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Overview

Common childhood illness. Caused by a virus and results in a rash of blisters which are very itchy. It can occur in adults as well.

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How contagious is Chickenpox?

When symptoms first appear until the last blisters have crusted. Children with chickenpox should not go to school until at least 5 days after the rash disappears. Virus stays dormant in the nerve roots of the spine, so generally you cannot catch chickenpox virus again. However, virus can reactivate in later life to cause shingles.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Causes

• Caused by herpes virus – Varicella-zoster virus (VZV).
• Highly contagious.
• Easily passed between members of families and school classmates through airborne particles, droplets in exhaled air and fluid from the blisters or sores.
• Can be transmitted indirectly by contact with articles of clothing and other items exposed to fresh drainage from open sores.

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Signs and symptoms

• Symptoms tend to appear 14 to 16 days after initial exposure but can occur any time from 10 days up to 21 days after contact with the virus.
• First symptoms – mild fever, moderate fever, general unwell feeling.
• The rash of chickenpox develops in crops with raised red spots arriving first, progressing to blisters that burst, creating open sores, before crusting over.
• Rash first appear on the back and chest then spreads to face, neck, arms and legs. New spots can continue to appear for up to 5 days.

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Medicines

May help in relieve itch, fever and discomfort

• Calamine lotions or cream.
• Antihistamines – to reduce the itch (Ask a pharmacist for further advice).
• Oral paracetamol for fever.
• Drink plenty of fluids if blisters/ ulcers in the mouth and throat make swallowing painful.
• Antiviral may be given to reduce the systemic infection caused by herpes virus.
• Antiviral cream/gel can be applied locally on the body as well as on the mouth.

*Consult a pharmacist at Lovy Pharmacy when choosing a supplement for your condition.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Self-care

• Get as much rest as possible.
• Take plenty of fluids.
• Can relieve the itch by patting or gently smacking the lesions.
• Keeps nails short to reduce the risk of infection.
• Avoid contact with persons who have not had chickenpox or shingles while disease is still contagious.

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Preventing Chickenpox

Vaccines are available for immunization of children over 9 months of age and adults.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row]

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Overview

Each year, January is marked as the Cervical Health Awareness Month by the United States Congress who estimated 12,000 diagnoses of cervical cancer in the U.S annually. However, cervical cancer is one of the most preventable cancers today. Early detection and treatment of abnormal cell changes that occur in the cervix can prevent most cases of cervical cancers. Human papillomavirus, which is also known as HPV, commonly causes these cell mutation. Regular testing is encouraged in sexually active individuals to maintain cervical health.

At early stage of cervical cancer, it can be asymptomatic. Advanced cervical cancer may lead to abnormal bleeding or discharge, for instance, bleeding after sexual intercourse.

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What is HPV?

HPV is a group of more than 150 related viruses. Some types of HPV such as HPV type 6 and 11 can cause genital warts, while some other different types such as HPV type 16 & 18 can cause cervical cell changes that are linked to cervical cancer if early detection is failed. At least 40 types of HPV are found to infect genital areas of males and females as well as sexual intercouse routes including genital-to-anal and genital-to-oral contacts. Although HPV infections is usually harmless and most are cleared naturally within 1 to 2 years and yet, if it does not, the risk of cervical cancer development is increased over time.

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Screening Tests

In addition to HPV infections, some other factors can increase the chance of cervical cancer, for example, HIV-infection, multiple sexual partners, long term hormonal contraceptives (> 5 years) and having given birth to three or more children. [2] Hence, sexually active individuals are recommended to have tests done on regular basis.

• Pap test (or pap smear)
  Recommended for women aged 21-65 years old. The test looks for precancers, or in other words, cell changes on the cervix that might cause cervical cancer if it is not followed up appropriately. If your pap test result is normal, you are advisable to repeat the test every three years.
• HPV DNA test
  Looks for the casual virus that cause cell changes on the cervix. The test is recommended along with pap test for women aged 30 years old and above. If your test result is normal, you may repeat HPV DNA test in five years.

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HPV Vaccines

HPV vaccines function to prevent infection from both high risk HPV types that cause cervical cancer and low risk types that result in genital warts. Gardasil®️ and Cervarix®️ are currently available HPV vaccines. Healthcare professionals suggest that all females ages 9 to 26 should be vaccinated for early protection.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

	Gardasil®️	Cervarix®️
Gender (FDA-approved)	Female and male	Female only
HPV types	Type 6, 11, 16 & 18	Type 16 & 18
Suitable age (years old)	9 to 26	10 to 25
Contraindication(s)	Pregnant History of any life-threatening allergic reactions Moderate to severe illness
Dosing schedule	0, 2, 6 months	0, 1, 6 months

 

Tested in thousands of people in many coutries, both vaccines have proven to be safe and well tolerated; the most common side effect has been soreness at the injection site.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

References

• National Cervical Cancer Coalition. Cervical Health Awareness Month. http://www.nccc-online.org/hpvcervical-cancer/cervical-health-awareness-month/
• Centers for Disease Control and Prevention. Cervical Cancer Awareness. [6th Jan 2016]. http://www.cdc.gov/cancer/dcpc/resources/features/cervicalcancer/
• National Cervical Cancer Coalition. Ten things to Know About HPV and Cervical Cancer. [2015].
• Malaysia index of Medical Specialities (MIMS). http://www.mims.com/Malaysia/home/Index

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Epidemiology and Etiology

Age of onset
Children, adolescents, and young adults.

