Brucellosis

Overview

Brucellosis is a bacterial infection that spreads from animals to people. Most commonly, people are infected by eating raw or unpasteurized dairy products. Sometimes, the bacteria that cause brucellosis can spread through the air or through direct contact with infected animals.

 

Signs and symptoms of brucellosis may include fever, joint pain, and fatigue. The infection can usually be treated with antibiotics. However, treatment takes several weeks to months, and the infection can recur.

 

Brucellosis affects hundreds of thousands of people and animals worldwide. Avoiding raw dairy products and taking precautions when working with animals or in a laboratory can help prevent brucellosis.

Symptoms

Symptoms of brucellosis may show up anytime from a few days to a few months after you have been infected. Signs and symptoms are similar to those of the flu and include:

Fever

Chills

Loss of appetite

Sweats

Weakness

Fatigue

Joint, muscle and back pain

Headache

Brucellosis symptoms may disappear for weeks or months and then return. Some people have chronic brucellosis and experience symptoms for years, even after treatment. Long-term signs and symptoms may include:

Fatigue

Recurrent fevers

Inflammation of the inner lining of the heart chambers (endocarditis)

Joint inflammation (arthritis)

Arthritis of the spinal bones (spondylitis)

Arthritis of joints where the spine and pelvis connect (sacroiliitis

                                                                    

When to see a doctor

Brucellosis can be hard to identify, especially in the early stages, when it often resembles other conditions, such as the flu. See your doctor if you develop a rapidly rising fever, muscle aches or unusual weakness and have any risk factors for the disease, or if you have a persistent fever.

Causes

Brucellosis affects many wild and domestic animals, including:

 

Cattle

Goats

Sheep

Pigs and wild hogs

Dogs, especially those used in hunting

Deer

Elk

Bison

Caribou

Moose

Camels

A form of brucellosis also affects harbor seals, porpoises, and certain whales.

 

The most common ways that bacteria spread from animals to people are by:

 

Eating raw dairy products. Brucella bacteria in the milk of infected animals can spread to humans in unpasteurized milk, ice cream, butter, and cheeses. The bacteria can also be transmitted in raw or undercooked meat of infected animals.

Inhaling contaminated air. Brucella bacteria spread easily in the air. Farmers, hunters, laboratory technicians and slaughterhouse workers can inhale the bacteria.

Touching blood and body fluids of infected animals. Bacteria in the blood, semen or placenta of an infected animal can enter your bloodstream through a cut or other wound. Because normal contact with animals — touching, brushing, or playing — does not cause infection, people rarely get brucellosis from their pets. Even so, people who have weakened immune systems should avoid handling dogs that are known to have the disease.

Brucellosis normally does not spread from person to person, but in a few cases, women have passed the disease to their children during birth or through their breast milk. Rarely, brucellosis may spread through sexual activity or through contaminated blood or bone marrow transfusions.

 

Risk factors

While brucellosis is rare in the United States, it is more common in other parts of the world, especially:

Southern Europe, including Portugal, Spain, Turkey, Italy, Greece, Southern France

Eastern Europe

Mexico, South and Central America

Asia

Africa

The Caribbean

The Middle East

 

Occupations at higher risk

People who work with animals or who come into contact with infected blood are at higher risk of brucellosis. Examples include:

 

Veterinarians

Dairy farmers

Ranchers

Slaughterhouse workers

Hunters

Microbiologists

Complications

Brucellosis can affect almost any part of your body, including your reproductive system, liver, heart, and central nervous system. Chronic brucellosis may cause complications in just one organ or throughout your body. Possible complications include:

 

Inflammation of the inner lining of the heart chambers (endocarditis). This is one of the most serious complications of brucellosis. Untreated endocarditis can damage or destroy the heart valves and is the leading cause of brucellosis-related deaths.

Arthritis. Joint inflammation is marked by pain, stiffness and swelling in the joints, especially the knees, hips, ankles, wrists, and spine. Inflammation of the joints in your spine (spondylitis) or the joints linking the lower spine and pelvis (sacroiliitis) can be particularly hard to treat and may cause lasting damage.

Inflammation and infection of the testicles (epididymo-orchitis). The bacteria that cause brucellosis can infect the epididymis, the coiled tube that connects the vas deferens and the testicle. From there, the infection may spread to the testicle itself, causing swelling and pain, which may be severe.

