What Is A Ruptured Spleen? What Causes A Ruptured Spleen?
Rupture of the capsule of the spleen is a potential catastrophe that requires immediate medical and surgical attention. Splenic rupture permits large amounts of blood to leak into the abdominal cavity, which is severely painful and life- threatening. Shock, and ultimately death, can result. Patients typically require immediate surgery.
The spleen is a fist-sized organ in the left upper quadrant of the abdomen that filters the blood by removing old or damaged blood cells and platelets using special white blood cells and helps the immune system by destroying bacteria and other foreign substances by opsonization and phagocytosis, and producing antibodies. It also stores approximately 33 percent of all platelets in the body.
A layer of tissue entirely covers the spleen in a capsule-like fashion, except where veins and arteries enter the organ. This tissue, called the splenic capsule, helps protect the spleen from direct injury.
In short, the spleen performs several functions including immune systems, filter functions, pitting, reservoir function and cytopoiesis.
It's important for a surgeon to be aware of the various functions of the spleen and the probable effects of splenectomy. Thus, a surgeon should try to preserve the spleen to maintain these functions.
What are the symptoms of a Ruptured Spleen?
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
If one notices any pain in the abdomen, specifically the upper left quadrant, this may be a symptom of a rupture. To determine what a ruptured spleen feels like, one has to have experienced some sort of a physical blow to the torso. The spleen won't just injure itself.
If you touch your stomach, the area will be tender to the touch as well as painful inside.
One must watch their vision. If you begin to feel light headed or even have blurry vision, it is a classic sign of what a ruptured spleen feel like. This means you could be losing a lot of blood inside your body.
Pay attention to mental awareness. Have someone you know to talk to you and make sure they believe you are not confused. When one loses enough blood, you will feel disoriented and confused.
What are the causes of a Ruptured Spleen?
Certain diseases and illnesses can also lead to a ruptured spleen. In such cases, the spleen becomes swollen and the capsule-like covering becomes thin. This makes the organ especially fragile and more likely to rupture if the abdomen receives a direct hit (such as forceful football tackle).
Blood cancers, infection and metabolic disorders are some of the things that can cause an enlarged spleen. Spleen enlargement can also be caused by liver diseases, such as cirrhosis and cystic fibrosis.
Rupture of a normal spleen can be caused by trauma, for example, in an accident. If an individual's spleen is enlarged, as is frequent in mononucleosis, most physicians will not allow activities (such as contact sports) where injury to the abdomen could be catastrophic.
Recent studies have also linked colonoscopy, a procedure that looks at the large intestine, to an increased risk of a ruptured spleen.
Diagnosing a Ruptured Spleen
A physical exam may be the only test done to diagnose a ruptured spleen. The doctor will feel the person's belly area and the abdominal area may feel hard and look swollen because it has filled with blood.
If there has been a great deal of blood loss from the spleen, the patient may have low blood pressure and a rapid heart rate. Sudden low blood pressure in someone who is believed to have a spleen injury, particularly a young person, is a sign that the condition is especially severe, and emergency surgery is needed.
Imaging tests can help diagnose a ruptured spleen. A computed tomography (CT) scan of the abdomen is one of the most common methods used. During the test, a special substance, called contrast, is injected into a vein, usually in the arm. The contrast helps the doctor determine the amount of bleeding from the spleen. Active bleeding from the spleen may not be seen on an abdominal CT scan without contrast.
However, a CT scan of the abdomen may only be done if time allows. A CT scan with contrast may take a while, and some people with spleen ruptures have died while waiting to have the test done. For this reason, a CT scan is not recommended for those with a spleen rupture who have unstable vital signs or low blood pressure due to the injury which suggests shock.
Diagnostic peritoneal lavage is a method to rapidly determine if blood is gathering in the abdominal area. It is fast and inexpensive, and can be done on spleen rupture patients who have low blood pressure.
An MRI of the abdomen may be an option for patients with kidney failure or who have severe allergies to the contrast substance used during a CT scan.
If the person is stable and does not need emergency surgery, laboratory tests such as a complete blood count (CBC) or hemoglobin level may be done at routine intervals to check for blood loss.
What are the treatment options for a Ruptured Spleen?
Doctors used to always remove a damaged spleen. However, removing the spleen can cause later problems, including an increased susceptibility to infections.
Doctors now realize that most small and many moderate-sized injuries to the spleen can heal without surgery, although blood transfusions are sometimes required and people must be treated in the hospital. When surgery is necessary, usually the entire spleen is removed (splenectomy), but sometimes surgeons are able to repair a small tear.
An alternative to open surgery for less urgent cases would be the removal of the spleen using a laparoscope. A thin tube with a camera is inserted through a small incision. Other tools are then inserted through other small incisions to remove the spleen.
Treatment for a ruptured spleen will depend on the severity of a patient's condition. If the doctor suspects that it is not an emergency situation, he may ask a patient to undergo blood and imaging tests first to clearly determine if the spleen has indeed ruptured. If the rupture is not big, a surgeon may be able to fix it without removing the entire organ.
Preventing a Ruptured Spleen
A ruptured spleen can be prevented by driving safely or by wearing protective gear while participating in sports. Avoid extreme or violent impacts in everyday life.
Some of the medical causes of an enlarged spleen may be preventable, such as cessation of alcohol abuse to prevent liver cirrhosis, or prophylaxis against malaria when planning a trip to an endemic area.
What Is Salivary Gland Cancer? What Causes Salivary Gland Cancer?
Salivary gland cancer is an uncommon type of cancer that starts in the tissue of one of the salivary glands. A salivary gland produces saliva, which keeps the mouth moist and helps the body with digestion. There are a number of salivary glands inside the mouth and two main types, major and minor. There are three pairs of major salivary glands, these are:
The parotid glands - the largest and most common salivary glands to suffer tumors, the parotid glands are just in front of each ear.
The sublingual glands - the smallest of the major salivary glands, these are located at the rear of the jaw.
The submadibular glands - these salivary glands are at the rear of the jaw.
There are hundreds of minor microscopic salivary glands all around the mouth. Tumors are not common in these, but if they do occur the chances are they will be cancerous (malignant). Places the minor salivary glands can be found include:
The salivary gland is any of the saliva-secreting exocrine glands of the oral cavity.
The World Health Organization places salivary gland tumor types into five main categories:
Malignant epithelial tumors - e.g. mucoepidermoid carcinoma
Benign epithelial tumors - e.g. Warthin tumor
Soft tissue tumors
Secondary tumors
Hematolymphoid tumors - e.g. Hodgkin lymphoma
What are the Signs and Symptoms of Salivary Gland Cancer?
A symptom is something the patient feels or reports, while a sign is something that other people, including the doctor detects. A headache may be an example of a symptom, while a rash may be an example of a sign.
The signs and symptoms for salivary gland cancer are:
Difficulty in opening mouth all the way
Facial muscles feel weak on one side of the face
Noticeable difference in shape of one side of the neck or face
Part of the face feels numb
Salivary gland is in constant pain
Swelling/lump around jaw, mouth or neck area
What are the Causes of Salivary Gland Cancer?
There is still little knowledge of salivary gland cancer but what has been found through research is that some salivary gland cancers have genetic irregularities. In the body there are some genes that control cell reproduction (oncogenes) and some that control their destruction (tumor suppressor genes).
In the case of cancer, one or both of these cell controlling gene types have mutated stopping the correct production and destruction of cells. Exposure to certain cancer causing chemicals (carcinogens) or radiation can cause genetic mutation, however the causes of most salivary gland cancer cases are unknown.
How is Salivary Gland Cancer Diagnosed?
Diagnosis of salivary gland cancer normally occurs when one of the above symptoms is noticed, causing the patient to visit their doctor. In order to properly diagnose the cancer the doctor will need to know the patient's medical history and perform a physical exam. This will involve examination of the sides of the face, the mouth and the area around the jaw.
