Category Archives: ___b) Disease

(Survival manual/6. Medical/b) Disease/Lassa fever)

What is Lassa fever?
Lassa is a Category A disease, according to the U.S., meaning it has the potential, like anthrax and botulism, to be used a biological weapon.
Lassa fever is an acute viral illness that occurs naturally in West Africa. The illness was discovered in 1969 when two missionary nurses died in Nigeria, West Africa. The cause of the illness was found to be Lassa virus, named after the town in Nigeria where the first cases originated. The virus, a member of the virus family Arenaviridae, is a single-stranded RNA virus and is zoonotic, or animal-borne.
In areas of Africa where the disease is endemic (that is, constantly present), Lassa fever is a significant cause of morbidity and mortality. While Lassa fever is mild or has no observable symptoms in about 80% of people infected with the virus, the remaining 20% have a severe multisystem disease. Lassa fever is also associated with occasional epidemics, during which the case-fatality rate can reach 50%.

Where is Lassa fever found?
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/lassaf.htm
Lassa fever is an endemic disease in portions of West Africa. It is recognized in Guinea, Liberia, Sierra Leone, as well as Nigeria. However, because the rodent species which carry the virus are found throughout West Africa, the actual geographic range of the disease may extend to other countries in the region.

How many people become infected?
The number of Lassa virus infections per year in West Africa is estimated at 100,000 to 300,000, with approximately 5,000 deaths. Unfortunately, such estimates are crude, because surveillance for cases of the disease is not uniformly performed. In some areas of Sierra Leone and Liberia, it is known that 10%-16% of people admitted to hospitals have Lassa fever, which indicates the serious impact of the disease on the population of this region. [Note: Lassa fever was discovered in 1969, now 40 years later, there have been outbreaks over much of the western side of the African continent]
At least two cases of Lassa fever have occurred in the United States, the first in Chicago, the second in New Jersey. Both individuals who had recently been traveling in endemic areas of Africa, one in Nigeria, the other in Liberia, and succumbed to the fever after returning to the United States. Several incidences of infection in the lab have occurred with Lassa virus, as in the case of well-known virologist Dr. Jordi Casals, who became infected with the virus after studying samples from the original Nigerian case.

In what animal host is Lassa virus maintained?
Mastomys rodent, also known as the “multimammate rat”.  Note the hairless tail.
The reservoir, or host, of Lassa virus is a rodent known as the “multimammate rat” of the genus Mastomys. It is not certain which species of Mastomys are associated with Lassa; however, at least two species carry the virus in Sierra Leone. Mastomys rodents breed very frequently, produce large numbers of offspring, and are numerous in the savannas and forests of West, Central, and East Africa. In addition, Mastomys generally readily colonize human homes. All these factors together contribute to the relatively efficient spread of Lassa virus from infected rodents to humans.

How do humans get Lassa fever?
There are a number of ways in which the virus may be transmitted, or spread, to humans. The Mastomys rodents shed the virus in urine and droppings. Therefore, the virus can be transmitted through direct contact with these materials, through touching objects or eating food contaminated with these materials, or through cuts or sores. Because Mastomys rodents often live in and around homes and scavenge on human food remains or poorly stored food, transmission of this sort is common. Contact with the virus also may occur when a person inhales tiny particles in the air contaminated with rodent excretions. This is called aerosol or airborne transmission. Finally, because Mastomys rodents are sometimes consumed as a food source, infection may occur via direct contact when they are caught and prepared for food.

Lassa fever may also spread through person-to-person contact. This type of transmission occurs when a person comes into contact with virus in the blood, tissue, secretions, or excretions of an individual infected with the Lassa virus. The virus cannot be spread through casual contact (including skin-to-skin contact without exchange of body fluids). Person-to-person transmission is common in both village and health care settings, where, along with the above-mentioned modes of transmission, the virus also may be spread in contaminated medical equipment, such as reused needles (this is called nosocomial transmission).

What are the symptoms of Lassa fever?
Signs and symptoms of Lassa fever typically occur 1-3 weeks after the patient comes into contact with the virus. These include fever, retrosternal pain (pain behind the chest wall), sore throat, back pain, cough, abdominal pain, vomiting, diarrhea, conjunctivitis, facial swelling, proteinuria (protein in the urine), and mucosal bleeding. Neurological problems have also been described, including hearing loss, tremors, and encephalitis. Because the symptoms of Lassa fever are so varied and nonspecific, clinical diagnosis is often difficult.

 How is the disease diagnosed in the laboratory?
Lassa fever is most often diagnosed by using enzyme-linked immunosorbent serologic assays (ELISA), which detect IgM and IgG antibodies as well as Lassa antigen. The virus itself may be cultured in 7 to 10 days. Immunohistochemistry performed on tissue specimens can be used to make a post-mortem diagnosis. The virus can also be detected by reverse transcription-polymerase chain reaction (RT-PCR); however, this method is primarily a research tool.

 Are there complications after recovery?
The most common complication of Lassa fever is deafness. Various degrees of deafness occur in approximately one-third of cases, and in many cases hearing loss is permanent. As far as is known, severity of the disease does not affect this complication: deafness may develop in mild as well as in severe cases.  Spontaneous abortion is another serious complication.

 What proportion of people die from the illness?
Approximately 15%-20% of patients hospitalized for Lassa fever die from the illness. However, overall only about 1% of infections with Lassa virus result in death. The death rates are particularly high for women in the third trimester of pregnancy, and for fetuses, about 95% of which die in the uterus of infected pregnant mothers.

 How is Lassa fever treated?
Ribavirin, an antiviral drug, has been used with success in Lassa fever patients. It has been shown to be most effective when given early in the course of the illness. Patients should also receive supportive care consisting of maintenance of appropriate fluid and electrolyte balance, oxygenation and blood pressure, as well as treatment of any other complicating infections. Ribavirin should be given intravenously for ten days.

What groups are at risk for getting the illness?
Individuals at risk are those who live or visit areas with a high population of Mastomys rodents infected with Lassa virus or are exposed to infected humans. Hospital staff are not at great risk for infection as long as protective measures are taken.

 How is Lassa fever prevented?
Wearing protective clothing — an important part of practicing barrier nursing methods.
Primary transmission of the Lassa virus from its host to humans can be prevented by avoiding contact with Mastomys rodents, especially in the geographic regions where outbreaks occur. Putting food away in rodent-proof containers and keeping the home clean help to discourage rodents from entering homes. Using these rodents as a food source is not recommended. Trapping in and around homes can help reduce rodent populations. However, the wide distribution of Mastomys in Africa makes complete control of this rodent reservoir impractical.

When caring for patients with Lassa fever, further transmission of the disease through person-to-person contact or nosocomial routes can be avoided by taking preventive precautions against contact with patient secretions (together called VHF isolation precautions or barrier nursing methods). Such precautions include wearing protective clothing, such as masks, gloves, gowns, and goggles; using infection control measures, such as complete equipment sterilization; and isolating infected patients from contact with unprotected persons until the disease has run its course.

What needs to be done to address the threat of Lassa fever?
Further educating people in high-risk areas about ways to decrease rodent populations in their homes will aid in the control and prevention of Lassa fever. Other challenges include developing more rapid diagnostic tests and increasing the availability of the only known drug treatment, ribavirin. Research is presently under way to develop a vaccine for Lassa fever.

