A Family Doctor's Tale - KAWASAKI DISEASE

DOC I HAVE KAWASAKI DISEASE

Kawasaki Disease is a childhood disease which was first seen in Japan which typically cause fever, swelling of the lymph nodes, and symptoms affecting the skin and mucous membranes.

It occurs mainly in children below 5 years.

One of its notable features other than high fever and skin peeling is the complication of the disease on the arterial system of the heart.

The cause of Kawasaki Disease is believed to be an infection although no causative organism has been found.

An autoimmune disease has been suggested as the cause of the Kawasaki disease.

The triad of symptoms which are common to Kawasaki Disease are:

1.Fever with headache lasting for more than 5 days

2.Swelling of one or more lymph nodes in the neck

3.blotchy red rash over the entire body with typical skin peeling in the second week of illness

Other symptoms are:
4.sore throat with sometimes tonsillar swelling

5.dry cracked and swollen lips

6.conjunctivitis

7.reddening of the palms and soles

8.swelling of the hands and feet

9.skin peeling from the tips of the fingers and toes in the second week of illness

Disease usually lasts for 2-3 weeks.

Diagnosis
1.Classical symptoms and signs as above especially high fever, lymph nodes enlargement, rash and peeling of the skin from the fingers and toes.

2.blood tests (complete blood count, ESR, blood culture).

3.X-rays of chest and neck

4.ECG or electrocardiogram of the heart

5.CT Scan of the heart

Complications of Kawasaki disease:
1.arthritis

2.myocarditis (inflammation of the heart muscles)

3.myocardial infarction (heart attack)

4.coronary artery disease

Treatment of Kawasaki disease:
Suspected cases should be treated as early as possible because of possible heart complications

1.Bed rest in isolation ward

2.Adequate fluids

3.Antipyretic medicines such as paracetamol for fever

4.Aspirin may be given (in spite of the danger of Reyes Syndrome) to prevent blockage of the coronary artery of the heart.

5.Injections of gamma globulin is the main treatment for Kawasaki disease.

6.corticosteroids is useful to reduce complications such as arthritis and myocarditis

Prognosis of Kawasaki Disease is generally good.

Most children make a full recovery after about 3 weeks.

Myocarditis and arthritis may last for 6 to 8 weeks.

Coronary artery disease improves gradually over 1 year.

In 1-2 per cent of patients serious heart complications may occur.

A Family Doctor's Tale- LEPTOSPIROSIS

DOC I HAVE LEPTOSPIROSIS

LEPTOSPIROSIS is an acute infectious illness caused by the bacteria Leptospira with a wide spectrum of illness from inapparent to fatal.

The bacteria which causes LEPTOSIROSIS is the Leptospira interrogans which is an extremely hardy bacteria occurring in domestic and wild animals.

Humans are accidental hosts.

Human infections occur through abraded skin and exposed mucous membranes from urine or tissues of infected animal or through contaminated water soil and vegetation.

The bacteria can affect the liver, kidney, skeletal muscle, heart, spleen, lungs and central nervous system.

Hemorrhagic changes and necrosis of tissues may occur together with interstitial edema and lympocytic, plasma cell and neutrophilic leucocyte infiltration.

Symptoms and Signs of LEPTOSPIROSIS are:
Incubation period is approximately 10 days.


Illness is typically biphasic.

A.Leptospiremic or First Phase
1.Organisms found in the blood and cerebrospinal fluid

2.Abrupt onset of headache, myalgia, high fever and chills

This will last 4-9 days

3.Anorexia, nausea, vomiting, cough, chest pain, hemoptysis, conjunctival suffusion, cutaneous rash and hemorrhages seen.

B.Immune or Second Phase:
1.Correlates with appearance of circulating IgM antibodies

2.Clinical manifestations in this phase varies:
Patient may be asymptomatic for 1-3 days with return of fever and other symptoms of first stage.

3.Iridocyclitis, optic neuritis, encephalitis, myelitis,
and perpheral neuropathy and meningismus may occur.

