Mydriasis

Mydriasis is a disorder of the eye in which the pupil of the eye dilates abnormally, and stays in dilated form regardless of the change in the light stimulus. It is a commonly observed fact that the pupil changes size, like the shutter of the lens, in order to adjust for changing lighting conditions and to protect the sensitive retina of the eye, but in the case of the person suffering from Mydriasis, the pupil remains dilated even in the broad daylight Causes This condition could even be caused by the use of drugs. Sometimes, the condition of mydriasis even occurs during intense sexual arousal. Drugs are among one of the major causes of the disease. A number of groups of drugs such as the anticholinergics like atropine, hallucinogens such as LSD and mescaline, dissociatives like ketamine could cause Mydriasis. Some antidepressants or other drugs increasing serotonin levels could also cause Mydriasis. Mydriasis could even result as one of the withdrawal symptoms of opioids like heroin and morphine. Sometimes, drugs called Mydriatics like tropicamide are administered for certain medical requirements or treatment of certain conditions such as photophobia, or intolerance to bright light, which can make the pupil dilate. Treatment The most common drugs that are used to treat Mydriasis are Phenylephrine, Scopolamine and Murocol2. They also suggest using eye protection until the condition is treated. However, seeking medical attention immediately is very important. Timely treatment goes a long way in curing or managing Mydriasis. The condition is often temporary, though becomes permanent due to improper treatment or ignorance often. Mydriasis that are due to health conditions and the outcome of treatment largely depend on the health condition itself. Generally the affected individual, does not experience pain, though discomfort persists until the condition is cured. There are few drugs that result in temporary Mydriasis, like for eg: eye drops used during a routine eye check-up. However, for all other related causes, a health specialist should be consulted. They suggest few tests and also analyze other symptoms, to determine the cause of the problem, to treat and eradicate it completely

Anthrax
Anthrax is an infectious disease due to a type of bacteria called Bacillus anthracis. Infection in humans most often involves the skin, gastrointestinal tract, or lungs. Causes, incidence, and risk factors

Anthrax commonly affects hoofed animals such as sheep, cattle, and goats, but humans who come into contact with infected animals can get sick from anthrax, too. In the past, the people who were most at risk for anthrax included farm workers, veterinarians, and tannery and wool workers. There are three main routes of anthrax infection: Cutaneous anthrax occurs when anthrax spores touch a cut or scrape on the skin.

It is the most common type of anthrax infection. The main risk is contact with animal hides or hair, bone products, and wool, or with infected animals. People most at risk for cutaneous anthrax include farm workers, veterinarians, and tannery and wool workers.

Inhalation anthrax develops when anthrax spores enter the lungs through the respiratory tract. It is most commonly contracted when workers breathe in airborne anthrax spores during processes such as tanning hides and processing wool. Breathing in spores means a person has been exposed to anthrax, but it does not mean the person will have symptoms.

The bacteria spores must "germinate" or sprout (the same way a seed might sprout before a plant grows) before the actual disease occurs. The process usually takes 1 to 6 days. Forty-three days is the longest known incubation period. Once the spores germinate, they release several toxic substances. These substances cause internal bleeding, swelling, and tissue death.

Gastrointestinal anthrax occurs when someone eats anthrax-tainted meat. Anthrax may be used as a biological weapon or for bioterrorism. In 2001, anthrax sent through the U.S. Postal Service infected 22 people; 7 survivors had confirmed cutaneous anthrax disease. Symptoms Symptoms of anthrax differ depending on the type of anthrax. Symptoms of cutaneous anthrax start 1 to 7 days after exposure:

An itchy sore develops that is similar to an insect bite. This sore may blister and form a black ulcer (sore). The sore is usually painless, but it is often surrounded by swelling. A scab often forms, and then dries and falls off within 2 weeks. Complete healing can take longer.

Symptoms of inhalation anthrax:

Begins with fever, malaise, headache, cough, shortness of breath, and chest pain Fever and shock may occur later

Symptoms of gastrointestinal anthrax usually occur within 1 week and may include:

Abdominal pain Bloody diarrhea Diarrhea Fever Mouth sores Nausea and vomiting (the vomit may contain blood)

Treatment Most people with anthrax are treated with antibiotics. Several antibiotics are effective, including penicillin, doxycycline, and ciprofloxacin. When treating inhalational anthrax, a combination of antibiotics should be used. Doctors often start treatment with ciprofloxacin plus another drug, given through a vein (intravenously). The length of treatment is about 60 days for people who have been exposed to anthrax, because it may take spores that long to germinate. Cutaneous (skin) anthrax is treated with antibiotics taken by mouth, usually for 7 to 10 days. Doxycycline and ciproflaxin are most often used.

Poliomyelitis
Poliomyelitis is a viral disease that can affect nerves and can lead to partial or full paralysis. Causes, incidence, and risk factors Poliomyelitis is a disease caused by infection with the poliovirus. The virus spreads by:

Direct person-to-person contact Contact with infected mucus or phlegm from the nose or mouth 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:

Lack of immunization against polio 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. As a result of a massive, global vaccination campaign over the past 20 years, polio exists only in a few countries in Africa and Asia.

Symptoms There are three basic patterns of polio infection: subclinical infections, nonparalytic, and paralytic. About 95% of infections are subclinical infections, which may not have symptoms. SUBCLINICAL INFECTION SYMPTOMS

General discomfort or uneasiness (malaise) Headache Red throat Slight fever Sore throat 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

Back pain or backache Diarrhea Excessive tiredness, fatigue Headache Irritability Leg pain (calf muscles) Moderate fever Muscle stiffness Muscle tenderness and spasm in any area of the body Neck pain and stiffness Pain in front part of neck Pain or stiffness of the back, arms, legs, abdomen Skin rash or lesion with pain Vomiting

Symptoms usually last 1 - 2 weeks. PARALYTIC POLIOMYELITIS

Fever 5 - 7 days before other symptoms Abnormal sensations (but not loss of sensation) in an area Bloated feeling in abdomen Breathing difficulty Constipation Difficulty beginning to urinate Drooling

Headache Irritability or poor temper control Muscle contractions or muscle spasms in the calf, neck, or back Muscle pain Muscle weakness that is only on one side or worse on one side

Comes on quickly Location depends on where the spinal cord is affected Worsens into paralysis

Sensitivity to touch; mild touch may be painful Stiff neck and back Swallowing difficulty

Treatment 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 their severity. Treatment may include:

Antibiotics for urinary tract infections Medications (such as bethanechol) for urinary retention Moist heat (heating pads, warm towels) to reduce muscle pain and spasms Painkillers to reduce headache, muscle pain, and spasms (narcotics are not usually given because they increase the risk of breathing trouble) Physical therapy, braces or corrective shoes, or orthopedic surgery to help recover muscle strength and function

