Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella enterica, subspecies enterica serovar typhi and, to a lesser extent, related serovars paratyphi A, B, and C.
The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within 1 month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications.
Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella enterica, subspecies enterica serovar typhi and, to a lesser extent, related serovars paratyphi A, B, and C.
The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within 1 month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications.
Pertussis : Highly contagious respiratory infection caused by Bordetella pertussis
Outbreaks first described in 16th century
Bordetella pertussis isolated in 1906
Estimated >300,000 deaths annually worldwide
Before the availability of pertussis vaccine in the 1940s, public health experts reported more than 200,000 cases of pertussis annually.
Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the pre-vaccine era.
In 2012, the last peak year, CDC reported 48,277 cases of pertussis.
Extremely contagious-attack rate 100%
Immunity is never complete
Protection begins to wane in 3-5 yrs after vaccination
Dengue virus rarely causes death. However, the infection can progress into a more serious condition known as severe dengue or dengue hemorrhagic fever. Symptoms of dengue hemorrhagic fever include: bleeding under the skin. frequent vomiting.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Brief and easily understandable description on measles along with images for undergraduate students. this presentation would help in picturising what measles is.
Tetanus Presentation
77 slides
Including drip rates of muscle relaxants
PDF : http://www.mediafire.com/download/k00ciibf73d7y6p/
For more, visit www.medicalgeek.com
Pertussis : Highly contagious respiratory infection caused by Bordetella pertussis
Outbreaks first described in 16th century
Bordetella pertussis isolated in 1906
Estimated >300,000 deaths annually worldwide
Before the availability of pertussis vaccine in the 1940s, public health experts reported more than 200,000 cases of pertussis annually.
Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the pre-vaccine era.
In 2012, the last peak year, CDC reported 48,277 cases of pertussis.
Extremely contagious-attack rate 100%
Immunity is never complete
Protection begins to wane in 3-5 yrs after vaccination
Dengue virus rarely causes death. However, the infection can progress into a more serious condition known as severe dengue or dengue hemorrhagic fever. Symptoms of dengue hemorrhagic fever include: bleeding under the skin. frequent vomiting.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Brief and easily understandable description on measles along with images for undergraduate students. this presentation would help in picturising what measles is.
Tetanus Presentation
77 slides
Including drip rates of muscle relaxants
PDF : http://www.mediafire.com/download/k00ciibf73d7y6p/
For more, visit www.medicalgeek.com
Chickenpox -symptoms |tests |management ( medical information ) martinshaji
Chickenpox is a highly contagious viral infection that causes an acute fever and blistered rash, mainly in children.
The name may be derived from the French term for chick pea, chiche pois. Another theory is that the word 'chicken' was derived from a slang term for 'child'. Chickenpox is also known as varicella.
please comment
thank you ...
Presented by Dr. Seraj Ahmad Jahanfar; Emergency and Critical Care physician at French Medical Institute for Mother and Children in Kabul, Afghanistan.
Abbott Diagnostics
Hematology
Educational Services
Intended Audience
This Learning Guide is intended to serve the basic educational needs of health care
professionals who are involved in the fields of laboratory medicine. Anyone associated with
the testing of the formed elements of the blood will find this monograph of special interest.
The monograph features basic information necessary to understand and appreciate the
importance of hematology testing in the laboratory and is intended for those who use
the hematology laboratory services, including, but not limited to, laboratory technicians,
laboratory technologists, supervisors and managers, nurses, suppliers, and other
physician office and laboratory support personnel.
Blood diseases cover a wide spectrum of illnesses, ranging from the anaemias, leukaemias and congenital coagulation disorders.
Haematological change may occur as a consequence of disease affecting any system and measurement of haematological parameters is an important part of routine clinical assessment.
A myeloprolifrative stem cell disorder resulting in
Proliferation of all haematopoietic lineages but
manifestation Predominantly in the granulocytic series.
The disease occurs chiefly between 30 and 80 years, with
A peak incidence at the 55 years.
*accounts for 20% of all leukaemis.
*found in all races.
*the aetiology is unknown.
