Measles: A Highly Infectious Disease

Measles is a viral infection caused by an RNA paramyxovirus. It is one of the most infectious viruses known and is spread through aerosol transmission. The incubation period is 10-14 days, and the virus is infective from the prodromal phase until four days after the rash starts. Measles is now rare in developed countries due to immunization programs, but outbreaks can occur when vaccination rates drop.

The prodromal phase of measles is characterized by irritability, conjunctivitis, fever, and Koplik spots. These white spots on the buccal mucosa typically develop before the rash. The rash starts behind the ears and then spreads to the whole body, becoming a discrete maculopapular rash that may become blotchy and confluent. Desquamation may occur after a week, typically sparing the palms and soles. Diarrhea occurs in around 10% of patients.

Measles is mainly managed through supportive care, and admission may be considered for immunosuppressed or pregnant patients. It is a notifiable disease, and public health should be informed. Complications of measles include otitis media, pneumonia, encephalitis, subacute sclerosing panencephalitis, febrile convulsions, keratoconjunctivitis, corneal ulceration, diarrhea, increased incidence of appendicitis, and myocarditis.

If an unvaccinated child comes into contact with measles, MMR should be offered within 72 hours. Vaccine-induced measles antibody develops more rapidly than that following natural infection.

The man in question has sexually acquired reactive arthritis (SARA), which is likely an immune mediated phenomenon linked to uro-genital micro-organisms. It affects men more than women and typically affects one to six joints asymmetrically in lower limbs. It may be associated with conjunctivitis, iritis, circinate balanitis, tenosynovitis or enthesitis. The most common causative organism is Chlamydia trachomatis. ANA, HIV test, and rheumatoid factor are incorrect answers. Urethral swab for microscopy is the correct answer. An x-ray of the knee is also an incorrect answer.

Pick’s Disease: A Rare Form of Dementia

Pick’s disease is a type of dementia that is not commonly seen. It is characterized by the degeneration of the frontal and temporal lobes of the brain. The symptoms of this disease depend on the location of the lobar atrophy, with patients experiencing either frontal or temporal lobe syndromes. Those with frontal atrophy may exhibit early personality changes, while those with temporal lobe atrophy may experience aphasia and semantic memory impairment.

Pathologically, Pick’s disease is associated with Pick bodies, which are inclusion bodies found in the neuronal cytoplasm. These bodies are argyrophilic, meaning they have an affinity for silver staining. Unlike Alzheimer’s disease, EEG readings for Pick’s disease are relatively normal.

To learn more about Pick’s disease, the National Institute of Neurological Disorders and Stroke provides an information page on frontotemporal dementia. this rare form of dementia can help individuals and their loved ones better manage the symptoms and seek appropriate treatment.

Interpretation of Laboratory Tests in Suspected Vasculitis

When evaluating a patient with suspected vasculitis, certain laboratory tests can aid in establishing a diagnosis. A positive anti-nuclear antibody (ANA) result is typically present in systemic lupus erythematosus, while anti-neutrophil cytoplasmic antibodies (ANCA) should always be done in suspected systemic vasculitis. In polyarteritis nodosa and vasculitis associated with connective tissue disease, anti-cytoplasmic antibodies directed against myeloperoxidase will produce a perinuclear staining pattern, while a cytoplasmic pattern is likely in Granulomatosis with polyangiitis, indicating antibodies to proteinase-3. A positive hepatitis B surface antigen is associated with polyarteritis nodosa of medium and small arteries. However, polyclonal gammaglobulinaemia on serum protein electrophoresis would be expected in systemic inflammatory disease and does not aid diagnosis. The rest of the tests listed would give non-specific changes and not be helpful in establishing a diagnosis.

In a patient with necrotising vasculitis of the skin, kidneys, gut, and joints, along with systemic features of fever, malaise, and weight loss, the best diagnosis is likely polyarteritis nodosa associated with hepatitis B. The negative serology makes systemic lupus erythematosus less likely, while the negative serial blood cultures make endocarditis-related arthropathy less likely. Although rheumatoid factor is positive, there is no clear involvement of the proximal interphalangeal and metacarpophalangeal joints, which is common in rheumatoid arthritis. It is important to interpret laboratory tests in the context of the patient’s clinical presentation and consider the most likely diagnosis based on all available information.

