Amoebiasis

Amoebiasis, also known as amebiasis or entamoebiasis,[1][2] is an infection caused by any of

the amoebas of the Entamoebagroup. Symptoms are most common upon infection by Entamoeba
histolytica. Amoebiasis can present with no, mild, or severesymptoms. Symptoms may include abdominal
pain, mild diarrhoea, bloody diarrhea or severe colitis with tissue death andperforation. This last
complication may cause peritonitis. People affected may develop anemia due to loss of blood.[3]

Signs and symptoms[edit]

Most infected people, about 90%,[5] are asymptomatic, but this disease has the potential to make the
sufferer dangerously ill. It is estimated that about 40,000 to 100,000 people worldwide die annually due to
amoebiasis.[6]
Infections can sometimes last for years. Symptoms take from a few days to a few weeks to develop and
manifest themselves, but usually it is about two to four weeks. Symptoms can range from
mild diarrhea to severe dysentery with blood and mucus. The blood comes from lesions formed by the
amoebae invading the lining of the large intestine. In about 10% of invasive cases the amoebae enter the
bloodstream and may travel to other organs in the body. Most commonly this means the liver,[7] as this is
where blood from the intestine reaches first, but they can end up almost anywhere in the body.
Onset time is highly variable and the average asymptomatic infection persists for over a year. It is
theorized that the absence of symptoms or their intensity may vary with such factors as strain of amoeba,
immune response of the host, and perhaps associated bacteria and viruses.

Cause[edit]
Amoebiasis is an infection caused by the amoeba Entamoeba histolytica. Likewise amoebiasis is
sometimes incorrectly used to refer to infection with other amoebae, but strictly speaking it should be
reserved for Entamoeba histolytica infection.[citation needed] Other amoebae infecting humans include:[10]

Parasites

Dientamoeba fragilis, which causes Dientamoebiasis

Entamoeba dispar

Entamoeba hartmanni

Entamoeba coli

Entamoeba moshkovskii

Endolimax nana and

Iodamoeba butschlii.

Transmission
Amoebiasis is usually transmitted by the fecal-oral route, but it can also be transmitted indirectly through
contact with dirty hands or objects as well as by anal-oral contact. Infection is spread through ingestion of
the cyst form of the parasite, a semi-dormant and hardy structure found in feces. Any non-encysted
amoebae, or trophozoites, die quickly after leaving the body but may also be present in stool: these are
rarely the source of new infections. Since amoebiasis is transmitted through contaminated food and
water, it is often endemic in regions of the world with limited modern sanitation systems, including Mxico,
Central America, western South America, South Asia, and western and southern Africa.[15]

Diagnosis
With colonoscopy it is possible to detect small ulcers of between 35mm, but diagnosis may be difficult as
the mucous membranebetween these areas can look either healthy or inflamed. [3]
Asymptomatic human infections are usually diagnosed by finding cysts shed in the stool.
Various flotation or sedimentation procedures have been developed to recover the cysts from fecal matter
and stains help to visualize the isolated cysts for microscopic examination. Since cysts are not shed
constantly, a minimum of three stools should be examined. In symptomatic infections, the motile form (the
trophozoite) can often be seen in fresh feces. Serological tests exist and most individuals (whether with
symptoms or not) will test positive for the presence of antibodies. The levels of antibody are much higher
in individuals with liver abscesses. Serology only becomes positive about two weeks after infection. More
recent developments include a kit that detects the presence of amoeba proteins in the feces and another
that detects ameba DNA in feces. These tests are not in widespread use due to their expense.

Prevention
To help prevent the spread of amoebiasis around the home :

Wash hands thoroughly with soap and hot running water for at least 10 seconds after using
the toilet or changing a baby's diaper, and before handling food.

Clean bathrooms and toilets often; pay particular attention to toilet seats and taps.

Avoid sharing towels or face washers.

To help prevent infection:

Avoid raw vegetables when in endemic areas, as they may have been fertilized using human
feces.
Boil water or treat with iodine tablets.
Avoid eating street foods especially in public places where others are sharing sauces in one
container

Treatment[edit]
Main article: Amoebicide

E. histolytica infections occur in both the intestine and (in people with symptoms) in tissue of the intestine
and/or liver.[15] As a result, two different classes of drugs are needed to treat the infection, one for each
location. Such anti-amoebic drugs are known as amoebicides.

