HFMD: causes, transmission, pathophysiology, symptoms, diagnosis and treatment. For patient education.
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Hand, foot and mouth disease is a common viral infection that affects mostly infants and young children. Infection is characterized by a rash on the hands and feet, and painful blisters inside the mouth. Outbreaks typically occur in daycare setting, during summer and early fall.
Most cases are caused by coxsackievirus A, serotype 16, but other enteroviruses can also be the cause. Notably, enterovirus 71, EV-71, is responsible for a more severe form of the disease. The viruses are non-enveloped, and contain a single plus-strand RNA.
An infected person may shed virus in respiratory droplets, oral and nasal secretions, blister fluid, and stool. The disease can spread through direct or indirect contacts with the infected. Patients are most contagious during the first week of illness, but can remain infectious for several weeks, even without symptoms.
After being inhaled or ingested, the virus replicates in the throat, tonsils, and lymphoid tissue of the small intestine. From there, it spreads to regional lymph nodes, and then further to various organs including the skin, heart, liver, and central nervous system.
Incubation period is 3 to 6 days. Infection typically starts with a low-grade fever and flu-like symptoms. Painful mouth sores appear a couple of days after the onset of fever, most often in the back of the throat. Skin rash commonly occurs on the hands, soles of the feet, and around the mouth, but can be anywhere on the body. The rash can be flat, raised or vesicular. Skin lesions are typically not itchy or painful.
Rarely, complications involving the central nervous system such as aseptic meningitis, encephalitis, or polio-like paralysis, may occur, especially with enterovirus 71, which has a significantly higher mortality rate.
Diagnosis is usually made based on symptoms. Antibody or PCR tests may be used to differentiate between coxsackievirus and enterovirus 71.
Hand, foot and mouth disease is usually mild and resolves on its own within 7 to 10 days. Treatment is supportive and includes pain and fever reducers, hydration, oral hygiene and a soft diet. Antiviral drugs may be used to treat infections by EV-71.
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Children in daycares are among the most at-risk
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The theme of World Health Day 2014 is vector-borne diseases, under the slogan “Small bite: big threat”. Vectors are small organisms that carry diseases and spread them from person to person and place to place. They can put our health at risk, at home and when we travel. Every year more than one million people die from vector-borne diseases, such as malaria, dengue, schistosomiasis, leishmaniasis and yellow fever. Many more people are left with chronic illness and disabilities as a result of infection.
It is time to draw global attention to the threat posed by vectors and vector-borne diseases. The World Health Day campaign aims to raise awareness of the threat posed by vectors and vector-borne diseases and to encourage families and communities to take simple measures to protect themselves.
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Lyme disease (vector-transmitted disease): causes, transmission, stages of Lyme disease, pathophysiology, complications, diagnosis, prevention and treatments. For patient education. This video is available for instant download licensing here: https://www.alilamedicalmedia.com/-/galleries/narrated-videos-by-topics/infectious-diseases/-/medias/2d244741-05aa-45fb-a550-0f5a31f8a4e6-lyme-disease-narrated-animation
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Voice by : Marty Henne
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Lyme disease is infection caused by several species of Borrelia bacteria, and is typically transmitted by ticks, in particular deer ticks (vector). Small mammals, such as mice and squirrels, are the primary reservoir for Borrelia. They host the larval and nymphal forms of deer ticks and infect them with the bacteria. Deer host adult ticks, but do not carry Borrelia. Lyme disease is most prevalent in areas where deer ticks are most abundant.
Not every tick bite leads to Lyme disease. To cause the disease, the tick must be infected with Borrelia, and the infected tick must attach to the human body long enough, typically for at least 36 hours, for the bacteria to enter the body.
The best way to prevent Lyme disease is to avoid tick bites, by staying away from wooded areas, or covering up the skin and using insect repellents; and if bitten, to remove the tick as soon as possible.
In the early stage of the disease, the bacteria spread from the site of the tick bite, forming a characteristic bull’s eye-shaped rash, called erythema migrans, that expands over the course of several days, then fades after 3 to 4 weeks. The rash is warm to touch but typically not itchy or painful. However, some patients may have an uncharacteristic rash, or no rash at all. Patients may also have flu-like symptoms and swollen lymph nodes at this stage.
Without treatment, the bacteria spread through the lymphatic system and bloodstream to other organs and other skin sites, and the disease progresses to the early-disseminated stage, stage 2, which typically starts after a month, and lasts for a couple of months. Symptoms are due to inflammation triggered by the bacteria in the affected organs. In the joints, inflammation causes joint pain, most commonly in the knees. In the nervous system, inflamed nerves can result in numbness and muscle weakness. Inflammation in the brain may lead to meningitis or cognitive defects, such as impaired memory. Rarely, infection can cause irregular heartbeats. Some patients may also have multiple ring-shaped secondary skin lesions.
