PHILADELPHIA – For the folks who promote vaccination, these are trying times. Recently, CNN hosted a segment titled: “Virus or Vaccine: Which is Worse?”
It’s enough to set Paul Offit to ranting, which he did this week at a meeting of the Infectious Diseases Society of America. Offit, a physician who heads the infectious disease division at Children’s Hospital of Philadelphia, has devoted a career to fighting illness. In his job, vaccines are often the most reliable weapon available, and cost-effective to boot. And although it’s astonishingly more dangerous to contract a disease than it is to get vaccinated for it, that message seems to have gotten lost somewhere along the way.
Offit traces this detour back to 1982, when DPT — the shot that prevents diphtheria, tetanus and pertussis – was (wrongly) linked to brain damage. “Three people believed their kids were harmed by the vaccine,” he says.
Offit has compassion for families who have a child who has suffered, whatever the cause may be, known or unknown. But since 1982, it’s been one accusation after another against vaccines. People tried to link the HIB vaccine to diabetes (no evidence), the hepatitis B vaccine to multiple sclerosis (all but one study found no link), and other vaccines to SIDS or autism. Recently, the HPV vaccine — which prevents cervical cancer – got linked to heart attacks and strokes (no proof).
And now the seasonal flu vaccine and H1N1 flu vaccine are being skipped by millions of people who somehow distrust the science that went into making them, even though the illnesses they cause can be fatal. Read more »
Tags: accusation, America, answer, aren, autism, barrage, belief, boot, brain, brain damage, bunch, cancer, career, cause, CDC, cervical cancer, chickenpox, child, Children, Clinics, CNN, compassion, cough, country, damage, Daycares, decision, Department, detour, diabetes, diphtheria, disease, Diseases, distrust, division, DPT, evidence, example, exposure, Facts, favor, flu, flu vaccine, focus, front, generation, gravitate, group, health, heart, heart attacks, hepatitis, hepatitis b, hepatitis b vaccine, Herd, HIB, hib vaccine, hiding, hospital, household, HPV, hpv vaccine, illness, immunity, infection, Infectious, infectious disease division, infectious diseases society, infectious diseases society of america, information, Internet, Jackson, job, Kansas City, kansas city mo, line, link, Mary Ann Jackson, Medicine, meeting, Mercy Hospitals, message, Mo., Mumps, notion, offit, Organization, outbreak, part, pathogen, Paul Offit, percent, person, pertussis, PHILADELPHIA, physician, point, population, Preventive, profile, proof, right, risk, Ronald Reagan, round, s hospital, safety, science, sclerosis, section, segment, shot, SIDS, Society, study, tetanus, trying times, United States, University, use, vaccination, vaccination rates, vaccine, Vanderbilt, virus, way, weapon, week, weren, William Schaffner, world
Posted in medicalmatrix | February 13, 2010 | 
Comments (0)
Background
Intracranial abscesses are uncommon, serious, life-threatening infections. They include brain abscess and subdural or extradural empyema and are classified according to the anatomical location or the etiologic agent. The term brain abscess is used in this article to represent all types of intracranial abscesses.
Intracranial abscesses can originate from infection of contiguous structures (eg, otitis media, dental infection, mastoiditis, sinusitis) secondary to hematogenous spread from a remote site (especially in patients with cyanotic congenital heart disease), after skull trauma or surgery, and, rarely, following meningitis. In at least 15% of cases, no source can be identified.
In recent years, the complex array of etiologic agents that cause brain abscess has become better understood.
Pathophysiology
Brain abscess is caused by intracranial inflammation with subsequent abscess formation. In at least 15% of cases, the source of the infection is unknown (cryptogenic). Infection may enter the intracranial compartment directly or indirectly via 3 routes.
