasma gondii should be detected in blood samples, body fluids, or tissues. There are several tests that may help to reveal the disease, such as antibody tests and polymerase chain reaction. In severe cases MRI (magnetic resonance imaging) and brain biopsy may be required.

Differential diagnoses may include many other diseases which can cause similar symptoms, such as Chagas’ disease, malaria, sepsis, cat scratch disease, and many others.

If a pregnant woman is infected, her baby should also be checked. The recommended methods of detection the infection in babies are amniocentesis (sampling of amniotic fluid), antibody titer, and ultrasound scan.

Otherwise healthy patients usually do not require special treatment. Sometimes atovaquone and clindamycin may be prescribed for patients with latent toxoplasmosis. However, people with severe symptoms or with weakened immune system may be prescribed such medications:

- pyrimethamine (antimalarial drug) is usually given in combination with sulfadiazine;
- antibiotics (such as Sulfadiazine, Clindamycin, spiramycin);
- spiramycin is usually given to infected pregnant women if the infection has not transmitted to the fetus yet. If the child is already infected, pyrimethamine and sulfadiazine may be used in extreme circumstances only, as these drugs may cause severe side effects.

Patients with weakened suppressed system may require life-long antibiotic therapy.

Prevention

There are a number of precautions that may help you to reduce the risk of getting the infections, among which are the following:

- Cook the meat properly, avoid eating undercooked meat;
- Avoid drinking unpasteurized milk;
- Wash fruit and vegetables properly;
- Wash knives, cutting boards and other kitchen utensils after cooking meat;
- Wear gloves when working in garden or handling soil;
- Wash your hands thoroughly with antibacterial soup after handling meat and soil;
- Take proper care of your cat, always wash your hands after cleaning its littering box or, which is better, wear gloves when cleaning it;
- Do not feed your cat with raw meet;
- Take care of your child, keep his/her hands clean, and explain him/her that it may be dangerous to touch their mouth with dirty hands.

Pregnant women should pay special attention to these prevention measures. Women who are planning to get pregnant may get tested to determine if there is a risk to transmit the infection to the fetus.

These articles can be used for informational purposes only. To get an accurate diagnosis consult your doctor!

Other presentations of this disease include kidney stones, tophus (a deposit of uric acid crystals at the surface of joints or in skin or cartilage), and urate nephropathy.

Gout incidence has increased in recent decades, which is believed to be caused by increased risk factors.

Causes and risk factors

The main underlying cause of the disease is elevated level of uric acid in the blood, or hyperuricemia. Normally this acid passes through kidney into urine, but when it is produced in excess, uric acid tends to crystalize and deposit in joints and tendons, or surrounding tissues. In its turn, high concentration of uric acid may be caused by a number of reasons which include:

- Diet (consumption of meat and seafood, asparagus and mushrooms, drinks containing fructose, and alcohol);
- Genetic predisposition;
- Renal underexcretion of uric acid;
- Physical trauma;
- Kidney problems that prevent removal of uric acid;
- Some medical conditions, such as metabolic syndrome, diabetes, high cholesterol level, hypertension, obesity, and abnormal lipid levels, often occur in combination with gout and are considered risk factors;
- Surgery;
- Age and sex (gout is more likely to occur in men, while in women it usually occurs after menopause);
- Taking certain medications (notably diuretics, niacin, aspirin, immunosuppressants) is associated with gout attacks;
- Cool temperatures.

Signs and symptoms

Gout is often characterized by sudden recurrent onsets of arthritis, associated with intense pain, redness, tenderness, warmth, and swelling of joints.

Joints symptoms may be accompanied by fatigue and fever. Attacks are more likely to occur at night. The symptoms usually remain severe within 12-24 hours after they begin, then they may cause milder discomfort for a few days or weeks. Even if not treated, gout attack usually resolves in 5-7 days. But most patients are likely to develop recurrent attack within a year, that’s why prevention is an important part of gout treatment.

