Marburg virus disease (MVD) - Marburg hemorrhagic fever

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Marburg virus disease (MVD)

Home › What is Ebola virus disease › 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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Back pain - Chronic low back pain - Treatment and management

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Chronic low back pain

Home > Back pain - Chronic low back pain - Treatment and management

Lower back pain is a common health problem and nearly 80% of adults experience it at some point in their life. Low back pain is a skeletomuscular disorder and it is considered chronic if it persists for more than twelve weeks. Without proper treatment the pain tends to become chronic.

Most of the causes of chronic low back pain (CLBP) are neuromusculoskeletal disorders like wrong posture, sprain in the lower back muscles, strain of soft tissues, slipped disc (herniated, or ruptured disc), sciatica ( sciatic neuritis) degenerative discs, spinal stenosis, fractures, trauma, skeletal irregularities, scoliosis, kyphosis, lordosis, osteoarthritis and osteoporosis.

Chronic lower back pain treatment options

image of lumbar region
site of chronic low back pain

The options are physical, medical, and surgical methods. The focus is on causative factors, relevant pathoanatomy and pain generators and their alleviation and removal. Generally the options are non-invasive methods like initial rest, medication and exercise. In the case of traumatic injury, structural damage or structural irregularities surgical options may be resorted to.

Bed rest for chronic LBP

Immediate bed rest for less than two days helps in the lessening of chronic pain and inflammation. However bed rest for longer period does not have increased benefits. Prolonged bed rest can be counterproductive. In fact prolonged bed rest can have deleterious effects by weakening the supportive muscles and leading to progressive hypo mobility of joints and prolonged recovery.

Physio-therapeutic treatments

Physiotherapy comprises a mixture of any of the methods like interferential treatment, laser, lumbar supports, shortwave diathermy, therapeutic ultrasound, hot/cold packs, traction, transcutaneous electrical nerve stimulation (TENS), massage and mobilization Though there may be marginal momentary reduction in low back pain there are no long term positive effects and advantages.

Exercise treatment

Exercises aimed at strengthening, endurance and flexibility
show lasting improvement in chronic low back pain reduction and function. These exercises do not require expensive training equipment. Muscle strengthening, muscle conditioning, aerobic, flexion, Alexander Technique and McKenzie exercises may be tried as per the preference of both the patient and therapist.

Chiropractic spinal manipulation and spinal mobilization

Manual treatment comprises spinal manipulation and spinal mobilization  The spinal manipulation is small amplitude high velocity thrust technique. It is usually a rapid movement beyond the movement range of the affected back joint. The patient has no control over the manipulation and the technique is prone to complications if done by persons lacking expertise.

Spinal mobilization is use of passive low-velocity movements to give mobility to a joint. Excluding movements that would further strain the lower back, mobilization within the limits of low back pain aids recovery. Mobilization techniques show improvement in pain reduction, motor activity and sympathetic nervous system activity. As the patient has control over the movement, this technique is considered as far safer to manipulation technique.

Pharmacological treatments for chronic LBP

Non Steroidal Anti Inflammatory Drugs (NSAIDs) are widely prescribed for their pain-killing potential and also for their anti-inflammatory action. The side-effects of NSAIDs are gastrointestinal complications like irritation, gastric ulcers and intestinal bleeding. Some NASIDs like rofecoxib have serious long-term effects like increases cardiovascular risk. Hence for long term use individual case has to be monitored.

Noradrenergic and noradrenergic-serotonergic antidepressants have been found to be moderately effective in reducing chronic pain in CLBP patients and quite effective when used as co-medication with NSAIDs. In patients with kidney diseases, glaucoma, chronic obstructive pulmonary disease and heart failure antidepressants should be avoided. Pregnant patients with chronic pain should not be given antidepressants without closely monitoring their health.

Opioid are short-term treatment for pain and disability in chronic low back pain. Weak opioid are prescribed only for short-term treatment as there is the risk of development of dependence and addiction. To avoid addiction, slow release opioid can be given.

Muscle relaxants like benzodiazepines are used for the short-term reduction from pain. However they have the side effects like allergy, addiction, drowsiness, dizziness and impaired liver function in the long run.

Capsicum pain plasters have capsaicin from chilli peppers which reduces low back pain. Hence application of capsicum pain plasters is an effective short-term treatment for CLBP.

Surgical treatments

Surgery for pain reduction is resorted to when all other conservative treatments have become ineffective in reducing of pain.
Surgical treatments for chronic low back pain include lumbar microdiscectomy, discectomy (involving partial or complete excision of an intervertebral disk), laminectomy (removal of portion of the vertebral bone called the lamina), foraminotomy (performed to reduce the symptoms of nerve root compression), disc replacement surgery or spinal fusion.

Spinal fusion surgery is considered in case of degenerative disc disease, facet joint degeneration or spinal instability and it aims at obtaining solid fusion of two or more affected vertebrae to give stability. As spinal fusion surgery has high rate of complications it may be performed only if the CLBP persists for more than two years and also in case of failed conservative treatments and severe pain.
 

