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Q Fever
Definition:
Q Fever is an acute infection of domestic animals (cattle, sheep, and sometimes pets) caused by a tiny bacterium called Coxiella burnetti. Occasionally the disease can be transmitted to humans.
Who is at risk?
- Livestock farmers, dairy workers;
- Veterinarians;
- Workers in close contact with animals or their carcasses, such as in the slaughter house or meat processing plant;
- Patients with pre-existing disease in their heart valves, such as transplanted or artificial heart valves.
Symptoms:
- General symptoms
- High fever (up to 104-105oF) with chills, and sweating
- Severe headache
- General tiredness and muscle aches
- Respiratory symptoms
- Sore throat
- Dry cough
- Chest pain
- Gastrointestinal symptoms
- Nausea, vomiting
- Diarrhea
- Abdominal pain
Most patients presented with persistent fever, which may progress to mental confusion. The bacteria can infect the lungs and lead to pneumonia, which may show up in chest X rays. The disease also affects the liver, which results in abnormal findings in blood tests similar to that of hepatitis. The bacteria can also infect the valves of the heart, resulting in a chronic condition known as endocarditis (Meaning: inflammation of the inner most lining of the heart cavities).
Treatment:
The bacterial disease can be treated with antibiotics such as tetracycline (Meaning: a family of broad-spectrum antibiotics effective against a remarkably wide variety of organisms) and chloramphenicol (Meaning: a broad-spectrum antibiotic that inhibits bacterial protein synthesis). Newer antibiotics belonging to the group called Quinolones are also highly effective. Usually a prolonged course of treatment (2 to 3 weeks) is necessary.
Prevention:
- Use only pasteurized milk and milk products.
- Do not visit farms and barns with diseased animals.
- Avoid close contact with animals.
- Quarantine imported animals.
- Facilities for handling animals should be located away from populated areas.
Quadriplegia
Definition:
Also known as tetraplegia, quadriplegia literally means "paralysis of all four limbs" as from a higher-level spinal cord injury. Very often this is the result of accidents damaging the upper part of the spinal cord.
The spinal cord is a long column of nervous tissue extending from the brain. The column of vertebral bones, which can be divided into the cervical, thoracic, lumbar, sacral and coccygeal segments, protects it. In each vertebral bone, nerve roots going through small holes connect the spinal cord with peripheral parts of the body, transferring sensation messages to and transmitting command information from the brain. Damage to the spinal cord in one vertebral level would effectively cut off sensation input and control signals of the body below that level from the brain's higher command centre.
Who is at risk?
Most cases of quadriplegia happen as a result of injuries to the upper spinal cord, with road accidents topping the list in Western countries. Other common causes are accidental falls, sports injuries, and violent acts. The severity of disability would depend on whether the cut-off is complete or partial, and the level involved. Quadriplegia / Tetraplegia results when a person has a spinal cord injury above the first thoracic vertebra. When the level of injury is lower, say, below the first thoracic vertebra, the upper limbs may be spared, and the condition is called paraplegia.
Symptoms:
In quadriplegics, all four limbs are paralyzed with loss of sensation. The patient would therefore be almost totally dependent on others in his or her daily living. A simple act such as marking a turn in the bed can be quite a chore. The loss of peripheral sensation means that the extremities are vulnerable to injuries and infections. In quadriplegics, the abdominal and chest muscles are also affected, resulting in weakened breathing and the inability to cough properly. Secretions can clog up the airway and food may aspirate. There is also loss of controlled function of the bladder and bowel. The patient may need a urinary catheter to empty the bladder, and urinary tract infections frequently occur. Constipation is a problem too.
Treatment:
For quadriplegics, there is no way to regain full mobility and sensation, but intensive Occupational Therapy, Physiotherapy and other forms of rehabilitation care can result in partial recovery, and prevent further complications. Although the rehabilitation process can be long, family and community support can make a real difference in the life of a quadriplegic.
