February 8, 2017

Transverse myelitis is a rare disease of the central nervous system involving inflammation in the spinal cord. Transverse’ refers to the inflammation being across the width of the spinal cord and ‘myelitis’ refers to the specific part of the spinal cord affected.

What is Spinal Cord? The spinal cord carries messages (nerve impulses) from the brain to the body and from the body to the brain. It is made up of different types of cells. The cells responsible for transmitting messages are called neurons. Neurons have long extensions called axons which carry the messages up and down the spinal cord. Axons are arranged in bundles called tracts. Some of the tracts carry motor function messages which stimulate muscles to produce movement and some of them carry sensory messages which control sensations such as touch, pain and temperature. To increase the speed at which the messages travel, most axons are surrounded by a whitish fatty substance called myelin which forms a protective covering (sheath) around them. Myelin is produced by specialised cells called oligodendrocytes.

Transverse myelitis is a disease causing injury to the spinal cord with varying degrees of weakness, sensory alterations, and autonomic dysfunction (the part of the nervous system that controls involuntary activity, such as the heart, breathing, the digestive system, and reflexes). The inflammation causes swelling which can block messages (nerve impulses) travelling along the spinal cord. The inflammation can also damage or destroy the myelin sheath surrounding the axons in the spinal cord, probably by damaging the specialised cells which produce myelin (the oligodendrocytes). Messages (nerve impulses) cannot be transmitted properly as myelin is stripped off the axons causing scarring.

The inflammation most commonly occurs in the thoracic section of the spinal cord (the middle section below the neck and above the stomach). The damage affects this area but it can also affect the areas of the spinal cord below the thoracic section: the lumbar section (lower back) and the sacrum (between the hips). Most people with transverse myelitis experience weakness and a change in sensation (unusual feelings) in the lower half of the body and have problems with their bowel and bladder.

Transverse myelitis may be caused by viral infections, spinal cord injuries, immune disorders (including systemic lupus erythematosus, Sjogren’s syndrome, sarcoidosis and multiple sclerosis) or insufficient blood flow through the blood vessels in the spinal cord. It may occur as a complication of such disorders as optic neuromyelitis, multiple sclerosis, smallpox, and measles, or as a complication of chickenpox or rabies vaccinations. Transverse myelitis may be caused by viral infections, spinal cord injuries, immune disorders (including systemic lupus erythematosus, Sjogren’s syndrome, sarcoidosis and multiple sclerosis) or insufficient blood flow through the blood vessels in the spinal cord. It may occur as a complication of such disorders as optic neuromyelitis, multiple sclerosis, smallpox, and measles, or as a complication of chickenpox or rabies vaccinations.

Who gets TM?

Transverse myelitis occurs in adults and children, in both genders, and in all races. Females have a higher risk of transverse myelitis than males. No genetic pattern is known. Transverse myelitis is not related to family history. A peak in incidence rates (the number of new cases per year) appears to occur between\ ages 10 and 19 years and 30 and 39 years. Although only a few studies have examined incidence rates, it is estimated that about 1,400 new cases of transverse myelitis are diagnosed each year in the United States, and approximately 33,000 Americans have some type of disability resulting from the disorder.

Causes

Immune System – Although a cause cannot be established in cases of idiopathic transverse myelitis, the inflammation is thought to be the result of the immune system mistakenly attacking the spinal cord. This is called an autoimmune reaction.

Virus and Infection – Transverse myelitis often develops at the same time as, or soon after, a viral or bacterial infection. The cases of transverse myelitis are also believed to be the result of an autoimmune reaction. Rather than the viral or bacterial infection itself directly causing the inflammation, it is thought that the immune system is stimulated to fight the infection and, mistakenly, also attacks the spinal cord. Viruses that can infect the spinal cord directly are herpes viruses, including the one that causes shingles and chickenpox (zoster) and West Nile virus. Other viruses may trigger an autoimmune reaction without directly infecting the spinal cord.

Vaccinations – Transverse myelitis can also develop after vaccinations, although this is very rare. Again, it is thought that the immune system is triggered to respond to the vaccination and mistakenly attacks the spinal cord.

Multiple sclerosis is a disorder in which the immune system destroys myelin surrounding nerves in the spinal cord and brain. Transverse myelitis can be the first sign of multiple sclerosis or represent a relapse. Transverse myelitis as a sign of multiple sclerosis usually manifests on only one side of your body.

Neuromyelitis optica (Devic’s disease) is a condition that causes inflammation and loss of myelin around the spinal cord and the nerve in the eye that transmits information to thebrain. Transverse myelitis associated with neuromyelitis optica usually affects both sides of the body.

Because some affected individuals also have autoimmune diseases such as systemic lupus erythematosus, Sjogren’s syndrome, and sarcoidosis, some scientists suggest that transverse myelitis may also be an autoimmune disorder. In addition, some cancers may trigger an abnormal immune response that may lead to transverse myelitis.

Symptoms

There are four classic symptoms of transverse myelitis (TM). Patients may have only one symptom, or a combination of the following –

  • Weakness of the legs and/or arms – Some patients report stumbling, dragging one foot or notice that both legs seem heavier than normal. Depending on the level of involvement within the spinal cord, coordination or strength in the hands and arms may also be affected.
  • Sensory alteration – Patients who are experiencing altered sensitivity usually report numbness, tingling, coldness or burning. Up to 80% of patients experience heightened sensitivity to touch. Some even report that wearing clothes or a light touch with a finger causes significant pain.
  • Pain – Up to half of those with TM report pain as the first symptom of the disorder. It can be localized to the back, or appear as sharp, shooting pain that radiates down the legs, arms or around the torso. Loss of the ability to experience pain or temperature sensitivity is one of the most common sensory changes.
  • Bowel and bladder dysfunction – Some patients report bowel or bladder dysfunction as their first symptom of TM. This may mean an increased frequency or urge to urinate or defecate, incontinence, difficulty voiding, and sensation of incomplete evacuation or constipation.

Treatment

  • Intravenous Steroids – Although there are no clinical trials that support a unique approach to treat patients experiencing TM, it is well recognized as a standard of care that patients suspected to have acute myelitis receive high-dose intravenous methyl-prednisolone for 3-5 days, unless there are compelling reasons not to. The decision to offer continued steroids or add a new treatment is often based on the clinical course and MRI appearance at the end of 5 days of steroids.
  • Plasma Exchange (PLEX) This is often used for those patients with moderate to aggressive forms of TM who don’t show much improvement after being treated with intravenous and oral steroids. Again, there has not been a clinical trial that proves PLEX effectiveness in TM but retrospective studies of patients with TM treated with IV steroids followed by PLEX showed a beneficial outcome. PLEX also has been shown to be effective in some patients with other autoimmune or inflammatory central nervous system disorders. Patients particularly benefit from early treatment, and will typically be started on PLEX within days of starting steroids. Particular benefit has been shown if started within the acute or subacute stage of the myelitis or in those patients who exhibit active inflammation on MRI. However, because of the risks implied by this procedure this intervention is determined by the treating physician on a case-by-case basis.
  • Antiviral medication – Some people who have a viral infection of the spinal cord may be treated with antiviral medication.
  • Pain medication – Chronic pain is a common complication of transverse myelitis. Medications that may lessen muscle pain include common pain relievers, including acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).
  • Cyclophosphamide – It is a chemotherapy drug that is often used to treat lymphomas or leukemia, is sometimes used. Patients receiving this treatment are carefully monitored for potential complications that may arise from immunosuppression.

Alternative Treatment

 

 

Posted in INFECTIOUS
February 8, 2017

Sjogren’s syndrome (pronounced Show- grins) is an auto immune disease – a disease in which the immune system turns against the body’s own cell. Sjögren’s syndrome is also known as “Mikulicz’s disease” and “Sicca syndrome”.

In Sjorgren’s Syndrome (SS) the immune system attacks the moisture producing glands and causes dryness in the mouth and eyes. In some cases, other parts of the body can be affected as well, resulting in multiple possible symptoms. It was first identified by a Swedish physician, Dr. Henrik Sjögren in 1933.

The immune system is responsible for protecting the body from various diseases by destroying harmful invaders like viruses and bacteria. In SS, the immune system attack the glands that produce tears and saliva (the lacrimal and salivary glands). Damage to these glands keeps them from working properly and causes dry eyes and dry mouth. Dry eyes are called kerato-conjunctivitis sicca, or KCS, and dry mouth is called xero-stomia. This disease can affect other glands too, such as the glands in the stomach, pancreas, and intestines, and can cause dryness in other places that need moisture, such as the nose, throat, airways, and skin. Since, SS causes inflammation in joints, muscles, skin, or other body tissue, it is considered to be a  rheumatic disease. Sjögren’s is also considered a disorder of connective tissue, which is the framework of the body that supports organs and tissues (joints, muscles, and skin).

Between 400,000 to 3.1 million Americans, i.e. about one to two percent of the population is affected by Sjogren’s syndrome. It generally affects people between 45 and 55 years old, although it can affect anyone regardless of age. It is also found mostly in women – women are 10 times more likely to have Sjögren’s than men.