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Is There a Real Biological Warfare Threat?
http://telemedicine.org/biowar/biologic.htm
Current unclassified information reveals that, despite the 1972 Geneva Biological Weapons Convention, at least seventeen countries are known or suspected of having offensive biological weapons programs.
Clearly, BW is a credible threat to our military, as it was during Desert Shield/Storm. Terrorist use of BW agents could kill many people to create an unparalleled medical, political, and social crisis. Despite the fact the biological weapons have never been used against the United States, we must prepare for a new age of terrorism. Civilian health-care workers must know how to recognize a BW attack in the event of terrorist use of BW agents on civilian populations.

Lassa fever may be spread as an aerosol or with dust-powder.

(Survival manual/6. Medical/b) Disease/Pneumonia)

Definition
Pneumonia is an inflammation of your lungs, usually caused by infection. Bacteria, viruses, fungi or parasites can cause pneumonia. Pneumonia is a particular concern if you’re older than 65 or have a chronic illness or impaired immune system. It can also occur in young, healthy people.
Pneumonia can range in seriousness from mild to life-threatening. Pneumonia often is a complication of another condition, such as the flu. Antibiotics can treat most common forms of bacterial pneumonias, but antibiotic-resistant strains are a growing problem. The best approach is to try to prevent infection.

Symptoms
Pneumonia symptoms can vary greatly, depending on any underlying conditions you may have and the type of organism causing the infection. Pneumonia often mimics the flu, beginning with a cough and a fever, so you may not realize you have a more serious condition.
Common signs and symptoms of pneumonia may include:
•  Fever
•  Cough
•  Shortness of breath
•  Sweating
•  Shaking chills
•  Chest pain that fluctuates with breathing (pleurisy)
•  Headache
•  Muscle pain
•  Fatigue
Ironically, people in high-risk groups such as older adults and people with chronic illnesses or weakened immune systems may have fewer or milder symptoms than less vulnerable people do. And instead of having the high fever that often characterizes pneumonia, older adults may even have a lower than normal temperature.

When to see a doctor
Because pneumonia can be life-threatening, see your doctor as soon as possible if you have a persistent cough, shortness of breath, chest pain, unexplained fever — especially a lasting fever of 102 F (38.9 C) or higher with chills and sweating — or if you suddenly feel worse after a cold or the flu.
Be especially prompt about seeking medical care if you’re an older adult or you smoke, drink excessively, have an injury, are undergoing chemotherapy or take medication such as prednisone that suppresses your immune system. For some older adults and people with heart failure or lung ailments, pneumonia can quickly become a life-threatening condition.

Causes
Your body has ways to protect your lungs from infection. In fact, you’re frequently exposed to bacteria and viruses that can cause pneumonia, but your body normally uses a number of defenses, such as cough and the normal microorganisms (flora) in your body, to prevent harmful organisms from invading and overwhelming your airways. However, numerous conditions, including malnutrition and systemic illness, can lower your protection and allow harmful organisms to get past your body’s defenses and into your lungs.
Once the invading organisms are in your lungs, white blood cells — a key part of your immune system — begin to attack them. The accumulating invaders, white blood cells and immune system proteins cause the tiny air sacs in your lungs to become inflamed and filled with fluid, leading to the difficult breathing that characterizes many types of pneumonia.

Classifications of pneumonia
Pneumonia is sometimes classified according to the cause of pneumonia:
1.  Community-acquired pneumonia. This refers to pneumonia you acquire in the course of your daily life — at school, work or the gym, for instance. The most common cause is the bacterium Streptococcus pneumoniae. Another, less common cause is Mycoplasma pneumoniae, a tiny organism that typically produces milder signs and symptoms than other types of pneumonia. Walking pneumonia, a term used to describe pneumonia that isn’t severe enough to require bed rest, may result from Mycoplasma pneumoniae.
2.  Hospital-acquired (nosocomial) pneumonia. If you’re hospitalized, you’re at a higher risk of pneumonia, especially if you’re breathing with the help of a mechanical ventilator, in an intensive care unit or have a weakened immune system. This type of pneumonia can be extremely serious, especially for older adults, young children and people with chronic obstructive pulmonary diseases (COPD) or HIV/AIDS.
Hospital-acquired pneumonia develops at least 48 hours after you’re admitted to the hospital. This category includes post-operative pneumonia — most common in people older than age 70 who have abdominal or chest surgery — and health-care associated pneumonia — acquired in chronic care facilities, centers where drugs are given by intravenous drip (infusion) and kidney dialysis centers.
A common predisposing factor for this type of pneumonia is gastroesophageal reflux disease (GERD). This occurs when some of the contents of your stomach flow back into the upper esophagus. From there, the gastroesophageal contents can be inhaled (aspirated) into your windpipe and then into your lower airways. Even small amounts of gastroesophageal reflux can lead to pneumonia in people who are hospitalized.
3.  Aspiration pneumonia. This type of pneumonia occurs when you aspirate foreign matter into your lungs — most often when the contents of your stomach enter your lungs after you vomit. This commonly happens when a brain injury or other condition affects your normal gag reflex.
Another cause of aspiration pneumonia is consuming too much alcohol. Aspiration occurs when the inebriated person passes out and then vomits due to the effects of alcohol on the stomach. If someone’s unconscious, it’s possible to aspirate the liquid contents and possibly solid food from the stomach into the lungs, causing aspiration pneumonia.
Difficulty swallowing, which occurs with diseases such as amyotrophic lateral sclerosis (ALS), Parkinson’s disease and strokes, may also lead to aspiration pneumonia.
4.  Pneumonia caused by opportunistic organisms. This type of pneumonia strikes people with weakened immune systems. Organisms that aren’t harmful for healthy people can be dangerous for people with AIDS and other conditions that impair the immune system, as well as people who have had an organ transplant. Medications that suppress your immune system, such as corticosteroids or chemotherapy, also can put you at risk of opportunistic pneumonia.
5.  Other pathogens. Outbreaks of the H5N1 influenza (bird flu) virus and severe acute respiratory syndrome (SARS) have caused serious, sometimes deadly pneumonia infections, even in otherwise healthy people. Although rare, anthrax, plague and tularemia also may cause pneumonia. Some forms of fungi, when inhaled can cause pneumonia. Tuberculosis in the lung also can cause pneumonia.

Risk factors
Factors associated with an increased risk of pneumonia include:
•  Age. If you’re age 65 or older, particularly if you have other conditions that make you more prone to developing pneumonia, you’re at increased risk of pneumonia. Very young children, whose immune systems aren’t fully developed, also are at increased risk of pneumonia.
•  Certain diseases. These include immune deficiency diseases such as HIV/AIDS and chronic illnesses such as cardiovascular disease, emphysema and other lung diseases, and diabetes. You’re also at increased risk if your immune system has been impaired by chemotherapy or long-term use of immunosuppressant drugs.
•  Smoking, alcohol abuse. Millions of microscopic hairs (cilia) cover the surface of the cells lining your bronchial tubes. The hairs beat in a wave-like fashion to clear your airways of normal secretions, but irritants such as tobacco smoke paralyze the cilia, causing secretions to accumulate. If these secretions contain bacteria, they can develop into pneumonia. Alcohol interferes with your normal gag reflex as well as with the action of the white blood cells that fight infection.
•  Hospitalization in an intensive care unit. Pneumonia acquired in the hospital tends to be more serious than other types of pneumonia. People who need mechanical ventilation are particularly at risk because the breathing tube bypasses the normal defenses of the upper respiratory tract, prevents coughing, may allow the stomach’s contents to back up into the esophagus where they can be inhaled (aspirated), and can harbor bacteria and other harmful organisms.
•  Having COPD and using inhaled corticosteroids for more than 24 weeks. Research indicates that this greatly increases your risk of developing pneumonia, possibly serious pneumonia.
•  Exposure to certain chemicals or pollutants. Your risk of developing some uncommon types of pneumonia may be increased if you work in agriculture, in construction or around certain industrial chemicals or animals. Exposure to air pollution or toxic fumes can also contribute to lung inflammation, which makes it harder for the lungs to clear themselves.
•  Surgery or traumatic injury. People who’ve had surgery or who are immobilized from a traumatic injury have a higher risk of pneumonia because surgery or serious injuries may make coughing — which helps clear your lungs — more difficult, and lying flat can allow mucus to collect in your lungs, providing a breeding ground for bacteria.
•  Ethnicity. If you’re a Native Alaskan or from certain Native American tribes, you’re at greater risk for contracting pneumonia.

