Friday, November 14

What is leptospirosis - Leptospirosis in humans (Weil's disease)

What is leptospirosis - Leptospirosis in humans (Weil's disease).

What is leptospirosis?

Leptospirosis is a highly infectious zoonotic disease caused by the Leptospira bacteria affecting humans and animals. Icteric leptospirosis in humans is known as Weil's disease. It may also appear as an asymptomatic and subclinical infection. Leptospirosis symptoms range widely and are usually ignored or wrongly diagnosed as some other human sickness. Untreated infection can become icteric, leading to hepatitis, meningitis, renal failure, respiratory failure, pulmonary hemorrhage, and even loss of human life. The disease is more prevalent in tropical, subtropical and temperate climates.

What causes leptospirosis?

Leptospirosis is caused by the spirochetes (spiral bacteria). The spirochetes belong to the genus Leptospira, the family Leptospiraceae, and the order Spirochaetales. These anaerobic bacteria are thin, coiled and motile. Comprising several pathogenic and nonpathogenic species, typical disease manifestations in humans such as Weil disease, jaundice, pretibial erythematous rash, meningitis and gastroenteritis are associated with different serovars (strains). The bacteria can enter the human body through the contaminated water and food, skin injuries, animal bites and mucous membrane.
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The bacteria spread to humans through the urine, feces or body fluids of the infected animals. They can infect a wide variety of domestic as well as wild animals, which not showing any symptoms of the disease, may continue to shed the bacteria into the surroundings for months together. These infective discharges, by contaminating the drinking water and food, can spread the infection to humans and animals.
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Floodwaters have been found to spread the disease far and wide and cause leptospirosis outbreaks.

What are the risks of exposure?

Human occupational exposure to infected animals can also spread the bacterial disease among farmers, veterinarians, fish farmers, dairy workers, abattoir workers, sewer workers and animal caretakers. People associated with water sports like, swimming, kayaking, rafting run the high risk of contracting leptospirosis, if the waters are polluted.

What are the symptoms of leptospirosis

The incubation period is usually 5-14 days but in some cases the symptoms have taken 2-30 days to develop in humans. The common clinical symptoms of the infection include, fever, headache, body pains, dry cough, rash, sore throat and chills. Gastrointestinal tract symptoms include anorexia, nausea, abdominal pain, vomiting, and diarrhea.
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Untreated leptospirosis may cause many systemic manifestations in humans, mostly by capillary vasculitis of the organ systems leading to hepatic failure, renal failure, pulmonary hemorrhage, respiratory failure, meningitis, interstitial myocarditis, adrenal hemorrhage, conjunctival suffusion and thrombotic thrombocytopenic purpura.
electron micrograph image of Leptospirosis bacteria
Leptospirosis causing bacteria
Image courtesy: the Centers for Disease Control/Rob Weyant/public domain

What is the treatment for leptospirosis

Mild infections in humans can be treated with doxycycline, ampicillin, penicillin, azithromycin, erythromycin or amoxicillin. For severe human leptospirosis, third-generation cephalosporins like cefotaxime and ceftriaxone may be administered. Intravenous penicillin G is also effective for mild to severe cases of infection.

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References:
1.Vijayachari P, Sugunan AP, Shriram AN. Leptospirosis: an emerging global public health problem. J Biosci. 2008 Nov;33(4):557-69.
2.Puliyath G, Singh S. Leptospirosis in pregnancy. Eur J Clin Microbiol Infect Dis. 2012 Oct;31(10):2491-6.
3.WasiƄski B. Leptospirosis--current problems. Przegl Epidemiol. 2011;65(3):471-6.


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Tuesday, October 28

Marburg virus disease (MVD) - Marburg hemorrhagic fever

Marburg virus disease (Marburg hemorrhagic fever) symptoms

What is Marburg virus disease?

Marburg virus disease, also known as Marburg hemorrhagic fever, is a severe and highly fatal disease caused by the filoviruses. The two filoviruses are Marburg virus (MARV) and Ravn virus (RAVV). The clinical symptoms are similar to Ebola virus disease. The typical symptoms are high fever, severe headache, malaise and severe haemorrhagic manifestations. The haemorrhagic symptoms include petechiae, purpura, hematomas, maculopapular rash and bleeding from multiple sites. The fruit bats in the endemic regions are considered to be carriers and reservoirs of the Marburg hemorrhagic fever virus. both MARV and RAVV have been isolated from bats.

