Ebola virus was discovered in 1976 and causes viral hemorrhagic fever in primates. It is transmitted through contact with body fluids from infected humans or animals. There are 5 species of Ebola virus, with Zaire being the most dangerous. Outbreaks typically occur in Central and West Africa near rainforests. The document then describes a case of Ebola virus disease in a 43-year-old physician evacuated from Sierra Leone. He developed ophthalmic manifestations including uveitis, which tested positive for Ebola virus by PCR. He was treated with corticosteroids, antivirals, and plasma from a survivor. The prognosis remained uncertain given the rare ocular involvement of Eb
Japanese encephalitis (JE) is a mosquito-borne viral disease that is the leading cause of viral encephalitis in Asia. It is caused by the JE virus and transmitted via Culex mosquitoes, primarily Culex tritaeniorhynchus. The virus cycles between pigs and birds as amplifying hosts and mosquitoes. Most human cases occur in rural agricultural areas where vectors breed. Clinical presentation ranges from asymptomatic infection to encephalitis. Acute encephalitis syndrome (AES) surveillance and case classification are important for monitoring JE disease burden and outbreaks. Laboratory confirmation requires detection of JE virus, antigens, RNA or IgM antibodies in serum or cerebrospinal fluid.
This case discusses a 7-year-old male who presented with a 6-day fever and convulsions. His symptoms did not improve with initial treatment. Extensive testing did not identify an infectious cause. He was diagnosed with autoimmune encephalitis based on his clinical presentation and improvement with immunotherapies. The document discusses how autoimmune causes now surpass viral infections as the most common cause of encephalitis in developing countries. It emphasizes the importance of considering and treating non-infectious autoimmune etiologies to achieve better neurological outcomes.
This document discusses several cases of acute encephalitis syndrome (AES) along with background information on AES etiologies and Japanese encephalitis (JE) epidemiology. Case 1 involves a 15-year-old boy with JE diagnosed by CSF IgM antibody testing who required ventilatory support and developed aphasia. Case 2 is a 65-year-old man with varicella zoster virus encephalitis diagnosed based on clinical presentation. Case 3 is a fatal case of dengue encephalitis diagnosed based on CSF findings and clinical course. Case 4 involved HSV encephalitis confirmed by PCR testing who recovered with acyclovir treatment. Case 5 involved mumps meningoencephalitis presenting with par
Two Cases of Fever in returned travelers - Slideset by Professor Ivan HungWAidid
This slideset by Professor Ivan Hung analyzes two different cases of fever in returned travelers: history, differentials, diagnosis and management, indicating also signs, symptoms and how to prevent it.
This case presentation discusses a 9-month-old male child who presented with fever for 2 days and 4-5 episodes of seizures. Laboratory investigations revealed acute meningoencephalitis. The child was diagnosed with acute meningoencephalitis and seizures. He was treated with intravenous antiepileptics, antibiotics including acyclovir, pantoprazole, and supportive medications. Some issues with the treatment plan included contraindications, inappropriate dosing, and frequency of medications. The presentation highlights the diagnosis and management of this case of acute meningoencephalitis with seizures in a child.
1) Ebola virus disease is caused by five species of the Ebolavirus genus. It was first recorded in 1976 and causes high fatality rates due to internal and external bleeding.
2) Symptoms include fever, headache, vomiting and diarrhea early on, and later bleeding from mucous membranes, skin and organs. There is no approved vaccine or treatment.
3) A 1976 case study describes a researcher who was infected via a needle prick. He was treated with interferon and convalescent serum and recovered slowly over 10 weeks despite developing severe symptoms including vomiting, diarrhea and organ dysfunction.
The document describes a case of acute flaccid paralysis (AFP) in a 12-year-old male who presented with pain and weakness in his lower limbs. On examination, he had hypotonia, hyporeflexia, and reduced motor strength in both upper and lower limbs. Guillain-Barré syndrome (GBS) is the most common cause of AFP and involves demyelination of peripheral nerves due to autoimmune attack. Key diagnostic features of GBS are rapid onset of symmetric ascending paralysis, intact sensation, absence of fever or cranial nerve involvement, and albuminocytologic dissociation on CSF analysis. Treatment involves hospitalization, IV immunoglobulin or plasmapher
This document discusses the management of Japanese encephalitis. It begins by outlining that JE is a leading cause of viral encephalitis in Asia. It has been effectively controlled through national vaccination programs. The document then discusses the virus, geographic distribution, pathogenesis, clinical presentation, investigations including lab diagnostics, differential diagnosis, treatment including supportive care, prevention including vaccination and vector control, and rehabilitation.
Japanese encephalitis (JE) is a mosquito-borne viral disease that is the leading cause of viral encephalitis in Asia. It is caused by the JE virus and transmitted via Culex mosquitoes, primarily Culex tritaeniorhynchus. The virus cycles between pigs and birds as amplifying hosts and mosquitoes. Most human cases occur in rural agricultural areas where vectors breed. Clinical presentation ranges from asymptomatic infection to encephalitis. Acute encephalitis syndrome (AES) surveillance and case classification are important for monitoring JE disease burden and outbreaks. Laboratory confirmation requires detection of JE virus, antigens, RNA or IgM antibodies in serum or cerebrospinal fluid.
This case discusses a 7-year-old male who presented with a 6-day fever and convulsions. His symptoms did not improve with initial treatment. Extensive testing did not identify an infectious cause. He was diagnosed with autoimmune encephalitis based on his clinical presentation and improvement with immunotherapies. The document discusses how autoimmune causes now surpass viral infections as the most common cause of encephalitis in developing countries. It emphasizes the importance of considering and treating non-infectious autoimmune etiologies to achieve better neurological outcomes.
This document discusses several cases of acute encephalitis syndrome (AES) along with background information on AES etiologies and Japanese encephalitis (JE) epidemiology. Case 1 involves a 15-year-old boy with JE diagnosed by CSF IgM antibody testing who required ventilatory support and developed aphasia. Case 2 is a 65-year-old man with varicella zoster virus encephalitis diagnosed based on clinical presentation. Case 3 is a fatal case of dengue encephalitis diagnosed based on CSF findings and clinical course. Case 4 involved HSV encephalitis confirmed by PCR testing who recovered with acyclovir treatment. Case 5 involved mumps meningoencephalitis presenting with par
Two Cases of Fever in returned travelers - Slideset by Professor Ivan HungWAidid
This slideset by Professor Ivan Hung analyzes two different cases of fever in returned travelers: history, differentials, diagnosis and management, indicating also signs, symptoms and how to prevent it.
This case presentation discusses a 9-month-old male child who presented with fever for 2 days and 4-5 episodes of seizures. Laboratory investigations revealed acute meningoencephalitis. The child was diagnosed with acute meningoencephalitis and seizures. He was treated with intravenous antiepileptics, antibiotics including acyclovir, pantoprazole, and supportive medications. Some issues with the treatment plan included contraindications, inappropriate dosing, and frequency of medications. The presentation highlights the diagnosis and management of this case of acute meningoencephalitis with seizures in a child.
1) Ebola virus disease is caused by five species of the Ebolavirus genus. It was first recorded in 1976 and causes high fatality rates due to internal and external bleeding.
2) Symptoms include fever, headache, vomiting and diarrhea early on, and later bleeding from mucous membranes, skin and organs. There is no approved vaccine or treatment.
3) A 1976 case study describes a researcher who was infected via a needle prick. He was treated with interferon and convalescent serum and recovered slowly over 10 weeks despite developing severe symptoms including vomiting, diarrhea and organ dysfunction.