Arthropod-borne hemorrhagic fever

The 12 distinct enveloped RNA viruses that cause most viral hemorrhagic fever (VHF) cases are members of 4 families: Arenaviridae, Bunyaviridae, Filoviridae, and Flaviviridae. Disease severity resulting from infection by these agents varies widely, but the most extreme manifestations include circulatory

instability, increased vascular permeability, and diffuse hemorrhage. In May 1995, these diseases came to worldwide attention with an outbreak of Ebola virus near the city of Kikwik, Zaire.[1] With increased international travel, these primarily tropical viruses may now be imported into nonendemic countries. Furthermore, several of these agents have been associated with nosocomial outbreaks involving health care workers and laboratory personnel. Viral hemorrhagic fevers share many common features. Infectious agents that are arthropod-borne (usually mosquitoes) cause many viral hemorrhagic fevers. For several viral hemorrhagic fevers, personto-person transmission may occur through direct contact with infected patients, their blood, or their secretions and excretions. Animal reservoirs are generally rats and mice, but domestic livestock, monkeys, and other primates may also serve as intermediate hosts. Yellow fever (the prototype virus of the Flaviviridae family), dengue, Hantavirus pulmonary syndrome (HPS), and hemorrhagic fever with renal failure syndrome (HFRS) are discussed in separate chapters (see Differentials). The other flaviviral hemorrhagic fevers (HFs), Alkhurma HF virus,[2, 3] Kyasanur Forest disease, and Omsk HF, are described only in cursory detail because they have very limited geographic distribution and/or have virtually disappeared from the endemic zones in which they were previously found. Pathophysiology Although common themes occur, the different viruses display variable pathophysiology. Hemorrhage is typically present in many organs, and effusions are common in serous cavities (although they may be minimal or absent in some patients). Widespread necrosis generally occurs, may be present in any organ system, and varies from modest and focal to massive in extent. Liver and lymphoid systems are usually extensively involved, and the lung regularly demonstrates varying degrees of interstitial pneumonitis, diffuse alveolar damage, and hemorrhage. Acute tubular necrosis and microvascular thrombosis may also be observed. The inflammatory response is usually minimal.

Physical Typical findings are not distinctive, including nonspecific conjunctival injection, facial and truncal flushing, petechiae, purpura, ecchymoses, icterus, epistaxis, gastrointestinal and genitourinary bleeding, and lymphadenopathy. Severe illness is associated with hypotension and shock, relative bradycardia, pneumonitis, pleural and pericardial effusions, hemorrhage, encephalopathy, seizures, coma, and death. Arenaviridae Patients with one of the South American HFs may present with conjunctivitis, pharyngeal enanthema with petechiae but without exudate, sore throat, or cough. Retrosternal pain is also a major symptom. The South American HFs may be marked by encephalopathic changes, including intention tremor, cerebellar signs, convulsions, and coma. Lassa fever often manifests with classic signs of meningitis.

Swollen baby syndrome describes severe Lassa fever in infants and toddlers with anasarca, abdominal distention, and spontaneous bleeding but pediatric disease is otherwise not distinctive from that observed in older patients. Bunyaviridae Patients with Rift Valley Fever (RVF) develop retinal vasculitis that may cause permanent blindness. Cotton wool spots are visible on the macula. Severe disease is associated with bleeding, shock, anuria, and icterus. Encephalitis may also occur without overlapping hemorrhagic fever. The most severe bleeding and ecchymoses among the viral hemorrhagic fevers characterize CrimeanCongo hemorrhagic fever (CCHF). Filoviridae Ebola virus causes clinically similar but more severe disease than the Marburg agent. On about the fifth day of illness with Ebola or Marburg virus, a distinct morbilliform rash develops on the trunk and an expressionless ghostlike facies has been described during this stage of illness. Patients with progressive disease hemorrhage from mucous membranes, venipuncture sites, and body orifices. Disseminated intravascular coagulation may be a feature of late disease. Flaviviridae Kyasanur Forest disease and Omsk HF are typical biphasic diseases with a febrile or hemorrhagic period that is often followed by CNS involvement, similar to tick-borne encephalitis (Central European encephalitis, Russian spring-summer encephalitis) except that hemorrhagic manifestations are not characteristic of the first phase of the tick-borne encephalitides. Alkhurma HFV typically produces fever, headache, retroorbital pain, joint pain, myalgias, anorexia, vomiting, leukopenia, thrombocytopenia, and elevated serum hepatic transaminases. Hemorrhagic or encephalitic manifestations occur in some patients. Causes South American HF and Lassa fever arise from inhalation of aerosolized fecal matter or urine of infected rodents and from rodent bites, usually during harvest, with work on small farms, or in newly developed areas. Interhuman transmission usually does not occur but is possible. RVF is acquired from mosquito bites or contact with the blood of infected domestic livestock. No interhuman transmission has been observed.

CCHF results from tick bites, squashing ticks, or exposure to aerosols or fomites from slaughtered sheep and cattle. Nosocomial epidemics have been observed a number of times. Ebola and Marburg infections occur from unknown sources, but links to primates and contact with other infected humans are observed. Medical Care Early diagnosis and supportive care can be lifesaving for most patients with viral hemorrhagic fever (VHF). The cornerstone of therapy for all these infections is judicious fluid and electrolyte management. Blood, platelet, and plasma replacement may be useful for Crimean-Congo hemorrhagic fever (CCHF). Infusion of convalescent plasma during the first 8 days of illness with Argentine HF reduces the mortality rate from 15-30% to less that 1%. Novel treatment studies using positively-charged phosphorodiamidate morpholino oligomers (PMOplus) demonstrate protection of monkeys infected with Ebola and Marburg viruses.These studies suggest a potential therapeutic modality for human infection for the future. Studies of high-dose mannose-binding lectin therapy in mice suggest a promising future therapeutic modality for Ebola (and other viruses) infection.

Brucellosis
Brucellosis is an infectious disease that occurs from contact with animals carrying Brucella bacteria. Causes, incidence, and risk factors Brucella can infect cattle, goats, camels, dogs, and pigs. The bacteria can spread to humans if you come in contact with infected meat or the placenta of infected animals, or if you eat or drink unpasteurized milk or cheese. Brucellosis is rare in the United States. About 100 - 200 cases occur each year. People working in jobs where they often come in contact with animals or meat -- such as slaughterhouse workers, farmers, and veterinarians -- are at higher risk. Symptoms Acute brucellosis may begin with mild flu-like symptoms, or symptoms such as:

Abdominal pain Back pain Chills

Excessive sweating Fatigue Fever Headache Joint pain Loss of appetite Weakness Weight loss

High fever spikes usually occur every afternoon. The name "undulant" fever is because the fever rises and falls in waves. Other symptoms that may occur with this disease:

Muscle pain Swollen glands

The illness may be chronic and last for years. Treatment Antibiotics are used to treat the infection and prevent it from coming back. Longer courses of therapy may be needed if there are complications.

Chickenpox
Chickenpox is a viral infection in which a person develops extremely itchy blisters all over the body. It used to be one of the classic childhood diseases. However, it has become much less common since the introduction of the chickenpox vaccine. Causes, incidence, and risk factors Chickenpox is caused by the varicella-zoster virus, a member of the herpesvirus family. The same virus also causes herpes zoster(shingles) in adults. Chickenpox can be spread very easily to others. You may get chickenpox from touching the fluids from a chickenpox blister, or if someone with the disease coughs or sneezes near you. Even those with mild illness may be contagious.