The doctor will mainly be looking for any lymph nodes that seem enlarged as this could be a sign of cancer. They may also be looking for muscle weakness or numbness in part of the face to determine if the cancer has spread to the nerves.
If more detail as to the cancer's spread is needed, the patient may require further tests such as Imaging Tests. These imaging tests can be very effective at determining the location and spread of any cancerous areas, they can also help see if a method of treatment is effectively reducing the cancerous area. The types of imaging tests that can be used are:
CT or CAT scan (Computed Tomography)
PET Scan (Positron Emission Tomography)
MRI (Magnetic Resonance Imaging)
X-rays
There are some cases in which a sample of the cancerous tissue may need to be extracted for further analysis, this process is known as a biopsy. There a few different types of biopsy used for salivary gland cancer, these are:
FNA biopsy (Fine Needle Aspiration) - As suggested by the name, this is when the doctor inserts a fine, hollow needle (attached to a syringe) into the tumor and removes some fluid and cells. This procedure is carried out under local anesthetic. The sample is then analyzed by a cancer diagnosis specialist to determine if it is cancerous.
Incisional biopsy - In this type of biopsy, a surgeon will anesthetize the area, make a small incision and take away a small part of the tumor. This procedure is occasionally used if a FNA biopsy has not been able to extract enough of the tumor for suitable analysis.
Surgery - There are some cases where FNA biopsies have turned out inconclusive, but the presence of cancer has been clear from other methods of diagnosis (sometimes the physical exam or imaging tests are enough to determine the cancer without needing an FNA biopsy at all). In this instance, surgery may be advised to remove the tumor entirely. The removed mass can then be tested to see if it was malignant.
What are the Treatment Options for Salivary Gland Cancer?
Surgery
This is normally the primary form of treatment for salivary gland cancer. The degree of surgery entirely depends on the size and location of the tumor. If the tumor is large, the whole salivary gland may need to be removed along with any nerves and ducts that the cancer may have spread to. If the cancerous area is small and easy to get to, then the surgeon may only need to remove the tumor and a small amount of surrounding tissue.
Here is some more detail of the types of surgery used to treat salivary gland cancer, and when they may be used:
Parotid gland surgery - this gland is the most common place to find salivary gland tumors. It is difficult to perform surgery on this gland because the facial nerve passes right through it. The surgeon would enter by making a small incision on the side of the face just in front of the ear. If the cancer has spread, the entire gland would need removing (total parotidectomy) and possibly even the facial nerve and surrounding tissue.
However it is quite often in this type of salivary gland cancer that the tumors occur in the superficial lobe, located near the outside of the gland. As long as the cancer hasn't spread, removing this lobe can solve the problem (superficial parotidectomy), and means the surgeon can avoid damaging the facial nerve.
Submandibular gland surgery - also known as sublingual gland surgery, this surgery is performed if the tumor is in the sublingual glands or the submandibular glands. In this case the entire gland would need to be removed, and possibly some of the neighboring bone and/or tissue. There is also a chance that some nerves that control the tongue may need to be removed.
Minor salivary gland surgery - Minor forms of salivary gland cancer can appear in parts of the mouth such as the tongue, lips and throat. During surgery, the cancer is removed along with some surrounding tissue.
Reconstructive surgery - As some of the above surgeries involve dissection of the facial muscles, bones and/or parts of the throat, the patient may need reconstructive surgery. A plastic surgeon would need to replace or repair parts of the face to aid in breathing or chewing. This may involve skin/tissue grafts and even nerve grafts depending on the location and scale of the original surgery.
Radiation Therapy
This is when high-powered energy particles or beams (such as x-rays) are directed at the affected part of the body to slow the growth of or destroy cancer cells.
Radiation therapy can be useful when the tumor is in a hard to reach area which would prevent surgery. However this method can be used to kill any malignant (cancerous) cells that could be left over after surgery. It might also be used to reduce the size of a tumor before surgery.
It is possible that the location of the tumor is in an area that makes it too risky for surgery. In this instance radiation therapy is used on its' own.
External beam radiation therapy is the most common form of radiation therapy used to treat salivary gland cancer. This therapy is very similar to an x-ray but with a more intense level of radiation. The treatments are usually given once a day, five days a week for up to seven weeks.
It has been discovered in recent years that there are newer types of radiation therapy that could be more successful than the typical method. An example of this is accelerated hyperfractionated radiation therapy, in which radiation is given twice daily over a shorter period of time.
The use of 3D imaging technology can now also be implemented into the therapy. Using MRI or CT scans the doctor can figure out the best angle and direction for the radiation to enter the body, maximizing effectiveness and minimizing risk. Examples of these methods are:
One more method is fast neutron beam radiation. This involves a beam of high energy neutrons being fired at the cancerous area. There have been studies to suggest that although this method can be more effective, the risk is greater.
Chemotherapy
Chemotherapy (Chemo) is a method of treatment where anti-cancer drugs are ingested either through the mouth or intravenously to kill the cancerous cells. Each drug can be used on their own, however combinations of two or more is the most common practice. Some of the drugs used are:
Chemotherapy is used when the patient has an advanced form of cancer that has spread to remote parts of the body. The drugs enter the bloodstream and are then sent to all areas of the body. Chemo is given in phases, where each treatment stage is followed with a recovery period. Each phase lasts from three to four weeks.
Chemotherapy is not a common method of treatment for salivary gland cancer but its' use is being explored. It has been used to aid radiation therapy or surgery as it can weaken the cancer cells and reduce the size of tumors. Chemo is not advised for patients in poor health.
What are the Risk Factors of Salivary Gland Cancer
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
Salivary gland cancer risk can be increased by the following factors:
Exposure to radiation - Patients who have received radiation therapy for cancers in the head and neck have a higher risk of developing salivary gland cancer. Experts say that exposure to a certain number of X-rays may also slightly increase the risk..
Age - The older you get, the higher your risk is of developing salivary gland cancer. Even though the majority of patients with this type of cancer are older, it can develop at any age.
Family History - Although rare, it is known that some people have greater genetic risk of developing salivary gland cancer than others.
Exposure at the workplace - There are certain substances, suggested by studies - such as nickel alloy dust and silica dust - that might increase risk of salivary gland cancer. However, due to limited data these links are not yet proven.
Other potential salivary gland cancer risks being researched but not yet proven are:
Cell phone use
Diet
Tobacco and Alcohol consumption
Risk Factors of Surgery
As previously mentioned, some salivary gland cancer surgery may involve incision or dissection of the mouth, skin, bone and or facial nerves. If this is the case the patient may experience the following:
Anesthesia problems
Healing trouble
Excessive bleeding
Wound infections
Pain after surgery - can be treated with medication.
Nerve damage - one side of the face droops or the patient can have trouble swallowing and/or talking.
Gustatory sweating - also known as Frey Syndrome, this is when nerves grow back unusually which can lead to sweating over some areas of the face when chewing. This can be treated either with more surgery or medication.
Risk Factors of Radiation
There are a few possible side effects when using radiation therapy. External beam radiation alone can cause the following (note: these symptoms usually disappear after the treatment):
There are some side effects specific to the use of radiation therapy for treatment of salivary gland cancer, because the radiation may also travel to other parts of the head and neck. These side effects include:
Use of the drug amifostine before each radiation treatment can decrease the damage done to the salivary glands by the radiation. However it is known to be a difficult drug for the body to endure.
Risk Factors of Chemotherapy
Chemotherapy is quite an aggressive form of treatment, as it attacks cells that are dividing rapidly. The problem is that as well as attacking cancer cells, it affects some healthy quick dividing cells such as hair follicles and cells in the lining of the mouth. The degree and nature of the side effects is dependent on which drugs are used and how long the treatments have been going on. The following are some of the common side effects of chemotherapy and are usually short term and some can be treated:
Reduced appetite
Nausea
Vomiting
Low white and red blood cell count (greatens risk of infections and can lead to fatigue)
Some specific drugs used in chemotherapy such as carboplatin can cause neuropathy (nerve damage), which can lead to pain, tingling or burning in the hands or feet as well as temperature sensitivity and even hearing loss. It is common for these to go away after the treatment ends but any of these symptoms are worth getting checked out by your doctor.
