Septicaemia Health Dictionary

A localised collection of pus. A minute abscess is known as a PUSTULE; a di?used production of pus is known as CELLULITIS or ERYSIPELAS. An abscess may be acute or chronic. An acute abscess is one which develops rapidly within the course of a few days or hours. It is characterised by a de?nite set of symptoms.

Causes The direct cause is various BACTERIA. Sometimes the presence of foreign bodies, such as bullets or splinters, may produce an abscess, but these foreign bodies may remain buried in the tissues without causing any trouble provided that they are not contaminated by bacteria or other micro-organisms.

The micro-organisms most frequently found are staphylococci (see STAPHYLOCOCCUS), and, next to these, streptococci (see STREPTOCOCCUS) – though the latter cause more virulent abscesses. Other abscess-forming organisms are Pseudomonas pyocyanea and Escherichia coli, which live always in the bowels and under certain conditions wander into the surrounding tissues, producing abscesses.

The presence of micro-organisms is not suf?cient in itself to produce suppuration (see IMMUNITY; INFECTION); streptococci can often be found on the skin and in the skin glands of perfectly healthy individuals. Whether they will produce abscesses or not depends upon the virulence of the organism and the individual’s natural resistance.

When bacteria have gained access – for example, to a wound – they rapidly multiply, produce toxins, and cause local dilatation of the blood vessels, slowing of the bloodstream, and exudation of blood corpuscles and ?uid. The LEUCOCYTES, or white corpuscles of the blood, collect around the invaded area and destroy the bacteria either by consuming them (see PHAGOCYTOSIS) or by forming a toxin that kills them. If the body’s local defence mechanisms fail to do this, the abscess will spread and may in severe cases cause generalised infection or SEPTICAEMIA.

Symptoms The classic symptoms of in?ammation are redness, warmth, swelling, pain and fever. The neighbouring lymph nodes may be swollen and tender in an attempt to stop the bacteria spreading to other parts of the body. Infection also causes an increase in the number of leucocytes in the blood (see LEUCOCYTOSIS). Immediately the abscess is opened, or bursts, the pain disappears, the temperature falls rapidly to normal, and healing proceeds. If, however, the abscess discharges into an internal cavity such as the bowel or bladder, it may heal slowly or become chronic, resulting in the patient’s ill-health.

Treatment Most local infections of the skin respond to ANTIBIOTICS. If pus forms, the abscess should be surgically opened and drained.

Abscesses can occur in any tissue in the body, but the principles of treatment are broadly the same: use of an antibiotic and, where appropriate, surgery.... abscess

An infectious disease caused by a soil bacterium, Burkholderia pseudomallei, seen in many areas of the tropics and is particularly prevalent during the wet season. The illness may present in a number of ways including life threatening acute septicaemia as well as pneumonia and chronic suppuration, which has a lower mortality.... melioidosis

A skin rash caused by bleeding into the skin from capillary blood vessels. The discrete purple spots of the rash are called purpuric spots or, if very small, petechiae. The disorder may be caused by capillary defects (nonthrombocytopenic purpura) or be due to a de?ciency of PLATELETS in the blood (thrombocytopenic purpura). Most worryingly, the rash may be due to a fulminant form of meningococcal SEPTICAEMIA called purpura fulminans. (See also HENOCH-SCHÖNLEIN PURPURA; IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP); THROMBOCYTOPENIA.).... purpura

Gonorrhoea is an in?ammatory disease caused by Neisseria gonococcous, affecting especially the mucous membrane of the URETHRA in the male and that of the VAGINA in the female, but spreading also to other parts. It is the most common of the SEXUALLY TRANSMITTED DISEASES (STDS). According to the WHO, 200 million new cases are noti?ed annually in the world. In the UK the incidence has been declining since 1991; in 1999 the rate per million of population was 385 for males (599.4 in 1991) and 171.3 for females (216.5 in 1991).

Causes The disease is directly contagious from another person already suffering from it – usually by sexual intercourse, but occasionally conveyed by the discharge on sponges, towels or clothing as well as by actual contact. The gonococcus is found in the discharge expressed from the urethra, which may be spread as a ?lm on a glass slide, suitably stained, and examined under the microscope; or a culture from the discharge may be made on certain bacteriological media and ?lms from this, similarly examined under the microscope. Since discharges resembling that of gonorrhoea accompany other forms of in?ammation, the identi?cation of the organism is of great importance. A gram-stained smear of urethral discharge enables rapid identi?cation of the gonococcus in around 90 per cent of men.

Symptoms These di?er considerably, according to whether the disease is in an acute or a chronic stage.

MEN After an incubation period of 2–10 days, irritation in the urethra, scalding pain on passing water, and a viscid yellowish-white discharge appear; the glands in the groin often enlarge and may suppurate. The urine when passed is hazy and is often found to contain yellowish threads of pus visible to the eye. After some weeks, if the condition has become chronic, the discharge is clear and viscid, there may be irritation in passing urine, and various forms of in?ammation in neighbouring organs may appear – the TESTICLE, PROSTATE GLAND and URINARY BLADDER becoming affected. At a still later stage the in?ammation of the urethra is apt to lead to gradual formation of ?brous tissue around this channel. This contracts and produces narrowing, so that urination becomes di?cult or may be stopped for a time altogether (the condition known as stricture). In?ammation of some of the joints is a common complication in the early stage – the knee, ankle, wrist, and elbow being the joints most frequently affected – and this form of ‘rheumatism’ is very intractable and liable to lead to permanent sti?ness. The ?brous tissues elsewhere may also develop in?ammatory changes, causing pain in the back, foot, etc. In occasional cases, during the acute stage, SEPTICAEMIA may develop, with in?ammation of the heart-valves (ENDOCARDITIS) and abscesses in various parts of the body. The infective matter occasionally is inoculated accidentally into the eye, producing a very severe form of conjunctivitis: in the newly born child this is known as ophthalmia neonatorum and, although now rare in the UK. has in the past been a major cause of blindness (see EYE, DISORDERS OF). WOMEN The course and complications of the disease are somewhat di?erent in women. It begins with a yellow vaginal discharge, pain on urination, and very often in?ammation or abscess of the Bartholin’s glands, situated close to the vulva or opening of the vagina. The chief seriousness, however, of the disease is due to the spread of in?ammation to neighbouring organs, the UTERUS, FALLOPIAN TUBES, and OVARIES, causing permanent destructive changes in these, and leading occasionally to PERITONITIS through the Fallopian tube with a fatal result. Many cases of prolonged ill-health and sterility or recurring miscarriages are due to these changes.

Treatment The chances of cure are better the earlier treatment is instituted. PENICILLIN is the antibiotic of choice but unfortunately the gonococcus is liable to become resistant to this. In patients who are infected with penicillin-resistant organisms, one of the other antibiotics (e.g. cefotaxime, cipro?oxacin or spectinomycin) is used. In all cases it is essential that bacteriological investigation should be carried out at weekly intervals for three or four weeks, to make sure that the patient is cured. Patients attending with gonorrhoea are asked if they will agree to tests for other sexually transmitted infections, such as HIV (see AIDS/HIV) and for assistance in contact tracing.... gonorrhoea

A form of blood-poisoning in which abscesses (see ABSCESS) appear in various parts of the body. (See also SEPTICAEMIA.)... pyaemia

A common name for septicaemia with toxaemia, a life-threatening illness caused by multiplication of bacteria and formation of toxins in the bloodstream. Septicaemia may be a complication of an infection in an organ or tissue. In some infective conditions, septic shock may be caused by toxins released by bacteria. Treatment is with antibiotic drugs and intensive therapy for shock. (See also bacteraemia.)... blood poisoning

In?ammation of the kidney (see KIDNEYS), usually the result of bacterial infection. The in?ammation may be acute or chronic. Acute pyelonephritis comes on suddenly, is commoner in women, and tends to occur when they are pregnant. Infection usually spreads up the URETER from the URINARY BLADDER which has become infected (CYSTITIS). Fevers, chills and backache are the usual presenting symptoms. ANTIBIOTICS should be given, and in severe cases the intravenous route may be necessary. SEPTICAEMIA is an occasional complication.

Chronic pyelonephritis may start in childhood, and the usual cause is back ?ow of urine from the bladder into one of the ureters – perhaps because of a congenital deformity of the valve where the ureter drains into the bladder. Constant urine re?ux results in recurrent infection of the kidney and damage to its tissue. Full investigation of the urinary tract is essential and, if an abnormality is detected, surgery may well be required to remedy it. HYPERTENSION and renal failure may be serious complications of pyelonephritis (see also KIDNEYS, DISEASES OF).... pyelonephritis

A dangerous disorder characterised by a severe fall in blood pressure and damage to the body tissues as a result of SEPTICAEMIA. The toxins from the septicaemia cause widespread damage to tissue, provoke clotting in small blood vessels, and seriously disturb the circulation. The kidneys, lungs and heart are particularly affected. The condition occurs most commonly in people who already have a chronic disease such as cancer, CIRRHOSIS of the liver or DIABETES MELLITUS. Septic shock may also develop in patients with immunode?ciency illnesses such as AIDS (see AIDS/HIV). The symptoms are those of septicaemia, coupled with those of SHOCK: cold, cyanotic limbs; fast, thready pulse; and a lowered blood pressure. Septic shock requires urgent treatment with ANTIBIOTICS, intravenous ?uids and oxygen, and may require the use of drugs to maintain blood pressure and cardiac function, arti?cial ventilation and/or renal DIALYSIS.... septic shock

A neurotransmitter found in the brain and around some blood vessels. It helps control body movements: a deficiency of dopamine in the basal ganglia (groups of nerve cells deep in the brain) causes Parkinson’s disease.

