Phutudom Public Health Center

Homeopathic Remedies As First Aid

2011-05-01T10:44:00.000+07:00

By Jeri Spencer
A homeopathic remedy kit is the ideal first aid kit to have for a wide range of problems that arise from everyday living while at home or traveling. Having multiple homeopathics close at hand makes dealing with minor injuries like the small bruises when a young child falls or bumps into something to the more seasonal issues of colds, allergies and flu much easier to deal with.

Typically when deciding on homeopathic remedies there are many different types of symptoms to look at. When using homeopathics as first aid, it is much easier to decide which remedy to take. Homeopathic reference books like Homeopathic Medicine at home by Maesimund Panos, M.D., or The Family Guide to Homeopathy by Andrew Lockie M.D. are great reference books to have at home. Either of these books makes learning about individual homeopathics and how to use them easy for the person new to homeopathy as well as a great homeopathic reference book for the person who is more experienced with choosing the correct remedy.

When purchasing a home homeopathic kit, it is important to look for one that meets your needs. If you are going to be using it at home with young children you want to have remedies that are appropriate for childhood situations. For young children the Hylands Kid's Kit is the perfect choice with six commonly used homeopathics: Arnica for swelling, bruises, and shock; Aconitum Napellus for inflammation and fevers; Belladonna for sore throats, coughs and fevers; Chamomilla for pain, colic and teething; Ferrum Phos for stuffy nose and congestion; Hepar Sulphuris for head colds, sore throats and laryingitis with the addition of Bumps 'n Bruises Ointment for topical applications.

If you want to have a good assortment of homeopathics for use at home, are planning on taking a family vacation, or flying around the world, a great choice is the Washington 100 homeopathic remedy kit. In addition to the 100 most popular homeopathic remedies, this homeopathic remedy kit comes with a small booklet with the remedies and what they are used for and a symptom list to help determine the best homeopathic remedy for the situation.

Whatever kit you choose, having a homeopathic remedy kit close at hand can make the difference between having a miserable crying child or having a good night's sleep, feeling terrible on your vacation or enjoying your trip. Be prepared and purchase your homeopathic remedy kit and homeopathic reference book today.

Dr. Jeri Spencer N.D. has been a Naturopathic Doctor for over 15 years. She attended Michigan State University and graduated with a BA in Education and a K-8 teaching certification before continuing on to Trinity School of Natural Health for a Masters in Herbology and her Naturopathic Doctor degree. She is a Certified Natural Health Practitioner and a Certified Nutritional Counselor.

Article Source: http://EzineArticles.com/6218720

Home care

2011-02-26T21:48:00.001+07:00

Home Care, (also referred to as domiciliary care or social care), is health care or supportive care provided in the patient's home by healthcare professionals (often referred to as home health care or formal care; in the United States, it is also known as skilled care) or by family and friends (also known as caregivers, primary caregiver, or voluntary caregivers who give informal care). Often, the term home care is used to distinguish non-medical care or custodial care, which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel, whereas the term home health care, refers to care that is provided by licensed personnel.

"Home care", "home health care" and "in-home care" are phrases that are used interchangeably in the United States to mean any type of care given to a person in their own home. Both phrases have been used in the past interchangeably regardless of whether the person requires skilled care or not. More recently, there is a growing movement to distinguish between "home health care" meaning skilled nursing care and "home care" meaning non-medical care. In the United Kingdom, "homecare" and "domiciliary care" are the preferred expressions.

Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home care providers render services in the client's own home. These services may include some combination of professional health care services and life assistance services.

Professional home health services could include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy.

Life assistance services include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship.

Getting Drug Addiction Help for You Or a Loved One

2010-09-22T18:05:00.001+07:00

Today, there is no problem finding a drug addiction counselor to help you. The Internet has made it possible for us to find anyone and anything without leaving our homes. Still, you can't just choose any drug addiction rehab professional or center.

Unfortunately, some centers are just in it for the money. If money is a problem, then state funded rehab institutions are an option, but these places are generally packed and are typically located in some of the worst areas of town. They also don't have the cash flow to keep patients long enough to get them ready emotionally for sobriety. When these people are released back into the community, they are unprepared to cope and usually end up using again.

Choosing the Right Drug Addiction Help Center

The best drug addiction centers are long term facilities. This is what you should be looking for in your search - a long term rehab center with a high success rate. Finding the right place involves a great deal of research and doing your homework.

It is important that the treatment center address the effects of addiction on your mind and body. You will also need to know what services the centers offer, and how their respective programs work. Does the facility sponsor inpatient and outpatient services or just one or the other?

The places you are reviewing should be able to provide some sort of informational materials on their services and methodologies, either tangible or online. This way you are able to explore the benefits and disadvantages of the drug addiction help center at your own pace and without being embarrassed by asking for help.

You can often tell how good a program is by how long they have been in business and their success rates. When selecting your rehab center, do not be afraid to ask questions. This is your life or the life of a loved one so you need to make the best decision possible. Do some research and find the best place for you.

As you're searching for drug addiction help, just remember that long-term, inpatient treatment centers offer the best chance for recovery, and that these centers are usually not free. The money shouldn't matter though because there is no price tag on a long, happy, and healthy life.

Is There a Cure For Anxiety? If So, What Is It?

2010-07-25T10:15:00.001+07:00

So, IS there a Cure for Anxiety?

While there are many remedies that help you deal with anxiety, there is really only one type of cure for anxiety and that is retraining the mind. I know, it probably sounds difficult and very in depth, but it's really not. In fact, it can take as little as 5 minutes.

Sounds crazy right? Not really....let me tell you why.

When you go through a situation such as extreme stress and it triggers anxiety the brains function actually moves from the front of the brain to the middle of the brain. Big deal right? Well, it actually is. The frontal portion of the brain helps you make logical decisions, where the middle of the brain is more emotional.

So, when a situation of anxiety arises, your emotions take over which actually heightens the anxiety situation because you start stressing more, the fear levels increase, and the anxiety just goes up and up. What is going to stop it when your emotions are involved?

This is where the techniques for retraining the mind come in. If you can retrain your mind to use the frontal portion of your brain during these heighten anxiety situations, then you will be making a logical decision and not an emotional one. As you will find, the logical decision is one such as "is this really as big of a deal as I think it is" or "what am I afraid of anyway".

This may sound familiar already, but if your emotions are involved during the anxiety attack, then the answers to these questions may be different than if you had logic involved.

So, the answer to "Is there a Cure for Anxiety" is a definite Yes!

Overcoming Anxiety Without Medication

2010-07-25T10:14:00.001+07:00

Is Overcoming Anxiety without Medication possible?

It is!

I have done a great deal of research on remedies for anxiety and panic attacks. I have found that there are really only a couple options to help cope with anxiety which are medication and over the counter remedies. However, there is really only one remedy that actually cures anxiety. It does not require any medication at all and actually cures your anxiety, did does not simply cover it up.

So, what is it then? It is techniques that actually show you how to retrain your mind to not have these anxieties and fears. Let me tell you how and why this works...

When you are in a situation in which anxiety occurs, your brain function actually moves from the frontal lobe of your brain to the middle. It is actually moving from logical thinking to more emotional thinking. Therefore, when the anxiety starts, your emotions take over, you get more anxious and it just snow balls from there.

If you use these techniques to retrain your mind, then before or even during an anxiety attack your brain function is able to stay in the frontal lobe of the brain and think logically instead of emotionally.

As you can see these techniques of retraining the mind to think logically during a high anxiety situation is actually curing the anxiety rather than coping with it. These techniques are how overcoming anxiety without medication is possible and will allow you to go back to leading a life without anxiety.

What Causes Generalized Anxiety Disorder?

2010-07-25T10:12:00.000+07:00

What causes Generalized Anxiety Disorder in the first place?

The exact cause of GAD is not fully known, however there are some factors that can play a part in developing GAD. Some of these factors are Genetics, Brain Chemistry and Environmental Factors.

* Genetics - Some research has found that family history may play a part in developing GAD. These tendencies may be passed on from generation to generation. Though one may have a family history of GAD does not necessarily mean you automatically have the symptoms, it may take a life experience or environmental factor to actually trigger the GAD.
* Brain Chemistry - Neurotransmitters in the brain are chemical messages that send information from nerve cell to nerve cell. If these neurotransmitters are out of balance, then the reaction the brain may have to a certain situation may be altered, thus causing anxiety or an anxiety attack.
* Environmental Factors - There are many environmental factors that can trigger anxiety, in fact almost anything in which you fear or gives you high levels of stress can essentially cause GAD. However, some of the most common environmental factors are stressful events, trauma such as abuse, a divorce or the death of a loved one. Another common factor is a major change in ones life, such as changing jobs or changing schools.

As you can see it is difficult to determine what causes generalized anxiety disorder. It may also be a combination of things that set GAD into motion.

Note that even though you may want to know what actually caused GAD to start in the first place, it is not necessary to know the cause in order to get help and cure it.

The Truth About the Lump in the Throat

2010-07-25T10:11:00.000+07:00

Everybody gets that familiar lump in the throat on the verge of every emotional outburst. When we are about to cry, scream or shout, this noticeable lump forms in our throat and seems to prevent us from breathing or even saying a word. What is this lump really?

Well the lump in our throat isn't really a lump after all. It is merely a physical sensation we get when our throat struggles to carry out two opposite functions at the same time. This is the same sensation we feel when we become emotional or are about to cry. Prior to an emotional outburst, natural human instinct brings us into a fight-or-flight state. Trigger factors such as the stress brought about by fear or anger causes our heart to pump a lot harder. As a result, our lungs work double time to keep up with the pumping and our vocal chords stretch wide open to accommodate the bigger gulps of air we have to take in to feed our lungs.

In the middle of our larynx is an opening that works like a valve which allows air to pass through into the lungs upon intake. This opening called the glottis is what temporarily closes up when we swallow. Our vocal chords are responsible for direct control over the glottis. It is at its largest when we scream and is at its smallest when we swallow.

The sensation of that lump in the throat occurs when, prior to that emotional outburst, we take in deep breaths. The action forces the glottis to be at its largest. At the same time, just before crying, we attempt to swallow the tears that are coming, which forces the vocal chords to compress on the glottis. Our vocal chords perform two contrary functions, compressing and expanding at the same time, and we feel that tension as the lump in our throat.

Blood Sugar Testing

2010-02-03T19:35:00.000+07:00

Source: Defeat Diabetes Foundation, Volume IV, Issue 7

Blood Sugar Testing

Questions:

What is a good blood sugar range for a person with diabetes?
How do I check my blood sugar?
When should I check my blood sugar?
What is my A1c Test?
What do the results of the A1c mean?

Answers:

What is a good blood sugar range for a person with diabetes?

