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.
Brucellosis, a bacterial disease caused by members of the genus Brucella, is an important zoonosis and a significant cause of reproductive losses in animals.
Brucellosis, a bacterial disease caused by members of the genus Brucella, is an important zoonosis and a significant cause of reproductive losses in animals.
Leptospirosis is a worldwide public health problem. In humid tropical and subtropical areas, where most developing
countries are found, it is a greater problem than in those with a temperate climate. The magnitude of the problem in
tropical and subtropical regions can be largely attributed to climatic and environmental conditions but also to the
great likelihood of contact with a Leptospira-contaminated environment caused by, for example, local agricultural
practices and poor housing and waste disposal, all of which give rise to many sources of infection. In countries with
temperate climates, in addition to locally acquired leptospirosis, the disease may also be acquired by travellers
abroad, and particularly by those visiting the tropics.
Leptospirosis is a potentially serious but treatable disease. Its symptoms may mimic those of a number of other
unrelated infections such as influenza, meningitis, hepatitis, dengue or viral haemorrhagic fevers. Some of these
infections, in particular dengue, may give rise to large epidemics, and cases of leptospirosis that occur during such
epidemics may be overlooked. For this reason, it is important to distinguish leptospirosis from dengue and viral
haemorrhagic fevers, etc. in patients acquiring infections in countries where these diseases are endemic. At present,
this is still difficult, but new developments may reduce the technical problems in the near future. It is necessary,
therefore, to increase awareness and knowledge of leptospirosis as a public health threat.
Adenoviridae is a group of medium sized, non-enveloped, double stranded DNA viruses that replicate and produce disease in the eye and in the respiratory, gastrointestinal and urinary tracts;
Please find the power point on Typhus and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
infestation with or disease caused by Clonorchis sinensis
invades bile ducts of the liver after ingestion in uncooked fish and when present in large numbers causes severe systemic reactions
Leptospirosis is a worldwide public health problem. In humid tropical and subtropical areas, where most developing
countries are found, it is a greater problem than in those with a temperate climate. The magnitude of the problem in
tropical and subtropical regions can be largely attributed to climatic and environmental conditions but also to the
great likelihood of contact with a Leptospira-contaminated environment caused by, for example, local agricultural
practices and poor housing and waste disposal, all of which give rise to many sources of infection. In countries with
temperate climates, in addition to locally acquired leptospirosis, the disease may also be acquired by travellers
abroad, and particularly by those visiting the tropics.
Leptospirosis is a potentially serious but treatable disease. Its symptoms may mimic those of a number of other
unrelated infections such as influenza, meningitis, hepatitis, dengue or viral haemorrhagic fevers. Some of these
infections, in particular dengue, may give rise to large epidemics, and cases of leptospirosis that occur during such
epidemics may be overlooked. For this reason, it is important to distinguish leptospirosis from dengue and viral
haemorrhagic fevers, etc. in patients acquiring infections in countries where these diseases are endemic. At present,
this is still difficult, but new developments may reduce the technical problems in the near future. It is necessary,
therefore, to increase awareness and knowledge of leptospirosis as a public health threat.
Adenoviridae is a group of medium sized, non-enveloped, double stranded DNA viruses that replicate and produce disease in the eye and in the respiratory, gastrointestinal and urinary tracts;
Please find the power point on Typhus and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
infestation with or disease caused by Clonorchis sinensis
invades bile ducts of the liver after ingestion in uncooked fish and when present in large numbers causes severe systemic reactions
Systemic Lupus erythematous , is world wide health problem
Here we talk about criteria for diagnosis investigation , Management and complication
With some scenarios to about disease and complication
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
6. 6
Tick Borne Infections - MN
Daniel J Anderson, MD
Lyme
1,293 cases in 2010
(21 % increase from 2009)
Anaplasma
720 cases in 2010
( > 100 % increase from 2009)
Ehrlichia New species of Ehrlichia reported 2011
Babesia 56 cases in 2010 (31 in 2009)
Powassan
(50 cases in all of US 1958-2009 )
6 MN cases 2008 - 2010
1 MN death from Powassan 2011 (at ANW)
RMSF
2000 cases / year in all of US
Sporadic cases in MN
1 death in MN 2009
7. 7Daniel J Anderson, MD
http://www.health.state.mn.us/divs/idepc/diseases/lyme/highrisk.html
Risk of Tick-borne infection is not
uniform throughout the state.
