Infectious diseases

Ebola Hemorrhagic Fever (Ebola Virus Disease)


Ebola hemorrhagic fever (Ebola virus disease) facts


  • Ebola hemorrhagic fever is a disease caused by four different strains of Ebola virus; these viruses infect humans and nonhuman primates. It is also referred to as Ebola virus disease.
  • Ebola hemorrhagic fever has a short history since it was discovered in 1976. There have been a few outbreaks, including the current (April 2014) “unprecedented epidemic” in Africa.


  • Symptoms and signs of Ebola virus disease include an incubation period of two to 21 days, starting with abrupt fever, headache, jointand muscle aches, sore throat, and weakness; progression of symptoms include diarrhea,vomiting, stomach pain, hiccups, and rash with more devastating symptoms of internal and external bleeding in many patients.
  • Ebola viruses are mainly found in primates in Africa and possibly the Philippines; there are only occasional outbreaks of infection in humans. Ebola hemorrhagic fever occurs mainly in Africa in the Republic of the Congo, Gabon, Sudan, Ivory Coast, and Uganda, but it may occur in other African countries.
  • Ebola virus can be spread by direct contact with blood and secretions, by contact with blood and secretions that remain on clothing, and by needles and/or syringes used to treat Ebola-infected patients.
  • Risk factors for Ebola hemorrhagic fever are travel to areas with endemic Ebola hemorrhagic fever and/or any close association with an infected person.
  • Early clinical diagnosis is difficult as the symptoms are nonspecific; however, if the patient is suspected to have Ebola, the patient needs to be isolated and local and state health departments need to be immediately contacted.
  • Definitive diagnostic tests for Ebola hemorrhagic fever are ELISAand/or PCR tests; viral cultivation and biopsy samples may also be used.
  • There is no standard treatment for Ebola hemorrhagic fever; only supportive therapy is available.
  • There are many complications from Ebola hemorrhagic fever; the prognosis for patients ranges from fair to poor since many patients died from the disease (death rate equals about 25%-100%).
  • Prevention of Ebola hemorrhagic fever is difficult; early testing and isolation of the patient, plus barrier protection for caregivers (mask, gown, goggles, and gloves), is very important to prevent others from getting infected.
  • Researchers are trying to understand the Ebola virus and pinpoint its ecological reservoirs to better understand how outbreaks occur. Researchers are actively trying to establish an effective vaccine against Ebola viruses by using several experimental methods, but there is no vaccine available currently.

Video of Ebola Virus surviver


What is Ebola hemorrhagic fever?

Ebola hemorrhagic fever is a viral disease caused by Ebola virus that results in nonspecific symptoms early in the disease and often causes internal and external hemorrhage (bleeding) as the disease progresses. Ebola hemorrhagic fever is considered one of the most lethal viral infections; the mortality rate (death rate) is very high during outbreaks (reports of outbreaks range from about 50% to 100% of humans infected, depending on the Ebola strain).

What is the history of Ebola hemorrhagic fever?

Ebola hemorrhagic fever was first noted in Zaire (currently, the Democratic Republic of the Congo or DRC) in 1976. The original outbreak was in a village near the Ebola River after which the disease was named. During that time, the virus was identified in person-to-person contact transmission. Of the 318 patients diagnosed with Ebola, 88% died. Since that time, there have been multiple outbreaks of Ebola virus, and five strains have been identified; four of the strains are responsible for the high death rates. The four Ebola strains are termed as follows: Zaire, Sudan, Tai Forest, and Bundibugyo virus, with Zaire being the most lethal strain. A fifth strain termed Reston has been found in the Philippines. The strain infects primates, pigs, and humans and causes few if any symptoms and no deaths in humans. Most outbreaks of the more lethal strains of Ebola have occurred in Africa and mainly in small- or medium-sized towns. Once recognized, African officials have isolated the area until the outbreak ceased. However, in this new outbreak that began in Africa in March 2014, some of the infected patients have reached larger city centers and have been hospitalized. Unfortunately, many people may have been exposed to the virus in the city, thus causing more infections (and deaths). This outbreak in Africa has now spread to Guinea’s capital and has been detected in the neighboring countries of Liberia and Sierra Leone. About 122 infected people have been diagnosed and 78 have died as of Apr. 1, 2014. The infecting Ebola virus detected this outbreak is the Zaire strain, the most pathogenic strain of Ebola. Health agencies are terming this outbreak as an “unprecedented epidemic.”


What causes Ebola hemorrhagic fever?

The cause of Ebola hemorrhagic fever is Ebola virus infection that results in coagulation abnormalities, including gastrointestinal bleeding, development of a rash, cytokine release, damage to the liver, and massive viremia (large number of viruses in the blood) that leads to damaged vascular cells that form blood vessels. As the massive viremia continues, coagulation factors are compromised and the microvascular endothelial cells are damaged or destroyed, resulting in diffuse bleeding internally and externally (bleeding from the mucosal surfaces like nasal passages and/or mouth and gums and even from the eyes [termed conjunctival bleeding]). This uncontrolled bleeding leads to blood and fluid loss and can cause hypotensive shock that causes death in many Ebola-infected patients.

What are risk factors for Ebola hemorrhagic fever?

The risk factors for Ebola hemorrhagic fever are travel to areas where Ebola infections (see current CDC travel advisories for African countries) have been reported. In addition, association with animals (mainly primates in the area where Ebola infections have been reported) is potentially a risk factor according to the CDC. Another potential source of the virus is eating “bush meat.” Bush meat is the meat of wild animals, including hoofed animals, primates, and rodents. Currently, evidence for any airborne transmission of this virus is lacking. During Ebola hemorrhagic fever outbreaks, health-care workers and family members and friends associated with an infected person are at the highest risk of getting the disease. Researchers who study Ebola hemorrhagic fever viruses are also at risk of developing the disease if a laboratory accident occurs.


What are Ebola virus disease symptoms and signs?


Unfortunately, early symptoms of Ebola virus disease are nonspecific and include the following: feverheadacheweakness,vomitingdiarrhea, stomach discomfort,decreased appetite, and joint and muscle discomfort. As the disease progresses, patients may develop other symptoms and signs such as a rash, eye redness, hiccups,sore throatcoughchest pain, bleeding both inside and outside the body (for example, mucosal surfaces, eyes), and difficulty breathing and swallowing. Ebola virus disease symptoms and signs may appear from about two to 21 days after exposure (average is eight to 10 days). It is unclear why some patients can survive and others die from this disease, but patients who die usually have a poor immune response to the virus.

How do physicians diagnose Ebola hemorrhagic fever?


Ebola hemorrhagic fever is diagnosed preliminarily by clinical suspicion due to association with other individuals with Ebola and with the early symptoms described above. Within a few days after symptoms develop, tests such as ELISA, PCR, and virus isolation can provide definitive diagnosis. Later in the disease or if the patient recovers, IgM and IgG antibodies against the infecting Ebola strain can be detected; similarly, studies using immunohistochemistry testing, PCR, and virus isolation in deceased patients is also done usually for epidemiological purposes.

What is the treatment for Ebola hemorrhagic fever?

According to the CDC and others, standard treatment for Ebola hemorrhagic fever is still limited to supportive therapy. Supportive therapy is balancing the patient’s fluid andelectrolytes, maintaining their oxygen status and blood pressure, and treating such patients for any complicating infections. Any patients suspected of having Ebola hemorrhagic fever should be isolated, and caregivers should wear protective garments. Currently, there is no vaccine or specific treatment for Ebola hemorrhagic fever.

What are complications of Ebola hemorrhagic fever?

Ebola hemorrhagic fever often has many complications; organ failures, severe bleeding, jaundice, delirium, shock, seizures, coma, and death (about 50% to 100% of infected patients). Those patients fortunate enough to survive Ebola hemorrhagic fever still may have complications that may take many months to resolve. Survivors may experience weakness, fatigue, headaches, hair loss,hepatitis, sensory changes, and inflammation of organs (for example, the testicles and the eyes).

What is the prognosis of Ebola hemorrhagic fever?

The prognosis of Ebola hemorrhagic fever is often poor; the death rate of this disease ranges from about 50% to 100%, and those who survive may experience the complications listed above.

Is it possible to prevent Ebola hemorrhagic fever? Is there a vaccine for Ebola hemorrhagic fever?

The main way to prevent getting Ebola hemorrhagic fever is to not travel to areas where it is endemic and by staying away from any patients who may have the disease. Medical caregivers may protect themselves from becoming affected by strict adherence to barriers to the virus (wearing gloves, gowns, goggles, and a mask). Currently, there is no vaccine available against the Ebola virus strains that cause Ebola hemorrhagic fever in humans.

What is the latest research on Ebola hemorrhagic fever?

Research on developing a vaccine against Ebola viruses is ongoing; successful vaccines have been developed that work in experimental animals (mice and guinea pigs but not against macaques monkeys). With new and larger outbreaks of Ebola hemorrhagic fever possible, researchers are intensely working to develop an effective vaccine utilizing genetically modified viruses, recombinant viruses, and inactivated Ebola viruses. Unfortunately, none are currently available.



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Human Immunodeficiency Virus (HIV)

What is HIV?