How can Salivary Gland Cancer be Prevented?
As there is little knowledge of the exact cause, there is no guaranteed way of preventing salivary gland cancer. The best that can be done to prevent it is to be wary of the risk factors. Eating a healthy diet, exercising regularly and avoiding tobacco and alcohol are effective ways of minimizing risk.
Also if you do work around nickel alloy dust, silica dust or radioactive substances, be sure to protect yourself against them. And remember that if you do suffer any of the symptoms listed in this article, it is worth seeing your doctor as the earlier it is caught the better.
Salmonella infection, or salmonellosis, is a bacterial disease of the intestinal tract. Salmonella is a group of bacteria that cause typhoid fever, food poisoning, gastroenteritis, enteric fever and other illnesses. People become infected mostly through contaminated water or foods, especially meat, poultry and eggs.
Salmonella is a gram-negative, rod-shaped bacilli that can cause diarrheal illness in humans. Put simply - Salmonella is a bacterium shaped like a rod with a cell wall composed of peptidoglycan.
Gram-negative is a term used in bacteriology for bacteria that lose the crystal violet stain and take the color of the red counterstain in Gram's method of staining. Gram-negative bacteria usually have a cell wall composed of a thin layer of peptidoglycan. Bacilli is the plural of bacillus. Bacteria that have a rod-like shape are called bacilli.
The Salmonella family includes over 2,300 serotypes of bacteria - they are microscopic one-celled organisms. Salmonella enteritidis and Salmonella typhimurium are responsible for over 50% of all human infections in the USA. Some Salmonella strains that exist in humans can make animals sick, and vice-versa. The bacteria live in the gut of infected humans and animals.
What is salmonellosis?
Salmonellosis is an infection caused by Salmonella. Approximately 1.4 million Americans are affected with salmonellosis every year, of which about 500 die, according to the CDC (Centers for Disease Control and Prevention). In 2004 US authorities announced that Salmonella was responsible for 42% of human bacterial infections, followed by Campylobacter 37%, Shigella 15%, E. coli O157:H7 2.6%.
According to the HPA (Health Protection Agency), in 2008 9,864 people were affected with salmonellosis in the UK. In most of Western Europe, in countries such as the UK, France, Germany, Scandinavia, Holland, Switzerland and Belgium, the incidence of salmonellosis is very much lower than in the USA.
What causes Salmonella infections (salmonellosis)?
Salmonella live in the intestines of birds, animals and humans. Most human infections are caused by eating food or drinking water that has been contaminated by feces (excrement). Foods that are most commonly infected are:
Uncooked meat, seafood and poultry - contamination most commonly occurs during the slaughtering process. Harvesting seafoods in contaminated waters is also a common cause.
Uncooked eggs - the Salmonella are usually present in the eggs when laid if the chicken is infected. Raw eggs may be found in some types of mayonnaise and homemade sauces.
Fruits and vegetables - if fruit and vegetables have been watered or washed in contaminated water there is a much higher chance they will be contaminated. Some kitchen practices may contaminate fruits and vegetables - if the person preparing the food handles raw meat and then touches the fruit without washing his/her hands, for example.
Lack of hygiene - kitchen surfaces that are not kept clean, lack of handwashing procedures during food preparation, and lack of handwashing after going to the toilet or changing a baby's diapers, are common routes for contamination and infection. A person with contaminated hands can pass the infection on to other people by touching them, or touching surfaces which others then touch.
Pet reptiles or amphibians - most reptiles and amphibians carry Salmonella in their gut without becoming ill. They shed the bacteria in their droppings, which can quickly spread onto their skin and then anything they come into contact with, including cages, toys, clothes, furniture and household surfaces. The Health Protection Agency (UK) advises families not to keep reptiles if there are children under 5, pregnant women, very elderly people, and/or people with weaker immune systems in the household.
What are the signs and symptoms of salmonellosis (Salmonella infection)?
Out of the thousands of types of Salmonella bacteria, only about twelve make people ill, usually with gastroenteritis. A smaller number cause typhoid fever, which can be a very serious and potentially fatal disease, especially in developing countries.
A sign is something the doctor can see or touch, such as a rash, while a symptom is something the patient feels, such as dizziness or headache.
Salmonella-induced Gastroenteritis signs and symptoms:
Salmonella-induced Typhoid fever signs and symptoms:
People who live in developed countries most commonly become infected when they travel abroad. The incubation period - time between becoming infected and symptoms appearing - is usually between 7 to 14 days. If Typhoid fever is left untreated symptoms develop over a course of four weeks, with additional symptoms appearing each week. The vast majority of patients respond rapidly to treatment and should not experience all the symptoms below if they receive treatment:
Typhoid symptoms during week 1
A dull headache in the front of the head.
A skin rash of pink spots.
Abdominal pain.
A progressive feeling of not being well.
Constipation or diarrhea (constipation more likely with adults, diarrhea more likely with children).
Mental confusion (delirium).
Dry cough.
A fever which usually rises to about 39-40c (103-104f) and settles there.
Vomiting (more common in children).
Additional typhoid symptoms during week 2 if left untreated:
Swelling of the abdomen.
Heart beat slows down.
Additional typhoid symptoms during week 3 if left untreated:
Weight loss.
Loss of appetite.
Exhaustion.
Yellow-green watery diarrhea, which usually has a foul smell.
Swelling of abdomen continues and becomes severe.
Panting.
Severe confusion, apathy, in some cases psychosis.
10%-15% of patients go on to develop the following life-threatening complications
Internal bleeding.
Rupturing or splitting of the bowel.
Myocarditis (inflammation of the myocardium, the heart muscle).
Multiple organ failure as the bacteria start releasing toxins.
Persistent typhoid symptoms during and after week 4
If the patient receives treatment and the complications responded to treatment, he/she has a good chance of making a recovery. However, weight loss and exhaustion may persist for some months.
How is Salmonella infection diagnosed?
Typically, diarrhea and vomiting are indicative of gastroenteritis, and there are no specific diagnostic tests required for most patients with the condition. A doctor will often take a detailed history concerning medical treatments, diet changes or food preparation habits, and travel destinations in his/her efforts to find the underlying illness and nature of the pathogen. A physical examination will be employed to be sure that the symptoms are not due to an infection such as appendicitis, gallbladder disease, pancreatitis, diverticulitis, Crohn's disease, ulcerative colitis, or other condition that weakens the immune system.
If fever, bloody stools, or diarrhea is persistent for longer than two weeks, a physician may consider blood and stool tests to determine the source of the symptoms.
If the patient develops symptoms suggestive of typhoid fever the GP (general practitioner) will ask the patient whether he/she has done any traveling abroad recently, as well as any contact with people who may be infected. A blood, stool, and/or urine test can help in the diagnosis. However, these tests do not always detect the presence of S. tyhpi bacteria, so the patient may have to undergo some additional tests. A bone marrow sample can more accurately detect the bacteria, but this is time consuming and painful, and is only done if other tests have presented no conclusive results. Additional tests used to diagnose typhoid fever include enzyme-linked immunosorbent assay (ELISA) and fluorescent antibody test. If typhoid fever is diagnosed the doctor will suggest that family/household members be tested as well.
What are the treatment options for salmonellosis (Salmonella infection)?
Salmonella-induced gastroenteritis treatment
Usually, symptoms will last for about one week and will resolve without any treatment. It is important to monitor the hydration levels of the patient by making sure he/she has an adequate fluid intake. If the doctor suspects the bacteria have entered the bloodstream, or are likely to, he/she may prescribe antibiotics.
Antimotility drugs (to stop diarrhea) generally are discouraged, especially in people with bloody diarrhea or diarrhea complicated by a fever.
