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WAYS OF TRANSMISSION HIV is transmitted in a number of different ways: Having sex (anal, vaginal, or oral), sharing needles and syringes, being exposed before or during birth or through breast feeding, blood transfusions.

EARLY SYMPTOMS OF HIV INFECTION About 60% will not have any symptoms when they first become infected with HIV. About 40% experiences symptoms between one week and two months after exposure to the virus. This illness may include one or more of the following symptoms:

  • Fever
  • Headache
  • Tiredness
  • Sore throat
  • Enlarged lymph nodes
  • Rash

These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.

More persistent or severe symptoms may not appear for 10 years or more after HIV first enters the body in adults, or within 2 years in children born with HIV infection. This period of "asymptomatic" infection varies greatly in each individual. Some people may begin to have symptoms within a few months, while others may be symptom-free for more than 10 years.

Even during the asymptomatic period, the virus is actively multiplying, infecting, and killing cells of the immune system. The virus can also hide within infected cells and lay dormant. The most obvious effect of HIV infection is a decline in the number of CD4 positive T (CD4+) cells found in the blood-the immune system's key infection fighters. The virus slowly disables or destroys these cells without causing symptoms.

As the immune system worsens, a variety of complications start to take over. For many people, the first signs of infection are large lymph nodes or "swollen glands" that may be enlarged for more than 3 months. Other symptoms often experienced months to years before the onset of AIDS include

  • Lack of energy
  • Weight loss
  • Frequent fevers and sweats
  • Persistent or frequent yeast infections (oral or vaginal)
  • Persistent skin rashes or flaky skin
  • Pelvic inflammatory disease in women that does not respond to treatment
  • Short-term memory loss

Some people develop frequent and severe herpes infections that cause mouth, genital, or anal sores, or a painful nerve disease called shingles. Children may grow slowly or be sick a lot.

WAYS OF TRANSMISSION Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.

SYMPTOMS OF CHLAMYDIA INFECTION About 75% of women and 50% of men will not have any symptoms when they are infected with Chlamydia. This illness may include one or more of the following symptoms:

Women:

  • Abnormal vaginal discharge
  • Burning sensation when urinating
  • Lower abdominal pain
  • Low back pain
  • Nausea
  • Fever
  • Pain during intercourse
  • Bleeding between menstrual periods

Men:

  • Discharge from penis
  • Burning sensation when urinating
  • Itching around the opening of the penis
  • Pain and swelling in the testicles

Men and women:

  • Rectal pain, discharge and/or bleeding
  • Sore throat

These symptoms usually occur within 1 to 3 weeks after infection.

COMPLICATIONS OF CHLAMYDIA INFECTION If untreated, Chlamydial infections can progress to serious reproductive and other health problems with both short-term and long-term consequences. Like the disease itself, the damage that Chlamydia causes is often "silent."

In women, untreated infection can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). This happens in up to 40 percent of women with untreated Chlamydia. PID can cause permanent damage to the fallopian tubes, uterus, and surrounding tissues. The damage can lead to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy (pregnancy outside the uterus). Women infected with Chlamydia are up to five times more likely to become infected with HIV, if exposed.

In men, infection sometimes spreads to the epididymis (the tube that carries sperm from the testis), causing pain, fever, and sterility.

Genital Chlamydial infection can also cause arthritis that can be accompanied by skin lesions and inflammation of the eye and urethra (Reiter's syndrome).

WAYS OF TRANSMISSION Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during delivery.

SYMPTOMS OF GONORRHEA INFECTION Most women and some men will not have any symptoms when they are infected with gonorrhea. This illness may include one or more of the following symptoms:

Women:

  • Abnormal vaginal discharge
  • Burning sensation when urinating
  • Bleeding between menstrual periods
  • Abdominal pain
  • Fever

Men:

  • Discharge from penis
  • Burning sensation when urinating
  • Pain and swelling in and near the testicles

Men and women:

  • Rectal pain, discharge, itching, soreness, bleeding and/or painful bowel movements
  • Sore throat

These symptoms usually occur within 2 to 30 days after infection.

COMPLICATIONS OF GONORRHEA INFECTION Untreated gonorrhea can cause serious and permanent health problems in both women and men.

In women, gonorrhea is a common cause of pelvic inflammatory disease (PID). About one million women each year in the United States develop PID. The symptoms may be quite mild or can be very severe and can include abdominal pain and fever. PID can lead to internal abscesses (pus-filled "pockets" that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube.

In men, gonorrhea can cause epididymitis, a painful condition of the ducts attached to the testicles that may lead to infertility if left untreated.

Gonorrhea can spread to the blood or joints. This condition can be life threatening. In addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea can transmit HIV more easily to someone else than if they did not have gonorrhea.

