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Prevention of Waterborne Illness

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101. 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

102. 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

103. 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

104. Amebic Meningoencephalitis (Overview)

amoebae as agents of human infection. J Infect Dis . 2009 Apr 15. 199(8):1104-6. . Centers for Disease Control and Prevention (CDC). Investigational drug available directly from CDC for the treatment of infections with free-living amebae. MMWR Morb Mortal Wkly Rep . 2013 Aug 23. 62 (33):666. . Linam WM, Ahmed M, Cope JR, Chu C, Visvesvara GS, da Silva AJ, et al. Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis. Pediatrics . 2015 Mar. 135 (3):e744-8 (...) water. Clin Infect Dis . 2012 Nov. 55(9):e79-85. . Naegleria fowleri — Primary Amebic Meningoencephalitis (PAM) — Amebic Encephalitis. Centers for Disease Control and Prevention. Available at . September 24, 2015; Accessed: September 6, 2016. Kemble SK, Lynfield R, Devries AS, Drehner DM, Pomputius WF 3rd, Beach MJ. Fatal Naegleria fowleri Infection Acquired in Minnesota: Possible Expanded Range of a Deadly Thermophilic Organism. Clin Infect Dis . 2012 Mar. 54(6):805-9. . Schuster FL, Yagi S, Gavali

2014 eMedicine Pediatrics

105. Hematopoietic Stem Cell Transplantation (Treatment)

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 Pediatrics

106. Intestinal Protozoal Diseases (Treatment)

therapy results in full recovery. Some patients with severe giardiasis may experience disaccharidase deficiency and may require lactose-free diets, but this is a temporary condition that usually does not last more than 2 weeks. Patients with AIDS and severe spore-forming protozoal infections (chronic diarrhea with wasting syndrome) require hypercaloric diets. This is indicated for the protozoal illness in addition to the wasting syndrome associated with the underlying disease. For amebic liver abscess (...) . . Carranza PG, Lujan HD. New insights regarding the biology of Giardia lamblia. Microbes Infect . 2009 Sep 20. . Muller N, von Allmen N. Recent insights into the mucosal reactions associated with Giardia lamblia infections. Int J Parasitol . Nov 2005. 35:1339-47. . Karanis P, Kourenti C, Smith H. Waterborne transmission of protozoan parasites: a worldwide review of outbreaks and lessons learnt. J Water Health . Mar 2007. 5:1-38. . Hunter PR, Thompson RC. The zoonotic transmission of Giardia

2014 eMedicine Pediatrics

107. Cyclosporiasis (Overview)

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

108. Cryptosporidiosis (Overview)

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

109. Leptospirosis (Treatment)

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

110. Fascioliasis (Overview)

Singh Arora, MD; Chief Editor: Russell W Steele, MD Share Email Print Feedback Close Sections Sections Fascioliasis Overview Background Fascioliasis is a waterborne and foodborne zoonotic disease caused by two parasites of class Trematoda, genus Fasciola ; namely F. hepatica and F . [ ] giganticaHumans are incidental hosts and become infected by ingesting contaminated watercress or water. The illness occurs worldwide, particularly in regions with intensive sheep or cattle production. Incidence (...) in preserved human stool samples. Am J Trop Med Hyg . 2009 Jul. 81(1):156-62. . Fascioliasis. DPDx: Centers for Disease Control and Prevention. Available at . Accessed: March 10, 2015. Ai L, Dong SJ, Zhang WY, et al. Specific PCR-based assays for the identification of Fasciola species: their development, evaluation and potential usefulness in prevalence surveys. Ann Trop Med Parasitol . 2010 Jan. 104(1):65-72. . Le TH, Nguyen KT, Nguyen NT, Doan HT, Le XT, Hoang CT, et al. Development and evaluation

