Fungal infections

Fungi are types of parasitic plants that include molds, mildew, and yeast. A fungal infection is an inflammatory condition in which fungi multiply and invade the skin, the digestive tract, the genitals, and other body tissues, particularly, the lungs and liver. Fungal infections of the skin are often called ringworm or tinea.

Description

Microscopic fungi, which are called dermatophytes, often live exclusively on such dead body tissues as hair, the outer layer of the skin, and the nails. The fungus grows best in moist, damp, dark places with poor ventilation and on skin that is irritated, weakened, or continuously moist. Superficial fungal infections include tinea capitis, an infection of the neck and scalp; tinea barbae, also called barber’s itch, along the beard area in adult males; tinea corporis on parts of the body, such as the arms, shoulders, or face; tinea cruris, or jock itch, involving the groin; tinea pedis, or athlete’s foot; tinea versicolor; and tinea unguium, or infection of the nails.

The term tinea gladiatorum is sometimes used to describe ringworm infections in atheletes. Tinea gladiatorum is most common in swimmers, wrestlers, and athletes involved in other contact sports. Fungal infections of the skin and nails are very common in children, but they can affect all age groups.


Systemic fungal infections occur when spores are touched or inhaled, or there is an overgrowth of fungi in or on the body. Such infections are most often a serious problem in those with suppressed immune systems. Candidiasis is a rather common fungal infection. When it occurs in the mouth, it is called thrush. Less often, it occurs in the mucous membranes of other parts of the digestive system, or in the vagina, heart valves, urinary tract, eyes, or blood.

Other systemic fungal infections include aspergillosis, which mostly affects the lungs and may also spread to the brain and kidneys; blastomycosis, a lung infection that may spread through the bloodstream; coccidioidomycosis, also known as San Joaquin or valley fever; mucormycosis, which can develop into a very serious, life-threatening infection; and histoplasmosis.

Causes & symptoms

Fungi are widespread in the environment, so it is not unusual that a certain amount of fungi and their spores end up being inhaled into the lungs or landing on the skin. Under conditions of moisture, warmth, irritation, or injury, these fungi grow rapidly and may cause illness. Superficial fungal infections may be due to an overgrowth of fungi already present, or the infection may be the result of contact with an infected person or with contaminated surfaces, bed sheets, towels, or clothing.

Fungal infections can be spread from one part of the body to another by scratching or touching. Additionally, tinea unguium infections have been linked to the use of methyl methacrylate, a glue used for attaching acrylic fingernails. Fungal spores are often present in soil and are likely to be inhaled when the soil is dug up or otherwise disturbed. Systemic fungal infections are commonly contracted in this way. In addition, fungi that normally inhabit the intestines, such as Candida albicans, may multiply, causing an infection due to an overgrowth of the fungi.

Tinea infections usually cause itchy, red, scaly, ring-shaped patches on the skin that spread easily. Hairs in the area of infection often fall out or break off, and the skin may crack. The skin may also develop a secondary bacterial infection. In tinea unguium, the nails discolor, crack, and thicken. Tinea versicolor may cause pigment changes in the skin that persist for up to a year.

Systemic fungal infections develop slowly. Symptoms often may be nonexistent, or there may be only the feeling of having a cold or the flu. Coughing, a fever, chest pain, chills, weight loss, and difficulty with breathing may become evident. Additional symptoms depend on the type and site of the infection.

Fungal infections are more common and more severe in people taking antibiotics, corticosteroids, immunosuppressant drugs, and contraceptives. This is also the case in people with endocrine disorders, immune diseases, and other conditions such as obesity, AIDS, tuberculosis, major burns, leukemia, and diabetes mellitus. Fungal infections often occur due to the use of antibiotic drugs for other conditions, because antibiotics kill off the bacteria that normally keep fungi at bay.

Diagnosis

Fungal infections of the skin, hair, and nails often can be diagnosed based on the characteristic appearance of affected areas. A KOH (potassium hydroxide) prep is a simple laboratory test to confirm the diagnosis. The test uses tissue samples treated with a 20% potassium hydroxide solution to detect fungi.

Examining the skin with a Wood’s ultraviolet lamp is another easy and convenient method to determine the presence of a fungus. Culture and sensitivity testing can be used if a more definitive diagnosis is required. Systemic fungal infections may be initially diagnosed from blood tests. Confirmation is determined by cultures made from sputum, blood, urine, bone marrow, or infected tissue samples.

Treatment

Among the herbs that slow down or halt the growth of fungus are goldenseal (Hydrastis canadensis), myrrh (Commiphora molmol), garlic (Allium sativa), pau d’arco (Tabeebuia impestiginosa), turmeric (Curcuma longa), oregano (Origanum vulgare), cinnamon (Cinnamonum zeylanicum), jewelweed, sage (Salvia officinalis), Impatiens aurea, yellow dock (Rumex crispus), the lichen known as old man’s beard (Usnea barbata), black walnut husks and bark (Juglans nigra), licorice (Glycyrrhiza glabra), and Calendula officinalis.

