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- Malaria.
- Measles.
- Meningitis.
- Mouth Ulcer.
- Mumps.
Malaria
Malaria is a parasitic disease transmitted through the bite of infected Anopheles mosquitoes.
Once the parasites (Plasmodium) enter the human body, they travel through the bloodstream to
the liver. In the liver they mature and then re-enter the bloodstream and infect red blood cells
and multiply inside them.
Within 48 to 72 hours of becoming infected, the red blood cells rupture, releasing more parasites
(merozoites) which in turn infect more red blood cells.
The life cycle varies according to the species of Plasmodium. For P. vivax it is 48 hours, P. malariae
72 hours, and P. falciparum 36 to 48 hours. Malaria causes anaemia, the result of destruction of red
blood cells and the problems caused by large amounts of free haemoglobin released into the circulation
after red blood cells rupture.
The symptoms of Malaria occur in cycles of 48 to 72 hours, due to the massive release of merozoites into the bloodstream.
Symptoms:
- Fever, chills and sweating.
- muscle pain.
- headache, nausea and vomiting.
- jaundice.
Treatment:
Malaria is treated with drugs such as Chloroquine (not for people with epilepsy or psychiatric disorders),
Quinine or quinidine, Halofantrine (not for people heart problems), Artemisinin, artemether, artesunate,
Primaquine (not for people with glucose-6-phosphate dehydrogenase, or G6PD, deficiency).
In severe cases, the person suffering from Malaria may require treatment in the intensive care unit of
a hospital, especially if there are complications involving the brain or kidneys.
Prognosis:
The outcome is expected to be good in most cases of malaria with treatment, but poor in Falciparum
infection with complications.
Complications:
- liver failure and kidney failure.
- destruction of blood cells (haemolytic anaemia).
- meningitis.
- rupture of the spleen and subsequent massive haemorrhage.
Prevention:
There is no effective inoculation against malaria, but antimalarial drugs may be given prophylactically
to persons travelling to areas where the disease is widespread, or to pregnant women in areas in which
the disease is endemic. Antimalarial drugs can be prescribed for visitors to areas where malaria is prevalent.
Treatment should begin two weeks before entering the area, and continue for 4 weeks after leaving the area.
The types of antimalarial medications prescribed will depend on the drug-resistance patterns in the areas to be visited.
Chloroquine, quinine, and the combination of pyrimethamine and sulfadoxine are some examples of drugs you may receive.
It is very important to know the countries and areas you will be visiting to obtain appropriate preventive support for
malaria.
Preventive measures are concentrated on destroying the mosquito by filling in swamps and other places containing stagnant
water where mosquitoes breed, and by use of insecticides and natural biologic predators of mosquitoes.
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Measles
Measles is usually a contagious childhood infection but it can be contracted at any age. It affects the respiratory system
and causes the skin to develop a measles rash. It is spread by infected persons through coughing and sneezing, and through
contact with contaminated items and surfaces. A person is contagious for one to two days before symptoms appear, and up to
four days after the rash appears.
Adults tend to suffer more severe symptoms than children do. Ear infection (Otitis Media) is a common complication of measles.
For older people it is common to be hospitalised for measles pneumonia. In rare cases, measles causes encephalitis
(brain infection) putting the patient at risk of suffering seizures, coma or dying, or leaving the patient with a long-term
risk of mental retardation or epilepsy.
In other rare cases, measles can attack the digestive organs (including the liver), the heart muscle or the kidneys. A pregnant
woman who develops a measles infection has an increased risk of premature labour, miscarriage or delivery of a low birth weight
baby.
People who have had measles develop a natural immunity and cannot contract it again.
Symptoms:
Measles symptoms start to appear 10 to 12 days after contact with a contagious person. Early symptoms include coughing, runny nose,
stuffy nose, malaise, red eyes, tearing and fever. Two to four days after these initial symptoms, blue-white spots with a red background
(Koplik's spots), located on the inside of the cheeks near the back molars start to appear. They are accompanied, either at the same
time or slightly later, by the appearance of the measles rash.
The measles rash is very red and is usually not itchy. It begins at the face and behind the ears, then spreads downward to the neck,
trunk, limbs, palms and soles. The rash begins to fade in about four days in the same order that it appeared - first the head and neck,
then trunk and limbs. There may remain a brownish discoloration where the rash use to be or flakiness in areas of affected skin, but
this is only temporary.
In some cases, the infected person may suffer enlarged lymph nodes ("swollen glands"), diarrhoea and vomiting, and inflammation of the eyes
(conjunctivitis), which make the eyes sensitive to light.
Treatment:
Measles symptoms are treated with acetaminophen (Paracetamol) to reduce fever and relieve discomfort. Children should not be given aspirin
due to the risk of Reye's Syndrome (a brain disorder that develops in children who have had certain viral illnesses and have been treated
with aspirin).
Plenty of bed rest and a cool-mist humidifier to soothe respiratory passages and relieve cough help. Antibiotics are given if Otitis Media or
bacterial pneumonia develops as a complication of measles infection.
Women who are considering becoming pregnant should ensure that they are adequately immunized against measles and other contagious diseases
that may affect the unborn child.
Most otherwise healthy patients recover completely from measles. Death is extremely rare (one to two out of every 1000 cases), usually
from pneumonia or encephalitis. About 3 percent of adults with measles develop symptoms of pneumonia that are severe enough to require
hospital treatment.
Prevention:
Measles can be prevented with the measles vaccine, which is usually given to children at the age of 15 months as part of the MMR
(measles, mumps and rubella) combination.
