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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Since human plague is rare in most parts of the world, routine vaccination is not needed other than for those at particularly high risk of exposure, nor for people living in areas with enzootic plague, meaning it occurs at regular, predictable rates in populations and specific areas, such as the western United States. It is not even indicated for most travellers to countries with known recent reported cases, particularly if their travel is limited to urban areas with modern hotels. The CDC thus only recommends vaccination for: (1) all laboratory and field personnel who are working with "Y. pestis" organisms resistant to antimicrobials; (2) people engaged in aerosol experiments with "Y. pestis"; and (3) people engaged in field operations in areas with enzootic plague where preventing exposure is not possible (such as some disaster areas).
A systematic review by the Cochrane Collaboration found no studies of sufficient quality to make any statement on the efficacy of the vaccine.
Bubonic plague is an infection of the lymphatic system, usually resulting from the bite of an infected flea, "Xenopsylla cheopis" (the rat flea). In very rare circumstances, as in the septicemic plague, the disease can be transmitted by direct contact with infected tissue or exposure to the cough of another human. The flea is parasitic on house and field rats, and seeks out other prey when its rodent hosts die. The bacteria remain harmless to the flea, allowing the new host to spread the bacteria. The bacteria form aggregates in the gut of infected fleas and this results in the flea regurgitating ingested blood, which is now infected, into the bite site of a rodent or human host. Once established, bacteria rapidly spread to the lymph nodes and multiply.
"Y. pestis" bacilli can resist phagocytosis and even reproduce inside phagocytes and kill them. As the disease progresses, the lymph nodes can haemorrhage and become swollen and necrotic. Bubonic plague can progress to lethal septicemic plague in some cases. The plague is also known to spread to the lungs and become the disease known as the pneumonic plague.
Transmission of "Y. pestis" to an uninfected individual is possible by any of the following means.
- droplet contact – coughing or sneezing on another person
- direct physical contact – touching an infected person, including sexual contact
- indirect contact – usually by touching soil contamination or a contaminated surface
- airborne transmission – if the microorganism can remain in the air for long periods
- fecal-oral transmission – usually from contaminated food or water sources
- vector borne transmission – carried by insects or other animals.
"Yersinia pestis" circulates in animal reservoirs, particularly in rodents, in the natural foci of infection found on all continents except Australia. The natural foci of plague are situated in a broad belt in the tropical and sub-tropical latitudes and the warmer parts of the temperate latitudes around the globe, between the parallels 55 degrees North and 40 degrees South.
Contrary to popular belief, rats did not directly start the spread of the bubonic plague. It is mainly a disease in the fleas ("Xenopsylla cheopis") that infested the rats, making the rats themselves the first victims of the plague. Infection in a human occurs when a person is bitten by a flea that has been infected by biting a rodent that itself has been infected by the bite of a flea carrying the disease. The bacteria multiply inside the flea, sticking together to form a plug that blocks its stomach and causes it to starve. The flea then bites a host and continues to feed, even though it cannot quell its hunger, and consequently the flea vomits blood tainted with the bacteria back into the bite wound. The bubonic plague bacterium then infects a new person and the flea eventually dies from starvation. Serious outbreaks of plague are usually started by other disease outbreaks in rodents, or a rise in the rodent population.
Bubonic plague is one of three types of plague caused by bacterium "Yersinia pestis". One to seven days after exposure to the bacteria, flu like symptoms develop. These include fever, headaches, and vomiting. Swollen and painful lymph nodes occur in the area closest to where the bacteria entered the skin. Occasionally the swollen lymph nodes may break open.
The three types of plague are the result of the route of infection: bubonic plague, septicemic plague, and pneumonic plague. Bubonic plague is mainly spread by infected fleas from small animals. It may also result from exposure to the body fluids from a dead plague infected animal. In the bubonic form of plague, the bacteria enter through the skin through a flea bite and travel via the lymphatic vessels to a lymph node, causing it to swell. Diagnosis is made by finding the bacteria in the blood, sputum, or fluid from lymph nodes.