Specific Leptospirosis Disease:
Weil's Disease:
is severe leptospirosis with
1.liver involvement with jaundice, hyperbilirubinemia
2.renal involvement with proteinuria, pyuria, hematuria
2.hemorrhagic manifestations with epistaxis, hemoptysis, GIT bleeding, subarachnoid hemorrhage
3.anemia
4.changes in consciousness
5.continuous fever
6.pneumonitis
7.aseptic meningitis
8.myocarditis

Doctors generally diagnose LEPTOSPIROSIS based on:
1. blood test and cultures.

2.cerebrospinal tests

3.animal innoculation

4.liver scan and ultrasound

LEPTOSIROSIS is a disease which can kill especially through its complications:
1.Liver disease due to damage to the liver leading to cirrhosis

2.Kidney disease can occur from damage to the kidney

3.Brain damage is rare but can occur from spread to the brain and meninges

4.Severe hemorrhage uncommon but can cause death

Treatment of  LEPTOSPIROSIS is :
LEPTOSPIROSIS is an infectious disease which can spread to other people through contaminated food and water.

1.Antibiotics such as penicillin and tetracycline are started once the diagnosis is confirmed.

2.intravenous drip and blood transfusion if necessary

Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache

2.antispasmodic drug to stop abdominal cramps

3.medicine to stop vomiting and itch

4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.

5.Get plenty of rest.

Prevention of LEPTOSPIROSIS can be by:
1..Avoid eating or drinking foods or liquids that might be contaminated especially by the germ and animals

5.Good food hygiene and hand washing

Prognosis of LEPTOSPIROSIS depends on the virulence of disease and general condition of the patient.

It is excellent with prompt treatment of leptospirosis infection.

Weil's disease is more serious but will respond well to treatment.

Infection of pregnant women may be associated with increased risk of fetal loss.

A Family Doctor's Tale -NIGHT BLINDNESS

DOC I HAVE Night Blindness

Night Blindness is defective vision in conditions of lowered illumination.

The main causes of Night Blindness is classified into 2 :

1.Congenital Night Blindness:
This is a simple congenital defect of:
a.dominant trait
b.recessive trait
c.recessive sex linked trait

2.Acquired Night Blindness:
This pathological state occurs when the rod function of the retina cells are depressed:
a.Vitamin A deficiency - prolonged deficiency can affect marked degenerative changes in the rods, then cones and subsequently in the neuronal layers of the retina


Causes of Vitamin A deficiency:
inadequate dietary intake
impaired absorption in celiac disease, tropical sprue or liver cirrhosis

b.retinitis pigmentosa - a degenerative disease of the retina affecting the cones and rods starting in the equatorial region and then spreading to the macular region

c.liver disease not associated with vitamin deficiency

d.rare mucopolysaccharidase deficiencies

e.Refsum disease

f.Choroideremia:
progressive atrophy of the choroid -very rare

g.Neuronal ceroid lipofuscinosis

h.Abetalipoproteinuria
Diffuse Night Blindness is inflammation in all areas of the uvea.

Night Blindness affects both eyes and are more common in the elderly:

Symptoms of night blindness:
1.inability to see well at dusk

2.worse after long phases in bright sunlight

Diagnosis of night blindness:
1.History, physical examination and family history eliminates the rarer causes of night blindness.

2.measurement of Vitamin A or carotene levels

3.An early clinical sign of Vitamin A deficiency is conjunctival prexerosis associated with triangular areas of keratinised epithelium at the temporal limbus .

These are called Bitot's spots.

Treatment of night blindness:
1.Most genetic causes of night blindness cannot be cured

2.Vitamin A deficiency:
high doses of Vitamin A of 50,000 to 100,000 units per day up to 14 days.
Longer treatment may cause Vitamin A toxicity and damage the liver.

3.Maintenance dose of 2500 units of Vitamin A(or 750mg) is recommended daily.

Prognosis of night blindness:
depends on the cause -no cure for genetic causes

Poor when due to secondary causes

Excellent in early treatment of Vitamin A deficiency

Prevention of night blindness:
1.knowledge of family history

2. avoid prolonged bright lights

3.Take natural forms of Vitamin A such as carotene in carrots, tomatoes, papaya and other vegetables and natural vitamin A in fish liver oils, liver and meat.

A Family Doctor's Tale - EYE INJURIES

DOC I HAVE AN EYE INJURY

EYE INJURY is an traumatic accident to the eye which is a delicate organ and cause permanent loss of vision.

