Pertussis Research Paper

Pertussis is a highly contagious bacterial disease that causes uncontrollable, violent coughing. The coughing can make it hard to breathe. A deep "whooping" sound is often heard when the patient tries to take a breath
Cause.
Pertussis, or whooping cough, is an upper respiratory infection caused by the Bordetella pertussis or Bordetella parapertussis bacteria. It is a serious disease that can cause permanent disability in infants, and even death.
When an infected person sneezes or coughs, tiny droplets containing the bacteria move through the air, and the disease is easily spread from person to person.
The infection usually lasts 6 weeks.
Symptoms
Initial symptoms, similar to the common cold, usually develop about a week after exposure
to the bacteria.
Severe episodes of coughing start about 10 to 12 days later. In children, the coughing often ends with a "whoop" noise. The sound is produced when the patient tries to take a breath. The whoop noise is rare in patients under 6 months of age and in adults.
Coughing spells may lead to vomiting or a short loss of consciousness. Pertussis should always be considered when vomiting occurs with coughing. In infants, choking spells are common.
Other pertussis symptoms include: * Runny nose * Slight fever (102 °F or lower) * Diarrhea
Test and Exam
The initial diagnosis is usually based on the symptoms. However, when the symptoms are not obvious, pertussis may be difficult to diagnose. In very young infants, the symptoms may be caused by pneumonia instead.
To know for sure, the health care provider may take a sample of mucus from the nasal secretions and send it to a lab, which tests it for pertussis. While this can offer an accurate diagnosis, the test takes some time, and treatment is usually started before the results are ready.
Some patients may have a complete blood count that shows large numbers of lymphocytes.
Treatment
If started early enough, antibiotics such as erythromycin can make the symptoms go away more quickly. And can help reduce the patient's ability to spread the disease to others.
Infants younger than 18 months need constant supervision because their breathing may temporarily stop during coughing spells. Infants with severe cases should be hospitalized.
An oxygen tent with high humidity may be used.
Fluids may be given through a vein if coughing spells are severe enough to prevent the person from drinking enough fluids.
Sedatives (medicines to make you sleepy) may be prescribed for young children.
Possible complication * Pneumonia * Convulsions * Seizure disorder (permanent) * Nose bleeds * Ear infections * Brain damage from lack of oxygen * Bleeding in the brain (cerebral hemorrhage) * Mental retardation * Slowed or stopped breathing (apnea) * Death
When to Contact a Medical Professional
Call 911 or get to an emergency room if the person has any of the following symptoms: * Bluish skin color, which indicates a lack of oxygen * Periods of stopped breathing (apnea) * Seizures or convulsions * High fever * Persistent vomiting * Dehydration
Prevention
DTaP vaccination, one of the recommended childhood immunizations, protects children against pertussis infection. DTaP vaccine can be safely given to infants. Five DTaP vaccines are recommended. They are usually given to children at ages 2 months, 4 months, 6 months, 15-18 months, and 4-6 years.
The Tdap vaccine should be given around age 11 or 12, and every 10 years thereafter.
During a pertussis outbreak, unimmunized children under age 7 should not attend school or public gatherings, and should be isolated from anyone known or suspected to be infected. This should last until 14 days after the last reported case.
Some health care organizations strongly recommend that adults up to the age of 65 years receive the adult form of the vaccine against pertussis
Whooping cough — or pertussis — is an infection of the respiratory system caused by the bacterium Bordetella pertussis (or B. pertussis). It's characterized by severe coughing spells that end in a "whooping" sound when the person breathes in.
Signs and Symptoms
The first symptoms of whooping cough are similar to those of a common cold: * runny nose * sneezing * mild cough * low-grade fever
After about 1 to 2 weeks, the dry, irritating cough evolves into coughing spells. During a coughing spell, which can last for more than a minute, the child may turn red or purple. At the end of a spell, the child may make a characteristic whooping sound when breathing in or may vomit. Between spells, the child usually feels well.
Although it's likely that infants and younger children who become infected with B. pertussis will develop the characteristic coughing episodes with their accompanying whoop, not everyone will. However, sometimes infants don't cough or whoop as older kids do. They may look as if they're gasping for air with a reddened face and may actually stop breathing for a few seconds during particularly bad spells.
Adults and adolescents with whooping cough may have milder or atypical symptoms, such as a prolonged cough without the coughing spells or the whoop.
Contagiousness
Pertussis is highly contagious. The bacteria spread from person to person through tiny drops of fluid from an infected person's nose or mouth. These may become airborne when the person sneezes, coughs, or laughs. Others then can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses.
Infected people are most contagious during the earliest stages of the illness up to about 2 weeks after the cough begins. Antibiotics shorten the period of contagiousness to 5 days following the start of antibiotic treatment.
Prevention
Whooping cough can be prevented with the pertussis vaccine, which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization. DTaP immunizations are routinely given in five doses before a child's sixth birthday. To give additional protection in case immunity fades, the AAP now recommends that kids ages 11-18 get a booster shot of the new combination vaccine (called Tdap), ideally when they're 11 or 12 years old, instead of the Td booster routinely given at this age. As is the case with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information.
Experts believe that up to 80% of nonimmunized family members will develop whooping cough if they live in the same house as someone who has the infection. For this reason, anyone who comes into close contact with someone who has pertussis should receive antibiotics to prevent spread of the disease. Young kids who have not received all five doses of the vaccine may require a booster dose if exposed to an infected family member.
Incubation
The incubation period (the time between infection and the onset of symptoms) for whooping cough is usually 7 to 10 days, but can be as long as 21 days.
Duration
Pertussis can cause prolonged symptoms.
The child usually has 1 to 2 weeks of common cold symptoms, followed by approximately 2 to 4 weeks of severe coughing, though the coughing spells can sometimes last even longer. The last stage consists of another several weeks of recovery with gradual resolution of symptoms. In some children, the recovery period may last for months.
Professional Treatment
Call the doctor if you suspect that your child has whooping cough. To make a diagnosis, the doctor will take a medical history, do a thorough physical exam, and take nose and throat mucus samples that will be examined and cultured for B. pertussis bacteria. Blood tests and a chest X-ray may also be done.
If your child has whooping cough, it will be treated with antibiotics, usually for 2 weeks. Many experts believe that the medication is most effective in shortening the infection when it's given in the first stage of the illness, before coughing spells begin. But even if antibiotics are started later, they're still important because they can stop the spread of the pertussis infection to others. Ask your doctor whether preventive antibiotics or vaccine boosters for other family members are
needed.
Some kids with whooping cough need to be treated in a hospital. Infants and younger children are more likely to be hospitalized because they're at greater risk for complications such as pneumonia, which occurs in about 1 in 5 children under the age of 1 year who have pertussis. Up to 75% of infants younger than 6 months old with whooping cough will receive hospital treatment. In infants younger than 6 months of age, whooping cough can even be life-threatening.
While in the hospital, a child may need suctioning of thick respiratory secretions.
Breathing will be monitored and oxygen given, if needed. Intravenous (IV) fluids might be required if the child shows signs of dehydration or has difficulty eating. Precautions will be taken to prevent the infection from spreading to other patients, hospital staff, and visitors.
Home Treatment
If your child is being treated for pertussis at home, follow the schedule for giving antibiotics exactly as your doctor prescribed. Giving cough medicine probably will not help, as even the strongest usually can't relieve the coughing spells of whooping cough.
During recovery, let your child rest in bed and use a cool-mist vaporizer to help loosen respiratory secretions and soothe irritated lungs and breathing passages. (Be sure to follow directions for keeping it clean and mold-free.) In addition, keep your home free of irritants that can trigger coughing spells, such as aerosol sprays, tobacco smoke, and smoke from cooking, fireplaces, and wood-burning
stoves.
Kids with whooping cough may vomit or not eat or drink much because of frequent coughing. So offer smaller, more frequent meals and encourage your child to drink lots of fluids. Watch for signs of dehydration, too, including thirst, irritability, restlessness, lethargy, sunken eyes, a dry mouth and tongue, dry skin, crying without tears, and fewer trips to the bathroom to urinate (or in infants, fewer wet diapers).
When to Call the Doctor
Call the doctor if you suspect that your child has whooping cough or has been exposed to someone with whooping cough, even if your child has already received all scheduled pertussis immunizations.
Your child should be examined by a doctor if he or she has prolonged coughing spells, especially if these spells: * make your child turn red or purple * are followed by vomiting * are accompanied by a whooping sound when your child breathes in after coughing
If your child has been diagnosed with whooping cough and is being treated at home, seek immediate medical care if he or she has difficulty breathing or shows signs of dehydration.
Measles is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses. Symptoms include fever, cough, runny nose, red eyes and a generalized, maculopapular, erythematous rash.
Measles is spread through respiration (contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission), and is highly contagious—90% of people without immunity sharing a house with an infected person will catch it. The infection has an average incubation period of 14 days (range 6–19 days) and infectivity lasts from 2–4 days prior, until 2–5 days following the onset of the rash (i.e. 4–9 days infectivity in total).[1]
An alternative name for measles in English-speaking countries is rubeola, which is sometimes confused with rubella (German measles); the diseases are unrelated.[2][3] In some other European languages, rubella and rubeola are synonyms, and rubeola is not an alternative name for measles.[4
Symptoms
The classical symptoms of measles include four day fevers, the three Cs—cough, coryza (runny nose) and conjunctivitis (red eyes). The fever may reach up to 40 °C (104 °F). Koplik's spots seen inside the mouth are pathognomonic (diagnostic) for measles but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising.