Synthetic dopamine is injected as an emergency treatment for shock caused by a myocardial infarction (heart attack) or septicaemia (blood infection) and as a treatment for severe heart failure.... dopamine

In?ammation affecting the membranes of the BRAIN or SPINAL CORD, or usually both. Meningitis may be caused by BACTERIA, viruses (see VIRUS), fungi, malignant cells or blood (after SUBARACHNOID HAEMORRHAGE). The term is, however, usually restricted to in?ammation due to a bacterium or virus. Viral meningitis is normally a mild, self-limiting infection of a few days’ duration; it is the most common cause of meningitis but usually results in complete recovery and requires no speci?c treatment. Usually a less serious infection than the bacterial variety, it does, however, rarely cause associated ENCEPHALITIS, which is a potentially dangerous illness. A range of viruses can cause meningitis, including: ENTEROVIRUSES; those causing MUMPS, INFLUENZA and HERPES SIMPLEX; and HIV.

Bacterial meningitis is life-threatening: in the United Kingdom, 5–10 per cent of children who contract the disease may die. Most cases of acute bacterial meningitis in the UK are caused by two bacteria: Neisseria meningitidis (meningococcus), and Streptococcus pneumoniae (pneumococcus); other bacteria include Haemophilus in?uenzae (a common cause until virtually wiped out by immunisation), Escherichia coli, Mycobacterium tuberculosis (see TUBERCULOSIS), Treponema pallidum (see SYPHILIS) and Staphylococci spp. Of the bacterial infections, meningococcal group B is the type that causes a large number of cases in the UK, while group A is less common.

Bacterial meningitis may occur by spread from nearby infected foci such as the nasopharynx, middle ear, mastoid and sinuses (see EAR, DISEASES OF). Direct infection may be the result of penetrating injuries of the skull from accidents or gunshot wounds. Meningitis may also be a complication of neurosurgery despite careful aseptic precautions. Immuno-compromised patients – those with AIDS or on CYTOTOXIC drugs – are vulnerable to infections.

Spread to contacts may occur in schools and similar communities. Many people harbour the meningococcus without developing meningitis. In recent years small clusters of cases, mainly in schoolchildren and young people at college, have occurred in Britain.

Symptoms include malaise accompanied by fever, severe headache, PHOTOPHOBIA, vomiting, irritability, rigors, drowsiness and neurological disturbances. Neck sti?ness and a positive KERNIG’S SIGN appearing within a few hours of infection are key diagnostic signs. Meningococcal and pneumococcal meningitis may co-exist with SEPTICAEMIA, a much more serious condition in terms of death rate or organ damage and which constitutes a grave emergency demanding rapid treatment.

Diagnosis and treatment are urgent and, if bacterial meningitis is suspected, antibiotic treatment should be started even before laboratory con?rmation of the infection. Analysis of the CEREBROSPINAL FLUID (CSF) by means of a LUMBAR PUNCTURE is an essential step in diagnosis, except in patients for whom the test would be dangerous as they have signs of raised intracranial pressure. The CSF is clear or turbid in viral meningitis, turbid or viscous in tuberculous infection and turbulent or purulent when meningococci or staphylococci are the infective agents. Cell counts and biochemical make-up of the CSF are other diagnostic pointers. Serological tests are done to identify possible syphilitic infection, which is now rare in Britain.

Patients with suspected meningitis should be admitted to hospital quickly. General pracitioners are encouraged to give a dose of intramuscular penicillin before sending the child to hospital. Treatment in hospital is usually with a cephalosporin, such as ceftazidime or ceftriaxone. Once the sensitivity of the organism is known as a result of laboratory studies on CSF and blood, this may be changed to penicillin or, in the case of H. in?uenzae, to amoxicillin. Local infections such as SINUSITIS or middle-ear infection require treatment, and appropriate surgery for skull fractures or meningeal tears should be carried out as necessary. Tuberculous meningitis is treated for at least nine months with anti-tuberculous drugs (see TUBERCULOSIS). If bacterial meningitis causes CONVULSIONS, these can be controlled with diazepam (see TRANQUILLISERS; BENZODIAZEPINES) and ANALGESICS will be required for the severe headache.

Coexisting septicaemia may require full intensive care with close attention to intravenous ?uid and electrolyte balance, control of blood clotting and blood pressure.

Treatment of close contacts such as family, school friends, medical and nursing sta? is recommended if the patient has H. in?uenzae or N. meningitidis: RIFAMPICIN provides e?ective prophylaxis. Contacts of patients with pneumococcal infection do not need preventive treatment. Vaccines for meningococcal meningitis may be given to family members in small epidemics and to any contacts who are especially at risk such as infants, the elderly and immuno-compromised individuals.

The outlook for a patient with bacterial meningitis depends upon age – the young and old are vulnerable; speed of onset – sudden onset worsens the prognosis; and how quickly treatment is started – hence the urgency of diagnosis and admission to hospital. Recent research has shown that children who suffer meningitis in their ?rst year of life are ten times more likely to develop moderate or severe disability by the age of ?ve than contemporaries who have not been infected. (See British Medical Journal, 8 September 2001, page 523.)

Prevention One type of bacterial meningitis, that caused by Haemophilus, has been largely controlled by IMMUNISATION; meningococcal C vaccine has largely prevented this type of the disease in the UK. So far, no vaccine against group B has been developed, but research continues. Information on meningitis can be obtained from the Meningitis Trust and the Meningitis Research Foundation.... meningitis

This infection is caused by nematode worms of the genus Strongyloides spp. – the great majority being from S. stercoralis. This helminth is present throughout most tropical and subtropical countries; a single case report has been made in England – about an individual who had not been exposed to such an environment. Larvae usually penetrate intact skin, especially the feet (as with hookworm infection). Unlike hookworm infection, eggs mature and hatch in the lower gastrointestinal tract; thus larvae can immediately re-enter the circulation in the colo-rectum or perianal region, setting up an auto-infection cycle. Therefore, infection can continue for the remaining lifespan of the individual. Severe malnutrition may be a predisposing factor to infection, as was the case in prisoners of war in south-east Asia during World War II.

Whilst an infected patient is frequently asymptomatic, heavy infection can cause jejunal mucosal abnormalities, and an absorptive defect, with weight loss. During the migratory phase an itchy linear rash (larva currens) may be present on the lower abdomen, buttocks, and groins; this gives rise to recurrent transient itching. In an immunosuppressed individual, the ‘hyperinfection syndrome’ may ensue; migratory larvae invade all organs and tissues, including the lungs and brain. Associated with this widespread infection, the patient may develop an Enterobacteriacae spp. SEPTICAEMIA; this, together with S. stercoralis larvae, produces a MENINGOENCEPHALITIS. There is no evidence that this syndrome is more common in patients with HIV infection.

Diagnosis consists of visualisation of S. stercoralis (larvae or adults) in a jejunal biopsy-section or aspirate. Larvae may also be demonstrable in a faecal sample, especially following culture. Eosinophilia may be present in peripheral blood, during the invasive stage of infection. Chemotherapy consists of albendazole. The formerly used benzimidazole compound, thiabendazole, is now rarely prescribed in an uncomplicated infection due to unpleasant side-effects; even so, in the ‘hyperinfection syndrome’ it probably remains the more e?ective of the two compounds.... strongyloidiasis

Thrombosis arising in the cavernous sinus of the sphenoid bone in the head.

Cause: Septicaemia or infected embolism conveyed from elsewhere – veins of the face, sinuses, head. May be a complication of meningitis.

Symptoms: headache, nausea, swelling of eyelids and forehead, pupils distended, veins of temples prominent, fever with severe constitutional disturbance.

Prognosis: usually fatal in the absence of orthodox antibiotics, but anti-staphylococcal herbs are helpful. Tinctures. Formula. Echinacea 3; Goldenseal 2; Myrrh (Tincture) 1. 1 teaspoon in water every 2 hours (acute). Thrice daily (chronic).

Treatment by or in liaison with general medical practitioner. ... cavernous sinus thrombosis

See SEPTICAEMIA.... blood-poisoning

Bone is not an inert sca?olding for the human body. It is a living, dynamic organ, being continuously remodelled in response to external mechanical and chemical in?uences and acting as a large reservoir for calcium and phosphate. It is as susceptible to disease as any other organ, but responds in a way rather di?erent from the rest of the body.

Bone fractures These occur when there is a break in the continuity of the bone. This happens either as a result of violence or because the bone is unhealthy and unable to withstand normal stresses.

SIMPLE FRACTURES Fractures where the skin remains intact or merely grazed. COMPOUND FRACTURES have at least one wound which is in communication with the fracture, meaning that bacteria can enter the fracture site and cause infection. A compound fracture is also more serious than a simple fracture because there is greater potential for blood loss. Compound fractures usually need hospital admission, antibiotics and careful reduction of the fracture. Debridement (cleaning and excising dead tissue) in a sterile theatre may also be necessary.

The type of fracture depends on the force which has caused it. Direct violence occurs when an object hits the bone, often causing a transverse break – which means the break runs horizontally across the bone. Indirect violence occurs when a twisting injury to the ankle, for example, breaks the calf-bone (the tibia) higher up. The break may be more oblique. A fall on the outstretched hand may cause a break at the wrist, in the humerus or at the collar-bone depending on the force of impact and age of the person. FATIGUE FRACTURES These occur after the bone has been under recurrent stress. A typical example is the march fracture of the second toe, from which army recruits suffer after long marches. PATHOLOGICAL FRACTURES These occur in bone which is already diseased – for example, by osteoporosis (see below) in post-menopausal women. Such fractures are typically crush fractures of the vertebrae, fractures of the neck of the femur, and COLLES’ FRACTURE (of the wrist). Pathological fractures also occur in bone which has secondary-tumour deposits. GREENSTICK FRACTURES These occur in young children whose bones are soft and bend, rather than break, in response to stress. The bone tends to buckle on the side opposite to the force. Greenstick fractures heal quickly but still need any deformity corrected and plaster of Paris to maintain the correction. COMPLICATED FRACTURES These involve damage to important soft tissue such as nerves, blood vessels or internal organs. In these cases the soft-tissue damage needs as much attention as the fracture site. COMMINUTED FRACTURES A fracture with more than two fragments. It usually means that the injury was more violent and that there is more risk of damage to vessels and nerves. These fractures are unstable and take longer to unite. Rehabilitation tends to be protracted. DEPRESSED FRACTURES Most commonly found in skull fractures. A fragment of bone is forced inwards so that it lies lower than the level of the bone surrounding it. It may damage the brain beneath it.

