Definition

Bulimia nervosa is a serious and sometimes life-threatening eating disorder affecting mainly young women. People with bulimia, known as bulimics, consume large amounts of food (binge) and then try to rid themselves of the food and calories (purge) by fasting, excessive exercise, vomiting, or using laxatives. The behavior often serves to reduce stress and relieve anxiety. Because bulimia results from an excessive concern with weight control and self-image, and is often accompanied by depression, it is also considered a psychiatric illness.

Description

Bulimia nervosa is a serious health problem for over two million adolescent girls and young women in the United States. The bingeing and purging activity associated with this disorder can cause severe damage, even death, although the risk of death is not as high as for anorexia nervosa, an eating disorder that leads to excessive weight loss.
Binge eating may in rare instances cause the stomach to rupture. In the case of purging, heart failure can result due to loss of vital minerals such as potassium. Vomiting causes other serious problems, including acid-related scarring of the fingers (if used to induce vomiting) and damage to tooth enamel. In addition, the tube that brings food from the mouth to the stomach (the esophagus) often becomes inflamed and salivary glands can become swollen. Irregular menstrual periods can also result, and interest in sex may diminish.

Causes and symptoms

Causes

The cause of bulimia is unknown. Researchers believe that it may be caused by a combination of genetic and environmental factors. Bulimia tends to run in families. Research shows that certain brain chemicals, known as neurotransmitters, may function abnormally in acutely ill bulimia patients. Scientists also believe there may be a link between bulimia and other psychiatric problems, such as depression and OCD. Environmental influences include participation in work or sports that emphasize thinness, such as modeling, dancing, or gymnastics. Family pressures also may play a role. One study found that mothers who are extremely concerned about their daughters' physical attractiveness and weight may help to cause bulimia. In addition, girls with eating disorders tend to have fathers and brothers who criticize their weight.

Symptoms

According to the American Anorexia/Bulimia Association, Inc., warning signs of bulimia include:
  • eating large amounts of food uncontrollably (bingeing)
  • vomiting, abusing laxatives or diuretics, or engaging in fasting, dieting, or vigorous exercise (purging)
  • preoccupation with body weight
  • using the bathroom frequently after meals
  • depression or mood swings
  • irregular menstrual periods
  • onset of dental problems, swollen cheeks or glands, heartburn or bloating

Diagnosis

Bulimia is treated most successfully when diagnosed early. But because the bulimic may deny there is a problem, getting medical help is often delayed. A complete physical examination in order to rule out other illnesses is the first step to diagnosis.
According to the American Psychiatric Association, a diagnosis of bulimia requires that a person have all of the following symptoms:
  • recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
  • a feeling of lack of control over eating during the binges
  • regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
  • persistent over-concern with body shape and weight

Treatment

Early treatment is important otherwise bulimia may become chronic, with serious health consequences. A comprehensive treatment plan is called for in order to address the complex interaction of physical and psychological problems in bulimia. A combination of drug and behavioral therapies is commonly used.
Behavioral approaches include individual psychotherapy, group therapy, and family therapy. Cognitive-behavioral therapy, which teaches patients how to change abnormal thoughts and behavior, is also used. Nutrition counseling and self-help groups are often helpful.
Antidepressants commonly used to treat bulimia include desipramine (Norpramin), imipramine (Tofranil), and fluoxetine (Prozac). These medications also may treat any co-existing depression.
In addition to professional treatment, family support plays an important role in helping the bulimic person. Encouragement and caring can provide the support needed to convince the sick person to get help, stay with treatment, or try again after a failure. Family members can help locate resources, such as eating disorder clinics in local hospitals or treatment programs in colleges designed for students.

Alternative treatment

Light therapy—exposure to bright, artificial light—may be useful in reducing bulimic episodes, especially during the dark winter months. Some feel that massage may prove helpful, putting people in touch with the reality of their own bodies and correcting misconceptions of body image. Hypnotherapy may help resolve unconscious issues that contribute to bulimic behavior.

Prognosis

Bulimia may become chronic and lead to serious health problems, including seizures, irregular heartbeat, and thin bones. In rare cases, it may be fatal.
Timely therapy and medication can effectively manage the disorder and help the bulimic look forward to a normal, productive, and fulfilling life.

Prevention

There is no known method to prevent bulimia.

Key terms

Binge — To consume large amounts of food uncontrollably within a short time period.
Diuretic — A drug that promotes the formation and excretion of urine.
Neurotransmitters — Certain brain chemicals that may function abnormally in acutely ill bulimic patients.
Obsessive-compulsive disorder (OCD) — A disorder that may accompany bulimia, characterized by the tendency to perform repetitive acts or rituals in order to relieve anxiety.
Purge — To rid the body of food and calories, commonly by vomiting or using laxatives.
Most bulimics find it difficult to stop their behavior without professional help. Many typically recognize that the behavior is not normal, but feel out of control. Some bulimics struggle with other compulsive, risky behaviors such as drug and alcohol abuse. Many also suffer from other psychiatric illnesses, including clinical depression, anxiety, and obsessive-compulsive disorder (OCD).
Most bulimics are females in their teens or early 20s. Males account for only 5-10% of all cases. People of all races develop the disorder, but most of those diagnosed are white.
Bulimic behavior is often carried out in secrecy, accompanied by feelings of guilt or shame. Outwardly, many people with bulimia appear healthy and successful, while inside they have feelings of helplessness and low self-esteem.

Resources

Organizations

American Anorexia/Bulimia Association, Inc. 293 Central Park West, Suite IR, New York, NY 10024. (212) 501-8351.
Anorexia Nervosa and Related Eating Disorders, Inc. P.O. Box 5102, Eugene, OR 97405. (541) 344-1144.
Center for the Study of Anorexia and Bulimia. 1 W. 91st St., New York, NY 10024. (212) 595-3449.
Eating Disorder Awareness. & Prevention, Inc., 603 Stewart St., Suite 803, Seattle, WA 98101. (206) 382-3587.
National Association of Anorexia Nervosa and Associated Disorders. Box 7, Highland Park, IL 60035. (708) 831-3438.
National Eating Disorders Organization (NEDO). 6655 South Yale Ave, Tulsa, OK 74136. (918) 481-4044.

Citations:


For Gale Encyclopedia of Medicine:

bulimia nervosa. (n.d.) Gale Encyclopedia of Medicine. (2008). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/bulimia+nervosa

For Dorland's Medical Dictionary:

bulimia nervosa. (n.d.) Dorland's Medical Dictionary for Health Consumers. (2007). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/bulimia+nervosa

For Segen's Dictionary:

bulimia nervosa. (n.d.) Segen's Medical Dictionary. (2011). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/bulimia+nervosa

For Miller-Keane Encyclopedia:

bulimia nervosa. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/bulimia+nervosa

Definition

A chronic eating disorder involving repeated and secretive episodes of eating, characterized by uncontrolled rapid ingestion of large quantities of food over a short period of time, it is also called bulimia nervosa,

It is an eating disorder occurring mainly in girls and young women, characterized by episodic binge eating followed by purging or other behaviors designed to prevent weight gain and by excessive influence of body shape and size on the patient's sense of self-worth.

Causes

there is currently no definite known cause of bulimia. Because of the complexity of the disorder, however there is evidence that bulimia and other eating disorders may be related to abnormalities in levels of chemical messengers (neurotransmitters) within the brain, specifically the neurotransmitter serotonin. Other studies of people with bulimia have found alterations in metabolic rate.