Inflammation and infections of the spleen and liver. Brucellosis can also affect the spleen and liver, causing them to enlarge beyond their usual size.

Central nervous system infections. These include potentially life-threatening illnesses such as inflammation of the membranes surrounding the brain and spinal cord (meningitis) or inflammation of the brain itself (encephalitis).;

 

Prevention

To reduce the risk of getting brucellosis, take these precautions:

 

Avoid unpasteurized dairy foods. In recent years in the United States, few cases of brucellosis have been linked to raw dairy products from domestic herds. Still, it is best to avoid unpasteurized milk, cheese and ice cream, no matter what their origin. If you are traveling to other countries, avoid all raw dairy foods.

Cook meat thoroughly. Cook a whole cut of meat until it reaches an internal temperature of 145 F (63 C) and let it rest for at least three minutes — a medium doneness. Cook ground meat to 160 F (71 C) — well done. Cook all poultry, including ground poultry, to 165 F (74 C). When traveling outside of the United States, avoid undercooked meats.

Wear gloves. If you are a veterinarian, farmer, hunter or slaughterhouse worker, wear rubber gloves when handling sick or dead animals or animal tissue or when assisting an animal giving birth.

Take safety precautions in high-risk workplaces. If you work in a laboratory, handle all specimens under appropriate biosafety conditions. Slaughterhouses should also follow protective measures, such as separating the killing floor from other processing areas and use of protective clothing.

Vaccinate domestic animals. In the United States, an aggressive vaccination program has nearly eliminated brucellosis in livestock herds. Because the brucellosis vaccine is live, it can cause disease in people. Anyone who has an accidental needle stick while vaccinating an animal should be treated.

Jan Ricks Jennings, MHA, LFACHE

Senior Consultant

Senior Management Resources, LLC

 

Jan.Jennings@EagleTalons.net

JanJenningsBlog.Blogspot.com

 

412.913.0636 Cell

724.733.0509 Office

 

October 25, 2022                                                                

                                                         Cryptococcal disease

😊

 

Cryptococcus gattii, formerly known as Cryptococcus neoformans var. gattii, is an encapsulated yeast found primarily in tropical and subtropical climates. Its teleomorph is Filobasidiella bacillispora, a filamentous fungus belonging to the class Tremellomycetes.

Cryptococcus gattii causes the human diseases of pulmonary cryptococcosis (lung infection), basal meningitis, and cerebral cryptococcomas. Occasionally, the fungus is associated with skin, soft tissue, lymph node, bone, and joint infections. In recent years, it has appeared in British Columbia, Canada and the Pacific Northwest.^[1] It has been suggested^[2][3] that global warming may have been a factor in its emergence in British Columbia. It has also been suggested that tsunamis, such as the 1964 Alaska earthquake and tsunami, might have been responsible for carrying the fungus to North America and its subsequent spread there.^[4] From 1999 through to early 2008, 216 people in British Columbia have been infected with C. gattii, and eight died from complications related to it.^[5] The fungus also infects animals, such as dogs, koalas, and dolphins.^[3] In 2007, the fungus appeared for the first time in the United States, in Whatcom County, Washington^[6] and in April 2010 had spread to Oregon.^[7] The most recently identified strain, designated VGIIc, is particularly virulent, having proved fatal in 19 of 218 known cases.^[8]

Cryptococcal disease is a very rare disease that can affect the lungs (pneumonia) and nervous system (causing meningitis and focal brain lesions called cryptococcomas) in humans. The main complication of lung infection is respiratory failure. Central nervous system infection may lead to hydrocephalus, seizures, and focal neurological deficit.

Environmental occurrence

Soil debris associated with certain tree species has been found frequently to contain C. gattii and less commonly VGI MATα, in Southern California. These isolates were fertile, were found to be indistinguishable from the human isolates by genome sequence were virulent in in vitro and animal tests. Isolates were found associated with Canary Island, American, and Pohutukawa tree  Leading up to the study one of the authors, Scott Filler, sent his daughter Elan to obtain and culture fungal samples in the greater Los Angeles area; one of these turned out to be C. gattii.^[11] Her work was presented at the Los Angeles County Science Fair, and she was credited as an author on the publication.^[12]

Lead author Deborah Springer said, "Just as people who travel to South America are told to be careful about drinking the water, people who visit other areas like California, the Pacific Northwest, and Oregon need to be aware that they are at risk for developing a fungal infection, especially if their immune system is compromised."^[13]

Epidemiology

The highest incidences of C. gattii infections occur in Papua New Guinea and Northern Australia. Cases have also been reported in other regions, indicating its spread to India, Brazil, Vancouver Island in Canada, and Washington, and Oregon in the United States.

