n. a blister or large vesicle. A filtering bleb is a blister-like cyst underneath the conjunctiva resulting from a surgical procedure such as *trabeculectomy, used in the treatment of glaucoma.
In the wake of the devastating terrorist attacks on buildings in New York and Washington on 11 September 2001, modi?ed anthrax spores were sent by mail from an unidenti?ed source to some prominent Americans. Several people were infected and a few died. This was the ?rst known use of anthrax as a terror weapon.
Prevention is most important by disinfecting all hides, wool and hair coming from areas of the world. An e?cient vaccine is now available. Treatment consists of the administration of large doses of the broad-spectrum antibiotic, CIPROFLOXACIN. If bioterrorism is thought to be the likely source of anthrax infection, appropriate decontamination procedures must be organised promptly.
Symptoms
EXTERNAL FORM This is the ‘malignant pustule’. After inoculation of some small wound, a few hours or days elapse, and then a red, in?amed swelling appears, which grows larger till it covers half the face or the breadth of the arm, as the case may be. Upon its summit appears a bleb of pus, which bursts and leaves a black scab, perhaps 12 mm (half an inch) wide. The patient is feverish and seriously ill. The in?ammation may last ten days or so, when it slowly subsides and the patient recovers, if surviving the fever and prostration.
INTERNAL FORM This takes the form of pneumonia with haemorrhages, when the spores have been drawn into the lungs, or of ulcers of the stomach and intestines, with gangrene of the SPLEEN, when they have been swallowed.
It is usually fatal in two or three days. Victims may also develop GASTROENTERITIS or MENINGITIS.... anthrax
Symptoms Symptoms vary with the age of infection. In young infants, herpes simplex may cause a generalised infection which is sometimes fatal. In young children the infection is usually in the mouth, and this may be associated with enlargement of the glands in the neck, general irritability and fever. The condition usually settles in 7–10 days. In adults the vesicles may occur anywhere in the skin or mucous membranes: the more common sites are the lips, mouth and face, where they are known as cold sores. The vesicles may also appear on the genitalia (herpes genitalis) or in the conjunctiva or cornea of the EYE, and the brain may be infected, causing ENCEPHALITIS or MENINGITIS. The ?rst sign is the appearance of small painful swellings; these quickly develop into vesicles which contain clear ?uid and are surrounded by a reddened area of skin. Some people are particularly liable to recurrent attacks, and these often tend to be associated with some debilitating condition or infection, such as pneumonia.
Except in the case of herpes of the cornea, the eruption clears completely unless it becomes contaminated with some other organism. In the case of the cornea, there may be residual scarring, which may impair vision.
Treatment Aciclovir is e?ective both topically as cream or eye drops or orally. In severe systemic infections it can be given intravenously.... herpes simplex
Causes Shingles is due to the same virus that causes chickenpox. This invades the ganglia of the nerves, particularly the spinal nerves of the chest and the ?fth cranial nerve which supplies the face. Despite being due to the same virus as chickenpox, it is rare for herpes zoster to occur as a result of contact with a case of chickenpox. On the other hand, it is not unusual for a patient with herpes zoster to infect a child with chickenpox. It is a disease of adults rather than children, and the older the person, the more likely he or she is to develop the disease. Thus in adults under 50, the incidence is around 2·5 per 1,000 people a year; between 50 and 60 it is around 5 per 1,000; whilst in octogenarians it is 10 per 1,000. Occasionally it may be associated with some serious underlying disease such as LEUKAEMIA, LYMPHADENOMA, or multiple myeloma (see MYELOMATOSIS).
Symptoms The ?rst symptoms are much like those of any feverish attack. The person feels unwell for some days, has a slight rise of temperature, and feels vague pain in the side or in various other parts. Often the area of skin to be affected feels hypersensitive (hyperaesthesia) as though something were rubbing on it. The pain ?nally settles at a point in the side, and, two or three days after the ?rst symptoms, the rash appears. Minute yellow blebs – or vesicles, as they are known – are seen on the skin of the back, of the side, or of the front of the chest, or simultaneously on all three, the points corresponding to the space between one pair of ribs right around. These blebs increase in number for some days, and spread until there is often a complete half-girdle around one side of the chest. The pain in this stage is severe, but it appears to vary a good deal with age, being slight in children and very severe in old people, in whom indeed herpes sometimes forms a serious illness. After one or two weeks, most of the vesicles have dried up and formed scabs. The pain may not pass o? when the eruption disappears, but may remain for weeks or even months – a condition known as post-herpetic NEURALGIA. Old people are prone to develop this condition.
Treatment ACICLOVIR or famciclovir can be given orally, and are e?ective if started in large doses early in the attack. Later, topical antibiotics may be required. Analgesics may be necessary if neuralgia is severe.... herpes zoster
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