Rabies

Rabies causes acute encephalitis in animals and people (rabies means "rage" in latin). In unvaccinated humans, rabies is almost always fatal once symptoms have expressed completely. However, post-exposure vaccination can prevent symptoms from developing.

rabies symptoms

When one thinks of the symptoms of rabies, a stereotypical image of an infected ("rabid") animal is a "mad dog" foaming at the mouth, but most mammals can become rabid, including cats, rabits, raccoons, skunks, foxes and wolves. Rabies may also present in a so-called 'paralytic' form, rendering the infected animal unnaturally quiet and withdrawn.

After a typical human infection by animal bite, the virus enters the nervous system. It then travels along the nerves towards the central nervous system. During this phase, there are no readily apparent rabies symtpoms.

The period between infection and the first flu-like symptoms is normally three to twelve weeks, but can be as long as two years. Soon after, the symptoms expand to cerebral dysfunction, anxiety, insomnia, confusion, agitation, abnormal behaviour, hallucinations, and progressing to delirium.

The production of large quantities of saliva and tears coupled with an inability to speak or swallow are typical during the later stages of the disease; this is known as "hydrophobia".

Death almost invariably results 2-10 days after the first symptoms; the handful of people who are known to have survived the disease were all left with severe brain damage.

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Whooping Cough

Whooping cough (Pertussis), is a highly contagious disease caused by the bacterium "Bordetella", most often B. Pertussis. There are 30–50 million cases per year, and about 300,000 deaths per year. Virtually all deaths occur in children under one year of age. Ninety percent of all cases occur in developing countries. The disease is spread by contact with airborne discharges from the mucous membranes of infected people.

whooping cough symptoms

The early symptoms of whooping cough are characterized by a mild respiratory infection such as:

• cough
• sneezing
• runny nose.

After one to two weeks whooping cough symptoms become more clearly unique to Pertussis, as the cough changes character, with paroxysms of coughing followed by an inspiratory "whooping" sound. This characteristic sound is very unique, and can easily be identified by most physicians.

Coughing fits may be followed by vomiting, which in severe cases leads to malnutrition and dehydration. Coughing fits gradually diminish over one to two months. Other complications of the disease include:

• pneumonia
• encephalitis
• pulmonary hypertension
• secondary bacterial super-infections

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Yeast Infection

Yeast is a fungus that grows freely throughout the world. Several strains grow in cooperation with the human body, and several are considered pathogenic. Typically when we are talking about yeast infections, we are discussing Candida Albicans, and the technical name for the infection is candidiasis.

Candidiasis is an infection of the skin and/or mucous membrane. It is usually located in the skin, nails, mouth, intestines, genitalia, bronchi, or lungs, but may invade the bloodstream as well. It is thought to occur primarily a secondary infection, associated with a compromised immune system. However, according to many theories in alternative medicine, Candida is seen as the primary infection resulting in the immune system dysfunction. In this theory, such diseases as Lupus, Eczema, Irritable Bowel Syndrome, and Arthritis may actually be caused by a systemic yeast infection. This is not to say that all of these diseases are caused by candidiasis, but tests should be conducted to determine if this infectious disease is involved.

For the purpose of this article, we will focus on what we traditionally think of when we discuss yeast infections, and will narrow the symptoms discussed to those traditionally associated with candidiasis.

yeast infection symptoms may include:

• Thrush: oral lesions consisting of painless, discrete white plaques that adhere on the oral and pharyngeal mucosa.
• Skin infections are:
  • red
  • macerated: appearing moist
  • usually occur in areas where skin folds upon itself.
• Invasive systemic infections may present in any organ including the brain, heart, kidneys, and eyes.
  • symptoms produced in systemic infections depend on the extent of the infection and the organs affected.