Hyper-eosinophilic Syndrome: A Rare Myeloproliferative Disorder

Hyper-eosinophilic syndrome is a rare myeloproliferative disorder that primarily affects men in the 30-40-year-old age group. It is characterized by a persistent and significantly elevated eosinophil count in the peripheral blood. The syndrome may involve the lungs and cardiovascular system, leading to fibrosis, restrictive cardiomyopathy, and thrombus formation. Patients may also experience angioedema or urticaria. Treatment typically involves high-dose corticosteroids, which lead to a response in around 50% of cases. Steroid-sparing agents may also be used. Imatinib is the drug of choice for patients carrying the FIP1L1/PDGFRA mutation. Acute eosinophilic pneumonia has a more rapid onset of symptoms, while chronic pulmonary eosinophilia and chronic parasitic infection are less likely diagnoses. Churg-Strauss syndrome is characterized by asthma symptoms and other features not present in this case.

Acute Dystonic-Dyskinetic Reactions Caused by Excess Metoclopramide Dose

Acute dystonic-dyskinetic reactions are more common in children and young adults, with females accounting for about 70% of cases. These reactions are usually caused by an excess of the recommended dose of metoclopramide. Symptoms include oculogyric crisis, opisthotonus, torticollis, trismus, and tetanus-like reactions. In some cases, a blue discolouration of the tongue may also occur. The effects of the reaction can occur within 30 minutes to 72 hours of starting treatment. Although the reaction is generally self-limiting, it can be reversed by administering an anticholinergic such as benzatropine or procyclidine, or an antihistamine such as diphenhydramine.

Overall, it is important to be cautious when administering metoclopramide and to follow the recommended dosage guidelines to avoid the occurrence of acute dystonic-dyskinetic reactions.

Diagnosis and Treatment of Panhypopituitarism

This individual is diagnosed with panhypopituitarism and is currently receiving adequate replacement therapy. The results of his thyroid function tests indicate hypopituitarism, with a low thyroid-stimulating hormone. Treatment for this condition would involve monitoring his free thyroxine (T4) concentration.

The patient is experiencing symptoms such as tiredness, poor concentration, and weight gain, which suggest growth hormone (GH) deficiency. This is further supported by the low IGF-1 concentration. If confirmed through appropriate testing and AGHDA score, GH therapy would be the most appropriate treatment.

In summary, the diagnosis of panhypopituitarism requires careful monitoring and management of hormone replacement therapy. The symptoms experienced by the patient can guide the appropriate testing and treatment for GH deficiency. Close monitoring and management of hormone levels are essential for the patient’s overall health and well-being.

In ischaemic stroke, only blood pressure of >220/120 mmHg requires acute intervention. Lower blood pressures do not benefit from acute blood pressure lowering. Trials have shown no benefit or potential harm from active intervention on top of existing medication or continuing anti-hypertensives. Labetalol and nicardipine are first line agents for lowering blood pressure, while nitroprusside is a second line option.

Alcoholic liver disease is a range of conditions that includes alcoholic fatty liver disease, alcoholic hepatitis, and cirrhosis. When investigating this disease, gamma-GT levels are typically elevated, and a ratio of AST:ALT greater than 3 strongly suggests acute alcoholic hepatitis. In terms of management, glucocorticoids like prednisolone are often used during acute episodes of alcoholic hepatitis. Maddrey’s discriminant function is used to determine who would benefit from glucocorticoid therapy, and pentoxyphylline may also be used. The STOPAH study compared the effectiveness of pentoxyphylline and prednisolone and found that prednisolone improved survival at 28 days, while pentoxyphylline did not improve outcomes.

Antibiotic Selection in Patients with Glucose-6-Phosphate Dehydrogenase Deficiency

Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency are at risk of haemolysis when exposed to oxidants. G6PD is required for the generation of NADPH, which maintains glutathione in a reduced form necessary for the removal of oxidative metabolites. Antibiotic selection in these patients is crucial to avoid drugs that can trigger haemolysis.

Co-amoxiclav is a safe option for patients with G6PD deficiency. However, antibiotics such as ciprofloxacin, chloramphenicol, nitrofurantoin, and co-trimoxazole should be avoided. Quinolones, including ciprofloxacin, are no longer recommended for uncomplicated cystitis due to significant levels of resistance among urinary pathogens. Chloramphenicol is mainly used for infections resistant to other antibiotics, but it can lead to haemolysis in patients with G6PD deficiency. Nitrofurantoin, although effective in treating UTIs, should also be avoided. Co-trimoxazole is reserved for pneumocystis pneumonia and should be avoided in patients with G6PD deficiency.

In conclusion, antibiotic selection in patients with G6PD deficiency should be carefully considered to avoid haemolysis. Co-amoxiclav is a safe option, while ciprofloxacin, chloramphenicol, nitrofurantoin, and co-trimoxazole should be avoided.