A good fasting blood sugar (before breakfast) is <110 mg/dl.*
A good blood sugar before bedtime is <140 mg/dl.*

*Remember that everyone is different and their reading will vary. Check with your doctor to find out your target blood sugar range.

How do I check my blood sugar?

* Wash your hands with soap and water. Use warm water to allow more blood to circulate to the fingers. Dry your hands well before you pierce your finger.
* Pierce the side of your finger. The tip of the finger contains more nerve endings and will hurt more than the side of your finger when pierced.
* Change which finger you pierce each time you test your blood sugar. Using the same finger will cause the skin to become tough and more difficult to stick.

If you have questions about how to use your monitor call the toll-free telephone number listed on the monitor.

When should I check my blood sugar?

You and your doctor can learn something about your control each time you test and record your blood sugar. The best times to check your sugar are:

* In the morning, before breakfast.
* 2 hours after a meal.
* Before you go to bed at night.
* Before and after you exercise.

If you are sick, have a fever or diarrhea, or have had changes in your medications, check your blood sugar more often.

Keep a log of your blood sugar levels, including the date and time of measurement. Bring this record with you each time you see your doctor. This will give you and your doctor a chance to check your blood sugar control and make changes in your treatment plan.

What is my A1c Test?

Self blood sugar testing reveals your blood sugar level at a particular moment. A1c is a blood test that reveals your average blood sugar level over the past 2-to-3 months. The result of this test gives you and your doctor a bigger picture of how well your diabetes is being controlled over time.

What do the results of the A1c test mean?

The results of the A1c test are given percentages:

* 6% = an average blood sugar of 120 mg/dl.
* 7% = an average blood sugar of 150 mg/dl.
* 8% = an average blood sugar of 180 mg/dl.
* 9% = an average blood sugar of 210 mg/dl.

A good A1c reading is below 6.5%.* Studies show that blood sugar levels under 150 mg/dl and A1c readings under 6.5%* reduce the risk of health problems related to poorly controlled diabetes, such as kidney, eye, heart, blood vessel, and nerve damage.

At least once a year show your doctor or diabetes nurse educator your blood glucose monitor and talk about any questions you may have.

*Reflects the new Diabetes Screening and Mangement Guidelines set by the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE), 2001.

Question: What are the normal ranges for the hemoglobin A1c?

Answer: Remember, the hemoglobin A1c result must be compared to the normal range for each particular lab. Eventually that normal range will be standardized to a range of 4-5% but some labs still have ranges that are quite different.

To convert the A1c to average blood glucose, consider the high end of the normal range (e.g. If normal is 4-6%, then 6%) is equal to 120 mg/dl. For each change in 1% of A1c, there is a corresponding increase or decrease of approximately 30 mg/dl average plasma glucose.

Question: What is the best way to measure control?

Answer: The A1c test is the preferred standard for measuring glycemic control. The A1c test measures your average blood glucose level over the past 2-to-3 months. It's the best tool you and your healthcare provider have to assess your overall control--and your risk of developing serious complications.

AACE recommends an A1c target goal of 6.5% or less, and also suggests having an A1c test at least 4 times per year.

* You and your physician should determine how often you should test.
* In fact, AACE recommends talking to your physician about your A1c during every visit.
* A1c testing is not substitute for regular blood glucose monitoring.

Question: If I'm measuring my A1c, is blood glucose self-monitoring also necessary?

Answer: The A1c test and blood glucose monitoring work together. The A1c test shows your average blood glucose over the past 2-to-3 months--while testing with a glucose monitor shows your glucose level at a specific point in time.

* If you're not in good control, self-monitoring your A1c and blood glucose can help you better understand your diabetes and how to manage it.
* Talk to your physician about self-monitoring--and if a specific monitoring plan may make sense for you.

Glucose

2010-02-03T19:30:00.000+07:00

Pediatric Blood (Sugar) Glucose Test
Concerned that your child's blood glucose levels may not be normal? The most common use of the blood glucose test is to check for diabetes mellitus. The test is also used to see how well the body is metabolizing glucose and the function of organs involved in that process: the pancreas, the liver, and the receptors that bring glucose into cells. (Blood Glucose Testing, Juvenile Diabetes, Type 1 Diabetes, Blood Sugar Level)

Glucosamine & Diabetes - News Update
Recent Diabetes news reports that oral glucosamine supplementation does not result in clinically significant alterations in glucose metabolism in patients with type 2 diabetes mellitus.(Diabetic Nutrition)

Blood Sugar Levels - Guidelines for Diabetes
Whether you have type 1 or type II diabetes or gestational diabetes, the goals of achieving control of blood glucose levels are similar: to keep blood glucose as close as possible to that of a person without diabetes.

Diabetic Ketoacidosis
Diabetic Ketoacidosis (DKA) can occur when you don't have enough insulin to meet your body's needs. Normally your body uses carbohydrate (glucose) for maintenance, but when there isn't enough insulin in your body, your cells can't access the glucose in your blood. Your body then resorts to burning fat in an unhealthy way. Your liver becomes involved in fat-burning, and the by-product is ketones. (Diabetic complications, High blood sugar level)

Waking Up With High Blood Glucose Levels
Morning readings can be so frustrating! Do you go to bed with a blood glucose of 120 mg/dL (6.6 mmol/L) and wake up with a blood glucose of 170 (9.4 mmol/L) or more? Is this happening in spite of following your diet, exercise and taking your medications as your doctor prescribed? Well, don't worry; all this may be happening due to the Dawn Phenomenon or the Somogyi Effect. (Diabetes Management and High Blood Sugar)

Explaining About Diabetes
Diabetes - or to give it its full name, diabetes mellitus - is a common condition in which the amount of glucose (sugar) in the blood is too high because the body is unable to use it properly. This is because the body's method of converting glucose into energy is not working as it should. Learn more about the two main types of diabetes. (Type 1 Diabetes, Type 2 Diabetes, Diabetes Symptoms)

How Stress Affects People With Diabetes
With people with diabetes, stress can alter blood glucose levels, the American Diabetes Association (ADA) notes. It does this in two ways. First, people under stress may not take good care of themselves. Second, stress hormones may also alter blood glucose levels directly. (Type 2 Diabetes, Stress)

Hitting A Nerve
Neuropathy is one of the best arguments to fight blood glucose control. It's a nerve disorder that can affect almost every system in your body. It results from bursts of high blood glucose that cause oxidative stress to the nerves. (Peripheral Neuropathy, Autonomic Neuropathy)

Curb Sugar Cravings
Hunger suddenly strikes. You need food, and you need it now. You rummage for that long-lost candy bar buried somewhere in your desk - anything to get a sugar fix. That rapid rise in blood glucose, along with the attendant release of the "feel-good" hormone serotonin, may make you feel better temporarily, but when your glucose levels soon nose-dive, you'll return to your low-serotonin state - a prime candidate for yet more sugar cravings.

Diabetes May Solve Puzzles Of The Brain
Glucose and the glucose-regulating hormone insulin have long been studied by scientists looking for a cure for diabetes. Now the substances are increasingly coming under the study of brain scientists because it appears they might just be golden keys to brain health as we age. (Alzheimers, Insulin, Diabetic Complications)

Glucose Intolerance Reversed by Carnitine Supplement
Supplementing with the nutrient carnitine helps obese animals to clear the extra sugar in their blood, something they had trouble doing on their own, researchers at Duke University Medical Center, North Carolina, report. A team led by Deborah Muoio, Ph.D., of the Duke Sarah W. Stedman Nutrition and Metabolism Center, also performed tests on human muscle cells that showed supplementing with carnitine might help older people with prediabetes, diabetes, and other disorders that make glucose (sugar) metabolism difficult. (Glucose Intolerance, Carnitine, Prediabetes)

Sustained High Blood Glucose May Damage Brain's Key Memory Center
An inability to quickly bring down high levels of sugar in the blood is associated with poor memory and may help explain some of the memory loss that occurs as we age, according to a new study by NYU School of Medicine researchers. The study raises the possibility that exercise and weight loss, which help control blood sugar levels, may be able to reverse some of the memory loss that accompanies aging. (Diabetes Research and High Blood Sugar)

Glucose and Immunity
Eating sugar also reduces the body's ability to fight infections. In 1908, researchers noted that diabetics were more susceptible than non-diabetics to infection. It took researchers until 1942 to discover that the bacteria-engulfing white blood cells of diabetics were essentially sleeping on the job. (Blood Sugar and Glucose and Diabetes Diet)

Diabetes and Colorectal Cancer
People with diabetes may be three times more likely to develop colorectal cancer, a recent study shows. Almost 10,000 adults between the ages of 45 and 79 were tested for a marker in the blood sugar, then were followed up six years later. Researchers found that those with diabetes or abnormal glucose metabolism were more likely to develop bowel cancer. (Diabetes Research)

Healthy Skin Made Easy
Diabetes can add to skin problems. High glucose levels are one reason; many bacteria thrive on sugar, making infections easier to get and harder to cure. Diabetic nerve disease and blood vessel disease are two other reasons; both can interfere with blood flow to the skin. In addition, nerve damage may dampen your ability to sense irritations and wounds, making it easier to injure yourself and not even notice. (Diabetes Education and Diabetes Management)

Compromising on Health Care

2009-12-19T10:20:00.000+07:00

ขั้นตอนการผลิตเซรุ่มแก้พิษงู

2009-11-28T14:13:00.000+07:00

Medicare

2009-10-16T18:20:00.000+07:00

Suzy Cohen on Antibiotics, Yeast Infections and Buggy Yogurt

2009-09-16T05:43:00.000+07:00

Yogurt and Yeast Infections

2009-09-16T05:41:00.000+07:00

Dr. Russell Blaylock on Alex Jones Tv 3/3:Harmful Side-Effects of The Swine Flu Vaccine

2009-09-12T06:19:00.001+07:00

Dr. Russell Blaylock on Alex Jones Tv 2/3:Harmful Side-Effects of The Swine Flu Vaccine

2009-09-12T06:18:00.000+07:00

Dr. Russell Blaylock on Alex Jones Tv 1/3:Harmful Side-Effects of The Swine Flu Vaccine

2009-09-12T06:17:00.000+07:00

What Fat people can learn about weight loss from Thin people

2009-09-11T17:10:00.001+07:00

10 Basics of a healthy weight loss diet

2009-09-11T17:09:00.000+07:00

Dole: We Can do Better on Health Care

2009-09-06T21:39:00.000+07:00

Dash diet to reduce kidney stone risk

2009-09-01T06:03:00.000+07:00

Healthy lifestyle and reduced risk of chronic disease

2009-09-01T06:02:00.001+07:00

Microbiology modern

2009-08-16T22:05:00.001+07:00

Modern
Bacteria, and other microorganisms, were first observed by Antonie van Leeuwenhoek in 1676 using a single-lens microscope of his own design. In doing so Leeuwenhoek made one of the most important discoveries in biology and initiated the scientific fields of bacteriology and microbiology.The name "bacterium" was introduced much later, by Ehrenberg in 1828, derived from the Greek βακτηριον meaning "small stick". While Van Leeuwenhoek is often cited as the first microbiologist, the first recorded microbiological observation, that of the fruiting bodies of molds, was made earlier in 1665 by Robert Hooke.

