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CHIKUNGUNYA FEVER

Chikungunya fever is a viral disease acquired by humans through the bite of infected mosquitoes. Chikungunya virus (CHIKV) was first identified in Tanzania in 1953, and has since been found in west, central and southern Africa and many areas of Asia. Chikungunya virus has caused many human epidemics in those areas since that time. CHIKV infection can cause a severe illness, that most often includes symptoms such as fever, headache, fatigue, nausea, vomiting, muscle pain, rash, and joint pain. There is no vaccine or specific antiviral treatment for chikungunya fever available. The best way to avoid CHIKV infection is to prevent mosquito bites.

Chikungunya is a relatively rare form of viral fever caused by an alphavirus that is spread by mosquito bites from Aedes aegypti mosquitoes, though recent research by the Pasteur Institute in Paris claims the virus has suffered a mutation that enables it to be transmitted by Aedes albopictus (Tiger mosquito). This was the cause of the plague in the Indian Ocean and a threat to the Mediterranean coast at present, requiring urgent meetings of health officials in the region.

The name is derived from the Makonde word meaning “that which bends up” in reference to the stooped posture developed as a result of the arthritic symptoms of the disease.

Chikungunya is generally not fatal. However, in 2005-2006, 200 deaths were associated with chikungunya on Réunion island and a widespread outbreak in India, primarily in Tamil Nadu, Karnataka, Kerala, and Andhra Pradesh. After flood and heavy rains in Rajasthan, India in August 2006, thousands of cases were detected in Rajsamand, Bhilwara, Udaipur, and Chittorgarh districts and also in adjoining regions of Gujarat and Madhya Pradesh, and in the neighbouring country of Sri Lanka. In the southern Indian state of Kerala, 125 deaths were attributed to Chikungunya with the majority of the casualties reported in the district of Alapuzha, primarily in Cherthala. In December 2006, an outbreak of 3,500 confirmed cases occurred in Maldives, and over 60,000 cases in Sri Lanka, with over 80 deaths. [1]. In October 2006 more than a dozen cases of Chikungunya were reported in Pakistan. A recent outbreak of the disease during June 2007 in Pathanamthitta, Kottayam and Alappuzha districts of South Kerala, India claimed more than 50 lives. It is confirmed officially that there are 7000 confirmed Chikungunya patients in these areas. Unofficial reports suggest that more than one hundred thousand are suffering from symptoms of chikungunya. Rumors float around of radio active waste from Tamil Nadu being dumped at the outskirts of this region, which mutated the mosquitos and spread the disease. The European Network for Diagnostics of “Imported” Viral Diseases claims new phylogenetic variants of virus which are fatal have been identified on Réunion. In August/September 2007 some 160 people were infected in Italies northern Ravenna region, resulting in one fatality.

Acute chikungunya fever typically lasts a few days to a couple of weeks, but as with dengue, West Nile fever, o’nyong-nyong fever and other arboviral fevers, some patients have prolonged fatigue lasting several weeks. Additionally, some patients have reported
incapacitating joint pain, or arthritis which may last for weeks or months. The prolonged joint pain associated with CHIKV is not typical of dengue. Co-circulation of dengue fever in many areas may mean that chikungunya fever cases are sometimes clinically misdiagnosed as dengue infections, therefore the incidence of chikungunya fever could be much higher than what has been previously reported.

No deaths, neuroinvasive cases, or hemorrhagic cases related to CHIKV infection have been conclusively documented in the scientific literature.

CHIKV infection (whether clinical or silent) is thought to confer life-long immunity.

Cases of chikungunya fever (between 1952-2006) have been reported in the countries depicted in red on this map.
In Africa, these include Burundi; Central African Republic; Comoros; Democratic Republic of Congo; Guinea; Kenya; Nigeria; Madagascar; Malawi; Mauritius; Mayotte; Reunion; Senegal; Seychelles, South Africa; Tanzania; Uganda; Zimbabwe.In Asia, these include Australia; Burma; Cambodia; India; Indonesia; Malaysia; Pakistan; Philippines; Taiwan; Thailand; Timor; Vietnam.