Diagnosis

DIFFERENTIAL DIAGNOSIS
• Schizophrenia
• GI disorders
• Neurologic disorders (seizures, Kleine-Levin syndrome, Klüver-Bucy syndrome)
• Brain neoplasms
• Psychogenic vomiting

LABORATORY TESTS
• Electrolyte abnormalities secondary to vomiting (hypokalemia and metabolic alkalosis) or to diarrhea from laxative abuse (hypokalemia and hyperchloremic metabolic acidosis)
• Hyponatremia, hypocalcemia, hypomagnesemia (caused by laxative abuse)
• Elevated cortisol, decreased LH, decreased FSH

TREATMENT

NONPHARMACOLOGIC THERAPY
• Cognitive behavioral therapy to control abnormal behaviors
• Use of food diaries, nutritional counseling, and planning meals at least a day in advance is useful to counter abnormal eating behaviors
• Correction of electrolyte abnormalities
ACUTE GENERAL Rx
• SSRIs are generally considered to be the safest medication option in these patients. They are useful in severely depressed patients and in those who fail to benefit from cognitive behavioral therapy.
• Prompt recognition and treatment of complications:

1.Ipecac cardiotoxicity from laxative abuse
2.Electrolyte abnormalities (see above)
3.Esophagitis and Mallory-Weiss tears; esophageal rupture from repeated vomiting
4.Aspiration pneumonia and pneumomediastinum
5.Menstrual irregularities (including amenorrhea)
6.GI abnormalities: acute gastric dilatation, pancreatitis, abdominal pain, constipation
CHRONIC Rx
• Psychotherapy continued for years and focused specifically on self-image and family and peer interactions is an integral part of successful recovery.
• Family therapy is also recommended, especially in younger patients.
 

REFERENCES


American Psychiatric Association: Practice guideline for the treatment of patients with eating disorders, Am J Psychiatry 157(suppl):4, 2000.

Bacaltchuk J, Hay P: Antidepressants versus placebo for people with bulimia nervosa, Cochrane Database Syst Rev (4):CD003931, 2001.

Bacaltchuk J, Hay P, Trefiglio R: Antidepressants versus psychological treatments and their combination for bulimia nervosa, Cochrane Database Syst Rev (4):CD003385, 2001.
 
 


Definition

plague with swelling of the lymph nodes, which form buboes in the femoral, inguinal, axillary, and cervical regions; in the severe form, septicemia occurs, producing petechial hemorrhages.

A contagious, often fatal epidemic disease caused by the bacterium Yersinia pestis, transmitted from person to person or by the bite of fleas from an infected host, especially a rat, and characterized by chills, fever, vomiting, diarrhea, and the formation of buboes.
 

Sign and Symptoms

the most common form of plague. It is characterized by painful buboes in the axilla, groin, or neck; fever often rising to 106° F (41.11° C); prostration with a rapid, thready pulse; hypotension; delirium; and bleeding into the skin from the superficial blood vessels.
 

Pathogenesis

The symptoms are caused by an endotoxin released by a bacillus, Yersinia pestis, usually introduced into the body by the bite of a rat flea that has bitten an infected rat. Inoculation with plague vaccine confers partial immunity; infection provides lifetime immunity.
 

Treatment

Treatment includes antibiotics, supportive nursing care, surgical drainage of buboes, isolation, and stringent precautions against spread of the disease
 

Management

Conditions favor a plague epidemic when a large infected rodent population lives with a large nonimmune human population in a damp, warm climate. Improved sanitary conditions and eradication of rats and other rodent reservoirs of Y. pestis may prevent outbreaks of the disease. 

 

Definition

Brucellosis is a bacterial disease caused by members of the Brucella genus that can infect humans but primarily infects livestock. Symptoms of the disease include intermittent fever, sweating, chills, aches, and mental depression. The disease can become chronic and recur, particularly if untreated.

Description

Also known as undulant fever, Malta fever, Gibraltar fever, Bang's disease, or Mediterranean fever, brucellosis is most likely to occur among those individuals who regularly work with livestock. The disease originated in domestic livestock but was passed on to wild animal species, including the elk and buffalo of the western United States. In humans, brucellosis continues to be spread via unpasteurized milk obtained from infected cows or through contact with the discharges of cattle and goats during miscarriage. In areas of the world where milk is not pasteurized, for example in Latin America and the Mediterranean, the disease is still contracted by ingesting unpasteurized dairy products. However, in the United States, the widespread pasteurization of milk and nearly complete eradication of the infection from cattle has reduced the number of human cases from 6,500 in 1940 to about 70 in 1994.

Causes and symptoms

The disease is caused by several different species of parasitic bacteria of the genus Brucella. B. abortus is found in cattle and can cause cows to abort their fetuses. B. suis is most often found in hogs and is more deadly when contracted by humans than the organism found in cattle. B. melitensis is found in goats and sheep and causes the most severe illness in humans. B. rangiferi infects reindeer and caribou, and B. canis is found in dogs.
A human contracts the disease by coming into contact with an infected animal and either allowing the bacteria to enter a cut, breathing in the bacteria, or by consuming unpasteurized milk or fresh goat cheese obtained from a contaminated animal. In the United States, the disease is primarily confined to slaughterhouse workers.
Scientists do not agree about whether brucellosis can be transmitted from one person to another, although some people have been infected from a tainted blood transfusion or bone marrow transplant. Newborn babies have also contracted the illness from their mothers during birth. Currently, it is believed that brucellosis can also be transmitted sexually.
The disease is not usually fatal, but the intermittent fevers (a source of its nickname, "undulant fever") can be exhausting. Symptoms usually appear between five days and a month after exposure and begin with a single bout of high fever accompanied by shivering, aching, and drenching sweats that last for a few days. Other symptoms may include headache, poor appetite, backache, weakness, and depression. Mental depression can be so severe that the patient may become suicidal.

Key terms

Antibody — A specific protein produced by the immune system in response to a specific foreign protein or particle called an antigen.
Chronic — Disease or condition characterized by slow onset over a long period of time.
Parasite — An organism living in or on, and obtaining nourishment from, another organism.
Pasteurization — The process of applying heat, usually to milk or cheese, for the purpose of killing, or retarding the development of, pathogenic bacteria.
In rare, untreated cases, the disease can become so severe that it leads to fatal complications, such as pneumonia or bacterial meningitis. B. melitensis can cause miscarriages, especially during the first three months of pregnancy. The condition can also occur in a chronic form, in which symptoms recur over a period of months or years.

Diagnosis

Brucellosis is usually diagnosed by detecting one or more Brucella species in blood or urine samples. The bacteria may be positively identified using biochemical methods or using a technique whereby, if present in the sample, the brucellosis bacteria are made to fluoresce. Brucellosis may also be diagnosed by culturing and isolating the bacteria from one of the above samples. Blood samples will also indicate elevated antibody levels or increased amounts of a protein produced directly in response to infection with brucellosis bacteria.

Treatment

Prolonged treatment with antibiotics, including tetracyclines (with streptomycin), co-trimoxazole, and sulfonamides, is effective. Bed rest is also imperative. In the chronic form of brucellosis, the symptoms may recur, requiring a second course of treatment.

Prognosis

Early diagnosis and prompt treatment is essential to prevent chronic infection. Untreated, the disease may linger for years, but it is rarely fatal. Relapses may also occur.

Prevention

There is no human vaccine for brucellosis, but humans can be protected by controlling the disease in livestock. After checking to make sure an animal is not already infected, and destroying those that are, all livestock should be immunized. Butchers and those who work in slaughterhouses should wear protective glasses and clothing, and protect broken skin from infection.
Some experts suggest that a person with the disease refrain from engaging in unprotected sex until free of the disease. The sexual partners of an infected person should also be closely monitored for signs of infection.

Resources

Organizations

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

Other

"Bacterial Diseases." Healthtouch Online Page. 〈http:www.healthtouch.com〉.
Centers for Disease Control. 〈http://www.cdc.gov/nccdphp/ddt/ddthome.htm〉.
 

