Sunday, January 27, 2008

MMIC PBL2 - Blog 2

Fungal DiseasesTreatmentPrevention
Tinea capitis(scalp ringworm)
-Oral antifungal medicines-Oral antifungal pills such as griseofulvin, terbinafine, itraconazole, fluconazole and ketoconazole

-Medicated shampoo maybe used to reduce the risk of spreading the scalp ringworm to someone else:such as selenium sulfide shampoo and ketoconazole shampoo

-Keep skin dry and cool

Tinea cruris(jock itch)-Antifungal creams or ills-Keep skin dry and cool
Tinea pedis(athelete’s foot)
Antifungal ointment, lotion, powder or spray such as terbinafine (Lamisil AT), clotrimazole (Lotrimin AF) and miconazole (Micatin)- Oral medications such as itraconazole (Sporanox), fluconazole (Diflucan) and terbinafine (Lamisil) -Keep skin dry and cool
Sporotrichosis-Oral potassium iodide such as itraconazole (Sporanox)nil
Histoplasmosis-Antifungal medications such as amphotericin B (Fungizone IV) and itraconazole (Sporanox)

-No vaccine is available.

-Itraconazole is used for chronic suppression,AIDS patients.

Disseminated candidiasis- Antifungal medications such as Amphotericin B and Fluconazole.

-Predisposing factors shold be reduced or eliminated.
-Oral thrush can be prevented by using Clotrimazole troches/nystatin "swish & swallow".
-No vaccine is available.

Chronic mucocutaneous candidiasis

-Antifungal agents, immunologic
therapies, and combination therapy

-Such as ketoconazole

-Predisposing factors shold be reduced or eliminated.
-Oral thrush can be prevented by using Clotrimazole troches/nystatin "swish & swallow".
-No vaccine is available.
Cryptococcal meningitis-Antifungal medications such as amphotericin B

-Fluconazole (Diflucan) is used to prevent the cryptococcal infection from coming back (maintenance treatment).

-No vaccine is available.

Aspergillosis-Oral corticosteroids-Antifungal medications such as amphotericin B and oriconazole-No vaccine is available.