These herbs can be applied to external fungus as infusions, salves, powders, or vinegars. Many of them can also be taken internally as capsules or tinctures. Antifungal herbs can be quite strong, however, and care should be taken that a given remedy is suitable for internal use.

When an infusion is used, the affected area should be washed or soaked in the herbal water for at least 15 minutes twice daily. Store-bought or homemade tea bags can be soaked in water or vinegar for about 10 minutes and then used as a poultice for the same effect.

Herbal vinegars make excellent remedies for fungus, as vinegar is in itself antifungal. “Gourmet” vinegars with such antifungal ingredients as oregano and garlic are often readily available at grocery stores. The vinegar can be applied a few times daily with cotton or compresses. In addition, a bentonite clay dusting powder can be useful for drying out the environment of moist skin in which fungus thrives. It works best when mixed with powdered antifungal herbs such as myrrh or goldenseal. Dusting powder is especially helpful for athlete’s foot.

Many herbs high in essential oils also have antifungal action, particularly tea tree (Melaleuca alternifolia), oregano, lavender (Lavandula officinalis), Eucalyptus spp., rose geranium (Pelargonium graveolens), peppermint (Mentha piperita), chamomile (Matricaria recutita), and myrrh. Peppermint oil is especially helpful in relieving the itching associated with many fungal infections. The simplest way to use aromatherapy to fight fungal infections is to add several drops of any single essential oil or combination of oils to bathwater.

Essential oil can also be added to mixtures for soaking or compresses. Tea tree is the herb most frequently recommended for the treatment of superficial fungal infections. As with all essential oils, the full-strength oil should be diluted in a carrier. A dilution of tea tree oil can be made by adding the essential oil to a carrier oil. This mixture can be added directly to the site of a skin infection.

A healthy diet should be maintained. Foods that are high in yeast, such as beer and wine, breads, and baked goods should be avoided. Fermented foods and sugary foods, including honey and fruit juices, should also be avoided until symptoms have cleared. Antifungal culinary herbs such as garlic, tumeric, oregano, sage, and cinnamon should be used liberally in foods. Yogurt containing live cultures can be incorporated into the diet to supply needed gut bacteria, and help reduce digestive infections such as candidiasis and thrush. Lactobacillus acidophilus and Lactobacillus bulgaricus can also be taken directly as supplements.

Supplements that can be taken for fungal infections include vitamins A, B complex, C, and E. Caprylic acid, an extract of the coconut plant, is also recommended as an antifungal, as well as grapefruit seed extract. Essential fatty acids, contained in evening primrose oil, fish liver oil, or flaxseed oil, can help reduce the inflammation of systemic or superficial fungal infections. A dose of one of these oils is recommended as a daily supplement.

Allopathic treatment

Superficial fungal infections are usually treated with such antifungal creams or sprays as tolnaftate (Aftate or Tinactin), clotrimazole, miconazole nitrate (Micatin products), clean and dry, and care should be taken to avoid contact with other parts of the body. If someone in the household has a superficial fungal infection, bed sheets, towels, floors, shower stalls, and other contact surfaces should be washed with hot water and disinfected after use. econazole, ketoconazole, ciclopirox, naftifine, itraconazole, terbinafine, fluconazole, or Whitfield’s tincture made of salicylic acid and benzoic acid.

If the infection is resistant, a doctor may prescribe an oral antifungal drug such as ketoconazole or griseofulvin. Drugs used for systemic infections include amphotericin B, which is highly toxic and is used for severe or life-threatening infections; the azoles, particularly fluconazole and itraconazole, which have been found to be the least toxic of these medications; and flucytosine alone or in combination with other antifungal medications. Fungal infections that become inflamed may be treated with a combination antifungal/steroid medication. Certain infections may require surgery.

Expected results

Infections usually respond to treatment within several weeks. However, many fungal infections are resistant to treatment, and it may take an extended time and repeated treatments to effect a cure. Infections may spread, and secondary bacterial infections may develop.

Medications for fungal infections are often strong, and their use may cause such undesirable side effects as headache, dizziness, nausea, vomiting, or abdominal pain. Fungal infections are usually not serious in otherwise healthy individuals. However, a systemic fungal infection may be severe and lifethreatening for those with compromised immune systems.