Systematic (non-random) error that results in an incorrect estimate of the association between exposure and risk of disease.
Can occur in all stages of a study
Not affected by study sample size
Difficult to adjust for afterwards, but can be reduced by adequate study design.
•Can never be totally avoided, but we must be aware of it and interpret our results accordingly
Tropic = shape response. [from Middle English tropik, Old French tropique, Latin tropicus, Greek tropikos, turn]
Viral tropism = the way the virus responds to external stimulus in order to attach to and infect cells
Medical college of wasit
Department of medicine
Case sheet history
Thing to remember :-
1) Stand on the right side of the patient with good confidence .
2) Introduce yourself as a medical student not as a doctor . ( you may face difficult question ).
3) Talk the patient gently with clear comprehensible words .
4) Remember don’t hurt the patient in your speak & touch .
Healthcare Improvement Scotland (HIS) is committed to equality and diversity and assesses all its publications for likely impact on the
six equality groups defined by age, disability, gender, race, religion/belief and sexual orientation.
SIGN guidelines are produced using a standard methodology that has been equality impact assessed to ensure that these equality
aims are addressed in every guideline. This methodology is set out in the current version of SIGN 50, our guideline manual, which can
be found at www.sign.ac.uk/guidelines/fulltext/50/index.html. The EQIA assessment of the manual can be seen at
www.sign.ac.uk/pdf/sign50eqia.pdf. The full report in paper form and/or alternative format is available on request from the
Healthcare Improvement Scotland Equality and Diversity Officer.
Every care is taken to ensure that this publication is correct in every detail at the time of publication. However, in the event of errors
or omissions corrections will be published in the web version of this document, which is the definitive version at all times. This version
can be found on our web site www.sign.ac.uk.
This document is produced from elemental chlorine-
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Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
How to Create Map Views in the Odoo 17 ERPCeline George
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The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
1. Human Herpesviruses
Varicella-zoster virus infection
(VZV/HHV-3)
Chickenpox
Associated Professor
Lali Sharvadze, MD, PhD
Infectious Diseases, AIDS & Clinical Immunology Research Center
2. •Herpes simplex type I (HHV-1)
•Herpes simplex type II (HHV-2)
•Varicella-zoster virus (VZV/HHV-3)
•Epstein-Barr virus (EBV/HHV-4)
•Cytomegalovirus (CMV/HHV-5)
•Human herpesvirus type 6 (HBLV/HHV-6)
•Human herpesvirus type 7 (HHV-7)
• Kaposi's sarcoma herpesvirus (KSHV/HHV-8)
HUMAN HERPESVIRUS TYPES
3. • HSV-1 causes Oral-facial infections, Gingivostomatitis
and pharyngitis
• HSV-2 is a sexually transmitted infection that causes
genital herpes
• Varicella-zoster virus causes Shingles (herpes
zoster) and Chickenpox
• Epstein-Barr virus causes Infectious mononucleosis
• Cytomegalovirus causes CMV mononucleosis and
immunocompromised host infections
• Human herpesvirus type 6 causes childhood illness known
as roseola infantum or sixth disease.
• Human herpesvirus type 7 cause a skin condition in
infants known as exanthema subitum,
• Human herpesvirus type 8 cause Sarcoma Kaposi's
6. Varicella-zoster virus (VZV) causes two distinct clinical
diseases:
varicella (chickenpox) and herpes zoster (shingles).
Chickenpox, a ubiquitous and extremely contagious
infection, is usually a benign illness of childhood
characterized by an exanthematous vesicular rash.
Human herpesvirusis
DEFINITION
8. Chickenpox is caused by Varicella Zoster Virus
VZV is a member of the family Herpesviridae, sharing with other
members such structural characteristics as a lipid envelope
surrounding a nucleocapsid with icosahedral symmetry,
a total diameter of ~180–200 nm, and centrally
located double-stranded DNA that is ~125,000 bp in length.
The family of Herpesviridae.
The genus of varicellovirus
Etiology
11. A clinical association between varicella and herpes zoster has been
recognized for nearly 100 years.