HAIR-LINE FRACTURES These occur when the bone is broken but the force has not been severe enough to cause visible displacement. These fractures may be easily missed. Symptoms and signs The fracture site is usually painful, swollen and deformed. There is asymmetry of contour between limbs. The limb is held uselessly. If the fracture is in the upper

limb, the arm is usually supported by the patient; if it is in the lower limb then the patient is not able to bear weight on it. The limb may appear short because of muscle spasm.

Examination may reveal crepitus – a bony grating – at the fracture site. The diagnosis is con?rmed by radiography.

Treatment Healing of fractures (union) begins with the bruise around the fracture being resorbed and new bone-producing cells and blood vessels migrating into the area. Within a couple of days they form a bridge of primitive bone across the fracture. This is called callus.

The callus is replaced by woven bone which gradually matures as the new bone remodels itself. Treatment of fractures is designed to ensure that this process occurs with minimal residual deformity to the bone involved.

Treatment is initially to relieve pain and may involve temporary splinting of the fracture site. Reducing the fracture means restoring the bones to their normal position; this is particularly important at the site of joints where any small displacement may limit movement considerably.

with plaster of Paris. If closed traction does not work, then open reduction of the fracture may

be needed. This may involve ?xing the fracture with internal-?xation methods, using metal plates, wires or screws to hold the fracture site in a rigid position with the two ends closely opposed. This allows early mobilisation after fractures and speeds return to normal use.

External ?xators are usually metal devices applied to the outside of the limb to support the fracture site. They are useful in compound fractures where internal ?xators are at risk of becoming infected.

Consolidation of a fracture means that repair is complete. The time taken for this depends on the age of the patient, the bone and the type of fracture. A wrist fracture may take six weeks, a femoral fracture three to six months in an adult.

Complications of fractures are fairly common. In non-union, the fracture does not unite

– usually because there has been too much mobility around the fracture site. Treatment may involve internal ?xation (see above). Malunion means that the bone has healed with a persistent deformity and the adjacent joint may then develop early osteoarthritis.

Myositis ossi?cans may occur at the elbow after a fracture. A big mass of calci?ed material develops around the fracture site which restricts elbow movements. Late surgical removal (after 6–12 months) is recommended.

Fractured neck of FEMUR typically affects elderly women after a trivial injury. The bone is usually osteoporotic. The leg appears short and is rotated outwards. Usually the patient is unable to put any weight on the affected leg and is in extreme pain. The fractures are classi?ed according to where they occur:

subcapital where the neck joins the head of the femur.

intertrochanteric through the trochanter.

subtrochanteric transversely through the upper end of the femur (rare). Most of these fractures of the neck of femur

need ?xing by metal plates or hip replacements, as immobility in this age group has a mortality of nearly 100 per cent. Fractures of the femur shaft are usually the result of severe trauma such as a road accident. Treatment may be conservative or operative.

In fractures of the SPINAL COLUMN, mere damage to the bone – as in the case of the so-called compression fracture, in which there is no damage to the spinal cord – is not necessarily serious. If, however, the spinal cord is damaged, as in the so-called fracture dislocation, the accident may be a very serious one, the usual result being paralysis of the parts of the body below the level of the injury. Therefore the higher up the spine is fractured, the more serious the consequences. The injured person should not be moved until skilled assistance is at hand; or, if he or she must be removed, this should be done on a rigid shutter or door, not on a canvas stretcher or rug, and there should be no lifting which necessitates bending of the back. In such an injury an operation designed to remove a displaced piece of bone and free the spinal cord from pressure is often necessary and successful in relieving the paralysis. DISLOCATIONS or SUBLUXATION of the spine are not uncommon in certain sports, particularly rugby. Anyone who has had such an injury in the cervical spine (i.e. in the neck) should be strongly advised not to return to any form of body-contact or vehicular sport.

Simple ?ssured fractures and depressed fractures of the skull often follow blows or falls on the head, and may not be serious, though there is always a risk of damage which is potentially serious to the brain at the same time.

Compound fractures may result in infection within the skull, and if the skull is extensively broken and depressed, surgery is usually required to check any intercranial bleeding or to relieve pressure on the brain.

The lower jaw is often fractured by a blow on the face. There is generally bleeding from the mouth, the gum being torn. Also there are pain and grating sensations on chewing, and unevenness in the line of the teeth. The treatment is simple, the line of teeth in the upper jaw forming a splint against which the lower jaw is bound, with the mouth closed.

Congenital diseases These are rare but may produce certain types of dwar?sm or a susceptibility to fractures (osteogenesis imperfecta).

Infection of bone (osteomyelitis) may occur after an open fracture, or in newborn babies with SEPTICAEMIA. Once established it is very di?cult to eradicate. The bacteria appear capable of lying dormant in the bone and are not easily destroyed with antibiotics so that prolonged treatment is required, as might be surgical drainage, exploration or removal of dead bone. The infection may become chronic or recur.

Osteomalacia (rickets) is the loss of mineralisation of the bone rather than simple loss of bone mass. It is caused by vitamin D de?ciency and is probably the most important bone disease in the developing world. In sunlight the skin can synthesise vitamin D (see APPENDIX 5: VITAMINS), but normally rickets is caused by a poor diet, or by a failure to absorb food normally (malabsorbtion). In rare cases vitamin D cannot be converted to its active state due to the congenital lack of the speci?c enzymes and the rickets will fail to respond to treatment with vitamin D. Malfunction of the parathyroid gland or of the kidneys can disturb the dynamic equilibrium of calcium and phosphate in the body and severely deplete the bone of its stores of both calcium and phosphate.

Osteoporosis A metabolic bone disease resulting from low bone mass (osteopenia) due to excessive bone resorption. Su?erers are prone to bone fractures from relatively minor trauma. With bone densitometry it is now possible to determine individuals’ risk of osteoporosis and monitor their response to treatment.

By the age of 90 one in two women and one in six men are likely to sustain an osteoporosis-related fracture. The incidence of fractures is increasing more than would be expected from the ageing of the population, which may re?ect changing patterns of exercise or diet.

Osteoporosis may be classi?ed as primary or secondary. Primary consists of type 1 osteoporosis, due to accelerated trabecular bone loss, probably as a result of OESTROGENS de?ciency. This typically leads to crush fractures of vertebral bodies and fractures of the distal forearm in women in their 60s and 70s. Type 2 osteoporosis, by contrast, results from the slower age-related cortical and travecular bone loss that occurs in both sexes. It typically leads to fractures of the proximal femur in elderly people.

Secondary osteoporosis accounts for about 20 per cent of cases in women and 40 per cent of cases in men. Subgroups include endocrine (thyrotoxicosis – see under THYROID GLAND, DISEASES OF, primary HYPERPARATHYROIDISM, CUSHING’S SYNDROME and HYPOGONADISM); gastrointestinal (malabsorption syndrome, e.g. COELIAC DISEASE, or liver disease, e.g. primary biliary CIRRHOSIS); rheumatological (RHEUMATOID ARTHRITIS or ANKYLOSING SPONDYLITIS); malignancy (multiple MYELOMA or metastatic CARCINOMA); and drugs (CORTICOSTEROIDS, HEPARIN). Additional risk factors for osteoporosis include smoking, high alcohol intake, physical inactivity, thin body-type and heredity.

Individuals at risk of osteopenia, or with an osteoporosis-related fracture, need investigation with spinal radiography and bone densitometry. A small fall in bone density results in a large increase in the risk of fracture, which has important implications for preventing and treating osteoporosis.

Treatment Antiresorptive drugs: hormone replacement therapy – also valuable in treating menopausal symptoms; treatment for at least ?ve years is necessary, and prolonged use may increase risk of breast cancer. Cyclical oral administration of disodium etidronate – one of the bisphosphonate group of drugs – with calcium carbonate is also used (poor absorption means the etidronate must be taken on an empty stomach). Calcitonin – currently available as a subcutaneous injection; a nasal preparation with better tolerance is being developed. Calcium (1,000 mg daily) seems useful in older patients, although probably ine?ective in perimenopausal women, and it is a safe preparation. Vitamin D and calcium – recent evidence suggests value for elderly patients. Anabolic steroids, though androgenic side-effects (masculinisation) make these unacceptable for most women.

With established osteoporosis, the aim of treatment is to relieve pain (with analgesics and physical measures, e.g. lumbar support) and reduce the risk of further fractures: improvement of bone mass, the prevention of falls, and general physiotherapy, encouraging a healthier lifestyle with more daily exercise.

Further information is available from the National Osteoporosis Society.

Paget’s disease (see also separate entry) is a common disease of bone in the elderly, caused by overactivity of the osteoclasts (cells concerned with removal of old bone, before new bone is laid down by osteoblasts). The bone affected thickens and bows and may become painful. Treatment with calcitonin and bisphosphonates may slow down the osteoclasts, and so hinder the course of the disease, but there is no cure.

If bone loses its blood supply (avascular necrosis) it eventually fractures or collapses. If the blood supply does not return, bone’s normal capacity for healing is severely impaired.

For the following diseases see separate articles: RICKETS; ACROMEGALY; OSTEOMALACIA; OSTEOGENESIS IMPERFECTA.

Tumours of bone These can be benign (non-cancerous) or malignant (cancerous). Primary bone tumours are rare, but secondaries from carcinoma of the breast, prostate and kidneys are relatively common. They may form cavities in a bone, weakening it until it breaks under normal load (a pathological fracture). The bone eroded away by the tumour may also cause problems by causing high levels of calcium in the plasma.

EWING’S TUMOUR is a malignant growth affecting long bones, particularly the tibia (calfbone). The presenting symptoms are a throbbing pain in the limb and a high temperature. Treatment is combined surgery, radiotherapy and chemotherapy.

MYELOMA is a generalised malignant disease of blood cells which produces tumours in bones which have red bone marrow, such as the skull and trunk bones. These tumours can cause pathological fractures.

