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What causes Glomerular Diseases ?

A number of different diseases can result in glomerular disease. It may be the direct result of an infection or a drug toxic to the kidneys, or it may result from a disease that affects the entire body, like diabetes or lupus. Many different kinds of diseases can cause swelling or scarring of the nephron or glomerulus. Sometimes glomerular disease is idiopathic, meaning that it occurs without an apparent associated disease. The categories presented below can overlap: that is, a disease might belong to two or more of the categories. For example, diabetic nephropathy is a form of glomerular disease that can be placed in two categories: systemic diseases, since diabetes itself is a systemic disease, and sclerotic diseases, because the specific damage done to the kidneys is associated with scarring. Autoimmune Diseases When the body's immune system functions properly, it creates proteinlike substances called antibodies and immunoglobulins to protect the body against invading organisms. In an autoimmune disease, the immune system creates autoantibodies, which are antibodies or immunoglobulins that attack the body itself. Autoimmune diseases may be systemic and affect many parts of the body, or they may affect only specific organs or regions. Systemic lupus erythematosus (SLE) affects many parts of the body: primarily the skin and joints, but also the kidneys. Because women are more likely to develop SLE than men, some researchers believe that a sexlinked genetic factor may play a part in making a person susceptible, although viral infection has also been implicated as a triggering factor. Lupus nephritis is the name given to the kidney disease caused by SLE, and it occurs when autoantibodies form or are deposited in the glomeruli, causing inflammation. Ultimately, the inflammation may create scars that keep the kidneys from functioning properly. Conventional treatment for lupus nephritis includes a combination of two drugs, cyclophosphamide, a cytotoxic agent that suppresses the immune system, and prednisolone, a corticosteroid used to reduce inflammation. A newer immunosuppressant, mychophenolate mofetil (MMF), has been used instead of cyclophosphamide. Preliminary studies indicate that MMF may be as effective as cyclophosphamide and has milder side effects. Goodpasture's Syndrome involves an autoantibody that specifically targets the kidneys and the lungs. Often, the first indication that patients have the autoantibody is when they cough up blood. But lung damage in Goodpasture's Syndrome is usually superficial compared with progressive and permanent damage to the kidneys. Goodpasture's Syndrome is a rare condition that affects mostly young men but also occurs in women, children, and older adults. Treatments include immunosuppressive drugs and a bloodcleaning therapy called plasmapheresis that removes the autoantibodies. IgA nephropathy is a form of glomerular disease that results when immunoglobulin A (IgA) forms deposits in the glomeruli, where it creates inflammation. IgA nephropathy was not recognized as a cause of glomerular disease until the late 1960s, when sophisticated biopsy techniques were developed that could identify IgA deposits in kidney tissue. The most common symptom of IgA nephropathy is blood in the urine, but it is often a silent disease that may go undetected for many years. The silent nature of the disease makes it difficult to determine how many people are in the early stages of IgA nephropathy, when specific medical tests are the only way to detect it. This disease is estimated to be the most common cause of primary glomerulonephritisthat is, glomerular disease not caused by a systemic disease like lupus or diabetes mellitus. It appears to affect men more than women. Although IgA nephropathy is found in all age groups, young people rarely display signs of kidney failure because the disease usually takes several years to progress to the stage where it causes detectable complications. No treatment is recommended for early or mild cases of IgA nephropathy when the patient has normal blood pressure and less than 1 gram of protein in a 24hour urine output. When proteinuria exceeds 1 gram/day, treatment is aimed at protecting kidney function by reducing proteinuria and controlling blood pressure. Blood pressure medicinesangiotensinconverting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs)that block a hormone called angiotensin are most effective at achieving those two goals simultaneously. Hereditary NephritisAlport Syndrome The primary indicator of Alport syndrome is a family history of chronic glomerular disease, although it may also involve hearing or vision impairment. This syndrome affects both men and women, but men are more likely to experience chronic kidney disease and sensory loss. Men with Alport syndrome usually first show evidence of renal insufficiency while in their twenties and reach total kidney failure by age 40. Women rarely have significant renal impairment, and hearing loss may be so slight that it can be detected only through testing with special equipment. Usually men can pass the disease only to their daughters. Women can transmit the disease to either their sons or their daughters. Treatment focuses on controlling blood pressure to maintain kidney function. Infectionrelated Glomerular Disease Glomerular disease sometimes develops rapidly after an infection in other parts of the body. Acute poststreptococcal glomerulonephritis (PSGN) can occur after an episode of strep throat or, in rare cases, impetigo (a skin infection). The Streptococcus bacteria do not attack the kidney directly, but an infection may stimulate the immune system to overproduce antibodies, which are circulated in the blood and finally deposited in the glomeruli, causing damage. PSGN can bring on sudden symptoms of swelling (edema), reduced urine output (oliguria), and blood in the urine (hematuria). Tests will show large amounts of protein in the urine and elevated levels of creatinine and urea nitrogen in the blood, thus indicating reduced kidney function. High blood pressure frequently accompanies reduced kidney function in this disease. PSGN is most common in children between the ages of 3 and 7, although it can strike at any age, and it most often affects boys. It lasts only a brief time and usually allows the kidneys to recover. In a few cases, however, kidney damage may be permanent, requiring dialysis or transplantation to replace renal function. Bacterial endocarditis, infection of the tissues inside the heart, is also associated with subsequent glomerular disease. Researchers are not sure whether the renal lesions that form after a heart infection are caused entirely by the immune response or whether some other disease mechanism contributes to kidney damage. Treating the heart infection is the most effective way of minimizing kidney damage. Endocarditis sometimes produces chronic kidney disease (CKD). HIV, the virus that leads to AIDS, can also cause glomerular disease. Between 5 and 10 percent of people with HIV experience kidney failure, even before developing fullblown AIDS. HIVassociated nephropathy usually begins with heavy proteinuria and progresses rapidly (within a year of detection) to total kidney failure. Researchers are looking for therapies that can slow down or reverse this rapid deterioration of renal function, but some possible solutions involving immunosuppression are risky because of the patients' already compromised immune system. Sclerotic Diseases Glomerulosclerosis is scarring (sclerosis) of the glomeruli. In several sclerotic conditions, a systemic disease like lupus or diabetes is responsible. Glomerulosclerosis is caused by the activation of glomerular cells to produce scar material. This may be stimulated by molecules called growth factors, which may be made by glomerular cells themselves or may be brought to the glomerulus by the circulating blood that enters the glomerular filter. Diabetic nephropathy is the leading cause of glomerular disease and of total kidney failure in the United States. Kidney disease is one of several problems caused by elevated levels of blood glucose, the central feature of diabetes. In addition to scarring the kidney, elevated glucose levels appear to increase the speed of blood flow into the kidney, putting a strain on the filtering glomeruli and raising blood pressure. Diabetic nephropathy usually takes many years to develop. People with diabetes can slow down damage to their kidneys by controlling their blood glucose through healthy eating with moderate protein intake, physical activity, and medications. People with diabetes should also be careful to keep their blood pressure at a level below 140/90 mm Hg, if possible. Blood pressure medications called ACE inhibitors and ARBs are particularly effective at minimizing kidney damage and are now frequently prescribed to control blood pressure in patients with diabetes and in patients with many forms of kidney disease. Focal segmental glomerulosclerosis (FSGS) describes scarring in scattered regions of the kidney, typically limited to one part of the glomerulus and to a minority of glomeruli in the affected region. FSGS may result from a systemic disorder or it may develop as an idiopathic kidney disease, without a known cause. Proteinuria is the most common symptom of FSGS, but, since proteinuria is associated with several other kidney conditions, the doctor cannot diagnose FSGS on the basis of proteinuria alone. Biopsy may confirm the presence of glomerular scarring if the tissue is taken from the affected section of the kidney. But finding the affected section is a matter of chance, especially early in the disease process, when lesions may be scattered. Confirming a diagnosis of FSGS may require repeat kidney biopsies. Arriving at a diagnosis of idiopathic FSGS requires the identification of focal scarring and the elimination of possible systemic causes such as diabetes or an immune response to infection. Since idiopathic FSGS is, by definition, of unknown cause, it is difficult to treat. No universal remedy has been found, and most patients with FSGS progress to total kidney failure over 5 to 20 years. Some patients with an aggressive form of FSGS reach total kidney failure in 2 to 3 years. Treatments involving steroids or other immunosuppressive drugs appear to help some patients by decreasing proteinuria and improving kidney function. But these treatments are beneficial to only a minority of those in whom they are tried, and some patients experience even poorer kidney function as a result. ACE inhibitors and ARBs may also be used in FSGS to decrease proteinuria. Treatment should focus on controlling blood pressure and blood cholesterol levels, factors that may contribute to kidney scarring. Other Glomerular Diseases Membranous nephropathy, also called membranous glomerulopathy, is the second most common cause of the nephrotic syndrome (proteinuria, edema, high cholesterol) in U.S. adults after diabetic nephropathy. Diagnosis of membranous nephropathy requires a kidney biopsy, which reveals unusual deposits of immunoglobulin G and complement C3, substances created by the body's immune system. Fully 75 percent of cases are idiopathic, which means that the cause of the disease is unknown. The remaining 25 percent of cases are the result of other diseases like systemic lupus erythematosus, hepatitis B or C infection, or some forms of cancer. Drug therapies involving penicillamine, gold, or captopril have also been associated with membranous nephropathy. About 20 to 40 percent of patients with membranous nephropathy progress, usually over decades, to total kidney failure, but most patients experience either complete remission or continued symptoms without progressive kidney failure. Doctors disagree about how aggressively to treat this condition, since about 20 percent of patients recover without treatment. ACE inhibitors and ARBs are generally used to reduce proteinuria. Additional medication to control high blood pressure and edema is frequently required. Some patients benefit from steroids, but this treatment does not work for everyone. Additional immunosuppressive medications are helpful for some patients with progressive disease. Minimal change disease (MCD) is the diagnosis given when a patient has the nephrotic syndrome and the kidney biopsy reveals little or no change to the structure of glomeruli or surrounding tissues when examined by a light microscope. Tiny drops of a fatty substance called a lipid may be present, but no scarring has taken place within the kidney. MCD may occur at any age, but it is most common in childhood. A small percentage of patients with idiopathic nephrotic syndrome do not respond to steroid therapy. For these patients, the doctor may recommend a lowsodium diet and prescribe a diuretic to control edema. The doctor may recommend the use of nonsteroidal antiinflammatory drugs to reduce proteinuria. ACE inhibitors and ARBs have also been used to reduce proteinuria in patients with steroidresistant MCD. These patients may respond to larger doses of steroids, more prolonged use of steroids, or steroids in combination with immunosuppressant drugs, such as chlorambucil, cyclophosphamide, or cyclosporine.

What causes Glomerular Diseases ?

A number of different diseases can result in glomerular disease. It may be the direct result of an infection or a drug toxic to the kidneys, or it may result from a disease that affects the entire body, like diabetes or lupus. Many different kinds of diseases can cause swelling or scarring of the nephron or glomerulus. Sometimes glomerular disease is idiopathic, meaning that it occurs without an apparent associated disease. The categories presented below can overlap: that is, a disease might belong to two or more of the categories. For example, diabetic nephropathy is a form of glomerular disease that can be placed in two categories: systemic diseases, since diabetes itself is a systemic disease, and sclerotic diseases, because the specific damage done to the kidneys is associated with scarring. Autoimmune Diseases When the body's immune system functions properly, it creates proteinlike substances called antibodies and immunoglobulins to protect the body against invading organisms. In an autoimmune disease, the immune system creates autoantibodies, which are antibodies or immunoglobulins that attack the body itself. Autoimmune diseases may be systemic and affect many parts of the body, or they may affect only specific organs or regions. Systemic lupus erythematosus (SLE) affects many parts of the body: primarily the skin and joints, but also the kidneys. Because women are more likely to develop SLE than men, some researchers believe that a sexlinked genetic factor may play a part in making a person susceptible, although viral infection has also been implicated as a triggering factor. Lupus nephritis is the name given to the kidney disease caused by SLE, and it occurs when autoantibodies form or are deposited in the glomeruli, causing inflammation. Ultimately, the inflammation may create scars that keep the kidneys from functioning properly. Conventional treatment for lupus nephritis includes a combination of two drugs, cyclophosphamide, a cytotoxic agent that suppresses the immune system, and prednisolone, a corticosteroid used to reduce inflammation. A newer immunosuppressant, mychophenolate mofetil (MMF), has been used instead of cyclophosphamide. Preliminary studies indicate that MMF may be as effective as cyclophosphamide and has milder side effects. Goodpasture's Syndrome involves an autoantibody that specifically targets the kidneys and the lungs. Often, the first indication that patients have the autoantibody is when they cough up blood. But lung damage in Goodpasture's Syndrome is usually superficial compared with progressive and permanent damage to the kidneys. Goodpasture's Syndrome is a rare condition that affects mostly young men but also occurs in women, children, and older adults. Treatments include immunosuppressive drugs and a bloodcleaning therapy called plasmapheresis that removes the autoantibodies. IgA nephropathy is a form of glomerular disease that results when immunoglobulin A (IgA) forms deposits in the glomeruli, where it creates inflammation. IgA nephropathy was not recognized as a cause of glomerular disease until the late 1960s, when sophisticated biopsy techniques were developed that could identify IgA deposits in kidney tissue. The most common symptom of IgA nephropathy is blood in the urine, but it is often a silent disease that may go undetected for many years. The silent nature of the disease makes it difficult to determine how many people are in the early stages of IgA nephropathy, when specific medical tests are the only way to detect it. This disease is estimated to be the most common cause of primary glomerulonephritisthat is, glomerular disease not caused by a systemic disease like lupus or diabetes mellitus. It appears to affect men more than women. Although IgA nephropathy is found in all age groups, young people rarely display signs of kidney failure because the disease usually takes several years to progress to the stage where it causes detectable complications. No treatment is recommended for early or mild cases of IgA nephropathy when the patient has normal blood pressure and less than 1 gram of protein in a 24hour urine output. When proteinuria exceeds 1 gram/day, treatment is aimed at protecting kidney function by reducing proteinuria and controlling blood pressure. Blood pressure medicinesangiotensinconverting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs)that block a hormone called angiotensin are most effective at achieving those two goals simultaneously. Hereditary NephritisAlport Syndrome The primary indicator of Alport syndrome is a family history of chronic glomerular disease, although it may also involve hearing or vision impairment. This syndrome affects both men and women, but men are more likely to experience chronic kidney disease and sensory loss. Men with Alport syndrome usually first show evidence of renal insufficiency while in their twenties and reach total kidney failure by age 40. Women rarely have significant renal impairment, and hearing loss may be so slight that it can be detected only through testing with special equipment. Usually men can pass the disease only to their daughters. Women can transmit the disease to either their sons or their daughters. Treatment focuses on controlling blood pressure to maintain kidney function. Infectionrelated Glomerular Disease Glomerular disease sometimes develops rapidly after an infection in other parts of the body. Acute poststreptococcal glomerulonephritis (PSGN) can occur after an episode of strep throat or, in rare cases, impetigo (a skin infection). The Streptococcus bacteria do not attack the kidney directly, but an infection may stimulate the immune system to overproduce antibodies, which are circulated in the blood and finally deposited in the glomeruli, causing damage. PSGN can bring on sudden symptoms of swelling (edema), reduced urine output (oliguria), and blood in the urine (hematuria). Tests will show large amounts of protein in the urine and elevated levels of creatinine and urea nitrogen in the blood, thus indicating reduced kidney function. High blood pressure frequently accompanies reduced kidney function in this disease. PSGN is most common in children between the ages of 3 and 7, although it can strike at any age, and it most often affects boys. It lasts only a brief time and usually allows the kidneys to recover. In a few cases, however, kidney damage may be permanent, requiring dialysis or transplantation to replace renal function. Bacterial endocarditis, infection of the tissues inside the heart, is also associated with subsequent glomerular disease. Researchers are not sure whether the renal lesions that form after a heart infection are caused entirely by the immune response or whether some other disease mechanism contributes to kidney damage. Treating the heart infection is the most effective way of minimizing kidney damage. Endocarditis sometimes produces chronic kidney disease (CKD). HIV, the virus that leads to AIDS, can also cause glomerular disease. Between 5 and 10 percent of people with HIV experience kidney failure, even before developing fullblown AIDS. HIVassociated nephropathy usually begins with heavy proteinuria and progresses rapidly (within a year of detection) to total kidney failure. Researchers are looking for therapies that can slow down or reverse this rapid deterioration of renal function, but some possible solutions involving immunosuppression are risky because of the patients' already compromised immune system. Sclerotic Diseases Glomerulosclerosis is scarring (sclerosis) of the glomeruli. In several sclerotic conditions, a systemic disease like lupus or diabetes is responsible. Glomerulosclerosis is caused by the activation of glomerular cells to produce scar material. This may be stimulated by molecules called growth factors, which may be made by glomerular cells themselves or may be brought to the glomerulus by the circulating blood that enters the glomerular filter. Diabetic nephropathy is the leading cause of glomerular disease and of total kidney failure in the United States. Kidney disease is one of several problems caused by elevated levels of blood glucose, the central feature of diabetes. In addition to scarring the kidney, elevated glucose levels appear to increase the speed of blood flow into the kidney, putting a strain on the filtering glomeruli and raising blood pressure. Diabetic nephropathy usually takes many years to develop. People with diabetes can slow down damage to their kidneys by controlling their blood glucose through healthy eating with moderate protein intake, physical activity, and medications. People with diabetes should also be careful to keep their blood pressure at a level below 140/90 mm Hg, if possible. Blood pressure medications called ACE inhibitors and ARBs are particularly effective at minimizing kidney damage and are now frequently prescribed to control blood pressure in patients with diabetes and in patients with many forms of kidney disease. Focal segmental glomerulosclerosis (FSGS) describes scarring in scattered regions of the kidney, typically limited to one part of the glomerulus and to a minority of glomeruli in the affected region. FSGS may result from a systemic disorder or it may develop as an idiopathic kidney disease, without a known cause. Proteinuria is the most common symptom of FSGS, but, since proteinuria is associated with several other kidney conditions, the doctor cannot diagnose FSGS on the basis of proteinuria alone. Biopsy may confirm the presence of glomerular scarring if the tissue is taken from the affected section of the kidney. But finding the affected section is a matter of chance, especially early in the disease process, when lesions may be scattered. Confirming a diagnosis of FSGS may require repeat kidney biopsies. Arriving at a diagnosis of idiopathic FSGS requires the identification of focal scarring and the elimination of possible systemic causes such as diabetes or an immune response to infection. Since idiopathic FSGS is, by definition, of unknown cause, it is difficult to treat. No universal remedy has been found, and most patients with FSGS progress to total kidney failure over 5 to 20 years. Some patients with an aggressive form of FSGS reach total kidney failure in 2 to 3 years. Treatments involving steroids or other immunosuppressive drugs appear to help some patients by decreasing proteinuria and improving kidney function. But these treatments are beneficial to only a minority of those in whom they are tried, and some patients experience even poorer kidney function as a result. ACE inhibitors and ARBs may also be used in FSGS to decrease proteinuria. Treatment should focus on controlling blood pressure and blood cholesterol levels, factors that may contribute to kidney scarring. Other Glomerular Diseases Membranous nephropathy, also called membranous glomerulopathy, is the second most common cause of the nephrotic syndrome (proteinuria, edema, high cholesterol) in U.S. adults after diabetic nephropathy. Diagnosis of membranous nephropathy requires a kidney biopsy, which reveals unusual deposits of immunoglobulin G and complement C3, substances created by the body's immune system. Fully 75 percent of cases are idiopathic, which means that the cause of the disease is unknown. The remaining 25 percent of cases are the result of other diseases like systemic lupus erythematosus, hepatitis B or C infection, or some forms of cancer. Drug therapies involving penicillamine, gold, or captopril have also been associated with membranous nephropathy. About 20 to 40 percent of patients with membranous nephropathy progress, usually over decades, to total kidney failure, but most patients experience either complete remission or continued symptoms without progressive kidney failure. Doctors disagree about how aggressively to treat this condition, since about 20 percent of patients recover without treatment. ACE inhibitors and ARBs are generally used to reduce proteinuria. Additional medication to control high blood pressure and edema is frequently required. Some patients benefit from steroids, but this treatment does not work for everyone. Additional immunosuppressive medications are helpful for some patients with progressive disease. Minimal change disease (MCD) is the diagnosis given when a patient has the nephrotic syndrome and the kidney biopsy reveals little or no change to the structure of glomeruli or surrounding tissues when examined by a light microscope. Tiny drops of a fatty substance called a lipid may be present, but no scarring has taken place within the kidney. MCD may occur at any age, but it is most common in childhood. A small percentage of patients with idiopathic nephrotic syndrome do not respond to steroid therapy. For these patients, the doctor may recommend a lowsodium diet and prescribe a diuretic to control edema. The doctor may recommend the use of nonsteroidal antiinflammatory drugs to reduce proteinuria. ACE inhibitors and ARBs have also been used to reduce proteinuria in patients with steroidresistant MCD. These patients may respond to larger doses of steroids, more prolonged use of steroids, or steroids in combination with immunosuppressant drugs, such as chlorambucil, cyclophosphamide, or cyclosporine.