Symptoms

The symptoms of Chikungunya include fever which can reach 39°C, (102.2°F) a petechial or maculopapular rash usually involving the limbs and trunk, and arthralgia or arthritis affecting multiple joints which can be debilitating. The symptoms could also include headache, conjunctival injection, and slight photophobia. In the present epidemic in the states of Andhra Pradesh and Tamil Nadu, India, high fever and crippling joint pain are the prevalent complaint. The fever typically lasts for two days and abruptly comes down. However, other symptoms, namely joint pain, intense headache, insomnia and an extreme degree of prostration last for a variable period, usually for about 5 to 7 days. But, patients have complained joint pains for much longer time periods depending on age of the patient. With younger patients recovering within 5 to 15 days and middle aged recovering in 1 to 2.5 months and more for old people. It has been observed that the severity of the disease as well as its duration is less in younger patients and pregnant women. No untoward effects of pregnancy is noticed following the infection.

Dermatological manifestations observed in a recent outbreak of Chikungunya fever in Southern India and Eastern Indiaincludes the following:

• Maculopapular rash
• Nasal blotchy erythema
• Freckle-like pigmentation over centro-facial area
• Flagellate pigmentation on face and extremities
• Lichenoid eruption and hyperpigmentation in photodistributed areas
• Multiple aphthous-like ulcers over scrotum, crural areas and axilla.
• Lympoedema in acral distribution (bilateral/unilateral)
• Multiple ecchymotic spots (Children)
• Vesiculobullous lesions (infants)
• Subungual hemorrhage
• Photo Urticaria
• Acral Urticaria
• Cephalgia
• Lumbago
• Vomiting
• Epistaxis and haemetemesis

Histopathologically, pigmentary changes, maculopapular rash, lichenoid rash, aphthous-like ulcers show lymphocytic infiltration around dermal blood vessels (Inamadar et al). Pedal oedema (swelling of legs) is observed in many patients, the cause of which remains obscure as it is not related to any cardiovascular, renal or hepatic abnormalities.

Prevention of CHIKV Infection

The best way to avoid CHIKV infection is to prevent mosquito bites. There is no vaccine or preventive drug. Prevention tips are similar to those for dengue or West Nile virus:

• Use insect repellent containing an DEET or another EPA-registered active ingredient on exposed skin. Always follow the directions on the package.
• Wear long sleeves and pants (ideally treat clothes with permethrin or another repellent).
• Have secure screens on windows and doors to keep mosquitoes out.
• Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children’s wading pools empty and on their sides when they aren’t being used.
• Additionally, a person with chikungunya fever or dengue should limit their exposure to mosquito bites in order to avoid further spreading the infection. The person should stay indoors or under a mosquito net.
• Homoeopathic medicines are found to be very effective in preventing the disease.

dr.rahees.k@live.in

CKICKENPOX (VARICELLA)

Chickenpox, also spelled chicken pox, is the common name for Varicella zoster, classically one of the childhood infectious diseases caught by and survived by almost every child.

Chickenpox is caused by the varicella-zoster virus (VZV), also known as human herpes virus 3 (HHV-3), one of the eight herpes viruses known to affect humans. It starts with conjunctival and catarrhal symptoms and then characteristic spots appearing in two or three waves, mainly on the body and head rather than the hands and becoming itchy raw pox (pocks), small open sores which heal mostly without scarring.

Most people contract chickenpox by age 15, the majority between age 5 and 9, but all ages can contract it. Chickenpox is usually more severe in adults than children. Winter and spring are the most common times of the year for chickenpox to occur.

Chickenpox has a 10-14 day incubation period and is highly contagious through physical contact two days before symptoms appear. Following primary infection there is usually lifelong protective immunity from further episodes of chickenpox. Recurrent chickenpox, commonly known as shingles, is fairly rare but more likely in people with compromised immune systems.