OSTEOID OSTEOMA is a harmless small growth which can occur in any bone. Its pain is typically removed by aspirin.

OSTEOSARCOMA is a malignant tumour of bone with a peak incidence between the ages of ten and 20. It typically involves the knees, causing a warm tender swelling. Removal of the growth with bone conservation techniques can often replace amputation as the de?nitive treatment. Chemotherapy can improve long-term survival.... bone, disorders of

These are broad-spectrum antibiotics. Most are semi-synthetic derivatives of cephalosporin C, an antibiotic originally derived from a sewage outfall in Sardinia.

First-generation examples still in use include cephalexin and cefadroxil. They are orally active and, along with second-generation cefaclor, have a similar antimicrobial spectrum. They are used for ‘resistant’ urinary infections and urinary infections in pregnancy. Cephalosporins have a similar pharmacology to that of penicillin, and about 10 per cent of patients allergic to penicillin will also be hypersensitive to cephalosporins. They are e?ective in treating SEPTICAEMIA, PNEUMONIA, MENINGITIS, biliary-tract infections and PERITONITIS.

Second-generation cefuroxime and cefamandole are less vulnerable to penicillinases and are useful for treating ‘resistant’ bacteria and Haemophilus in?uenzae and Neisseria gonorrhoea. Third-generation cephalosporins include cefotaxime, ceftazidime and others; these are more e?ective than the second-generation in treating some gram-negative infections, especially those causing septicaemia.... cephalosporins

An antibiotic derived from a soil organism, Streptomyces venezuelae. It is also prepared synthetically. A potent broad-spectrum antibiotic, chloramphenicol may, however, cause serious side-effects such as aplastic ANAEMIA, peripheral NEURITIS, optic neuritis and, in neonates, abdominal distension and circulatory collapse. The drug should therefore be reserved for the treatment of life-threatening infections such as Haemophilus in?uenzae, SEPTICAEMIA or MENINGITIS, typhoid fever (see ENTERIC FEVER) and TYPHUS FEVER, when the causative organism proves resistant to other drugs. However, because it is inexpensive, it is used widely in developing countries. This antibiotic is available as drops for use in eye and ear infection, where safety is not a problem.... chloramphenicol

Toxin released when certain bacterial species (especially the Gram negative rods) die. Symptoms not specific to the bacterial specie s (eg endotoxic shock in Gram negative rod septicaemias).... endotoxin

Along with DEXTRAN and GELATIN, this is a substance with a large molecular structure used to treat shocked patients with burns (see BURNS AND SCALDS) or SEPTICAEMIA in order to expand and maintain their blood volume. Like other plasma substitutes, this form of starch can be used as an emergency, short-term treatment for severe bleeding until blood for transfusion is available. Plasma substitutes must be used with caution in patients who have heart disease or impairment of their kidney function. Patients should be monitored for hypersensitivity reactions and for changes in their BLOOD PRESSURE (see SHOCK).... etherified starch

The process by which infective material is brought into the system through a small wound in the skin or in a mucous membrane. Many infectious diseases are contracted by accidental inoculation of microbes – as is blood-poisoning (see SEPTICAEMIA). Inoculation is now used as a preventive measure against many infectious diseases. (See also VACCINE.)... inoculation

A condition in which the number of LEUCOCYTES in the blood is greatly reduced – by, say, ANAEMIA or cancer. It is also a dangerous sign in severe SEPTICAEMIA.... leucopenia

A rare disease, although the causal organism, Listeria monocytogenes, is widely distributed in soil, silage, water, and various animals, with consequent risk of food contamination – for example, from unpasteurised soft cheese. Neonates are mainly affected – often as a result of a mild or inapparent infection in the pregnant mother. The disease presents in two main forms: MENINGOENCEPHALITIS, or SEPTICAEMIA with enlarged LYMPH glands. Elderly adults occasionally develop the ?rst form, while younger adults are more likely to develop a mild or even inapparent form. The disease is treated with ANTIBIOTICS such as ampicillin (see PENICILLIN) or CHLORAMPHENICOL.... listeriosis

Paediatrics is the branch of medicine which deals with diseases of children, but many paediatricians have a wider role, being employed largely outside acute hospitals and dealing with child health in general.

History Child health services were originally designed, before the NHS came into being, to ?nd or prevent physical illness by regular inspections. In the UK these were carried out by clinical medical o?cers (CMOs) working in infant welfare clinics (later, child health clinics) set up to ?ll the gap between general practice and hospital care. The services expanded greatly from the mid 1970s; ‘inspections’ have evolved into a regular screening and surveillance system by general practitioners and health visitors, while CMOs have mostly been replaced by consultant paediatricians in community child health (CPCCH).

Screening Screening begins at birth, when every baby is examined for congenital conditions such as dislocated hips, heart malformations, cataract and undescended testicles. Blood is taken to ?nd those babies with potentially brain-damaging conditions such as HYPOTHYROIDISM and PHENYLKETONURIA. Some NHS trusts screen for the life-threatening disease CYSTIC FIBROSIS, although in future it is more likely that ?nding this disease will be part of prenatal screening, along with DOWN’S (DOWN) SYNDROME and SPINA BIFIDA. A programme to detect hearing impairment in newborn babies has been piloted from 2001 in selected districts to ?nd out whether it would be a useful addition to the national screening programme. Children from ethnic groups at risk of inherited abnormalities of HAEMOGLOBIN (sickle cell disease; thalassaemia – see under ANAEMIA) have blood tested at some time between birth and six months of age.

Illness prevention At two months, GPs screen babies again for these abnormalities and start the process of primary IMMUNISATION. The routine immunisation programme has been dramatically successful in preventing illness, handicap and deaths: as such it is the cornerstone of the public health aspect of child health, with more potential vaccines being made available every year. Currently, infants are immunised against pertussis (see WHOOPING COUGH), DIPHTHERIA, TETANUS, POLIOMYELITIS, haemophilus (a cause of MENINGITIS, SEPTICAEMIA, ARTHRITIS and epiglottitis) and meningococcus C (SEPTICAEMIA and meningitis – see NEISSERIACEAE) at two, three and four months. Selected children from high-risk groups are o?ered BCG VACCINE against tuberculosis and hepatitis vaccine. At about 13 months all are o?ered MMR VACCINE (measles, mumps and rubella) and there are pre-school entry ‘boosters’ of diphtheria, tetanus, polio, meningococcus C and MMR. Pneumococcal vaccine is available for particular cases but is not yet part of the routine schedule.

Health promotion and education Throughout the UK, parents are given their child’s personal health record to keep with them. It contains advice on health promotion, including immunisation, developmental milestones (when did he or she ?rst smile, sit up, walk and so on), and graphs – called centile charts – on which to record height, weight and head circumference. There is space for midwives, doctors, practice nurses, health visitors and parents to make notes about the child.

Throughout at least the ?rst year of life, both parents and health-care providers set great store by regular weighing, designed to pick up children who are ‘failing to thrive’. Measuring length is not quite so easy, but height measurements are recommended from about two or three years of age in order to detect children with disorders such as growth-hormone de?ciency, malabsorption (e.g. COELIAC DISEASE) and psychosocial dwar?sm (see below).

All babies have their head circumference measured at birth, and again at the eight-week check. A too rapidly growing head implies that the infant might have HYDROCEPHALUS – excess ?uid in the hollow spaces within the brain. A too slowly growing head may mean failure of brain growth, which may go hand in hand with physically or intellectually delayed development.

At about eight months, babies receive a surveillance examination, usually by a health visitor. Parents are asked if they have any concerns about their child’s hearing, vision or physical ability. The examiner conducts a screening test for hearing impairment – the so-called distraction test; he or she stands behind the infant, who is on the mother’s lap, and activates a standardised sound at a set distance from each ear, noting whether or not the child turns his or her head or eyes towards the sound. If the child shows no reaction, the test is repeated a few weeks later; if still negative then referral is made to an audiologist for more formal testing.

The doctor or health visitor will also go through the child’s developmental progress (see above) noting any signi?cant deviation from normal which merits more detailed examination. Doctors are also recommended to examine infants developmentally at some time between 18 and 24 months. At this time they will be looking particularly for late walking or failure to develop appropriate language skills.... child health

A family of bacteria of which three varieties cause disease. Neisseria meningitidis causes meningococcal MENINGITIS and SEPTICAEMIA. It is divided into three groups: A, B and C; group B accounts for most meningitis cases in the UK, mostly affecting children. Neisseria gonorrhoeae causes GONORRHOEA. The bacteria are gram-negative (see GRAM’S STAIN) cocci usually occurring in pairs. A third variety is Moraxella catarrhalis: this occurs in the nose and throat and sometimes causes ear infection and low-grade infection of the respiratory tract.... neisseriaceae

Small red MACULES due to haemorrhage in the skin. They may be caused by trauma – such as by tight pressure, as in strangulation – or even by the e?ect of violent coughing. Bleeding and clotting disorders may provoke petechiae, and they are a feature of many childhood viral infections. Most importantly they may be a sign of SEPTICAEMIA due to a meningococcus (see NEISSERIACEAE).... petechiae

A measurement of the concentration of hydrogen ions in a solution that is calculated as a negative logarithm. A neutral solution has a pH of 7·0 and this ?gure falls for a solution with increasing acidity and rises if the alkalinity increases. Measuring the pH of arterial blood has a major role in managing serious respiratory or cardiac disease including SHOCK and SEPTICAEMIA.... ph

Cinchona spp.