Causes

While it’s not known exactly what causes Sjogren’s syndrome, a combination of the following may be to blame:

  • Abnormal immune response
  • Sex hormones
  • Inheritance or genetics
  • Environment (although the exact environmental factors aren’t known)

It is classified in the following :

  • Primary – The syndrome is developed by itself and not as the result of another condition. For example, certain people are born with specific genes that make them more vulnerable to a faulty immune system. Then, many years later, an environmental factor, possibly a common virus, triggers the immune system to stop working properly.
  • Secondary – The syndrome is developed in combination with another autoimmune disorder, such as lupus or rheumatoid arthritis

The causes are listed as below –

  • Autoimmune Factor – Salivary glands that produce saliva exist in “grape-like” clusters. There are no or few lymphocytes in the normal salivary gland but are present in Sjogren’s syndrome. Lymphocytes are part of the immune system that normally protect the body from infection and tumors. When they appear to attack the body’s tissue (as in Sjögren’s syndrome, systemic lupus, or in rheumatoid arthritis), the term “autoimmunity” is used. Lymphocytes originate in the bone marrow. Two types of lymphocytes, termed “T cells” and “B cells” are responsible for mediating immune reactions. The entire lymphoid system is precisely regulated, largely by messenger molecules that instruct cells to “turn on” or “turn off.” Autoimmunity, the excessive reaction against one’s own tissues, then results from a failure of the normal regulation of T cells and B cells. This may be due either to an excessive production of helper signals or a failure to respond to suppressor signals. As a consequence, lymphocytes infiltrate the tissues and attack normal cellular structures.
  • Virus & Infections – Studies suggest that a virus is involved. One possible candidate is the Epstein-Barr virus (EBV), which causes infectious mononucleosis, a condition characterized by swollen salivary glands, joint aches and fatigue. Virtually all adults have been infected with EBV by age 20 years. After the initial infection, this virus normally resides in the salivary glands for life but causes no problems. We and others have speculated that this virus (or a closely-related virus) may trigger an autoimmune response in genetically susceptible individuals.

It is thought that an as yet unknown infectious agent damages the salivary gland and attracts the “immune” lymphocytes into the salivary gland. These lymphocytes release specific autoantibodies such as rheumatoid factor (RF) and antinuclear antibodies; antibodies are directed against proteins termed Sjögren’s-associated antigens A and B (or SS-A and SS-B). These antibodies can enter the bloodstream and are measured in the blood tests that we obtain to confirm the diagnosis of Sjögren’s syndrome.

  • Hereditary Factor – Particular genes (such as human leukocyte antigen or HLA genes) are inherited in the same manner from parents as are genes for hair color or eye color; that is, one gene from each parent. The HLA genes are important in controlling the immune response and many current research studies are trying to determine exactly how they perform this task. A specific gene named HLA-DR3 is found in high frequency in Caucasian patients with primary Sjögren’s syndrome.
  • Evironmental Factors – These include:
    • Toxic Metal Exposure – Studies have shown that exposure to toxic metals such as mercury, cadmium, lead, arsenic, aluminum, nickel and other heavy metals can be linked to the autoimmune process: The heavy metals induce autoantibodies, which then create autoimmune diseases, including Sjogren’s syndrome. These free radicals then alter the body’s pH (which must be kept constant). An altered pH allows viruses, bacteria, candida and other pathogens to thrive, which then sets the stage for more free radicals. The free radicals damage the cells, making it impossible for the cells to communicate with each other. Autoimmunity results when the immune system attacks the damaged cells.
    • Toxic Chemical Exposure – Toxins such as pesticides, solvents, industrial chemicals, even household cleaners and hair dyes are being implicated in autoimmune diseases. These toxins are everywhere, and they greatly increase the risk of all diseases in general.
    • Smoking – Smoking increases the risk of several autoimmune diseases, primarily because of the chemicals in cigarettes. 
  • Nutritional Deficiencies – Poor diet is an important factor in autoimmunity because poor nutrition compromises the immune system. Processed foods are loaded with chemicals, hormones, steroids, trans-fats and sugars, which promote the creation of free radicals in the body, which in turn damage the cells.

Symptoms

The main symptoms are

  • Dry eyes—Your eyes may be red and burn and itch. People say it feels like they have sand in their eyes. Also, your vision may be blurry, and bright light, especially fluorescent lighting, might bother you.
  • Dry mouth—Dry mouth feels like a mouth full of cotton. It’s difficult to swallow, speak, and taste. Your sense of smell can change, and you may develop a dry cough. Also, because you lack the protective effects of saliva, dry mouth increases your chances of developing cavities and mouth infections.

Both primary and secondary Sjögren’s syndrome can affect other parts of the body as well, including the skin, joints, lungs, kidneys, blood vessels, and nervous system, and cause symptoms such as –

  • Dry skin
  • Skin rashes
  • Thyroid problems
  • Joint and muscle pain
  • Pneumonia
  • Vaginal dryness – painful sexual intercourse
  • Numbness and tingling in the extremities

When Sjögren’s affects other parts of the body, the condition is called extraglandular involvement because the problems extend beyond the tear and salivary glands. Finally, Sjögren’s can cause extreme fatigue that can seriously interfere with daily life.

Less common features of Sjögren’s syndrome are:

  • Irritation of the nerves in the arms, hands, legs, or feet (neuropathy)
  • Feeling of numbness or tingling
  • Thyroid gland abnormalities
  • Skin rashes
  • Memory loss, difficulty concentrating or confusion
  • Gastrointestinal problems, such as acid reflex, bloating, abdominal pain, or diarrhea
  • Inflammation of the lungs, kidneys (unlike lupus nephritis), liver, or pancreas
  • Cancer of the lymphatic tissue (occurs in up to 5% of patients with the disease)

Treatment

The goals of treatment are to decrease discomfort and reduce the harmful effects of dryness. Generally, physicians use medications to control symptoms (symptomatic treatment). The type of treatment will be tailored to each patient’s symptoms and needs.

  • Good oral hygiene – Good mouth/dental care may prevent or reduce dental decays, infections, or tooth loss:
    • Toothpastes (biotene type) and oral gels are available for people with dry mouth These products may also have antibacterial action to reduce the severity of dental cavities over a long period of time.
    • Chewing sugar-free gums can be helpful.
    • Taking frequent sips of water without swallowing (spitting it out) may improve dry mouth.
  • Increasing Eye Moisture
    • Dry eyes are mainly treated with the use of artificial tears. A wide variety of over-the-counter products is available. Artificial tears can be used regularly and more often in dry environmental conditions such as on airplanes, in air-conditioned buildings, and on windy days.
    • While artificial tears are helpful, they often do not last long enough. Thicker      preparations (gel form) that last longer are available. These are often used at bedtime because they can sometimes cause blurry vision. Eye doctors can prescribe an eye drop called Restasis to treat more severe form of dry eyes. A small procedure called punctal plugs, to slow the disappearance of tears, is another treatment option when artificial tears are not sufficient.
  • Medications – Medications that tend to reduce body fluids should be avoided.
    • Mild pain-relieving medications (analgesics), including acetaminophen, such as Tylenol or non-steroidal anti-inflammatory drugs – NSAIDs, such as Motrin and Aleve, can reduce muscle or joint pain.
    • In some patients, the anti-rheumatic drug hydroxychloroquine has been beneficial in decreasing pain and salivary gland swelling and improving fatigue, muscle pain, joint pain, or rash. This drug generally does not help with dry symptoms, however.
    • For patients with internal organ symptoms (particularly when the disease affects internal organs), steroids and immunosuppressive medications may be used. These include medicines such as prednisone (a steroid) and, rarely, chemotherapy-type medications.
    • Systemic corticosteroids and/or immunosuppressive agents like cytotoxic drugs have been used for various extra glandular symptoms of SS, such as: vasculitis, lung involvement kidney involvement. However, cytotoxic agents should be used with great care as they may increase the risk of lymphoma.
    • Water-based vaginal lubricants (K-Y Jelly, Astroglide, Replens, Luvena) can ease vaginal dryness and painful intercourse. Estrogen creams or other preparations may be helpful for women who have vaginal dryness due to reduced estrogen levels related to menopause.

It is important to know that the medications also involve numerous side effects that can prove harmful and may result in creating additional complications.

  • Balance of rest and exercise – Guided exercise programs can help patients overcome fatigue, maintain flexibility, and overcome joint and muscle pain. Good sleep hygiene is helpful for improving fatigue and body pain.

Alternative Treatment

Alternative medicine definitely has more treatment options. The model of simply fixing the gut, stabilizing the blood sugar level, balancing the hormones, taking enough essential fatty acids and anti-inflammatory protocols, and so forth, are effective. However, they are not any different than treating any type of autoimmune disorders.