In severe cases gout may cause such complications as chronic gout (repeated attacks of gout that may affect multiple joints), advanced gout, also known as tophus, and kidney stones (occurrence of urate crystals in the kidney causing different urinary problems).

Diagnosis

Gout diagnosis is based on the identification of tophus or urate crystals in synovial or joint fluid. To identify the crystals, synovial fluid samples should be examined. Other examinations performed include blood tests (which can reveal hyperuricemia), white blood cell count, renal function test, and joint X-ray.

Differential diagnoses include septic and rheumatoid arthritis, and pseudogout.

Treatment of gout

There are several methods of goat treatment, including medication and lifestyle modification, which are often used in combination. Treatment is aimed at relieving acute attacks, prevention of further attacks, and reducing the risk of complication. The first-line treatment of gout involves medication therapy, which may include:

- Nonsteroidal anti-inflammatory drugs, or NSAIDs, (such as ibuprofen or naproxen) are used to manage pain;
- Other pain-relievers, such as colchicine, are used if a patient cannot take NSAIDs. It may also be used after the attack to prevent its recurrence;
- Corticosteroids, such as prednisone, are used to manage pain and inflammation;
- Xanthine oxidase inhibitors (such as allopurinol and febuxostat) are used to prevent complications, as they limit uric acid production;
- Probenecid may also be used to prevent complications, but it features other mechanism of action: it improves removal of uric acid from the body.

Pain and swelling may be also reduced by application of ice packs and keeping the effected joint elevated. During the medication therapy it is recommended to follow such guidelines:

- Drink 8-10 cups of water daily;
- Avoid drinking alcohol;
- Avoid fatty foot;
- Take adequate amount of proteins, preferably from fat-free dairy and eggs;
- Keep a healthy weight;
- Limit meat and fish intake.

Alternative treatment suggests increased daily intake of coffee, vitamin C, and cherries. These products are believed to lower uric acid level.

Surgery is performed rarely and is required only in severe cases when tophi develop.

Prevention

In order to decrease the risk of gout it is recommended to maintain normal uric acid levels by consuming coffee, dairy products, vitamin C, and drinking enough fluids. It is also recommended to limit intake of meat and seafood, high-cholesterol and high-fat foods, alcohol and fructose. Keeping prevention measures is of great importance for people who are at higher risk of developing gout.

These articles can be used for informational purposes only. To get an accurate diagnosis consult your doctor!

Causes of yeast infections

The most common causative agent of candidiasis is Candida albicans. Less common species that may affect people include C. Tropicalis, C. Dubliniensis, and C. Lusitaniae. Candida albicans as well as many other fungal bacteria are not caught by human but are present in healthy people causing no harm. However, there are several risk factors which can increase the risk of its growth and developing:

- taking oral contraceptives;
- being pregnant;
- using detergents, such a soaps, shower gels or bubble bath, as they may affect the vaginal flora and increase the risk of getting vaginal yeast infection;
- suffering from diabetes;
- taking antibacterial antibiotics or steroids;
- undergoing radiation therapy or chemotherapy;
- wearing dentures for a long time;
- high-cardohydrates diet, as it may increase the risk of thrush;
- having weakened immune system (due to HIV or AIDC, cancer, etc.);
- environmental risk factors include warm and humid climate.

Types of candidiasis

Yeast infections commonly affect moist and warm skin areas, such as underarms, however it may occur in any other body areas. Candidiasis is divided into several types depending on its clinical presentation and causes.

- Angular cheilitis is characterized by inflammatory lesions at the corners of the mouth.

- Antibiotics candidiasis is caused by use of certain antibiotics.
- Candidal intertrigo occurs between intertriginous skin folds.
- Candidal paronychia affects nail folds.

- Candidal vulvovaginitis occurs on vagina’s mucous membranes.
- Chronic mucocutaneous candidiasis is a chronic infection of mucosal surfaces, skin, or nails
- Diaper candidiasis affect diaper area of a child.