The Human Immunodeficiency Virus (HIV) is a retrovirus that pass infection to humans when it is in touch with human tissue like mouth, eyes, vagina, anal area or cut in the skin. The infection progresses slowly where the virus will be present in the body at all stages. 

  • Statistics
  • Signs and Symptoms
  • Transmission and Prevention
  • Diagnosis
  • Treatment
  • Conclusion



Since the outbreak of HIV, 70 million individuals have been affected by the HIV virus where statistics show that around 35 million people have died from AIDS (Acquired Immunodeficiency Syndrome). As of the end of the year 2011, 34 million people were reported as being infected with this virus. 

Signs and Symptoms

The time period from HIV infection to its progression to AIDS is not consistent. Scarcely, people infected with HIV  develop difficulties that will lead to AIDS within a period of 1 year. Moreover, some other individuals show no symptoms, asymptomatic, for a period of 20 years. The advancement of infection from HIV to AIDS, without antiviral therapy, is about 8-10 years. The time period that takes for an individual to develop AIDS, thus varies. The rationale behind this yet remains unknown and is an active area of research currently.

Many individuals will first experience the diverse symptoms of acute infection within a couple of weeks. The symptoms are generally like the symptoms of influenza which include mild fever, pain and aches that has the tendency to become very severe too. The most common symptoms of HIV infection that a person infected may experience are:-

  • Fever
  • Muscle and joint aches
  • Sore throat
  • Swollen lymph nodes in the neck.

 Nevertheless, the reason behind why only some individuals with HIV infection develop these symptoms remain unknown. Additionally, the link between these symptoms, which one may experience or not,  and the disease that will follow suit in the near future, remains unknown too. After the primary infection, the individuals with the infection will subsequently go through a “no-symptom” phase, commonly known as asymptomatic. When the patient is tested at this stage, although he or she might have symptoms of primary infection, antibody  testing will yield a negative result. This is during the first few weeks of infection. If the medical doctor suspects infection due to the symptoms the patient experiences and due to exposure to HIV that might have taken place recently, the doctor will order other tests. The medical doctor will order tests that will look for the virus of interest that will circulate the blood system. A viral load test or assay test (antibody/antigen combination test) that will recognise the HIV antigen will be ordered. 

Identification of primary infection in patients is of particular importance in order to give the best possible treatment for the patient at an early stage and also to avoid transmission of the virus to others. This is of high importance as the patient with primary infection will have very high levels of the HIV virus in their body making them extremely infectious. When the individual is in the aysmptomatic stage, he or she can find out if they are infected or not through tests. Generally, a test to detect HIV antibodies will be undertaken.

As mentioned previously, patients are subjected to an asymptomatic period that can last for years shortly after primary infection. At this phase, the immune system of the affected individual deteriorates due to the CD4 cells which will decline progressively. Thus, other mild symptoms of HIV manifests and may include fungal infections like vaginal or oral candidiasisthrush, fungal infection of nails, hairy leukoplakia, persistent rashes, fatigue, loss of weight and diarrhoea. When the individual experiences these symptoms, a test for HIV should be performed abruptly, if for some reason it has not been done.

As the immune system progressively deteriorates, the patient will experience more severe symptoms and complications of HIV which may include other serious infections, serious weight loss problems, malignancy and deterioration of mental function. Clinically, HIV is categorised into three: experiencing no symptoms, mild symptoms and severe symptoms.

Transmission and Prevention

Nearly all persons infected with HIV, even if they exhibit any symptoms or not, will have the HIV viruses  in inconsistent levels in their blood and genital discharges. HIV can be transmitted through contact of these discharges from infected persons with the tissues lining the orifices in the body (the vagina, anal area, mouth, eyes any cuts in the skin etc) of a non-infected person. There are many methods for the spread of HIV and the most frequent of these are through sexual interaction, sharing of needles, from an infected mother to her baby (at the time of pregnancy, delivery, or breastfeeding).

Sexual spread of HIV can be from men to women, women to men, men to men or women to women. This could be through vaginal, anal and oral sex. In order to protect one’s self from sexual transmission of HIV, it is advised that one abstains from any sexual contact with one’s spouse or partner until it is certain that they are HIV-uninfected. It is important that both the partners test themselves for HIV for a period of 12-24 weeks following their most recent possible disclosure to the virus. This should be done  as it can take up to several months for the virus to be detected through the HIV antibody tests. If one is unable to abstain from sexual interaction or intercourse one can seek protection by the use of latex barriers. The usage of condoms during sexual intercourse will act as a barrier and will not let any ejaculatory secretions from an infected person coming into contact with any of the orifices of his or her sexual partner.

The transmission of HIV through HIV contaminated blood is generally by means of  sharing needles during the use of prohibited drugs and or anabolic steroids which are used to enhance the development of muscles. Other methods of transmission include piercing body parts, tattoo arts etc. The transmission of this infectious virus and other ailments like hepatitis can be easily avoided by using sterilised needles or having one needle per individual. At the start of the HIV outbreak, several individuals infected were those who had transfusions or donations of blood or components of blood. For instance, blood and its constituents were used for haemophiliacs, that lead to HIV. This method of contracting the deadly virus is now very rare in the US as blood or other blood components are well tested and screened for antibodies to HIV and the HIV itself prior to any transfusion or donation.

The possibility of contracting HIV through ordinary contact with infected individuals has shown to be very unlikely. Kissing too is usually regarded to be risk free, but the presence of open sores, cuts or blood in the mouth can lead to the contraction of HIV. Studies have shown that the content of HIV in saliva to be very low in comparison to genital discharges, this explains why kissing is usually regarded risk free. HIV can be found in large quantities in blood so it is always advisable to be cautious when sharing other objects that can cause cuts or bleeding; these include razors, shaving equipments, scissors, toothbrushes etc. Therefore one should refrain from sharing such objects with infected persons. Likewise, with no sexual contact or direct exposure to blood with an infected person, the danger of contracting the disease in a school or working environment is very unlikely.


Back in the mid 1980s, a blood test was found that could detect the antibodies to HIV in the body. These antibodies become available as a result of the immune response that will be generated to a foreign particle, in this case the HIV virus. The test that is almost always used to detect and diagnose HIV infection is the ELISA. When ELISA shows a positive result for HIV antibodies, the results will be confirmed again using another test called the Western blot. These tests that utilise the antibodies produced by the immune system in response to HIV infection is the best test out there to detect the infection.

Currently, tests are becoming more advanced. The antibodies can now be detected in the saliva of the patient and test results can be given out within 20 minutes. FDA approved OraQuick home HIV antibody test is available which only requires saliva to test a patient for HIV infection. This has resulted in an increased number of people being tested for this infection.

The immune system triggers antibody production against the virus within a couple of weeks. As previously mentioned, during this period of primary infection, the antibody test will show negative results. This period is referred to as the window period. At this stage, diagnosis can be carried out if a test used detect the virus in the blood and not the antibodies is available. These tests can be for HIV RNA or p24 antigen. Lately, a new test has been developed and approved; this test can not only detect HIV antibodies but can also detect the p24 antigen. Therefore, the window period is considerably reduced as diagnosis can be made earlier. Furthermore, many testing centres are available in the country who perform routine check ups on blood samples that are HIV antibody negative for HIV RNA.

Despite the fact that the tests are constantly improving for HIV detection, it still needs volunteers who would come up for testing. It is reported that about 20% of the HIV virus infected individuals in the United States are ignorant of their condition as they have never been tested for it. Consequently, the Centre for Disease Control and Prevention urged the  general population to test for HIV when they are in need of the health care system for any medical condition. Individuals who are between 13-64 years only were urged to do so. Moreover, any information and other resources were made available to the public by their local centres for HIV testing.


No cure is available for HIV infection or for AIDS. However, a number of medications are available which can be used in combination. The drugs are aimed to control the virus. Currently, 32 antiretroviral drugs, or ARVs, are available that are approved by the FDA for HIV infection. The drugs control and suppress the virus to undetectable levels. However, the drugs are not able to completely eradicate the virus out of the body. This suppression of the virus can make the patients live longer and healthier lives.

Treatment should commence when the patient has severe symptoms, the CD4 count is below 500, if the patient is pregnant, the patient has kidney disease related to HIV and when the patient is treated for hepatitis B. Treatment is not all that easy. The treatment plan prescribed for the patient will require him or her to take a variety of drugs at a specific time every day forever. Side effects to this treatment include abnormal pulse rate, nausea, vomiting, diarrhoea, skin rash, weak bones and death of bones which is commonly seen in hip joints.

How well a patient is responding to the administered treatment will be determined by the viral load and CD4 counts. Viral load is generally tested at the very beginning of treatment and every 3-4 months during treatment. On the other hand, CD4 counts will be checked and monitored every six months. The main aim of HIV treatment is to decrease the viral  load drastically to undetectable levels in the body. It is important to understand that the patient is still capable of transmitting the HIV virus to others although his or her levels are undetectable.


