Whooping Cough Infection

Whooping cough is a highly contagious respiratory tract infection.
It is characterized by a severe hacking cough followed by a high-pitched intake of breath that sounds like a "whoop."
The organism responsible for the infection is Bordetella pertussis.
The infection is spread through droplet infection.
Whooping cough affects mainly children under 5 years old (90%).

Catarrhal Stage: lasts for about one week, characterized by highly infectious upper respiratory catarrh, conjunctivitis, rhinitis, and unproductive cough.
Paroxysmal Stage: characterized by severe bouts of coughing, more severe at night, with each paroxysm consisting of a succession of short sharp coughs, ending in a deep inspiration during which the characteristic whoop may be heard.
Convalescence Stage: cough becomes less frequent, and sputum less tenacious.

Respiratory complications:
- Bronchopneumonia
- Atelectasis
- Bronchiectasis
Other complications:
- Convulsions
- Conjunctival hemorrhage
- Prolapse of rectum

Blood CP: WBC count is 15000-20000/uL, 60-80% of which are lymphocytes.
Diagnosis is established by isolating the organism from a nasopharynx swab culture.

Antibiotics: Erythromycin 500 mg 6-hourly for 10 days, or Clarithromycin or Azithromycin.
Cough suppressants: e.g., Methadone.
Maintenance of nutrition.

Diphtheria is an acute infection caused by Corynebacterium diphtheriae.
It usually attacks the respiratory tract but may involve any mucous membrane or skin wound.
Spread by respiratory secretions, food, or water contaminated by feces from a patient or carrier.
Age: typically a disease of childhood, but increasingly affecting adults due to non-immunization in childhood.

Vibrio cholerae multiply in the lumen of the small bowel and are non-invasive.
They secrete a powerful exotoxin (enterotoxin) that activates adenylyl cyclase in intestinal epithelial cells, producing hypersecretion of water and chloride, causing massive diarrhea.
Severe dehydration follows rapidly.

Stage of evacuation: sudden onset with frequent loose motions, initially yellow, soon becoming colorless, watery, and typical "rice-water" stools.
Stage of collapse: intense dehydration, leading to:
- Muscular cramps due to electrolyte depletion
- Cold, clammy, and wrinkled skin
- Sunken eyes
- B.P. falls
- Pulse not palpable
- Urine output diminished

Diagnosis is usually clinical.
Presence of rapidly motile vibrio's in fresh stool by dark-field illumination is diagnostic.
Culture of stool or rectal swabs should be taken.

Replacement of fluid and electrolytes:
- ORS in mild cases
- Ringer lactate 2-3 liters in the first hour, followed by normal saline one liter/hour until the pulse and blood pressure return.
Drugs: Ciprofloxacin (Novidat) infusion IV twice daily.

Tetanus is an infection caused by the bacterium Clostridium tetani.
Spores of Clostridium tetani are present in feces of herbivorous animals and men, and therefore also found in soil.
Any kind of damage to skin or mucous membrane may cause entrance of spores to underlying tissue.
Spores germinate and bacilli multiply only in anaerobic conditions, which occur in areas of tissue necrosis.
The bacteria release an exotoxin with an affinity for motor nerve endings and motor nerve cells.

Prodromal symptoms: non-specific, such as fever, headache, and irritability.
Presenting symptoms:
- Trismus: spasm of the masseter muscles, causing difficulty in opening the mouth and in masticating.
- Rigidity: affecting the muscles of the face, neck, and trunk, producing pain and stiffness in the neck and back.
Symptoms of established disease:
- Rigidity: affecting the erector spinae and abdominal muscles, producing an exaggerated lumbar lordosis, neck retraction, and abdominal rigidity.
- Muscle spasm: spasm of facial muscles, producing a typical facial appearance with raised eyebrows, tightly closed eyes, and drawing back of the lips to expose clenched teeth.

Neutralize absorbed toxin: Human tetanus antitoxin 3000 IV.
Prevent further toxin production:
- Debridement of the wound.
- Benzylpenicillin 600 mg 6-hourly.
- Metronidazole if allergic to penicillin.
Control spasms:
- Nurse in a quiet room.
- Avoid unnecessary stimuli.
- Diazepam IV if spasms continue; paralyze the patient and ventilate.
General measures:
- Maintain hydration and nutrition.
- Treat secondary infections.

Active immunization: Tetanus toxoids are administered as two doses 4-6 weeks apart, with a third dose 6-12 months later, and booster doses every 10 years.
Passive immunization: Passive immunization should be used in non-immunized persons and whenever a wound is contaminated or likely to have devitalized tissue.
Destruction of spores: Destruction of spores in operation theatres by filtered ventilation and by use of antiseptics on floors and walls.
Treatment of wounds: Debridement + penicillium.

Anemia occurs when there are not enough red blood cells or the red blood cells do not work as they should.
Red blood cells carry oxygen throughout the body, providing energy to cells.
Without healthy red blood cells, the body does not get the energy it needs to function.
Left untreated, anemia can be life-threatening.

Foot problems are common in people with diabetes.
They can occur over time when high blood sugar damages the nerves and blood vessels in the feet.
Nerve damage, called diabetic neuropathy, can cause numbness, tingling, pain, or a loss of feeling in the feet.
If there is no feeling in the feet, it may not be possible to detect cuts, blisters, or ulcers.
Wounds may not heal well due to poor blood flow, which can lead to gangrene or amputation.

Check feet every day.
Wash feet every day.
Ask the doctor how to remove corns and calluses safely.
Trim toenails straight across with a clipper.
Always wear well-fitting shoes and socks or slippers to protect the feet when walking.
Protect feet from heat and cold.
Keep the blood flowing in the feet.
Get feet checked at health care visits.

Spinal cord disorders are injuries and diseases that damage the spinal cord, which carries signals between the brain and the rest of the body.
Damage to the spinal cord can disrupt these signals, affecting bodily functions and causing permanent disability.
Some spinal cord disorders originate outside the spinal cord, including disorders caused by spinal injuries or compression of the spinal cord.