The field of bacteriology (later a subdiscipline of microbiology) is generally considered to have been founded by Ferdinand Cohn (1828–1898), a botanist whose studies on algae and photosynthetic bacteria led him to describe several bacteria including Bacillus and Beggiatoa. Cohn was also the first to formulate a scheme for the taxonomic classification of bacteria.Louis Pasteur (1822–1895) and Robert Koch (1843–1910) were contemporaries of Cohn’s and are often considered to be the founders of medical microbiology. Pasteur is most famous for his series of experiments designed to disprove the then widely held theory of spontaneous generation, thereby solidifying microbiology’s identity as a biological science.Pasteur also designed methods for food preservation (pasteurization) and vaccines against several diseases such as anthrax, fowl cholera and rabies. Koch is best known for his contributions to the germ theory of disease, proving that specific diseases were caused by specific pathogenic microorganisms. He developed a series of criteria that have become known as the Koch's postulates. Koch was one of the first scientists to focus on the isolation of bacteria in pure culture resulting in his description of several novel bacteria including Mycobacterium tuberculosis, the causative agent of tuberculosis.

While Pasteur and Koch are often considered the founders of microbiology, their work did not accurately reflect the true diversity of the microbial world because of their exclusive focus on microorganisms having direct medical relevance. It was not until the work of Martinus Beijerinck (1851–1931) and Sergei Winogradsky (1856–1953), the founders of general microbiology (an older term encompassing aspects of microbial physiology, diversity and ecology), that the true breadth of microbiology was revealed.Beijerinck made two major contributions to microbiology: the discovery of viruses and the development of enrichment culture techniques.While his work on the Tobacco Mosaic Virus established the basic principles of virology, it was his development of enrichment culturing that had the most immediate impact on microbiology by allowing for the cultivation of a wide range of microbes with wildly different physiologies. Winogradsky was the first to develop the concept of chemolithotrophy and to thereby reveal the essential role played by microorganisms in geochemical processes. He was responsible for the first isolation and description of both nitrifying and nitrogen-fixing bacteria

Microbiology ancient

2009-08-16T22:03:00.000+07:00

Ancient
The existence of microorganisms was hypothesized for many centuries before their actual discovery in the 17th century. In 600 BCE, the ancient Indian surgeon Susruta held microbes responsible for several diseases and explained in Sushruta Samhita that they can be transmitted through contact, air or water. Theories on microorganisms was made by Roman scholar Marcus Terentius Varro in a book titled On Agriculture in which he warns against locating a homestead in the vicinity of swamps:

“ ...and because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases.

This passage seems to indicate that the ancients were aware of the possibility that diseases could be spread by yet unseen organisms.

In The Canon of Medicine (1020), Abū Alī ibn Sīnā (Avicenna) stated that bodily secretion is contaminated by foul foreign earthly bodies before being infected.[5] He also hypothesized on the contagious nature of tuberculosis and other infectious diseases, and used quarantine as a means of limiting the spread of contagious diseases.

When the Black Death bubonic plague reached al-Andalus in the 14th century, Ibn Khatima hypothesized that infectious diseases are caused by "minute bodies" which enter the human body and cause disease.

In 1546 Girolamo Fracastoro proposed that epidemic diseases were caused by transferable seedlike entities that could transmit infection by direct or indirect contact or even without contact over long distances.

All these early claims about the existence of microorganisms were speculative in nature and not based on any data or science. Microorganisms were neither proven and observed, nor correctly and accurately described until the 17th century. The reason for this was that all these early inquiries lacked the most fundamental tool in order for microbiology and bacteriology to exist as a science, and that was the microscope

Microbiology

2009-08-16T22:02:00.001+07:00

Microbiology (from Greek μῑκρος, mīkros, "small"; βίος, bios, "life"; and -λογία, -logia) is the study of microorganisms, which are unicellular or cell-cluster microscopic organisms.[1] This includes eukaryotes such as fungi and protists, and prokaryotes. Viruses, though not strictly classed as living organisms, are also studied.[2] In short; microbiology refers to the study of life and organisms that are too small to be seen with the naked eye.

Microbiology is a broad term which includes virology, mycology, parasitology, bacteriology and other branches. A microbiologist is a specialist in microbiology.

Microbiology is researched actively, and the field is advancing continually. We have probably only studied about one percent of all of the microbe species on Earth.[3] Although microbes were first observed over three hundred years ago, the field of microbiology can be said to be in its infancy relative to older biological disciplines such as zoology and botany.

Louis Pasteur

2009-08-16T21:47:00.001+07:00

Louis Pasteur (pronounced: [pastøʁ] December 27, 1822 – September 28, 1895) was a French chemist and microbiologist born in Dole. He is best known for his remarkable breakthroughs in the causes and preventions of disease. His discoveries reduced mortality from puerperal fever, and he created the first vaccine for rabies. His experiments supported the germ theory of disease. He was best known to the general public for inventing a method to stop milk and wine from causing sickness - this process came to be called pasteurization. He is regarded as one of the three main founders of microbiology, together with Ferdinand Cohn and Robert Koch. Pasteur also made many discoveries in the field of chemistry, most notably the molecular basis for the asymmetry of certain crystals.[1] He is buried beneath the Institute Pasteur

Louis Pasteur was born on December 27, 1822 in Dole in the Jura region of France and grew up in the town of Arbois.There, he later had his house and laboratory, which is now a Pasteur museum. His father, Jean Pasteur's college headmaster, who recommended that the young man apply for the École Normale Supérieure, which accepted him, after recognizing Louis’s natural talent. After serving briefly as professor of physics at Dijon Lycée in 1848, he became professor of chemistry at the University of Strasbourg, where he met and courted Marie Laurent, daughter of the university's rector in 1849. They were married on May 29, 1849 and together they had five children, only two of whom survived to adulthood, three of them died, two of typhoid and one of a brain tumor. This incident later persuaded Pasteur to try and find cures for diseases such as typhoid.

Catholic observers often said that Louis Pasteur remained through out his whole life an ardent Christian. According to his grandson Pasteur Vallery-Radot, however, Pasteur had only kept from his Catholic background a spiritualism without religious practice. The well-known quotation attributed to Pasteur: "The more I know, the more nearly is my faith that of the Breton peasant. Could I but know all I would have the faith of a Breton peasant's wife." would be apocryphal.Maurice Vallery-Radot, grandson of the brother of the son-in-law of Pasteur and outspoken Catholic,holds that Pasteur fundamentally remained catholic, but does not claim that he went to mass

Pneumonic plague

2009-08-13T18:14:00.003+07:00

Pneumonic plague is one of three main forms of plague, all of which are caused by the bacterium Yersinia pestis. It is more virulent and rarer than bubonic plague. The difference between the versions of plague is simply the location of the infection. Pneumonic plague is an infection in the lung(s), bubonic plague is an infection of the buboes or lymph nodes, while septicemic plague is an infection in the blood stream.

Typically, pneumonic form is due to a secondary spread from advanced infection of an initial bubonic form. Primary pneumonic plague results from inhalation of fine infective droplets and can be transmitted from human to human without involvement of fleas or animals. Untreated pneumonic plague has a very high fatality rate

Epidemiology
Since 2001, the World Health Organization (WHO) has reported six plague outbreaks, though some may go unreported because they often happen in remote areas. Between 1998 and 2008, nearly 24,000 cases have been reported, including about 2,000 deaths, in Africa, Asia, the Americas and Eastern Europe.The vast majority of the world's cases (98%) are in Africa.

Pathology and transmission
Pneumonic plague can be caused in two ways: primary, which results from the inhalation of aerosolised plague bacteria, or secondary, when septicemic plague spreads into lung tissue from the bloodstream. Pneumonic plague is not exclusively vector-borne like bubonic plague; instead it can be spread from person to person. There have been cases of pneumonic plague resulting from the dissection or handling of contaminated animal tissue. This is one type of the formerly known Black Plague. It could kill 90%–100% of a population if the victims coughed and passed on the bacteria.

Symptoms
The most apparent symptom of pneumonic plague is coughing, often with hemoptysis. With pneumonic plague, the first signs of illness are fever, headache, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery sputum.The pneumonia progresses for two to four days and may cause respiratory failure and shock. Without early treatment, patients will die, some within 24 hours.

When they begin, pneumonic plague symptoms can often include:

-Fever
-Weakness
-Headache
Rapidly developing pneumonia with:

-Shortness of breath
-Chest pain
-Cough
-Bloody or watery sputum (saliva and discharge from respiratory passages).

Prognosis and treatment
Pneumonic plague is a very aggressive infection requiring early treatment. To reduce the risk of death, antibiotics must be given within 24 hours of first symptoms. Streptomycin, gentamicin, tetracyclines, and chloramphenicol are all effective against pneumonic plague.

Antibiotic treatment for seven days will protect people who have had direct, close contact with infected patients. Wearing a close-fitting surgical mask also protects against infection.

Without treatment, the mortality rate from pneumonic plague approaches 100%.

China
The People's Republic of China has eradicated the pneumonic plague from most parts of the country, but still reports occasional cases in remote Western areas where the disease is carried by rats and the marmots that live across the Himalayan plateau. Outbreaks can be caused when a person eats an infected marmot or comes into contact with fleas carried by rats. A 2006 WHO report from an international meeting on plague cited a Chinese government disease expert as saying that most cases of the plague in China's northwest occur when hunters are contaminated while skinning infected animals.The expert said at the time that due to the region's remoteness, the disease killed more than half the infected people. The report also said that since the 1990s, there was a rise in plague cases in humans—from fewer than 10 in the 1980s to nearly 100 cases in 1996 and 254 in 2000.Official statistics posted on the Chinese Health Ministry's Web site showed no cases of plague in 2007 and 2008.

The most recent outbreak of the disease in China began in August 2009 in Ziketan Town located in Qinghai Province and is an ongoing situation. The town has been sealed off and so far three people have died as a result of the disease.According to spokesperson Vivian Tan of the WHO office in Beijing, "In cases like this [in August 2009], we encourage the authorities to identify cases, to investigate any suspicious symptoms among close contacts and to treat confirmed cases as soon as possible. So far, they have done exactly that. There have been sporadic cases reported around the country in the last few years so the authorities do have the experience to deal with this

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WHO: Swine flu epidemic in ‘grace period’

2009-05-19T10:49:00.001+07:00

updated 11:27 a.m. ET May 18, 2009
GENEVA - China, Britain, Japan and other countries urged the World Health Organization on Monday to be very cautious about declaring the arrival of a swine flu pandemic, fearing that a premature announcement could cause worldwide panic and confusion. WHO bent to their wishes.

