Saturday 14 May 2011

Childhood Diseases

Diseases can be devastating for anyone, but it seems particularly unfair when they attack children. Unfortunately, many diseases seem to take a special interest in the young, infecting them more frequently and vigorously than they do adults.

In this section, you will learn about several common childhood diseases, and why some diseases seem to prey on the young. It's not all gloom and doom, though, for researchers have made great strides in controlling many childhood diseases. Vaccines, in particular, have saved thousands of young lives, and with proper use they will continue to do so.
Why the Young?

Children are more susceptible to diseases for a number of reasons. The major reason for children's increased susceptibility is that they have had limited exposure to diseases and therefore haven't yet built the immunologic defenses required to fend off certain diseases. The environment plays an important role as well. Children in day care centers and in school pass infections around and then take them home and pass them to siblings and parents. This is a cycle that is difficult to break. Children also don't always practice good hygiene and that makes them both susceptible to as well as good transmitters of disease.

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Mosquito and Tick-Borne Diseases

Mosquitoes serve as vectors, or carriers, of the malaria parasite. Bloodthirsty mosquitoes and ticks also carry disease-causing bacteria and viruses, which can be passed on to people when they are bitten by the bugs. And unlike malaria, which isn't endemic to the United States, these other mosquito- and tick-borne diseases are sometimes found in our own backyards.

This section covers three mosquito-borne diseases and two tick-borne diseases. The first two, yellow fever and dengue, are also called hemorrhagic fevers, because one of their symptoms is small hemorrhages under the skin. Diseases like Lyme are spread by ticks, while West Nile is spread by mosquitoes. West Nile doesn't cause many infections but it has caused a great deal of panic due to heavy media attention in the United States.

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Food-Borne Diseases

In 1993 in Seattle, Washington, several school-aged children became ill, suffering from diarrhea and stomach cramps. This was no flu outbreak, though. Epidemiologists determined that the cause of the illness was a bacterium called E. coli 0157:H7. The children had all eaten infected hamburgers at the same Jack in the Box restaurant. Overall, 500 people in the Pacific Northwest got E. coli 0157:H7 infections that year, and three of the children from the Seattle outbreak died.

The CDC used DNA fingerprinting to track the bacteria and link the illnesses in people to undercooked hamburger patties from a Jack in the Box restaurant. Hamburgers from the restaurant were recalled, preventing further illness.

The Jack in the Box incident got a lot of media attention because of the number of children who got sick and because the source of the infection was a large chain restaurant. However, such food-borne illnesses are common throughout the world, and the incidents rarely ever get media attention.

Many different bacteria—all of them with complicated-sounding names—are responsible for causing food-borne diseases. In this section you'll read about six of the most common bacteria. Fortunately, most food-borne illnesses don't last long and aren't very dangerous, but there are cases where there are possible serious long-term effects, which we'll address, too.

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Rare and Deadly Diseases

The media loves a good story—one that's full of gory or otherwise disturbing details and that preys upon people's fears. Outbreaks of diseases such as Ebola, Marburg, and mad cow fit this bill perfectly.

Whereas tuberculosis and hepatitis, diseases that cause far more deaths and sicknesses, rarely get a headline, a single outbreak of any of the diseases discussed in this section will almost always make the front page of your local daily and get a mention (with lots of frightening footage) on the nightly news.

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Tropical Diseases

Many diseases are caused by organisms that thrive in tropical climates or live inside flies that are common in the tropics. Many of these so-called “tropical diseases” are treatable; however, developing countries don't always have access to the medications they need to treat them. Consequently, many people unnecessarily suffer and even die from tropical diseases.

In this section, you will find out about some of the most common tropical diseases, their treatment, and how to prevent them.

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Sexually Transmitted Diseases

In This Section

    * The most common sexually transmitted diseases
    * Symptoms, diagnosis, and treatment
    * How to limit the risk for developing an STD
    * What to do if you think you have an STD

Sexually transmitted diseases (STDs), formerly referred to as “venereal diseases,” are among the most common infectious diseases in the world. Amazingly, an estimated 333 million new cases of curable sexually transmitted diseases occur each year among adults. The United States has the highest rate of STDs in the industrialized world, exceeding other nations by 50 to 100 times.

