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Prevention of Waterborne Illness

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81. Pneumonia, Community-Acquired (Follow-up)

, the clinical signs and symptoms of CAP are not sufficiently specific to reliably differentiate the exact etiologic agent. [ ] Therefore, additional testing remains necessary to identify the pathogen and to optimize therapy in CAP. Workup Standard diagnostic studies for CAP include the following: Chest radiography Sputum Gram stain and/or culture Blood cultures Other laboratory tests Depending on the perceived severity of illness and suspected etiology, additional workup may be warranted, including (...) of respiratory specimens, blood, and pleural fluid; PCR of respiratory samples; or antigen tests should be used to target therapy whenever possible. Inpatient CAP therapy usually consists of intravenous antibiotics followed by transition to an oral course of therapy. [ , , , ] Patients who are severely ill or who are unable to tolerate or absorb oral medications may require a longer duration of parenteral therapy before switching to an oral antibiotic. [ ] Mild to moderately ill patients with CAP may

2014 eMedicine.com

82. Listeria Monocytogenes (Follow-up)

) Delicatessen turkey breast August 1998 to January 1999 Multiple states in the United States Hot dogs, deli meats 1997 [ ] Italy Corn 1997 [ ] Sweden Rainbow trout 1995 [ ] Switzerland Soft cheese 1994 [ ] Illinois Chocolate milk 1992 [ ] France Rillettes (pork product) 1985 [ ] California Mexican-style soft cheese 1983 [ ] New England Unpasteurized milk 1981 [ ] Canada Coleslaw Previous Next: Prevention The following are measures that can be used to prevent listeriosis: Cook all raw food thoroughly. Wash (...) , Christou L, Akritidis N. Category B potential bioterrorism agents: bacteria, viruses, toxins, and foodborne and waterborne pathogens. Infect Dis Clin North Am . 2006 Jun. 20(2):395-421, x. . Mylonakis E, Paliou M, Hohmann EL, Calderwood SB, Wing EJ. Listeriosis during pregnancy: a case series and review of 222 cases. Medicine (Baltimore) . 2002 Jul. 81(4):260-9. . Sheffield JS. Sepsis and septic shock in pregnancy. Crit Care Clin . 2004 Oct. 20(4):651-60; viii. . Mylonakis E, Hohmann EL, Calderwood SB

2014 eMedicine.com

83. Leptospirosis (Follow-up)

-Apr. 30(2):109-15. . Githeko AK, Lindsay SW, Confalonieri UE, Patz JA. Climate change and vector-borne diseases: a regional analysis. Bull World Health Organ . 2000. 78(9):1136-47. . . National Research Council. Advancing the Science of Climate Change . Washington, DC: The National Academies Press; 2010. CDC. From the Centers for Disease Control and Prevention. Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000. JAMA . 2001 (...) in Langau, Austria, 2010. Wien Klin Wochenschr . 2011 Dec. 123(23-24):751-5. . CDC. From the Centers for Disease Control and Prevention. Outbreak of acute febrile illness and pulmonary hemorrhage--Nicaragua, 1995. JAMA . 1995 Dec 6. 274(21):1668. . Gaynor K, Katz AR, Park SY, Nakata M, Clark TA, Effler PV. Leptospirosis on Oahu: an outbreak associated with flooding of a university campus. Am J Trop Med Hyg . 2007 May. 76(5):882-5. . Socolovschi C, Angelakis E, Renvoisé A, Fournier PE, Marié JL, Davoust

2014 eMedicine.com

84. Cyclospora (Follow-up)

diarrhea. Am J Trop Med Hyg . 1999 Apr. 60(4):584-6. . Fleming CA, Caron D, Gunn JE, Barry MA. A foodborne outbreak of Cyclospora cayetanensis at a wedding: clinical features and risk factors for illness. Arch Intern Med . 1998 May 25. 158(10):1121-5. . Goodgame RW. Understanding intestinal spore-forming protozoa: cryptosporidia, microsporidia, isospora, and cyclospora. Ann Intern Med . 1996 Feb 15. 124(4):429-41. . Graczyk TK, Ortega YR, Conn DB. Recovery of waterborne oocysts of Cyclospora (...) -SMZ, but the response may not be as favorable. Previous Next: Deterrence/Prevention The risk of acquiring Cyclospora infection can be reduced significantly (but not eliminated), particularly in developing countries, by adhering to health guidelines, including the following: Wash hands with soap and water prior to eating. Drink only purified water. In developing countries, tap water is considered unpurified. Consume only bottled water known to be safe. Purify water either by boiling (bringing