As the agency opened its annual meeting, WHO Director-General Dr. Margaret Chan said she had listened carefully to the concerns of member states and would follow their instructions.

The new swine flu virus continues to spread rapidly, but the world is still short of facing a pandemic, Chan said, keeping the alert level at the currently phase 5 out of a possible 6, indicating a global outbreak is likely.

"This virus may have given us a grace period, but we do not know how long this grace period will last," Chan said. "No one can say whether this is just the calm before the storm."

At phase 6, the world has a swine flu pandemic — meaning there is an epidemic in at least two world regions.

Read more about WHO: Swine flu epidemic in ‘grace period’

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Risk Factors for Diabetes

2009-05-15T11:57:00.001+07:00

1. History of diabetes in a parent or sibling

A recent report based on information from adults previously diagnosed with diabetes who participated in the National Health and Nutrition Examination Survey showed that individuals with a first degree relative (mother, father, brother, sister) had an increased risk of getting diabetes. Individuals who had a first degree relative with diabetes had a 14.3% chance of developing diabetes. This study also showed individuals risk for diabetes increased with the number of family members diagnosed with diabetes (2).

2. Obesity & physical inactivity

Obesity is defined as being 20% over desired body weight or having a BMI (body mass index) of 30 or greater. Obesity can keep your body from making enough insulin or using insulin properly.

Physical inactivity can also increase your risk for diabetes. Regular exercise helps to lower blood sugar levels and is important for weight control.

3. History or gestational diabetes, PCOS (Polycystic Ovarian Syndrome), or having a baby greater than 9 lbs.

Women with a history of gestational diabetes have a 40% greater chance of having diabetes later in their life (3).

4. Race

Certain races/ethnic groups are at greater risk for getting diabetes.

Ethinic groups at risk include:

African American
Hispanic American/Latino
American Indian
Native Alaskan
Asian American
Pacific Islander

5. Age

You are at greater risk for diabetes if you are older than 45 years of age. Your risk for diabetes continues to increase with age.

6. High blood pressure and high cholesterol

If you have high blood pressure and/or high cholesterol, this also increases your risk for diabetes.

Is there anything I can do to decrease my risk of diabetes?
Yes! Recent studies have shown promising results at reducing the risk of diabetes. Age, race, and family history you have no control over, but with diet and lifestyle modifications you can significantly reduce your risk for diabetes. The Diabetes Prevention Program, a recent federally funded study, has shown that modifications in diet and exercise decrease the risk of getting diabetes significantly. Persons in this study exercised for 30 minutes 5 times per week, followed a low-fat and low-calorie diet, and lost 5%-7% of thier body weight. These individuals reduced their risk of getting type 2 diabetes by 58% (3).

What if I have risk factors for diabetes?
If you are above 45 years of age, you may want to be tested for diabetes. You may also want to be tested if you are under 45 and have one or more risk factors.

References

1. Centers for Disease Control and Prevention. National diabetes fact sheet:,

2. Annis AM, Caulder MS, Cook ML, Duquette D. Family history, diabetes, and other demographic and risk factors among participants of the National Health and Nutrition Examination Survey 1999–2002. Prev Chronic Dis, 2005 Apr. Available from:

3. Food and Drug Administration. Diabetes Information: Questions and Answers,

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Vaccination

2009-04-10T19:27:00.000+07:00

Vaccination is the administration of antigenic material (the vaccine) to produce immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by a pathogen. Vaccination is considered to be the most effective and cost-effective method of preventing infectious diseases. The material administrated can either be live but weakened forms of pathogens (bacteria or viruses), killed or inactivated forms of these pathogens, or purified material such as proteins. Smallpox was the first disease people tried to prevent by purposely inoculating themselves with other types of infections; smallpox inoculation was started in China or India before 200 BC.In 1718, Lady Mary Wortley Montague reported that the Turks had a habit of deliberately inoculating themselves with fluid taken from mild cases of smallpox, and that she had inoculated her own children.Before 1796 when British physician Edward Jenner tested the possibility of using the cowpox vaccine as an immunisation for smallpox in humans for the first time, at least six people had done the same several years earlier: a person whose identity is unknown, England, (about 1771), Mrs. Sevel, Germany (about 1772), Mr. Jensen, Germany (about 1770), Benjamin Jesty, England, in 1774, Mrs. Rendall, England (about 1782) and Peter Plett, Germany, in 1791.

The word vaccination was first used by Edward Jenner in 1796. Louis Pasteur furthered the concept through his pioneering work in microbiology. Vaccination (Latin: vacca—cow) is so named because the first vaccine was derived from a virus affecting cows—the relatively benign cowpox virus—which provides a degree of immunity to smallpox, a contagious and deadly disease. In common speech, 'vaccination' and 'immunization' generally have the same colloquial meaning. This distinguishes it from inoculation which uses unweakened live pathogens, although in common usage either is used to refer to an immunization. The word "vaccination" was originally used specifically to describe the injection of smallpox vaccine.

Vaccination efforts have been met with some controversy since their inception, on ethical, political, medical safety, religious, and other grounds. Early success and compulsion brought widespread acceptance and mass vaccination campaigns were undertaken which are credited with greatly reducing the incidence of many diseases in numerous geographic regions

10 Tips to Healthy Eating and Physical Activity For You

2009-03-31T17:49:00.001+07:00

1.Start your day with breakfast.

Breakfast fills your "empty tank" to get you going after a long night without food. And it can help you do better in school. Easy to prepare breakfasts include cold cereal with fruit and low-fat milk, whole-wheat toast with peanut butter, yogurt with fruit, whole-grain waffles or even last night's pizza

2.Get Moving!

It's easy to fit physical activities into your daily routine. Walk, bike or jog to see friends. Take a 10-minute activity break every hour while you read, do homework or watch TV. Climb stairs instead of taking an escalator or elevator. Try to do these things for a total of 30 minutes every day.

3.Snack Smart.

Snacks are a great way to refuel. Choose snacks from different food groups—a glass of low-fat milk and a few graham crackers, an apple or celery sticks with peanut butter and raisins, or some dry cereal. If you eat smart at other meals, cookies, chips and candy are OK for occasional snacking.

4.Work up a sweat.

Vigorous work-outs—when you're breathing hard and sweating—help your heart pump better, give you more energy and help you look and feel your best. Start with a warm-up that stretches your muscles. Include 20 minutes of aerobic activity, such as running, jogging or dancing. Follow-up with activities that help make you stronger such as push-ups or lifting weights. Then cool-down with more stretching and deep breathing.

5.Balance your food choices—don't eat too much of one thing.

You don't have to give up foods like hamburgers, french fries and ice cream to eat healthfully. You just have to be smart about how often and how much of them you eat. Your body needs nutrients like protein, carbohydrates, fat and many different vitamins and minerals such as vitamins C and A, iron and calcium from a variety of foods. Balancing food choices from the Food Guide Pyramid and checking out the Nutrition Facts Panel on food labels will help you to get all these nutrients.

6.Get fit with friends or family.

Being active is much more fun with friends or family. Encourage others to join you and plan one special physical activity event, like a bike ride or hiking, with a group each week.

7.Eat more grains, fruits and vegetables.

These foods give you carbohydrates for energy, plus vitamins, minerals and fiber. Besides, they taste good! Try breads such as whole-wheat, bagels and pita. Spaghetti and oatmeal are also in the grain group.

Bananas, strawberries and melons are some great tasting fruits. Try vegetables raw, on a sandwich or in a salad.

8.Join in physical activities at school.

Whether you take a physical education class or do other physical activities at school, such as intramural sports, structured activities are a sure way to feel good, look good and stay physically fit.

9.Foods aren't good or bad.

A healthy eating style is like a puzzle with many parts. Each part—or food—is different. Some foods may have more fat, sugar or salt while others may have more vitamins or fiber. There is a place for all these foods. What makes a diet good or bad is how foods fit together. Balancing your choices is important. Fit in a higher-fat food, like pepperoni pizza, at dinner by choosing lower-fat foods at other meals. And don't forget about moderation. If two pieces of pizza fill you up, don't eat a third.

10.Make healthy eating and physical activities fun!

Take advantage of physical activities you and your friends enjoy doing together and eat the foods you like. Be adventurous—try new sports, games and other activities as well as new foods. You'll grow stronger, play longer, and look and feel better! Set realistic goals—don't try changing too much at once.

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TREATMENT OF CHRONIC HBV INFECTION

2009-02-14T22:32:00.001+07:00

The goals of treatment are to prevent or delay the complications from chronic HBV infection, including cirrhosis and liver cancer. Chronic HBV infection cannot be cured, but it can be controlled. By suppressing multiplication of the virus, damage to the liver can be prevented. Reversal of liver inflammation and fibrosis (scarring) can occur with treatment.

Who Should be Treated?

There are two essential laboratory tests that are used to determine whether treatment is needed:

ALT level (usually at least two values, three months apart)
HBV DNA level
Candidates for treatment are patients with elevated ALT levels and elevated HBV DNA levels.

Patients that are potential candidates for treatment are further divided into two groups, depending upon whether HBeAg is present or not. The two groups are referred to as HBeAg-positive chronic hepatitis B and HBeAg-negative chronic hepatitis B. The distinction is important because the approach to treatment differs for the two groups. The specific cut-offs to define what is an “elevated” HBV DNA level differs in patients who are HBeAg positive versus HBeAg negative (Figures below).

For persons who are HBeAg positive and have a HBV DNA level ≥20, 000 IU/ml in the blood, the ALT level determines if treatment is needed. If the ALT level is normal, no treatment is needed. If the ALT level is two-times the normal level or higher, treatment is definitely needed and if the ALT level is above the normal range but only 1-2 times the normal level, than treatment may be needed, but additional testing may be needed to make the decisions. A liver biopsy is used to determine whether treatment is indicated in persons who have elevated HBV DNA levels but whose ALT level is borderline elevated.
For persons who are HBeAg negative and have a HBV DNA level ≥2, 000 IU/ml in the blood, the ALT level determines if treatment is needed. If the ALT level is normal, no treatment is needed. If the ALT level is two-times the normal level or higher, treatment is definitely needed and if the ALT level is above the normal range but only 1-2 times the normal level, than treatment may be needed, but additional testing may be needed to make the decisions. A liver biopsy is used to determine whether treatment is indicated in persons who have elevated HBV DNA levels but whose ALT level is borderline elevated.
Additionally, all patients with cirrhosis, regardless of the ALT level, need to be considered for treatment (Table 6). Patients with cirrhosis and signs of liver dysfunction or failure (called decompensated cirrhosis) need to be referred for consideration of liver transplantation.