The document describes a case of acute flaccid paralysis (AFP) in a 12-year-old male who presented with pain and weakness in his lower limbs. On examination, he had hypotonia, hyporeflexia, and reduced motor strength in both upper and lower limbs. Guillain-Barré syndrome (GBS) is the most common cause of AFP and involves demyelination of peripheral nerves due to autoimmune attack. Key diagnostic features of GBS are rapid onset of symmetric ascending paralysis, intact sensation, absence of fever or cranial nerve involvement, and albuminocytologic dissociation on CSF analysis. Treatment involves hospitalization, IV immunoglobulin or plasmapher
This document discusses the management of Japanese encephalitis. It begins by outlining that JE is a leading cause of viral encephalitis in Asia. It has been effectively controlled through national vaccination programs. The document then discusses the virus, geographic distribution, pathogenesis, clinical presentation, investigations including lab diagnostics, differential diagnosis, treatment including supportive care, prevention including vaccination and vector control, and rehabilitation.
Jaylee Kraft, a 19-year-old college student, presented to the emergency department with symptoms of a severe headache, fever, chills, and irritability after a weekend hiking trip. Her friends reported she had been acting unusually impatient and confused. On examination, she was found to have a high fever, neck stiffness, photophobia, and petechiae. The physician suspects bacterial meningitis based on her symptoms and orders diagnostic tests including a lumbar puncture. The results show an elevated white count and decreased glucose in the CSF, supporting the diagnosis of bacterial meningitis. Antibiotics and other medications are ordered to treat the infection and manage symptoms.
AFP is a clinical syndrome characterized by rapid onset of weakness or paralysis in one or more limbs. Common causes of AFP include Guillain-Barré syndrome, poliomyelitis, transverse myelitis, and traumatic neuritis. For polio eradication efforts, all AFP cases must be reported and investigated within 48 hours by collecting two stool specimens at least 24 hours apart and analyzing them for the presence of wild poliovirus. Isolating wild poliovirus from stool specimens would classify the case as confirmed polio.
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
ACUTE FLACCID PARALYSIS
Kanishk Deep Sharma
definition
Sudden onset of weakness or paralysis over a period of 15 days in a patient aged less than 15 years age
Ddx
poliomyelitis
Non enveloped, positive stranded RNA virus
Genus ENTEROVIRUS
family PICORNAVIRIDAE
3 antigenically distinct serotypes:-1,2,3
pathogenesis
•Entry into mouth.
•Replication in pharynx, GI tract, Local Lymphatic.
•Hematologic spread to lymphatic and central nervous system.
•Viral spread along nerve fibers.
•Destruction of motor neurons
Immunity
Initially protected by maternal antibodies for first few weeks of life
Types
Asymptomatic
Abortive Polio
Non-paralytic
Paralytic
Spinal
Bulbar
Bulbospinal
Cf- asymptomatic
• Accounts for approximately 95% of cases
• Virus stays in intestinal tract and does not attack the nerves
• Virus is shed in the stool so infected individual is still able to infect others
Cf-abortive
•Does not lead to paralysis
•Mild symptoms seen such as sore throat, fever, n/v, diarrhea, constipation ( Minor illness)
•Most recover in <1><5><4days />95% immune after 3 doses
Immunity probably lifelong
Inactivated polio vaccine
Humoral immunity and to some extend pharyngeal immunity
Duration of immunity not known with certainty
Strategies for polio eradication
Global Polio Eradication Initiative launched in 1988
Polio cases have decreased by over 99%
1988 - >125 countries
In 2010 - 4 countries
The remaining countries are Afghanistan, India, Nigeria and Pakistan
Core strategies
High infant immunization coverage with four doses of oral poliovirus vaccine (OPV) in the first year of life
Supplementary doses of OPV to all children under five years of age during national immunization days
AFP surveillance among children under fifteen years of age
Targeted “mop-up” campaigns once wild poliovirus transmission is limited to a specific focal area.
Immunisation in india
Polio Vaccination under UIP
OPVº birth
OPV1 6 wks
OPV2 10 wks
OPV3 14 wks
OPV4 16-24 Months
Pulse Polio Immunization (PPI)
The supplementary immunization activities (SIAs) in India launched in 1995
Irrespective of the immunisation status
Usually Dec & Jan – Peak transmission
aim
Providing additional OPV doses to every child aged <5><15 years who have had the onset of flaccid paralysis within the preceding 60 days
All cases that are found are investigated immediately, with collection of two stool specimens before administration of OPV.
This document provides an overview of various pediatric diseases and conditions organized into sections on neonatology, infectious diseases, and specific infections. Key points include:
- Vernix caseosa and lanugo hair are normal newborn skin features providing lubrication and protection. Necrotizing enterocolitis is a serious intestinal infection of preterm infants treated with bowel rest and antibiotics or surgery.
- Common bacterial infections like GABHS can cause pharyngitis, scarlet fever, or rheumatic fever. Diphtheria causes membrane formation and potential cardiac/neurologic complications.
- Viral infections like measles cause a rash and can lead to pneumonia or encephalitis. Congen
This document provides an overview of tick-borne infections including Lyme disease, anaplasmosis, ehrlichiosis, babesiosis, Powassan virus, and Rocky Mountain spotted fever. It discusses the epidemiology, ecology, clinical presentation, diagnosis, treatment and prevention of these infections. Key points include expanding ranges for ticks and infections, new diagnostic tests such as nucleic acid tests, similarities and differences between diseases, and recommendations for doxycycline treatment of most infections.
Acute disseminated encephalomyelitis (ADEM) is a monophasic demyelinating disease of central nervous system (CNS) which is most frequently associated with an antecedent infection (identified in ~ 50-77%). 5% of ADEM cases follow immunization. Post infectious autoimmune events associated with Japanese encephalitis (JE) have been limited to Guillian Barre Syndrome (GBS) and JE virus vaccine related ADEM. We hereby report a case of 18 year boy who presented to us with fever, urinary retention, bilateral diminution of vision and acute onset paraparesis. Japanese encephalitis was diagnosed by elevated IgM titres against JE virus in cerebrospinal fluid (CSF). ADEM was confirmed by MRI brain and spinal cord. Our patient also developed bilateral eye optic neuritis presenting clinically as sudden onset blurring of vision in both eye one day after admission and confirmed by visual evoked potential (VEP) study. His symptoms improved after giving high dose intravenous methylprednisolone.
AFP surveillance is critical for global polio eradication. All cases of acute flaccid paralysis in children under 15 are investigated to differentiate between polio and other causes like Guillain-Barre syndrome, transverse myelitis, traumatic neuritis, and post-diphtheritic polyneuropathy. Stool specimens are collected from AFP cases and tested to isolate poliovirus. If wild poliovirus is isolated, the case is confirmed as polio. Surveillance ensures rapid detection of wild poliovirus circulation.
Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis among infants. It is an autoimmune disorder that causes acute, rapidly progressive, and potentially fatal paralysis. The classic presentation involves ascending symmetric motor weakness, areflexia, and ataxia. Treatment involves hospitalization, IV immunoglobulin, plasmapheresis, and supportive care including ventilation if needed. Most patients recover fully but some have residual deficits and rare cases are chronic or fatal.
This document discusses acute encephalitis syndrome. It defines encephalitis as an acute inflammatory process involving brain tissue and meningoencephalitis as inflammation of both the meninges and brain tissue. Japanese encephalitis is identified as one of the most common causes of acute encephalitis syndrome. It is a mosquito-borne viral infection spread between pigs and birds as amplifying hosts, with humans as incidental hosts. The clinical presentation involves an initial prodromal stage of fever and headache, followed by an encephalitic stage with altered mental status such as confusion or coma. Treatment involves supportive care and empiric antiviral therapy with acyclovir and antibiotics until causative organisms are identified.