The most common methods of diagnosis of Marburg virus disease are reverse transcription polymerase chain reaction (RT-PCR) and antigen-capture enzyme-linked immunosorbent assay (ELISA). Presently there is no effective treatment for Marburg virus disease. Early supportive treatment, care and hydration may help in the survival of the patient. Death occurs due to multiple organ dysfunction syndrome (MODS), previously known as multiple organ failure (MOF).
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Marburg hemorrhagic virus is transmitted among humans by direct contact with the body fluids, skin and tissues of the infected individuals. There is no evidence of marburgviruses getting transmitted by aerosol in MVD outbreaks. The medical personnel must strictly follow barrier nursing techniques while caring and treating Marburg virus disease patients. They should wear disposable face mask, gloves, goggles and gown. Many cases of Marburg hemorrhagic fever were reported in visitors to bat-infested mines or caves. Avoiding visit to caves and avoiding skin contact with bats, primates and their excretions in endemic regions is highly recommended.
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Marburg virus disease was first identified in 1967 epidemics in Marburg and Frankfurt in Germany and Belgrade in the former Yugoslavia. Of the 31 people infected seven died. The Marburg hemorrhagic fever was contracted from infected monkeys imported from Uganda. During the 1998–2000 outbreak in Congo, Of the 154 people who contracted Marburg virus, 128 died. During the 2004–2005 outbreak of hemorrhagic fever in Angola, Of the 252 people who contracted Marburg virus, 227 died.

Symptoms in clinical phases of Marburg Hemorrhagic Fever

A general list of observed symptoms as the hemorrhagic fever infection progresses is given below. Please note that the disease progression symptoms may vary among patients in respect to earlier health status.
Incubation: Incubation period of the hemorrhagic fever is usually 5-9 days. Variation in this period range from 2 days to 21 days.
Clinical onset of symptoms (1-5 days): The onset of the hemorrhagic fever symptoms are sudden with high fever and severe headache. The patient may also suffer from symptoms like serious bouts of chills and shivering followed by malaise and fatigue. Nausea, vomiting, diarrhea, loss of appetite, muscular pain, nonproductive cough, pharyngitis, relative bradycardia and abdominal pain may be present in Marburg virus disease. As the Marburg hemorrhagic fever progresses, symptoms like diffuse erythematous, non pruritic maculopapular rash may appear on the skin.
Symptoms of early organ phase: This phase of Marburg hemorrhagic fever may last from day 6 to day 13 from the day of clinical onset. The hemorrhagic fever symptoms include conjunctivitis, edema, shortness of breath and widespread rash. Central nervous system disease with symptoms like encephalitis, tremors, slurred speech, seizures, confusion, muscle fasciculations, delirium, apathy, paralysis and aggression may appear in Marburg viral disease. By the end of the early organ phase, hemorrhagic symptoms like blood in stools, bleeding from skin puncture sites, mucosal & visceral hemorrhaging appear.
Symptoms of late organ phase: From day 14 to day 21 the hemorrhagic fever survivors will go into convalescence phase. They may suffer from symptoms of fibromyalgia and hepatitis. In fatal Marburg virus disease cases the health continues to deteriorate, leading to symptoms like diffuse coagulopathy, convulsions, altered level of consciousness, coma, shock and death.

Treatment and management of the hemorrhagic fever

There is no standard treatment for the hemorrhagic infection. Early detection, diagnosis and providing supportive care may save lives. Some of the supportive measures for Marburg hemorrhagic fever are:
  • balancing the patient's fluids and electrolytes of patients with symptoms
  • maintaining blood pressure
  • supporting breathing
  • pain management in patients with symptoms
  • administration of anticoagulants early in infection
  • replacing lost blood and clotting factors of patients with the symptoms
  • treatment for opportunistic infections in patients of the hemorrhagic fever disease

Risks of contracting Marburg virus

The following are are high-risk factors in contracting MVD:
  • skin contact with patients with the symptoms of Marburg virus disease
  • direct skin contact with the hemorrhagic fever patients
  • direct contact with body fluids, excretions, tissues of the patients with symptoms
  • handling blood and secretions of Marburg hemorrhagic fever patients
  • direct contact with equipment, beddings, utensils etc of the patients
  • placing of intravenous lines in patients
  • inserting catheters and using suction devices on Marburg virus disease patients
  • handling the dead bodies in the endemic zone
  • handling ill or dead fruit bats, monkeys and other wild animals
  • accidental infection of workers in any facility investigating the virus
  • handling contaminated injection equipment
  • accidental needle injuries

