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Malaria
Definition:
Malaria is a serious disease caused by a single-celled parasite residing in the red blood cells. The disease is transmitted by certain species of the Anopheles mosquito. There are four different types of the malaria parasite. The most deadly type is called Plasmodium falciparum. Globally the disease causes nearly a million deaths a year.
Who is at risk?
- Travelers coming from areas with no malaria
- Young children and infants who have yet to acquire any immunity
- Pregnant women, who have reduced immunity to malaria. The risks for spontaneous abortion, stillbirth and premature delivery are much higher.
People who grow up in endemic countries often have acquired some immunity against the parasite, and may experience only mild symptoms.
Symptoms:
The classical symptoms of malaria are episodic, cyclical attacks of:
- Shaking chills
- High fever
- Profuse sweating
Exceptions often occur. Early symptoms such as fever, headache, general feeling of discomfort, muscles aches and tiredness can be non-specific. The disease can be missed if the doctor is not aware of the travel history.
Treatment:
- A number of anti-malarial drugs are available. The disease is most susceptible to treatment early in its course when the load of parasites is not so high.
- Drug resistant malaria is increasingly common. A new anti-malarial drug which is derived from a plant is commonly used in Traditional Chinese Medicine and has proved promising.
- The WHO recommends that the new drug should be combined with conventional therapies so as to prevent drug resistance from occurring.
Prevention:
- There is no effective vaccine against malaria. Travelers should take preventive measures to avoid mosquito bites.
- Consult your doctor if anti-malarial drugs for prophylaxis are necessary in your destination.
- Travelers should take note of their journeys and report them to the doctor whenever they fall ill after a trip.
- Pregnant women should not visit areas where malaria is highly endemic.
Measles
Definition:
Measles is a highly contagious respiratory infection with a characteristic rash caused by a virus which belongs to the family of paramyxovirus. One can develop measles if they come into contact with droplets from the nose, mouth, or throat of an infected person.
Who is at risk?
Measles used to be a disease of children. If not immune, anyone of any age can come down with measles if exposed to the virus. In areas with universal vaccination like Hong Kong, outbreaks of measles tend to occur among older children, adolescents or young persons whose immunity has decreased after immunization. Young infants below 6 to 8 months old are generally protected due to immunity passed on from their mothers.
Symptoms:
Symptoms such as runny nose, muscle pain, sore throat, fever, cough, and bloodshot eye appear 8 to 12 days after exposure to the virus. An itchy rash will emerge around the fifth day, and may last 4 to 7 days, starting on the head and spreading to other body parts. Globally, pneumonia complicating measles is a common cause of death, so with diarrhea. Occasionally, the virus can affect the heart, the liver and the brain. The disease is more severe in adults.
Treatment:
There is no specific treatment for measles. Symptoms may be relieved with bed rest, drugs, and humidified air. Antibiotics are only useful when bacterial infections are present.
Prevention:
Patients with measles should be isolated at home until at least 4 full days after the rash first appeared. A safe and effective vaccine has been in use for decades. It is combined with the mumps and rubella vaccines called the MMR. The first dose should be given at 12-15 months of age, followed by a second dose at primary school entry.
Meningitis
Definition:
Inflammation of the membranes (meninges) and fluid (cerebrospinal fluid) that cover and surround the brain or spinal cord.
Meningitis can be caused by viral, bacterial, or rarely fungal infections. Bacterial meningitis can be rapidly fatal and is most damaging to a child's developing brain.
Who is at risk?
- Children younger than 5 years of age, especially if not immunized
- Adolescents and young adults
- People living in crowded environment or in dormitories
- People exposed to animals at work
- People with compromised immune system
Symptoms:
Common symptoms of meningitis include:
- High fever
- Severe headache
- Vomiting and nausea
- Confusion, apathy, and listlessness
- Bulging of the soft spot (fontanel) on the head in infants
- Convulsions
- Intolerance to light
- Stiff neck
Bacterial meningitis can be fatal within a few days. Even if recovered, there is a risk of permanent brain damage and residual deafness. Symptoms may be very non-specific in small infants, especially in the newborn period.
Treatment:
Meningitis can be treated with antibiotics if it is caused by a bacterial infection. Usually the drug must be given in high doses by intravenous route to ensure that it can reach the site of infection.