The characteristic measles rash is classically described as a generalized, maculopapular, erythematous rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing itching. The rash is said to "stain", changing colour from red to dark brown, before disappearing.[citation needed]
Complications
Complications with measles are relatively common, ranging from relatively mild and less serious diarrhea, to pneumonia and encephalitis (subacute sclerosing panencephalitis), corneal ulceration leading to corneal scarring.[5] Complications are usually more severe amongst adults who catch the virus.
Cause
Patients with the measles should be placed on respiratory precautions.[8]
Humans are the only known natural host of measles, although the virus can infect some non-human primate species.
Diagnosis
Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three C's (cough, coryza, conjunctivitis). Observation of Koplik's spots is also diagnostic of measles.
Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens. In children, where phlebotomy is inappropriate, saliva can be collected for salivary measles specific IgA test. Positive contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis. The contact with any infected person in any way, including semen through sex, saliva, or mucus can cause infection.
Prevention
In developed countries, most children are immunized against measles by the age of 18 months, generally as part of a three-part MMR vaccine (measles, mumps, and rubella). The vaccination is generally not given earlier than this because children younger than 18 months usually retain anti-measles immunoglobulins (antibodies) transmitted from the mother during pregnancy. A second dose is usually given to children between the ages of four and five, in order to increase rates of immunity. Vaccination rates have been high enough to make measles relatively uncommon. Even a single case in a college dormitory or similar setting is often met with a local vaccination program, in case any of the people exposed are not already immune.
In developing countries where measles is highly endemic, the WHO recommend that two doses of vaccine be given at six months and at nine months of age. The vaccine should be given whether the child is HIV-infected or not.[9] The vaccine is less effective in HIV-infected infants, but the risk of adverse reactions is low.
Treatment
There is no cure for measles. Most patients with uncomplicated measles will recover with rest and supportive treatment.
Some patients will develop pneumonia as a sequel to the measles. Other complications include ear infections, bronchitis, and encephalitis. Acute measles encephalitis has a mortality rate of 15%, while there is no specific treatment for measles encephalitis, antibiotics are required for bacterial pneumonia, sinusitis, and bronchitis that can follow measles. All other treatment is symptomatic, with ibuprofen, or acetaminophen to reduce fever and pain, a fast acting bronchodialater for cough.
Prognosis
Definition
Measles is a viral infection that causes an illness displaying a characteristic skin rash known as an exanthem. Measles is also sometimes called rubeola, five-day measles, or hard measles.
Description
Measles infections appear all over the world. Incidence of the disease in the United States is down to a record low and only 86 confirmed cases were reported in the year 2000. Of these, 62% were definitely linked to foreigners or international travel. Prior to the current effective immunization program, large-scale measles outbreaks occurred on a two to three year cycle, usually in the winter and spring. Smaller outbreaks occurred during the off-years. Babies up to about eight months of age are usually protected from contracting measles, due to antibodies they receive from their mothers in the uterus. Once someone has had measles, he or she can never get it again.
Causes & Symptoms
Measles is caused by a type of virus called a paramyxovirus. It is an extremely contagious infection, spread through the tiny droplets that may spray into the air when a person carrying the virus sneezes or coughs. About 85% of those people exposed to the virus will become infected with it. About 95% of those people infected with the virus will develop the illness. Once someone is infected with the virus, it takes about seven to 18 days before he or she actually becomes ill. The most contagious time period is the three to five days before symptoms begin through about four days after the characteristic measles rash has begun to appear.
The first signs of measles infection are fever, extremely runny nose, red, runny eyes, and a cough. A few days later, a rash appears in the mouth, particularly on the mucous membrane that lines the insides of the cheek. This rash consists of tiny white dots (like grains of salt or sand) on a reddish bump. These are called Koplik's spots, and are unique to measles infection. The throat becomes red, swollen, and sore.
A couple of days after the appearance of the Koplik's spots, the measles rash begins. It appears in a characteristic progression, from the head, face, and neck, to the trunk, then abdomen, and next out along the arms and legs. The rash starts out as flat, red patches, but eventually develops some bumps. The rash may be somewhat itchy. When the rash begins to appear, the fever usually climbs higher, sometimes reaching as high as 105°F (40.5°C). There may be nausea, vomiting, diarrhea, and multiple swollen lymph nodes. The cough is usually more problematic at this point, and the patient feels awful. The rash usually lasts about five days. As it fades, it turns a brownish color, and eventually the affected skin becomes dry and flaky.
Many patients (about 5–15%) develop other complications. Bacterial infections, such as ear infections, sinus infections, and pneumonia are common, especially in children. Other viral infections may also strike the patient, including croup, bronchitis, laryngitis, or viral pneumonia. Inflammation of the liver, appendix, intestine, or lymph nodes within the abdomen may cause other complications. Rarely, inflammation of the heart or kidneys, a drop in platelet count (causing episodes of difficult-to-control bleeding), or reactivation of an old tuberculosis infection can occur.
An extremely serious complication of measles infection is the inflammation and subsequent swelling of the brain. Called encephalitis, this can occur up to several weeks after the basic measles symptoms have resolved. About one out of every 1,000 patients develops this complication, and about 10–15% of these patients die. Symptoms include fever, headache, sleepiness, seizures, and coma. Long-term problems following recovery from measles encephalitis may include seizures and mental retardation.
A very rare complication of measles can occur up to 10 years or more following the initial infection. Called subacute sclerosing panencephalitis, this is a slowly progressing, smoldering, swelling, and destruction of the entire brain. It is most common among people who had measles infection prior to the age of two years. Symptoms include changes in personality, decreased intelligence with accompanying school problems, decreased coordination, and involuntary jerks and movements of the body. As the disease progresses, the patient becomes increasingly dependent, ultimately becoming bedridden and unaware of his or her surroundings. Blindness may develop, and the temperature may spike (rise rapidly) and fall unpredictably as the brain structures responsible for temperature regulation are affected. Death is inevitable.
Measles during pregnancy is a serious disease, leading to increased risk of a miscarriage or stillbirth. In addition, the mother's illness may progress to pneumonia.
Diagnosis
Measles is almost always diagnosed based on its characteristic symptoms, including Koplik's spots, and a rash that spreads from central body structures out towards the arms and legs. If there is any doubt as to the diagnosis, then a specimen of body fluids (mucus or urine) can be collected and combined with fluorescent-tagged measles virus antibodies. Antibodies are produced by the body's immune cells that can recognize and bind to markers (antigens) on the outside of specific organisms, in this case the measles virus. Once the fluorescent antibodies have attached themselves to the measles antigens in the specimen, the specimen can be viewed under a special microscope to verify the presence of the measles virus.
Treatment
There are a variety of general measures that can be taken to treat measles and help the patient feel more comfortable. These include: * humidifying the air to ease cough * drinking plenty of fluids to prevent dehydration * keeping the room lights dim to relieve sensitivity to light * getting plenty of rest * eating nutritious and easily digestible food * Allopathic Treatment * There are no medications available to cure measles. Treatment is primarily aimed at helping the patient to be as comfortable as possible, and watching carefully so that antibiotics can be started promptly if a bacterial infection develops. Fever and discomfort can be treated with acetaminophen (Tylenol) or ibuprofen (Advil, Motrin, Nuprin). Children with measles should never be given aspirin, as this increases the risk of the fatal disease Reye's syndrome. * Prevention * Measles is a highly preventable infection. A very effective vaccine exists, made of live measles viruses that have been treated so they cannot cause infection. The important markers on the viruses are intact and cause the immune system to produce antibodies. In the event of a future infection with measles virus the antibodies will quickly recognize the organism and eliminate it. Measles vaccines are usually given at about 15 months of age. Prior to that age, the baby's immune system is not mature enough to initiate a reaction strong enough to ensure long-term protection from the virus. A repeat injection should be given at about 10 or 11 years of age. Outbreaks on college campuses have occurred among nonimmunized or incorrectly immunized students. * Measles vaccine should not be given to a pregnant woman, however, in spite of the seriousness of gestational measles. The reason for not giving this particular vaccine during pregnancy is the risk of transmitting measles to the unborn child.
CHICKEN POX
You haven't been feeling so great for the last few days, and you've had a runny nose and a cough. Then one morning you wake up and stumble into the bathroom. You look in the mirror with blurry eyes and — yikes! You have chickenpox!
What Is Chickenpox?
Chickenpox is caused by a virus called varicella zostervaricella zoster. People who get the virus often develop a rash of spots that look like blisters all over their bodies. The blisters are small and sit on an area of red skin that can be anywhere from the size of a pencil eraser to the size of a dime.
You've probably heard that chickenpox are itchy. It's true. The illness also may come along with a runny nose and cough. But the good news is that chickenpox is a common illness for kids and most people get better by just resting like you do with a cold or the flu. And the really good news is that, thanks to the chickenpox vaccinevaccine, lots of kids don't get chickenpox at all. Kids who do get it, if they got the shot, often get less severe cases, which means they get better quicker.
What Happens When You Have Chickenpox?
Chickenpox may start out seeming like a cold: You might have a runny or stuffy nose, sneezing, and a cough. But 1 to 2 days later, the rash begins, often in bunches of spots on the chest and face. From there it can spread out quickly over the entire body — sometimes the rash is even in a person's ears and mouth. The number of pox is different for everyone. Some people get just a few bumps; others are covered from head to toe.
At first, the rash looks like pinkish dots that quickly develop a small blister on top (a blister is a bump on your skin that fills up with fluid). After about 24 to 48 hours, the fluid in the blisters gets cloudy and the blisters begin to crust over.
Chickenpox blisters show up in waves, so after some begin to crust over, a new group of spots may appear. New chickenpox usually stop appearing by the seventh day, though they may stop as early as the third day. It usually takes 10–14 days for all the blisters to be scabbed over and then you are no longer contagious.