Prognosis

The average fatality is 60%. In outbreaks fatality was as high as 80%. In the surviving patients, recovery may be protracted and many systemic ailments may linger on.
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Though the surviving Marburg hemorrhagic fever patient develops antibodies, the virus is known to persist in seminal fluids and breast milk and cause secondary infection and disease. No approved vaccines are available to prevent the spread of Marburg infection.


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    References:
    1.http://www.who.int/csr/disease/marburg/en/
    2.http://www.cdc.gov/vhf/marburg/
    3.https://www.gov.uk/marburg-virus-disease-origins-reservoirs-transmission-and-guidelines


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    Current topic in health and fitness tips: Marburg virus disease (Marburg hemorrhagic fever) causes, symptoms and treatment.
  • Wednesday, October 15

    What is Ebola virus disease (EVD) - Ebola definition

    What is Ebola virus disease and its definition

    What is Ebola virus disease?

    Ebola disease is a hemorrhagic fever caused by a type of RNA virus. Ebola is highly contagious and often fatal. Ebola is transmitted through contact with the body fluids of an infected person. It was discovered in 1976 in Africa and is named after a river in the Democratic Republic of the Congo. There are four subtypes of this virus of which one type appears to affect only primates. The rest of three can infect and spread from human to human.

    In an outbreak, the first infection is usually occurs from an affected animal to humans. The virus infection can spread through contaminated needles, body fluids, vomit, blood, faeces, urine and direct skin contact. The infection becomes highly contagious in its later stages. The incubation period spans between 2-21 days. There is high mortality rate among the infected. Even the dead body may remain contagious up to three days. Health care personnel attending EVD patients are required to wear protective equipment. There is no standard treatment for this disease.
    | | | | |
    Definition of Ebola virus disease
    Definition by merriam-webster.com: "the hemorrhagic fever caused by the Ebola virus —called also Ebola Fever."
    Definition by thefreedictionary.com: "a severe and often fatal disease in humans and nonhuman primates (monkeys and chimpanzees) caused by the Ebola virus; characterized by high fever and severe internal bleeding; can be spread from person to person; is largely limited to Africa."
    Definition by yourdictionary.com: "Ebola hemorrhagic fever, is a type of RNA virus that causes Ebola hemorrhagic fever. It is highly contagious and is often fatal in humans and some primates, like monkeys and gorillas."

    What are the symptoms of Ebola disease

    The early symptoms include high fever, sore throat, chest pain, shortness of breath, fatigue, body aches, muscle pain, joint pain, severe headaches, vomiting, diarrhea, hiccups, difficulty in swallowing and abdominal pain. This phase is followed by bleeding phase.
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    There is both internal and external bleeding. Blood may be coughed up, vomited or excreted in stool. Bleeding of skin can form petechiae and purpura. The blood loss can lead to death.

    What is the treatment for Ebola disease

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    There is no standard treatment for this disease and early supportive care and hydration can help in survival. In some cases antiviral medicines were found to be helpful. Vaccines for this disease are under development in many research centres.

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    References:
    1.http://www.mayoclinic.org/diseases-conditions/ebola-virus/basics/definition/con-20031241


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    Current topic in health and fitness tips: What is ebola disease and its definition.
    Image source: http://en.wikipedia.org/wiki/File:Ebola_virus_virion.jpg
    Author: CDC/Cynthia Goldsmith | License: Public domain

    Sunday, August 31

    What is malaria disease? - Definition of malaria

    Malaria immunity What is malaria disease - Malaria definition

    What is malaria disease?

    Malaria is a vector-borne life-threatening infectious disease. It is caused by protozoan parasites from the Plasmodium family and spread by the mosquito of the genus Anopheles. Individuals with the disease have repeated bouts of high fever, chills, shivering and flu-like symptoms. According to the World Health Organization, in 2012 an estimated 207 million clinical cases of malaria occurred worldwide resulting in 627,000 deaths.