The Human Immunodeficiency Virus (HIV) is a retrovirus that pass infection to humans when it is in touch with human tissue like mouth, eyes, vagina, anal area or cut in the skin. The infection progresses slowly where the virus will be present in the body at all stages. Since the outbreak of HIV, 70 million individuals have been affected by the HIV virus where statistics show that around 35 million people have died from AIDS.  The most common symptoms of HIV infection that a person infected may experience are fever, muscle and joint aches, sore throat and swollen lymph nodes in the neck. Currently, tests are becoming more advanced. The antibodies can now be detected in the saliva of the patient and test results can be given out within 20 minutes. No cure is available for HIV infection or for AIDS. However, a number of medications are available which can be used in combination. The drugs are aimed to control the virus.Side effects to this treatment include abnormal pulse rate, nausea, vomiting, diarrhoea, skin rash, weak bones and death of bones which is commonly seen in hip joints.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE



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What is Toxoplasmosis?

Toxoplasmosis, or toxo, is a type of infection that arise due to a unicellular parasite called Toxoplasma gondii. This infection is typically acquired when one is in close proximity to cats or their faeces or when one consumes raw or uncooked meat. 

The U.S Centres for Disease Control and Prevention (CDC) has reported that more than 60 million individuals in the United States are likely to carry the parasite causing this infection, Toxoplasma gondii. However, only a few will display its symptoms due to a healthy immune system which will keep one being afflicted with  the illness.


  •  Causes of Toxoplasmosis
  • Risk Factors of Toxoplasmosis
  • Symptoms of Toxoplasmosis
  • Toxoplasmosis in Babies
  • Diagnosis of Toxoplasmosis
  • Prevention of Toxoplasmosis
  • Treatment for Toxoplasmosis
  • Cats
  • Prognosis for Toxoplasmosis
  • Conclusion

Causes of Toxoplasmosis

The parasite, Toxoplamosis gondii,  can be acquired by a few ways that will result in toxoplasmosis:

  • When in contact with cat or their faeces.
  • Consuming food that is raw or undercooked.
  • Drinking raw milk from a goat that is infected with the parasite. This can occur as goats are said to be intermediate host for this parasite.
  • Blood transfusion or organ transplantation from a person that has toxoplasmosis.

 Risk Factors of Toxoplasmosis

There are several situations that can make an individual vulnerable to acquiring toxoplasmosis. The following situations outline some of the risk factors:-

  • Touching your mouth with your hands after cleaning cat’s litter, gardening or any other situations where one may come into contact with cat’s faeces.
  • Consuming food that is raw or undercooked, particularly pork, lamb or venison.
  • Usage of kitchen utensils or others that have not been thoroughly cleaned after they have been in contact with raw meat.
  • Consuming goat milk that is considered raw.
  • Touching your mouth with your hands after handling raw or undercooked meat.
  • An individual who has had organ transplantation or blood transfusion.

It is important to note that, a pregnant woman infected with toxoplasmosis can transmit the parasite to the baby. This can result in dreadful complications.

Symptoms of Toxoplasmosis

Many individuals afflicted with this infection are not conscious of having it. Having mentioned that, the symptoms of toxo are flu like which include lymph nodes that are swollen, muscle aches and pains which may last from a few days to a couple of weeks. If you have a proper active immune system you may not be afflicted with this infection again during your lifetime.

A number of people will show symptoms of toxo. This is mainly due to the immune system which limits the parasite from causing any illness. Nevertheless, an individual who possess a compromised immune system  is at  considerable risk for being afflicted with serious consequences of toxo. These people include ones with immune system disorders, HIV, AIDS, patients undergoing chemotherapy as well as patients who were subjected to an organ transplant. It is important to understand that these patients are at risk of attaining the infection again which will cause serious problems of toxo. Problems include considerable damage to the eye, brain or other related organs. Ocular toxoplasmosis is a type of toxo that causes  damage to the eyes like blurred vision, reduction in vision, pain (mostly in brightly lit areas), eye redness and tearing (information provided by CDC).

Toxoplasmosis in Babies

Congenital toxoplasmosis is a condition where the foetus is infected with the parasite. The immune system of foetuses are not fully developed. The baby has a fully mature immune system only after birth. Thus, pregnant women who were exposed to this parasite in the first few months or during their pregnancy  is at high risk of attaining this infection.

The Organisation of Tetralogy Specialists have reported that the foetus has a 20% chance of getting the infection if the mother if affected with toxo. Furthermore, when the pregnant woman contracts the parasite causing this infection in the first trimester, the foetus has a 10%-15% chance of getting infected too. Statistics of toxoplasmosis have shown that in the United States alone, 4,000 babies are born with this infection in a year. Additionally, women who get infected 6 months prior to pregnancy are not likely to transmit the parasite to the unborn child.

Newborn babies show no symptoms of the infection. However, a small percentage of the babies infected are born with brain damage or congenital eye damage. Regrettably, the signs and symptoms pertaining to the infection appear only a few months after birth. Certain signs of toxo like jaundice, skin rash and lymph node enlargement may be seen at birth.

Babies who are born with this infection can exhibit:-

  • Mental retardation
  • Convulsions
  • Spasticity
  • Cerebral palsy
  • Deafness
  • Impaired vision
  • Microcephaly- abnormally small sized head
  • Hydrocephalus- abnormally large sized head due to high pressure on the brain.

Diagnosis of Toxoplasmosis

Toxoplasmosis is diagnosed through a blood test. The blood test will indicate the presence or absence of the parasite in the blood, Toxoplasma gondii. The results will also help the doctor assess the patient’s condition. For instance, it will indicate whether the patient contracted the parasite recently, also known as acute, or not.

Prevention of Toxoplasmosis

Toxoplasmosis generally cause mild symptoms and at times no symptoms at all.  A healthy and a fully developed immune system eradicates the parasite causing the infection from the body; therefore most people should not worry about attaining this type of infection. No vaccine for toxoplasmosis is available at the moment.

Nonetheless, if you are suffering from any type of condition affecting the efficiency of the immune system or if you are pregnant the following steps should be taken to prevent  getting toxoplasmosis:

  • If your immune system is compromised; get a blood test. The results will indicate if you have the  infection or not. If you are positive for the toxoplasmosis parasite, your doctor will proceed with necessary medication to prevent getting the infection again.
  • Women who plan to get pregnant can consider being tested for this parasite.
  • A pregnant woman should discuss the risks of being infected with toxo with her doctor. The doctor may ask for a blood test.
  • One must wear gloves and other necessary protective clothing when gardening or doing outdoor activities that involve handling soil. Cats use sandboxes as litter boxes which may increase the risk of contracting toxo. One should wash his or her hands with warm water and soap after such activities. It is very important to adhere to such practices before eating and before preparing food.
  • People who are at risk should allow someone else to handle  raw food. If no one is available to do this task on your behalf, you may wear latex gloves and wash with hot water and soap the cutting boards, sinks, knives and other kitchen utensils that was in contact with raw meat. After the task is completed, wash hands thoroughly with soap and warm water.
  • Meat should be cooked thoroughly.

Treatment for Toxoplasmosis 

When your diagnosed with toxoplasmosis it is important to discuss with your doctor the necessary steps to be undertaken henceforth. One such issue is to determine whether treatment is necessary at this stage. In healthy individuals who are not pregnant, treatment is not needed. Symptoms that arise will generally disappear in a couple of weeks. However, individuals with weak immune systems and pregnant women are usually treated with drugs  which will treat the parasite causing the infection. Patients who have HIV require lifelong treatment to keep the parasite from causing adverse effects.


Taking cats to be your pets doesn’t cause any serious issue unless you are having immune system disorders or if your pregnant. Cornell College of Veterinary Medicine has stated that there are several steps that can be undertaken to prevent the infection from arising.

Primarily, as a preventative step you can protect your cat from being exposed to the toxo parasite. Keeping cats indoors and feeding them dry or canned food are few of such preventative steps. It is important to understand that cats can be easily be exposed or infected by the parasite when it consumes raw and undercooked meat that contains the parasite. It can also be infected when eating rodents and birds that carries the toxo parasite. However, if your cat cannot be kept indoors and has a tendency to roam about the neighbourhood; make sure to keep the cat off beds, pillows and other types of furniture around the house that you may use. Additionally, when bringing a new cat into your household don’t bring one that has been an outdoor cat or one that has been fed raw meat as it may carry the parasite. Stray cats and kittens should be avoided and not taken into your home. You can also test your cat and check for the parasite. You can discuss with your vet any other questions you may have about cats and toxoplasmosis and discuss preventative care to be taken in order to avoid being infected.

Video of Toxoplasmosis

Video of Toxoplasmosis

Importantly, if you are having immune disorders or if you are expecting, allow someone else who do not fall into either of these categories to change your cat’s litter box. However, if this is not possible for you, wear latex gloves and clean the litter box on a daily basis as the parasite which will be in the infected cat’s faeces requires a couple of days after being excreted to become infectious.  After performing this task, wash your hands thoroughly with warm water and soap.

Another important question to address is if the infected cat will most definitely spread the infection to its keeper. The answer is no. Cats will only transmit toxoplasmosis after a few weeks after being infected with the parasite. Your cat will not show any signs or symptoms of toxo when first infected which is the case in humans too. As a result, most individuals owning a cat do not know that the cat is indeed infected as their cat will appear healthy with no apparent symptoms. In addition, there are no accurate tests available to detect the parasite in cat’s faeces. 

