Dengue Fever

What is dengue fever?

Dengue is a viral disease transmitted by Aedes mosquitoes mainly in tropical and subtropical areas of the world,
with the greatest risks occurring in:

 South Pacific
 South Central Asia 
 Caribbean
 Central and South America 
 Africa

Dengue fever occurs most often in urban areas, but may be found in rural areas also, particularly in areas with
elevation less than 4,000 feet. Transmission of the virus, via Aedes mosquitoes, usually occurs during and shortly
after the rainy season. These mosquitoes are most active during the day and are often found near human dwellings,
often indoors.

Pathophysiology

Dengue virus infections often are not apparent. Dengue classical occurs mainly in nonimmune, non-adults and
children. Symptoms begin after 5 - 10 days the incubation period. DHF / DSS usually occurs during a second
dengue infection in people who either actively or passively preexisting (mother) has acquired immunity to a
dengue virus serotype heterologous. The disease begins abruptly with a small step in 2-4 days followed by a rapid
deterioration. Increased vascular permeability, bleeding, and possibly DIC may be mediated by dengue circulating
antigen-antibody complexes, complement activation, and the release of vasoactive amines. In the process of
eliminating infected immune cells, proteases and lymphokines may be released and activate the coagulation
cascade and complete vascular permeability factor.

What are the symptoms of dengue fever?

Dengue fever may be confused with other infectious diseases such as influenza or malaria. Symptoms may include:

 sudden onset, high fever

 severe headaches
 joint and muscle pain
 nausea
 vomiting
 rash that appears three to four days after the onset of fever

The illness may last up to 10 days, with recovery often taking two to four weeks.

More severe, but less common, forms of the disease include dengue hemorrhagic fever and dengue shock
syndrome. Among these diseases, symptoms resemble those of dengue fever, but may progress to faintness, shock,
and generalized bleeding.

How can dengue fever be prevented?

Because there is not a vaccine for dengue fever, travelers should:

 avoid mosquito bites by using insect repellents on skin and clothing.

 stay in well screened or air conditioned areas.

When sleeping areas are not air conditioned or screened, the use of aerosol insecticides indoors and bednets are
recommended.
How is dengue fever diagnosed?

Dengue fever infection is diagnosed by a special blood test to determine the presence of the virus or antibodies. See
your physician if you become sick within a month of returning from travel in a tropical area, and be prepared to
give your complete travel itinerary, so that the physician can evaluate the possibility that your symptoms were
caused by a dengue infection.

Treatment for dengue fever:

Specific treatment will be determined by your physician based on:

 your overall health and medical history

 extent of the disease
 your tolerance for specific medications, procedures, or therapies
 expectations for the course of the disease
 your opinion or preference

The symptoms of dengue fever are generally treated with bed rest and fluids. Medications may be used to reduce
fever, such as acetaminophen, but aspirin should be avoided.

Pneumonia
What is pneumonia?
Pneumonia is an inflammation of the lungs caused by bacteria, viruses, or chemical irritants. It is a serious
infection or inflammation in which the air sacs fill with pus and other liquid.

 Lobar pneumonia - affects one or more sections (lobes) of the lungs.

 Bronchial pneumonia (or bronchopneumonia) - affects patches throughout both lungs.

Facts about pneumonia:

 Pneumonia can occur year round, but is usually seen in the fall, winter, and early spring.
 Boys are affected by pneumonia more often than girls.
 There is an increased chance of developing pneumonia in a crowded area.

What are the different types of pneumonia?

The main types of pneumonia are:

 Bacterial pneumonia - caused by various bacteria. The streptococcus pneumonia is the most common
bacterium that causes bacterial pneumonia.

Many other bacteria may cause bacterial pneumonia including:

o Group B streptococcus (most common in newborns)
o Staphylococcus aureus
o Group A streptococcus (most common in children over age 5)

Bacterial pneumonia may have a quick onset and the following symptoms may occur:

o productive cough
o pain in the chest
o vomiting or diarrhea
 o decrease in appetite
o fatigue
 viral pneumonia - caused by various viruses, including the following:
o respiratory syncytial virus, or RSV (most commonly seen in children under age 5)
o parainfluenza virus
o influenza virus
o adenovirus

Early symptoms of viral pneumonia are the same as those of bacterial pneumonia. However, with viral
pneumonia, the respiratory involvement happens slowly. Wheezing may occur and the cough may worsen.