2014 eMedicine.com

85. Hematopoietic Stem Cell Transplantation (Follow-up)

undergoing bone marrow transplantation. Among the most important have been in selecting hematopoietic stem cell donors and the tissue source, optimizing transplantation conditioning, reducing the morbidity and mortality from transplantation conditioning, and preventing and treating graft versus host disease. [ ] Patient education For patient education information, see the . Previous Next: Indications for HSCT Interpretation of the results of trials is always complicated by the problem of patient (...) -Blackfan anemia Osteopetrosis Inborn errors of metabolism Autoimmune disorders *Uncommon in children; common reasons for transplantation in adults Previous Next: Prognosis Transplantation-related mortality and morbidity rates have considerably decreased because of improved conditioning regimens, human leukocyte antigen (HLA) typing, supportive care, and prevention and treatment of serious infections. Currently, overall and event-free survival rates are based on the individual's disease pathology

2014 eMedicine.com

86. Pseudomonas Infection (Overview)

17, 2018 Author: Selina SP Chen, MD, MPH; Chief Editor: Russell W Steele, MD Share Email Print Feedback Close Sections Sections Pseudomonas Infection Overview Background In 1882, Gessard first discovered Pseudomonas , a strictly aerobic, gram-negative bacterium of relatively low virulence. The organism is ubiquitous, with a predilection to moist environments, primarily as waterborne and soilborne organisms. Pseudomonal species have been found in soil, water, plants, and animals; Pseudomonas (...) and animals through direct contact with a contaminated source. In otherwise healthy hosts, disease manifestations range from acute to chronic local suppurative infections to septicemia with multiple abscesses in all organs of the body. Previous Next: Epidemiology Frequency United States According to data from the Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance System, P aeruginosa can be rated as follows: Number 1 cause of intensive care unit (ICU)–related

2014 eMedicine Pediatrics

87. Kawasaki Disease (Diagnosis)

, and pyuria. The American Heart Association (AHA) suggests an algorithm for the diagnosis of incomplete KD in the most recent guideline. [ ] Echocardiography is the study of choice to evaluate for CAAs. Serial echocardiograms should be obtained as follows: At the time of KD diagnosis 1-2 weeks after the onset of the illness 5-6 weeks after the onset of the illness See and for more details. Management The principal goal of treatment is to prevent coronary artery disease. Intravenous immunoglobulin (IVIG (...) immunity. Epidemiologic data suggest, however, that person-to-person transmission of the disease is unlikely. Some authors have proposed a controversial association of KD with recent carpet shampooing, flooding, the use of a humidifier in the room of a child with an antecedent respiratory illness, [ ] and locations near bodies of water. [ ] These data have led to a waterborne vector hypothesis. The overall clinical presentation of patients with KD is similar to that of patients with a viral

2014 eMedicine Pediatrics

88. Intestinal Protozoal Diseases (Diagnosis)

. Among all intestinal protozoa, those listed in Table 1 have been confirmed to cause GI disease. Others, such as Trichomonas hominis (in infants) and Entamoeba polecki (associated with pigs), have rarely been associated with diarrheal disease and are not discussed in this article. Table 1. Protozoa Associated with Intestinal Illness in Humans Name Mode of Transmission Symptoms Flagellates G lamblia Contaminated water, fecal-oral Nausea, bloating, gas, diarrhea, anorexia Dientamoeba fragilis Fecal (...) intestine and has no evident life cycle in humans. Cysticlike stages are rare and have been found in patients with acquired immunodeficiency syndrome (AIDS) and in vitro. The mechanisms of how this parasite causes illness have not been elucidated yet. Previous Next: Epidemiology Frequency United States At least 325 water-associated outbreaks of parasitic protozoan disease have been reported. [ ] North America and Europe accounted for 93% of all reports, and nearly two thirds occurred in the United