Besides the rash, someone with chickenpox might also have a stomachache, a fever, and may just not feel well.
How Does Chickenpox Spread?
Chickenpox is contagiouscontagious, meaning that someone who has it can easily spread it to someone else. Someone who has chickenpox is most contagious during the first 2 to 5 days that he or she is sick. That's usually about 1 to 2 days before the rash shows up. So you could be spreading around chickenpox without even knowing it!
A person who has chickenpox can pass it to someone else by coughing or sneezing. When he or she coughs, sneezes, laughs, and even talks, tiny drops come out of the mouth and nose. These drops are full of the chickenpox virus. It's easy for someone else to breathe in these drops or get them on his or her hands. Before you know it, the chickenpox virus has infected someone new.
Itchy Itchy, Scratchy Scratchy
If you are that unlucky person, how do you keep your chickenpox from driving you crazy? They itch, but you're not supposed to scratch them.
These tips can help you feel less itchy: * Keep cool because heat and sweat will make you itch more. You might want to put a cool, wet washcloth on the really bad areas. * Trim your fingernails, so if you do scratch, they won't tear your skin. * Soak in a lukewarm bath. Adding some oatmealoatmeal to your bath water can help relieve the itching. * Have your mom or dad help you apply calamine lotion, which soothes itching.
Don't Scratch
Scratching the blisters can tear your skin and leave scars. Scratching can also let germs in, and the blisters could get infected. If your fever goes higher and an area of your skin gets really red, warm, and painful, tell an adult right away. You'll need to see a doctor because you could have a skin infection.
While you have the chickenpox, a pain reliever like acetaminophenacetaminophen might help you feel better, but let your parents help you with this. Do not take aspirin because it can cause a rare but serious illness in kids called Reye syndromeReye syndrome. Medicines and creams that may stop the itch can also be helpful.
It doesn't usually happen, but let your parents know if you feel especially bad. Sometimes, chickenpox leads to other, more serious illnesses.
Usually, you won't have any major problems and you'll get better in a week or two. And when all the blisters have scabs, you're not contagious anymore and you can go back to school! In a few days, the scabs will fall off. And once you've had chickenpox, it's unlikely you'll ever get it again.
Get a Shot, Avoid the Dots!
Not long ago, 3 million people got chickenpox each year in the United States. But now that kids receive the shot, fewer and fewer people get chickenpox. Have you had the chickenpox vaccine? You might not remember because it's often given at age 1. But you can get it when you're older, too. Ask your mom or dad if you've had yours. You'll be glad that you did if chickenpox starts making its way around your school!
Chicken pox
Chickenpox is one of the classic childhood diseases. A child or adult with chickenpox may develop hundreds of itchy, fluid-filled blisters that burst and form crusts. Chickenpox is caused by a virus.
The virus that causes chickenpox is varicella-zoster, a member of the herpesvirus family. The same virus also causes herpes zoster (shingles) in adults.
Causes

In a typical scenario, a young child is covered in pox and out of school for a week. The first half of the week the child feels miserable from intense itching; the second half from boredom. Since the introduction of the chickenpox vaccine, classic chickenpox is much less common.
Chickenpox can be spread very easily to others. You may get chickenpox from touching the fluids from a checkenpox blister, or if someone with chickenpox coughs or sneezes near you. The vaccine usually prevents the chickenpox disease completely or makes the illness very mild. Even those with mild illness may be contagious.
When someone becomes infected, the pox usually appear 10 to 21 days later. People become contagious 1 to 2 days before breaking out with pox. They remain contagious while uncrusted blisters are present.
Most cases of chickenpox occur in children younger than 10. The disease is usually mild, although serious complications sometimes occur. Adults and older children usually get sicker than younger children do.
Children whose mothers have had chickenpox or have received the chickenpox vaccine are not very likely to catch it before they are 1 year old. If they do catch chickenpox, they often have mild cases. This is because antibodies from their mothers' blood help protect them. Children under 1 year old whose mothers have not had chickenpox or the vaccine can get severe chickenpox.
Severe chickenpox symptoms are more common in children whose immune system does not work well. This may be caused by an illness or medicines such as chemotherapy and steroids. symptoms Most children with chickenpox act sick, with symptoms such as a fever, headache, tummy ache, or loss of appetite for a day or two before breaking out in the classic pox rash. These symptoms last 2 to 4 days after breaking out.
The average child develops 250 to 500 small, itchy, fluid-filled blisters over red spots on the skin. * The blisters often appear first on the face, trunk, or scalp and spread from there. Appearance of the small blisters on the scalp usually confirms the diagnosis. * After a day or two, the blisters become cloudy and then scab. Meanwhile, new crops of blisters spring up in groups. The pox often appear in the mouth, in the vagina, and on the eyelids. * Children with skin problems such as eczema may get more than 1,500 pox.
Most pox will not leave scars unless they become infected with bacteria from scratching.
Some children who have had the vaccine will still develop a mild case of chickenpox. They usually recover much more quickly and have only a few pox (less than 30). These cases are often harder to diagnose. However, these children can still spread chieckenpox to others.
Exams and Tests
Chickenpox is usually diagnosed from the classic rash and the child's medical history. Blood tests, and tests of the pox blisters themselves, can confirm the diagnosis if there is any question.
Treatment
In most cases, it is enough to keep children comfortable while their own bodies fight the illness. Oatmeal baths in lukewarm water provide a crusty, comforting coating on the skin. An oral antihistamine can help to ease the itching, as can topical lotions. Trim the fingernails short to reduce secondary infections and scarring.
Safe antiviral medicines have been developed. To work well, they usually must be started within the first 24 hours of the rash. * For most otherwise healthy children without severe symptoms, antiviral medications are usually not used. Adults and teens, who are at risk for more severe symptoms, may benefit if the case is seen early in its course. * For those with skin conditions (such as eczema or recent sunburn), lung conditions (such as asthma), or those who have recently taken steroids, the antiviral medicines may be very important. The same is also true for adolescents and children who must take aspirin on an ongoing basis. * Some doctors also give antiviral medicines to people in the same household who subsequently come down with chickenpox. Because of their increased exposure, they would normally experience a more severe case of chickenpox.
DO NOT GIVE ASPIRIN to someone who may have chickenpox. Use of aspirin has been associated with a serious condition called Reyes Syndrome. Ibuprofen has been associated with more severe secondary infections. Acetaminophen may be used.
Until all chickenpox sores have crusted over or dried out, avoid playing with other children, going back to school, or returning to work.
Possible Complications * Women who get chickenpox during pregnancy are at risk for congenital infection of the fetus. * Newborns are at risk for severe infection, if they are exposed and their mothers are not immune. * A secondary infection of the blisters may occur. * Encephalitis is a serious, but rare complication. * Reye's syndrome, pneumonia, myocarditis, and transient arthritis are other possible complications of chickenpox. * Cerebellar ataxia may appear during the recovery phase or later. This is characterized by a very unsteady walk.
When to Contact a Medical Professional
Call your health care provider if you think that your child has chickenpox or if your child is over 12 months of age and has not been vaccinated against chickenpox.
Prevention
Because chickenpox is airborne and very contagious before the rash even appears, it is difficult to avoid. It is possible to catch chickenpox from someone on a different aisle in the supermarket, who does not even know they have chickenpox!
A chickenpox vaccine is part of the routine immunization schedule. * Children receive two doses of the traditional chickenpox vaccine. The first should be given when the child is 12 - 15 months old. Children should receive the second dose when they are 4 - 6 years old. * People ages 13 and older who have not received the vaccine and have not had chickenpox should get two doses, 4 - 8 weeks apart.
Almost no one will develop moderate or severe chickenpox if they have received the chickenpox vaccine. The small number of children who do develop chickenpox after they have received the vaccine have only a mild case.
The chickenpox vaccine does not require a booster later in life. However, a similar but different vaccine given later in life may reduce the incidence of herpes zoster (shingles).
Talk to your doctor if you think your child might be at high risk for complications and might have been exposed. Immediate preventive measures may be important. Giving the vaccine early after exposure may still reduce the severity of the disease.
What is Tetanus?
Tetanus is a serious life-threatening condition that affects the brain and the entire nervous system caused by a toxin of a common bacterium, Clostridium tetani. The spores of this bacterium are practically not found in virgin soil but frequently present in cultivated soil. It is also found in the human colon, house dust, animal feces, warehouses, contaminated heroin, and even in operating rooms. Indeed, they may be found anywhere. Once the spores penetrate the wounded skin, they germinate and produce a toxin (tetanospasmin) that invades the blood stream causing the illness.
Why is it called Lockjaw?
Tetanospasmin, next to botulism toxin, is one of the most potent microbial poisons. Once the spores are in the blood stream, they move inward toward the spinal cord at a speed of about 0.416 inch an hour, or about ten inches a day. After a week to 3 weeks, they start to cause short-circuiting of the nerve signals and block the ability of the muscles to relax. As a result, sustained muscle contractions develop, including lockjaw. The spasms of the facial muscles spread to the neck (causing nuchal rigidity, meaning stiffness of the neck), the hands, arms and legs, and also to the back, leading to severe (often fatal) breathing distress. Somehow, the spasms are initiated and aggravated by noise or touch.
How deadly is tetanus?
The mortality rate of tetanus is about 40% after it has spread, even in state-of-the-art medical centers. Each year, about one million infants die of tetanus because of poor hygiene. After the U.S. immunization laws were legislated in the 1970s, the reported cases of tetanus dramatically dropped to about 50 cases annually (75% of these are adults who have never had immunization).