Chickenpox is very highly contagious. It is easily passed between members of families and school classmates through airborne particles, droplets in exhaled air and fluid from the blisters or sores. It also can be transmitted indirectly by contact with articles of clothing and other items exposed to fresh drainage from open sores. Patients are contagious up to five days (more commonly, one to two days) before and five days after the date that their rash appears. When the sores have crusted over, the person is usually no longer contagious.

Chickenpox is rarely fatal (usually from varicella pneumonia), with pregnant women and those with a suppressed immune systems being more at risk. Pregnant women not known to be immune and who come into contact with chickenpox may need urgent treatment as the virus can cause serious problems for the baby. This is less of an issue after 20 weeks.

Later in life, viruses remaining dormant in the nerves can reactivate causing localised eruptions of shingles. This occurs particularly in people with compromised immune systems, such as the elderly, and perhaps even those suffering sunburn. Unlike chickenpox which normally fully settles, shingles may result in persisting post-herpetic neuralgia pain.

Signs and Symptoms

Chickenpox is a highly contagious disease that spreads from person to person by direct contact or through the air from an infected person’s coughing or sneezing. Touching the fluid from a chickenpox blister can also spread the disease. A person with chickenpox is contagious from 1-2 days before the rash appears until all blisters have formed scabs. This may take 5-10 days. It takes from 10-21 days after contact with an infected person for someone to develop chickenpox.

Symptoms tend to appear 14 to 16 days after initial exposure but can occur any time from 10 days up to 21 days after contact with the virus. Chickenpox is characterized by one to two days of mild fever up to 102 degrees F, general weakness, and a rash, often the first sign of the disease. Rarely, a person may have the disease without the rash. The rash of chickenpox develops in crops with raised red spots arriving first, progressing to blisters that burst, creating open sores, before crusting over. This process usually starts on the scalp, then the trunk (its area of greatest concentration), and finally the arms and legs. Any area of skin that is irritated (by diaper rash, poison ivy, eczema, sunburn, etc.) is likely to be hard hit by the rash. The rash is typically very itchy (pruritic).

The chickenpox lesions (blisters) start as a 2–4 mm red papule which develops an irregular outline (rose petal). A thin-walled, clear vesicle (dew drop) develops on top of the area of redness. This “dew drop on a rose petal” lesion is very characteristic for chickenpox. After about 8–12 hours the fluid in the vesicle gets cloudy and the vesicle breaks leaving a crust. The fluid is highly contagious, but once the lesion crusts over, it is not considered contagious. The crust usually falls off after 7 days sometimes leaving a crater-like scar. Although one lesion goes through this complete cycle in about 7 days, another hallmark of chickenpox is the fact that new lesions crop up every day for several days. Therefore, it may take about a week until new lesions stop appearing and existing lesions crust over. Children are not to be sent back to school until all lesions have crusted over.

Second infections with chickenpox occur in immunocompetent individuals, but are uncommon. Such second infections are rarely severe. A soundly-based conjecture being carefully assessed in countries with low prevalence of chickenpox due to immunisation, low birth rates, and increased separation is that immunity has been reinforced by subclinical challenges and this is now less common.(Meaning is unclear please FIXME) This is more dangerous with shingles. There have been reported cases of repeat infections. Chickenpox is highly contagious and is spread through the air when infected people cough or sneeze, or through physical contact with fluid from lesions on the skin. Zoster, also known as shingles, is a reactivation of chickenpox and may also be a source of the virus for susceptible children and adults. It is not necessary to have physical contact with the infected person for the disease to spread. Those infected can spread chickenpox before they know they have the disease - even before any rash develops. In fact, people with chickenpox can infect others from about 2 days before the rash develops until all the sores have crusted over, usually 4-5 days after the rash starts.

