Smileband health topics

Relapsing fever is a systemic spirochetal disease in which periods of fever lasting 2–7 days alternate with afebrile periods of 4–14 days; the number of relapses varies from 1 to 10 without treatment. Febrile periods are often associated with shaking chills, sweats, headache, muscle and joint pain, and can be associated with a rash. Photophobia, eye pain, dizziness, dry cough, nausea, vomiting, or lack of appetite can also occur. Each febrile period terminates by a crisis (abrupt symptom change). Symptoms can be more severe without treatment.

 

TBRF occurs in the western U.S. and is usually linked to sleeping in rustic, rodent-infested cabins in mountainous areas and high elevations.

 

Arizona 5 year median: 1 cases

 

Transmission

Transmission occurs when an individual is bitten by an infected tick. Transmission can also occur mother to child in pregnant women.

Incubation period is 2 to 18 days.  Isolation Precautions

Tick-borne relapsing fever is not directly transmitted person-to-person. 

Standard precautions are recommended in healthcare settings. 

Prevention for Patients

• Avoid sleeping in rodent infested buildings
• Inspect buildings on a regular basis for rodent activity
• Eliminate rodent nesting areas
• Use proper food and waste handling practices that eliminate food sources for rodents
• Rodent–proof cabin/buildings by sealing holes in foundation and walls and use screens to prevent rodent entry

Public Health Actions
Public health will conduct an epidemiological investigation on a case or suspect case. 

Smileband health topics

Salmonellosis is a bacterial infection that is caused by Salmonella species. The most common species seen in the United States are Salmonella serotype Typhimurium and Salmonella serotype Enteritidis.

 

The illness can have variable severity and is commonly manifested by:

• diarrhea (sometimes bloody)
• abdominal pain
• nausea
• vomiting

Asymptomatic infections may occur and the organism may cause extraintestinal infections.

In Arizona, there is usually a range from 600 to 1000 cases of Salmonellosis (excluding S. Typhi and S. Paratyphi) reported yearly.

 

Arizona 5 year median: 1,010 cases

 

Transmission
Salmonella is transmitted through contaminated food or water, or contact with infected animals. Salmonella is also transmitted person-to-person by the fecal-oral route.

Animals may be a source of Salmonella infection for humans. Salmonella may also be found in the feces of some pets, especially those with diarrhea. Reptiles, such as turtles, lizards, and snakes, and amphibians, such as frogs, are particularly likely to harbor Salmonella. Many chicks and young birds carry Salmonella in their feces. Lab Tests & Specimen Info

Test*	Specimen
Culture (All positive Salmonella samples are automatically forwarded to the State Public Health Laboratory for further serotyping.)	Stool

Immunoassay tests are not recommended.

Isolation Precautions
Enteric precautions are recommended in healthcare settings. 

Prevention for Patients 

• If served undercooked meat, poultry or eggs in a restaurant, send it back to the kitchen for further cooking.
• Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw meat or poultry.
• Be particularly careful with foods prepared for infants, the elderly, and the immunocompromised.
• Wash hands with soap after handling reptiles, birds, or baby chicks, and after contact with pet feces.
• Avoid direct or even indirect contact between reptiles (turtles, iguanas, other lizards, snakes) and infants or immunocompromised persons.
• Don't work with raw poultry or meat, and an infant (e.g., feed, change diaper) at the same time.
• Mother's milk is the safest food for young infants. Breastfeeding prevents salmonellosis and many other health problems.

Public Health Actions
Public health will conduct an epidemiologic investigation to determine the source, risk factors, and transmission settings.

Smileband health topics

The 'Croydon Cat Ripper' appears to have struck again after a black cat was found dead with the killer's tell-tale signs - its head and tail were removed. A £10,000 reward is now being offered for information that leads to the 'low life scum's' capture.

Snarl, a local animal rescue and rehabilitation shelter, have seen the mutilation of the cat-killer's victims more than 400 times.

The serial killer has also murdered squirrels, foxes and rabbits since 2014

It is understood by Snarl that the killer is a white man in his 40s, around 5ft 9in tall, who is likely to be from Croydon, due to the ease in which he moves around the area. When Tony Jenkins, founder of Snarl, presented the latest fatality to a vet he recoiled at the sight, along with its missing head and tail its body had been sliced open. 

Mr Jenkins, when speaking to AFP, said: 'It was the classic head and tail removal: clean cuts on both, with a bit of additional mutilation to the stomach area,

'We've had cats matching that exact same thing in all sorts of different areas,

'Lowlife scum.'

