Pertussis-whooping cough

Pertussis-About Pertussis:

Whooping cough (Pertussis; whooping cough) is acute respiratory infections caused by Bordetella pertussis, the clinical features of paroxysmal cough spasm and cough array terminal appears cock inspiratory roar. Duration of up to 2 to 3 months, infants prone to suffocation, and death. More common in children under the age of five. Symptoms paroxysmal continuous cough, and cough after deep inspiration, have a special high-pitched roar.

Whooping cough - a modern medical pathology
Whooping cough prevention of whooping cough bacteria invade the respiratory tract, attached to breed and produce endotoxin in the cilia of airway epithelial cells, causing the destruction of the ciliary dyskinesia and ciliated cells. Extensive inflammation of the bronchial mucosa, increased mucus secretion, cilia damage: accumulation of secretions continue to stimulate the respiratory nerve endings to stimulate the afferent to the cerebral cortex, caused by reflex, spasmodic cough cough center of the cerebral cortex formed excited stove. Therefore, in recovery or have recovered a few months later, crying and other factors can still induce pertussis-like cough.

Whooping cough - clinical performance
The disease severity and duration of disease vary widely, 3 to 21 day incubation period, clinical can be divided into three.

Prodromal period: seen coughing, sneezing, fever and upper respiratory symptoms. 3 to 4 days, the symptoms alleviate, fever disappeared, cough become more intensified, and gradually developed to clonic spasm of the current infectious.

Spasm cough period: 2 to 6 weeks, characterized by paroxysmal spasmodic cough. Frequent short cough attack was breath-state, with a deep inhale, then a cock crow sound of high pitched inspiratory roar, and then cough spasm 1, so repeatedly, until it coughed up a large number of thick sputum or vomiting. Cough spasm when the surface of red lips cyanosis, tongue overhang, jugular vein distention, body bent for lumps. Eyelid edema, eye conjunctival bleeding, nose bleeds, severe cases, intracranial hemorrhage can occur. And ulcers due to friction tongue tie, light condition, the majority of spasm cough is still generally good, as usual demeanor, activity and diet.

Neonates and young infants, the condition is more serious. Due to the weakness of the breathing muscles and thorax, inability to cough, inspiratory tone roar. Tracheal and bronchial stenosis, sputum difficult to expectorate, prone to cause blockage and often paroxysmal breath-hold, cyanosis, asphyxia, and timely for artificial respiration to help breathing recovery. And prone to cerebral hypoxia and convulsions. Early symptoms, severe asphyxia, and poor prognosis.

Recovery period: cough gradually reduced, roar disappear to stop coughing, mental appetite returned to normal. Case of smoke, odor, upper respiratory tract infection, cough spasm may appear again, but lighter. Upper respiratory tract infections and bronchitis more spasm cough disappeared.

Whooping cough - diagnosis
Epidemiology: 1 to 3 weeks before the onset of pertussis exposure history, no history of vaccination.
Clinical manifestations

Pertussis - Laboratory tests
Blood: the precursor of the end to see the WBC count increased, generally in the 15 × 109 / L or more, classified lymphocytes accounted for 60 to 70 percent.
Erythrocyte sedimentation rate: usually normal.
Bacterial culture: cough chatter law directly to the face of the petri dish to the oral cavity in children with a distance of about 3 to 5 cm, cough five to six sound, about to the petri dish into the incubation in a 37 ° C incubator. Nasopharyngeal posterior wall of excretion were cultured. Both early-positive rate of 90%.
The serum agglutination test and complement fixation test: double titer 4-fold increase can be confirmed only for retrospective diagnosis.

Whooping cough - complications
Pneumonia: secondary lung infection.
Encephalitis: more common in small babies. Vomiting, unconsciousness, convulsions, cerebrospinal fluid did not change much.
Deterioration of tuberculosis: tuberculosis deterioration caused by the spread, and meningitis in the tuberculosis systemic miliary tuberculosis or occurs.
Frequency of cough lingual frenulum ulcer; intra-abdominal pressure increased, umbilical hernia, inguinal hernia, rectal prolapse occurs.

Day cough - differential diagnosis
Acute bronchitis: irritating cough and inspiratory laryngeal Ming, fever, hoarseness, cough cock crow-like roar.
Endotracheal foreign body: a history of foreign body aspiration, X-ray examination can help diagnosis.
Bronchial lymph node tuberculosis: hilar lymphadenopathy oppression trachea caused by the array of cough, but the lack of typical cock crow-like echo. According to the TB contact history, tuberculin test, ESR, X-ray examination can be used for identification.
4 whooping cough syndrome: Vice Bordetella pertussis and other bacteria and some viruses may also cause pertussis-like symptoms, the clinical symptoms, blood picture, X-ray found with pertussis are similar, but often be isolated from adenovirus, respiratory viruses, Mycoplasma pneumoniae, or vice Bordetella pertussis, but not isolated from Bordetella pertussis.