Prevention

Good personal hygiene should be maintained. In the case of superficial infections, the skin should be kept clean and dry, and care should be taken to avoid contact with other parts of the body. If someone in the household has a superficial fungal infection, bed sheets, towels, floors, shower stalls, and other contact surfaces should be washed with hot water and disinfected after u

Gonorrhea

Gonorrhea is a highly contagious sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae bacterium. The genitourinary tract is the main system that is usually affected, but gonorrhea can also spread to the rectum, the throat, and the eyes. Left untreated, gonorrhea can spread through the bloodstream and infect the brain, heart valves, joints, and the reproductive system. Exposure to an infected mother during birth may cause permanent blindness in the newborn.

Description

Gonorrhea, commonly referred to as “the clap,” is the most prevalent reportable disease in the United States. Adolescents and young adults are in the highest risk category, with more than 80% of gonorrhea cases affecting the 15–29 year-old age group. Individuals living in urban areas who have multiple sex partners have the highest risk of contracting the disease.

Still, the incidence of gonorrhea has been steadily declining since 1987. This appears to be largely due to increased public awareness about the risks and prevention of contracting STDs such as herpes and HIV. However, in 2002, the Centers for Disease Control (CDC) expressed concern about rising rates of gonorrhea in certain urban areas during 1999 and 2000. About 650,000 new cases of gonorrhea occur every year in the United States. In particular, rates of gonorrhea were increasing substantially among men who have sex with men.


Causes & symptoms

Gonorrhea is transmitted very efficiently. It can be spread by merely contacting the fluids of an infected person as well as by sexual contact. A person runs a 60–90% chance of contracting the disease after just one sexual encounter with an infected person. The symptoms usually begin between one day and two weeks after the initial encounter with the infection.

People who are infected with gonorrhea commonly experience increasingly frequent and painful urination, and the urethra may be painful and swollen. There may be a thick white, yellowish, or bloody discharge from the penis or vagina. Other symptoms may include nausea, vomiting, fever, chills, and pain during intercourse.

In the case of oral infection, there may be a sore throat or pain during swallowing. An anal infection may cause rectal itching, rectal discharge, and a constant urge to move the bowels. Women who show symptoms of gonorrhea often have abdominal pain and breakthrough bleeding (spotting) between menstrual periods. However, many women who have gonorrhea do not experience any symptoms.

In infants and children, irritation, redness, swelling with a pus-like discharge, and possibly pain and a change in urination may point to a gonorrhea infection. The infection may be due to child abuse or exposure to infected materials. An in-depth history should be taken if gonorrhea is suspected.

Diagnosis

The initial diagnosis of gonorrhea will be based on symptoms, sexual history, and at-risk behavior. One laboratory test for diagnosis involves the observation of a gram-stained sample of the discharge under a microscope. In the gram stain test, the sample is dyed, washed with various solutions, and dyed with a different color. The final color identifies the class of bacteria present in the sample. The advantage of this test is that results can be obtained very quickly so that treatment can commence at the initial visit. In the vast majority of men, it is quite accurate; however, the test is not very accurate for women.

For all women and for men with a questionable gram-stain reading, samples of the discharge from the infected area can be collected and cultured. The sample is incubated for up to two days, which provides enough time for the bacteria to multiply and be accurately identified.

This test is very accurate and specific for gonorrhea, but improper handling can lead to a false-negative reading. Other tests coming into favor include the ELISA (enzyme-linked immunosorbent assay) antibody test and DNA probe testing of genetic material from the discharge, both of which are quite accurate in identifying Neisseria gonorrhoeae.


Treatment

Although there is nothing that can totally replace antibiotics in the treatment of gonorrhea, certain herbs and minerals may be used to supplement the treatment. These may be used to improve the body’s immune function: zinc, multivitamins and mineral complexes, vitamin C, and garlic (Allium sativum). Lactobacillus acidophilus in supplements and live-culture yogurts help replenish gastrointestinal flora that may be destroyed by the intake of antibiotics.

Several herbs may reduce symptoms and help speed healing. These include kelp (Macrocystis pyrifera and related species), Calendula officinalis, myrrh (Commiphora molmol), and Thuja occidentalis. These herbs can be taken by the mouth or used as a douche. The Chinese herb Coptis chinensis, used for damp-heat infections, is helpful in treating the genitourinary tract, especially if pelvic inflammatory disease (PID) develops.

An herbalist should be consulted to make recommendations for further complications. Some recommend a three-day cleansing fast to quicken and support healing. Fasting should be done only with the approval and supervision of a physician. Referral to an acupuncturist is also recommended, as there may be acupressure and acupuncture points that will help with system cleansing.

Allopathic treatment

The typical treatment for gonorrhea is penicillin or a penicillin derivative, given orally or by injection. If the patient is pregnant or allergic to penicillin, erythromycin may be substituted. Gonorrhea has become more difficult and expensive to treat since the 1970s because it has become increasingly resistant to certain antibiotics.