What is (are) Glomerular Diseases ?

Renal failure is any acute or chronic loss of kidney function and is the term used when some kidney function remains. Total kidney failure, sometimes called endstage renal disease (ESRD), indicates permanent loss of kidney function. Depending on the form of glomerular disease, renal function may be lost in a matter of days or weeks or may deteriorate slowly and gradually over the course of decades. Acute Renal Failure A few forms of glomerular disease cause very rapid deterioration of kidney function. For example, PSGN can cause severe symptoms (hematuria, proteinuria, edema) within 2 to 3 weeks after a sore throat or skin infection develops. The patient may temporarily require dialysis to replace renal function. This rapid loss of kidney function is called acute renal failure (ARF). Although ARF can be lifethreatening while it lasts, kidney function usually returns after the cause of the kidney failure has been treated. In many patients, ARF is not associated with any permanent damage. However, some patients may recover from ARF and subsequently develop CKD. Chronic Kidney Disease Most forms of glomerular disease develop gradually, often causing no symptoms for many years. CKD is the slow, gradual loss of kidney function. Some forms of CKD can be controlled or slowed down. For example, diabetic nephropathy can be delayed by tightly controlling blood glucose levels and using ACE inhibitors and ARBs to reduce proteinuria and control blood pressure. But CKD cannot be cured. Partial loss of renal function means that some portion of the patient's nephrons have been scarred, and scarred nephrons cannot be repaired. In many cases, CKD leads to total kidney failure. Total Kidney Failure To stay alive, a patient with total kidney failure must go on dialysishemodialysis or peritoneal dialysisor receive a new kidney through transplantation. Patients with CKD who are approaching total kidney failure should learn as much about their treatment options as possible so they can make an informed decision when the time comes. With the help of dialysis or transplantation, many people continue to lead full, productive lives after reaching total kidney failure.

What to do for Glomerular Diseases ?

The kidneys filter waste and extra fluid from the blood. The filtering process takes place in the nephron, where microscopic blood vessel filters, called glomeruli, are attached to fluidcollecting tubules. A number of different disease processes can damage the glomeruli and thereby cause kidney failure. Glomerulonephritis and glomerulosclerosis are broad terms that include many forms of damage to the glomeruli. Some forms of kidney failure can be slowed down, but scarred glomeruli can never be repaired. Treatment for the early stages of kidney failure depends on the disease causing the damage. Early signs of kidney failure include blood or protein in the urine and swelling in the hands, feet, abdomen, or face. Kidney failure may be silent for many years. The Nephrotic Syndrome The nephrotic syndrome is a condition marked by very high levels of protein in the urine; low levels of protein in the blood; swelling, especially around the eyes, feet, and hands; and high cholesterol. The nephrotic syndrome is a set of symptoms, not a disease in itself. It can occur with many diseases, so prevention relies on controlling the diseases that cause it. Treatment of the nephrotic syndrome focuses on identifying and treating the underlying cause, if possible, and reducing high cholesterol, blood pressure, and protein in the urine through diet, medication, or both. The nephrotic syndrome may go away once the underlying cause, if known, is treated. However, often a kidney disease is the underlying cause and cannot be cured. In these cases, the kidneys may gradually lose their ability to filter wastes and excess water from the blood. If kidney failure occurs, the patient will need to be on dialysis or have a kidney transplant.

What to do for Glomerular Diseases ?

The kidneys filter waste and extra fluid from the blood. The filtering process takes place in the nephron, where microscopic blood vessel filters, called glomeruli, are attached to fluidcollecting tubules. A number of different disease processes can damage the glomeruli and thereby cause kidney failure. Glomerulonephritis and glomerulosclerosis are broad terms that include many forms of damage to the glomeruli. Some forms of kidney failure can be slowed down, but scarred glomeruli can never be repaired. Treatment for the early stages of kidney failure depends on the disease causing the damage. Early signs of kidney failure include blood or protein in the urine and swelling in the hands, feet, abdomen, or face. Kidney failure may be silent for many years. The Nephrotic Syndrome The nephrotic syndrome is a condition marked by very high levels of protein in the urine; low levels of protein in the blood; swelling, especially around the eyes, feet, and hands; and high cholesterol. The nephrotic syndrome is a set of symptoms, not a disease in itself. It can occur with many diseases, so prevention relies on controlling the diseases that cause it. Treatment of the nephrotic syndrome focuses on identifying and treating the underlying cause, if possible, and reducing high cholesterol, blood pressure, and protein in the urine through diet, medication, or both. The nephrotic syndrome may go away once the underlying cause, if known, is treated. However, often a kidney disease is the underlying cause and cannot be cured. In these cases, the kidneys may gradually lose their ability to filter wastes and excess water from the blood. If kidney failure occurs, the patient will need to be on dialysis or have a kidney transplant.

What is (are) High Blood Pressure and Kidney Disease ?

Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood, and high blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body. Factors that can increase this force include higher blood volume due to extra fluid in the blood and blood vessels that are narrow, stiff, or clogged. Blood pressure test results are written with two numbers separated by a slash. For example, a health care provider will write a blood pressure result as 120/80. A health care provider will say this blood pressure result as 120 over 80. The top number is called the systolic pressure and represents the pressure as the heart beats and pushes blood through the blood vessels. The bottom number is called the diastolic pressure and represents the pressure as blood vessels relax between heartbeats. Most people without chronic health conditions have a normal blood pressure if it stays below 120/80. Prehypertension is a systolic pressure of 120 to 139 or a diastolic pressure of 80 to 89. High blood pressure is a systolic pressure of 140 or above or a diastolic pressure of 90 or above.1 People should talk with their health care provider about their individual blood pressure goals and how often they should have their blood pressure checked.

What is (are) High Blood Pressure and Kidney Disease ?

The kidneys are two beanshaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. In men the urethra is long, while in women it is short. Kidneys work at the microscopic level. The kidney is not one large filter. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a twostep process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which sends needed minerals back to the bloodstream and removes wastes. The final product becomes urine.

What are the symptoms of High Blood Pressure and Kidney Disease ?

Most people with high blood pressure do not have symptoms. In rare cases, high blood pressure can cause headaches. Kidney disease also does not have symptoms in the early stages. A person may have swelling called edema, which happens when the kidneys cannot get rid of extra fluid and salt. Edema can occur in the legs, feet, or ankles and less often in the hands or face. Once kidney function decreases further, symptoms can include appetite loss nausea vomiting drowsiness or feeling tired trouble concentrating sleep problems increased or decreased urination generalized itching or numbness dry skin headaches weight loss darkened skin muscle cramps shortness of breath chest pain

How to diagnose High Blood Pressure and Kidney Disease ?

A health care provider diagnoses high blood pressure when multiple blood pressure testsoften repeated over several visits to a health care providers officeshow that a systolic blood pressure is consistently above 140 or a diastolic blood pressure is consistently above 90. Health care providers measure blood pressure with a blood pressure cuff. People can also buy blood pressure cuffs at discount chain stores and drugstores to monitor their blood pressure at home. Kidney disease is diagnosed with urine and blood tests. Urine Tests Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine. Albumin is a protein in the blood that can pass into the urine when the kidneys are damaged. A patient collects the urine sample in a special container in a health care providers office or a commercial facility. The office or facility tests the sample onsite or sends it to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color when blood or protein is present in urine. Urine albumintocreatinine ratio. A health care provider uses the albumin and creatinine measurement to determine the ratio between the albumin and creatinine in the urine. Creatinine is a waste product in the blood that is filtered in the kidneys and excreted in the urine. A urine albumintocreatinine ratio above 30 mg/g may be a sign of kidney disease. Blood Test A blood test involves having blood drawn at a health care providers office or a commercial facility and sending the sample to a lab for analysis. A health care provider may order a blood test to estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate (eGFR). The results of the test indicate the following: eGFR of 60 or above is in the normal range eGFR below 60 may indicate kidney damage eGFR of 15 or below may indicate kidney failure Get Screened for Kidney Disease Kidney disease, when found early, can be treated to prevent more serious disease and other complications. The National Kidney Foundation recommends people with high blood pressure receive the following regular screenings: blood pressure tests urine albumin eGFR Health care providers will help determine how often people with high blood pressure should be screened.

How to prevent High Blood Pressure and Kidney Disease ?

The best way to slow or prevent kidney disease from high blood pressure is to take steps to lower blood pressure. These steps include a combination of medication and lifestyle changes, such as healthy eating physical activity maintaining a healthy weight quitting smoking managing stress No matter what the cause of the kidney disease, high blood pressure can increase damage to the kidneys. People with kidney disease should keep their blood pressure below 140/90.4 Medication Medications that lower blood pressure can also significantly slow the progression of kidney disease. Two types of blood pressurelowering medications, angiotensinconverting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have been shown effective in slowing the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a health care provider may prescribe a diuretica medication that helps the kidneys remove fluid from the blood. A person may also need beta blockers, calcium channel blockers, and other blood pressure medications.

What to do for High Blood Pressure and Kidney Disease ?

Following a healthy eating plan can help lower blood pressure. A health care provider may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan. DASH focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in sodium, which often comes from salt. The DASH eating plan is low in fat and cholesterol features fatfree or lowfat milk and dairy products, fish, poultry, and nuts suggests less red meat, sweets, added sugars, and sugarcontaining beverages is rich in nutrients, protein, and fiber Read more about DASH at www.nhlbi.nih.gov/health/resources/heart/hbpdashindex.htm. A dietitian may also recommend this type of diet for people who have already developed kidney disease. A diet low in sodium and liquid intake can help reduce edema and lower blood pressure. Reducing saturated fat and cholesterol can help control high levels of lipids, or fats, in the blood. Health care providers may recommend that people with kidney disease eat moderate or reduced amounts of protein, though the benefits of reducing protein in a persons diet is still being researched. Proteins break down into waste products that the kidneys filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients. People with kidney disease who are on a restricted protein diet should be monitored with blood tests that can show low nutrient levels. In addition, consuming too much alcohol raises blood pressure, so people should limit alcoholic drinkstwo per day for men and one per day for women. A health care provider can help people change their diet to meet their individual needs. Physical Activity Regular physical activity can lower blood pressure and reduce the chances of other health problems. A health care provider can provide information about how much and what kinds of activity are safe. Most people should try to get at least 30 to 60 minutes of activity most or all days of the week. A person can do all physical activity at once or break up activities into shorter periods of at least 10 minutes each. Moderate activities include brisk walking, dancing, bowling, riding a bike, working in a garden, and cleaning the house. Body Weight People who are overweight or obese should aim to reduce their weight by 7 to 10 percent during the first year of treatment for high blood pressure. This amount of weight loss can lower the chance of health problems related to high blood pressure. Overweight is defined as a body mass index (BMI)a measurement of weight in relation to heightof 25 to 29. A BMI of 30 or higher is considered obese. A BMI lower than 25 is the goal for keeping blood pressure under control.5 Smoking People who smoke should quit. Smoking can damage blood vessels, raise the chance of high blood pressure, and worsen health problems related to high blood pressure. People with high blood pressure should talk with their health care provider about programs and products they can use to quit smoking. Stress Learning how to manage stress, relax, and cope with problems can improve emotional and physical health. Some activities that may help reduce stress include exercising practicing yoga or tai chi listening to music focusing on something calm or peaceful meditating

What to do for High Blood Pressure and Kidney Disease ?

Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood, and high blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body. High blood pressure can damage blood vessels in the kidneys, reducing their ability to work properly. When the force of blood flow is high, blood vessels stretch so blood flows more easily. Eventually, this stretching scars and weakens blood vessels throughout the body, including those in the kidneys. High blood pressure is the second leading cause of kidney failure in the United States after diabetes. A health care provider diagnoses high blood pressure when multiple blood pressure testsoften repeated over several visits to a health care providers officeshow that a systolic blood pressure is consistently above 140 or a diastolic blood pressure is consistently above 90. Kidney disease is diagnosed with urine and blood tests. The best way to slow or prevent kidney damage from high blood pressure is to take steps to lower blood pressure. These steps include a combination of medication and lifestyle changes, such as healthy eating physical activity maintaining a healthy weight quitting smoking managing stress No matter what the cause of the kidney disease, high blood pressure can increase damage to the kidneys. People with kidney disease should keep their blood pressure below 140/90.

What is (are) What I need to know about Cirrhosis ?

Cirrhosis* is scarring of the liver. Scar tissue forms because of injury or longterm disease. Scar tissue replaces healthy liver tissue and blocks the normal flow of blood through the liver. A healthy liver makes proteins helps fight infections cleans the blood helps digest food stores a form of sugar that your body uses for energy A liver with too much scar tissue cannot work properly. You cannot live without a liver that works. But early treatment can control symptoms and keep cirrhosis from getting worse. *See the Pronunciation Guide for tips on how to say the words in bold type.

What causes What I need to know about Cirrhosis ?

Causes of cirrhosis include heavy alcohol use some drugs, medicines, and harmful chemicals infections chronic hepatitis B, C, or Dviral infections that attack the liver autoimmune hepatitis, which causes the bodys immune system to destroy liver cells nonalcoholic fatty liver disease, which is often caused by obesity diseases that damage or destroy bile ductstubes that carry bile from the liver Some inherited diseasesdiseases that are passed from parent to childcan cause cirrhosis: hemochromatosis, a disease that causes iron to collect in the liver Wilson disease, a condition that causes copper to build up in the liver porphyria, a disorder that affects the skin, bone marrow, and liver

What are the symptoms of What I need to know about Cirrhosis ?

You may have no symptoms in the early stages of cirrhosis. As cirrhosis gets worse you may feel tired or weak lose your appetite feel sick to your stomach lose weight notice red, spidershaped blood vessels under your skin Cirrhosis can lead to other serious problems: You may bruise or bleed easily, or have nosebleeds. Bloating or swelling may occur as fluid builds up in your legs or abdomenthe area between your chest and hips. Fluid buildup in your legs is called edema; buildup in your abdomen is called ascites. Medicines, including those you can buy over the counter such as vitamins and herbal supplements, may have a stronger effect on you. Your liver does not break medicines down as quickly as a healthy liver would. Waste materials from food may build up in your blood or brain and cause confusion or difficulty thinking. Blood pressure may increase in the vein entering your liver, a condition called portal hypertension. Enlarged veins, called varices, may develop in your esophagus and stomach. Varices can bleed suddenly, causing you to throw up blood or pass blood in a bowel movement. Your kidneys may not work properly or may fail. Your skin and the whites of your eyes may turn yellow, a condition called jaundice. You may develop severe itching. You may develop gallstones. In the early stages, cirrhosis causes your liver to swell. Then, as more scar tissue replaces healthy tissue, your liver shrinks. A small number of people with cirrhosis also get liver cancer.

How to diagnose What I need to know about Cirrhosis ?

Your doctor will examine you and may perform blood tests to see whether your liver is working properly imaging tests, which may show the size of your liver and show swelling or shrinkage a liver biopsy, in which a doctor uses a needle to take a small piece of liver tissue to view with a microscope to look for scar tissue

What are the treatments for What I need to know about Cirrhosis ?

Once you have cirrhosis, nothing can make all the scar tissue go away. But treating the cause will keep cirrhosis from getting worse. For example, if cirrhosis is from heavy alcohol use, the treatment is to completely stop drinking alcohol. If cirrhosis is caused by hepatitis C, then the hepatitis C virus is treated with medicine. Your doctor will suggest treatment based on the cause of your cirrhosis and your symptoms. Being diagnosed early and carefully following a treatment plan can help many people with cirrhosis. In the late stages of cirrhosis, certain treatments may not be effective. In that case, your doctor will work with you to prevent or manage the problems that cirrhosis can cause. What if the cirrhosis treatment doesnt work? If too much scar tissue forms, your liver could fail. Then you will need a liver transplant. A liver transplant can return you to good health. For information about liver transplantation, see the booklet What I need to know about Liver Transplantation from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

What are the treatments for What I need to know about Cirrhosis ?