1. Acute flaccid paralysis (AFP) can present asymmetrically or symmetrically. Asymmetrical AFP may be caused by poliomyelitis or non-polio enteroviruses, while symmetrical AFP may be Guillain-Barré syndrome or transverse myelitis.
2. Important considerations in the evaluation of a child with AFP include differentiating acute infections from post-injection paralysis, obtaining a thorough history of recent vaccinations or infections, and ruling out treatable causes with imaging or lumbar puncture when indicated.
3. Proper management depends on the stage of illness, with the acute stage prioritizing isolation and prevention of paralysis progression, the restoration stage involving physi
2 severe respiratory infections in the icuIslam Ibrahim
This document discusses challenges in managing severe pneumonia in the intensive care unit (ICU). It identifies major concerns as high mortality, especially from acute respiratory distress syndrome (ARDS), and significant morbidity. Severe pneumonia in the ICU can be community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), or ICU-acquired pneumonia (ICUAP). Main challenges include timely diagnosis, prevention of HAP/VAP, managing complications like ARDS, ensuring timely appropriate antimicrobial treatment, and assessing severity to guide triage and management. The document recommends a clinical bundle for severe pneumonia that includes risk assessment, early ICU evaluation
This document discusses Japanese encephalitis (JE), a mosquito-borne viral disease. It provides background on JE, noting it is a leading cause of viral encephalitis in Asia. The purpose is to review potential new treatment approaches, as vaccines are available but the disease persists and outbreaks are challenging to predict. The virus life cycle and transmission between mosquitoes and pigs/birds is described. While some treatment trials have occurred, none have proven effective due to small sample sizes. The document discusses the virus pathogenesis and potential immunological targets for treatment, such as reducing inflammation. It reviews existing compounds with anti-JE activity in animal models that could be tested in humans.
The document summarizes information about the Ebola virus. It discusses that Ebola causes a severe hemorrhagic fever in humans and other primates with high mortality rates. It was first identified in 1976 near the Ebola River in Africa. Transmission occurs through contact with body fluids of infected humans or animals. Symptoms include fever, weakness, and bleeding. There is currently no approved vaccine or treatment, though experimental therapies are being studied. Prevention relies on avoiding contact with infected animals/people and bodily fluids through protective equipment and safe burials.
Acute flaccid paralysis (AFP) is characterized by sudden onset of weakness or paralysis over a period of 15 days in patients under 15 years old. The most common causes of AFP are poliomyelitis, Guillain-Barré syndrome, and transverse myelitis. Poliomyelitis is caused by poliovirus and typically causes asymmetric flaccid paralysis that may lead to long-term disabilities. Guillain-Barré syndrome is an acute inflammatory disorder of peripheral nerves caused by post-infectious autoimmunity. Transverse myelitis is spinal cord inflammation that causes symmetric paralysis of the lower limbs.
This document provides information about acute flaccid paralysis (AFP), including its definition, causes, surveillance, and clinical management. AFP is defined as paralysis of acute onset (less than 4 weeks) where the limbs are flaccid and tone is decreased. The main causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, and traumatic neuritis. Surveillance of AFP cases is important for monitoring polio eradication efforts. All AFP cases should be reported, investigated, and have stool samples collected and tested for poliovirus. Proper clinical evaluation and management is needed to diagnose the cause and provide specific treatment.
This document summarizes information about cough from Feigin & Cherry's Textbook of Pediatric Infectious Diseases. It classifies cough based on anatomy, etiology, age, and whether it involves the upper or lower respiratory tract. For the upper respiratory tract, common causes are viral infections like RSV, adenovirus, and rhinovirus or bacterial infections such as H. influenzae and S. pyogenes. For the lower respiratory tract, main causes include viral and bacterial pneumonia. Signs differ between upper vs lower respiratory tract infections.
A 29-year-old female presented with severe frontal headache, vomiting, and neck stiffness for one week. A lumbar puncture revealed cryptococcal meningitis. She was started on amphotericin B and fluconazole for induction and consolidation therapy. Monitoring showed worsening anemia and kidney injury from the amphotericin B treatment. The patient's symptoms improved but serial lumbar punctures and cultures were needed to ensure sterilization of the cerebrospinal fluid and check for potential drug resistance before completing the full antifungal treatment course.
Pediatrics notes about "Acute flaccid paralysis". These notes were published in 2018.
You can download them from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
This document is an invitation to the wedding of Elizabeth Mary and Thomas Stephen, which will take place on August 8, 2014 at 5pm at the Chapel of Saint Thomas Aquinas in Saint Paul, Minnesota. A reception will follow at the Schulze Grand Atrium at the University of Saint Thomas in Minneapolis. The invitation provides details on the ceremony location, reception venue, hotel accommodations, and RSVP information for the wedding.
Jaylee Kraft, a 19-year-old college student, presented to the emergency department with symptoms of a severe headache, fever, chills, and irritability after a weekend hiking trip. Her friends reported she had been acting unusually impatient and confused. On examination, she was found to have a high fever, neck stiffness, photophobia, and petechiae. The physician suspects bacterial meningitis based on her symptoms and orders diagnostic tests including a lumbar puncture. The results show an elevated white count and decreased glucose in the CSF, supporting the diagnosis of bacterial meningitis. Antibiotics and other medications are ordered to treat the infection and manage symptoms.
AFP is a clinical syndrome characterized by rapid onset of weakness or paralysis in one or more limbs. Common causes of AFP include Guillain-Barré syndrome, poliomyelitis, transverse myelitis, and traumatic neuritis. For polio eradication efforts, all AFP cases must be reported and investigated within 48 hours by collecting two stool specimens at least 24 hours apart and analyzing them for the presence of wild poliovirus. Isolating wild poliovirus from stool specimens would classify the case as confirmed polio.
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
ACUTE FLACCID PARALYSIS
Kanishk Deep Sharma
definition
Sudden onset of weakness or paralysis over a period of 15 days in a patient aged less than 15 years age
Ddx
poliomyelitis
Non enveloped, positive stranded RNA virus
Genus ENTEROVIRUS
family PICORNAVIRIDAE
3 antigenically distinct serotypes:-1,2,3
pathogenesis
•Entry into mouth.
•Replication in pharynx, GI tract, Local Lymphatic.
•Hematologic spread to lymphatic and central nervous system.
•Viral spread along nerve fibers.
•Destruction of motor neurons
Immunity
Initially protected by maternal antibodies for first few weeks of life
Types
Asymptomatic
Abortive Polio
Non-paralytic
Paralytic
Spinal
Bulbar
Bulbospinal
Cf- asymptomatic
• Accounts for approximately 95% of cases
• Virus stays in intestinal tract and does not attack the nerves
• Virus is shed in the stool so infected individual is still able to infect others
Cf-abortive
•Does not lead to paralysis
•Mild symptoms seen such as sore throat, fever, n/v, diarrhea, constipation ( Minor illness)
•Most recover in <1><5><4days />95% immune after 3 doses
Immunity probably lifelong
Inactivated polio vaccine
Humoral immunity and to some extend pharyngeal immunity
Duration of immunity not known with certainty
Strategies for polio eradication
Global Polio Eradication Initiative launched in 1988
Polio cases have decreased by over 99%
1988 - >125 countries
In 2010 - 4 countries
The remaining countries are Afghanistan, India, Nigeria and Pakistan
Core strategies
High infant immunization coverage with four doses of oral poliovirus vaccine (OPV) in the first year of life
Supplementary doses of OPV to all children under five years of age during national immunization days
AFP surveillance among children under fifteen years of age
Targeted “mop-up” campaigns once wild poliovirus transmission is limited to a specific focal area.