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Psoriatic Arthritis

Psoriatic arthritis is a type of inflammatory arthritis that affects around 20% of people suffering from the chronic skin condition Psoriasis. It occurs more commonly in patients with tissue type HLA-B27. Treatment of psoriatic arthritis is similar to that of Rheumatoid arthritis. More than 80% of patients with psoriatic arthritis will have psoriatic nail lesions characterised by pitting of the nails. Psoriatic arthritis is said to be a sero-negative spondyloarthropathy.

Psoriatic arthritis can develop at any age, however on average it tends to appear about 10 years after the first signs of psoriasis. For the majority of people this is between the ages of 30 and 50, but it can also affect children. Men and women are equally affected by this condition. In about one in seven cases the arthritis symptoms may occur before any skin involvement. As well as causing joint inflammation, psoriatic arthritis can cause Tendonitis and a sausage-like swelling of the digits known as dactilytis.

Types of Psoriatic Arthritis

There are five main types of psoriatic arthritis; these are symmetric, asymmetric, distal interphalangeal predominant (DIP), spondylitis and arthritis mutilans.

Symmetric nature of Psoriatic Arthritis

This type accounts for around 50% of cases, and affects joints on both sides of the body simultaneously. This type is most similar to Rheumatoid arthritis and is disabling in around 50% of all cases.

Asymmetric nature of Psoriatitc Arthritis

This type affects around 35% of patients and is generally mild. This type does not occur in the same joints on both sides of the body and usually only involves less than 3 joints.

Arthritis Mutilans

Affects less than 5% of patients and is a severe, deforming and destructive arthritis. This condition can progress over months or years causing severe joint damage.

Spondylitis

This type is characterised by stiffness of the spine or neck, but can also affect the hands and feet, in a similar fashion to symmetric arthritis.

Distal Interphalangeal Predominant

This type of psoriatic arthritis is found in about 5% of patients, and is characterised by inflammation and stiffness in the joints nearest to the ends of the fingers and toes. Nail changes are often marked.

Treatments for Psoriatic arthritis

Treatments for this disease include joint injections.

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Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. It is a disabling and painful inflammatory condition, which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and muscles.

Derived from the Greek rheumatos= flowing, -oid= in the shape of, arthr= joint, itis= condition involving inflammation

Symptoms of Rheumatoid Arthritis

The American College of Rheumatology has defined (1987) the following criteria for Rheumatoid Arthritis:

• Morning stiffness of >1 hour.
• Arthritis and soft-tissue swelling of >3 of 14 joints/joint groups
• Arthritis of hand joints
• Symmetric arthritis
• Subcutaneous nodules in specific places
• Rheumatoid factor at a level above the 95th percentile
• Radiological changes suggestive of joint erosion

Four criteria have to be met, although many patients are treated despite not meeting the criteria.

The symptoms that distinguish rheumatoid arthritis are inflammation and soft-tissue swelling of many joints at the same time (polyarthritis). The hands are generally affected in a symmetric fashion. The pain generally improves with use of the affected joints, and there is usually stiffness of all joints in the morning that lasts over 1 hour.

If the arthritis has been longstanding, the inflammatory activity has led to erosion and destruction of the joint surface, which impairs their range of movement and leads to deformity. The fingers are typically deviated towards the little finger (ulnar deviation) and can assume unnatural shapes.

Subcutaneous nodules on extensor surfaces, e.g. the elbows, are often present.

Diagnosis of Rheumatoid Arthritis

When RA is being clinically suspected, immunological studies are required, such as rheumatoid factor (RF, a specific antibody). A negative RF does not rule out RA; rather, the arthritis is called seronegative. During the first year of illness, rheumatoid factor is frequently negative. 80% patients eventually convert to seropositive status. RF is also seen in other illnesses, like Sjogren's syndrome, therefore the test is not very specific. Because of this low specificity, a new serological test has been developed in recent years, which tests for the presence of so called anti-citrullinated protein (ACP) antibodies.

