Chickenpox

Chickenpox

Definition:

Chickenpox (varicella) was once considered a rite of passage for most children. Before routine chickenpox vaccination, virtually everyone had been infected by the time they reached adulthood, sometimes with serious complications. Today, the number of cases and hospitalizations is down dramatically.

However, when chickenpox does occur, it's highly contagious among people who aren't immune. Most people think of chickenpox as a mild disease — and, for most, it is. Unfortunately, there's no way to know who will develop a severe case.
The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications.

Symptoms:

The signs and symptoms of chickenpox are:

• A red, itchy rash, initially resembling insect bites, on your face, scalp, chest and back
• Small, liquid-filled blisters that break open and crust over
• Fever
• Abdominal pain or loss of appetite
• Mild headache
• General feeling of unease and discomfort (malaise) or irritability
• A dry cough
• Headache

The chickenpox rash goes through these three phases:

• Raised pink or red bumps (papules), which break out in different spots over several days
• Fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking
• Crusts and scabs, which cover the broken blisters and take several more days to heal

New bumps continue to appear for several days. As a result, you may have all three stages of the rash — bumps, blisters, and scabbed lesions — at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over.

The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, and lesions may form in the throat, eyes and mucous membranes of the urethra, anus and vagina. New spots continue to appear for several days.

When to see a doctor
If you suspect that you or your child has chickenpox, consult your doctor. He or she usually can easily diagnose chickenpox by examining the rash and by noting the presence of accompanying symptoms. Your doctor can also prescribe medications to lessen the severity of chickenpox and treat complications, if necessary. Be sure to call ahead for an appointment, to avoid waiting and possibly infecting others in a crowded waiting room.
Also, be sure to let your doctor know if any of these complications occur:

• The rash spreads to one or both eyes.
• The rash gets very red, warm or tender, indicating a possible secondary bacterial skin infection.
• The rash is accompanied by dizziness, disorientation, rapid heartbeat, shortness of breath, tremors, loss of muscle coordination, worsening cough, vomiting, stiff neck or a fever higher than 103 F (39.4 C).
• Anyone in the household is immune deficient or younger than 6 months old.

Complications:

Chickenpox is normally a mild disease. But it can be serious and can lead to complications, especially in these high-risk groups:

• Newborns and infants whose mothers never had chickenpox or the vaccine
• Adults
• Pregnant women
• People whose immune systems are impaired by medication, such as chemotherapy, or another disease
• People who are taking steroid medications for another disease or condition, such as children with asthma
• People with the skin condition eczema

A common complication of chickenpox is a bacterial infection of the skin. Chickenpox may also lead to pneumonia or, rarely, an inflammation of the brain (encephalitis), both of which can be very serious.

Chickenpox and shingles
Anyone who had chickenpox is at risk of a latent illness called shingles. After a chickenpox infection, some of the varicella-zoster virus may remain in your nerve cells. Many years later, the virus can reactivate and resurface as shingles — a painful band of short-lived blisters. The virus is more likely to reappear in older adults and people with weakened immune systems.

Shingles can lead to its own complication — a condition in which the pain of shingles persists long after the blisters disappear. This complication, called postherpetic neuralgia, can be severe.
A shingles vaccine is available and is recommended for adults age 60 and older who have had chickenpox in the past.

Chickenpox and pregnancy
Other complications of chickenpox affect pregnant women. Chickenpox early in pregnancy can result in a variety of problems in a newborn, including low birth weight and birth defects, such as limb abnormalities. A greater threat to a baby occurs when the mother develops chickenpox in the week before birth. Then it can cause a serious, life-threatening infection in a newborn.
If you're pregnant and not immune to chickenpox, talk to your doctor about the risks to you and your unborn child.

Treatments and drugs:

In otherwise healthy children, chickenpox typically requires no medical treatment. Your doctor may prescribe an antihistamine to relieve itching. But for the most part, the disease is allowed to run its course.