Immunisation in india
Polio Vaccination under UIP
OPVº birth
OPV1 6 wks
OPV2 10 wks
OPV3 14 wks
OPV4 16-24 Months
Pulse Polio Immunization (PPI)
The supplementary immunization activities (SIAs) in India launched in 1995
Irrespective of the immunisation status
Usually Dec & Jan – Peak transmission
aim
Providing additional OPV doses to every child aged <5><15 years who have had the onset of flaccid paralysis within the preceding 60 days
All cases that are found are investigated immediately, with collection of two stool specimens before administration of OPV.
This document provides an overview of various pediatric diseases and conditions organized into sections on neonatology, infectious diseases, and specific infections. Key points include:
- Vernix caseosa and lanugo hair are normal newborn skin features providing lubrication and protection. Necrotizing enterocolitis is a serious intestinal infection of preterm infants treated with bowel rest and antibiotics or surgery.
- Common bacterial infections like GABHS can cause pharyngitis, scarlet fever, or rheumatic fever. Diphtheria causes membrane formation and potential cardiac/neurologic complications.
- Viral infections like measles cause a rash and can lead to pneumonia or encephalitis. Congen
This document provides an overview of tick-borne infections including Lyme disease, anaplasmosis, ehrlichiosis, babesiosis, Powassan virus, and Rocky Mountain spotted fever. It discusses the epidemiology, ecology, clinical presentation, diagnosis, treatment and prevention of these infections. Key points include expanding ranges for ticks and infections, new diagnostic tests such as nucleic acid tests, similarities and differences between diseases, and recommendations for doxycycline treatment of most infections.
Acute disseminated encephalomyelitis (ADEM) is a monophasic demyelinating disease of central nervous system (CNS) which is most frequently associated with an antecedent infection (identified in ~ 50-77%). 5% of ADEM cases follow immunization. Post infectious autoimmune events associated with Japanese encephalitis (JE) have been limited to Guillian Barre Syndrome (GBS) and JE virus vaccine related ADEM. We hereby report a case of 18 year boy who presented to us with fever, urinary retention, bilateral diminution of vision and acute onset paraparesis. Japanese encephalitis was diagnosed by elevated IgM titres against JE virus in cerebrospinal fluid (CSF). ADEM was confirmed by MRI brain and spinal cord. Our patient also developed bilateral eye optic neuritis presenting clinically as sudden onset blurring of vision in both eye one day after admission and confirmed by visual evoked potential (VEP) study. His symptoms improved after giving high dose intravenous methylprednisolone.
AFP surveillance is critical for global polio eradication. All cases of acute flaccid paralysis in children under 15 are investigated to differentiate between polio and other causes like Guillain-Barre syndrome, transverse myelitis, traumatic neuritis, and post-diphtheritic polyneuropathy. Stool specimens are collected from AFP cases and tested to isolate poliovirus. If wild poliovirus is isolated, the case is confirmed as polio. Surveillance ensures rapid detection of wild poliovirus circulation.
Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis among infants. It is an autoimmune disorder that causes acute, rapidly progressive, and potentially fatal paralysis. The classic presentation involves ascending symmetric motor weakness, areflexia, and ataxia. Treatment involves hospitalization, IV immunoglobulin, plasmapheresis, and supportive care including ventilation if needed. Most patients recover fully but some have residual deficits and rare cases are chronic or fatal.
This document discusses acute encephalitis syndrome. It defines encephalitis as an acute inflammatory process involving brain tissue and meningoencephalitis as inflammation of both the meninges and brain tissue. Japanese encephalitis is identified as one of the most common causes of acute encephalitis syndrome. It is a mosquito-borne viral infection spread between pigs and birds as amplifying hosts, with humans as incidental hosts. The clinical presentation involves an initial prodromal stage of fever and headache, followed by an encephalitic stage with altered mental status such as confusion or coma. Treatment involves supportive care and empiric antiviral therapy with acyclovir and antibiotics until causative organisms are identified.
1. Acute flaccid paralysis (AFP) can present asymmetrically or symmetrically. Asymmetrical AFP may be caused by poliomyelitis or non-polio enteroviruses, while symmetrical AFP may be Guillain-Barré syndrome or transverse myelitis.
2. Important considerations in the evaluation of a child with AFP include differentiating acute infections from post-injection paralysis, obtaining a thorough history of recent vaccinations or infections, and ruling out treatable causes with imaging or lumbar puncture when indicated.
3. Proper management depends on the stage of illness, with the acute stage prioritizing isolation and prevention of paralysis progression, the restoration stage involving physi
2 severe respiratory infections in the icuIslam Ibrahim
This document discusses challenges in managing severe pneumonia in the intensive care unit (ICU). It identifies major concerns as high mortality, especially from acute respiratory distress syndrome (ARDS), and significant morbidity. Severe pneumonia in the ICU can be community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), or ICU-acquired pneumonia (ICUAP). Main challenges include timely diagnosis, prevention of HAP/VAP, managing complications like ARDS, ensuring timely appropriate antimicrobial treatment, and assessing severity to guide triage and management. The document recommends a clinical bundle for severe pneumonia that includes risk assessment, early ICU evaluation
This document discusses Japanese encephalitis (JE), a mosquito-borne viral disease. It provides background on JE, noting it is a leading cause of viral encephalitis in Asia. The purpose is to review potential new treatment approaches, as vaccines are available but the disease persists and outbreaks are challenging to predict. The virus life cycle and transmission between mosquitoes and pigs/birds is described. While some treatment trials have occurred, none have proven effective due to small sample sizes. The document discusses the virus pathogenesis and potential immunological targets for treatment, such as reducing inflammation. It reviews existing compounds with anti-JE activity in animal models that could be tested in humans.
The document summarizes information about the Ebola virus. It discusses that Ebola causes a severe hemorrhagic fever in humans and other primates with high mortality rates. It was first identified in 1976 near the Ebola River in Africa. Transmission occurs through contact with body fluids of infected humans or animals. Symptoms include fever, weakness, and bleeding. There is currently no approved vaccine or treatment, though experimental therapies are being studied. Prevention relies on avoiding contact with infected animals/people and bodily fluids through protective equipment and safe burials.
Acute flaccid paralysis (AFP) is characterized by sudden onset of weakness or paralysis over a period of 15 days in patients under 15 years old. The most common causes of AFP are poliomyelitis, Guillain-Barré syndrome, and transverse myelitis. Poliomyelitis is caused by poliovirus and typically causes asymmetric flaccid paralysis that may lead to long-term disabilities. Guillain-Barré syndrome is an acute inflammatory disorder of peripheral nerves caused by post-infectious autoimmunity. Transverse myelitis is spinal cord inflammation that causes symmetric paralysis of the lower limbs.
This document provides information about acute flaccid paralysis (AFP), including its definition, causes, surveillance, and clinical management. AFP is defined as paralysis of acute onset (less than 4 weeks) where the limbs are flaccid and tone is decreased. The main causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, and traumatic neuritis. Surveillance of AFP cases is important for monitoring polio eradication efforts. All AFP cases should be reported, investigated, and have stool samples collected and tested for poliovirus. Proper clinical evaluation and management is needed to diagnose the cause and provide specific treatment.
This document summarizes information about cough from Feigin & Cherry's Textbook of Pediatric Infectious Diseases. It classifies cough based on anatomy, etiology, age, and whether it involves the upper or lower respiratory tract. For the upper respiratory tract, common causes are viral infections like RSV, adenovirus, and rhinovirus or bacterial infections such as H. influenzae and S. pyogenes. For the lower respiratory tract, main causes include viral and bacterial pneumonia. Signs differ between upper vs lower respiratory tract infections.