Early in the twentieth century, similarities in the histopathologic
features of skin lesions resulting from varicella and herpes zoster
were demonstrated.
Viral isolates from patients with chickenpox and herpes zoster
produced similar alterations in tissue culture.
These results suggested that the viruses
were biologically similar.
12. Restriction endonuclease analyses of viral DNA
from a patient with chickenpox who subsequently
developed herpes zoster verified
the molecular identity
of the two viruses responsible for these different
clinical presentations.
14. • Chickenpox is an airborne disease which
spreads easily through the coughs and sneezes
of an infected person.
• It may be spread from one to two days before
the rash appears until all lesions have crusted
over.
• It may also spread through contact with the
blisters.
16. After initial inhalation of contaminated respiratory
droplets, the virus infects the conjunctivae or the mucosae
of the upper respiratory tract.
Viral proliferation occurs in regional lymph nodes of the
upper respiratory tract 2-4 days after initial infection; this
is followed by primary viremia on postinfection days 4-6.
A second round of viral replication occurs in the body's
internal organs, most notably the liver and the spleen,
followed by a secondary viremia 14-16 days post infection.
This secondary viremia is characterized by diffuse viral
invasion of capillary endothelial cells and the epidermis.
Pathophysiology
17. infection may involve localized blood vessels of the skin, resulting
in necrosis and epidermal hemorrhage. With the evolution of
disease, the vesicular fluid becomes cloudy because of the
recruitment of polymorphonuclear leukocytes and the presence of
degenerated cells and fibrin.
Ultimately, the vesicles either rupture and release their fluid (which
includes infectious virus) or are gradually reabsorbed.
During chickenpox, (Presumably), the virus infects dorsal root
ganglia where it remains latent and establishes lifelong residence
(latent infection) until reactivated.
19. Chickenpox occurs in all parts of the world. As of 2013 140
million cases of chickenpox occurred.
Before routine immunization the number of cases occurring each
year was similar to the number of people born.
Since immunization the number of infections in the United States
has decreased nearly 90%. In 2013 chickenpox resulted in 7,000
deaths globally.
Death occurs in about 1 per 60,000 cases. Chickenpox was not
separated from smallpox until the late 19th century.
The first documented use of the term chicken pox was in 1658.
Various explanations have been suggested for the use of "chicken"
in the name, one being the relative mildness of the disease.
20. Humans are the only known reservoir for VZV.
Chickenpox is highly contagious, with an attack rate of at least 90%
among susceptible (seronegative) individuals.
Persons of both sexes and all races are infected equally.
Chickenpox becomes epidemic among susceptible individuals
during seasonal peaks—namely, late winter and early spring in the
temperate zone.
Historically, children 5–9 years old are most commonly
affected and account for 50% of all cases.
VZV vaccination during the second year of life has dramatically
changed the epidemiology of infection, has coursed significant
decrease in the annualized incidence of chickenpox.
23. • Incubation period (Phase)
• Prodromal period (Phase)
• Exanthem period (Phase)
• Reconvalencence period (Phase)
The Disease has 4 Phases
24. The incubation period of chickenpox ranges
from 10–21 days but is usually 14–17 days.
During these period patient is asymptomatic
25. A few patients develop a prodrome 1–2 days
before onset of the exanthem.
The prodromal symptoms in adolescents and
adults are nausea, loss of appetite, aching muscles,
and headache.
Prodromal period
Pre eruptive stage
26. In many children the illness is not usually
preceded by prodromal symptoms, and the first
sign is the rash or the spots in the oral cavity.
Prodromal period
Pre eruptive stage
Onset of symptoms usually is sudden, with mild or moderate fever
Malaise
This stage is lasts for about 24 hours in children and 2-3-days in adult
27. eruptive stage
Exanthem period (Phase)
The skin lesions—the hallmark of the infection
This stage is characterized by the
• Rapid evolution
• Pleomorfizm
• Fever
28. The rash begins as multiple small red bumps (papules) that look like
pimples or insect bites. These lesions are small and have an
erythematous (erythematous macules) base with a diameter of
5–10 mm.