2014 eMedicine Pediatrics

89. Leptospirosis (Diagnosis)

the last trimester of pregnancy and have had high-risk exposure should present promptly for treatment to prevent in utero infection. Newborns of ill mothers can also be treated. Leptospires may be shed in breastmilk for an unknown duration. Travelers and participants in "adventure racing" or other freshwater sports who may be hiking and may otherwise be exposed to fresh water, soil, mud, and vegetation are at higher risk, especially those older than 60 years or those who are immunosuppressed (...) and vector-borne diseases: a regional analysis. Bull World Health Organ . 2000. 78(9):1136-47. . . National Research Council. Advancing the Science of Climate Change . Washington, DC: The National Academies Press; 2010. CDC. From the Centers for Disease Control and Prevention. Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000. JAMA . 2001 Feb 14. 285(6):728-30. . CDC. Update: leptospirosis and unexplained acute febrile illness among

2014 eMedicine Pediatrics

90. Streptococcal Infection, Group A (Overview)

(SPEs) to function as superantigens. Scarlet fever When a fine, diffuse, erythematous rash is present in the setting of acute streptococcal pharyngitis, the illness is called scarlet fever. The rash of scarlet fever is caused by the pyrogenic exotoxins (ie, SPE A, B, C, and F). The rash highly depends on toxin expression; preexisting humoral immunity to the specific SPE toxin prevents the clinical manifestations of scarlet fever. Scarlet fever has apparently become less common and less virulent than (...) by bacterial toxins and enzymes (eg, lipase, hyaluronidase, collagenase, streptokinase), interactions among organisms (synergistic infections), local tissue factors (eg, decreased blood and oxygen supply), and general host factors (eg, immunocompromised state, chronic illness, surgery). As the infection spreads deep along the fascial planes, vascular occlusion, tissue ischemia, and necrosis occur. [ ] Although GAS is often isolated in cases of necrotizing fasciitis, this disease state is frequently

2014 eMedicine Pediatrics

91. Pseudomonas Infection (Diagnosis)

: Dec 17, 2018 Author: Selina SP Chen, MD, MPH; Chief Editor: Russell W Steele, MD Share Email Print Feedback Close Sections Sections Pseudomonas Infection Overview Background In 1882, Gessard first discovered Pseudomonas , a strictly aerobic, gram-negative bacterium of relatively low virulence. The organism is ubiquitous, with a predilection to moist environments, primarily as waterborne and soilborne organisms. Pseudomonal species have been found in soil, water, plants, and animals; Pseudomonas (...) and animals through direct contact with a contaminated source. In otherwise healthy hosts, disease manifestations range from acute to chronic local suppurative infections to septicemia with multiple abscesses in all organs of the body. Previous Next: Epidemiology Frequency United States According to data from the Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance System, P aeruginosa can be rated as follows: Number 1 cause of intensive care unit (ICU)–related

2014 eMedicine Pediatrics

92. Leptospirosis (Overview)

the last trimester of pregnancy and have had high-risk exposure should present promptly for treatment to prevent in utero infection. Newborns of ill mothers can also be treated. Leptospires may be shed in breastmilk for an unknown duration. Travelers and participants in "adventure racing" or other freshwater sports who may be hiking and may otherwise be exposed to fresh water, soil, mud, and vegetation are at higher risk, especially those older than 60 years or those who are immunosuppressed (...) and vector-borne diseases: a regional analysis. Bull World Health Organ . 2000. 78(9):1136-47. . . National Research Council. Advancing the Science of Climate Change . Washington, DC: The National Academies Press; 2010. CDC. From the Centers for Disease Control and Prevention. Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000. JAMA . 2001 Feb 14. 285(6):728-30. . CDC. Update: leptospirosis and unexplained acute febrile illness among