WAYS OF TRANSMISSION Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth.

SYMPTOMS OF SYPHILIS INFECTION Many people infected with syphilis don't get any symptoms, except the primary stage chancre, until they enter the last stage of the disease. Although transmission occurs from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, transmission may occur from persons who are unaware of their infection.

Primary stage symptoms:

  • A single sore, a chancre, usually firm, round, small and painless.

Secondary stage symptoms:

  • Skin rash
  • Mucous membrane lesions
  • Fever
  • Swollen lymph glands
  • Sore throat
  • Patchy hair loss
  • Headaches
  • Weight loss
  • Muscle aches
  • Fatigue

Latent stage:

  • No symptoms

Late stage:

  • Difficulty coordinating muscle movements
  • Paralysis
  • Numbness
  • Gradual blindness
  • Dementia
  • Death

The symptom for the first stage usually occur within 10 to 90 days after infection, symptoms for the late stage can occur after 10 to 20 years

WAYS OF TRANSMISSION Hepatitis B is spread when blood, semen, or other body fluid infected with the hepatitis B virus enters the body. People can become infected with the virus during activities such as: Sex, Sharing items such as razors or toothbrushes, Birth, Sharing needles and syringes, Direct contact with the blood or open sores of an infected person, Exposure to blood from needlesticks or other sharp instruments.

EARLY SYMPTOMS OF HEPATITIS B INFECTION About 50% - 70% will not have any symptoms when they become infected with hepatitis B. This illness may include one or more of the following symptoms:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay-colored bowel movements
  • Joint pain
  • Jaundice

Symptoms begin to occur 60 - 150 days after infection and usually last less than one month but can persist for up to six months.

COMPLICATIONS OF HEPATITIS B INFECTION Approximately 25% of those who become chronically infected during childhood and 15% of those who become chronically infected after childhood die prematurely from cirrhosis or liver cancer, and the majority remain asymptomatic until onset of cirrhosis or end-stage liver disease.

The risk for chronic infection varies according to the age at infection and is greatest among young children. Approximately 90% of infants and 25% - 50% of children aged 1 - 5 years will remain chronically infected with HBV. By contrast, approximately 95% of adults recover completely from HBV infection and do not become chronically infected.

DIAGNOSIS A positive test for HBsAg followed by another positive test 6 months later indicates chronic infection.

TREATMENT For acute infection there is no medication available. For chronic infection there are several antiviral drugs available which, if administered early, can keep the disease from progressing into a lethal stage.

WAYS OF TRANSMISSION Hepatitis C is spread when blood infected with the hepatitis C virus enters the body of a person. People can become infected with the virus during activities such as: Sex, Sharing items such as razors or toothbrushes, Birth, Sharing needles and syringes.

EARLY SYMPTOMS OF HEPATITIS C INFECTION About 70% - 80% will not have any symptoms when they become infected with hepatitis C. When symptoms do occur they may include one or more of the following:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay-colored bowel movements
  • Joint pain
  • Jaundice

If symptoms occur they begin to occur 2 - 24 weeks after infection.

COMPLICATIONS OF HEPATITIS C INFECTION Most persons with chronic HCV infection are asymptomatic. However, many have chronic liver disease, which can range from mild to severe, including cirrhosis and liver cancer. Chronic liver disease in HCV-infected persons is usually insidious, progressing slowly without any signs or symptoms for several decades. Some persons with chronic HCV infection develop medical conditions due to hepatitis C that are not limited to the liver. These conditions are thought to be attributable to the body's immune response to HCV infection. Such conditions can include

  • Diabetes mellitus, which occurs three times more frequently in HCV-infected persons
  • Glomerulonephritis, a type of kidney disease caused by inflammation of the kidney
  • Essential mixed cryoglobulinemia, a condition involving the presence of abnormal proteins in the blood
  • Porphyria cutanea tarda, an abnormality in heme production that causes skin fragility and blistering
  • Non-Hodgkins lymphoma, which might occur somewhat more frequently in HCV-infected persons

SYMPTOMS OF PROSTATE CANCER Many men with prostate cancer often have no symptoms. If symptomsappear, they can include one or more of the following:

  • Blood in the urine
  • The need to urinate frequently, especially at night
  • Weak or interrupted urine flow
  • Pain or burning feeling while urinating
  • Inability to urinate
  • Constant pain in the lower back, pelvis, or upper thighs

The PSA test is a blood test that measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present.

COMPLICATIONS OF PROSTATE CANCER Some prostate cancers become a serious threat to health by growing quickly, spreading beyond the prostate gland to other parts of the body, and causing death. Among the leading causes of cancer death in men, prostate cancer is second, behind lung cancer. When compared with all causes of death in men over age 45, prostate cancer ranks fifth.