In fact, according to projections from the Centers for Disease Control and Prevention, 30% of the strains of gonorrhea were resistant to routine antibiotics in 1994, and resistance has been increasing steadily. Because of this, the doctor may also prescribe probenecid, which will increase the antibiotic activity.

In 2002, the Centers for Disease Control (CDC) updated guidelines concerning antibiotics for treating gonorrhea. Resistance of the infection has increased to certain classes of drugs, particularly when gonorrhea was contracted in certain states, particularly California. Guidelines had already warned against use of these drugs, called fluoroquinolones, in Hawaii, other Pacific islands, and Asia.

Since other STDs, such as chlamydia and syphilis, often occur with gonorrhea, patients may also be tested and treated for these related infections. Patients should refrain from sexual intercourse until treatment is complete and should return for follow-up testing. Anyone the patient has had sexual contact with during the time of infection should be notified and treated, even if those persons do not show symptoms. Doctors are required to report this disease to public health officials.

More than one health care provider may have to be consulted. Physicians trained in obstetrics or gynecology may be involved if gynecological complications occur. Men who experience complications may be referred to a urologist. There are also infectious disease doctors who specialize in the treatment of infectious diseases, including STDs.

Expected results

The prognosis for patients with gonorrhea varies based on how early the disease is detected and treated. Patients who are treated early and properly can be entirely cured of the disease. The most common complication is PID. PID can occur in up to 40% of women with gonorrhea and may result in damage to the fallopian tubes, an ectopic pregnancy, or sterility. If an infected woman is pregnant, gonorrhea can be passed on to the eyes of the newborn during delivery. This can lead to infection and blindness.

Although the risk of infertility due to gonorrhea is higher in women than in men, men may also become sterile if urethritis (inflammation of the urethra) develops. Complications of gonorrhea can affect the prostate, testicles, and surrounding glands as well. In either gender, inflammation, abscesses, and scarring can occur. In approximately 2% of patients with untreated gonorrhea, the infection may spread throughout the body and can cause fever, arthritis-like joint pain, and skin lesions.

Prevention

Currently, there is no vaccine for gonorrhea. The best prevention is to abstain from having sex, or to engage in sex only when in a mutually monogamous relationship in which both partners have been tested for STDs. The next line of defense against gonorrhea is the use of condoms, which have been shown to be highly effective in preventing disease.

The use of a diaphragm can also reduce the risk of infection. Since the risk of contracting gonorrhea increases with the number of sexual partners, those who have sexual contact with more than one partner are advised to be tested regularly for gonorrhea and other STDs.

Hay Fever

Hay fever, which is also called allergic rhinitis, is a common allergic condition. A main feature of the condition is an inflammation of the nasal passages, or rhinitis, caused by an allergic reaction to pollen. Hay fever usually occurs when airborne plant pollens are at their highest levels in the spring, summer, and early fall.

Hay fever is one of the most common chronic diseases in the United States. It is estimated that about 35 million people in the United States are affected. Hay fever can develop at any age, but it shows up most often in childhood through the early 20s. The term “hay fever” is not quite accurate, since the pollen of hay grasses is only one of the many possible allergens involved, and there is no fever. Although an allergy to pollen does not appear to be inherited, the tendency to allergic sensitivity in general may run in families.

Causes & symptoms

Of all the causes of allergies, pollen is one of the most widespread. Trees, weeds, and grasses produce pollen in large amounts for seed production. These pollens are dispersed by the wind, and many never reach the intended targets. Instead, they are inhaled through the nose and throat. Different plants release their pollen at different times of the year, so the timing of hay fever symptoms varies from person to person, depending on which plants provoke a response.


For people with hay fever, inhaled pollen grains are identified by the body as foreign invaders. This is probably due to a dysfunction in the immune system. The mast cells of the immune system act as storage containers for highly reactive chemical granules, including histamine.

Allergens trigger a release of these granules, and the mast cells spill their chemicals into neighboring blood vessels and nerve cells. Histamine dilates the blood vessels, causing fluids to escape into surrounding tissues. This results in swelling, pooling of fluid in the tissues, and redness of the nose and eyes. Histamine also stimulates pain receptors, and causes the itchiness and discomfort of the nose, eyes, and throat that are common hay fever symptoms.

Inflammation of the nose, or rhinitis, is the major symptom of hay fever. Inflammation causes itching, sneezing, runny nose, redness, and tenderness. Swelling of the sinuses can constrict the eustachian tube that connects the inner ear to the throat, causing a feeling of congestion and popping in the ears. Mucus from the sinuses may run down the back of the throat, leading to throat irritation and redness.

Seasonal fatigue and sinus headaches may also be indications of hay fever, as well as respiratory congestion and a decreased sense of smell. Severe allergies can lead to dark circles under the eyes, puffy eyelids, and creases under the eyes. Characteristically, children with hay fever may push their noses upward with the palm of their hand or twitch their noses to clear the congestion.