Typhoid fever treatment
The Salmonella bacteria that causes typhoid can be killed by antibiotics such as ciprofloxacin or ceftriaxone. However, some strains become resistant to antibiotics after long-term use, and antibiotics have known side-effects.
Additional treatments for typhoid include drinking fluid to prevent dehydration and eating a healthy diet to ensure the absorption of nutrients.
Prevention of Salmonella infection
Wash your hands with soap and warm water..
..before preparing food
..before eating food
..after going to the toilet
..after changing a baby's diapers (UK/Ireland/Australia: nappies)
..after touching pets and other animals
..after gardening.
Don't keep cooked and raw foods next to each other.
In the fridge, place raw foods in the shelves below ready-to-eat foods.
Thoroughly wash raw fruits and vegetables before eating.
Cook food thoroughly, especially meats.
Keep all cooking utensils and work surfaces clean.
Regularly swap used dish cloths for clean ones.
Beware of drinking untreated water from streams, rivers and lakes.
Do not keep pet reptiles or amphibians inside the house if there are elderly people, pregnant women, very young children, or somebody with a weakened immune system in the household.
Of somebody in your household becomes infected with Salmonella, wash all dirty clothes, bedding, and towels in the washing machine at the hottest setting possible. Thoroughly clean toilet seats, toilet bowls, all handles in the toilet, basins and taps after use with a detergent and hot water, followed by a household disinfectant.
SARS or Severe acute respiratory syndrome is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003.
Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was contained.
This fact sheet gives basic information about the illness and what CDC has done to control SARS in the United States.
The SARS outbreak of 2003
According to the World Health Organization (WHO), a total of 8,098 people worldwide became sick with SARS during the 2003 outbreak. Of these, 774 died.
In the United States, only eight people had laboratory evidence of SARS-CoV infection. All of these people had traveled to other parts of the world with SARS. SARS did not spread more widely in the community in the United States.
What are the symptoms of SARS?
In general, SARS begins with a high fever (temperature greater than 100.4°F [>38.0°C]). Other symptoms may include headache, an overall feeling of discomfort, and body aches.
Some people also have mild respiratory symptoms at the outset. About 10 percent to 20 percent of patients have diarrhea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia.
How does SARS spread?
The main way that SARS seems to spread is by close person-to-person contact. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes.
Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to 3 feet) through the air and deposited on the mucous membranes of the mouth, nose, or eyes of persons who are nearby.
The virus also can spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose, or eye(s). In addition, it is possible that the SARS virus might spread more broadly through the air (airborne spread) or by other ways that are not now known.
What does "close contact" mean?
In the context of SARS, close contact means having cared for or lived with someone with SARS or having direct contact with respiratory secretions or body fluids of a patient with SARS.
Examples of close contact include kissing or hugging, sharing eating or drinking utensils, talking to someone within 3 feet, and touching someone directly. Close contact does not include activities like walking by a person or briefly sitting across a waiting room or office.
CDC response to SARS during the 2003 outbreak
CDC worked closely with WHO and other partners in a global effort to address the SARS outbreak of 2003. For its part, CDC took the following actions:
Activated its Emergency Operations Center to provide round-the-clock coordination and response.
Committed more than 800 medical experts and support staff to work on the SARS response.
Deployed medical officers, epidemiologists, and other specialists to assist with on-site investigations around the world.
Provided assistance to state and local health departments in investigating possible cases of SARS in the United States.
Conducted extensive laboratory testing of clinical specimens from SARS patients to identify the cause of the disease.
Initiated a system for distributing health alert notices to travelers who may have been exposed to cases of SARS.
SARS news
For the latest news on SARS, and to sign up to newsletters or news alerts, please visit our SARS news section.
What is scabies? What are its symptoms? How is it transmitted?
Scabies is a skin condition caused by tiny insects called mites. Scabies is a nuisance, not an infection. It is common in children. Some people believe children get scabies because they have not been washed properly, but scabies has nothing to do with cleanliness.
What are the symptoms of scabies?
The mites that cause scabies dig deep into the skin and cause a very itchy rash. The rash looks like curvy white threads, tiny red bumps or scratches, and it can appear anywhere on the body. It usually shows up between fingers, or around wrists or elbows. On a baby, it can appear on the head, face, neck and body.
How is scabies transmitted?
Scabies spreads from person to person by touch or by contact with the clothes or other personal items of someone who has it. The mites can live on clothes, other objects and off skin for four days. The mites will die after four days if the items are stored in a plastic bag. Washing clothes or other personal items, and bed sheets and blankets in hot water and then putting them in a dryer on the 'hot' cycle also gets rid of the mites.
How can scabies be treated?
Scabies can be treated with a cream from your doctor. Even after the cream gets rid of mites, a child may still be itchy for a few weeks. It doesn't mean that the mites are still there. It just means that the child is still reacting to them. Continues - Canadian Paediatric Society
Scarlet fever, also known as scarlatina, is a disease caused by a toxin (erythrogenic exotoxin) released by Streptococcus pyogenes or group A beta-hemolytic streptococcus - the disease occurs in a small percentage of patients with strep infections, such as strep throat or impetigo. Although scarlatina may be used interchangeably with scarlet fever, scarlatina is more commonly used to refer to the less acute form of scarlet fever.
The bacterial illness, scarlet fever, causes a distinctive pink-red rash, which occurs when the bacteria release toxins.
Scarlet fever is extremely contagious - people can catch it by breathing in the bacteria in airborne droplets that come from an infected individual's sneezes or coughs. Infection may also occur as a result of touching the skin of an infected person, or touching surfaces or objects that the infected person has touched.
Scarlet fever is rare these days, mainly because antibiotics are used to treat strep infections.
Scarlet fever is much more common among children aged 5 to 15 years than other people. It used to be considered a serious childhood illness. However, modern antibiotics have made it a much less threatening disease. If left untreated scarlet fever can sometimes lead to serious conditions that affect human organs, including the heart and kidneys.
Scarlet fever or Scarlatina is "An acute exanthematous disease, caused by infection with streptococcal organisms producing an erythrogenic toxin, marked by fever and other constitutional disturbances, and a generalized eruption of closely aggregated bright red points or small macules followed by desquamation in large scales, shreds, or sheets; mucous membrane of the mouth and fauces is usually also involved."
What are the signs and symptoms of scarlet fever?
A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
Signs and symptoms generally appear about one to four days after initial infection. The first symptoms are usually:
A very sore and red throat (sometimes with white or yellowish patches).
A fever of 101 F (38.3 C) or higher, frequently with chills. 12 to 48 hours later the rash will appear.
Rash - red blotches appear on the skin; they then turn into a fine pink-red rash that looks like sunburn. The skin feels rough, like sandpaper, when touched.
The rash spreads to the ears, neck, elbows, inner thighs and groin, chest and some other parts of the body. Although the rash does not usually appear on the face, the patient's cheeks will become flushed and the area around his/her mouth appear pale.
If a glass is pressed on the skin the rash will turn white (blanche).
After about six days the rash usually fades. In milder cases, such as scarlatina, the rash may be the only symptom. Scarlet fever may also have the following signs and symptoms:
Pastia's lines - broken blood vessels in the folds of the body, for example the armpits, groin, elbows, knees and neck.
Stomachache
Swollen neck glands (lymph nodes) that are tender to the touch
Tongue - a white coating forms on the tongue. This eventually peels away leaving a strawberry tongue; the tongue is red and swollen.
Vomiting
If the patients has other symptoms, such as severe muscle aches, vomiting or diarrhea the doctor will have to rule out other possible causes, such as toxic shock syndrome.
The skin of the hands and feet will usually peel for up to six weeks after the rash has gone.
What are the risk factors for scarlet fever?
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
Children - aged from 5 to 15 years have a higher risk of developing scarlet fever compared to other people.
Close contact - the strep bacteria can spread more easily among people in close contact. If somebody in the household carries the bacteria, infection may spread more readily among household members (and colleagues at school).
What causes scarlet fever?