Prognosis for Toxoplasmosis 

Majority of people (around 80% to 90%) who get afflicted with this infection will not have serious adverse long term effects. Prognosis of a foetus or infant that is infected with this parasite is quite variable and solely depends on how severe the infection is. The prognosis is worse for foetus which gets infected at an early stage. When a pregnant woman carries a foetus that is quite severely infected she may undergo a miscarriage. Newborns can also be born with problems related to their mental or physical well being. Additionally, patients with weakened immune systems also have a variable prognosis which solely depends on how well they respond to treatment. HIV patients and other patients with permanent immune system disorders will have to adhere to treatment plans for life.


Toxoplasmosis, or toxo, is a type of infection that arise due to a unicellular parasite called Toxoplasma gondii. This infection is typically acquired when one is in close proximity to cats or their faeces or when one consumes raw or uncooked meat. The parasite, Toxoplamosis gondii,  can be acquired by a few ways that will result in toxoplasmosis: when in contact with cat or their faeces, consuming food that is raw or undercooked etc. It is important to note that, a pregnant woman infected with toxoplasmosis can transmit the parasite to the baby. This can result in dreadful complications. The symptoms of toxo are flu like which include lymph nodes that are swollen, muscle aches and pains which may last from a few days to a couple of weeks. Congenital toxoplasmosis is a condition where the foetus is infected with the parasite. Toxoplasmosis is diagnosed through a blood test.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE



Click here for PDF



We welcome your comments at the end of the article.



The Team Manager Web Diseases




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What is Impetigo?

Impetigo is a highly contagious bacterial skin infection caused by Staphylococcus (staph) and Streptococcus (strep). Impetigo is fairly more common in children and pre schoolers, 2-5 year olds, than in adults. The infection can flare up in a warm and humid environment and most times spread through close contact like in the case of family members. 

  • Types of Impetigo
  • Diagnosis of Impetigo
  • Is it Contagious?
  • Available Treatments for Impetigo
  • Complications of Impetigo
  • Prevention of Impetigo
  • Conclusion


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Types of Impetigo

Two forms of impetigo are reported namely bullous impetigo and non bullous impetigo. The two forms are explained in detail below:-

  • Bullous Impetigo- This type of impetigo in children result from the staph bacteria. Staph bacteria produce a type of toxin that will affect cell adhesion. Cell adhesion is the binding of one cell to another. The toxins affect cell adhesion in such a way that a  separation between  the two layers of skin is observed, the  epidermis which is the outermost layer of skin and the dermis the lower layer of skin. This separation results in blisters medically referred to as bulla. Blisters or bullae can arise in many parts of the skin. Most of the time it can be seen in the buttocks as well as the trunk region. The bullae are easily broken and contain a clear yellow liquid inside. Due to its fragility, once broken it may expose red and raw skin. During the final stages, a dark crust may be observed. During the time of healing, the dark crust will break down.
  • Non Bullous Impetigo- This is the most common form of impetigo. Non bullous impetigo can result from both types of bacteria mentioned afore, staph and strep. In the beginning, small red papules will be seen which are quite similar to insect bites. These abrasions quickly progress to small blisters. From blisters it will in turn progress to pustules which will have a characteristic crust, honey coloured, over a scab. It takes about a week for this process to transpire. These abrasions or lesions most of the time occur close to the nose and on the face. Having said that, non bullous impetigo may occur in other areas like the arms and legs which are less commonly seen. From time to time, one may report swelling of lymph nodes or glands that are situated nearby the infection.

Diagnosis of Impetigo

A health care professional will diagnose impetigo based on clinical appearance of the condition. Thus, diagnosing impetigo is not that complex and is quite straightforward. However, in some occasions other medical conditions may bear a resemblance to impetigo. For example, infections that arise due to ringworm called tinea or mites called scabies may be mistaken for or misdiagnosed as impetigo. Thus, one should undertstand that not every blister that may arise in one’s body is an infection from impetigo. Occasionally, other types of infections or skin diseases can produce tissue inflammation resulting in blisters. For instance, conditions such as herpes, poison ivy, eczema, allergies of skin, bites if insects, chickenpox,etc may result in blisters. Additionally, one may encounter with secondary infection of these skin lesions. Health care professionals may require culture tests and other forms of medical evaluation techniques may be used to  determine if the patient will need only topical antibacterial creams or whether he or she should prescribe oral antibiotics too.

Is it Contagious?

Yes, impetigo is contagious. One may acquire impetigo due to direct contact with a person who already has the condition. Popular ways of transmission include clothes and towels, toys or household utensils. It is important to understand that impetigo has the ability to spread to other areas of one’s body. This is a very common phenomenon among children with impetigo. In addition, mini epidemic outbreaks of the condition can occur in day care centres. Bacteria, namely staph or strep, can enter the body through a break or opening in the skin which most of the time occur from cuts or scrapes. A toddler is often afflicted with the condition as a result of inflammation of nasal openings due to drainage of the nasal area that comes about as a consequence of a cold.

In this case, the coherence or the integrity of the skin is severely is damaged due to the unceasing covering of nasal discharge that is said to be purulent. As a result, adults can be afflicted with this condition due to direct contact with children who are infected. Humidity, heat and existence of eczema can make one vulnerable to the infection which result from impetigo. Repetitive infections may be suffered by some. This is due to the presence of bacteria, strep or staph, occupying certain areas of the nose and which may spread to other regions of one’s body. 

 Available Treatments for Impetigo 

It is important to note that impetigo is not a serious condition and therefore is easily treatable. Mild forms of the condition can be treated by light cleansing of the affected area, removal of the dark crusts on scab and by applying prescribed antibiotic ointments by the medical doctor. Other non-prescription over the counter ointments that are available are usually not very effective against impetigo. Severe forms of impetigo, like in the case of bullous impetigo, one may require antibiotic medications to get better. This form of medication is taken orally.

Lately, scientists have discovered that  the bacteria causing impetigo, especially staph, have acquired resistance to a number of antibiotics prescribed to patients. Therefore, a health care professional may require bacterial culture tests in order to make a proper decision. These tests help the medical doctor to assess the need of oral therapy in one. Penicillin derivatives and cephalosporins are some of the antibiotics that are said to very effective against the condition. When the medical doctor obtain the results of a bacterial culture, he may assess it thoroughly and may suspect other types of bacteria that may be present. Staph bacteria, which are drug resistant, may show up. In this case other antibiotics are used. Thus, treatment of impetigo is chiefly guided by laboratory results such as culture tests and antibiotic sensitivity tests.

 Complications of Impetigo

A serious complication of impetigo that may arise in one and which is caused by the strep bacteria is glomerulonephritis. This condition results in the inflammation of the kidneys which is a serious condition. However, one being afflicted with glomerulonephritis as a result of impetigo is very rare. Additionally, many physicians and specialists in this area of medicine are not quite convinced that the treatment of impetigo will help in the prevention of kidney inflammation.

 Impetigo and Scars

The blisters and dark crusts that arise from impetigo are only superficial. This means that it will not leave any scars behind once the condition is treated. The skin that was damaged will have a red appearance after the crusts are gone. However, this redness will last for a couple of days or weeks only.


Video of Impetigo

Prevention of Impetigo

The most effective way of preventing one from acquiring this infection is by regularly washing hands with warm water and soap. This is an effective way of preventing the spread of infection. Other ways of preventing the spread of infection is by using a clean set of towels and washcloths each time you require it. In addition, one should not share towels, razors, clothes and other products with members of the family or friends. One should completely avoid touching oozing blisters to stop the spread of infection. After touching the affected area of the skin he or  she should wash their hands thoroughly.

Additionally, one should keep the skin clean to prevent impetigo. Minor cuts and scrapes should be cleaned with soap and water. Mild antibacterial soaps may be effective too.



Impetigo is a highly contagious bacterial skin infection caused by Staphylococcus (staph) and Streptococcus (strep). Impetigo is fairly more common in children and pre schoolers, 2-5 year olds, than in adults. The infection can flare up in a warm and humid environment and most times spread through close contact like in the case of family members. There are two forms of the condition namely bullous impetigo and non bullous impetigo. Impetigo can be easily treated with prescribed antibiotics or antibiotic ointments. It is not a serious condition and scarring is very rare. A serious complication of impetigo that may arise in one and which is caused by the strep bacteria is glomerulonephritis. This too is rare. The most effective way of preventing one from acquiring this infection is by regularly washing hands with warm water and soap. One may acquire impetigo due to direct contact with a person who already has the condition. Popular ways of transmission include clothes and towels, toys or household utensils.



We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE



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We welcome your comments at the end of the article.



The Team Manager Web Diseases




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Gardnerella Vaginalis

What is Gardnerella Vaginalis?

It is a gram-variable rod, facultative anaerobic bacteria as it can appear as gram positive or gram positive. It was previously known as Haemophilus vaginalis, Coryebacterium vaginalis and finally renamed to Gardnerella vaginalis.