Anthrax
Anthrax is an infection caused by the bacterium Bacillus anthracis.[1] It can occur in four forms: skin,
inhalation, intestinal, and injection.[2] Symptoms begin between one day and two months after contracting
the infection. The skin form presents with a small blister with surrounding swelling that often turns into a
painless ulcer with a black center. The inhalation form presents with fever, chest pain, and shortness of
breath. The intestinal form presents with nausea, vomiting, diarrhea, or abdominal pain. The injection
form presents with fever and an abscess at the site of drug injection.[3]
Anthrax is spread by contact with the spores of the bacteria, which are often from infectious animal
products. Contact is by breathing, eating, or through an area of broken skin. It does not typically spread
directly between people.[4] Risk factors include people who work with animals or animal products,
travelers, postal workers, and military personnel.[5] Diagnosis can be confirmed based on finding
antibodies or the toxin in the blood or by culture of a sample from the infected site.[6]

Signs and symptoms

Cutaneous anthrax, also known as Hide porter's disease, is when anthrax occurs on the skin. It presents
as a boil-like skin lesion that eventually forms an ulcer with a black center (eschar). The black eschar
often shows up as a large, painless necrotic ulcer (beginning as an irritating and itchy skin lesion or blister
that is dark and usually concentrated as a black dot, somewhat resembling bread mold) at the site of
infection. In general, cutaneous infections form within the site of spore penetration between two and five
days after exposure. Unlike bruises or most other lesions, cutaneous anthrax infections normally do not
cause pain.[15]

Cause
Bacillus anthracis is a rod-shaped, Gram-positive, aerobic bacterium about 1 by 9 m in size. It was
shown to cause disease by Robert Koch in 1876 when he took a blood sample from an infected cow,
isolated the bacteria and put them into a mouse.[20] The bacterium normally rests in endospore form in the
soil, and can survive for decades in this state. Herbivores are often infected whilst grazing, especially
when eating rough, irritant, or spiky vegetation: the vegetation has been hypothesized to cause wounds
within thegastrointestinal tract permitting entry of the bacterial endospores into the tissues, though this
has not been proven. Once ingested or placed in an open wound, the bacterium begins multiplying inside
the animal or human and typically kills the host within a few days or weeks. The endospores germinate at
the site of entry into the tissues and then spread by the circulation to the lymphatics, where the bacteria
multiply.

Prevention[edit]
If a person is suspected as having died from anthrax, precautions should be taken to avoid skin contact
with the potentially contaminated body and fluids exuded through natural body openings. The body should
be put in strict quarantine. A blood sample should then be collected and sealed in a container and
analyzed in an approved laboratory to ascertain if anthrax is the cause of death. Then, the body should be

incinerated. Microscopic visualization of the encapsulated bacilli, usually in very large numbers, in a blood
smear stained with polychrome methylene blue (McFadyean stain) is fully diagnostic, though culture of
the organism is still the gold standard for diagnosis. Full isolation of the body is important to prevent
possible contamination of others. Protective, impermeable clothing and equipment such as rubber gloves,
rubber apron, and rubber boots with no perforations should be used when handling the body. No skin,
especially if it has any wounds or scratches, should be exposed. Disposable personal protective
equipment is preferable, but if not available, decontamination can be achieved by autoclaving. Disposable
personal protective equipment and filters should be autoclaved, and/or burned and buried. B.
anthracis bacillii range from 0.55.0 m in size. Anyone working with anthrax in a suspected or confirmed
person should wear respiratory equipment capable of filtering this size of particle or smaller.

Treatment
Anthrax cannot be spread directly from person to person, but a person's clothing and body may be
contaminated with anthrax spores. Effective decontamination of people can be accomplished by a
thorough wash-down with antimicrobial soap and water. Waste water should be treated with bleach or
other antimicrobial agent. Effective decontamination of articles can be accomplished by boiling them in
water for 30 minutes or longer. Chlorine bleach is ineffective in destroying spores and vegetative cells on
surfaces, though formaldehyde is effective. Burning clothing is very effective in destroying spores. After
decontamination, there is no need to immunize, treat, or isolate contacts of persons ill with anthrax unless
they were also exposed to the same source of infection.

Coronary artery disease

Coronary artery disease (CAD), also known as ischemic heart disease (IHD),[4] is a group of diseases
that includes: stable angina, unstable angina, myocardial infarction, and sudden cardiac death.[5] It is
within the group of cardiovascular diseases of which it is the most common type.[6] A common symptom
is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw.[7] Occasionally it
may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few
minutes, and get better with rest.[7] Shortness of breath may also occur and sometimes no symptoms are
present.[7]The first sign is occasionally a heart attack.[8] Other complications include heart failure or
an irregular heartbeat.[8]

Signs and symptoms[edit]

Chest pain that occurs regularly with activity, after eating, or at other predictable times is termed
stable angina and is associated with narrowings of the arteries of the heart.
Angina that changes in intensity, character or frequency is termed unstable. Unstable angina may
precede myocardial infarction. In adults who go to the emergency department with an unclear cause of
pain, about 30% have pain due to coronary artery disease. [22]