How is it used?

AFP is used to help detect and diagnose cancers of the liver, testes, and ovaries. It is often ordered to monitor people with chronic liver diseases such as cirrhosis or chronic hepatitis B because they have an increased lifetime risk of developing liver cancer. A doctor may order an AFP test to try to detect liver cancer when it is in its earliest, and most treatable, stages.

What does the test result mean?

Increased AFP levels may indicate the presence of cancer, most commonly liver cancer, cancer of the ovary, and germ cell tumor of the testes. Elevated levels may also sometimes be seen with other cancers such as stomach, colon, lung, breast, and lymphoma. Other diseases such as cirrhosis and hepatitis can also cause increased levels.

SYMPTOMS OF COLORECTAL CANCER People who have colorectal cancer don't always have symptoms, especially at first. Someone could have colorectal cancer and not know it. If there are symptoms, they may include one or more of the following:

  • Blood in or on your stool (bowel movement)
  • Pains, aches, or cramps in your stomach that don't go away
  • Losing weight and you don't know why
  • Change in bowel habits (constipation or diarrhea)

Colorectal cancer is cancer that occurs in the colon or rectum. Sometimes it is called colon cancer, for short. Colorectal cancer affects both men and women of all racial and ethnic groups. For men, colorectal cancer is the third most common cancer. For women, colorectal cancer is the second most common cancer among Asian/Pacific Islander and Hispanic women, and the third most common cancer among white, black, and American Indian/Alaska Native women.

Of cancers that affect both men and women, colorectal cancer is the second leading cancer killer in the United States, but it doesn't have to be. If everybody had regular screening tests, as many as 60% of deaths from colorectal cancer could be prevented.Colorectal cancer screening saves lives. Screening can find precancerous polyps—abnormal growths in the colon or rectum—so that they can be removed before turning into cancer. Screening also helps find colorectal cancer at an early stage, when treatment often leads to a cure.

Disease

Infection with malaria parasites may result in a wide variety of symptoms, ranging from absent or very mild symptoms to severe disease and even death. Malaria disease can be categorized as uncomplicated or severe (complicated). In general, malaria is a curable disease if diagnosed and treated promptly and correctly.

All the clinical symptoms associated with malaria are caused by the asexual erythrocytic or blood stage parasites. When the parasite develops in the erythrocyte, numerous known and unknown waste substances such as hemozoin pigment and other toxic factors accumulate in the infected red blood cell. These are dumped into the bloodstream when the infected cells lyse and release invasive merozoites. The hemozoin and other toxic factors such as glucose phosphate isomerase (GPI) stimulate macrophages and other cells to produce cytokines and other soluble factors which act to produce fever and rigors and probably influence other severe pathophysiology associated with malaria.

Plasmodium falciparum-infected erythrocytes, particularly those with mature trophozoites, adhere to the vascular endothelium of venular blood vessel walls and do not freely circulate in the blood. When this sequestration of infected erythrocytes occurs in the vessels of the brain it is believed to be a factor in causing the severe disease syndrome known as cerebral malaria, which is associated with high mortality.

Incubation Period

Following the infective bite by the Anopheles mosquito, a period of time (the "incubation period") goes by before the first symptoms appear. The incubation period in most cases varies from 7 to 30 days.

Antimalarial drugs taken for prophylaxis by travelers can delay the appearance of malaria symptoms by weeks or months, long after the traveler has left the malaria-endemic area. (This can happen particularly with P. vivax which can produce dormant liver stage parasites; the liver stages may reactivate and cause disease months after the infective mosquito bite.)

Uncomplicated Malaria

The classical (but rarely observed) malaria attack lasts 6-10 hours. It consists of

  • a cold stage (sensation of cold, shivering)
  • a hot stage (fever, headaches, vomiting; seizures in young children)
  • and finally a sweating stage (sweats, return to normal temperature, tiredness).

Classically (but infrequently observed) the attacks occur every second day with the "tertian" parasites P. falciparum and P. vivax.

More commonly, the patient presents with a combination of the following symptoms:

  • Fever
  • Chills
  • Sweats
  • Headaches
  • Nausea and vomiting
  • Body aches
  • General malaise

In countries where cases of malaria are infrequent, these symptoms may be attributed to influenza, a cold, or other common infections, especially if malaria is not suspected.

