BACTERIA TULAREMIA ("rabbit fever"): Scientific name: Francisella tulerensis Transmission: -Through broken skin. -Undercooked infected meat.

-Inhalation. -Bite of mosquito, tick, and horsefly. -Eye conjunctiva touched by contaminated hands. Host animals: Predominately rabbits and to a lesser extent over 100 mammals and 25 avian species. Incubation period: One - 10 days Clinical symptoms: -Through broken skin: flu-like in nature with skin ulceration at point of organism entry. -Ingestion: diarrhea and vomiting. -Inhalation: pneumonia. Treatment: Tetracyclines or dihydrostreptomycin. Prognosis: Ranges from complete cure to rare but possible death. Prevention: -Exam gloves when exposed to animal blood, particularly that of rodents and lagamorphs. -Tick control. -Properly cooked contaminated meat. -Avoid urine contaminated water. -Good personal hygiene. LEPTOSPIROSIS: Scientific name: Leptospiras spp. Transmission: -Direct contact with infected animal. -Indirect via urine infected soil, water, or food. -Through intact skin, mouth, or nostrils. Host animals: Rodents, mustalids, and marine mammals. Incubation period: Two to 14 days. Clinical symptoms: -Icteric type (Well's disease): includes fever, nausea, headache, vomiting, diarrhea, constipation, skin hemorrhages, and jaundice. -Anicteric type: similar to icteric type but less severe symptoms. -Stiff neck. Treatment: Penicillin, tetracyclines, or dihydrostreptomycin. Recovery time: Icteric, one-two months; Anicteric, one month. Prognosis: Good. Prevention: -Good personal hygiene. -Proper waste disposal. -Rodent proofing food supplies and buildings. -Vaccine is available but seldom prescribed.

LYME DISEASE: Scientific name: Borrelia spp. Transmission: Bite of nymph-stage tick. Host animals: All, including domestics. Incubation period: One or more weeks. (Exception is a visual ring-shaped lesion or "bull's-eye" which appears at site of bite within 48 hours in approximately 30% of exposures. Clinical symptoms: -Fever with chills, sweating, headaches, vertigo, fatigue, and diminished concentration. -Chronic, reoccurring arthritis. -Neurologic or cardiac problems. Treatment: Megadoses of prescribed antibiotics, orally or intravenous. Prognosis: Good with early intervention; Chronic symptoms possible with delayed treatment. Prevention: -Lyme vaccine protection.

-Tick control in animals as well as in the environment. -Avoid bite wounds and saliva of tick infested animals. -Personal tick inspections. -Immediate medical consultation if exposed. CHLAMYDIOSIS (psittacosis or ornithosis): Scientific name: Chlamydia psittaci. Transmission: Inhalation of aerosolized feces. Host animals: Over 100 avian species including pigeons, raptors, and finches. Incubation period: Four to 15 days. Clinical symptoms: Flu-like symptoms which can develop into bronchopneumonia. May be severe in persons over 50. Treatment: Chlortetracycline. Prognosis: Good; very low mortality rate. Prevention: Control of avian fecal matter. SALMONELLOSIS (A common, worldwide zoonose): Scientific name: Salmonella spp. Transmission: -Fecal-oral. -Fecal contaminated food and water. Host animals: Common in opossums but can be found in all vertebrates. Incubation period: Six to 48 hours. Clinical symptoms: Diarrhea, vomiting, dehydration, and low-grade fever. Treatment: Supportive care, bed rest, and electrolytic fluids. Antibiotics are contraindicated unless salmonella group is identified. Prognosis: Recovery in two-four days. Prevention: Personal hygiene to prevent fecal-oral exposure. TETANUS (Lockjaw) (Not zoonotic but worthy of mention): Scientific name: Clostridium tetani Transmission: Puncture wound Host animal: -Skin punctures by claws or teeth -Skin punctures with rusty wire or nails. Incubation period: Up to one week. Clinical symptoms: -Stiffness of the jaw (lockjaw), the esophageal muscles, and muscles of the neck. Facial muscles contract, and hysteria is produced. -Descending trauma develops in the back and extremities. Treatment: -Intensive care hospitalization. -Wound debridement. -Tetanus immune globulin injection. -Intense medication regiment. Prognosis: Depends on severity but usually fatal. Prevention: Tetanus vaccine protection. A booster shot if inflicted with a bite or other puncture wound. MYCOSES (Fungi) ASPERGILLOSIS: Scientific name: Aspergillus fumigatus. Transmission: Inhalation of fungal spores. Host animals: Captive birds, mainly waterfowl and raptors. Incubation period: Undetermined. Clinical symptoms: Respiratory disorder. (Except for persons debilitated by disease, illness, or on long term medication, most persons are resistant to infection.) Treatment: Antifungal drugs. Prognosis: Good with proper treatment. Prevention: -Personal hygiene. -Do not house waterfowl on wood shavings. -Dispose of moldy waterfowl food or bedding. -Use of masks during necropsies of suspect animals. HISTOPLASMOSIS (Not zoonotic but worthy of mention): Scientific name: Histoplasma capsulatum.