Complications
How serious pneumonia is for you usually depends on your overall health and the type and extent of pneumonia you have. If you’re young and healthy, your pneumonia often can be treated successfully. However, some organisms that cause pneumonia are so virulent that they overwhelm the defense mechanisms, even in otherwise healthy people.
If you have heart failure or lung ailments, especially if you smoke, or if you’re older, your pneumonia may be harder to treat successfully. You’re also more likely to develop complications, some of which can be life-threatening.

Pneumonia complications may include:
•  Bacteria in your bloodstream. Pneumonia can be life-threatening when inflammation from the disease fills the air sacs in your lungs and interferes with your ability to breathe. In some cases the infection may invade your bloodstream (bacteremia). It can then spread quickly to other organs.
•  Fluid accumulation and infection around your lungs. Sometimes fluid accumulates between the thin, transparent membrane (pleura) covering your lungs and the membrane that lines the inner surface of your chest wall — a condition known as pleural effusion. Normally, the pleurae are smooth, allowing your lungs to slide easily along your chest wall when you breathe in and out. But when the pleurae around your lungs become inflamed (pleurisy) — often as a result of pneumonia — fluid can accumulate and may become infected (empyema).
•  Lung abscess. A cavity containing pus (abscess) that forms within the area affected by pneumonia is another potential complication.
•  Acute respiratory distress syndrome (ARDS). The pneumonia involves most areas of both lungs, making breathing difficult and depriving your body of oxygen. Underlying lung disease of any kind, but especially COPD, makes you more susceptible to ARDS.

Tests and diagnosis
Your doctor may first suspect pneumonia based on your medical history and a physical exam. You may undergo some or all of these tests:
•  Physical exam. During the exam, your doctor listens to your lungs with a stethoscope to check for abnormal bubbling or crackling sounds (rales) and for rumblings (rhonchi) that signal the presence of thick liquid.
•  Chest X-rays. X-rays can confirm the presence of pneumonia and determine the extent and location of the infection.
•  Blood and mucus tests. You may have a blood test to measure your white cell count and look for the presence of viruses, bacteria or other organisms. Your doctor also may examine a sample of your mucus or your blood to help identify the particular microorganism that’s causing your illness.

Medication Choices
Although experts differ on their recommendations, the first antibiotic used is usually one that kills a wide range of bacteria (broad-spectrum antibiotic). All antibiotics used have a high cure rate for pneumonia.
If you do not have to go to the hospital, your doctor may use any of the following antibiotics:
•  Macrolides, such as azithromycin, clarithromycin, and erythromycin.
•  Tetracyclines, such as doxycycline.
•  Fluoroquinolones, such as gemifloxacin, levofloxacin, and moxifloxacin.
Pasted from <http://www.webmd.com/lung/tc/pneumonia-medications>

Home treatment with high-dose oral amoxicillin is equivalent to currently recommended hospitalization and parenteral ampicillin for treatment of severe pneumonia without underlying complications, suggesting that WHO recommendations for treatment of severe pneumonia need to be revised,” the study authors write.

[DOSING: For most infections in adults the dosing regimens for amoxicillin are 250 mg every 8 hours, 500 mg every 8 hours, 500 mg every 12 hours or 875 mg every 12 hours, depending on the type and severity of infection.
Amoxicillin can be taken with or without food.
Pasted from <http://www.medicinenet.com/amoxicillin/article.htm>]

•  Bacterial. Doctors usually treat bacterial pneumonia with antibiotics. Although you may start to feel better shortly after beginning your medication, be sure to complete the entire course of antibiotics. Stopping medication too soon may cause your pneumonia to return. It also helps create strains of bacteria that are resistant to antibiotics.
•  Viral. Antibiotics aren’t effective against most viral forms of pneumonia. And although a few viral pneumonias may be treated with antiviral medications, the recommended treatment generally is rest and plenty of fluids.
•  Mycoplasma. Mycoplasma pneumonias are treated with antibiotics. Even so, recovery may not be immediate. In some cases fatigue may continue long after the infection itself has cleared. Many cases of mycoplasma pneumonia go undiagnosed and untreated. The signs and symptoms mimic those of a bad chest cold, so some people never seek medical attention. The symptoms generally go away on their own.
•  Fungal. If your pneumonia is caused by a fungus, you’ll likely be treated with antifungal medication.

Dealing with your symptoms
In addition to these treatments, your doctor may recommend over-the-counter medications to reduce fever, treat your aches and pains, and soothe the cough associated with pneumonia. You don’t want to suppress your cough completely, though, because coughing helps clear your lungs. If you must use a cough suppressant, use the lowest dose that helps you get some rest.

When hospitalization is needed
If you have severe pneumonia, you’ll be hospitalized and treated with intravenous antibiotics and possibly put on oxygen. If you don’t need oxygen, you may recover as quickly at home with oral antibiotics as in the hospital, especially if you have access to qualified home health care. Sometimes you may spend three or four days in the hospital receiving intravenous antibiotics and then continue to recover at home with oral medication.

Follow-up treatment
Your doctor will most likely schedule a follow-up X-ray and an office visit after your initial diagnosis and treatment. By that time your infection should have cleared, but it’s important for your doctor to see you, even if you’re feeling better. Follow-up appointments and X-rays are especially important in smokers.
If you’re not feeling better, the follow-up visit is an opportunity for your doctor to determine whether your course of treatment isn’t working and order more tests to get more information about your condition.

Lifestyle and home remedies
If you have pneumonia, the following measures can help you recover more quickly and decrease your risk of complications:
•  Get plenty of rest. Even when you start to feel better, be careful not to overdo it.
•  Stay home from school or work until after your temperature returns to normal and you stop coughing up mucus. This advice depends partially on how sick you were. If uncertain, ask your doctor. Because pneumonia can recur within a week or so, it may be better not to return to a full workload until you’re sure you’re well.
•  Drink plenty of fluids, especially water. Liquids keep you from becoming dehydrated and help loosen mucus in your lungs.
•  Take the entire course of any prescribed medications. Stopping medication too soon can cause your pneumonia to come back and contributes to the development of antibiotic-resistant bacteria.
•  Keep all of your follow-up appointments. Even though you feel better, your lungs may still be infected. It’s important to have your doctor monitor your progress.