Viral pneumonias may make a child susceptible to bacterial pneumonia.

 mycoplasma pneumonia - presents somewhat different symptoms and physical signs than other types of
pneumonia. It is caused by mycoplasmas, the smallest free-living agents of human disease, which have the
characteristics of both bacteria and viruses, but which are not classified as either. They generally cause a
mild, widespread pneumonia that affects all age groups.

Symptoms usually do not start with a cold, and may include the following:

o fever and cough are the first to develop

o cough that is persistent and may last three to four weeks
o a severe cough that may produce some mucus

Other less common pneumonias may be caused by the inhaling of food, liquid, gases or dust, or by fungi.
Pathophysiology

The invading organism causes symptoms, in part, by provoking an overly exuberant immune response in the lungs.
The small blood vessels in the lungs (capillaries) become leaky, and protein-rich fluid seeps into the alveoli. This
results in a less functional area for oxygen-carbon dioxide exchange. The patient becomes relatively oxygen
deprived, while retaining potentially damaging carbon dioxide. The patient breathes faster and faster, in an effort to
bring in more oxygen and blow off more carbon dioxide.

Mucus production is increased, and the leaky capillaries may tinge the mucus with blood. Mucus plugs actually
further decrease the efficiency of gas exchange in the lung. The alveoli fill further with fluid and debris from the
large number of white blood cells being produced to fight the infection.

Consolidation, a feature of bacterial pneumonias, occurs when the alveoli, which are normally hollow air spaces
within the lung, instead become solid, due to quantities of fluid and debris.

Viral pneumonias, and mycoplasma pneumonias, do not result in consolidation. These types of pneumonia
primarily infect the walls of the alveoli and the parenchyma of the lung.

Read more: Pneumonia - Pathophysiology Of Pneumonia http://science.jrank.org/pages/5358/Pneumonia-

Pathophysiology-pneumonia.html#ixzz0Xpr13QTS

What are the symptoms of pneumonia?

In addition to the symptoms listed above, all pneumonias share the following symptoms. However, each child may
experience symptoms differently. Symptoms may include:
  fever
 chest or stomach pain
 decrease in appetite
 chills
 breathing fast or hard
 vomiting
 headache
 not feeling well
 fussiness

The symptoms of pneumonia may resemble other problems or medical conditions. Always consult your child's
physician for a diagnosis.

How is pneumonia diagnosed?

Diagnosis is usually made based on the season and the extent of the illness. Based on these factors, your physician
may diagnose simply on a thorough history and physical examination, but may include the following tests to
confirm the diagnosis:

 chest x ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of
internal tissues, bones, and organs onto film.
 blood tests - blood count for evidence of infection; arterial blood gas to analyze the amount of carbon
dioxide and oxygen in the blood.
 sputum culture - a diagnostic test performed on the material that is coughed up from the lungs and into the
mouth. A sputum culture is often performed to determine if an infection is present.
  pulse oximetry - an oximeter is a small machine that measures the amount of oxygen in the blood. To obtain
this measurement, a small sensor (like a Band-Aid) is taped onto a finger or toe. When the machine is on, a
small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.

Treatment for pneumonia:

Specific treatment for pneumonia will be determined by your child's physician based on:

 your child's age, overall health, and medical history

 extent of the condition
 cause of the condition
 your child's tolerance for specific medications, procedures, or therapies
 expectations for the course of the condition
 your opinion or preference

Treatment may include antibiotics for bacterial pneumonia. Antibiotics may also speed recovery from mycoplasma
pneumonia and some special cases. There is no clearly effective treatment for viral pneumonia, which usually
resolves on its own.

Other treatment may include:

 appropriate diet
 increased fluid intake
 cool mist humidifier in the child's room
 acetaminophen (for fever and discomfort)
 medication for cough

Some children may be treated in the hospital if they are having severe breathing problems. While in the hospital,
treatment may include:
  intravenous (IV) or oral antibiotics
 intravenous (IV) fluids, if your child is unable to drink well
 oxygen therapy
 frequent suctioning of your child's nose and mouth (to help get rid of thick secretions)
 breathing treatments, as ordered by your child's physician

Hepatitis B
What is hepatitis?

The liver is one of the organs that helps with digestion but is not part of the digestive tract. It is the largest organ in
the body and carries out many important functions, such as making bile, changing food into energy, and cleaning
alcohol and poisons from the blood.

Hepatitis is inflammation of the liver that sometimes causes permanent damage. It is caused by viruses, bacteria,
certain medicines, or alcohol. It may also be caused by certain diseases such as: autoimmune diseases, metabolic
diseases, and congenital (present at birth) abnormalities (biliary atresia, Wilson's disease). Generally, symptoms of
hepatitis include fever, jaundice, and an enlarged liver. There are several types of hepatitis.