Unlike is not particularly associated with human immunodeficiency virus infection or other forms of immunosuppression. The fungus can cause disease in healthy people, potentially due to its ability to grow extremely rapidly within white blood cells.^[14]

In the United States, C. gattii serotype B, subtype VGIIa, is largely responsible for clinical cases. The VGIIa subtype was responsible for the outbreaks in Canada; it then appeared in the U.S. Pacific Northwest.

According to a CDC summary, from 2004 to 2010, 60 cases were identified in the U.S.: 43 in Oregon, 15 from Washington, and one each from Idaho and California. Slightly more than half of these case were immunocompromised; 92% of all isolates were of the VGIIa subtype. In 2007, the first case in North Carolina was reported, subtype VGI, which is identical to the isolates found in Australia and California. In 2009, one case was identified in Arkansas.

The multiple clonal clusters in the Pacific Northwest likely arose independently of each other as a result of sexual reproduction occurring within the highly sexual VGII population.^[15] VGII C. gattii have probably undergone either bisexual or unisexual reproduction in multiple different locales, thus giving rise to novel virulent phenotypes.

Transmission

The infection is caused by inhaling yeasts or spores. The fungus is not transmitted from person to person or from animal to person. A person with cryptococcal disease is not contagious.



                             
                                                                                                       

Symptoms

Most people who are exposed to the fungus do not become ill. In people who become ill, symptoms appear many weeks to months after exposure. Symptoms of cryptococcal disease include:

·         Prolonged cough (lasting weeks or months)

·         Sputum production

·         Sharp chest pain

·         Shortness of breath

·         Sinusitis (cottony drainage, soreness, pressure)

·         Severe headache (meningitis, encephalitis, meningoencephalitis)

·         Stiff neck (prolonged and severe nuchal rigidity)

·         Muscle soreness (mild to severe, local or diffuse)

·         Photophobia (excessive sensitivity to light)

·         Blurred or double vision

·         Eye irritation (soreness, redness)

·         Focal neurological deficit

·         Fever (delirium, hallucinations)

·         Confusion (abnormal behavior changes, inappropriate mood swings)

·         Seizures

·         Dizziness

·         Night sweats

·         Weight loss

·         Nausea (with or without vomiting)

·         Skin lesions (rashes, scaling, plaques, papules, nodules, blisters, subcutaneous tumors or ulcers)

·         Lethargy

·         Apathy

Diagnosis

Culture of sputum, bronchoalveolar lavage, lung biopsy, cerebrospinal fluid or brain biopsy specimens on selective agar allows differentiation between the five members of the C. gattii species complex and the two members of the C. neoformans species complex.

Molecular techniques may be used to speciate Cryptococcus from specimens that fail to culture.

Cryptococcal antigen testing from serum or cerebrospinal fluid is a useful preliminary test for cryptococcal infection and has high sensitivity for disease. It does not distinguish between different species of Cryptococcus.

Treatment

Medical treatment consists of prolonged intravenous therapy (for 6–8 weeks or longer) with the antifungal drug amphotericin B, either in its conventional or lipid formulation. The addition of oral or intravenous flucytosine improves response rates. Oral fluconazole is then administered for six months or more.

Antifungals alone are often insufficient to cure C. gattii infections, and surgery to resect infected lung (lobectomy) or brain is often required. Ventricular shunts and Ommaya reservoirs are sometimes employed in the treatment of central nervous system infection.

People who have C. gattii infection need to take prescription antifungal medication for at least 6 months; usually the type of treatment depends on the severity of the infection and the parts of the body that are affected.

·         For people who have asymptomatic infections or mild-to-moderate pulmonary infections, the treatment is usually fluconazole.

·         For people who have severe lung infections, or infections in the central nervous system (brain and spinal cord), the treatment is amphotericin B in combination with flucytosine.

                             

 

Jan Ricks Jennings, MHA, LFACHE

Senior Consultant

Senior Management Services

Senior Management Resources, LLC

Jan,Jennings@EagleTalon.net

JanJenningBlog.Blogspot.com

 

412,913.0636 Cell

724.733.0509 Office 

                                                                                    Cancer

 

 

 

Overview

Cancer refers to any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue. Cancer often has the ability to spread throughout your body.