A person with chickenpox become contagious 1 to 2 days before their blisters appear. They remain contagious until all the blisters have crusted over. Most cases of chickenpox occur in children younger than 10. The disease is usually mild, although serious complications sometimes occur. Adults and older children usually get sicker than younger children. Children whose mothers have had chickenpox or have received the chickenpox vaccine are not very likely to catch it before they are 1 year old. If they do catch chickenpox, they often have mild cases. This is because antibodies from their mothers' blood help protect them. Children under 1 year old whose mothers have not had chickenpox or the vaccine can get severe chickenpox. Severe chickenpox symptoms are more common in children whose immune system does not work well because of an illness or medicines such as chemotherapy and steroids. Symptoms Most children with chickenpox have the following symptoms before the rash appears:

Fever Headache Stomach ache

The chickenpox rash occurs about 10 to 21 days after coming into contact with someone who had the disease. The average child develops 250 to 500 small, itchy, fluid-filled blisters over red spots on the skin.

The blisters are usually first seen on the face, middle of the body, or scalp After a day or two, the blisters become cloudy and then scab. Meanwhile, new blisters form in groups. They often appear in the mouth, in the vagina, and on the eyelids. Children with skin problems such as eczema may get thousands of blisters.

Most pox will not leave scars unless they become infected with bacteria from scratching. Some children who have had the vaccine will still develop a mild case of chickenpox. They usually recover much more quickly and have only a few pox (less than 30). These cases are often harder to diagnose. However, these children can still spread chickenpox to others. Treatment Treatment involves keeping the person as comfortable as possible. Here are things to try:

Avoid scratching or rubbing the itchy areas. Keep fingernails short to avoid damaging the skin from scratching.

Wear cool, light, loose bedclothes. Avoid wearing rough clothing, particularly wool, over an itchy area. Take lukewarm baths using little soap and rinse thoroughly. Try a skin-soothing oatmeal or cornstarch bath. Apply a soothing moisturizer after bathing to soften and cool the skin. Avoid prolonged exposure to excessive heat and humidity. Try over-the-counter oral antihistamines such as diphenhydramine (Benadryl), but be aware of possible side effects such as drowsiness. Try over-the-counter hydrocortisone cream on itchy areas.

Medications that fight the chickenpox virus are available but not given to everyone. To work well, the medicine usually must be started within the first 24 hours of the rash.

Antiviral medication is not usually prescribe to otherwise healthy children who do not have severe symptoms. Adults and teens, who are at risk for more severe symptoms, may benefit from antiviral medication if it is given early. Antiviral medication may be very important in those who have skin conditions (such as eczema or recent sunburn), lung conditions (such as asthma), or who have recently taken steroids. Some doctors also give antiviral medicines to people in the same household who also develop chickenpox, because they will usually develop more severe symptoms.

DO NOT GIVE ASPIRIN OR IBUPROFEN to someone who may have chickenpox. Use of aspirin has been associated with a serious condition called Reyes syndrome. Ibuprofen has been associated with more severe secondary infections. Acetaminophen (Tylenol) may be used. A child with chickenpox should not return to school or play with other children until all chickenpox sores have crusted over or dried out. Adults should follow this same rule when considering when to return to work or be around others.

Diphtheria
Diphtheria is an acute infectious disease caused by the bacteria Corynebacterium diphtheriae. Causes, incidence, and risk factors Diphtheria spreads through respiratory droplets (such as those produced by a cough or sneeze) of an infected person or someone who carries the bacteria but has no symptoms. Diphtheria can also be spread by contaminated objects or foods (such as contaminated milk).

The bacteria most commonly infects the nose and throat. The throat infection causes a gray to black, tough, fiber-like covering, which can block the airways. In some cases, diphtheria may first infect the skin, producing skin lesions. Once infected, dangerous substances called toxins, produced by the bacteria, can spread through your bloodstream to other organs, such as the heart, and cause significant damage. Because of widespread and routine childhood DPT immunizations, diphtheria is now rare in many parts of the world. There are fewer than five cases of diphtheria a year in the United States. Risk factors include crowded environments, poor hygiene, and lack of immunization. Symptoms Symptoms usually occur 2 to 5 days after you have come in contact with the bacteria.

Bluish coloration of the skin Bloody, watery drainage from nose Breathing problems

Difficulty breathing Rapid breathing Stridor

Chills Croup-like (barking) cough Drooling (suggests airway blockage is about to occur) Fever Hoarseness Painful swallowing Skin lesions (usually seen in tropical areas) Sore throat (may range from mild to severe)

Note: There may be no symptoms. Treatment

If the health care provider thinks you have diphtheria, treatment should be started immediately, even before test results are available. Diphtheria antitoxin is given as a shot into a muscle or through an IV (intravenous line). The infection is then treated with antibiotics, such as penicillin and erythromycin. People with diphtheria may need to stay in the hospital while the antitoxin is being received. Other treatments may include:

Fluids by IV Oxygen Bed rest Heart monitoring Insertion of a breathing tube Correction of airway blockages

Anyone who has come into contact with the infected person should receive an immunization or booster shots against diphtheria. Protective immunity lasts only 10 years from the time of vaccination, so it is important for adults to get a booster of tetanus-diphtheria (Td) vaccine every 10 years. Those without symptoms who carry diphtheria should be treated with antibiotics.

Shigellosis or Bacillary Dysentery

Shigellosis is an acute bacterial infection of the lining of the intestines. Causes, incidence, and risk factors Shigellosis is caused by a group of bacteria called Shigella. There are several types of Shigella.

Shigella sonnei, also called "group D" Shigella, is responsible for most cases of shigellosis in the United States. Shigella flexneri, or "group B" Shigella, cause almost all other cases. Shigella dysenteriae type 1 is rare in the U.S. but can lead to deadly outbreaks in developing countries.

People infected with the bacteria release it into their stool. The bacteria can spread from an infected person to contaminate water or food, or directly to another person. Getting just a little bit of the Shigella bacteria into your mouth is enough to cause symptoms. Outbreaks of shigellosis are associated with poor sanitation, contaminated food and water, and crowded living conditions. Shigellosis is common among travelers in developing countries and workers or residents of refugee camps. There are about 18,000 cases of shigellosis per year in the United States. The condition is most commonly seen in day care centers and similar places. Symptoms Symptoms usually develop about 1 to 7 days (average 3 days) after you come in contact with the bacteria. Symptoms include:

Acute (sudden) abdominal pain or cramping Acute (sudden) fever Blood, mucus, or pus in stool Crampy rectal pain (tenesmus) Nausea and vomiting Watery diarrhea

Treatment The symptoms usually last 2 to 7 days. The goal of treatment is to replace fluids and electrolytes (salt and minerals) lost in diarrhea. Medications that stop diarrhea are generally not given because they may prolong the course of the disease. Self-care measures to avoid dehydration include drinking electrolyte solutions to replace the fluids lost by diarrhea. Several varieties of electrolyte solutions are now available over the counter. Antibiotics can help shorten the length of the illness and help prevent it from spreading to others in group living or day care situations. They may also be prescribed for patients with severe symptoms. Frequently used antibiotics include sulfamethoxazole and trimethoprim (Bactrim), ampicillin, ciprofloxacin (Cipro), or azithromycin.