What is hepatitis B?
Hepatitis B is a blood-borne microorganism transmitted by exposure to the hepatitis B virus through infectious
body fluids.

Hepatitis B is one of the most frequently reported, vaccine-preventable diseases in the United States. It is estimated
that approximately 46,000 infections occur each year and an estimated 1.4 million people have chronic hepatitis B.

Pathophysiology

Hepatitis B virus (HBV) is a hepadnavirus. It is an extremely resistant strain capable of withstanding extreme
temperatures and humidity. Hepatitis B virus (HBV) can survive when stored for 15 years at –20°C, for 24 months
at –80°C, for 6 months at room temperatures, and for 7 days at 44°C. The viral genome consists of a partially
double-stranded circular DNA of 3.2 kilobase (kb) pairs that encodes 4 overlapping open reading frames, as
follows:

 S for the surface or envelope gene encoding the pre-S1, pre-S2, and the S protein
 C for the core gene, encoding for the core nucleocapsid protein and the e antigen
 X for the X gene encoding the X protein
 P for the polymerase gene encoding a large protein promoting priming RNA-dependent and DNA-dependent
DNA polymerase and RNase H activities

What are the symptoms of hepatitis B?

Hepatitis B has a wide range of symptoms. It may be mild, without symptoms, or it may cause chronic hepatitis. In
some cases, hepatitis B can lead to full-blown liver failure and death. The following are the most common
symptoms of hepatitis B. However, each individual may experience symptoms differently. Symptoms may include:

 loss of appetite
  nausea
 fatigue
 vomiting
 jaundice - yellowing of the skin and eyes.
 dark urine
 clay colored or light stools
 abdominal pain
 occasionally, skin rashes, arthralgias (joint pain), and arthritis occur
 enlarged liver

The symptoms of hepatitis B may resemble other medical conditions or problems. Always consult your physician
for a diagnosis.

How is hepatitis B transmitted?

Transmission of hepatitis B virus occurs through blood and body fluid exposure such as blood, semen, vaginal
secretions, or saliva. Infants may also develop the disease if they are born to a mother who has the virus. Infected
children often spread the virus to other children if there is frequent contact or a child has many scrapes or cuts.

Who is at risk for hepatitis B:

One out of 20 people in the US will develop hepatitis B at some time during their lives. The following describe
persons who are at risk for developing hepatitis B:

 children born to mothers who have hepatitis B (the illness may present up to five years after the child is
born)
 children who are born to mothers who have immigrated from a country where hepatitis B is widespread such
as southeast Asia and China
 persons who live in long-term care facilities or who are disabled
  persons who live in households where another member is infected with the virus
 persons who have a blood-clotting disorder such as hemophilia
 persons who require dialysis for kidney failure
 persons who may participate in high-risk activities such as intravenous (IV) drug use and/or unprotected
heterosexual or homosexual sexual contact
 persons who have a job that involves contact with human blood
 persons who received blood transfusions or blood products before the early 1990s

A vaccine for hepatitis B does exist and is now widely used for routine childhood immunization.

Prevention of hepatitis B:

A vaccine for the prevention of hepatitis B is available. Given in three shots over a period of time, the vaccine is
suggested for everyone age 18 years and younger, as well as for adults over age 18 who are at risk for the infection.

How is hepatitis B diagnosed?

In addition to a complete physical examination and laboratory tests for blood and urine, diagnostic procedures for
hepatitis B may involve a liver biopsy (a procedure performed to remove tissue or cells from the body for
examination under a microscope).

Treatment for hepatitis B:

Specific treatment for hepatitis B will be determined by your physician based on:

 your age, overall health, and medical history

 extent of the disease
 your tolerance for specific medications, procedures, or therapies
 expectations for the course of the disease
  your opinion or preference

Treatment may include biological therapy with interferon. Currently, there is no cure for hepatitis B. Prevention is
crucial.

Leptospirosis  
What is leptospirosis ?

Leptospirosis is a bacterial disease that affects humans and animals. In overseas countries, it usually occurs in
people who work outdoors or with animals, like farmers, veterinarians, or sewer workers, and people who
participate in recreational activities like swimming, hiking, canoeing, sailing, or fishing.

Pathophysiology

The leptospires are thin, coiled, gram-negative, aerobic organisms 6-20 µm in length. They are motile, with hooked
ends and paired axial flagella (one on each end), enabling them to burrow into tissue. Motion is marked by
continual spinning on the long axis. They are unique among the spirochetes in that they can be isolated on artificial
media.