  • Detoxification Therapy – Detoxification thrapy utilizes clinical procedures that safely reduce the body’s burden of toxic chemicals, including chemicals stored following occupational, accidental, and/or chronic airborne exposures. Chemicals bind to human tissues on the basis of their lipophilic properties — meaning literally “attracted to fats.”
  • Green tea and EGCG for Sjogren’s syndrome – Green tea polyphenols reduce autoimmune symptoms in a murine model for human Sjogren’s syndrome and protect human salivary acinar cells from TNF-alpha-induced cytotoxicity. Green tea contains several antioxidants that have been shown to curb inflammation, prevent cell death, and possibly even ward off cancer. EGCG reduced the severity and delayed the onset of salivary gland damage associated with Sjogren’s syndrome.
  • Fish oils, Wheat Germ oil & flax seeds – Effect of omega-3 and vitamin E supplementation on dry mouth in patients with Sjögren’s syndrome. Omega3 Fatty acid rich fish oil (FO) and vitamin E may delay the progress of certain autoimmune diseases. omega-3 (n-3) increases saliva production in patients with Sjögren’s syndrome. Wheat germ oil helps in stimulating saliva production in patients with Sjögren’s syndrome.
  • DHEA – Low serum levels of sex steroids are associated with disease characteristics in primary Sjogren’s syndrome; supplementation with dehydroepiandrosterone restores the concentrations. It also helps in stimulating saliva production.
  • Flavonoids – Plant-derived flavonoids are inhibitors of various intracellular processes, notably phosphorylation pathways, and potential inhibitors of cellular autoimmunity. This includes – apigenin and luteolin, fisitin, quercetin, morin and hesperitin. It acts as strong inhibitors for T cells.
  • Rose hip herbal remedy for SS, Probiotic for gut
  • Vitamin D – Vitamin D inhibits pro-inflammatory processes by suppressing the enhanced activity of immune cells that take part in the autoimmune reaction. Supplementation may be therapeutically beneficial particularly for Th1 mediated autoimmune disorders. Some reports imply that vitamin D may even be helpful in multiple sclerosis and diabetes type 1.

Integrated Treatment

Integrated medical practitioners treat the whole body as a single system and work with interdependent, oscillating energies and seek to achieve balance and integration of the entire body. There are natural, non-invasive, and wholistic approaches that incline toward discovering the imbalances, and integrate to correct them through diet and nutrition, exercise, acupuncture, massage, and individual customized education.

With the variety of symptoms that encompass Sjogren’s syndrome, it is very important to have a plan and helpful practitioner who works with full oversight and a set of complimentary skills under one roof, i.e. our center.

 

Posted in INFECTIOUS
February 8, 2017

Sinusitis is an inflammation or infection of the sinuses, the air-filled chambers in the skull that are located around the nose. Symptoms of sinusitis include thick nasal discharge, facial pain or pressure, fever, and reduced sense of smell. Depending on how long these symptoms last, sinusitis is classified as acute, subacute, chronic, or recurrent. Viruses are the most common cause of acute sinusitis, but bacteria are responsible for most of the serious cases.

Sinusitis, also called rhinosinusitis, affects about 1 in 8 adults annually and generally occurs when viruses or bacteria infect the sinuses (often during a cold) and begin to multiply. Part of the body’s reaction to the infection causes the sinus lining to swell, blocking the channels that drain the sinuses. This causes mucus and pus to fill up the nose and sinus cavities.

What are Sinuses?

Sinuses are hollow spaces in the bones around the nose that connect to the nose through small, narrow channels. The sinuses stay healthy when the channels are open, which allows air from the nose to enter the sinuses and mucus made in the sinuses to drain into the nose.

Four pairs of sinuses, known as the paranasal air sinuses, connect to the nasal passages (the two airways running through the nose):

  • Frontal sinuses (behind the forehead)
  • Maxillary sinuses (behind the cheekbones)
  • Ethmoid sinuses (behind the nose)
  • Sphenoid sinuses (behind the eyes)

Sinusitis occurs if obstruction or congestion cause the paranasal sinus openings to become blocked. When the sinus openings become blocked or too much mucus builds up in the chambers, bacteria and other germs can grow more easily, leading to infection and inflammation.

Types of Sinusitis

  • Acute sinusitis gives rise to severe symptoms but is usually short-lived. Acute sinusitis usually occurs following a cold. Typically a green-yellow nasal discharge occurs a week or more after the onset of the cold and this is associated with severe pain around the cheeks, eyes and/or forehead. This may be associated with swelling and a high fever along with toothache.
  • Chronic sinusitis is sinusitis that continues for many weeks. Chronic sinusitis may be caused by an acute sinus infection which fails to resolve or as a result of an underlying allergy affecting the lining membranes of the nose and sinuses. Common symptoms include nasal obstruction, headache, nasal discharge, low grade fever, reduced sense of smell, facial pain and halitosis.

Causes

Infections – Most adults will get colds and upper respiratory tract infections up to three times a year. Children get them more frequently. Bacterial infections often follow the common cold. When the mucus changes from clear to yellow or green it usually means a bacterial infection has developed. Both viral and bacterial infections cause swelling of the tissues inside the nose and thickening of the normal mucus. This slows down or even stops proper sinus drainage and infection in the sinus may ensue.

Irritants – Air pollution, smoke and chemical irritants, for example some sprays containing pesticides, disinfectants and household detergents, may cause swelling and blockage of the lining of the nose causing a narrowing of the drainage opening from the sinuses. This can once again lead to impairment of sinus drainage and consequent infection.

Allergies – Allergies can cause inflammation inside the nose. Common symptoms of an allergic reaction include nasal stuffiness, runny nose, sneezing and itchy watery eyes. Chronic sinusitis is sometimes associated with asthma. Allergies are responsible for asthma in some patients and may also cause nasal stuffiness making the asthma more difficult to control.

Structural problems – Occasionally structural problems within the nasal cavity can cause a narrowing. Some of these can be caused as a result of trauma while others may develop during the growth period. Occasionally the structural narrowing can be so severe that mucus builds up behind these areas of blockage giving rise to sinus infection.

Risk Factors

  • Certain factors increase a person’s susceptibility to sinusitis, including:
  • Frequent colds (especially for young children)
  • Cigarette smoking (active or passive)
  • Regular use of nasal decongestant sprays (for more than two to three days)
  • Untreated hay fever or other allergies
  • Structural abnormalities of the nose
  • Nasal polyps (swellings in the linings of the nose or sinuses)
  • Dental disease, such as untreated tooth abscess.

Symptoms

Common symptoms of sinusitis include

  • Postnasal drip
  • Discolored nasal discharge (greenish in color)
  • Nasal stuffiness or congestion
  • Tenderness of the face (particularly under the eyes or at the bridge of the nose)
  • Frontal headaches
  • Pain in the teeth
  • Coughing
  • Fever
  • Fatigue
  • Bad breath

Sinus disease is often confused with rhinitis, a medical term used to describe the symptoms that accompany nasal inflammation and irritation. Rhinitis only involves the nasal passages. It could be caused by a cold or allergies.

Allergies can play an important role in chronic (long-lasting) or seasonal rhinitis episodes. Nasal and sinus passages become swollen, congested, and inflamed in an attempt to flush out offending inhaled particles that trigger allergies. Pollen are seasonal allergens. Molds, dust mites and pet dander can cause symptoms year-round.

Asthma also has been linked to chronic sinus disease. Some people with a chronic nasal inflammation and irritation and/or asthma can develop a type of chronic sinus disease that is not caused by infection. Appropriate treatment of sinus disease often improves asthma symptoms.

Complications

Asthma flare-ups – Chronic sinusitis can trigger an asthma attack.

Meningitis – This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.

Vision problems – If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.

Aneurysms or blood clots – Infection can cause problems in the veins surrounding the sinuses, interfering with blood supply to your brain and putting you at risk of a stroke.

Osteomyelitis – Adolescent males with acute frontal sinusitis are at particular risk for severe problem. n such cases, the patient usually experiences headache, fever, and a soft swelling over the bone known as Pott’s puffy tumor.

Treatment

Antibiotics – Antibiotics are standard treatments for bacterial sinusitis. Antibiotics are usually taken from 3 to 28 days, depending on the type of antibiotic. Because the sinuses are deep-seated in the bones, and blood supply is limited, longer treatments may be prescribed for people with longer lasting or severe cases. Antibiotics help eliminate sinus disease by attacking the bacteria that cause it, but until the drugs take effect, they do not do much to alleviate symptoms. Some over-the-counter medications can help provide relief.

Nasal decongestant sprays – Topical nasal decongestants can be helpful if used for no more than three to four days. These medications shrink swollen nasal passages, facilitating the flow of drainage from the sinuses. Overuse of topical nasal decongestants can result in a dependent condition in which the nasal passages swell shut, called rebound phenomenon.

Antihistamines – Antihistamines block inflammation caused by an allergic reaction so they can help to fight symptoms of allergies that can lead to swollen nasal and sinus passages.

Nasal decongestants and antihistamines – Over-the-counter combination drugs should be used with caution. Some of these drugs contain drying agents that can thicken mucus. Only use them when prescribed by your doctor.

Topical nasal corticosteroids – These prescription nasal sprays prevent and reverse inflammation and swelling in the nasal passages and sinus openings, addressing the biggest problem associated with sinusitis. Topical nasal corticosteroid sprays are also effective in shrinking and preventing the return of nasal polyps. These sprays at the normal dose are not absorbed into the blood stream and could be used over long periods of time without developing “addiction.”