Persons with diarrhea who cannot drink fluids by mouth because of nausea may need medical attention and fluids through a vein (intravenously).This is especially common in small children. Persons who take diuretics ("water pills") may need to stop taking such medicines if they have acute shigella enteritis. Never stop taking any medicine without first talking to your health care provider.

Dengue fever
Dengue fever is a virus-caused disease that is spread by mosquitoes. Causes, incidence, and risk factors Dengue fever is caused by one of four different but related viruses. It is spread by the bite of mosquitoes, most commonly the mosquito Aedes aegypti, which is found in tropic and subtropic regions. This includes parts of:

Indonesian archipelago into northeastern Australia South and Central America Southeast Asia Sub-Saharan Africa Some parts of the Caribbean

Dengue fever is being seen more often in world travelers. Dengue fever should not be confused with Dengue hemorrhagic fever, which is a separate disease that is caused by the same type of virus but has much more severe symptoms. Symptoms Dengue fever begins with a sudden high fever, often as high as 104 - 105 degrees Fahrenheit, 4 to 7 days after the infection. A flat, red rash may appear over most of the body 2 - 5 days after the fever starts. A second rash, which looks like the measles, appears later in the disease. Infected people may have increased skin sensitivity and are very uncomfortable. Other symptoms include:

Fatigue Headache (especially behind the eyes) Joint aches

Muscle aches Nausea Swollen lymph nodes Vomiting

Treatment There is no specific treatment for dengue fever. You will need fluids if there are signs of dehydration. Acetaminophen (Tylenol) is used to treat a high fever. Avoid taking aspirin.

Food poisoning
Last reviewed: January 10, 2011. Food poisoning occurs when you swallow food or water that has been contaminated with certain types of bacteria, parasites, viruses, or toxins. Most cases of food poisoning are due to common bacteria such as Staphylococcus or Escherichia coli (E. coli). Causes, incidence, and risk factors Food poisoning more commonly occurs after eating at picnics, school cafeterias, large social functions, or restaurants. One or more people may become sick. Food poisoning is caused by certain bacteria, viruses, parasites, or toxins. Types of food poisoning include:

Botulism (Clostridium botulinum) Campylobacter enteritis Cholera E. coli enteritis Fish poisoning Listeria Staphylococcus aureus Salmonella Shigella

Bacteria may get into your food in different ways:

Meat or poultry may come into contact with intestinal bacteria when being processed Water that is used during growing or shipping may contain animal or human waste Improper food handling or preparation

Food poisoning often occurs from eating or drinking:

Any food prepared by someone who did not wash their hands properly Any food prepared using unclean cooking utensils, cutting boards, or other tools Dairy products or food containing mayonnaise (such as coleslaw or potato salad) that have been out of the refrigerator too long Frozen or refrigerated foods that are not stored at the proper temperature or are not reheated properly Raw fish or oysters Raw fruits or vegetables that have not been washed well Raw vegetable or fruit juices and dairy Undercooked meats or eggs Water from a well or stream, or city or town water that has not been treated

Infants and elderly people are at the greatest risk for food poisoning. You are also at higher risk if:

You have a serious medical condition, such as kidney disease or diabetes You have a weakened immune system You travel outside of the United States to areas where there is more exposure to germs that cause food poisoning

Pregnant and breastfeeding women have to be especially careful to avoid food poisoning. Symptoms When you develop symptoms depends on the exact cause of the food poisoning. The most common types of food poisoning generally cause symptoms within 2 - 6 hours of eating the food. Possible symptoms include:

Abdominal cramps

Diarrhea (may be bloody) Fever and chills Headache Nausea and vomiting Weakness (may be serious and lead to respiratory arrest, as in the case of botulism)

Treatment You will usually recover from the most common types of food poisoning within a couple of days. The goal is to make you feel better and make sure your body maintains the proper amount of fluids.

Don't eat solid foods until the diarrhea has passed, and avoid dairy products, which can worsen diarrhea (due to a temporary state of lactose intolerance). Drink any fluid (except milk or caffeinated beverages) to replace fluids lost by diarrhea and vomiting. Give children an electrolyte solution sold in drugstores.

If you have diarrhea and are unable to drink fluids (for example, due to nausea or vomiting), you may need medical attention and fluids given through a vein (by IV). This is especially true for young children. If you take diuretics, you need to manage diarrhea carefully. Talk to your health care provider -- you may need to stop taking the diuretic while you have the diarrhea. Never stop or change medications without talking to your health care provider and getting specific instructions. For the most common causes of food poisoning, your doctor would NOT prescribe antibiotics. You can buy medicines at the drugstore that help slow diarrhea. Do not use these medicines without talking to your health care provider if you have bloody diarrhea or a fever. Do not give these medicines to children. If you have eaten toxins from mushrooms or shellfish, you will need medical attention right away. The emergency room doctor will take steps to empty out your stomach and remove the toxin.

Viral Gastroenteritis
Rotavirus infection; Norwalk virus; Gastroenteritis - viral; Stomach flu

Viral gastroenteritis is inflammation of the stomach and intestines from a virus. The infection can lead to diarrhea and vomiting. It is sometimes called the "stomach flu." Causes, incidence, and risk factors Viral gastroenteritis is a leading cause of severe diarrhea in both adults and children. Many types of viruses can cause gastroenteritis. The most common ones are:

Astrovirus Enteric adenovirus Norovirus (also called Norwalk-like virus). It is common among school-age children. Rotavirus, the leading cause of severe gastroenteritis in children. It can also infect adults exposed to children with the virus. Outbreaks may also occur in nursing homes.

These viruses are often found in contaminated food or drinking water. Symptoms of viral gastroenteritis usually appear within 4 - 48 hours after exposure to the contaminated food or water. Those with the highest risk for severe gastroenteritis include the young, the elderly, and people who have suppressed immune systems. Symptoms

Abdominal pain Diarrhea Nausea Vomiting

Other symptoms may include:

Chills Clammy skin Excessive sweating Fever Joint stiffness Leakage (incontinence) of stool Muscle pain

Poor feeding Vomiting blood (very rare) Weight loss

Treatment The goal of treatment is to prevent dehydration by making sure the body has as much water and fluids as it should. Fluids and electrolytes (salt and minerals) lost through diarrhea or vomiting must be replaced by drinking extra fluids. Even if you are able to eat, you should still drink extra fluids between meals.

Older children and adults can drink sports beverages such as Gatorade, but these should not be used for children. Instead, use the electrolyte and fluid replacement solutions or freezer pops available in food and drug stores. Do NOT use fruit juice (including apple juice), sodas or cola (flat or bubbly), Jell-O, or broth. All of these have a lot of sugar, which makes diarrhea worse, and they don't replace lost minerals. Drink small amounts of fluid (2-4 oz.) every 30-60 minutes, rather than trying to force large amounts at one time, which can cause vomiting. Use a teaspoon or syringe for an infant or small child. Breast milk or formula can be continued along with extra fluids. You do NOT need to switch to a soy formula.