Transmission: Inhalation of spores. Host animals: Indirectly through avian feces. Incubation period: Undetermined Clinical symptoms: Mild, self-limited respiratory infection. If severe: fever, anemia, enlargement of spleen and liver, leukopenia, pulmonary distress, adrenal necrosis, and ulcers of the gastrointestinal tract. Treatment: Intravenous medication. Prognosis: Good except occasionally in debilitated elderly or pulmonary patients. Prevention: Routine disposal of bird droppings in roost areas. (Histoplasmosis occurs naturally in the soil. Long term accumulation of avian feces can enrich the soil to favor development of the airborne spores.) VIRUSES RABIES: Scientific name: None. Also known as LYSSA or HYDROPHOBIA. Transmission: Injection of virus via bite wound. Also possible transmission through wounds which have bled within 24 hours, and mucous membrane invasion. Host animal: All mammals. Seldom diagnosed in small rodents and lagamorphs (rabbits). Viral serotypes are relatively species-specific and do not pass easily from animal to animal in "spill-over" species. Incubation period: Usually four-six weeks; seldom as short as one week or up to one year. Clinical symptoms: -Site of viral entry is painful, tingles, and sensitive to temperature changes. -Fear of water (hydrophobia, a human symptom only). -Restlessness. -Convulsions produced by sensory stimuli. Treatment: Critical intensive medical care. Prognosis: Death in almost all cases. Prevention: -Pre-exposure rabies vaccine and timely boosters. -Post-exposure vaccine regiment if you suspect direct exposure. -Glove use when working with wild mammal species or stray companion animals. -Use of appropriate disinfectants. -Sun/air drying of contaminated surfaces. PARASITES RACCOON ROUNDWORM: Scientific name: Baylisascaris procyonis. (Baylisascaris columnaris, the skunk roundworm, has the same life cycle and effect on intermediate hosts but is not as prevalent.) Transmission: Ingestion of egg (ova). Host animal: Raccoons (skunks for columnaris). Incubation period: Variable. Once ova is ingested it must mature to larval stage and enter intestinal wall to prevent elimination from the digestive system. Clinical symptoms: Varies with number of active larva and body tissue damaged (see Prognosis). Treatment: At onset of symptoms, use of prescribed anthel-mintics may destroy larval migrans but cannot repair previous damage. Prognosis: Varies with number of active larva and body tissue (mainly organs) damaged. Baylis larva are drawn toward brain tissue and sometimes, the retina of the eye. Prevention: -Personal hygiene (fecal-oral contamination). -Proper and timely fecal removal from cage. (Egg isn't infectious in the environment for approximately 30 days.) -Active worming program for incoming wildlife. (Parasite in neonatal intakes is same age of host. Shedding of eggs begin at 6 weeks, host orphan can be wormed at approximately 5 weeks.) IMPORTANT NOTE: Eggs may remain viable in the environment for a year or more. They have a high resistance to decontamination procedures due to dense cell walls and sticky surface. The only sure methods of elimination, once established, is by autoclave, torching with propane, gasoline, or fuel oil, or boiling in lye or LYSOL . Small children are most at risk and should be discourage from playing with firewood when brought indoors if fecal deposits have been found on woodpile. Handling firewood with latex gloves should be a strong consideration. CRYPTOSPORIDIOSIS (Protozoa): Scientific name: Cryptosporidia spp. Transmission: Fecal-oral route. Host animals: Most vertebrates. Incubation period: Five to 21 days

Clinical symptoms: Nausea, mild fever, abdominal pain, body aches, chills, sweating, watery diarrhea. Treatment: Supportive care including ample intake of hydration fluids. No microbial drugs against the parasite has been proven safe and effective. Prognosis: -If otherwise healthy: recovery by 9-14 days. -Reduce normal activity for an interval following clinical recovery. -Immunosuppressed: Diarrhea may be prolonged for up to two years withwasting as well as above symptoms. Prevention: -Personal hygiene (fecal-oral contamination). HIV/AIDS Alternative Name: Human immunodeficiency virus infection Transmission: The human immunodeficiency virus (HIV) can be spread by the following: y Contaminated blood transfusions and blood products y Intimate sexual contact y The use of contaminated needles and syringes The virus may also spread from a mother to her baby, either at birth or through breastfeeding. People who become infected with HIV may have no symptoms for up to 10 years, but they can still pass the infection to others. After being exposed to the virus, it usually takes about 3 months for the HIV ELISA blood test to change from HIV negative to HIV positive. HIV has spread throughout the US. The disease is more prevalent in urban areas, especially in inner cities. Symptoms: Diarrhea y Fatigue y Fever y Frequent vaginal yeast infections y Headache y Mouth sores, including fungal (candida) infection y Muscular stiffness or aching y Rash of various types, including seborrheic dermatitis y Sore throat y Swollen lymph glands Note: At the time of diagnosis with HIV infection, many people may not have experienced any symptoms Treatment: Doctors often recommend drug therapy for patients who are committed to taking all their medications and have a CD4 count below 500 cells/mL (indicating their immune system is suppressed). Some people, including pregnant women and people with kidney or neurological problems related to HIV, may need treatment regardless of their CD4 count. It is extremely important for people with HIV to take all doses of their medications, otherwise the virus will quickly become resistant to the drugs. Therapy always involves a combination of antiviral drugs. Pregnant women with HIV infection are treated to reduce the chance of transmitting HIV to their babies. People with HIV infection need to become educated about the disease and treatment so that they can be active participants in making decisions with their health care provider.