Prevention
The following suggestions can help keep you healthy:
•  Get vaccinated. Because pneumonia can be a complication of the flu, getting a yearly flu shot is a good way to prevent viral influenza pneumonia, which can lead to bacterial pneumonia. In addition, even though there is some controversy of its effectiveness, especially in older adults, doctors recommend getting a vaccination against pneumococcal pneumonia at least once after age 50, and if you have any risk factors, every five years thereafter. Your doctor will recommend a pneumonia vaccine even if you’re younger than 50 if you’re a smoker, if you have a lung or cardiovascular disease, certain types of cancer, diabetes or sickle cell anemia, if your immune system is compromised, or if you’ve had your spleen removed for any reason.
A vaccine known as pneumococcal conjugate vaccine can help protect young children against pneumonia. It’s recommended for all children younger than age 2 and for children ages 2 to 5 years who are at particular risk of pneumococcal disease, such as those with an immune system deficiency, cancer, cardiovascular disease or sickle cell anemia, or those who attend a group day care center. Side effects of the pneumococcal vaccine are generally minor and include mild soreness or swelling at the injection site.
•  Wash your hands. Your hands are in almost constant contact with germs that can cause pneumonia. These germs enter your body when you touch your eyes or rub the inside of your nose. Washing your hands often and thoroughly and can help reduce your risk. When washing isn’t possible, use an alcohol-based hand sanitizer, which can be more effective than soap and water in destroying the bacteria and viruses that cause disease. What’s more, most hand sanitizers contain ingredients that keep your skin moist. Carry one in your purse or in your pocket.
•  Don’t smoke. Smoking damages your lungs’ natural defenses against respiratory infections.
•  Take care of yourself. Proper rest and a diet rich in fruits, vegetables and whole grains along with moderate exercise can help keep your immune system strong.
•  Get treatment for GERD. Treat symptomatic GERD, and lose weight if you’re overweight.
•  Protect others from infection. If you have pneumonia, try to stay away from anyone with a compromised immune system. When that isn’t possible, you can help protect others by wearing a face mask and always coughing into a tissue.
Pasted from <http://www.mayoclinic.com/health/pneumonia/DS00135/DSECTION=prevention>

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My personal choice-action regarding pneumonia vaccination:
[During 2004, at age 62 years and still active in the work force, I had my first pneumonia vaccination; its administration was covered by my company’s medical insurance. (Seven years passed….) Now age 69, and at the beginning of the 2011-2012 flu season, I received both my annual ‘flu shot’ and the 2nd ‘booster’ dose of the pneumococcal polysaccharide vaccine (PPV), these minimal expenses were covered by my Medicare insurance.]

Pneumonia Vaccine: Why immunize?
Pneumococcal disease is the cause of severe illness and even death; it kills more people in the United State each year than all other vaccine-preventable diseases combined. Everyone is susceptible to pneumococcal disease; however, some people are at greater risk from this illness. The at-risk population includes: seniors, 65 and older, the very young, as well as those with health issues including
alcoholism, heart or lung disease, kidney failure, diabetes, HIV infections, frequent acid reflux, and certain types of cancer.

Pneumococcal disease can lead to serious infections of the lungs (pneumonia), the blood
(bacteremia), and the covering of the brain (meningitis). Some statistics:
•  One out of every twenty people die from pneumococcal pneumonia. [5%]
•  Two out of every ten who get bacteremia.
•  Three out of every ten who get meningitis.

People with health issues (as mentioned above) are at even greater risk to die from this disease. Drugs (e.g. penicillin) once so effective in treating these infections are now at a disadvantage as this illness becomes more drug resistant. Immunization now plays a key role in prevention of this disease.
The pneumococcal polysaccharide vaccine (PPV) protects against 23 types of pneumococcal bacteria.
Most healthy adults who receive immunization develop protection to most or all of these types within two to three weeks of receiving the shot. The at-risk population includes: the aged, children under 2 years of age,  and those with certain long-term illnesses may not respond as well, or at all.

How many doses of PPV are needed? One dose of PPV is all that is usually required, however, under some circumstances a second dose may be given. For example: Aged 65 and older who received their first dose before 65 – if 5 or more years have passed since that initial dose.

(Survival manual/6. Medical/b) Disease/Typhoid fever)

Definition
<http://www.mayoclinic.com/health/typhoid-fever/DS00538>
Typhoid fever is caused by the bacteria Salmonella typhi. Typhoid fever is rare in industrialized countries; however, remains a serious health threat in the developing world.  Typhoid fever spreads through contaminated food and water or through close contact with someone who’s infected. Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea.
When treated with antibiotics, most people with typhoid fever feel better within a few days, although a small percentage may die of complications. [Please keep in mind, of the many diseases one might contract in the aftermath of a SHTF situation, your chance of recovery and-or rate of recovery is in part, related to your overall state of health, nutrition, access to sanitary water and protection from exposure, as well as the medical care given. Mr Larry]
Vaccines against typhoid fever are available, but they’re only partially effective. Vaccines are usually reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.

Symptoms
Although children with typhoid fever sometimes become sick suddenly, signs and symptoms are more likely to develop gradually — often appearing one to three weeks after exposure to the disease.
1. First week of illness
Once signs and symptoms do appear, you’re likely to experience:
•  Fever, often as high as 103 or 104 F.
•  Headache
•  Weakness and fatigue
•  Sore throat
•  Abdominal pain
•  Diarrhea or constipation
•  Rash
Children are more likely to have diarrhea, whereas adults may become severely constipated. During the second week, you may develop a rash of small, flat, rose-colored spots on your lower chest or upper abdomen. The rash is temporary, usually disappearing in two to five days.

2. Second week of illness
If you don’t receive treatment for typhoid fever, you may enter a second stage during which you become very ill and experience:
•  Continuing high fever
•  Either diarrhea that has the color and consistency of pea soup, or severe constipation
•  Considerable weight loss
•  Extremely distended abdomen

3. Third week of illness
By the third week, you may:
•  Become delirious
•  Lie motionless and exhausted with your eyes half-closed in what’s known as the typhoid state.
Life-threatening complications often develop at this time.

4. Fourth week of illness
Improvement may come slowly during the fourth week. Your fever is likely to decrease gradually until your temperature returns to normal in another week to 10 days. But signs and symptoms can return up to two weeks after your fever has subsided.

When to see a doctor
See a doctor immediately if you suspect you have typhoid fever. If you become ill while traveling in a foreign country, call the U.S. Consulate for a list of doctors.

Causes
Typhoid fever is caused by a virulent bacterium called Salmonella typhi. Although they’re related, this isn’t the same as the bacteria responsible for salmonellosis, another serious intestinal infection.

Fecal-oral route
The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected. In developing nations, where typhoid is endemic, most cases result from contaminated drinking water and poor sanitation. The majority of people in industrialized countries pick up the typhoid bacteria while traveling and spread it to others through the fecal-oral route.
This means that S. typhi is passed in the feces and sometimes in the urine of infected people. You can contract the infection if you eat food handled by someone with typhoid fever who hasn’t washed carefully after using the bathroom. You can also become infected by drinking water contaminated with the bacteria.

Typhoid carriers
Even after treatment with antibiotics, a small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tract or gallbladder, often for years. These people, called chronic carriers, shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.