Hep AThere is no specific treatment for HAV and most people fight off the virus naturally, returning to full health within a couple of months. The doctor will advise avoiding alcohol and fatty foods as these can be hard for the liver to process and may exacerbate the inflammation. Hepatitis A immunisation is given in a series of injections. The first single injection in the arm gives protection for a year. The second booster injection at 6 to 12 months extends protection for up to 10 years.
HEPATITIS BIn the majority of patients with active HBV, symptoms will not be severe and treatment will not be required Antiviral medication is given as treatment to those with chronic symptoms to help prevent further liver damage. These medications may be injected or given in pill form. Examples are Interferon Alpha, Lamivudine and BaracludeThree immunisation injections are given over a period of 3-6 months. A blood test is taken once the course of injections is completed to check that they have worked. Immunity should last for at least 5 years.
NAIROVIRUSThe antiviral drug ribavirin has been used in treatment of established CCHF infection with apparent benefit. Both oral and intravenous formulations seem to be effective. Avoidance of areas where tick vectors are abundant and when they are active (Spring to Fall); Regular examination of clothing and skin for ticks, and their removalUse of repellents.
WEST NILE FEVERThere is no specific treatment for West Nile virus infection. Intensive supportive therapy is directed toward the complications of brain infections. Anti-inflammatory medications, intravenous fluids, and intensive medical monitoring may be required in severe casesWhen you are outdoors, use insect repellent containing an EPA-registered active ingredient.
RABIESIf rabies vaccine treatment is called for, it should be started as soon as possible after exposure. Counting the first day of vaccine treatment as day 0, injections are administered on days 0, 3, 7, 14, and 28. The rabies vaccine is administered after exposure to the virus. No matter where the wound, authorities emphasize that the first and most valuable preventive measure is thorough cleaning of the site with soap and water, and immediate medical attention.
JAPANESE ENCEPHALITISnilIn general, vaccine should be offered to persons spending a month or longer in endemic areas during the trans-mission season, especially if travel will include rural areas. Use of insect repellants
YELLOW FEVER Serious cases of yellow fever always need hospital treatment. As there are no products that combat the virus itself, the doctor can only treat the symptoms. If there is a lack of fluid in the body, leading to disturbances in the electrolyte balance, this can be remedied by administration of fluids by intravenous drip. In mild cases, the pain may be relieved with simple painkillers. High temperatures can be treated by cooling the patient and giving them appropriate medicines to lower the temperature, such as aspirin (eg Disprin) or ibuprofen (eg Nurofen).Vaccination available: This vaccine contains a live, weakened form of the yellow fever virus. It provokes the body's immune response without causing the disease.
Leishmania virus itraconazole/ Fluconazole/ Paromomycin/ miltefosine (impavido)· Stay in well-screened or air-conditioned areas as much as possible.
Avoid outdoor activities, especially from dusk to dawn, when sand flies are the most active.· When outside, wear long-sleeved shirts, long pants, and socks. Tuck your shirt into your pants.
· Apply insect repellent on uncovered skin and under the ends of sleeves and pant legs. Follow the instructions on the label of the repellent. The most effective repellents are those that contain the chemical DEET (N,N-diethylmetatoluamide). The concentration of DEET varies among repellents. Repellents with DEET concentrations of 30%-35% are quite effective, and the effect should last about 4 hours. Lower concentrations should be used for children (no more than 10% DEET). Repellents with DEET should be used sparingly on children from 2 to 6 years old and not at all on children less than 2 years old.· Spray clothing with permethrin-containing insecticides. The insecticide should be reapplied after every five washings.
· Spray living and sleeping areas with an insecticide to kill insects.· If you are not sleeping in an area that is well screened or air-conditioned, use a bed net and tuck it under your mattress. If possible, use a bed net that has been soaked in or sprayed with permethrin. The permethrin will be effective for several months if the bed net is not washed. Keep in mind that sand flies are much smaller than mosquitoes and therefore can get through smaller holes. Fine-mesh netting (at least 18 holes to the inch; some sources say even finer) is needed for an effective barrier against sand flies. This is particularly important if the bed net has not been treated with permethrin. However, it may be uncomfortable to sleep under such a closely woven bed net when it is hot.NOTE: Bed nets, repellents containing DEET, and permethrin should be purchased before traveling and can be found in hardware, camping, and military surplus stores
RIFT VALLEY FEVERRibavirin . Hepatotoxic medication as well as aspirin and NSAIDs should be avoided during the acute disease.
Contact with sick or dead animals must be avoided.Smithburn vaccine (single dose, life-long protection), or vaccination with the formol-inactivated vaccine (boosters needed).
For personal protection covering clothing (long sleeves, long trousers), insect repellents (best with DEET) and impregnated mosquito nets are adequate in normal situations. Barrier-nursing is indicated in the care of patients.
There is still no commercial vaccine available for humans. It is true that experimental cell-culture vaccines for medical use do exist, but they are not easy to obtain.
General precautions to be taken when at camp

Preferably apply insect repellent whenever the individual is in the jungle and also apply before sleeping. This is to lower the risk of getting beaten by insects (sandflies, mosquitoes, etc.). Before consuming food, ensure to wash hands with clean water or boiled river/ stream water to reduce chances of consuming vectors of viruses. Ensure consumption of fluids from clean bottled water or boiled water from water bodies. Observe good personal hygiene to reduce chances of being infected by viruses and to reduce chances of transmitting viruses to other platoon members. Quarantine sick individuals to reduce chances of spreading the viruses contracted. Clean wounds or cuts properly to reduce chances of infection.


SchistosomiasisPraziquantel/ Oxamniquine/

· Swimming in the ocean and in chlorinated swimming pools is generally thought to be safe
· Drink safe water(don’t drink water coming directly from canals, lakes, rivers, streams or springs is safe, you should either boil water for 1 minute or filter water before drinking it. Boiling water for at least 1 minute will kill any harmful parasites, bacteria, or viruses present. Iodine treatment alone WILL NOT GUARANTEE that water is safe and free of all parasites.
· Bath water should be heated for 5 minutes at 150o F. Water held in a storage tank for at least 48 hours should be safe for showering
· Vigorous towel drying after an accidental, very brief water exposure may help to prevent the Schistosoma parasite from penetrating the skin. You should NOT rely on vigorous towel drying to prevent schistosomiasis
Castor oil as an oral- penetration

metronidazoleiodoquinol /
· Purification of drinking water. Water can be purified by filtering, boiling, or treatment with iodine.
· Proper food handling. Measures include protecting food from contamination by flies, cooking food properly, washing one's hands after using the bathroom and before cooking or eating, and avoiding foods that cannot be cooked or peeled when traveling in countries with high rates of balantidiasis.
· Careful disposal of human feces. Monitoring the contacts of balantidiasis patients. The stools of family members and sexual partners of infected persons should be tested for the presence of cysts or trophozoites.