The highest risk is central and SE
sections
8. 8Daniel J Anderson, MD
More Anaplasma than Lyme in
Aitkin, Beltrami, Cass, Crow Wing
& Hubbard counties
The risk of different tick-borne
infections also is not uniform
throughout the state
20. 20
Lyme
3-30 days after tick bite (BEFORE fever)
Erythema migrans (EM)
70 - 80 % of patients get rash
STARI
Very similar to Lyme disease
“expanding Bull’s Eye” lesions
RMSF
90 % -- usually 2 - 5 days AFTER fever
Initially small pink macules on wrists /
ankles
LATER petchial
Tularemia Skin ulcer w regional lymphadenopathy
RASH
Daniel J Anderson, MD
23. 23
Lyme
Pathogen. Borrelia burgdorferi (spirochete)
Clinical
EM rash, Bell’s palsy, AV block, CNS, Arthropathy
Co-infection -- ~ 5-10 % with Anaplasma || ~ 2 % with Babesia
Dx
IgM: HGA can cause false + IgM for Lyme
IgM can persist for years (even if no clinical disease)
After 8 weeks, should always have + IgG
Treatment -- no data for prolonged therapy
Prevention -- Doxycycline 200 mg if engorged tick < 72 h after bite
Daniel J Anderson, MD
24. 24
Lyme Diagnosis
Clinical diagnosis (ie no serology needed) if exposure to deer tick AND
Bilateral Bell’s Palsy
III ° AV block or complete heart block [CHB]
Characteristic erythema migrans [EM] rash
Daniel J Anderson, MD
26. 26
Lyme Serology
Criteria for positive
Western blot IgG ≥ 5 bands
Western blot IgM ≥ 2 bands
Chronology
Early IgM +
After 4-8 weeks
nearly all IgG + (regardless of RST test strain used)
SO, if IgG still negative > 8 weeks illness, then “+ IgM” is false +
IgM
HGA can cause false + IgM
+ IgM can persist for years ... may NOT correlate at all w clinical state
Daniel J Anderson, MD
27. 27
Lyme Testing:
Unvalidated tests with unproven use
Test assays whose accuracy and clinical usefulness have not been
adequately established. Unvalidated tests available as of 2011
include:
• Capture assays for antigens in urine
• Culture, immunofluorescence staining, or cell sorting of cell wall-
deficient or cystic forms of B. burgdorferi
• Lymphocyte transformation tests
• Quantitative CD57 lymphocyte assays
• “Reverse Western blots”
• In-house criteria for interpretation of immunoblots
• Measurements of antibodies in joint fluid (synovial fluid)
• IgM or IgG tests without a previous ELISA/EIA/IFA
Daniel J Anderson, MD
28. 28
Lyme PCR
Most useful for late arthritis if
done on synovial fluid
Limited use in CSF
Daniel J Anderson, MD
29. 29
Lyme Disease Treatment
Oral Therapy for all except neurological / late
arthritis or initially for high degree AV block
IV therapy: for meningitis, late arthritis or initially
for high degree AV block
Daniel J Anderson, MD
30. 30
Lyme Disease Rx Duration
2-3 weeks for most early infections - tho’
some data suggest 10 days sufficient
2-4 weeks for meningitis / arthritis
4-8 weeks for late arthritis
Prolonged courses of therapy? .
No proven benefit
There are proven adverse consequences
(C diff, death, IV clots, ...)
Daniel J Anderson, MD
31. 31
Lyme Disease
Treatment
Reinfection rate rare (approximately 4 %)
Post Exposure Prophylaxis (PEP) -
single dose doxycycline 200 mg if < 72 hours
Daniel J Anderson, MD
33. 33
Human Granulocytic Anaplasomsis [HGA]
Pathogen Anaplasma phagocytophilum
Clinical
up to 35 % coinfected with Lyme and/or Babesia
fever, chills, headache, myalgia, and malaise,cough, diarrhea, confusion,
and lymphadenopathy,
17 % severe multisystem organ failure / SIRS / even death (Lyme does not
do this)
rash is not common
Data
leukopenia, thrombocytopenia,
mild hepatitis / transaminitis
Daniel J Anderson, MD
34. 34
Human Granulocytic Anaplasomsis [HGA]
Dx
Peripheral blood smear (in WBCs)
30 - 80 % + morulae
seen in granulocytes
Serology
NATs (PCR)
Treatment
Doxycycline (will also cover potential Lyme coinfection)
Daniel J Anderson, MD
36. 36
Human Monocytotropic Ehrlichiosis
[HME]
Pathogens
E canis / E chaffeensis / / E muris
Clinical
< 50 % with rash (but more often than with HGA)
More common farther south than Anaplasmosis (HGA)
Data -- Lymphopenia, morulae RARE on blood smear (vs HGA)
Dx -- Serology, PCR
Treatment - doxycycline
Daniel J Anderson, MD
37. 37Daniel J Anderson, MD
Anaplasmosis
HGA
Ehrlichiosis
HME
Farther north
MN & WI
Farther south
Iowa & Missouri
~ 50 % morulae
on blood smear
RARELY see
morulae in blood smear
rash is RARE
rash more common
(though still < 50 %)
serology / PCR
blood smear
serology / PCR
doxycycline doxycycline
39. 39
Babesiosis
Pathogen Babesia microtii (MN, WI, East coast), B divergens & B
duncani in other locations
Clinical
fatigue/weakness/malaise followed within days by fever
(>38° C) and one or more of the following: shaking chills,
sweats, headache, myalgia, arthralgia, and anorexia
Malaise, myalgia, arthralgia, and shortness of breath
differentiate babesiosis from other febrile illnesses
fatigue and malaise persist for several months
Daniel J Anderson, MD
40. 40
Babesiosis
Diagnosis
Blood smear (in RBCs)
Tetrad of ring forms
“Maltese Cross”
Serology
PCR
Treatment
Mild: atovaquone + azithromycin
Severe: clindamycin + quinine + exchange transfusion
Daniel J Anderson, MD
55. 55
References
The Clinical Assessment, Treatment, and Prevention of Lyme
Disease, Human Granulocytic Anaplasmosis, and Babesiosis:
Clinical Practice Guidelines by the Infectious Diseases Society of
America. Clin Infect Dis. (2006) 43 (9): 1089-1134
http://cid.oxfordjournals.org/content/43/9/1089.full
National Institue of Allergy and Infectious Diseases. Tickborne
Diseases website.
http://www.niaid.nih.gov/topics/tickborne/pages/default.aspx
![2
Tick-Borne Infections
Challenges
Expanding / changing geography of ticks / infections
New infections / newly recognized “old” infections
Newly identified -- new Ehrlichia species 2011
Old infections | new to MN -- Powassan fever, RMSF
Clinical clues that might suggest tick-borne infection
Fever plus [rash, severe headache, mild hepatitis]
low blood cell counts [esp platelets]]
Diagnostic tests -- blood smear, serology, PCR
Daniel J Anderson, MD](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)