If too much scar tissue forms, your liver could fail. Then you will need a liver transplant. A liver transplant can return you to good health. For information about liver transplantation, see the booklet What I need to know about Liver Transplantation from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

How to prevent What I need to know about Cirrhosis ?

To prevent cirrhosis, see your doctor for treatment of your liver disease. Many of the causes of cirrhosis are treatable. Early treatment may prevent cirrhosis. try to keep your weight in the normal range. Being overweight can make several liver diseases worse. do not drink any alcohol. Alcohol can harm liver cells. Drinking large amounts of alcohol over many years is one of the major causes of cirrhosis. do not use illegal drugs, which can increase your chances of getting hepatitis B or hepatitis C. see your doctor if you have hepatitis. Treatments for hepatitis B, C, and D are available. If you are on treatment, carefully follow your treatment directions. if you have autoimmune hepatitis, take your medicines and have regular checkups as recommended by your doctor or a liver specialist.

What to do for What I need to know about Cirrhosis ?

Cirrhosis is scarring of the liver. Scar tissue replaces healthy liver tissue. Some common causes of cirrhosis include heavy alcohol use, hepatitis infections, and nonalcoholic fatty liver disease. In the early stages of cirrhosis, you may have no symptoms. As the disease gets worse, cirrhosis can cause serious problems. Once you have cirrhosis, nothing can make all the scar tissue go away. But treatment can prevent cirrhosis from getting worse. If too much scar tissue forms and your liver fails, you will need a liver transplant. You can take steps to prevent cirrhosis or keep it from getting worse.

What is (are) 4 Steps to Manage Your Diabetes for Life ?

What is diabetes? There are three main types of diabetes: Type 1 diabetes Your body does not make insulin. This is a problem because you need insulin to take the sugar (glucose) from the foods you eat and turn it into energy for your body. You need to take insulin every day to live. Type 2 diabetes Your body does not make or use insulin well. You may need to take pills or insulin to help control your diabetes. Type 2 is the most common type of diabetes. Gestational (jestTAYshunal) diabetes Some women get this kind of diabetes when they are pregnant. Most of the time, it goes away after the baby is born. But even if it goes away, these women and their children have a greater chance of getting diabetes later in life. You are the most important member of your health care team. You are the one who manages your diabetes day by day. Talk to your doctor about how you can best care for your diabetes to stay healthy. Some others who can help are: dentist diabetes doctor diabetes educator dietitian eye doctor foot doctor friends and family mental health counselor nurse nurse practitioner pharmacist social worker How to learn more about diabetes. Take classes to learn more about living with diabetes. To find a class, check with your health care team, hospital, or area health clinic. You can also search online. Join a support group inperson or online to get peer support with managing your diabetes. Read about diabetes online. Go to National Diabetes Education Program. Take diabetes seriously. You may have heard people say they have a touch of diabetes or that their sugar is a little high. These words suggest that diabetes is not a serious disease. That is not correct. Diabetes is serious, but you can learn to manage it. People with diabetes need to make healthy food choices, stay at a healthy weight, move more every day, and take their medicine even when they feel good. Its a lot to do. Its not easy, but its worth it! Why take care of your diabetes? Taking care of yourself and your diabetes can help you feel good today and in the future. When your blood sugar (glucose) is close to normal, you are likely to: have more energy be less tired and thirsty need to pass urine less often heal better have fewer skin or bladder infections You will also have less chance of having health problems caused by diabetes such as: heart attack or stroke eye problems that can lead to trouble seeing or going blind pain, tingling, or numbness in your hands and feet, also called nerve damage kidney problems that can cause your kidneys to stop working teeth and gum problems Actions you can take Ask your health care team what type of diabetes you have. Learn where you can go for support. Learn how caring for your diabetes helps you feel good today and in the future.

What is (are) Acanthamoeba - Granulomatous Amebic Encephalitis (GAE); Keratitis ?

Acanthamoeba is a microscopic, freeliving ameba (singlecelled living organism) commonly found in the environment that can cause rare, but severe, illness. Acanthamoeba causes three main types of illness involving the eye (Acanthamoeba keratitis), the brain and spinal cord (Granulomatous Encephalitis), and infections that can spread throughout the entire body (disseminated infection).

Who is at risk for Acanthamoeba - Granulomatous Amebic Encephalitis (GAE); Keratitis? ?

Acanthamoeba keratitis Acanthamoeba keratitis is a rare disease that can affect anyone, but is most common in individuals who wear contact lenses. In the United States, an estimated 85% of cases occur in contact lens users. The incidence of the disease in developed countries is approximately one to 33 cases per million contact lens wearers. For people who wear contact lenses, certain practices can increase the risk of getting Acanthamoeba keratitis: Storing and handling lenses improperly Disinfecting lenses improperly (such as using tap water or topping off solutions when cleaning the lenses or lens case) Swimming, using a hot tub, or showering while wearing lenses Coming into contact with contaminated water Having a history of trauma to the cornea Contact lens wearers who practice proper lens care and noncontact lens wearers can still develop the infection. For additional information on contact lens care and prevention of Acanthamoeba keratitis visit CDC’s web page on Prevention and Control. There have been no reports of Acanthamoeba keratitis being spread from one person to another. Granulomatous Amebic Encephalitis (GAE) Granulomatous Amebic Encephalitis (GAE) and disseminated infection are very rare forms of Acanthamoeba infection and primarily affect people with compromised immune systems. While unusual, disseminated infection can also affect healthy children and adults. Conditions that may increase a patient’s risk for GAE and disseminated infection include: AIDS Organ/Tissue transplant Steroids or excessive use of antibiotics Diabetes Mellitus Cancer Disorders in which white blood cells in the lymphatic tissue are overproduced or abnormal Disorders in which blood cells or blood clotting mechanisms do not function properly or are abnormal Liver cirrhosis Lupus

How to diagnose Acanthamoeba - Granulomatous Amebic Encephalitis (GAE); Keratitis ?

Early diagnosis is essential for effective treatment of Acanthamoeba keratitis. The infection is usually diagnosed by an eye specialist based on symptoms, growth of the ameba from a scraping of the eye, and/or seeing the ameba by a process called confocal microscopy. Granulomatous Amebic Encephalitis (GAE) and disseminated infection are more difficult to diagnose and are often at advanced stages when they are diagnosed. Tests useful in the diagnosis of GAE include brain scans, biopsies, or spinal taps. In disseminated disease, biopsy of the involved sites (e.g. , skin, sinuses) can be useful in diagnosis.

What are the treatments for Acanthamoeba - Granulomatous Amebic Encephalitis (GAE); Keratitis ?

Early diagnosis is essential for effective treatment of Acanthamoeba keratitis. Several prescription eye medications are available for treatment. However, the infection can be difficult to treat. The best treatment regimen for each patient should be determined by an eye doctor. If you suspect your eye may be infected with Acanthamoeba, see an eye doctor immediately. Skin infections that are caused by Acanthamoeba but have not spread to the central nervous system can be successfully treated. Because this is a serious infection and the people affected typically have weakened immune systems, early diagnosis offers the best chance at cure. Most cases of brain and spinal cord infection with Acanthamoeba (Granulomatous Amebic Encephalitis) are fatal.

How to prevent Acanthamoeba - Granulomatous Amebic Encephalitis (GAE); Keratitis ?

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What is (are) Parasites - Angiostrongyliasis (also known as Angiostrongylus Infection) ?

Angiostrongylus cantonensis is a parasitic worm of rats. It is also called the rat lungworm. The adult form of the parasite is found only in rodents. Infected rats pass larvae of the parasite in their feces. Snails and slugs get infected by ingesting the larvae. These larvae mature in snails and slugs but do not become adult worms. The life cycle is completed when rats eat infected snails or slugs and the larvae further mature to become adult worms.

Who is at risk for Parasites - Angiostrongyliasis (also known as Angiostrongylus Infection)? ?

Angiostrongylus cantonensis Angiostrongylus cantonensis, also known as the rat lungworm, is a parasitic nematode (worm) that is transmitted between rats and mollusks (such as slugs or snails) in its natural life cycle. Other animals that become infected such as freshwater shrimp, land crabs, frogs, and planarians of the genus Platydemus, are transport hosts that are not required for reproduction of the parasite but might be able to transmit infection to humans if eaten raw or undercooked. Humans are accidental hosts who do not transmit infection to others. Most cases of infection are diagnosed in Southeast Asia and the Pacific Basin, but the parasite has also been found in Australia, some areas of Africa, the Caribbean, Hawaii and Louisiana. Outbreaks of human angiostrongyliasis have involved a few to hundreds of persons; over 2,800 cases have been reported in the literature from approximately 30 countries. It is likely that the parasite has been spread by rats transported on ships and by the introduction of mollusks such as the giant African land snail (Achatina fulica). In addition, the semislug, Parmarion martensi (native of Southeast Asia)has spread in regions of Hawaii and is found to often be infected with A. cantonensis, and the freshwater snail Pomacea canaliculata (native of South America) has been introduced into Taiwan and China and has been implicated in outbreaks of disease in those countries. Risk factors for infection with A. cantonensis include the ingestion of raw or undercooked infected snails or slugs; or pieces of snails and slugs accidentally chopped up in vegetables, vegetable juices, or salads; or foods contaminated by the slime of infected snails or slugs. It is possible that ingestion of raw or undercooked transport hosts (freshwater shrimp, land crabs, frogs, etc. ) can result in human infection, though this is less certain. In addition, contamination of the hands during the preparation of uncooked infected snails or slugs could lead to ingestion of the parasite. Angiostrongylus costaricensis Angiostrongylus costaricensis is a parasitic nematode (worm) that resides in rodents and uses mollusks, such as slugs, as an intermediate host. Rats, such as the cotton rat, transmit the larvae through their feces. Slugs then ingest the larvae. Humans are accidental hosts of the parasite. The parasite is not able to complete its life cycle in humans and eventually dies in the abdomen. Human infection principally occurs in Latin America and the Caribbean, with a few cases suspected in the United States and in the Republic of Congo. The organism is also found in animals in the Southern U.S. (Texas). Risk factors for infection with A. costaricensis are not well established but are likely to be ingestion of infected slugs or raw vegetables or vegetable juices contaminated with slugs or their slime, which can contain A. costaricensis larvae. The infection of transport hosts, which are not essential to the lifecycle of the parasite, has not been identified and any role in human infection is not known, in contrast to A. cantonensis. Some reports have shown the case rate to be higher in children 6 to 12 years of age, males, and in persons of higher socioeconomic status. There has been one foodrelated outbreak in Guatemala that affected primarily adults.

How to diagnose Parasites - Angiostrongyliasis (also known as Angiostrongylus Infection) ?

Angiostrongylus cantonensis Diagnosing A. cantonensis infections can be difficult, in part because there are no readily available blood tests. Important clues that could lead to the diagnosis of infection are a history of travel to where the parasite is known to be found and ingestion of raw or undercooked snails, slugs, or possibly transport hosts (such as frogs, fresh water shrimp or land crabs) in those areas. A high level of eosinophils, a blood cell that can be elevated in the presence of a parasite, in the blood or in the fluid that surrounds the brain can be another important clue. Persons worried that they might be infected should consult their health care provider. Angiostrongylus costaricensis Diagnosing A. costaricensis infections can be difficult, in part because there are no readily available blood tests. Important clues that could lead to the diagnosis of infection are a history of travel to where the parasite is known to be found and ingestion of raw or undercooked slugs or food contaminated by infected slugs or their slime. A high blood level of eosinophils, a blood cell that can be elevated in the presence of a parasite, can be another important clue. Persons worried that they might be infected should consult their health care provider.

What are the treatments for Parasites - Angiostrongyliasis (also known as Angiostrongylus Infection) ?

Angiostrongylus cantonensis There is no specific treatment for A. cantonensis infection. There is some evidence that certain supportive treatments may reduce the severity of headache and the duration of symptoms. Persons with symptoms should consult their health care provider for more information. Angiostrongylus costaricensis There is no specific treatment for A. costaricensis infections. Most infections resolve spontaneously though sometime surgical treatment is necessary to removed portions of inflamed intestine. Persons with symptoms should consult their health care provider for more information.

How to prevent Parasites - Angiostrongyliasis (also known as Angiostrongylus Infection) ?

Angiostrongylus cantonensis Prevention of A. cantonensis infections involves educating persons residing in or traveling to areas where the parasite is found about not ingesting raw or undercooked snails and slugs, freshwater shrimp, land crabs, frogs, and monitor lizards, or potentially contaminated vegetables, or vegetable juice. Removing snails, slugs, and rats found near houses and gardens should also help reduce risk. Thoroughly washing hands and utensils after preparing raw snails or slugs is also recommended. Vegetables should be thoroughly washed if eaten raw. Angiostrongylus costaricensis Prevention of A. costaricensis infections involves educating persons residing in and traveling to areas where the parasite is known to be found about not ingesting raw or undercooked slugs or potentially contaminated vegetables or vegetable juices. Removing slugs and rats found near houses and gardens should help reduce risk. Thoroughly washing hands and utensils after preparing raw slugs is also recommended. Vegetables should be thoroughly washed if eaten raw.

what is yersiniosis for Yersinia ?

Yersiniosis is an infectious disease caused by a bacterium of the genus Yersinia. In the United States, most human illness is caused by one species, Y. enterocolitica. Infection with Y. enterocolitica can cause a variety of symptoms depending on the age of the person infected. Infection with Y. enterocolitica occurs most often in young children. Common symptoms in children are fever, abdominal pain, and diarrhea, which is often bloody. Symptoms typically develop 4 to 7 days after exposure and may last 1 to 3 weeks or longer. In older children and adults, rightsided abdominal pain and fever may be the predominant symptoms, and may be confused with appendicitis. In a small proportion of cases, complications such as skin rash, joint pains, or spread of bacteria to the bloodstream can occur.

how common is infection with y. enterocolitica for Yersinia ?

Y. enterocolitica is a relatively infrequent cause of diarrhea and abdominal pain. Based on data from the Foodborne Diseases Active Surveillance Network (FoodNet), which measures the burden and sources of specific diseases over time, approximately one cultureconfirmed Y. enterocolitica infection per 100,000 persons occurs each year. Children are infected more often than adults, and the infection is more common in the winter.

how can y. enterocolitica infections be diagnosed for Yersinia ?

Y. enterocolitica infections are generally diagnosed by detecting the organism in the stools. Many laboratories do not routinely test for Y. enterocolitica,so it is important to notify laboratory personnel when infection with this bacterium is suspected so that special tests can be done. The organism can also be recovered from other sites, including the throat, lymph nodes, joint fluid, urine, bile, and blood.

how can y. enterocolitica infections be treated for Yersinia ?

Uncomplicated cases of diarrhea due to Y. enterocolitica usually resolve on their own without antibiotic treatment. However, in more severe or complicated infections, antibiotics such as aminoglycosides, doxycycline, trimethoprimsulfamethoxazole, or fluoroquinolones may be useful.

what are public health agencies doing to prevent or control yersiniosis for Yersinia ?

The Centers for Disease Control and Prevention (CDC) monitors the frequency of Y. enterocolitica infections through the foodborne disease active surveillance network (FoodNet). In addition, CDC conducts investigations of outbreaks of yersiniosis to control them and to learn more about how to prevent these infections. CDC has collaborated in an educational campaign to increase public awareness about prevention of Y. enterocolitica infections. The U.S. Food and Drug Administration inspects imported foods and milk pasteurization plants and promotes better food preparation techniques in restaurants and food processing plants. The U.S. Department of Agriculture monitors the health of food animals and is responsible for the quality of slaughtered and processed meat. The U.S. Environmental Protection Agency regulates and monitors the safety of our drinking water supplies.

What is (are) Yellow Fever Vaccination ?

If you continue to live or travel in yellow feverendemic areas, you should receive a booster dose of yellow fever vaccine after 10 years. After receiving the vaccine, you should receive an International Certificate of Vaccination (yellow card) that has been validated by the vaccination center. This Certificate becomes valid 10 days after vaccination and lasts for 10 years. You will need this card as proof of vaccination to enter certain countries.

What are the symptoms of Anaplasmosis ?