Rubiaceae

San: Cinchona, Kunayanah

Hin: Kunain Mal: Cinchona, Quoina

Tam: Cinchona

Importance: Cinchona, known as Quinine, Peruvian or Crown bark tree is famous for the antimalarial drug ‘quinine’ obtained from the bark of the plant. The term cinchona is believed to be derived from the countess of cinchon who was cured of malaria by treating with the bark of the plant in 1638. Cinchona bark has been valued as a febrifuge by the Indians of south and central America for a long time. Over 35 alkaloids have been isolated from the plant; the most important among them being quinine, quinidine, cinchonine and cinchonidine. These alkaloids exist mainly as salts of quinic, quinovic and cinchotannic acids. The cultivated bark contains 7-10% total alkaloids of which about 70% is quinine. Similarly 60% of the total alkaloids of root bark is quinine. Quinine is isolated from the total alkaloids of the bark as quinine sulphate. Commercial preparations contain cinchonidine and dihydroquinine. They are useful for the treatment of malarial fever, pneumonia, influenza, cold, whooping couphs, septicaemia, typhoid, amoebic dysentery, pin worms, lumbago, sciatica, intercostal neuralgia, bronchial neuritis and internal hemorrhoids. They are also used as anesthetic and contraceptive. Besides, they are used in insecticide compositions for the preservation of fur, feathers, wool, felts and textiles. Over doses of these alkaloids may lead to deafness, blindness, weakness, paralysis and finally collapse, either comatose or deleterious. Quinidine sulphate is cardiac depressant and is used for curing arterial fibrillation.

Distribution: Cinchona is native to tropical South America. It is grown in Bolivia, Peru, Costa Rica, Ecuador, Columbia, Indonesia, Tanzania, Kenya, Zaire and Sri Lanka. It was introduced in 1808 in Guatemala,1860 in India, 1918 in Uganda, 1927 in Philippines and in 1942 in Costa Rica. Roy Markham introduced the plant to India. The first plantation was raised in Nilgiris and later on in Darjeeling of West Bengal. The value of the tree was learnt by Jessuit priests who introduced the bark to Europe. It first appeared in London pharmacopoeia in 1677 (Husain, 1993).

Botany: The quinine plant belongs to the family Rubiaceae and genus Cinchona which comprises over 40 species. Among these a dozen are medicinally important. The commonly cultivated species are C. calisaya Wedd., C. ledgeriana Moens, C. officinalis Linn., C. succirubra Pav. ex Kl., C. lancifolia and C. pubescens. Cinchona species have the chromosome number 2n=68. C. officinalis Linn. is most common in India. It is an evergreen tree reaching a height of 10-15m. Leaves are opposite, elliptical, ovate- lanceolate, entire and glabrous. Flowers are reddish-brown in short cymbiform, compound cymes, terminal and axillary; calyx tubular, 5-toothed, obconical, subtomentose, sub-campanulate, acute, triangular, dentate, hairy; corolla tube 5 lobed, densely silky with white depressed hairs, slightly pentagonal; stamens 5; style round, stigma submersed. Fruit is capsule ovoid-oblong; seeds elliptic, winged margin octraceous, crinulate-dentate (Biswas and Chopra, 1982).

Agrotechnology: The plant widely grows in tropical regions having an average minimum temperature of 14 C. Mountain slopes in the humid tropical areas with well distributed annual rainfall of 1500-1950mm are ideal for its cultivation. Well drained virgin and fertile forest soils with pH 4.5-6.5 are best suited for its growth. It does not tolerate waterlogging. Cinchona is propagated through seeds and vegetative means. Most of the commercial plantations are raised by seeds. Vegetative techniques such as grafting, budding and softwood cuttings are employed in countries like India, Sri Lanka, Java and Guatemala. Cinchona succirubra is commonly used as root stock in the case of grafting and budding. Hormonal treatment induces better rooting. Seedlings are first raised in nursery under shade. Raised seedbeds of convenient size are prepared, well decomposed compost or manure is applied , seeds are broadcasted uniformly at 2g/m2, covered with a thin layer of sand and irrigated. Seeds germinate in 10-20 days. Seedlings are transplanted into polythene bags after 3 months. These can be transplanted into the field after 1 year at 1-2m spacing. Trees are thinned after third year for extracting bark , leaving 50% of the trees at the end of the fifth year. The crop is damaged by a number of fungal diseases like damping of caused by Rhizoctoria solani, tip blight by Phytophthora parasatica, collar rot by Sclerotiun rolfsii, root rot by Phytophthora cinnamomi, Armillaria mellea and Pythium vexans. Field sanitation, seed treatment with organo mercurial fungicide, burning of infected plant parts and spraying 1% Bordeaux mixture are recommended for the control of the diseases (Crandall, 1954). Harvesting can be done in one or two phases. In one case, the complete tree is uprooted, after 8-10 years when the alkaloid yield is maximum. In another case, the tree is cut about 30cm from the ground for bark after 6-7 years so that fresh sprouts come up from the stem to yield a second crop which is harvested with the under ground roots after 6-7 years. Both the stem and root are cut into convenient pieces, bark is separated, dried in shade, graded, packed and traded. Bark yield is 9000-16000kg/ha (Husain, 1993).

Properties and activity: Over 35 alkaloids have been isolated from Cinchona bark, the most important among them are quinine, quinidine, cinchonine, cinchonidine, cinchophyllamine and idocinchophyllamine. There is considerable variation in alkaloid content ranging from 4% to 20%. However, 6-8% yield is obtained from commercial plantations. The non alkaloidal constituents present in the bark are bitter glycosides, -quinovin, cinchofulvic, cinchotannic and quinic acids, a bitter essential oil possessing the odour of the bark and a red coloring matter. The seed contains 6.13% fixed oil. Quinine and its derivatives are bitter, astringent, acrid, thermogenic, febrifuge, oxytocic, anodyne, anti-bacterial, anthelmintic, digestive, depurative, constipating, anti pyretic, cardiotonic, antiinflammatory, expectorant and calcifacient (Warrier et al, 1994; Bhakuni and Jain, 1995).... cinchona

A type of streptococcal bacterium (see STREPTOCOCCUS) which can cause otitis media (see EAR, DISEASES OF – Diseases of the middle ear), TONSILLITIS, PNEUMONIA, MENINGITIS and SEPTICAEMIA. It is usually sensitive to PENICILLIN.... pneumococcus

This is derived from COLLAGEN, the chief constituent of CONNECTIVE TISSUE. It is a colourless, transparent substance which dissolves in boiling water, and on cooling sets into a jelly. Such a jelly is a pleasant addition to the invalid diet, especially when suitably ?avoured, but it is of relatively little nutritive value as not more than one ounce can be taken in the day (i.e. the amount required to make one pint of jelly). Although it is a protein, it is lacking in several of the vital amino acids. The ordinary household ‘stock’ made from boiling bones contains gelatin. Mixed with about two and a half times its weight of glycerin, gelatin forms a soft substance used as the basis for many pastilles and suppositories. Partially degraded gelatin is sometimes given as a PLASMA-substitute transfusion for short-term emergency treatment for patients in SHOCK as a result of a severe blood or ?uid loss from burns or SEPTICAEMIA.... gelatin

The presence of bacteria in the bloodstream. Bacteraemia occurs briefly after many minor surgical operations and dental treatment. The immune system usually prevents the bacteria from multiplying and causing damage. However, in people who have abnormal heart valves, the bacteria may settle on the valve and cause endocarditis. If the immune system is damaged or suppressed, septicaemia (an infection of the blood) may develop.... bacteraemia

A bacterial infection of the skin and the tissues beneath it, usually affecting the face, neck, or legs. Cellulitis is most commonly caused by streptococci bacteria, which enter the skin via a wound. The affected area is hot, tender, and red, and there may be fever and chills. Untreated cellulitis at the site of a wound may progress to bacteraemia and septicaemia or, occasionally, to gangrene. Cellulitis is usually more severe in people with reduced immune response, such as those with diabetes mellitus or an immunodeficiency disorder. Treatment is with an antibiotic such as a penicillin drug or erythromycin. (See also erysipelas.)... cellulitis

Gram-negative (see GRAM’S STAIN), rod-like, aerobic, non-sporing and non-motile parasitic bacteria. Mostly found in the respiratory tract, they may be part of the normal ?ora, but may also be responsible for several diseases. The main pathogenic species of haemophilus is H. in?uenzae, which may cause severe exacerbations of chronic BRONCHITIS, as well as MENINGITIS, EPIGLOTTITIS, SINUSITIS, and otitis media (see EAR, DISEASES OF). Other species may cause conjunctivitis (see EYE, DISORDERS OF) or CHANCROID. Haemophilus species are sensitive to a wide range of antibiotics, though generally resistant to penicillin. Infants are routinely immunised with Haemophilus B vaccine to prevent meningitis, septicaemia and epiglottitis

– all potentially fatal disesases.... haemophilus

Diseases, usually of an infectious nature, which are required by law to be made known to a health o?cer or local authority. (See INFECTION.) Certain occupational diseases are also noti?able.

Noti?able diseases in the UK (For more information on a speci?c disease, refer to the separate dictionary entry.) Acute encephalitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery (amoebic or bacillary) Ebola virus disease Food poisoning Lassa fever Leprosy (reported to Chief Medical O?cer at the Department of Health) Leptospirosis Malaria Marburg disease Measles Meningitis Meningococcal septicaemia (without meningitis) Mumps Ophthalmia neonatorum Paratyphoid fever Plague Rabies Relapsing fever Rubella Scarlet fever Smallpox Tetanus Tuberculosis Typhoid fever Typhus Viral haemorrhagic fever (including Lassa fever) Viral hepatitis Whooping cough Yellow fever

Reporting AIDS is voluntary (and in con?dence) to the Director, Communicable Diseases Surveillance Centre (PHLS).... notifiable diseases

An infection, once called puerperal fever, that starts in the genital tract within ten days after childbirth, miscarriage or abortion (see PREGNANCY AND LABOUR). Once a scourge of childbirth, with many women dying from the infection, the past 50 years have seen a dramatic decline in its incidence in developed countries, with only 1–3 per cent of women having babies now being affected. This decline is due to much better maternity care and the advent of ANTIBIOTICS. Infection usually starts in the VAGINA and is caused by the bacteria that normally live in it: they can cause harm because of the mother’s lowered resistance, or when part of the PLACENTA has been retained in the genital tract. The infection usually spreads to the UTERUS and sometimes to the FALLOPIAN TUBES. Sometimes bacteria may enter the vagina from other parts of the body.