Virtually any type of tree or grass may cause hay fever, although plants with showy flowers usually produce a sticky pollen that is much less likely to become airborne. Among North American plants, weeds are the most prolific producers of allergenic pollen.

Ragweed is the major culprit, but other plant pollens that routinely affect hay fever sufferers include sagebrush, lamb’squarter, Russian thistle, and English plantain. Grasses include timothy grass, Kentucky bluegrass, Johnson grass, Bermuda grass, redtop grass, orchard grass, and sweet vernal grass. Trees that produce allergenic pollen include oak, ash, elm, hickory, pecan, box elder, and mountain cedar.

Diagnosis

The diagnosis of hay fever is usually simple. A thorough history of the illness is important in diagnosing allergies, including whether the symptoms vary according to time of day or the season, and possible exposures. When symptoms always appear during a particular season and disappear with the onset of cold weather, hay fever is almost certainly the culprit.

For a more definitive diagnosis, a skin prick test is used, in which a diluted extract of the suspected allergen is injected superficially or scratched into the skin and the reaction is observed. Another test is a provocative challenge, which is performed by putting an extract of the suspected allergen onto the conjunctiva of the eye or in the nose or lungs.

When such direct skin testing is not possible, various methods of testing the blood may be used. Other conditions causing rhinitis, such as infection, may have to be ruled out by a nasal smear, in which a sample of mucus is taken on a swab for examination.


Treatment

Alternative treatments for hay fever often focus on modulation of the body’s immune response. They frequently center around diet and lifestyle adjustments. A healthy diet high in fiber and whole foods, including generous amounts of vegetables, grains, nuts, and raw seeds should be maintained. Plenty of fluids should be consumed. Six to eight glasses of water daily are recommended, along with plenty of herbal teas.

Raw vegetable juices are also beneficial, particularly carrot, celery, beet, cucumber, spinach, and parsley. Meat, dairy, and foods high in saturated fats may aggravate a hay fever condition, and should be limited in the diet. It is also best to avoid dairy products, wheat, eggs, citrus fruits, chocolate, peanuts, shellfish, food colorings, and preservatives, especially sulfites. These are all common food allergens that may worsen hay fever symptoms. Caffeine, alcohol, tobacco, and sugar should be avoided, as well.

Beneficial supplements for treating hay fever include vitamins A, E, and B complex. Vitamin C, especially the buffered type, is a natural antihistamine. In substantial amounts it can help stabilize the mucous membrane response to allergens. Bioflavonoids prevent the release of histamine, and can be taken in combination with vitamin C. Essential fatty acids, contained in evening primrose oil, fish oil, or flaxseed oil, are also recommended as a daily supplement.

Glutathione peroxidase is an enzyme that blocks a key inflammatory reaction in the hay fever cycle. It can play a key role in neutralizing the allergic reactions of hay fever. Selenium is a trace mineral that may help stop the inflammation due to allergens and reduce other allergy symptoms.

For symptom relief, nettles (Urtica dioica) have been reported to have the ability to clear the sinuses and to greatly reduce other symptoms. Tincture of licorice (Glycerrhiza glabra) is also recommended. A good tincture combination for hay fever is comprised of equal parts of black cohosh (Cimicifuga racemosa), Chinese skullcap (Scutellaria baicalensis), pleurisy root, orbutterflyweed (Asclepias tuberosa), catnip (Nepeta cataria), and cayenne pepper (Capsicum frutescens).

Other western herbal remedies herbs found to be effective include ginger root (Zingiber officinale), eyebright (Euphrasia officinalis), goldenseal (Hydrastis canadensis), ephedra, horseradish (Amoracia rusticana), and mullein (Verbascum thapsus). Bee pollen may also be effective in alleviating or eliminating hay fever symptoms. Bee pollen should be taken a few months before the hay fever season starts. It desensitizes the body and can dramatically reduce hay fever symptoms.

Acute attacks of hay fever often respond to homeopathic remedies. Possible hay fever remedies include Allium cepa, Arsenicum album, euphrasia, Ferrum phosphoricum, gelsemium, Natrum muriaticum, Nux vomica, sabadilla, and wyethia, depending on the associated symptoms. Since hay fever is often associated with deep-seated health problems, it is often best addressed with a constitutional remedy and the guidance of an experienced homeopathic practitioner.

Indoor allergens can cause increased sensitivity to outdoor allergens. Therefore allergy testing for allergens other than pollen should be done, and those allergens should be removed from the diet or the environment to the greatest extent possible.