Anaplasmosis is a disease caused by the bacterium Anaplasma phagocytophilium. This pathogen is transmitted to humans by the bite of an infected tick. The blacklegged tick (Ixodes scapularis) is the vector of A. phagocytophilum in the northeast and upper midwestern United States. The western blacklegged tick (Ixodes pacificus) is the primary vector in Northern California. The first symptoms of anaplasmosis typically begin within 12 weeks after the bite of an infected tick. A tick bite is usually painless, and some patients who develop anaplasmosis do not remember being bitten. The following is a list of symptoms commonly seen with this disease. However, it is important to note that few people with the disease will develop all symptoms, and the number and combination of symptoms varies greatly from person to person. Fever Headache Muscle pain Malaise Chills Nausea / Abdominal pain Cough Confusion Rash (rare with anaplasmosis) Anaplasmosis can be a serious illness that can be fatal if not treated correctly, even in previously healthy people. Severe clinical presentations may include difficulty breathing, hemorrhage, renal failure or neurological problems. The estimated case fatality rate (i.e., the proportion of persons who die as a result of their infection) is less than 1%. Patients who are treated early may recover quickly on outpatient medication, while those who experience a more severe course may require intravenous antibiotics, prolonged hospitalization or intensive care. Rash Rash is rarely reported in patients with anaplasmosis and the presence of a rash may signify that the patient has a coinfection with the pathogen that causes Lyme disease or another tickborne disease, such as Rocky Mountain Spotted Fever . Immunecompromised Individuals The severity of anaplasmosis may depend in part on the immune status of the patient. Persons with compromised immunity caused by immunosuppressive therapies (e.g., corticosteroids, cancer chemotherapy, or longterm immunosuppressive therapy following organ transplant), HIV infection, or splenectomy appear to develop more severe disease, and casefatality rates for these individuals are characteristically higher than casefatality rates reported for the general population. Blood Transfusion and Organ Transplant Risks Associated with Anaplasma species Because A. phagocytophilum infects the white blood cells and circulates in the blood stream, this pathogen may pose a risk to be transmitted through blood transfusions. Anaplasma phagocytophilum has been shown to survive for more than a week in refrigerated blood. Several cases of anaplasmosis have been reported associated with the transfusion of packed red blood cells donated from asymptomatic or acutely infected donors. Patients who develop anaplasmosis within a month of receiving a blood transfusion or solid organ transplant should be reported to state health officials for prompt investigation. Use of leukoreduced blood products may theoretically decrease the risk of transfusionassociated transmission of these pathogens. However, the filtration process does not remove all leukocytes or bacteria not associated with leukocytes from leukoreduced blood. Therefore, while this process may reduce the risk of transmission, it does not eliminate it completely. Physician Diagnosis There are several aspects of anaplasmosis that make it challenging for healthcare providers to diagnose and treat. The symptoms vary from patient to patient and can be difficult to distinguish from other diseases. Treatment is more likely to be effective if started early in the course of disease. Diagnostic tests based on the detection of antibodies will frequently appear negative in the first 710 days of illness. For this reason, healthcare providers must use their judgment to treat patients based on clinical suspicion alone. Healthcare providers may find important information in the patient’s history and physical examination that may aid clinical diagnosis. Information such as recent tick bites, exposure to areas where ticks are likely to be found, or history of recent travel to areas where anaplasmosis is endemic can be helpful in making the diagnosis. The healthcare provider should also look at routine blood tests, such as a complete blood cell count or a chemistry panel. Clues such as a low platelet count (thrombocytopenia), low white blood cell count (leukopenia), or elevated liver enzyme levels are helpful predictors of anaplasmosis, but may not be present in all patients. After a suspect diagnosis is made on clinical suspicion and treatment has begun, specialized laboratory testing should be used to confirm the diagnosis of anaplasmosis. Laboratory Detection During the acute phase of illness, a sample of whole blood can be tested by polymerase chain reaction (PCR) assay to determine if a patient has anaplasmosis. This method is most sensitive in the first week of illness, and rapidly decreases in sensitivity following the administration of appropriate antibiotics. Although a positive PCR result is helpful, a negative result does not completely rule out the diagnosis, and treatment should not be with held due to a negative result. During the first week of illness a microscopic examination of blood smears (known as a peripheral blood smear) may reveal morulae (microcolonies of anaplasma) in the cytoplasm of white blood cells in up to 20% of patients. During A. phagocytophilum infection, morulae are most frequently observed in granulocytes. However, the observance of morulae in a particular cell type cannot conclusively identify the infecting species. Culture isolation of A. phagocytophilum is only available at specialized laboratories; routine hospital blood cultures cannot detect the organism. Figure 1: Morulae detected in a granulocyte on a peripheral blood smear, associated with A. phagocytophilum infection. When a person develops anaplasmosis, their immune system produces antibodies to A. phagocytophilum, with detectable antibody titers usually observed by 710 days after illness onset. It is important to note that a negative test during the first week of illness does not rule out anaplasmosis as a cause of illness. The gold standard serologic test for diagnosis of anaplasmosis is the indirect immunofluorescence assay (IFA) using A. phagocytophilum antigen, performed on paired serum samples to demonstrate a significant (fourfold) rise in antibody titers. The first sample should be taken as early in the disease as possible, preferably in the first week of symptoms, and the second sample should be taken 2 to 4 weeks later. In most cases of anaplasmosis, the first IgG IFA titer is typically low, or “negative,” and the second typically shows a significant (fourfold) increase in IgG antibody levels. IgM antibodies usually rise at the same time as IgG near the end of the first week of illness and remain elevated for months or longer. Also, IgM antibodies are less specific than IgG antibodies and more likely to result in a false positive. For these reasons, physicians requesting IgM serologic titers should also request a concurrent IgG titer. Serologic tests based on enzyme immunoassay (EIA) technology are available from some commercial laboratories. However, EIA tests are qualitative rather than quantitative, meaning they only provide a positive/negative result, and are less useful to measure changes in antibody titers between paired specimens. Furthermore, some EIA assays rely on the evaluation of IgM antibody alone, which may have a higher frequency of false positive results. Antibodies to A. phagocytophilum may remain elevated for months or longer after the disease has resolved, or may be detected in persons who were previously exposed to antigenically related organisms. Between 510% of currently healthy people in some areas may have elevated antibody titers due to past exposure to A. phagocytophilum or similar organisms. Therefore, if only one sample is tested it can be difficult to interpret, while paired samples taken weeks apart demonstrating a significant (fourfold) rise in antibody titer provides the best evidence for a correct diagnosis of anaplasmosis. For more indepth information about the diagnosis of anaplasmosis, please visit http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5504a1.htm Treatment Doxycycline is the first line treatment for adults and children of all ages and should be initiated immediately whenever anaplasmosis is suspected. Use of antibiotics other than doxycycline or other tetracyclines has been associated with a higher risk of fatal outcome for some rickettsial infections. Doxycycline is most effective at preventing severe complications from developing if it is started early in the course of disease. Therefore, treatment must be based on clinical suspicion alone and should always begin before laboratory results return. If the patient is treated within the first 5 days of the disease, fever generally subsides within 2472 hours. In fact, failure to respond to doxycycline suggests that the patient’s condition might not be due to anaplasmosis. Severely ill patients may require longer periods before their fever resolves. Resistance to doxcycline or relapses in symptoms after the completion of the recommended course have not been documented. Recommended Dosage Doxycycline is the first line treatment for adults and children of all ages: Adults: 100 mg every 12 hours Children under 45 kg (100 lbs): 2.2 mg/kg body weight given twice a day Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement. Standard duration of treatment is 7 to 14 days. Some patients may continue to experience headache, weakness and malaise for weeks after adequate treatment. Treating children The use of doxycycline to treat suspected anaplasmosis in children is standard practice recommended by both CDC and the AAP Committee on Infectious Diseases. Unlike older generations of tetracyclines, the recommended dose and duration of medication needed to treat anaplasmosis has not been shown to cause staining of permanent teeth, even when five courses are given before the age of eight. Healthcare providers should use doxycycline as the firstline treatment for suspected anaplasmosis in patients of all ages. Other Treatments In cases of life threatening allergies to doxycycline and in some pregnant patients for whom the clinical course of anaplasmosis appears mild, physicians may need to consider alternate antibiotics. Although recommended as a secondline therapeutic alternative to treat Rocky Mountain Spotted Fever , chloramphenicol is not recommended for the treatment of anaplasmosis, as studies have shown a lack of efficacy. Rifampin has been used successfully in several pregnant women with anaplasmosis, and studies suggest that this drug appears effective against Anaplasma species. However, rifampin is not effective in treating RMSF, a disease that may be confused with anaplasmosis. Healthcare providers should be cautious when exploring treatments other than doxycycline, which is highly effective in treating both. Other antibiotics, including broad spectrum antibiotics are not considered highly effective against A. phagocytophilum, and the use of sulfa drugs during acute illness may worsen the severity of infection. Prophylaxis (Preventive Treatment) Antibiotic treatment following a tick bite is not recommended as a means to prevent anaplasmosis. There is no evidence this practice is effective, and this may simply delay onset of disease. Instead, persons who experience a tick bite should be alert for symptoms suggestive of tickborne illness and consult a physician if fever, rash, or other symptoms of concern develop. For more indepth information about treatment, please visit http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5504a1.htm Other Considerations The clinical presentation for anaplasmosis can resemble other tickborne diseases, such as Rocky Mountain Spotted Fever and ehrlichiosis. Similar to anaplasmosis, these infections respond well to treatment with doxycycline. Healthcare providers should order diagnostic tests for additional agents if the clinical history and geographic association warrant. For more indepth about other similar tickborne diseases, please visit http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5504a1.htm .

What is (are) Anaplasmosis ?

More detailed information on the diagnosis, management, and treatment of anaplasmosis is available in Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever, Ehrlichioses, and Anaplasmosis – United States. *Case definitions have been updated since publication How to Contact the Rickettsial Zoonoses Branch at CDC The general public and healthcare providers should first call 1800CDCINFO (18002324636) for questions regarding RMSF and other rickettsial diseases. If a consultation with a CDC scientist specializing in rickettsial diseases is advised, your call will be appropriately forwarded. Case Definitions 2008 Case Definition Case Report Forms For confirmed and probable cases of anaplasmosis that have been identified and reported through the National Notifiable Disease Surveillance System, states are also encouraged to submit additional information using the CDC Case Report Form (CRF). This form collects additional important information that routine electronic reporting does not, such as information on how the diagnosis was made, and whether the patient was hospitalized or died. If a different statespecific form is already used to collect this information, this information may be submitted to CDC in lieu of a CRF. 2010 CDC Case Report Form: Tickborne Rickettsial Diseases (2010 version) [PDF – 3 pages] How to Submit Specimens to CDC for RMSF Testing Private citizens may not directly submit specimens to CDC for testing. If you feel that diagnostic testing is necessary, consult your healthcare provider or state health department. State Health Departments Specimens may be submitted to CDC for testing for anaplasmosis. To coordinate specimen submission, please call 4046391075 during business hours (8:00 4:30 ET). U.S. Healthcare Providers: U.S. healthcare providers should not submit specimens for testing directly to CDC. CDC policy requires that specimens for testing be submitted through or with the approval of the state health department. Please contact your state health department, who will assist you with specimen submission and reporting of infection. For general questions about anaplasmosis, please call 1800CDCINFO (18002324636). If you have questions about a suspect ehrlichiosis case, please first consult your state health department. Healthcare providers requiring an epidemiologic or laboratory consultation on anaplasmosis may also call 4046391075 during business hours (8:00 4:30 ET). Or 7704887100 after hours. Non U.S. Healthcare Providers: NonU.S. healthcare providers should consult CDC prior to submitting specimens for testing. For general questions about anaplasmosis, please call 1800CDCINFO (18002324636). If you would like to discuss a suspect anaplasmosis case with CDC, please call 4046391075 during business hours (8:00 4:30 ET), or 7704887100 after hours.

Who is at risk for Hendra Virus Disease (HeV)? ?

Transmission of Hendra virus to humans can occur after exposure to body fluids and tissues or excretions of horses infected with Hendra virus. Horses may be infected after exposure to virus in the urine of infected flying foxes. To date, no humantohuman transmission has been documented.

What are the symptoms of Hendra Virus Disease (HeV) ?

After an incubation of 916 days, infection with Hendra virus can lead to respiratory illness with severe flulike signs and symptoms. In some cases, illness may progress to encephalitis. Although infection with Hendra virus is rare, the case fatality is high: 4/7 (57%).

Who is at risk for Hendra Virus Disease (HeV)? ?

Australia’s “Flying fox” bats (genus Pteropus) are the natural reservoir of Hendra virus. Serologic evidence for HeV infection have been found in all fours species of Australian flying foxes, but spillover of the virus in horses is limited to coastal and forested regions in Australia (Queensland and New South Wales states) (see Henipavirus Distribution Map). People at highest risk are those living within the distribution of the flying foxes and with occupational or recreational exposure to horses that have had potential contact with flying foxes in Australia.

How to diagnose Hendra Virus Disease (HeV) ?

Laboratory tests that are used to diagnose Hendra virus (HV) and Nipah virus (NV) include detection of antibody by ELISA (IgG and IgM), real time polymerase chain reaction (RTPCR), and virus isolation attempts. In most countries, handling Hendra virus needs to be done in high containment laboratories. Laboratory diagnosis of a patient with a clinical history of HV or NV can be made during the acute and convalescent phase of the disease by using a combination of tests including detection of antibody in the serum or the cerebrospinal fluid (CSF), viral RNA detection (RTPCR) in the serum, CSF, or throat swabs, and virus isolation from the CSF or throat swabs.

What are the treatments for Hendra Virus Disease (HeV) ?

The drug ribavirin has been shown to be effective against the viruses in vitro, but the clinical usefulness of this drug is uncertain. A postexposure therapy with a Nipah/Hendra neutralizing antibody, efficacious in animal models is in human preclinical development stages in Australia.

How to prevent Hendra Virus Disease (HeV) ?

The occurrence of the disease in humans has been associated only with infection of an intermediate species such as horses. Early recognition of the disease in the intermediate animal host is probably the most crucial means of limiting future human cases. Hendra virus infection can be prevented by avoiding horses that are ill or may be infected with HeV and using appropriate personal protective equipment when contact is necessary, as in veterinary procedures. A commercial vaccine has been recently licensed in Australia for horses and could be beneficial for other animal species and eventually humans.

What is (are) Parasites - Lice - Head Lice ?

The head louse, or Pediculus humanus capitis, is a parasitic insect that can be found on the head, eyebrows, and eyelashes of people. Head lice feed on human blood several times a day and live close to the human scalp. Head lice are not known to spread disease.

Who is at risk for Parasites - Lice - Head Lice? ?

In the United States, infestation with head lice (Pediculus humanus capitis) is most common among preschool and elementary schoolage children and their household members and caretakers. Head lice are not known to transmit disease; however, secondary bacterial infection of the skin resulting from scratching can occur with any lice infestation. Getting head lice is not related to cleanliness of the person or his or her environment. Head lice are mainly spread by direct contact with the hair of an infested person. The most common way to get head lice is by headtohead contact with a person who already has head lice. Such contact can be common among children during play at: school, home, and elsewhere (e.g., sports activities, playgrounds, camp, and slumber parties). Uncommonly, transmission may occur by: wearing clothing, such as hats, scarves, coats, sports uniforms, or hair ribbons worn by an infested person; using infested combs, brushes or towels; or lying on a bed, couch, pillow, carpet, or stuffed animal that has recently been in contact with an infested person. Reliable data on how many people get head lice each year in the United States are not available; however, an estimated 6 million to 12 million infestations occur each year in the United States among children 3 to 11 years of age. Some studies suggest that girls get head lice more often than boys, probably due to more frequent headtohead contact. In the United States, infestation with head lice is much less common among AfricanAmericans than among persons of other races. The head louse found most frequently in the United States may have claws that are better adapted for grasping the shape and width of some types of hair but not others.

How to diagnose Parasites - Lice - Head Lice ?

Misdiagnosis of head lice infestation is common. The diagnosis of head lice infestation is best made by finding a live nymph or adult louse on the scalp or hair of a person. Because adult and nymph lice are very small, move quickly, and avoid light, they may be difficult to find. Use of a finetoothed louse comb may facilitate identification of live lice. If crawling lice are not seen, finding nits attached firmly within ¼ inch of the base of hair shafts suggests, but does not confirm, the person is infested. Nits frequently are seen on hair behind the ears and near the back of the neck. Nits that are attached more than ¼ inch from the base of the hair shaft are almost always nonviable (hatched or dead). Head lice and nits can be visible with the naked eye, although use of a magnifying lens may be necessary to find crawling lice or to identify a developing nymph inside a viable nit. Nits are often confused with other particles found in hair such as dandruff, hair spray droplets, and dirt particles. If no nymphs or adults are seen, and the only nits found are more than ¼ inch from the scalp, then the infestation is probably old and no longer active — and does not need to be treated.

What are the treatments for Parasites - Lice - Head Lice ?

