Monday, April 12, 2010


Varicella or chickenpox is an acute disease caused by varicella-zoster virus (VZV) and characterized by generalized vesicular rash.
The incubation period is usually about 7- 14 days and this disease is known to be spread by direct contact. Airborne spread has also been demonstrated especially in hospitals.
Varicella is more common than other childhood diseases during the early months of life. After the first 2 weeks of life, the disease is generally mild. Maternal antibody transferred across the placenta may not be as effective in protecting infants against this disease as antibodies against other viruses.
Varicella is characterized by a generalized eruption that is centripetal in distribution with erythematous macules, papules, vesicles, and scabbed lesions. The vesicles are superficial, with varying amounts of erythema at their bases.
During the early phase of the eruption, lesions are found on the face, scalp, and trunk. Often, lesions can be detected in the scalp before their appearance on the skin by running the fingers through the hair. Later, new lesions appear on the extremities. By this time, the earlier lesions have dried and crusted. Excoriations are common, attesting to the pruritic nature of the lesions.
Mucous membranes of the conjunctiva and oropharynx are more frequently involved in adults than in children. New lesions continue to appear over a 3- or 4-day period, after which the rate of their appearance decelerates markedly.
Most children have a mild illness with few systemic complaints and an average maximal temperature of about 38.3° C. It is more common for adults to have considerable malaise, muscle ache, arthralgia, and headache. These may precede the first skin lesions by 24 to 48 hours.
The most common complication of Varicella is bacterial infections of the skin. The major complications of varicella in adults are encephalitis and pneumonia.
Infection produces a diffuse interstitial type of pneumonia with hypoxia resulting from poor diffusion of gases. Diffuse calcification of the lung parenchyma may be found years after recovery.
Encephalitis in childhood is most commonly manifested by a cerebellitis, which usually occurs at the end of the first week or during the second week after the onset of rash. This complication is almost always self-limited.
To help diagnose, serologic confirmation of the diagnosis can be made using a variety of techniques. The enzyme-linked immunosorbent assay (ELISA) and the latex agglutination assay are the most generally available. The laboratory director should be consulted regarding appropriate time of collection of specimens as well as interpretation of data.
Major therapeutic objectives are the prevention of superinfection and relief of pruritus. To relief pruritus can be accomplished frequently by application of calamine lotion. It is advisable to trim and file nails to reduce the damage from scratching. Bacterial superinfection can best be prevented by encouraging daily bathing with an antibacterial soap.

Relief of systemic symptoms may require additional medication such as acetaminophen, although this may increase pruritus.

Antiviral that usually used for adolescent and adults is acyclovir (800 mg per oral five times daily for 5-7 days).

Thursday, March 18, 2010

Molluscum Contagiosum (Dimple Warts)

Molluscum contagiosum is a viral disease that caused pox virus family that clinically form papuls, and there are grooves on the surface with a mass contain molluscum bodies. Molluscum warts occur characteristically in small children and in young adults, although they may be seen occasionally in any age group. The incubation of this warts is estimated to vary from 14 days to 6 months.

This warts usually starts from single or small lesion and then spread wide to face, trunk, extremities. For Young adults more often present with lesions on the lower abdomen, pubic escutcheon, or inner thighs contracted during sexual transmission.

For children, molluscum warts are usually spread by close physical contact. Especially with their activities such as swimming in pool facilities, communal shower facilities, and contact sports.

For young adult, the most common of transmission is sexual contact.

For people with low immunity such as AIDs, Leukemia, people with chemotherapy, this warts can be the provoking factor too.

Histopathologic examination can help us to diagnose this disease. We can find molluscum bodies that contain virus particles from infected epidermis.
Patient should avoid communal swimming pools, baths, and shared clothing items. Because that activities can make contamination to other people.

The principle of treatment is to remove the mass containing molluscum bodies. We can use tools such as blackheads extractor, syringes, or curette. For young adults, should also be therapy for their sexual partner.

The most effective in adult cases  is Light freezing with liquid nitrogen (LN2). This treatment useful, non scaring and must be repeated every 10 to 14 days until clear.

The prognosis of this disease better if all the lesions have been removed.
Friday, March 12, 2010

Acute Pancreatitis

Acute pancreatitis is an inflammatory process arising in the exocrine pancreas, with variable involvement of peripancreatic tissues or remote organ systems. Incidence of acute pancreatitis from about 10 to 50 case per 100,000 per year.

Gallstone disease and alcoholism are the most common etiology of this disease in industrialized country. Other etiologies are infection (ascariasis, mumps, cytomegalo virus infection), hyperlipidemia, chronic hypercalcemia, abdominal trauma (blunt or penetrating), surgery.

Acute pancreatitis primary complain is abdominal pain (about 95%). The characteristic of this pain are epigastric location and radiates to the back in one-half to two-thirds of patients and usually worsened by ingesting food or alcohol or by vomiting. Patient usually assume a knee-to-chest position to relief their pain. Other symptoms are nausea, vomiting and distention of abdominal.
On examination, abdominal tenderness is usually present. It may be mild and limited to the epigastrium or marked, diffuse, and accompanied by abdominal rigidity and rebound tenderness.
Fever, tachycardia, tachypnea and hypotension manifest depend of the severity of this disease. Patient with biliary obstruction usually present icterus.