Allopathic treatment

The goal of most medical approaches to hay fever treatment is reduction of symptoms. Avoidance of the allergens is best, but this is often not possible. When it is not possible, drug therapy is the major form of medical treatment used. Care should be taken, however, since a wide variety of antihistamines are available, and they all have potential side effects that impact function. These may include drowsiness, heart problems, and harmful interactions with other medications and medical conditions. The extended use of topical decongestants can cause rebound congestion that is worse than the original problem.

Antihistamines block the action of histamine. They are most effective when used preventively, before symptoms appear. Over-the-counter antihistamines are often sufficient to provide relief for hay fever symptoms. People with severe or frequent symptoms, however, may need stronger, prescription antihistamines. Azelastine, an antihistamine nasal spray, is effective and causes fewer side effects than oral antihistamines. When antihistamines do not relieve nasal symptoms, a nasal spray of cromolyn sodium is sometimes used. It works by preventing the release of histamine and similar chemicals.

Decongestants constrict blood vessels and counteract the effects of histamine. They may also be helpful in reducing symptoms such as nasal congestion. Nasal sprays are available that can be applied directly inside the nose. Oral decongestants are available as well. Phenylpropanolamine, phenylephrine, or pseudoephedrine are available in many preparations combined with antihistamines to increase the effectiveness of the drugs. Decongestants are stimulants and may cause increased heart rate and blood pressure, headaches, and agitation.

Corticosteroids may be prescribed to reduce severe symptoms. An intranasal corticosteroid spray can be quite useful in reducing inflammation of the mucous membranes. Severe symptoms that do not respond to other treatment may require a course of oral corticosteroids. Corticosteroids are best started before allergy season begins. They are especially effective because they work more slowly and last longer than most other types of medication.

Late in 2001, researchers reported the first of many new drugs that may change treatment of hay fever and asthma: omalizumab. A monoclonal antibody, omalizumab works by blocking immunoglobulin E (IgE), an antibody produced in excessive amounts in people suffering from hay fever.

Expected results

It is possible that hay fever can be outgrown if the immune system becomes less sensitive to the pollen. However, while hay fever may improve over time, it may also get worse or even lead to the development of new allergies. Hay fever treatment may sometimes cause uncomfortable and even dangerous side effects. However, most people can achieve acceptable hay fever relief with a combination of preventive strategies and treatment.

Prevention

There is no known way to prevent development of hay fever, but subsequent attacks may be reduced or prevented. Immunotherapy, also known as desensitization or allergy shots, involves injections of very small but gradually increasing amounts of an allergen over several weeks or months, with periodic boosters.

This serves to acclimatize, or familiarize, the body to encountering the allergen without having a major allergic response. Individuals receiving allergy shots will be monitored closely following each shot because of the small risk of anaphylaxis. Full benefits of the shots may take up to several years to achieve, and even then about one person in five does not receive any benefit from the immunotherapy.

Reducing exposure to pollen may reduce symptoms of hay fever. Most trees produce pollen in the spring, while most grasses and flowers produce pollen during the summer, and ragweed and other late-blooming plants produce pollen during late summer and early autumn. People with hay fever should be aware of their particular “pollen season” and remain indoors whenever possible during that time. A pollen count can be used as a general guide for when it is most advisable to stay indoors to avoid contact with the pollen. Unfortunately, moving to a region with consistently low pollen counts is rarely effective, since new allergies often develop to the local flora.

Further strategies to prevent or reduce hay fever attacks include the following:

• Remain indoors with windows closed during the morning hours, when pollen levels are highest.
• Car windows should be kept rolled up while driving.
• A surgical facemask can be worn when outside.
• Forests and fields of grasses should be avoided, especially at the height of the pollen season.
• Clothes and hair should be washed after being outside.
• Air conditioners or air filters should be used in the home, and their filters should be changed regularly.

Impetigo

Impetigo

Impetigo is a contagious bacterial infection of the skin. It primarily afflicts children and the elderly. Ecthyma is a more severe form of impetigo with sores affecting a deeper layer of the skin. It often leaves scarring and discoloration of the skin.

The first sign of impetigo is a clear, fluid-filled bump, called a vesicle, which appears on the skin. The vesicle soon dries out and develops a scab-like, honey-colored crust, which breaks open and leaks fluid. These vesicles usually appear grouped closely together, and they may spread out and cover a large area of the skin.

Impetigo often affects the area around the nose and mouth; however, it can spread to anywhere on the skin, but especially the arms and legs, as well as the diaper areas of infants. The condition called ecthyma is a form of impetigo in which the sores that develop are larger, filled with pus, and covered with brownish-black scabs that may lead to scarring. Impetigo infections most commonly occur during warmer weather.

Infections

Infections

An infection is a condition in which viruses, bacteria, fungi, or parasites enter the body and cause a state of disease. Such invaders are called pathogens. They damage cells of the body by adhering to and damaging the cell walls, releasing toxic substances or causing allergic reactions.