General Guidelines Treatment for head lice is recommended for persons diagnosed with an active infestation. All household members and other close contacts should be checked; those persons with evidence of an active infestation should be treated. Some experts believe prophylactic treatment is prudent for persons who share the same bed with activelyinfested individuals. All infested persons (household members and close contacts) and their bedmates should be treated at the same time. Some pediculicides (medicines that kill lice) have an ovicidal effect (kill eggs). For pediculicides that are only weakly ovicidal or not ovicidal, routine retreatment is recommended. For those that are more strongly ovicidal, retreatment is recommended only if live (crawling) lice are still present several days after treatment (see recommendation for each medication). To be most effective, retreatment should occur after all eggs have hatched but before new eggs are produced. When treating head lice, supplemental measures can be combined with recommended medicine (pharmacologic treatment); however, such additional (nonpharmacologic) measures generally are not required to eliminate a head lice infestation. For example, hats, scarves, pillow cases, bedding, clothing, and towels worn or used by the infested person in the 2day period just before treatment is started can be machine washed and dried using the hot water and hot air cycles because lice and eggs are killed by exposure for 5 minutes to temperatures greater than 53.5°C (128.3°F). Items that cannot be laundered may be drycleaned or sealed in a plastic bag for two weeks. Items such as hats, grooming aids, and towels that come in contact with the hair of an infested person should not be shared. Vacuuming furniture and floors can remove an infested person's hairs that might have viable nits attached. Treatment of the infested person(s): Requires using an Overthecounter (OTC) or prescription medication. Follow these treatment steps: Before applying treatment, it may be helpful to remove clothing that can become wet or stained during treatment. Apply lice medicine, also called pediculicide, according to the instructions contained in the box or printed on the label. If the infested person has very long hair (longer than shoulder length), it may be necessary to use a second bottle. Pay special attention to instructions on the label or in the box regarding how long the medication should be left on the hair and how it should be washed out. Have the infested person put on clean clothing after treatment. If a few live lice are still found 8–12 hours after treatment, but are moving more slowly than before, do not retreat. The medicine may take longer to kill all the lice. Comb dead and any remaining live lice out of the hair using a fine–toothed nit comb. If, after 8–12 hours of treatment, no dead lice are found and lice seem as active as before, the medicine may not be working. Do not retreat until speaking with your health care provider; a different pediculicide may be necessary. If your health care provider recommends a different pediculicide, carefully follow the treatment instructions contained in the box or printed on the label. Nit (head lice egg) combs, often found in lice medicine packages, should be used to comb nits and lice from the hair shaft. Many flea combs made for cats and dogs are also effective. After each treatment, checking the hair and combing with a nit comb to remove nits and lice every 2–3 days may decrease the chance of self–reinfestation. Continue to check for 2–3 weeks to be sure all lice and nits are gone. Nit removal is not needed when treating with spinosad topical suspension. Retreatment is meant to kill any surviving hatched lice before they produce new eggs. For some drugs, retreatment is recommended routinely about a week after the first treatment (7–9 days, depending on the drug) and for others only if crawling lice are seen during this period. Retreatment with lindane shampoo is not recommended. Supplemental Measures: Head lice do not survive long if they fall off a person and cannot feed. You don't need to spend a lot of time or money on housecleaning activities. Follow these steps to help avoid re–infestation by lice that have recently fallen off the hair or crawled onto clothing or furniture. Machine wash and dry clothing, bed linens, and other items that the infested person wore or used during the 2 days before treatment using the hot water (130°F) laundry cycle and the high heat drying cycle. Clothing and items that are not washable can be dry–cleaned OR sealed in a plastic bag and stored for 2 weeks. Soak combs and brushes in hot water (at least 130°F) for 5–10 minutes. Vacuum the floor and furniture, particularly where the infested person sat or lay. However, the risk of getting infested by a louse that has fallen onto a rug or carpet or furniture is very low. Head lice survive less than 1–2 days if they fall off a person and cannot feed; nits cannot hatch and usually die within a week if they are not kept at the same temperature as that found close to the human scalp. Spending much time and money on housecleaning activities is not necessary to avoid reinfestation by lice or nits that may have fallen off the head or crawled onto furniture or clothing. Do not use fumigant sprays; they can be toxic if inhaled or absorbed through the skin. Prevent Reinfestation: More on: Prevention & Control Overthecounter Medications Many head lice medications are available "overthecounter" without a prescription at a local drug store or pharmacy. Each overthecounter product approved by the FDA for the treatment of head lice contains one of the following active ingredients. If crawling lice are still seen after a full course of treatment contact your health care provider. Pyrethrins combined with piperonyl butoxide; Brand name products: A–200*, Pronto*, R&C*, Rid*, Triple X*, Licide* Pyrethrins are naturally occurring pyrethroid extracts from the chrysanthemum flower. Pyrethrins are safe and effective when used as directed. Pyrethrins can only kill live lice, not unhatched eggs (nits). A second treatment is recommended 9 to 10 days after the first treatment to kill any newly hatched lice before they can produce new eggs. Pyrethrins generally should not be used by persons who are allergic to chrysanthemums or ragweed. Pyrethrin is approved for use on children 2 years of age and older. Permethrin lotion, 1%; Brand name product: Nix*. Permethrin is a synthetic pyrethroid similar to naturally occurring pyrethrins. Permethrin lotion 1% is approved by the FDA for the treatment of head lice. Permethrin is safe and effective when used as directed. Permethrin kills live lice but not unhatched eggs. Permethrin may continue to kill newly hatched lice for several days after treatment. A second treatment often is necessary on day 9 to kill any newly hatched lice before they can produce new eggs. Permethrin is approved for use on children 2 months of age and older. Prescription Medications The following medications, in alphabetical order, approved by the U.S. Food and Drug Administration (FDA) for the treatment of head lice are available only by prescription. If crawling lice are still seen after a full course of treatment, contact your health care provider. Benzyl alcohol lotion, 5%; Brand name product: Ulesfia lotion* Benzyl alcohol is an aromatic alcohol. Benzyl alcohol lotion, 5% has been approved by the FDA for the treatment of head lice and is considered safe and effective when used as directed. It kills lice but it is not ovicidal(i.e., does not kill lice eggs). A second treatment is needed 9 days after the first treatment to kill any newly hatched lice before they can produce new eggs. Benzyl alcohol lotion is intended for use on persons who are 6 months of age and older and its safety in persons aged more 60 years has not been established. It can be irritating to the skin. Ivermectin lotion, 0.5%; Brand name product: Sklice* Ivermectin lotion, 0.5% was approved by the FDA in 2012 for treatment of head lice in persons 6 months of age and older. It is not ovicidal, but appears to prevent nymphs (newly hatched lice) from surviving. It is effective in most patients when given as a single application on dry hair without nit combing. It should not be used for retreatment without talking to a healthcare provider. Given as a tablet in mass drug administrations, oral ivermectin has been used extensively and safely for over two decades in many countries to treat filarial worm infections. Although not FDAapproved for the treatment of lice, ivermectin tablets given in a single oral dose of 200 micrograms/kg repeated in 10 days or 400 micrograms/kg repeated in 7 days has been shown effective against head lice. It should not be used in children weighing less than 15 kg or in pregnant women. Spinosad 0.9% topical suspension; Brand name product: Natroba* Spinosad is derived from soil bacteria. Spinosad topical suspension, 0.9%, was approved by the FDA in 2011. Since it kills live lice as well as unhatched eggs, retreatment is usually not needed. Nit combing is not required. Spinosad topical suspension is approved for the treatment of children 6 months of age and older. It is safe and effective when used as directed. Repeat treatment should be given only if live (crawling) lice are seen 7 days after the first treatment. For second–line treatment only: Lindane shampoo 1%; Brand name products: None available Lindane is an organochloride. The American Academy of Pediatrics (AAP) no longer recommends it as a pediculocide. Although lindane shampoo 1% is approved by the FDA for the treatment of head lice, it is not recommended as a first–line treatment. Overuse, misuse, or accidentally swallowing lindane can be toxic to the brain and other parts of the nervous system; its use should be restricted to patients for whom prior treatments have failed or who cannot tolerate other medications that pose less risk. Lindane should not be used to treat premature infants, persons with HIV, a seizure disorder, women who are pregnant or breast–feeding, persons who have very irritated skin or sores where the lindane will be applied, infants, children, the elderly, and persons who weigh less than 110 pounds. Retreatment should be avoided. When treating head lice Do not use extra amounts of any lice medication unless instructed to do so by your physician or pharmacist. The drugs used to treat lice are insecticides and can be dangerous if they are misused or overused. All the medications listed above should be kept out of the eyes. If they get onto the eyes, they should be immediately flushed away. Do not treat an infested person more than 2–3 times with the same medication if it does not seem to be working. This may be caused by using the medicine incorrectly or by resistance to the medicine. Always seek the advice of your health care provider if this should happen. He/she may recommend an alternative medication. Do not use different head lice drugs at the same time unless instructed to do so by your physician or pharmacist. *Use of trade names is for identification purposes only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Services.

How to prevent Parasites - Lice - Head Lice ?

Head lice are spread most commonly by direct headtohead (hairtohair) contact. However, much less frequently they are spread by sharing clothing or belongings onto which lice have crawled or nits attached to shed hairs may have fallen. The risk of getting infested by a louse that has fallen onto a carpet or furniture is very small. Head lice survive less than 1–2 days if they fall off a person and cannot feed; nits cannot hatch and usually die within a week if they are not kept at the same temperature as that found close to the scalp. The following are steps that can be taken to help prevent and control the spread of head lice: Avoid headtohead (hairtohair) contact during play and other activities at home, school, and elsewhere (sports activities, playground, slumber parties, camp). Do not share clothing such as hats, scarves, coats, sports uniforms, hair ribbons, or barrettes. Do not share combs, brushes, or towels. Disinfest combs and brushes used by an infested person by soaking them in hot water (at least 130°F) for 5–10 minutes. Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with an infested person. Machine wash and dry clothing, bed linens, and other items that an infested person wore or used during the 2 days before treatment using the hot water (130°F) laundry cycle and the high heat drying cycle. Clothing and items that are not washable can be drycleaned OR sealed in a plastic bag and stored for 2 weeks. Vacuum the floor and furniture, particularly where the infested person sat or lay. However, spending much time and money on housecleaning activities is not necessary to avoid reinfestation by lice or nits that may have fallen off the head or crawled onto furniture or clothing. Do not use fumigant sprays or fogs; they are not necessary to control head lice and can be toxic if inhaled or absorbed through the skin. To help control a head lice outbreak in a community, school, or camp, children can be taught to avoid activities that may spread head lice.

What is (are) Parasites - Fascioliasis (Fasciola Infection) ?

Fascioliasis is an infectious disease caused by Fasciola parasites, which are flat worms referred to as liver flukes. The adult (mature) flukes are found in the bile ducts and liver of infected people and animals, such as sheep and cattle. In general, fascioliasis is more common in livestock and other animals than in people. Two Fasciola species (types) infect people. The main species is Fasciola hepatica, which is also known as "the common liver fluke" and "the sheep liver fluke." A related species, Fasciola gigantica, also can infect people.

Who is at risk for Parasites - Fascioliasis (Fasciola Infection)? ?

Fascioliasis occurs in many areas of the world and usually is caused by F. hepatica, which is a common liver fluke of sheep and cattle. In general, fascioliasis is more common and widespread in animals than in people. Even so, the number of infected people in the world is thought to exceed 2 million. Fasciola hepatica is found in more than 50 countries, in all continents except Antarctica. It is found in parts of Latin America, the Caribbean, Europe, the Middle East, Africa, Asia, and Oceania. Fasciola gigantica is less widespread. Human cases have been reported in the tropics, in parts of Africa and Asia, and also in Hawaii. In some areas where fascioliasis is found, human cases are uncommon (sporadic). In other areas, human fascioliasis is very common (hyperendemic). For example, the areas with the highest known rates of human infection are in the Andean highlands of Bolivia and Peru. Special conditions are needed for fascioliasis to be present in an area, and its geographic distribution is very patchy (focal). The eggs passed in the stool of infected mammals have to develop (mature) in a suitable aquatic snail host to be able to infect another mammalian host. Requirements include sufficient moisture and favorable temperatures (above 50°F) that allow the development of miracidia, reproduction of snails, and larval development within the snails. These factors also contribute to both the prevalence and level (intensity) of infection. Prevalence is highest in areas where climatic conditions promote development of cercariae. More on: Biology Infective Fasciola larvae (metacercariae) are found in contaminated water, either stuck to (encysted on) water plants or floating in the water, often in marshy areas, ponds, or flooded pastures. People (and animals) typically become infected by eating raw watercress or other contaminated water plants. The plants may be eaten as a snack or in salads or sandwiches. People also can get infected by ingesting contaminated water, such as by drinking it or by eating vegetables that were washed or irrigated with contaminated water. Infection also can result from eating undercooked sheep or goat livers that contain immature forms of the parasite. The possibility of becoming infected in the United States should be considered, despite the fact that few locally acquired cases have been documented. The prerequisites for the Fasciola life cycle exist in some parts of the United States. In addition, transmission because of imported contaminated produce could occur, as has been documented in Europe.

How to diagnose Parasites - Fascioliasis (Fasciola Infection) ?

The standard way to be sure a person is infected with Fasciola is by seeing the parasite. This is usually done by finding Fasciola eggs in stool (fecal) specimens examined under a microscope. More than one specimen may need to be examined to find the parasite. Sometimes eggs are found by examining duodenal contents or bile. Infected people don't start passing eggs until they have been infected for several months; people don't pass eggs during the acute phase of the infection. Therefore, early on, the infection has to be diagnosed in other ways than by examining stool. Even during the chronic phase of infection, it can be difficult to find eggs in stool specimens from people who have light infections. Certain types of blood tests can be helpful for diagnosing Fasciola infection, including routine blood work and tests that detect antibodies (an immune response) to the parasite. More on: Resources for Health Professionals: Diagnosis

What are the treatments for Parasites - Fascioliasis (Fasciola Infection) ?

The first step is to make sure the diagnosis is correct. For more information, patients should consult their health care provider. Health care providers may consult with CDC staff about the diagnosis and treatment of fascioliasis. The drug of choice is triclabendazole. In the United States, this drug is available through CDC, under a special (investigational) protocol. The drug is given by mouth, usually in one or two doses. Most people respond well to the treatment. More on: Resources for Health Professionals: Treatment

How to prevent Parasites - Fascioliasis (Fasciola Infection) ?

No vaccine is available to protect people against Fasciola infection. In some areas of the world where fascioliasis is found (endemic), special control programs are in place or are planned. The types of control measures depend on the setting (such as epidemiologic, ecologic, and cultural factors). Strict control of the growth and sale of watercress and other edible water plants is important. Individual people can protect themselves by not eating raw watercress and other water plants, especially from endemic grazing areas. As always, travelers to areas with poor sanitation should avoid food and water that might be contaminated (tainted). Vegetables grown in fields that might have been irrigated with polluted water should be thoroughly cooked, as should viscera from potentially infected animals.

What is (are) Acinetobacter in Healthcare Settings ?

Acinetobacter [asz−in−ée−toe–back−ter] is a group of bacteria commonly found in soil and water. While there are many types or “species” of Acinetobacter and all can cause human disease, Acinetobacter baumannii [asz−in−ée−toe–back−ter boemaaneeie] accounts for about 80% of reported infections. Outbreaks of Acinetobacter infections typically occur in intensive care units and healthcare settings housing very ill patients. Acinetobacter infections rarely occur outside of healthcare settings.

What are the symptoms of Acinetobacter in Healthcare Settings ?

Acinetobacter causes a variety of diseases, ranging from pneumonia to serious blood or wound infections, and the symptoms vary depending on the disease. Acinetobacter may also “colonize” or live in a patient without causing infection or symptoms, especially in tracheostomy sites or open wounds.

Who is at risk for Acinetobacter in Healthcare Settings? ?

Acinetobacter poses very little risk to healthy people. However, people who have weakened immune systems, chronic lung disease, or diabetes may be more susceptible to infections with Acinetobacter. Hospitalized patients, especially very ill patients on a ventilator, those with a prolonged hospital stay, those who have open wounds, or any person with invasive devices like urinary catheters are also at greater risk for Acinetobacter infection. Acinetobacter can be spread to susceptible persons by persontoperson contact or contact with contaminated surfaces.

How to prevent Acinetobacter in Healthcare Settings ?

Acinetobacter can live on the skin and may survive in the environment for several days. Careful attention to infection control procedures, such as hand hygiene and environmental cleaning, can reduce the risk of transmission.

What are the treatments for Acinetobacter in Healthcare Settings ?

Acinetobacter is often resistant to many commonly prescribed antibiotics. Decisions on treatment of infections with Acinetobacter should be made on a casebycase basis by a healthcare provider. Acinetobacter infection typically occurs in ill patients and can either cause or contribute to death in these patients.

What is (are) Parasites - Scabies ?

Scabies is an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimplelike skin rash. The scabies mite usually is spread by direct, prolonged, skintoskin contact with a person who has scabies. Scabies is found worldwide and affects people of all races and social classes. Scabies can spread rapidly under crowded conditions where close body and skin contact is frequent. Institutions such as nursing homes, extendedcare facilities, and prisons are often sites of scabies outbreaks. Child care facilities also are a common site of scabies infestations.

Who is at risk for Parasites - Scabies? ?

Transmission Human scabies is caused by an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The adult female scabies mites burrow into the upper layer of the skin (epidermis) where they live and deposit their eggs. The microscopic scabies mite almost always is passed by direct, prolonged, skintoskin contact with a person who already is infested. An infested person can spread scabies even if he or she has no symptoms. Humans are the source of infestation; animals do not spread human scabies. Persons At Risk Scabies can be passed easily by an infested person to his or her household members and sexual partners. Scabies in adults frequently is sexually acquired. Scabies is a common condition found worldwide; it affects people of all races and social classes. Scabies can spread easily under crowded conditions where close body and skin contact is common. Institutions such as nursing homes, extendedcare facilities, and prisons are often sites of scabies outbreaks. Child care facilities also are a common site of scabies infestations. Crusted (Norwegian) Scabies Some immunocompromised, elderly, disabled, or debilitated persons are at risk for a severe form of scabies called crusted, or Norwegian, scabies. Persons with crusted scabies have thick crusts of skin that contain large numbers of scabies mites and eggs. The mites in crusted scabies are not more virulent than in noncrusted scabies; however, they are much more numerous (up to 2 million per patient). Because they are infested with such large numbers of mites, persons with crusted scabies are very contagious to other persons. In addition to spreading scabies through brief direct skintoskin contact, persons with crusted scabies can transmit scabies indirectly by shedding mites that contaminate items such as their clothing, bedding, and furniture. Persons with crusted scabies should receive quick and aggressive medical treatment for their infestation to prevent outbreaks of scabies.

How to diagnose Parasites - Scabies ?

Diagnosis of a scabies infestation usually is made based upon the customary appearance and distribution of the the rash and the presence of burrows. Whenever possible, the diagnosis of scabies should be confirmed by identifying the mite or mite eggs or fecal matter (scybala). This can be done by carefully removing the mite from the end of its burrow using the tip of a needle or by obtaining a skin scraping to examine under a microscope for mites, eggs, or mite fecal matter (scybala). However, a person can still be infested even if mites, eggs, or fecal matter cannot be found; fewer then 1015 mites may be present on an infested person who is otherwise healthy.

What are the treatments for Parasites - Scabies ?

Suggested General Guidelines It is important to remember that the first time a person gets scabies they usually have no symptoms during the first 2 to 6 weeks they are infested; however they can still spread scabies during this time. Treatment should be given to both the infested person and to household members and sexual contacts, particularly those who have had prolonged direct skintoskin contact with the infested person. Both sexual and close personal contacts who have had direct prolonged skintoskin contact with an infested person within the preceding month should be examined and treated. All persons should be treated at the same time to prevent reinfestation. Scabies may sometimes be sexuallyacquired in adults, but is rarely sexuallyacquired in children. Bedding, clothing, and towels used by infested persons or their household, sexual, and close contacts (as defined above) anytime during the three days before treatment should be decontaminated by washing in hot water and drying in a hot dryer, by drycleaning, or by sealing in a plastic bag for at least 72 hours. Scabies mites generally do not survive more than 2 to 3 days away from human skin. Use of insecticide sprays and fumigants is not recommended. Medications Used to Treat Scabies Products used to treat scabies are called scabicides because they kill scabies mites; some also kill mite eggs. Scabicides used to treat human scabies are available only with a doctor’s prescription. No “overthecounter” (nonprescription) products have been tested and approved to treat scabies. Scabicide should be applied to all areas of the body from the neck down to the feet and toes. In addition, when treating infants and young children, scabicide also should be applied to their entire head and neck because scabies can affect their face, scalp, and neck, as well as the rest of their body. The scabicide should be applied to a clean body and left on for the recommended time before washing it off. Clean clothing should be worn after treatment. The instructions contained in the box or printed on the label always should be followed carefully. Always contact a doctor or pharmacist if unsure how to use a particular medicine. Because the symptoms of scabies are due to a hypersensitivity reaction (allergy) to mites and their feces (scybala), itching still may continue for several weeks after treatment even if all the mites and eggs are killed. If itching still is present more than 2 to 4 weeks after treatment or if new burrows or pimplelike rash lesions continue to appear, retreatment may be necessary. Skin sores that become infected should be treated with an appropriate antibiotic prescribed by a doctor.

How to prevent Parasites - Scabies ?