Nasal saline washes – Nasal rinses can help clear thickened secretions from the nasal passages.

Surgery – If drug therapies have failed, surgery may be recommended as a last resort. It is usually performed by an otolaryngologist. Anatomical defects are the most common target of surgery.

Alternative Treatment

Bromelain – Several studies suggest that bromelain, an enzyme derived from pineapples, may help reduce inflammation and swelling and relieve symptoms of sinusitis.

Quercetin – Quercetin is a flavonoid, a plant pigment responsible for the colors found in fruits and vegetables.

Probiotics – Probiotics, or “friendly” bacteria, may be helpful if you are taking antibiotics for sinusitis. They may also reduce your chances of developing allergies. Probiotics may not be appropriate for certain people who are extremely immunocompromised or who take immunosuppresent drugs.

N-acetylcysteine – NAC is a modified form of a dietary amino acid that works as an antioxidant in the body. It also helps thin mucus.

Sinupret – The herbs it contains may work by thinning mucus and helping the sinuses drain, and they may also help strengthen the immune system.

Chiropractic – Although no studies have examined using chiropractic to treat sinusitis, some practitioners suggest it may decrease pain and improve sinus drainage for some people.

Posted in INFECTIOUS
February 8, 2017

Shingles, also known as Herpes Zoaster, is a localized, painful rash caused by reactivation of the varicella zoster virus (VZV) which also causes chickenpox. The virus remains hidden in the body after chickenpox infection for many years and reoccurs later as shingles. Approximately 30% of all people who have been infected with chickenpox will later develop shingles.

A shingles rash usually appears on one side of the face or body and lasts from 2 to 4 weeks. Its main symptom is pain, which can be quite severe. Other symptoms of shingles can include fever, headache, chills and upset stomach. Very rarely, a shingles infection can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death.

Shingles is very common. Fifty percent of all Americans will have had shingles by the time they are 80. While shingles occurs in people of all ages, it is most common in 60- to 80-year-olds. In fact, one out of every three people 60 years or older will get shingles.

Shingles can occur at any age, but is most common in people who are over 50 years of age. Among people who are over 80 years of age, about 11 people in every 1,000 have shingles each year. Shingles is much less common in children.

Shingles is not spread from person to person. However, the blister fluid from the shingles rash is infectious and contact with the blister fluid can cause chickenpox in a person who has not previously had chickenpox. Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.

Causes

The virus that causes chickenpox also causes shingles. After a person gets rid of the chickenpox, the virus stays in the body. The virus travels to the nerves where it sleeps. Shingles appears when the virus wakes up. It is not clear what reactivates or “wakes up” the virus. A short-term weakness in immunity may cause this.

Shingles is much less contagious than chickenpox. But a person with shingles can still spread the virus. Anyone who has not had chickenpox can get this virus.

If the virus spreads to someone who has not had it, the person will get chickenpox — not shingles. Newborns and those with a weak immune system have the highest risk of getting the virus from someone who has shingles.

This virus spreads when the person has uncovered, open blisters and someone touches the blisters. Once the blisters form scabs, the person is no longer contagious.

Who is at risk?

Some people who have had chickenpox have a higher risk of getting shingles. These people –

  • Are 50 years of age or older.
  • Have an illness or injury.
  • Are under great stress.
  • Have a weakened immune system.

Some illnesses and medical treatments can weaken a person’s immune system and increase the risk. These include –

  • Cancer.
  • HIV/AIDS.
  • Some cancer treatments, such as chemotherapy or radiation.
  • Medicine taken to prevent rejection of a transplanted organ.
  • Cortisone when taken for a long time.

Symptoms

Shingles tends to cause more pain and less itching than chickenpox. Common signs and symptoms are –

The warning – An area of skin may burn, itch, tingle, or feel very sensitive. This usually occurs in a small area on 1 side of the body. These symptoms can come and go or be constant. Most people experience this for 1 to 3 days. It can last longer.

Rash – A rash then appears in the same area.

Blisters – The rash soon turns into groups of clear blisters. The blisters turn yellow or bloody before they crust over (scab) and heal. The blisters tend to last 2 to 3 weeks.

Pain – It is uncommon to have blisters without pain. Often the pain is bad enough for a doctor to prescribe painkillers. Once the blisters heal, the pain tends to lessen. The pain can last for months after the blisters clear.

Flu-like symptoms – The person may get a fever or headache with the rash.

Complications

  • Scarring
  • Secondary bacterial skin infection
  • Nerve complications such as nerve palsies
  • Pneumonia
  • Eye damage where the ophthalmic nerve has been affected.
  • Ramsay Hunt syndrome if shingles affects the nerves of the face or ear

Treatment

It is best to get treatment immediately. Treatment can include –

Pain relievers to help ease the pain – The pain can be very bad, and prescription painkillers may be necessary.

Anti-viral medicine – This medicine may be prescribed when a doctor diagnoses shingles within 72 hours of the rash first appearing. The earlier anti-viral treatment is started, the better it works. Anti-viral medicines include famciclovir, valacyclovir, and acyclovir. These can lessen the pain and the amount of time the pain lasts.

Nerve blocks – Given for intense pain, these injections (shots) contain a numbing anesthetic and sometimes a corticosteroid.

Corticosteroids – To lower swelling and pain, some patients may get corticosteroid pills with their anti-viral medicine. This treatment is not common because it can make the rash spread.

Treatments for pain after the rash clears – Certain anti-depressants, pain relievers, anesthetic creams and patches, and anti-seizure medicines can help.

Alternative Treatment

Rhus toxicodendron (Rhus tox) is useful when blisters emerge that are not only painful but very itchy, and warmth brings relief. The pain is worse at night and less noticeable when moving about.

Arsenicum album is indicated for shingles with red, burning lesions that are relieved by warmth and are worse at night, causing great restless anxiety.

Mezereum is indicated if there is severe pain, if the skin burns and itches and forms brown scabs, or if the is person middle-aged or elderly. Lasting neuralgic pains that shoot along the nerve after the skin has healed are often helped by this remedy.

Ranunculus is useful if there are nerve pains and itching, or the slightest touch, movement or eating makes the symptoms worse.

Lachesis is prescribed if the left side of the body is affected, plus some swelling, which is aggravated by wan-nth but is relieved by cold.

Apis is used when the swelling and stinging pains predominate, improve with cold and become aggravated by heat.

Adenosine monophosphate (AMP) – The study used injections of AMP, so researchers don’t know if taking AMP orally would have any effect. People who take dipyridamole (Persatine) or carbamazepine (Tegretol) should not take AMP.

Vitamins B-12 and E – A few studies suggest that vitamin E (1,200 to 1,600 mg per day) and injections of B-12 (but not oral B-12) might help reduce symptoms of postherpetic neuralgia.

Cayenne – Capsaicin cream made from cayenne pepper can relieve pain when applied to the skin. Capsaicin may help relieve the pain of post-herpetic neuralgia, and an over-the-counter ointment is approved for this treatment.

Licorice – Traditionally, licorice gel has been used topically (applied to the skin) to treat shingles and postherpetic neuralgia. In test tubes, one of the constituents of licorice, called glycyrrhizin, stops the varicella zoster virus from reproducing.

 

Reference –

http://www.medicinenet.com/shingles_herpes_zoster/page4.htm#what_is_the_treatment_for_shingles

https://www.nia.nih.gov/health/publication/shingles

https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q—t/shingles/who-gets-causes

http://www.nhs.uk/Conditions/Shingles/Pages/Symptoms.aspx

www.shinglesaware.co.uk

 

Posted in INFECTIOUS
February 8, 2017

Postherpetic neuralgia (PHN) can be an unfortunate result of herpes zoster infection (shingles). It is defined broadly as any pain that remains after healing of herpes zoster lesions or rash, usually after a three month period.

Shingles (also known as herpes zoster) is a skin rash that can be very painful. It is a viral infection of the nerves, and the nerves affected by shingles can occasionally continue to cause severe pain after the shingles have cleared. Shingles appear as a rash, patch, or a line of painful blisters which arise on the skin over a nerve in the shape of a band. This band follows the distribution of a specific nerve where the virus has been living before its spread to the skin. Shingles affects both men and women equally. This disease is caused by the same virus that causes chicken pox (varicella zoster). Chicken pox usually affects young children, and its symptoms involve itchy blisters all over the body. Once these symptoms go away, the varicella zoster virus stays in the nerves near the spine. It is almost as if the virus “goes to sleep”. It will “wake up”, however, when the body’s immune system is

If the pain caused by shingles continues after the shingles is over – within two to four weeks – it is known as post-herpetic neuralgia. It is estimated that about one-in-five patients with shingles will go on to have post-herpetic neuralgia. Post-herpetic neuralgia (PHN) is more common as people get older – it is uncommon in children weakened. The virus then grows in the nerves, causing pain. When the virus reaches the skin, it causes the shingles rash.

Each year approximately 1,000,000 people in the U.S. develop shingles or herpes zoster. Of these, it is estimated approximately 10-20% (about 200,000) will go on to develop PHN.