Citations:

For Gale Encyclopedia of Medicine:

brucellosis. (n.d.) Gale Encyclopedia of Medicine. (2008). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/brucellosis

For Dorland's Medical Dictionary:

brucellosis. (n.d.) Dorland's Medical Dictionary for Health Consumers. (2007). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/brucellosis

For The American Heritage® Medical Dictionary:

brucellosis. (n.d.) The American Heritage® Medical Dictionary. (2007). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/brucellosis

For Mosby's Medical Dictionary:

brucellosis. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/brucellosis

For Miller-Keane Encyclopedia:

brucellosis. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/brucellosis

For Veterinary Dictionary:

brucellosis. (n.d.) Saunders Comprehensive Veterinary Dictionary, 3 ed.. (2007). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/brucellosis

For McGraw-Hill Concise Dictionary of Modern Medicine:

brucellosis. (n.d.) McGraw-Hill Concise Dictionary of Modern Medicine. (2002). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/brucellosis
 

Definition

Acute inflammation of the walls of the smaller bronchial tubes, with irregular areas of consolidation due to spread of the inflammation into the peribronchiolar alveoli and the alveolar ducts of the lungs. Also called bronchial pneumonia.

Explanation

an acute inflammation of the lungs and bronchioles, characterized by chills, fever, high pulse and respiratory rates, bronchial breathing, cough with purulent bloody sputum, severe chest pain, and abdominal distension. The disease is usually a result of the spread of infection from the upper to the lower respiratory tract, 

Causes

most common caused by the bacterium Mycoplasma pneumoniae, Staphylococcus pyogenes, or Streptococcus pneumoniae. Atypical forms of bronchopneumonia may occur in viral and rickettsial infections. The most common cause in infancy is the respiratory syncytial virus

Clinical Findings

Bronchopneumonia may lead to pleural effusion, empyema, lung abscess, peripheral thrombophlebitis, respiratory failure, congestive heart failure, and jaundice

Treatment

Treatment includes administration of an antibiotic, oxygen therapy, supportive measures to keep the bronchi clear of secretions, and relief of pleural pain.

bronchopneumonia. (n.d.) Dorland's Medical Dictionary for Health Consumers. (2007). Retrieved October 17 2012 from http://medical-dictionary.thefreedictionary.com/Bronchopneumonia


Definition

Bronchitis is an inflammation of the air passages between the nose and the lungs, including the windpipe or trachea and the larger air tubes of the lung that bring air in from the trachea (bronchi). Bronchitis can either be of brief duration (acute) or have a long course (chronic). Acute bronchitis is usually caused by a viral infection, but can also be caused by a bacterial infection and can heal without complications. Chronic bronchitis is a sign of serious lung disease that may be slowed but cannot be cured.

Description

Although acute and chronic bronchitis are both inflammations of the air passages, their causes and treatments are different. Acute bronchitis is most prevalent in winter. It usually follows a viral infection, such as a cold or the flu, and can be accompanied by a secondary bacterial infection. Acute bronchitis resolves within two weeks, although the cough may persist longer. Acute bronchitis, like any upper airway inflammatory process, can increase a person's likelihood of developing pneumonia.
Anyone can get acute bronchitis, but infants, young children, and the elderly are more likely to get the disease because people in these age groups generally have weaker immune systems. Smokers and people with heart or other lung diseases are also at higher risk of developing acute bronchitis. Individuals exposed to chemical fumes or high levels of air pollution also have a greater chance of developing acute bronchitis.
Chronic bronchitis is a major cause of disability and death in the United States. The American Lung Association estimates that about 14 million Americans suffer from the disease. Like acute bronchitis, chronic bronchitis is an inflammation of airways accompanied by coughing and spitting up of phlegm. In chronic bronchitis, these symptoms are present for at least three months in each of two consecutive years.
Chronic bronchitis is caused by inhaling bronchial irritants, especially cigarette smoke. Until recently, more men than women developed chronic bronchitis, but as the number of women who smoke has increased, so has their rate of chronic bronchitis. Because this disease progresses slowly, middle-aged and older people are more likely to be diagnosed with chronic bronchitis.

Key terms

Acute — Disease or condition characterized by the rapid onset of severe symptoms.
Bronchi — The larger air tubes of the lung that bring air in from the trachea.
Chronic — Disease or condition characterized by slow onset over a long period of time.
Chronic obstructive pulmonary disease (COPD) — A term used to describe chronic lung diseases, like chronic bronchitis, emphysema, and asthma.
Emphysema — One of the several diseases called chronic obstructive pulmonary diseases, emphysema involves the destruction of air sac walls to form abnormally large air sacs that have reduced gas exchange ability and that tend to retain air within the lungs. Symptoms include labored breathing, the inability to forcefully blow air out of the lungs, and an increased susceptibility to respiratory tract infections.
Chronic bronchitis is one of a group of diseases that fall under the name chronic obstructive pulmonary disease (COPD). Other diseases in this category include emphysema and chronic asthmatic bronchitis. Chronic bronchitis may progress to emphysema, or both diseases may be present together.

Causes and symptoms

Acute bronchitis

Acute bronchitis usually begins with the symptoms of a cold, such as a runny nose, sneezing, and dry cough. However, the cough soon becomes deep and painful. Coughing brings up a greenish yellow phlegm or sputum. These symptoms may be accompanied by a fever of up to 102°F (38.8°C). Wheezing after coughing is common.
In uncomplicated acute bronchitis, the fever and most other symptoms, except the cough, disappear after three to five days. Coughing may continue for several weeks. Acute bronchitis is often complicated by a bacterial infection, in which case the fever and a general feeling of illness persist. To be cured, the bacterial infection should be treated with antibiotics.

Chronic bronchitis

Chronic bronchitis is caused by inhaling respiratory tract irritants. The most common irritant is cigarette smoke. The American Lung Association estimates that 80-90% of COPD cases are caused by smoking. Other irritants include chemical fumes, air pollution, and environmental irritants, such as mold or dust.
Chronic bronchitis develops slowly over time. The cells that line the respiratory system contain fine, hair-like outgrowths from the cell called cilia. Normally, the cilia of many cells beat rhythmically to move mucus along the airways. When smoke or other irritants are inhaled, the cilia become paralyzed or snap off. When this occurs, the cilia are no longer able to move mucus, and the airways become inflamed, narrowed, and clogged. This leads to difficulty breathing and can progress to the life-threatening disease emphysema.
A mild cough, sometimes called smokers' cough, is usually the first visible sign of chronic bronchitis. Coughing brings up phlegm, although the amount varies considerably from person to person. Wheezing and shortness of breath may accompany the cough. Diagnostic tests show a decrease in lung function. As the disease advances, breathing becomes difficult and activity decreases. The body does not get enough oxygen, leading to changes in the composition of the blood.

Diagnosis

Initial diagnosis of bronchitis is based on observing the patient's symptoms and health history. The physician will listen to the patient's chest with a stethoscope for specific sounds that indicate lung inflammation, such as moist rales and crackling, and wheezing, that indicates airway narrowing. Moist rales is a bubbling sound heard with a stethoscope that is caused by fluid secretion in the bronchial tubes.
A sputum culture may be performed, particularly if the sputum is green or has blood in it, to determine whether a bacterial infection is present and to identify the disease-causing organism so that an appropriate antibiotic can be selected. Normally, the patient will be asked to cough deeply, then spit the material that comes up from the lungs (sputum) into a cup. This sample is then grown in the laboratory to determine which organisms are present. The results are available in two to three days, except for tests for tuberculosis, which can take as long as two months.
Occasionally, in diagnosing a chronic lung disorder, the sample of sputum is collected using a procedure called a bronchoscopy. In this procedure, the patient is given a local anesthetic, and a tube is passed into the airways to collect a sputum sample.
A pulmonary function test is important in diagnosing chronic bronchitis and other variations of COPD. This test uses an instrument called a spirometer to measure the volume of air entering and leaving the lungs. The test is done in the doctor's office and is painless. It involves breathing into the spirometer mouthpiece either normally or forcefully. Volumes less than 80% of the normal values indicate an obstructive lung disease.
To better determine what type of obstructive lung disease a patient has, the doctor may do a chest x ray, electrocardiogram (ECG), and blood tests. An electrocardiogram is an instrument that is used to measure the electrical activity of the heart and is useful in the diagnosis of heart conditions. Other tests may be used to measure how effectively oxygen and carbon dioxide are exchanged in the lungs.