The body has a set series of responses to infection, which mostly involve body chemicals, body tissues, and the immune system. It was recently reported that infection is the fourth leading cause of death in the United States and kills more people than cancer and heart disease combined.

Pathogens are everywhere in a person’s daily environment: They may enter the body through breathing, ingested food or water, sexual contact, open wounds, or contact with contaminated objects. Having entered the body, pathogens begin to reproduce.

Kidney Infections

Kidney infection is a general term used to describe infection of the kidney by bacteria, fungi, or viruses. The infecting microbe may have invaded the kidney from the urinary bladder or from the bloodstream. The disease is characterized by fever, chills, back pain, and, often, the symptoms associated with bladder infection.

As the principle part of the urinary system, the kidneys process the fluid component of blood (called plasma) to maintain appropriate water volume and concentrations of chemicals. The waste product formed from this process is called urine.

Urine travels from the kidney, through tubes called ureters, to the urinary bladder, and is eliminated from the body through a tube called the urethra. The kidneys and ureters comprise the upper urinary tract, and the bladder and urethra comprise the lower urinary tract.

Malaria

Malaria

Malaria is 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. The disease can be treated with medication, but it often recurs.

Malaria is endemic (occurs frequently in a particular locality) in many third world countries. Isolated, small outbreaks sometimes occur within the boundaries of the United States, with most of the cases reported as having been imported from other locations.

Malaria is a growing problem in the United States. Although only about 1400 new cases were reported in the United States and its territories in 2000, many involved returning travelers. In addition, locally transmitted malaria has occurred in California, Florida, Texas, Michigan, New Jersey, and New York City.

Measles

Measles

Measles is a viral infection that causes an illness displaying a characteristic skin rash known as an exanthem. Measles is also sometimes called rubeola, five-day measles, or hard measles.

Measles infections appear all over the world. Incidence of the disease in the United States is down to a record low and only 86 confirmed cases were reported in the year 2000.

Of these, 62% were definitely linked to foreigners or international travel. Prior to the current effective immunization program, large-scale measles outbreaks occurred on a two to three year cycle, usually in the winter and spring.

Meningitis

Patient in meningitis ward, pediatric hospital, Luanda, Angola

Meningitis is a potentially fatal inflammation of the meninges, the thin, membranous covering of the brain and the spinal cord.

Meningitis is most commonly caused by infection by bacteria, viruses, or fungi, although it can also be caused by bleeding into the meninges, cancer, diseases of the immune system, and an inflammatory response to certain types of chemotherapy or other chemical agents. The most serious and the most difficult to treat types of meningitis tend to be those caused by bacteria.

Meningitis is a particularly dangerous infection because of the very delicate nature of the brain. Brain cells are some of the only cells in the body that, once killed, will not regenerate themselves. Therefore, if enough brain tissue is damaged by an infection, then serious lifelong handicaps will remain.

Mononucleosis

Mononucleosis

Infectious mononucleosis is caused by the Epstein-Barr virus, which in teenagers and young adults may result in acute symptoms that last for several weeks. Fatigue and low energy can linger for several months.

Infectious mononucleosis (IM), also called mono or glandular fever, is commonly transmitted among teenagers and young adults by kissing or sexual activity; hence it is sometimes called the “kissing disease.”

By age 35–40, approximately 95% of the population has been infected with the Epstein-Barr virus (EBV) that causes IM. Although anyone can develop mononucleosis, primary (first) infections commonly occur in young adults between the ages of 15 and 35. Symptoms of IM are particularly common in teenagers.

Pelvic inflammatory disease

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a term used to describe any infection in the lower female reproductive tract that spreads upward to the upper female reproductive tract. The lower female genital tract consists of the vagina and the cervix. The upper female genital tract consists of the body of the uterus, the fallopian or uterine tubes, and the ovaries.

PID is the most common and the most serious consequence of infection with sexually transmitted diseases (STD) in women. Over one million cases of PID are diagnosed annually in the United States, and it is the most common cause for hospitalization of reproductive-age women.

Sexually active women aged 15–25 are at highest risk for developing PID. The disease can also occur, although less frequently, in women having monogamous sexual relationships. The most serious consequences of PID are increased risk of infertility and ectopic pregnancy.

Pleurisy

Pleurisy

Pleurisy is an inflammation of the membrane that surrounds and protects the lungs (the pleura). Inflammation occurs when an infection or damaging agent irritates the pleural surface. Sharp chest pains are the primary symptom of pleurisy.

Pleurisy, also called pleuritis, is a condition that generally stems from an existing respiratory infection, disease, or injury. In people who have otherwise good health, respiratory infections or pneumonia are the main causes of pleurisy. This condition used to be more common, but with the advent of antibiotics and modern disease therapies, pleurisy has become less prevalent.