Cancer is the second-leading cause of death in the world. But survival rates are improving for many types of cancer, thanks to improvements in cancer screening, treatment and prevention.

Symptoms

Signs and symptoms caused by cancer will vary depending on what part of the body is affected.

Some general signs and symptoms associated with, but not specific to, cancer, include:

·         Fatigue

·         Lump or area of thickening that can be felt under the skin

·         Weight changes, including unintended loss or gain

·         Skin changes, such as yellowing, darkening or redness of the skin, sores that won't heal, or changes to existing moles

·         Changes in bowel or bladder habits

·         Persistent cough or trouble breathing

·          

·         Difficulty swallowing

·         Hoarseness

·         Persistent indigestion or discomfort after eating

·         Persistent, unexplained muscle or joint pain

·         Persistent, unexplained fevers or night sweats

·         Unexplained bleeding or bruising

When to see a doctor

Make an appointment with your doctor if you have any persistent signs or symptoms that concern you.

 

Causes

Cancer is caused by changes (mutations) to the DNA within cells. The DNA inside a cell is packaged into a large number of individual genes, each of which contains a set of instructions telling the cell what functions to perform, as well as how to grow and divide. Errors in the instructions can cause the cell to stop its normal function and may allow a cell to become cancerous.

What do gene mutations do?

A gene mutation can instruct a healthy cell to:

·         Allow rapid growth. A gene mutation can tell a cell to grow and divide more rapidly. This creates many new cells that all have that same mutation.

·         Fail to stop uncontrolled cell growth. Normal cells know when to stop growing so that you have just the right number of each type of cell. Cancer cells lose the controls (tumor suppressor genes) that tell them when to stop growing. A mutation in a tumor suppressor gene allows cancer cells to continue growing and accumulating.

·         Make mistakes when repairing DNA errors. DNA repair genes look for errors in a cell's DNA and make corrections. A mutation in a DNA repair gene may mean that other errors aren't corrected, leading cells to become cancerous.

These mutations are the most common ones found in cancer. But many other gene mutations can contribute to causing cancer.

What causes gene mutations?

Gene mutations can occur for several reasons, for instance:

·         Gene mutations you're born with. You may be born with a genetic mutation that you inherited from your parents. This type of mutation accounts for a small percentage of cancers.

·         Gene mutations that occur after birth. Most gene mutations occur after you're born and aren't inherited. A number of forces can cause gene mutations, such as smoking, radiation, viruses, cancer-causing chemicals (carcinogens), obesity, hormones, chronic inflammation and a lack of exercise.

Gene mutations occur frequently during normal cell growth. However, cells contain a mechanism that recognizes when a mistake occurs and repairs the mistake. Occasionally, a mistake is missed. This could cause a cell to become cancerous.

How do gene mutations interact with each other?

The gene mutations you're born with and those that you acquire throughout your life work together to cause cancer.

For instance, if you've inherited a genetic mutation that predisposes you to cancer, that doesn't mean you're certain to get cancer. Instead, you may need one or more other gene mutations to cause cancer. Your inherited gene mutation could make you more likely than other people to develop cancer when exposed to a certain cancer-causing substance.

It's not clear just how many mutations must accumulate for cancer to form. It's likely that this varies among cancer types.

More Information

Risk factors

While doctors have an idea of what may increase your risk of cancer, the majority of cancers occur in people who don't have any known risk factors. Factors known to increase your risk of cancer include:

Your age

Cancer can take decades to develop. That's why most people diagnosed with cancer are 65 or older. While it's more common in older adults, cancer isn't exclusively an adult disease — cancer can be diagnosed at any age.

Your habits

Certain lifestyle choices are known to increase your risk of cancer. Smoking, drinking more than one drink a day for women and up to two drinks a day for men, excessive exposure to the sun or frequent blistering sunburns, being obese, and having unsafe sex can contribute to cancer.

You can change these habits to lower your risk of cancer — though some habits are easier to change than others.

Your family history

Only a small portion of cancers are due to an inherited condition. If cancer is common in your family, it's possible that mutations are being passed from one generation to the next. You might be a candidate for genetic testing to see whether you have inherited mutations that might increase your risk of certain cancers. Keep in mind that having an inherited genetic mutation doesn't necessarily mean you'll get cancer.