How does tetanus spores enter our body?
The tetanus spores enter our system thru animal bites, burns, ulcers, infected umbilical cords, contaminated surgical wounds, needle injection sites, and thru the commonly blamed “rusty nail.” Wounds resulting from any dirty item which has been in contact with soil or animal dung are suspect. The incubation period (time span from exposure to appearance of symptoms) averages two weeks, although in some cases lasting to several months.
What are the signs and symptoms?
The initial presentation may include headache and depression, malaise and fever, followed by swallowing discomfort and difficulty opening the jaws. Then, the neck becomes stiff and the cheek muscles go into spasm, giving the face a sardonic grin (risus sardonicus). Irritability soon develops and the spasms involve the entire body, leading to painful involuntary contraction of all muscles. There will be restlessness, anorexia and uncontrolled drooling of saliva. In a few cases, tetanus develops even without a previous history of a cut or a wound.
Can one get tetanus from a minor skin prick?
If the person is not immunized, yes, even from pricking a finger on a rose thorn, or a tiny needle stick. A study from Great Britain reported that about 33% of tetanus cases in that country resulted from a very trivial injury the patients had not even noticed or remembered. This is why immunization is very important in preventing this fatal disease.
How deadly is tetanus toxin?
The tetanus toxin is deadly poisonous (second only to botulism toxin). One tenth of a milligram of tetanospasmin is the fatal dose for an adult. Once this toxin reaches the nervous system, it can no longer be neutralized by antibodies produced by immunization or even by antitoxin. Prognosis in these cases is almost always fatal. Again, prevention is the key.
What vaccine is available to prevent tetanus?
DTaP immunization (used to be known as DPT) incorporates vaccines for the prevention of Diptheria (severe throat infection), Pertusis (whooping cough) and Tetanus. This is given when the infant is 2 months old, 4 months and six months, a set of 3 shots. A fourth injection is given when the child is 12-18 months old, a fifth shot at age 4 to 6, and a booster Tetanus-Diptheria (Td) at age 11 to 12 years old. Among adults, vaccination with Td is recommended every ten years. Adults who never had any immunization for tetanus will require a series of 3 injections of Td vaccine.
Can there be allergy to the vaccine?
Yes, it is possible for a person to be allergic to DTap or any other vaccines, or to any drug, for that matter. Your physician will guide you accordingly after a good history-taking and a thorough physical examination. The valuable benefits from immunization of any type is certainly worth the little risk getting it might entail. In general, available vaccines today are very safe.
How is the tetanus patient managed?
The main objective of the treatment is to tide the patient over the stage of the ailment preventing any deadly complications from occurring. The problems include asphyxia (suffocation) during spasm, exhaustion from generalized involuntary body spasms, pneumonia resulting from stomach contents backing up and into the lungs, and demise as a consequence of disorders of the control of vital brain functions like blood pressure, heart rhythm, and breathing. Penicillin and anti-toxin are given, plus a lot of supportive care.
Does the patient have to be on a ventilator?
Not all, but some cases may require a tracheostomy (a finger-size metal tube inserted thru the neck to the breathing pipe to allow patients to breathe better) and this tube is connected to a respirator, which will take over the breathing for the patient until he is able to breathe well on his/her own. The milder cases may respond to simple sedation and a quiet room to prevent spasms and not need a tracheostomy and/or a respirator.
Is it not too late to be immunized?
Unless one already has been infected with a full blown tetanus, it is never too late to have prophylactic (preventive) immunization. The procedure is simple and most effective, and it behooves everyone to acquire this protection from a horrible and deadly disease, a fatal illness that is preventable. For a more specific and personal advice, tailored to your individual situation and need, consult your physician. Your appropriate and prompt attention may save your life.
DIPTHERIA
An acute infectious disease caused by Corynebacterium diphtheriae, and characterized by the production of a systemic toxin and the formation of a false membrane on the lining of the mucous membrane of the throat and other respiratory passages, causing difficulty in breathing, high fever, and weakness. The toxin is particularly harmful to the tissues of the heart and central nervous system.

Shick test-(Medicine) Med a skin test to determine immunity to diphtheria: a dilute diphtheria toxin is injected into the skin; within two or three days a red inflamed area will develop if no antibodies are present
About Diphtheria
Diphtheria is a bacterial infection that spreads easily and occurs quickly. It mainly affects the nose and throat. Children under 5 and adults over 60 years old are particularly at risk for contracting the infection. People living in crowded or unclean conditions, those who aren't well nourished, and children and adults who don't have up-to-date immunizations are also at risk.
Diphtheria is rare in the United States and Europe, where health officials have been immunizing children against it for decades. However, it's still common in developing countries where immunizations aren't given routinely. In 1993 and 1994, more than 50,000 cases were reported during a serious outbreak of diphtheria in countries of the former Soviet Union.
Signs and Symptoms
In its early stages, diphtheria can be mistaken for a bad sore throat. A low-grade fever and swollen neck glands are the other early symptoms.
The toxin, or poison, caused by the bacteria can lead to a thick coating in the nose, throat, or airway. This coating is usually fuzzy gray or black and can cause breathing problems and difficulty in swallowing. The formation of this coating (or membrane) in the nose, throat, or airway makes a diphtheria infection different from other more common infections (such as strep throat) that cause sore throat.
As the infection progresses, the person may: * have difficulty breathing or swallowing * complain of double vision * have slurred speech * even show signs of going into shock (skin that's pale and cold, rapid heartbeat, sweating, and an anxious appearance)
In cases that progress beyond a throat infection, diphtheria toxin spreads through the bloodstream and can lead to potentially life-threatening complications that affect other organs of the body, such as the heart and kidneys. The toxin can cause damage to the heart that affects its ability to pump blood or the kidneys' ability to clear wastes. It can also cause nerve damage, eventually leading to paralysis. Up to 40% to 50% of those who don't get treated can die.
Prevention
Preventing diphtheria depends almost completely on immunizing children with the diphtheria/tetanus/pertussis (DTP or DTaP) vaccine and non-immunized adults with the diphtheria/tetanus vaccine (DT). Most cases of diphtheria occur in people who haven't received the vaccine at all or haven't received the entire course.
The immunization schedule calls for: * DTaP vaccines at 2, 4, and 6 months of age * booster dose given at 12 to 18 months * booster dose given again at 4 to 6 years * booster shots given every 10 years after that to maintain protection
Although most children tolerate it well, the vaccine sometimes causes mild side effects such as redness or tenderness at the injection site, a low-grade fever, or general fussiness or crankiness. Severe complications, such as an allergic reaction, are rare.
Contagiousness
Diphtheria is highly contagious. It's easily passed from the infected person to others through sneezing, coughing, or even laughing. It can also be spread to others who pick up tissues or drinking glasses that have been used by the infected person.
People who have been infected by the diphtheria bacteria can infect others for up to 4 weeks, even if they don't have any symptoms. The incubation period (the time it takes for a person to become infected after being exposed) for diphtheria is 2 to 4 days, although it can range from 1 to 6 days.
Treatment
Children and adults with diphtheria are treated in a hospital. After a doctor confirms the diagnosis through a throat culture, the infected person receives a special anti-toxin, given through injections or through an IV, to neutralize the diphtheria toxin already circulating in the body, as well as antibiotics to kill the remaining diphtheria bacteria.
If the infection is advanced, people with diphtheria may need a ventilator to help them breathe. In cases in which the toxins may have spread to the heart, kidneys, or central nervous system, patients may need intravenous fluids, oxygen, or heart medications.
A person with diphtheria must also be isolated. Family members (as well as others who spend a lot of time with the person with diphtheria) who haven't been immunized, or who are very young or elderly, must be protected from contact with the patient.
When someone is diagnosed with diphtheria, the doctor will notify the local health department and will take steps to treat everyone in the household who may have been exposed to the bacteria. This will include assessment of immune status, throat cultures, and booster doses of the diphtheria vaccine. They will also receive antibiotics as a precaution.
Immediate hospitalization and early intervention allow most patients to recover from diphtheria. After the antibiotics and anti-toxin have taken effect, someone with diphtheria will need bed rest for a while (4 to 6 weeks, or until full recovery). Bed rest is particularly important if the person's heart has been affected by the disease. Myocarditis, or inflammation of the heart muscle, can be a complication of diphtheria.
Those who have recovered should still receive a full course of the diphtheria vaccine to prevent a recurrence because contracting the disease doesn't guarantee lifetime immunity.
When to Call the Doctor
Call your doctor immediately if you or your child has symptoms of diphtheria, if you observe symptoms in someone else, if anyone in your family is exposed to diphtheria, or if you think that you or a family member is at risk. It's important to remember, though, that most throat infections are not diphtheria, especially in countries that have routine immunizations against it.
If you're not sure if your child has been vaccinated against diphtheria, make an appointment. Also make sure your own booster immunizations are current. International studies have shown that a significant percentage of adults over 40 years of age aren't adequately protected against diphtheria and tetanus.
Scarlet fever is a disease caused by infection with the group A Streptococcus bacteria (the same bacteria that causes strep throat).
Causes
Scarlet fever was once a very serious childhood disease, but now is easily treatable. It is caused by the streptococcal bacteria, which produce a toxin that leads to the hallmark red rash of the illness.
The main risk factor is infection with the bacteria that causes strep throat. A history of strep throat or scarlet fever in the community, neighborhood, or school may increase the risk of infection.
Symptoms
The time between becoming infected and having symptoms is short, generally 1 - 2 days. The illness typically begins with a fever and sore throat.