The shelter started a hunt for the cat-killer after a series of deaths kept cropping up on social media in the Croydon area.

Mr Jenkins and his co-founder Boudicca Rising began investigating the suspicious demise of these poor creatures. After consulting vets, pet owners and local residents they pieced together a map and timeline of the killings. 

Scotland Yard police headquarters and the Royal Society for the Prevention of Cruelty to Animals, Britain's biggest animal welfare charity, both started inquiries after receiving information from Mr Jenkins.

According to Mr Jenkins the cats died from blunt force trauma and the possibility that the killer was another animal was quickly ruled out.

Smileband health topics

British researchers have made a breakthrough that means hospital scanners costing millions and weighing up to three tons could be shrunk down to the size of laptop computers. MRI scanners are vital in a huge range of applications - from detecting brain tumours to tears in ligaments in the knee.

But they are too bulky to be used during surgery, for example. University of York scientists say the breakthrough paves the way to miniaturising the machines – and using them in ‘real time’ during operations.

It could soon transform our ability to diagnose and treat diseases including cancer, diabetes and dementia.

The research is in the early stages, but the team say the breakthrough is comparable to the leap the from computers used 40 years ago to those of the present day.

Professor Simon Duckett from the Centre for Hyperpolarisation in Magnetic Resonance at the University of York said: ‘What we think we have the potential to achieve with MRI what could be compared to improvements in computing power and performance over the last 40 years.

‘While they are a vital diagnostic tool, current hospital scanners could be compared to the abacus, the recent development of more sensitive scanners takes us to Alan Turing’s computer and we are now attempting to create something scalable and low-cost that would bring us to the tablet or smartphone’. This changes the direction the molecules spin in the human body – polarising them to all spin in the same direction.

When molecules are spinning the same way, they can be picked up by the scanner using radio waves.

The new research uses a technique that polarises glucose – and this allows much cheaper, weaker magnets to carry out the same activity.

Professor Duckett said: ‘In theory, it would provide an imaging technique that could be used in an operating theatre.’

‘For example, when a surgeon extracts a brain tumour from a patient they aim to remove all the cancerous tissue while at the same time removing as little healthy tissue as possible. This technique could allow them to accurately visualise cancerous tissue at a far greater depth there and then.’

Dr Peter Rayner, Research Associate at the University of York, said: ‘Our method reflects one of the most significant advances in magnetic resonance in the last decade.’

Smileband general news

Sex robots could make men not women obsolete, according to a top mathematician.  Dr Cathy O'Neil from Harvard University claims females of the future could get spoiled by 'dashing menbots' who also do the dishes.

It's a basic human need to want someone to love and have sex with but most women also look for someone who does their fair share of chores around the house.

The mathematician says it is 'entirely possible' that robots will outperform men and women of the future could choose to live with menbots instead. There are around five makers of sex robots worldwide, with prices ranging from around £4,000 ($5,400) to more than £11,600 ($15,700) for a 'deluxe' model.

The market for sexbots is currently 95 per cent male dominated but that could all be about to change.

'I think it’s the men who should be worried. It’s entirely possible that robots can outperform them', said Dr Cathy O'Neil who has a PhD in mathematics from Harvard University.

'In the #MeToo age, I feel like raising standards is quite reasonable. It’s called for, in fact', she said, writing for Bloomberg. 

Contrary to what the name suggests, not everyone will use their doll purely for sex.

And these robots could be good at doing the dishes and other household chores, Dr O'Neil said. 

Despite the dangers of hackers turning sex robots into killers she believes that would not make them more of a threat than real men.

'Given the baseline murder rate for human sexual partners, it’s hard to get too worried. Plus, if they can understand female anatomy — I mean, really understand it — maybe it’s worth the risk', Dr O'Neil said.

The Harvard mathemetician suggested that women and men may coexist but not cohabitate. As a result she believes this could make us stronger as a community.

'We’ll come together, online or in person, and be more respectful, more relaxed, less edgy. It’s worth a try. So bring on the sex robots', she said. 

Smileband health topics

What is cherubism?

Cherubism is a rare genetic condition that affects the bones of your lower jaw and sometimes upper jaw. The bones are replaced with cyst-like tissue growths that are not as dense. This makes the cheeks look round and swollen, but it is usually painless. 