Leptospires belong to the order Spirochaetales and the family Leptospiraceae. Traditionally, the organisms are
classified based on antigenic differences in the lipopolysaccharide envelopes that surround the cell wall. Serologic
detection of these differences, therefore, is based on identifying serovars within each species. Based on this system,
the genus Leptospira contains two species—the pathogenic Leptospira interrogans, with at least 218 serovars, and
the nonpathogenic, free-living, saprophytic Leptospira biflexa, which has at least 60 serovars.
Current studies that classify the organisms based on DNA relatedness identify at least 7 pathogenic species of
leptospires. However, organisms that are identical serologically may be different genetically, and organisms with
the same genetic makeup may differ serologically. Therefore, some authors feel that the traditional serologic
system is the most useful from a diagnostic and epidemiologic standpoint.

Although not fully understood, leptospires are believed to enter the host through abrasions in healthy skin, through
sodden and waterlogged skin, directly through intact mucus membranes or conjunctiva, through the nasal mucosa
and cribriform plate, through the lungs (after inhalation of aerosolized body fluid), or through the placenta during
pregnancy. Virulent organisms in a susceptible host gain rapid access to the bloodstream through the lymphatics,
resulting in leptospiremia and spread to all organs. The incubation period is usually 5-14 days but has been
described from 72 hours to a month or more.

If the host survives the acute infection, septicemia and multiplication of the organism persist until the development
of opsonizing immunoglobulin in the plasma, followed by rapid immune clearance. However, after clearance from
the blood, leptospires remain in immunologically privileged sites, including the renal tubules, brain, and anterior
chamber of the eye, for weeks to months. In humans, leptospires in the renal tubules and resulting leptospiruria
rarely persist longer than 60 days.

During acute infection, leptospires are thought to multiply in the small blood vessel endothelium, resulting in
damage and vasculitis. The major clinical manifestations of the disease are believed to be secondary to this
mechanism, which can affect nearly any organ system.

 In the kidneys, interstitial nephritis, tubular necrosis, and impaired capillary permeability, as well as the
associated hypovolemia, result in renal failure.
 Liver involvement is marked by centrilobular necrosis and Kupffer cell proliferation, with hepatocellular
dysfunction.
 Pulmonary involvement is secondary to alveolar and interstitial vascular damage resulting in hemorrhage.
This complication is considered to be the major cause of leptospirosis-associated death.
  The skin is affected by epithelial vascular insult.
 Skeletal muscle involvement is secondary to edema, myofibril vacuolization, and vessel damage.
 The damage to the vascular system as a whole can result in capillary leakage, hypovolemia, and shock.
Many patients with leptospirosis may develop disseminated intravascular coagulation (DIC), hemolytic
uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), and vasculitis. Thrombocytopenia
indicates severe disease and should raise suspicion for a risk of bleeding.

Clinical manifestations of leptospirosis after the acute infection are the result of the inflammatory response, as well
as action of the remaining organisms in the aqueous humor.

Causative agent

Leptospirosis is caused by bacteria of the genus Leptospira. They may be free-living or associated with animal
hosts and survive well in fresh water, soil, and mud in tropical areas. Animal hosts include cattle, pigs, horses,
dogs, rodents and wild animals.

Mode of transmission

Leptospirosis is transmitted from animals to humans through the contact of skin, especially mucosal surfaces of
eyes or nose, or broken skin. Indirect transmission via contact with Leptospira contaminated water or soil, is
thought to be responsible for most cases. Direct contact with urine or tissues of infected animals, or occasionally
consumption of contaminated water or food can also cause the infection. The disease is normally not transmitted
from person to person.

Incubation period

The incubation period usually is 5-14 days, with a range of 2-30 days.
Clinical features

Symptoms include high fever, headache, chills, muscle pain, and vomiting, and may include jaundice, red eyes,
abdominal pain, diarrhoea or rash. If the disease is not treated, the patient could develop kidney damage,
meningitis, liver failure, and respiratory distress. In rare cases death occurs. The duration of illness ranges from a
few days to three weeks or longer. Recovery of untreated cases can take several months.

Treatment

Leptospirosis can be treated with antibiotics.