The rash usually first appears on the neck and chest, then spreads over the body. It is described as "sandpapery" in feel. The texture of the rash is more important than the appearance in confirming the diagnosis. The rash can last for more than a week. As the rash fades, peeling (desquamation) may occur around the fingertips, toes, and groin area.
Other symptoms include: * Abdominal pain * Bright red color in the creases of the underarm and groin (Pastia's lines) * Chills * Fever * General discomfort (malaise) * Headache * Muscle aches * Sore throat * Swollen, red tongue (strawberry tongue) * Vomiting
Exams and Tests * Physical examination * Throat culture positive for Group A Strep * Rapid antigen detection (throat swab)
Treatment
Antibiotics are used to kill the bacteria that causes the throat infection. This is crucial to prevent rheumatic fever, a serious complication of strep throat and scarlet fever.
Outlook (Prognosis)
With proper antibiotic treatment, the symptoms of scarlet fever should get better quickly. However, the rash can last for up to 2 - 3 weeks before it fully goes away.
Possible Complications
Complications are rare with the right treatment, but can include: * Acute rheumatic fever * Bone or joint problems (osteomyelitis or arthritis) * Ear infection (otitis media) * Inflammation of a gland (adenitis) or abscess * Kidney damage (glomerulonephritis) * Liver damage (hepatitis) * Meningitis * Pneumonia * Sinusitis
When to Contact a Medical Professional
Call your health care provider if: * You develop symptoms of scarlet fever * Your symptoms do not go away 24 hours after beginning antibiotic treatment * You develop new symptoms
Prevention
Bacteria are spread by direct contact with infected people, or by droplets exhaled by an infected person. Avoid contact with infected people.
About Scarlet Fever
Scarlet fever is caused by an infection with group A streptococcus bacteria. The bacteria make a toxin (poison) that can cause the scarlet-colored rash from which this illness gets its name.
Not all streptococci bacteria make this toxin and not all kids are sensitive to it. Two kids in the same family may both have strep infections, but one child (who is sensitive to the toxin) may develop the rash of scarlet fever while the other may not. Usually, if a child has this scarlet rash and other symptoms of strep throat, it can be treated with antibiotics. So if your child has these symptoms, it's important to call your doctor.
Symptoms of Scarlet Fever
The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps and it may itch. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks. Areas of rash usually turn white when you press on them. By the sixth day of the infection the rash usually fades, but the affected skin may begin to peel.
Aside from the rash, there are usually other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever above 101° Fahrenheit (38.3° Celsius), and swollen glands in the neck. The tonsils and back of the throat may be covered with a whitish coating, or appear red, swollen, and dotted with whitish or yellowish specks of pus. Early in the infection, the tongue may have a whitish or yellowish coating. A child with scarlet fever also may have chills, body aches, nausea, vomiting, and loss of appetite.
When scarlet fever occurs because of a throat infection, the fever typically stops within 3 to 5 days, and the sore throat passes soon afterward. The scarlet fever rash usually fades on the sixth day after sore throat symptoms began, but skin that was covered by rash may begin to peel. This peeling may last 10 days. With antibiotic treatment, the infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.
In rare cases, scarlet fever may develop from a streptococcal skin infection like impetigo. In these cases, the child may not get a sore throat.
Preventing Scarlet Fever
The bacterial infection that causes scarlet fever is contagious. A child who has scarlet fever can spread the bacteria to others through nasal and throat fluids by sneezing and coughing. If a child has a skin infection caused by strep bacteria, like impetigo, it can be passed through contact with the skin.
In everyday life, there is no perfect way to avoid the infections that cause scarlet fever. When a child is sick at home, it's always safest to keep that child's drinking glasses and eating utensils separate from those of other family members, and to wash these items thoroughly in hot soapy water. Wash your own hands frequently as you care for a child with a strep infection.
Treating Scarlet Fever
If your child has a rash and the doctor suspects scarlet fever, he or she will usually take a throat culture (a painless swab of throat secretions) to see if the bacteria grow in the laboratory. Once a strep infection is confirmed, the doctor will likely prescribe an antibiotic for your child to be taken for about 10 days.
Caring for a Child With Scarlet Fever
A child with severe strep throat may find that eating is painful, so providing soft foods or a liquid diet may be necessary. Include soothing teas and warm nutritious soups, or cool soft drinks, milkshakes, and ice cream. Make sure that the child drinks plenty of fluids.
Use a cool-mist humidifier to add moisture to the air, since this will help soothe the sore throat. A moist warm towel may help to soothe swollen glands around your child's neck.
If the rash itches, make sure that your child's fingernails are trimmed short so skin isn't damaged through scratching.
When to Call the Doctor
Call the doctor whenever your child suddenly develops a rash, especially if it is accompanied by a fever, sore throat, or swollen glands. This is especially important if your child has any of the symptoms of strep throat, or if someone in your family
Scarlet fever, or scarlatina, is an illness that brings on a rash covering most of the body, a strawberry-like appearance of the tongue and usually a high fever. The most common source of scarlet fever is one form of a common bacterial infection known as strep throat. Scarlet fever is almost always accompanied by a sore throat and other signs and symptoms of a typical strep throat infection.
Scarlet fever is most common in children 5 to 15 years of age. Although scarlet fever was once considered a serious childhood illness, antibiotic treatments have made it less threatening.
Nonetheless, if left untreated, scarlet fever (like strep throat) can result in more serious conditions that affect the heart, kidneys and other parts of the body.
Symptoms
If your child has scarlet fever, he or she may experience these common signs and symptoms: * Red rash that looks like a sunburn and feels like sandpaper * Red lines (Pastia's lines) in folds of skin around the groin, armpits, elbows, knees and neck * Strawberry-like red and bumpy appearance of the tongue, often covered with a white coating early in the disease * Flushed face with paleness around the mouth * Fever of 101 F (38.3 C) or higher, often with chills * Very sore and red throat, sometimes with white or yellowish patches * Difficulty swallowing * Enlarged glands in the neck (lymph nodes) that are tender to the touch * Nausea or vomiting * Headache
The sore throat, enlarged lymph nodes and fever are likely to appear first, while the "scarlet" signs and symptoms of scarlet fever usually appear on the second day of illness. If your child has scarlet fever, the rash and flushing will likely begin on his or her face or neck, later spreading to the chest, trunk, arms and legs. The rash won't appear on the palms of the hands or soles of the feet.
The rash and the redness in the face and tongue usually last about a week. After these signs and symptoms have subsided, the skin affected by the rash often peels.
When to see a doctor
Talk to your doctor if your child has any one of the following signs or symptoms: * A sore throat with a fever * A fever of 102 F (38.9 C) or higher — 100.4 F (38 C) rectal temperature for infants younger than 3 months of age * A sore throat that doesn't get better within 24 to 48 hours * A sore throat with swollen or tender glands in the neck * A rash * Difficulty swallowing or opening his or her mouth all the way
Causes
By Mayo Clinic staff
A bacterium called Streptococcus pyogenes, or group A beta-hemolytic streptococcus, causes scarlet fever. This is the same bacterial infection that causes strep throat, but the strain of bacteria causing scarlet fever releases toxins that produce the rash, Pastia's lines, flushed face and red tongue.
How the infection spreads
Strep bacteria that cause scarlet fever spread from one person to another by fluids from the mouth and nose. If an infected person coughs or sneezes, the bacteria can become airborne, or the bacteria may be present on things the person touches — a drinking glass or a doorknob. If you're near an infected person, you may inhale airborne bacteria. If you touch something an infected person has touched and then touch your own nose or mouth, you could pick up the bacteria.
The incubation period — the time between exposure and illness — is usually two to four days. If scarlet fever isn't treated, a person may be contagious for a few weeks even after the illness itself has passed. And someone may carry scarlet fever strep bacteria without being sick. Therefore, it's difficult to know if you've been exposed.
Scarlet fever strep bacteria can also contaminate food, especially milk, but this mode of transmission isn't as common.
Rare causes of scarlet fever
Rare causes of scarlet fever are other strains of Streptococcus pyogenes associated with either a skin infection (impetigo) or a uterine infection contracted during childbirth. These cases result in the characteristic fever, rash and other "scarlet" signs and symptoms but not those associated with a throat infection.
Risk factors
By Mayo Clinic staff
Children 5 to 15 years of age are more likely than are other people to get scarlet fever.
Scarlet fever strep bacteria spread more easily among people in close contact. If a child carries the bacteria, the disease can spread easily among family members or schoolmates.
Complications
By Mayo Clinic staff
Scarlet fever rarely results in serious complications, particularly if promptly and appropriately treated with antibiotics. But post-scarlet fever disorders may occur. These include: * Rheumatic fever. Rheumatic fever is an inflammatory disease that can affect the heart, joints, skin and nervous system. Long-term effects may include damage to heart valves; other heart disorders; and a syndrome called Sydenham's chorea, which causes emotional instability, muscle weakness and jerky movements of the hands, feet and face. Appropriate treatment of strep bacteria infection greatly reduces the risk of rheumatic fever. * Poststreptococcal glomerulonephritis. Poststreptococcal glomerulonephritis is inflammation of the kidneys that results from certain byproducts of strep bacteria infection. This disorder may cause long-term kidney disease. * Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Research suggests that strep bacteria infection may cause an autoimmune response that worsens symptoms in children with certain disorders including obsessive-compulsive disorder, Tourette syndrome and attention-deficit/hyperactivity disorder (ADHD). The increased severity of symptoms usually is temporary, lasting from weeks to months before symptoms improve again.