Sex
More common in boys.

Etiology
Most commonly MSSA. Community acquired MRSA becoming more common. Outbreaks of P. aeruginosa infections are associated with inadequately chlorinated pools, hot tubs, etc.

Predisposing factors

• Chronic S. aureus carrier state (nares, axillae, perineum, vagina).
• Diabetes Mellitus.
• Obesity.
• Poor hygiene.
• Immunocompromised.
• Hyper-IgE syndrome (Job’s syndrome).
• Corticosteroid use.

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Pathogenesis

Folliculitis, furuncles, and carbuncles represent a continuum of severity of S. aureus infection. Portal of entry: Hair follicle, break in the integrity of skin. MRSA infections often have high morbidity due to delay in administration of effective antibiotic. Control or eradication of carrier state treats / prevents folliculitis, furuncle, and carbuncle formation.

Infectious causes:

• S. aureus (most common).
• Streptococcus species.
• Mixed bacteria infection.

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Risk factors of Folliculitis

Local Trauma

• Abrasions.
• Surgical wounds or draining abscess.
• Shaving.

 

Aggravates S. Aureus Folliculitis

• Exposure to occlusive dressing.
• Tar.
• Adhesive plaster.
• Plastic occlusive dressing.

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Furuncles

Usually occur in areas of friction or perspiration. Lesion is usually a firm, tender, red nodule that becomes more painful and may drain pus.

• Known as abscess or boils.
• Usually start as folliculitis.
• Deep folliculitis – spread to deeper tissue

 

Walled off nodule of purulent infection:

• Painful.
• Firm or fluctuant.
• Fever is uncommon.
• Can be at any site.
• Most often in areas of friction.

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Carbuncles

• Broad, swollen, erythematous, deep, and painful masses, usually on the back of the neck.
• Patient with diabetes especially susceptible.
• Commonly associated with constitutional symptoms such as fever and chills.
• Bacteremia and spread are a risk.
• Uncommon in children

 

Carbuncle involves a coalition of furuncles:

• Deeper, more extensive involvement
• Require greater degree of debridement

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Management

• Antimicrobial treatment usually not necessary for smaller boils.
• Warm saline compresses to promote drainage.
• Incision and drainage may be required, especially for carbuncles.
• Topical antibiotics.
• Mupirocin (Bactroban) cream or ointment.
• Fucidin cream or ointment.
• Erythromycin 2% solution.
• Clindamycin Solution.
• To be applied two to three times a day for 7 to 10 days.
• Only applicable for smaller boils.
• Systemic antibiotics.
• Cloxacillin (covers methicillin-sensitive S. aureus [MSSA] and S. pyogenes):
  – Adults: 250–500 mg orally every 6 hours.
  – Pediatrics: 25–50 mg/kg orally divided into four doses.
• Cephalexin (covers MSSA and S. pyogenes)
  – Adults: 250–500 mg orally every 6 hours.
  – Pediatrics: 25–50 mg/kg orally divided into four doses.
• Clindamycin (covers MSSA, some CA-MRSA, and S. pyogenes)
  – Adults: 300–600 mg orally every 6–8 hours.
  – Pediatrics: 10–30 mg/kg/day orally divided into three or four doses.
  – Is an oral option for CA-MRSA, but is cross-resistant with erythromycin.
• Antimicrobial treatment should be for 7–10 days.

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Surgery

Incision and drainage are often adequate for treatment of abcesses, furuncles or carbuncles.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Recurrent Furunculosis

Usually related to persistent s. aureus in the nares, perineum, and body folds.

Topical Therapy 

Shower with povidone iodine soap. Apply mupirocin ointment daily to the inside of nares and other sites of s.aureus carriage.

Systemic Therapy

Appropriate antibiotic treatment is continued until all lesions have resolved. Secondary prophylaxis may be given once a day for many months.

Carrier State

Rifampicin: 600mg PO for 7 to 10 days for eradication of carrier state.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

References

• Stevens DL, Bisno AL, Chambers HF, et al. Prac­tice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005;41:1371–406.
• Liu C, Bayer A, Cosgrove E, et al. Clinical prac­tice guidelines by the Infectious Diseases Society of America for treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:1–38.
• Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med 1996;334:240–5.
• Tennvall GR, Apelqvist J, Eneroth M. Costs of deep foot infections in patients with diabetes mel­litus. Pharmacoeconomics 2000;18:225–38.
• Fitzpatrick’s. Color Atlas and Synopsis of Clinical Dermatology 5th edition. McGraw Hill New York 2005. Pg 586 – 560.

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