    The disease is mosquito-borne and can only be transmitted from an affected person to another healthy person by mosquito bite. In some rare cases improperly sterilized injection needles had spread the infection. Malaria disease predominantly affects the red blood cells. The parasites enter the erythrocytes for their growth process. After undergoing development and asexual multiplication, they cause the death of the infected host cell and re-enter the bloodstream to infect more cells. Plasmodium species, P. falciparum, P. vivax, P. ovale and P. malariae are known to affect and infect.

    The babies of pregnant women affected by this infection, have low birth weight and decreased survivability.
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    Prompt diagnosis and treatment, can cure the disease. A malaria relapse is always possible as the parasite may not get totally eradicated and remain dormant in the liver to get reactivated after months or even years. Vaccines for the infection have been developed and are undergoing trials.
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    Malaria definition

    image of an Anopheles stephensi mosquito
    Image of malaria vector
    Anopheles stephensi mosquito
    Definition by thefreedictionary.com: "It is defined as a serious infectious disease spread by certain mosquitoes. It is most common in tropical climates. It is characterized by recurrent symptoms of chills, fever, and an enlarged spleen."
    Definition by medterms.com: "An infectious disease caused by protozoan parasites from the Plasmodium family that can be transmitted by the bite of the Anopheles mosquito or by a contaminated needle or transfusion."
    Definition by merriam-webster.com: "a serious disease that causes chills and fever and that is passed from one person to another by the bite of mosquitoes."
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    The recorded * history of malaria dates back to circa 1323 BC. DNA analysis conducted in 2010 showed the presence of malaria in King Tutankhamun (ruled ca. 1332 BC – 1323 BC), an Egyptian pharaoh. The * life cycle of malaria parasite passes through two hosts. When an Anopheles mosquito ingests the blood of an infected person, the gametocytes of the parasite enter the mosquito's stomach and go through various stages to form sporozoites. The infected mosquito transmits the disease to a new human host.

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    References:
    1.http://www.who.int/topics/malaria/en/
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    Image source:http://en.wikipedia.org/wiki/File:Anopheles_stephensi.jpeg
    Image author:Jim Gathany, CDC.
    Image license: Public domain
    Current topic in health and fitness tips: What is malaria disease and its definition.

    Saturday, August 23

    Smoking? - Major diseases caused by smoking cigarettes

    Quit smoking - major diseases are caused by smoking cigarettes.
    Quit smoking. One of the causes of many life-threatening diseases is smoking. Cigarette smoking causes,initiates or promotes chronic obstructive pulmonary diseases (COPD), many types of cancers and cardiovascular Diseases. Even after quitting smoking, the risk of lung cancer may persist for more than 10 years. Cigarette smoke contains hundreds of toxic chemicals. It also contains nearly 70 carcinogens (cause cancer), including arsenic, vinyl chloride and 1,3–butadiene. People usually start smoking cigarettes in their teens just for the heck of it or under peer pressure.

    How does smoking become an addiction?

    Cigarette smoking becomes an addiction in a very short period of time. Nicotine is the known addictive chemical in cigarettes. Search is still going on for finding other possible addictive substances in the cigarette. Nicotine, a naturally occurring chemical found in tobacco is as addictive as heroin or cocaine.

    Nicotine reaches the brain within seconds from the starting of smoking. Nicotine affects the chemistry of brain and the smoker develops physical and psychological dependence.
    major diseases are caused by smoking cigarettes
    1.diseases caused by smoking
    However the effect wears off within a few minutes after putting out the cigarette. The withdrawal symptoms start and the craving for nicotine makes the person to light up again. Treating withdrawal symptoms is much easier than facing life-threatening diseases.

    Smoking caused diseases

    There is an awareness in the population that smoking can cause many health problems.
    Many still continue to light up cigarettes because they do not know the severity of the health hazards. Smoking cigarette does not just end you up with sore throat and cough. Several fatal and devastating diseases will be the outcome of this harmful habit.

    Smoking caused malignancy and cancers

    Smoking significantly increases the lifetime risk of developing cancer. The direct contact with carcinogenic chemicals in the cigarette, their fumes and heat from cigarette cause mutations in the genes and growth of malignant cells in the oral cavity. The cancers of the oral cavity, including those affecting lips, tongue, floor of the oral cavity, insides of the cheeks and gum, are common among the smoking population.