Other complications
Other complications that may result from untreated scarlet fever include: * Bacterial infection of the blood (bacteremia) * Ear infection (otitis media) * Inflammation of the membranes and fluid that surround the brain and spinal cord (meningitis) * Infection of the bone behind the ear (mastoiditis) * Infection of the heart's inner lining (endocarditis) * Pneumonia * Inflammation of mucous membranes and buildup of fluids in the sinuses (sinusitis) * Arthritis * Pus-filled sac (abscess) in the throat * Skin infections
Preparing for your appointment
By Mayo Clinic staff
You're likely to start by first seeing your family doctor or your child's pediatrician. However, when you call to set up your appointment, you may be urged to seek immediate medical care if your child is experiencing any of the following: * High fever * Severe sore throat or difficulty swallowing * Intense abdominal pain or vomiting * Severe headache
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready.
What you can do * Write down any symptoms your child has been experiencing, and for how long. * Make a list of your child's key medical information, including other conditions he or she is being treated for and any medications your child is taking. * Write down questions to ask your doctor.
The list below suggests questions to raise with your doctor about scarlet fever. Don't hesitate to ask more questions during your appointment at any time that you don't understand something. * Does my child have scarlet fever? * Are there any other possible causes for my child's symptoms? * What kinds of tests does my child need? * What treatment do you recommend? * How soon after my child begins treatment will he or she begin to feel better? * Is my child at risk of any long-term complications related to scarlet fever? * Is there anything I can do to help soothe my child's skin while it heals? * When can my child return to school? * Is my child contagious? How can I reduce my child's risk of passing the illness to others? * Is there a generic alternative to the medicine you're prescribing?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask: * What are your child's symptoms? * When did your child first begin experiencing symptoms? * Has your child had a sore throat or difficulty swallowing? * Has your child had a fever? How high was the fever, and how long did it last? * Has your child had abdominal pain or vomiting? * Has your child been eating adequately? * Has your child complained of headache? * Has your child recently had a strep infection? * Has your child recently been exposed to anyone with a strep infection? * Has your child been diagnosed with any other medical conditions, including mental health disorders? * Is your child currently taking any medications?
What you can do in the meantime
While you wait for your appointment, you may be able to ease your child's discomfort with over-the-counter pain relievers such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others). Don't give aspirin to your child without first consulting your child's doctor. Drinking fluids, gargling salt water and using a humidifier may improve your child's throat pain. Children older than age 4 can suck on throat lozenges.
Tests and diagnosis
By Mayo Clinic staff
Your doctor will conduct an exam to determine the cause of your child's sore throat, rash and other symptoms. He or she will: * Look at the condition of your child's throat, tonsils and tongue * Feel your child's neck to determine if lymph nodes are enlarged * Assess the appearance and texture of the rash
If your doctor suspects strep as the cause of your child's illness, he or she will also swab the back of your child's throat to collect material that may harbor strep bacteria. Tests for the strep bacterium are important because a number of conditions can cause the signs and symptoms of scarlet fever, and these illnesses may require different treatments. If there are no strep bacteria, then some other factor is causing the illness.
Your doctor may order one or more of the following laboratory tests: * Throat culture. The sample from your child's throat is examined in a laboratory test in which the bacteria can thrive. Although this is a very reliable test, the results may take as long as two days. * Rapid antigen test. Your doctor may also order a rapid antigen test, sometimes called a rapid strep test, which can detect foreign proteins (antigens) associated with strep bacteria infection. This test can be completed during a visit to your doctor's office. This test is less reliable than is a throat culture. If a rapid antigen test is negative, your doctor will probably order the throat culture to ensure an accurate diagnosis. * Rapid DNA test. Your doctor may also be able to order a relatively new rapid test that uses DNA technology to detect strep bacteria from a throat swab in a day or less. These tests are at least as accurate as throat cultures, and the results are available sooner.
Treatments and drugs
If your child has scarlet fever, your doctor will likely prescribe an antibiotic medication. Examples include: * Penicillin, in pill form or by injection * Amoxicillin (Amoxil, Trimox) * Azithromycin (Zithromax) * Clarithromycin (Biaxin) * Clindamycin (Cleocin) * A cephalosporin such as cephalexin (Keflex)
Make sure your child completes the full course of prescribed antibiotics as directed by your doctor, even when your child is feeling better. Failure to follow the treatment guidelines may not completely eradicate the infection and will increase your child's risk of developing post-strep disorders.
If he or she isn't feeling better within 24 to 48 hours after starting the medication, call your doctor.
Your child will no longer be contagious after 24 hours on antibiotics and can return to school when he or she is feeling better and no longer has a fever.
Lifestyle and home remedies
You can take a number of steps to reduce your child's discomfort and pain. * Treat fever and pain. Consult your doctor about using ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) to control the fever and minimize throat pain. You may also put a lukewarm cloth on your child's forehead to cool the fever if he or she doesn't have chills. * Provide adequate fluids. Give your child plenty of water to keep the throat moist and prevent dehydration. * Prepare a saltwater gargle. If your child is able to gargle water, give him or her salty water to gargle and then spit out. This may ease the throat pain. * Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat. * Offer lozenges. Children older than age 4 can suck on lozenges to relieve a sore throat. * Provide comforting foods. Warm liquids such as soup and cold treats like popsicles can soothe a sore throat. * Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.
Lifestyle and home remedies
You can take a number of steps to reduce your child's discomfort and pain. * Treat fever and pain. Consult your doctor about using ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) to control the fever and minimize throat pain. You may also put a lukewarm cloth on your child's forehead to cool the fever if he or she doesn't have chills. * Provide adequate fluids. Give your child plenty of water to keep the throat moist and prevent dehydration. * Prepare a saltwater gargle. If your child is able to gargle water, give him or her salty water to gargle and then spit out. This may ease the throat pain. * Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat. * Offer lozenges. Children older than age 4 can suck on lozenges to relieve a sore throat. * Provide comforting foods. Warm liquids such as soup and cold treats like popsicles can soothe a sore throat. * Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat. * Poliomyelitis, often called polio or infantile paralysis, is an acute viral infectious disease spread from person to person, primarily via the fecal-oral route.[1] The term derives from the Greek poliós (πολιός), meaning "grey", myelós (µυελός), referring to the "spinal cord", and the suffix -itis, which denotes inflammation.[2] Although around 90% of polio infections cause no symptoms at all, affected individuals can exhibit a range of symptoms if the virus enters the blood stream.[3] In about 1% of cases the virus enters the central nervous system, preferentially infecting and destroying motor neurons, leading to muscle weakness and acute flaccid paralysis. Different types of paralysis may occur, depending on the nerves involved. Spinal polio is the most common form, characterized by asymmetric paralysis that most often involves the legs. Bulbar polio leads to weakness of muscles innervated by cranial nerves. Bulbospinal polio is a combination of bulbar and spinal paralysis.[4] * Poliomyelitis was first recognized as a distinct condition by Jakob Heine in 1840.[5] Its causative agent, poliovirus, was identified in 1908 by Karl Landsteiner.[5] Although major polio epidemics were unknown before the late 19th century, polio was one of the most dreaded childhood diseases of the 20th century. Polio epidemics have crippled thousands of people, mostly young children; the disease has caused paralysis and death for much of human history. Polio had existed for thousands of years quietly as an endemic pathogen until the 1880s, when major epidemics began to occur in Europe; soon after, widespread epidemics appeared in the United States.[6] By 1910, much of the world experienced a dramatic increase in polio cases and frequent epidemics became regular events, primarily in cities during the summer months. These epidemics—which left thousands of children and adults paralyzed—provided the impetus for a "Great Race" towards the development of a vaccine. Developed in the 1950s, polio vaccines are credited with reducing the global number of polio cases per year from many hundreds of thousands to around a thousand.[7] Enhanced vaccination efforts led by the World Health Organization, UNICEF and Rotary International could result in global eradication of the disease.[8] * The term poliomyelitis is used to identify the disease caused by any of the three serotypes of poliovirus. Two basic patterns of polio infection are described: a minor illness which does not involve the central nervous system (CNS), sometimes called abortive poliomyelitis, and a major illness involving the CNS, which may be paralytic or non-paralytic.[9] In most people with a normal immune system, a poliovirus infection is asymptomatic. Rarely the infection produces minor symptoms; these may include upper respiratory tract infection (sore throat and fever), gastrointestinal disturbances (nausea, vomiting, abdominal pain, constipation or, rarely, diarrhea), and influenza-like illness.[4] * The virus enters the central nervous system in about 3% of infections. Most patients with CNS involvement develop non-paralytic aseptic meningitis, with symptoms of headache, neck, back, abdominal and extremity pain, fever, vomiting, lethargy and irritability.[2][10] Approximately 1 in 200 to 1 in 1000 cases progress to paralytic disease, in which the muscles become weak, floppy and poorly controlled, and finally completely paralyzed; this condition is known as acute flaccid paralysis.[11] Depending on the site of paralysis, paralytic poliomyelitis is classified as spinal, bulbar, or bulbospinal. Encephalitis, an infection of the brain tissue itself, can occur in rare cases and is usually restricted to infants. It is characterized by confusion, changes in mental status, headaches, fever, and less commonly seizures and spastic paralysis.[12] * Poliomyelitis is caused by infection with a member of the genus Enterovirus known as poliovirus (PV). This group of RNA viruses prefers to inhabit the gastrointestinal tract.[1] PV infects and causes disease in humans alone.[3] Its structure is very simple, composed of a single (+) sense RNA genome enclosed in a protein shell called a capsid.[3] In addition to protecting the virus’s genetic material, the capsid proteins enable poliovirus to infect certain types of cells. Three serotypes of poliovirus have been identified—poliovirus type 1 (PV1), type 2 (PV2), and type 3 (PV3)—each with a slightly different capsid protein.[13] All three are extremely virulent and produce the same disease symptoms.[3] PV1 is the most commonly encountered form, and the one most closely associated with paralysis.