Scarlet fever is caused by a bacterium called Streptococcus pyogenes, or group A beta-hemolytic streptococcus. This is the same bacterium that causes strep throat. When the bacteria release toxins scarlet fever symptoms occur, including the rash, Pastia's lines, red tongue and flushed face.
Scarlet fever transmits from human-to-human by fluids from the mouth and nose. When an infected individual coughs or sneezes the bacteria become airborne in droplets of water and can be inhaled. The bacteria may land on surfaces, such as drinking glasses, work surfaces and doorknobs and infect people who touch them with their hands and then touch their own nose or mouth. The bacteria may also be inhaled.
If you touch the skin of an individual with a streptococcal skin infection there is a risk of becoming infected.
People who share towels, baths, clothes or bed linen with an infected person risk becoming infected themselves.
A person with scarlet fever who is not treated may be contagious for several weeks, even after symptoms have gone. It is also possible for somebody to carry the infection and be contagious, even though they never had any symptoms - only people who are susceptible to the toxins released by streptococcal bacteria develop symptoms. These factors make it harder for individuals to know whether they have been exposed.
Although much less common, people may become infected by touching or consuming contaminated food, especially milk.
Other types strains of Streptococcus pyogenes linked to either skin infections, such as impetigo, or uterine infections that may occur during childbirth may also cause scarlet fever - however, this is much rarer.
Diagnosing scarlet fever
The characteristic rash and symptoms usually make it fairly easy for a doctor to diagnosis scarlet fever. The doctor may take a throat swab in order to determine which bacteria caused the infection. Sometimes a blood test is also ordered.
Rapid DNA test - a throat swab is taken. Results are returned within a day at the most.
In the United Kingdom and many other countries scarlet fever is a notifiable disease. This means that any confirmed cases must be reported to local health authorities.
What are the treatment options for scarlet fever?
According to the National Health Service (NHS), UK, the majority of mild cases of scarlet fever resolve themselves within a week without treatment. The NHS advises people to get treatment anyway, as this will accelerate recovery and reduce the risk of complications. Patients generally recover about four to five days after treatment begins.
Antibiotics - a 10-day course of antibiotics is the most common treatment for scarlet fever. In the UK, and many other countries this involves taking oral penicillin. Patients who are allergic to penicillin may take erythromycin instead. Patients are advised to stay at home during the course of the antibiotic treatment.
The fever will usually go away within 12 to 24 hours of taking the first antibiotic medication.
According to the Mayo Clinic, USA, a child with scarlet fever may be prescribed one of the following antibiotics:
It is important to complete the full course of antibiotics, even if symptoms go away before it is finished. Otherwise, the infection may not be completely eradicated, raising the risk of subsequent post-strep disorders.
If the patient does not start feeling better within 24 to 48 hours after starting the antibiotic treatment, call the doctor.
Within 24 hours of starting the antibiotics the patient will no longer be contagious.
Other treatments - it is important to drink plenty of liquids, especially if there is no appetite. The room should be kept cool.
Tylenol (paracetamol) may help relieve aches and pains, as well as bringing the fever down.
Calamine lotion may help with itchy skin.
What are the possible complications of scarlet fever?
In the majority of cases there are no complications. If any occur, they may include:
Inflammation of the kidney(s) - poststreptococcal glomerulonephritis, resulting from certain byproducts of strep bacteria. In some cases there may be long-term kidney disease.
Endocarditis - infection of the heart's inner lining
Infection of the bone and bone marrow (osteomyelitis)
PANDAS (Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) - according to the Mayo Clinic, USA, some research has indicated that strep bacterial infection may trigger an autoimmune response that exacerbates symptoms of certain childhood disorders, such as OCD (obsessive-compulsive disorder), Tourette syndrome and ADHD (attention deficit hyperactivity disorder). The increase in symptoms does not usually last for more than a few weeks or months.
Scarlet fever prevention
The best prevention strategies for scarlet fever, as with all highly infectious diseases, are:
Isolation - keep the patient away from other people. Keep the child away from school.
Handkerchiefs or tissues that the patient has used should be washed or disposed of immediately. If you have touched any of these wash your hands thoroughly with warm water and soap.
Handwashing - the patient, usually a child, should be taught to wash his/her hands thoroughly and frequently.
Dining utensils - do not share drinking glasses or eating utensils with the patient.
Coughing and sneezing - the patient should be taught to cover his/her mouth and nose when coughing and sneezing. This should be done into a tissue or handkerchief. If one is not available it is better to cough/sneeze into the inside of the elbow - coughing into one's hands raises the risk of contaminating things when they are touched.
What Is Schistosomiasis (Bilharzia)? What Causes Schistosomiasis (Bilharzia)?
Schistosomiasis, or bilharzias, bilharziosis, or snail fever is a parasitic disease caused by various species of fluke of the genus Schostosoma. Schistosomiasis has a low mortality rate; however, as it is commonly a chronic illness it can cause serious damage to internal organs, and may even undermine growth and cognitive development in children.
When the urinary system is infected there is a significantly higher risk in adults of developing bladder cancer. Schistosomiasis may infect the gastrointestinal tract and the liver.
The WHO (World Health Organization) believes that approximately 200 million people globally are infected. London's (England) Hospital for Tropical Diseases sees about 200 cases per year, all of them UK citizens coming home from abroad. Schistosomiasis may be found in the following geographical areas (Source: National Health Service, UK):
Africa - mainly in sub-Saharan Africa. However, the NHS (National Health Service), UK, says that cases of infection among travelers returning from Lake Malawi are not uncommon. In the Nile River Valley, Egypt, there are also cases.
South America - Venezuela, Suriname and Brazil.
Caribbean - Antigua, Dominican Republic, Guadeloupe, Martinique, Saint Lucia
The Middle East - Saudi Arabia, Yemen, Iraq and Iran
Southern China
Southeast Asia - Philippines, Laos, Cambodia, Central Indonesia, and the Mekong Delta
Schistosomiasis can affect people of any age; more typically children living in developing countries are especially vulnerable. Swimming in contaminated fresh water rivers, canals, lakes and streams in areas where schistosomiasis is endemic significantly raises the risk of becoming infected.
Schistosomiasis is " Infection with a species of Schistosoma; manifestations of this often chronic and debilitating disease vary with the infecting species but depend in large measure on tissue reaction (granulation and fibrosis) to the eggs deposited in venules and in the hepatic portals, the latter resulting in portal hypertension and esophageal varices, as well as liver damage leading to cirrhosis."
What are the signs and symptoms of schistosomiasis?
A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
The types of signs and symptoms with Schistosomiasis depend on the species of fluke (worm) and the stage of infection. In the majority of cases signs and symptoms are the result of the body's reaction to the worms' eggs, and not the worms themselves.
Early symptoms may be:
Swimmer's itch, which includes..
Itchy skin
A skin rash
These early symptoms may appear within hours of being infected and can persist for up to about seven days.
Signs and symptoms weeks after infection may include:
Blood in urine - this is later, when the eggs pass into the urinary system
How do people get schistosomiasis?
People may become infected if they have direct contact with contaminated fresh water which is inhabited by a certain types of water snail - the snails carry the worm. Contact includes swimming, washing or paddling in the water, as well as drinking it or eating food that has been washed in untreated water.
The following types of Schistosomiasis can infect humans:
Schistosoma mansoni (ICD-10 B65.1) and Schistosoma intercalatum (B65.8) cause intestinal Schistosomiasis
Schistosoma japonicum (B65.2) and Schistosoma mekongi (B65.8) cause Asian intestinal Schistosomiasis
The infection cycle begins when fresh (not salt) water becomes infected with the eggs of the parasite through feces and urine of infected humans. The eggs hatch in the water and the worms reproduce inside the water snails. Tiny cercariae (larvae) are released into the water - the larvae can survive for up to 48 hours in the water.
The cercariae can penetrate human skin and enter our bloodstream. In the bloodstream they travel through the blood vessels of the lungs and liver, and then to the veins around the bowel and bladder.