These diseases exert a high emotional toll on afflicted individuals, as well as an economic burden on our healthcare system. More than 20 STDs including chlamydia, gonorrhea, syphilis, genital warts, genital herpes, and viral hepatitis have now been identified as affecting men and women of all backgrounds and economic levels.
Our Current Situation

There are an estimated 15.3 million new cases of STDs in the United States each year, 3 million of which occur in people between the ages of 13 and 19. Nearly two thirds of all STDs occur in people younger than 25! The incidence of STDs is rising partly because people have become sexually active earlier, with more frequent sex partners. Many STDs cause no symptoms, and those that do may be confused with other diseases not transmitted through sexual contact. An infected person, whether he or she has symptoms or not, may transmit an STD to a sex partner. For this reason, periodic screening is recommended for individuals with multiple sex partners.

STDs tend to be more severe for women than for men. In some cases, STDs may spread to the uterus and fallopian tubes, causing pelvic inflammatory disease, a major cause of both infertility and ectopic pregnancy (when the embryo grows in the fallopian tube instead of the uterus). STDs in women are also associated with some cervical cancer. STDs can be passed from a mother to baby before, during, or immediately after birth.

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he good news is, however, that when diagnosed and treated early, many STDs can be managed effectively or cured.
Reducing the Chance of Infection

The only completely effective means of protection against STD infection is to abstain from sexual intercourse. For most of the sexually active world, this is an impractical solution.

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So for those people engaging in intercourse, the best way to minimize risk is to …

    * Have a mutually monogamous sexual relationship with an uninfected partner.
    * Use barrier methods of contraception, such as condoms.
    * Avoid anal intercourse.
    * Delay having sexual relations as long as possible, as young people tend to be more susceptible to infections.
    * Keep the total number of sex partners at a minimum.
    * Have regular checkups even in the absence of STD symptoms.

If an STD infection is suspected, a doctor should be consulted. Information is readily available from local health departments, as well as from STD and family planning clinics.

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Tuberculosis

In an age when we believe that we have the tools to conquer most diseases, the ancient scourge of tuberculosis (TB) still causes 2 million deaths a year worldwide—more than any other single infectious organism—reminding us that we still have a long way to go. Even equipped with drugs to treat TB effectively, we haven't managed to eradicate this deadly infection.

What is the history of tuberculosis? And how has it managed to survive for so long? This section will answer these questions, plus describe the symptoms and treatment options available for TB.
An Ancient Scourge That Still Kills Today

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Mycobacterium tuberculosis, the bacteria that causes tuberculosis, has been around for centuries. Recently, fragments of the spinal columns from Egyptian mummies from 2400 B.C.E. were found to have definite signs of the ravages of this terrible disease. Also called consumption, TB was identified as the most widespread disease in ancient Greece, where it was almost always fatal. But it wasn't until centuries later that the first descriptions of the disease began to appear. Starting in the late seventeenth century, physicians began to identify changes in the lungs common in all consumptive, or TB, patients. At the same time, the earliest references to the fact that the disease was infectious began to appear.

In 1720, the English doctor Benjamin Marten was the first to state that TB could be caused by “wonderfully minute living creatures.” He went further to say that it was likely that ongoing contact with a consumptive patient could cause a healthy person to get sick. Although Marten's findings didn't help to cure TB, they did help people to better understand the disease.

The sanitorium, which was introduced in the mid-nineteenth century, was the first positive step to contain TB. Hermann Brehmer, a Silesian botany student who had TB, was told by his doctor to find a healthy climate. He moved to the Himalayas and continued his studies. He survived his bout with the illness, and after he received his doctorate, built an institution in Gorbersdorf, where TB patients could come to recuperate. They received good nutrition and were outside in fresh air most of the day. This became the model for the development of sanitoria around the world.

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In 1865, French military doctor Jean-Antoine Villemin demonstrated that TB could be passed from people to cattle and from cattle to rabbits. In 1882, Robert Koch discovered a staining technique that allowed him to see the bacteria that cause TB under a microscope.

Until the introduction of surgical techniques to remove infected tissue and the development of x-rays to monitor the disease, doctors didn't have great tools to treat TB. TB patients could be isolated, which helped reduce the spread of the disease, but treating it remained a challenge.