When a person is infested with scabies mites the first time, symptoms may not appear for up to two months after being infested. However, an infested person can transmit scabies, even if they do not have symptoms. Scabies usually is passed by direct, prolonged skintoskin contact with an infested person. However, a person with crusted (Norwegian) scabies can spread the infestation by brief skintoskin contact or by exposure to bedding, clothing, or even furniture that he/she has used. Scabies is prevented by avoiding direct skintoskin contact with an infested person or with items such as clothing or bedding used by an infested person. Scabies treatment usually is recommended for members of the same household, particularly for those who have had prolonged skintoskin contact. All household members and other potentially exposed persons should be treated at the same time as the infested person to prevent possible reexposure and reinfestation. Bedding and clothing worn or used next to the skin anytime during the 3 days before treatment should be machine washed and dried using the hot water and hot dryer cycles or be drycleaned. Items that cannot be drycleaned or laundered can be disinfested by storing in a closed plastic bag for several days to a week. Scabies mites generally do not survive more than 2 to 3 days away from human skin. Children and adults usually can return to child care, school, or work the day after treatment. Persons with crusted scabies and their close contacts, including household members, should be treated rapidly and aggressively to avoid outbreaks. Institutional outbreaks can be difficult to control and require a rapid, aggressive, and sustained response. Rooms used by a patient with crusted scabies should be thoroughly cleaned and vacuumed after use. Environmental disinfestation using pesticide sprays or fogs generally is unnecessary and is discouraged.

how vaccines prevent disease

Why Are Childhood Vaccines So Important? It is always better to prevent a disease than to treat it after it occurs. Diseases that used to be common in this country and around the world, including polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, rotavirus and Haemophilus influenzae type b (Hib) can now be prevented by vaccination. Thanks to a vaccine, one of the most terrible diseases in history – smallpox – no longer exists outside the laboratory. Over the years vaccines have prevented countless cases of disease and saved millions of lives. Immunity Protects us From Disease Immunity is the body’s way of preventing disease. Children are born with an immune system composed of cells, glands, organs, and fluids located throughout the body. The immune system recognizes germs that enter the body as "foreign invaders” (called antigens) and produces proteins called antibodies to fight them. The first time a child is infected with a specific antigen (say measles virus), the immune system produces antibodies designed to fight it. This takes time . . . usually the immune system can’t work fast enough to prevent the antigen from causing disease, so the child still gets sick. However, the immune system “remembers” that antigen. If it ever enters the body again, even after many years, the immune system can produce antibodies fast enough to keep it from causing disease a second time. This protection is called immunity. It would be nice if there were a way to give children immunity to a disease without their having to get sick first. In fact there is: Vaccines contain the same antigens (or parts of antigens) that cause diseases. For example, measles vaccine contains measles virus. But the antigens in vaccines are either killed, or weakened to the point that they don’t cause disease. However, they are strong enough to make the immune system produce antibodies that lead to immunity. In other words, a vaccine is a safer substitute for a child’s first exposure to a disease. The child gets protection without having to get sick. Through vaccination, children can develop immunity without suffering from the actual diseases that vaccines prevent. Top of Page More Facts Newborn babies are immune to many diseases because they have antibodies they got from their mothers. However, this immunity goes away during the first year of life. If an unvaccinated child is exposed to a disease germ, the child's body may not be strong enough to fight the disease. Before vaccines, many children died from diseases that vaccines now prevent, such as whooping cough, measles, and polio. Those same germs exist today, but because babies are protected by vaccines, we don’t see these diseases nearly as often. Immunizing individual children also helps to protect the health of our community, especially those people who cannot be immunized (children who are too young to be vaccinated, or those who can’t receive certain vaccines for medical reasons), and the small proportion of people who don’t respond to a particular vaccine. Vaccinepreventable diseases have a costly impact, resulting in doctor's visits, hospitalizations, and premature deaths. Sick children can also cause parents to lose time from work. Related Pages Why Immunize? Vaccines: A Safe Choice Parents Guide to Immunizations For Parents: How Vaccines Prevent Diseases Top of Page Images and logos on this website which are trademarked/copyrighted or used with permission of the trademark/copyright or logo holder are not in the public domain. These images and logos have been licensed for or used with permission in the materials provided on this website. The materials in the form presented on this website may be used without seeking further permission. Any other use of trademarked/copyrighted images or logos requires permission from the trademark/copyright holder...more This graphic notice means that you are leaving an HHS Web site. For more information, please see the Exit Notification and Disclaimer policy.

Who is at risk for ? ?

Measles: Make Sure Your Child Is Protected with MMR Vaccine Measles starts with a fever. Soon after, it causes a cough, runny nose, and red eyes. Then a rash of tiny, red spots breaks out. Measles can be serious for young children. Learn about protecting your child from measles with MMR vaccine. Protect your child at every age. Click on your child's age group for vaccine information. View or print agespecific vaccine information [252 KB, 27 pages] Records & Requirements Recording immunizations Finding immunization records Interpreting abbreviations on records Immunization requirements for child care and schools Making the Vaccine Decision How vaccines prevent diseases Vaccine side effects/risks Vaccine ingredients Ensuring vaccine safety Vaccines and your child’s immune system Learn More About Preteen and Teen Vaccines The Vaccines For Children program has helped prevent diseases and save lives…big time! [enlarged view] Watch The Immunization Baby Book Learn what vaccines your child needs, when they are needed, and why it is so important to follow the CDC’s recommended immunization schedule as you flip through this video baby book (4:04 mins) on CDCTV or on YouTube. Who & When (Immunization Schedules) Birth through 6 Years Schedule [2 pages] Create a schedule for your child 7 through 18 Years Schedule [2 pages] 19 Years and Older Schedule [2 pages] Learn more about how CDC sets the immunization schedule for your family Knowing the childhood vaccination rates in your community is important. More Diseases and the Vaccines that Prevent Them Learn more about the 16 diseases that can be prevented with vaccines, as well as the benefits and risks of vaccination. Learn More About... Adoption and Vaccines Pregnancy Help Paying for Vaccines Evaluating Information on the Web

How to prevent ?

Vaccines and Preventable Diseases On this Page Vaccine Shortages & Delays Potential New Vaccines Vaccines: The Basics FAQ about Vaccines & Diseases they Prevent VACCINEPREVENTABLE DISEASES OR, find it by Vaccine Anthrax Cervical Cancer Diphtheria Hepatitis A Hepatitis B Haemophilus influenzae type b (Hib) Human Papillomavirus (HPV) H1N1 Flu (Swine Flu) Influenza (Seasonal Flu) Japanese Encephalitis (JE) Measles Meningococcal Mumps Pertussis (Whooping Cough) Pneumococcal Poliomyelitis (Polio) Rabies Rotavirus Rubella (German Measles) Shingles (Herpes Zoster) Smallpox Tetanus (Lockjaw) Tuberculosis Typhoid Fever Varicella (Chickenpox) Yellow Fever At a Glance Vaccinepreventable disease levels are at or near record lows. Even though most infants and toddlers have received all recommended vaccines by age 2, many underimmunized children remain, leaving the potential for outbreaks of disease. Many adolescents and adults are underimmunized as well, missing opportunities to protect themselves against diseases such as Hepatitis B, influenza, and pneumococcal disease. CDC works closely with public health agencies and private partners to improve and sustain immunization coverage and to monitor the safety of vaccines so that this public health success story can be maintained and expanded in the century to come. Vaccine Shortages & Delays The latest national information about vaccine supplies and guidance for healthcare providers who are facing vaccine shortages or delays Chart of shortages & delays Potential New Vaccines Resources for finding information on potential vaccines, research and development status, licensure status, etc. New Vaccine Surveillance Network Program evaluates impact of new vaccines and vaccine policies through a network of 6 US sites Status of Licensure and Recs for New Vaccines American Academy of Pediatrics (AAP) Potential New Vaccines Immunization Action Coalition (IAC) Vaccines: The Basics Without vaccines, epidemics of many preventable diseases could return, resulting in increased – and unnecessary – illness, disability, and death. All about vaccines How vaccines prevent disease List of all vaccinepreventable diseases List of all vaccines used in United States Photos of vaccinepreventable diseases and/or people affected by them View all... FAQ about Vaccines & Diseases they Prevent What are the ingredients in vaccines? What vaccines do adults need? What vaccines do children need? What vaccines are used in the United States? What diseases do vaccines prevent? View all... Related Pages Basics and Common Questions Who Should NOT Get These Vaccines? Unprotected Stories Top of Page Images and logos on this website which are trademarked/copyrighted or used with permission of the trademark/copyright or logo holder are not in the public domain. These images and logos have been licensed for or used with permission in the materials provided on this website. The materials in the form presented on this website may be used without seeking further permission. Any other use of trademarked/copyrighted images or logos requires permission from the trademark/copyright holder...more This graphic notice means that you are leaving an HHS Web site. For more information, please see the Exit Notification and Disclaimer policy.

what diseases are vaccine preventable

List of VaccinePreventable Diseases The following links will lead you to the main page that describes both the disease and the vaccine(s). Vaccines are available for all of the following vaccinepreventable diseases (unless otherwise noted): Anthrax Cervical Cancer (Human Papillomavirus) Diphtheria Hepatitis A Hepatitis B Haemophilus influenzae type b (Hib) Human Papillomavirus (HPV) Influenza (Flu) Japanese encephalitis (JE) Measles Meningococcal Mumps Pertussis Pneumococcal Polio Rabies Rotavirus Rubella Shingles (Herpes Zoster) Smallpox Tetanus Typhoid Tuberculosis (TB) Varicella (Chickenpox) Yellow Fever Related Pages For Parents: What You Need to Know List of Vaccines Used in U.S. Photos of diseases Top of Page Images and logos on this website which are trademarked/copyrighted or used with permission of the trademark/copyright or logo holder are not in the public domain. These images and logos have been licensed for or used with permission in the materials provided on this website. The materials in the form presented on this website may be used without seeking further permission. Any other use of trademarked/copyrighted images or logos requires permission from the trademark/copyright holder...more This graphic notice means that you are leaving an HHS Web site. For more information, please see the Exit Notification and Disclaimer policy.

how is hps diagnosed and treated for Hantavirus ?

Diagnosing HPS Diagnosing HPS in an individual who has only been infected a few days is difficult, because early symptoms such as fever, muscle aches, and fatigue are easily confused with influenza. However, if the individual is experiencing fever and fatigue and has a history of potential rural rodent exposure, together with shortness of breath, would be strongly suggestive of HPS. If the individual is experiencing these symptoms they should see their physician immediately and mention their potential rodent exposure. Treating HPS There is no specific treatment, cure, or vaccine for hantavirus infection. However, we do know that if infected individuals are recognized early and receive medical care in an intensive care unit, they may do better. In intensive care, patients are intubated and given oxygen therapy to help them through the period of severe respiratory distress. The earlier the patient is brought in to intensive care, the better. If a patient is experiencing full distress, it is less likely the treatment will be effective. Therefore, if you have been around rodents and have symptoms of fever, deep muscle aches, and severe shortness of breath, see your doctor immediately. Be sure to tell your doctor that you have been around rodents—this will alert your physician to look closely for any rodentcarried disease, such as HPS.

what are the symptoms for Hantavirus ?

Due to the small number of HPS cases, the "incubation time" is not positively known. However, on the basis of limited information, it appears that symptoms may develop between 1 and 5 weeks after exposure to fresh urine, droppings, or saliva of infected rodents. Early Symptoms Early symptoms include fatigue, fever and muscle aches, especially in the large muscle groups—thighs, hips, back, and sometimes shoulders. These symptoms are universal. There may also be headaches, dizziness, chills, and abdominal problems, such as nausea, vomiting, diarrhea, and abdominal pain. About half of all HPS patients experience these symptoms. Late Symptoms Four to 10 days after the initial phase of illness, the late symptoms of HPS appear. These include coughing and shortness of breath, with the sensation of, as one survivor put it, a "...tight band around my chest and a pillow over my face" as the lungs fill with fluid. Is the Disease Fatal? Yes. HPS can be fatal. It has a mortality rate of 38%.

how can hps be prevented for Hantavirus ?

Eliminate or minimize contact with rodents in your home, workplace, or campsite. If rodents don't find that where you are is a good place for them to be, then you're less likely to come into contact with them. Seal up holes and gaps in your home or garage. Place traps in and around your home to decrease rodent infestation. Clean up any easytoget food. Recent research results show that many people who became ill with HPS developed the disease after having been in frequent contact with rodents and/or their droppings around a home or a workplace. On the other hand, many people who became ill reported that they had not seen rodents or rodent droppings at all. Therefore, if you live in an area where the carrier rodents are known to live, try to keep your home, vacation place, workplace, or campsite clean. For more information on how you can prevent rodent infestations, the following information is available on the CDC Rodents site:

what is the history of hps for Hantavirus ?

The "First"Outbreak In May 1993, an outbreak of an unexplained pulmonary illness occurred in the southwestern United States, in an area shared by Arizona, New Mexico, Colorado and Utah known as "The Four Corners". A young, physically fit Navajo man suffering from shortness of breath was rushed to a hospital in New Mexico and died very rapidly. While reviewing the results of the case, medical personnel discovered that the young man's fiancée had died a few days before after showing similar symptoms, a piece of information that proved key to discovering the disease. As Dr. James Cheek of the Indian Health Service (IHS) noted, "I think if it hadn't been for that initial pair of people that became sick within a week of each other, we never would have discovered the illness at all". An investigation combing the entire Four Corners region was launched by the New Mexico Office of Medical Investigations (OMI) to find any other people who had a similar case history. Within a few hours, Dr. Bruce Tempest of IHS, working with OMI, had located five young, healthy people who had all died after acute respiratory failure. A series of laboratory tests had failed to identify any of the deaths as caused by a known disease, such as bubonic plague. At this point, the CDC Special Pathogens Branch was notified. CDC, the state health departments of New Mexico, Colorado and Utah, the Indian Health Service, the Navajo Nation, and the University of New Mexico all joined together to confront the outbreak. During the next few weeks, as additional cases of the disease were reported in the Four Corners area, physicians and other scientific experts worked intensively to narrow down the list of possible causes. The particular mixture of symptoms and clinical findings pointed researchers away from possible causes, such as exposure to a herbicide or a new type of influenza, and toward some type of virus. Samples of tissue from patients who had gotten the disease were sent to CDC for exhaustive analysis. Virologists at CDC used several tests, including new methods to pinpoint virus genes at the molecular level, and were able to link the pulmonary syndrome with a virus, in particular a previously unknown type of hantavirus. Researchers Launch Investigations to Pin Down the Carrier of the New Virus Researchers knew that all other known hantaviruses were transmitted to people by rodents, such as mice and rats. Therefore, an important part of their mission was to trap as many different species of rodents living in the Four Corners region as possible to find the particular type of rodent that carried the virus. From June through midAugust of 1993, all types of rodents were trapped inside and outside homes where people who had hantavirus pulmonary syndrome had lived, as well as in piñon groves and summer sheep camps where they had worked. Additional rodents were trapped for comparison in and around nearby households as well. Taking a calculated risk, researchers decided not to wear protective clothing or masks during the trapping process. "We didn't want to go in wearing respirators, scaring...everybody", John Sarisky, an Indian Health Service environmental disease specialist said. However, when the almost 1,700 rodents trapped were dissected to prepare samples for analysis at CDC, protective clothing and respirators were worn. Among rodents trapped, the deer mouse (Peromyscus maniculatus) was found to be the main host to a previously unknown type of hantavirus. Since the deer mouse often lives near people in rural and semirural areas—in barns and outbuildings, woodpiles, and inside people's homes—researchers suspected that the deer mouse might be transmitting the virus to humans. About 30% of the deer mice tested showed evidence of infection with hantavirus. Tests also showed that several other types of rodents were infected, although in lesser numbers. The next step was to pin down the connection between the infected deer mice and households where people who had gotten the disease lived. Therefore, investigators launched a casecontrol investigation. They compared "case" households, where people who had gotten the disease lived, with nearby "control" households. Control households were similar to those where the casepatients lived, except for one factor: no one in the control households had gotten the disease. The results? First, investigators trapped more rodents in case households than in control households, so more rodents may have been living in close contact with people in case households. Second, people in case households were more likely than those in control households to do cleaning around the house or to plant in or handplow soil outdoors in fields or gardens. However, it was unclear if the risk for contracting HPS was due to performing these tasks, or with entering closedup rooms or closets to get tools needed for these tasks. In November 1993, the specific hantavirus that caused the Four Corners outbreak was isolated. The Special Pathogens Branch at CDC used tissue from a deer mouse that had been trapped near the New Mexico home of a person who had gotten the disease and grew the virus from it in the laboratory. Shortly afterwards and independently, the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) also grew the virus, from a person in New Mexico who had gotten the disease as well as from a mouse trapped in California. The new virus was called Muerto Canyon virus — later changed to Sin Nombre virus (SNV) — and the new disease caused by the virus was named hantavirus pulmonary syndrome, or HPS. The isolation of the virus in a matter of months was remarkable. This success was based on close cooperation of all the agencies and individuals involved in investigating the outbreak, years of basic research on other hantaviruses that had been conducted at CDC and USAMRIID, and on the continuing development of modern molecular virologic tests. To put the rapid isolation of the Sin Nombre virus in perspective, it took several decades for the first hantavirus discovered, the Hantaan virus, to be isolated. HPS Not Really a New Disease As part of the effort to locate the source of the virus, researchers located and examined stored samples of lung tissue from people who had died of unexplained lung disease. Some of these samples showed evidence of previous infection with Sin Nombre virus—indicating that the disease had existed before the "first" known outbreak—it simply had not been recognized! Other early cases of HPS have been discovered by examining samples of tissue belonging to people who had died of unexplained adult respiratory distress syndrome. By this method, the earliest known case of HPS that has been confirmed has been the case of a 38yearold Utah man in 1959. Interestingly, while HPS was not known to the epidemiologic and medical communities, there is evidence that it was recognized elsewhere. The Navajo Indians, a number of whom contracted HPS during the 1993 outbreak, recognize a similar disease in their medical traditions, and actually associate its occurrence with mice. As strikingly, Navajo medical beliefs concur with public health recommendations for preventing the disease. Why Did the Outbreak Occur in the Four Corners Area? But why this sudden cluster of cases? The key answer to this question is that, during this period, there were suddenly many more mice than usual. The Four Corners area had been in a drought for several years. Then, in early 1993, heavy snows and rainfall helped droughtstricken plants and animals to revive and grow in largerthanusual numbers. The area's deer mice had plenty to eat, and as a result they reproduced so rapidly that there were ten times more mice in May 1993 than there had been in May of 1992. With so many mice, it was more likely that mice and humans would come into contact with one another, and thus more likely that the hantavirus carried by the mice would be transmitted to humans. PersontoPerson Spread of HPS Decided Unlikely "Although persontoperson spread [of HPS] has not been documented with any of the other known hantaviruses, we were concerned [during this outbreak] because we were dealing with a new agent", said Charles Vitek, a CDC medical investigator. Researchers and clinicians investigating the ongoing outbreak were not the only groups concerned about the disease. Shortly after the first few HPS patients died and it became clear that a new disease was affecting people in the area, and that no one knew how it was transmitted, the news media began extensive reporting on the outbreak. Widespread concern among the public ensued. Unfortunately, the first victims of the outbreak were Navajo. News reports focused on this fact, and the misperception grew that the unknown disease was somehow linked to Navajos. As a consequence, Navajos found themselves at the center of intense media attention and the objects of the some people's fears. By later in the summer of 1993, the media frenzy had quieted somewhat, and the source of the disease was pinpointed. Researchers determined that, like other hantaviruses, the virus that causes HPS is not transmitted from person to person the way other infections, such as the common cold, may be. The exception to this is an outbreak of HPS in Argentina in 1996. Evidence from this outbreak suggests that strains of hantaviruses in South America may be transmissable from person to person. To date, no cases of HPS have been reported in the United States in which the virus was transmitted from one person to another. In fact, in a study of health care workers who were exposed to either patients or specimens infected with related types of hantaviruses (which cause a different disease in humans), none of the workers showed evidence of infection or illness. HPS Since the First Outbreak After the initial outbreak, the medical community nationwide was asked to report any cases of illness with symptoms similar to those of HPS that could not be explained by any other cause. As a result, additional cases have been reported. Since 1993, researchers have discovered that there is not just one hantavirus that causes HPS, but several. In June 1993, a Louisiana bridge inspector who had not traveled to the Four Corners area developed HPS. An investigation was begun. The patient's tissues were tested for the presence of antibodies to hantavirus. The results led to the discovery of another hantavirus, named Bayou virus, which was linked to a carrier, the rice rat (Oryzomys palustris). In late 1993, a 33yearold Florida man came down with HPS symptoms; he later recovered. This person also had not traveled to the Four Corners area. A similar investigation revealed yet another hantavirus, named the Black Creek Canal virus, and its carrier, the cotton rat (Sigmodon hispidus). Another case occurred in New York. This time, the Sin Nombrelike virus was named New York1, and the whitefooted mouse (Peromyscus leucopus), was implicated as the carrier. More recently, cases of HPS stemming from related hantaviruses have been documented in Argentina, Brazil, Canada, Chile, Paraguay, and Uruguay, making HPS a panhemispheric disease. References Information for this page was developed using the CDC video Preventing Hantavirus Disease and resource articles listed in the bibliography.