The risk of developing PHN increases with age and can affect at least 40% of all herpes zoster patients over age 50 and 75% of herpes zoster patients over age 75. PHN is the single most common neurologic condition in elderly patients

Causes

The nerve damage caused by shingles disrupts the proper functioning of the nerve. The faulty nerve becomes confused and sends random, chaotic (uncontrolled) pain signals to the brain, which the patient feels as a throbbing, burning pain along the nerve.

Experts believe that shingles results in scar tissue forming next to nerves and pressing on them, causing them to send inaccurate signals, many of which are pain signals to the brain. However, nobody is really sure why some shingles patients go on to develop postherpetic neuralgia.

Symptoms

Symptoms are usually limited to the area of skin where the shingles outbreak first occurred. Symptoms may include:

  • Occasional sharp burning, shooting, jabbing pain
  • Constant burning, throbbing, or aching pain
  • Extreme sensitivity to touch
  • Extreme sensitivity to temperature change
  • Itching
  • Numbness
  • Headaches

In rare cases, if the nerve also controls muscle movement, the patient may experience muscle weakness or paralysis.

Some patients may find the symptoms interfere with their ability to carry out some daily activities, such as bathing or dressing. Postherpetic neuralgia may also cause fatigue and sleeping difficulties.

Treatment

Treatment will depend on the type of pain, as well as some aspects of the patient’s physical, neurological and mental health.

Antidepressants – These help patients with postherpetic neuralgia not because the patient is depressed, but because they affect key brain chemicals, such as serotonin and norepinephrine, which influence not only depression, but also how the body interprets pain. Dosages for postherpetic neuralgia will tend to be lower than for depression, unless the patient has both depression and postherpetic neuralgia. Examples of drugs that inhibit the reuptake of serotonin or norepinephrine are tricyclic antidepressants, such as amitriptyline, desipramine (Norpramin), nortriptyline (Pamelor) and duloxetine (Cymbalta). They will not get rid of the pain, but are said to make it more bearable.

Anticonvulsants – As with trigeminal neuralgia pain, postherpetic pain can be lessened with anticonvulsants, because they are effective calming down nerve impulses and stabilize abnormal electrical activity in the nervous system caused by injured nerves. Gabapentin (Neurontin), pregabalin (Lyrica) are examples of commonly prescribed anticonvulsants for this type of pain.

Steroids – A corticosteroid medication is injected into the area around the spinal cord. Injected steroids are effective for postherpetic neuralgia patients with chronic pain (persistent long-term pain). The patient should not receive this medication until the shingles pustular skin rash has completely disappeared.

Painkillers – This may include tramadol (Ultram) or oxycodone (OxyContin). There is a small risk of dependency.

TENS (transcutaneous electrical nerve stimulation) – Electrodes are placed over the areas where pain occurs. Small electrical impulses are emitted. The patient turns the TENS device on and off as required. Some patients obtain significant pain relief from TENS, while others don’t. Experts are not sure why the electrical impulses relieve pain. Some say that TENS stimulates endorphin release – endorphins are the body’s natural painkillers; some people call them natural “feel good” chemicals.

Spinal cord or peripheral nerve stimulation – Similar to TENS, but here the devices are implanted under the skin, along the course of peripheral nerves. These devices are a safe, efficient, and effective way to relieve many types of neuropathic pain conditions, including trigeminal neuralgia.

Alternative Treatment

Proteolytic Enzymes – Proteolytic enzymes are enzymes that are produced naturally by the pancreas to help digest protein we eat. They help in pain relief and skin improvement.

Capsaicin Cream – Although people may not have heard of capsaicin before, if you’ve ever eaten a chili pepper and felt the mouth burn. Capsaicin is the active ingredient in chili peppers and is sometimes used for postherpetic neuralgia.

Colloidal silver is an extremely effective pathogen destroyer which can be taken internally as well as applied topically. Colloidal silver attaches itself to viruses and prevents them from replicating and there are specific silver receptors on human nerve tissue – the location where the shingles virus “hides out”.

 

Reference –

http://www.centerforhomeopathy.com/shingles-post-herpetic-neuralgia/

http://emedicine.medscape.com/article/1143066-treatment

http://www.nhs.uk/Conditions/postherpetic-neuralgia/Pages/Treatment.aspx

http://www.healingchronicpain.org/neuralgia/frequency

http://www.med.or.jp/english/pdf/2004_11/529_536.pdf

http://patient.info/health/postherpetic-neuralgia-leaflet

http://www.medicalnewstoday.com/articles/160253.php

http://www.nhs.uk/conditions/postherpetic-neuralgia/Pages/Introduction.aspx

http://emedicine.medscape.com/article/1143066-overview

 

Posted in INFECTIOUS
February 8, 2017

Pelvic inflammatory disease (PID) is an infection induced inflammation of a woman’s pelvic organs. The pelvic organs include the uterus (womb), fallopian tubes, ovaries, and cervix. It is a complication often caused by some STDs, like Chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID. Other bacteria that normally live in the vagina can also cause it, especially after a termination of pregnancy, or having intra uterine device (IUD/coil) fitted.

In PID, inflammation spreads from the vagina or cervix to the upper genital tract, with endometritis as an intermediate stage in the pathogenesis of disease. The hallmark of the diagnosis is pelvic diagnosis combined with inflammation of the lower genital tract; women with PID often have a very subtle symptoms and signs.

Pelvic inflammatory disease is common. More than one million U.S. women get PID every year. As a result of PID, more than 100,000 women become infertile each year. In addition, a large proportion of the 100,000 ectopic (tubal) pregnancies that occur each year can be linked to PID. The rate of infection is highest among teenagers.

PID can lead to serious, long-term problems –

  • Infertility—One in ten women with PID becomes infertile. PID can cause scarring of the fallopian tubes. This scarring can block the tubes and prevent an egg from being fertilized.
  • Ectopic pregnancy—Scarring from PID also can prevent a fertilized egg from moving into the uterus. Instead, it can begin to grow in the fallopian tube. The tube may rupture (break) and cause life-threatening bleeding into the abdomen and pelvis. Emergency surgery may be needed if the ectopic pregnancy is not diagnosed early.
  • Chronic pelvic pain—PID may lead to long-lasting pelvic pain.

Causes

In most cases the PID is caused by an infection which starts in the vagina and then makes it way to the cervix, and can move onto the fallopian tubes and ovaries. Often more than one type of bacteria may be causing the infection.

  • Chlamydia and Gonorrhea – Chlamydia is the most common cause (50% to 65% of cases in the UK), followed by gonorrhea (14% of cases in the UK). Sometimes PID may be caused by a combined Chlamydia-gonorrhea infection.
  • Childbirth, abortion or miscarriage – bacteria can get into the vagina during/after childbirth, abortion or miscarriage; it then multiplies and spreads, causing PID. The infection can spread more easily because the cervix may not have fully closed.
  • IUD – the intrauterine device, also known as a coil can increase the risk of infection which may lead to PID.
  • Endometrial biopsy – this procedure, during which a sample of tissue is taken for analysis, has a risk of infection and subsequent PID.
  • Appendicitis – there is a slight risk of developing PID if a woman has appendicitis.
  • Women who are sexually active and less than 25 years of age, have several sexual partners, or do not use barrier contraceptives have a higher risk of developing PID.

Symptoms

Some women with PID have only mild symptoms or have no symptoms at all. Because the symptoms can be vague, many cases are not recognized by women or their gynecologists or other health care professionals. Listed are the most common signs and symptoms of PID:

  • Abnormal vaginal discharge
  • Pain in the lower abdomen (often a mild ache)
  • Pain in the upper right abdomen
  • Abnormal menstrual bleeding
  • Fever and chills
  • Painful urination
  • Nausea and vomiting
  • Painful sexual intercourse
  • Fatigue

Having one of these signs or symptoms does not mean that you have PID. It could be a sign of another serious problem, such as appendicitis or ectopic pregnancy. You should contact your gynecologist or other health care professional if you have any of these signs or symptoms.

Treatment

PID can be treated. However, treatment of PID cannot reverse the scarring caused by the infection. The longer the infection goes untreated, the greater the risk for long-term problems, such as infertility.

  • Antibiotics – treatment for PID depends on the cause, but usually involves administering antibiotics. If the patient does not respond to antibiotic treatment within three days she should go back to her doctor or hospital, who may recommend intravenous antibiotic therapy or a change of medication.

As PID is frequently caused by more than just one type of bacteria at any one time, doctors tend to prescribe two antibiotics, which are taken together. As soon as the doctor knows which bacterium or bacteria are causing the disease, antibiotic therapy may become more targeted. Examples of antibiotics for PID include ofloxacin, metronidazole, ceftriaxone and doxycycline.

A course of antibiotics usually lasts 14 days. Patients with very severe symptoms will be hospitalized and receive their medication intravenously.

  • Surgery – the fallopian tubes may have scarring, or there may be abscesses that need to be drained. Surgery may be needed, either laparoscopy (keyhole surgery) or salpingectomy (removal of one or both fallopian tubes). Doctors are reluctant to remove both fallopian tubes, because the woman will not be able to get pregnant naturally.
  • Sexual partner – the doctor may advise the woman to have her sexual partner checked and if necessary, treated for an STD (sexually transmitted disease). If the partner has an STD there is a serious risk of recurrence.