INITIAL EVALUATION OF PATIENT WITH CHRONIC HBV INFECTION

2009-02-14T22:31:00.000+07:00

The initial evaluation of a patient diagnosed with chronic hepatitis B infection includes the following:

1. History and physical examination

Determination of how infection was acquired (to estimate duration of infection)
Alcohol use (as factor that affects HBV disease severity)
Family history of HBV infection (suggests mother-infant or early childhood exposure to HBV)
Family history of liver cancer (this is a risk factor for liver cancer)
Assessment for physical findings of cirrhosis

2. Diagnostic tests

Alanine aminotransferase (ALT or SGPT) and aspartate aminotransferase (AST or SGOT) = indication of liver inflammation
Total bilirubin, albumin, prothrombin time = indication of liver function. These will be in normal range unless cirrhosis is present
Serologic and virologic markers for HBV infection = tests of the virus and antibodies
Anti-HBe, HBeAg, (e antigen and antibody are used to identify the phase of infection – see Table 4), HBV DNA quantitation
Anti-HDV (hepatitis D antibody), anti-HCV (hepatitis C antibody)
Liver biopsy in selected patients
Surveillance tests for liver cancer in those at risk (see Surveillance for Hepatocellular Carcinoma section below)
Ultrasound of the liver
Alpha-fetoprotein

Role of Liver Biopsy
Although a liver biopsy is not essential to make the diagnosis of chronic hepatitis B, the liver biopsy provides the most accurate means of assessing the severity of liver disease. In chronic hepatitis B, the severity of infection is measured by the degree of necroinflammatory activity (grade) and amount of fibrosis or scarring (stage). The grade and stage of disease is often used to determine whether treatment is needed and for how long the treatment needs to be continued. For example, patients with cirrhosis require long-term treatment. It is important to be aware of the imperfect correlation between the liver blood tests and the severity of fibrosis on the biopsy. Patients with normal liver blood tests can have fibrosis and even cirrhosis on biopsy. For this reason, it has been recommended that a liver biopsy be considered in patients with minimally or mildly elevated ALT levels (less than twice the normal limit), in order to determine whether the disease on the biopsy is more severe than the blood levels (ALT) suggest.

PREVENTING DISEASE COMPLICATIONS

2009-02-14T22:30:00.000+07:00

Preventing the complications of chronic infection involves three general aspects:

1. Undergo evaluation to determine stage of disease and establish regular monitoring for complications, including surveillance tests to look for liver cancer.
2. Make healthy lifestyle choices so that additional harm to the liver does not occur. The lifestyle factors of greatest importance are:

a. Avoidance of alcohol
b. Maintenance of ideal body weight to prevent a fatty liver
c. Limiting use of acetaminophen (Tylenol®) to no more than 2000 mg per 24 hours

3. Undergo evaluation to determine whether specific treatment of chronic HBV infection is necessary

PREVENTING TRANSMISSION OF HBV TO OTHERS

2009-02-14T22:29:00.000+07:00

HBV is spread by blood or sexual contact.

To protect sexual partners, members of the household, or colleagues at work, the following measures to prevent transmission of HBV are recommended:

Using latex condoms when having sex; sexual contacts should be vaccinated
Never sharing personal grooming items that may be contaminated with blood such as razors, toothbrushes, or nail clippers
Cover open sores, cuts or scratches
Clean any blood-contaminated surfaces with bleach

The following activities are NOT associated with spread of HBV:

Sharing of food and utensils
Kissing, hugging
Handshakes or casual contact
Coughing or sneezing

NATURAL HISTORY OF CHRONIC HBV INFECTION

2009-02-14T22:28:00.000+07:00

Chronic hepatitis B is a dynamic disease with variable levels of hepatitis B virus measurable in the blood, and changing levels of ALT, a marker of liver injury. There are four phases of disease that are recognized (Table below). Not all persons with chronic HBV infection will experience all four of these phases, but determination of phase of infection has important implications for treatment. Only those who are in the immune clearance (also referred to as HBeAg-positive chronic hepatitis B) or immune reactivation (also referred to as HBeAg-negative chronic hepatitis B) phases are recommended to undergo treatment. These two phases represent the most active phases of the disease, when liver injury occurs and during which time the risk of progression of disease is highest.

Long-term studies of patients with chronic HBV indicate that for patients with HBeAg-positive chronic hepatitis B, the annual risk of progressing to cirrhosis is 5% per year and for patients with HBeAg-negative chronic hepatitis B, the risk if 1-2 % per year (see below). Once cirrhosis develops, there is a 5% risk per year of developing liver failure or liver cancer. While liver cancer is most frequent in patients with chronic hepatitis B and cirrhosis, it can also develop in persons with chronic hepatitis B who do not have cirrhosis. The estimated risk for these latter persons with chronic hepatitis B is estimated to be 0.4% per year and is related to duration of infection, sex and family history.

Risk factors for the development of cirrhosis are known (Table below) and include host, viral and environment factors. Of the known factors, alcohol use and obesity are the potentially modifiable factors. Heavy use of alcohol is to be avoided. Diabetes and obesity are associated with fatty liver and a fatty liver can lead to an additional injury in the liver and accelerate progression to cirrhosis in some patients. This factor has only recently been recognized as an important contributing cause for cirrhosis in patients with viral hepatitis. Several viral factors have been associated with increased risk of cirrhosis and these may be partially modifiable with treatment. For example, high HBV DNA levels in the blood have been associated with a higher risk of cirrhosis and treatments resulting achieving a low or undetectable HBV DNA level may reduce this risk.

INTERPRETATION OF BLOOD TESTS

2009-02-14T22:26:00.000+07:00

There are a number of antigen and antibody tests used to assess the phase of infection in persons with chronic HBV. Additionally, the level of virus in the blood can be measured to give a viral load result. These tests are essential in determining if and when to treat and are also used during treatment to determine when treatment can be stopped.

1. Serologic Tests (measurement of HBV antigens and antibodies)

HBsAg: indicates presence of hepatitis B (in both acute and chronic infection)
HBeAg: indicates phase of infection associated with high level of hepatitis B in the blood
Anti-HBs (or HBsAb: antibody against HBsAg). When present this indicates resolved infection. In persons with chronic HBV infection, there is an approximately 1% chance per year of developing anti-HBs.
Anti-HBe (or HBeAb): antibody against HBeAg. When present, this is associated with a lower level of hepatitis B virus in the blood.
Anti-HBc: indicates prior exposure to hepatitis B (present in acute and chronic HBV and persists for life). There is little role of this test in the follow-up of patients with chronic hepatitis B.

2. Virologic Tests (measurement of viral DNA or viral load)
There are two types of tests used to measure HBV DNA: qualitative and quantitative tests.

Qualitative HBV DNA test reports results as POSITIVE or NEGATIVE. A positive result indicates there is at least 50 IU/ml of HBV DNA detected (could be much higher). A negative result indicates there is less than 50 IU/ml of HBV DNA present.
Quantitative HBV DNA test reports results as the number of viral international units present in a milliliter of blood (IU/ml). There are a number of different assays used and they differ on how sensitive the assay is to detection of low levels of virus but most assays currently used can detect as little as 50 IU/ml.
With improvements made in quantitative tests in the past five years, qualitative tests are less frequently used.

3. Other Specialized Tests Used

HBV Genotype (subtype of hepatitis B viru). There are 8 genotypes of HBV (labeled A-H) that are identified by examining the genetic make-up of the virus. HBV genotypes have been associated with different responses to antiviral therapy, so this test may be done if treatment is being considered.

HBV Resistance Testing: For patients on treatment for chronic hepatitis B, monitoring for resistance to the drugs is necessary. These tests detect certain changes in the virus that are known to be associated with drug resistance. These tests are not FDA-approved but are available in some commercial laboratories.

SYMPTOMS AND SIGNS OF CHRONIC HEPATITIS B

2009-02-14T22:25:00.000+07:00

Most persons with chronic hepatitis B infection are without any symptoms and do not recall any prior history of acute hepatitis. When symptoms are present – the most common is fatigue – they are not very specific to liver disease and may be overlooked. In fact, many persons with HBV do not know they have it. However, if suspected, the infection can be easily diagnosed with blood tests.

Symptoms are more frequent in persons with chronic HBV infection who are experiencing a “flare” of hepatitis or if they have progressed to the phase of cirrhosis and liver failure. In these cases, symptoms may include right upper quadrant pain, jaundice (yellowish discoloration of eyes and skin), nausea, and loss of appetite. If liver failure develops many additional symptoms can occur including decreased mental alertness, swelling of legs and abdomen, and bleeding complications.

Physical findings are typically absent. Liver enlargement or tenderness may be seen. Patients with cirrhosis may have skin changes indicative of cirrhosis, an enlarged spleen, swelling of lower legs or abdomen, or jaundice.

CHRONIC HBV INFECTION

2009-02-14T22:24:00.000+07:00

An estimated 1.25 million Americans have chronic hepatitis B infection. Many individuals living in the U.S. were born in areas of the world where the prevalence of HBV is high and infection with HBV occurred at the time of birth or in early childhood. The prevalence of chronic HBV infection is higher is certain racial-ethnic groups, notably Asian-Americans who have prevalence rates of infection of approximately 10%. For this reason, it is recommended that persons from endemic areas of HBV should be tested for hepatitis B.

Strictly speaking, chronic HBV infection is defined by the presence of HBsAg in the blood for a period of six months or more. In practice, individuals with evidence of liver disease who are HBsAg positive have chronic HBV infection and there is little need to wait for six months to confirm the diagnosis. Additional antigen and antibody tests are used to define the phase of infection in those who are chronically-infected.

Chronic HBV infection is a potentially serious disease that can lead to cirrhosis, end-stage liver disease, and hepatocellular carcinoma (liver cancer). Individuals with chronic HBV infection, even if they have no symptoms, have a 12 to 300 fold higher risk of developing liver cancer than persons without chronic HBV infection. Because of these serious consequences of chronic infection, it is important to identify those who are infected, so that treatment can be offered to prevent these complications.

Preventing HBV Infection after Exposure

2009-02-14T22:23:00.000+07:00

For persons who have been exposed to HBV within the prior two week period, post-exposure prophylaxis should be given to prevent symptomatic infection. Post-exposure prophylaxis consists of two therapies: the HBV vaccine and hepatitis B immunoglobulin (HBIG).

HBIG is effective in all ages regardless of concurrent medical conditions and is given as an intramuscular injection. HBV vaccine is usually given concomitantly if there is an indication for lifelong protection.
If given in a timely fashion (within seven days following a needle exposure to HBV or within 14 days of a sexual exposure to HBV), both HBIG and HBV vaccine are highly effective in preventing HBV infection, with less than 5% of persons becoming symptomatic.