A 29-year-old female presented with severe frontal headache, vomiting, and neck stiffness for one week. A lumbar puncture revealed cryptococcal meningitis. She was started on amphotericin B and fluconazole for induction and consolidation therapy. Monitoring showed worsening anemia and kidney injury from the amphotericin B treatment. The patient's symptoms improved but serial lumbar punctures and cultures were needed to ensure sterilization of the cerebrospinal fluid and check for potential drug resistance before completing the full antifungal treatment course.
Pediatrics notes about "Acute flaccid paralysis". These notes were published in 2018.
You can download them from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
This document is an invitation to the wedding of Elizabeth Mary and Thomas Stephen, which will take place on August 8, 2014 at 5pm at the Chapel of Saint Thomas Aquinas in Saint Paul, Minnesota. A reception will follow at the Schulze Grand Atrium at the University of Saint Thomas in Minneapolis. The invitation provides details on the ceremony location, reception venue, hotel accommodations, and RSVP information for the wedding.
1. Dokumen tersebut membahas tentang polinomial, termasuk definisi polinomial, contoh binomial dan trinomial, nilai polinomial, penjumlahan, pengurangan, perkalian, pembagian, dan pemfaktoran polinomial.
Marco Polo and his family embarked on a journey by wooden ship to China to meet the emperor Kublai Khan. They brought food and supplies for the voyage, which involved crossing the Mediterranean Sea and felt some sea sickness. Their ship traveled to Jerusalem where Polo's father was asked to retrieve special oil for the emperor. Kublai Khan wanted teachers from Polo's homeland to come to China to teach their language and culture.
Este documento presenta los comandos más importantes de Aulaclic para crear una página web, incluyendo códigos de texto para personalizar el color, tipo y tamaño de letra. Explica el proceso de crear una página a nuestro gusto y agregar un formulario una vez terminada.
Ejaz Ahmed is seeking a career in audit, accounting, or finance. He has over 15 years of relevant experience. He holds an ACCA certification and master's degrees in accounting. His experience includes roles as a Financial Accountant, Assistant Manager of Finance and Accounts, Audit Senior, and National Finance Expert for UNIDO. He has skills in financial reporting, management accounting, analysis, assurance, internal controls, and computer programs like MS Office, QuickBooks, and Peachtree.
The document discusses colors and includes the following:
- A song about the colors of the rainbow: red, orange, yellow, green, blue, indigo, and violet.
- Vocabulary words and definitions for colors including green, violet, yellow, brown.
- Example questions and answers about object colors like "What color is it?" "It is green."
- A conversation between students asking about the colors of objects like pencils and erasers.
- An activity where students unscramble letters to identify colors and complete sentences.
This document contains a series of situations and dialogues related to speaking ability standards. It provides 5 response options for each situation and asks the reader to choose the most appropriate expression based on the context of the situation. It covers situations such as asking to open a window, ordering a drink on a flight, checking train seats, taking phone messages, asking an instructor a question, and more. The document also contains passages and questions to test reading comprehension of dialogues and schedules.
The document discusses key performance indicators (KPIs) for a payable accountant position. It provides examples of KPIs, steps to create KPIs, common mistakes to avoid, and how to design effective KPIs. It also lists additional KPI materials and resources available on the kpi123.com website related to performance appraisal forms, methods, and review phrases.
Getting Advice On Central Issues For Villas In Marrakech
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This document provides information about travel destinations and accommodations in Morocco, specifically Marrakesh. It discusses the various types of hotels and riads available in Marrakesh for visitors, from luxury hotels to more affordable traditional options. It also mentions attractions in Marrakesh like the souks, gardens, and entertainment from magicians and snake charmers. The document suggests that a trip to Morocco would not be complete without spending time in the vibrant city of Marrakesh.
This document discusses adult learning theories and assumptions. It outlines five assumptions of adult learners: that they see themselves as self-directed, draw from life experiences, are ready to learn subjects relevant to their roles, are problem-solvers who learn best through doing, and are internally motivated. The document also notes that adult learners want to know why they are learning something and learn best when the subject can be immediately applied.
The boy does not want to go to school and thinks of excuses to avoid it. His father insists that he must go. The boy is reluctant but his father writes a letter explaining his delay and sends him to school. The boy walks to school with guilty thoughts, scared to face his teacher who gets irritated by his indifferent behavior and provoking answers in class without asking permission.
The document contains 20 short conversations or statements with 4 response options each. It appears to be a test of appropriate responses in various situations involving daily English language use and social interactions. While the level of detail provided makes summarizing challenging, the overall purpose seems to be assessing proficiency in selecting respectful, situationally correct responses in brief English dialogs.
This document discusses key performance indicators (KPIs) for a company accountant position. It provides examples of KPIs, steps to create KPIs, common mistakes to avoid, how KPIs should be designed, different types of KPIs, and recommends visiting an online site for more KPI materials and examples.
The document provides an excerpt from an English textbook with an exercise for students to practice their learning independently due to time constraints from the teacher. The exercise involves listening to conversations at a clothing store and choosing the correct answers about a customer named Zack shopping for items. It discusses him listening to emails, needing to purchase certain items, and deciding to go shopping at the local supermarket.
The document discusses Ebola virus disease (EVD), including that it is a deadly virus transmitted through contact with infected body fluids that causes hemorrhagic fever. It outlines the virus's history, symptoms, transmission, treatments being tested including vaccines, and current outbreak statistics showing exponential growth in West Africa.
A 35-year-old man presents with a 3-day history of diarrhea, vomiting and fever. He reports attending the funeral of a family member who died from bleeding 2 weeks ago. On exam, he has mild conjunctival injection, a faint rash, epigastric tenderness and hepatomegaly. His differential diagnosis includes Ebola virus disease. Ebola virus is transmitted through contact with infected wildlife or humans. Management involves isolation, standard precautions, oral rehydration and symptom control through a syndromic approach.
1. Dengue is a viral disease spread by mosquitoes that is increasingly prevalent in the Philippines, especially during rainy months in urban areas.
2. There are four distinct serotypes of the dengue virus that cause disease in humans. Infection progresses through febrile, critical, and recovery phases.
3. Treatment depends on disease severity and presence of warning signs like abdominal pain, vomiting, bleeding, or organ impairment. Mild cases can be treated at home with rest, fluids and paracetamol while more severe cases require hospitalization and intravenous fluids.
This document provides information on dengue fever. It discusses the dengue virus, which is a flavivirus transmitted by Aedes aegypti mosquitoes. It outlines the clinical presentation of dengue fever and dengue hemorrhagic fever. It also discusses pathogenesis, diagnosis, management including fluid therapy, and prevention through vector control measures targeting the Aedes mosquito. The distribution of dengue is global in tropical and subtropical regions. India has a major burden of dengue disease.
The Ebola virus first appeared in Africa in 1976 and causes a severe hemorrhagic fever with high fatality rates. It is believed to originate from wildlife like gorillas and chimpanzees. While its natural reservoir is unknown, human outbreaks are often linked to proximity to infected wildlife. The virus can spread through direct contact with bodily fluids and some research has shown potential for airborne transmission. There is currently no approved vaccine or treatment, though supportive care methods are used. Prevention relies on isolation protocols, protective equipment for medical workers, safe burial practices, and addressing potential bioterrorism threats posed by the virus.
This document provides information on acute flaccid paralysis (AFP), including its definition, causes, and significance. It discusses poliomyelitis, including the pathogenesis, clinical features, treatment, and prevention of the disease. Finally, it outlines the differential diagnosis of AFP and provides details on polio vaccines and surveillance efforts to achieve polio eradication.
The document summarizes information about the 2014-2015 Ebola virus outbreak in West Africa, the Ebola virus itself, symptoms and transmission of Ebola virus disease, treatment and prevention. It provides statistics showing over 8,000 cases and 4,800 deaths across Guinea, Liberia and Sierra Leone as of October 2014. The Ebola virus is an RNA virus that causes severe hemorrhagic fever in humans and other primates. Transmission occurs through contact with body fluids of infected people or contaminated materials. There is no approved vaccine but experimental treatments are being developed.