Food may be offered frequently in small amounts. Suggested foods include:

Cereals, bread, potatoes, lean meats Plain yogurt, bananas, fresh apples Vegetables

People with diarrhea who are unable to drink fluids because of nausea may need intravenous (directly into a vein) fluids. This is especially true in small children. Antibiotics do not work for viruses.

Drugs to slow down the amount of diarrhea (anti-diarrheal medications) should not be given without first talking with your health care provider. They may cause the infection to last longer. DO NOT give these anti-diarrheal medications to children unless directed to do so by a health care provider. People taking water pills (diuretics) who develop diarrhea may be told by their health care provider to stop taking the diuretic during the acute episode. However, DO NOT stop taking any prescription medicine without first talking to your doctor. The risk of dehydration is greatest in infants and young children, so parents should closely monitor the number of wet diapers changed per day when their child is sick.

Bacterial gastroenteritis
Infectious diarrhea - bacterial gastroenteritis; Acute gastroenteritis; Gastroenteritis - bacterial Bacterial gastroenteritis is inflammation of the stomach and intestines caused by bacteria. Causes, incidence, and risk factors Many different types of bacteria can cause bacterial gastroenteritis, including:

Campylobacter jejuni (see: Campylobacter enteritis) E. coli (see: E. coli enteritis) Salmonella (see: Salmonella enteritis) Shigella (see: Shigella enteritis) Staphylococcus Yersinia

Bacterial gastroenteritis can affect one person or a group of people who all ate the same food containing the bacteria. The condition more commonly occurs after eating at picnics, school cafeterias, large social functions, or restaurants. Bacteria may get into your food in different ways:

Meat or poultry may come into contact with intestinal bacteria when being processed Water that is used during growing or shipping may contain animal or human waste Improper food handling or preparation

Food poisoning often occurs from eating or drinking:

Any food prepared by someone who did not wash their hands properly Any food prepared using unclean cooking utensils, cutting boards, or other tools Dairy products or food containing mayonnaise (such as coleslaw or potato salad) that have been out of the refrigerator too long Frozen or refrigerated foods that are not stored at the proper temperature or are not reheated properly Raw fish or oysters Raw fruits or vegetables that have not been washed well Raw vegetable or fruit juices and dairy Undercooked meats or eggs Water from a well or stream, or city or town water that has not been treated

Symptoms Symptoms depend on the type of bacteria that caused the sickness. All types of food poisoning cause diarrhea. Other symptoms include:

Abdominal cramps Abdominal pain Bloody stools Loss of appetite Nausea and vomiting

Treatment You will usually recover from the most common types of bacterial gastroenteritis within a couple of days. The goal is to make you feel better and avoid dehydration. These things may help you feel better if you have diarrhea:

Drink 8 to 10 glasses of clear fluids every day. Water is best. Drink at least 1 cup of liquid every time you have a loose bowel movement. Eat small meals throughout the day, instead of 3 big meals. Eat some salty foods, such as pretzels, soup, and sports drinks.

Eat some high potassium foods, such as bananas, potatoes without the skin, and watered-down fruit juices.

Give your child fluids for the first 4 to 6 hours. At first, try 1 ounce (2 tablespoons) of fluid every 30 to 60 minutes. Try an over-the-counter drink, such as Pedialyte or Infalyte. Do not water down these drinks. Pedialyte is also available as a popsicle. Watered-down fruit juice, or broth, may also help. See also: Diarrhea in children If you have diarrhea and are unable to drink fluids because of nausea or vomiting, you may need to go to the hospital to receive fluids through a vein (IV). This is especially true for young children. If you take diuretics, talk to your health care provider. You may need to stop taking the diuretic while you are sick. Never stop or change medications without talking to your health care provider and getting specific instructions. Antibiotics are usually not prescribed for most common types of bacterial gastroenteritis, unless the diarrhea is extremely severe. Do not use over-the-counter medicines to treat diarrhea without talking to your doctor first. They should not be given to children.

Influenza
Influenza virus infection, one of the most common infectious diseases, is a highly contagious airborne disease that causes an acute febrile illness and results in variable degrees of systemic symptoms, ranging from mild fatigue to respiratory failure and death. These symptoms contribute to significant loss of workdays, human suffering, mortality, and significant morbidity. Although the usual strains of influenza that circulate in the annual influenza cycle constitute a substantial public health concern, far more lethal influenza strains than these have emerged periodically. These deadly strains produced 3 global pandemics in the last century, the worst of which occurred in 1918. Called the Spanish flu (although cases appeared earlier in the United States and elsewhere in Europe), this pandemic killed an estimated 20-50 million persons, with 549,000 deaths in the United States alone. In addition to humans, influenza also infects a variety of animal species. Some of these influenza strains are species specific, but new strains of influenza may spread from other animal species to humans (see Pathophysiology). The term avian influenza used in this context refers to zoonotic human infection with an influenza strain that primarily affects birds.

Swine influenza refers to infections from strains derived from pigs. For more information on the 2009 influenza pandemic, a recombinant influenza consisting of a mix of swine, avian, and human gene segments, see the article H1N1 Influenza (Swine Flu). The signs and symptoms of influenza overlap with those of many other viral upper respiratory tract infections (URTIs). Viruses including adenoviruses,enteroviruses, and paramyxoviruses may initially cause influenzalike illness. The early presentation of mild or moderate cases of flavivirus infections (eg,dengue) may initially mimic influenza. For example, some cases of West Nile fever acquired in New York in 1999 were clinically misdiagnosed as influenza. (See Differentials.) The criterion standard for diagnosing influenza A and B is a viral culture of nasopharyngeal samples and/or throat samples. However, the process may require 3-7 days, long after the patient has left the clinic, office, or emergency department and well past the time when drug therapy could be efficacious. Recently, nucleic acid polymerase chain reaction (PCR) types of laboratory tests have become available, with turnaround times of less than 24 hours and good sensitivity. In September 2011 the FDA approved a new CDC-developed test to diagnose influenza infections, including avian influenza. The Human Influenza Virus Real-Time RT-PCR Detection and Characterization Panel (rRT-PCR Flu Panel) is an in vitro laboratory diagnostic test that can provide results within 4 hours. It is the only in vitro diagnostic test for influenza that is cleared by the FDA for use with lower respiratory tract specimens and will be given at no cost to qualified international public health laboratories. Other older bedside rapiddiagnostic tests are available, but because of cost, availability, and sensitivity issues, most physicians diagnose influenza based on clinical criteria alone. (See Workup.) The avian influenza (H5N1) virus is best identified by conducting an H5N1-specific reverse-transcriptase polymerase chain reaction. This assay can be performed at all state and many local public health laboratories. Viral culture of H5N1 should be performed only in a biosafety level 3 laboratory. (See Workup.) As with other diseases, prevention of influenza is the most effective strategy. Each year in the United States, a vaccine that contains antigens from the strains most likely to cause infection during the winter flu season is produced. The vaccine provides good protection against immunized strains, becoming effective 10-14 days after administration. Antiviral agents are also available that can prevent some cases of influenza; when given after the development of influenza, they can reduce the duration and severity of illness Etiology Influenza results from infection with 1 of 3 basic types of influenza virus: A, B, or C. Influenza A is generally more pathogenic than influenza B. Epidemics of influenza C have been reported, especially in young children. In the United States, during the 2010-2011 influenza season, both influenza A and B viruses circulated, with the predominant virus type varying over time and by region. Influenza viruses are classified within the family Orthomyxoviridae.