Prevention is through public health measures such as not handling dead animals in areas where plague is common. Vaccines have not been found to be very useful for plague prevention. Several antibiotics are effective for treatment including streptomycin, gentamicin, and doxycycline. Without treatment it results in the death of 30% to 90% of those infected. Death, if it occurs, is typically within ten days. With treatment the risk of death is around 10%. Globally there are about 650 documented cases a year which result in ~120 deaths. The disease is most common in Africa.
The plague is believed to be the cause of the Black Death that swept through Asia, Europe, and Africa in the 14th century and killed an estimated 50 million people. This was about 25% to 60% of the European population. Because the plague killed so many of the working population, wages rose due to the demand for labor. Some historians see this as a turning point in European economic development. The term "bubonic" is derived from the Greek word , meaning "groin". The term "buboes" is also used to refer to the swollen lymph nodes.
Pneumonic plague can be caused in two ways: primary, which results from the inhalation of aerosolised plague bacteria, or secondary, when septicaemic plague spreads into lung tissue from the bloodstream. Pneumonic plague is "not" exclusively vector-borne like bubonic plague; instead it can be spread from person to person. There have been cases of pneumonic plague resulting from the dissection or handling of contaminated animal tissue. This is one type of the plague formerly known as the Black Death.
Pneumonic plague is a severe lung infection caused by the bacterium "Yersinia pestis". Symptoms include fever, headache, shortness of breath, chest pain, and cough. They typically start about three to seven days after exposure. It is one of three forms of plague, the other two being septicemic plague and bubonic plague.
The pneumonic form may occur following an initial bubonic or septicemic plague infection. It may also result from breathing in airborne droplets from another person or cat infected with pneumonic plague. The difference between the forms of plague is the location of infection; in pneumonic plague the infection is in the lungs, in bubonic plague the lymph nodes, and in septicemic plague within the blood. Diagnosis is by testing the blood, sputum, or fluid from a lymph node.
While vaccines are being worked on, in most countries they are not yet commercially available. Prevention is generally by avoiding contact with rodents. It is recommended that those infected be isolated from others. Treatment of pneumonic plague is with antibiotics.
Plague is present among rodents in Africa, the Americas, and Asia. Pneumonic plague is more serious and less common than bubonic plague. The total reported number of all types of plague in 2013 was 783. Untreated pneumonic plague has a mortality of nearly 100%. Some hypothesize that the pneumonic version of the plague was mainly responsible for the Black Death that resulted in approximately 50 million deaths in the 1300s.
Human "Yersinia" infections most commonly result from the bite of an infected flea or occasionally an infected mammal, but like most bacterial systemic diseases, the disease may be transmitted through an opening in the skin or by inhaling infectious droplets of moisture from sneezes or coughs. In both cases septicemic plague need not be the result, and in particular, not the initial result, but it occasionally happens that bubonic plague for example leads to infection of the blood, and septicemic plague results. If the bacteria happen to enter the bloodstream rather than the lymph or lungs, they multiply in the blood, causing bacteremia and severe sepsis. In septicemic plague, bacterial endotoxins cause disseminated intravascular coagulation (DIC), where tiny blood clots form throughout the body, commonly resulting in localised ischemic necrosis, tissue death from lack of circulation and perfusion.
DIC results in depletion of the body's clotting resources, so that it can no longer control bleeding. Consequently, the unclotted blood bleeds into the skin and other organs, leading to red or black patchy rash and to hematemesis (vomiting blood) or hemoptysis (spitting blood). The rash may cause bumps on the skin that look somewhat like insect bites, usually red, sometimes white in the center.
Untreated septicemic plague is almost always fatal. Early treatment with antibiotics reduces the mortality rate to between 4 and 15 percent. Death is almost inevitable if treatment is delayed more than about 24 hours, and some people may even die on the same day they with the disease.