Prevention

 Reducing both direct contact with infected pets and animals and indirect contact with animal urine-
contaminated fresh water, soil, and mud is the most effective prevention means.
 For people with high occupational risk like workers in rice fields, sugar cane plantations, mines, sewer
systems, and slaughterhouses; animal caretakers and veterinarians, wearing of protective clothing, such as
impermeable gloves and high rubber boots, is recommended.
 Avoid swimming, rafting or wading in water that might be contaminated.
 Immunization of pets (e.g. dogs) with Leptospira vaccines may prevent and reduce the transmission of the
disease but vaccination is not completely effective due to a limited coverage in the vaccine for the numerous
types of the organism.
 Wash hands after handling the pets or animals, and disinfect contaminated areas with a solution of 1 part
household bleach in 10 parts water.
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the
human immune system caused by the human immunodeficiency virus (HIV).

This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to
opportunistic infections and tumors. HIV is transmitted through direct contact of a mucous membrane or the
bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast
milk.

This transmission can involve anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles,
exchange between mother and baby during pregnancy, childbirth, breastfeeding or other exposure to one of the
above bodily fluids.

AIDS is now a pandemic. In 2007, it was estimated that 33.2 million people lived with the disease worldwide, and
that AIDS killed an estimated 2.1 million people, including 330,000 children. Over three-quarters of these deaths
occurred in sub-Saharan Africa, retarding economic growth and destroying human capital.

Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth
century. AIDS was first recognized by the U.S. Centers for Disease Control and Prevention in 1981 and its cause,
HIV, identified in the early 1980s.

Although treatments for AIDS and HIV can slow the course of the disease, there is currently no vaccine or cure.
Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but these drugs are
expensive and routine access to antiretroviral medication is not available in all countries. Due to the difficulty in
treating HIV infection, preventing infection is a key aim in controlling the AIDS pandemic, with health
organizations promoting safe sex and needle-exchange programmes in attempts to slow the spread of the virus.
Symptoms

A generalized graph of the relationship between HIV copies (viral load) and CD4 counts over the average course of
untreated HIV infection; any particular individual's disease course may vary considerably.                      CD4+ T
Lymphocyte count (cells/mm³)                      HIV RNA copies per mL of
plasma

The symptoms of AIDS are primarily the result of conditions that do not
normally develop in individuals with healthy immune systems. Most of these
conditions are infections caused by bacteria, viruses, fungi and parasites that are
normally controlled by the elements of the immune system that HIV damages.

Opportunistic infections are common in people with AIDS. HIV affects nearly
every organ system.
People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical
cancer and cancers of the immune system known as lymphomas. Additionally, people with AIDS often have
systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and
weight loss. The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of
these infections in the geographic area in which the patient lives.

Pulmonary infections

X-ray of Pneumocystis pneumonia (PCP). There is increased white (opacity) in the lower
lungs on both sides, characteristic of PCP

Pneumocystis pneumonia (originally known as Pneumocystis carinii pneumonia, and still

abbreviated as PCP, which now stands for Pneumocystis pneumonia) is relatively rare in
healthy, immunocompetent people, but common among HIV-infected individuals. It is
caused by Pneumocystis jirovecii.

Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries, it was a common
immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested
individuals, although it does not generally occur unless the CD4 count is less than 200 cells per µL of blood.

Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent
people via the respiratory route, is easily treatable once identified, may occur in early-stage HIV disease, and is
preventable with drug therapy. However, multidrug resistance is a potentially serious problem.

Even though its incidence has declined because of the use of directly observed therapy and other improved
practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-
stage HIV infection (CD4 count >300 cells per µL), TB typically presents as a pulmonary disease. In advanced
HIV infection, TB often presents atypically with extrapulmonary (systemic) disease a common feature. Symptoms
are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary
and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.

Cause
For more details on this topic, see HIV.

Scanning electron micrograph of HIV-1, colored green, budding from a

cultured lymphocyte.

AIDS is the most severe acceleration of infection with HIV. HIV is a

retrovirus that primarily infects vital organs of the human immune
system such as CD4+ T cells (a subset of T cells), macrophages and
dendritic cells. It directly and indirectly destroys CD4+ T cells.

Once HIV has killed so many CD4 + T cells that there are fewer than 200 of these cells per microliter (µL) of blood,
cellular immunity is lost. Acute HIV infection progresses over time to clinical latent HIV infection and then to
early symptomatic HIV infection and later to AIDS, which is identified either on the basis of the amount of CD4 + T
cells remaining in the blood, and/or the presence of certain infections, as noted above.

In the absence of antiretroviral therapy, the median time of progression from HIV infection to AIDS is nine to ten
years, and the median survival time after developing AIDS is only 9.2 months. However, the rate of clinical disease
progression varies widely between individuals, from two weeks up to 20 years.