- Erosio interdigitalis blastomycetica is characterized by oval-shaped areas of white skin between the fingers.

- Oral candidiasis, or thrush, occurs in the mouth.

- Perianal candidiasis affects the perianal area.
- Systemic candidiasis occurs in immunocompromised persons. It penetrates the bloodstream and may affect internal organs, such as brain, kidney, and heart. It is the most dangerous and potentially-life threatening type.

Candidiasis symptoms

Candidiasis symptoms vary depending on the type of infection and the area infected. Here are the most common symptoms of the disease:

- Mild skin infections usually cause minimal discomfort, limited to redness and itching.
- In most cases skin fungus look like red rash with scale edges.

- Thrush (oral candidiasis) is characterized be thick whitish patches forming on the mucous membranes in the mount, most often on the tongue and palate. The underlying tissue of the patches may bleed if the patches are wiped away. Thrush may cause pain while eating.

- If candida affect vaginal mucous membranes, it may cause itching, soreness, burning, and whitish discharge. Sometimes women experience pain during sexual intercourse. The infection may also affect a man’s penis causing sores on the foreskin or near the head, itching and burning.

Diagnosis and treatment of candidiasis

The diagnosis is made on the basis of microscopic examination of a scraping of the affected area or culturing.

- Most candidal infections may be treated at home with antimycotis, or topical antifungal drugs, such as clotrimazole, flukonazole, nystatin, or ketoconazole. The dosing may vary depending on the type of infection. For severe cases amphotericin B, voriconazole, or caspofungin may be prescribed.
- Vaginal fungus may be treated with one of the following vaginal suppositories: tioconazole, miconazole, clotrimazole, or butoconazole. These medications are to be massaged into vaginal mucous membranes.
- Thrush is treated with nystatin. It is also recommended to rinse the mouth with salt water.
- Patients with suppressed immune system often need hospitalization where they are administrated antibiotics intravenously.
Patients with strong immunity usually improve within a week. Patients with suppressed immune system usually recover longer and they are more likely to have recurring infections.

Candidiasis prevention

The most effective way to reduce the risk of developing yeast infection is to prevent bacteria from growing and penetrating the skin or mucous membrane. You can do this by practicing proper hygiene, notably it is recommended to:

- maintain oral hygiene by brushing the teeth daily and flossing;
- take a shower regularly and pay special attention to intertriginous skin areas;
- dry the skin carefully after the shower;
- avoid sweetening or wearing wet clothes (such as swimsuit) for a long time;
- wear loose underwear.

There are also some dietary recommendations that will also help control candida growth:

- limit sugars and alcohol intake;
- include to your diet garlic, as it has antibacterial effect and improves the immune system;
- eat live yogurts and drink milk, as these products contain useful bacteria that may fight candida.

These articles can be used for informational purposes only. To get an accurate diagnosis consult your doctor!

Diphtheria was named by French physician Pierre Bretonneau in 1826 and its name derives from Greek word meaning “leather”, referred to the pseudomembrane forming in the throat of infected people.

Causes and risk factors

Diphteria is caused by anaerobic Gram-positive bacterium Corynebacterium diphtheria.

This bacterium was identified in 1884 by Friedrich Loeffler, however the disease itself has been known since ancient times.
The disease is highly contagious and may be transmitted through direct contacts or through inhaling of bacterium containing in secretions released by infected persons during coughing or sneezing. The infection may be also spread by people who have no signs of the disease.

The bacterium may also spread through infected objects or foods, such as cups, toys, or towels. The risk factors for getting the disease include lack of immunization, overcrowded conditions, poor hygiene and having suppressed immune system. People travelling to endemic areas are also at increased risk. The infection is more likely to be spread in winter and spring seasons.

The incubation period of diphtheria lasts from two to seven days.