Septicemic plague is caused by horizontal and direct transmission. Horizontal transmission is the transmitting of a disease from one individual to another regardless of blood relation. Direct transmission occurs from close physical contact with individuals, through common air usage, from direct bite from a flea or an infected rodent. Most common rodents may carry the bacteria and so may Leporidae such as rabbits:
Significant carriers of the bacteria in the United States include:
- Rats
- Prairie dogs
- Squirrels
- Chipmunks
- Rabbits
The bacteria are cosmopolitan, mainly in rodents in all continents except Australia and Antarctica. The greatest frequency of human plague infections occur in Africa. The bacteria most commonly appear in rural areas and wherever there is poor sanitation, overcrowding, and high rodent populations in urban areas. Outdoor activities such as hiking, camping, or hunting where plague-infected animals may be found, increase the risk of contracting septicemic plague, and so do certain occupations such as veterinary or other animal-related work.
As of 2017 there is no commercially available vaccine. A vaccine has been in development for scrub typhus known as the scrub typhus vaccine.
Anthrax can enter the human body through the intestines (ingestion), lungs (inhalation), or skin (cutaneous) and causes distinct clinical symptoms based on its site of entry. In general, an infected human will be quarantined. However, anthrax does not usually spread from an infected human to a noninfected human. But, if the disease is fatal to the person's body, its mass of anthrax bacilli becomes a potential source of infection to others and special precautions should be used to prevent further contamination. Inhalational anthrax, if left untreated until obvious symptoms occur, is usually fatal.
Anthrax can be contracted in laboratory accidents or by handling infected animals or their wool or hides. It has also been used in biological warfare agents and by terrorists to intentionally infect as exemplified by the 2001 anthrax attacks.
The following steps and precautions should be used to avoid infection of the septicemic plague:
- Caregivers of infected patients should wear masks, gloves, goggles and gowns
- Take antibiotics if close contact with infected patient has occurred
- Use insecticides throughout house
- Avoid contact with dead rodents or sick cats
- Set traps if mice or rats are present around the house
- Do not allow family pets to roam in areas where plague is common
- Flea control and treatment for animals (especially rodents)
The spores are able to survive in harsh conditions for decades or even centuries. Such spores can be found on all continents, including Antarctica. Disturbed grave sites of infected animals have been known to cause infection after 70 years.
Occupational exposure to infected animals or their products (such as skin, wool, and meat) is the usual pathway of exposure for humans. Workers who are exposed to dead animals and animal products are at the highest risk, especially in countries where anthrax is more common. Anthrax in livestock grazing on open range where they mix with wild animals still occasionally occurs in the United States and elsewhere. Many workers who deal with wool and animal hides are routinely exposed to low levels of anthrax spores, but most exposure levels are not sufficient to develop anthrax infections. A lethal infection is reported to result from inhalation of about 10,000–20,000 spores, though this dose varies among host species. Little documented evidence is available to verify the exact or average number of spores needed for infection.
Historically, inhalational anthrax was called woolsorters' disease because it was an occupational hazard for people who sorted wool. Today, this form of infection is extremely rare in advanced nations, as almost no infected animals remain.
The American Public Health Association recommends treatment based upon clinical findings and before culturing confirms the diagnosis. Without treatment, death may occur in 10 to 60 percent of patients with epidemic typhus, with patients over age 60 having the highest risk of death. In the antibiotic era, death is uncommon if doxycycline is given. In one study of 60 hospitalized patients with epidemic typhus, no patient died when given doxycycline or chloramphenicol. Some patients also may need oxygen and intravenous (IV) fluids.
Treatment is similar to hepatitis B, but due to its high lethality, more aggressive therapeutic approaches are recommended in the acute phase. In absence of a specific vaccine against delta virus, the vaccine against HBV must be given soon after birth in risk groups.
Lábrea fever is a coinfection or superinfection of hepatitis D or delta virus and hepatitis B (HBV). The infection by delta virus may occur in a patient who already has the HBV, or both viruses may infect at the same time a previously uninfected patient. Delta virus can only multiply in the presence of HBV, therefore vaccination against HBV prevents infection. Thus, American and Brazilian scientists have determined that the delta virusa, virus, which is a small circular RNA virus, is normally unable to cause illness by itself, due to a defect. When it is combined with HBV, Lábrea hepatitis may ensue. The main discovery of delta virus and HBV association was done by Dr. Gilberta Bensabath, a leading tropical virologist of the Instituto Evandro Chagas, of Belém, state of Pará, and her collaborators.