Risk factors
Typhoid fever remains a serious worldwide threat — especially in the developing world — affecting more than 21 million people each year, according to the Centers for Disease Control and Prevention. [Typhoid is out there and its serious. We in the advanced nations keep it at bay with our energy driven public health sanitary systems. As long as the health infrastructure continue working, we’re safe, but if the power goes out regionally, for a long period of time, Typhoid will be ‘just another dangerous disease’ to deal with. Mr Larry]
The disease is endemic in India, Southeast Asia, Africa, South America and many other areas.
Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.
If you live in a country where typhoid fever is rare, you’re at increased risk if you:
•  Work in or travel to areas where typhoid fever is endemic
•  Work as a clinical microbiologist handling Salmonella typhi bacteria
•  Have close contact with someone who is infected or has recently been infected with typhoid fever
•  Have an immune system weakened by medications such as corticosteroids or diseases such as HIV/AIDS
•  Drink water contaminated by sewage that contains S. typhi

Treatments and drugs
Antibiotic therapy is the only effective treatment for typhoid fever.
Commonly prescribed antibiotics: Ceftraixone, ciprofloxacin and levofloxacin are the drugs of choice for treatment of typhoid fever.
In the United States, doctors often prescribe ciprofloxacin for nonpregnant adults. Ceftriaxone — an injectable antibiotic — is an alternative for women who are pregnant and for children who may not be candidates for ciprofloxacin. These drugs can cause side effects, and long-term use can lead to the development of antibiotic-resistant strains of bacteria.

Other treatment steps aimed at managing symptoms include:
•  Drinking fluids. This helps prevent the dehydration that results from a prolonged fever and diarrhea. If you’re severely dehydrated, you may need to receive fluids through a vein in your arm (intravenously).
•  Eating a healthy diet. Non bulky, high-calorie meals can help replace the nutrients you lose when you’re sick.
•  Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop.
•  Symptoms may return if the treatment has not completely cured the infection.
•  When appropriate treatment is started early, the prognosis for typhoid fever is good. With treatment, the mortality rate of typhoid fever is generally under 1 percent and few complications occur.
•  Even with treatment, however, approximately 20 percent of people have another episode (relapse) of typhoid fever, although the relapse is usually not as severe as the first infection. Certain factors that can increase the risk for a relapse include:
_  Age over 50
_  Presence of gallstones
_  Female gender.

Prevention
In many developing nations, the public health goals [read: infrastructure] that can help prevent and control typhoid — safe drinking water, improved sanitation and adequate medical care — may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk populations is the best way to control typhoid fever.
Two vaccines are currently in use — one is injected in a single dose, and the other is given orally over a period of days. Neither vaccine is 100 percent effective, and both require repeat immunizations as vaccine effectiveness diminishes over time.

If you’re traveling to an area where typhoid fever is endemic, [or it becomes endemic in your community] consider being vaccinated. But because the vaccine won’t provide complete protection, be sure to follow these guidelines as well:
•  Wash your hands. Frequent hand washing is the best way to control infection. Wash your hands thoroughly with hot, soapy water, especially before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water isn’t available.
•  Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than uncarbonated bottled water is. Wipe the outside of all bottles and cans before you open them. Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.
•  Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can’t peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
•  Choose hot foods. Avoid food that’s stored or served at room temperature. Steaming hot foods are best. And although there’s no guarantee that meals served at the finest restaurants are safe, it’s best to avoid food from street vendors — it’s more likely to be contaminated.
[Typhoid prevention techniques are similar to those for ‘Travelers diarrhea’.]

To prevent infecting others
If you’re recovering from typhoid, these measures can help keep others safe:
•  Wash your hands often. This is the single most important thing you can do to keep from spreading the infection to others. Use plenty of hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.
•  Clean household items daily. Clean toilets, door handles, telephone receivers and water taps at least once a day with a household cleaner and paper towels or disposable cloths.
•  Avoid handling food. Avoid preparing food for others until your doctor says you’re no longer contagious. If you work in the food service industry or a health care facility, you won’t be allowed to return to work until tests show that you’re no longer shedding typhoid bacteria.
•  Keep personal items separate. Set aside towels, bed linen and utensils for your own use and wash them frequently in hot, soapy water. Heavily soiled items can be soaked first in disinfectant.
<http://www.mayoclinic.com/health/typhoid-fever/DS00538>

(Survival manual/6. Medical/b) Disease/Streptococcal infections) 

Overview of streptococcal infections

Group A streptococcal (strep) infections are caused by group A streptococcus, a bacterium responsible for a variety of health problems. These infections can range from a mild skin infection or sore throat to severe, life-threatening conditions such as toxic shock syndrome and necrotizing fasciitis, commonly known as flesh eating disease.
Most people are familiar with strep throat, which along with minor skin infection, is the most common form of the disease. Health experts estimate that more than 10 million mild infections (throat and skin) like these occur every year.

In addition to step throat and superficial skin infections, group A strep bacteria can cause infections in tissues (group of cells joined together to perform the same function) at specific body sites, including lungs, bones, spinal cord, and abdomen.

In 2004, 3,833 cases of severe group A streptococcal disease were reported to the Centers for Disease Control and Prevention. All severe group A strep infections may lead to shock, organ failure, and death. Health care providers must recognize and treat such infections quickly.

1.  Strep throat
Symptoms of strep throat
Your health care provider may call it acute streptococcal pharyngitis. If you have strep throat infection, you will have a red and painful sore throat and may have white patches on your tonsils. You also may have swollen lymph nodes in your neck, run a fever, and have a headache. Nausea, vomiting, and abdominal pain can occur but are more common in children than in adults.

People at the greatest risk of getting a severe strep infection are
•  Children with chickenpox
•  People with suppressed immune systems
•  Burn victims
•  Elderly people with cellulitis, diabetes, blood vessel disease, or cancer
•  People taking steroid treatments or chemotherapy
•  Intravenous drug users

Pasted from <http://www.emedexpert.com/conditions/strep-throat.shtml>

Severe strep infections
Some types of group A strep bacteria cause severe infections. These include
•  Bacteremia (blood stream infections)
•  Toxic shock syndrome (multi-organ infection)
•  Necrotizing fasciitis (flesh-eating disease)

Transmission of strep throat
You can get strep throat and other group A strep infections by direct contact with saliva or nasal discharge from an infected person. Most people do not get group A strep infections from casual contact with others, but a crowded environment like a dormitory, school, or an institutional setting such as a nursing home can make it easier for the bacteria to spread. There have also been reports of contaminated food, especially milk and milk products, causing infection. You can get sick within 3 days after being exposed to the germ. Once infected, you can pass the infection to others for up to 2 to 3 weeks even if you don’t have symptoms. After 24 hours of antibiotic treatment, you will no longer spread the germs to others.

Diagnosis of strep throat
Your health care provider will take a throat swab. This will be used for a culture (a type of laboratory test) or a rapid strep test, which only takes 10 to 20 minutes. If the result of the rapid test is negative, you may get a follow-up culture to confirm the results, which takes 24 to 48 hours. If the culture test is also negative, your health care provider may suspect you do not have strep, but rather another type of infection. The results of these throat cultures will affect what your health care provider decides to be the best treatment. Most sore throats are caused by viral infections, however, and antibiotics are useless against them.

Treatment for strep throat
If you have a strep infection, your health care provider will prescribe an antibiotic. This will help reduce symptoms, and after 24 hours of taking the medicine, you will no longer be able to spread the infection to others. Treatment will also reduce the chance of complications.

Health experts think penicillin is the best medicine for treating strep throat because it has been proven to be effective, safe, and inexpensive. Your health care provider may have you take pills for 10 days or give you a shot. If you are allergic to penicillin there are other antibiotics your health care provider can give you to clear up the illness.