    The carcinogens in the cigarettes find their way into lungs while inhaling and can also cross the tissue barrier and get circulated to other parts of the body. This unfortunate habit can also induce other type of cancers such as:
    • Laryngeal carcinoma
    • Pharyngeal Cancer
    • Pulmonary carcinoma
    • Esophageal cancer
    • nasal cancer
    • Stomach cancer
    • Acute myeloid leukemia

    Smoking caused cardiovascular diseases

    These are diseases of the cardiovascular system which affect the heart and major and minor blood vessels.
    Nicotine in the cigarette increases the level of LDL (bad cholesterol) leading to clogging, narrowing and hardening of the arteries. The narrowing of arteries is atherosclerosis. Cigarette smoking can cause accumulation of degenerative material in the inner layer of arterial walls, known an atheroma. The deposits in the blood vessels can narrow down and close the passage altogether and the disease is known as thrombosis. The clogged blood vessels can affect the individual's function depending upon the blood vessel involved and the degree of obstruction.

    Arterial thrombosis, the formation of a thrombus in an artery, and atheroma can cause diseases like coronary thrombosis, cerebral thrombosis, myocardial infarction (heart attack), stroke, abdominal aortic aneurysm and pulmonary embolism. Thrombosis can affect the veins. Venous thrombosis affecting deep veins (femoral veins), portal veins, renal veins, jugular veins, hepatic vein, subclavian vein and dural venous sinuses may cause many vascular diseases.

    Respiratory diseases

    This harmful habit causes many non cancerous diseases of the respiratory system.
    Oral cancer induced by smoking
    2.smoking caused oral cancer

    The fumes from the burning cigarette can irritate the lining of the lungs and can damage alveoli (air sacs). The fumes also kill the the cilia, hair-like structures present in the lining of the trachea which are involved in the cleaning of the air passage. The air passages may also narrow down due to thickening of the passages and accumulation of mucus. Lung function also gets regressed and hampered by smoking cigarettes. Chronic obstructive pulmonary disease (COPD), chronic cough, chronic bronchitis and emphysema (a degenerative disease) develop and progress into severity. About 50% of the people diagnosed with COPD die within ten years.

    Prenatal and postnatal diseases caused by smoking

    Nicotine, toxic fumes and other chemicals inhaled by the mother get passed on to the fetus through placenta and cause decreased fetal growth, premature births, abruptio placentae (placental abruption) and low birth weight.
    Maternal cigarette smoking is found to have caused miscarriages, stillbirths and death of the baby during birth. Nursing mothers addicted to this habit can pass on harmful chemicals to the infants. It also found that maternal cigarette use can contribute to sudden infant death syndrome.

    Impotence due to cigarette smoking

    Smoking cigarettes causes erectile dysfunction (impotence) as the blood vessels get narrowed and sufficient blood supply is not maintained for erection.

    Passive smoking

    When one or both the parents are habituated to cigarette smoking, other nonsmoking members in the family undergo passive smoking. The family members, especially children are affected with respiratory diseases. They may also be affected by the fatal diseases, depending upon the amount and frequency of inhaled fumes.

    This harmful habit also increases the risk factor for developing autoimmune diseases, type 2 diabetes, osteoporosis and loss of bone mass.


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    Image:1: Diseases caused by smoking cigarettes
    License:Public domain.
    Image 2: Oral cancer - a disease caused by smoking
    Image source: http://en.wikipedia.org/wiki/File:Mouth_cancer_bionerd.jpg
    Image author: Bionerd | License: CC BY 3.0.
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    References:
    1.Prabhat Jha, Richard Peto. Global Effects of Smoking, of Quitting, and of Taxing Tobacco. N Engl J Med 2014; 370:60-68 January, 2014.
    2.Joshi V, Matthews C, Aspiras M, de Jager M, Ward M, Kumar P. Smoking decreases structural and functional resilience in the subgingival ecosystem. J Clin Periodontol. 2014 Aug 19. doi: 10.1111/jcpe.12300.
    3.Kalucka S. Consequences of passive smoking in home environment. Przegl Lek. 2007;64(10):632-41.
    Current topic in health and fitness tips: major diseases are caused by smoking cigarettes.

    Monday, April 7

    Baby teething fever - Does teething cause fever or diarrhea?

    Does teething cause fever or diarrhea in babies?
    Teething in babies does not cause high fever or severe diarrhea. Teething is being incorrectly attributed to be the cause of several childhood ailments. Some of the symptoms of teething are swollen gum, decreased appetite for solid foods, irritability, drooling, rash on face, ear rubbing, gum rubbing, crying, pain, biting and sucking.