If left untreated, the late stage, stage 3, begins months to years after the initial infection. The most common feature is joint pain, or Lyme arthritis. Patients may also present with aseptic meningitis, Bell’s palsy, nerve pain, or cognitive deficits. Some patients may be misdiagnosed as having fibromyalgia.
Diagnosis is based on symptoms, especially the characteristic rash, history of a tick bite, and lab tests for antibodies against the bacteria, which are positive a few weeks after the bite. However, diagnosis can be difficult as many patients do not recall having a tick bite or a rash.
In most cases, Lyme disease can be treated successfully with 2 weeks of oral antibiotics. Patients with neurological symptoms may require intravenous antibiotics and a longer treatment course. The earlier the treatment begins, the higher the chance of full recovery.
A small number of patients may have symptoms that last for months after they finish treatment. This condition is called post-treatment Lyme disease syndrome, PTLDS, and is likely caused by an autoimmune response triggered by the bacteria rather than the infection itself. Additional antibiotic treatments are not useful, but patients with PTLDS usually recover slowly over time.
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Gout disease is a common form of inflammatory arthritis characterized by recurrent attacks of painful joint pain. Category: bone, joint and muscles disorder, metabolic disorders.
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Cushing syndrome is a group of conditions caused by high levels of circulating cortisol or related corticosteroids.
A gout attack occurs suddenly, often at night. The affected joint is swollen, red and warm to touch. The initial attack usually involves only one joint, most often in the big toe, and lasts a few days. Subsequent flares may involve multiple joints and can last for weeks, with shorter intervals of remission in between.
Gout is caused by deposits of urate crystals in the joints, which may happen when blood levels of uric acid are too high. Uric acid is a waste product from the breakdown of purines, a major component of DNA and RNA. Because body’s cells are constantly renewed, uric acid is constantly produced and removed in urine. High serum urate level may result from decreased urate excretion, increased urate production, and/or overconsumption of purines.
The most common cause is the kidney’s decreased ability to excrete uric acid, which can be hereditary, or a result of kidney diseases, medications such as diuretics, alcohol use, or lead poisoning. Increased production of urate may occur in conditions with abnormally high cellular turnover or cell death, or in obesity, as urate production increases with greater body surface area. Overconsumption of purine-rich foods can contribute to higher urate level, but is rarely the only cause.
High concentration of urate promotes its precipitation and formation of crystals in joints, causing inflammation and pain. Because uric acid crystals form more easily in cooler temperatures, gout more often affects joints of the extremities. Urate crystals may also deposit under the skin around the joints, forming hard lumps, called tophi, that are not usually painful but can limit joint motions and lead to deformities. Joint damage caused by gout also increases the risk of developing osteoarthritis. In the kidneys, urate deposits may form stones, blocking urine flow.
Gout is more common in men. It often starts in middle age in men, and after menopause in women. Other risk factors include diets, obesity, other health conditions, family history, and surgery or trauma.
Diagnosis requires detection of urate crystals in synovial joint fluid. Because not all people with high serum urate levels develop gout, a blood test alone is not sufficient for diagnosis.
Acute gout attacks are treated with anti-inflammatory drugs, such as NSAIDs, regular use of which may also help prevent or reduce frequency of attacks. Because tophi can be dissolved by lowering serum urate, medications that block urate production or increase urate excretion may be used for this purpose.
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Gout may be triggered by an increasing level of uric acid in our body. It guarantees an intense pain usually at the big toe joints and is more likely to flare at night (approximately 2.4 times more frequent than the daytime). This is because the concentration of uric acid increases while we’re sleeping. While asleep, through breathing and sweating, our body loses moisture. Less water content in the blood equals higher concentration of uric acid and may lead to hyperuricemia, the precursor to gout.

Holding our breath while sleeping is out of the option so the other factor that we can control to manage our uric acid level is through diet. Avoid eating a diet rich in red meat and seafood with high purine content. It’s also highly risky to consume alcohol and beverages sweetened with fruit sugar. Further treatment includes several types of drugs that can block the uric acid production such as Allopurinol and Febuxostat.

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REFERENCES:
Purines made in the body
https://www.sciencedirect.com/science/article/pii/S0167527315303429
Extra urate is flushed out through urine
https://www.uofmhealth.org/health-library/aa15402
Foods with high purine content
https://www.medicalnewstoday.com/articles/322590
Gout Diet
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524
General
https://www.cdc.gov/arthritis/basics/gout.html
https://www.niams.nih.gov/health-topics/gout
https://www.nhs.uk/conditions/gout/
https://my.clevelandclinic.org/health/diseases/4755-gout

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