Serum amylase consentration has been used to diagnose acute pancreatitis for more than 70 years. But serum amylase levels may also be elevated in several conditions that can closely mimic acute pancreatitis (e.g., cholangitis, gastrointestinal perforation or ischemia, ruptured ectopic pregnancy).

Abdominal CT scan also has a great contribution to help us diagnose acute pancreatitis. Abdominal ultrasonography may be useful in determining whether gallstones are the cause of an episode of acute pancreatitis.

Providing supportive care, Decreasing pancreatic inflammation and preventing the complications are the goal of treatment. For mild acute pancreatitis, patient need full bed rest, intravenous hydration and electrolytes, analgesia to relief pain. For severy acute pancreatitis, patient usually need an intensive care unit with careful attention to monitoring of hemodynamics , urine output, and respiratory and renal function. Patients should initially be kept at bed rest with no oral intake, and large amounts of intravenous narcotic analgesics are typically needed for pain relief as well as nasogastric suction for treatment of severe ileus, nausea, and vomiting. Several pharmacologic agents have been tried to inactivate trypsin and other serine proteases, decrease pancreatic secretion and reduce inflammation.

The most lethal complication is hypovolemia shock due to transudation and exudation of fluid into the retroperitoneum and peritoneum.
Friday, March 5, 2010

Learning about Antrax

Antrax isi zoonotic infection caused by Bacillus anthracis (an aerobic, nonmotile, gram-positive bacillus). Antrax causes human disease by way of direct animal contact or through exposure to contaminated animal hides, meat or other products. No human-to-human transmission has been demonstrated.
In 1979, in Sverdlovsk in the former Soviet Union, the largest known epidemic of inhalational anthrax occurred; it was later found to have been the result of an accidental release of anthrax spores from a military research facility. 
Antrax can manifest to cutaneus type (the most cases), inhalational, oropharyngeal, gastrointestinal, sepsis, and meningeal disease. The cutaneus type is beginning as a nonspecific, erythematous, painless, pruritic papule or macule that appears after an incubation period of 3 to 4 days. This type is usually more severe on the neck or face than on the trunk or extremities. The vesicle subsequently ulcerates and forms a characteristic centrally depressed black chancre (or malignant pustule).

For inhalation type or wool sorter's disease, this disease begins with an influenza-like prodrome that lasts for 1 to 6 days, followed by sudden deterioration with dyspnea, strider, cyanosis, and hypoxemia. Spesific clinical manifestation of this type is widening of the mediastinum due to hilar adenopathy.
Laboratory confirmation can be made by demonstration of the causative organism in blood, tissue fluids, and exudates by direct microscopic examination and culture, or by animal inoculation. Another laboratory studies are ELISA, PCR and a rapid hand-held immunochromatographic assay.
Drug of choice of this disease is Penicillin that virtually eliminates the spread of cutaneous anthrax and essentially reduces the mortality rate to zero. Another alternative drugs are tetracycline, erythromycin, chloramphenicol, and ciprofloxacin.
To prevent Antrax, we should give vaccination of domestic livestock, prohibition of the slaughter of unvaccinated animals, and burning of animals suspected of having anthrax.
Wednesday, March 3, 2010

Brain Abscess

Brain abscess affects the brain's parenchyma directly, whereas parameningeal infections produce suppuration in potential spaces covering the brain and spinal cord (epidural abscess and subdural empyema) or produce occlusion of the contiguous venous sinuses and cerebral veins (cerebral venous sinus thrombosis).
The condition that predispose to the development brain abscess are : otogenic (otitis media, mastoiditis), dental (dental abscess), penetrating or non penetrating head injury, cerebral infarction and tumor, post operative neurosurgical procedure, sinus (sinusitis), cardiac (infective endocarditis), pulmonary (lung abscess, bronchiectasis).
Clinical manifestation that usually present are fever, meningeal sign, increasing intracranial mass effect (nausea, depressed level of consciousness, and papilledema). Focal neurologic deficits depend on the site of the lesion, which in turn will be determined by the causal or predisposing condition. Headache is an important initial symptom in 80 to 90% of patients with bacterial abscess.
Examination of the cranium, ears, paranasal sinuses, oral cavity, heart, and lungs may provide important clues to the etiology. lumbar puncture is contraindicated for patients with signs of  increased intracranial pressure. Cultures of blood and sputum may identify the organism and its antimicrobial sensitivity.
Magnetic resonance imaging (MRI) allows detection of early changes, such as brain edema, and is preferable to computed tomography (CT).  
Brain abscess need urgent intervention. Because of the risk for cerebral herniation with large lesions, treatment of cerebral edema (intravenous dexamethasone) may be needed even while initiating surgical intervention.
Nonsurgical treatment may be considered in patients with : small lesion size, an already identified pathogen, no symptoms or signs of increased intracranial pressure requiring neurosurgical intervention, a deep or inaccessible lesion, multiple abscesses, a contraindication to surgery (e.g., a bleeding diathesis).
Factors associated with a poor prognosis include age, multiple abscesses, and diagnostic delay in the absence of systemic signs of infection.