Many factors affect the rate of progression. These include factors that influence the body's ability to defend against
HIV such as the infected person's general immune function. Older people have weaker immune systems, and
therefore have a greater risk of rapid disease progression than younger people.
Poor access to health care and the existence of coexisting infections such as tuberculosis also may predispose
people to faster disease progression. The infected person's genetic inheritance plays an important role and some
people are resistant to certain strains of HIV. An example of this is people with the homozygous CCR5-Δ32
variation are resistant to infection with certain strains of HIV. HIV is genetically variable and exists as different
strains, which cause different rates of clinical disease progression

Perinatal transmission

The transmission of the virus from the mother to the child can occur in utero during the last weeks of pregnancy
and at childbirth. In the absence of treatment, the transmission rate between a mother and her child during
pregnancy, labor and delivery is 25%.

However, when the mother takes antiretroviral therapy and gives birth by caesarean section, the rate of
transmission is just 1%. The risk of infection is influenced by the viral load of the mother at birth, with the higher
the viral load, the higher the risk. Breastfeeding also increases the risk of transmission by about 4 %

Pathophysiology
This section may require cleanup to meet Wikipedia's quality standards. Please improve this section if you
can. (April 2008)

The pathophysiology of AIDS is complex, as is the case with all syndromes. Ultimately, HIV causes AIDS by
depleting CD4+ T helper lymphocytes. This weakens the immune system and allows opportunistic infections. T
lymphocytes are essential to the immune response and without them, the body cannot fight infections or kill
cancerous cells. The mechanism of CD4+ T cell depletion differs in the acute and chronic phases.
During the acute phase, HIV-induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4+
T cell depletion, although apoptosis may also be a factor. During the chronic phase, the consequences of
generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T
cells appear to account for the slow decline in CD4+ T cell numbers.

Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is
infected, the bulk of CD4+ T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa,
which harbors the majority of the lymphocytes found in the body. The reason for the preferential loss of mucosal
CD4+ T cells is that a majority of mucosal CD4 + T cells express the CCR5 coreceptor, whereas a small fraction of
CD4+ T cells in the bloodstream do so.

HIV seeks out and destroys CCR5 expressing CD4 + cells during acute infection. A vigorous immune response
eventually controls the infection and initiates the clinically latent phase. However, CD4 + T cells in mucosal tissues
remain depleted throughout the infection, although enough remain to initially ward off life-threatening infections.

Continuous HIV replication results in a state of generalized immune activation persisting throughout the chronic
phase. Immune activation, which is reflected by the increased activation state of immune cells and release of
proinflammatory cytokines, results from the activity of several HIV gene products and the immune response to
ongoing HIV replication. Another cause is the breakdown of the immune surveillance system of the mucosal
barrier caused by the depletion of mucosal CD4+ T cells during the acute phase of disease.

This results in the systemic exposure of the immune system to microbial components of the gut’s normal flora,
which in a healthy person is kept in check by the mucosal immune system. The activation and proliferation of T
cells that results from immune activation provides fresh targets for HIV infection. However, direct killing by HIV
alone cannot account for the observed depletion of CD4 + T cells since only 0.01–0.10% of CD4 + T cells in the
blood are infected.

A major cause of CD4+ T cell loss appears to result from their heightened susceptibility to apoptosis when the
immune system remains activated. Although new T cells are continuously produced by the thymus to replace the
ones lost, the regenerative capacity of the thymus is slowly destroyed by direct infection of its thymocytes by HIV.
Eventually, the minimal number of CD4 + T cells necessary to maintain a sufficient immune response is lost,
leading to AIDS

Cells affected

Diagnosis

The diagnosis of AIDS in a person infected with HIV is based on the presence of certain signs or symptoms. Since
June 5, 1981, many definitions have been developed for epidemiological surveillance such as the Bangui definition
and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was
not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the World
Health Organization staging system for HIV infection and disease, using clinical and laboratory data, is used and in
developed countries, the Centers for Disease Control (CDC) Classification System is used.

Prevention

The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from
mother to fetus or child during perinatal period. It is possible to find HIV in the saliva, tears, and urine of infected
individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible

Alternative medicine

Various forms of alternative medicine have been used to treat symptoms or alter the course of the disease. Current
studies indicate that alternative medicine therapies have little effect on the mortality or morbidity of the disease,
but may improve the quality of life of individuals with AIDS. The psychological benefits of these therapies are the
most important use. Acupuncture has been used to alleviate some symptoms with no success and cannot cure the
HIV infection. Several randomized clinical trials testing the effect of herbal medicines have shown that there is no
evidence that these herbs have any effect on the progression of the disease, but may instead produce serious side-
effects.