A second MMR vaccine is now given at the age of 12 years when they are in primary six.
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Meningitis
Meningitis is an infection of the membranes (meninges) covering the brain and spinal cord caused by bacteria, viruses, and fungi;
chemical toxins such as lead and arsenic.
Bacterial Meningitis:
The most common causes are Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and
Haemophilus influenzae, which are responsible for approximately 70 per cent of all cases. The incidence is age-related.
In adults, S. pneumoniae and N. meningitidis cause most of the cases; in children aged 1 month to 15 years,
N. meningitidis and H. influenzae predominate.
It occurs usually as a secondary complication of a bacterial or viral infection affecting the ears, nasal passage or upper respiratory
tract. Its onset is rapid and, in the case of bacterial meningitis, if not treated quickly can result in death within a few hours or
lead to permanent neurological damage.
Viral Meningitis:
This is less severe and most people recover from it fully. The common viruses involved are Coxsackie and echovirus (enterovirus).
Other enteroviruses and mumps are additional causes.
Prognosis:
The outcome is expected to be good in most cases of malaria with treatment, but poor in Falciparum infection with complications.
Symptoms:
- High fever, nausea and vomiting.
- Severe headache and sensitivity to light.
- Stiff neck (pain when bending neck forward), shoulders or back.
- Bumpy and pinpoint dark red or purplish rash on any part of the body (meningococcal meningitis).
- Mental confusion.
- Seizures and coma.
Treatment:
Treatment needs to commence immediately. Antibiotics, usually Penicillin, are administered intravenously for bacterial meningitis.
Antibiotics do not work for viral meningitis. Any secondary symptoms arising from Meningitis such as brain swelling and seizures
will also require medical attention. Hospitalisation may be necessary.
Prevention:
Currently there is a vaccine, Haemophilus vaccine (HiB vaccine), which can prevent one type of meningitis in children. People who
are in close contact with a person suffering from bacterial meningitis should take precautions to protect themselves from the infection.
There is also a vaccine that protects against four strains of N. meningitidis, but it is not routinely used and is not effective in children
under 18 months of age. The vaccine against N. meningitidis is advised for those going for pilgrimage to Saudi Arabia. Travellers should
receive the vaccine at least 1 week before departure, if possible.
A vaccine to prevent meningitis due to S. pneumoniae (also called pneumococcal meningitis) can also prevent other forms of infection due to S. pneumoniae.
The pneumococcal vaccine is not effective in children under 2 years of age but is useful for persons over 65 years of age and younger
persons with certain chronic medical problems.
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Mouth Ulcer
Mouth ulcers are caused by many disorders for example, canker sore (aphthous), leukoplakia, gingivostomatitis, oral cancer, oral lichen planus
and oral thrush. The most common mouth ulcer is Aphthous ulcer. It is an open sore in the mouth, which appears as a painful white or yellow sore
(ulcer) surrounded by a bright red area.
They may occur at any age, but usually first appear between the ages of 10 and 40. Women are more prone than men. The cause is unknown.
There may be an inherited tendency or an immune system link.
Ulcers may develop in response to mouth injury such as dental procedures or aggressive tooth cleaning.
They may occur at the site of a bite when the tongue or cheek is bitten.
They can also triggered by stress, dietary deficiencies (especially iron, folic acid, or vitamin B12), menstrual periods, hormonal changes,
food allergies, and similar situations. They may occur with no identifiable cause.
They usually appear on the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gums. They usually begin with a
tingling or burning sensation, followed by a red spot or bump that ulcerates. Pain spontaneously decreases in 7 to 10 days, with complete
healing in 1 to 3 weeks.
Occasionally, a severe occurrence may be accompanied by fever or lethargy. Recurrence is common and may continue for years.
Treatment:
Treat the mouth ulcer with topical corticosteroids (Kenalog in orabase or Oracorte E), or other soothing preparations.
Avoid hot or spicy foods as this will make the mouth ulcers more painful.
Prevention:
Good oral hygiene may help in the prevention of some types of mouth ulcers or complications from mouth ulcers. This includes brushing the teeth at
least twice per day, flossing at least daily, and going for regular dental checkup and cleaning.
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Mumps
Mumps is a highly contagious viral infection that causes swelling in the parotid glands (the glands which produce saliva). The mumps (paramyxovirus)
virus is spread by coughing, sneezing and through the saliva of an infected person.
Although mumps may affect adults, children between the ages of 5 - 15 years are most prone.
Symptoms:
- Facial pain.
- Swollen parotid glands in neck, temples or jaw.
- Fever, headache and sore throat.
- Males may experience pain or lumps in their testicles, and swelling in
the scrotum. However this rarely causes infertility problems.
- Meningoencephalitis (infection of the central nervous system). It does not cause permanent damage.
Treatment:
Treat mumps by relieving its symptoms. Acetaminophen (Paracetamol or Panadol) can be given to reduce fever and relieve pain.
For children, aspirin should not be given because of the risk of Reye's syndrome, a brain problem that develops in children
who have had certain viral illnesses (including mumps) and have had aspirin given to them to treat symptoms.
Warm or cold compresses can be given to relieve pain and swelling in the parotid glands. Cool compresses and scrotal support
can be given to reduce pain and swelling in the testicles. Avoid foods that stimulate the parotid glands (stimulating the glands
causes pain) such as fruit juices and tart beverages.
Prevention:
Mumps can be prevented by administering the Mumps, Measles, Rubella vaccine (MMR). This vaccine is given at the age of 15 months.
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