Treatment

Acute bronchitis

When no secondary infection is present, acute bronchitis is treated in the same way as the common cold. Home care includes drinking plenty of fluids, resting, not smoking, increasing moisture in the air with a cool mist humidifier, and taking acetaminophen (Datril, Tylenol, Panadol) for fever and pain. Aspirin should not be given to children because of its association with the serious illness, Reye's syndrome.
Expectorant cough medicines, unlike cough suppressants, do not stop the cough. Instead they are used to thin the mucus in the lungs, making it easier to cough up. This type of cough medicine may be helpful to individuals suffering from bronchitis. People who are unsure about what type of medications are in over-the-counter cough syrups should ask their pharmacist for an explanation.
If a secondary bacterial infection is present, the infection is treated with an antibiotic. Patients need to take the entire amount of antibiotic prescribed. Stopping the antibiotic early can lead to a return of the infection. Tetracycline or ampicillin are often used to treat adults. Other possibilities include trimethoprim/sulfamethoxazole (Bactrim or Septra) and the newer erythromycin-like drugs, such as azithromycin (Zithromax) and clarithromycin (Biaxin). Children under age eight are usually given amoxicillin (Amoxil, Pentamox, Sumox, Trimox), because tetracycline discolors permanent teeth that have not yet come in.

Chronic bronchitis

The treatment of chronic bronchitis is complex and depends on the stage of chronic bronchitis and whether other health problems are present. Lifestyle changes, such as quitting smoking and avoiding secondhand smoke or polluted air, are an important first step. Controlled exercise performed on a regular basis is also important.
Drug therapy begins with bronchodilators. These drugs relax the muscles of the bronchial tubes and allow increased air flow. They can be taken by mouth or inhaled using a nebulizer. A nebulizer is a device that delivers a regulated flow of medication into the airways. Common bronchodilators include albuterol (Ventolin, Proventil, Apo-Salvent) and metaproterenol (Alupent, Orciprenaline, Metaprel, Dey-Dose).
Anti-inflammatory medications are added to reduce swelling of the airway tissue. Corticosteroids, such as prednisone, can be taken orally or intravenously. Other steroids are inhaled. Long-term steroid use can have serious side effects. Other drugs, such as ipratropium (Atrovent), are given to reduce the quantity of mucus produced.
As the disease progresses, the patient may need supplemental oxygen. Complications of COPD are many and often require hospitalization in the latter stages of the disease.

Alternative treatment

Alternative practitioners focus on prevention by eating a healthy diet that strengthens the immune system and practicing stress management. Bronchitis can become serious if it progresses to pneumonia, therefore, antibiotics may be required. In addition, however, there are a multitude of botanical and herbal medicines that can be formulated to treat bronchitis. Some examples include inhaling eucalyptus or other essential oils in warm steam. Herbalists recommend a tea made of mullein (Verbascum thapsus), coltsfoot (Tussilago farfara), and anise seed (Pimpinella anisum). Homeopathic medicine and traditional Chinese medicine may also be very useful for bronchitis, and hydrotherapy can contribute to cleaning the chest and stimulating immune response.

Prognosis

When treated, acute bronchitis normally resolves in one to two weeks without complications, although a cough may continue for several more weeks. The progression of chronic bronchitis, on the other hand, may be slowed, and an initial improvement in symptoms may be achieved. Unfortunately, however, there is no cure for chronic bronchitis, and the disease can often lead to or coexist with emphysema. Taken together, all forms of COPD are a leading cause of death.

Prevention

The best way to prevent bronchitis is not to begin smoking or to stop smoking. Smokers are ten times more likely to die of COPD than non-smokers. Smokers who stop show improvement in lung function. Other preventative steps include avoiding chemical and environmental irritants, such as air pollution, and maintaining good overall health. Immunizations against certain types of pneumonia (as well as influenza) are an important preventative measure for anyone with lung or immune system diseases.

Resources

Organizations

American Lung Association. 1740 Broadway, New York, NY 10019. (800) 586-4872. http://www.lungusa.org.
National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.
National Jewish Center for Immunology and Respiratory Medicine. 1400 Jackson St., Denver, CO 80206. (800) 222-5864. 〈http://www.nationaljewish.org/main.html〉.
 

Citations:

For Gale Encyclopedia of Medicine:

bronchitis. (n.d.) Gale Encyclopedia of Medicine. (2008). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/Bronchitis

For Dorland's Medical Dictionary:

bronchitis. (n.d.) Dorland's Medical Dictionary for Health Consumers. (2007). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/Bronchitis

For The American Heritage® Medical Dictionary:

bronchitis. (n.d.) The American Heritage® Medical Dictionary. (2007). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/Bronchitis

For Mosby's Medical Dictionary:

bronchitis. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/Bronchitis

For Miller-Keane Encyclopedia:

bronchitis. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/Bronchitis

For Dictionary of Complementary and Alternative Medicine:

bronchitis. (n.d.) Jonas: Mosby's Dictionary of Complementary and Alternative Medicine. (2005). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/Bronchitis

For Dental Dictionary:

bronchitis. (n.d.) Mosby's Dental Dictionary, 2nd edition. (2008). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/Bronchitis

For Veterinary Dictionary:

bronchitis. (n.d.) Saunders Comprehensive Veterinary Dictionary, 3 ed.. (2007). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/Bronchitis

For McGraw-Hill Concise Dictionary of Modern Medicine:

bronchitis. (n.d.) McGraw-Hill Concise Dictionary of Modern Medicine. (2002). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/Bronchitis
 

Definition

Bronchiolitis is an acute viral infection of the small air passages of the lungs called the bronchioles.

Description

Bronchiolitis is extremely common. It occurs most often in children between the ages of two and 24 months, with peak infection occurring between three and six months of age. About 25% of infants have bronchiolitis during their first year, and 95% have had the disease by their second birthday. In temperate climates, bronchiolitis peaks from winter to late spring. In subtropical climates, the disease peaks from October to February.
Children who attend daycare or who live in crowded conditions and those who are exposed to second-hand smoke at home are more likely to develop bronchiolitis. Premature infants and children born with heart and lung defects or HIV/AIDS are more likely to have severe, life-threatening infections. Bronchiolitis occurs more often in boys than girls, with boys being hospitalized at 1.5 times the rate of girls. Bronchiolitis is a significant cause of respiratory disease worldwide. The World Health Organization (WHO) has funded research to develop a vaccine against the disease, but thus attempts have been unsuccessful.

Causes and symptoms

Bronchiolitis is caused by several different viruses. The most common of these is respiratory syncytial virus (RVS), which is responsible for about 100,000 hospitalizations of children under age four each year. Two subtypes of RSV have been identified, one of which causes most of the severe bronchiolitis infections. In addition, bronchiolitis can be caused by influenza, parainfluenza, and adenoviruses, all of which are common from fall through spring. These viruses are spread in tiny drops of fluid from an infected person's nose and mouth through direct contact, such as shaking hands, or kissing. The viruses can also live several hours on countertops, toys, or used tissues and easily infect people who handle contaminated items. The time from infection to the appearance of symptoms varies from two to seven days.

Diagnosis

Bronchiolitis is usually diagnosed through a physical examination by a pediatrician or family physician. The physician often finds an increased heart rate, rapid, labored breathing, and crackles in the lungs when the child inhales. Signs of ear infection (otitis media) and throat infection (pharyngitis) are sometimes present.
Although laboratory tests are available that can within in a few hours confirm the presence of RSV, these tests are not routinely necessary. The oxygen level in the blood may be measured through pulse oximetry in babies who are having difficulty breathing. Inadequate oxygen in the blood is an indication that hospitalization is necessary. Chest x-rays may be done on severely ill children to rule out other conditions.