What is (are) Parasites - Babesiosis ?

Babesiosis is caused by microscopic parasites that infect red blood cells. Most human cases of Babesia infection in the United States are caused by the parasite Babesia microti. Occasional cases caused by other species (types) of Babesia have been detected. Babesia microti is spread in nature by Ixodes scapularis ticks (also called blacklegged ticks or deer ticks). Tickborne transmission is most common in particular regions and seasons: it mainly occurs in parts of the Northeast and upper Midwest; and it usually peaks during the warm months. Babesia infection can range in severity from asymptomatic to life threatening. The infection is both treatable and preventable. Frequently Asked Questions (FAQs) Podcasts

Who is at risk for Parasites - Babesiosis? ?

People can get infected with Babesia parasites in several ways: The main way is through the bite of an infected tick—during outdoor activities in areas where babesiosis is found (see below). A less common way is by getting a transfusion from a blood donor who has a Babesia infection but does not have any symptoms. (No tests have been licensed yet for screening blood donors for Babesia.) Rare cases of congenital transmission—from an infected mother to her baby (during pregnancy or delivery)—have been reported. Babesia parasites are not transmitted from persontoperson like the flu or the common cold. Many different species (types) of Babesia parasites have been found in animals, only a few of which have been found in people. Babesia microti—which usually infects whitefooted mice and other small mammals—is the main species that has been found in people in the United States. Occasional (sporadic) cases of babesiosis caused by other Babesia species have been detected. Babesia microti is transmitted in nature by Ixodes scapularis ticks (also called blacklegged ticks or deer ticks). Tickborne transmission primarily occurs in the Northeast and upper Midwest, especially in parts of New England, New York state, New Jersey, Wisconsin, and Minnesota. The parasite typically is spread by the young nymph stage of the tick, which is most apt to be found (seeking or "questing" for a blood meal) during warm months (spring and summer), in areas with woods, brush, or grass. Infected people might not recall a tick bite because I. scapularis nymphs are very small (about the size of a poppy seed).

How to diagnose Parasites - Babesiosis ?

In symptomatic people, babesiosis usually is diagnosed by examining blood specimens under a microscope and seeing Babesia parasites inside red blood cells. To be sure the diagnosis is correct, your health care provider might have specimens of your blood tested by a specialized reference laboratory (such as at CDC or a health department). More on: Resources for Health Professionals: Diagnosis

What are the treatments for Parasites - Babesiosis ?

Effective treatments are available. People who do not have any symptoms or signs of babesiosis usually do not need to be treated. Before considering treatment, the first step is to make sure the diagnosis is correct. For more information, people should talk to their health care provider. More on: Resources for Health Professionals: Treatment

How to prevent Parasites - Babesiosis ?

Steps can be taken to reduce the risk for babesiosis and other tickborne infections. The use of prevention measures is especially important for people at increased risk for severe babesiosis (for example, people who do not have a spleen). Avoiding exposure to tick habitats is the best defense. Babesia microti is spread by Ixodes scapularis ticks, which are mostly found in wooded, brushy, or grassy areas, in certain regions and seasons. No vaccine is available to protect people against babesiosis. However, people who live, work, or travel in tickinfested areas can take simple steps to help protect themselves against tick bites and tickborne infections. During outdoor activities in tick habitats, take precautions to keep ticks off the skin. Walk on cleared trails and stay in the center of the trail, to minimize contact with leaf litter, brush, and overgrown grasses, where ticks are most likely to be found. Minimize the amount of exposed skin, by wearing socks, long pants, and a longsleeved shirt. Tuck the pant legs into the socks, so ticks cannot crawl up the inside of the pants. Wear lightcolored clothing, to make it easier to see and remove ticks before they attach to skin. Apply repellents to skin and clothing. Follow the instructions on the product label. Products that contain DEET (N,Ndiethylmetatoluamide) can be directly applied to exposed skin and to clothing, to help keep ticks away (by repelling them). The product label includes details about how and where to apply the repellent, how often to reapply it, and how to use it safely on children. Permethrin products can be applied to clothing/boots (not to skin), actually kill ticks that come in contact with the treated clothing, and usually stay effective through several washings. After outdoor activities, conduct daily tick checks and promptly remove any ticks that are found. Thorough, daily tick checks are very important. The I. scapularis nymphs that typically spread B. microti are so small (about the size of a poppy seed) that they are easily overlooked. But they usually must stay attached to a person for more than 3648 hours to be able to transmit the parasite. Remove ticks from clothing and pets before going indoors. Conduct a fullbody exam for ticks. Use a handheld or fulllength mirror to view all parts of the body. Be sure to check behind the knees, between the legs (groin/thighs), between the toes, under the arms (armpits), around the waist, inside the belly button, the back of the neck, behind and in the ears, as well as in and around the scalp, hairline, and hair. Remember to check children and pets, too. Remove ticks that are attached to the skin as soon as possible, preferably by using pointed (finetipped) tweezers. Grab the tick’s mouth parts close to the skin, and slowly pull the tick straight out (with steady outward pressure), until the tick lets go. More on: Removing Ticks More on: Ticks

How to diagnose Tuberculosis (TB) ?

Tuberculosis (TB) is a disease that is spread through the air from one person to another. There are two kinds of tests that are used to determine if a person has been infected with TB bacteria: the tuberculin skin test and TB blood tests. A positive TB skin test or TB blood test only tells that a person has been infected with TB bacteria. It does not tell whether the person has latent TB infection (LTBI) or has progressed to TB disease. Other tests, such as a chest xray and a sample of sputum, are needed to see whether the person has TB disease. Tuberculin skin test: The TB skin test (also called the Mantoux tuberculin skin test) is performed by injecting a small amount of fluid (called tuberculin) into the skin in the lower part of the arm. A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm. The health care worker will look for a raised, hard area or swelling, and if present, measure its size using a ruler. Redness by itself is not considered part of the reaction. The skin test result depends on the size of the raised, hard area or swelling. It also depends on the person’s risk of being infected with TB bacteria and the progression to TB disease if infected. Positive skin test: This means the person’s body was infected with TB bacteria. Additional tests are needed to determine if the person has latent TB infection or TB disease. A health care worker will then provide treatment as needed. Negative skin test: This means the person’s body did not react to the test, and that latent TB infection or TB disease is not likely. TB blood tests: TB blood tests (also called interferongamma release assays or IGRAs) measure how the immune system reacts to the bacteria that cause TB. An IGRA measures how strong a person’s immune system reacts to TB bacteria by testing the person’s blood in a laboratory. Two IGRAs are approved by the U.S. Food and Drug Administration (FDA) and are available in the United States: QuantiFERON®–TB Gold InTube test (QFTGIT) TSPOT®.TB test (TSpot) Positive IGRA: This means that the person has been infected with TB bacteria. Additional tests are needed to determine if the person has latent TB infection or TB disease. A health care worker will then provide treatment as needed. Negative IGRA: This means that the person’s blood did not react to the test and that latent TB infection or TB disease is not likely. IGRAs are the preferred method of TB infection testing for the following: People who have a difficult time returning for a second appointment to look for a reaction to the TST. There is no problem with repeated IGRAs. Testing for TB in BCGVaccinated Persons Many people born outside of the United States have been BCGvaccinated. People who have had a previous BCG vaccine may receive a TB skin test. In some people, BCG may cause a positive skin test when they are not infected with TB bacteria. If a TB skin test is positive, additional tests are needed. IGRAs, unlike the TB skin tests, are not affected by prior BCG vaccination and are not expected to give a falsepositive result in people who have received BCG. Choosing a TB Test The person’s health care provider should choose which TB test to use. Factors in selecting which test to use include the reason for testing, test availability, and cost. Generally, it is not recommended to test a person with both a TST and an IGRA. Diagnosis of Latent TB Infection or TB Disease If a person is found to be infected with TB bacteria, other tests are needed to see if the person has TB disease. TB disease can be diagnosed by medical history, physical examination, chest xray, and other laboratory tests. TB disease is treated by taking several drugs as recommended by a health care provider. If a person does not have TB disease, but has TB bacteria in the body, then latent TB infection is diagnosed. The decision about treatment for latent TB infection will be based on a person’s chances of developing TB disease. Diagnosis of TB Disease People suspected of having TB disease should be referred for a medical evaluation, which will include Medical history, Physical examination, Test for TB infection (TB skin test or TB blood test), Chest radiograph (Xray), and Appropriate laboratory tests See Diagnosis of TB (Fact sheet) for more information about TB diagnosis. Related Links For Patients For Health Care Providers

How to prevent Tuberculosis (TB) ?

Infection Control in Health Care Settings Tuberculosis (TB) transmission has been documented in health care settings where health care workers and patients come in contact with people who have TB disease. People who work or receive care in health care settings are at higher risk for becoming infected with TB; therefore, it is necessary to have a TB infection control plan as part of a general infection control program designed to ensure the following: prompt detection of infectious patients, airborne precautions, and treatment of people who have suspected or confirmed TB disease. In order to be effective, the primary emphasis of a TB infection control program should be on achieving these three goals. In all health care settings, particularly those in which people are at high risk for exposure to TB, policies and procedures for TB control should be developed, reviewed periodically, and evaluated for effectiveness to determine the actions necessary to minimize the risk for transmission of TB. The TB infection control program should be based on a threelevel hierarchy of control measures and include: Administrative measures Environmental controls Use of respiratory protective equipment The first and most important level of the hierarchy, administrative measures, impacts the largest number of people. It is intended primarily to reduce the risk of uninfected people who are exposed to people who have TB disease. The second level of the hierarchy is the use of environmental controls to reduce the amount of TB in the air. The first two control levels of the hierarchy also minimize the number of areas in the health care setting where exposure to TB may occur. The third level of the hierarchy is the use of respiratory protective equipment in situations that pose a high risk of exposure to TB. Use of respiratory protection equipment can further reduce the risk for exposure of health care workers. More: Information about Infection Control in Health Care Settings TB Prevention Preventing Exposure to TB Disease While Traveling Abroad Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments (for example, clinics, hospitals, prisons, or homeless shelters). Travelers who will be working in clinics, hospitals, or other health care settings where TB patients are likely to be encountered should consult infection control or occupational health experts. They should ask about administrative and environmental procedures for preventing exposure to TB. Once those procedures are implemented, additional measures could include using personal respiratory protective devices. Travelers who anticipate possible prolonged exposure to people with TB (for example, those who expect to come in contact routinely with clinic, hospital, prison, or homeless shelter populations) should have a tuberculin skin test (TST) or interferongamma release assay (IGRA) test before leaving the United States. If the test reaction is negative, they should have a repeat test 8 to 10 weeks after returning to the United States. Additionally, annual testing may be recommended for those who anticipate repeated or prolonged exposure or an extended stay over a period of years. Because people with HIV infection are more likely to have an impaired response to both the TST and IGRA, travelers who are HIV positive should tell their physicians about their HIV infection status. More: Tuberculosis Information for International Travelers What to Do If You Have Been Exposed to TB If you think you have been exposed to someone with TB disease, contact your health care provider or local health department to see if you should be tested for TB. Be sure to tell the doctor or nurse when you spent time with someone who has TB disease. More: What to Do If You Have Been Exposed to TB Preventing Latent TB Infection from Progressing to TB Disease Many people who have latent TB infection never develop TB disease. But some people who have latent TB infection are more likely to develop TB disease than others. Those at high risk for developing TB disease include: People with HIV infection People who became infected with TB bacteria in the last 2 years Babies and young children People who inject illegal drugs People who are sick with other diseases that weaken the immune system Elderly people People who were not treated correctly for TB in the past If you have latent TB infection and you are in one of these highrisk groups, you should take medicine to keep from developing TB disease. There are several treatment options for latent TB infection. You and your health care provider must decide which treatment is best for you. If you take your medicine as instructed, it can keep you from developing TB disease. Because there are less bacteria, treatment for latent TB infection is much easier than treatment for TB disease. A person with TB disease has a large amount of TB bacteria in the body. Several drugs are needed to treat TB disease.

What are the treatments for Tuberculosis (TB) ?

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. Not everyone infected with TB bacteria becomes sick. As a result, two TBrelated conditions exist: latent TB infection and TB disease. Both latent TB infection and TB disease can be treated. Learn more about the difference between latent TB infection and TB disease. Treatment for Latent TB Infection People with latent TB infection have TB bacteria in their bodies, but they are not sick because the bacteria are not active. People with latent TB infection do not have symptoms, and they cannot spread TB bacteria to others. However, if TB bacteria become active in the body and multiply, the person will go from having latent TB infection to being sick with TB disease. For this reason, people with latent TB infection are often prescribed treatment to prevent them from developing TB disease. Treatment of latent TB infection is essential for controlling and eliminating TB in the United States. Because there are less bacteria in a person with latent TB infection, treatment is much easier. Four regimens are approved for the treatment of latent TB infection. The medications used to treat latent TB infection include: isoniazid (INH) rifampin (RIF) rifapentine (RPT) Certain groups of people (such as people with weakened immune systems) are at very high risk of developing TB disease once infected with TB bacteria. Every effort should be made to begin appropriate treatment and to ensure completion of the entire course of treatment for latent TB infection. More: Treatment for Latent TB Infection Treatment for TB Disease TB bacteria become active (multiplying in the body) if the immune system can't stop them from growing. When TB bacteria are active, this is called TB disease. TB disease will make a person sick. People with TB disease may spread the bacteria to people with whom they spend many hours. TB disease can be treated by taking several drugs for 6 to 9 months. There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the firstline antiTB agents that form the core of treatment regimens include: isoniazid (INH) rifampin (RIF) ethambutol (EMB) pyrazinamide (PZA) Regimens for treating TB disease have an initial phase of 2 months, followed by a choice of several options for the continuation phase of either 4 or 7 months (total of 6 to 9 months for treatment). Learn more about the continuation phase of treatment. It is very important that people who have TB disease finish the medicine, taking the drugs exactly as prescribed. If they stop taking the drugs too soon, they can become sick again; if they do not take the drugs correctly, the TB bacteria that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat. More: Treatment for TB Disease Treatment Completion Treatment completion is determined by the number of doses ingested over a given period of time. Although basic TB regimens are broadly applicable, there are modifications that should be made under special circumstances (such as people with HIV infection, drug resistance, pregnancy, or treatment of children).

What is (are) Tuberculosis (TB) ?

The Division of Tuberculosis Elimination (DTBE) Laboratory Branch (LB) provides services for the following tests on mycobacterial cultures. Any local health department, licensed physician's office, licensed laboratory or licensed health care facility may submit cultures for testing but they must be routed through either their state health department or other authorized facility. Genotyping State or local TB control programs A genotyping laboratory, in Michigan is under contract with CDC to provide genotyping services to TB programs in the United States. Three genotyping methods to identify TB strains: Spoligotyping Mycobacterial interspersed repetitive unit (MIRU) analysis IS6110based restriction fragment length polymorphism (RFLP) analysis For more information, view the Guide to the Application of Genotyping to Tuberculosis Prevention and Control. DTBE epidemiologic investigations and surveillance activities The LB provides support for DTBE epidemiologic investigations and surveillance activities. TB genotyping results, when combined with epidemiologic data, help to distinguish TB patients who are involved in the same chain of recent transmission. Drug susceptibility testing The LB performs drug susceptibility testing for selected Mycobacterium species referred from state or other authorized health facilities. Cultures of mycobacteria are tested by the indirect proportion method with antituberculosis drugs incorporated into 7H10 agar plates. Additional Resources

what research is being done for Tuberculosis (TB) ?