The doctor may need to obtain a sample of the cerebrospinal fluid before starting antibiotics to confirm the diagnosis and identify the germs so as to ensure that they are sensitive to the prescribed antibiotic.
Prevention:
Although meningitis can be caused by several different kinds of bacteria, a number of vaccines are available in recent decade to protect children against this fatal illness:
- Haemophilus influenzae type b (Hib) vaccine
- Pneumococcal conjugate vaccine
- Meningococcal conjugate vaccine
The above vaccines are all available in Hong Kong. Unfortunately they are not yet included in the routine childhood immunization program subsidized by the government in Maternal and Child Health Clinics. Talk with your healthcare provider if your child should be given these vaccines.
Menopause
Definition:
Menopause is a normal part of life. Many women experience a variety of symptoms as a result of the hormonal changes associated with the transition through menopause. These hormones are important for keeping the vagina and uterus healthy as well as for normal menstrual cycles and for successful pregnancy. Estrogen also helps to keep bones healthy. It helps women keep good cholesterol levels in their blood. Declining levels of the hormones estrogen and progesterone cause changes in your periods.
- Premature menopause: For most women, menopause is a normal occurrence and occurs at an average at age between 48-52. If menopause occurs in a woman younger than 40 years, it is considered premature. Menopause is considered late if it occurs in a woman older than 55 years.
- Perimenopause or climateric: The hormonal changes associated with menopause actually begin prior to the last menstrual period, during a 2- to 5-year period called perimenopause.
- Surgical menopause: Surgical menopause is the removal of the ovaries.
Who is at risk?
- Menopause is more likely to occur at a slightly earlier age in women who smoke, have never been pregnant, or live at high altitudes;
- People with systemic lupus erythematosus tend to have premature menopause;
- People who had surgical removal on the ovaries.
Symptoms:
- Changes in periods: Many women become less regular; some have a lighter flow than normal; others have a heavier flow and may bleed for many days.
- Hot flashes: A hot flash is a sudden feeling of heat in the upper part or all of your body. Your face and neck become flushed followed by heavy sweating and cold shivering.
- Problems with the vagina and bladder: The genital area can get drier and thinner as estrogen levels change. This dryness may make sexual intercourse painful. Vaginal infections can become more common. Urinary incontinence might occur.
- Sex: Some women find that their feelings about sex change with menopause. Some have changes to the vagina, such as dryness, that makes sexual intercourse painful. Others feel freer and sexier after menopause probably because of the relief that pregnancy is no longer a worry.
- Sleep problems: Some women find they have a hard time getting a good night sleep. Hot flashes also may cause some women to wake up.
- Mood changes. Shifts in mood may also be caused by stress, family changes such as children leaving home, or feeling tired. Depression is NOT a symptom of menopause.
- Weight gain, thinning of skin and changing shapes of the breasts.
- Osteoporosis: For women, the loss of estrogen around the time of menopause causes more bone to be lost than is replaced. If too much bone is lost, bones become thin and weak and can break easily.
- Cholesterol level and heart disease: The total cholesterol and LDL level tend to increase after menopause. Younger women have a lower risk of heart disease than men do at the same age. But after menopause, a woman's risk of heart disease is almost the same as a man.
Treatment:
- Hormone Replacement Therapy (HRT) is often prescribed to replenish the body with the estrogen it no longer produces. HRT typically consists of an estrogen/progestin supplement, usually given orally or through a skin patch.
- Estrogen is the component that treats the hot flashes, vaginal dryness, and increased risk of heart disease and osteoporosis (thinning of the bones).
- The known benefits: HRT can help prevent osteoporosis and relieve symptoms such as hot flashes.
- The known risks: Research on HRT has showed that HRT may increase risk of breast cancer and does not protect women from heart disease.
Prevention:
Postmenopausal women should consume 1,500 mg of calcium daily to prevent loss of bone mineral density. 400 IU daily dose of Vitamin D would assist in the calcium absorption.
Mumps
Definition:
Mumps is an acute viral infection that causes swelling and inflammation of the salivary glands. The parotid gland situating on the face below and in front of the ear is most commonly involved. Occasionally mumps can also affect salivary glands under the jaw.
Who is at risk?