For people who have a high risk of complications from chickenpox, doctors sometimes prescribe medications to shorten the duration of the infection and to help reduce the risk of complications.
If you or your child falls into a high-risk group, your doctor may suggest an antiviral drug such as acyclovir (Zovirax) or another drug called immune globulin intravenous (IGIV). These medications may lessen the severity of the disease when given within 24 hours after the rash first appears. Other antiviral drugs, such as valacyclovir (Valtrex) and famciclovir (Famvir), also may lessen the severity of the disease, but have been approved for use only in adults. In some cases, your doctor may recommend getting the chickenpox vaccine after exposure to the virus. This can prevent the disease or lessen its severity.

If complications do develop, your doctor will determine the appropriate treatment. Treatment for skin infections and pneumonia may be with antibiotics. Treatment for encephalitis is usually with antiviral drugs. Hospitalization may be necessary.
Don't give anyone with chickenpox — child or adult — any medicine containing aspirin because this combination has been associated with a condition called Reye's syndrome.

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Creutzfeldt-Jakob disease

Creutzfeldt-Jakob disease

Definition:

Creutzfeldt-Jakob (KROITS-felt YAH-kobe) disease is a degenerative brain disorder that leads to dementia and, ultimately, death. Symptoms of Creutzfeldt-Jakob disease (CJD) sometimes resemble those of other dementia-like brain disorders, such as Alzheimer's, but Creutzfeldt-Jakob disease usually progresses much more rapidly.

Creutzfeldt-Jakob disease captured public attention in the 1990s when some people in the United Kingdom developed a form of the disease — variant CJD (vCJD) — after eating meat from diseased cattle. However, "classic" Creutzfeldt-Jakob disease has not been linked to contaminated beef.
Although serious, CJD is rare, and vCJD is the least common form. Worldwide, there is an estimated one case of Creutzfeldt-Jakob disease diagnosed per million people each year, most commonly in older adults.

Symptoms:

Creutzfeldt-Jakob disease is marked by rapid mental deterioration, usually within a few months. Initial signs and symptoms of CJD typically include:

• Personality changes
• Anxiety
• Depression
• Memory loss
• Impaired thinking
• Blurred vision
• Insomnia
• Difficulty speaking
• Difficulty swallowing
• Sudden, jerky movements

As the disease progresses, mental symptoms worsen. Most people eventually lapse into a coma. Heart failure, respiratory failure, pneumonia or other infections are generally the cause of death. The disease usually runs its course in about seven months, although a few people may live up to one or two years after diagnosis.

In people with the rarer vCJD, psychiatric symptoms may be more prominent in the beginning, with dementia — the loss of the ability to think, reason and remember — developing later in the course of the illness. In addition, this variant affects people at a younger age than classic CJD does, and appears to have a slightly longer duration — 12 to 14 months.

Causes:

Creutzfeldt-Jakob disease and its variants belong to a broad group of human and animal diseases known as transmissible spongiform encephalopathies (TSEs). The name derives from the spongy holes, visible under a microscope, that develop in affected brain tissue.

The cause of Creutzfeldt-Jakob disease and other TSEs appears to be abnormal versions of a kind of protein called a prion. Normally, these proteins are harmless, but when they're misshapen they become infectious and can wreak havoc on normal biological processes.

How CJD is transmitted
The risk of CJD is low. The disease can't be transmitted through coughing or sneezing, touching, or sexual contact. The three ways it develops are:

• Sporadically. Most people with classic CJD develop the disease for no apparent reason. CJD that occurs without explanation is termed spontaneous CJD or sporadic CJD and accounts for the majority of cases.
  
• By inheritance. In the United States, about 5 to 10 percent of people with CJD have a family history of the disease or test positive for a genetic mutation associated with CJD. This type is referred to as familial CJD.
  