Vaccine Safety
The HBV vaccine has an excellent safety record [4]. There are reports of Gillian-Barré syndrome, multiple sclerosis, and other neurological conditions in some recipients of HBV vaccines, but the available data does not support a causal relationship between the vaccine and these neurologic disorders. The most frequent side effects are pain at the injection site, fever, headache, muscle aches, and mild fatigue. An allergic reaction to the vaccine may occur but is extremely rare, estimated to be 1 per 1.1 million doses given

HBV Vaccines

2009-02-14T22:22:00.000+07:00

The two vaccines licensed in the United States are not live vaccines but rather are produced by recombinant DNA technology: Engerix-B (GlaxoSmithKline, Research Triangle Park, North Carolina) and Recombivax-HB (Merck, Whitehouse Station, New Jersey). Each is given in a three-dose series over a six month (up to 12 month) period in adults. The recommended doses and schedule of injections are shown in the Table below.
Both vaccines are highly immunogenic with 95-100% of healthy adult and 90-95% of health children and adolescents developing a protective level of antibody after completing the three-injection series.
There is also a combination of HAV and HBV vaccines available (Twinrix; GlaxoSmithKline, Research Triangle Park, North Carolina) for adults. Several combination infant/childhood vaccinations containing HBV vaccine are available including Pediarix (Diphtheria, Pertussis, Tetanus, Polio and HBV) and Comvax (HBV and Hemophilus influenzae type b).
Factors that have been associated with a lower the response to the vaccine are low birth weight infants, age older than 40 years, male sex, smoking, obesity, and certain medical conditions that include immune deficiency (e.g., HIV infection), kidney failure on dialysis, and cirrhosis.
Booster shots are currently not recommended. Protective levels of antibody have been documented for up to 10 years. Even when the levels of antibody decline to low (less than 10 mIU/mL) or undetectable levels, nearly all vaccinated persons remain protected against HBV infection. The mechanism for continued vaccine-induced protection is through the preservation of immune cells within the body that are still able to mount an appropriate immune response if exposure to the virus occurs.

PREVENTING HBV INFECTION

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The most effective means of protecting oneself from acquiring HBV infection is by vaccination. A vaccine for HBV has been available since 1981. In the U.S., the current immunization strategy includes universal vaccination of infants, routine vaccination of previously unvaccinated children and adolescents to age 18, and targeted vaccination of previously unvaccinated adults who are at risk of HBV infection (Table below). While the infant, child and adolescent vaccination programs have been quite successful, HBV vaccination in adults who are at risk is suboptimal. Of the 51,000 new HBV infections in 2005, approximately 95% occurred in adults. New strategies to identify adults at risk and provide HBV vaccination have been recently recommended by the CDC
In addition to vaccination, other measures to prevent HBV include:
Using latex condoms when having sex
Never sharing drugs, syringes, needles, or “works”
Never sharing personal grooming items that may be contaminated with blood such as razors, toothbrushes, or nail clippers
Never expose oneself to needles that may have been reused (e.g., tattoo or body piercing, medical care in some countries)
If pregnant, test to see if you are infected with HBV so that the infant can be given hepatitis B immune globulin and vaccination at birth to prevent infection.

TREATMENT OF ACUTE HEPATITIS B

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The primary treatment of acute hepatitis B is support care. The focus is on alleviating symptoms associated with hepatitis. For most patients this includes:

- Bed rest
- Insuring adequate fluid intake (especially if vomiting and diarrhea present)
- Use of analgesics (pain relievers) in limited amounts for fever and joint pains

Close follow-up with a physician is essential and all medications taken, even over-the-counter products, should be taken with physician approval to minimize any risk of additional harm to the liver.

Antiviral Therapy
There are several safe and effective drugs that reduce HBV viral levels and improve liver tests when given to patients with chronic HBV infection (see below). At the present time, treatment of acute hepatitis B infection with antiviral drugs – such as lamivudine, entecavir, adefovir or telbivudine – is not generally recommended because the vast majority of healthy adults will resolve the infection on their own.

However, it is controversial as to whether treatment of those with severe hepatitis is beneficial. Few studies of treatment during acute HBV infection have been done. The available data suggest that antiviral therapy does not provide an clinical benefit and its use is not routinely recommended in persons with acute HBV [3]. Nevertheless, antiviral use appears to be safe and many clinicians use it for those patients with more severe acute hepatitis. Additionally, for those with fulminant hepatitis B, antiviral therapy is given to assist with management of the HBV infection should the patient require a liver transplant.

WHAT IS THE USUAL COURSE OF ACUTE HEPATITIS B INFECTION

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The average incubation period is two to three months, with range of a few weeks to six months, depending upon how much virus is transmitted at the time of exposure.

Symptoms and Signs of Acute Hepatitis
The symptoms for acute hepatitis B are not specific, but rather are the same symptoms seen in patients with acute hepatitis of any cause so the diagnosis of acute hepatitis B requires additional testing.

Symptoms can be non-specific and include:

Fatigue
Nausea, vomiting, loss of appetite
Diarrhea, possibly weight loss
Fever
Pain in the right upper portion of the abdomen
Dark urine
Jaundice (yellowing of skin and eyes): seen only about 30% of persons with acute HBV

Symptoms can be more severe in those who are immune compromised or who have chronic liver disease. Rarely the HBV infection can cause injury to organs other than the liver. Immune responses to the virus and complexes of virus and antibody can precipitate rashes, arthritis (joint pain), and glomerulonephritis (kidney inflammation).

Laboratory Test Abnormalities
The most important laboratory abnormalities identified on blood tests in symptomatic patients are:

Marked elevations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), usually 1000-2000 IU/L

The ALT is usually slightly higher than the AST. These tests reflect the severity of liver inflammation and injury.
Elevated levels of bilirubin (cause of the jaundice)
There may also be changes in the tests that reflect liver function including the prothrombin time (a measure of clotting capacity) and albumin (a measure of protein production and destruction

Clinical Course

The time course for acute HBV infection is depicted in the Figure below. Several antibodies develop during infection reflecting the immune system’s response to different parts of the virus. The viral antigens and antibodies that are detected during acute infection are used to make the diagnosis of acute HBV and to determine whether the infection has resolved or not.

Following acute infection, hepatitis B surface antigen (HBsAg) is detected in the blood at a median 30-60 days after exposure to the virus. The diagnosis of acute HBV infection is based on detection of HBsAg and IgM antibody to hepatitis B core antigen (IgM anti-HBc) at the time of symptoms. The IgM anti-HBc level declines within six months and another form of antibody to hepatitis B core antigen called IgG anti-HBc develops slightly later and persists indefinitely as a marker of past infection. In persons whose immune systems eliminate HBV, an antibody to HBsAg (called anti-HBs) becomes detectable during convalescence and coincides with the disappearance of HBsAg. The presence of anti-HBs indicates recovery from acute infection and immunity from re-infection. Anti-HBs is also the antibody that develops when vaccination is given. If the immune system is unable to eliminate HBV, the HBsAg persists in the blood and anti-HBs is not detectable. These persons have persistent virus and develop chronic hepatitis.

HOW IS HBV INFECTION ACQUIRED

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HBV is transmitted from one person to another by contact with infected blood (or items contaminated by blood) or by sexual contact. HBV has been shown to remains infectious on surfaces contaminated with blood or body secretions for at least seven days. Blood, semen, and saliva are infectious, with the highest concentration of HBV in blood and lower levels found in semen and saliva. The infection can also be transmitted from mother to infant, usually at the time of delivery.

In the U.S., most new infections occur in adolescents and adults. The most frequently reported risk factors for infection were sex (multiple sexual partners, men having sex with men) and sharing of needles or drug paraphernalia (“works”) accounting for approximately 50% and 15% of all new cases of infection. Other risk factors for HBV infection include household contact with an infected person, work in the healthcare setting, hemodialysis workers and patients, other contact with contaminated needles as might occur with tattoos or body piercing in certain settings, receipt of contaminated blood or organs, or travel to areas with high prevalence of HBV infection. Blood transfusion is now a rare cause of acute HBV infection since routine screening of blood donors and blood was undertaken.

In other parts of the world where HBV infection is more prevalent in the general population –such as in Southeast Asia, parts of South America, and Africa – HBV is more frequently acquired at birth or in early childhood. The age at which persons become infected with HBV strongly influences the likelihood of recovery from the acute infection and immunity against development of chronic HBV infection. Individuals exposed to HBV at a young age are much more likely to become a chronic carrier of the virus.

HOW DOES HEPATITIS B VIRUS CAUSE HEPATITIS?

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HBV is a hepatotrophic virus, meaning the virus replicates only within the liver. The virus gains access to the liver through blood. Once in the liver, HBV multiples and new viruses are exported from the liver cells back into the blood circulation. The immune system mounts an attack on the virus replicating in the liver and tries to eliminate the virus. This immune response results in inflammation and liver cell injury, which is termed “hepatitis.” If the immune response against HBV is robust and successful in eliminating the liver cells infected with virus, the person will recover from the infection. This is resolved acute HBV infection. The antibodies made by the individual’s immune system will protect them against future infection with HBV. After recovery from the acute infection, the liver returns to normal (hepatitis resolves) and there are no residual liver effects. In some individuals infected with HBV, however, the immune response is not successful in eliminating the virus. In these persons, the virus will establish a persistent infection in the liver. This is called chronic HBV infection and persons with chronic infection are at risk for liver damage over many years and can develop cirrhosis and liver cancer.

Hepatitis B

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Hepatitis B can cause both acute and chronic infection. Worldwide, there are approximately 350-400 million persons infected with chronic hepatitis B. Chronic hepatitis B infection cannot be cured, but it can be controlled. Several treatment options are available for those with chronic infection and treatment can prevent or even reverse the complications of liver disease. A safe and effective vaccine is available to protect individuals from getting hepatitis B.

Hepatitis B virus (HBV) is a small enveloped DNA virus that belongs to the Hepadnaviridae family of viruses. Worldwide, there are approximately 350-400 million persons infected with hepatitis B, but the prevalence of infection varies significantly by country (Figure below shows the percent of the population infected with hepatitis B). In the United States, 1% of the population is infected, whereas in countries such as China, approximately nearly 10% of the population is infected. Hepatitis B can cause both acute and chronic infection. Chronic HBV infection cannot be cured, but it can be controlled. Moreover, HBV infection can be prevented by vaccination.

Epidemiology

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Varicella zoster virus has a high level of infectivity and is prevalent worldwide,[43] and has a very stable prevalence from generation to generation.[44] VZV is a benign disease in a healthy child in developed countries. However, varicella can be lethal to individuals who are infected later in life or who have low immunity. The number of people in this high-risk group has increased, due to the HIV epidemic and the increase in immunosuppressive therapies. Infections of varicella in institutions such as hospitals are also a significant problem, especially in hospitals that care for these high-risk populations.