TB Epidemiologic Studies Consortium The TB Epidemiologic Studies Consortium (TBESC) was established to strengthen, focus, and coordinate tuberculosis (TB) research. The TBESC is designed to build the scientific research capacities of state and metropolitan TB control programs, participating laboratories, academic institutions, hospitals, and both non and forprofit organizations. TB Trials Consortium The TB Trials Consortium (TBTC) is a collaboration of North American and international clinical investigators whose mission is to conduct programmatically relevant research concerning the diagnosis, clinical management, and prevention of TB infection and disease. Behavioral and Social Science Research Behavioral and social science research has the potential to make a tremendous impact on TB elimination efforts. This research is needed to 1) understand how behaviors of both patients and providers affect TBrelated care seeking, diagnosis, treatment success, and prevention; and 2) understand how other social, cultural, and environmental influences affect health seeking and treatment outcomes related to TB.

What is (are) Parasites - Toxocariasis (also known as Roundworm Infection) ?

Frequently Asked Questions (FAQs) Fact Sheets

Who is at risk for Parasites - Toxocariasis (also known as Roundworm Infection)? ?

Infected dogs and cats shed Toxocara eggs in their feces into the environment. Once in the environment, it takes 2 to 4 weeks for Toxocara larvae to develop and for the eggs to become infectious. Humans or other animals can be infected by accidentally ingesting Toxocara eggs. For example, humans can become infected if they work with dirt and accidentally ingest dirt containing Toxocara eggs. Although rare, people can be infected by eating undercooked or raw meat from an infected animal such as a lamb or rabbit. Because dogs and cats are frequently found where people live, there may be large numbers of infected eggs in the environment. Once in the body, the Toxocara eggs hatch and roundworm larvae can travel in the bloodstream to different parts of the body, including the liver, heart, lungs, brain, muscles, or eyes. Most infected people do not have any symptoms. However, in some people, the Toxocara larvae can cause damage to these tissues and organs. The symptoms of toxocariasis, the disease caused by these migrating larvae, include fever, coughing, inflammation of the liver, or eye problems. A U.S. study in 1996 showed that 30% of dogs younger than 6 months deposit Toxocara eggs in their feces; other studies have shown that almost all puppies are born already infected with Toxocara canis. Research also suggests that 25% of all cats are infected with Toxocara cati. Infection rates are higher for dogs and cats that are left outside for more time and allowed to eat other animals. In humans, it has been found that almost 14% of the U.S. population has been infected with Toxocara. Globally, toxocariasis is found in many countries, and prevalence rates can reach as high as 40% or more in parts of the world. There are several factors that have been associated with higher rates of infection with Toxocara. People are more likely to be infected with Toxocara if they own a dog. Children and adolescents under the age of 20 are more likely to test positive for Toxocara infection. This may be because children are more likely to eat dirt and play in outdoor environments, such as sandboxes, where dog and cat feces can be found. This infection is more common in people living in poverty. Geographic location plays a role as well, because Toxocara is more prevalent in hot, humid regions where eggs are kept viable in the soil.

How to diagnose Parasites - Toxocariasis (also known as Roundworm Infection) ?

If you think you or your child may have toxocariasis, you should see your health care provider to discuss the possibility of infection and, if necessary, to be examined. Toxocariasis can be difficult to diagnose because the symptoms of toxocariasis are similar to the symptoms of other infections. A blood test is available that looks for evidence of infection with Toxocara larvae. In addition to the blood test, diagnosis of toxocariasis includes identifying the presence of typical clinical signs of VT or OT and a history of exposure to cats and dogs.

What are the treatments for Parasites - Toxocariasis (also known as Roundworm Infection) ?

Visceral toxocariasis can be treated with antiparasitic drugs such as albendazole or mebendazole. Treatment of ocular toxocariasis is more difficult and usually consists of measures to prevent progressive damage to the eye. More on: Resources For Health Professionals: Treatment

How to prevent Parasites - Toxocariasis (also known as Roundworm Infection) ?

Controlling Toxocara infection in dogs and cats will reduce the number of infectious eggs in the environment and reduce the risk of infection for people. Have your veterinarian treat your dogs and cats, especially young animals, regularly for worms. This is especially important if your pets spend time outdoors and may become infected again. There are several things that you can do around your home to make you and your pets safer: Clean your pet’s living area at least once a week. Feces should be either buried or bagged and disposed of in the trash. Wash your hands after handling pet waste. Do not allow children to play in areas that are soiled with pet or other animal feces and cover sandboxes when not in use to make sure that animals do not get inside and contaminate them. Wash your hands with soap and warm water after playing with your pets or other animals, after outdoor activities, and before handling food. Teach children the importance of washing hands to prevent infection. Teach children that it is dangerous to eat dirt or soil. More on: Handwashing Toxocara eggs have a strong protective layer which makes the eggs able to survive in the environment for months or even years under the right conditions. Many common disinfectants are not effective against Toxocara eggs but extreme heat has been shown to kill the eggs. Prompt removal of animal feces can help prevent infection since the eggs require 2 to 4 weeks to become infective once they are out of the animal.

What is (are) Parasites - Schistosomiasis ?

Schistosomiasis, also known as bilharzia, is a disease caused by parasitic worms. Infection with Schistosoma mansoni, S. haematobium, and S. japonicum causes illness in humans; less commonly, S. mekongi and S. intercalatum can cause disease. Although the worms that cause schistosomiasis are not found in the United States, more than 200 million people are infected worldwide.

Who is at risk for Parasites - Schistosomiasis? ?

Schistosomiasis is an important cause of disease in many parts of the world, most commonly in places with poor sanitation. Schoolage children who live in these areas are often most at risk because they tend to spend time swimming or bathing in water containing infectious cercariae. If you live in, or travel to, areas where schistosomiasis is found and are exposed to contaminated freshwater, you are at risk. Areas where human schistosomiasis is found include: Schistosoma mansoni distributed throughout Africa: There is risk of infection in freshwater in southern and subSaharan Africa–including the great lakes and rivers as well as smaller bodies of water. Transmission also occurs in the Nile River valley in Sudan and Egypt South America: including Brazil, Suriname, Venezuela Caribbean (risk is low): Dominican Republic, Guadeloupe, Martinique, and Saint Lucia. S. haematobium distributed throughout Africa: There is risk of infection in freshwater in southern and subSaharan Africa–including the great lakes and rivers as well as smaller bodies of water. Transmission also occurs in the Nile River valley in Egypt and the Mahgreb region of North Africa. found in areas of the Middle East S. japonicum found in Indonesia and parts of China and Southeast Asia S. mekongi found in Cambodia and Laos S. intercalatum found in parts of Central and West Africa.

How to diagnose Parasites - Schistosomiasis ?

Stool or urine samples can be examined microscopically for parasite eggs (stool for S. mansoni or S. japonicum eggs and urine for S. haematobium eggs). The eggs tend to be passed intermittently and in small amounts and may not be detected, so it may be necessary to perform a blood (serologic) test. More on: Resources for Health Professionals: Diagnosis

What are the treatments for Parasites - Schistosomiasis ?

Safe and effective medication is available for treatment of both urinary and intestinal schistosomiasis. Praziquantel, a prescription medication, is taken for 12 days to treat infections caused by all Schistosoma species. More on: Resources for Health Professionals: Treatment

How to prevent Parasites - Schistosomiasis ?

Prevention No vaccine is available. The best way to prevent schistosomiasis is to take the following steps if you are visiting or live in an area where schistosomiasis is transmitted: Avoid swimming or wading in freshwater when you are in countries in which schistosomiasis occurs. Swimming in the ocean and in chlorinated swimming pools is safe. Drink safe water. Although schistosomiasis is not transmitted by swallowing contaminated water, if your mouth or lips come in contact with water containing the parasites, you could become infected. Because water coming directly from canals, lakes, rivers, streams, or springs may be contaminated with a variety of infectious organisms, you should either bring your water to a rolling boil for 1 minute or filter water before drinking it. Bring your water to a rolling boil for at least 1 minute will kill any harmful parasites, bacteria, or viruses present. Iodine treatment alone WILL NOT GUARANTEE that water is safe and free of all parasites. Water used for bathing should be brought to a rolling boil for 1 minute to kill any cercariae, and then cooled before bathing to avoid scalding. Water held in a storage tank for at least 1 2 days should be safe for bathing. Vigorous towel drying after an accidental, very brief water exposure may help to prevent the Schistosoma parasite from penetrating the skin. However, do not rely on vigorous towel drying alone to prevent schistosomiasis. Those who have had contact with potentially contaminated water overseas should see their health care provider after returning from travel to discuss testing. More on: Schistosomiasis in Travelers Control In countries where schistosomiasis causes significant disease, control efforts usually focus on: reducing the number of infections in people and/or eliminating the snails that are required to maintain the parasite’s life cycle. For all species that cause schistosomiasis, improved sanitation could reduce or eliminate transmission of this disease. In some areas with lower transmission levels, elimination of schistosomiasis is considered a "winnable battle" by public health officials. Control measures can include mass drug treatment of entire communities and targeted treatment of schoolage children. Some of the problems with control of schistosomiasis include: Chemicals used to eliminate snails in freshwater sources may harm other species of animals in the water and, if treatment is not sustained, the snails may return to those sites afterwards. For certain species of the parasite, such as S. japonicum, animals such as cows or water buffalo can also be infected. Runoff from pastures (if the cows are infected) can contaminate freshwater sources.

What is (are) Parasites - Toxoplasmosis (Toxoplasma infection) ?

A singlecelled parasite called Toxoplasma gondii causes a disease known as toxoplasmosis. While the parasite is found throughout the world, more than 60 million people in the United States may be infected with the Toxoplasma parasite. Of those who are infected, very few have symptoms because a healthy person’s immune system usually keeps the parasite from causing illness. However, pregnant women and individuals who have compromised immune systems should be cautious; for them, a Toxoplasma infection could cause serious health problems.

Who is at risk for Parasites - Toxoplasmosis (Toxoplasma infection)? ?

Toxoplasmosis is caused by the protozoan parasite Toxoplasma gondii. In the United States it is estimated that 22.5% of the population 12 years and older have been infected with Toxoplasma. In various places throughout the world, it has been shown that up to 95% of some populations have been infected with Toxoplasma. Infection is often highest in areas of the world that have hot, humid climates and lower altitudes. Toxoplasmosis is not passed from persontoperson, except in instances of mothertochild (congenital) transmission and blood transfusion or organ transplantation. People typically become infected by three principal routes of transmission. Foodborne transmission The tissue form of the parasite (a microscopic cyst consisting of bradyzoites) can be transmitted to humans by food. People become infected by: Eating undercooked, contaminated meat (especially pork, lamb, and venison) Accidental ingestion of undercooked, contaminated meat after handling it and not washing hands thoroughly (Toxoplasma cannot be absorbed through intact skin) Eating food that was contaminated by knives, utensils, cutting boards, or other foods that had contact with raw, contaminated meat Animaltohuman (zoonotic) transmission Cats play an important role in the spread of toxoplasmosis. They become infected by eating infected rodents, birds, or other small animals. The parasite is then passed in the cat's feces in an oocyst form, which is microscopic. Kittens and cats can shed millions of oocysts in their feces for as long as 3 weeks after infection. Mature cats are less likely to shed Toxoplasma if they have been previously infected. A Toxoplasmainfected cat that is shedding the parasite in its feces contaminates the litter box. If the cat is allowed outside, it can contaminate the soil or water in the environment as well. People can accidentally swallow the oocyst form of the parasite. People can be infected by: Accidental ingestion of oocysts after cleaning a cat's litter box when the cat has shed Toxoplasma in its feces Accidental ingestion of oocysts after touching or ingesting anything that has come into contact with a cat's feces that contain Toxoplasma Accidental ingestion of oocysts in contaminated soil (e.g., not washing hands after gardening or eating unwashed fruits or vegetables from a garden) Drinking water contaminated with the Toxoplasma parasite Mothertochild (congenital) transmission A woman who is newly infected with Toxoplasma during pregnancy can pass the infection to her unborn child (congenital infection). The woman may not have symptoms, but there can be severe consequences for the unborn child, such as diseases of the nervous system and eyes. Rare instances of transmission Organ transplant recipients can become infected by receiving an organ from a Toxoplasmapositive donor. Rarely, people can also become infected by receiving infected blood via transfusion. Laboratory workers who handle infected blood can also acquire infection through accidental inoculation.

How to diagnose Parasites - Toxoplasmosis (Toxoplasma infection) ?

The diagnosis of toxoplasmosis is typically made by serologic testing. A test that measures immunoglobulin G (IgG) is used to determine if a person has been infected. If it is necessary to try to estimate the time of infection, which is of particular importance for pregnant women, a test which measures immunoglobulin M (IgM) is also used along with other tests such as an avidity test. Diagnosis can be made by direct observation of the parasite in stained tissue sections, cerebrospinal fluid (CSF), or other biopsy material. These techniques are used less frequently because of the difficulty of obtaining these specimens. Parasites can also be isolated from blood or other body fluids (for example, CSF) but this process can be difficult and requires considerable time. Molecular techniques that can detect the parasite's DNA in the amniotic fluid can be useful in cases of possible mothertochild (congenital) transmission. Ocular disease is diagnosed based on the appearance of the lesions in the eye, symptoms, course of disease, and often serologic testing.

What are the treatments for Parasites - Toxoplasmosis (Toxoplasma infection) ?

Healthy people (nonpregnant) Most healthy people recover from toxoplasmosis without treatment. Persons who are ill can be treated with a combination of drugs such as pyrimethamine and sulfadiazine, plus folinic acid. Pregnant women, newborns, and infants Pregnant women, newborns, and infants can be treated, although the parasite is not eliminated completely. The parasites can remain within tissue cells in a less active phase; their location makes it difficult for the medication to completely eliminate them. Persons with ocular disease Persons with ocular toxoplasmosis are sometimes prescribed medicine to treat active disease by their ophthalmologist. Whether or not medication is recommended depends on the size of the eye lesion, the location, and the characteristics of the lesion (acute active, versus chronic not progressing). Persons with compromised immune systems Persons with compromised immune systems need to be treated until they have improvement in their condition. For AIDS patients, continuation of medication for the rest of their lives may be necessary, or for as long as they are immunosuppressed. More on: Resources for Health Professionals: Treatment

How to prevent Parasites - Toxoplasmosis (Toxoplasma infection) ?

People who are healthy should follow the guidelines below to reduce risk of toxoplasmosis. If you have a weakened immune system, please see guidelines for Immunocompromised Persons. Reduce Risk from Food To prevent risk of toxoplasmosis and other infections from food: Freeze meat for several days at subzero (0° F) temperatures before cooking to greatly reduce chance of infection. Peel or wash fruits and vegetables thoroughly before eating. Wash cutting boards, dishes, counters, utensils, and hands with hot soapy water after contact with raw meat, poultry, seafood, or unwashed fruits or vegetables. More on: Handwashing The U.S. Government and the meat industry continue their efforts to reduce T. gondii in meat. Reduce Risk from the Environment To prevent risk of toxoplasmosis from the environment: Avoid drinking untreated drinking water. Wear gloves when gardening and during any contact with soil or sand because it might be contaminated with cat feces that contain Toxoplasma. Wash hands with soap and warm water after gardening or contact with soil or sand. Teach children the importance of washing hands to prevent infection. Keep outdoor sandboxes covered. Feed cats only canned or dried commercial food or wellcooked table food, not raw or undercooked meats. Change the litter box daily if you own a cat. The Toxoplasma parasite does not become infectious until 1 to 5 days after it is shed in a cat's feces. If you are pregnant or immunocompromised: Avoid changing cat litter if possible. If no one else can perform the task, wear disposable gloves and wash your hands with soap and warm water afterwards. Keep cats indoors. Do not adopt or handle stray cats, especially kittens. Do not get a new cat while you are pregnant.

What is (are) Parasites - Leishmaniasis ?

Leishmaniasis is a parasitic disease that is found in parts of the tropics, subtropics, and southern Europe. Leishmaniasis is caused by infection with Leishmania parasites, which are spread by the bite of infected sand flies. There are several different forms of leishmaniasis in people. The most common forms are cutaneous leishmaniasis, which causes skin sores, and visceral leishmaniasis, which affects several internal organs (usually spleen, liver, and bone marrow).

Who is at risk for Parasites - Leishmaniasis? ?

Leishmaniasis is found in people in focal areas of more than 90 countries in the tropics, subtropics, and southern Europe. The ecologic settings range from rain forests to deserts. Leishmaniasis usually is more common in rural than in urban areas, but it is found in the outskirts of some cities. Climate and other environmental changes have the potential to expand the geographic range of the sand fly vectors and the areas in the world where leishmaniasis is found. Leishmaniasis is found on every continent except Australia and Antarctica. In the Old World (the Eastern Hemisphere), leishmaniasis is found in some parts of Asia, the Middle East, Africa (particularly in the tropical region and North Africa, with some cases elsewhere), and southern Europe. It is not found in Australia or the Pacific islands. In the New World (the Western Hemisphere), it is found in some parts of Mexico, Central America, and South America. It is not found in Chile or Uruguay. Occasional cases of cutaneous leishmaniasis have been acquired in Texas and Oklahoma. The number of new cases per year is not known with certainty. For cutaneous leishmaniasis, estimates of the number of cases range from approximately 0.7 million (700,000) to 1.2 million (1,200,000). For visceral leishmaniasis, estimates of the number of cases range from approximately 0.2 million (200,000) to 0.4 million (400,000). The cases of leishmaniasis evaluated in the United States reflect travel and immigration patterns. For example, many of the cases of cutaneous leishmaniasis in U.S. civilian travelers have been acquired in common tourist destinations in Latin America, such as in Costa Rica. Overall, infection in people is caused by more than 20 species (types) of Leishmania parasites, which are spread by about 30 species of phlebotomine sand flies; particular species of the parasite are spread by particular sand flies. The sand fly vectors generally are the most active during twilight, evening, and nighttime hours (from dusk to dawn). In many geographic areas where leishmaniasis is found in people, infected people are not needed to maintain the transmission cycle of the parasite in nature; infected animals (such as rodents or dogs), along with sand flies, maintain the cycle. However, in some parts of the world, infected people are needed to maintain the cycle; this type of transmission (human—sand fly—human) is called anthroponotic. In areas with anthroponotic transmission, effective treatment of individual patients can help control the spread of the parasite.