About 200 cases of cherubism have been reported worldwide. The condition is usually discovered during early childhood, though symptoms may get better after puberty. 

Keep reading to learn more about how this condition presents, what causes it, and more.  Symptoms

The most common symptoms of cherubism are:

• round, swollen-looking cheeks
• a wide jaw
• loose, misplaced, or missing teeth
• eyes that turn slightly upward (in advanced stages)

People with cherubism show no signs of it at birth. It starts to appear in early childhood, usually between the ages of 2 and 5 years. The tissue growths in the jaw grow rapidly until the child is about 7 or 8 years old. At that point, the tissue usually stops growing or grows more slowly for several years.

When someone with cherubism reaches puberty, the effects of the condition usually begin to reverse. For many people, the cheeks and jaw start to return to their typical size and shape in early adulthood. When this happens, normal bone replaces the tissue growths again. 

Many people show little or no outward sign of cherubism by their 30s or 40s. In some rare cases, though, the symptoms last throughout adulthood and don’t reverse. Causes

Cherubism is a genetic disorder. This means there’s a mutation, or permanent change, to the DNA pattern of at least one gene. Mutations can affect a single gene or multiple genes. 

About 80 percent  of people with cherubism have a mutation to the same gene, called SH3BP2. Studies suggest this gene is involved in creating cells that break down bone tissue. That could be why when this particular gene is mutated, it affects bone growth in the jaws.

In the remaining 20 percent of people with cherubism, the cause is most likely a genetic disorder, too. However, it isn't known which gene is affected.

Smileband health topics

Q fever is caused by the bacterium Coxiella burnetii. The organism is very hardy and is resistant to heat, drying, and many disinfectants, so it is able to survive in the environment for long periods. Q fever can result in acute or chronic illness. Symptoms vary greatly between individuals, and about half of the people with Q fever will not show any symptoms. Acute cases of Q fever begin with a sudden onset of one or more of the following:

• high fevers (up to 104°-105°F)
• severe headache
• general discomfort and fatigue
• muscle pain, confusion
• sore throat
• chills, sweats
• dry cough
• nausea
• vomiting
• diarrhea
• stomach pain
• chest pain.

Fever usually lasts for 1 to 2 weeks. Chronic Q fever may result in less than 5% of acutely infected patients, presenting within six weeks of acute infection, up to many years later.

 

Those at highest risk for chronic Q fever are pregnant women, immunosuppressed persons, and patients with pre-existing heart valve defects. Endocarditis is the most common manifestation of chronic Q fever.

 

Over the last 5 years, there have been approximately 8 cases of Q fever reported yearly.

 

Arizona 5 year median: 7 cases

 

Transmission
People usually become infected with Q fever through inhalation of dust contaminated with dried placental material, birth fluids, and excreta of infected herd animals. Other modes of transmission, such as tick bites and human-to-human transmission, are very rare. Consumption of raw or unpasteurized dairy products from infected animals is another method of exposure.

Incubation period is 2 to 3 weeks.

Lab Tests & Specimen Info

Test*	Specimen
IgG/IgM Serology (The convalescent specimen should be taken 2-4 weeks after the acute)	Serum (acute and convalescent)
PCR	Serum

Smileband health topics

Pertussis or whooping cough is a highly contagious respiratory disease that is caused by the bacteria Bordetella pertussis.

 

The disease generally goes through three stages: catarrhal stage, paroxysmal stage, and convalescent stage. In the catarrhal stage, the individual has a runny nose, mild cough and low-grade fever which usually lasts 1-2 week. This is when the individual is the most contagious. The paroxysmal stage is when the paroxysms and posttussive vomiting can occur. This can last 1-6 weeks. The convalescent stage is when coughing lessens and the individual begins to recover gradually.

 

In Arizona, there has been a general increase in the number of pertussis cases reported each year.

 

Arizona 5 year median: 580 cases

 

Transmission
Pertussis is transmitted person to person by contact with aerosolized droplets from an infected person.

The incubation period is 7-10 days with a range of 5 to 21 days.

Lab Tests & Specimen Info

Test*	Specimen
Culture (Culture is not as likely to be positive if > 2 weeks since cough onset)	NP Swab (synthetic swabs only)
PCR (PCR is not as likely to be positive if > 4 weeks since cough onset)	NP Swab (synthetic swab on

  Isolation Precautions

Standard and droplet precautions are recommended for 5 days after initiation of therapy or until 3 weeks after cough onset.