During treatment, you may start to feel better within 4 days. This can happen even without treatment. Still, it is very important to finish all your medicine to prevent complications. Children with strep throat are usually treated with amoxicillin.

Treatments and drugs
A number of medications are available to cure strep throat, relieve its symptoms and prevent its spread.
Antibiotics
If you or your child has strep throat, your doctor will likely prescribe an oral antibiotic such as:
__A.  Penicillin. This drug may be given by injection in some cases — such as if you have a young child who is having a hard time swallowing or is vomiting from strep throat.
Penicillin V (Penicillin VK)
Since its introduction in the 1940s, penicillin has been the “gold standard” treatment for strep throat and still remains the drug of choice in many cases of strep throat. The ability of penicillin and other penicillin antibiotics (e.g., amoxicillin) to kill group A streptococci has not changed in more than 50 years. There has never been a group A streptococcus grown from a person that has been resistant to penicillin. Penicillin has proven efficacy and safety. It is a narrow-spectrum agent that does not promote antimicrobial resistance.
Penicillin V dosage:
•  Children: 250 mg two or three times daily for 10 days
•  Adults: 500 mg two or three times for daily 10 days
Pasted from <http://www.emedexpert.com/conditions/strep-throat.shtml>

__B.  Amoxicillin. This drug is in the same family as penicillin, but is often a preferred option for children because it tastes better and is available as a chewable tablet.
Amoxicillin
Amoxicillin, a broader spectrum penicillin, may have some advantages because of higher blood levels, longer plasma half-life, and lower protein binding activity. Suspensions of this drug taste better than penicillin V suspensions, and chewable tablets are available. However, gastrointestinal side effects and skin rash may be more common with amoxicillin.

Amoxicillin has no microbiologic advantage over the less expensive penicillin. Some studies show that amoxicillin given just once a day may work as well as penicillin V given more often.
Amoxicillin dosage:
•  Children: 40 mg/kg per day in three divided doses for 10 days
•  Adults: 500 mg three times daily for 10 days
Pasted from <http://www.emedexpert.com/conditions/strep-throat.shtml>

Symptom relievers
In addition to antibiotics, your doctor may suggest over-the-counter medications to relieve throat pain and reduce fever, such as:
•  Ibuprofen (Advil, Motrin, others)
•  Acetaminophen (Tylenol, others)

Because of the risk of Reye’s syndrome, a potentially life-threatening illness, don’t give aspirin to young children and teenagers. Be careful with acetaminophen, too.
Taken in large doses, it can cause liver problems. Read and follow label directions. Talk to your doctor or pharmacist if you have questions.
Pasted from <http://www.mayoclinic.com/health/strep-throat/DS00260/DSECTION=treatments-and-drugs>

Complications of strep throat
Untreated group A strep infection can result in rheumatic fever and post-streptococcal lomerulonephritis (PSGN).
Rheumatic fever develops about 18 days after a bout of strep throat and causes joint pain and heart disease. It can be followed months later by Sydenham’s chorea, a disorder where the muscles of the torso and arms and legs are marked with dancing and jerky movements. PSGN is an inflammation of the kidneys that may follow an untreated strep throat but more often comes after a strep skin
infection. Both disorders are rarely seen in the United States because of prompt and effective treatment of most cases of strep throat.
.

2.  Skin infections: Impetigo, Cellulitis, Erysipelas
a)  Impetigo
Impetigo is an infection of the top layers of the skin and is most common among children ages 2 to 6 years. It usually starts when the bacteria get into a cut, scratch, or insect bite. Impetigo is usually caused by staphylococcus (staph), a different bacterium, but can be caused by group A streptococcus. Skin infections are usually caused by different types (strains) of strep bacteria than those that cause strep throat. Therefore, the types of strep germs that cause impetigo are usually different from those that cause strep throat.
Symptoms of impetigo
Symptoms start with red or pimple-like lesions (sores) surrounded by reddened skin. These lesions can be anywhere on your body, but mostly on your face, arms, and legs. Lesions fill with pus, then break open after a few days and form a thick crust. Itching is common. Your health care provider can diagnose the infection by looking at the skin lesions.
Transmission of impetigo
The infection is spread by direct contact with wounds or sores or nasal discharge from an infected person. Scratching may spread the lesions. From the time of infection until you show symptoms is usually 1 to 3 days. If your skin doesn’t have breaks in it, you can’t be infected by dried streptococci in the air.
Treatment for impetigo
Impetigo can be treated with a topical ointment or oral antibiotic. Mupirocin is a typical ointment that may be prescribed by your doctor. Oral antibiotics such as penicillins or cephalosporins are used for more severe infections. To prevent the spread of the infection to other parts of the body, avoid scratching the blisters or sores. Because impetigo is commonly seen in children, it may be helpful to cut the fingernails and cover the affected areas of the body with bandages or gauze. It also is important to prevent the spread of infection to other individuals in close contact by not sharing things such as blankets, linens, toys, or clothing.

b) Cellulitis and erysipelas
Cellulitis is inflammation of the skin and deep underlying tissues. Erysipelas is an inflammatory disease of the upper layers of the skin. Group A strep germs are the most common cause of both conditions.
Symptoms of cellulitis and erysipelas
Symptoms of cellulitis may include fever and chills and swollen “glands” or lymph nodes. Your skin will be painful, red, and tender. Your skin may blister and then scab over. You may also have perianal (around the anus) cellulitis may with itching and painful bowel movements.
With erysipelas, a fiery red rash with raised borders may occur on your face, arms, or legs. Your skin will be hot, red, and have sharply defined raised areas. The infection may come back, causing chronic swelling of your arms or legs (lymphedema).
Transmission of cellulitis or erysipelas
Both cellulitis and erysipelas begin with a minor incident, such as a bruise. They can also begin at the site of a burn, surgical cut, or wound, and usually affect your arm or leg. When the rash appears on your trunk, arms, or legs, however, it is usually at the site of a surgical cut or wound. Even if you have no symptoms, you carry the germs on your skin or in your nasal passages and can transmit the disease to others.
Treatment of  cellulitis and erysipelas
Oral antibiotics are used to treat mild cellulitis; more severe cases must be treated with intravenous antibiotics in a hospital. Antibiotics that may be used include cephalosporins, dicloxacillin,  clindamycin, or vancomycin. Swelling can be lessened by elevating the affected area, such as the legs or arms. To stop cellulitis from occurring again, it is important to keep applying lotion to the skin and to maintain good skin cleanliness.

.
3.  Scarlet Fever
Scarlet fever is another form of group A strep disease  that can follow strep throat. It is usually contagious and lasts for a specific length of time whether or not it is treated.

Symptoms of scarlet fever
In addition to the symptoms of strep throat, a red rash appears on the sides of your chest and abdomen. It may spread to cover most of your body. This rash appears as tiny, red pinpoints and has a rough texture like sandpaper. When pressed on, the rash loses color or turns white. There may also be dark red lines in the folds of skin. You may get a bright strawberry-red tongue and flushed (rosy) face, while the area around your mouth remains pale. The skin on the tips of your fingers and toes often peels after you get better. If you have a severe case, you may have a high fever, nausea, and vomiting. 

What are the signs and symptoms of scarlet fever?
Scarlet fever usually starts with a sudden fever associated with sore throat, swollen neck glands, headache, nausea, vomiting, loss of appetite, swollen and red strawberry tongue, abdominal pain, body aches, and malaise.