Alternative Treatment

A comprehensive treatment plan for PID may include a range of alternative therapies.

  • Nutritional Supplement –
    • Multivitamin supplement – Intake of antioxidant vitamins A, C, and E, the B complex vitamins and trace minerals such as magnesium, calcium, zinc and selenium.
    • Omega 3 fatty acids – Intake of fish oil help reduce inflammation.
    • Probiotic – Probiotic yogurt that contains live cultures (good bacteria) is a great remedy to fight this bacterial infection. The good bacteria in this yogurt will help fight the bad bacteria and restore good bacteria in your vagina. It also helps maintain a healthy vaginal pH balance.
    • Vitamin C This vitamin is essential for the proper functioning of the immune system. It also helps with the formation of collagen, which is very important if you are suffering from a vaginal infection or PID. Collagen is a protein that is found in an abundant supply in the body. It maintains the integrity of skin, ligaments, tendons and bone. If the collagen matrix (which is the main component of connective tissue) is intact, infection is less likely to spread, and your organs are less likely to become scarred by the infection. The bacteria can spread through the connective tissue so having extra vitamin C at this time will help to strengthen the connective tissue, make it more resistant, and decrease the time it takes for your body to repair damaged tissue.

o   Beta-carotene – Beta-carotene is a type of vitamin A that is known to help your body produce collagen, and it also helps to keep your cartilage strong. It is important that you have adequate levels in your body to help stop the spread of infection. Beta-carotene is also a powerful antioxidant and is found in high concentrations in the ovaries. However, if there isn’t enough in the body, levels in the ovaries will be inadequate, and the ovaries will be less likely to be able to fight off attacking infectious agents. Studies show that adequate levels of beta-carotene can help to prevent excess cell damage. Beta-carotene is also vital for immune function and for the normal growth of the type of tissue found in the vagina.

  • Garlic – Often called ‘nature’s antibiotic’, garlic is very important while you are trying to fight off an infection because it has strong antibacterial properties. So not only can it help to deal with the present infection, but it can help to prevent a recurrence by making the body an inhospitable place for invaders
  • Herbs – Herbs are one way to strengthen and tone the body’s systems.
    • Green Tea
    • Cat’s claw
    • Bromelain
    • Reishi Mushroom
    • Olive Leaf
  • Acupuncture – Acupuncture may help enhance immune function and reduce pain and inflammation, especially in women with chronic PID. Acupuncturists often target their protocols to draining what they call “Damp Heat” from the area. This is done using both acupuncture and Chinese herbal preparations.

 

 

Reference –

http://www.marilynglenville.com/womens-health-issues/vaginal-infections/

http://www.earthclinic.com/cures/pelvic_inflammatory_disease.html

http://www.webmd.com/women/tc/pelvic-inflammatory-disease-home-treatment

http://infertiltysolutionsng.info/blog/natural-treatment-for-pelvic-inflammatory-disease-pid/

http://emedicine.medscape.com/article/256448-treatment

http://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/basics/treatment/con-20022341

http://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/basics/treatment/con-20022341

http://www.nejm.org/doi/pdf/10.1056/NEJMra1411426

http://www.medicinenet.com/pelvic_inflammatory_disease/article.htm

http://www.medicinenet.com/pelvic_inflammatory_disease/article.htm

http://www.marilynglenville.com/womens-health-issues/vaginal-infections/

 

 

Posted in INFECTIOUS
February 8, 2017

PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. The term is used to describe a subset of children who have Obsessive Compulsive Disorder (OCD) and/or tic disorders such as Tourette’s Syndrome, and in whom symptoms worsen following strep infections such as “Strep throat” and Scarlet Fever.

The symptoms are usually dramatic, happen “overnight and out of the blue,” and can include motor and/or vocal tics, obsessions, and/or compulsions. In addition to these symptoms, children may also become moody, irritable, experience anxiety attacks, or show concerns about separating from parents or loved ones.

PANDAS was first discovered in 1998 by Dr. Susan Swedo during a Pediatric Obsessive Compulsive Disorder study when it was found some children’s OCD behaviors began shortly after a strep infection. In any autoimmune disease, it is the consequence of a misguided immune response against self-antigens by autoantibodies that results in the damage of specific organs. In the case of PANDAS, the child’s brain is being attacked.

In every bacterial infection, the body produces antibodies against the invading bacteria, and the antibodies help eliminate the bacteria from the body. However in Rheumatic Fever, the antibodies mistakenly recognize and “attack” the heart valves, joints, and/or certain parts of the brain. This phenomenon is called “molecular mimicry”, which means that proteins on the cell wall of the strep. bacteria are similar in some way to the proteins of the heart valve, joints, or brain. Because the antibodies set off an immune reaction which damages those tissues, the child with Rheumatic Fever can get heart disease (especially mitral valve regurgitation), arthritis, and/or abnormal movements known as Sydenham’s Chorea or St. Vitus Dance. In PANDAS, it is believed that something very similar to Sydenham’s Chorea occurs. One part of the brain that is affected in PANDAS is the Basal Ganglia, which is believed to be responsible for movement and behavior. Thus, the antibodies interact with the brain to cause tics and/or OCD, instead of Sydenham Chorea.

Causes

The strep bacteria is a very ancient organism which survives in its human host by hiding from the immune system as long as possible. It does this by putting molecules on its cell wall that look nearly identical to molecules found on the child’s heart, joints, skin, and brain tissues. This is called “molecular mimicry” and allows the strep bacteria to evade detection for a time.

However, the molecules on the strep bacteria are eventually recognized as foreign to the body and the child’s immune system reacts to them by producing antibodies. Because of the molecular mimicry, the antibodies react not only with the strep molecules, but also with the human host molecules that were mimicked.

The cross-reactive antibodies then trigger an immune reaction that “attacks” the mimicked molecules in the child’s own tissues. Studies show that some cross-reactive “anti-brain” antibodies target the brain, causing OCD, tics, and the other neuropsychiatric symptoms of PANDAS.

A leaky gut, whereby undigested proteins, pathogens, and toxins can pass into the bloodstream provoking inflammation and immune reaction generally underlies autoimmunity. It also makes absorption of nutrients difficult which adds to immune dysfunction. Over 70% of the immune system is in the gut.

Who is at risk?

ANDAS is a rare condition. It is believed that approximately one in 2,000 children are affected, though the diagnosis may be overlooked due to some of the common symptoms associated with the disease. In fact, there are some researchers who recommend including PANDAS in a category of other disorders which include similar neuropsychiatric symptoms called CANS (childhood acute neuropsychiatric symptoms) or PANS (pediatric acute-onset neuropsychiatric syndrome).

PANDAS is considered a pediatric disorder and typically first appears in childhood from age 3 to puberty. Reactions to strep infections are rare after age 12, but the investigators recognize that PANDAS could occur (rarely) among adolescents. It is unlikely that someone would experience these post-strep neuropsychiatric symptoms for the first time as an adult, but it has not been fully studied.

It is possible that adolescents and adults may have immune-mediated OCD, but this is not known

Symptoms

Children with PANDAS seem to have dramatic ups and downs in their OCD and/or tic severity. Tics or OCD which are almost always present at a relatively consistent level do not represent an episodic course. Many kids with OCD or tics have good days and bad days, or even good weeks and bad weeks. However, patients with PANDAS have a very sudden onset or worsening of their symptoms, followed by a slow, gradual improvement. If they get another strep infection, their symptoms suddenly worsen again. The increased symptom severity usually persists for at least several weeks, but may last for several months or longer. The tics or OCD then seem to gradually fade away, and the children often enjoy a few weeks or several months without problems. When they have another strep throat infection, the tics or OCD may return just as suddenly and dramatically as they did previously. Symptom onset includes Primary ONSET of OCD and/or Severe Anxiety along with at least two other following symptoms –

  • Obsessive compulsive disorder
  • Tics (motor and verbal)
  • Sensory Processing Disorder
  • ADD/ADHD
  • Age regression
  • Choreiform movements
  • Hyperactivity
  • Mood fluctuations
  • Changes in handwriting
  • Personality changes
  • Oppositional Defiant Disorder
  • Deterioration in math skills
  • Separation anxiety
  • Depression
  • Rages
  • Urinary incontinence, urgency and increased frequency (daytime or nighttime)
  • Anorexia

Treatment

Treatment options for children who are diagnosed with PANDAS are emerging.  The most common initial intervention is a combination of cognitive behavioral therapy (CBT), SSRI medications, antibiotics (with a minimum trial of 4-5 weeks), and supplements (such as vitamin D, Omega 3, and probiotics).  While some children may exhibit an improvement in symptoms when using antibiotics or SSRI medications, it is also often recommended to consult with a psychologist that is experienced in this area.