Treatment

The degree of respiratory distress determines treatment. Individuals with mild symptoms are treated as if they have a cold with rest, fluids, and a cool air humidifier. Babies who are struggling to breath may hospitalized and given supplemental humidified oxygen. Their breathing will be monitored and if necessary fluids will be given intravenously to prevent dehydration. Occasionally infants need mechanical ventilation to fill and empty the lungs until the airways open.
Those children with compromised immune systems from diseases such as congenital HIV/AIDS and transplant patients are at highest risk for severe infections, serious complications, and death. Children with congenital heart and lung disorders are also at higher risk, as are infants under six weeks old. These high risk children may be admitted to pediatric intensive care units and treated with ribvarin (Virazole), a drug that keeps the virus from reproducing. This drug is reserved for the most critical cases.

Alternative treatment

Although there are alternative treatments for cold symptoms, such as echinacea and zinc, parents should consult their health practitioner about the appropriateness of using these treatments in very young children.

Prognosis

The majority of children who get bronchiolitis, even severe infections, recover without complications in one to two weeks, although fatigue and a light cough may linger longer. About 60% of people develop only cold-like symptoms without lung involvement. However, the disease accounts for about 100,000 pediatric hospitalizations and 4,500 deaths each year. Deaths usually occur because medical care is not sought soon enough.
Although many viral illnesses, like chicken pox, can be contracted only once, after which individuals develop immunity, people can get bronchiolitis multiple times. However, after the first infection, the symptoms are usually mild.

Prevention

The viruses that cause bronchiolitis spread very easily, making prevention difficult. Common sense measures such as frequent hand washing and keeping children away from crowds and sick individuals are only partially effective. Certain very high risk babies can be treated during the peak virus season with monthly injections of antiviral immunoglobulins to protect against RSV infection. These injections cost several thousand dollars per child per season and are reserved for children whose life could be at risk if they became infected. Antiviral immunoglobulins are used only for prevention and are not effective as a treatment once the infection has been acquired.
 

Key terms

Bronchiole — A thin air passage in the lung that branches off a larger airway.
Congenital — A condition that an individual is born with.
Bronchiolitis affects individuals differently depending on their age. In adults, older children, and some infants, bronchiolitis viruses causes symptoms similar to a mild cold—runny nose, stuffy head, and mild cough. The lungs are not involved, and these symptoms clear up without any medical treatment. In some children under age two, the cold-like upper respiratory symptoms worsen after a day or two. The lung tissue begins to swell and produce mucus, and the cells lining the bronchioles begin to slough off into the air passages. As the airways narrow from swelling, and mucus accumulation, breathing becomes difficult, and the child makes a wheezing or whistling sound with each breath. Lung involvement can occur quite rapidly.
The most common signs of bronchiolitis involve the infant's struggle to breathe. The child may take 50-60 breaths per minute and may develop brief periods when they stop breathing (apnea) and begin to turn blue (cyanosis). This occurs most often in babies who were born very prematurely or who are under six weeks of age and babies with congenital heart and lung problems and compromised immune systems. Babies may also stop eating, because it is becomes difficult for them to swallow and breathe at the same time. They may have a low fever, cough, and vomiting.
 

Resources

Other

"Bronchitis." Medline Plus Medical Encyclopedia 19 January 2005 [cited 16 February 2005]. http://www.nlm.nih.gov/medlineplus/ency/article/000975.htm.
DeNicola, Lucian K. and Michael Gayle. Bronchiolitis, 17 July 2003 [cited 16 February 2005]. http://www.emedicine.com/ped/topic287.htm.
Kirlov, Leonard R. Respiratory Syncytial Virus Infection, 24 November 2004 [cited 16 February 2005]. http://www.emedicine.com/ped/topic2706.htm.
Louden, Mark. Pediatrics, Bronchiolitis, 21 May 2001 [cited 16 February 2005]. http://www.emedicine.com/emerg/topic365.htm.
"Respiratory Syncytial Virus (RSV)." Medline Plus Medical Encyclopedia 19 January 2005 [cited 16 February 2005]. http://www.nlm.nih.gov/medlineplus/ency/article/001564.htm
 

Citations:

For Gale Encyclopedia of Medicine:

bronchiolitis. (n.d.) Gale Encyclopedia of Medicine. (2008). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/bronchiolitis

For Dorland's Medical Dictionary:

bronchiolitis. (n.d.) Dorland's Medical Dictionary for Health Consumers. (2007). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/bronchiolitis

For The American Heritage® Medical Dictionary:

bronchiolitis. (n.d.) The American Heritage® Medical Dictionary. (2007). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/bronchiolitis

For Mosby's Medical Dictionary:

bronchiolitis. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/bronchiolitis

For Miller-Keane Encyclopedia:

bronchiolitis. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/bronchiolitis

For Veterinary Dictionary:

bronchiolitis. (n.d.) Saunders Comprehensive Veterinary Dictionary, 3 ed.. (2007). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/bronchiolitis

For McGraw-Hill Concise Dictionary of Modern Medicine:

bronchiolitis. (n.d.) McGraw-Hill Concise Dictionary of Modern Medicine. (2002). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/bronchiolitis
 
 

A severe form of measles characterized by dark, hemorrhagic skin eruptions. Also called hemorrhagic measles.

It is an acute tickborne illness caused by the bacterium Rickettsia rickettsii. The disease is characterized by a sudden onset of headache, chills, and fever, which can persist for 2 to 3 weeks. A characteristic rash appears on the extremities and trunk about the fourth day of illness.

Causes

The main cause of Black Measles is bacteria. These bacteria grow inside the cells of the person's body that it is trying to infect. It multiplies in the cells and also damages the infected cells. Rickettsia is a genus that belongs to a bacterial tribe. This particular genus has many other different species of bacteria that can cause human diseases. The main cause of Black Measles is the bacterium Rickettsia rickettsii.

Treatment

Seek doctor to know and diagnosis. No matter how slight the condition is, medical intervention is necessary. Doctors will prescribe certain antibiotics to take care of the problem. Most doctors go with Doxycycline, which helps in reducing the intensity or severity of the condition and the treatment plan should begin immediately after diagnosis.





 Definition

Plague is a serious, potentially life-threatening infectious disease that is usually transmitted to humans by the bites of rodent fleas. It was one of the scourges of early human history. There are three major forms of the disease: bubonic, septicemic, and pneumonic.