Contiguous suppurative focus (45-50% of cases)
Direct extension may occur through necrotic areas of osteomyelitis in the posterior wall of the frontal sinus, as well as through the sphenoid and ethmoid sinuses.This direct route of intracranial extension is more commonly associated with chronic otitic infection and mastoiditis than with sinusitis. Odontogenic infections can spread to the intracranial space via direct extension or a hematogenous route. Contiguous spread could extend to various sites in the central nervous system, causing cavernous sinus thrombosis; retrograde meningitis; and epidural, subdural, and brain abscess. Read more »
Tags: abdominal, abscess formation, abscesses, administration, age, agent, AIDS, array, artery, article, availability, Background, body, brain, brain abscess, cause, cavernous sinus thrombosis, central nervous system, cerebellum, Chronic, Clinical, compartment, complication, congenital, congenital heart disease, contamination, Contiguous, contiguous structures, course, decrease, dental infection, diagnosis, dilatation, disease, distribution, drug, dural, emergence, emissary veins, empyema, entry, epidural, esophageal, ethmoid, ethmoid sinuses, etiologic agent, etiologic agents, evidence, exacerbation, extension, extradural, focus, formation, fracture, Frequency, frontal sinus, fulmi, fulminant, fungal, Haemophilus, heart, Hematogenous, history, HIV, hospital, imaging, indolent, infection, inflammation, influenzae, injection, International, Intracranial, introduction, life, lobe, location, lung, mode, Morbidity, Mortality, MRI, mucosa, mucosal, necrotic areas, network, neutropenia, Odontogenic, odontogenic infections, osteomyelitis, paranasal, Pathophysiology, posterior, prevalence, problem, rate, resul, retrograde, route, Rupture, seed, sequelae, Sex, shrapnel, site, skin, skull, source, space, sphenoid, spread, structure, subdural, surgery, system, term, Thrombophlebitis, transplantation, trauma, United States, use, vaccine, vasculature, wall, world
Posted in medicalmatrix | | Comments (0)
Background
The word tetanus comes from the Greek tetanos, which is derived from the term teinein, meaning to stretch. Tetanus appears in military medical documents throughout the ages. Slapping infected dung on the umbilical cords of newborns (ie, as part of ritualistic ceremonies) caused rampant tetanus neonatorum or trismus nascentium in the West Indies and in Africa. Osler’s textbook describes the “eight days sickness” caused by umbilical sepsis, which killed 84 of 125 children within a fortnight of birth in St. Kilda, Scotland. During World War I, tetanus occurred in 1.47 per 1000 British wounded and in 12.5 per 1000 persons involved in the Peninsular campaign. Nicolaier discovered the anaerobic bacillus Clostridium tetani in 1885. In 1889, Koch’s pupil, Kitasato, obtained the bacillus of tetanus in pure culture and associated the disease to animals.
Although rare, the disease has not been eradicated, and early diagnosis and intervention are life saving. Prevention is the ultimate management strategy for tetanus. The 4 clinical types of tetanus are generalized, local, cephalic, and neonatal.
Neonatal tetanus is a major cause of infant mortality in underdeveloped countries, but this form is rare in the United States. Infection results from cord contamination during unsanitary delivery conditions, coupled with a lack of maternal immunization. At the end of the first week of life, infected infants become irritable, feed poorly, and develop rigidity with spasms. This form of tetanus has a very poor prognosis for survival.
Cephalic tetanus is uncommon and usually occurs following head trauma or otitis media. Patients with this form present with cranial nerve palsies. The infection may be localized or may become generalized.
Patients with local tetanus present with persistent rigidity in the muscle group close to the injury site. The muscular rigidity is caused by a dysfunction in the interneurons that inhibit the alpha motor neurons of the affected muscles. No further CNS involvement occurs, and this form has very low mortality rates. Read more »
Tags: action, activity, adduction, advent, Africa, alpha, axonal, Background, birth, bond, California, campaign, cause, cause of infant mortality, Cephalic, chain, Clostridium, clostridium tetani, clothing, CNS, contamination, cord, cranial, culture, delivery, delivery conditions, diagnosis, disease, disulfide, dung, dust, dysfunction, dysphagia, end, extension, failure, feed, flexion, form, fortnight, Frequency, germinate, group, head, head trauma, hemolysin, immunization, immunocompetent, incidence, infant, infection, injury, instability, International, interneurons, intervention, involvement, Kilda, Kitasato, Koch, lack, life, management, manure, masseter, maternal, medical documents, Morbidity, Mortality, motor, motor neurons, muscle, muscle group, muscular rigidity, nascentium, neonatal, neonatal tetanus, neonatorum, nerve, nerve palsies, neuronal, Nicolaier, noise, Nuchal, Osler, otitis media, pain, part, Pathophysiology, Peninsular, peninsular campaign, poor prognosis, prevention, prognosis, protein, pupil, recovery, release, response, rigidity, saving, Scotland, sensorium, sepsis, sickness, site, skin, Slapping, smile, soil, spasm, st kilda scotland, strategy, survival, system, teinein, tendon, term, tet, tetani, tetanolysin, tetanospasmin, tetanus, tetanus neonatorum, textbook, tissue, Tonic, touch, toxin, transport, trauma, ultimate management, umbilical cords, United States, war, week, West Indies, word, world, world war i, year
Posted in medicalmatrix | | Comments (0)
Background
Mycoplasma species are the smallest free-living organisms. These organisms are unique among prokaryotes in that they lack a cell wall, a feature largely responsible for their biologic properties such as their lack of a reaction to Gram stain and their lack of susceptibility to many commonly prescribed antimicrobial agents, including beta-lactams. Mycoplasmal organisms are usually associated with mucosal surfaces, residing extracellularly in the respiratory and urogenital tracts. They rarely penetrate the submucosa, except in the case of immunosuppression or instrumentation, when they may invade the bloodstream and disseminate to different organs and tissues throughout the body.