Fever, an o?ensive-smelling post-partum vaginal discharge (lochia) and pain in the lower abdomen are the main features. Untreated, the women may develop SALPINGITIS, PERITONITIS and septicaemia. Antibiotics are used to treat the infection and any retained placental tissue must be removed.... puerperal sepsis

An antibacterial drug given by injection to treat serious infections such as meningitis and septicaemia. Gentamicin can damage the kidneys or inner ear if the dosage is not carefully controlled. The drug is also used in eye and ear drops but is unlikely to cause serious side effects with this use.... gentamicin

An infection of horses caused by the bacterium PSEUDOMONAS MALLEI. In rare cases, it is transmitted to humans, causing symptoms including fever and general aches and pains. Ulcers may develop where bacteria entered the skin; if bacteria enters the lungs, pneumonia may occur. In severe cases, septicaemia may follow. Treatment is with antibiotics.... glanders

Any disease or disorder of the small blood vessels. It may be a feature of conditions such as diabetes mellitus, septicaemia, eclampsia, glomerulonephritis, and advanced cancer. When microangiopathy occurs with these conditions, the small blood vessels become distorted, and red blood cells are damaged. This causes microangiopathic haemolytic anaemia (see anaemia, haemolytic)... microangiopathy

Infection of a wound or body tissues with bacteria that leads to the formation of pus or to the multiplication of the bacteria in the blood. (See also bacteraemia; septicaemia; septic shock.)... sepsis

A class of bacteria containing the organism responsible for the bubonic plague (YERSINIA PESTIS). In other forms, yersinia is responsible for a variety of infections, such as gastroenteritis, particularly in young children, and arthritis and septicaemia in adults.... yersinia

n. a third-generation *cephalosporin antibiotic that has good activity against Gram-negative bacteria (including Pseudomonas). It is used for the treatment of urinary and respiratory tract infections, cellulitis, meningitis, and septicaemia. Side-effects include reaction at the site of injection, diarrhoea, and hypersensitivity reactions.... ceftazidime

(ECMO) a technique that is accepted as a rescue treatment for otherwise fatal respiratory failure in newborn babies or infants due to prematurity or overwhelming septicaemia (e.g. meningitis). It involves modified prolonged *cardiopulmonary bypass to support gas exchange, which allows the lungs to rest and recover. ECMO is only available in selected high-technology centres.... extracorporeal membrane oxygenation

A state of acute circulatory failure in which the heart’s output of blood is inadequate to provide normal PERFUSION of the major organs. It is accompanied by a fall in arterial blood pressure and is characterised by systemic arterial hypotension (arterial blood pressure less than 80 mm of mercury), sweating and signs of VASOCONSTRICTION (for example, pallor, CYANOSIS, a cold clammy skin and a low-volume pulse). These signs may be associated with clinical evidence of poor tissue perfusion, for example to the brain and kidneys, leading to mental apathy, confusion or restlessness and OLIGURIA.

Shock may result from loss of blood or plasma volume. This may occur as a result of haemorrhage or severe diarrhoea and vomiting. It may also result from peripheral pooling of blood due to such causes as TOXAEMIA or ANAPHYLAXIS. The toxaemia is commonly the result of a SEPTICAEMIA in which leakage through capillaries reduces circulating blood volume. Another form is called cardogenic shock, and is due to failure of the heart as a pump. It is most commonly seen as a result of myocardial infarction (see under HEART, DISEASES OF).

If failure of adequate blood ?ow to vital organs is prolonged, the effects can be disastrous. The ischaemic intestine permits the transfer of toxic bacterial products and proteins across its wall into the blood; renal ISCHAEMIA prevents the maintenance of a normal electrolyte and acid-base balance.

Treatment If the shock is a result of haemorrhage or diarrhoea or vomiting, replacement of blood, lost ?uid and electrolytes is of prime importance. If it is due to septicaemia, treatment of the infection is of paramount importance, and in addition, intravenous ?uids and vasopressor drugs will be required. Cardiogenic shock is treated by attention to the underlying cause. Full intensive care is likely to be required, and arti?cial ventilation and DIALYSIS may both be needed.... shock

Chronic in?ammation of the lining of the COLON and RECTUM. The disease affects around 50 people per 100,000; it is predominantly a disease of young and middle-aged adults.

Symptoms The onset may be sudden or insidious. In the acute form there is severe diarrhoea and the patient may pass up to 20 stools a day. The stools, which may be small in quantity, are ?uid and contain blood, pus and mucus. There is always fever, which runs an irregular course. In other cases the patient ?rst notices some irregularity of the movement of the bowels, with the passage of blood. This becomes gradually more marked. There may be pain but usually a varying amount of abdominal discomfort. The constant diarrhoea leads to emaciation, weakness and ANAEMIA. As a rule the acute phase passes into a chronic stage. The chronic form is liable to run a prolonged course, and most patients suffer relapses for many years. SIGMOIDOSCOPY, BIOPSY and abdominal X-RAYS are essential diagnostic procedures.

Treatment Many patients may be undernourished and need expert dietary assessment and appropriate calorie, protein, vitamin and mineral supplements. This is particularly important in children with the disorder. While speci?c nutritional treatment can initiate improvement in CROHN’S DISEASE, this is not the case with ulcerative colitis. CORTICOSTEROIDS, given by mouth or ENEMA, help to control the diarrhoea. Intravenous nutrition may be required. The anaemia is treated with iron supplements, and with blood infusions if necessary. Blood cultures should be taken, repeatedly if the fever persists. If SEPTICAEMIA is suspected, broad-spectrum antibiotics should be given. Surgery to remove part of the affected colon may be necessary and an ILEOSTOMY is sometimes required. After recovery, the patient should remain on a low-residue diet, with regular follow-up by the physician, Mesalazine and SULFASALAZINE are helpful in the prevention of recurrences.

Patients and their relatives can obtain help and advice from the National Association for Colitis and Crohn’s Disease.... ulcerative colitis

a condition in which sudden rapid destruction of red blood cells (see haemolysis) causes acute renal failure due partly to obstruction of small arteries in the kidneys. The haemolysis also causes a reduction in the number of platelets, which can lead to severe haemorrhage. The syndrome may occur as a result of septicaemia following a respiratory or gastrointestinal infection (especially by pathogenic *Escherichia coli), eclamptic fits in pregnancy (see eclampsia), or as a reaction to certain drugs. There may also be small sporadic outbreaks of the condition without any obvious cause.... haemolytic uraemic syndrome

An infective disease of worldwide distribution, the manifestations of which vary in di?erent localities. The causative organisms of all forms of typhus fever belong to the genus RICKETTSIA. These are organisms which are intermediate between bacteria and viruses in their properties, and measure 0·5 micrometre or less in diameter.

Louse typhus, in which the infecting rickettsia is transmitted by the louse, is of worldwide distribution. More human deaths have been attributed to the louse via typhus, louse-borne RELAPSING FEVER and trench fever, than to any other insect with the exception of the MALARIA mosquito. Louse typhus includes epidemic typhus, Brill’s disease – which is a recrudescent form of epidemic typhus – and TRENCH FEVER.

Epidemic typhus fever, also known as exanthematic typhus, classical typhus, and louse-borne typhus, is an acute infection of abrupt onset which, in the absence of treatment, persists for 14 days. It is of worldwide distribution, but is largely con?ned today to parts of Africa. The causative organism is the Rickettsia prowazeki, so-called after Ricketts and Prowazek, two brilliant investigators of typhus, both of whom died of the disease. It is transmitted by the human louse, Pediculus humanus. The rickettsiae can survive in the dried faeces of lice for 60 days, and these infected faeces are probably the main source of human infection.

Symptoms The incubation period is usually 10–14 days. The onset is preceded by headache, pain in the back and limbs and rigors. On the third day the temperature rises, the headache worsens, and the patient is drowsy or delirious. Subsequently a characteristic rash appears on the abdomen and inner aspect of the arms, to spread over the chest, back and trunk. Death may occur from SEPTICAEMIA, heart or kidney failure, or PNEUMONIA about the 14th day. In those who recover, the temperature falls by CRISIS at about this time. The death rate is variable, ranging from nearly 100 per cent in epidemics among debilitated refugees to about 10 per cent.

Murine typhus fever, also known as ?ea typhus, is worldwide in its distribution and is found wherever individuals are crowded together in insanitary, rat-infested areas (hence the old names of jail-fever and ship typhus). The causative organism, Rickettsia mooseri, which is closely related to R. prowazeki, is transmitted to humans by the rat-?ea, Xenopsyalla cheopis. The rat is the main reservoir of infection; once humans are infected, the human louse may act as a transmitter of the rickettsia from person to person. This explains how the disease may become epidemic under insanitary, crowded conditions. As a rule, however, the disease is only acquired when humans come into close contact with infected rats.

Symptoms These are similar to those of louse-borne typhus, but the disease is usually milder, and the mortality rate is very low (about 1·5 per cent).

Tick typhus, in which the infecting rickettsia is transmitted by ticks, occurs in various parts of the world. The three best-known conditions in this group are ROCKY MOUNTAIN SPOTTED FEVER, ?èvre boutonneuse and tick-bite fever.

Mite typhus, in which the infecting rickettsia is transmitted by mites, includes scrub typhus, or tsutsugamushi disease, and rickettsialpox.

Rickettsialpox is a mild disease caused by Rickettsia akari, which is transmitted to humans from infected mice by the common mouse mite, Allodermanyssus sanguineus. It occurs in the United States, West and South Africa and the former Soviet Union.

Treatment The general principles of treatment are the same in all forms of typhus. PROPHYLAXIS consists of either avoidance or destruction of the vector. In the case of louse typhus and ?ea typhus, the outlook has been revolutionised by the introduction of e?cient insecticides such as DICHLORODIPHENYL TRICHLOROETHANE (DDT) and GAMMEXANE.

