CHRONIC CLINICAL FEATURES (late obatructive phase) 1. Hydrocele - is conmon with w bancroti

Meningism (g) Tender muscles (h) Tender enlarged liver and spleen Complictions - Severe are - myocardtlis. hepatic failure, severe bleeding associated with thrombocytopenia, DIC, secondary bacterial infection Tick-borne - Attacks generally milder and shorter, but may be followed by more relapses. DIAGNOSIS -(a) Louse-bome - Appearance of spirochetes In peripheral blood during a paroxysm (b) Tick -borne Infection - intraperitoneal lnjection of blood into mouse or rat produces numerous spirochetes in the rodents tail blood within 3-5 days. TREATMENT - Louse-bome relapsing lever - Adults - Tetracycline 250 mg .IV single dose Children - Erythromycin lactobionate 10 mg/kg IV single dose Tick-bome - Adults- Tetracycline 500 mg. p.o. q.d.s for 10 days Chitfren - Erythromycin 125-250 mg. q.d.s. FOR 10 days. 15. LYME DISEASE Lyme disease is caused by the tick-bome spirochaete Borrelia burgdoferi. Erythema migrans is the early skin lesion, and is the most common clinical mamfestation Transmision usually lakes place when an inlecfed tick (lxodid tick) bites. CLINICAL FEATURES Stage Iborreliosis Erythema marginatum. aofcalized erythematous rash appearing 2-30 days alter a bite. There may beofcal lymphadenopathy Stage II borreliosis After dissemination, the organsm can affect many tissues, principally the nervous, musculoskeletal (persistent arthralgia and small joint arthritis) and cardiovascular system (conduction defects, rarely cardomyopathy), and the skin There may be 'flu-like'illness Multiple areas of erythema migrans can occur. Stage III borreliosis: is unusual Chronic lyme arthritis of knee. Acrodermatitis chronica atrophicans Rarely chronic progressive encephalomyelitis. DIAGNOSIS - Antibody tests Specimens found reactive on Initial testing should be invesiigated using Western blot. TREATMENT - Amoxicillin, doxcyclin and cephalosporin’s, or azithromycin orally. Puerperal antibiotics include benzylpanicillin. cefotaxime and ceftriaxone. 16 WORM INFECTIONS Fllariasis Etiology - Filartal Infections are caused by parasistic tissue-dwelling, filarial nematode warms, which are transmited by blting Insects. Two main types of filariasis are: 1. Lymphatic fallrisis is. Transmited by mosqutoes. 2. Subcutaneous fillriasis (onchocerciasis) tramited by biting flies. LIFE CYCLE - Adult female worms situated in various (issues in the human host produce embryonic mcrofilariae which are sucked up by mosquitoes or bung flies during a blood meal Microfilariae develop to their larval stage in the insect vector and are passed on to a new human host in which the final maturation to adult worme takes place Adult filarial worms do not multiply in man Periodicity of microfilariae - in most endemic areas the mcrofilarriae of W bancrofit appear in greatest numbers in peripheral blood in the night between 10 p.m. and 2 a.m. during the day they return to the pulmonary capillaries Mcrofilariae of B. malayi exhibit either nocturnal periodcity, or dumal periodcity with ,a peak In the early evenings Lymphatic filarlasis - can be caused by Wuchereria bancrofti, transmited by Anopheles. Culex and Aedes mosquitoes. Brugla malayi, transmited by Mansonia and Anophsles mosquitoes brugia timori, transmited by Manaonia and Anopheles mosquitoes Clinical features - Two syndromes - (a) Lymptiatic frlariasis caused by adult or developing adult worme, producing episodic inflammation of lymphatic vessels, followed by obstrctive lymphatic. lesions (b) Syndrome - caused by immune hyparresponsiveness of human host against microfilaria, producing occut fileriasis (circulating filarial antigens or microfilaraemia). ACUTE CLINICAL FEATURES 1 Filarial lever-Attacks of fever with rigors and with headache and rnalaise, lasting- 3-s recurring at Intervals. and sometimes associated with an attack of filarial adenolymphangitis. 2. Filarial lymphangitis and lymphadenitis - fa) Acute lymphangitis - in extramities with lever with riugors and toxemia. The tender inflamedly lymphatics are seen as red streaks. it may be accompanied by itchy, irregular erythamatous swelling ot the skin scattered over the body, which may sometimes appear In absence of local lymphangitis Lymphatics anywhere in the body may be Involed, Those of spermatic cord and testis are especially susceptible (b) Lymphadanltis - occurs episodically. most often in inguinal area. Other sites are medial aspect of leg. axilla or medial side of arm. Occasionally in the breast Invoivement of intra-abdominal Iymphatic may produce clinical appearances of acute abdomen Secondary grarn-postiive bacterial infections cause suppurative lymphadenitis or abscess formation particullarly in the breast, or in muscle resembling tropical pyomysitis. CHRONIC CLINICAL FEATURES (late obatructive phase) 1. Hydrocele - is conmon with w bancroti. 2. Lymph oedema - is most common in lower limbs but also occurs in the upper limbs or the breast .3. Elephantiasis - results from further progression with drmatasclerotic and papillomatous changes superimposed Lymphoedema and elephantlasis are mush more pronounced on one side of the body, possibly because the parasites tend of congregate Thckening of both skin and overlying tissues. One or both legs and scrotum most commonly involved Upper extremitles, breast and labia may also be affected. 4. Finally rupture of lymphatic varices - into renal pelvis or