Complications

Complications can and do occur from chickenpox. Infection of the open pox sore by bacteria can injure the skin, sometimes causing scarring, especially if the patient scratches the inflamed area. Bacterial skin infection is, in fact, the most common complication of chickenpox in children. The next most common complications in children affect the central nervous system and include a disorder of the cerebellar portion of the brain (cerebellar ataxia with wobbliness, dizziness, tremor, and altered speech), encephalitis (inflammation of the brain with headaches, seizures, and decreased consciousness), damaged nerves (nerve palsies) and Reye’s syndrome (a potentially fatal combination of liver and brain disease that can be associated with aspirin. Children with fever should not take aspirin.). Especially serious complications can occur in patients with AIDS, lupus, leukemia, and cancer. Complications also occur in people taking immune-suppressing drugs, such as cortisone-related medications. Newborn infants whose mothers have chickenpox in the last trimester of pregnancy are at increased risk from the disease. If the mother develops the disease from five days before to two days after delivery, the fatality rate for the baby is up to 30%.

Congenital defects in Babies

These may occur if the child’s mother was exposed to VZV during pregnancy. Effects on the foetus may be minimal in nature but physical deformities range in severity from under developed toes and fingers, to severe anal and bladder malformation. Possible problems include:

• Damage to brain: encephalitis, microcephaly, hydrocephaly, aplasia of brain
• Damage to the eye (optic stalk, optic cap, and lens vesicles), microphthalmia, cataracts, chorioretinitis, optic atrophy.
• Other neurological disorder: damage to cervical and lumbosacral spinal cord, motor/sensory deficits, absent deep tendon reflexes, anisocoria/Horner’s syndrome
• Damage to body: hypoplasia of upper/lower extremities, anal and bladder sphincter dysfunction
• Skin disorders: (cicatricial) skin lesions, hypopigmentation

Most people develop lifetime immunity to chickenpox after the first occurrence and never experience it again. But the virus can sometimes resurface later in life as shingles (zoster). The current aim in the U.S. and many other countries is to achieve universal (or nearly universal) immunization of children with the chickenpox vaccine. The vaccination requires only one shot given at about one year of age. If an older person has not had chickenpox, the shot may be given at any time. There have been few significant adverse reactions to the chickenpox vaccine. All children, except those with a compromised immune system, should have the vaccination.

dr.rahees.k@live.in

Ten diseases that cannot be cured with Modern Medicine

Modern medicine has done much to eradicate and cure disease, but it has failed in some areas. Of those areas, at least one disease that cannot be cured is suffered by many people in the world every year - the common cold.

The following is a list of the top ten incurable diseases.

10. Ebola

Ebola is a virus of the family Filoviridae that is responsible for a severe and often fatal viral hemorrhagic fever; outbreaks in primates such as gorillas and chimpanzees as well as humans have been recorded. The disease is characterized by extreme fever, rash, and profuse hemorrhaging. In humans, fatality rates range from 50 to 90 percent.

The virus takes its name from the Ebola River in the northern Congo basin of central Africa, where it first emerged in 1976. Outbreaks that year in Zaire (now Congo [Kinshasa]) and The Sudan resulted in hundreds of deaths, as did another outbreak in Zaire in 1995. Ebola is closely related to the Marburg virus, which was discovered in 1967, and the two are the only members of the Filoviridae that cause epidemic human disease. A third related agent, called Ebola Reston, caused an epidemic in laboratory monkeys in Reston, Virginia, but apparently is not fatal to humans.

9. Polio

Polio is known in full as poliomyelitis - also called infantile paralysis. It is an acute viral infectious disease of the nervous system that usually begins with general symptoms such as fever, headache, nausea, fatigue, and muscle pains and spasms and is sometimes followed by a more serious and permanent paralysis of muscles in one or more limbs, the throat, or the chest. More than half of all cases of polio occur in children under the age of five. The paralysis so commonly associated with the disease actually affects fewer than 1 percent of persons infected by the poliovirus.