    High body temperature, severe nasal discharge, persistent cough, persistent vomiting, decrease in urine output and severe diarrhea may require medical attention and are not classic symptoms of eruption of primary teeth.

    In a survey of 550 parents in Udaipur, India, regarding parental beliefs about teething in babies, Gauri Kakatkar et al, found that "teething was incorrectly attributed to fever (70%), diarrhea (87.5%), and sleep disturbances (48.2%)". The research work was published in the journal 'Brazilian Oral Research' in 2012 Mar-April.

    R.S.Ispas et al conducted a cross-sectional survey of seven groups of health professionals in New Zealand on persisting misconceptions about signs and symptoms of teething. The research work was published in 'the New Zealand dental journal' in March, 2013. The researchers concluded that one-third of participants incorrectly attributed fever to teething. 27% of participants attributed primary teeth eruption as cause of diarrhea.

    These findings show that there is a common lack of knowledge about baby teething among parents as well as prevalence of misconceptions about the symptoms of teething in health professionals. There is an urgent need to educate parents regarding the teething process and its management and to dispel misconceptions about fever and diarrhea. Some health professionals may have to update their concepts about the causes of childhood illnesses like fever and diarrhea.

    Does teething cause high fever in babies?

    The primary tooth eruption may give discomfort, pain and stress to the baby for a week.
  • Four days prior to emergence of tooth and three days post-emergence are important in tooth eruption. In some babies, due to stress, pain and gum inflammation, there may be slightly elevated body temperature which is considered as low-grade fever (less than 102°F). Mild fever in babies may also be due to infection in the split gum. Injuries to gum while biting on objects can also give rise to mild infection and elevated temperature and fever.

    The age at which deciduous teeth erupt also coincides with the decline in antibody supply from the mother as well as exposure to infections. Parents must pay attention to any fever greater than 102°F and seek medical advice. They should not dismiss high fever as a symptom connected with primary teeth eruption. High fever, above 102°F, may be due to some underlying serious illness.

    Does teething cause severe diarrhea in babies?

    Babies tend to bite or chew any object they can lay their hands on during teething. Lack of hygiene or proper parental care can lead to infections of gastrointestinal system. Sometimes babies may injure their own gums and have infections. In such situations babies may have fever and diarrhea. Excessive salivation and swallowing the saliva may also cause mild diarrhea.

    If the baby suffers from severe diarrhea, medical advice must be sought. Severe diarrhea can lead to dehydration and many health complications. Most common cause of severe diarrhea is viral gastroenteritis. Certain types of bacteria or parasites can also cause diarrhea. If the teething baby affect by diarrhea has dry skin, dry mouth, sunken eyes or cries without tears, it is symptom of severe dehydration and immediate medical aid is required.

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    References:
    1.Ispas RS, Mahoney EK, Whyman RA. Teething signs and symptoms: persisting misconceptions among health professionals in New Zealand. N Z Dent J. 2013 Mar;109(1):2-5.
    2.Sood S, Sood M. Teething: myths and facts. J Clin Pediatr Dent. 2010 Fall;35(1):9-13.
    3.Owais, A., Zawaideh, F. and Bataineh, O. (2010), Challenging parents’ myths regarding their children’s teething. International Journal of Dental Hygiene, 8: 28–34.
    4.Gauri Kakatkar, Ramesh Nagarajappa, Nagesh Bhat, Vikas Prasad, Archana Sharda, Kailash Asawa. Parental beliefs about children's teething in Udaipur, India: a preliminary study. Braz Oral Res. 2012 Mar-Apr;26(2):151-7.

    Current topic in health and fitness tips:
    Does teething cause fever or diarrhea in babies?

    Tuesday, March 18

    Teething rash - Baby teething rash on face - Drool rash

    Drool and teething rash on baby's face
    Teething rash is drool rash. Teething in babies is quite often followed by drool rash. Understanding the teething process can make us realize the basic cause of the associated drool rash. Tooth buds appear on both the arches (jaws) when the fetus is about eight weeks old. They keep on growing inside the gum.