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HIV/AIDS

The June 5, 1981, Centers for Disease Control and Prevention's (CDC) weekly report of disease trends noted an unusual pattern of opportunistic infections in five gay men. The report began …

    In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia [a fungal infection of the lungs] at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candida mucosal [yeast] infection.

The report ended with a poignant editorial note:

    Pneumocystis pneumonia in the United States is almost exclusively limited to severely immunosuppressed patients. The occurrence of pneumocystosis in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual. The fact that these patients were all homosexuals suggests an association between some aspect of a homosexual lifestyle or disease acquired through sexual contact and Pneumocystis pneumonia in the population ….

    All the above observations suggest the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumocystosis and candidiasis …

The age of AIDS had begun!

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Malaria

Malaria is one of the most successful parasites ever known to mankind. After thousands of years, it remains the world's most pervasive infection, affecting at least 91 different countries and some 300 million people. The disease causes fever, shivering, joint pain, headache, and vomiting. In severe cases, patients can have jaundice, kidney failure, and anemia, and can lapse into a coma.

It is ever-present in the tropics and countries in sub-Saharan Africa, which account for nearly 90 percent of all malaria cases. The majority of the remaining cases are clustered in India, Brazil, Afghanistan, Sri Lanka, Thailand, Indonesia, Vietnam, Cambodia, and China. Malaria causes 1 to 1.5 million deaths each year, and in Africa, it accounts for 25 percent of all deaths of children under the age of five.
A Brief History of Malaria

Ancient accounts of malaria date back to Vedic writings of 1600 B.C.E. in India and to the fifth century B.C.E. in Greece, when the great Greek physician Hippocrates, often called “the Father of Medicine,” described the characteristics of the disease and related them to seasons and location. The discovery of an association of malaria with stagnant waters led the Romans to develop drainage programs, which were among the first documented preventions against malaria. In seventh-century Italy, the disease was prevalent in foul-smelling swamps near Rome and was named mal' aria Italian for “bad air.”

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Malaria epidemics ravaged Europe and Africa for centuries. Like many diseases, it traveled with tradesmen, settlers, and conquering forces. Over four centuries of the slave trade, millions of Africans died from malaria, which may have come to the New World along with slaves.

Despite malaria's preference for the tropics, the disease has had an impact on the history of the United States, too. Known commonly as “fever and ague,” malaria took its toll on early American settlers. In the book Little House on the Prairie, Laura Ingalls Wilder vividly describes its impact. Malaria devastated the 1607 Jamestown colony and regularly ravaged the South and Midwest. The incidence of malaria in the United States peaked in 1875. Yet, in 1914, more than 600,000 new cases were still occurring.

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Malaria has been a factor in nearly all United States military campaigns. During the Civil War, armies on both sides sustained more than 1.2 million cases of malaria. It continued to be a problem in both World Wars, the Korean War, and the Vietnam War. In the latter, malaria appeared in a newer, more deadly, drug-resistant form.

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Common Infectious Diseases Worldwide

The following is a list of the most common infectious diseases throughout the world today. Accurate caseload numbers are difficult to determine, especially because so many of these diseases are endemic to developing countries, where many people do not have access to modern medical care. Approximately half of all deaths caused by infectious diseases each year can be attributed to just three diseases: tuberculosis, malaria, and AIDS. Together, these diseases cause over 300 million illnesses and more than 5 million deaths each year.

The list does not include diseases that have received a significant amount of media attention in recent years—such as Ebola Hemorrhagic Fever or West Nile Virus > but which in fact have infected a relatively small number of people

African Trypanosomiasis (“sleeping sickness”): African trypanosomiasis is spread by the tsetse fly, which is common to many African countries. The World Health Organization (WHO) estimates that nearly 450,000 cases occur each year. Symptoms of the disease include fever, headaches, joint pains, and itching in the early stage, and confusion, sensory disturbances, poor coordination, and disrupted sleep cycles in the second stage. If the disease goes untreated in its first stage, it causes irreparable neurological damage; if it goes untreated in its second stage, it is fatal.