2014 eMedicine Pediatrics

93. Kawasaki Disease (Overview)

, and pyuria. The American Heart Association (AHA) suggests an algorithm for the diagnosis of incomplete KD in the most recent guideline. [ ] Echocardiography is the study of choice to evaluate for CAAs. Serial echocardiograms should be obtained as follows: At the time of KD diagnosis 1-2 weeks after the onset of the illness 5-6 weeks after the onset of the illness See and for more details. Management The principal goal of treatment is to prevent coronary artery disease. Intravenous immunoglobulin (IVIG (...) immunity. Epidemiologic data suggest, however, that person-to-person transmission of the disease is unlikely. Some authors have proposed a controversial association of KD with recent carpet shampooing, flooding, the use of a humidifier in the room of a child with an antecedent respiratory illness, [ ] and locations near bodies of water. [ ] These data have led to a waterborne vector hypothesis. The overall clinical presentation of patients with KD is similar to that of patients with a viral

2014 eMedicine Pediatrics

94. Intestinal Protozoal Diseases (Overview)

. Among all intestinal protozoa, those listed in Table 1 have been confirmed to cause GI disease. Others, such as Trichomonas hominis (in infants) and Entamoeba polecki (associated with pigs), have rarely been associated with diarrheal disease and are not discussed in this article. Table 1. Protozoa Associated with Intestinal Illness in Humans Name Mode of Transmission Symptoms Flagellates G lamblia Contaminated water, fecal-oral Nausea, bloating, gas, diarrhea, anorexia Dientamoeba fragilis Fecal (...) intestine and has no evident life cycle in humans. Cysticlike stages are rare and have been found in patients with acquired immunodeficiency syndrome (AIDS) and in vitro. The mechanisms of how this parasite causes illness have not been elucidated yet. Previous Next: Epidemiology Frequency United States At least 325 water-associated outbreaks of parasitic protozoan disease have been reported. [ ] North America and Europe accounted for 93% of all reports, and nearly two thirds occurred in the United

2014 eMedicine Pediatrics

95. Amebic Meningoencephalitis (Follow-up)

Amebic Meningoencephalitis (Follow-up) Amebic Meningoencephalitis Treatment & Management: Approach Considerations, Prevention, Consultations Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvOTk2MjI3LXRyZWF0bWVudA (...) like an overwhelming acute bacterial meningitis unresponsive to routine antibacterial agents. Next: Prevention Measures to prevent PAM and GAE include the following: The clinician should routinely discuss with individuals the risks of exposure to free-living amoebae in warm, typically stagnant, freshwater Some have advocated the avoidance of diving and jumping into these waters Advise individuals to consider the use of nose plugs for unavoidable exposures Advise individuals to verify adequate

2014 eMedicine Pediatrics

96. Streptococcal Infection, Group A (Diagnosis)

(SPEs) to function as superantigens. Scarlet fever When a fine, diffuse, erythematous rash is present in the setting of acute streptococcal pharyngitis, the illness is called scarlet fever. The rash of scarlet fever is caused by the pyrogenic exotoxins (ie, SPE A, B, C, and F). The rash highly depends on toxin expression; preexisting humoral immunity to the specific SPE toxin prevents the clinical manifestations of scarlet fever. Scarlet fever has apparently become less common and less virulent than (...) by bacterial toxins and enzymes (eg, lipase, hyaluronidase, collagenase, streptokinase), interactions among organisms (synergistic infections), local tissue factors (eg, decreased blood and oxygen supply), and general host factors (eg, immunocompromised state, chronic illness, surgery). As the infection spreads deep along the fascial planes, vascular occlusion, tissue ischemia, and necrosis occur. [ ] Although GAS is often isolated in cases of necrotizing fasciitis, this disease state is frequently