TUBERCULOSIS Tuberculosis, MTB or TB (short for tubercle bacillus) is a common and in many cases lethal infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis Signs and Symptoms: When the disease becomes active, 75% of the cases involve infection in the lungs (pulmonary TB). Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and fatigue.[6] In the other 25% of active cases, the infection moves from the lungs, causing other kinds of TB, collectively denoted extrapulmonary tuberculosis.[7] This occurs more commonly in immunosuppressed persons and young children. Extrapulmonary infection sites include the pleura in tuberculous pleurisy, the central nervous system in meningitis, the lymphatic system in scrofula of the neck, the genitourinary system in urogenital tuberculosis, and bones and joints in Pott's disease of the spine. An especially serious form is disseminated TB, more commonly known as miliary tuberculosis. Extrapulmonary TB may co-exist with pulmonary TB.[8] Treatment: Surgical treatment of TB may be used if medications are ineffective. There are three surgical treatments for pulmonary TB: pneumothorax, in which air is introduced into the chest to collapse the lung; thoracoplasty, in which one or more ribs are removed; and removal of a diseased lung, in whole or in part. It is possible for patients to survive with one healthy lung. Spinal TB may result in a severe deformity that can be corrected surgically. Medication: Most patients with TB can recover if given appropriate medication for a sufficient length of time. Three principles govern modern drug treatment of TB:

Lowering the number of bacilli as quickly as possible. This measure minimizes the risk of transmitting the disease. When sputum cultures become negative, this has been achieved. Conversely, if the sputum remains positive after five to six months, treatment has failed. y Preventing the development of drug resistance. For this reason, at least two different drugs and sometimes three are always given at first. If drug resistance is suspected, at least two different drugs should be tried. y Long-term treatment to prevent relapse. Five drugs are most commonly used today to treat tuberculosis: isoniazid (INH, Laniazid, Nydrazid); rifampin (Rifadin, Rimactane); pyrazinamide (Tebrazid); streptomycin; and ethambutol (Myambutol). The first three drugs may be given in the same capsule to minimize the number of pills in the dosage. As of 1998, many patients are given INH and rifampin together for six months, with pyrazinamide added for the first two months. Hospitalization is rarely necessary because many patients are no longer infectious after about two weeks of combination treatment. Follow-up involves monitoring of side effects and monthly sputum tests. Of the five medications, INH is the most frequently used drug for both treatment and prevention. y Bacterial Meningitis Haemophilus influenzae meningitis is a bacterial infection of the membranes covering the brain and spinal cord (meninges). See also: y Aseptic meningitis y Meningitis y Meningitis - cryptococcal y Meningitis - Gram-negative y Meningitis - meningococcal y Meningitis - pneumococcal y Meningitis - staphylococcal y Meningitis - tuberculous Causes H. influenzae meningitis is caused by Haemophilus influenzae bacteria. These bacteria should not be confused with the disease influenza, an upper respiratory infection caused by the influenza virus. Before the Hib vaccine became available, H. influenzae was the leading cause of bacterial meningitis in children under age 5. Since the introduction of the vaccine in the U.S., H. influenzae meningitis occurs in less than 2 in 100,000 children. It still causes 5% - 10% of bacterial meningitis cases in adults. H. influenzae meningitis may occur after an upper respiratory infection. The infection usually spreads from the respiratory tract to the bloodstream, and then to the meninges. At the meninges, the bacteria produce infection and inflammation, causing serious illness and sometimes death. Risk factors include: y Ear infection (otitis media) y Family member with an H. influenzae infection y Native American race y Placement in day care y Sinus infection (sinusitis) y Sore throat (pharyngitis) y Upper respiratory infection Symptoms Symptoms usually come on quickly, and may include: y Fever and chills y Mental status changes y Nausea and vomiting y Sensitivity to light (photophobia) y Severe headache y Stiff neck (meningismus) Other symptoms that can occur with this disease: y Agitation y Bulging fontanelles y Decreased consciousness y Poor feeding and irritability in children y Rapid breathing y Unusual posture, with the head and neck arched backwards (opisthotonos) Exams and Tests Physical examination will usually show:

y Fast heart rate y Fever y Mental status changes y Stiff neck For a patient who is suspected of having meningitis, it is important to perform a lumbar puncture ("spinal tap"), in which spinal fluid (known as cerebrospinal fluid, or CSF) is collected for testing. Tests that may be done include: y Blood culture y Chest x-ray y CSF examination for cell count, glucose, and protein y CT scan of the head y Gram stain, other special stains, and culture of CSF Treatment Treatment with antibiotics should be started as soon as possible. Ceftriaxone is one of the most commonly used antibiotics. If the antibiotic is not working and the health care provider suspects antibiotic resistance, chloramphenicol with ampicillin may be used. Sometimes corticosteroids may be used, especially in children. Unvaccinated people who are in close contact with someone who has H. influenzae meningitis should be given antibiotics to prevent infection. Such people include: y Household members y Rommates in dormitories y Those who come into close contact with an infected person Outlook (Prognosis) Early treatment improves the outcome. However, 3 - 5% of patients do not survive. Young children and adults over 50 have the highest risk of death. Possible Complications y Brain damage y Buildup of fluid between the skull and brain (subdural effusion) y Hearing loss y Hydrocephalus y Seizures When to Contact a Medical Professional Call the local emergency number (such as 911) or go to an emergency room if you suspect meningitis in a young child who has the following symptoms: y Feeding problems y High-pitched cry y Irritability y Persistent, unexplained fever Call the local emergency number if you develop any of the serious symptoms listed above. Meningitis can quickly become a lifethreatening illness. Prevention To protect infants and young children: y Hib immunizations for infants and children are recommended by the American Academy of Pediatrics and the Advisory Committee on Immunization Practices. y Several types of Hib vaccine are available for children ages 2 months and older. All unvaccinated family members and close contacts (especially in health care or school settings) of people with this type of meningitis should begin antibiotic treatment as soon as possible to prevent spread of the infection. Ask your health care provider about this during the first visit. Close contacts in the same household, school, or day care center should be watched for early signs of the disease as soon as the first case is diagnosed. If two cases occur in a day care center, preventive antibiotics should be considered. Always use good hygiene habits, such as washing hands before and after changing a diaper, and after using the bathroom. Alternative Names H. influenzae meningitis; H. flu meningitis Meningococcal Infection - Definition, Causes, Symptoms and Treatment Meningococcal Definition Meningococcal meningitis is an infection. It may be caused by the bacterium Neisseria meningitidis (also known as meningococcus) that causes inflammation of the membranes covering the brain and spinal cord. Meningococcal disease manifests most commonly as meningitis and meningococcemia that may progress rapidly to purpura fulminans, shock, and death. However, other manifestations might be observed.