Prevention:
In order to prevent quadriplegia, we should aim at preventing accidental spinal cord injuries as a result of Industrial accidents, road accidents, accidental falls and sports injuries. The nerve cells in our brain and spinal cord have very limited power to regenerate. Prompt treatment in all cases of spinal injury is vital. Injuries to the cervical spine can be easily missed.
Quincke's Edema (Angioedema)
Definition:
The term angioedema (sometimes called angioneurotic edema) describes the allergic condition manifested as recurrent acute edema of the skin or mucus membranes. When angioedema is at risk of involving the uvula, it is referred to as Quincke's edema.
The uvula is the soft tissue hanging from the middle lower border of the soft palate. It prevents ingested substances from entering the nasal cavity when we swallow. It also plays an important role when we make sounds. When the uvula and its surrounding structures suddenly swell up, the upper airway may be blocked, so much so that a patient may die from asphyxiation if not treated promptly.
Who is at risk?
Angioedema and urticaria (hives) are closely related. Patients who are vulnerable to urticaria are at higher risk of angioedema. In fact the two often happen together. Like urticaria, angioedema can be provoked by physical means, such as cold, pressure, vibration, or fever. People who are allergic to drugs or to food substances can develop angioedema when exposed. Insect venoms can also provoke angioedema in sensitized individuals.
Angioedema can be hereditary. For our defence apart from antibodies, the complement system is another important biochemical system mediating our immune responses. Some patients born with a genetic abnormality in one component of the complement system are prone to repeated attacks of urticaria and angioedema. An acquired form of the disorder has been described in patients with cancer and immune disorders.
Angioedema can be the presenting symptoms of the so-called "immediate hypersensitivity type I reactions". This is a most severe form of allergy, and can be rapidly fatal. Patients suffering from asthma, allergic rhinitis or chronic eczema often have high levels of a special type of antibody called IgE. This hypersensitive allergic state is called "atopy" and "atopic" individuals are particularly prone to severe allergic responses.
Symptoms:
There is marked swelling of the lips, eyelids, mouth and the tongue because of edema, as the body fluid leaks from capillaries to the tissue space. The patient looks disfigured and red, often with a rash. When the airway is affected, the patient complains of a foreign body sensation or fullness in the throat, possibly associated with a muffled voice and gagging. A look into the throat would find that the uvula is swollen, pale, and somewhat translucent (uvular hydrops). If greatly enlarged, the uvula might rest on the tongue and move in and out with respiration.
Treatment:
Angioedema, when involving the face and neck around the mouth, is an acute emergency. The patient needs medical attention immediately. Get to the nearest emergency room or hospital as soon as possible. Call an ambulance if the patient is having difficulty in breathing.
Before professional help is available, you should:
- Loosen up clothing and accessories in the neck, such as the collar, neck ties and necklaces.
- Give oxygen if available.
- Take a note of what might have been triggering an allergic response, such as the kind of food or medicine the patient has been taking. Also note physical agents such as inhalants or insect bites that might have triggered the attack.
- Comfort the patient, who is often anxious and restless. Ask him to breathe slowly and rhythmically.
- The patient may have a hoarse voice. Do not talk unless necessary. Do not shout.
- Some patients may have experienced an attack before, and may be carrying drugs for emergency use. Help the patient to locate them. Read the instructions carefully and follow each step accordingly. The drug may be in the form injections that the patient has been taught to administer himself in critical situations.
Doctors may give oxygen to relieve the breathing difficulty and administer injections of adrenaline, a hormone from the adrenal glands which is highly effective for allergic emergencies. He may also set up an intravenous line to treat shock and give drugs such as antihistamines and corticosteroids. Medicine may also be delivered in the form of a mist through a facial mask. In desperate situations, doctors may need to open up a hole in the windpipe to save a patient dying from asphyxiation.
Prevention:
- Avoid drugs and food substances that you may be allergic to. List their names and show it whenever you visit a doctor.
- Patients with recurrent attacks should discuss with their doctors the practicability of having an emergency supply of medicine, such as Epipen (a syringe-ready preparation of adrenaline) to stock at home in case of emergency. Make sure you understand when and how to use it.