Although scientists have isolated at least 17 species of Mycoplasma from humans, 4 types of organisms are responsible for most clinically significant infections that may come to the attention of practicing physicians. These species are Mycoplasma pneumoniae, Mycoplasma hominis, Mycoplasma genitalium, and Ureaplasma species. The focus of this article is infections caused by M pneumoniae; articles on Ureaplasma infections (eg, Ureaplasma Infection) and genital mycoplasmal infections contain discussions of infections caused by other mycoplasmal species.
Pathophysiology
M pneumoniae is perhaps best known as the cause of walking or atypical pneumonia, but the most frequent clinical syndrome caused by this organism is actually tracheobronchitis or bronchiolitis, often accompanied by upper respiratory tract manifestations. Pneumonia develops in only 5%-10% of persons who are infected. Acute pharyngitis and myringitis are less common.
After inhalation of respiratory aerosols, the organism attaches to host cells in the respiratory tract. The P1 adhesin and other accessory proteins mediate attachment, followed by induction of ciliostasis, local inflammation that consists primarily of perivascular and peribronchial infiltration of mononuclear leukocytes, and tissue destruction that may be mediated by liberation of peroxides. Recently, M pneumoniae has been shown to produce an exotoxin that is believed to play a role in the damage to the respiratory epithelium that occurs during acute infection. The organism also has the ability to exist intracellularly. Additionally, acute mycoplasmal respiratory tract infection may be associated with exacerbations of chronic bronchitis and asthma. More extensive information on the pathogenesis of mycoplasmal respiratory infections is available in a recent review article.
Spread of infection throughout households is common, although person-to-person transmission is slower than for many other common bacterial respiratory tract infections; close contact appears necessary. Generally, the incubation period is 2-3 weeks. The organism may persist in the respiratory tract for several months, and sometimes for years in patients who are immunosuppressed, after initial infection. Read more »
Tags: ability, Acute, acute pharyngitis, adhesin, administration, aerosols, antimicrobial, article, asplenia, asthma, attachment, attention, atypical pneumonia, Background, beta lactams, bloodstream, body, bronchiolitis, case, cause, cell, climate, contact, damage, degree, destruction, disease, Epidemics, epidemiology, epithelium, evidence, exotoxin, failure, fall, feature, focus, Frequency, genitalium, geography, Gram, gram stain, greate, hospitalization, immunity, immunosuppression, incidence, increase, incubation, induction, infection, infiltration, inflammation, information, inhalation, instrumentation, International, Japan, lack, liberation, living organisms, majority, mononuclear, mononuclear leukocytes, Morbidity, Mortality, mucosal, mucosal surfaces, Mycoplasma, mycoplasma species, Mycoplasmal, mycoplasmal infections, myringitis, organism, Pathophysiology, peribronchial, period, perivascular, pneumonia, pneumoniae, prokaryotes, proportion, reaction, recovery, resolution, review, risk, role, sequelae, seroprevalence, Severe, sickle, spread, Streptococcus, Subclinical, submucosa, summer, susceptibility, syndrome, term, tissue, tissue destruction, tract, transmission, United States, upper respiratory tract, Ureaplasma, urogenital, wall, year
Posted in medicalmatrix | | Comments (0)