Prevention[edit]
Up to 90% of cardiovascular disease may be preventable if established risk factors are avoided. [51]
[52]
Prevention involves: exercise, decreasing obesity, treating hypertension, ahealthy diet,
decreasing cholesterol levels, and stopping smoking. Medications and exercise are roughly equally
effective.[53] High levels of physical activity reduce the risk of coronary artery disease by about 25%. [54]
In diabetes mellitus, there is little evidence that very tight blood sugar control improves cardiac risk
although improved sugar control appears to decrease other problems like kidney failure and blindness.
The World Health Organization (WHO) recommends "low to moderate alcohol intake" to reduce risk of
coronary artery disease while high intake increases the risk. [55]

Leprosy
Leprosy, also known as Hansen's disease (HD), is a long-term infection caused by
the bacilli Mycobacterium leprae[2] andMycobacterium lepromatosis.[3] Initially, infections are without
symptoms and typically remain this way from 5 to as long as 20 years. [2] Symptoms that develop
include granulomas of the nerves, respiratory tract, skin, and eyes.[2] This may result in a lack of ability to
feel pain and thus loss of parts of extremities due to repeated injuries or infection due to unnoticed
wounds.[4]Weakness and poor eyesight may also be present.[4]

Signs and symptoms[edit]

Leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper
respiratory tract; skin lesions (light or dark patches) are the primary external sign. [14] If untreated, leprosy
can progress and cause permanent damage to the skin, nerves, limbs, and eyes. Contrary to folklore,
leprosy does not cause body parts to fall off, although they can become numb or diseased as a result of
secondary infections; these occur as a result of the body's defenses being compromised by the primary
disease.[15][16] Secondary infections, in turn, can result in tissue loss, causing fingers and toes to become
shortened and deformed, as cartilage is absorbed into the body.[15][16][17]

Prevention[edit]
Early detection of the disease is important, since physical and neurological damage may be irreversible
even if cured. Medications can decrease the risk of those living with people with leprosy from acquiring
the disease and likely those with whom people with leprosy come into contact outside the home.
[44]
However, concerns are known of resistance, cost, and disclosure of a person's infection status when
doing follow-up of contacts. Therefore, the WHO recommends that people who live in the same
household be examined for leprosy and only be treated if symptoms are present. [44]

Treatment
A number of leprostatic agents are available for treatment. For paucibacillary (PB or tuberculoid) cases,
treatment with daily dapsone and monthly rifampicin for six months is recommended.[4] While for
multibacillary (MB or lepromatous) cases, treatment with daily dapsone and clofazimine along with
monthly rifampicin for 12 months is recommended.[4]

Multidrug therapy (MDT) remains highly effective, and people are no longer infectious after the first
monthly dose.[23] It is safe and easy to use under field conditions due to its presentation in calendar blister
packs.[23] Relapse rates remain low, and no resistance to the combined drugs is seen.[23]

Asthma
Asthma is a common long term inflammatory disease of the airways of the lungs.[2] It is characterized by
variable and recurring symptoms, reversible airflow obstruction, and bronchospasm.[3] Symptoms include
episodes of wheezing, coughing, chest tightness, and shortness of breath.[4] These episodes may occur a
few times a day or a few times per week. Depending on the person they may become worse at night or
with exercise.[2]

Signs and symptoms

Asthma is characterized by recurrent episodes of wheezing, shortness of breath, chest tightness,
and coughing.[21] Sputummay be produced from the lung by coughing but is often hard to bring up.
[22]
During recovery from an attack, it may appearpus-like due to high levels of white blood cells
called eosinophils.[23] Symptoms are usually worse at night and in the early morning or in response to
exercise or cold air.[24] Some people with asthma rarely experience symptoms, usually in response to
triggers, whereas others may have marked and persistent symptoms. [25]

Prevention
The evidence for the effectiveness of measures to prevent the development of asthma is weak. [118] Some
show promise including: limiting smoke exposure both in utero and after delivery, breastfeeding, and
increased exposure to daycare or large families but none are well supported enough to be recommended
for this indication.[118] Early pet exposure may be useful.[119] Results from exposure to pets at other times are
inconclusive[120] and it is only recommended that pets be removed from the home if a person has allergic
symptoms to said pet.[121] Dietary restrictions during pregnancy or when breast feeding have not been
found to be effective and thus are not recommended.[121]Reducing or eliminating compounds known to
sensitive people from the work place may be effective. [105] It is not clear if annual influenza
vaccinations effects the risk of exacerbations.[122] Immunization; however, is recommended by the World
Health Organization.[123] Smoking bans are effective in decreasing exacerbations of asthma. [124]