Ebola is a deadly virus that causes hemorrhagic fever in humans and nonhuman primates. It was first identified in Africa in 1976 and has caused several outbreaks with high fatality rates. The virus is transmitted through contact with body fluids of infected individuals. While there is no approved vaccine or treatment, prevention relies on isolation protocols, personal protective equipment, and sterilization of medical equipment to control outbreaks. Further research seeks to understand Ebola virus pathogenesis and reservoirs to aid in developing countermeasures.
Ebola virus is a growing threat that causes viral hemorrhagic fever outbreaks in Africa. It was first identified in 1976 near the Ebola River and belongs to the filovirus family. There are 5 species of Ebola virus. The virus enters through mucosal surfaces or breaks in the skin and spreads through contact with infected patients or cadavers. Symptoms include fever, vomiting, and hemorrhaging, and the virus targets immune cells. There is no approved vaccine, so prevention relies on isolation, protective equipment for healthcare workers, and avoiding contact with bodily fluids of infected individuals.
This document discusses Epstein-Barr virus (EBV) infectious mononucleosis. It defines EBV and describes the typical clinical presentation of fever, pharyngitis, lymphadenopathy, and fatigue. Complications are outlined as neurological, hematological, splenic rupture, respiratory, or hepatic issues. Risk factors include people ages 15-30 and those with frequent social contact. Diagnosis involves history, exam findings, and lab tests like mono spot testing and antibody levels. Treatment is generally supportive with rest, hydration, and pain medications while monitoring for complications.
A 20-year-old Spanish man traveling in Thailand for a martial arts competition was admitted to a local hospital in Koh Samui, Thailand with fever, headache, and decreased consciousness. His condition worsened over 48 hours, developing seizures, paralysis, and decreased responsiveness. Testing revealed positive IgM antibodies for Japanese encephalitis virus (JEV) in his serum. JEV is a mosquito-borne virus that causes viral encephalitis, with high incidence in parts of Asia. Personal protection from mosquito bites and vaccination are recommended for travelers to endemic areas.
This document provides an overview of dengue, including its epidemiology, life cycle, pathogenesis, clinical features, diagnosis, management, prognosis, and prevention. Some key points:
- Dengue is a self-limited viral infection transmitted by mosquitoes that infects 50-100 million people yearly and is a major public health challenge due to lack of vaccines or treatments.
- There are four serotypes of the dengue virus. Infection causes an acute febrile illness that in some cases progresses to severe dengue with plasma leakage and potential complications including shock.
- Diagnosis is based on virus detection, serology, or PCR. Management focuses on supportive care and fluid management. Prevention emphasizes mosquito control
This document summarizes a seminar presentation on Lassa fever given by Dr. D.C. Briggs. It begins with an introduction covering viral hemorrhagic fevers in general and key characteristics of Lassa fever. It then discusses the epidemiology of Lassa fever, including its reservoir, transmission, and recent outbreaks in Nigeria. The document outlines the pathogenesis, clinical features, case definition, differential diagnosis, complications and management of Lassa fever cases. It concludes with the standard operating procedures for managing suspected Lassa fever cases at UPTH.
Measles, mumps, and chickenpox are vaccine-preventable viral diseases. Measles causes respiratory and neurological complications and over 1 million deaths annually worldwide. Chickenpox results in a rash and can lead to pneumonia or encephalitis. Mumps causes parotid gland swelling and can result in meningitis or orchitis. Vaccines exist for all three diseases and have greatly reduced global cases, though outbreaks still occur in unvaccinated populations. Routine childhood immunization is the primary prevention strategy.
This document provides an overview of dengue fever. It begins with a brief history, noting the first recognized epidemics in the late 18th century. It then discusses the epidemiology, including that it is caused by any of four serotypes of dengue virus transmitted by Aedes mosquitoes. The pathogenesis section explains how secondary infection with a different serotype can result in more severe disease via antibody-dependent enhancement. The clinical course is described as having febrile, critical and recovery phases. Common features like thrombocytopenia and hemorrhagic tendencies are also summarized.
Rabies and polio are viral diseases spread through contact with infected animals for rabies and through the fecal-oral route for polio. Rabies causes acute encephalitis and is nearly always fatal once symptoms develop. It is prevented through vaccination and prompt post-exposure prophylaxis. Polio causes paralysis in a small percentage of cases. It is defined by inflammation of the spinal cord and three types are distinguished by the site of paralysis. Mass vaccination has eliminated polio in most countries.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
3. Ebola
• Discovered in 1976
• Single-stranded negative sense RNA Virus
• Order: Mononegavirales
• Family: Filoviridae
– Viral Hemorrhagic Fever in primates
• Genus: Ebolavirus is 1 of 3 members of the
Filoviridae family (filovirus),
– Marburg virus and Cueva virus
4. SPECIES
• Genus Ebolavirus comprises 5 distinct species:
Bundibugyo ebolavirus (BDBV)
Zaire ebolavirus (EBOV)
most dangerous
Sudan ebolavirus (SUDV)
Reston ebolavirus (RESTV)
• Taï Forest ebolavirus (TAFV).
• BDBV, EBOV, and SUDV have been associated with large EVD
outbreaks in Africa, whereas RESTV and TAFV have not.
• The RESTV species, found in Philippines and the People’s Republic
of China, can infect humans, but no illness or death in humans from
this species has been reported to date.
Outbreaks of
AFRICA
5.
6. • The virus is transmitted to people from wild animals and spreads in the human
population through human-to-human transmission.
• EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical
rainforests.
7. Transmission
•The virus is spread through direct
contact (through broken skin or mucous
membranes) with
i. sick person's blood or body fluids
(urine, saliva, feces, vomit, sweat and
semen)
ii. objects (such as needles) that have
been contaminated with infected
body fluids.
iii. Infected animals.
8. Transmission
Animal to human
• Consumption of
raw meat
• Contact with fruit
bat, pigs, apes-
animal handlers
• Animal products
(blood, urine and
feces.)
Human to human
• Close contact with
infected patients
• Care personnels
of patient
• Health care
workers
Prompt and safe
burial of dead
bodies.
No to Autopsy
Virus contained
in dead body for
a period 4 weeks.
9. Transmission
• Men who have recovered from the illness can
still spread the virus to their partner through
their semen for up to 7 weeks after recovery.
10.
11. Pathophysiology
• Endothelial cells, mononuclear phagocytes,
and hepatocytes are the main targets of infection. After
infection, a secreted glycoprotein (sGP) known as the Ebola
virus glycoprotein (GP) is synthesized.
• Ebola replication overwhelms protein synthesis of infected
cells and host immune defenses.
• The GP forms a trimeric complex, which binds the virus to the
endothelial cells lining the interior surface of blood vessels.
12. Pathophysiology
• The sGP forms a dimeric protein that interferes with
the signaling of neutrophils which allows the virus
to evade the immune system by inhibiting early
steps of neutrophil activation.
• These white blood cells also serve as carriers to
transport the virus throughout the entire body to
places such as the lymph nodes, liver, lungs, and
spleen.
15. • Morbidity and mortality rates are
very high, and they vary with the
strain of Ebola
• Fatality rate 25% to 90%
• Recovery is slow in those who survive
Prognosis
16. Why Is Ebola So Deadly?
• Virus usually detected late with more severe
signs and symptoms
• Often mistaken for malaria, typhoid fever,
dysentery, influenza, or bacterial infections
• Appears in sporadic outbreaks
• People die from the massive blood loss, not
necessarily from the disease
• 10% Survival rate
18. Treatment
• No ebola virus Disease-specific
treatment exists.