Gardnerella vaginalis is responsible for a disorder named Bacterial Vaginosis where the normal flora of women’s vagina is displaced by a group of other floras. Inother term, there will be an imbalance of bacterial in the vagina. Other bacteria that could cause this are Mobiluncus, Peptostreptococcus, Ureaplasma, Bacteriodes, Prevotella, Veillonella, Eubacterium and Mycoplasma hominis.The mechanism of vaginal flora imbalance is not clear and understood yet.

Bacterial vaginosis is the commonest cause for vaginitis and presents with acute symptoms for 50% of women. It is not considered a sexually transmitted disease because this can occur spontaneously; without sexually activity. Gardnerella vaginalis can be found as a normal flora of vagina in some women.

This is easily diagnosed and easily treated with antibiotics.


Gardnerella Vaginalis


  • Symptoms of Gardnerella Vaginalis
  • Pathogenesis of Gardnerella Vaginalis
  • Diagnosis and Investigation of Gardnerella Vaginalis
  • Treatment of Gardnerella Vaginalis
  • Prevention of Gardnerella Vaginalis
  • Complication of Gardnerella Vaginalis
  • Conclusion



Symptoms of Gardnerella Vaginalis

Infection of Gardnerella is usually at the vaginal, called bacterial vaginosis. Most women present with thin, greyish white discharge with fishy odour. The discharges are more prominent and copious after sexual intercourse and during menses. There can be symptoms of vaginal irritation such as itchiness, redness and edematous. Although it is rare, some women experience dyspareunia, which is pain at vagina during sexual intercourse. Not all, but it is common to have burning sensation during urination.

In some women, around 30% are asymptomatic.

For men with Gardnerella Vaginosis, they will too be asymptomatic.



Pathogenesis of Gardnerella Vaginalis

How Gardnerella vaginalis causes bacterial vaginosis is not clear as it is still in a debate. More studies and evidence suggest that the key component in this disorder is actually the biofilm produced by Gardnerella vaginalis. Some theorize that the adherence of Gardnerella vaginalis to the vaginal wall epithelium forms a net for other species of bacteria to take place and grow there.

A normal vagina flora has good amount of lactobacilli to produce hydrogen peroxide. When the amount of lactobacilli in the vagina decreases, overgrowth of vaginal anaerobs happens, this is usually the Gardnerella vaginalis. The pH of vagina increases to facilitate further growth of the organisms there. With this large amount of anaerobic bacterias, large amount of proteolytic carboxylase enzyme promotes squamous epithelial cell exfoliation and adherence of Gardnerella vaginalis. This will go into the cycle that promotes even more growth of Gardnerella vaginalis and other bacterias.



Diagnosis and Investigation of Gardnerella Vaginalis

It is important to seek medical care as many of vaginal discharge or irritations are symptoms of sexually transmitted disease. So it is advisable to seek treatment in a healthcare early, to not wait until complications develop.

There are many kits that can be found at the pharmacy or hospitals for a quick test of Gardnerella vaginalis. These tests are made in simple easy reading cards for the detection of Gardnerella vaginalis. Some are DNA probe based test for the concentration of Gardnerella vaginalis, testing for elevation of sialidase activity or test cards for proline-aminopeptidase.

A sample of discharge will be taken from the vagina for a few tests. The sample should be taken from swabs of sides of vaginal wall.


pH Test

It is a test where a pH indicator paper is used. A pH of 4.0-4.5 is normal and a pH of more than 4.5 is suggestive of Gardnerella vaginalis and Trichomoniasis.

There are also test cards that can be bought in pharmacy for quick testing. Although it is very sensitive for Bacterial vaginosis, one must remember that it is just a pH testing card. This result has to be correlated to the clinical symptoms and findings.



The obtained vaginal discharge sample will be prepared with normal saline and seen under a microsope. If more than 20% of clue cells are seen, then it is very suggestive of Bacterial vaginosis. Clue cells have granular appearance where bacteria, in coccobacilli form adhere to the squamous epithelial cells of vagina. They usually adhere at the edge of the epithelial cells giving a studded appearance.

If clue cells are seen with more white blood cells than epithelial cells, called leukorrhea, it is often associated with Chlamydia infection. Although not confirmative, it is advisable to get a STD screening done.


Whiff Test

The Whiff test is where a small portion of vaginal discharge is added with 10% potassium hydroxide. If a very strong fishy odour is present, it is very likely to be Bacterial vaginosis. This test is highly sensitive.



The culture of vaginal discharge is not indicated in the diagnosis of Gardnerella vaginalis or bacterial vaginosis. As Gardnerella vaginalis can be a normal flora in a healthy woman, so a culture will be positive in most women. Thus, culture plays no role in diagnosis of Gardnerella vaginalis.


Diagnosis Standard

The diagnostic standard in research uses Hay/Ison criteria for the evaluation of gram stain smear of vaginal discharges. But this uses more expertise, resources and very time consuming.

For that, most healthcare centres prefer to use the Amselcriteria, that is simpler and easier. This is because the test for the criteria is widely available in most hospitals and not expensive or time consuming.


Amsel criteria

Amsel criteria are often used for the diagnosis of Bacterial vaginosis. If 3 out of 4 criteria are present, then it is highly suggestive of Bacterial vaginosis.

  1. An appearance of thin vaginal discharge
  2. A vaginal pH of more than 4.5
  3. More than 20% of clue cells seen
  4. Positive Whiff test


Fast Tests

Affirm VP III

The Affirm VP III test is a DNA probe assay for detecting Gardnerella vaginalis at high concentration. It is a recommended test as it complements a physical examination of vaginal discharges’ appearance and pH testing. The best feature is that it takes less than 1 hour for the test result.


 OSOM BVBlue system

The OSOM BVBlue system is a test to detect the presence of high sialidase enzyme activity which is produced by Gardnerella vaginalis in vaginal discharge. This enzyme activity can also be produced by Mobiluncus, Bacteriodes and Prevotells. The result can be obtained between 10-20 minutes and is highly sensitive


FemExam Pip Activity Test

The FemExam Pip Activity Test card detects prolineamino peptidase activity of anaerobes, usually the Gardnerella vaginalis. It is also a very sensitive test. And the fastest test that yields result in less than 10 minutes.

There is also the FemExam pH and amines test card that detects the vaginal fluid pH where an elevation of pH is suggestive of Gardnerella vaginalis. This test is also one of the favourites as the result is ready in approximately 2-5 minutes.


 Other screenings

Although Gardnerella vaginalis or Bacterial vaginosis is not a sexually transmitted disease, it is important to remember that the commonest cause for vaginal discharge is sexually transmitted disease. It is good to have STD screening done if there is vaginal discharge and irritation.



Treatment of Gardnerella Vaginalis

Medical Treatment

Non pregnant patients

The recommended regime for Bacterial vaginosis is 7 day course of oral Metronidazole and vaginal Metronidazole gel and vaginal Clindamycin cream. The dosage for oral Metronidazole should be 500mg, to be taken twice a day. Metronidazole gel is recommended to be at 0.7% and Clindamycin cream to be 2%.

A single oral dose of high concentrated Metronidazole is not advisable.

Alternatively, if one is allergic to Metronidazole, oral Clindamycin can be taken. The dosage is recommended for 300mg twice a day for 7 days.


Pregnant patients

For pregnant patients, a lower dose of oral Metronidazole 250mg, three times a day is prescribed with vaginal Metronidazole gel and vaginal Clindamycin cream. It is important to have regular check up with a certified Obstetrician as there is a risk of preterm labour. This is to prevent preterm labour and other adverse outcomes of the pregnancy.

There is no role in screening all pregnancy with Gardnerella vaginalis. There is only indication for treatment when it is symptomatically diagnosed and investigated.


Asymptomatic patients

There is no indication for the treatment of asymptomatic patients unless she has an upcoming gynaecology procedure. Asymptomatic patients are well and has no risk of other infections.



Metronidazole is a commonly used antibiotic for anaerobic bacteria. When on a course of Metronidazole, it is important to not consume alcohol during the antibiotic course and 24 hours later to avoid disulfiram like reactions. The reactions include flushing of the skin, headache, nausea and vomiting.

Other side effects of Metronidazole are metallic taste in the mouth, transient neutropenia, prolonged INR and possibility of peripheral neuropathy. There is a chance of having an allergic reaction to Metronidazole although it is very rare. If such reactions present, please visit the nearest healthcare centre immediately.



Oral Clindamycin is usually take if one is allergic or cannot tolerate oral Metronidazole. However, oral Clindamycin has lower efficacy than oral Metronidazole. But, the vaginal Clindamycin cream is preferred more than Metronidazole gel. It is important to watchout for pseudomembranous colitis when Clindamycin is prescribed.



About 30% of women with Bacterial vaginosis will have recurrence after 3 months. While there is no solid cause for the recurrence, reinfection is possible but it is actually more likely to be due to failed eradication of the offending organism by the prescribed antibiotics.

For this group, a 2 week course of oral antibiotics is recommended with vaginal Metronidazole or Clindamycin cream.



Another important step is to stop douching or any other vaginal cleansing product as this will further displace the normal flora of the vaginal and cause more imbalance of the flora.


Sexual partners

There are no role and benefits in treating the male sexual partners as there is no association of women’s therapy response being influence by the treatment of her male sexual partner.

