DOC I HAVE SCARLET FEVER
Scarlet Fever is an acute febrile infectious disease of the upper respiratory tract caused by the erythrogenic toxin associated with the bacillus Group A Streptococcus(GAS).
Scarlet Fever is transmitted through the air through
1.droplets from the infected tonsillar or pharyngeal area of infected patients.
2.infected articles or food,
3.infected wounds or
4.infected umbilical stumps of neonates
It is highly infectious, being communicable from 24 hours before onset of symptoms to 2 to 3 weeks after onset of symptoms.
Asymptomatic carriers can also spread the disease.
Incubation period is 2 - 5 days.
The organism enters the blood from the throat and produce an erythrogenic toxin which causes the symptoms of fever and rash.
The rash is the main symptom which gives rise to the scarlet appearance, hence the name Scarlet Fever.
The infections occur in persons of all ages but peak incidence is 5- 15 years. Males are affected equally as females.
Usually 1 attack will confer permanent immunity to the erythrogenic toxin of GAS streptococcus.
The Signs and Symptoms of Scarlet Fever are:
Symptoms start off with:
1. sudden onset of headache
2. high fever 39-40 degrees centigrades
3. chills and rigors
4. sore throat(infected tonsils)
5. vomiting
6. cervical lymphadenopathy
Subsequent symptoms follows:
1.punctate erythrematous rash appearing 12 to 24 hours later after the fever, starting from the neck and chest then spreads rapidly.
The face is not affected.
2.Facial flushing and pale area around the mouth
3.Dark red lines along skin creases (Pastia's lines)
4.Rash blanches when pressed
5.Tongue coated with white fur with occasional red papillae (white strawberry tongue) The white fur peels on the third day and becomes red by the fourth day (red strawberry tongue)
How to diagnose Scarlet Fever?
-------------------------------------------------------------
1.Symptoms of fever , rash and strawberry tongue
2.ESR raised very high sometimes > 80
3.moderate leucocytosis
4.Throat swab for culture ans sensitivity
The complications of Scarlet Fever are:
1.otitis media
2.rheumatic fever
3.glomerulonephritis
4.henoch-schonlein purpura
The Treatment of Scarlet Fever is:
Isolation in hospital may be needed.
1.Antibiotics (penicillin or amoxicillin) are used in the treatment of Scarlet Fever. Treatment is for at least 10 days.
Alternatives are cephalosporins such as cephelexin in penicillin sensitive patients
2.Paracetamol is given for fever and pain
3.Bed rest , fluids and general supportive care
The Prevention for Scarlet Fever is by:
Avoiding infected patients
Use a mask in clouded places
General personal hygiene including washing hands after contact with possible contact with mucous discharge from nose, infected items or clothing and after meals
Recently in June 2011 there is an outbreak of new cases of Scarlet Fever in Hong Kong.
Prognosis of Scarlet Fever is good.
In fact after the introduction of antibiotics, there is very few cases of Scarlet Fever.
Early therapy with antibiotics produce excellent recovery
In rare cases complications such as rheumatic fever and glomerulonephritis can occur
Wednesday, July 6, 2011
Monday, July 4, 2011
A Family Doctor's Tale - HYPOPARATHYROIDISM
DOC I HAVE HYPOPARATHYROIDISM
Hypoparathyroid disease is a condition when the parathyroid gland produces too little parathyroid hormones resulting in hypocalcemia.
Hypoparathyroid disease is caused by:
Primary
Primary Hypoparathyroid disease is a rare congenital condition which usually occurs in children below the age of sixteen but can persists throughout adult life
Secondary.
Secondary Hypoparathyroid disease is usually related to surgical resection of the thyroid during which partial to total removal of the parthyroid gland occurs.
As a result of better surgical techniques , less permanent loss of the parathyroid glands occurs during throidectomy.
Instead transient deficiency may occur due to injuries to the parathyroid glands during the surgery, temporary reduction of blood supply to the parathyroid gland and hemorrhage during the surgery.
Neither the administration of radfioactive iodine or radiation to the thyroid gland has been known to cause Secondary Hypoparathyroid disease.
Symptoms:
1.tetany from lowered blood calcium
Tetany which appeared in 70 per cent of cases appears as a carpopedal spasm where the stiff hollowed hand with rigid fingers is flexed at the second metacarpal-phalangeal joint, wrist and elbow joints and the legs and feet are extended.