• Treatment is primarily supportive in nature
and includes minimizing invasive
procedures, balancing fluids and
electrolytes to counter dehydration
19. Treatment
• Administration of anticoagulants early in infection to
prevent or control disseminated intravascular
coagulation
Administration of procoagulants late in infection to
control bleeding
Maintaining oxygen levels, pain management, and
the use of medications to treat bacterial or fungal
secondary infections.
20. Vaccines
• No vaccine is currently available for humans.
• Promising candidates are DNA vaccines or
vaccines derived from adenoviruses, vesicular
stomatitis Indian virus (VSIV) or filovirus-like
particles (VLPs)
• Vaccines have protected nonhuman primates
• DNA vaccines, adenovirus-based vaccines, and
VSIV-based vaccines have entered clinical
trials
24. Emory Ebola Patient #3
• 43yo male, Physician evacuated from Sierra
Leone
• “sickest patient with Ebola virus that we’ve
cared for at Emory”
25. History of Present Illness
• Day 1: Fever, malaise, fatigue, headache
• Day 2: EVD confirmed by RT-PCR
• Day 3: Petechial rash, 1st dose of TKM-100802
• Day 4: Admission (9/3/14)
• Exam:
• 126/73, 51bpm, 40C 98% O2
• Increased work of breathing, petechial rash -> delirium
• Labs: WBC 2.6 PLT 62 AST:155
26. Hospitalization Course
• Day 6: Severe gastroenteritis and hepatitis
• Day 9: AKI and Respiratory distress
– Intubation and mechanical ventilation
• Day 11: Cardiac arrhythmias and worsening
acidosis
• Day 21: Extubated -> Delirium
27. Hospitalization Course
• Day 29: Improving mental status
– Ambulates with assistance
• Day 35: Dialysis held
– Blood test negative for EBOV by RT-PCR
• Day 40: Discharged
– 30lb weight loss, easy fatigability, muscle
weakness, word-finding difficulties
29. Day 70 of Illness
11/14/14
• Improving Symptoms
– Ambulation improving
– Occasional word-finding difficulty
– Gaining weight
• New Symptoms
– Hair loss, coming out in clumps
– Marked decreased hearing L>R
– Low back pain
– Enthesitis: Bilateral Achilles tendons
– Occsional blurry vision bilaterally
• Transient burning lasting for a few seconds, every few days
30. Day 80 of Illness
• Improving symptoms
– Back and joint pains
– Tendinitis
– Word-finding difficulties
• Worsening symptoms
– Blurred vision
– Mild light sensitivity
– Increased need for reading glasses
31. Day 80 of Illness
• PE
• VA 20/15 OU
• IOP OD 10mmHg, OS 9
mmHg
• SLE
– C/S Quiet OU
– K Mild arcus senilis OU
– AC D/Q OU
– Iris WNL OU, Blue irides
OU
– Lens Clear OU
– Ant Vitreous Quiet
36. Day 80 of Illness
• Posterior Uveitis/Chorioretinitis Inactive
– ? Post inflammatory viral changes
• s/p Ebola Virus Disease convalescent
• Plan
– Observation
– Follow-up 3-4 weeks
37. Day 97 of Illness
12/11/14
• Acute onset of symptoms
– Headache and retro-orbital aching sensation
– Blurred vision and haloes
– Photophobia
• Recommended urgent evaluation
– Diagnosis? Acute angle closure
38. Day 97 of Illness
12/11/14
• VA 20/20 OS
• IOP 44mmHg OS
• SLE OS
– Mild corneal edema, trace cell
• Gonioscopic evaluation
– No evidence of angle closure
• Plan:
– Diamox 250mg and administered ocular hypertensives
decreased 35 mmHg
– Pred forte 1% QID OS
– Systemic and topical ocular hypotensives
39.
40.
41. Day 99 of Illness
12/13/14
• Primary Diagnosis: Hypertensive Anterior Uveitis
• Interval History
– Escalating pain symptoms over next 2 days
– Increasing anterior chamber inflammation
• Differential Diagnosis
– Herpes simplex virus 1 and 2
– Cytomegalovirus
– Varicella zoster virus
– Toxoplasmosis, syphilis, sarcoidosis, HLA-B27 associated
– Ebola virus associated Uveitis
42. Day 99 of Illness
12/13/14
• Plan
– Conjunctiva and tear film specimen taken for
Ebola virus PCR
– Anterior Chamber Paracentesis for PCR testing
– Serologic evaluation for autoimmune/infectious
etiologies
– Referral to infectious disease
48. Day 103 of Illness
12/17/14
• VA OS 20/150
• IOP OS 15mmHg
• Hypopion 0.5mm
• Plan
– Continue oral prednisone 80mg/day (1mg/kg)
– Topical Prednisolone acetate 1% q1 OS
49. Day 110 of Illness
12/22/14
• Interval History
– Improving eye pain
• VA OS 20/800 IOP OS 1mmHg
• SLE
– C/S – Quiet conjunctiva
– K -2+ stromal edema w/ decemet folds
– AC – 1+ cells
– Iris - WNL
– Lens – Clear
– Vit – 2+ vitreous haze
66. What we know about ocular manifestations of Ebola
(Majid Moshirfar,1 Carlton R Fenzl,2 Zhan Li3November 2014)
• Ocular signs observed in both the acute and
late settings
• Conjunctival injection
– 58% of infected patients
– Often presents bilaterally
• Subconjunctival hemorrhage
• Excessive lacrimation
• Unclear pathophysiology of manifestations
67. What we know about ocular manifestations of Ebola
(Majid Moshirfar,1 Carlton R Fenzl,2 Zhan Li3November 2014)
• Subacute/chronic ophthalmic manifestations:
– Two pathways:
• they may rapidly progress to a more intense
hemorrhagic state where death is nearly inevitable
• they may enter a convalescent phase.
– at risk for uveitic episodes.
• Despite the complexity of findings, treatment
required only topical steroids and cycloplegia.
68. Late Ophthalmologic Manifestations in Survivors of the 1995 Ebola Virus
Epidemic in Kikwit, Democratic Republic of the Congo
(Colebunders et at 1999)
• Cumulative total of suspected cases of EBO hemorrhagic fever (EHF)
was 316, of whom 245 (77%) died
• acute phase of EBO infection
– conjunctival injection
• 48% and 58%
• a relatively early sign of EHF
– bilateral conjunctivitis
• acute phase of the epidemic was highly predictive for the diagnosis of an EBO
infection;
– subconjunctival hemorrhages also been reported
– blurred vision or blindness
• etiology of these ocular manifestations remains unclear
• Ophthalmologic examinations considered potentially risky
procedures for health care workers
– the nurse-ophthalmologist died during the EBO epidemic
69. Late Ophthalmologic Manifestations in Survivors of the 1995 Ebola Virus
Epidemic in Kikwit, Democratic Republic of the Congo
(Colebunders et at 1999)
• Twenty (28%) of the 71 EBO survivors were enrolled in a 3-month
follow-up study
• Three participants (15%) presented with ocular manifestations
during the convalescent period of their infection
• fourth EBO survivor outside this cohort, who also had ocular
problem
• all 20 EBO survivors and the additional noncohort patient met the
clinical definition for infection with EBO that was used during the
epidemic. Moreover, serologic results (ELISA) were positive for EBO
infection for all 21 patients
• The clinical features of the 4 EHF cases during the acute EHF illness
were similar to the clinical features observed in other EHF patients.
70. Late Ophthalmologic Manifestations in Survivors of the 1995 Ebola Virus
Epidemic in Kikwit, Democratic Republic of the Congo
(Colebunders et at 1999)
• 15% or 3/20 survivors of the 1995 Ebola outbreak
in the Democratic Republic of the Congo enrolled
in a follow-up study and 1 other survivor
• Developed ocular manifestations after being
asymptomatic for 1 month.