• By contamination. A small number of people have developed CJD after being exposed to infected human tissue during a medical procedure, such as a cornea or skin transplant. Also, because standard sterilization methods do not destroy abnormal prions, a few people have developed CJD after undergoing brain surgery with contaminated instruments. Cases of CJD related to medical procedures are referred to as iatrogenic CJD. Variant CJD is linked primarily to eating beef infected with bovine spongiform encephalopathy (BSE), the medical term for mad cow disease.

Complications:

As with other causes of dementia, Creutzfeldt-Jakob disease profoundly affects the brain as well as the body, although CJD and its variants usually progress much more rapidly. People with CJD usually withdraw from friends and family and eventually lose the ability to recognize or relate to them in any meaningful way. They also lose the ability to care for themselves, and many eventually slip into a coma. The disease ultimately is fatal.
Physical complications, all of which may become life-threatening, include:

• Infection
• Heart failure
• Respiratory failure

Treatments and drugs:

 No effective treatment exists for Creutzfeldt-Jakob disease or any of its variants. A number of drugs have been tested — including steroids, antibiotics and antiviral agents — and have not shown benefits. For that reason, doctors focus on alleviating pain and other symptoms and on making people with these diseases as comfortable as possible.

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Common warts

Common warts

Definition:

Common warts are small, grainy skin growths that occur most often on your fingers or hands. Rough to the touch, common warts also often feature a pattern of tiny black dots — sometimes called seeds — which are small, clotted blood vessels.
Common warts are caused by a virus and are transmitted by touch. Children and young adults are more likely to develop common warts, as are people who have weakened immune systems. Common warts usually disappear on their own, but many people choose to remove them because they find them bothersome or embarrassing.

Symptoms:

Common warts are:

• Small, fleshy, grainy bumps
• Flesh-colored, white, pink or tan
• Rough to the touch

Common warts usually occur on your fingers and hands. They may occur singly or in multiples. Warts may bleed if picked or cut. They often contain tiny black dots, which are small, clotted blood vessels.
When to see a doctor
Most common warts don't require medical treatment, but some people choose to have their warts treated because they're bothersome, spreading or a cosmetic concern.

Causes:

Warts are caused by the human papillomavirus (HPV). There are more than 100 types of HPV, and different types of the virus cause different types of warts. Most types of HPV cause relatively harmless conditions such as common warts, while others may cause serious disease such as cancer of the cervix.

Wart viruses pass from person to person. You can also get the wart virus indirectly by touching a towel or object used by someone who has the virus. Each person's immune system responds to the HPV virus differently, so not everyone who comes in contact with HPV develops warts.
If you have warts, you can spread the virus to other places on your own body. Warts usually spread through breaks in your skin, such as a hangnail or scrape. Biting your nails also can cause warts to spread on your fingertips and around your nails.

Complications:

 Because warts shed HPV, new warts can appear as quickly as old ones go away. They can also spread to other people.

Treatments and drugs:

Many common warts don't require treatment. They usually disappear within two years, though new ones may develop nearby. You may want to treat them for cosmetic purposes, if they're causing discomfort or to prevent their spread. Home treatment is often effective in curing common warts.
If you have stubborn warts and home treatment isn't helping, your doctor may suggest one of the following approaches, based on the location of your wart, the degree of your symptoms and your preferences. Doctors generally start with the least painful, least destructive methods, especially when dealing with young children.

• Freezing (cryotherapy, or liquid nitrogen therapy). Your doctor may use liquid nitrogen to destroy your wart by freezing it. This treatment is usually only mildly painful and is often effective, although you may need repeated treatments. Freezing works by causing a blister to form under and around your wart. Then, the dead tissue sloughs off within a week or so.
• Minor surgery. This involves cutting away the wart tissue or burning it with electricity. However, the injection of anesthetic given before this surgery can be painful, and the surgery may leave a scar. For these reasons, surgery is usually reserved for warts that haven't responded to other therapies.

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