In general, herpes zoster has no seasonal incidence and does not occur in epidemics.In temperate zones chickenpox is a disease of children, with most cases occurring during the winter and spring, most likely due to school contact; there is no evidence for regular epidemics. In the tropics chickenpox typically occurs among older people.[46] Incidence is highest in people who are over age 55, as well as in immunocompromised patients regardless of age group, and in individuals undergoing psychological stress. Non-whites may be at lower risk; it is unclear whether the risk is increased in females. Other potential risk factors include mechanical trauma, genetic susceptibility, and exposure to immunotoxins.

The incidence rate of herpes zoster ranges from 1.2 to 3.4 per 1,000 person-years among healthy individuals, increasing to 3.9–11.8 per 1,000 person‐years among those older than 65 years.Similar incidence rates have been observed worldwide.Herpes zoster develops in an estimated 500,000 Americans each year. Multiple studies and surveillance data demonstrate no consistent trends in incidence in the U.S. since the chickenpox vaccination program began in 1995.It is likely that incidence rate will change in the future, due to the aging of the population, changes in therapy for malignant and autoimmune diseases, and changes in chickenpox vaccination rates; a wide adoption of zoster vaccination could dramatically reduce the incidence rate.

In one study, it was estimated that 26% of patients who contract herpes zoster eventually present with complications. Postherpetic neuralgia arises in approximately 20% of patients.A study of 1994 California data found hospitalization rates of 2.1 per 100,000 person-years, rising to 9.3 per 100,000 person-years for ages 60 and up.An earlier Connecticut study found a higher hospitalization rate; the difference may be due to the prevalence of HIV in the earlier study, or to the introduction of antivirals in California before 1994.

A 2008 study revealed that people with close relatives who have had shingles are themselves twice as likely to develop it themselves. The study speculates that there are genetic factors in who is more susceptible to VZV.

Prevention

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A live vaccine for VZV exists, marketed as Zostavax. In a 2005 study of 38,000 older adults it prevented half the cases of herpes zoster and reduced the number of cases of postherpetic neuralgia by two-thirds. A 2007 study found that the zoster vaccine is likely to be cost-effective in the U.S., projecting an annual savings of $82 to $103 million in healthcare costs with cost-effectiveness ratios ranging from $16,229 to $27,609 per quality-adjusted life year gained.In October 2007 the vaccine was officially recommended in the U.S. for healthy adults aged 60 and over. Adults also receive an immune boost from contact with children infected with varicella, a boosting method that prevents about a quarter of herpes zoster cases among unvaccinated adults, but which is becoming less common in the U.S. now that children are routinely vaccinated against varicella.

In the United Kingdom and other parts of Europe, population-based immunization is not practiced. The rationale is that until the entire population could be immunized, adults who have previously contracted VZV would derive benefit from occasional exposure to VZV (from children), which serves as a booster to their immunity to the virus and may reduce the risk of shingles later on in life. The UK Health Protection Agency states that while the vaccine is licensed in the UK there are no plans to introduce it into the routine childhood immunization scheme, although it may be offered to healthcare workers who have no immunity to VZV.

A 2006 study of 243 cases and 483 matched controls found that fresh fruit is associated with a reduced risk of developing shingles: people who consumed less than one serving of fruit a day had three times the risk as those who consumed over three servings, after adjusting for other factors such as total energy intake. For those aged 60 or more, vitamins and vegetable intake had a similar association.

Treatment

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The aims of treatment are to limit the severity and duration of pain, shorten the duration of a shingles episode, and reduce complications. Symptomatic treatment is often needed for the complication of postherpetic neuralgia.

Antiviral drugs inhibit VZV replication and reduce the severity and duration of herpes zoster with minimal side effects, but do not reliably prevent postherpetic neuralgia. Of these drugs, aciclovir has been the standard treatment, but the new drugs valaciclovir and famciclovir demonstrate similar or superior efficacy and good safety and tolerability.The drugs are used both as prophylaxis (for example in AIDS patients) and as therapy during the acute phase. Antiviral treatment is recommended for all immunocompetent individuals with herpes zoster over 50 years old, preferably given within 72 hours of the appearance of the rash. Complications in immunocompromised individuals with herpes zoster may be reduced with intravenous aciclovir. In people who are at a high risk for repeated attacks of shingles, five daily oral doses of aciclovir are usually effective.Administering gabapentin along with antivirals may offer relief of postherpetic neuralgia.

Patients with mild to moderate pain can be treated with over-the-counter analgesics. Topical lotions containing calamine can be used on the rash or blisters and may be soothing. Occasionally, severe pain may require an opioid medication, such as morphine. Once the lesions have crusted over, capsaicin cream (Zostrix) can be used. Topical lidocaine and nerve blocks may also reduce pain.

Orally administered corticosteroids are frequently used in treatment of the infection, despite clinical trials of this treatment being unconvincing. Nevertheless, one trial studying immunocompetent patients older than 50 years of age with localized herpes zoster, suggested that administration of prednisone with aciclovir improved healing time and quality of life.Upon one-month evaluation, aciclovir with prednisone increased the likelihood of crusting and healing of lesions by about two-fold, when compared to placebo. This trial also evaluated the effects of this drug combination on quality of life at one month, showing that patients had less pain, and were more likely to stop the use of analgesic agents, return to usual activities and have uninterrupted sleep. However, when comparing cessation of herpes zoster-associated pain or post herpetic neuralgia, there was no difference between aciclovir plus prednisone, or simply aciclovir alone. Because of the risks of corticosteroid treatment, it is recommended that this combination of drugs only be used in people more than 50 years of age, due to their greater risk of postherpetic neuralgia.

Treatment for herpes zoster ophthalmicus is similar to standard treatment for herpes zoster at other sites. A recent trial comparing aciclovir with its prodrug, valaciclovir, demonstrated similar efficacies in treating this form of the disease.The significant advantage of valciclovir over aciclovir is its dosing of only 3 times/day (compared with aciclovir's 5 times/day dosing), which could make it more convenient for patients and improve adherence with therapy.

Prognosis

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The rash and pain usually subside within three to five weeks, but about one in five patients develops a painful condition called postherpetic neuralgia, which is often difficult to manage. In some patients, herpes zoster can reactivate presenting as zoster sine herpete: pain radiating along the path of a single spinal nerve (a dermatomal distribution), but without an accompanying rash. This condition may involve complications that affect several levels of the nervous system and cause multiple cranial neuropathies, polyneuritis, myelitis, or aseptic meningitis. Other serious effects that may occur in some cases include partial facial paralysis (usually temporary), ear damage, or encephalitis. During pregnancy, first infections with VZV, causing chickenpox, may lead to infection of the fetus and complications in the newborn, but chronic infection or reactivation in shingles are not associated with fetal infection.

There is a slightly increased risk of developing cancer after a herpes zoster infection. However, the mechanism is unclear and mortality from cancer did not appear to increase as a direct result of the presence of the virus.Instead, the increased risk may result from the immune suppression that allows the reactivation of the virus

Pathophysiology

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The causative agent for herpes zoster is varicella zoster virus (VZV), a double-stranded DNA virus related to the Herpes simplex virus group. Most people are infected with this virus as children, and suffer from an episode of chickenpox. The immune system eventually eliminates the virus from most locations, but it remains dormant (or latent) in the ganglia adjacent to the spinal cord (called the dorsal root ganglion) or the ganglion semilunare (ganglion Gasseri) in the base of the skull. However, repeated attacks of herpes zoster are rare,and it is extremely rare for patients to suffer more than three recurrences.

Herpes zoster occurs only in people who have had chickenpox, and although it can occur at any age, the majority of sufferers are more than 50 years old. The disease results from the virus reactivating in a single sensory ganglion. In contrast to Herpes simplex virus, the latency of VZV is poorly understood. The virus has not been recovered from human nerve cells by cell culture and the location and structure of the viral DNA is not known. Virus-specific proteins continue to be made by the infected cells during the latent period, so true latency, as opposed to a chronic low-level infection, has not been proven.Although VZV has been detected in autopsies of nervous tissue, there are no methods to find dormant virus in the ganglia in living people.

Unless the immune system is compromised, it suppresses reactivation of the virus and prevents herpes zoster. Why this suppression sometimes fails is poorly understood,but herpes zoster is more likely to occur in people whose immune system is impaired due to aging, immunosuppressive therapy, psychological stress, or other factors.Upon reactivation, the virus replicates in the nerve cells, and virions are shed from the cells and carried down the axons to the area of skin served by that ganglion. In the skin, the virus causes local inflammation and blisters. The short and long-term pain caused by herpes zoster comes from the widespread growth of the virus in the infected nerves, which causes inflammation.

The symptoms of herpes zoster cannot be transmitted to another person. However, during the blister phase, direct contact with the rash can spread VZV to a person who has no immunity to the virus. This newly-infected individual may then develop chickenpox, but will not immediately develop shingles. Until the rash has developed crusts, a person is extremely contagious. A person is also not infectious before blisters appear, or during postherpetic neuralgia (pain after the rash is gone). The person is no longer contagious after the virus has disappeared.

Diagnosis

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If the rash has appeared, identifying this disease (making a differential diagnosis) only requires a visual examination, since very few diseases produce a rash in a dermatomal pattern (see map). However, herpes simplex virus (HSV) can occasionally produce a rash in such a pattern. The Tsanck smear is helpful for diagnosing acute infection with a herpes virus, but does not distinguish between HSV and VZV.

When the rash is absent (early or late in the disease, or in the case of zoster sine herpete), herpes zoster can be difficult to diagnose.Apart from the rash, most symptoms can occur also in other conditions.

Laboratory tests are available to diagnose herpes zoster. The most popular test detects VZV-specific IgM antibody in blood; this only appears during chickenpox or herpes zoster and not while the virus is dormant.In larger laboratories, lymph collected from a blister is tested by the polymerase chain reaction for VZV DNA, or examined with an electron microscope for virus particles.

In a recent study, samples of lesions on the skin, eyes, and lung from 182 patients with presumed herpes simplex or herpes zoster were tested with real-time PCR or with viral culture.In this comparison, viral culture detected VZV with only a 14.3% sensitivity, although the test was highly specific (specificity=100%). By comparison, real-time PCR resulted in 100% sensitivity and specificity. Overall testing for herpes simplex and herpes zoster using PCR showed a 60.4% improvement over viral culture.