[14] * Individuals who are exposed to the virus, either through infection or by immunization with polio vaccine, develop immunity. In immune individuals, IgA antibodies against poliovirus are present in the tonsils and gastrointestinal tract and are able to block virus replication; IgG and IgM antibodies against PV can prevent the spread of the virus to motor neurons of the central nervous system.[15] Infection or vaccination with one serotype of poliovirus does not provide immunity against the other serotypes, and full immunity requires exposure to each serotype.[15] * A rare condition with a similar presentation, nonpoliovirus poliomyelitis, may result from infections with non-poliovirus enteroviruses.[16] * Poliomyelitis is highly contagious and spreads easily by human-to-human contact.[15] In endemic areas, wild polioviruses can infect virtually the entire human population.[17] It is seasonal in temperate climates, with peak transmission occurring in summer and autumn.[15] These seasonal differences are far less pronounced in tropical areas.[17] The time between first exposure and first symptoms, known as the incubation period, is usually 6 to 20 days, with a maximum range of 3 to 35 days.[18] Virus particles are excreted in the feces for several weeks following initial infection.[18] The disease is transmitted primarily via the fecal-oral route, by ingesting contaminated food or water. It is occasionally transmitted via the oral-oral route,[14] a mode especially visible in areas with good sanitation and hygiene.[15] Polio is most infectious between 7–10 days before and 7–10 days after the appearance of symptoms, but transmission is possible as long as the virus remains in the saliva or feces.[14] * Factors that increase the risk of polio infection or affect the severity of the disease include immune deficiency,[19] malnutrition,[20] tonsillectomy,[21] physical activity immediately following the onset of paralysis,[22] skeletal muscle injury due to injection of vaccines or therapeutic agents,[23] and pregnancy.[24] Although the virus can cross the placenta during pregnancy, the fetus does not appear to be affected by either maternal infection or polio vaccination.[25] Maternal antibodies also cross the placenta, providing passive immunity that protects the infant from polio infection during the first few month
PATHOPHYSIOLOGY
Poliovirus enters the body through the mouth, infecting the first cells it comes in contact with—the pharynx (throat) and intestinal mucosa. It gains entry by binding to an immunoglobulin-like receptor, known as the poliovirus receptor or CD155, on the cell membrane.[27] The virus then hijacks the host cell's own machinery, and begins to replicate. Poliovirus divides within gastrointestinal cells for about a week, from where it spreads to the tonsils (specifically the follicular dendritic cells residing within the tonsilar germinal centers), the intestinal lymphoid tissue including the M cells of Peyer's patches, and the deep cervical and mesenteric lymph nodes, where it multiplies abundantly. The virus is subsequently absorbed into the bloodstream.[28]
Known as viremia, the presence of virus in the bloodstream enables it to be widely distributed throughout the body. Poliovirus can survive and multiply within the blood and lymphatics for long periods of time, sometimes as long as 17 weeks.[29] In a small percentage of cases, it can spread and replicate in other sites such as brown fat, the reticuloendothelial tissues, and muscle.[30] This sustained replication causes a major viremia, and leads to the development of minor influenza-like symptoms. Rarely, this may progress and the virus may invade the central nervous system, provoking a local inflammatory response. In most cases this causes a self-limiting inflammation of the meninges, the layers of tissue surrounding the brain, which is known as non-paralytic aseptic meningitis.[2] Penetration of the CNS provides no known benefit to the virus, and is quite possibly an incidental deviation of a normal gastrointestinal infection.[31] The mechanisms by which poliovirus spreads to the CNS are poorly understood, but it appears to be primarily a chance event—largely independent of the age, gender, or socioeconomic position of the individual.[31]
[edit] Paralytic polio
Denervation of skeletal muscle tissue secondary to poliovirus infection can lead to paralysis.
In around 1% of infections, poliovirus spreads along certain nerve fiber pathways, preferentially replicating in and destroying motor neurons within the spinal cord, brain stem, or motor cortex. This leads to the development of paralytic poliomyelitis, the various forms of which (spinal, bulbar, and bulbospinal) vary only with the amount of neuronal damage and inflammation that occurs, and the region of the CNS that is affected.
The destruction of neuronal cells produces lesions within the spinal ganglia; these may also occur in the reticular formation, vestibular nuclei, cerebellar vermis, and deep cerebellar nuclei.[31] Inflammation associated with nerve cell destruction often alters the color and appearance of the gray matter in the spinal column, causing it to appear reddish and swollen.[2] Other destructive changes associated with paralytic disease occur in the forebrain region, specifically the hypothalamus and thalamus.[31] The molecular mechanisms by which poliovirus causes paralytic disease are poorly understood.
Early symptoms of paralytic polio include high fever, headache, stiffness in the back and neck, asymmetrical weakness of various muscles, sensitivity to touch, difficulty swallowing, muscle pain, loss of superficial and deep reflexes, paresthesia (pins and needles), irritability, constipation, or difficulty urinating. Paralysis generally develops one to ten days after early symptoms begin, progresses for two to three days, and is usually complete by the time the fever breaks.[32]
The likelihood of developing paralytic polio increases with age, as does the extent of paralysis. In children, non-paralytic meningitis is the most likely consequence of CNS involvement, and paralysis occurs in only 1 in 1000 cases. In adults, paralysis occurs in 1 in 75 cases.[33] In children under five years of age, paralysis of one leg is most common; in adults, extensive paralysis of the chest and abdomen also affecting all four limbs—quadriplegia—is more likely.[34] Paralysis rates also vary depending on the serotype of the infecting poliovirus; the highest rates of paralysis (1 in 200) are associated with poliovirus type 1, the lowest rates (1 in 2,000) are associated with type 2.[35]
[edit] Spinal polio
The location of motor neurons in the anterior horn cells of the spinal column.
Spinal polio is the most common form of paralytic poliomyelitis; it results from viral invasion of the motor neurons of the anterior horn cells, or the ventral (front) gray matter section in the spinal column, which are responsible for movement of the muscles, including those of the trunk, limbs and the intercostal muscles.[11] Virus invasion causes inflammation of the nerve cells, leading to damage or destruction of motor neuron ganglia. When spinal neurons die, Wallerian degeneration takes place, leading to weakness of those muscles formerly innervated by the now dead neurons.[36] With the destruction of nerve cells, the muscles no longer receive signals from the brain or spinal cord; without nerve stimulation, the muscles atrophy, becoming weak, floppy and poorly controlled, and finally completely paralyzed.[11] Progression to maximum paralysis is rapid (two to four days), and is usually associated with fever and muscle pain.[36] Deep tendon reflexes are also affected, and are usually absent or diminished; sensation (the ability to feel) in the paralyzed limbs, however, is not affected.[36]
The extent of spinal paralysis depends on the region of the cord affected, which may be cervical, thoracic, or lumbar.[37] The virus may affect muscles on both sides of the body, but more often the paralysis is asymmetrical.[28] Any limb or combination of limbs may be affected—one leg, one arm, or both legs and both arms. Paralysis is often more severe proximally (where the limb joins the body) than distally (the fingertips and toes).[28]
Bulbar polio
The location and anatomy of the bulbar region (in orange)
Making up about 2% of cases of paralytic polio, bulbar polio occurs when poliovirus invades and destroys nerves within the bulbar region of the brain stem.[4] The bulbar region is a white matter pathway that connects the cerebral cortex to the brain stem. The destruction of these nerves weakens the muscles supplied by the cranial nerves, producing symptoms of encephalitis, and causes difficulty breathing, speaking and swallowing.[10] Critical nerves affected are the glossopharyngeal nerve, which partially controls swallowing and functions in the throat, tongue movement and taste; the vagus nerve, which sends signals to the heart, intestines, and lungs; and the accessory nerve, which controls upper neck movement. Due to the effect on swallowing, secretions of mucus may build up in the airway causing suffocation.[32] Other signs and symptoms include facial weakness, caused by destruction of the trigeminal nerve and facial nerve, which innervate the cheeks, tear ducts, gums, and muscles of the face, among other structures; double vision; difficulty in chewing; and abnormal respiratory rate, depth, and rhythm, which may lead to respiratory arrest. Pulmonary edema and shock are also possible, and may be fatal.[37]
[edit] Bulbospinal Polio
Approximately 19% of all paralytic polio cases have both bulbar and spinal symptoms; this subtype is called respiratory polio or bulbospinal polio.[4] Here the virus affects the upper part of the cervical spinal cord (C3 through C5), and paralysis of the diaphragm occurs. The critical nerves affected are the phrenic nerve, which drives the diaphragm to inflate the lungs, and those that drive the muscles needed for swallowing. By destroying these nerves this form of polio affects breathing, making it difficult or impossible for the patient to breathe without the support of a ventilator. It can lead to paralysis of the arms and legs and may also affect swallowing and heart functions.[38]
[edit] Diagnosis
Paralytic poliomyelitis may be clinically suspected in individuals experiencing acute onset of flaccid paralysis in one or more limbs with decreased or absent tendon reflexes in the affected limbs, that cannot be attributed to another apparent cause, and without sensory or cognitive loss.[39]
A laboratory diagnosis is usually made based on recovery of poliovirus from a stool sample or a swab of the pharynx. Antibodies to poliovirus can be diagnostic, and are generally detected in the blood of infected patients early in the course of infection.[4] Analysis of the patient's cerebrospinal fluid (CSF), which is collected by a lumbar puncture ("spinal tap"), reveals an increased number of white blood cells (primarily lymphocytes) and a mildly elevated protein level. Detection of virus in the CSF is diagnostic of paralytic polio, but rarely occurs.[4]
If poliovirus is isolated from a patient experiencing acute flaccid paralysis, it is further tested through oligonucleotide mapping (genetic fingerprinting), or more recently by PCR amplification, to determine whether it is "wild type" (that is, the virus encountered in nature) or "vaccine type" (derived from a strain of poliovirus used to produce polio vaccine).[40] It is important to determine the source of the virus because for each reported case of paralytic polio caused by wild poliovirus, it is estimated that another 200 to 3,000 contagious asymptomatic carriers exist.[41]
[edit] Prevention
[edit] Passive immunization
In 1950, William Hammon at the University of Pittsburgh purified the gamma globulin component of the blood plasma of polio survivors.[42] Hammon proposed that the gamma globulin, which contained antibodies to poliovirus, could be used to halt poliovirus infection, prevent disease, and reduce the severity of disease in other patients who had contracted polio. The results of a large clinical trial were promising; the gamma globulin was shown to be about 80% effective in preventing the development of paralytic poliomyelitis.[43] It was also shown to reduce the severity of the disease in patients that developed polio.[42] The gamma globulin approach was later deemed impractical for widespread use, however, due in large part to the limited supply of blood plasma, and the medical community turned its focus to the development of a polio vaccine.[44]
[edit] Vaccine
A child receives oral polio vaccine.