Between 5 and 10 percent of infected persons display only the general symptoms outlined above, and more than 90 percent show no signs of illness at all. For those infected by the poliovirus, there is no cure, and in the mid-20th century hundreds of thousands of children were struck by the disease every year. Since the 1960s, thanks to widespread use of polio vaccines, polio has been eliminated from most of the world, and it is now endemic only in several countries of Africa and South Asia. Approximately 1,000–2,000 children are still paralyzed by polio each year, most of them in India.

8. Lupus Erythematosus

Also often referred to simply as lupus, this is an autoimmune disorder that causes chronic inflammation in various parts of the body. Three main types of lupus are recognized—discoid, systemic, and drug-induced.

Discoid lupus affects only the skin and does not usually involve internal organs. The term discoid refers to a rash of distinct reddened patches covered with grayish brown scales that may appear on the face, neck, and scalp. In about 10 percent of people with discoid lupus, the disease will evolve into the more severe systemic form of the disorder.

Systemic lupus erythematosus is the most common form of the disease. It may affect virtually any organ or structure of the body, especially the skin, kidneys, joints, heart, gastrointestinal tract, brain, and serous membranes (membranous linings of organs, joints, and cavities of the body.) While systemic lupus can affect any area of the body, most people experience symptoms in only a few organs. The skin rash, if present, resembles that of discoid lupus. In general, no two people will have identical symptoms. The course of the disease is also variable and is marked by periods when the disease is active and by other periods when symptoms are not evident (remission).

7. Influenza

Influenza, also known as the flu, or grippe, is an acute viral infection of the upper or lower respiratory tract that is marked by fever, chills, and a generalized feeling of weakness and pain in the muscles, together with varying degrees of soreness in the head and abdomen.

Influenza is caused by any of several strains of orthomyxoviruses, categorized as types A, B, and C. The three major types generally produce similar symptoms but are completely unrelated antigenically, so that infection with one type confers no immunity against the others. The A viruses cause the great influenza epidemics, and the B viruses cause smaller localized outbreaks; the C viruses are not important causes of disease in humans. Between pandemics, the viruses undergo constant, rapid evolution (a process called antigenic drift) in response to the pressures of human population immunity. Periodically, they undergo major evolutionary change by acquiring a new genome segment from another influenza virus (antigenic shift), effectively becoming a new subtype to which none, or very few, of the population is immune.

6. Creutzfeldt-Jakob Disease

Creutzfeldt-Jakob disease is a rare fatal degenerative disease of the central nervous system. Creutzfeldt-Jakob disease occurs throughout the world at an incidence of one person in a million; however, among certain populations, such as Libyan Jews, rates are somewhat higher. The disease commonly occurs in adults between the ages of 40 and 70, although some young adults have been stricken with the disease. Both men and women are affected equally. The onset of the disease is usually characterized by vague psychiatric or behavioral changes, which are followed within weeks or months by a progressive dementia that is often accompanied by abnormal vision and involuntary movements. There is no known cure for the disease, which is usually fatal within a year of the onset of symptoms.

The disease was first described in the 1920s by the German neurologists Hans Gerhard Creutzfeldt and Alfons Maria Jakob. Creutzfeldt-Jakob disease is similar to other neurodegenerative diseases such as kuru, a human disorder, and scrapie, which occurs in sheep and goats. All three diseases are types of transmissible spongiform encephalopathies, so called because of the characteristic spongelike pattern of neuronal destruction that leaves brain tissue filled with holes.

5. Diabetes

Diabetes is a disorder of carbohydrate metabolism characterized by impaired ability of the body to produce or respond to insulin and thereby maintain proper levels of sugar (glucose) in the blood.

There are two major forms of the disease. Type I diabetes, formerly referred to as insulin-dependent diabetes mellitus (IDDM) and juvenile-onset diabetes, usually arises in childhood. It is an autoimmune disorder in which the diabetic person’s immune system produces antibodies that destroy the insulin-producing beta cells. Because the body is no longer able to produce insulin, daily injections of the hormone are required.