Day cough - Introduction
Pertussis Pertussis is a pediatric infectious respiratory disease caused by Bordetella pertussis is highly contagious. The clinical features of cough gradually worsened paroxysmal spasmodic cough, cough the end of the cock crow sound, untreated patients, the course may be continued in March, hence the name "whooping cough". Infant and severe, complicated by pneumonia and encephalopathy.

Whooping cough - therapy
Pertussis. Rest and diet: indoor quiet, fresh air and proper temperature and humidity, to enable the patient to rest quietly. Attention to nutrition, to avoid inducing spasm cough factors.
(2) drug treatment: Early antimicrobial agents available, the preferred erythromycin 30 ~~ 50mg/kg / day, can also be used to chloramphenicol, 30 ~ 50mg/kg / day, efficiency Sulfamethoxazole tablets are also effective. Control spasm cough may at its discretion elect corticosteroids, vitamin K1, pertussis encephalopathy, convulsions, available phenobarbital sodium 5mg/kg intramuscularly, or the stability of each 0.1 ~ 0. 3mg/kg intravenous injection, and the other using mannitol or Yamanashi alcohol each 1 ~ 2g/kg intravenous injection, dexamethasone intravenous drip to reduce intracranial pressure.

Whooping cough - acupuncture
Whooping cough, acupuncture, skin, needle, acupoint injection, and cupping therapy have more satisfactory results. Since the eighties, after the summary further improve the clinical efficacy is more significant. The look on some of the information collected, the efficiency is almost close to 100%. At present, the treatment of this disease in the acupoints on to take on more and Lung Meridian, take care of children with characteristics of needling, bleeding or light stimulus without leaving the needle prick main.

Undo edits

Whooping cough etiology:
Bordetella pertussis is a pathogen of whooping cough.
Bordetella pertussis is a Gram-negative short coccobacilli, usually in the medium requires a large number (15% ~ 25%) of good blood to breed, blood - glycerol - Potato (BG medium) separation of this bacteria is the most appropriate. Freshly isolated Bordetella pertussis phase Ⅰ bacteria. Phase Ⅰ colonies smooth, capsule, drug and strong, with endotoxin and exotoxin. Virulence after continuous switched colonies become rough gradually weakened the strength of antigen is not the same, such a virulence Bordetella pertussis is known as Part II, III, IV phase. Phase Ⅰ pertussis Pathogenicity symptoms must also be phase Ⅰ bacteria produced vaccine to produce immunity. Bacteria to survive outside the body capacity is weak, can only survive for two hours at room temperature, sunlight exposure of one hour or heating 60 ° C for 15 minutes inactivated, can soon be commonly used chemical disinfectants destroyed. Bout's genus (Bordetella Bacillus), there are vice Bordetella pertussis the (B.parapertusis), the bronchial corruption bacilli (B.bronchiseptica). This two form similar to Bordetella pertussis, the former can cause pertussis-like respiratory symptoms, but no cross-immunity to Bordetella pertussis. The latter is mainly animal pathogens. Bout's genus in the fourth birds, Bout bacteria (B.avium) bacteria and bronchial corruption similar bacteria is a pathogen of birds, has not attracted the extraordinary infection.

Pertussis - pathogens and epidemiology
Bordetella pertussis is a Gram-negative short bacillus, must be on a special medium containing blood to grow. The bacteria containing endotoxin and exotoxin, the bacteria leave the human body to survive, the weak UV resistance, sunlight direct exposure to one hour, or heated to 50 ~ 60 ° C by 10 to 15 minutes to dry for several hours can be inactivated . Can also be commonly used chemical disinfectants rapidly inactivated. Deputy Bordetella pertussis for the package of special genus, morphology, and pertussis genus consistent, but different antigen, no cross immunity. The patient is the only source of infection by droplet infection. The crowd of whooping cough has universal susceptibility, but the infant was the strongest.

 

 

Mumps-epidemic parotitis

Mumps-About Mumps:

Mumps (epidemic parotitis) is an acute respiratory infectious disease caused by the mumps virus infringement of the parotid gland. Mumps is a common respiratory diseases in children and adolescents, and adults have the disease, caused by the mumps virus. The pain and swelling of the parotid gland of non-suppurative prominent symptoms, the virus may invade the glandular tissue or nervous system, liver, kidney, heart, joints, almost all the organs. Therefore, often can cause meningoencephalitis, orchitis, pancreatitis, mastitis, the ovarian Yandeng symptoms.

Mumps - Overview
Mumps salivary glands of three pairs, the parotid gland, sublingual gland and submandibular gland, the largest of which one pair of the parotid gland. Children got mumps, face swollen like a fat face. Parotid gland is located on both sides of the cheek near the ear lobe at the mumps when swelling of the parotid gland is the earlobe as the center, to spread around, so mumps in the community known as the "big mouth". In some places there are "pig fat" argument. Sometimes swelling is more serious and tends to "pig", so people also call such symptoms as "pig fat" habits.

