This is a multisystem disease caused by the spirochetes Borrelia (B.) hermsii, B. turicatae, and B. parkeri. Borrelia recurrentis is confined to the Horn of Africa and causes louse-borne, epidemic relapsing fever. Other species of Borrelia causing the endemic tick-borne variety occur in pockets in Africa, South America, and Asia. Relapsing fever does not occur in the UK.
Causes
Relapsing fever is caused by bacteria known as spirochetes, closely related to the organisms that cause Lyme disease. The bacteria may be transmitted to humans by either ticks or lice. Within two weeks of infection, affected people develop sudden-onset high fever. In louse-borne relapsing fever, the initial episode usually lasts three to six days and is usually followed by a single, milder episode.
After several cycles of fever, some people may develop dramatic central nervous system signs such as seizures, stupor, and coma. The Borrelia organism may also invade heart and liver tissues, causing inflammation of the heart muscle (myocarditis) and inflammation of the liver (hepatitis). Diffuse bleeding and pneumonia are other complications of this illness. In the U.S., TBRF usually occurs west of the Mississippi River, particularly in the mountainous West and the high deserts and plains of the Southwest. In the mountains of California, Utah, Arizona, New Mexico, Colorado, Oregon, Washington, infections are usually caused by B. hermsii and are often acquired in cabins in forests. It is possible that the risk now extends into the southeastern United States.
Symptoms
Common symptoms are -
1. Repeating bouts of fever 2. Chills 3. Headache 4. Muscle and joint pain lasting 2 - 9 days
Treatment
The diagnosis can be confirmed by the presence of Borrelia in repeated thick and thin blood films of febrile patients stained with Giemsa or Wrights stain. More recently a quantitative buffy coat analysis has been shown to be both sensitive and specific in the diagnosis of relapsing fever. TBRF is easily treated with one to two weeks of antibiotics. Most individuals will lose their fever within 24 hours of antibiotic treatment and return to normal within a week. Long-term complications and death due to TBRF are extremely rare. The recommended treatment for patients is doxycycline at a dosage of 100 mg orally, twice daily for seven to 10 days, or tetracycline at a dosage of 500 mg, four times daily for seven to 10 days. When tetracycline is contraindicated a macrolide antibiotic may be prescribed. Penicillins are effective but should be given intravenously, especially when CNS involvement is suspected.
Psoriasis is believed to be an immune-mediated disease. Psoriasis is an inflammatory skin condition. Between 10% and 30% of people who develop psoriasis get a related form of arthritis called ?psoriatic arthritis,? which causes inflammation of the joints. Females develop plaque psoriasis earlier than males. Psoriasis usually occurs in adults. It is affected around 2% of the population in the UK. It sometimes runs in families. Several factors are thought to aggravate psoriasis. These include stress and excessive alcohol consumption. Individuals with psoriasis may suffer from depression and loss of self-esteem. As such, quality of life is an important factor in evaluating the severity of the disease. There also is a genetic component associated with psoriasis. Approximately one-third of people who develop psoriasis have at least one family member with the condition.
There are five types of Psoriasis Plaque psoriasis is the most common type of psoriasis. About 80% of people who develop psoriasis have plaque psoriasis, which appears as patches of raised, reddish skin covered by silvery-white scale. The first peak occurrence of plaque psoriasis is in people aged 16-22 years. The second peak is in people aged 57-60 years. These patches, or plaques, frequently form on the elbows, knees, lower back, and scalp. However, the plaques can occur anywhere on the body. The other types are guttate psoriasis (small, red spots on the skin), pustular psoriasis (white pustules surrounded by red skin), inverse psoriasis (smooth, red lesions form in skin folds), and erythrodermic psoriasis (widespread redness, severe itching, and pain). Regardless of type, psoriasis usually causes discomfort. The skin often itches, and it may crack and bleed
Causes of Psoriasis
1.Immune-mediated disorder.
2.Migrate to the dermis.
3.Trigger the release of cytokines (tumor necrosis factor-alpha TNFa.).
4.Stress (physical and mental).
5.Skin injury.
6.Streptococcal infection.
Symptoms of Psoriasis
1.Red patches of skin.
2.Small scaling spots.
3. Itching.
4.Burning.
5.Soreness.
6.Swollen and stiff joints.
Treatment of Psoriasis
There are 3 basic types of treatments for psoriasis: (1) topical therapy (drugs used on the skin), (2) phototherapy (light therapy), and (3) systemic therapy (drugs taken into the body). Vitamin D reduce skin inflammation and help prevent skin cells from reproducing. Vitamin D analogue that may be used alone to treat mild to moderate psoriasis.There can be substantial variation between individuals in the effectiveness of specific psoriasis treatments. Moisturizers help sooth affected skin and reduce the dryness which accompanies the build-up of skin on psoriatic plaques. Ointment and creams containing coal tar, dithranol (anthralin), corticosteroids, vitamin D3 analogues (for example, calcipotriol), and retinoids are routinely used. Some topical agents are used in conjunction with other therapies, especially phototherapy. Tazarotene (Tazorac) is a topical retinoid that is available as a gel or cream. Tazarotene reduces the size of the patches and the redness of the skin.
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