2014 eMedicine Pediatrics

111. Giardiasis (Overview)

in children than in adults. [ , ] G intestinalis can cause asymptomatic colonization or acute or chronic diarrheal illness. The organism has been found in as many as 80% of raw water supplies from lakes, streams, and ponds and in as many as 15% of filtered water samples. [ , ] It is a common cause of chronic diarrhea and growth retardation in children in developing countries. Giardiasis usually represents a zoonosis with cross-infectivity between animals and humans. Giardia intestinalis has been isolated (...) of genes implicated in the apoptotic cascade and the formation of reactive oxygen species. Panaro et al demonstrated that Giardia trophozoites induce cell apoptosis by activation of both intrinsic and extrinsic apoptotic pathways, down-regulation of the antiapoptotic protein Bcl-2, and up-regulation of the proapoptotic Bax. These findings suggest a possible role for caspase-dependent apoptosis in the pathogenesis of giardiasis. [ ] Giardia can also prevent the formation of nitric oxide, a compound

2014 eMedicine Pediatrics

112. Hematopoietic Stem Cell Transplantation (Overview)

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 Pediatrics

113. Hematopoietic Stem Cell Transplantation (Diagnosis)

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

114. Leptospirosis in Humans (Treatment)

disease. [ ] Women who become ill during 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 (...) , 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 Feb 14. 285(6):728-30. . CDC. Update

2014 eMedicine Emergency Medicine

115. Legionnaires Disease (Treatment)

, 2018 Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD Share Email Print Feedback Close Sections Sections Legionnaires Disease Overview Background Legionnaires disease (LD) is the pneumonia caused by Legionella pneumophila. LD also refers to a more benign, self-limited, acute febrile illness known as Pontiac fever, which has been linked serologically to L pneumophila, although it presents without pneumonia. (See Pathophysiology and Etiology.) L pneumophila is an important cause (...) is a small, aerobic, waterborne, gram-negative, unencapsulated bacillus that is nonmotile, catalase-positive, and weakly oxidase-positive. It is a fastidious organism and does not grow anaerobically or on standard media. Buffered charcoal yeast extract (CYE) agar is the primary medium used for isolation of the bacterium. (See Workup.) The Legionellaceae family consists of more than 42 species, constituting 64 serogroups. L pneumophila is the most common species, causing up to 90% of the cases

2014 eMedicine Emergency Medicine

116. Leptospirosis in Humans (Overview)

disease. [ ] Women who become ill during 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 (...) , 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 Feb 14. 285(6):728-30. . CDC. Update

2014 eMedicine Emergency Medicine

117. Legionnaires Disease (Overview)

, 2018 Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD Share Email Print Feedback Close Sections Sections Legionnaires Disease Overview Background Legionnaires disease (LD) is the pneumonia caused by Legionella pneumophila. LD also refers to a more benign, self-limited, acute febrile illness known as Pontiac fever, which has been linked serologically to L pneumophila, although it presents without pneumonia. (See Pathophysiology and Etiology.) L pneumophila is an important cause (...) is a small, aerobic, waterborne, gram-negative, unencapsulated bacillus that is nonmotile, catalase-positive, and weakly oxidase-positive. It is a fastidious organism and does not grow anaerobically or on standard media. Buffered charcoal yeast extract (CYE) agar is the primary medium used for isolation of the bacterium. (See Workup.) The Legionellaceae family consists of more than 42 species, constituting 64 serogroups. L pneumophila is the most common species, causing up to 90% of the cases

2014 eMedicine Emergency Medicine

118. Pediatrics, 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 Emergency Medicine

119. Legionnaires Disease (Diagnosis)

, 2018 Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD Share Email Print Feedback Close Sections Sections Legionnaires Disease Overview Background Legionnaires disease (LD) is the pneumonia caused by Legionella pneumophila. LD also refers to a more benign, self-limited, acute febrile illness known as Pontiac fever, which has been linked serologically to L pneumophila, although it presents without pneumonia. (See Pathophysiology and Etiology.) L pneumophila is an important cause (...) is a small, aerobic, waterborne, gram-negative, unencapsulated bacillus that is nonmotile, catalase-positive, and weakly oxidase-positive. It is a fastidious organism and does not grow anaerobically or on standard media. Buffered charcoal yeast extract (CYE) agar is the primary medium used for isolation of the bacterium. (See Workup.) The Legionellaceae family consists of more than 42 species, constituting 64 serogroups. L pneumophila is the most common species, causing up to 90% of the cases

2014 eMedicine.com

120. 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.com

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