    A newborn already has primary teeth growing inside the gums. As the teeth grow, the gums swell and become sensitive and painful. Due to the gum irritation the baby may start drooling a lot. The baby may develop rash around the mouth and other areas like chin, cheeks, neck and chest, which are constantly wet with saliva. Generally when the baby is about six months old, the teething commences and usually the lower central incisors start emerging out of the gums.

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    The drool rash should not be confused with eczema or diaper inflammation. Diaper rash typically appears on the diaper area as prickly red spots. The inflammation may become severe and may spread to baby's buttocks, tummy and thighs. It is usually triggered by moisture and wetness in the diaper area. Bacterial growth on the remnants of urine or stool leads to the skin inflammation. Frequent changing of diapers and keeping the diaper area dry will help. Eczema (atopic dermatitis) causes red, swollen and itchy inflammation of the skin. Eczema may flare-up in affected babies when they are teething.

    Causes of teething rash

    The cause of the inflammation is excessive drooling. As there is excessive salivation, the area around the mouth becomes constantly moist. Babies may drool even while sleeping. The saliva soaked skin becomes chapped and gives rise to inflammation. Opportunistic bacteria and fungi may start growing on the inflamed skin and worsen the drool rash. The saliva may get spread on to the baby's cheeks. The saliva may also drip on to the chin, neck and chest and cause rash in all these areas.

    Treatment for drool rash

    To control and stop the rash from spreading the first effort by the parents is to keep the baby's mouth area dry by frequent dabbing with a soft cloth. Care should be taken not to wipe the tender skin as it may get further inflamed. To reduce the salivation the baby may given some cool soother, ring or cloth to chew on. A bib can be placed and changed regularly to keep the neck and chest dry and clean from saliva. Petroleum jelly may be applied on areas of baby's skin likely to get wet in order to keep out the drool and teething rash.

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    Drool and teething rash on baby's face.

    Wednesday, March 12

    Primary teeth - Milk teeth

    Primary teeth - deciduous, baby, temporary or milk teeth
    The primary teeth or milk teeth are the first set of teeth to develop in infants. The primary teeth erupt and become visible in the mouth typically when the baby is about six months old. There are many exceptions, and teething in some babies may be delayed and start as late as 18th month. Some infants may be born with natal teeth and in some teething may start in the first month itself.
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    In general, the primary teeth start erupting by about sixth month of age. It may take 30-36 months for the completion of eruption of all the primary dentition. In total, twenty milk teeth are formed, ten on the maxilla and ten on the mandible. The primary dentition is made up of two central incisors, two lateral incisors, two canines and two first molars and two second molars on each jaw. The child starts losing the milk teeth by the 6th year to be replaced by permanent dentition. The falling of primary dentition and their replacement may go on till 12-13 years of age.

    Milk teeth development

    The primary dentition start developing during the pregnancy. When the human embryo reaches sixth week of development, dental lamina is formed as an in-growth of oral ectoderm. The process starts in the midline and spreads to posterior region.
    dental lamina and dental bud
    dental lamina and bud

    By the time the fetus reaches eight weeks stage, ten dental buds are formed on the upper arches as well as the lower arches. These dental buds keep developing inside the gums and by the sixth month erupt out of the gums. Generally, the mandibular central incisors are the first milk teeth to appear. The maxillary second molars are the last to erupt.

    Nutrition for milk teeth development

    Calcium, phosphorus, vitamin A, vitamin C and vitamin D are essential nutrients for the proper development of healthy dentition. Dental enamel and dentin are composed of hydroxyapatite crystals and calcium and phosphorus are needed for their proper formation. Vitamin D regulates the availability of calcium. The deficiency of these minerals and vitamin D may result in less mineralization of hard structures.

    Keratin and collagen are required in the developmental process. Vitamin A is necessary for keratin formation and vitamin c is essential collagen synthesis. The deficiency of vitamin A may affect enamel formation. Fluoride makes the structure resistant to demineralization and caries formation by getting incorporated into the developing hard tissues. Excess of fluoride during teeth development can lead to fluorosis.

    Eruption of primary teeth

    The central incisors erupt by 6-12 months and the lateral incisors emerge by 9-16 months. The mandibular incisors appear earlier than their maxillary counterparts. First molars emerge by 12-20 months and second molars emerge by 22-36 months. The canines appear by 15-24 months of age.