Cholera: Cholera is a disease spread mostly through contaminated drinking water and unsanitary conditions. It is endemic in the Indian subcontinent, Russia, and sub-Saharan Africa. It is an acute infection of the intestines with the bacterium Vibrio cholerae. Its main symptom is copious diarrhea. Between 5% and 10% of those infected with the disease will develop severe symptoms, which also include vomiting and leg cramps. In its severe form, cholera can cause death by dehydration. An estimated 200,000 cases are reported to WHO annually.

Cryptosporidiosis: Cryptosporidiosis has become one of the most common causes of waterborne disease in the United States in recent years; it is also found throughout the rest of the world. It is caused by a parasite that spreads when a water source is contaminated, usually with the feces of infected animals or humans. Symptoms include diarrhea, stomach cramps, an upset stomach, and slight fever. Some people do not exhibit any symptoms.

Dengue: WHO estimates that 50 million cases of dengue fever appear each year. It is spread through the bite of the Aedes aegypti mosquito. Recent years have seen dengue outbreaks all over Asia and Africa. Dengue fever can be mild to moderate, and occasionally severe, though it is rarely fatal. Mild cases, which usually affect infants and young children, involve a nonspecific febrile illness, while moderate cases, seen in older children and adults, display high fever, severe headaches, muscle and joint pains, and rash. Severe cases develop into dengue hemorrhagic fever, which involves high fever, hemorrhaging, and sometimes circulatory failure.

Hepatitis A: Hepatitis A is a highly contagious liver disease caused by the hepatitis A virus. Spread primarily by the fecal-oral route or by ingestion of contaminated water or food, the number of annual infections worldwide is estimated at 1.4 million. Symptoms include fever, fatigue, jaundice, and dark urine. Although those exposed usually develop lifelong immunity, the best protection against Hepatitis A is vaccination.

Hepatitis B: Approximately 2 billion people are infected with the hepatitis B virus (HBV), making it the most common infectious disease in the world today. Over 350 million of those infected never rid themselves of the infection. Hepatitis is an inflammation of the liver that causes symptoms such as jaundice, extreme fatigue, nausea, vomiting, and stomach pain; hepatitis B is the most serious form of the disease. Chronic infections can cause cirrhosis of the liver or liver cancer in later years.

Hepatitis C: Hepatitis C is a less common, and less severe, form of hepatitis. An estimated 180 million people worldwide are infected with hepatitis C virus (HCV); 3–4 million more are infected every year. The majority of HCV cases are asymptomatic, even in people who develop chronic infection.

HIV/AIDS: See Understanding AIDS.

Influenza: Several influenza epidemics in the 20th century caused millions of deaths worldwide, including the worst epidemic in American history, the Spanish influenza outbreak that killed more than 500,000 in 1918. Today influenza is less of a public health threat, though it continues to be a serious disease that affects many people. Approximately 20,000 people die of the flu in the United States every year. The influenza virus attacks the human respiratory tract, causing symptoms such as fever, headaches, fatigue, coughing, sore throat, nasal congestion, and body aches.

Japanese Encephalitis: Japanese encephalitis is a mosquito-borne disease endemic in Asia. Around 50,000 cases occur each year; 25% to 30% of all cases are fatal.

Leishmaniasis: Leishmaniasis is a disease spread by the bite of the sandfly. It is found mostly in tropical countries. There are several types of leishmaniasis, and they vary in symptoms and severity. Visceral leishmaniasis (VL, or kala azar) is the most severe; left untreated, it is always fatal. Its symptoms include fever, weight loss, anemia, and a swelling of the spleen and liver. Mucocutaneous leishmaniasis (MCL, or espundia) produces lesions that affect the nose, mouth, and throat and can destroy their mucous membranes. Cutaneous leishmaniasis (CL) produces skin ulcers, sometimes as many as 200, that cause disability and extensive scarring. Diffuse cutaneous leishmaniasis (DCL) is similar to CL, and infected people are prone to relapses. Approximately 12 million cases of leishmaniasis exist today.

Malaria: Malaria is a mosquito-borne disease that affects more than 500 million people annually, causing between 1 and 3 million deaths. It is most common in tropical and subtropical climates and is found in 90 countries—but 90% of all cases are found in Sub-Saharan Africa. Most of its victims are children. The first stage consists of shaking and chills, the next stage involves high fever and severe headache, and in the final stage the infected person's temperature drops and he or she sweats profusely. Infected people also often suffer from anemia, weakness, and a swelling of the spleen. Malaria was almost eradicated 30 years ago; now it is on the rise again.