Mumps is acute respiratory infections caused by the mumps virus infringement of the parotid gland, the patient is the source of infection, inhalation of droplets is the main route of transmission, contact with patients after 2-3 weeks of onset. Mumps mainly for one or both sides of the earlobe enlargement, swelling of the parotid gland often has hemispherical to the earlobe as the center edge of clear surface heating angle pain, local pain in the mouth or chew. Parotid gland swelling in the incidence of 1-3 days, the most obvious, and then gradually subsided, about two weeks the swelling completely subsided. 3-5 days in the early stages, may have fever, fatigue, and do not want to eat and other systemic symptoms.

Once a mumps, and children should be immediately isolated bed rest. The diet should be soft, easy to digest, avoid spicy food such as hot and sour. Because these foods are easy to stimulate the salivary glands, resulting in local pain intensified. To drink water, keep your mouth clean, mouthwash can also be used to compound borax solution. Swelling of the parts can be used TCM herbs, take 15 grams of natural indigo, or wishful golden powder 15 grams of proprietary Chinese medicines, water and mix thoroughly. The external application can reduce local pain, and help the swelling. While serving Banlangen granules.

Once the children got mumps should be isolated to the parotid gland swelling dissipated before nursery or school, in order to avoid transmission to other children. Mumps easy to be popular in nurseries in found that children should be strengthened morning check suspicious children have contact with children should be observed for 21 days, while preventive oral Banlangen granules. General continuous 3-5 days. It should be noted, gamma globulin on the mumps prevention.

Mumps - CausesMumps infection sourcesEarly patients and latent infection. The presence of the virus in the saliva of patients with a longer time, before the cheek swelling six days to nine days after the gills swollen virus can be isolated from the patient's saliva highly contagious, so in these two weeks. Infected with mumps virus, mumps performance, and other organs such as brain or testicular symptoms, saliva and urine can also be detected in the virus. About 30 ~ 40% of patients in a pandemic, only a subclinical infection, upper respiratory tract infection is an important source of infection.
Mumps - route of transmissionThe virus spread by droplets in the saliva (saliva, and contaminated clothing can also be infection) contagious than measles, chicken pox for the weak. Pregnant women infected with the disease can be transmitted through the placenta to the fetus, and lead to fetal malformations or death, also increased the incidence of abortion.
Mumps - susceptibilityGenerally susceptible to decreased susceptibility with increasing age. After puberty onset men than women. The disease can have a lasting immunity.

Mumps - disease symptoms
Mumps incubation period of 8-30 days, with an average of 18 days. Mostly more acute onset, no prodromal symptoms. Fever, chills, headache, sore throat, poor appetite, nausea, vomiting, body aches, a few hours parotid swelling became clear, the temperature up to above 39 ℃, the adults are generally more serious. Parotid gland swelling of the most characteristic. Generally earlobe forward under development, shaped like a pear-shaped, the edge is unclear; local skin tension, shiny but not red, touch of tough and flexible, a touch of pain; speech, chewing (especially into acidic diet) to stimulate saliva secretion, leading to the pain got worse; usually the side of the parotid gland swelling after a four days involving the contralateral, and bilateral swelling by about 75%. Submandibular or sublingual gland may also be involved.
Severe parotid gland surrounding tissue, a high degree of edema, facial deformation, and can be difficulty in swallowing. The parotid duct openings early swelling and extrusion the parotid always without purulent discharge from the overflow openings. Parotid gland swelling in 1 to 3 days reached a peak 4 to 5 days gradually subside and return to normal. A distance of about 10 to 14 days. Submandibular and sublingual gland involvement, or separately. Submandibular gland enlargement, showing the anterior mandibular swelling and can touch the swollen glands. Sublingual gland enlargement visible tongue and floor of the mouth swelling, and difficulty in swallowing.