Some weeks later the worms are mature - they mate and start producing eggs. These eggs pass through the walls of the bladder and/or intestine and eventually leave the body through urine or feces; and thus the cycle starts again.
It is not possible to catch Schistosomiasis from a person who is infected. Human infection is only possible from contaminated water in which the snails reside.
How is Schistosomiasis diagnosed?
Anybody who has been in areas of the world where schistosomiasis is endemic or known to exist, has been in contact with fresh water and has some of the signs and symptoms mentioned above, they should tell their doctor or contact a health clinic. In Europe, the USA, Canada and Japan the GP (general practitioner, primary care physician) will interview and examine the patient and refer him/her to an infectious disease or tropical medicine specialist.
The National Health Service (NHS), UK, advises anybody who has been to an area where Schistosomiasis is known to occur, and was in contact with contaminated fresh water, to have a check-up three months after the last possible exposure - even if they have no signs or symptoms.
The patient will be asked by the doctor where they have travelled, how long they were there, and whether there was any contact with contaminated water. If there are any symptoms, the doctor will ask about them, such as when they first appeared and whether the individual has an itchy rash or blood in his/her urine.
A stool or urine sample will probably be taken to determine whether any eggs are present. The stool exam is more common. Eggs can be detected in the urine in infections with S. japonicum and with S. intercalatum.
A blood sample will generally also be required. The worm takes about 40 days to mature; so it may take three months after exposure to contaminated water before the blood sample can provide any reliable results.
If the patient has intestinal symptoms a biopsy of the rectum may be ordered. The doctor may also order a biopsy if he/she suspects infection, but urine and blood samples are negative. A biopsy of the bladder for S. haematobium may be taken.
What are the treatment options for Schistosomiasis?
Praziquantel - a medication which is given as a short course generally clears up the infection. Even patients in advanced stages will be effectively treated. However, the medication does nothing to prevent re-infection.
MASTA (Medical Advisory Services for Travelers Abroad) warns about fake or poor quality medications which may be on sale in various parts of the world.
A course of Praziquantel is usually very effective as long as significant damage or complications have not yet occurred.
In areas where schistosomiasis is endemic, a single oral dose of Praziquantel annually can help keep infection rates and complications down.
Research is currently underway into developing a schistosomiasis vaccine which will halt the parasite's lifecycle in humans.
Untreated Schistosomiasis
If the patient does not receive treatment and the eggs stay in the body, the patient may eventually experience long term effects, which include:
Bleeding of the bladder
Ulceration of the bladder
Liver damage
Eventual kidney failure
Cancer
If the eggs get into the bloodstream they can get into various vital organs, resulting in lung, heart, intestinal and CNS (central nervous system) damage.
Recurrent infections, especially over a period of years, can result in serious damage to vital organs.
Prevention
Not swimming or coming into contact with potentially contaminated fresh water in areas where schistosomiasis is known to occur helps.
The elimination of the water-dwelling snails that are a natural reservoir of the disease may be effective - they may be eradicated with acrolein, copper sulfate, and niclosamide.
Some studies have shown that the introduction of crayfish populations to areas where the snails exist may help control the snail population. As with any ecological intervention, this must be carried out with caution.
It is possible to design irrigation schemes that make it difficult for the snails to colonize the water; thus reducing potential human exposure.
What Is Schizoaffective Disorder? What Causes Schizoaffective Disorder?
Schizoaffective disorder is characterized by a combination of schizophrenia and affective (mood) disorder symptoms - there is disagreement on whether it is a type of mood disorder or schizophrenia. However, most health care professionals (clinicians) agree it is mainly a form of schizophrenia; not all experts agree on whether it should be treated as a distinct disorder.
An individual diagnosed with schizoaffective disorder is said to have recurring episodes of elevated or depressed mood, or of simultaneously elevated and depressed mood that either occur together with or alternate with distortions of perception. Put simply - the individual experiences a combination of schizophrenia symptoms (hallucinations, delusions) and mood disorder symptoms (mania or depression).
This disorder typically affects cognition (thinking, knowing, remembering, judging and problem-solving) and emotion. The patient may experience auditory hallucinations (hearing hallucinations), bizarre delusions, paranoia, and may have disorganized speech and thinking with considerable social and occupational dysfunction (has problems socially and at work).
Diagnoses before the age of 13 are extremely rare. The vast majority of patients experience the onset of symptom during early adulthood.
According to the National Alliance on Mental Illness (NAMI), prevalence in the USA is between 2 to 5 in every 1,000 people.
1. an illness manifested by an enduring major depressive, manic, or mixed episode along with delusions, hallucinations, disorganized speech and behavior, and negative symptoms of schizophrenia. In the absence of a major depressive, manic, or mixed episode, there must be delusions or hallucinations for several weeks.
2. a DSM diagnosis that is established when the specified criteria are met.
Clinicians will only diagnose schizoaffective disorder if the patient has at some point shown delusions or hallucinations for a minimum of two weeks with no symptoms of mood disorder.
The most common mood disorder to accompany the schizophrenia features is either:
bipolar disorder - in such cases it will be termed bipolar-type schizoaffective.
depression - in such cases it will be termed depressive-type schizoaffective.
The following signs and symptoms may be present in an individual with schizoaffective disorder:
Delusions - fixed and/or false beliefs
Disorganized thinking - thoughts are confused and unclear
Hallucinations
Paranoid ideas and thoughts
Periods of depression
Strange perceptions
Strange thoughts
Manic mood, or an unexpected boost of energy and behaviors that are out of character
Poor temper control
Irritability
Incoherent speech
Irrelevant speech
Attention problems
Catatonic behavior - the patient hardly responds; there may be agitation that does not appear to be triggered by the environment
Lack of concern for his/her own physical appearance
Lack of concern for personal hygiene
Memory problems
Problems falling asleep
Problems staying asleep
What are the risk factors for schizoaffective disorder?
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
Experts say that schizoaffective disorder, like in schizophrenia, is caused by variations or delays in the way a human's brain develops during childhood - it is a neurodevelopmental disorder.
Genetics - people with a close relative who has schizoaffective disorder have a higher risk of developing the disorder themselves, compared to other individuals. The following factors may also increase the risk:
Having a relative with schizophrenia
Having a relative with a mood disorder
Age - the influence here is on the type of disorder. Older individuals tend to have depressive type schizoaffective disorder, while younger ones are more likely to have the bipolar type.
Parental age - advanced paternal age at the time of conception, a common cause of genetic mutations, has been linked to a higher risk of schizophrenia spectrum disorders, of which schizoaffective disorder is a part.
Fetal exposure and birth - some experts have speculated that perhaps fetal exposure to toxins or viral illness, or even birth complications, may play a role. However, there are no studies to back this up.
What are the causes of schizoaffective disorder?
We are not sure what causes the disorder - what exactly happens. A significant number of scientists believe an imbalance of serotonin and dopamine in the brain is a key cause - these are neurotransmitters; chemicals that help pass on electronic signals in the brain, as well as helping control mood.
Many different biological and environmental factors are thought to interact with the individual's genes in ways that can either increase or lower that individual's risk for developing the disorder.
The physiology of patients diagnosed with schizoaffective disorder appears to be similar but not identical to that of those diagnosed with schizophrenia and severe bipolar disorder.
Diagnosing schizoaffective disorder
Diagnosis is based on experiences reported by the patient, as well as behavior abnormalities reported by family members, friends and colleagues to a psychiatrist, psychiatric nurse, social worker or clinical psychologist in a clinical assessment. There is a list of criteria that must be met for an individual to be diagnosed with schizoaffective disorder - these depend on the presence and duration of specific signs and symptoms. The criteria are spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association - the criteria, known as DSM-IV-TR, includes:
Schizophrenia with mood symptoms
A mood disorder with schizophrenia symptoms
Both a mood disorder and schizophrenia
A non-schizophrenia psychotic disorder, as well as a mood disorder
(see further down for more details on DSM-IV-TR)
Diagnosis must be reached after ruling out the direct effects of a substance, or the result of a general medical condition. The symptoms may be mimicked by steroid use, Cushing's syndrome, HIV-related illness, temporal lobe epilepsy, neurosyphilis, thyroid or parathyroid problems, alcohol abuse, drug abuse, and metabolic syndrome.