Other alternative treatments

Back school is a combination of education and skill program aimed to lower the chronic LBP. There are some short-term positive results. However there may not be any long-term benefit.
Brief educational interventions to promote self treatment by the patient can be given by the physiotherapist or physician to reduce disability and sickness. Brief educational interventions should provide reassurance and positive messages that encourage the patient to return to normal activities.
Cognitive-behavioral treatment methods are effective for chronic pain, functional status and behavioral outcomes.
Intensive multidisciplinary biopsychosocial rehabilitation treatment program consisting of combination of physical, pharmacological, vocational, and behavioral components are very effective in alleviating the chronic LBP and improving the functionality, especially in patients who have failed mono-disciplinary treatment options.
Neuro-Reflexotherapy has been effective in the treatment of chronic low back pain. Short-term treatment can be taken up to lower chronic pain.
Percutaneous electrical nerve stimulation (PENS) are effective in reduction of chronic low back pain.

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Image source:
http://en.wikipedia.org/wiki/File:Lumbar_region_in_human_skeleton.svg
Image author: LadyofHats Mariana Ruiz Villarreal
License: public domain

References:
1.http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
2.Karjalainen K, Malmivaara A, van Tulder M, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Cochrane Database Syst Rev. 2003;(2):CD002193.
3.http://www.musculoskeletalnetwork.com/pain/content/article/1145622/1507555
4.http://www.backpaineurope.org/web/files/WG2_Guidelines.pdf

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Chronic low back pain - Treatment

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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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

Knee pain remedies - Knee pain help

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Nutrition, Health & Wellness

Knee pain remedies

Help for prevention, treatment, relief and remedies for knee pain

Knee pain is a very common problem faced by us at one time or another and the remedies during the pain and self help in preventing injuries are very important.
Knee is the most used joint of the body, and is the largest and the very complex one. As knee is a weight-bearing joint, all our daily activities like standing up, straightening, sitting, bending, walking, running, twisting and rotating are with its help and any pain or injury requires seeking immediate remedies.

To deal with knee pain two aspects of remedies are to be considered. Foremost is in taking preventive measures to protect ourselves from injuries to knee. The second aspect is in seeking immediate remedies and medical help when knee injuries occur.

Help in preventing knee pain

1. We have to keep our body weight under control so that the stress on this weight-bearing joint is reduced.
2. We have to avoid running on hard  surface and also on uneven surface.
3. We should use proper suitable foot wear to protect this joint from taking jarring shocks while walking or running.
4. Proper warming up is a must before doing any strenuous activities or exercise.
5. Exercising your hamstrings (muscles on the back of thigh), quadriceps (muscles on the front of thigh), abductors (muscles on outer thigh) and adductors (muscles on inner thigh) regularly will keep the joints flexible, strong, stress free and less susceptible to injury.
6. We should not neglect persistent pain and inflammation and seek medical help at the earliest.

Help and remedies in acute injuries

Acute injuries may occur during strenuous sports by twisting of knee or falling. In such situations pain relieving sprays and medication can help momentarily. However immediate medical help must be sought to control further damages due to inflammation, bleeding into the joint, edema and fluid accumulation. It is important to note that inflammation and swelling hampers free movement of the knee and can lead to further damages.

Help and remedies in Overuse

Our postures, repetitive movement, overuse and excessive pressure may cause knee pain due to inflammation of the various bursae (bursitis) around the knee joint. Bursae are small sacs of synovial fluid resting at the points where muscles and tendons slide over bone and they make the normal movement smooth, frictionless and painless.

Remedies for knee pain due to overuse are restrained activities, physiotherapy, anti-inflammatory drugs and use of ice packs.
Ice pack remedies
Ice is useful in reducing pain and swelling. Ice pack may be kept around the knee for about 15 minutes. After 48 hours, alternating warm pack and cold pack every thirty seconds also reduces swelling. This can be done for ten to twenty times.

Wax bath
One of the very useful and effective remedies is wax bath. However you have to seek the help of a physiotherapist for equipment etc.

Compression bandage
Compression wrapping with elastic bandage of the affected knee also brings down swelling.

Elevation
Keep the affected joint at a higher elevation, if possible above the level of heart to bring down fluid accumulation and swelling.

Rheumatoid arthritis
Rheumatoid arthritis also causes inflammation of bursae and the remedies lies in anti-inflammatory medicine and in seeking the help of medical professional.

Help and remedies for Osteoarthritis of knee

Osteoarthritis, a form of degenerative arthritis involving cartilage, is another common cause of joint inflammation, especially in elderly. Rest, anti-inflammatory medicine and exercises to strengthen the thigh muscles are the remedies. Also seek the help of medical expert for advice on your nutritional status.

Chondromalacia patella

Chondromalacia patella usually occurs in teens and young adults causing pain. In this condition the knee cap (patella) at the knee joint does not slide properly and rubs against the lower part of the thigh bone. Rest, use of anti-inflammatory medicine and physiotherapy are the remedies. Seek doctor's help if the knee pain is severe or persists.