Morbidity and mortality among HIV-infected adults with adequate dietary nutritional intake is unaffected by
multivitamin supplementation. A large Tanzanian trial in immunologically and nutritionally compromised pregnant
and lactating women showed a number of benefits to daily multivitamin supplementation for both mothers and
children. Dietary intake of micronutrients at RDA levels by HIV-infected adults is recommended by the World
Health Organization. There is some evidence that vitamin A supplementation in children reduces mortality and
improves growth. Daily doses of selenium can suppress HIV viral burden with an associated improvement of the
CD4 count. Selenium can be used as an adjunct therapy to standard antiviral treatments, but cannot itself reduce
mortality and morbidity

#3

What is Passive Immunity?

This occurs when antibodies are passed into your body from a source, other than yourself. For example, as a baby,
you can receive antibodies from your mother's milk, or even from the placenta, whilst still in utero. This is called
natural passive immunity. This type of immunity however, is only temporary, as the antibodies are removed by the
liver.

You can also achieve passive immunity artificially from an injection that you would receive for protection from
various conditions, such as tetanus. Again, this protection against disease is only temporary.

What is Active Immunity?

This is when the body creates its own antibodies after exposure to an antigen. Once exposed to infection, the body
begins an immune response. This process though, is slow, so you can begin to suffer symptoms of your illness,
unless of course, you have been exposed to the same antigen before, in which case your body's response is fast and
no - or only a few symptoms - may appear.

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Immunization (vaccination) is a way to trigger your immune system and prevent serious, life-threatening diseases.
Information

Our bodies are designed to protect us from infections. When you are exposed to a virus or bacteria, your immune
system actually learns from the experience. The next time your body is exposed to the same infection, your
immune system often recognizes it and sets out to destroy it.

Immunization exposes you to a very small, very safe amount of the most important infections. This exposure helps
your immune system recognize and attack the infection and prevent the disease it may cause. If you are exposed to
the full-blown disease later in life, you will either not become infected or have a much milder infection. This is a
natural way to deal with infectious diseases.

After immunizations were introduced on a wide scale, infections such as tetanus, diphtheria, mumps, measles,
pertussis (whooping cough), and polio became rare. Newer immunization have also decreased certain types of
meningitis, pneumonia, and ear infections in children.

Four different types of vaccines are currently available.

 Attenuated (weakened) live virus is used in the measles, mumps, and rubella (MMR) vaccine and the
varicella (chicken pox) vaccine. These vaccines may cause serious infections in people with weakened
immune systems.
 Killed (inactivated) viruses or bacteria are used in some vaccines, such as the influenza vaccine. These
vaccines are safe, even in people with weakened immune systems.
 Toxoid vaccines, such as the diphtheria or tetanus vaccines, contain a toxin or chemical made by the bacteria
or virus. They make you immune to the harmful effects of the infection rather than the infection itself.
 Biosynthetic vaccines contain human-made substances that the immune system thinks are infectious
organisms. The Hib (Haemophilus influenzae type B) conjugate vaccine is one example.
Immunizations for Your Baby Get the Facts

Beginning in the mid-1800s, development and wide-spread use of mass immunizations have all but eradicated
many diseases that previously killed thousands of children every year in the United States. But the fact that deaths
from common childhood diseases have dropped to almost nothing has created an unintended consequence: Many
young parents today never witness the impact of these killer diseases. Thus, today's Central Texas parents along
with others nationwide sometimes focus on the very small percentage of children with bad reactions and wonder
whether vaccinations recommended during the first year of life are worth the risk. Pediatrician Anna C. Bell, MD
of Children's Medical Group believes - emphatically - yes.

"Many believe that immunizations are the greatest medical success story of the past century. Diseases that used to
kill hundreds of thousands of children have been reduced to almost undetectable levels. We are able to protect
against 12 bacteria and viruses during the first year of life," says Dr. Bell."

She cautions that immunizations are not without side effects. "As with any medication given, there is potential for
a reaction. The most common side effects seen in babies after vaccinations are fever, fussiness, or fatigue. These
symptoms may last for a day or two and fully resolve without any complications. There can also be a little redness
or swelling at the injection site. More severe, but rare, reactions include a seizure or anaphylaxis reaction. For this
reason, immunizations are always administered under medical care where oxygen and emergency medications are
available. That being said, vaccinations are very safe and their proven benefits much outweigh the potential side
effects."