Mumps - diagnosis1, peripheral bloodWhite blood cell count are mostly normal or slightly increased, the relative increase in lymphocytes. White blood cell count can increase complications occasional leukemoid reaction.2, serum and urine amylase determinationSerum amylase of 90% of patients with mild and moderate increase, to help diagnosis. Increased amylase levels are often associated with parotid swelling degree proportional toBut increased the enzyme may also be made with the pancreas and small intestine serous adenosis related to the change.3, serology(1) and antibody test: low titer, such as 1:2 ie, prompted current infection. Application of gel hemolysis test (gel hemolysis test) in recent years, is consistent with the neutralization test, while the simple and rapid detection of neutralizing antibodies, but the method needs further improvement.(2) Complement fixation test: diagnostic value of the suspected cases, double serum titer (early in the course and the 2 to 3 weeks) increased more than four times, or a titer of 1:64 has diagnostic significance . Such as conditions permit, should be simultaneous determination of S antibody and V antibodies. Increased S antibody showed that newly infected with the V antibody increased the S antibody is not increased, only previously trained infection.(3) The hemagglutination inhibition test: virus-infected chick embryo, the amniotic fluid and allantoic fluid can make the chicken erythrocyte agglutination, mumps convalescent serum of patients with a strong inhibition of aggregation was relatively weak, while the inhibitory effect of early serum , such as twice a titer difference of more than four times, that is the case of positive.4, virus isolationOther organizations of the early cases, saliva, urine, blood, cerebrospinal fluid and brain, thyroid and other detachable mumps virus. Procedures than the complex, currently unconditional generally carried out.5, urine routine examinationUrine when the urine, renal involvement with proteinuria, red white blood cells, and even the change of the urine similar nephritis.6, the ECGThe electrocardiogram shows the combined myocarditis: arrhythmia, T wave flat, ST segment depression.
Mumps - the types of diseasesMumps is divided into pyogenic and viral two.
Suppurative parotitisInfection caused by bacteria, mainly Staphylococcus aureus. Common cause: the parotid secretory function decline, more common in acute infectious diseases and frail patients; parotid duct port blocking; inflammation of the parotid neighboring groups silk; symptoms are fever, leukocytosis, the parotid local redness, swelling, pain, heat, when lesions into the suppuration of extrusion parotid pus outflow from the catheter port.
MumpsA higher incidence of infection history of exposure may be bilateral or unilateral involvement in early childhood or adolescence, white blood cells not only does not increase but reduce or almost local symptoms and purulent, but no purulent tendency.
Laboratory tests:
(A) blood: white blood cell count is normal or slightly lower, the relative increase in post-lymphocytes. White blood cell count can increase complications.
(B) Determination of serum and urine amylase: serum amylase of 90% of patients with mild and moderate increased help diagnosis. Increased amylase levels are often associated with parotid swelling degree proportional to
(C) serological tests.
(1) and antibody test: low titer, such as 1:2 prompt-specific immune response. And antibody specificity, but not for routine use.
(2) complement fixation and hemagglutination inhibition test: Determination of early and convalescent serum complement fixation and hemagglutination inhibition antibody, significant growth can be diagnosed more than four times (titer). Foreign enzyme-linked immunosorbent adsorption method and the indirect fluorescence immunoassay to detect IgM antibodies can be used for early diagnosis.
(3) virus isolates: patients with early isolated the virus in saliva, urine, blood, cerebrospinal fluid.
(4) urinary renal involvement can occur when the urine protein, red white, and even similar to the change of Urine.
Mumps - treatmentMumps drug treatmentAcute suppurative parotitis early drug treatment, antibiotics, traditional Chinese medicine Jing anti-sepsis scattered flavors xiaoduyin; method of stimulating the secretion in order to maintain the smooth flow of saliva secretion. If the course of the disease for more than a week into the suppuration of incision surgery should be carried out. Viral mumps there is no effective therapy, you can use the aforementioned Chinese medicine treatment, Bacterial infections can be the use of antibiotics.
Mumps: also known as "mumps". Winter-prone disease, more common in the 5 - to 10-year-old children. Acute infectious disease caused by a virus Mainly transmitted by droplets and contact the patient after multiple in crowded places such as kindergartens, schools, barracks and so on. Once your child has suffered from mumps, and will never again be contracting this disease, because he has lifelong immunity. Most parts of the requirements of preschool children vaccinated. If you do not establish a lifelong immunity, you need to passive injection of anti-mumps vaccines. Inoculation Ma, wind, cheek triple vaccine or mumps vaccine can prevent the occurrence of the disease.
The early symptoms of mumps is generally lighter, showing increased body temperature moderate headache, muscle aches. Parotid gland enlargement is often the starting signs of the disease, 7 - 10 days, often the side of the parotid gland is first swollen, 2 - 3 days after the contralateral parotid gland appeared swollen, sometimes swelling only unilateral, parotid gland enlargement characterized by the earlobe as the center forward, the next expansion of the edge is unclear bomb sexy, touch, pain and tenderness, the surface of the skin is not red, can be thermal, mouth, chew especially when eating acidic foods The pain worsened. Swelling and pain in 3 - 5 days reached a peak and subside in about a week. Often the parotid gland orifices red and swollen. May have swelling in the ipsilateral pharynx and soft palate, tonsil to the midline shift; laryngeal edema can also occur; upper chest or edema, trunk, and occasionally a red rash or hives. Bring great suffering to the children, mumps, parotid gland pain, a small number of patients in the pancreas, meninges, brain, liver and heart will be varying degrees of damage. Serious harm to the body of this disease is not only the parotid gland itself, but its complications, should be highly vigilant and prevent complications. The common complications: meningitis, orchitis, and acute pancreatitis.

Mumps - Prevention
Warming in spring, a variety of large population of bacteria is a high incidence of mumps, it can be spread through saliva and so on.

Therefore, mumps epidemic periods, adults is best not to bring the child to a more public place.

Found mumps children treated in isolation, do not touch other children. It is understood that in the male infertility, some patients actually caused by the mumps. Mumps virus is particularly fond of the meninges, ovarian, etc. parasitic cause of these tissue inflammation.