Meningococcal infections may occur sporadically or in epidemics; virulent infections may be fatal within a matter of hours.Meningococcal is also called as Meningococcal Bacteremia, Bacterial in the Blood, Meningococcal Blood Poisoning, and Meningococcal Septicemia. Meningococcal Causes Most cases of meningococcal meningitis occur in children, from infancy to adolescence. Meningococcus is the most common cause of bacterial meningitis in children and the second most common cause of bacterial meningitis in adults. Neisseria meningitidis has at least seven serogroups (A, B, C, D, X, Y, Z); group A causes most epidemics. Neisseria meningitidis frequently lives in the upper respiratory tract with no evidence of illness. The leading cause of bacterial meningitis is the ill-named bacterium Haemophilus influenzae b, originally thought to be an influenza virus. Meningococcal can be caused by bacteria, viruses, fungi, or other organisms, usually introduced via the bloodstream from infections elsewhere in the body. Family members and those closely exposed to an infected individual are at increased risk. The infection occurs more frequently in winter and early spring. It is transmitted from person-to-person by respiratory droplets. Meningococcal Symptorms Clinical features of meningococcal infection vary. The symptoms of meningococcal bacteremia include a sudden, spiking fever. In 10% to 20% of patients, this progresses to fulminant meningococcemia, with extreme prostration, enlargement of skin lesions, disseminated intravascular coagulation (DIC), and shock. The other symptoms of the meningococcal may be included: y Rash y Nausea y Vomiting y Irritability y Stiff neck y Anxious appearing y Pinpoint red spots y Severe headache y Severe malaise y Sensitivity to light y Mental status changes Meningococcal Treatments Patients are often admitted to the intensive care unit of the hospital. Intensive monitoring and treatment are needed. Respiratory isolation for first 24 hours, to avoid spread to other patients High doses of corticosteroids may be given for shock (must be given early). Antibiotics such as ceftriaxone are prescribed and given intravenously for this disease. Other medicines may be used to treat the complications arising from the increased spinal fluid pressure. Sometimes steroid medication is used, more often in children than adults.

Tetanus Tetanus is infection of the nervous system with the potentially deadly bacteria Clostridium tetani (C. tetani). Symptoms Tetanus often begins with mild spasms in the jaw muscles (lockjaw). The spasms can also affect the chest, neck, back, and abdominal muscles. Back muscle spasms often cause arching, called opisthotonos. Sometimes the spasms affect muscles that help with breathing, which can lead to breathing problems. Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups. This is called tetany. These episodes can cause fractures and muscle tears. Other symptoms include: y Drooling y Excessive sweating y Fever y Hand or foot spasms y Irritability y Swallowing difficulty y Uncontrolled urination or defecation Treatments Treatment may include: y Antibiotics, including penicillin, clindamycin, erythromycin, or metronidazole (metronidazole has been most successful) y Bedrest with a nonstimulating environment (dim light, reduced noise, and stable temperature) y Medicine to reverse the poison (tetanus immune globulin) y Muscle relaxers such as diazepam

y Sedatives y Surgery to clean the wound and remove the source of the poison (debridement) Breathing support with oxygen, a breathing tube, and a breathing machine may be necessary. Tests & Diagnostics Your doctor will perform a physical exam and ask questions about your medical history. No specific lab test is available to determine the diagnosis of tetanus. Other tests may be used to rule out meningitis, rabies, strychnine poisoning, and other diseases with similar symptoms. Botulism is a rare but serious illness caused by Clostridium botulinum bacteria. The bacteria may enter the body through wounds, or they may live in improperly canned or preserved food. Symptoms Symptoms usually appear 8 - 36 hours after consuming contaminated food. There is NO fever with this infection. In adults, symptoms may include: y Abdominal cramps y Breathing difficulty that may lead to respiratory failure y Difficulty swallowing and speaking y Double vision y Dry mouth y Nausea y Temporary lack of breathing y Vomiting y Weakness with paralysis (equal on both sides of the body) Symptoms in infants may include: y Constipation y Weakness, loss of muscle tone y Weak cry y Poor feeding and weak sucking y Respiratory distress y Alertness, despite weakness Causes & Risk Factors Clostridium botulinum is found in soil and untreated water throughout the world. It produces spores that survive in improperly preserved or canned food, where they produce toxin. When eaten, even tiny amounts of this toxin can lead to severe poisoning. The foods most commonly contaminated are home-canned vegetables, cured pork and ham, smoked or raw fish, and honey or corn syrup. Botulism may also occur if the organism enters open wounds and produces toxin there. Infant botulism occurs when living bacteria or its spores are eaten and grow within the baby's gastrointestinal tract. The most common cause of infant botulism is eating honey or corn syrup. Clostridium botulinum also occurs normally in the stool of some infants. Approximately 110 cases of botulism occur in the U.S. per year. The majority are in infants. Tests & Diagnostics The doctor will perform a physical exam. There may be signs of: y Absent or decreased deep tendon reflexes y Absent or decreased gag reflex y Eyelid drooping y Muscle function/feeling loss y Paralyzed bowel y Speech impairment y Urine retention with inability to urinate Blood tests can be done to identify the toxin. A stool culture may also be ordered. Lab tests can be done on the suspected food to confirm botulism. Treatments Botulinus antitoxin is given. Breathing trouble requires hospitalization. The health care team will establish a clear airway and provide supportive therapy. A tube may be inserted through the nose or mouth into the windpipe to provide an airway for oxygen. A breathing machine may be needed. Intravenous fluids can be given when the patient has swallowing difficulties. A feeding tube may be inserted in the nose. Cases of botulism are reported to state health authorities or the U.S. Centers for Disease Control and Prevention by health care providers so that the contaminated food can be removed from stores. Antibiotics are often given, but have not been shown to always be beneficial. Drugs Older children and adults with botulism are sometimes treated with an antitoxin derived from horse serum that is distributed by the Centers for Disease Control and Prevention. The antitoxin (effective against toxin types A, B, and E) inactivates only the botulinum toxin that is