After another 12 to 24 hours the spots typically become itchy, fluid-
filled bumps called vesicles, which continue to appear in crops
for the next 2 to 5 days.
The rash is very itchy, and cool baths or calamine lotion may help to
manage the itching.
Exanthem period (Phase)
29. The rash first appear (Within a few hours or days) on the scalp, neck ,
face or upper half of the trunk and very rapidly (over hours) spread to
involve other areas of the body
In any area of skin, lesions of a variety of stages can be
seen.
These blisters can spread to cover much of the skin, and in some cases
also may be found inside the mouth, nose, ears, vagina, or
rectum.
Successive crops appear over a 2- to 4-day period.
Exanthem period (Phase)
30.
31. Exanthem period (Phase)
After the chickenpox red spot appears, it usually takes
about 1 or 2 days for the spot to go through all its stages.
This includes blistering, bursting, drying and crusting
over.
New red spots will appear every day for up to 5-7 days.
It usually takes about 10 days after the first symptoms
before all blisters have crusted over. This is when the person
with chickenpox can return to day care, school, or work.
32.
33.
34.
35. A hallmark of chickenpox is that all stages (red bumps,
blisters (vesicles), and scabs) can appear on the body at the
same time.
37. Some individuals have very few lesions, while others have
as many as 2000.
Younger children tend to have fewer vesicles than older
individuals.
Disease severity varies from person to person, but older
patients tend to have more severe diseases.
Secondary and tertiary cases within families are associated
with a relatively large number of vesicles.
Disease severity
38. In the immunocompetent patient, chickenpox is usually a
benign illness associated with tiredness, weakness and with
body temperatures of 37.8°–39.4°C (100°–103°F) of 3–5
days’ duration.
Immunocompromised patients —both children and adults,
particularly those with leukemia—have lesions (often with a
hemorrhagic base) that are more numerous and take longer to
heal than those of immunocompetent patients.
Immunocompromised individuals are also at greater risk for
visceral complications, which occur in 30–50% of cases and
are fatal 15% of the time in the absence of antiviral therapy.
Disease severity
39. Patients are infectious ~ 48 h before
onset of the vesicular rash, during the
period of vesicle formation (which
generally lasts 4–5 days), and until all
vesicles are crusted.
When is patient infectious?
(VZV is communicable….)
41. The most common infectious complication of varicella is
secondary bacterial superinfection of the skin, which is
usually caused by Streptococcus pyogenes or
Staphylococcus including strains that are methicillin-
resistant..
Skin infection results from excoriation of lesions after
scratching.
Gram’s staining of skin lesions should help clarify the
etiology of unusually erythematous and pustulated lesions.
Bacterial superinfection
42. The most common extracutaneous site of
involvement in children is the CNS.
The syndrome of acute cerebellar ataxia and
meningeal
inflammation generally appears ~21 days after
onset of the rash and rarely develops in the pre
eruptive phase.
The cerebrospinal fluid (CSF) contains lymphocytes
and elevated levels of protein.
CNS complications
43. CNS involvement is a benign complication of VZV
infection in children and generally does not require
hospitalization.
Aseptic meningitis, encephalitis, transverse
myelitis, and Guillain-Barré syndrome can also
occur.
Encephalitis is reported in 0.1–0.2% of children
CNS complications
44. Varicella pneumonia, the most serious complication following
chickenpox, develops more commonly in adults (up to 20%
of cases) than in children and is particularly severe in pregnant
women.
Pneumonia due to VZV usually has its onset 3–5 days into
the illness and is associated with tachypnea, cough, dyspnea, and
fever. Cyanosis, pleuritic chest pain, and hemoptysis are common.
Roentgenographic evidence of disease consists of nodular infiltrates
and interstitial pneumonitis.
Resolution of pneumonitis parallels improvement of the skin rash;
however, patients may have persistent fever and compromised
pulmonary function for weeks.
Varicella pneumonia
45. Other complications of chickenpox include: myocarditis,
nephritis, arthritis, bleeding diatheses, acute
glomerulonephritis, and hepatitis.