Physical findings may include:

  • Elevated temperatures
  • Perspiration
  • Weakness
  • Enlarged spleen
  • Mild jaundice
  • Enlargement of the liver
  • Increased respiratory rate

Severe Malaria

Severe malaria occurs when infections are complicated by serious organ failures or abnormalities in the patient's blood or metabolism. The manifestations of severe malaria include

  • Cerebral malaria, with abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities
  • Severe anemia due to hemolysis (destruction of the red blood cells)
  • Hemoglobinuria (hemoglobin in the urine) due to hemolysis
  • Acute respiratory distress syndrome (ARDS), an inflammatory reaction in the lungs that inhibits oxygen exchange, which may occur even after the parasite counts have decreased in response to treatment
  • Abnormalities in blood coagulation
  • Low blood pressure caused by cardiovascular collapse
  • Acute kidney failure
  • Hyperparasitemia, where more than 5% of the red blood cells are infected by malaria parasites
  • Metabolic acidosis (excessive acidity in the blood and tissue fluids), often in association with hypoglycemia
  • Hypoglycemia (low blood glucose). Hypoglycemia may also occur in pregnant women with uncomplicated malaria, or after treatment with quinine.

Severe malaria is a medical emergency and should be treated urgently and aggressively.

Malaria Relapses

In P. vivax infections, patients having recovered from the first episode of illness may suffer several additional attacks ("relapses") after months or even years without symptoms. Relapses occur because P. vivax have dormant liver stage parasites ("hypnozoites") that may reactivate. Treatment to reduce the chance of such relapses is available and should follow treatment of the first attack.

Other Manifestations of Malaria

  • Neurologic defects may occasionally persist following cerebral malaria, especially in children. Such defects include trouble with movements (ataxia), palsies, speech difficulties, deafness, and blindness.
  • Recurrent infections with P. falciparum may result in severe anemia.
  • Malaria during pregnancy (especially P. falciparum) may cause severe disease in the mother, and may lead to premature delivery or delivery of a low-birth-weight baby.
  • On rare occasions, P. vivax malaria can cause rupture of the spleen.
  • Hyperreactive malarial splenomegaly (also called "tropical splenomegaly syndrome") occurs infrequently and is attributed to an abnormal immune response to repeated malarial infections. The disease is marked by a very enlarged spleen and liver, abnormal immunologic findings, anemia, and a susceptibility to other infections (such as skin or respiratory infections).

Tuberculosis

"TB" is short for tuberculosis. TB disease is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal.

How TB Spreads

TB is spread through the air from one person to another. The TB bacteria are put into the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected.

Latent TB Infection and TB Disease

Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection and active TB disease.

  • Latent TB Infection

    TB bacteria can live in your body without making you sick. This is called latent TB infection (LTBI). In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. People with latent TB infection do not feel sick and do not have any symptoms. The only sign of TB infection is a positive reaction to the tuberculin skin test or TB blood test. People with latent TB infection are not infectious and cannot spread TB bacteria to others. However, if TB bacteria become active in the body and multiply, the person will get sick with TB disease.

  • TB Disease

    TB bacteria become active if the immune system can't stop them from growing. When TB bacteria are active (multiplying in your body), this is called TB disease. TB disease will make you sick. People with TB disease may spread the bacteria to people they spend time with every day. Many people who have latent TB infection never develop TB disease. Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria. Other people may get sick years later, when their immune system becomes weak for another reason. For persons whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is much higher than for persons with normal immune systems.

The Difference between Latent TB Infection and TB Disease

A Person with Latent TB Infection A Person with TB Disease
Has no symptoms Has symptoms that may include: - a bad cough that lasts 3 weeks or longer - pain in the chest - coughing up blood or sputum - weakness or fatigue - weight loss - no appetite - chills - fever - sweating at night
Does not feel sick Usually feels sick
Cannot spread TB bacteria to others May spread TB bacteria to others
Has a skin test or blood test result indicating TB infectionHas a skin test or blood test result indicating TB infection
Has a normal chest x-ray and a negative sputum smearMay have an abnormal chest x-ray, or positive sputum smear or culture
Needs treatment for latent TB infection to prevent active TB diseaseNeeds treatment to treat active TB disease

How is it used?

This test is used to diagnose infection due to Helicobacter pylori. A positive test for H. pylori indicates that your gastrointestinal pain may be caused by a peptic ulcer due to this bacterium. Taking antibiotics will kill the bacteria and may stop the pain and the ulceration.

When is it used?

If you experiencing gastrointestinal pain and symptoms of an ulcer, you may order a H. pylori test to determine if there is evidence of this disease. Some of these symptoms may include:

  • indigestion
  • feeling of fullness or bloating
  • nausea
  • belching and regurgitation

What does the test result mean?

A positive H. pylori test signifies that you have been infected with this organism. In recent years, scientific data support that this bacteria causes stomach ulcers and appropriate treatment can destroy the bacteria and stop the disease.

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