2.epileptic fits and tonic convulsions occurs in 40 per cent of cases
3.laryngeal spasm of muscles (may be dangerous)
4.spasm of the smooth muscle of blood vessel causing numbness due to poor blood circulation
5.diarrhea due to spasm of the smooth muscles of the gastrintestinal tract
6.mental changes including anxiety, depression, psychoses
Signs:
1.neuromuscular excitabilty may show up as contraction of the facial muscles in response to a light tap on the facial nerve in front of the ear(Chvostek's sign)
2.Dorsal flexion and abduction of the foot may occur by a tapping the lateral surface of the fibula just below its heal(Peroneal sign)
3.Inflation of a blood pressure cuff above the systolic pressure may cause the hand the typical position seen in carpopedal spasm(Trousseau's sign)
4.Skin is dry rough and scaly with patchy or generalised erythema
5.Nails may be brittle with transverse ridges
Diagnosis:
1. blood test is done for presence of low parathyroid hormone levels.
2. Blood calcium is low in hypoparathyroidism
3. Blood phosphate is high in primary
Treatment:
1.Hypocalcemia is treated with intravenous injections of calcium gluconate under cardiac monitoring as excess calcium may affect the heart
2.oral Calcium supplements(Calcium Chloride is the most effective) is given in most cases as a long term treatment usually with improvement of blood Calcium level
3.Large doses of Vitamin D may be necessary in some cases.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
surgery of thyroid gland should be done carefully so as not to remove the parathyroid gland or damage it
Hypoparathyroid disease is a condition when the parathyroid gland produces too little parathyroid hormones resulting in hypocalcemia.
Hypoparathyroid disease is caused by:
Primary
Primary Hypoparathyroid disease is a rare congenital condition which usually occurs in children below the age of sixteen but can persists throughout adult life
Secondary.
Secondary Hypoparathyroid disease is usually related to surgical resection of the thyroid during which partial to total removal of the parthyroid gland occurs.
As a result of better surgical techniques , less permanent loss of the parathyroid glands occurs during throidectomy.
Instead transient deficiency may occur due to injuries to the parathyroid glands during the surgery, temporary reduction of blood supply to the parathyroid gland and hemorrhage during the surgery.
Neither the administration of radfioactive iodine or radiation to the thyroid gland has been known to cause Secondary Hypoparathyroid disease.
Symptoms:
1.tetany from lowered blood calcium
Tetany which appeared in 70 per cent of cases appears as a carpopedal spasm where the stiff hollowed hand with rigid fingers is flexed at the second metacarpal-phalangeal joint, wrist and elbow joints and the legs and feet are extended.
2.epileptic fits and tonic convulsions occurs in 40 per cent of cases
3.laryngeal spasm of muscles (may be dangerous)
4.spasm of the smooth muscle of blood vessel causing numbness due to poor blood circulation
5.diarrhea due to spasm of the smooth muscles of the gastrintestinal tract
6.mental changes including anxiety, depression, psychoses
Signs:
1.neuromuscular excitabilty may show up as contraction of the facial muscles in response to a light tap on the facial nerve in front of the ear(Chvostek's sign)
2.Dorsal flexion and abduction of the foot may occur by a tapping the lateral surface of the fibula just below its heal(Peroneal sign)
3.Inflation of a blood pressure cuff above the systolic pressure may cause the hand the typical position seen in carpopedal spasm(Trousseau's sign)
4.Skin is dry rough and scaly with patchy or generalised erythema
5.Nails may be brittle with transverse ridges
Diagnosis:
1. blood test is done for presence of low parathyroid hormone levels.
2. Blood calcium is low in hypoparathyroidism
3. Blood phosphate is high in primary
Treatment:
1.Hypocalcemia is treated with intravenous injections of calcium gluconate under cardiac monitoring as excess calcium may affect the heart
2.oral Calcium supplements(Calcium Chloride is the most effective) is given in most cases as a long term treatment usually with improvement of blood Calcium level
3.Large doses of Vitamin D may be necessary in some cases.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
surgery of thyroid gland should be done carefully so as not to remove the parathyroid gland or damage it
Saturday, July 2, 2011
Thursday, June 30, 2011
A Family Doctor's Tale - HYPOCALCEMIA
DOC I HAVE HYPOCALCEMIA
Hypocalcemia is defined as low Calcium (less than 8.4 mg per liter) in the blood.
Normal blood Calcium varies from 8.4 to 10.4 mg per liter.
Calcium and phosphate are interrelated both regulated by the parathyroid hormones and Vitamin D which control the calcium and phosphate exchange between the blood and three important systems in the body:
1.skeletal
2.gastrointestinal
3.renal
Parathyroid hormones acts mainly on the bones and kidney to raise the blood calcium and increase the phosphate excretion.