2014 eMedicine Pediatrics

97. Cyclosporiasis (Diagnosis)

Author: Shipra Gupta, MD; Chief Editor: Russell W Steele, MD Share Email Print Feedback Close Sections Sections Cyclosporiasis Overview Practice Essentials In August 2017, the Centers for Disease Control and Prevention issued a Health Alert Network advisory following an increase in reported cases of cyclosporiasis. The advisory guides providers to consider a diagnosis of cyclosporiasis in patients who experience prolonged or remitting-relapsing diarrhea. Between May 1, 2017 and August 2, 2017, 206 (...) as of August, 2014, CDC had been notified of 304 ill persons with confirmed Cyclospora infection in 2014. 64% of cases were reported from Texas and 64% were reported in July 2014. Preliminary investigation linked cases in Texas with Cilantro from Mexico; however, none of the cases outside Texas were linked to cilantro. International Worldwide, most fecal isolates have been obtained from residents of developing countries or from travelers returning from these regions. [ , ] Cyclosporiasis is endemic

2014 eMedicine Pediatrics

98. Cryptosporidiosis (Diagnosis)

in about 4% of stools sent for parasitologic examination. Seroprevalence studies using antibody assays suggest that 25-35% of the population in industrialized countries (including the United States) have had cryptosporidiosis at some time in their life. Cryptosporidium species also cause waterborne outbreaks of diarrhea. In 1993, more than 400,000 cases of diarrheal illness due to Cryptosporidium infection were reported in Milwaukee, Wisconsin. [ ] Waterborne outbreaks continue to be common worldwide (...) , Xiao L, Yoder JS, Centers for Disease Control and Prevention. Cryptosporidiosis surveillance -- United States, 2011-2012. MMWR Suppl . 2015 May 1. 64 (3):1-14. . Chalmers RM, Smith R, Elwin K, Clifton-Hadley FA, Giles M. Epidemiology of anthroponotic and zoonotic human cryptosporidiosis in England and Wales, 2004-2006. Epidemiol Infect . 2011 May. 139(5):700-12. . Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson MA, Roy SL, et al. Foodborne illness acquired in the United States--major

2014 eMedicine Pediatrics

99. Cryptosporidiosis (Treatment)

, suppresses diarrhea in chronic cryptosporidiosis. Previous Next: Fluid and electrolyte loss Replacement of fluids and electrolytes is the critically important first step in the management of cryptosporidiosis, particularly in patients with large diarrheal losses. Fluids should include sodium, potassium, bicarbonate, and glucose. Oral rehydration is the preferred mode, but severely ill patients may require parenteral fluids. Biliary involvement Biliary involvement in cryptosporidiosis requires specific (...) interventions. Acalculous cholecystitis should be treated with cholecystectomy. Patients with sclerosing cholangitis can usually be treated with endoscopic retrograde cholangiopancreatography (ERCP), although sphincterotomy may result in temporary relief. In selected cases, recurrence may be prevented by placing a stent. Previous Next: Prevention of Cryptosporidiosis Water purification is the most important public health measure in the prevention of cryptosporidiosis. [ , ] Because chlorination has little

2014 eMedicine Pediatrics

100. Cyclosporiasis (Treatment)

. Protozoal infections in patients with AIDS. Cryptosporidiosis, isosporiasis, cyclosporiasis, and microsporidiosis. Infect Dis Clin North Am . 1994 Jun. 8(2):483-98. . Murray P, Rosenthal K, Pfaller M. Intestinal and Urogenital protozoa. Medical Microbiology . 7th edition. 2013. 745-758. Huang P, Weber JT, Sosin DM, Griffin PM, Long EG, Murphy JJ, et al. The first reported outbreak of diarrheal illness associated with Cyclospora in the United States. Ann Intern Med . 1995 Sep 15. 123(6):409-14. . Carter (...) of cyclosporiasis associated with imported raspberries, Philadelphia, pennsylvania, 2000. Emerg Infect Dis . 2002 Aug. 8(8):783-8. . . CDC. From the Centers for Disease Control and Prevention. Outbreaks of cyclosporiasis--United States, 1997. JAMA . 1997 Jun 11. 277(22):1754. . CDC. From the Centers for Disease Control and Prevention. Update: outbreaks of cyclosporiasis--1997. JAMA . 1997 Jul 9. 278(2):108. . CDC. From the Centers for Disease Control and Prevention. Update: outbreaks of cyclosporiasis--United

2014 eMedicine Pediatrics

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