However, because of the high incidence of association of Bacterial vaginosis with sexually transmitted diseases, it is important to screen her male counterpart for sexually transmitted diseases.



Prevention of Gardnerella Vaginalis

Gardnerella Vaginalis infection or Bacterial vaginosis can be prevented by practicing a good vaginal hygiene. If one regularly uses a tampon during menstruation, it is advisable for a frequent change. A tampon usage of more than 6 hours predisposes to infection.

Any intrauterine device or diaphragm that is used during sexual intercourse should be cleaned before usage. The best will be using a sterile disposable device to minimise the risk of infection.

Douching is a common practice for some women. But excessive douching could displace the good and important flora in the vagina. This will cause an imbalance of flora that is predisposed to bacterial vaginosis.

A condom provides a barrier at the genitalia between men and women during sexual intercourse. Although not 100%, condom prevents the transmission of Gardnerella vaginalis from men to women or vice versa. As most men with Gardnerella vaginalisis asymptomatic, they would not know if they have them.

Finally, a monogamy sexual practice can prevent Bacterial vaginosis as it is more commonly associated with multiple sexual partners. This can also prevent sexually transmitted diseases.



Complications of Gardnerella Vaginalis

Gardnerella vaginalis infection is not a life threatening or chronic illness but it should be treated. If Bacterial vaginosis is not treated, this could lead to ascending infection. Pelvic Inflammatory Disease is not the complication, but it is closely association with sexually transmitted diseases. With that, STD could be undetected and leads to more adverse outcomes.

In pregnancy, there is a higher risk for premature labour with premature birth of a preterm baby. There could also be chorioamnionitis; the infection of amniotic fluid that could cause premature birth and predisposing the baby to sepsis. There could also be a postpartum fever experienced by mothers with Gardnerella vaginalis.




Although it is a mild condition and treatable, it is important to check for associated infections such as Gonorrhea and Chlamydia. About 60% of women with sexually transmitted disease have Bacterial vaginosis also.




We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

Click here for PDF

We welcome your comments at the end of the article.
The Team Manager Web Diseases




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Be the first to comment - What do you think?  Posted by Natalie C - April 22, 2013 at 20:18

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Scarlet Fever

What is Scarlet Fever?

Scarlet fever is an infection caused by bacteria; group A beta-haemolytic streptococci; called streptococcus pyogenes that is commonly seen in children from age 4-9 years old. This bacteria causes many other infections, commonly a sore throat and fever or an infected skin wound. It is a more common infection in children than in adult.

A very distinguish feature of Scarlet fever is the characteristic of the rash. The red skin rash that is usually at the chest, back and limbs. If diagnosed and treated early, Scarlet fever has a good outcome after being treated with antibiotics. Before the development and advancement of antibiotics, Scarlet fever has caused many deaths of young children in the past. However, even with advancement of antibiotics, complications of Scarlet fever can still happen and with mortality from severe infection.

scarlet fever

Streptococcus was first identified by Louis Pasteur and Theodor Billroth in 1870s. In 1884, a German physician named Friedrich Loeffler succeeding in relating Scarlet fever to streptococci by discovering the presence of streptococci found the in Scarlet fever patients. This association is later confirmed by Gladys Dick, George Dick and Alphonse Dochez.

In 1920s, Scarlet fever was known to be cause by group A streptococcus and its toxin. Scarlet fever was common then, and has caused many deaths of young children. After the discovery of penicillin, the incidence of Scarlet fever has dropped markedly with fewer deaths of young children from Scarlet fever.

Currently, Scarlet fever is only commonly seen in developing countries. Even so, the number of complications and mortality is much lesser compared to early 20th century. It is a notifiable disease in the United Kingdom.


  • Causes of Scarlet fever
  • Symptoms of Scarlet fever
  • Diagnosis and Investigation of Scarlet fever
  • Treatment of Scarlet fever
  • Prevention of Scarlet fever
  • Complication of Scarlet fever
  • Conclusion                                        

Causes of Scarlet fever

Scarlet fever is an infection caused by group A streptococcus, the streptococcus pyrogenes, a gram positive coccus. The strain of streptococcus pyrogenes will produce an exotoxin called erythrogenic toxin or pyrogenic toxin when it is infected by a certain bacteriophage. Scarlet fever is cause by the pyrogenic toxin, with exotoxin A that is most common. The bacteriophage T12 carries the exotoxin A and integrates into the streptococcal genome.

This infection is contracted by aerosol, inhalation of the bacteria from respiratory droplets of infected child. Another route of infection is by close skin contact. It is not a food borne or feco-oral disease.

This bacteria is also the culprit for rheumatic fever and ordinary streptococcal sore throat, but they produce different toxins.

In some children, they are labelled as asymptomatic carriers where the streptococcus pyrogenes is found in the upper respiratory tract; nose, ear and throat of the children but do not cause any symptoms.

By 10 years old, most children are protected by the acquired antibodies, which is why Scarlet fever is more common in the young children age less than 10.

Video of Scarlet Fever


Symptoms of Scarlet fever

In most cases, Scarlet fever starts with a high grade fever with chills and moderate to severe sore throat. Most fever peaks at the 2nd day and last for another two to three days. At the course of time, most will feel lethargic, fatigue, generalised muscle ache and fever. Some will have abdominal pain, nausea and vomiting. The cervical lymph nodes, which are at the neck region, can be enlarged and painful. In a small number of patient, Scarlet fever do not start with sore throat but starts with an infected skin wound.

After 2-3 days, a very distinguish rash that usually begins at the chest and back will appear. Then, the rash will spread to the upper limbs and lower limbs in a couple of days. The face will also look flushed with red cheeks. This rash appears blotchy red and generalised small elevations are felt on it, or felt like a rough patch, known as maculopapular patch. The skin has a feel similar to sand paper when touched.  When pressed with pressure, the skin blanches, where it turns pale and the colour returns when the pressure is lifted.  For most children, the rash does not itch.

After a week, the rashes will slowly disappear and then there could be peeling of the skin on fingers and toes, armpits and groin area called desquamation.

Pastialines, can be seen at the armpits, inguinal region or at the antecubital area. These lines are due to the hyperpigmentation of the skin; often appear at the same time as the maculopapular rash. In some, the capillary is fragile and may even rupture.

There can also have an appearance of very bright red tongue or known as strawberry tongue. The tongue is coated by a layer of white membrane with red edematous papillae, similar to the bright red colour of strawberries. There could also be forchheimer spots, which is small red spots that appears on the soft palate. The pharynx (back of the throat) and the tonsils will looks inflamed red or sometimes have exudates or pus.


Diagnosis and Investigation of Scarlet fever

Clinical Diagnosis

The diagnosis of Scarlet fever can be made clinically, by the description of symptoms and the clinical examination of the rash, throat and lymph nodes.


Throat swab

A throat swab is usually done and sent for rapid test for the presence of streptococcus. It is important to swab only the posterior pharynx and tonsils, avoiding other structures in the mouth. This test is very sensitive for Scarlet fever when done correctly.

If the rapid test is positive or highly suspicious for Scarlet fever, the throat swab will be sent for a culture as it could isolate the culprit bacteria. A rapid test takes minutes to be complete but a throat swab culture takes at least 48 hours for growth.


Full Blood Count

The test will show an elevation of total white cells with predominance of neutrophils. At 2nd week, there could be an elevation of eosinophils in some patients.


Antistreptolysin O titre

This is a blood test to check the titre of antistreptolysin O antibody which is produced against streptolysin O, a oxygen labile haemolytic toxin. A raised level indicates a present or past infection of group A streptococcus. A raised of titre in paired blood samples are more significant as the antibodies rise after 1-3 weeks and peak at the fifth week.

When evaluated together with clinical diagnosis, this is an excellent test for Scarlet fever and Rheumatic fever.


Blood culture

It is not a common investigation to do a blood culture, but it is usually done in severe infection or when the diagnosis is unclear. In some cases where the infection is so severe that the bacteria enters the blood stream, which is sterile in healthy humans.  When the blood culture grows bacteria, it is called group A streptococcus bacteremia.


Urine FEME

This examination is to watch out for proteins in the urine which is seen in glomerulonephritis, a complication of Scarlet fever.



Treatment of Scarlet fever

It is very important to be well rested for a speedy recovery. A couple days of bed rest, adequate amount of oral fluids and oral antibiotics will be sufficient. Paracetamols are excellent to reduce the fever and sore throat.

If detected and diagnoses early, Scarlet fever is easily treatable with oral antibiotics as outpatient. If the infection has spread with complications, hospital admission is required for close monitoring and intravenous antibiotics.

The goal of treatment is to shorten the duration of the illness, to minimize the spread of streptococcus, to prevent Rheumatic fever, glomerulonephritis and other complications.


Oral antibiotics

The oral antibiotics used are the same as those used to treat streptococcal sore throat. As most streptococcus is sensitive to beta-lactam antibiotics, oral penicillin or amoxicillin is the drug of choice with the duration of 10 days. Early start of antibiotics is very effective and prevents complications from taking place. It is important to remember that some streptococci are resistant to penicillin, thus needing macrolides or cephalosporins.