The primary risk factor for human infection with avian H5N1 influenza virus is direct contact with diseased or deceased birds infected with it. Contact with excrement from infected birds or contaminated surfaces or water are also considered mechanisms of infection. Close and prolonged contact of a caregiver with an infected person is believed to have resulted in at least 1 case. Other specific risk factors are not apparent given the few cases to date. Prehospital Care Prehospital care is predominantly supportive. Supplemental oxygenation to manage respiratory symptoms or objective hypoxia may be needed. Ventilatory support with a bag-valve-mask device and/or with field intubation may be required if the patient is in respiratory failure. Intravenous access should be obtained, and a bolus of a crystalloid can be administered to support hemodynamic stability. Attention should be given to the appropriate use of personal protective equipment (PPE) by the prehospital providers and advance notification should be given to the hospital regarding the potential need for patient respiratory isolation. General guidelines in low-risk areas are that patients with fever and respiratory complaints should wear a standard mask, if tolerated, to decrease airborne droplets. Inpatient Care Most frequently, hospitalization is necessary when influenza exacerbates underlying chronic diseases. Some patients, especially elderly individuals, may be too weak to care for themselves alone at home. On occasion, the direct pathologic effects of influenza may require hospitalization. Most commonly, this is influenza pneumonia.

Medication Summary The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Agents include vaccines and antiviral drugs (ie, amantadine, rimantadine, oseltamivir, zanamivir). The uricosuric agent probenecid may be used as an adjunct to antiviral treatment. Antiviral Agents Class Summary Antiviral drugs indicated for treatment of influenza include neuraminidase inhibitors (ie, oseltamivir and zanamivir) and amantadine and rimantadine. Neuraminidase inhibitors act directly on the viral proteins, decreasing the virulence of infection. Vaccines Class Summary

Influenza A and B vaccine is administered each year prior to flu season. The CDC analyzes the vaccine subtypes each year and makes any necessary changes based on worldwide trends. In April 2007, the US Food and Drug Administration (FDA) approved the first vaccine for H5N1 influenza (ie, avian influenza or bird flu). It is available only to government agencies and for stockpiles. Uricosuric Agents Class Summary Agents that inhibit the tubular secretion of the active metabolite of the drug may be used as adjunctive therapy with the antiviral drug oseltamivir.

Typhus (Louse Borne)

Murine typhus; Epidemic typhus; Endemic typhus; Brill-Zinsser disease; Jail fever Typhus is a bacterial disease spread by lice or fleas. Causes, incidence, and risk factors Typhus is caused by one of two types of bacteria: Rickettsia typhi or Rickettsia prowazekii. The form of typus depends on which type of bacteria causes the infection. Rickettsia typhi causes murine or endemic typhus. Endemic typhus is uncommon in the United States. It is usually seen in areas where hygiene is poor and the temperature is cold. Endemic typhus is sometimes called "jail fever." Murine typhus occurs in the southeastern and southern United States, often during the summer and fall. It is rarely deadly. Risk factors for murine typhus include:

Exposure to rat fleas or rat feces Exposure to other animals (such as cats, opossums, raccoons, skunks, and rats)

Rickettsia prowazekii causes epidemic typhus and Brill-Zinsser disease. Brill-Zinsser disease is a mild form of epidemic typhus. It occurs when the disease re-activates in a person who was previously infected. It is more common in the elderly. Lice and fleas of flying squirrels spread the bacteria. Symptoms Symptoms of murine or endemic typhus may include:

Abdominal pain Backache

Diarrhea Dull red rash that begins on the middle of the body and spreads Extremely high fever (105 - 106 degrees Fahrenheit), which may last up to 2 weeks Hacking, dry cough Headache Joint and muscle pain Nausea Vomiting

Symptoms of epidemic typhus may include:

Chills Cough Delirium High fever (104 degrees Fahrenheit) Joint pain (arthralgia) Lights that appear very bright; light may hurt the eyes Low blood pressure Rash that begins on the chest and spreads to the rest of the body (except the palms of the hands and soles of the feet) Severe headache Severe muscle pain (myalgia) Stupor

The early rash is a light rose color and fades when you press on it. Later, the rash becomes dull and red and does not fade. People with severe typhus may also develop small areas of bleeding into the skin (petechiae). Treatment Treatment includes antibiotics such as:

Doxycycline

Tetracycline Chloramphenicol (less common)

Tetracycline taken by mouth can permanently stain teeth that are still forming. It is usually not prescribed for children until after all of their permanent teeth have grown in. Patients with epidemic typhus may need intravenous fluids and oxygen.

Body lice
Body lice are tiny parasites (Pediculus humanus corporis) that spread through close contact with other people. There are three types of lice:

Body lice Head lice Pubic lice

This article focuses on body lice. Causes, incidence, and risk factors Lice feed on human blood and live in the seams and folds of clothing. They lay their eggs and deposit waste matter on the skin and clothing. You can catch body lice if you come in direct contact with someone who has lice, or with infected clothing, towels, or bedding. Body lice are bigger than other types of lice. You are more likely to get body lice if you have poor hygiene or live in close (overcrowded) conditions. Infestation is unlikely to last on anyone who bathes regularly, and who has at least weekly access to freshly laundered clothing and bedding. If the lice fall off of a person, they die within about 5 - 7 days at room temperature. Symptoms

Intense itching is the main symptom. It is usually worse at the waistband, in the armpits, at the bra strap, or anywhere clothing is tighter and closer to the body. Red bumps appear on the skin. They may become crusted or scabbed from scratching. Areas around the waist or groin may become thickened or discolored when lice have been present for a long time.

Treatment Body lice mainly live in clothing. Destroy or carefully wash infected clothing in hot water (at least 130 degrees F), then machine dry using a hot cycle. Your doctor may also recommend a prescription cream or wash containing permethrin, malathione, or benzyl alcohol. However, hygiene and washing clothes, bedding, and towels are most important and are usually enough.

Head lice
Head lice are tiny insects that live on the skin covering the top of your head, called the scalp. Lice can be spread by close contact with other people. Head lice may also be found in eyebrows and eyelashes. See also:

Body lice Pubic lice

Causes, incidence, and risk factors Head lice infect hair on the head. Tiny eggs on the hair look like flakes of dandruff. However, instead of flaking off the scalp, they stay put. Head lice can live up to 30 days on a human. Their eggs can live for more than 2 weeks.

Head lice spread easily, particularly among school children. Head lice are more common in close, overcrowded living conditions. You can get head lice if you:

Come in close contact with a person who has lice Touch the clothing or bedding of someone who has lice Share hats, towels, brushes, or combs of someone who has had lice

Having head lice does NOT mean the person has poor hygiene or low social status. Having head lice causes intense itching, but does not lead to serious medical problems. Unlike body lice, head lice never carry or spread diseases.