unattached to nerve endings. Early injection of the antitoxin, ideally within 24 hours of onset of symptoms, can preserve nerve endings, prevent progression of the disease, and reduce mortality. Unfortunately, infants cannot receive the antitoxin used for adults. For them, human botulism immune globulin (BIG) is the preferred treatment. It is available in the United States through the Infant Botulism Treatment and Prevention Program in Berkeley, California. BIG neutralizes toxin types A, B, C, D, and E before they can bind to nerves. This antitoxin can provide protection against A and B toxins for approximately four months. Though many infants recover with supportive care, BIG cuts hospital stay in half and, therefore, reduces hospital costs by 50 percent as well. Aside from the specific antitoxin, no therapeutic drugs are used to treat botulism. Antibiotics are not effective for preventing or treating botulism because the Clostridium group of toxins are not sensitive to them. In fact, antibiotic use is discouraged for infants because bacteria could potentially release more toxin into a baby's system as they are killed. Antibiotics can be used, however, to treat secondary respiratory tract and other infections. Complications y Aspiration pneumonia and infection y Long-lasting weakness y Nervous system problems for up to 1 year y Respiratory distress Prevention NEVER give honey or corn syrup to infants younger than 1 year old -- not even just a little taste on a pacifier. Prevent infant botulism by exclusively breastfeeding, if possible. Always throw away bulging cans or foul-smelling preserved foods. Sterilizing home-canned foods by pressure cooking at 250 degrees Fahrenheit for 30 minutes may prevent botulism. Keep foil-wrapped baked potatoes hot or in the refrigerator, not out in room temperature. Leprosy Definition Leprosy is a slowly progressing bacterial infection that affects the skin, peripheral nerves in the hands and feet, and mucous membranes of the nose, throat, and eyes. Destruction of the nerve endings causes the the affected areas to lose sensation. Occasionally, because of the loss of feeling, the fingers and toes become mutilated and fall off, causing the deformities that are typically associated with the disease. Description Leprosy is also known as Hansen's disease after G. A. Hansen, who in 1878 identified the bacillus Mycobacterium leprae that causes the disease. The infection is characterized by abnormal changes of the skin. These changes, called lesions, are at first flat and red. Upon enlarging, they have irregular shapes and a characteristic appearance. The lesions are typically darker in color around the edges with discolored pale centers. Because the organism grows best at lower temperatures the leprosy bacillus has a preference for the skin, the mucous membranes and the nerves. Infection in and destruction of the nerves leads to sensory loss. The loss of sensation in the fingers and toes increases the risk of injury. Inadequate care causes infection of open wounds. Gangrene may also follow, causing body tissue to die and become deformed. Because of the disabling deformities associated with it, leprosy has been considered one of the most dreaded diseases since biblical times, though much of what was called leprosy in the Old Testament most likely was not the same disease. Its victims were often shunned by the community, kept at arm's length, or sent to a leper colony. Many people still have misconceptions about the disease. Contrary to popular belief, it is not highly communicable and is extremely slow to develop. Household contacts of most cases and the medical personnel caring for Hansen's disease patients are not at particular risk. It is very curable, although the treatment is long-term, requiring multiple medications. The World Health Organization (WHO) puts the number of identified leprosy cases in the world at about 600,000 as of the early 2000s. Seventy percent of all cases are found in just three countries: India, Indonesia, and Myanamar (Burma). The infection can be acquired, however, in the Western Hemisphere as well. There are about 5000 reported cases in the United States as of 2004, almost all of which involve immigrants from developing countries. Cases also occur in some areas of the Caribbean. Although it was thought for many years that only humans are affected by the disease, 15% of wild armadillos in southern Texas and Louisiana have been found to be infected with M. leprae. Causes and symptoms The organism that causes leprosy is a rod-shaped bacterium called Mycobacterium leprae. This bacterium is related to Mycobacterium tuberculosis, the causative agent of tuberculosis. Because special staining techniques involving acids are required to view these bacteria under the microscope, they are referred to as acid-fast bacilli (AFB). When Mycobacterium leprae invades the body, one of two reactions can take place. In tuberculoid leprosy (TT), the milder form of the disease, the body's immune cells attempt to seal off the infection from the rest of the body by surrounding the offending pathogen. Because this response by the immune system occurs in the deeper layers of the skin, the hair follicles, sweat glands, and nerves can be destroyed. As a result, the skin becomes dry and discolored and loses its sensitivity. Involvement of nerves on the face, arms, or legs can cause them to enlarge and become easily felt by the doctor. This finding is highly suggestive of TT. The scarcity of bacteria in this type of leprosy leads to it being referred to as paucibacillary (PB) leprosy. Seventy to eighty percent of all leprosy cases are of the tuberculoid type.

