Infection « ThePclinic

Sepsis after Cat Bite

: Image by Per Ola Wiberg (Powi) via Flickr

A middle aged lady came to me after 5 days of a cat bite.She was limping. There was swelling at the site of bite i.e.lower leg .It was a hard feeling there.She was getting treatment from one of my colleague and had been referred to me for pain at the site .The wound was in the process of healing.A blood sugar test was within normal range.So I continued the same antibiotics and treatment as prescribed earlier.I was skeptical of the hard feeling which suggest a smoldering inflammation.But no pus point was visible from outside.An X-Rays of the part was taken to exclude infection of underlying bone but was normal.So,I thought the inflammation will resolve.The wound healed after a few days only to show two pus points later.Now I am sure about pus under the skin.That part was explored .A lot of old blood clots removed along with some pus.Now the patient is doing well.

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Retrospectively,I assume that the bite was a little bit severe and there was a collection of blood underneath the skin.The collected blood revealed only after the infection.

So, apart from vaccination against rabies the wound should be inspected right at the time of first reporting of patient.Appropriate action for collected blood should be taken along with antibacterial treatment.Vaccination against tetanus is mandatory.

Filed under: General — Tags: Infection, rabies — Dr.Prahallad @ September 11, 2009 8:35 pm

About H1N1 Influenza

: Image by harold.lloyd (won’t somebody think of the bokeh?) via Flickr

My friend in PeerPower.com has sent this message to me requesting for wide circulation.I would like to add a few things a few here.As regards the mask and precautions he is right.But using a mask is better to no use.What I called something is better than nothing.Moreover it will obstruct other secondary bacterial invasion to cause a pneumonia in the already immune compromised patient.It may be helpful to the patient if not to the contacts.Tamiflu is a virostatic drug which will prevent rapid proliferation.I can conclude that confining the less sever cases to home with usual precautions is a good strategy.And sever cases be treated at hospital.

: Oseltamivir

———- Forwarded message ———-
From: Sanjib Kumar <no-reply@peerpower.com>
Date: 2009/8/18
Subject: PeerPower Message – HINI Precautions
To: drppanda@gmail.com

Subject: HINI Precautions

: H1N1 Virus

Image by groovelock via Flickr

Message:
Dear All
A very logical and constructive solution to prevent you from getting infected with H1N1..Plz share it to all friends and relatives.
The hype in media about the utility of face masks and N95 respirators as a tool for general protection against H1N1 can’t be deplored enough. Please realize that this is not an official advice, especially the one about face masks or N95.
·Most N95 respirators are designed to filter 95% particulates of 0.3µ, while the size of H1N1 virus is about 0.1µ. Hence, dependence on N95 to protect against H1N1 is like protecting against rain with an umbrella made of mosquito net.

·Tamiflu does not kill but prevents H1N1 from further proliferation till the virus limits itself in about 1-2 weeks (its natural cycle).

: Image by ■ Guerry via Flickr

about 1-2 weeks (its natural cycle).
H1N1, like other Influenza A viruses, only infects the upper respiratory tract and proliferates (only) there. The only portals of entry are the nostrils and mouth/ throat. In a global epidemic of this nature, it’s almost impossible not coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.
While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps – can be practiced:
1. Frequent hand-washing (well highlighted in all official communications)..
2. “Hands-off-the-face” approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).
3. Gargle twice a day with warm salt water (use Listerine if you don’t trust salt). H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms.
Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don’t underestimate this simple, inexpensive and powerful preventative method.

: Image by Rescue Dog via Flickr

4. Similar to 3 above, clean your nostrils at least once every day with warm salt water. Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.
5. Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.
6. Drink as much of warm liquids as you can. Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.
Happy breathing!

ppanda

Filed under: General — Tags: Conditions and Diseases, Health, Infection, Infectious disease, Influenza A virus subtype H1N1, Influenzavirus A, Oseltamivir, Virus — Dr.Prahallad @ August 19, 2009 8:04 pm

Orchitis

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I do not remember if I have seen bilateral orchitis in the recent past that I saw to-day.The enlargement is quite remarkable.May be it is due to the delay in arrival to the hospital.Orchitis is inflammation of testis commonly by bacteria in an adult but in tropical countries usually filarial. .In children it is usually of viral in origin.Here the testis enlarges and becomes painful accompanied by fever.Epididymis is also involved most of the times.It follows an urinary tract infection through backward infection.
Support of testis,analgesics to relieve the pain and antibiotics to control infection are required.Investigations like urine examination along with culture and sensitivity test and ultrasonography of testis and abdomen are important to support treatment.

Filed under: General — Tags: Antibiotic, Bacteria, Genitourinary Disorders, Health, Infection, Pain, Urinary tract infection — @ July 31, 2009 6:46 am

Appendicular Lump

My patient of Appendicular Lump is recovering from the grave situation.Now the fever has subsided,vomiting reduced and appetite is returning.She was on conservative management.But full oral feed has not been allowed .I think she can take normal diet after another two days.
In case she has not improved I would have been forced to discontinue the conservative management in favor of intervention.Now the intervention would have meant drainage of pus from the lump and if possible closing of the stump of the apendix.It could have drawn me to the possible worst complications namely perforation of intestine and damage to the nearby structures.

But as things improved now I plan to go for an interval appendectomy after a lapse of six weeks.By this time the lump of conglomerated intestines would have resolved exposing the appendix.Adhesion if any would have matured to be safely dissected out .Patient’s general condition must have improved a lot .The infection would have gone.
Let us hope for the best.

Filed under: General — Tags: Gastrointestinal perforation, Infection, Intestine, Surgery — @ July 19, 2009 8:02 pm

Appendicular Lump

The slender ,hanging structure is appendix

Poor, most of the time bear the brunt of disease aggression.One of the serious complications of appendicitis is appendicular lump.After an acute attack if not treated adequately (without Surgery) body tries to contain the infection.In the process the near by intestine and omentum try to isolate the infected appendix by surrounding it from all the sides and in the process a mass or lump is formed in side the abdomen to be felt from lower abdomen.This may in turn progress to abscess (collection of pus) formation,perforation of apendix and even infection of blood called septicemia.

Infected appendix

These patients are usually treated conservatively as surgery at this stage is riskier. But still if the lump progresses the conservstive treatment is abandoned in favor of intervention (Surgery).Again here it may not be possible for the surgeon to treat for cure of disease .He has to amelorate the potentially grave situation and defer a definitive surgery to a later date.

All these carry risk for the patient.And in this part of India there are poor people who do not have any other option rather than to accept the situation.They come late because of various reasons.One important aspect being their financial status.Initially they they expect this pain in abdomen may not be severe and go away automatically,better to wait rather than to go to a doctor and spend money which is a wastage .That amount can be used to feed themselves.But in the long run when it aggravates they even sell all their property to get treated.
Treatment facilities in terms of man power and infrastructure is lacking in this part .Added to it is the high pricing of drugs and indifferent attitude of Govt. service providing agencies compels the poor to sit at home expecting auto cure , go to quack or indulge in folk remedies.

This grim situation should improve to claim that India is a welfare state.