Description

Plague has been responsible for three great world pandemics, which caused millions of deaths and significantly altered the course of history. A pandemic is a disease occurring in epidemic form throughout the entire population of a country, a people, or the world. Although the cause of the plague was not identified until the third pandemic in 1894, scientists are virtually certain that the first two pandemics were plague because a number of the survivors wrote about their experiences and described the symptoms.
The first great pandemic appeared in AD 542 and lasted for 60 years. It killed millions of citizens, particularly people living along the Mediterranean Sea. This sea was the busiest, coastal trade route at that time and connected what is now southern Europe, northern Africa, and parts of coastal Asia. This pandemic is sometimes referred to as the Plague of Justinian, named for the great emperor of Byzantium who was ruling at the beginning of the outbreak. According to the historian Procopius, this outbreak of plague killed 10,000 people per day at its height just within the city of Constantinople.
The second pandemic occurred during the fourteenth century, and was called the Black Death because its main symptom was the appearance of black patches (caused by bleeding) on the skin. It was also a subject found in many European paintings, drawings, plays, and writings of that time. The connections between large active trading ports, rats coming off the ships, and the severe outbreaks of the plague were understood by people at the time. This was the most severe of the three, beginning in the mid-1300s with an origin in central Asia and lasting for 400 years. Between a fourth and a third of the entire European population died within a few years after plague was first introduced. Some smaller villages and towns were completely wiped out.
The final pandemic began in northern China, reaching Canton and Hong Kong by 1894. From there, it spread to all continents, killing millions.
The great pandemics of the past occurred when wild rodents spread the disease to rats in cities, and then to humans when the rats died. Another route for infection came from rats coming off ships that had traveled from heavily infected areas. Generally, these were busy coastal or inland trade routes. Plague was introduced into the United States during this pandemic and it spread from the West towards the Midwest and became endemic in the Southwest of the United States.
About 10-15 Americans living in the southwestern United States contract plague each year during the spring and summer. The last rat-borne epidemic in the United States occurred in Los Angeles in 1924–25. Since then, all plague cases in this country have been sporadic, acquired from wild rodents or their fleas. Plague can also be acquired from ground squirrels and prairie dogs in parts of Arizona, New Mexico, California, Colorado, and Nevada. Around the world, there are between 1,000 and 2,000 cases of plague each year. Recent outbreaks in humans occurred in Africa, South America, and Southeast Asia.
Some people and/or animals with bubonic plague go on to develop pneumonia (pneumonic plague). This can spread to others via infected droplets during coughing or sneezing.
Plague is one of three diseases still subject to international health regulations. These rules require that all confirmed cases be reported to the World Health Organization (WHO) within 24 hours of diagnosis. According to the regulations, passengers on an international voyage who have been to an area where there is an epidemic of pneumonic plague must be placed in isolation for six days before being allowed to leave.
While plague is found in several countries, there is little risk to United States travelers within endemic areas (limited locales where a disease is known to be present) if they restrict their travel to urban areas with modern hotel accommodations.
Over the past few years, this infection primarily of antiquity has become a modern issue. This change has occurred because of the concerns about the use of plague as a weapon of biological warfare or terrorism (bioterrorism). Along with anthrax and smallpox, plague is considered to be a significant risk. In this scenario, the primary manifestation is likely to be pneumonic plague transmitted by clandestine aerosols. It has been reported that during World War II the Japanese dropped "bombs" containing plague-infected fleas in China as a form of biowarfare.

Causes and symptoms

Fleas carry the bacterium Yersinia pestis, formerly known as Pasteurella pestis. The plague bacillus can be stained with Giemsa stain and typically looks like a safety pin under the microscope. When a flea bites an infected rodent, it swallows the plague bacteria. The bacteria are passed on when the fleas, in turn, bite a human. Interestingly, the plague bacterium grows in the gullet of the flea, obstructing it and not allowing the flea to eat. Transmission occurs during abortive feeding with regurgitation of bacteria into the feeding site. Humans also may become infected if they have a break or cut in the skin and come in direct contact with body fluids or tissues of infected animals.
More than 100 species of fleas have been reported to be naturally infected with plague; in the western United States, the most common source of plague is the golden-manteled ground squirrel flea. Chipmunks and prairie dogs have also been identified as hosts of infected fleas.
Since 1924, there have been no documented cases in the United States of human-to-human spread of plague from droplets. All but one of the few pneumonic cases have been associated with handling infected cats. While dogs and cats can become infected, dogs rarely show signs of illness and are not believed to spread disease to humans. However, plague has been spread from infected coyotes (wild dogs) to humans. In parts of central Asia, gerbils have been identified as the source of cases of bubonic plague in humans.

Bubonic plague

Two to five days after infection, patients experience a sudden fever, chills, seizures, and severe headaches, followed by the appearance of swellings or "buboes" in armpits, groin, and neck. The most commonly affected sites are the lymph glands near the site of the first infection. As the bacteria multiply in the glands, the lymph node becomes swollen. As the nodes collect fluid, they become extremely tender. Occasionally, the bacteria will cause an ulcer at the point of the first infection.

Septicemic plague

Bacteria that invade the bloodstream directly (without involving the lymph nodes) cause septicemic plague. (Bubonic plague also can progress to septicemic plague if not treated appropriately.) Septicemic plague that does not involve the lymph glands is particularly dangerous because it can be hard to diagnose the disease. The bacteria usually spread to other sites, including the liver, kidneys, spleen, lungs, and sometimes the eyes, or the lining of the brain. Symptoms include fever, chills, prostration, abdominal pain, shock, and bleeding into the skin and organs.

Pneumonic plague

Pneumonic plague may occur as a direct infection (primary) or as a result of untreated bubonic or septicemic plague (secondary). Primary pneumonic plague is caused by inhaling infective drops from another person or animal with pneumonic plague. Symptoms, which appear within one to three days after infection, include a severe, overwhelming pneumonia, with shortness of breath, high fever, and blood in the phlegm. If untreated, half the patients will die; if blood poisoning occurs as an early complication, patients may die even before the buboes appear.
Life-threatening complications of plague include shock, high fever, problems with blood clotting, and convulsions.

Diagnosis

Plague should be suspected if there are painful buboes, fever, exhaustion, and a history of possible exposure to rodents, rabbits, or fleas in the West or Southwest. The patient should be isolated. Chest x rays are taken, as well as blood cultures, antigen testing, and examination of lymph node specimens. Blood cultures should be taken 30 minutes apart, before treatment.
A group of German researchers reported in 2004 on a standardized enzyme-linked immunosorbent assay (ELISA) kit for the rapid diagnosis of plague. The test kit was developed by the German military and has a high degree of accuracy as well as speed in identifying the plague bacillus. The kit could be useful in the event of a bioterrorist attack as well as in countries without advanced microbiology laboratories.

Treatment

As soon as plague is suspected, the patient should be isolated, and local and state departments notified. Drug treatment reduces the risk of death to less than 5%. The preferred treatment is streptomycin administered as soon as possible. Alternatives include gentamicin, chloramphenicol, tetracycline, or trimethoprim/sulfamethoxazole.

Prognosis

Plague can be treated successfully if it is caught early; the mortality rate for treated disease is 1-15% but 40-60% in untreated cases. Untreated pneumonic plague is almost always fatal, however, and the chances of survival are very low unless specific antibiotic treatment is started within 15-18 hours after symptoms appear. The presence of plague bacteria in a blood smear is a grave sign and indicates septicemic plague. Septicemic plague has a mortality rate of 40% in treated cases and 100% in untreated cases.

Prevention

Anyone who has come in contact with a plague pneumonia victim should be given antibiotics, since untreated pneumonic plague patients can pass on their illness to close contacts throughout the course of the illness. All plague patients should be isolated for 48 hours after antibiotic treatment begins. Pneumonic plague patients should be completely isolated until sputum cultures show no sign of infection.
Residents of areas where plague is found should keep rodents out of their homes. Anyone working in a rodent-infested area should wear insect repellent on skin and clothing. Pets can be treated with insecticidal dust and kept indoors. Handling sick or dead animals (especially rodents and cats) should be avoided.
Plague vaccines have been used with varying effectiveness since the late nineteenth century. Experts believe that vaccination lowers the chance of infection and the severity of the disease. However, the effectiveness of the vaccine against pneumonic plague is not clearly known.
Vaccinations against plague are not required to enter any country. Because immunization requires multiple doses over a 6-10 month period, plague vaccine is not recommended for quick protection during outbreaks. Moreover, its unpleasant side effects make it a poor choice unless there is a substantial long-term risk of infection. The safety of the vaccine for those under age 18 has not been established. Pregnant women should not be vaccinated unless the need for protection is greater than the risk to the unborn child. Even those who receive the vaccine may not be completely protected. The inadequacy of the vaccines available as of the early 2000s explains why it is important to protect against rodents, fleas, and people with plague. A team of researchers in the United Kingdom reported in the summer of 2004 that an injected subunit vaccine is likely to offer the best protection against both bubonic and pneumonic forms of plague.