The pleura is a double-layered structure made up of an inner membrane, which surrounds the lungs, and an outer membrane, which lines the chest cavity. The pleural membranes are very thin, close together, and have a fluid coating in the narrow space between them. This liquid acts as a lubricant, so that when the lungs inflate and deflate during breathing, the pleural surfaces can easily glide over one another.

Pneumonia

Pneumonia

Pneumonia is an infection of the lung that can be caused by nearly any class of organism known to cause human infections. These include bacteria, amoebae, viruses, fungi, and parasites.

In the United States, pneumonia is the sixth most common disease leading to death; 2 million Americans develop pneumonia each year, and 40,000–70,000 die from it.

Pneumonia is also the most common fatal infection acquired by already hospitalized patients. In developing countries, pneumonia ties with diarrhea as the most common cause of death.

Rabies

Rabies

Rabies is a viral illness that can affect any mammal but is most common in carnivores (flesh-eaters). It is sometimes referred to as a zoonosis, or disease of animals that can be communicated to humans.

Rabies is usually transmitted in the saliva through a bite wound. The virus attacks the central nervous system, and is fatal once symptoms begin, with very rare exceptions.

Rabies, also known as hydrophobia, belongs to the rhabdovirus family. Fewer than 10% of animal cases reported in the United States in 1998 were in domestic animals. Raccoons accounted for the largest number of cases in wild animals.

Rhinitis

Rhinitis

Rhinitis is inflammation of the mucous lining of the nose.

Rhinitis is a nonspecific term that covers nasal congestion due to infections, allergies, and other disorders. In rhinitis, the mucous membranes of the nose become infected or irritated, producing a discharge, congestion, and swelling of the tissues.

The most widespread form of infectious rhinitis is the common cold. The common cold is the most frequent viral infection in the general population. Colds are self-limited, lasting about three to 10 days, although they are sometimes followed by a bacterial infection.

Rheumatic fever

Manifestations of rheumatic fever

Rheumatic fever (RF) is an illness that occurs as a complication of untreated or inadequately treated strep throat infection. Rheumatic fever causes inflammation of tissues and organs and can result in serious damage to the heart valves, joints, central nervous system and skin.

Rheumatic fever is rare in the United States, though there were outbreaks in both New York City and in Utah in the 1990s. The disease is more prevalent in the developing world, where rheumatic fever is the leading cause of heart disease. In some countries, as many as one to two percent of children are afflicted with the disease.

Though the exact cause of rheumatic fever is unknown, the disease usually follows the contraction of a throat infection caused by a member of the Group A streptococcus (strep) bacteria (called strep throat). The streptococcus A bacteria has also been linked to many serious diseases, including “flesh-eating” disease and toxic shock syndrome.

Scabies

Scabies

Scabies, also known as sarcoptic acariasis, is a contagious, parasitic skin infection caused by a tiny mite (sarcoptes scabiei).

Scabies is caused by a tiny, 0.3 mm-long, parasitic insect called a mite. When a human comes into contact with the female mite, the mite burrows under the skin, laying eggs along the lines of its burrow.

These eggs hatch, and the resulting offspring rise to the surface of the skin; mate; and repeat the cycle either within the skin of the original host; or within the skin of its next victim, causing red lesions.

Scarlet fever

Scarlet fever

Scarlet fever is an infection caused by a streptococcus bacterium. It can be transmitted through the air or by physical contact and primarily affects children between four and eight years of age. In temperate climates, scarlet fever is most common during the late fall, winter, and early spring.

Scarlet fever is characterized by a sore throat,a fever of 103–104°F (39.4–40°C), and a sandpaper-like rash on reddened skin.

If scarlet fever is untreated, such serious complications can develop; as rheumatic fever (a heart disease) or kidney inflammation (glomerulonephritis).

Rubella

Rash of rubella

Rubella is a highly contagious viral disease, spread through contact with discharges from the nose and throat of an infected person.

A person infected with the rubella virus is contagious for about seven days before any symptoms appear and continues to spread the disease for about four days after the appearance of symptoms. Rubella has an incubation period of 12–23 days.

Rubella is also called German measles or the three-day measles. This disease was once a common childhood illness, but its occurrence has been drastically reduced since vaccine against rubella became available in 1969.

Shingles

Shingles

Shingles, also called herpes zoster, gets its name from both the Latin and French words for belt or girdle and refers to girdle-like skin eruptions that may occur on the trunk of the body.

The virus that causes chickenpox, the Varicella zoster virus (VSV), can become dormant in nerve cells after an episode of chickenpox and later re-emerge as shingles.

Initially, red patches of rash develop into blisters. Because the virus travels along the nerve to the skin, it can damage the nerve and cause it to become inflamed. This condition can be very painful. If the pain persists long after the rash disappears, it is known as post-herpetic neuralgia (PHN).