– Complained of ocular pain, photophobia,
hyperlacrimation, and loss of visual acuity.
• Ocular examination revealed uveitis in all 4
patients.
71. Late Ophthalmologic Manifestations in Survivors of the 1995 Ebola Virus
Epidemic in Kikwit, Democratic Republic of the Congo
(Colebunders et at 1999)
• 4 cases, the diagnosis of uveitis was confirmed
by an ophthalmologist.
• The pathogenesis of this uveitis may be a
delayed hypersensitivity reaction to viral
antigens
• All patients improved with a topical treatment
of 1% atropine and steroids
72. Ocular Manifestations of Ebola Virus Disease: An
Ophthalmologist’s Guide to Prevent Infection and Panic
(Enzo Maria Vingolo et al. 11 March 2015)
• The main problem in assessing human-to-
human Ebola virus transmission
• Minimum infectious dose of the
microorganisms is unknown
• EVD patients
– unlikely seek specialized healthcare, as
ophthalmologic care
– likely to seek emergency services and
hospitalization
73. Ocular Manifestations of Ebola Virus Disease: An
Ophthalmologist’s Guide to Prevent Infection and Panic
(Enzo Maria Vingolo et al. 11 March 2015)
• Conjunctivitis
– key early EVD sign
– typically bilateral, asymptomatic, and nonicteric
– appear even 6-7 days before patients seek EVD-related
care
• Persistent and nonhemorrhagic conjunctivitis in EVD
– good prognostic factor
• Summarizing, bilateral, asymptomatic, and nonicteric
conjunctivitis is one of the earliest and most frequent
signs of EVD and has an important prognostic value.
74. Ocular Manifestations of Ebola Virus Disease: An
Ophthalmologist’s Guide to Prevent Infection and Panic
(Enzo Maria Vingolo et al. 11 March 2015)
• Uveitis:
– Late Ophthalmologic Symptom
– 20% of convalescent patients
– asymptomatic for up to 1-2 months
– characterized by ocular pain, photophobia, hyperlacrimation,
and loss of visual acuity
• Pathogenesis of uveitis
– delayed hypersensitivity reaction to RNA viral antigens
• Uveitis can be treated with topical steroids
• patients are considered safe and not infectious
– Even with detectable in tears of acute-phase EVD patients
• Nevertheless, PPE must always be adopted in patients with
ascertained epidemiological risk.
75. Ebola warning for ophthalmologists
(Rose Scneider, May 09, 2015)
• “Ebola virus can remain viable in some body fluids for
an extended period of time after the initial onset of the
disease”
• “If the Ebola epidemic continues, ophthalmologists
throughout the world will be seeing patients with post-
Ebola uveitis, will need to recognize and treat this
condition, and will need to take appropriate increased
precautions in performing surgical procedures on these
patients,”
– Russell N. Van Gelder, AAO president
Editor's Notes
Among the five strains of Ebola virus, the Zaire strain appears to be the most virulent, with a mortality rate of up to 90%. Despite extensive research, the molecular basis for this virulence has not been determined.
Typical symptoms of people suffering from Ebola include fever, muscle aches, weakness, sore throat and headaches. This is followed by vomiting, diarrhea and a body rash and then soon after, unexplained hemorrhaging of internal organs. While signs of the virus can appear anywhere from 2 to 21 days after the person has been exposed, the average is between 8 to 10 days. Though there is no cure, patients can recover from the disease provided their immune systems are strong enough to fight the virus. Those patients also develop antibodies that protects them from the disease for at least a decade.
The good news is that quarantining infected patients can easily stop the spread of the disease. That's because Ebola is not an airborne virus like the common cold that can be passed on when an infected person coughs or sneezes. For the virus to spread, people have to come in direct contact with blood or other bodily fluids - like saliva, mucus etc. This happens only if the person physically touches an open wound on the infected person or objects (like needles) that he/she has been using.
If instruments are not disposable, they must be sterilized before being used again. Without adequate sterilization of the instruments, virus transmission can continue and amplify an outbreak.
Ebola targets endothelial cells and white blood cells and replicates from within weakening the host immune defenses.
Secretes ebolva virus glucoprotein which has 2 functions
1. Attaches to endothelial cell lining of the BV, disrupting the walls, Platelet unable to clot well and leads to profuse and often fatal bleeding.
2. Interferes with neutrophil activation, and WBC serves as carriers go other organs
M and M vary with strain
Fatal 25-90%
Slow recovery
Like HIV, Patients die because of blood loss and not the disease
No exact treatment
Primarily supportive
TKM 100802 investigational drug, category Vaccines and antisera
Aspartate aminotransferase (AST). The AST enzyme is also found in muscles and many other tissues besides the liver
elevated amounts in the blood, liver damage is most likely present.
Reverse transcription polymerase chain reaction
Reverse transcription polymerase chain reaction
Reverse transcription polymerase chain reaction
inflammation of the entheses, the sites where tendons or ligaments insert into the bone
Reverse transcription polymerase chain reaction
inflammation of the entheses, the sites where tendons or ligaments insert into the bone
Montage Fundus Photographs 10 Weeks after the Onset of Ebola Virus Disease.
Multiple peripheral chorioretinal scars with hypopigmented haloes are visible in the right eye (Panel A) and left eye (Panel B) (white arrows). A small intraretinal hemorrhage (black arrow) is adjacent to a chorioretinal scar in the left eye.
Montage Fundus Photographs 10 Weeks after the Onset of Ebola Virus Disease.
Multiple peripheral chorioretinal scars with hypopigmented haloes are visible in the right eye (Panel A) and left eye (Panel B) (white arrows). A small intraretinal hemorrhage (black arrow) is adjacent to a chorioretinal scar in the left eye.
Montage Fundus Photographs 10 Weeks after the Onset of Ebola Virus Disease.
Multiple peripheral chorioretinal scars with hypopigmented haloes are visible in the right eye (Panel A) and left eye (Panel B) (white arrows). A small intraretinal hemorrhage (black arrow) is adjacent to a chorioretinal scar in the left eye.
OD
Hyperpigmented scar with hypopigented halo
Retinal opacity – FA hyperflourescence temporal and nasal
Spectral OCT – full thickness retinal abnormalities and changes
Convalescent recovering from an illness or operation
Left sided complains
Reverse transcription polymerase chain reaction
inflammation of the entheses, the sites where tendons or ligaments insert into the bone
Inferior cornea arlts triangle
Nongranulomatous keratic precipitates in the endothelium= inflammation
Slit-Lamp Photograph of the Left Eye 14 Weeks after the Onset of Ebola Virus Disease.
Mild corneal edema, rare keratic precipitates (arrows), and inflammatory cells and protein in the anterior chamber are consistent with acute anterior uveitis.
Extremely high concentration of ebola virus RNA in the aqeous higher than
Ebola RNA in blood peak viremia at day 5 at 20
Extremely high concentration of ebola virus RNA in the aqeous higher than
Ebola RNA in blood peak viremia at day 5 at 20
WNL within normal limits
WNL within normal limits
Heterochromia and hypotony
WNL within normal limits
AC improve but Significant vitreous haze
B-scan
Choroid thickening
Peripheral choroidal
Misshapened globe
Severe Vitritis obscuring optic nerve and retinal blood vessels
Difluprednate 0.05% is a sterile, topical anti- inflammatory corticosteroid
Increase IOP
Difluprednate 0.05% is a sterile, topical anti- inflammatory corticosteroid
Increase IOP
Difluprednate 0.05% is a sterile, topical anti- inflammatory corticosteroid
Increase IOP