Symptoms of  Scarlet Fever
The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps and it may itch. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks. Areas of rash usually turn white when you press on them. By the sixth day of the infection the rash usually fades, but the affected skin may begin to peel.

Aside from the rash, there are usually other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever above 101° Fahrenheit (38.3° Celsius), and swollen glands in the neck. The tonsils and back of the throat may be covered with a whitish coating, or appear red,
swollen, and dotted with whitish or yellowish specks of pus. Early in the  infection, the tongue may have a whitish or yellowish coating. A child with scarlet fever also may have chills, body aches, nausea, vomiting, and loss of appetite.

When scarlet fever occurs because of a throat infection, the fever typically stops within 3 to 5 days, and the sore  throat passes soon afterward. The scarlet fever rash usually fades on the sixth day after sore throat symptoms began, but skin that was covered by rash may begin to peel. This peeling may last 10 days. With antibiotic treatment, the infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.

Scarlet fever, synopsis
The characteristic rash appears 12-48 hours after the start of the fever. The rash usually starts below the ears, neck, chest, armpits and groin before spreading to the rest of the body over 24 hours.
Scarlet spots or blotches, giving a boiled lobster appearance, are often the first sign of rash.
As skin lesions progress and become more widespread, they start to look like sunburn with goose pimples. The skin may have a rough sandpaper-like feel.
In body folds, especially the armpits and elbows, fragile blood vessels (capillaries) can rupture and cause classic red streaks called Pastia lines. These may persist for 1-2 days after the generalised rash has
gone.
In the untreated patient, the fever peaks by the second day and gradually returns to normal in 5-7 days. When treated with appropriate antibiotics, the fever usually resolves within 12-24 hours.
By about the sixth day of the infection the rash starts to fade and peeling, similar to that of sunburned skin, occurs. Peeling of the skin is most prominent in the armpits, groin, and tips of the fingers and/or toes and may continue up to 6 weeks.
Pasted from <http://www.dermnetnz.org/bacterial/scarlet-fever.html>

Transmission of scarlet fever
You can get scarlet fever the same way as strep throat-through direct contact with throat mucus, nasal discharge, and saliva of an infected person.

Treatments and drugs
A number of medications are available to cure strep throat, relieve its symptoms and prevent its spread.
Scarlet fever is treated with antibiotics. The standard treatment is penicillin, but amoxicillin is usually
given instead. Amoxicillin is a derivative of penicillin and tastes better, which makes it easier to give it to children.
Although treatment for just five days may be enough to treat the infection, treatment is given for ten days in order to prevent future complications of rheumatic fever and rheumatic heart disease.
Ten days of treatment has been proven to prevent these complications.[3]

If a person is allergic to penicillin, then erythromycin, clindamycin, or azithromycin is used. Azithromycin (Zithromax) may be used instead of penicillin because fewer doses are needed. However, it has not yet been proven that this azithromycin definitely prevents rheumatic fever or rheumatic heart disease.

An intramuscular dose of penicillin G as a one-time shot is also effective and may be used instead, particularly where compliance may be difficult. Some parents of children with scarlet fever and some adults may prefer the one-time shot instead of the 10-day course of antibiotics.

There is no need to retest a person who has been treated for strep throat or scarlet fever, as the cure rate is virtually 100%.

Home comfort
•  Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin and others) to relieve pain and reduce fever
•  Soothing gargles to fight sore throat (in adults and older children who can gargle safely)
•  A cool-mist humidifier to soothe the breathing passages and throat
•  A liquid diet, including warm soups or cold milkshakes, if the patient’s sore throat makes it difficult to swallow solid foods

You Need To Know
•  The rash of scarlet fever is caused by streptococcal pyrogenic exotoxins produced by certain strains of the group A strep bacteria that causes strep throat. Since not all strains of strep produce this exotoxin, you don’t get scarlet fever every time you get strep throat.
•  The rash of scarlet fever usually lasts about 3 or 4 days.
•  Scarlet fever used to be a much more serious infection then it is today.
•  Children with scarlet fever are contagious until they have been on an antibiotic for at least 24 hours.
Pasted from <http://pediatrics.about.com/od/sorethroats/a/07_scarletfever.htm>

Definition
      The common cold is a viral infection of your upper respiratory tract — your nose and throat. A common cold is usually harmless, although it may not feel that way. If it’s not a runny nose, sore  throat and cough, it’s the watery eyes, sneezing and congestion — or maybe all of the above. In fact, because any one of more than 100 viruses can cause a common cold, signs and symptoms tend to vary greatly.
Preschool children are at greatest risk of frequent colds, but even healthy adults can expect to have a few colds each year. Most people recover from a common cold in about a week or two. If symptoms don’t improve, see your doctor.

Symptoms
      Symptoms of a common cold usually appear about one to three days after exposure to a cold-causing virus. Signs and symptoms of a common cold may include:

• Runny or stuffy nose
• Itchy or sore throat
• Cough
• Congestion
• Slight body aches or a mild headache
• Sneezing
• Watery eyes
• Low-grade fever
• Mild fatigue

The discharge from your nose may become thicker and yellow or green in color as a common cold runs its course. What makes a cold different from other viral infections is that you generally won’t have a high fever. You’re also unlikely to experience significant fatigue from a common cold.

When to see a doctor
For adults — seek medical attention if you have:

• Fever of 103 F (39.4 C) or higher
• Fever accompanied by sweating, chills and a cough with colored phlegm
• Significantly swollen glands
• Severe sinus pain

For children — in general, children are sicker with a common cold than adults are and often develop complications, such as ear infections. Your child doesn’t need to see the doctor for a routine common
cold. But seek medical attention right away if your child has any of the following signs or symptoms:

• Fever of 103 F (39.4 C) or higher in children age 2 or older
• Fever of 102 F (38.9 C) or higher in children ages 6 weeks to 2 years
• Fever of 100 F (37.8 C) in newborns up to 6 weeks
• Signs of dehydration, such as urinating less often than usual
• Not drinking adequate fluids
• Fever that lasts more than three days
• Vomiting or abdominal pain
• Unusual sleepiness
• Severe headache
• Stiff neck
• Difficulty breathing
• Persistent crying
• Ear pain
• Persistent cough

If symptoms in a child or an adult last longer than 10 days, call your doctor.

 Causes
Although more than 100 viruses can cause a common cold, the rhinovirus is the most common culprit, and it’s highly contagious.
A cold virus enters your body through your mouth or nose. The virus can spread through droplets in the air when someone who is sick coughs, sneezes or talks. But it also spreads by hand-to-hand contact with someone who has a cold or by using shared objects, such as utensils, towels, toys or telephones. If you touch your  eyes, nose or mouth after such contact or exposure, you’re likely to “catch” a cold.