The greatest danger of eye injury comes from sharp objects such as pencils, nails, and knife.
Sharp objects injury to the eye can lead to puncture of the eyeball with extrusion of the eye contents and will require surgery.

Scratches and cuts that damage the cornea and the white of the eye are the most common eye injuries.

Causes of EYE INJURIES can be divided into:
1.Superficial injuries that include corneal scratches and superficial cuts even by the edge of a paper,sand ,or grainy dirt particles.

2.Chemical injuries that occur when liquids such as acids or alkali(bleach, thinner, battery acid) enter the eye

3.Blunt injuries to structures of the eye that give rise to swelling of the eyelid or bruising of the tissues around the eye(examples are sports like basketball, football, boxing or martial arts or home repairs where balls, fists or hammer may hit the eye)

4.Penetrating injuries are serious injuries or cuts in the eye which may result in foreign objects including metal bodies being left in the eye. They require urgent medical attention and surgery.

Symptoms varies from mild to severe:

1.Severe pain in the eye or around the eye

2.burning sensation in the eye especially exposed to chemicals

3.blurred vision

4.Discharge -may be due to eye infection


5.Light sensitivity - sensitive to bright lights

6.bruises around the eyelids or cuts

Signs of injury to surface of or area around the eye:
1.bruising of the eyelid and surrounding area usually due to trauma

2.swelling of the eye or eyelid

3.tenderness of the eye


4.blurred vision

5.redness of the eye

6.feeling of something in the eye

Signs of injury to the inside of the eye:
1.blurred vision

2.seeing floating bodies or flashes of light

3.bleeding into the back of the eye(vitreous hemorrhage)

Diagnosis of EYE INJURIES:
1.Mild cases like chemical splash or small dust particles can be treated by a family doctor

2.More severe cases require an eye specialist to examine the eye with a slit lamp microscope to determine the inside of the eye including the retina and cornea.

3.Movements of the eye and testing of the nerves to eye may be needed.

4.X-rays of the may reveal fractures of the eye socket.

5.Ultrasound of the eye may be needed if there is a lot of bleeding in the eye

6.CAT scan or MRI of the eye may be necessary if a penetrating eye injury is suspected or a foreign body may be present.

The complication is always the risk of :
1.Severe infection of the eye especially with pseudomonas infection causing infection of the anterior chamber of the eye and then spreading to the rest of eye resulting in loss of an eye.

2.Scarring of the EYE INJURY resulting in partial loss of vision

3.metal from foreign body in the eye can cause loss of vision

Treatment depends on the type and extent of EYE INJURY:
A.Superficial injuries can be diagnosed with a stain called fluorescin.
Abrasions and depth of lacerations can be seen clearly with this. They require antibiotics and an eye patch.

Close follow up is needed when there is infection.

B. Chemical injuries require copious flushing of the eye to remove as much chemicals as possible and to minimize damage to the eye. Follow up is necessary to watch up for late complications such as raised eye pressure.

C.Traumatic Injuries to the eye
Bruises to the eye or eyelid -ice packs can be used to reduce swelling during the first 49 hours followed by warm compression to clear the blood

D. Penetrating injuries to the eye :
when there is vitreous hemorrhage or retinal detachment, a surgical procedure called vitreotomy may be necessary to restore vision.
This is a retina surgery where fine instruments are used to remove blood from the the inside of the eye or repair retinal detachment. An air bubble or silicone oil may be injected at the end of procedure to keep the eye in the normal shape.
Vitreotomy may also be necessary in penetrating injuries to remove any foreign body and repair any cuts or laceration inside the eye.
Foreign bodies that are not removed or untreated can result in severe eye infections and blindness.

The prognosis depends on the severity of the eye injury.

Most cases can be restored to normal if treated early.

Some cases may have minimum scarring of the cornea with possible loss of some vision.

Rarely the eye may be lost if there is severe infection and no treatment.

Prevention of Eye Injuries:
1.Take proper safety precautions when dealing with chemicals
and cleaning fluids.

2.Wear goggles when working with sharp instruments or poer tools like drill or saw

3.Avoid rubbing the eyes with hands when handling household cleaning fluids or chemicals of any kind

4. wash the hands thoroughly after handling chemicals or dusts from saws or drills.