Hepatitis C
Hepatitis is caused by hepatitis C virus. Hepatitis C virus is detected by the present of anti - HCV antibodies. Hepatitis C virus is a member of the flavivirus. Hepatitis C virus may lead to acute cases of hepatitis and chronic cases of hepatitis. Patient may suffer from mild cases of jaundice or remain asymptomatic in primary cases of hepatitis C. Liver cirrhosis is commonly associated with chronic hepatitis C virus infection. Hepatitis C virus infection may also predispose individual to hepatocellular carcinoma indirectly. Hepatocellular carcinoma may occur due to compensation reaction as a consequences of liver injury. Liver injury occur due to the action cytotoxic T cell which clear the hepatitis C virus from the system. There will be pools of dividing cells which are prone to mutation. The mode of transmission of hepatitis C virus infection is parenterally due to the exposure to the blood and blood products. Hepatitis C virus may infect the liver. Hepatitis C virus may mutate which lead to variation in the envelope protein. As a result, hepatitis C virus may escape virus neutralizing antibodies. Organ transplant recipient and intravenous drug users are at high risk of developing hepatitis C virus infection. The treatment of hepatitis C virus infection may include avoiding intravenous drug uses, screening blood product and medication such as ribavirin and interferon - alpha.
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Rotavirus Infection
Rotavirus may cause acute cases of viral gastroenteritis which is common in children age 6 - 24 months. The common symptoms and signs of rotavirus / gastroenteritis may include fever,non bloody diarrhea and vomiting and nausea. Rotavirus infection can be confirmed by enzyme immunoassay. Rotavirus antigen in the stool will be detected. The common mode of transmission is fecal oral route. Rotavirus will lyses the enterocytes of the small intestine. The villi will be stunted due to the damaged of the enterocytes. Patient may suffer from loss of protein and loss of sodium. There will also be decreased in the production of digestive enzymes and decreased in the absorptive surface area of the intestine due to the damage of the mucosal layer of the small intestine. Patient may suffer from hyperosmotic effect which lead to diarrhea. Severe rotavirus infection may occur mostly in immunocompromised patient or malnutrition individual. The treatment may include oral rehydration to replace fluid and electrolytes loss, The common complication of severe diarrhea are loss of electrolytes and dehydration. Good personal hygiene and improved sanitation may reduce the risk of infection. Hydatid Cyst Disease
Hydatid cyst disease is caused by Echinococcus granulosus which is a segmented flatworm. The common mode of transmission is via ingestion of the eggs in contaminated water and food. The water and food are contaminated with dog feces. Dog ( definitive host) which get infected by eating sheep ( sheep is an intermediate host). Echinococcus granulosus infection can be detected via serological testing. Echinococcus granulosus consists of 3 proglottids with a scolex. Patient may develop hydatid cyst in the liver, brain and lung which can be detected via CT scan or X Ray. The hydatid cyst may rupture which lead to anaphylactic reaction and dissemination of infectious protoscoleces. Ingestion of eggs may lead to the development of the embryos which present in the intestinal cells and enter the blood system. The hydatid cyst / fluid filled cyst will form from a larvae which develop in the tissue. Hydatid cyst consist of capsule filled with protoscoleces. The treatment may include surgical removal of the hydatid cyst. The medication such as albendazole is also given. Undulating Fever
Undulating fever is caused by brucella. Brucella can be detected via culture and serological analysis. There are four species of brucella such as brucella melitensis ( target goats and sheep), brucella canis ( target dogs), brucella suis ( target swine) and brucella abortus (target cattle). Brucella is a gram negative rod. This forms of undulating fever is also known as Mediterranean remittent fever and Malta fever. Patient may also suffer from headache, fatigue and chills. The common mode of transmission is ingestion of contaminated cheese or milk, or due to cut or breaks in the skin ( direct inoculation) from contact with infected animals. Pasteurization of the milk products are required. Remittent fever may occur due to the release or periodic endotoxin. Granulomas may also be formed form intracellular survival in cells of the reticuloendothelial system. Patient should be treated with antibiotic such as tetracycline, trimethoprim - sulfamethoxazole, gentamicin and rifampicin. Sleeping Sickness
Sleeping sickness is caused by trypanosoma brucei which is a flagellated trypomastigote. Tsetse fly is the vector of transmission of the trypanosoma brucei infection. Physical protection is used to avoid bites from tsetse fly. The characteristic of sleeping sickness may include chancre or ulcer at the site of bite of tsetse fly. Patient may present with cyclical fever. There will also be enlargement of the posterior cervical lymph node ( Winterbottom’s sign). Chronic case may be manifested in demyelinating encephalitis. Demyelinating encephalitis may present with coma and death. There are two different strains of trypanosoma brucei which include rhodesiense ( the reservoirs are domestic or wild animals) and gambiense. The trypomastigote can be detected in the cerebrospinal fluid, blood or lymph node aspiration. The IgM antibody levels are elevated. The antigenic variation of the surface of the glycoproteins of trypanosoma brucei may lead to an effective evasion of the humoral human response and the cyclic nature of the fever. Trypanosoma brucei infection may be spread to central nervous system via the blood. In this case melarsoprol is used to treat the condition. Generally acute cases can be treated with suramin and pentamidine. Trichuris trichiura infection