Moreover, mumps also prone to meningitis. And more generally within a week after the parotid swelling occurs, manifested as high fever, severe headache, love to sleep, nausea, vomiting, neck hard. At this time should be vigilant, hospitalized in a timely manner.

Some of pancreatitis is caused by the mumps, the main manifestations were abdominal pain, often accompanied by vomiting, fever, abdominal distension, diarrhea or constipation and other symptoms. In addition, mumps may also cause hearing loss, severe cases can cause deafness.

Chagas Disease

Chagas Disease-About Chagas Disease:

Chagas disease is also known as Chagas disease, which can be life-threatening infection caused by T. cruzi chronic cardiomyopathy and giant esophagus or Hirschsprung disease, severe cases can be sudden death. The past, mainly in South America, now the United States, Canada and Europe and the Western Pacific countries more and more to find in this case. Disease, mainly through blood transfusion, organ donation, as well as vertical transmission mother to child infection, food contamination is one of the routes of transmission.The most effective way to prevent Chagas disease vector control. If the acute stage of infection, the start of treatment, the disease is completely curable, but the effect is weakened with the prolongation of the time of patients infected, therefore, should treat the infection as soon as possible.

Chagas disease - IntroductionChagas disease Chagas disease is caused by T. cruzi infection chronic cardiomyopathy and giant esophagus or Hirschsprung disease.Chagas disease was discovered in 1909 by a Brazilian doctor Chagas, also known as Chagas disease. It is the parasite Trypanosoma cruzi caused a life-threatening diseases. Was limited to South America, Chagas disease has spread to other parts of the world, currently estimated 1000 million people are infected, but at high risk of more than 2500 people. If the acute stage of infection, the start of treatment, the disease is completely curable, but the effect is weakened with the prolongation of the time of patients infected, therefore, should treat the infection as soon as possible.Chagas disease - Signs and symptomsChagas disease in two phases:The initial acute phase lasted about two months after infection. In the acute stage, a large number of parasites with the blood circulation. Most cases of asymptomatic or symptoms are mild, but may include fever, headache, swollen lymph nodes, pale, muscle pain, difficulty breathing, swelling of the abdomen or chest pain. Typical signs of triatomine bug bites less than 50% of those who, first of all visible lesions or side of the eyelid bruising swelling.In the chronic phase, parasites hidden in the muscle of the heart and digestive tract. Up to 30% of patients with cardiac disorders, up to 10% of the digestive tract (typically the esophagus or colon to expand), neurological or mixed lesions. In the next few years, the infection can lead to sudden death or myocardial damage caused by heart failure.

Chagas disease - diagnosis
Peripheral blood of the acute phase of Trypanosoma high number of thin blood films or thick blood film examination can easily be found. The number of misprision of blood or chronic phase of Trypanosoma rarely required in organs such as blood or lymph node aspirates were cultured to confirm the diagnosis. Other diagnostic methods, there are a host inoculation diagnosis (laboratory-reared triatomine bites suspicious patients, to check the contents of the rectum of triatomine; or suspicious patient's blood injected into experimental animals) or by PCR amplification to detect blood or organization of trypanosome DNA in solution. Serological tests can produce false positive results in visceral leishmaniasis or mucocutaneous leishmaniasis patients.

Route of transmission of Chagas disease:
Infected feces spread mainly by blood-sucking triatomine bugs. These bugs generally live in poor conditions of rural or suburban buildings housing gap. They are usually hidden in the daytime, night out activities, taking a person's blood. They are usually bites the face and other skin exposure, and bug bites near defecation. When people out of bug feces can wipe the bite, eyes, mouth or any skin breakage when the parasite enters the human body.

Chagas disease can also spread through the following means:

1: T. cruzi contaminated food, such as by contact with the feces of triatomine bugs;

2: Use of blood for a blood transfusion of infected blood donors;

3: During pregnancy or childbirth, spread by infected mothers to newborns;

4: infection of donor organs for organ transplants;

5: lab accidents.

Undo edits

Chagas disease - geographical distributionChagas disease occurs mainly in South America, but the past 10 years, the United States, Canada and Europe and the Western Pacific countries is also increasing the detection of cases. This increase in global population movements are closely related. In addition, one of the ways of blood transfusion, organ donation, as well as mother to child infection and vertical transmission is the spread of the disease, the disease spread to other food contamination.Chagas disease - treatmentCan be used to kill parasites, benzyl metronidazole or NOx furosemide for Mo treat Chagas disease. Quickly in the acute stage of infection after the start of medication, the effectiveness of these two drugs to cure the disease is almost 100%. However, the efficiency of the two drugs with the time of patients infected and weakened. The treatment also applies to recurrent infection (eg, immunosuppression), congenital infection in children and early chronic phase patients. Shall to the extent of infection among adults, especially those who are asymptomatic, and provide treatment. May occur due to the longer course of treatment (up to two months) and adverse reactions (up to 40% of treated patients), drug treatment should be measured in the prevention or delay the formation of the potential benefits of Chagas disease.Pregnant women, or kidney or liver failure should not use benzyl metronidazole and nifurtimox. NOx furosemide for Mo is also taboo for the background of neurological or mental disorders.In addition, you may need specialized treatment of the heart or gastrointestinal symptoms.