Diphtheria symptoms

In some cases diphtheria affection may be limited to skin causing skin lesions.

This type of the disease is referred to as skin, or cutaneous, diphtheria.

In most cases the disease is referred to as respiratory diphtheria. It is characterized by other severe symptoms, which affect the throat and nose and include:

- sore throat, hoarseness, and cough;
- fatigue;
- fever (up to 38C, or 100.4F) with chills;
- headache;
- bluish skin color;
- lymphadenopathy (lymph nodes disease) characterized by swollen lymph nodes;

- swollen neck, sometimes referred to as bull neck;

- inflammation of mucous membranes;
- formation of membranous pharyngitis (a false membrane) in the throat, notably on the tonsils (two small lymphoid tissues in the throat), on the pharynx (a cavity behind the nose and mouth), or on the nasal cavity. This membranes usually cause difficulty or painful swallowing or breathing, rapid breathing, stridor, and bloody nasal discharge.

Vaccinated people normally develop no symptoms, however they may become a carrier of the infection and spread it to other people.

In severe cases bacterial toxins produced by corynebacterium diphtheria may spread through the bloodstream to other part of the body and cause severe complications, such as arrhythmias (irregular heart beat), myocarditis (inflammation of heart muscle) or peripheral neuropathy (dysfunction of peripheral nerves). The disease may also affect kidneys.

The mortality rate ranges between 5 and 10% in adults and may be as high as 20% in children and adults over 40 years of age.

Diagnosis and treatment

Preliminary diagnosis may be made on the basis of physical examination and reported symptoms. The doctor may reveal such signs as pseudomembrane (greyish or black covering in the throat) when looking in the mouth, neck swelling, and enlarged lymph nodes. The diagnosis is confirmed by identification of corynebacterium diphtheria by throat culture or Gram stain. Electrocardiogram may be performed to ensure that the heart is not affected.

If diphtheria is suspected, the treatment should be initiated immediately without waiting for confirmation. At first diphtheria antitoxin is administrated intravenously or into the muscle. This antitoxin neutralizes toxin produced by corynebacterium diphtheria. Then the disease is treated with antibiotics, namely with penicillin and erythromycin. People may need hospitalization for the period of treatment. Besides, the following treatments may be required:

- intravenous fluids;
- oxygen supply;
- intubation, or inserting of a breathing tube;
- removal or airway blockages.

During the treatment bed rest should be kept. Alternative medicine recommends taking orange and pineapple juices and garlic to help the immune system to fight the infection.

Infected person should stay isolated.

Recovery usually takes a long time lasting for several weeks.

Prevention

Nowadays diphtheria vaccination is highly recommended in most developed countries, which has significantly decreased the incidence of the infection during last decades. This vaccine is a part of a three-in-one vaccine for diphtheria, tetanus and pertussis (DTaP-vaccine), and is recommended to be administrated during infancy as a series of five shots at the following ages: 2, 4, 6 month, 15-18 months, and 4-6 years.

The immunity to the disease weakens in 10-year period and it is recommended to administrate booster TD vaccine (for diphtheria and tetanus) each 10 years. You should also update your vaccination if you going to travel to endemic countries.
If you have come in contact with infected person, visit your doctor even if you are not experiencing any symptoms of the infection.

These articles can be used for informational purposes only. To get an accurate diagnosis consult your doctor!

Lichen planus causes

The exact cause of lichen planus is not understood. It is known that there are several risk factors for getting the disease, which include:

- taking medication for heart disease and high blood pressure (LP may occur as an allergic reaction to these medications);
- suffering from hepatitis C;
- exposure to chemical substances (LP may occur as an allergic reaction to gold, arsenic, iodide, etc.)
- being a woman (the disease is more likely to affect females).

Lichen planus is not a contagious or a hereditary disease. It is more likely to affect middle-aged adults.