Infected patients show extensive destruction of liver tissue, with steatosis of a particular type (microsteatosis, characterized by small fat droplets inside the cells), and infiltration of large numbers of inflammatory cells called "morula cells", comprised mainly by macrophages containing delta virus antigens.
In the 1987 Boca do Acre study, scientists did an epidemiological survey and reported delta virus infection in 24% of asymptomatic HBV carriers, 29% of acute nonfulminant hepatitis B cases, 74% of fulminant hepatitis B cases, and 100% of chronic hepatitis B cases. The delta virus seems to be endemic in the Amazon region.
Aleutian disease, also known as mink plasmacytosis, is a disease which causes spontaneous abortion and death in minks and ferrets. It is caused by "Carnivore amdoparvovirus 1" (also known as "Aleution diease virus", ADV), a highly contagious parvovirus in the genus "Amdoparvovirus".
The virus has been found as a natural infection in the "Mustelidae" family within mink, ferrets, otters, polecats, stone and pine martens and within other varying carnivores such as skunks, genets, foxes and raccoons. This is most commonly explained as because they all share resources and habitats.
Zymotic disease was a 19th-century medical term for acute infectious diseases, especially "chief fevers and contagious diseases (e.g. typhus and typhoid fevers, smallpox, scarlet fever, measles, erysipelas, cholera, whooping-cough, diphtheria, &c.)".
Zyme or microzyme was the name of the organism presumed to be the cause of the disease.
As originally employed by Dr W. Farr, of the British Registrar-General's department, the term included the diseases which were "epidemic, endemic and contagious," and were regarded as owing their origin to the presence of a morbific principle in the system, acting in a manner analogous to, although not identical with, the process of fermentation.
In the late 19th century, Antoine Béchamp proposed that tiny organisms he termed "microzymas", and not cells, are the fundamental building block of life. Bechamp claimed these microzymas are present in all things—animal, vegetable, and mineral—whether living or dead . Microzymas are what coalesce to form blood clots and bacteria. Depending upon the condition of the host, microzymas assume various forms. In a diseased body, the microzymas become pathological bacteria and viruses. In a healthy body, microzymas form healthy cells. When a plant or animal dies, the microzymas live on. His ideas did not gain acceptance.
The word "zymotic" comes from the Greek word ζυμοῦν "zumoûn" which means "to ferment". It was in British official use from 1839. This term was used extensively in the English Bills of Mortality as a cause of death from 1842. Robert Newstead (1859–1947) used this term in a 1908 publication in the "Annals of Tropical Medicine and Parasitology", to describe the contribution of house flies ("Musca domestica") towards the spread of infectious diseases. However, by the early 1900s, bacteriology "displaced the old fermentation theory", and so the term became obsolete.
In her "Diagram of the causes of mortality in the army in the East", Florence Nightingale depicts The blue wedges measured from the centre of the circle represent area for area the deaths from Preventible or Mitigable Zymotic diseases ; the red wedges measured from the centre the deaths from wounds, & the black wedges measured from the centre the deaths from all other causes.
The vast majority of victims fully recover without significant lasting problems (sequelae). Death from latrodectism is reported as high as 5% to as low as 0.2%. In the United States, where antivenom is rarely used, there have been no deaths reported for decades.
Despite frequent reference to youth and old age being a predisposing factor it has been demonstrated that young children appear to be at lowest risk for a serious bite, perhaps owing to the rapid use of antivenom. Bite victims who are very young, old, hypotensive, pregnant or who have existing heart problems are reported to be the most likely to suffer complications. However, due to the low incidence of complications these generalizations simply refer to special complications (see Special circumstances).