Chagas disease - the control and prevention measures
Chagas disease is no vaccine for trypanosomiasis. The most effective way to prevent the disease in South America is the vector control. Prevention of disease through blood transfusion and organ transplantation, the need for blood screening.

Initially (> 9000 years ago), T. cruzi and affects only the wild animals. The disease later spread to domestic animals and humans. The number of T. cruzi in South America's wild animal hosts, which means not eradicate the parasite. Therefore, the control objective is to eliminate the spread and providing health care for the infected and sick people.

T. cruzi can infect certain types of triatomine bugs, most of them found in the Americas. By geographic region, WHO recommends to take the following preventive and control measures:

1: the spraying of insecticides on the housing and the surrounding area;

2: Improved housing prevent vector disaster;

3: Individual preventive measures such as mosquito nets;

4: food preparation, transportation, storage and consumption of good health measures; food contamination can also lead to disease spread, therefore, the most effective prevention and control measures for disease vector control, such as spraying of insecticides in their houses. strengthen the health measures in food preparation, transport and storage.

5: The screening of blood donors;

6: Detection of organ, tissue or cell donors and recipients;

7: the screening of newborns of infected mothers and siblings of infected children in order to provide early diagnosis and treatment.




Chagas disease - the World Health Organization's response
Since the 1990s, Latin America, Southern Cone regions, Central America, Andean Pact and the Pan American Health Organization Amazon basin inter-governmental action has achieved important success in parasites and disease vector control. These multinational operations led to significantly reduce the spread of the domestic vector. In addition, throughout Latin America, significantly reduces the risk of transmission through blood transfusion. Was able to achieve these advances because of the epidemic the firm commitment of the Member States, the strength of its research and control institutions, as well as many international partners.

At the same time, we need to face a series of additional challenges:

1: to have the persistence to maintain and consolidate control of progress;

2: The original idea was that the disease-free areas - such as the Amazon basin, there Chagas disease;

3: In the control has been progress in the region - for example, in Argentina and Bolivia, the Chaco region, the re-emergence of the disease;

4: mainly due to an increasing number of population movements between Latin America and the rest of the world caused by the spread of the disease;

5: the millions of infected patients to diagnosis and treatment.

In order to achieve the elimination of Chagas disease transmission and disease endemic and non endemic countries with HIV / patients with the goal of health care, WHO has sought increased interconnection and cooperation at the global level and to strengthen regional and national capacities, with emphasis on:

1: to strengthen the epidemiological surveillance and information systems;

2: prevention of diseases through blood transfusions and organ transplants spread of disease endemic and non endemic countries;

3: Promote recognition diagnostic test method for screening and diagnosis of infections;

4: expansion of the secondary prevention of congenital transmission and congenital and non congenital infection case management;

5: To promote and to reach a consensus on adequate case management.

Kala-azar-visceral leishmaniasis

Kala-azar-About Kala-azar:

Kala-azar, also known as visceral leishmaniasis, kala-azar caused by Leishmania donovani, transmitted by sandflies of chronic endemic infectious diseases clinical long-term irregular fever, splenic swelling, weight loss, anemia, leukopenia and plasmaglobulin characteristics.

Kala-azar - Disease description:
Kala-azar virus diseases caused by Leishmania infection, known as leishmaniasis. Leishmaniasis is widely distributed in many countries of Asia, Europe, Africa, Latin America and other continents. Serious harm to human body zoonotic parasitic diseases. The global prevalence of TDR (1989) more than 12 million each year to 4 million new infections; 4.2 million died from the disease in 1998. Clinical damage Organization,

Leishmaniasis can be divided into three different types:
① visceral leishmaniasis (VL) in India, often dark pigment of the skin of patients calm and have a fever, so called the kala-azar, against Leishmania donovani visceral organs (such as the spleen, liver, bone marrow, etc.) Erzhi diseases. Failure to receive timely treatment, can often fatal.

② mucocutaneous leishmaniasis, caused by the Brazilian Leishmania. Protozoan parasitic cause skin lesions on the skin, via lymph or blood to invade the nasopharyngeal mucosa, can cause mucous membrane lesions. In severe cases, the nasal septum, and even the cartilage of the larynx and other organs are also injury. Distributed in Central and South America, Africa, Ethiopia and Sudan have a case report.

③ cutaneous leishmaniasis. Popular in Africa, Latin America, Southwest Asia, the Mediterranean basin and the former Soviet Union in some areas. Caused by the tropical Leishmania and Mexico Leishmania. Tropical Leishmania can be divided into two separate subspecies of Leishmania tropical Leishmania. The two subspecies have different features in morphology: clinical manifestations and epidemiology. Chinese kala-azar caused by Leishmania donovani.