Like RF, this test can detect approximately 80% of all RA patients, but is rarely positive in non-RA patients, giving it a specificity of around 98%. In addition, ACP antibodies can be often detected in early stages of the disease, or even before disease onset. Currently, most common test for ACP antibodies is the anti-CCP (cyclic citrulinated peptide) test. Also, several other blood tests are usually done to allow for other causes of arthritis, such as lupus erythematosus. The erythrocyte sedimentation rate (ESR), C-reactive protein, full blood count, renal function, liver enzymes and immunological tests (e.g. antinuclear antibody/ANA) are all performed at this stage. Ferritin can reveal hemochromatosis, which can mimic RA.

Pathophysiology

The cause of Rheumatoid Arthritis is unknown, but long suspected to be infectious. Mycoplasma, Erysipelothrix, Epstein-Barr virus, parvovirus and rubella have been suspected but never supported in epidemiological studies. As in other autoimmune diseases, the "mistaken identity" theory suggests that an offending organism causes an immune response that leaves behind antibodies that are specific to that organism. The antibodies are not specific enough, though. They begin an immune attack against, in this case, the synovium, because some molecule in the synovium "looks like" a molecule on the offending organism that created the initial immune reaction.

Autoimmune diseases require that the affected individual have a defect in the ability to distinguish self from foreign molecules. This ability is acquired in the first year of life. There are markers on many cells that confer this self-identifying feature. However, some classes of markers allow for RA to happen. 90% of patients with RA have the cluster of markers known as the HLA-DR4/DR1 cluster, whereas only 40% of controls do. Thus, in theory, RA requires susceptibility to the disease through genetic endowment with specific markers and an infectious event that triggers an autoimmune response.

Once triggered, the immune response causes inflammation of the synovium. Modern pharmacological treatments of RA target these early and intermediate molecular mediators of inflammation, including tumor necrosis factor alpha (TNF-?), interleukin (IL)–1, IL-6, transforming growth factor beta, IL-8, fibroblast growth factor and platelet-derived growth factor. Once the inflammatory reaction is established, the synovium thickens, the cartilage and the underlying bone begins to disintegrate and evidence of joint destruction accrues.

Treatment of Rheumatoid Arthritis

Pharmacological treatment of Rheumatoid Arthritis can be divided into disease-modifying antirheumatic drugs (DMARDs), anti-inflammatory agents and analgesics. DMARDs have been found to produce durable remissions and delay or halt disease progression. This is not true of anti-inflammatories and analgesics.

DMARDs can be further subdivided into xenobiotic agents and biological agents. Xenobiotic agents are those DMARDs that do not occur naturally in the body, as opposed to biologicals.

Xenobiotics

Xenobiotics include:

• gold salts
• D-penicillamine
• hydroxychloroquine
• sulfasalazine (SSZ)
• methotrexate (MTX)
• azathioprine
• cyclosporin A
• minocycline
• leflunomide

The most important and most common adverse events relate to liver and bone marrow toxicity (MTX, SSZ, leflunomide, azathioprine, gold compounds, D-penicillamine), renal toxicity (cyclosporine A, parenteral gold salts, D-penicillamine), pneumonitis (MTX), allergic skin reactions (gold compounds, SSZ), autoimmunity (D-penicillamine, SSZ, minocycline) and infections (azathioprine, cyclosporine A). Hydroxychloroquine may cause ocular toxicity.

Biological agents for Rheumatoid Arthritis

Biological agents include:

• tumor necrosis factor (TNF?) blockers - etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira)
• interleukin-1 blockers - anakinra

Anti-inflammatory agents and analgesics

Anti-inflammatory agents include:

• glucocorticoids
• Non-steroidal anti-inflammatory drug (NSAIDs, most also act as analgesics) Analgesics include:
• acetaminophen
• opiates
• lidocaine topical

Other options for Rheumatoid Arthritis

Other therapies are weight loss, physiotherapy , joint injections, and special tools to improve hard movements (e.g. special tin-openers). Severely affected joints may require joint replacement surgery, such as knee replacement.

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