Two types of vaccines are used throughout the world to combat polio. Both types induce immunity to polio, efficiently blocking person-to-person transmission of wild poliovirus, thereby protecting both individual vaccine recipients and the wider community (so-called herd immunity).[45]
The first candidate polio vaccine, based on one serotype of a live but weakened (attenuated) virus, was developed by the virologist Hilary Koprowski. Koprowski's prototype vaccine was given to an eight-year-old boy on February 27th, 1950. Koprowski continued to work on the vaccine throughout the 1950s, leading to large-scale trials in the then Belgian Congo and the vaccination of seven million children in Poland against serotypes PV1 and PV3 between 1958 and 1960.[46]
The first inactivated virus vaccine was developed in 1952 by Jonas Salk, and announced to the world on April 12, 1955.[47] The Salk vaccine, or inactivated poliovirus vaccine (IPV), is based on poliovirus grown in a type of monkey kidney tissue culture (Vero cell line), which is chemically inactivated with formalin.[15] After two doses of IPV (given by injection), 90% or more of individuals develop protective antibody to all three serotypes of poliovirus, and at least 99% are immune to poliovirus following three doses.[4]
Subsequently, Albert Sabin developed another live, oral polio vaccine (OPV). It was produced by the repeated passage of the virus through non-human cells at sub-physiological temperatures.[48] The attenuated poliovirus in the Sabin vaccine replicates very efficiently in the gut, the primary site of wild poliovirus infection and replication, but the vaccine strain is unable to replicate efficiently within nervous system tissue.[49] A single dose of Sabin's oral polio vaccine produces immunity to all three poliovirus serotypes in approximately 50% of recipients. Three doses of live-attenuated OPV produce protective antibody to all three poliovirus types in more than 95% of recipients.[4] Human trials of Sabin's vaccine began in 1957,[50] and in 1958 it was selected, in competition with the live vaccines of Koprowski and other researchers, by the US National Institutes of Health.[46] It was licensed in 1962[50] and rapidly became the only polio vaccine used worldwide.[46]
Because OPV is inexpensive, easy to administer, and produces excellent immunity in the intestine (which helps prevent infection with wild virus in areas where it is endemic), it has been the vaccine of choice for controlling poliomyelitis in many countries.[51] On very rare occasions (about 1 case per 750,000 vaccine recipients) the attenuated virus in OPV reverts into a form that can paralyze.[18] Most industrialized countries have switched to IPV, which cannot revert, either as the sole vaccine against poliomyelitis or in combination with oral polio vaccine.[52]
[edit] Treatment
A modern negative pressure ventilator (iron lung)
There is no cure for polio. The focus of modern treatment has been on providing relief of symptoms, speeding recovery and preventing complications. Supportive measures include antibiotics to prevent infections in weakened muscles, analgesics for pain, moderate exercise and a nutritious diet.[53] Treatment of polio often requires long-term rehabilitation, including physical therapy, braces, corrective shoes and, in some cases, orthopedic surgery.[37]
Portable ventilators may be required to support breathing. Historically, a noninvasive negative-pressure ventilator, more commonly called an iron lung, was used to artificially maintain respiration during an acute polio infection until a person could breathe independently (generally about one to two weeks). Today many polio survivors with permanent respiratory paralysis use modern jacket-type negative-pressure ventilators that are worn over the chest and abdomen.[54]
Other historical treatments for polio include hydrotherapy, electrotherapy, massage and passive motion exercises, and surgical treatments such as tendon lengthening and nerve grafting.[11] Devices such as rigid braces and body casts—which tended to cause muscle atrophy due to the limited movement of the user—were also touted as effective treatments.[55]
[edit] Prognosis
Patients with abortive polio infections recover completely. In those that develop only aseptic meningitis, the symptoms can be expected to persist for two to ten days, followed by complete recovery.[56] In cases of spinal polio, if the affected nerve cells are completely destroyed, paralysis will be permanent; cells that are not destroyed but lose function temporarily may recover within four to six weeks after onset.[56] Half the patients with spinal polio recover fully, one quarter recover with mild disability and the remaining quarter are left with severe disability.[57] The degree of both acute paralysis and residual paralysis is likely to be proportional to the degree of viremia, and inversely proportional to the degree of immunity.[31] Spinal polio is rarely fatal.[32]
Without respiratory support, consequences of poliomyelitis with respiratory involvement include suffocation or pneumonia from aspiration of secretions.[54] Overall, 5–10% of patients with paralytic polio die due to the paralysis of muscles used for breathing. The mortality rate varies by age: 2–5% of children and up to 15–30% of adults die.[4] Bulbar polio often causes death if respiratory support is not provided;[38] with support, its mortality rate ranges from 25 to 75%, depending on the age of the patient.[4][58] When positive pressure ventilators are available, the mortality can be reduced to 15%.[59]
[edit] Recovery
Many cases of poliomyelitis result in only temporary paralysis.[11] Nerve impulses return to the formerly paralyzed muscle within a month, and recovery is usually complete in six to eight months.[56] The neurophysiological processes involved in recovery following acute paralytic poliomyelitis are quite effective; muscles are able to retain normal strength even if half the original motor neurons have been lost.[60] Paralysis remaining after one year is likely to be permanent, although modest recoveries of muscle strength are possible 12 to 18 months after infection.[56]
One mechanism involved in recovery is nerve terminal sprouting, in which remaining brainstem and spinal cord motor neurons develop new branches, or axonal sprouts.[61] These sprouts can reinnervate orphaned muscle fibers that have been denervated by acute polio infection,[62] restoring the fibers' capacity to contract and improving strength.[63] Terminal sprouting may generate a few significantly enlarged motor neurons doing work previously performed by as many as four or five units:[33] a single motor neuron that once controlled 200 muscle cells might control 800 to 1000 cells. Other mechanisms that occur during the rehabilitation phase, and contribute to muscle strength restoration, include myofiber hypertrophy—enlargement of muscle fibers through exercise and activity—and transformation of type II muscle fibers to type I muscle fibers.[62][64]
In addition to these physiological processes, the body possesses a number of compensatory mechanisms to maintain function in the presence of residual paralysis. These include the use of weaker muscles at a higher than usual intensity relative to the muscle's maximal capacity, enhancing athletic development of previously little-used muscles, and using ligaments for stability, which enables greater mobility.[64]
[edit] Complications
Residual complications of paralytic polio often occur following the initial recovery process.[10] Muscle paresis and paralysis can sometimes result in skeletal deformities, tightening of the joints and movement disability. Once the muscles in the limb become flaccid, they may interfere with the function of other muscles. A typical manifestation of this problem is equinus foot (similar to club foot). This deformity develops when the muscles that pull the toes downward are working, but those that pull it upward are not, and the foot naturally tends to drop toward the ground. If the problem is left untreated, the Achilles tendons at the back of the foot retract and the foot cannot take on a normal position. Polio victims that develop equinus foot cannot walk properly because they cannot put their heel on the ground. A similar situation can develop if the arms become paralyzed.[65] In some cases the growth of an affected leg is slowed by polio, while the other leg continues to grow normally. The result is that one leg is shorter than the other and the person limps and leans to one side, in turn leading to deformities of the spine (such as scoliosis).[65] Osteoporosis and increased likelihood of bone fractures may occur. Extended use of braces or wheelchairs may cause compression neuropathy, as well as a loss of proper function of the veins in the legs, due to pooling of blood in paralyzed lower limbs.[38][66] Complications from prolonged immobility involving the lungs, kidneys and heart include pulmonary edema, aspiration pneumonia, urinary tract infections, kidney stones, paralytic ileus, myocarditis and cor pulmonale.[38][66]
[edit] Post-polio syndrome
Main article: Post-polio syndrome
Around a quarter of individuals who survive paralytic polio in childhood develop additional symptoms decades after recovering from the acute infection, notably muscle weakness, extreme fatigue, or paralysis. This condition is known as post-polio syndrome (PPS).[67] The symptoms of PPS are thought to involve a failure of the over-sized motor units created during recovery from paralytic disease.[68][69] Factors that increase the risk of PPS include the length of time since acute poliovirus infection, the presence of permanent residual impairment after recovery from the acute illness, and both overuse and disuse of neurons.[67] Post-polio syndrome is not an infectious process, and persons experiencing the syndrome do not shed poliovirus.[4]