Symptoms Symptoms of head lice include:

Intense itching of the scalp Small, red bumps on the scalp, neck, and shoulders (bumps may become crusty and ooze) Tiny white specks (eggs, or nits) on the bottom of each hair that are hard to get off

Lice on scalp and clothing may be difficult to see, unless there are a lot of them. Treatment Lotions and shampoos containing 1% permethrin (Nix) often work well. They can be bought at the store without a prescription. If these do not work, a doctor can give you a prescription for stronger medicine. Such medicine should be used exactly as directed.

To use the medicine shampoo, first rinse and dry the hair. Then apply the medicine to the hair and scalp. After 10 minutes, rinse it off. Check for lice and nits again in 8 to 12 hours. If the lice seem active, talk to your healthcare provider before retreating.

Ask your health care provider if you need to treat those who shared a bed or clothing with the person that has had lice.

An important part of treatment is removing the eggs (nits). Certain products make the nits easier to remove. Some dishwashing detergents can help dissolve the "glue" that makes the nits stick to the hair shaft.

You can remove the eggs with a nit comb. Before doing this, rub olive oil in the hair or run the metal comb through beeswax. This helps make the nits easier to remove. Metal combs with very fine teeth are stronger and more effective than plastic nit combs. These metal combs are easier to find in pet stores or on the Internet than in pharmacies. Removing eggs may prevent the lice from returning if the medication fails to kill every one of them. Treat children and adults with lice promptly and thoroughly. Wash all clothes and bed linens in hot water with detergent. This also helps prevent head lice from spreading to others during the short period when head lice can survive off the human body. Repeat combing for nits in 7 - 10 days.

Malathion 0.5% in isopropanol is FDA approved for the treatment of head lice. Apply it to dry hair until the hair and scalp are wet. Leave it on for 12 hours. Malathion may be useful for resistant infections. Treatment can cause significant side effects in children younger than 6 months old, the elderly, and anyone weighing less than 110 lbs (50 kg), especially when the treatment is used repeatedly in a short period of time.

Pubic lice
Pubic lice are small, six-legged creatures that infect the pubic hair area and lay eggs. These lice can also be found in armpit hair and eyebrows. Causes, incidence, and risk factors Pubic lice are known as Phthirus pubis. Lice infestation is found mostly in teenagers and usually spreads during sexual activity. Sometimes, pubic lice can spread through contact with objects such as toilet seats, sheets, blankets, or bathing suits at a store. However, this type of spreading is rare. Animals cannot spread lice to humans. Other types of lice include:

Body lice (Pediculus humanus corporis) Head lice (Pediculus humanus capitis)

Risk factors include:

Having multiple sexual partners Having sexual contact with an infected person Sharing bedding or clothing with an infected person

Symptoms Almost anyone with pubic lice will have itching in the area covered by pubic hair (it often gets worse at night). This itching may start soon after getting infected with lice, or it may not start for up to 2 - 4 weeks after contact. Other symptoms:

Skin reaction that is bluish-gray in color Sores (lesions) in the genital area due to bites and scratching

Treatment Pubic lice are best treated with a prescription wash containing permethrin, such as Elimite or Kwell:

Thoroughly work the shampoo into the pubic hair and surrounding area for at least 5 minutes. Rinse well. Comb the pubic hair with a fine-toothed comb to remove eggs (nits). Applying vinegar to pubic hair before combing may help loosen nits, but the hair should be dry when applying the shampoo.

A single treatment is all that is usually needed. If another treatment is recommended, it should be done 4 days to 1 week later. Over-the-counter medications for the treatment of lice include Rid and Nix. Malathione lotion is another treatment option. While you are treating pubic lice, wash all clothing and linens in hot water. Items that cannot be washed may be sprayed with a medicated spray or sealed (suffocated) in plastic bags and not used for 10 - 14 days. It is important for all intimate contacts to be treated at the same time. People with pubic lice should be evaluated for other sexually-transmitted infections at the time of diagnosis.

Scabies
Scabies is an easily spread skin disease caused by a very small species of mite. Causes, incidence, and risk factors Scabies is found worldwide among people of all groups and ages. It is spread by direct contact with infected people, and less often by sharing clothing or bedding. Sometimes whole families are affected. Outbreaks of scabies are more common in nursing homes, nursing facilities, and child care centers. The mites that cause scabies burrow into the skin and deposit their eggs, forming a burrow that looks like a pencil mark. Eggs mature in 21 days. The itchy rash is an allergic response to the mite. Scabies is spread by skin-to-skin contact with another person who has scabies. Pets and animals cannot spread human scabies. It is also not very likely for scabies to be spread by:

A swimming pool Contact with the towels, bedding, and clothing of someone who has scabies, unless the person has what is called "crusted scabies"

Symptoms

Itching, especially at night Rashes, especially between the fingers Sores (abrasions) on the skin from scratching and digging Thin, pencil-mark lines on the skin

Mites may be more widespread on a baby's skin, causing pimples over the trunk, or small blisters over the palms and soles.

In young children, the head, neck, shoulders, palms, and soles are involved. In older children and adults, the hands, wrists, genitals, and abdomen are involved.

Treatment Prescription medicated creams are commonly used to treat scabies infections. The most commonly used cream is permethrin 5%. Other creams include benzyl benzoate, sulfur in petrolatum, and crotamiton. Lindane is rarely used because of its side effects.

Creams are applied all over the body. The whole family or sexual partners of infected people should be treated, even if they do not have symptoms. Creams are applied as a one-time treatment or they may be repeated in 1 week. Wash underwear, towels, and sleepwear in hot water. Vacuum the carpets and upholstered furniture. For difficult cases, some health care providers may also prescribe medication taken by mouth to kill the scabies mites. Ivermectin is a pill that may be used. Itching may continue for 2 weeks or more after treatment begins, but it will disappear if you follow your health care provider's treatment plan. You can reduce itching with cool soaks and calamine lotion. Your doctor may also recommend an oral antihistamine.

Bed Bug
Cimicidae (or sometimes bedbugs) are small parasitic insects. The most common type is Cimex lectularius. The term usually refers to species that prefer to feed on human blood. All insects in this family live by feeding exclusively on the blood of warm-blooded animals. A number of health effects may occur due to bed bugs, including skin rashes, psychological effects, and allergic symptoms. Diagnosis involves both finding bed bugs and the occurrence of compatible symptoms. Treatment is otherwise symptomatic. In the developed world, bed bugs were largely eradicated as pests in the early 1940s, but have increased in prevalence since about 1995. Because infestation of human habitats has been on the increase, bed bug bites and related conditions have been on the rise as well. The exact causes of this resurgence remain unclear; it is variously ascribed to greater foreign travel, more frequent exchange of secondhand furnishings among homes, a greater focus on control of other pests resulting in neglect of bed bug countermeasures, and increasing resistance to pesticides. Bed bugs have been known as human parasites for thousands of years. The name "bed bug" is derived from the insect's preferred habitat of houses and especially beds or other areas where people sleep. Bed bugs, though not strictly nocturnal, are mainly active at night and are capable of feeding unnoticed on their hosts. They have however been known by a variety of names, including wall louse, mahogany flat, crimson rambler, heavy dragoon, chinche and redcoat. Cause Dwellings can become infested with bed bugs in a variety of ways, from:

Bugs and eggs that "hitchhiked in" on pets, or on clothing and luggage Infested items (such as furniture or clothing) brought in Nearby dwellings or infested items, if there are easy routes (through duct work or false ceilings)

Wild animals (such as bats or birds) People visiting from a source of infestation; bed bugs, like roaches, are transferred by clothing, luggage, or a person's body.