Vitamin D increases the intestinal absorption of calcium and phosphate.
Hypocalcemia or low calcium level in the blood is caused by:
1.Hypoparathyroidism from surgical removal of parathyroid gland during thyroidectomy
2.Idiopathic hypoparathyroidism from genetic causes, sometimes unknown causes
3.Malabsorption of calcium, Vitamin D or phosphates from diet.
4.Hypoalbuminemia
5.Chronic renal failure
5.Osteomalacia -lack of mineralization of the bone matrix
6.Rickets - abnormal condition of the bones caused by low Vitamin D
7. Hyperventilation- calcium is bonded to the carbonate in the blood. If the carbon dioxide level in the blood is low, then less calcium is present because the carbonate in the blood is low.
Symptoms of hypocalcemia:
1.neuromuscular hyperexcitabilty resulting in tetany(a cramp condition of the index finger )
2.convulsions
3.stridor -due to tightening of the muscle of vocal cord
4.smooth muscles tightening
5.diarrhea
Signs:
1.Trousseau's sign - Raising the blood pressure to 200 systolic using the blood pressure cuff on the upper arm can cause the typical sign of tetany or obstretician's finger in hypocalcemia
2.Chvostek's sign - tapping the seventh nerve on the same side of the jaw as the tetany sign can cause the finger to jerk confirming hypocalcemia
Diagnosis:
1.Plasma Calcium levels
2.Blood phosphate level
3.Total serum protein levels
low serum calcium in the presence of low albumin allows a higher free cacium concentration making the patient to be normocalcemic. (normal blood cacium)
4.Bone density test
Treatment:
1.Intravenous calcium carbonate under cardiac monitoring as excessive calcium may affect the heart
2.oral Calcium supplements is given in most cases as a long term treatment usually with improvement of blood Calcium level
3.Large doses of Vitamin D may be necessary in some cases.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate electrolyte replacement after exercise
also after vomiting and diarrhea
Hypocalcemia is defined as low Calcium (less than 8.4 mg per liter) in the blood.
Normal blood Calcium varies from 8.4 to 10.4 mg per liter.
Calcium and phosphate are interrelated both regulated by the parathyroid hormones and Vitamin D which control the calcium and phosphate exchange between the blood and three important systems in the body:
1.skeletal
2.gastrointestinal
3.renal
Parathyroid hormones acts mainly on the bones and kidney to raise the blood calcium and increase the phosphate excretion.
Vitamin D increases the intestinal absorption of calcium and phosphate.
Hypocalcemia or low calcium level in the blood is caused by:
1.Hypoparathyroidism from surgical removal of parathyroid gland during thyroidectomy
2.Idiopathic hypoparathyroidism from genetic causes, sometimes unknown causes
3.Malabsorption of calcium, Vitamin D or phosphates from diet.
4.Hypoalbuminemia
5.Chronic renal failure
5.Osteomalacia -lack of mineralization of the bone matrix
6.Rickets - abnormal condition of the bones caused by low Vitamin D
7. Hyperventilation- calcium is bonded to the carbonate in the blood. If the carbon dioxide level in the blood is low, then less calcium is present because the carbonate in the blood is low.
Symptoms of hypocalcemia:
1.neuromuscular hyperexcitabilty resulting in tetany(a cramp condition of the index finger )
2.convulsions
3.stridor -due to tightening of the muscle of vocal cord
4.smooth muscles tightening
5.diarrhea
Signs:
1.Trousseau's sign - Raising the blood pressure to 200 systolic using the blood pressure cuff on the upper arm can cause the typical sign of tetany or obstretician's finger in hypocalcemia
2.Chvostek's sign - tapping the seventh nerve on the same side of the jaw as the tetany sign can cause the finger to jerk confirming hypocalcemia
Diagnosis:
1.Plasma Calcium levels
2.Blood phosphate level
3.Total serum protein levels
low serum calcium in the presence of low albumin allows a higher free cacium concentration making the patient to be normocalcemic. (normal blood cacium)
4.Bone density test
Treatment:
1.Intravenous calcium carbonate under cardiac monitoring as excessive calcium may affect the heart
2.oral Calcium supplements is given in most cases as a long term treatment usually with improvement of blood Calcium level
3.Large doses of Vitamin D may be necessary in some cases.
4.Treat underlying cause.
5.Frequent monitoring of progress by blood studies
Prognosis:
is good in most cases depending on rapidity of treatment and cause.
Prevention:
adequate electrolyte replacement after exercise
also after vomiting and diarrhea
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