Key terms

Bioterrorism — The use of disease agents to terrorize or intimidate a civilian population.
Buboes — Smooth, oval, reddened, and very painful swellings in the armpits, groin, or neck that occur as a result of infection with the plague.
Endemic — A disease that occurs naturally in a geographic area or population group.
Epidemic — A disease that occurs throughout part of the population of a country.
Pandemic — A disease that occurs throughout a regional group, the population of a country, or the world.
Septicemia — The medical term for blood poisoning, in which bacteria have invaded the bloodstream and circulates throughout the body.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Plague (Bubonic Plague; Pestis; Black Death)." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Davis, S., M. Begon, L. DeBruyn, et al. "Predictive Thresholds for Plague in Kazakhstan." Science 304 (April 30, 2004): 736-738.
Gani, R., and S. Leach. "Epidemiologic Determinants for Modeling Pneumonic Plague Outbreaks." Emerging Infectious Diseases 10 (April 2004): 608-614.
Splettstoesser, W. D., L. Rahalison, R. Grunow, et al. "Evaluation of a Standardized F1 Capsular Antigen Capture ELISA Test Kit for the Rapid Diagnosis of Plague." FEMS Immunology and Medical Microbiology 41 (June 1, 2004): 149-155.
Titball, R. W., and E. D. Williamson. "Yersinia pestis (Plague) Vaccines." Expert Opinion on Biological Therapy 4 (June 2004): 965-973.
Velendzas, Demetres, MD, and Susan Dufel, MD. "Plague." eMedicine December 2, 2004. http://www.emedicine.com/EMERG/topic428.htm.

Organizations

Centers for Disease Control. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.
National Institute of Allergies and Infectious Diseases, Division of Microbiology and Infectious Diseases. Bldg. 31, Rm. 7A-50, 31 Center Drive MSC 2520, Bethesda, MD 20892.
World Health Organization. Division of Emerging and Other Communicable Diseases Surveillance and Control. 1211 Geneva 27, Switzerland.

Other

Bacterial Diseases (Healthtouch). 〈http://www.healthtouch.com/level1/leaflets/105825/105826.htm〉.
Bug Bytes. 〈http://www.isumc.edu/bugbytes/〉.
Centers for Disease Control. http://www.cdc.gov/travel/travel.html.
Infectious Diseases Weblink. 〈http://pages.prodigy.net/pdeziel/〉.
International Society of Travel Medicine. http://www.istm.org.
World Health Organization. http://www.who.ch/.
 

Citations:

For Gale Encyclopedia of Medicine:

plague. (n.d.) Gale Encyclopedia of Medicine. (2008). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/plague

For Dorland's Medical Dictionary:

plague. (n.d.) Dorland's Medical Dictionary for Health Consumers. (2007). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/plague

For The American Heritage® Medical Dictionary:

plague. (n.d.) The American Heritage® Medical Dictionary. (2007). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/plague

For Mosby's Medical Dictionary:

plague. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/plague

For Miller-Keane Encyclopedia:

plague. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/plague

For Dental Dictionary:

plague. (n.d.) Mosby's Dental Dictionary, 2nd edition. (2008). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/plague

For Veterinary Dictionary:

plague. (n.d.) Saunders Comprehensive Veterinary Dictionary, 3 ed.. (2007). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/plague

For McGraw-Hill Concise Dictionary of Modern Medicine:

plague. (n.d.) McGraw-Hill Concise Dictionary of Modern Medicine. (2002). Retrieved October 16 2012 from http://medical-dictionary.thefreedictionary.com/plague
 

Definition

Beriberi is a disease caused by a deficiency of thiamine (vitamin B1) that affects many systems of the body, including the muscles, heart, nerves, and digestive system. Beriberi literally means "I can't, I can't" in Singhalese, which reflects the crippling effect it has on its victims. It is common in parts of southeast Asia, where white rice is the main food. In the United States, beriberi is primarily seen in people with chronic alcoholism.

Description

Beriberi puzzled medical experts for years as it ravaged people of all ages in Asia. Doctors thought it was caused by something in food. Not until the early 1900s did scientists discover that rice bran, the outer covering that was removed to create the polished white rice preferred by Asians, actually contained something that prevented the disease. Thiamine was the first vitamin identified. In the 1920s, extracts of rice polishings were used to treat the disease.
In adults, there are different forms of beriberi, classified according to the body systems most affected. Dry beriberi involves the nervous system; wet beriberi affects the heart and circulation. Both types usually occur in the same patient, with one set of symptoms predominating.
A less common form of cardiovascular, or wet beriberi, is known as "shoshin." This condition involves a rapid appearance of symptoms and acute heart failure. It is highly fatal and is known to cause sudden death in young migrant laborers in Asia whose diet consists of white rice.
Cerebral beriberi, also known as Wernicke-Korsakoff syndrome, usually occurs in chronic alcoholics and affects the central nervous system (brain and spinal cord). It can be caused by a situation that aggravates a chronic thiamine deficiency, like an alcoholic binge or severe vomiting.
Infantile beriberi is seen in breastfed infants of thiamine-deficient mothers, who live in developing nations.
Although severe beriberi is uncommon in the United States, less severe thiamine deficiencies do occur. About 25% of all alcoholics admitted to a hospital in the United States show some evidence of thiamine deficiency.

Causes and symptoms

Thiamine is one of the B vitamins and plays an important role in energy metabolism and tissue building. It combines with phosphate to form the coenzyme thiamine pyrophosphate (TPP), which is essential in reactions that produce energy from glucose or that convert glucose to fat for storage in the tissues. When there is not enough thiamine in the diet, these basic energy functions are disturbed, leading to problems throughout the body.
Special situations, such as an over-active metabolism, prolonged fever, pregnancy, and breastfeeding, can increase the body's thiamine requirements and lead to symptoms of deficiency. Extended periods of diarrhea or chronic liver disease can result in the body's inability to maintain normal levels of many nutrients, including thiamine. Other persons at risk are patients with kidney failure on dialysis and those with severe digestive problems who are unable to absorb nutrients. Alcoholics are susceptible because they may substitute alcohol for food and their frequent intake of alcohol decreases the body's ability to absorb thiamine.
The following systems are most affected by beriberi:
  • Gastrointestinal system. When the cells of the smooth muscles in the digestive system and glands do not get enough energy from glucose, they are unable to produce more glucose from the normal digestion of food. There is a loss of appetite, indigestion, severe constipation, and a lack of hydrochloric acid in the stomach.
  • Nervous System. Glucose is essential for the central nervous system to function normally. Early deficiency symptoms are fatigue, irritability, and poor memory. If the deficiency continues, there is damage to the peripheral nerves that causes loss of sensation and muscle weakness, which is called peripheral neuropathy. The legs are most affected. The toes feel numb and the feet have a burning sensation; the leg muscles become sore and the calf muscles cramp. The individual walks unsteadily and has difficulty getting up from a squatting position. Eventually, the muscles shrink (atrophy) and there is a loss of reflexes in the knees and feet; the feet may hang limp (footdrop).
  • Cardiovascular system. There is a rapid heartbeat and sweating. Eventually the heart muscle weakens. Because the smooth muscle in the blood vessels is affected, the arteries and veins relax, causing swelling, known as edema, in the legs.
  • Musculoskeletal system. There is widespread muscle pain caused by the lack of TPP in the muscle tissue.
Infants who are breastfed by a thiamine-deficient mother usually develop symptoms of deficiency between the second and fourth month of life. They are pale, restless, unable to sleep, prone to diarrhea, and have muscle wasting and edema in their arms and legs. They have a characteristic, sometimes silent, cry and develop heart failure and nerve damage.

Diagnosis

A physical examination will reveal many of the early symptoms of beriberi, such as fatigue, irritation, nausea, constipation, and poor memory, but the deficiency may be difficult to identify. Information about the individual's diet and general health is also needed.