Signs and symptoms

If the disease affects oral mucosa, it may cause the following symptoms:

- painful lesions, usually located on the tongue or on the inside of the cheeks, and sometimes on the gums.

There are three forms of oral lesions: reticular (presents as white streaks), bullous (looks like raised fluid-filled vesicles), and erosive form (looks like red ulcers);
- blue-white pimples;

- painful ulcers.

In case of skin lichen planus, the following signs may occur:

- lesions on the wrists, legs, torso, or genitalia.

The lesions are usually reddish or purple, may have sharp borders and scaly surface. As the lesions heal they turn to blue-black or brown and persist for a long time;
- Itching;
- papules of 2-4 cm;

- sometimes blisters or ulcers may develop.

LP may also affect the genitals and cause itchy purplish lesions on the tip of the penis (in men), itching lesions or painful sores on the external genitalia (in women). In rare cases the disease may affect nails and lead to ridges on the nails, splitting or cracking of the nails, or loss of the nail.

Other symptoms of the disease include metallic taste in the mouth, hair loss (if the disease affects the scalp), and dry mouth. In rare severe cases mouth ulcers may develop to cancer.

Types of lichen planus

There are several types of lichen planus, depending on its clinical presentation:

- annular LP (develops as rings or accurate groupings);

- linear LP (features lace-like developing);

- hypertrophic LP (the most pruritic form, usually occurs on the arms and legs);
- atrophic LP (is characterized by white-blue papules);
- ulcerative LP (develops painful bullae or ulcers on feet);
- vesiculobullous, or bullous LP (occurs as vesicles and bullae);
- follicular lichen planus (involves hair loss);

- acnitic LP (features hyperpigmented violaceous-brown papules);

Lichen planus is also classified by the affected area into palmoplanter LP (affects palms and soles), mucosal LP, LP of nails, LP of the scalp, and inverse LP.

Diagnosis and treatment

Preliminary diagnosis is made on the basis of visual examination of skin or mouth lesion. In order to confirm the diagnosis, lesion biopsy may be required. Your doctor may also test your blood sample to exclude hepatitis C, which may be the trigger of the disease. Sometimes allergy tests are performed to reveal a possible cause of your condition.

There is no cure for lichen planus, but there are medications that cat improve its symptoms, among which are:

- steroids (both oral and topical);
- topical or oral corticosteroids (such as clobetasol and prednisone);
- immunosuppressants, such as tacrolimus or cyclosporine;
- oral or topical retinoid (a form of vitamin A) may reduce itching;
- lidocaine mouthwashes may be used for mouth lesions treatment;
- antihistamines;
- hydroxychloroquine;
- antibacterials, such as dapsone.

Non-medication treatment includes ultraviolet light therapy. You can also reduce itching by applying cold to the affected skin. Among the alternative ways of treatment are aloe vera and purslane.

However, even if successfully treated, lichen planus may stay dormant in the organism and recur after several years.
The choice of treatment is rather extensive due to numerous clinical presentations of lichen planus and due to the fact, that the exact cause of the disease remains unknown.

Usually patients recover within 18 months after treatment initiation.

Prevention

There is no effective way to prevent lichen planus, as the causes of the disease are not understood and its risk factors can hardly be avoided. All you can do is to seek medical care as soon as you notice any lesions on your skin or in the mouth to start early treatment and to improve recovery.

If you have already got lichen planus, you can prevent it from aggravation by keeping the following recommendations:

- limit stress;
- avoid scratching the lesions;
- avoid skin injures;
- if you have lesions in the mouth, you should give up smoking and stop using alcohol (to reduce the risk of cancer development) and to practice proper oral hygiene (visit your dentist regularly, brush the teeth twice a day, and floss the mouth);
- avoid foods and beverages that can irritate lesions in the mouth (such as citruses, tomatoes, spicy foods, salty products, caffeine).

These articles can be used for informational purposes only. To get an accurate diagnosis consult your doctor!