    The importance of milk teeth

    The appearance of milk teeth and their proper development is very important for the development of buccal cavity. The permanent dentition develop from the same dental germ. The development of the skill of chewing of food and speech require functional primary dentition. The jaw bones and muscles depend upon the milk teeth for developing proper dimensions and form of the dental arches for the emergence of permanent dentition. Early loss of primary incisors usually does not have effect on the later dentition. However the early loss of primary canines or primary molars may result in space loss for the permanent dentition.

    Differences between the primary and permanent teeth

    Though the internal anatomy is similar, the primary and permanent dentition differ in many aspects. The permanent dentition is larger in size. Premolars are present in the permanent dentition. The enamel in the primary dentition is less mineralized, thinner and more translucent. Due to thin layer of enamel caries can form easily. The pulp chambers are large and the roots small and narrow in primary dentition. The primary dentition is temporary and falls off to give place for the permanent one.

    Caring for primary teeth

    The sooner we start cleaning infant’s milk teeth, the better. Gums and milk teeth may be wiped clean with a clean warm soft moist cloth after feeds. Depending upon the number of erupted milk dentition, the baby may be introduced to daily brushing by 12-18 months of age. By the age of 2 years a visit to a dentist is recommended to know the health status of the primary dentition. The caries formed in the milk teeth may affect the health of the permanent dentition.

    Caries prevention in milk teeth

    Poor oral hygiene is the root cause of caries formation. Infants tend to fall asleep while breast-feeding or bottle-feeding. The last mouthful of milk may remain in the mouth if they were feeding in the lying position. The milk may decay and caries may develop. To prevent teeth decaying and also infections of the eustachian tubes and ear, infant's head must be at a higher elevation than the throat while feeding milk. It prevents milk from staying back in the mouth even if the baby falls asleep whilst feeding.

    References:
    1.Alexander K. C. Leung and William Lane M. Robson. Natal teeth: a review. J Natl Med Assoc. 2006 February; 98(2): 226–228. PMCID: PMC2595049.
    Image source: http://en.wikipedia.org/wiki/File:Dentallamina11-17-05.jpg
    image author: Dozenist | License: CC BY-SA 3.0
    Current topic on health and fitness tips:
    Milk teeth are primary teeth.

    Sunday, February 23

    Natal teeth - Neonatal teeth

    Neonatal teeth - Natal teeth
    Natal teeth are present at the time of birth. Neonatal teeth grow after birth during the first month. Except for the time of appearance, there is not much difference between these teeth. Natal teeth are uncommon and one in every 2,000 to 3,000 infants may have them at birth. In some infants their presence may be associated with certain medical conditions.

    Actually these teeth are primary deciduous dentitions, which have emerged very early. The most commonly affected are the lower central incisors. They usually occur in pairs. In very rare cases primary maxillary incisors or primary lower canines may be involved. In a few cases they may be supernumerary and get replaced by the true primary dentition. A dental roentgenogram can help in differentiating the supernumerary incisors.

    Though the exact etiology is not clear, maternal health during pregnancy appear to predispose the fetus in developing this condition. Maternal exposure to infections, fever, trauma, hormones, chemicals and toxin can become causative factors.

    The teeth may be smaller than the primary incisors and may appear conical and yellowish. The root may be absent or poorly developed. They have hypoplastic or hypomineralized enamel, irregular dentin and most of them are mobile. Some may have shell-like crown structure loosely attached to gingival tissue.

    These teeth may interfere while feeding or breastfeeding. The nipples may get lacerated and become infected and painful. There is a great chance for the infant to hurt and damage the tongue leading to sublingual ulceration (Riga-Fede disease). If the incisors are wobbly and loose there is a risk of swallowing or aspirating them into lungs. In such situations their extraction may be considered by the dentist.

    In some rare cases they may be associated with genetic disorders such as Ellis–van Creveld syndrome, Meckel-Gruber syndrome and Sotos syndrome. Natal teeth are also associated with congenital disorders like Hallermann–Streiff syndrome, jadassohn-lewandowsky syndrome (pachyonychia congenita), craniofacial dysostosis syndrome, steatocystoma multiplex, Wiedemann-Rautenstrauch syndrome and Pierre Robin syndrome.


    References:
    1.Alexander K. C. Leung and William Lane M. Robson. Natal teeth: a review. J Natl Med Assoc. 2006 February; 98(2): 226–228. PMCID: PMC2595049.


    Current topic in health and fitness tips:
    Neonatal teeth - Natal teeth.