Hepatic involvement, is usually asymptomatic, is common
in chickenpox and is generally characterized by elevated
levels of liver enzymes, particularly aspartate and alanine
aminotransferases.
Other complications
46. Perinatal varicella is associated with a high mortality rate when
maternal disease develops:
within 5 days before delivery or within 48 h thereafter.
Because the newborn does not receive protective
transplacental antibodies and has an immature immune system,
the illness may be unusually severe.
The reported mortality rate is as high as 30% in this group.
Congenital varicella , with clinical manifestations of limb
hypoplasia, cicatricial skin lesions, and microcephaly at birth, is
extremely uncommon.
Perinatal varicella
48. The diagnosis of chickenpox is not
difficult.
The characteristic rash and a
history of recent exposure should
lead to a prompt diagnosis.
49. Serology is the most common method of
laboratory diagnosis.
The detection of VZV –specific IgM is considered
diagnostic of acute infection.
Also, a fourfold or greater increase in VZV specific
IgG antibody levels between acute- and
convalescent-phase serum specimens.
50. Chickenpox also can be diagnosed by detection of
VZV DNA
by reverse-transcriptase polymerase chain reaction
(RT-PCR) from clinical specimens
Isolation of VZV in culture also is possible but it is
very expensive
52. Medical management of chickenpox in the immunologically
normal host is directed toward the prevention of avoidable
complications.
Obviously, good hygiene includes daily bathing and soaks.
Secondary bacterial infection of the skin can be avoided by
scrupulous skin care, particularly with close cropping of fingernails.
Pruritus can be decreased with topical dressings or the
administration of antipruritic drugs. Water baths and wet compresses
are better than drying lotions for the relief of itching.
53. Administration of aspirin to children with
chickenpox should be avoided because of the
association of aspirin derivatives with the
development of Reye’s syndrome.
54. Acyclovir (800 mg by mouth five times daily),
or
valacyclovir (1 g three times daily),
or
Famciclovir (250 mg three times daily)
Treatment duration
for 5–7 days is recommended
Antiviral drugs
for adolescents and adults with chickenpox
Antiviral therapy can be helpful if started within
24-48 h of symptoms
55. Acyclovir (20 mg/kg every 6 h)
Antiviral drugs
For children <12 years of age acyclovir is recommended.
56. In severely immunocompromised hosts (e.g., transplant recipients,
patients with lymphoproliferative malignancies), chickenpox
(including disseminated disease)
should be treated, with IV acyclovir, which reduces the occurrence of
visceral complications.
The dose is 10 mg/kg every 8 h for 7 days.
For low-risk immunocompromised hosts, oral therapy with
valacyclovir or famciclovir appears beneficial.
If medically feasible, it is desirable to decrease
immunosuppressive treatment concomitant with the
administration of IV acyclovir.
58. • Passive Immunization by specific
immunoglobulin
• Active Immunization by Vaccine
• Antiviral drugs
Prophylaxis
59. First
A live attenuated varicella vaccine.
Is recommended for all children >1 year of age (up to 12 years of age)
who have not had chickenpox and for adults known to be seronegative
for VZV.
Two doses are recommended for all children: the first at 12–15
months of age and the second at ~4–6 years of age.
VZV seronegative persons >13 years of age should receive two doses
of vaccine at least 1 month apart. The vaccine is both safe and
efficacious.
Three methods are used for the prevention of VZV infections.
60. A second approach
is to administer varicella-zoster immune globulin (VZIG)
to individuals who are susceptible, are at high risk for
developing complications of varicella, and have had a
significant exposure.
This product should be given within 96 h (preferably
within 72 h) of the exposure.
Three methods are used for the prevention of VZV infections.
61. third approach
Lastly, antiviral therapy can be given as prophylaxis to individuals
at high risk who are ineligible for vaccine or who are beyond the
96-h window after direct contact.
While the initial studies have used acyclovir, similar benefit can be
anticipated with either valacyclovir or famciclovir.
Therapy is instituted 7 days after intense exposure.
At this time, the host is midway into the incubation period. This
approach significantly decreases disease severity, if not totally
preventing disease.
Three methods are used for the prevention of VZV infections.