Prevention for Patients
Vaccination is the best prevention method. Tdap vaccine is recommended for pregnant women during their third trimester to help protect the infant. Also, it is recommended for anyone who will be caring for the infant to also have a Tdap vaccine.

Public Health Actions
Untreated individuals should be excluded from school or childcare for 3 weeks following the onset of a cough and treated individuals should be excluded until 5 days of antibiotic treatment is completed. 

Public health will conduct an epidemiological investigation on a case or suspect case.

Smileband health topics

Methycillin-resistant Staphylococcus aureus(MRSA) is a type of staph bacteria resistant to beta-lactam antibiotics. Anyone can get MRSA and infections range from mild to life-threatening. Individuals may be carriers of MRSA and have it on their skin or in their nose but still be asymptomatic. These individual can still infected others with MRSA even though they are asymptomatic.

 

In the community, most MRSA infections are skin infections and are generally mild. Skin infections often look like a boil, pimple, or spider bite.

 

The more serious MRSA infections often occur in healthcare settings. In a healthcare setting, such as a hospital or nursing home, MRSA can cause severe problems such as bloodstream infections, pneumonia and surgical site infections.

 

In Arizona over the last 10 years there have been a range of 1,000 to 1,400 cases of invasive MRSA reported each year.

 

Arizona 5 year median: 1,155 cases

 

Transmission
Infections occur due to direct contact with contaminated surfaces or skin.

In the community, MRSA easily spreads in settings such as daycare, correctional facilities, or sport camps by frequent skin-to-skin contact, crowding, compromised skin, contaminated items and surfaces and lack of cleanliness.

In health care settings, poor adherence to standard infection control precautions (e.g. hand hygiene) can lead to transmission between patients and to clusters of infections.

Lab Tests & Specimen Info

Test*	Specimen
Culture	Specimen from a normally sterile site
Susceptibility testing	Isolate

  Isolation Precautions

Patients with MRSA should be put on standard and contact precautions.

Prevention for Patients
Maintaining good hand and body hygiene is the best prevention method.

• Washing hands often, and cleaning body regularly, especially after exercise.
• Keeping cuts, scrapes, and wounds clean and covered until healed.
• Avoid sharing personal items such as towels, washcloths, razors, clothing, and uniforms.

Individuals are infectious as long as the sores are draining.

Public Health Actions
Cases should be excluded from school or child care only if the sores cannot be covered.

Public health will conduct an epidemiological investigation on an outbreak.

Smileband Health issues

Diphtheria is an infection caused by toxigenic strains of the bacteria Corynebacterium diphtheriae.

Initial symptoms consist of:

• sore throat
• difficulty swallowing
• malaise
• low-grade fever

The pathogen produces a toxin that interferes with cellular processes causing tissue destruction, which in turn causes the most notable symptom of diphtheria, a grayish-white pseudomembrane over the tonsils, pharynx, or larynx. The membrane can cause the airway to become obstructed which can be fatal. The toxin can be absorbed into the bloodstream and can cause damage to tissue throughout the body.

Cases of diphtheria are still seen throughout the world and many of those cases are from southeast Asia.

There has not been a case of diphtheria reported in Arizona in the last 10 years.

Transmission

Diphtheria is spread by respiratory tract droplets and contact with skin lesions. Rarely, fomites and raw milk or milk products can act as a mode of transmission. Fully immunized individuals can act as carriers. 

Test*	Specimen
Culture	NP swab (synthetic only), Throat swab (synthetic only)

 Isolation Precautions

Isolate and institute droplet precautions for a pharyngeal diphtheria case or a suspect case.

Isolate and institute contact precautions for a cutaneous diphtheria case or suspect case. 

Prevention for Patients
Vaccination is the best prevention method. >95% of healthy adults and infants, children, and adolescents develop adequate antibody response after a 3-dose series. Tdap booster is recommended for adults in place of the Td booster

In untreated individuals, the pathogen can be present in discharges for 2 – 6 weeks after infection. In properly treated individuals they will no longer be contagious 48 hours after the treatment

Public Health Actions
Antitoxin is available through the CDC and should be given as soon as possible after diagnosis, even before culture results are determined. 

Cases of diphtheria should be excluded from working as a food handler, caring for patients in a healthcare institution, or caring for children in or attending a school or child care establishment until a set of cultures negative for C. diphtheriaeis obtained from the nose and throat specimen.

Public health will conduct an epidemiological investigation on a case or suspect case.