In lepromatous (LL) leprosy, which is the second and more contagious form of the disease, the body's immune system is unable to mount a strong response to the invading organism. Hence, the organism multiplies freely in the skin. This type of leprosy is also called the multibacillary (MB) leprosy, because of the presence of large numbers of bacteria. The characteristic feature of this disease is the appearance of large nodules or lesions all over the body and face. Occasionally, the mucous membranes of the eyes, nose, and throat may be involved. Facial involvement can produce a lion-like appearance (leonine facies). This type of leprosy can lead to blindness, drastic change in voice, or mutilation of the nose. Leprosy can strike anyone; however, children seem to be more susceptible than adults. Well-defined skin lesions that are numb are the first symptoms of tuberculoid leprosy. Lepromatous leprosy is characterized by a chronic stuffy nose due to invasion of the mucous membranes, and the presence of nodules and lesions all over the body and face. Although patients with leprosy are commonly thought not to suffer pain, neuroapthic pain caused by inflammation of peripheral nerve endings is increasingly recognized as a major complication of the disease in many patients. Corticosteroids may be given to reduce the inflammation. The incubation period of the leprosy bacillus varies anywhere from six months to ten years. On an average, it takes four years for the symptoms of tuberculoid leprosy to develop. Probably because of the slow growth of the bacillus, lepromatous leprosy develops even more slowly, taking an average of eight years for the initial lesions to appear. It is still not very clear how the leprosy bacillus is transmitted from person to person; about 50% of patients diagnosed with the disease have a history of close contact with an infected family member. Since untreated patients have a large number of M. leprae bacilli in their nasal secretions, it is thought that transmission may take place via nasal droplets. The milder tubercular form of leprosy may be transmitted by insect carriers or by contact with infected soil. The incidence of leprosy is highest in the poverty belt of the globe. Therefore, environmental factors such as unhygienic living conditions, overpopulation, and malnutrition may also be contributing factors favoring the infection. It is also possible that genetic factors are involved in susceptibility to leprosy. In 2003, scientists conducting a genome scan of a large Vietnamese family with many cases of leprosy found that susceptibility to the disease was linked to region q25 on the long arm of chromosome 6. Further study indicated that the leprosy susceptibility gene lies within a region shared by two genes for Parkinson's disease. Further research may confirm that the emergence of leprosy in certain individuals is related to inheritance of genes for Parkinson's disease. Diagnosis One of the hallmarks of leprosy is the presence of AFB in smears taken from the skin lesions, nasal scrapings, or tissue secretions. In patients with LL leprosy, the bacilli are easily detected; however, in TT leprosy the bacteria are very few and almost impossible to find. In such cases, a diagnosis is made based on the clinical signs and symptoms, the type and distribution of skin lesions, and history of having lived in an endemic area. The signs and symptoms characteristic of leprosy can be easily identified by a health worker after a short training period. There is no need for a laboratory investigation to confirm a leprosy diagnosis, except in very rare circumstances. In an endemic area, if smears from an individual show the presence of AFB, or if he has typical skin lesions, he should definitely be regarded as having leprosy. Usually, there is slight discoloration of the skin and loss of skin sensitivity. Thickened nerves accompanied by weakness of muscles supplied by the affected nerve are very typical of the disease. One characteristic occurrence is a foot drop where the foot cannot be flexed upwards, affecting the ability to walk. Treatment The most widely used drug for leprosy is dapsone (DDS). However, the emergence of dapsone-resistant strains prompted the introduction of multidrug therapy, or MDT. MDT combines dapsone, rifampin (Rifadin; also known as rifampicin), and clofazimine (Lamprene), all of which are powerful antibacterial drugs. Patients with MB leprosy are usually treated with all three drugs, while patients with PB leprosy are only given rifampin and dapsone. Usually three months after starting treatment, a patient ceases being infectious, though not everyone with this disease is necessarily infectious before treatment. Depending on the type of leprosy, the time required for treatment may vary from six months to two years or more. Each of the drugs has minor side effects. Dapsone can cause nausea, dizziness, palpitations, jaundice and rash. A doctor should be contacted immediately if a rash develops. Dapsone also interacts with the second drug, rifampin. Rifampin increases the metabolizing of dapsone in the body, requiring an adjustment of the dapsone dosage. rifampin may also cause muscle cramps, or nausea. If jaundice, flulike symptoms or a rash appear, a doctor should be contacted immediately. The third drug, clofazimine may cause severe abdominal pain and diarrhea, as well as discoloration of the skin. Red to brownish black discoloration of the skin and bodily fluids, including sweat, may persist for months to years after use. Thalidomide, the most famous agent of birth defects in the twentieth century, is now being used to treat complications of leprosy and similar diseases. Thalidomide regulates the immune response by suppressing a protein, tumor necrosis factor alpha. Leprosy patients should be aware that treatment itself can cause a potentially serious immune system response called a lepra reaction. When antibiotics kill M. leprae, antigens (the proteins on the surface of the organism that initiate the body's immune system response) are released from the dying bacteria. In some people, when the antigens combine with the antibodies to M. Leprae in the bloodstream, a reaction called erythema nodosum leprosum may occur, resulting in new lesions and peripheral nerve damage. Cortisonetype medications and, increasingly, thalidomide are used to minimize the effects of lepra reactions. In some cases, severe ulcers caused by leprosy may be treated surgically with small skin grafts. Prognosis Leprosy is curable; however, the deformities and nerve damage associated with leprosy are often irreversible. Preventions or rehabilition of these defects is an integral part of management of the disease. Reconstructive surgery, aimed at preventing and correcting deformities,