Type II diabetes, formerly called non-insulin-dependent diabetes mellitus (NIDDM) and adult-onset diabetes, usually occurs after 40 years of age and becomes more common with increasing age. It arises from either sluggish pancreatic secretion of insulin or reduced responsiveness in target cells of the body to secreted insulin. It is linked to genetics and obesity, notably upper-body obesity. People with type II diabetes can control blood glucose levels through diet and exercise and, if necessary, by taking insulin injections or oral medications.

4. HIV/AIDS

AIDS is the byname of acquired immunodeficiency syndrome - a transmissible disease of the immune system caused by the human immunodeficiency virus (HIV). HIV slowly attacks and destroys the immune system, the body’s defense against infection, leaving an individual vulnerable to a variety of other infections and certain malignancies that eventually cause death. AIDS is the final stage of HIV infection, during which time fatal infections and cancers frequently arise.

HIV/AIDS spread to epidemic proportions in the 1980s, particularly in Africa, where the disease may have originated. Spread was likely facilitated by several factors, including increasing urbanization and long-distance travel in Africa, international travel, changing sexual mores, and intravenous drug use. According to the United Nations 2004 report on AIDS, some 38 million people are living with HIV, approximately 5 million people become infected annually, and about 3 million people die each year from AIDS. Some 20 million people have died of the disease since 1981.

3. Asthma

Asthma is a chronic disorder of the lungs in which inflamed airways are prone to constrict, causing episodes of breathlessness, wheezing, coughing, and chest tightness that range in severity from mild to life-threatening. Inflamed airways become hypersensitive to a variety of stimuli, including dust mites, animal dander, pollen, air pollution, cigarette smoke, medications, weather conditions, and exercise. Stress can exacerbate symptoms.

Asthmatic episodes may begin suddenly or may take days to develop. Although an initial episode can occur at any age, about half of all cases occur in persons younger than 10 years of age, with boys being affected more often than girls. Among adults, however, the incidence of asthma is approximately equal in men and women. When asthma develops in childhood, it is often associated with an inherited susceptibility to allergens, substances such as pollen, dust mites, or animal dander that may induce an allergic reaction. In adults, asthma also may develop in response to allergens, but viral infections, aspirin, and exercise may cause the disease as well. Adults who develop asthma may have nasal polyps or sinusitis.

2. Cancer

Cancer refers to a group of more than 100 distinct diseases characterized by the uncontrolled growth of abnormal cells in the body. Cancer affects one in every three persons born in developed countries and is a major cause of sickness and death throughout the world. Though it has been known since antiquity, significant improvements in cancer treatment have been made since the middle of the 20th century, mainly through a combination of timely and accurate diagnosis, selective surgery, radiation therapy, and chemotherapeutic drugs. Such advances actually have brought about a decrease in cancer deaths (at least in developed countries), and grounds for further optimism are seen in laboratory investigations into elucidating the causes and mechanisms of the disease.

Owing to continuing advances in cell biology, genetics, and biotechnology, researchers now have a fundamental understanding of what goes wrong in a cancer cell and in an individual who develops cancer—and these conceptual gains are steadily being converted into further progress in prevention, diagnosis, and treatment of this disease.

1. The Common Cold

The common cold is an acute viral infection that starts in the upper respiratory tract, sometimes spreads to the lower structures, and may cause secondary infections in the eyes or middle ears. More than 100 agents cause the common cold, including parainfluenza, influenza, respiratory syncytial viruses, and reoviruses. Rhinoviruses, however, are the most frequent cause.

The popular term common cold reflects the feeling of chilliness on exposure to a cold environment that is part of the onset of symptoms. The feeling was originally believed to have a cause-and-effect relationship with the disease, but this is now known to be incorrect. The cold is caught from exposure to infected people, not from a cold environment, chilled wet feet, or drafts. People can carry the virus and communicate it without experiencing any of the symptoms themselves. Incubation is short — usually one to four days. The viruses start spreading from an infected person before the symptoms appear, and the spread reaches its peak during the symptomatic phase.

Source: listverse.com