Kala-azar is widely distributed in the world. Occurs mainly in India, China and Bangladesh, and Nepal in Asia. Mediterranean coastal regions and countries in East Africa, North Africa, Europe, former Soviet Central Asia, some countries in Central and South America the disease epidemic.

Kala-azar - signs and symptoms:

Suffering from kala-azar, kala-azar make immunocompromised immunocompromised patients not only have specific cellular immune suppression, but also up pathogenic organisms ability to generate cellular and humoral immune response to reduce, that is, non-specific inhibition of this patient's body protozoa breed fast, too much to produce antigens, and the collective in the immune response is related. Human innate immunity of Leishmania donovani, leishmaniasis is more common in infants and children. The prognosis for kala-azar, however acquired immunity can be a solid product that can resist re-infection with Leishmania. Kala-azar patients cured Houlishiman prime intradermal test (LDT) positive was a curve of 20 - 29 years reached a peak, after a downward trend, the positive reaction can be maintained as long as 50 years, the response intensity does not diminish. Seen patients cured, the availability of life-long immunity. Skin kala-azar (PkDL) part of kala-azar patients in the course of treatment with antimonials or cured after a few years or even ten years after the occurrence of skin kala-azar. Patients in other parts of the face, neck, limbs or trunk of many with Leishmania skin nodules, nodules were of varying sizes granuloma. Or was dark papules common in the face and neck, some resembles lepromatous leprosy. Type skin kala-azar in China first in the prime was found three cases of the 1950s, has been reported that more than 100 cases. In 1988, 55.0% of simultaneous damage to the skin and internal organs, 35% of patients with visceral lesions disappeared after many years, and 10% of patients had neither check to see visceral infection, nor kala-azar history.

The the lymph kala-azar (LGVL) kala-azar history, lesions were confined to the lymph nodes visceral leishmaniasis, also known as lymph node-type kala-azar.

Kala-azar/visceral leishmaniasis - disease etiologyDogs kala-azar bacteria, depending on the source of infection, kala-azar epidemiology can be broadly divided into three different types, namely, the human type, the type of dog sources and natural foci of type; analysis of India, the Mediterranean basin and the Central Asian desert of kala-azar are typical examples.
(1) people Source: also known as the plain type, more common in the plains, located in the Huang-Huai region of northern Jiangsu, Anhui, Lunan, Yudong and southern Hebei, northern Hubei, Shaanxi, Guanzhong and within the Xinjiang Kashi ground. Mainly in the population distribution of kala-azar patients with youth-oriented, baby, dogs rarely infected patients as the main source of infection. Media home habitat type sandflies and Xinjiang long tube sandflies. Such areas, kala-azar has been controlled, no further new cases have been in years, but even can be found in the skin type of kala-azar.
(2) dogs Source: also known as hill-type, more common in the mountainous area, located in the outskirts of counties in Gansu, Qinghai, Ningxia, northern Sichuan, northern Shaanxi, Hebei, Northeast, Liaoning and Beijing, human infections from dogs . Patients scattered, the vast majority of patients are children, the baby's infection rate is high, the adults rarely get sick. Media for wild habitat type sandflies. Such areas as Chinese kala-azar endemic areas.
(3) natural foci: also known as the desert type, distributed in some desert areas of Xinjiang and Inner Mongolia. The patients were mainly seen in infants and young children under 2 years of age more than 90% of patients. Adult access to such areas often suffer from the lymph node type kala-azar cases of dissemination. Media of wild habitat Chrysopa, Wu sandfly followed Alexander sandfly. Animal host has not yet been found. Desertification affected areas and the hills affected areas Leishmania kDNa the homology, while the smaller and plain-affected areas of the kDNA homology. Therefore, the three popular types of pathogens like Leishmania loved ones can be summarized gondii strains (ie, the type of human worm strains) and pro-animal strains of insects (including the dog source type natural foci gondii strains).
It can be speculated that kala-azar was originally some wild animal diseases in the process of biological evolution, the Leishmania passed from wildlife to dogs, and then transmitted to humans by dogs. In this process, the Leishmania genes mutate, and been preserved in the new host and the environment, the gradual formation of different types of kala-azar pathogens.