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offers the greatest hope for disabled patients. Sometimes, the deformities are such that the patients will not benefit from this type of surgery. Comprehensive care involves teaching patients to care for themselves. If the patients have significant nerve damage or are at high risk of developing deformities, they must be taught to take care of their insensitive limbs, similar to diabetics with lower leg nerve damage. Lacking the sensation of pain in many cases, the patients should constantly check themselves to identify cuts and bruises. If adequate care is not taken, these wounds become festering sores and a source of dangerous infection. Physiotherapy exercises are taught to the patients to maintain a range of movement in finger joints and prevent the deformities from worsening. Prefabricated standardized splints are available and are extremely effective in correcting and preventing certain common deformities in leprosy. Special kinds of footwear have been designed for patients with insensitive feet in order to prevent or minimize the progression of foot ulcers. Prevention By early diagnosis and appropriate treatment of infected individuals, even a disease as ancient as leprosy can be controlled. People who are in immediate contact with the leprosy patient should be tested for leprosy. Annual examinations should also be conducted on these people for a period of five years following their last contact with an infectious patient. Some physicians have advocated dapsone treatment for people in close household contact with leprosy patients. The WHO Action Program for the Elimination of Leprosy adopted a resolution calling for the elimination of leprosy around the world by the year 2005. This goal is not likely to be reached, however; a computer simulation performed for WHO by a team of Dutch researchers in 2004 indicates that leprosy is likely to persist in some parts of the world until 2020, although its incidence will continue to decline. Alternative Names Polio; Infantile paralysis; Post-polio syndrome Back to TopCauses Poliomyelitis is a disease caused by infection with the poliovirus. The virus spreads by direct person-to-person contact, by contact with infected mucus or phlegm from the nose or mouth, or by contact with infected feces. The virus enters through the mouth and nose, multiplies in the throat and intestinal tract, and then is absorbed and spread through the blood and lymph system. The time from being infected with the virus to developing symptoms of disease (incubation) ranges from 5 - 35 days (average 7 - 14 days). Risks include: y Lack of immunization against polio and then exposure to polio y Travel to an area that has experienced a polio outbreak In areas where there is an outbreak, those most likely to get the disease include children, pregnant women, and the elderly. The disease is more common in the summer and fall. Between 1840 and the 1950s, polio was a worldwide epidemic. Since the development of polio vaccines, the incidence of the disease has been greatly reduced. Polio has been wiped out in a number of countries. There have been very few cases of polio in the Western hemisphere since the late 1970s. Children in the United States are now routinely vaccinated against the disease. Outbreaks still occur in the developed world, usually in groups of people who have not been vaccinated. Polio often occurs after someone travels to a region where the disease is common. Thanks to a massive, global, vaccination campaign over the past 20 years, polio exists only in a few countries in Africa and Asia. Back to TopSymptoms There are three basic patterns of polio infection: subclinical infections, nonparalytic, and paralytic. Approximately 95% of infections are subclinical infections, which may not have symptoms. SUBCLINICAL INFECTION y General discomfort or uneasiness (malaise) y Headache y Red throat y Slight fever y Sore throat y Vomiting People with subclinical polio infection might not have symptoms, or their symptoms may last 72 hours or less. Clinical poliomyelitis affects the central nervous system (brain and spinal cord), and is divided into nonparalytic and paralytic forms. It may occur after recovery from a subclinical infection. NONPARALYTIC POLIOMYELITIS y Back pain or backache y Diarrhea y Excessive tiredness, fatigue y Headache y Irritability y Leg pain (calf muscles) y Moderate fever y Muscle stiffness

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y Muscle tenderness and spasm in any area of the body y Neck pain and stiffness y Pain in front part of neck y Pain or stiffness of the back, arms, legs, abdomen y Skin rash or lesion with pain y Vomiting Symptoms usually last 1 - 2 weeks. PARALYTIC POLIOMYELITIS y Fever 5 - 7 days before other symptoms y Abnormal sensations (but not loss of sensation) in an area y Bloated feeling in abdomen y Breathing difficulty y Constipation y Difficulty beginning to urinate y Drooling y Headache y Irritability or poor temper control y Muscle contractions or muscle spasms in the calf, neck, or back y Muscle pain y Muscle weakness, asymmetrical (only on one side or worse on one side) o Comes on quickly o Location depends on where the spinal cord is affected o Worsens into paralysis y Sensitivity to touch; mild touch may be painful y Stiff neck and back y Swallowing difficulty Back to TopExams and Tests The health care provider may find signs of meningeal irritation (similar to meningitis), such as stiff neck or back stiffness with difficulty bending the neck. The person also might have difficulty lifting the head or lifting the legs when lying flat on the back, and their reflexes might be abnormal. Tests include: y Routine CSF examination y Test for levels of antibodies to the polio virus y Viral cultures of throat washings, stools, or cerebrospinal fluid (CSF) Back to TopTreatment The goal of treatment is to control symptoms while the infection runs its course. People with severe cases may need lifesaving measures, especially breathing help. Symptoms are treated based on how severe they are. Treatments include: y Antibiotics for urinary tract infections y Medications (such as bethanechol) for urinary retention y Moist heat (heating pads, warm towels) to reduce muscle pain and spasms y Pain killers to reduce headache, muscle pain, and spasms (narcotics are not usually given because they increase the risk of breathing difficulty) y Physical therapy, braces or corrective shoes, or orthopedic surgery to help recover muscle strength and function Back to TopOutlook (Prognosis) What to expect depends on the form of the disease (subclinical, nonparalytic, or paralytic) and the site affected. If the spinal cord and brain are not involved, which is the case more than 90% of the time, complete recovery is likely. Brain or spinal cord involvement is a medical emergency that may result in paralysis or death (usually from respiratory difficulties). Disability is more common than death. Infection high in the spinal cord or in the brain increases the risk of breathing problems. Back to TopPossible Complications y Aspiration pneumonia y Cor pulmonale y High blood pressure y Kidney stones y Lack of movement y Lung problems y Myocarditis

