Showing posts with label symptoms. Show all posts
Showing posts with label symptoms. Show all posts

Tuesday, October 28

Marburg virus disease (MVD) - Marburg hemorrhagic fever

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Nutrition, Health & Wellness

Marburg virus disease (MVD)
› › 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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  • Friday, November 30

    Pneumonia in elderly people - Causes, symptoms & treatment

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    Nutrition, Health & Wellness

    Pneumonia in elderly people
    Home > Pneumonia in children and infants - Signs, symptoms & causes > Causes, symptoms and treatment of pneumonia in elderly people
    Pneumonia in elderly people, unlike younger patients, may have very subtle symptoms and by the time diagnosis is done and treatment is commenced the situation may become very serious and life threatening. Pneumonia is an inflammation of the lungs followed by fluid accumulation in alveoli air sacs and is usually caused by viruses, bacteria, fungi, parasites and other organisms. The inflammation and fluid accumulation in alveoli causes reduced blood flow to the affected part as well as reduced oxygen uptake.

    In general elderly patients have feeble organ level and body level responses to any infection. Unfortunately, most of the elderly people and their caregivers are unable to understand the symptoms of pneumonia and by the time action is taken the condition turns serious.

    Causes of pneumonia in elderly people

    Though pneumonia is caused by viruses, bacteria, fungi and other organisms, in elderly, Streptococcus pneumoniae bacteria account for most of the infections and are the major cause of death. The infection can start with flue like symptoms of the upper respiratory tract and can spread fast to the lower respiratory tract and the lungs. Damage of lung tissue can occur and the infection may spread to the blood causing bacteremia. If most areas of the lungs are involved acute respiratory distress syndrome (ARDS) may be caused.

    The complications of pneumonia in the elderly can be life-threatening, apart from the possibility of bacteremia, meningitis, kidney failure and heart failure can occur. The lung infections triggered by viruses are generally milder but there is always the risk of opportunistic bacterial infections including Streptococcus pneumoniae.

    In elderly people, aspiration pneumonia is caused by difficulties in swallowing leading to mouth secretions and food going to the lungs and causing infection and pneumonia. Issues with swallowing are common in elderly patients which require treatment.

    Symptoms of pneumonia in elderly people

    General symptoms of pneumonia are:
    • week feeling
    • lethargy
    • productive cough
    • greenish or yellowish sputum
    • chills
    • difficulty in breathing
    • symptoms of shallow breathing
    • chest pain
    • muscle pain
    • fever
    • symptoms of skin and nails turning bluish
    • confusion
    • nausea
    • abdominal pain and diarrhea
    • decreased level of consciousness.
    In elderly persons the pneumonia symptoms may be fewer and fever may not be present. Symptoms like Chest pain, shallow breathing, decreased appetite, feeling cold and difficulty in breathing may be observed. All the symptoms may not be present and observed symptoms can be pieced together to get a clearer picture of the situation. Symptoms like slightly confused state of mind together with changes in their behavior and appearance can also indicate the underlying problem.

    Pneumonia - Tests and diagnosis
    Simple diagnosis by listening to the patient's lungs can confirm pneumonia. Typical rales (clicking, rattling, or crackling noises) and rhonchus ( coarse rattling sound) can be picked up by a stethoscope signalling lung infection and inflammation. A chest x-ray or CT scan can confirm the disease and give us the location of inflammation. Blood and sputum analysis can tell us about the pathogen involved in pneumonia so that it can be treated.

    Treatment of pneumonia in elderly people

    Medical care must be sought for treatment if in the elderly person symptoms like have breathing problem or lung infection is suspected.
    The cause of the pneumonia has to be found out for the treatment. Bacterial pneumonia is treated with antibiotics. Antibiotic treatment should carried out as per the advice of the doctor.

    In rare cases antiviral medication is given for viral pneumonia. For the treatment of aspiration pneumonia corticosteroids may be prescribed. To reduce the fever antipyretic medicine may be prescribed. Unless necessary cough suppressants are avoided in the treatment.

    Sufficient rest can help in alleviating the symptoms and also help in the treatment of pneumonia. Drinking plenty of fluids helps in loosening the lung secretions and their removal by coughing. With proper treatment the patient will recover in about two weeks.

    Pneumonia - Risk factors in elderly people

    Many habits and health conditions increase the risk of lung infections and pneumonia. Some of the risk factors are:
    • chronic obstructive pulmonary disease (COPD), cystic fibrosis, asthma, bronchiectasis
    • heart, lung, spleen or kidney diseases
    • health conditions like stroke, diabetes, dementia and Alzheimer's, amyotrophic lateral sclerosis (ALS)
    • untreated illness
    • decreased ability to cough
    • decreased productive cough
    • bad oral hygiene
    • inactivity
    • spending too much time in bed
    • malnutrition
    • use of narcotics, antihistamines
    • intoxication
    • alcohol
    • weakened immune systems
    • long-term use of immunosuppressant drugs
    • chemotherapy treatment for cancer
    • smoking
    • using inhaled corticosteroids
    • exposure to air pollution or toxic fumes
    • HIV/AIDS

    Pneumonia - Prevention with vaccination

    Yearly vaccination for seasonal flu can go a long way in the prevention of pneumonia in elderly. Influenza virus can predispose an elderly person for developing bacterial pneumonia. Influenza itself can move on to the lungs and cause viral pneumonia.

    As for bacterial lung infection, doctors recommend a one-time shot of pneumococcal polysaccharide vaccine (PPSV) against Streptococcus pneumoniae for elderly people above 65 years. The prevention vaccination may have to be repeated after 5-6 years.

    In the United States, PPSV is recommended for elderly people above 65 years of age as a prevention. Adults having symptoms of poor health and also long-term serious health problems are also advised to get vaccinated with PPSV as prevention. PPSV is recommended as prevention for smokers and children above two years of age having serious health problems. Adults and elderly people suffering from  asthma, COPD, congestive heart failure, Severe renal problems,  liver diseases, diabetes requiring medication, HIV/AIDS and asplenia do require vaccination as prevention and protection against pneumonia.

    Very important: If an elderly person under your care appears to have symptoms like difficulty in breathing, cough, chest pain or lethargy immediately seek medical help without delay for proper treatment to prevent complications and save life.

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    Pneumonia in children and infants - Signs, symptoms & causes.

    Reference:
    1. Höffken G, Halank M, Gillissen A. Treatment of severe pneumonia--community-acquired and "early onset" nosocomial Med Klin (Munich). 2004 Jul 15;99(7):362-71.
    2. Schmidt-Ioanas M, Lode H. Treatment of pneumonia in elderly patients. Expert Opin Pharmacother. 2006 Apr;7(5):499-507.

    Current topic: Causes, symptoms and treatment of pneumonia in elderly people