Key terms

B vitamins — This family of vitamins consists of thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), biotin, folic acid (B9), and cobalamin (B12). They are interdependent and involved in converting glucose to energy.
Coenzyme — A substance needed by enzymes to produce many of the reactions in energy and protein metabolism in the body.
Edema — An excess accumulation of fluid in the cells and tissues.
Enzyme — A protein that acts as a catalyst to produce chemical changes in other substances without being changed themselves.
Metabolism — All the physical and chemical changes that take place within an organism.
Peripheral neuropathy — A disease affecting the portion of the nervous system outside the brain and spinal chord. One or more nerves can be involved, causing sensory loss, muscle weakness and shrinkage, and decreased reflexes.
Thiamine pyrophosphate (TPP) — The coenzyme containing thiamine that is essential in converting glucose to energy.
There are many biochemical tests based on thiamine metabolism or the functions of TPP that can detect a thiamine deficiency. Levels of thiamine can be measured in the blood and urine and will be reduced if there is a deficiency. The urine can be collected for 24 hours to measure the level of thiamine excreted. Another reliable test measures the effect of TPP on red blood cell activity since all forms of beriberi affect the metabolism of red blood cells.
An electroencephalogram (EEG), which measures electrical activity in the brain, may be done to rule out other causes of neurologic changes. Observing improvements in the patient after giving thiamine supplements will also confirm the diagnosis.

Treatment

Treatment with thiamine reverses the deficiency in the body and relieves most of the symptoms. Severe thiamine deficiency is treated with high doses of thiamine given by injection into a muscle (intramuscular) or in a solution that goes into a vein (intravenously) for several days. Then smaller doses can be given either by injection or in pill form until the patient recovers. Usually there are other deficiencies in the B vitamins that will also need treatment.
The cardiovascular symptoms of wet beriberi can respond to treatment within a few hours if they are not too severe. Heart failure may require additional treatment with diuretics that help eliminate excess fluid and with heart-strengthening drugs like digitalis.
Recovery from peripheral neuropathy and other symptoms of dry beriberi may take longer and patients frequently become discouraged. They should stay active; physical therapy will also help in recovery.
Infantile beriberi is treated by giving thiamine to both the infant and the breast feeding mother until levels are normal.
In Wernicke-Korsakoff syndrome, thiamine should be given intravenously or by injection at first because the intestinal absorption of thiamine is probably impaired and the patient is very ill. Most of the symptoms will be relieved by treatment, though there may be residual memory loss.
Excess thiamine is excreted by the body in the urine, and negative reactions to too much thiamine are rare. Thiamine is unstable in alkali solutions, so it should not be taken with antacids or barbiturates.

Alternative treatment

Alternative treatments for beriberi deal first with correcting the thiamine deficiency. As in conventional treatments, alternative treatments for beriberi stress a diet rich in foods that provide thiamine and other B vitamins, such as brown rice, whole grains, raw fruits and vegetables, legumes, seeds, nuts, and yogurt. Drinking more than one glass of liquid with a meal should be avoided, since this may wash out the vitamins before they can be absorbed by the body. Thiamine should be taken daily, with the dose depending on the severity of the disease. Additional supplements of B vitamins, a multivitamin and mineral complex, and Vitamin C are also recommended. Other alternative therapies may help relieve the person's symptoms after the thiamine deficiency is corrected.

Prognosis

Beriberi is fatal if not treated and the longer the deficiency exists, the sicker the person becomes. Most of the symptoms can be reversed and full recovery is possible when thiamine levels are returned to normal and maintained with a balanced diet and vitamin supplements as needed.

Prevention

A balanced diet containing all essential nutrients will prevent a thiamine deficiency and the development of beriberi. People who consume large quantities of junk food like soda, pretzels, chips, candy, and high carbohydrate foods made with unenriched flours may be deficient in thiamine and other vital nutrients. They may need to take vitamin supplements and should improve their diets.

Dietary requirements

The body's requirements for thiamine are tied to carbohydrate metabolism and expressed in terms of total intake of calories. The current recommended dietary allowances (RDA) are 0.5 mg for every 1000 calories, with a minimum daily intake of 1 mg even for those who eat fewer than 2,000 calories in a day. The RDA for children and teenagers is the same as for adults: 1.4 mg daily for males over age eleven, and 1.1 mg for females. During pregnancy, an increase to 1.5 mg daily is needed. Because of increased energy needs and the secretion of thiamine in breast milk, breast feeding mothers need 1.5 mg every day. In infants, 0.4 mg is advised.

Food sources

The best food sources of thiamine are lean pork, beef, liver, brewer's yeast, peas and beans, whole or enriched grains, and breads. The more refined the food, as in white rice, white breads, and some cereals, the lower the thiamine. Many food products are enriched with thiamine, along with riboflavin, niacin, and iron, to prevent dietary deficiency.
During the milling process, rice is polished and all the vitamins in the exterior coating of bran are lost. Boiling the rice before husking preserves the vitamins by distributing them throughout the kernel. Food enrichment programs have eliminated beriberi in Japan and the Phillipines.
Like all B vitamins, thiamine is water soluble, which means it is easily dissolved in water. It will leach out during cooking in water and is destroyed by high heat and overcooking.

Resources

Periodicals

Ryan, Ruth, et al. "Beriberi Unexpected." Psychosomatics May-June 1997: 191-294.
 

Citations:

For Gale Encyclopedia of Medicine:

beriberi. (n.d.) Gale Encyclopedia of Medicine. (2008). Retrieved October 14 2012 from http://medical-dictionary.thefreedictionary.com/beriberi

For Dorland's Medical Dictionary:

beriberi. (n.d.) Dorland's Medical Dictionary for Health Consumers. (2007). Retrieved October 14 2012 from http://medical-dictionary.thefreedictionary.com/beriberi

For The American Heritage® Medical Dictionary:

beriberi. (n.d.) The American Heritage® Medical Dictionary. (2007). Retrieved October 14 2012 from http://medical-dictionary.thefreedictionary.com/beriberi

For Mosby's Medical Dictionary:

beriberi. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved October 14 2012 from http://medical-dictionary.thefreedictionary.com/beriberi

For Miller-Keane Encyclopedia:

beriberi. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved October 14 2012 from http://medical-dictionary.thefreedictionary.com/beriberi

For Dental Dictionary:

beriberi. (n.d.) Mosby's Dental Dictionary, 2nd edition. (2008). Retrieved October 14 2012 from http://medical-dictionary.thefreedictionary.com/beriberi

For Veterinary Dictionary:

beriberi. (n.d.) Saunders Comprehensive Veterinary Dictionary, 3 ed.. (2007). Retrieved October 14 2012 from http://medical-dictionary.thefreedictionary.com/beriberi
 

Definition

Facial paralysis or weakness with a sudden onset, caused by swelling or inflammation of the seventh cranial nerve, which controls the facial muscles. Disseminated Lyme disease sometimes causes Bell's palsy.


It is a unilateral paralysis of the facial nerve, thought to result from trauma to the nerve, compression of the nerve, or infection, of which herpes simplex virus is thought to be the most common. Any or all branches of the nerve may be affected. The person may not be able to close an eye or control salivation on the affected side. It usually resolves over weeks but can leave some permanent damage, including decreased taste and hypersensitivity to noise on the affected side. Also called Bell's paralysis.


Sign and Symptoms

Symptoms of Bell's palsy include:
  • Sudden weakness or paralysis on one side of face that causes it to droop. This is the main symptom.
  • Drooling.
  • Eye problems, such as excessive tearing or a dry eye.
  • Loss of ability to taste.
  • Pain in or behind ear.
  • Numbness in the affected side of face.
  • Increased sensitivity to sound.

Diagnosis

Doctor may diagnose Bell's palsy by asking questions, such as about how symptoms developed. He or she will also give a physical and neurological exam to check facial nerve function.
If the cause of symptoms is not clear, may need other tests, such as blood tests, an MRI, or a CT scan.

Treatment

Most people who have Bell's palsy recover completely, without treatment, in 1 to 2 months. This is especially true for people who can still partly move their facial muscles. But a small number of people may have permanent muscle weakness or other problems on the affected side of the face.

Patient may need to take a corticosteroid. This medicine can lower your risk for long-term problems from Bell\s palsy. Doctor may also have take antiviral medicine, such as acyclovir. Antiviral medicines used alone don?t help with Bell's palsy