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y Paralytic ileus (loss of intestinal function) y Permanent muscle paralysis, disability, deformity y Pulmonary edema y Shock y Urinary tract infections Post-polio syndrome is a complication that develops in some patients, usually 30 or more years after their initial infection. Weakness may get worse in muscles that were previously weakened. Weakness may also develop in muscles that previously were thought not to be affected. Rabies is an often deadly viral infection that is mainly spread by infected animals. Symptoms The actual time between infection and when you get sick (called the "incubation period") ranges from 10 days - 7 years. The average incubation period is 3 - 7 weeks. Symptoms may include: y Anxiety, stress, and tension y Drooling y Convulsions y Exaggerated sensation at the bite site y Excitability y Loss of feeling in an area of the body y Loss of muscle function y Low-grade fever (102 degrees F or lower) y Muscle spasms y Numbness and tingling y Pain at the site of the bite y Restlessness y Swallowing difficulty (drinking causes spasms of the voicebox) Causes & Risk Factors Rabies is spread by infected saliva that enters the body through a bite or broken skin. The virus travels from the wound to the brain, where it causes swelling, or inflammation. This inflammation leads to symptoms of the disease. Most rabies deaths occur in children. In the past, human cases in the United States usually resulted from a dog bite, but recently, more cases of human rabies have been linked to bats and raccoons. Although dog bites are a common cause of rabies in developing countries, there have been no reports of rabies caused by dog bites in the United States for a number of years due to widespread animal vaccination. Other wild animals that can spread the rabies virus include: y Foxes y Skunks Very rarely, rabies has been transmitted without an actual bite. This is believed to have been caused by infected saliva that has gotten into the air. The United Kingdom had once completely eradicated rabies, but recently, rabies-infected bats have been found in Scotland. Tests & Diagnostics If an animal bites you, try to gather as much information about the animal as possible. Call your local animal control authorities to safely capture the animal. If rabies is suspected, the animal will be watched for signs of rabies. A special test called immunofluorescence is used to look at the brain tissue after an animal is dead. This test can reveal whether or not the animal had rabies. The same test can be used to check for rabies in humans, using a piece of skin from the neck. Doctors may also look for the rabies virus in your saliva or spinal fluid. Treatments Clean the wound well with soap and water, and seek professional medical help. You'll need a doctor to thoroughly clean the wound and remove any foreign objects. Most of the time, stitches should not be used for animal bite wounds. If there is any risk of rabies, you will be given a series of a preventive vaccine. This is generally given in five doses over 28 days. Most patients also receive a treatment called human rabies immunoglobulin (HRIG). This is given the day the bite occured. There is no known effective treatment for people with symptoms of a rabies infection. Complications Untreated, rabies can lead to coma and death. In rare cases, some people may have an allergic reaction to the rabies vaccine. Prevention To help prevent rabies: y Avoid contact with animals you don't know. y Get vaccinated if you work in a high-risk occupation or travel to countries with a high rate of rabies.

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Make sure your pets receive the proper immunizations. Dogs and cats should get rabies vaccines by 4 months of age, followed by a booster shot 1 year later, and another one every 1 or 3 years, depending on the type of vaccine used. y Follow quarantine regulations on importing dogs and other mammals in disease-free countries. Trypanosomiasis or trypanosomosis is the name of several diseases in vertebrates caused by parasitic protozoan trypanosomes of the genus Trypanosoma. Approximately 500,000 men, women and children in 36 countries of sub-Saharan Africa suffer from human African trypanosomiasis which is caused by either Trypanosoma brucei gambiense or Trypanosoma brucei rhodesiense. The other human form of trypanosomiasis, called Chagas disease, causes 21,000 deaths per year [1] mainly in Latin America. Human trypanosomiases See main article: Human trypanosomiasis y Human African trypanosomiasis, transmitted by the tsetse fly infected with Trypanosoma brucei, see African trypanosomiasis (sleeping sickness) y Human American trypanosomiasis, transmitted by the assassin bug infected with Trypanosoma cruzi, see Chagas disease Chagas endemic zones (in red) y Nagana, or Animal African trypanosomiasis, also called 'Souma' or 'Soumaya' in Sudan. y Surra y Mal de caderas (of central South America) y Murrina de caderas (of Panama; Derrengadera de caderas) y Dourine y Cachexial fevers (various) y Gambian horse sickness (of central Africa) y Baleri (of Sudan) y Kaodzera (Rhodesian trypanosomiasis) y Tahaga (a disease of camels in Algeria) y Galziekte, galzietzke (bilious fever of cattle; gall sickness of South Africa) y Peste-boba (of Venezuela; Derrengadera) Diagnosis Diagnosing African trypanosomiasis requires the documentation of T.brucei in blood smears, lymph node aspirates, or CSF.[2] Presentation of the disease outside the endemic areas, especially in Western Europe, may present a diagnostic problem to the treating physician[3] treatment American trypanosomiasis is currently treated with a variety of antifungal agents, including benznidazole and nifurtimox. Melarsoprol is another drug which is used for the treatment of T. b. gambiensie. y

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