Trichuris trichiura is a form of nematode roundworm / whipworm which present in the intestine. Trichuris trichiura can be detected by stool examination which may reveal the present of barrel shaped eggs with plug at each end. Transmission is via ingestion of eggs from soil which is contaminated with human feces. Trichuris trichiura infection may be spread if human feces is used as fertilizer. Good personal hygiene and proper human waste disposal is required to prevent the spread of trichuris trichiura infection. Larvae will hatch in the small intestine after ingestion of eggs and spread to the colon. Larvae will be matured into adult in the colon. There will be local case of ulceration after the adult form of trichuris trichiura attaching itself to the colon. The symptoms may trichuris trichiuria infection may include anemia ( significant loss of blood), bloody diarrhea, tenesmus, abdominal pain and rectal prolapse. The treatment may include albendazole and mebendazole. Cysticercosis
Cysticercosis is caused by taenia solium. Taenia solium is a form of cestode which is also known as pork tapeworm or segmental flatworm. Stool examination may reveal the strobila with one or more hermaphrodite with proglottids ( 5- 12 uterine branches). Cysticercosis is caused by the formation of cysticerci in organs and tissue such as brain, muscle, eyes and lung. The symptoms are best on the deposition of the cysticerci which include seizures and meningoencephalitis ( cysticerci is calcify and often seen in the CT scan, MRI scan or x ray). Mild cases of infection of taenia solium may just present with mild gastrointestinal disturbance. Cysticercosis may occur due to fecal oral transmission of the taenia solium eggs. The eggs are directly ingested while the larvae invading the bloodstream and the cysticerci embed in various type of tissue. Taenia solium may attached in the scolex. The adult tapeworm may grow up to 5 meters. The treatment may include praziquantel , surgical excision or albendazole. Opportunistic disseminated disease
Mycobacterium avium intracellulare is acid fast rod which forms opportunistic disseminated disease and pulmonary disorders. Mycobacterium avium intracellulare is a slow growing bacteria which consist of mycolic acid in the cell wall. Mycobacterium avium intracellulare infection mostly affect immunocompromised patient and the mode of transmission is the inhalation of the aerosol or ingestion of infected food. Mycobacterium avium intracellulare is a slow growing organism which can be found in the water and soil. Mycobacterium avium intracellulare is the common form of systemic infection in HIV / AIDS patient. Leptospirosis
Leptospirosis is caused by leptospira interrogans. Leptospira interrogans can be detected via serological diagnosis. Leptospira interrogans is a gram negative spirochetes. It can be detected via cultured from cerebrospinal fluid and blood ( within narrow window of infection). The common mode of transmission is via exposure to the contaminated soil and contaminated water from the urine of the infected animal ( rodents, cattle, dogs and wild animals which act as reservoirs. Leptospirosis is a biphasic illness. Leptospirosis consist of two phase, first phase include flu like fever, myalgia and chills. The second phase consists of aseptic meningitis and iritis. In serious cases, patient may present with Weil’s disease. Weil’s disease may lead to extensive vascular damage. These may lead to renal failure and hepatic failure. Spirochetes may enter the bloodstream via the abrasion of the mucus membrane and the skin. Later the spirochetes will multiply and spread to organs and tissues. The treatment of leptospirosis may include antibiotics such as penicillin and tetracycline. Prophylactic doxycycline is given for high risk person. Anemia associated with tapeworm infection
Diphyllobothrium latum is a broad fish tapeworm/ segmental flatworm or cestode. Diphyllobothrium latum may lead to megaloblastic anemia due to deficiency of vitamin B12 which occur as the diphyllobothrium latum compete with the human host for vitamin B12. The freshwater fish or crustaceans are the intermediate host. The mode of transmission is from ingestion of raw, pickled or undercooked freshwater fish. It is important to prevent ingestion of undercooked fish. Besides suffering from megaloblastic anemia, patient may also suffer from neurological complication. Adult tapeworm will remain attach to the intestine via scolex. The tapeworm may grow up to 13 meters length. The strobila of the diphyllobothrium latum may contain one or more hermaphrodite proglottids. The proglottids appear to be wide with rosette pattern of the branches of uterine. The eggs of diphyllobothrium latum appear to be a lidlike operculum and elongated. The treatment may include praziquantel. |
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