The value of the former was well shown by its use after World War II: this resulted in almost complete freedom from the epidemics of typhus which ravaged Eastern Europe after World War I, being responsible for 30 million cases with a mortality of 10 per cent. Now only 10,000–20,000 cases occur a year, with around a few hundred deaths. E?cient rat control is another measure which reduces the risk of typhus very considerably. In areas such as Malaysia, where the mites are infected from a wide variety of rodents scattered over large areas, the wearing of protective clothing is the most practical method of prophylaxis. CURATIVE TREATMENT was revolutionised by the introduction of CHLORAMPHENICOL and the TETRACYCLINES. These antibiotics altered the prognosis in typhus fever very considerably.... typhus fever

chick embryos injected with the living, attenuated strain (17D) of pantropic virus. Only one injection is required, and immunity persists for many years. Re-inoculation, however, is desirable every ten years. (See YELLOW FEVER.)

Haemophilus vaccine (HiB) This vaccine was introduced in the UK in 1994 to deal with the annual incidence of about 1,500 cases and 100 deaths from haemophilus MENINGITIS, SEPTICAEMIA and EPIGLOTTITIS, mostly in pre-school children. It has been remarkably successful when given as part of the primary vaccination programme at two, three and four months of age – reducing the incidence by over 95 per cent. A few cases still occur, either due to other subgroups of the organism for which the vaccine is not designed, or because of inadequate response by the child, possibly related to interference from the newer forms of pertussis vaccine (see above) given at the same time.

Meningococcal C vaccine Used in the UK from 1998, this has dramatically reduced the incidence of meningitis and septicaemia due to this organism. Used as part of the primary programme in early infancy, it does not protect against other types of meningococci.

Varicella vaccine This vaccine, used to protect against varicella (CHICKENPOX) is used in a number of countries including the United States and Japan. It has not been introduced into the UK, largely because of concerns that use in infancy would result in an upsurge in cases in adult life, when the disease may be more severe.

Pneumococcal vaccine The pneumococcus is responsible for severe and sometimes fatal childhood diseases including meningitis and septicaemia, as well as PNEUMONIA and other respiratory infections. Vaccines are available but do not protect against all strains and are reserved for special situations – such as for patients without a SPLEEN or those who are immunode?cient.... yellow fever vaccine is prepared from

a vaccine that provides protection against four different strains (A, C, W, and Y) of the bacterium Neisseria meningitidis (the meningococcus) that causes *meningitis and septicaemia. It also prevents the carriage of the bacteria in the nose and back of the throat. In Britain it is offered to children aged 14 years and students going to college and university for the first time.... menacwy vaccine

The BRAIN is the organ of the mind. Normal conscious alertness depends upon its continuous adequate supply with oxygen and glucose, both of which are essential for the brain cells to function normally. If either or both of these are interrupted, altered consciousness results. Interruption may be caused by three broad types of process affecting the brain stem: the reticular formation (a network of nerve pathways and nuclei-connecting sensory and motor nerves to and from the cerebrum, cerebellum, SPINAL CORD and cranial nerves) and the cerebral cortex. The three types are di?use brain dysfunction – for example, generalised metabolic disorders such as URAEMIA or toxic disorders such as SEPTICAEMIA; direct effects on the brain stem as a result of infective, cancerous or traumatic lesions; and indirect effects on the brain stem such as a tumour or OEDEMA in the cerebrum creating pressure within the skull. Within these three divisions are a large number of speci?c causes of unconsciousness.

Unconsciousness may be temporary, prolonged or inde?nite (see PERSISTENT VEGETATIVE STATE (PVS)), depending upon the severity of the initiating incident. The patient’s recovery depends upon the cause and success of treatment, where given. MEMORY may be affected, as may motor and sensory functions; but short periods of unconsciousness as a result, say, of trauma have little obvious e?ect on brain function. Repeated bouts of unconsciousness (which can happen in boxing) may, however, have a cumulatively damaging e?ect, as can be seen on CT (COMPUTED TOMOGRAPHY) scans of the brain.

POISONS such as CARBON MONOXIDE (CO), drug overdose, a fall in the oxygen content of blood (HYPOXIA) in lung or heart disease, or liver or kidney failure harm the normal chemical working or metabolism of nerve cells. Severe blood loss will cause ANOXIA of the brain. Any of these can result in altered brain function in which impairment of consciousness is a vital sign.

Sudden altered consciousness will also result from fainting attacks (syncope) in which the blood pressure falls and the circulation of oxygen is thereby reduced. Similarly an epileptic ?t causes partial or complete loss of consciousness by causing an abrupt but temporary disruption of the electrical activity in the nerve cells in the brain (see EPILEPSY).

In these events, as the brain’s function progressively fails, drowsiness, stupor and ?nally COMA ensue. If the cause is removed (or when the patient spontaneously recovers from a ?t or faint), normal consciousness is usually quickly regained. Strokes (see STROKE) are sometimes accompanied by a loss of consciousness; this may be immediate or come on slowly, depending upon the cause or site of the strokes.

Comatose patients are graded according to agreed test scales – for example, the GLASGOW COMA SCALE – in which the patient’s response to a series of tests indicate numerically the level of coma.

Treatment of unconscious patients depends upon the cause, and range from ?rst-aid care for someone who has fainted to hospital intensive-care treatment for a victim of a severe head injury or massive stroke.... unconsciousness

Linn.

Synonym: Y recurvifolia Salisb.

Family: Liliaceae; Agavaceae.

Habitat: Native to Central America; introduced into India as a garden plant.

English: Spanish Dagger-Plant, Adam's Needle.

Action: Fruit—anti-inflammatory, blood purifier, cholagogue. Used in rheumatism, oedema, bronchitis, asthma and chest diseases; also for ulcers, sores, dysentery and haemorrhagic septicaemia.

Yuccas are an important source of steroidal sapogenins, precursors of sex-hormones and steroids. Related species, Yucca bacata, Y. glauca, and Y brevifolica, are used for hormonal disturbances, menstrual disorders, varicose veins, arthritis and rheumatism.

Oxycanthin, extracted from Yucca plant, is used for the treatment of pruritus. It also stimulates hair growth.

The leaves of Yucca gloriosa contain sapogenins—titogenin derivatives, smilagenin, hecogenin, diosgenin, glo- riogenin, 12-beta-hydroxysmilagenin and chlorogenin. Beta-sitosterol is also reported from leaves.

Essential oil from leaves contains cis- 9-nonadecene and cis-8-heptadecene as major constituents.... yucca gloriosa

Breakdown and ulceration of tissues from pressure on parts of the body overlying bone in those confined to bed for long periods. Poor or obstructed circulation interferes with tissue replacement and drainage, giving place to local gangrene. Weak body health disposes: anaemia, poor nutrition or absence of a fatty barrier between skin and bone. Commences with superficial redness, turning to blue and progressing to fat and muscle necrosis. Prognosis: destruction of bone and septicaemia.

Prevention is best. Wipe over possible areas with whisky or Vodka following with Oil of St John’s Wort. Bed patients are encouraged to spend at least 2 or 3 hours out of bed daily. Many kinds of bed-care aids exist: inflatable rings, water beds and padded protection. Vitamin C deficiency exists in most cases. Treatment. Herbal antibiotics: Wild Indigo, Myrrh, Milk Thistle, Goldenseal, Echinacea, Marigold. Supportives: Comfrey, Sarsaparilla, Vitamin E.

Tablets/capsules. Goldenseal, Echinacea, Sarsaparilla.

Powders. Parts: Echinacea 2; Goldenseal 1; Liquorice 1. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.

Tinctures. Wild Indigo 1; Echinacea 2; Goldenseal quarter. 1-2 teaspoons in water 3 times daily. Practitioner. Tincture Echinacea BHP (1983) 20ml; Tincture Goldenseal BPC (1949) 5ml; Tincture Marigold BPC (1934) 10ml. Low alcohol vodka to 100ml. Sig: 5ml (3i) tds aq. cal. AC. (Anonymous) Topical. Early stages: Comfrey poultice or ointment. Marshmallow and Slippery Elm ointment; Oil St John’s Wort, Rue tea. Fresh pulp of Aloe Vera. Later stages: Sunlight soap plaster. Official medicine at the turn of the century used Lassar’s paste or zinc and castor oil ointment which are still effective. Distilled extract of Witch Hazel. For threatened gangrene, skin breakdown with formation of slough: (1) Zinc and Castor oil ointment (or cream) plus a little powdered Myrrh. (2) Cold poultice of Comfrey powder. ... bedsores

n. (pl. meningococci) the bacterium *Neisseria meningitidis, which can cause a serious form of septicaemia and is a common cause of *meningitis. —meningococcal adj.... meningococcus

a vaccine that protects against infection by the bacterium *Streptococcus pneumoniae, which can cause serious diseases, including pneumonia, septicaemia, and *meningitis. Children under 2 years of age and adults over 65 years are at particular risk. Since September 2006, the pneumococcal vaccine has become part of the childhood *immunization programme. It is also offered to people over the age of 65 as a single vaccination that will protect for life.... pneumococcal vaccine

Disorders resulting from abnormalities in any of the components of blood or from infection. Disorders include types of anaemia, polycythaemia, bleeding disorders, and unwanted clot formation (thrombosis), hypoalbuminaemia (albumin deficiency) and agammaglobulinaemia (deficiency of gamma-globulin). Blood disorders such as sickle cell anaemia, thalassaemia, and haemophilia are inherited. Bone marrow cancers that affect production of blood components include leukaemia, polycythaemia vera, and multiple myeloma. Blood poisoning is usually due to septicaemia or a toxin such as carbon monoxide. Some drugs can cause blood abnormalities as a side effect. (See also anaemia, haemolytic; anaemia, iron-deficiency; anaemia, megaloblastic; malaria; hyperbilirubinaemia.)... blood, disorders of

Analysis of a sample of blood to give information on its cells and proteins and any of the chemicals, antigens, antibodies, and gases that it carries. Such tests can be used to check on the health of major organs, as well as on respiratory function, hormonal balance, the immune system, and metabolism. Blood tests may look at numbers, shape, size, and appearance of blood cells and assess the function of clotting factors. The most important tests are blood count and blood group tests if transfusion is needed. Biochemical tests measure chemicals in the blood (see acid–base balance; kidney function tests; liver function tests). Microbiological tests (see immunoassay) look for microorganisms that are in the blood, as

in septicaemia. Microbiology also looks for antibodies in the blood, which may confirm immunity to an infection. blood transfusion The infusion of large volumes of blood or blood products directly into the bloodstream to remedy severe blood loss or to correct chronic anaemia. In an exchange transfusion, nearly all of the recipient’s blood is replaced by donor blood. Before a transfusion, a sample of the recipient’s blood is taken to identify the blood groups, and it is matched with suitable donor blood. The donor blood is transfused into an arm vein through a plastic cannula. Usually, each unit (about 500 ml) of blood is given over 1–4 hours; in an emergency, 500 ml may be given in a couple of minutes. The blood pressure, temperature, and pulse are monitored during the procedure.