If one is allergic to penicillin, macrolides such as erythromycin can be taken. Clarithomycin and Clindamycin are also often used. A shorter course of Azithromycin for 5 days has gain popularity and is very effective.


Intravenous antibiotics

When there is a distant spread of infection with complications, intravenous antibiotics are indicated to prevent severe outcomes. Intravenous antibiotics that could be used are penicillin, cephalosporin and macrolides. It is important to check for sensitivity and resistance of streptococcus to the selected antibiotics to ensure efficacy.



If there is peritonsillar abscess, surgical drainage is indicated to prevent further complications. A more aggressive intravenous antibiotic is indicated for these patients.



There is no role for prophylaxis of Scarlet fever. For individuals that have close contact or exposure to Scarlet fever, it is important to be watchful for symptoms. If there is any symptom of Scarlet fever, medical treatment should be sought immediately. This is especially in young children, less than 5 years old. Most adult will not be affected.



Currently, there are no vaccines available for protection against streptococcus pyogenes. There have been many attempts to develop the vaccine but all have failed. The difficulty to produce a vaccine is due to the huge variety of streptococcus pyogenes strains that is not possible to vaccinate a population.



Prevention of Scarlet fever

Since Scarlet fever is spread by the inhalation of respiratory droplets, it is important to avoid a close contact with the infected patient. Wearing a face mask could protect the respiratory droplets at a length.

Frequent hand washing and hygiene help to prevent contamination of daily used items. This is a great step to prevent a spread of Scarlet fever. It is also important not to share towels, linens, utensils and personal items to prevent a spread.

If infected, there should be a home quarantine where the infected person should not go to work, school or any public places to avoid the spread. However, most patients are not contagious after 24 hours on antibiotics treatment.



Complication of Scarlet fever

Most of the patients respond very well to antibiotics to achieve full recovery with no residual infection. However, some do not progress well to respond to the antibiotics. In these cases, severe complications can occur and even be life threatening.

The most common complication is sepsis, or bacteremia where the bacteria enters the sterile blood stream. Patient could go into septic shock and most would need an intensive care unit admission. Further complication from that will be a meningitis or brain abscess that has high morbidity and mortality rate. Although it is rare, intracranial venous sinus thrombosis could happen.

Not uncommon, pneumonia and empyema occur as a distant spread of streptococcus pyogenes.  Osteomyelitis or septic arthritis is rare but is seen in late treatment cases.


Toxin mediated

Toxin mediated complication that could happen is myocarditis and toxic shock like syndrome. This is common in children and could be lethal if not treated appropriately. Myocarditis and toxic shock like syndrome is the common cause for mortality in Scarlet fever.


Immune mediated

Immune mediated complications are erythema nodosum, Rheumatic fever and glomerulonephritis.  Glomerulonephritis and Rheumatic fever is a chronic disease that causes prolonged stay in hospital and lifelong follow up in medical care. With the effective treatment and eradication of Scarlet fever in developed nation, the incidence of Rheumatic fever and glomerulonephritis has decreased markedly.


Local spread

The local spread of the bacteria from the upper respiratory tract to the local surrounding tissues can cause pus pockets to form, called peritonsillar abscess.  A more distant spread causes mastoiditis, sinusitis and otitis media.




Scarlet fever is a common infection for children with excellent outcome when treated early with antibiotics. It is important to recognise the symptoms and proceed to seek early medical care to prevent complications.




We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

Click here for PDF

We welcome your comments at the end of the article.
The Team Manager Web Diseases




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Sexually Transmitted Diseases

What are Sexually Transmitted Diseases?

Sexually transmitted diseases or better known as STD or venereal disease is not uncommon. It is one of the commonest illness in the world with extensive impact to public health care and socially. As the rate of sexual activities increases with higher high risk sexual behaviour and not practicing safe sex, the incidence of STD s increases steadily each year. The World Health Organization estimates that 340 million people are infected each year by a curable STD.  STDs are mostly seen in young men and women, more in homosexual or bisexual men.

Although it could be very traumatising or embarrassing to seek medical help, it is very important to do so if suspected the sign and symptoms of STD. The healthcare staff also should be alert and be sensitive to ensure privacy and confidentiality.


  • Causes of STDs
  • Symptoms of STDs
  • Diagnosis and Investigation of STD
  • Treatment Chlamydia Trachomatis
  • STD Prevention
  • Conclusion

Causes of STDs

There is a long list of causes for STD, commonly bacteria, viruses, fungi and even parasites. These infections can be spread by all types of unprotected sexual activity that involves semen and vaginal discharges. It is not uncommon that one could get infected by multiple pathogens especially in those with high risk sexual behaviour.

A high risk sexual behaviour is characterized by multiple sexual partners, frequent sexual partner changes and unprotected sex.  STD has also been shown have higher incidence in young people, homo or bi-sexual men, recreational drug use, alcohol and frequent travels.

Bacterial STD

The commonest cause is Chlamydia Trachomatis, a intracellular obligate bacteria and Neiserria Gonorrhea, a intracellular diplococcic bacteria that infects epithelium of conjunctiva, pharynx, urogenital tract and rectum. They usually coexist together, thus the STD screening includes these 2 organisms.

Another common organism is Treponema Pallidum, a motile spirochetes that is not limited to genitourinary system but could cause systemic illness if not treated early. The common name for this infection is syphilis. It is acquired by close sexual contact and transplacentally to neonates.

A less common bacteria is Klebsiella Granulomatis,a gram negative bacillus, also known as granuloma inguinale.

Video of STD

Viral STD

The commonest virus is Human Papillomavirus (HPV) 6,11,16 and 18 that causes genital warts. Most HPV is acquired by direct sexual contact and neonates acquired them from the infected birth canal. Neonates may have anogenital warts or laryngeal papillomas from inhalation.

Another common viral STD is Herpes Simplex Virus (HSV) 1 and 2 that causes genital herpes. They are spread by mucosal exposure or non intact skin surface to the virus. Most genital herpes are cause by HSV 2 and oral lesion by HSV 1. With the increasing practice of oral sex, HSV 1 and HSV 2 are no longer confined to oral cavity or genitals.

Hepatitis B (HBV) and Hepatitis C (HCV) are DNA viruses that are spread by blood products and sexual contact. Although there are vaccinations, HBV and HCV remains endemic in Asia.

Human Immune Deficiency Virus (HIV) is RNA retrovirus that is transmitted by blood product, bodily fluid and sexual contact.  The acute infection is often asymptomatic or just a mild viral fever. The symptoms of illness are mainly due to complications of immunodeficiency.


Fungi STD

In women, vaginal infection of Candida Albicans is common and not necessary signify STD. However, it is not common for men to be infected. So, if a men presents with candida infection, he most likely contracted it during sexual activity.

Parasite STD

Phthirus pubis is a blood sucking insect, known as lice that cause pediculosis pubis. They are transferred by close contact to the host where they are attached to the pubic hair. These lice can also be found at the eyelashes and eyebrows.

Sarcoptes Scabiei, also known as mites is spread by close sexual contact or within the same household. It can affect any part of the body but rarely the face.

Trichomonas Vaginalis, a flagellates protozoa causes trichomoniasis, mostly in women. They are less common but has high prevalence of coinfection with other STDs.

Symptoms of STDs

There are many symptoms of STD, but the common symptoms that are presented are painful or painless urethral discharge in men, vaginal discharge and genital ulceration. Some women will have itching and redness at the vagina.

The common causative agents for urethral discharge in men are Neiserria Gonorrhea, Chlamydia Trachomatis, Trichomonas Vaginalis, HPV, HSV and Treponema pallidum.

The common causative agents for vaginal discharge in women are Neiserria Gonorrhea, Chlamydia Trachomatis, Trichomonas Vaginalis, HSV and Candida Albicans.

Genital Ulcerations in STD are caused by Treponema Pallidum, Chalamydia Trachomatis, HPV and HSV infection.

STD also causes miscarriages and fetal abnormalities. Pelvic Inflammatory Disease (PID) is the complication of untreated STD.

Chlamydia Trachomatis

In men, 50% of Chlamydia infections are asymptomatic. The symptomatic infection will cause anterior urethritis(inflammation of urethra) with dysuria and urethral discharge.  If the infection is not treated, it will ascends and cause epididymitis. Men who practise anoreceptive intercourse may experience proctitis.

In women, up to 80% are asymptomatic as infection in endocervix is difficult to be notices. Some will have vaginal discharge, lower abdominal pain or post coital bleeding. If left untreated, the infection will ascend to cause acute salphingitis. Most women will experience dysuria (pain during urination).

Neonates can acquire this infection through the birth canal and presents with mucopurulent conjunctivitis or pneumonia.

Neiserria Gonorrhea

In men, 90% are symptomatic with anterior urethritis is and urethral discharge. The ascending infection leads to epididymitis and proctatitis. Rectal infection causes pain, itch and discharges.

In women, up to 50% are asymptomatic. The infected site is usually the endocervix that could cause vaginal discharge. Ascending infection leads to dysuria, pelvic pain and intermenstrual bleeding. The complications of gonorrhoea include Bartholin’s abscess and Fitzhugh Curtis Syndrome that develops perihepatitis.  Gonorrhea is also the leading cause of infertility in women.