Often, the treatment protocol for PANDAS includes exposure and ritual prevention (ERP), which is a specific type of CBT. Using ERP, the psychologist helps the child to understand their obsessions, compulsions, and movements, how to challenge these symptoms as well as related anxiety. It is also important that the child learn specific therapeutic and stress management skills to practice in between sessions.  ERP is also used to lessen the probability and severity of future exacerbations.

doctor may prescribe penicillin, amoxicillin (Amoxil), azithromycin (Zithromax), or another antibiotic. For severe and refractory symptoms, the use of other treatments aimed at controlling the immune response have been studied and found to be effective. These include the use of intravenous immunoglobulin, steroids, and plasmapheresis (plasma exchange therapy in which blood is withdrawn from an individual and the liquid portion is removed and replaced and the blood is transfused back into the individual).

Alternative Treatment

  • N-acetyl cysteine/NAC has been found to help with some OCD symptoms.
  • Natural anti-inflammatories, such as Curcumin, can be also useful.
  • Natural antibiotics/anti-virals such as Olive Leaf Extract/OLE and Grapefruit Seed Extract/GSE.
  • Omega-3 supplements can support healthy brain function.
  • Using probiotics is very important to ensure optimum gut flora environments are not depleted during antibiotic treatments and for good overall immunity. As a precaution, avoid any that contain the streptococcus thermophilus strain.

 

 

Reference –

http://patient.info/doctor/pandas-paediatric-autoimmune-neuropsychiatric-disorder-associated-with-streptococcal-infection

http://www.pandasnetwork.org/SWEDOMRIstudy2000281%5B1%5D.pdf

http://www.adhd.com.au/PANDAS.htm

http://latitudes.org/dr-william-walsh-autism-ocd-pandas-depression-methylation/

http://www.chinatourmap.com/panda/diet.html

 

 

Posted in INFECTIOUS
February 8, 2017

Mycoplasma pneumonia is a common respiratory pathogen that produces diseases of varied severity ranging from mild upper respiratory tract infection to severe atypical pneumonia. This type of pneumonia is also called atypical pneumonia because the symptoms are different from those of pneumonia due to other common bacteria.

Mycoplasma pneumoniae infection is spread when an infected person talks, coughs or sneezes small droplets containing infectious agents into the air. The droplets in the air may be breathed in by those nearby. Infection may be spread by contact with hands, tissues and other articles soiled by infected nose and throat discharges. Mycoplasma pneumoniae infection is also spread by direct contact with the infected person.

Causes

Mycoplasma pneumonia usually affects people younger than 40. People who live or work in crowded areas such as schools and homeless shelters have a high chance of getting this condition. But many people who get sick with it have no known risk factors.

Mycoplasma pneumoniae infection is spread when an infected person talks, coughs or sneezes small droplets containing infectious agents into the air. The droplets in the air may be breathed in by those nearby. Infection may be spread by contact with hands, tissues and other articles soiled by infected nose and throat discharges. Mycoplasma pneumoniae infection is also spread by direct contact with the infected person.

Risk Factors

Mycoplasma pneumoniae is a common cause of respiratory infections in school-age children and young adults. (Mycoplasma pneumoniae infection is rare in children younger than 5.) Cough, sore throat, fever, and fatigue are common symptoms. Many people will have only mild infection and will recover on their own.

  • Older adults
  • People who have diseases that compromise their immune system, such as HIV
  • People who have lung disease
  • People who have sickle cell disease
  • Children younger than age 5

People at highest risk include those who live or work in crowded settings, such as –

  • Schools
  • College dormitories
  • Military barracks
  • Nursing homes
  • Hospitals

People at risk for severe disease include people:

  • Recovering from a respiratory illness
  • With a weakened immune system
  • With asthma

Symptoms

The most common type of illness, especially in children, is tracheobronchitis, commonly known as chest cold. This chest cold often comes with a few types of upper respiratory tract symptoms –

  • Sore throat
  • Being tired (fatigue)
  • Fever
  • Slowly worsening cough that can last for weeks or months
  • Headache

Children younger than 5 years old often do not run a fever when they have M. pneumoniae infection. Instead they may have signs that appear more like a cold than pneumonia. They sometimes wheeze, vomit, and have diarrhea.

Less common symptoms include –

  • Ear pain
  • Eye pain or soreness
  • Muscle aches
  • joint stiffness
  • and
  • Neck lump
  • Rapid breathing
  • Skin lesions or rash

Complications

  • Central nervous system problems
  • Hematologic problems
  • Musculoskeletal problems
  • Skin problems
  • Gastrointestinal problems
  • Renal problems
  • Ophthalmologic problems
  • Cardiac problems

Treatment

Mycoplasma infection is usually treated with a macrolide antibiotic, usually erythromycin or roxithromycin. These reduce infectivity to others, and may improve respiratory symptoms as well as associated skin rash.

Clarithromycin, and azithromycin are more expensive, and may require approval from an Infectious Diseases Physician for their use in New Zealand. They require less frequent dosing than erythromycin or roxithromycin, and are less likely to result in gastrointestinal side effects.

No vaccine is available for Mycoplasma pneumoniae infection.

Macrolides, the first choice of antibiotics for children, include –

  • erythromycin
  • clarithromycin
  • roxithromycin
  • azithromycin

Antibiotics prescribed for adults include –

  • doxycycline
  • tetracycline
  • quinolones

Corticosteroids – Not all people respond to antibiotic treatment. Alternative treatments include the following corticosteroids –

  • prednisolone
  • methylprednisone

 

 

 

Posted in INFECTIOUS
February 8, 2017

Mononucleosis, also known as the “kissing disease,” or simply “mono,” is a group of symptoms that occur in some individuals who become infected with Epstein-Barr virus (EBV). It is a common infection and often causes minimal symptoms, especially when children have it. However, in adolescents and young adults, it often causes more intense symptoms and missed school. At least 25% of teenagers and young adults who get infected with EBV will develop infectious mononucleosis.

Mononucleosis is transmitted primarily by oral contact with exchange of saliva—hence its popular name, “the kissing disease.” The incubation period is thought to be about 30 to 40 days. The disease incapacitates individuals for varying periods of time; some affected people are physically fit for normal activities within two or three weeks, while others remain ill for as long as two months.

Causes

Mononucleosis is caused by the epstein-barr virus, a member of the herpes virus family. The disease develops if the virus is encountered for the first time at an age when the response of the body’s immune system is most vigorous (that is, during adolescence and early adult life). The peak incidence of the illness occurs around the ages of 15 and 17.

Mono is contagious, although less so than the common cold. EBV passes from person to person primarily through contact with saliva. Kissing and sharing food, drinks, or utensils commonly spread the virus. Although EBV is present in the respiratory tract * , it usually is not transmitted by coughing or sneezing. Some people will become sick and be able to spread the virus for weeks, especially those who are infected but do not feel sick and pass the virus to others without realizing it. The virus usually remains inactive after the first infection, but some people may spread it from time to time throughout their life.

Risk Factors

The following factors can raise your risk for developing mono –

  • Age- Mono is most common among people ages 15 to 24. After age 35, the rate is low.
  • Blood transfusion
  • Weakened immune system

Symptoms

Mono is most commonly characterized by the following symptoms –

  • Sore throat
  • Fatigue
  • Swollen glands (enlarged lymph nodes) in the neck and possibly elsewhere

Additional symptoms may also be present, including –

  • Fever
  • Headache
  • Nausea
  • Muscle aches
  • Rash
  • Enlarged spleen (the organ that lies under the left-side of the rib cage)

The time between when a person is exposed to mono and when symptoms appear is around 30 to 50 days. Fever and sore throat usually go away first, but fatigue and lymph node swelling may last for one to two months. Mono is most contagious during this first period, when the fever and sore throat are present.

Complications

Severe complications are uncommon. They may include anemia, problems with the central nervous system or liver, rupture of the spleen, or inflammation of the heart. People who have had mononucleosis are at incresed risk of developing multiple sclerosis (MS).

Treatment

There is no cure for mono, but your health care provider may prescribe the following medications to treat your symptom

  • Treating secondary infections – Occasionally, a streptococcal (strep) infection accompanies the sore throat of mononucleosis. Patients may also develop a sinus infection or an infection of the tonsils (tonsillitis).
  • Risk of rash with some medications – Amoxicillin and other penicillin derivatives aren’t recommended for people with mononucleosis. In fact, some people with mononucleosis who take one of these drugs may develop a rash. The rash, however, doesn’t necessarily mean that they’re allergic to the antibiotic. If needed, other antibiotics that are less likely to cause a rash are available to treat infections that may accompany mononucleosis.
  • Self Help
    • Rest
    • Eating healthy foods
    • Drinking lots of fluids

Alternative Treatment

Omega-3 fatty acids, such as fish oil, to help reduce inflammation and improve immunity.

Probiotic supplement for gastrointestinal and immune health.

Vitamin C – A water soluble vitamin, vitamin C is necessary for normal growth and development. Vitamin C is also an antioxidant and immune support. As such, vitamin C is an effective component of a mono treatment regimen for supporting the immune system and shortening the duration of the condition.

Green tea for antioxidant, anti-inflammatory, and immune effects.

Echinacea to strengthen the immune system.

Astragalus seem to kill viruses.

Cranberry appears to fight viruses, although no one knows whether it works against the EBV.

Acupuncture – Although no scientific studies have reviewed the use of acupuncture for mono, it may help reduce symptoms, improve immune function, and relieve congestion (blockage of qi, or energy flow) of the liver, spleen, and lymph.