If mismatched blood is accidentally introduced into the circulation, antibodies in the recipient’s blood may cause donor cells to burst, leading to shock or kidney failure. Less severe reactions can produce fever, chills, or a rash. Reactions can also occur as a result of an allergy to transfused blood components. All

blood used for transfusion is carefully screened for a number of infectious agents, including HIV (the AIDS virus) and hepatitis B and hepatitis C.

In elderly or severely anaemic patients, transfusion can overload the circulation, leading to heart failure.

In patients with chronic anaemia who need regular transfusion over many years, excess iron may accumulate (haemosiderosis) and damage organs such as the heart, liver, and pancreas.

Treatment with desferrioxamine to remove excess iron may be needed.... blood tests

Inflammation of the common bile duct (see biliary system). There are 2 types: acute ascending cholangitis and sclerosing cholangitis. Acute ascending cholangitis is usually due to bacterial infection of the duct and its bile, generally as a result of blockage of the duct by, for example, a gallstone (see bile duct obstruction). The infection spreads up the duct and may affect the liver. The main symptoms are recurrent bouts of jaundice, abdominal pain, chills, and fever. Mild attacks are treated with antibiotics and a high intake of fluids. In severe, life-threatening attacks, which may be accompanied by septicaemia and kidney failure, the infected material may be drained from the bile duct by surgery or endoscopy.

Sclerosing cholangitis is a rare condition in which all the bile ducts within and outside the liver become narrowed.

The condition causes cholestasis, chronic jaundice, and itching of the skin.

The liver is progressively damaged.

Colestyramine may relieve itching.

The only other treatment available is a liver transplant.... cholangitis

a pale area surrounded by haemorrhage sometimes seen in the retina, with the aid of an *ophthalmoscope, in those who have bacterial endocarditis, septicaemia, or leukaemia. [M. Roth (1839–1915), Swiss physician]... roth spot

n. a genus of motile rodlike Gram-negative bacteria that inhabit the intestines of animals and humans and cause disease. They ferment glucose, usually with the formation of gas. The species S. paratyphi causes *paratyphoid fever, and S. typhi causes *typhoid fever. Other species of Salmonella cause *food poisoning, gastroenteritis, and septicaemia.... salmonella

n. blood poisoning by toxins of saprophytic bacteria (bacteria living on dead or decaying matter). Compare pyaemia; septicaemia; toxaemia.... sapraemia

(pyogenic arthritis) infection in a joint. The joint is swollen, hot, and tender, and movement causes severe pain. The infecting organism (usually Staphylococcus aureus) can enter the joint via the bloodstream, from an injection or penetrating injury, or by direct spread from an adjacent area of osteomyelitis. The condition is a surgical emergency as it can lead to rapid destruction of articular cartilage, loss of joint function, and septicaemia. Treatment is by *arthrotomy or irrigation of the joint by arthroscopy, with appropriate antibiotic therapy.... septic arthritis

A way of understanding speech by interpreting movements of the mouth and tongue. Lip-reading is often used by people who are deaf.

liquid paraffin A lubricant laxative drug obtained from petroleum. It can cause anal irritation, and prolonged use may impair the absorption of vitamins from the intestine into the blood. lisinopril An ACE inhibitor drug commonly used to treat hypertension. lisp A common speech disorder caused by protrusion of the tongue between the teeth so that the “s” sound is replaced by “th”. Sometimes the cause is a cleft palate (see cleft lip and palate). In most children, there is no physical defect and lisping disappears by the age of about 4. listeriosis An infection that is common in animals and may also affect humans. It is caused by the bacterium LISTERIA MONOCYTOGENES, which is widespread in the environment, especially in soil. Possible sources of human infection include soft cheese, ready-prepared coleslaw and salads, and improperly cooked meat.

In most adults, the only symptoms are fever and aching muscles. There may also be sore throat, conjunctivitis, diarrhoea, and abdominal pain. Pneumonia, septicaemia, and meningitis may develop in severe cases. However, listeriosis can be life-threatening, particularly in elderlypeople, those with reduced immunity, and newborn babies. In pregnant women, infection may cause a miscarriage.

The condition is diagnosed by blood tests and analysis of other body fluids, such as urine. Treatment is with antibiotic drugs, such as ampicillin.... lip-reading

Inflammation of the peritoneum. Peritonitis is a serious, usually acute, condition. The most common cause is perforation of the stomach or intestine wall, which allows bacteria and digestive juices to move into the abdominal cavity. Perforation is usually the result of a peptic ulcer, appendicitis, or diverticulitis. Peritonitis may also be associated with acute salpingitis, cholecystitis, or septicaemia.

There is usually severe abdominal pain. After a few hours, the abdomen feels hard, and peristalsis stops (see ileus, paralytic). Other symptoms are fever, bloating, nausea, and vomiting.

Diagnosis is made from a physical examination. Surgery may be necessary to deal with the cause. If the cause is unknown, a laparoscopy or an exploratory laparotomy may be performed. Antibiotic drugs and intravenous infusions of fluid are often given. In most cases, a full recovery is made. Intestinal obstruction, caused by adhesions, may occur at a later stage.... peritonitis

Infections due to any of the salmonella group of bacteria. One type of salmonella causes typhoid fever; others commonly result in bacterial food poisoning, most often through contamination of hens’ eggs or chicken. Infants, the elderly, and people who are debilitated are most susceptible.

Symptoms of salmonella food poisoning usually develop suddenly 12–24 hours after infection and include headache, nausea, abdominal pain, diarrhoea, and sometimes fever. The symptoms usually last for only 2 or 3 days, but, in severe cases, dehydration or septicaemia may develop.

Treatment is by rehydration therapy.

In severe cases, fluid replacement by intravenous infusion may be needed.... salmonella infections

An infection anywhere in the urinary tract. It has differing symptoms, depending on the area affected. Urethritis causes a burning sensation when urine is being passed. Cystitis causes a frequent urge to pass urine, lower abdominal pain, haematuria, and, often, general malaise with a mild fever. Pyelonephritis causes fever and pain in the back under the ribs. Cystitis and pyelonephritis are almost always the result of a bacterial infection. Urethritis is often due to a sexually transmitted infection, such as gonorrhoea, but may have other causes. Urethral infections are more common in men. Infections further up the urinary tract are more common in women. In men, there is often a predisposing factor, such as an enlarged prostate gland (see prostate, enlarged). In women, pregnancy is a risk factor.

In both sexes, causes of urinary tract infections include stones (see calculus, urinary tract), bladder tumours, congenital abnormalities of the urinary tract, or defective bladder emptying as a result of spina bifida or a spinal injury. The risks of developing a urinary tract infection can be reduced by strict personal hygiene, drinking lots of fluids, and regularly emptying the bladder.

Urethritis can lead to the formation of a urethral stricture. Cystitis usually only causes complications if the infection spreads to the kidneys. Pyelonephritis, if it is left untreated, can lead to permanent kidney damage, septicaemia, and septic shock.

The infection is diagnosed by the examination of a urine culture. Further investigations using urography or ultrasound scanning may be necessary. Most infections of the urinary tract are treated with antibiotic drugs.... urinary tract infection

n. an *aminoglycoside antibiotic used to treat septicaemia, lung infection caused by Pseudomonas in patients with cystic fibrosis, and urinary, skin, abdominal, and central nervous system infections. Kidney damage or hearing impairment may occur with high doses or prolonged use.... tobramycin

n. blood poisoning that is caused by toxins formed by bacteria growing in a local site of infection. It produces generalized symptoms, including fever, diarrhoea, and vomiting. Compare pyaemia; sapraemia; septicaemia.... toxaemia

a state of acute *shock due to *septicaemia. The commonest cause is a retained foreign body (e.g. a tampon or IUCD) combined with the presence of staphylococci (see also streptococcal toxic shock syndrome). The condition can be life-threatening if not treated aggressively with appropriate antibiotics and supportive care (including fluid and electrolyte replacement).... toxic shock syndrome

acute haemorrhage in the adrenal glands with haemorrhage into the skin associated with the sudden onset of acute bacteraemic *shock. It is usually caused by meningococcal septicaemia (see meningitis). [R. Waterhouse (1873–1958), British physician; C. Friderichsen (20th century), Danish physician]... waterhouse–friderichsen syndrome

n. a genus of Gram-positive nonmotile spherical bacteria occurring in chains. Most species are saprophytes; some are pathogenic. Many pathogenic species are haemolytic, i.e. they have the ability to destroy red blood cells in blood agar. This provides a useful basis for classifying the many different strains. Strains of S. pyogenes (the ?-haemolytic streptococci) are associated with many infections, including *scarlet fever, and produce many *exotoxins. Strains of the ?-haemolytic streptococci are associated with bacterial *endocarditis. The species S. pneumoniae (formerly Diplococcus pneumoniae) – the pneumococcus – is associated with serious diseases, including pneumonia, pneumococcal *meningitis, and septicaemia; it is also a common bacterial cause of ear infections (see also pneumococcal vaccine). It occurs in pairs, surrounded by a capsule (see quellung reaction). S. mutans has been shown to cause dental caries. See also Lancefield classification; streptokinase. —streptococcal adj.... streptococcus