Management Eradication of bed bugs frequently requires a combination of pesticide and non-pesticide approaches. Pesticides that have historically been found to be effective include: pyrethroids, dichlorvos and malathion.[7] Resistance to pesticides has increased significantly over time and there are concerns of negative health effects from their use. Mechanical approaches such as vacuuming up the insects and heat treating or wrapping mattresses have been recommended. The carbamate insecticide propoxur is highly toxic to bed bugs, but in the United States the Environmental Protection Agency (EPA) has been reluctant to approve such an indoor use because of its potential toxicity to children after chronic exposure. Predators Natural enemies of bed bugs include the masked hunter (also known as "masked bed bug hunter"),cockroaches, ants, spiders (particularly Thanatus flavidus),mites and centipedes. The Pharaoh ant's (Monomorium pharaonis) venom is lethal to bed bugs. Biological pest control is not very practical for eliminating bed bugs from human dwellings.

Tape Worm
Tapeworms are parasites that can live in people's intestines (bowel). They belong to a class of worms called cestoda, so are known medically as cestodes. Tapeworms tend to be flat, segmented and ribbon-like. Humans can catch them by:

touching contaminated faeces (stools) and placing their hands near their mouth swallowing food or water containing traces of contaminated faeces eating raw contaminated pork, beef or fish

The tapeworms that most commonly infect humans include:

the pork tapeworm (Taenia solium) the beef tapeworm (Taenia saginata) the fish tapeworm (Diphyllobothrium latum) the dwarf tapeworm (Hymenolepis nana) the dog tapeworm (Echinococcus granulosus)

a tapeworm infection usually occurs when you eat raw contaminated pork, beef or freshwater fish (see box, left).

Not all tapeworms are acquired in the same way. Causes of the different types of tapeworm infection are outlined below. Pork and beef tapeworms Infection with adult pork or beef tapeworms can be caused by eating raw or undercooked pork or beef that contain tapeworm larvae (newly hatched worms). The larvae grow into adult worms in your intestines (bowel). In the case of the pork tapeworm, you can:

swallow the eggs in food or water contaminated with human faeces (stools) transfer the eggs to your mouth after contact with an infected person or with contaminated clothing

The eggs then develop into larvae inside your body and invade other areas, such as your muscles and brain. This is why symptoms of a tapeworm larvae infection are different to those of an adult tapeworm infection, which is confined to your intestines (see Tapeworm infections - symptoms for more information). Pork and beef tapeworms are more commonly found in developing countries such as Africa, the Middle East, Eastern Europe, Mexico, Southeast Asia and South America.

Tapeworm lifecycle 1. Animal or fish swallows the eggs Tapeworm eggs are found in the faeces (stools) of infected humans. The eggs are swallowed by an animal (usually a pig or cattle) when it:

eats food or drinks water containing traces of the contaminated faeces grazes on soil that contains traces of the contaminated faeces

Sometimes, the eggs can be swallowed by a crustacean that is then eaten by a freshwater fish. 2. Larvae develop inside the animal or fish Once inside the animal or fish, the tapeworm eggs hatch into larvae, which invade the wall of the intestines and are carried in the bloodstream to the muscles, where they form cysts (tiny sacs of larvae). 3. The cysts are eaten by humans A human swallows tapeworm cysts when they eat the undercooked meat of the contaminated animal or the raw contaminated fish. The cysts hatch inside the human and develop into adult worms, which attach themselves to the wall of the intestines, grow in length and produce eggs.

In the case of the pork tapeworm, the human may have swallowed the eggs directly, so the cysts would form inside the human body before hatching and growing into adult worms. The eggs of the adult tapeworms are passed out of the human body in faeces, and the cycle starts again. Cysticercosis The larvae (cysticerci) of the pork tapeworm can cause cysticercosis. This is when cysts (tiny sacs) enclosing the larvae settle outside your intestines in other tissues and organs, such as your lungs, liver, eye or brain. The cysts grow very slowly and cause inflammation (swelling). If they settle in an organ, such as the liver, they affect its normal function. The cysts can become infected with bacteria (a secondary infection) and can burst. If a cyst bursts, its content can cause a severe and sometimes life-threatening allergic reaction called anaphylaxis (see the Health A-Z topic on Anaphylaxis for more information). Neurocysticercosis is a particularly dangerous complication of infection with pork tapeworm larvae. It affects the brain and central nervous system, causing headaches and affecting sight. It can also cause meningitis, epilepsy or dementia. If the infection is severe, it can be fatal.

Treating a tapeworm infection Adult tapeworm infections are treated with anthelmintic medication. Anthelmintic medication:

kills parasitic worms makes the worms pass out of your intestine in your faeces (stools)

The medication works by dissolving or attacking the tapeworm. Little of the medication is absorbed by your digestive system. Your GP will probably prescribe niclosamide or praziquantel, to be taken in a single dose. Niclosamide and praziquantel are only available on a named-patient basis. This means that the medicine is not generally available on prescription, in this case because tapeworm infections in the UK are so rare. Your GP or pharmacist may have to make special arrangements to get hold of the medicine for you. If treatment does not get rid of the tapeworm's neck and head, the whole tapeworm can grow again. For the treatment to be effective, the neck and head will need to come out of your intestine in your faeces. Some doctors suggest that using a laxative may help the tapeworm to come out in your faeces. Also, with the pork tapeworm, some doctors suggest that you take medicine to prevent you vomiting (an antiemetic). This is because some doctors think that if you vomit, you might re-infect yourself by swallowing tapeworm larvae.

You will probably need to provide several samples of your faeces over two to four months so that your GP can check if the treatment has been effective. This is because the eggs, larvae or segments are not released regularly into your faeces. Hygiene while you are being treated The medication only attacks the adult tapeworm and not its eggs, so hygiene is very important. It is possible to re-infect yourself while you are being treated. For example, you could pass tapeworm eggs into your faeces and then transfer them to your mouth with contaminated hands. Wash your hands thoroughly before eating and after using the toilet. Other members of your family or household should do the same. Treating a tapeworm larvae infection Your GP may recommend anthelmintic medication to treat infection with tapeworm larvae. They may prescribe albendazole, also only available on a named-patient basis (see above). Your GP may continue to prescribe albendazole after the initial treatment to prevent cysts (tiny sacs of larvae) coming back. In some cases, cysts containing tapeworm larvae may be removed by surgery. Your doctor may recommend injecting a cyst with medication such as formalin to kill the tapeworm larvae before the cyst is removed. Sometimes, surgery to remove cysts may not be possible, for example if the cysts are close to major blood vessels or organs