There are no biological tests which confirm schizoaffective disorder. However, tests are often ordered to exclude medical illnesses and conditions which rarely may be linked to psychotic symptoms. The doctor may order the following diagnostic tests:
Blood tests - to measure TSH to exclude hypothyroidism or hyperthyroidism, basic electrolytes and serum calcium to exclude metabolic disturbance, full blood count including ESR to rule out a systemic infection or chronic (long-term) disease, and serology to exclude syphilis or HIV infection.
EEG (electroencephalography) - to rule out epilepsy.
CT (computed tomography) scan of the head - to rule out brain lesions.
The doctor needs to rule out a delirium, which can be distinguished by visual hallucinations, acute onset and varying levels of consciousness (indicating a medical illness).
DSM-IV-TR criteria for a diagnosis of schizoaffective disorder:
Criterion A - At least two of the symptoms below are present for most of a 1-month period (or a shorter period if symptoms improved with treatment:
Delusions
Hallucinations
Disorganized speech, such as frequent derailment (speech jumps from one topic to another unrelated topic (or only slightly related) in mid-sentence) or incoherence, which is a manifestation of formal thought disorder
Grossly disorganized behavior, such as dressing inappropriately, crying often, or catatonic behavior.
Negative symptoms, such as:
Affective flattening - diminishment of, or absence of, emotional expressiveness
Alogia - lack or decline in speech
Avolition - lack or drop in motivation
Anhedonia - inability to experience pleasurable emotions from normally pleasurable life events such as eating, exercise, social interaction or sexual activities
Negative symptoms are not the same as depression symptoms.
If the delusions are deemed bizarre, or hallucinations consist of at least two voices talking to each other or just one voice participating in a running commentary of the patient's actions, then just that symptom is required to meet criterion A.
and at some point during the illness, there as at least one of the three listed below:
A major depressive episode
A manic episode
A mixed episode
Criterion B - delusions or hallucinations were present for at least two weeks during the illness, without major mood symptoms.
Criterion C - symptoms meeting criteria for a mood episode are present for a considerable part of the overall duration of both the active and residual period of the illness.
Criterion D - neither another medical condition, nor drug abuse, nor a medication(s) is causing the symptoms.
Subtypes - two schizoaffective disorder subtypes exist and may be noted in a diagnosis, bases on the mood constituent of the disorder:
Bipolar type - if a manic episode or a mixed episode is included.
Major depressive episodes commonly occur in the bipolar subtype (not always). However, they are not required for DSM-IV diagnosis.
Depressive type - this type is noted when major depressive episodes occur exclusively - if major depressive episodes (without manic or mixed episodes) are part of the presentation.
Distinguishing a schizoaffective disorder from schizophrenia and from mood disorder may be challenging. In schizoaffective disorder the mood symptoms are more prominent, and generally last much longer than in schizophrenia.
What are the treatment options for schizoaffective disorder?
The best treatment for schizoaffective disorder is a combination of medications, such as antipsychotics, antidepressants or mood stabilizers, and psychological interventions (counseling). Treatment specifics depends on various factors, including how severe symptoms are, as well as what subtype the patient may have (depressive-type or bipolar type).
The following medications may be used:
Antipsychotics (neuroleptics) - used to help with psychotic symptoms, which may include hallucinations, paranoia and delusions. Examples include clozapine (Clozaril), risperidone (Risperdal) and olanzapine (Zyprexa).
Mood stabilizers - these can smooth out the highs and lows of bipolar disorder (manic depression) which affect patients with the bipolar-type of schizoaffective disorder. Examples include lithium (Eskalith, Lithobid) and divalproex (Depakote).
Antidepressants - used when depression is the underlying mood disorder. These medications may help with such symptoms as hopelessness, concentration, insomnia and sadness. Examples include citalopram (Celexa), fluoxetine (Prozac) and escitalopram (Lexapro).
The following therapies may also be recommended:
Counseling and psychotherapy - a good psychotherapist/counselor can help the patient understand their condition and feel positive about the future. Sessions typically focus on real-life plans, relationships, and problems the patient encounters. The therapist may also introduce new behaviors for home and workplace settings.
Group therapy or family therapy - some patients respond well when they are able to talk about their problems with other people. During periods of psychosis these sessions can help as a reality check. Group therapy also helps the patient feel that he/she is not alone.
Experts say that patients with schizoaffective disorder tend to have a better prognosis than those with schizophrenia, while those with just mood disorders have a better prognosis than individuals with schizoaffective disorder.
What are the possible complications of schizoaffective disorder?
There is a higher risk of developing schizophrenia
There is a higher risk of having major depression
There is a higher risk of having bipolar disorder
With treatment, patients tend to have a better prognosis than do individuals with schizophrenia, but not as good as people who just have mood disorders.
What are the signs and symptoms for schizoaffective disorder?
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
Typically, a patient will have psychotic symptoms - including hallucinations, paranoid thoughts and disorganized thinking, as well as depression or manic moods (mood disturbance). Their antisocial behavior tends to leave them isolated. However, symptoms tend to vary from patient-to-patient.
Psychotic symptoms and mood disturbances either occur simultaneously or interchangeably. The individual will usually go through cycles of symptom severity.
The word schizophrenia comes from the Greek word skhizein meaning "to split" and the Greek word Phrenos (phren) meaning "diaphragm, heart, mind". According to Medilexicon's medical dictionary, schizophrenia is "A term coined by Bleuler, synonymous with and replacing dementia praecox, denoting a common type of psychosis, characterized by abnormalities in perception, content of thought, and thought processes (hallucinations and delusions) and by extensive withdrawal of interest from other people and the outside world, with excessive focusing on one's own mental life. Now considered a group or spectrum of disorders rather than a single entity, with distinction sometimes made between process schizophrenia and reactive schizophrenia. The "split" personality of schizophrenia, in which individual psychic components or functions split off and become autonomous, is popularly but erroneously identified with multiple personality, in which two or more relatively complete personalities dominate by turns the psychic life of a patient.".
In 1910, the Swiss psychiatrist, Eugen Bleuler (1857-1939) created the term Schizophrenie.
Schizophrenia is a mental disorder that generally appears in late adolescence or early adulthood - however, it can emerge at any time in life. It most commonly strikes between the ages of 15 to 25 among men, and about 25 to 35 in women. In many cases the disorder develops so slowly that the sufferer does not know he/she has it for a long time. While, with other people it can strike suddenly and develop fast.
It is a complex, chronic, severe, and disabling brain disorder and affects approximately 1% of all adults globally. Experts say schizophrenia is probably many illnesses masquerading as one. Research indicates that schizophrenia is likely to be the result of faulty neuronal development in the brain of the fetus, which later in life emerges as a full-blown illness.
The brain
Our brain consists of billions of nerve cells. Each nerve cell has branches that give out and receive messages from other nerve cells. The ending of these nerve cells release neurotransmitters - types of chemicals. These neurotransmitters carry messages from the endings of one nerve cell to the nerve cell body of another. In the brain of a person who has schizophrenia, this messaging system does not work properly.
What are the signs and symptoms of schizophrenia?
There is, to date, no physical or laboratory test that can absolutely diagnose schizophrenia. The doctor, a psychiatrist, will make a diagnosis based on the patient's clinical symptoms. However, physical testing can rule out some other disorders and conditions which sometimes have similar symptoms, such as seizure disorders, thyroid dysfunction, brain tumor, drug use, and metabolic disorders.
Symptoms and signs of schizophrenia will vary, depending on the individual. The symptoms are classified into four categories:
Positive symptoms - also known as psychotic symptoms. These are symptoms that appear, which people without schizophrenia do not have. For example, delusion.