Signs and symptoms

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The earliest symptoms of herpes zoster, which include headache, fever, and malaise, are nonspecific, and may result in an incorrect diagnosis.These symptoms are commonly followed by sensations of burning pain, itching, hyperesthesia (oversensitivity), or paresthesia ("pins and needles": tingling, pricking, or numbness).The pain may be extreme in the affected dermatome, with sensations that are often described as stinging, tingling, aching, numbing or throbbing, and can be interspersed with quick stabs of agonizing pain.In most cases, after 1–2 days (but sometimes as long as 3 weeks) the initial phase is followed by the appearance of the characteristic skin rash. The pain and rash most commonly occurs on the torso, but can appear on the face, eyes or other parts of the body. At first, the rash appears similar to the first appearance of hives; however, unlike hives, herpes zoster causes skin changes limited to a dermatome, normally resulting in a stripe or belt-like pattern that is limited to one side of the body and does not cross the midline.Zoster sine herpete describes a patient who has all of the symptoms of herpes zoster except this characteristic rash.

Later, the rash becomes vesicular, forming small blisters filled with a serous exudate, as the fever and general malaise continue. The painful vesicles eventually become cloudy or darkened as they fill with blood, crust over within seven to ten days, and usually the crusts fall off and the skin heals: but sometimes after severe blistering, scarring and discolored skin remain.

Development of the shingles rash

Herpes zoster may have additional symptoms, depending on the dermatome involved. Herpes zoster ophthalmicus involves the orbit of the eye and occurs in approximately 10–25% of cases. It is caused by the virus reactivating in the ophthalmic division of the trigeminal nerve. In a few patients, symptoms may include conjunctivitis, keratitis, uveitis, and optic nerve palsies that can sometimes cause chronic ocular inflammation, loss of vision, and debilitating pain.Herpes zoster oticus, also known as Ramsay Hunt syndrome type II, involves the ear. It is thought to result from the virus spreading from the facial nerve to the vestibulocochlear nerve. Symptoms include hearing loss and vertigo (rotational dizziness).

Herpes zoster

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Herpes zoster (or simply zoster), commonly known as shingles, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. The initial infection with varicella zoster virus (VZV) causes the acute (short-lived) illness chickenpox, and generally occurs in children and young people. Once an episode of chickenpox has resolved, the virus is not eliminated from the body but can go on to cause shingles—an illness with very different symptoms—often many years after the initial infection.

Varicella zoster virus can become latent in the nerve cell bodies and less frequently in non-neuronal satellite cells of dorsal root, cranial nerve or autonomic ganglion,without causing any symptoms.In an immunocompromised individual, perhaps years or decades after a chickenpox infection, the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve. The virus may spread from one or more ganglia along nerves of an affected segment and infect the corresponding dermatome (an area of skin supplied by one spinal nerve) causing a painful rash.Although the rash usually heals within two to four weeks, some sufferers experience residual nerve pain for months or years, a condition called postherpetic neuralgia. Exactly how the virus remains latent in the body, and subsequently re-activates is not understood.

Throughout the world the incidence rate of herpes zoster every year ranges from 1.2 to 3.4 cases per 1,000 healthy individuals, increasing to 3.9–11.8 per year per 1,000 individuals among those older than 65 years. Antiviral drug treatment can reduce the severity and duration of herpes zoster, if a seven to ten day course of these drugs is started within 72 hours of the appearance of the characteristic rash.

Diagnosing sinusitis: when is it time to see your doctor?

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Table One lists many of the differences between sinusitis and colds and allergies. Understanding these differences is helpful, but it won't make your symptoms go away. If severe nasal symptoms linger for more than a week or two, it's advisable to see your doctor. A visit to your Primary Care Physician (PCP) is often a good first step.

History: A good patient history is the single most important tool your doctor has to confirm the diagnosis of sinusitis. This same history is also critical for determining whether something other than sinusitis could be causing your problems. For example, if you only have facial pain without congestion or drainage, your problem could be neurological in nature, with migraine headaches and neuralgia as possibilities, and you may be referred to a neurologist. If you have sneezing, itchy eyes, and thin, watery post-nasal drip, it's likely you have allergies, and you may be referred to an allergist.

Exam: Once the history is completed, your PCP may look inside your nose with a small flashlight. She won't be able to see into your sinuses, but she can see the front portion of the nasal cavity and assess how much swelling there is and whether any drainage is present.

If your symptoms persist, your PCP may refer you to a specialist known as an Ear, Nose, and Throat doctor (ENT) or Otolaryngologist. The ENT doctor will likely examine you with a thin telescope known as a nasal endoscope. This endoscope can be passed into the nose with a minimal amount of discomfort to visualize the areas through which the sinuses drain (Figure).

How do I know if I have sinusitis, a cold, or an allergy

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Unless you have prior experience with sinusitis, you may have trouble distinguishing it from other ailments such as colds and allergies. People often mistakenly confuse the three because so many of their symptoms are similar. But they are, in fact, three different entities, with three different causes.

Colds: Whereas sinusitis is often caused by bacteria, colds are caused by viruses. These much smaller microorganisms invade the body's cells, where they reproduce and are eventually released into the bloodstream to invade other cells. The body's immune system is usually quite effective at controlling viral infections, so most colds go away within a week. Colds can occur at any time but are most common during winter ("cold season"). What can be confusing is that it's not uncommon for a cold to precede a sinus infection.
Allergies: Allergies are usually caused by environmental irritants such as pollen, dust mites, or pet dander, not bacteria or viruses. These irritants, known as allergens, activate an immune response that is different from the immune response to an infection. During allergic reactions, a powerful molecule called histamine causes the membranes of the upper respiratory tract, including the nose and sinuses, to swell and weep mucus. Histamine release can also trigger repeated sneezing and make your nose and eyes itch.
Allergies can be either perennial, meaning they occur year-round, or seasonal. Allergies to dust and pet dander are often perennial. Seasonal allergies tend to be worst during the spring, when flowers and trees bloom, and the fall, when ragweed is in the air. As with colds, allergies may precede and trigger sinusitis.

Table One: Telling Symptoms. The decision on how to treat sinusitis, cold, and allergy symptoms depends on what’s causing them. Here’s how to tell them apart.

Symptoms of sinusitis

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Facial pressure/headache: The dull, throbbing pain, ache, or pressure that is a hallmark of sinusitis results from inflamed tissue putting pressure on nerve endings in the lining of your sinuses. This pain's location is often specific to the infected sinus:

· Frontal sinusitis causes forehead pain or headache.

· Maxillary sinusitis causes cheek pain, which may radiate to the teeth in the upper jaw.

· Ethmoid sinusitis causes pain between the eyes or across the bridge of the nose.

Sphenoid sinusitis causes pain behind the eyes, on the top of the scalp, or along the back of the head.

If all four pairs of sinuses are infected (what's known as pansinusitis), your pain and pressure is usually more spread out and may encompass the entire face or head.

Difficulty breathing through the nose/congestion: The combination of swollen nasal membranes and excess mucus makes it difficult to breathe through your nose.

For some sinus sufferers, the term congestion refers not to blocked nasal breathing, but to a sense of fullness or blockage of the face, particularly in the cheeks. This sensation is caused by blockage of the sinuses themselves. When ostia swell shut, the mucous membranes in the sinuses absorb oxygen, creating negative pressure (or a vacuum), which can produce this sense of facial congestion, or even pain.

Nasal drainage/post-nasal drip: Mucus from the sinuses normally drains in minute quantities into the nose and down the back of the throat before being swallowed. During an infection, increased secretion by the nose and sinuses results in a larger volume of mucus, which is often thick and yellow or green. This mucus, which may contain large quantities of bacteria and white blood cells, flows down the back of the nose and throat. Some people blow a large amount of mucus out the front of the nose as well.

Other symptoms of sinusitis include:

Loss of smell: The roof of the nasal cavity is lined with smell receptors. Swelling of the membranes in the nose can block the odor molecules from reaching these receptors, leaving you with a reduced sense of smell.

Loss of taste: A normal sense of taste, particularly the ability to perceive different flavors, depends on an intact sense of smell. Consequently, many people who lose smell from sinusitis also describe a corresponding decrease in their sense of taste.

Bad breath: The discolored mucus that drains from infected sinuses contains bacteria and debris that emit foul-smelling odors. As a result, thick mucus that runs down the back of your throat may produce bad breath (halitosis) when these odors are exhaled.

Cough: When mucus runs down the back of the throat, it may touch the vocal cords and trigger an involuntary cough response. Coughing is often worst when lying down at night or upon awakening in the morning.

Sore throat: The thick mucus that drains during a sinus infection is more acidic than normal watery mucus, so it can irritate the membranes that line your throat.

Fatigue: Your body uses extra energy to mount an immune response. This shifting of calorie reserves from normal daily activity to infection-fighting can leave you feeling tired. In addition, poor nasal breathing and frequent coughing during the night can cause poor quality sleep, resulting in less energy during the day.

Ear fullness: Inflammation and drainage from sinusitis may block the eustachian tubes, passageways that connect your ears to the back of your nose. If these tubes become blocked, you can develop an uncomfortable feeling of fullness or pressure in the ears.

Fever: Occasionally, the body may mount a fever in response to the marked inflammation and the presence of a large quantity of bacteria during a sinus infection. Fever is more common in acute, rather than chronic sinusitis. Acute sinusitis refers to a sinus infection which lasts less than 4 weeks.

Causes of sinusitis

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The sinuses can become blocked by anything that leads to swelling inside the nose. A common cold is the most frequent cause, but environmental allergies, such as hay fever, which cause the membranes lining the nasal cavity to swell can also result in a sinus infection. Other causes include dry indoor heat during the winter months or a deviated nasal septum. (The septum is the partition that separates the right and left sides of the nasal cavity. If it is very crooked, it can obstruct the sinus outflow passages and lead to sinusitis.)

What is sinusitis?

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Sinusitis is an inflammation or infection of the sinuses. The sinuses are air-containing spaces within the bones of the skull and face. We have four pairs of sinuses – the frontal, maxillary, ethmoid, and sphenoid sinuses (see figures). These sinuses are lined with tiny glands that secrete a thin layer of mucus which sweeps bacteria and other foreign particles out of the sinuses and into the nose through pinpoint openings called ostia. If these ostia become blocked, the sinuses fill up with mucus. When bacteria overgrow in this mucus, the sinuses become infected and sinusitis occurs.

Sinus Infections (Sinusitis)

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Introduction
If you have sinusitis, you are not alone. Sinusitis is one of the most commonly diagnosed diseases in the United States, affecting more than 30 million adults. Americans make nearly 800,000 emergency department visits annually for sinusitis. Over $2 billion is spent each year in the U.S. for over the counter medications for nasal and sinus disorders, and about $200 million on prescription medications. Furthermore, people with sinus problems undergo more than 460,000 sinus surgeries each year in the U.S., making it one of the most commonly performed surgical procedures (1,2).

These numbers are up from a decade ago, and health experts expect further increases in the future. Possibly due to pollution and other factors, the prevalence of all breathing-related ailments – not just sinusitis, but also allergies and asthma – is rising and shows no signs of leveling off. And not only is sinusitis common, it strikes people during their most productive years. It’s far more likely to occur between the ages of 20 and 65 than during childhood or teen years, or late in life.

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