ADV is highly contagious. It is transferred through a ferret's bodily fluids. This an infection can also be transmitted in utero or by direct/indirect contact with those mink who are infected. Additionally, once symptoms have been indicated, the mink is unfortunately sure to die.
It can lie dormant in dried urine or on an owner's clothes and shoes for up to two years. Known cases of ADV positive ferrets should not be taken to places where they may come in contact with other ferrets. They also should not be allowed to run on floors or other areas where uninfected ferrets or their owners may come in contact with residual traces of the virus from the infected animals.
The cause of hemolytic crises in this disease is unknown (mainly due to intravascular haemolysis). There is rapid and massive destruction of red blood cells resulting in hemoglobinemia (hemoglobin in the blood, but outside the red blood cells), hemoglobinuria (hemoglobin in urine), intense jaundice, anuria (passing less than 50 milliliters of urine in a day), and finally death in the majority of cases.
The most probable explanation for blackwater fever is an autoimmune reaction apparently caused by the interaction of the malaria parasite and the use of quinine. Blackwater fever is caused by heavy parasitization of red blood cells with "Plasmodium falciparum". There has been at least one case, however, attributed to "Plasmodium vivax".
Blackwater fever is a serious complication of malaria, but cerebral malaria has a higher mortality rate. Blackwater fever is much less common today than it was before 1950. It may be that quinine plays a role in triggering the condition, and this drug is no longer commonly used for malaria prophylaxis. Quinine remains important for treatment of malaria.
In sheep, the disease, referred to as "black disease", results from interaction of bacteria (especially Clostridium novyi) and liver fluke (Fasciola hepatica).
The treatment is antimalarial chemotherapy, intravenous fluid and sometimes supportive care such as intensive care and dialysis.
Infectious necrotic hepatitis is a disease of large animals, especially sheep, caused by "Clostridium novyi" infection. The primary infection is intestinal and transferred by the faecal-oral route. Spores of "C. novyi" escape from the gut and lodge in the liver, where they remain dormant until some injury creates anaerobic conditions for them to germinate, causing local necrosis and widespread damage to the microvascular system, resulting in subcutaneous bleeding and blackening of the skin, hence the common name "black disease."
Sweating sickness, also known as "English sweating sickness" or "English sweate" (), was a mysterious and highly contagious disease that struck England, and later continental Europe, in a series of epidemics beginning in 1485. The last outbreak occurred in 1551, after which the disease apparently vanished. The onset of symptoms was dramatic and sudden, death often occurring within hours. Although its cause remains unknown, it has been suggested that an unknown species of hantavirus was responsible for the outbreak.
Bites from "Latrodectus" occur usually because of accidental contact with the spiders. The species are not aggressive to humans naturally, but may bite when trapped. As such, bite incidents may be described as accidents. Reports of epidemics were associated with agricultural areas in Europe in the last two centuries. However the European spider is associated with fields and humans come in contact only during harvest. For example, in the 1950s researchers believed that three bites happened each year and with an epidemic up to 180 each year.
Conversely, redback and North American black widows live in proximity with people and several thousand black widow bites are reported to Poison Control in the United States each year. About 800 are reported by medical personnel. Amongst those 800 bites only a dozen had major complications and none were fatal.
In Perth, Australia, for example there were 156 bites in children from redback spiders over 20 years. Twice as many boys were bitten as girls, mostly toddlers. A third of the children developed latrodectism and there were no deaths.
An escharotic is a substance that causes tissue to die and slough off. Examples include acids, alkalis, carbon dioxide, metallic salts and sanguinarine, as well as certain medicines like imiquimod. Escharotics known as black salves, containing ingredients such as zinc chloride and sanguinarine containing bloodroot extracts, were traditionally used in herbal medicine as topical treatments for localised skin cancers, but often cause scarring and can potentially cause serious injury and disfigurement. Consequently, escharotic salves are very strictly regulated in most western countries and while some prescription medicines are available with this effect, unauthorized sales are illegal. Some prosecutions have been pursued over unlicensed sales of escharotic products such as Cansema.