Negative symptoms - these refer to elements that are taken away from the individual; loss or absence of normal traits or abilities that people without schizophrenia normally have. For example, blunted emotion.
Cognitive symptoms - these are symptoms within the person's thought processes. They may be positive or negative symptoms, for example, poor concentration is a negative symptom.
Emotional symptoms - these are symptoms within the person's feelings. They are usually negative symptoms, such as blunted emotions.
Below is a list of the major symptoms:
Delusions - The patient has false beliefs of persecution, guilt of grandeur. He/she may feel things are being controlled from outside. It is not uncommon for people with schizophrenia to describe plots against them. They may think they have extraordinary powers and gifts. Some patients with schizophrenia may hide in order to protect themselves from an imagined persecution.
Hallucinations - hearing voices is much more common than seeing, feeling, tasting, or smelling things which are not there, but seem very real to the patient.
Thought disorder - the person may jump from one subject to another for no logical reason. The speaker may be hard to follow. The patient's speech might be muddled and incoherent. In some cases the patient may believe that somebody is messing with his/her mind.
Other symptoms schizophrenia patients may experience include:
Lack of motivation (avolition) - the patient loses his/her drive. Everyday automatic actions, such as washing and cooking are abandoned. It is important that those close to the patient understand that this loss of drive is due to the illness, and has nothing to do with slothfulness.
Poor expression of emotions - responses to happy or sad occasions may be lacking, or inappropriate.
Social withdrawal - when a patient with schizophrenia withdraws socially it is often because he/she believes somebody is going to harm them. Other reasons could be a fear of interacting with other humans because of poor social skills.
Unaware of illness - as the hallucinations and delusions seem so real for the patients, many of them may not believe they are ill. They may refuse to take medications which could help them enormously for fear of side-effects, for example.
Cognitive difficulties - the patient's ability to concentrate, remember things, plan ahead, and to organize himself/herself are affected. Communication becomes more difficult.
What causes schizophrenia?
Nobody has been able to pinpoint one single cause. Experts believe several factors are generally involved in contributing to the onset of schizophrenia.
The likely factors do not work in isolation, either. Evidence does suggest that genetic and environmental factors generally act together to bring about schizophrenia. Evidence indicated that the diagnosis of schizophrenia has an inherited element, but it is also significantly influenced by environmental triggers. In other words, imagine your body is full of buttons, and some of those buttons result in schizophrenia if somebody comes and presses them enough times and in the right sequences. The buttons would be your genetic susceptibility, while the person pressing them would be the environmental factors.
Below is a list of the factors that are thought to contribute towards the onset of schizophrenia:
Your genes
If there is no history of schizophrenia in your family your chances of developing it are less than 1%. However, that risk rises to 10% if one of your parents was/is a sufferer.
A gene that is probably the most studied "schizophrenia gene" plays a surprising role in the brain: It controls the birth of new neurons in addition to their integration into existing brain circuitry, according to an article published by Cell.
Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. They also believe that this imbalance is most likely caused by your genes making you susceptible to the illness. Some researchers say other the levels of other neurotransmitters, such as serotonin, may also be involved.
Changes in key brain functions, such as perception, emotion and behavior lead experts to conclude that the brain is the biological site of schizophrenia.
Although there is no evidence to prove or even indicate that family relationships might cause schizophrenia, some patients with the illness believe family tension may trigger relapses.
Environment
Although there is yet no definite proof, many suspect that prenatal or perinatal trauma, and viral infections may contribute to the development of the disease. Perinatal means "occurring about 5 months before and up to one month after birth".
Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocussed. This can trigger relationship problems, divorce and unemployment. These factors are often blamed for the onset of the disease, when really it was the other way round - the disease caused the crisis. Therefore, it is extremely difficult to know whether schizophrenia caused certain stresses or occurred as a result of them.
Some drugs
Cannabis and LSD are known to cause schizophrenia relapses.
What are the treatment options for schizophrenia?
Psychiatrists say the most effective treatment for schizophrenia patients is usually a combination of medication, psychological counseling, and self-help resources.
Anti-psychosis drugs have transformed schizophrenia treatment. Thanks to them, the majority of patients are able to live in the community, rather than stay in hospital. In many parts of the world care is delivered in the community, rather than in hospital.
The primary schizophrenia treatment is medication. Sadly, compliance is a major problem. Compliance, in medicine, means following the medication regimen. People with schizophrenia often go off their medication for long periods during their lives, at huge personal costs to themselves and often to those around them as well.
The majority of patients go off their medication within the first year of treatment. In order to address this, successful schizophrenia treatment needs to consist of a life-long regimen of both drug and psychosocial, support therapies. The medication can help control the patient's hallucinations and delusions, but it cannot help them learn to communicate with others, get a job, and thrive in society.
Although a significant number of people with schizophrenia live in poverty, this does not have to be the case. A person with schizophrenia who complies with the treatment regimen long-term will be able to lead a happy and productive life.
The first time a person experiences schizophrenia symptoms can be very unpleasant. He/she may take a long time to recover, and that recovery can be a lonely experience. It is crucial that a schizophrenia sufferer receives the full support of his/her family, friends, and community services when onset appears for the first time.
Medications
The medical management of schizophrenia generally involves drugs for psychosis, depression and anxiety. This is because schizophrenia is a combination of thought disorder, mood disorder and anxiety disorder.
Risperidone (Risperdal) - introduced in America in 1994. This drug is less sedating than other atypical antipsychotics. There is a higher probability, compared to other atypical antipsychotics, of extrapyramidal symptoms (affecting the extrapyramidal motor system, a neural network located in the brain that is involved in the coordination of movement). Although weight gain and diabetes are possible risks, they are less likely to happen, compared with Clozapine or Olanzapine.
Olanzapine (Zyprexa) - approved in the USA in 1996. A typical dose is 10 to 20 mg per day. Risk of extrapyramidal symptoms is low, compared to Risperidone. This drug may also improve negative symptoms. However, the risks of serious weight gain and the development of diabetes are significant.
Quetiapine (Seroquel) - came onto the market in America in 1997. Typical dose is between 400 to 800 mg per day. If the patient is resistant to treatment the dose may be higher. The risk of extrapyramidal symptoms is low, compared to Risperidone. There is a risk of weight gain and diabetes, however the risk is lower than Clozapine or Olanzapine.
Ziprasidone (Geodon) - became available in the USA in 2001. Typical doses range from 80 to 160 mg per day. This drug can be given orally or by intramuscular administration. The risk of extrapyramidal symptoms is low. The risk of weight gain and diabetes is lower than other atypical antipsychotics. However, it might contribute to cardiac arrhythmia, and must not be taken together with other drugs that also have this side effect.
Clozapine (Clozaril) - has been available in the USA since 1990. A typical dose ranges from 300 to 700 mg per day. It is very effective for patients who have been resistant to treatment. It is known to lower suicidal behaviors. Patients must have their blood regularly monitored as it can affect the white blood cell count. The risk of weight gain and diabetes is significant.
How common is schizophrenia?
The prevalence of schizophrenia globally varies a slightly, depending on which report you look at, from about 0.7% to 1.2% of the adult population in general. Most of these percentages refer to people suffering from schizophrenia "at some time during their lives".
An Australian study found that schizophrenia is more common in developed nations than developing ones. It also found that the illness is less widespread than previously thought. Estimates of 10 per 1,000 people should be changed to 7 or 8 per 1,000 people, the study concluded.
In the USA about 2.2 million adults, or about 1.1% of the population age 18 and older in a given year have schizophrenia.
Schizophrenia is not a 'very' common disease. Approximately 1% of people throughout the globe suffer from schizophrenia (or perhaps a little less than 1% in developing countries) at some point in their lives. It is estimated that about 1.2% of Americans, a total of 3.2 million people, have the disorder at some point in their lives. Globally, about 1.5 million people each year are diagnosed with schizophrenia. In the UK it is estimated that about 600,000 people have schizophrenia.