Neonates acquire gonorrhoea from their infected mothers and presents with opthalmia neonatorum, similar to conjunctivitis.

Treponema Pallidum

Treponema Pallidum is better known as Syphilis, which is a chronic systemic disease with 3 stages. The early stage of disease, or primary syphilis manifest as painless hard chancre(at infected site, usually at penile shaft or vulva) and painless regional lymphadenopathy. This lesion will resolve spontaneously.

If not treated, secondary syphilis will occur after 3 to 6 weeks with fever, rash, malaise and generalised lymphadenopathy.  The rash is red or brown in colour, non itching, usually starts from trunk and spread to the extremities, palms and soles.

Tertiary syphilis can occur 3 to 20years after primary syphilis. There will be generalised granulomatous lesions(gumma) at skin, bones and viscerals. Cardiovascular involvement manisfest as thoracic aneurysm or aortic regurgitation. Neurosyphilis includes meningitis and tabes dorsalis.

Congenital syphilis could cause still birth. Babies who survive often fail to thrive, has nasal discharge and mucous membranous lesion similar to secondary syphilis. In late stages, commonly after 2 years old, there could be facial gumma, Hutchinson’s teeth, abnormalities of long bone and uveitis.

 Klebsiella Granulomatis

The symptoms start late after an incubation period of 1 to 6 months. It begins with subcutaneous nodules at the genitals and subsequently progress to beefy red painless ulcerative lesion that is highly vascular and is easy to bleed. Commonly involve the genitalia, but any mucosa membrane can be affected, including mouth and anus. Painless lymphadenopathy accompanies too.


In men, warts (small painless nodules) develop at the penile shaft and subpreputial space and sometimes involving urethra and meatus. In immunosuppressed or men who practise anoreceptive intercourse, warts can be found in the perianal region and rectum.

In women, warts starts at the external genitalia and perianal region, and could ascend up to the vagina and cervix.


Genital Herpes is one of the commonest STD and the symptoms are easy to recognize.  Primary genital herpes starts with low grade fever, generalised malaise, myalgia and headache for a day. Then, the painful vesicles (blister like) starts to appear at the genitalia, crust after a few days and finally heal without scarring. The painful vesicles can also be found at thigh, buttock and perianal region. While both men and women will develop vesicles, most women will experience severe dysuria that could cause urinary retention.

Tender inguinal lymphadenopathy is often present. Aseptic meningitis can happen as neurological complication.


Hepatitis B & Hepatitis C

Around 50% of infected people will experience acute infection. They cause fever, generalized malaise, jaundice and hepatomegaly. Lymphadenopathy is also present with abdominal pain. Most acute infections are simple and not life threatening. It is the complication that is disabling. After acute infection, most will resolve, some will be chronic carriers with chronic hepatitis causing liver cirrhosis or liver failure. This predispose to hepatocellular carcinoma, or liver cancer.



Acute infection is often symptomatic. After seroconversion, most will have maculopapular rash, generalized myalgia, malaise and fever. Most will recover completely after 1-2 weeks. Some will proceed to have constitutional symptoms such as loss of appetite, loss of weight and night sweats. Few years later, or even later when the CD4 count drops, if untreated they will have symptomatic HIV infection, or AIDS – Acquires Immune Deficiency Syndrome. AIDS is defined by a list of infection or condition. Some common examples of AIDS defining conditions are candidiasis in trachea or lungs, extrapulmonary Cryptococcus infection,CMV, chronic HSV, Kaposi’s sarcoma, Burkitt’s lymphoma, disseminated tuberculosis, toxoplasmosis encephalopathy and many more.


Trichomonas Vaginalis

In men, they are usually asymptomatic. But some do complaint of mild urethral discharge and urinary frequency.

In women, some may be asymptomatic but most will experience offensive vaginal discharge and vaginal irritation.

Candida Albicans

In men, the affected region is usually around the foreskin causes itching and pain.

In women, itchiness and pain at the vulva is the commonest symptom. Depending on each individual, vaginal discharge may or may not be present. The vaginal discharge are curdy white thick discharges.

Phthirus Pubis

The symptoms usually start early with itching at the pubic area in both men and women. Very tiny bugs could be seen at the pubic hair or from undergarments.


Similar to pubic lice, the symptoms are intense itching at the pubic area in both men and women. Small moving bugs could be seen at the pubic hair or undergarments. Itchy papules and pustules are often seen with linear skin burrows.


Diagnosis and Investigation of STD

It is important to seek medical care if you suspect yourself being exposed to STD.  As most infections can be asymptomatic, it is crucial to be investigated early before being symptomatic or complications set it. Often times, STD could have multiple causative organism at once.

The investigations vary between symptomatic and asymptomatic individuals.

In asymptomatic women

A high vaginal swab is taken and tested for Gonorrhoea and Chlamydia by culture. A urine test is also done by Nuclei Acid Amplification Test (NAAT) for Gonorrhoea and Chlamydia. There are also simple urine test kits that can be taken at home if she feels shy to go to a clinic.

Blood test is taken for serology test of syphilis, HIV and Hepatitis.

In asymptomatic men

A urethral swab is taken for culture and also urine NAAT to test for Gonorrhoea and Chlamydia.

Blood test is taken for serology test of syphilis, HIV and Hepatitis.

In asymptomatic homosexual men

A urethral, rectal and oropharyngeal  swab is taken for culture and also urine NAAT to test for Gonorrhoea and Chlamydia.

Blood test is taken for serology test of syphilis, HIV and Hepatitis.


In symptomatic men

Swabs are taken from urethra, rectum and the oropharynx to test for Gonorrhea, Chlamydia and Trichomonas. Urine test for Chlamydia is taken as well as blood for seroly test of HIV, Hepatitis, HSV and Syphilis.

In symptomatic women

Swabs are taken from cervix, vagina, rectum and the oropharynx to test for Gonorrhea, Chlamydia and Trichomonas. Urine test for Chlamydia is taken as well as blood for seroly test of HIV, Hepatitis, HSV and Syphilis.

In the symptomatic patients will ulcers, a sample will be taken for microscopy examination to determine Treponema and Klebsiella, and also culture for HSV.

Other test that can be done for women includes a pregnancy test and cervical cytology – pap smear.



Chlamydia Trachomatis

1st line treatment is with single oral Azithromycim or oral Doxycycline for a week. Erythromycin, Oflaxacin and Levofloxacin can be used as alternatives for a week.

Neiserria Gonorrhea

1st line treatment is single oral Cefixime or intramuscular injection of Ceftriaxone. Other alternatives are intramuscular injection of Cefotaxime, Cefoxitin and Ceftizoxime.

Treponema Pallidum

A single dose of intramuscular injection of Penicillin G is the treatment. Oral Doxycycline and Tetracycline can be used as alternatives for 2 weeks.

Klebsiella Granulomatis

Oral Doxycycline for 3 weeks or longer; until complete healing of the ulcers. Other alternatives are oral Azithromycin, Ciprofloxacin and Trimethoprim-sulfamethoxazole.


There is no cure for HPV, therapies are only to reduce the size of warts. Topical cream of Podofilox, Imiquimod can be used externally. Cryotherapy and trichloroacetic acid can be administered by dermatologist.


Oral Acyclovir for 10 days is the standard treatment. Some centres uses Famciclovir which is equally potent.

Hepatitis B & Hepatitis C

There is only supportive treatment for infectious hepatitis. For chronic HBV carrier, Lamivudine is given depending on the case.


There is no cure for HIV. Highly Active Antiretroviral therapy (HAART) aims to supress the HIV RNA concentration to ensure immune function of the patient.  There are many other drugs that are still in experimental phase for better outcome.

Trichomonas Vaginalis

Single dose of oral Metronidazole is effective or some will opt for a week.

Candida Albicans

A single dose of vaginal pessary – Clotrimazole is sufficient or an oral dose of Fluconazole. Antifungal cream for external genitalia in men and women help with the itching.

Phthirus Pubis & Scabies

5% Permethrin is used to treat entire household and sexual partners. It is to be applied over whole body including neck and scalp, wash off only after 12 hours. The process has to be repeated a week later.



For pregnant patients, they should be cared in a combined prenatal clinic consist of infectious physician and also an obstetrician.  Oral penicillin, Ceftriaxone, Azithromycin and Metronidazole are safe in pregnancy.


Sexual Assault

For sexually assaulted patients, prophylaxis should be given after the investigations are done.  They will be given a single dose of IM Ceftriaxone, oral Doxycycline, Metronidazole and Azithromycin.  Hepatitis B vaccination should be given, and to complete a course of 3 injections. HIV prophylaxis is depending on the case.


STD Prevention

Sexual promiscuity is the main cause of STD. So, the prevention starts from avoiding sexual promiscuity, practicing monogamous sexual relationship.

Practicing safe sex with condoms has 90% protection from STD. This is because close sexual contact is not protected by a condom.

It is important to have regular check-up and early investigation if suspected STD. Vaccinations for Hepatitis B and Human Papillomavirus are available.



Prevention of STD is better than cure as some diseases are incurable.  Most of the common STD can be cured with simple medical treatment. So, it is important to seek help immediately if you suspect yourself having STD.


We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

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