Kala-azar - diagnostic testsKala-azar microscope, the pathogen checkDetection of pathogens can be confirmed. Should be noted that disseminated histoplasmosis identification of fungal disease, the disease is spread through the respiratory tract, fungi prevalent in tropical and subtropical. Patients with prolonged fever, hepatosplenomegaly, pancytopenia, and other symptoms. Sporozoite diameter 2-4μm, oval mostly involved the monocyte-macrophage cell system, bone marrow smears of findings pathogens and Leishmania, but no kinetoplast.
(1) biopsy 1) smear: a bone marrow aspiration smear is most common. Iliac bone puncture is simple, safe, and protozoa detection rate of 80% -90%. Multiple choice enlarged lymph node biopsy, lymph nodes, such as the groin, humeral trochlea, neck lymph nodes. The detection rate of about 46% -87%. Can also be used as a lymph node biopsy. Spleen puncture a higher detection rate of 90.6% -99.3%. However, unsafe, generally less or not. 2) culture: these puncture inoculated in NNN medium with sterile method, the temperature inside the set of 20 ℃ -25 ℃. After about one week in culture to check to see movement and lively before flagella, sentenced to a positive result. This method is more sensitive smear. But takes a long time, with the Schneider's medium, the better. 3 days to appear before the flagellar body. Strict aseptic culture. 3) animal inoculation method: biopsy material inoculated into susceptible animals (such as the golden hamster, in BALB / c mice, etc.) 1 - 2 months after the liver, spleen for imprint smear, Wright's dye staining .(2) Skin biopsy: skin nodules with a sterile needle punctured the skin, take a little tissue fluid with a scalpel to scrape a little organization smear, staining,
2, immune diagnosis method
The research focus of the immune diagnosis of parasitic diseases in order to transfer from the detection of antibodies to the detection of circulating antigen. From kala-azar immune Diagnostic Research Center, the superiority of the latter.(A) serum levels of circulating antigen: monoclonal antibody - antigen spot test (McAB-AST), For the diagnosis of kala-azar, the positive rate of 97.03%. False positive 0.2%. The sensitivity, specificity, reproducibility was good, and has a simple and feasible, only micro serum, etc., if necessary, to do the quantitative determination. The law also has to reflect the current infection, to determine whether the "cure" or "relapse" unique advantages.(2) detection of serum antibodies: such as enzyme-linked immunosorbent assay (ELISA). Indirect hemagglutination test (IHA), counter immuno electrophoresis (CIE), an indirect assay (IF), direct agglutination test (DA) and so can be used. The dot-ELISA-positive rate was also higher, but check antibodies are often associated with cross reaction to other diseases, has its limitations in the diagnosis of leishmaniasis, and the antibody easily disappear in the short term, is not easy for efficacy assessment.(3) the Leishmania prime intradermal test: The method is simple, so the earlier and more widely used in kala-azar epidemiology. Of the Act must be in the patient healed, only positive reactions, and to maintain a very long time, or even a lifetime to keep positive, it can not be used as diagnostic tools of the present patients. Used to determine the affected areas and non-infected areas, to determine the prevalence and assessment of control effect, has a certain value.
3, molecular biological methods
(1) polymerase chain reaction (PCR): better detection of kala-azar, sensitivity and specificity are high. Chinese scholars L, was amplified by PCR. d species-specific kDNA fragments used for diagnosis of kala-azar, the positive rate of 95.5% (21/22), and bone marrow smears from 91% (20/22), all controls were negative. Reverse transcription - polymerase chain reaction (RT-PCR), the diagnosis of kala-azar, the method is compared with rDNA as the template RCR method is sensitive to 100 times higher.
(2) kDNA probe method: This method is sensitive, specific, easily obtained. Assay Sichuan kala-azar endemic area 71 dogs marginal ear skin tissue, the positive rate of 40.8% (29/71). The coincidence rate of 85.9% (61/71) and bone marrow smears.

Kala-azar - treatment program

Kala-azar China to take the check treatment in the majority of kala-azar endemic areas, kill dogs and comprehensive measures in the eradication of media sandflies, 1958, China announced that the basic elimination of kala-azar. The number of patients has been dropped by 53 million in the 1950s the annual number of patients 100 cases. Kala-azar occurred pandemic required for natural and social factors still exist, should be active in the prevention and control of kala-azar.
The liberation of the early treatment of kala-azar, pentavalent antimonials sodium stibogluconate, domestic agents better for Adams antimony black g.

Suffering from kala-azar in immunocompromised patients not only have specific cellular immune suppression, and reduced ability of the cellular and humoral immune response, that is, non-specific inhibition up pathogenic organisms, which is fast with the patient's body protozoa breeding, resulting in antigen too and more collective in the immune reaction is related.

Kala-azar - prevention
Face kala-azar patients with the control of the media: the elimination of media Sandfly is a fundamental measure of the control of kala-azar, the need for a fundamental sandfly ecological habits, to take the measures appropriate countermeasures. Bromine cyanide Ju fat residual spraying, long tube of the family dwelling or the home habitat of sandfly kill better. Personal protection should be strengthened, to reduce and avoid sand flies sting.

Recurrent preventive measures:
(1) in the affected areas sandfly season before the advent of mass screening and cure all patients, and patients regularly pursued for one year, and strive to cure.
(2) In all areas of kala-azar and canine visceral leishmaniasis, especially in the hilly areas, only the treatment of patients is difficult to guarantee eradication of kala-azar, regular registration check on the dogs and found dogs should be culled buried.
(3) The affected areas from May to September each year sandfly activity season in the living room, circle toilet attached to measures to take off lacewing.
(4) popular season to do a good job in the health of the living room, keep the air and light and the ground was dry, to prevent mature hiding and young of breeding, field staff exposed part rubbed repellent, sleep at night can be used spinning mosquito nets to prevent sandfly bites. good personal protection.