Measles: Measles is a disease that has seen a drastic reduction in countries where a vaccine is readily available, but it is still prevalent in developing countries, where most of the 242,000 deaths (out of 30 million cases) it caused in 2006 occurred. Symptoms include high fever, coughing, and a maculo-papular rash; common complications include diarrhea, pneumonia, and ear infections.

Meningitis: Meningitis, often known as spinal meningitis, is an infection of the spinal cord. It is usually the result of a viral or bacterial infection. Bacterial meningitis is more severe than viral meningitis and may cause brain damage, hearing loss, and learning disabilities. An estimated 1.2 million cases of bacterial meningitis occur every year, over a tenth of which are fatal. Symptoms include severe headache, fever, nausea, vomiting, lethargy, delirium, photophobia, and a stiff neck.

Onchocerciasis (“river blindness”): Onchocerciasis is caused by the larvae of Onchocerca volvulus, a parasitic worm that lives in the human body for years. It is endemic in Africa, where nearly all of the 18 million people infected with the disease live. Of those infected, over 6.5 million have developed dermatitis and 270,000 have gone blind. Symptoms include visual impairment, rashes, lesions, intense itching, skin depigmentation, and lymphadenitis.

Pneumonia: Pneumonia has many possible causes, but it is usually an infection of the streptococcus or mycoplasma bacteria. These bacteria can live in the human body without causing infection for years, and only surface when another illness has lowered the person's immunity to disease. Streptococcus pneumoniae causes streptococcal pneumonia, the most common kind, which is more severe than mycoplasmal pneumonia. S. pneumoniae is responsible for more than 100,000 hospitalizations for pneumonia annually, as well as 6 million cases of otitis media and over 60,000 cases of invasive diseases such as meningitis.

Rotavirus: Rotavirus is the most common cause of viral gastroenteritis worldwide. It kills more than 600,000 children each year, mostly in developing countries. Symptoms include vomiting, watery diarrhea, fever, and abdominal pain.

Schistosomiasis: Schistosomiasis is a parasitic disease that is endemic in many developing countries. Roughly 200 million people worldwide are infected with the flukeworm, whose eggs cause the symptoms of the disease. Some 120 million of those infected are symptomatic, and 20 million suffer severely from the infection. Symptoms include rash and itchiness soon after becoming infected, followed by fever, chills, coughing, and muscle aches.

Shigellosis: Shigella infection causes an estimated 600,000 deaths worldwide every year. It is most common in developing countries with poor sanitation. Shigella bacteria cause bacillary dysentery, or shigellosis. Symptoms include diarrhea with bloody stool, vomiting, and abdominal cramps.

Strep Throat: Strep throat is caused by the streptococcus bacteria. Several million cases of strep throat occur every year. Symptoms include a sore throat, fever, headache, fatigue, and nausea.

Tuberculosis: Tuberculosis causes nearly 2 million deaths every year, and WHO estimates that nearly 1 billion people will be infected between 2000 and 2020 if more effective preventive procedures are not adopted. The TB bacteria are most often found in the lungs, where they can cause chest pain and a bad cough that brings up bloody phlegm. Other symptoms include fatigue, weight loss, appetite loss, chills, fever, and night sweats.

Typhoid: Typhoid fever causes an estimated 600,000 deaths annually, out of 12–17 million cases. It is usually spread through infected food or water. Symptoms include a sudden and sustained fever, severe headache, nausea, severe appetite loss, constipation, and sometimes diarrhea.

Yellow Fever: Yellow fever causes an estimated 30,000 deaths each year, out of 200,000 cases. The disease has two phases. In the “acute phase,” symptoms include fever, muscle pain, headache, shivers, appetite loss, nausea, and vomiting. This lasts for 3–4 days, after which most patients recover. But 15% will enter the “toxic phase,” in which fever reappears, along with other symptoms, including jaundice; abdominal pain; vomiting; bleeding from the mouth, nose, eyes, and stomach; and deterioration of kidney function (sometimes complete kidney failure). Half of all patients in the toxic phase die within two weeks; the other half recover.

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