Parents often express concerns and have many questions: Should my child get immunizations? If so, when? Are
they safe? Why do they have to have them?
"Discuss any specific concerns or worries with your child's doctor. We are here as a resource for you and to help
you sort thorough all of the contradicting and often confusing information that is available," she advises.

Important First Year Immunizations

Immunizations commonly given to babies during the first year of life provide protection against 12 childhood
diseases that previously were associated with death and disability among children.

"Vaccines work by creating memory for the bodys immune system," says Dr. Bell. "Our immune system is a group
of cells and chemicals that fight infection. When the body is exposed to a bacteria or virus, the immune system
creates 'antibodies' that act as warriors to kill the foreign bacteria or virus. Most of the time this does not happen
quickly enough and the bacteria or virus is able to make us sick. Once the immune system is able to generate
enough antibodies that are able to kill off the foreign bacteria or virus, we 'fight off' the illness and recover.
Immunizations work to create a small 'army' of antibodies in advance of an infection that are ready and waiting
when the disease strikes. When the body first sees the slightest sign of that particular bacteria or virus, it is ready
and able to kill it off before any disease is caused. So, just by nature of how they work, vaccinations work to
strengthen the immune system."

Recommended first-year immunizations prevent:

Diphtheria -- Bacteria produces toxins in the body that destroy and infect the tissues of the respiratory tract. The
swelling and exudate that form can obstruct the airway causing respiratory failure. Treatable with antibiotics
depending on severity of infection.

Tetanus -- Bacteria creates muscles spasms and whole body rigidity. Muscles of the jaw and neck can become
very stiff. Seizures can occur. Spasms can continue 3 4 weeks and complete recovery may take months. Death is
caused by spasm of the muscles that interferes with breathing.
Pertussis -- Also known as whooping cough, bacteria causes infection leading to cold-like symptoms followed by
coughing attacks. Pneumonia is a common complication. Booster advised at age 10 and re-vaccination for adult
caregivers recommended.

Polio -- Virus infects the spinal cord causing paralysis. Highly contagious with almost 100 percent of unvaccinated
household contacts becoming infected by contact. Global polio eradication may be achieved during the next
decade.

Haemophilus influenzae type b (Hib) -- Bacterial infection that is often severe, particularly among infants.
Before immunization, it was the leading cause of bacterial meningitis among children and associated with other
invasive disease such as pneumonia, septic arthritis, epiglottitis and cellulitis. Infections that were not fatal
commonly resulted in life-long complications such as hearing impairment.

Pneumococcal disease -- the bacteria Streptococcus pneumoniae commonly causes infections such as pneumonia,
bacteria in the blood stream (bacteremia), and meningitis. The Prevnar vaccine was released in 2000 and illness
and death from the disease continues to decline. The highest rates of invasive disease occur among children
younger than 2 years.

Rotavirus -- Highly contagious virus causes severe diarrhea. It is most dangerous when it leads to dehydration and
infants are often hospitalized.

Hepatitis B -- Virus causes a liver infection that can lead to chronic hepatitis. It is transmitted by blood or sexual
content. Parents often question why it is given to babies, but an actual decline in chronic liver disease and cirrhosis
was achieved only after it was placed on the childhood immunization schedule. It is not associated with common
side effects for other vaccines.

Measles -- Highly contagious viral infection that was nearly universal before the vaccine was developed. Serious
complications can include brain swelling and seizures, pneumonia, nerve damage, and exposure during pregnancy.
Mumps -- Highly contagious viral infection that can cause meningitis and hearing loss. It sometimes causes
orchitis (testicular inflammation) in males which rarely leads to sterility. Deafness occurs in 1 per 20,000 cases, but
hearing loss on only side is associated in 80% of cases.

Rubella -- Highly contagious virus causes a rash, fatigue, and other nonspecific symptoms. The greatest benefit of
vaccination is life-long immunity that prevents transmission during pregnancy. If a baby is exposed to the rubella
virus in the womb, there is a high chance of Congenital Rubella Syndrome especially in the first trimester. It may
lead to fetal death, spontaneous abortion, premature delivery, deafness, eye defects, heart defects, and/or
neurologic damage.

Varicella -- Highly contagious viral infection commonly known as chickenpox. Virtually all people acquired the
disease prior to development of the vaccine. Commonly causes specific rash and fever. Complications including
secondary bacterial infections leading to blood stream infections, pneumonia and central nervous system
complications can occur.