Mumps used to be a ubiquitous disease in children ages two through twelve. Most children are now protected by an effective vaccine that is incorporated in the two doses of MMR vaccine recommended by the Department of Health in Hong Kong and in most of the developed world. The disease can still occur in people who are not vaccinated, or in patients whose antibody levels have waned.
Symptoms:
Symptoms usually start 18 days after exposure to the virus, but can range from 12 to 25 days. Symptoms include:
- Pain or swelling just below and in front of the lower ear lobe. Fever, usually lasting about two to three days
- Earache that is aggravated by chewing
- Sore muscles
- Loss of appetite
- Headache
In 15 to 25 % of male patients, the virus can affect the testicles that can lead to infertility. The virus can also cause meningitis or encephalitis.
Treatment:
There is no specific treatment for mumps. Treatment is with symptomatic. Some patients may find relief by applying warm moist towels over the swelling. Patients should rest in bed and drink plenty of fluids while being observed for complications. Chewing and sour food can stimulate the salivary glands and provoke pain and should be avoided. Children with mumps should be kept at home for 9 days after the swelling begins.
Prevention:
The Department of Health in Hong Kong recommends all children should receive one dose of MMR (measles, mumps, rubella) vaccine at 12 months of age and another dose at Primary 1. The vaccine is very safe and the two-dose schedule can effectively prevent the three highly infectious diseases from occurring in the community.
Meckel's diverticulum
Definition:
This is a congenital defect where a small pouch is protruding from the lower end of the small intestine. The condition is common, but most patients do not experience symptoms unless complication occurs.
Who is at risk?
Symptoms caused by Meckel¡¦s diverticulum are most common in small children and infants. The condition is more common in male.
Symptoms:
- Rectal bleeding
Painless rectal bleeding is the most common symptom caused by Meckel¡¦s diverticulum. The amount of blood loss can be massive and acute. The color may appear dark red or even black. - Iron deficiency anemia
Sometimes, bleeding may be so slow that it is not noticed until the patient is found to be anemic. - Vomiting
In some patients, the Meckel¡¦s diverticlum may get tangled up and result in intestinal obstruction. The patient may suffer from repeated vomiting and abdominal pain. - Abdominal pain
Rarely, the diverticulum may get infected and inflamed, causing acute abdominal pain that mimic acute appendicitis.
Treatment:
The doctor may order a special test called a Technetium Scan. A minute dose of radioactive substance is injected into the vein, which shows up the Meckel¡¦s diverticulum on a special camera. Treatment is surgical if symptomatic. The affected part of the small bowel is removed. This may be performed under laparascopy. Meckel¡¦s diverticulum found incidentally may be left alone if the chance of complication is low. Some surgeons do recommend surgical removal even if it is not symptomatic.
Prevention:
This is a congenital defect that patients are born with it. The condition is not hereditary. There is no way to prevent it.
Migraine
Definition:
A severe, disabling headache, usually affecting only one side of the head. It is believed to be caused by abnormal changes in blood vessel tone mediated by chemicals in the body.
Who is at risk?
- Females. Some experience attacks at the onset of their menstrual period.
- Young age: Migraines usually begin in childhood, adolescence or early adulthood and is most common in 30 to 40 years olds.
- Family history of migraine
Symptoms:
A typical migraine attack often lasts four to 72 hours. Shortly before the attack the person may feel tired, depressed, with poor concentration. Some patients may experience sensory warning symptoms or signs (auras), such as flashes of light, blind spots or tingling in the arm or leg before the pain, which is often intense and:
- Confined to one side of the head, though may affect both sides
- Has a pulsating or throbbing quality
- Worsens with physical activity
- Associated with nausea with or without vomiting
- Associated with sensitivity to light and sound
Treatment:
Typically migraine is episodic. Mild attacks may be treated with over-the-counter painkillers and rest. Others may require stronger analgesics in combination, or medications that target against chemicals which dilate the blood vessels. The frequency and intensity of migraine attacks vary from person to person. For patients with frequent and debilitating attacks, the doctor may prescribe medication to be taken on a regular basis as a preventive measure.
Prevention:
- Manage stress: Stress and migraines often go hand in hand.
- Avoid triggers. If certain foods seem to have triggered your headaches in the past, such as aged cheese, avocados or raisins, eliminate those from your diet to see if it helps.
- Establish a good sleeping habit. Migraines are often triggered by a poor night's sleep.
- Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines.