Risk factors
Cold viruses are almost always present in the environment. But the following factors can increase your chances of getting a cold:
•  Age. Infants and preschool children are especially susceptible to common colds because they haven’t yet developed resistance to most of the viruses that cause them. But an immature immune system isn’t the only thing that makes kids vulnerable. They also tend to spend lots of time with other children and frequently aren’t careful about washing their hands and covering
their mouth and nose when they cough and sneeze. Colds in newborns can be problematic if they interfere with nursing or breathing through the nose.
•  Immunity. As you age, you develop immunity to many of the viruses that cause common colds. You’ll have colds less frequently than you did as a child. However, you can still come down with a cold when you are exposed to cold viruses or have a weakened immune system. All of these
factors increase your risk of a cold.
•  Time of year. Both children and adults are more susceptible to colds in fall and winter. That’s because children are in school, and most people are spending a lot of time indoors. In places where there is no winter season, colds are more frequent in

Complications
•  Acute ear infection (otitis media). Ear  infection occurs when bacteria or viruses infiltrate the space behind the eardrum. It’s a frequent complication of common colds in children. Typical
signs and symptoms include earache and, in some cases, a green or yellow discharge from the nose or the return of a fever following a common cold.
Children who are too young to verbalize their distress may simply cry or sleep restlessly. Ear pulling is not a reliable sign.
•  Wheezing. A cold can trigger wheezing in children with asthma.
•  Sinusitis. In adults or children, a common  cold that doesn’t resolve may lead to sinusitis — inflammation and infection of the sinuses.
•  Other secondary infections. These include strep throat (streptococcal pharyngitis), pneumonia, bronchitis in adults, and croup or bronchiolitis in children. These infections need to be treated by a doctor.

Treatment and drugs
There’s no cure for the common cold.
Antibiotics are of no use against cold viruses. Over-the-counter (OTC) cold preparations won’t cure a common cold or make it go away any sooner, and most have side effects. Here’s a look at the pros and cons of some common cold remedies.
•  Pain relievers. For fever, sore throat and headache, many people turn to acetaminophen (Tylenol, others) or other mild pain relievers. Keep in mind that acetaminophen can cause liver damage,
especially if taken frequently or in larger than recommended doses. Don’t give acetaminophen to children under 3 months of age, and be especially careful when giving acetaminophen to older babies and children because the dosing guidelines can be confusing. Never give aspirin  to children. It has been associated with Reye’s syndrome — a rare but potentially fatal illness.
•  Decongestant nasal sprays. Benadryl® Allergy contains the histamine-blocker diphenhydramine. This product relieves: runny nose; sneezing; itchy, watery eyes; itchy throat.
Adults shouldn’t use decongestant drops or sprays for more than a few days because prolonged use can cause chronic rebound inflammation of mucous membranes. And children shouldn’t use decongestant drops or sprays at all. There’s little evidence that they work in young children, and they may cause side effects.
•  Cough syrups. Mucinex Oral This medication is used for the temporary relief of coughs caused by the common cold, bronchitis, and other breathing illnesses. Dosage is based on your age, medical condition, and response to treatment.  Pasted from http://www.webmd.com/drugs/drug-63818-Mucinex+Oral.aspx?drugid=63818&drugname=Mucinex+Oral)

Note: The Food and Drug Administration (FDA) and the American Academy of Pediatrics strongly recommend against giving OTC cough and cold medicines to children younger than age 2.
Over-the-counter cough and cold medicines don’t effectively treat the underlying cause of a child’s cold, and won’t cure a child’s cold or make it go away any sooner. These medications also have potential side effects, including rapid heart rate and convulsions. Don’t give your child two medicines with the same active ingredient, such as an antihistamine, decongestant or pain reliever.

Lifestyle and home remedies
You may not be able to cure your common cold, but you can make yourself as comfortable as possible. These tips may help:
1.  Drink lots of fluids. Water, juice, clear broth or warm lemon water are all good choices. They help replace fluids lost during mucus production or fever. Avoid alcohol and caffeine, which can cause dehydration, and cigarette smoke, which can aggravate your symptoms.
2.  Try chicken soup. Generations of parents have spooned chicken soup into their sick children’s mouths. Now scientists have put chicken soup to the test, discovering that it does seem to help relieve cold and flu symptoms in two ways. First, it acts as an anti-inflammatory by inhibiting the
movement of neutrophils — immune system cells that help the body’s response to inflammation. Second, it temporarily speeds up the movement of mucus through the nose, helping relieve congestion and limiting the time viruses are in contact with the nasal lining.
3.  Get some rest. If possible, stay home from work if you have a fever or a bad cough, or are drowsy after the medications. This will give you a chance to rest as well as reduce the chances that you’ll infect
others. Wear a mask when you have a cold if you live or work with someone with a chronic disease or compromised immune system.
4.  Adjust your room’s temperature and humidity. Keep your room warm, but not overheated. If the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing. Be sure to keep the humidifier clean to prevent the growth of bacteria and molds.
5.  Soothe your throat. A saltwater gargle — 1/4 to 1/2 teaspoon (1.2 milliliters to 2.5 milliliters) salt dissolved in an 8-ounce (237 milliliters) glass of warm water — can temporarily relieve a sore or scratchy throat.
6.  Use saline nasal drops. To help relieve nasal congestion, try saline nasal drops. You can buy these drops over-the-counter, and they’re effective, safe and nonirritating, even for children. In infants, experts recommend instilling several saline drops into one nostril, then gently suctioning that nostril with a bulb syringe (push the bulb in about 1/4 to 1/2 inch, or about 6 to 12 millimeters). Doing this before feeding your baby can improve your child’s ability to nurse or take a bottle, and before bedtime it may improve sleep. Saline nasal sprays may be used in older children.

Alternative medicine
Various herbs and supplements are popular for preventing or relieving colds, but scientific support is uneven for most. Here’s an update on some popular choices:
Zinc. A comprehensive analysis of clinical-trial data on zinc and colds concluded that zinc actually appears to be beneficial. The conclusion comes with a few caveats. Researchers haven’t determined the most effective formulation, dose or duration of zinc treatment for colds. Zinc lozenges can leave a bad taste in your mouth, and some trial participants reported nausea as a side effect of the lozenges. Zinc-based nasal sprays, not included in the recent, positive analysis, pose a different problem. The FDA warns that these products can take away your sense of smell, possibly for good.
Vitamin C. It appears that for the most part taking vitamin C won’t help the average person prevent colds. However, taking vitamin C at the onset of cold symptoms may shorten the duration of symptoms.
Echinacea. Studies on the effectiveness of echinacea at preventing or shortening colds are mixed. Some studies show no benefit. Others show a significant reduction in the severity and duration of
cold symptoms when taken in the early stages of a cold. One reason study results have been inconclusive may be that the type of echinacea plant and preparation used from one study to the next have varied considerably. Research on the role of echinacea in treating the common cold is ongoing. In the meantime, if your immune system is healthy and you are not taking prescription medications, using echinacea supplements is unlikely to cause harm.

Prevention
      No vaccine has been developed for the common cold, which can be caused by many different viruses. But you can take some common-sense precautions to slow the spread of cold viruses:
1.  Wash your hands. Clean your hands thoroughly and often, and teach your children the importance of hand washing. Wash hands immediately upon arriving home from any ‘away’ activities.
2.  Scrub your stuff. Keep kitchen and bathroom countertops clean, especially when someone in your family has a common cold. Wash children’s toys periodically.
3.  Use tissues. Always sneeze and cough into tissues. Discard used tissues right away, and then wash your hands carefully. Teach children to sneeze or cough into the bend of their elbow when they don’t
have a tissue. That way they cover their mouths without using their hands.
4.  Don’t share. Don’t share drinking glasses or utensils with other family members. Use your own glass or disposable cups when you or someone else is sick. Label the cup or glass with the name of the person with the cold.
5.  Steer clear of colds. Avoid close, prolonged contact with anyone who has a cold.
6.  Choose your child care center wisely. Look for a child care setting with good hygiene practices and clear policies about keeping sick children at home.
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(Survival Manual/6. Medical/b) Disease/Common cold)