oral rehydration
mixture or salts,
sugar and water
drunk in large amount

· Wash your hands. Frequent hand washing is the best way to control cholera infection. Wash your hands thoroughly with hot, soapy water, especially before eating or preparing food, after using the toilet, and when you return from public places. Carry an alcohol-based hand sanitizer for times when water isn't available.
· Avoid untreated water. Contaminated drinking water is the most common source of cholera infection. For that reason, drink only bottled water or water you've boiled or disinfected yourself. Hot beverages such as coffee and tea as well as bottled or canned soft drinks, and wine and beer are generally safe. Carefully wipe the outside of all bottles and cans before you open them and ask for drinks without ice. Use bottled water to brush your teeth.
· Eat food that's completely cooked and hot. Choose food that's been thoroughly cooked and is served hot. Cholera bacteria can survive on room temperature food for up to five days and aren't destroyed by freezing. It's best to avoid street vendor food, but if you do buy it, make sure your meal is cooked in your presence and served hot.
· Avoid sushi. Don't eat raw or improperly cooked fish and seafood of any kind. · Be careful with fruits and vegetables. When you're traveling, make sure that all fruits and vegetables that you eat are cooked or have thick skins that you peel yourself. Avoid lettuce in particular because it may have been rinsed in contaminated water.
· Be wary of dairy foods. Avoid ice cream, which is often contaminated, and unpasteurized milk. Cholera vaccine. Because travelers have a low risk of contracting cholera and because the traditional injected vaccine offers minimal protection, no cholera vaccine is currently available in the United States. A few countries offer two oral vaccines that may provide longer and better immunity than the older versions did. If you'd like more information about these vaccines, contact your doctor or local office of public health. Keep in mind that no country requires immunization against cholera as a condition for entry.

or diloxanide

· Drinking only water that has been bottled in sanitary conditions or boiled (water-purifying tablets are ineffective against amebic cysts)
· Eating only cooked or peeled vegetables or fruits
· Protecting food from fly contamination Washing hands after defecation and before preparing or eating food


Stools of patients with cryptosporidiosis are highly infectious
· Frequent washing of the hands, including under the fingernails
· Not eating unwashed fruits unless peeled
· Boiling water if there is any doubt about its source · Boiling stream or river
water for three minutes
· Using filter paper with pore size of 1 micro<>

bactrim /
· Drinking only water that has been bottled in sanitary conditions or boiled (water-purifying tablets are ineffective against amebic cysts)
· Eating only cooked or peeled vegetables or fruits
· Protecting food from cyclosporasis contamination
Washing hands after defecation and before preparing or eating food
Toxoplasmosispyrimethamine /
trisulfapyrimidines /
folinic acid/

· Make sure your physician checks your blood for toxoplasma antibodies
. Use work gloves and wash your hands afterwards.
· Control flies and cockroaches as much as possible. They can spread contaminated soil or cat feces onto food.
· Avoid eating raw or undercooked meat (or poultry) and unwashed fruits and vegetables.
· Wash your hands thoroughly before you eat and after handling raw meat, soil, sand or cats.
· Avoid rubbing your eyes or face when preparing food, and wipe the counter clean afterwards.
Avoid eating raw eggs and drinking unpasteurized milk.

Giardiasismetronidazole (Flagyl)/
furazolidone (Furoxone)/
paromycin (Humatim), /
quinacrine (Atrabine)
· Frequent washing of the hands, including under the fingernails
· Not eating unwashed fruits unless peeled
· Boiling water if there is any doubt about its source
· Boiling stream or river water for three minutes
· Using filter paper with pore size of 1 micro <>
artemisin- derivatives/
· evaluating the risk of exposure to infection · preventing mosquito bites by using DEET mosquito repellant, bed nets, and clothing that covers most of the body chemoprophylaxis (preventive medications)

Na stibogluconate (Na
antimony gluconate) /
meglumine antimonite/

insect repellents containing DEET provide protection. Insect screens, bed nets,and clothing are more effective if treated with permethrin or pyrethrum, because the tiny flies can penetrate mechanical barriers.

Vaccines are not currently available. Wear long selves shirt and long pants and sock.(tuck in shirt into the pants)


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