Your health conditions

Some chronic health conditions, such as ulcerative colitis, can markedly increase your risk of developing certain cancers. Talk to your doctor about your risk.

Your environment

The environment around you may contain harmful chemicals that can increase your risk of cancer. Even if you don't smoke, you might inhale secondhand smoke if you go where people are smoking or if you live with someone who smokes. Chemicals in your home or workplace, such as asbestos and benzene, also are associated with an increased risk of cancer.

Complications

Cancer and its treatment can cause several complications, including:

·         Pain. Pain can be caused by cancer or by cancer treatment, though not all cancer is painful. Medications and other approaches can effectively treat cancer-related pain.

·         Fatigue. Fatigue in people with cancer has many causes, but it can often be managed. Fatigue associated with chemotherapy or radiation therapy treatments is common, but it's usually temporary.

·         Difficulty breathing. Cancer or cancer treatment may cause a feeling of being short of breath. Treatments may bring relief.

·         Nausea. Certain cancers and cancer treatments can cause nausea. Your doctor can sometimes predict if your treatment is likely to cause nausea. Medications and other treatments may help you prevent or decrease nausea.

·         Diarrhea or constipation. Cancer and cancer treatment can affect your bowels and cause diarrhea or constipation.

·         Weight loss. Cancer and cancer treatment may cause weight loss. Cancer steals food from normal cells and deprives them of nutrients. This is often not affected by how many calories or what kind of food is eaten; it's difficult to treat. In most cases, using artificial nutrition through tubes into the stomach or vein does not help change the weight loss.

·         Chemical changes in your body. Cancer can upset the normal chemical balance in your body and increase your risk of serious complications. Signs and symptoms of chemical imbalances might include excessive thirst, frequent urination, constipation and confusion.

·         Brain and nervous system problems. Cancer can press on nearby nerves and cause pain and loss of function of one part of your body. Cancer that involves the brain can cause headaches and stroke-like signs and symptoms, such as weakness on one side of your body.

·         Unusual immune system reactions to cancer. In some cases the body's immune system may react to the presence of cancer by attacking healthy cells. Called paraneoplastic syndromes, these very rare reactions can lead to a variety of signs and symptoms, such as difficulty walking and seizures.

·         Cancer that spreads. As cancer advances, it may spread (metastasize) to other parts of the body. Where cancer spreads depends on the type of cancer.

·         Cancer that returns. Cancer survivors have a risk of cancer recurrence. Some cancers are more likely to recur than others. Ask your doctor about what you can do to reduce your risk of cancer recurrence. Your doctor may devise a follow-up care plan for you after treatment. This plan may include periodic scans and exams in the months and years after your treatment, to look for cancer recurrence.

 

Prevention

Doctors have identified several ways to reduce your risk of cancer, such as:

·         Stop smoking. If you smoke, quit. If you don't smoke, don't start. Smoking is linked to several types of cancer — not just lung cancer. Stopping now will reduce your risk of cancer in the future.

·         Avoid excessive sun exposure. Harmful ultraviolet (UV) rays from the sun can increase your risk of skin cancer. Limit your sun exposure by staying in the shade, wearing protective clothing or applying sunscreen.

·         Eat a healthy diet. Choose a diet rich in fruits and vegetables. Select whole grains and lean proteins. Limit your intake of processed meats.

·         Exercise most days of the week. Regular exercise is linked to a lower risk of cancer. Aim for at least 30 minutes of exercise most days of the week. If you haven't been exercising regularly, start out slowly and work your way up to 30 minutes or longer.

·         Maintain a healthy weight. Being overweight or obese may increase your risk of cancer. Work to achieve and maintain a healthy weight through a combination of a healthy diet and regular exercise.

·         Drink alcohol in moderatio, if you choose to drink. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.

·         Schedule cancer screening exams. Talk to your doctor about what types of cancer screening exams are best for you based on your risk factors.

·         Ask your doctor about immunizations. Certain viruses increase your risk of cancer. Immunizations may help prevent those viruses, including hepatitis B, which increases the risk of liver cancer, and human papillomavirus (HPV), which increases the risk of cervical cancer and other cancers. Ask your doctor whether immunization against these viruses is appropriate for you.

·        

Jan Ricks Jennings

Senior Constant

Senior Management Resources, LLC

Jan.Jennings@EagleTalons.net

JanJennuingsblog.Blogspot.com

724.733.0509  Office

412,913,0626 Cell