Traditional Chinese Medicine – Studies show that people with EBV have fewer symptoms when given a combination of homeopathic remedies noted in the section on homeopathy and TCM remedies including Atractylodes alba, Glycyrrhiza recens, Rehmannia preparata, Bupleurum, Cortex magnolia, Phragmites, Belamcanda, Sophora, subprostrata, Siler, Angelica dahurica, Paeonia alba, Dendrobium, Polygonatum officinal, and Cnidium. Chinese herbs are prescribed on an individual basis.

 

Reference –

http://familydoctor.org/familydoctor/en/diseases-conditions/mononucleosis/treatment.html

http://www.medicinenet.com/infectious_mononucleosis/article.htm

http://www.mayoclinic.org/diseases-conditions/mononucleosis/diagnosis-treatment/treatment/txc-20165946

http://kidshealth.org/en/parents/mono.html

http://emedicine.medscape.com/article/222040-overview

http://www.pamf.org/teen/health/diseases/mono.html

http://umm.edu/health/medical/altmed/condition/mononucleosis

http://www.fpnotebook.com/id/virus/Mncls.htm

http://www.childrenshospital.org/conditions-and-treatments/conditions/i/infectious-mononucleosis/treatments

http://www.nature.com/cti/journal/v4/n2/full/cti20151a.html

http://www.encyclopedia.com/topic/infectious_mononucleosis.aspx

https://www.sciencedaily.com/terms/infectious_mononucleosis.htm

https://www.nlm.nih.gov/medlineplus/infectiousmononucleosis.html

http://www.humanillnesses.com/Infectious-Diseases-He-My/Mononucleosis-Infectious.html

 

Posted in INFECTIOUS
February 8, 2017

Molluscum contagiosum is a viral skin infection that causes either single or multiple raised, pearl-like bumps (papules) on the skin. It is a chronic infection, so lesions may persist from a few months to a few years. However, most cases resolve in six to nine months. It produces harmless, noncancerous growths in the skin’s top layers. The disease is spread by direct contact with the skin of an infected person or sharing towels with someone who has the disease. Outbreaks have occasionally been reported in child care centers.

Molluscum is a common skin problem with small, harmless raised spots. The spots can stay on the body for a few weeks, several months or more than a year. It is caused by the Molluscum Contagiosum Virus (MCV). This virus only lives in humans.

The lesions, known as Mollusca, are small, raised, and usually white, pink, or flesh-colored with a dimple or pit in the center. They often have a pearly appearance. They’re usually smooth and firm. In most people, the lesions range from about the size of a pinhead to as large as a pencil eraser (2 to 5 millimeters in diameter). They may become itchy, sore, red, and/or swollen.

Molluscum is contagious and can be spread from person to person or to different areas in the same person. It can also be spread by children sharing baths or pools through bath toys and towels. Usually it does not need any treatment. Good personal hygiene can help prevent it spreading.

Causes

Molluscum contagiosum is caused by a virus that is a member of the poxvirus family. You can get the infection in different ways.

This is a common infection in children and occurs when a child comes into direct contact with a lesion or an object that has the virus on it. The infection is most often seen on the face, neck, armpit, arms, and hands. But it may occur anywhere on the body, except the palms and soles.

The virus can spread through contact with contaminated objects, such as towels, clothing, or toys.

The virus also spreads by sexual contact. Early lesions on the genitals may be mistaken for herpes or warts. But unlike herpes, these lesions are painless.

Persons with a weakened immune system (due to conditions such as HIV/AIDS) may have a rapidly spreading case of molluscum contagiosum.

Risk Factors

Molluscum contagiosum is common enough that you should not be surprised if you see someone with it or if someone in your family becomes infected. Although not limited to children, it is most common in children 1 to 10 years of age.

People at increased risk for getting the disease include –

  • People with weakened immune systems (i.e., HIV-infected persons or persons being treated for cancer) are at higher risk for getting molluscum contagiosum. Their growths may look different, be larger, and be more difficult to treat.
  • Atopic dermatitis may also be a risk factor for getting molluscum contagiosum due to frequent breaks in the skin. People with this condition also may be more likely to spread molluscum contagiousm to other parts of their body for the same reason.
  • People who live in warm, humid climates where living conditions are crowded.

In addition, there is evidence that molluscum infections have been on the rise in the United States since 1966, but these infections are not routinely monitored because they are seldom serious and routinely disappear without treatment.

Symptoms

Bumps on the skin can be  the only sign that a person has molluscum contagiosum. These bumps often appear about 7 weeks after being exposed to the virus that causes molluscum. Sometimes, the bumps do not appear for many months.

When the bumps appear on the skin, they often –

  • Begin as small, firm, dome-shaped growths.
  • Have a surface that feels smooth, waxy, or pearly.
  • Are flesh-colored or pink.
  • Have a dimple in the center. The dimple may be filled with a thick, white substance that is cheesy or waxy.
  • Are painless, but some bumps itch.
  • Turn red as the person’s immune system fights the virus.
  • Appear on other areas of the body after a person scratches or picks the bumps. Scratching or picking can spread the virus.

In adults, the bumps often appear on the face, neck, armpits, arms, and hands. Other common places for bumps to appear are the genitals, abdomen, and inner thighs. Adults often get molluscum contagiosum through sexual contact.

If a person has a disease that weakens the immune system, such as AIDS, the bumps can grow very large. A person may have 100 or more bumps on the face alone.

Complications

Problems that can occur include any of the following –

  • Persistence, spread, or recurrence of lesions
  • Secondary bacterial skin infections

Treatment

Treatment for molluscum is usually recommended if lesions are in the genital area (on or near the penis, vulva, vagina, or anus). If lesions are found in this area it is a good idea to visit your healthcare provider as there is a possibility that you may have another disease spread by sexual contact.

Oral therapy – Gradual removal of lesions may be achieved by oral therapy. This technique is often desirable for pediatric patients because it is generally less painful and may be performed by parents at home in a less threatening environment.

Podophyllotoxin cream (0.5%) is reliable as a home therapy for men but is not recommended for pregnant women because of presumed toxicity to the fetus.

Therapy for immunocompromised persons – Most therapies are effective in immunocompetent patients; however, patients with HIV/AIDS or other immunosuppressing conditions often do not respond to traditional treatments. In addition, these treatments are largely ineffective in achieving long-term control in HIV patients.

Physical removal of lesions may include cryotherapy (freezing the lesion with liquid nitrogen), curettage (the piercing of the core and scraping of caseous or cheesy material), and laser therapy. These options are rapid and require a trained health care provider, may require local anesthesia, and can result in post-procedural pain, irritation, and scarring.

Laser therapy – Pulsed dye laser therapy is the treatment of choice when there are multiple lesions. Any surgical treatment requires to be repeated each time, new crops of lesions appear.

Cryotherapy – It involves killing infected cells by “freezing” them with a pressurized liquid spray, usually liquid nitrogen or nitrous oxide. The procedure is relatively painless and can be performed by any health professional. The infected cells may fall off immediately or fade over several days.

Alternative Treatment

Zell Oxygen is an incredible remedy to activate and strengthen the immune system and will speed a successful outcome over chronic (long term) and acute (short term) infections is most likely.

Collodial Silver  has been found to attack all known harmful virus and bacteria.

Olive Leaf Extract is rapidly being recognised as a natural alternative to antibiotics. Extremely beneficial for people with viral and fungal infections and a non-toxic way to strengthen the immune system. Scientific research has shown that the active ingredient in olive leaf extract, oleuropein, has powerful healing properties and can fight bacteria, viruses, fungi and parasites that cause infection and disease.

Vitamin Oils – Specific combinations of different vitamin oils to get rid of the papules caused by Molluscum Contagiosum.

Garlic – Molluscum is viral and caused by a pox virus, according to the Centers for Disease Control. Eating raw garlic might help the body’s immune system fight off the underlying virus, helping the eruptions to disappear more rapidly than ordinarily. Garlic has anti-viral and anti-fungal properties in its active ingredient allicin, which work to destroy viruses both internally and on the skin.

Turmeric, with its potent active ingredient curcumin, has properties that are reported to be anti-viral, anti-microbial and anti-inflammatory, making it an excellent natural remedy to boost the immune system, and one that might have potent effects on the mollusucm virus, hastening its demise in the body. Because turmeric has strong anti-inflammatory properties, it can not only be taken orally but the powered turmeric applied to the skin as a poltice

 

Reference –

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/molluscum-contagiosum

http://www.hopkinsmedicine.org/healthlibrary/conditions/dermatology/molluscum_contagiosum_85,P00299/

http://www.mayoclinic.org/diseases-conditions/molluscum-contagiosum/basics/definition/con-20026391

http://www.cdc.gov/poxvirus/molluscum-contagiosum/risk.html

https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/molluscum-contagiosum

http://www.dermnetnz.org/viral/molluscum-contagiosum.html

http://kidshealth.org/en/parents/molluscum-contagiosum.html

http://www.emedicinehealth.com/molluscum_contagiosum/article_em.htm

 

Posted in INFECTIOUS