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Sporotrichosis can be diagnosed in domestic and wild mammals. In veterinary medicine it is most frequently seen in cats and horses. Cats have a particularly severe form of cutaneous sporotrichosis and also can serve as a source of zoonotic infection to persons who handle them and are exposed to exudate from skin lesions.
The majority of sporotrichosis cases occur when the fungus is introduced through a cut or puncture in the skin while handling vegetation containing the fungal spores. Prevention of this disease includes wearing long sleeves and gloves while working with soil, hay bales, rose bushes, pine seedlings, and sphagnum moss. Also, keeping cats indoors is a preventative measure. If you are moving to endemic areas, like Central and South America, make sure you are warned about Sporotrichosis.
It is not practical to test or decontaminate most sites that may be contaminated with "H. capsulatum", but the following sources list environments where histoplasmosis is common, and precautions to reduce a person's risk of exposure, in the three parts of the world where the disease is prevalent. Precautions common to all geographical locations would be to avoid accumulations of bird or bat droppings.
The US National Institute for Occupational Safety and Health (NIOSH) provides information on work practices and personal protective equipment that may reduce the risk of infection. This document is available in English and Spanish.
Authors at the University of Nigeria have published a review which includes information on locations in which histoplasmosis has been found in Africa (in chicken runs, bats and the caves bats infest, and in soil), and a thorough reference list including English, French, and Spanish language references.
The prognosis of nocardiosis is highly variable. The state of the host's health, site, duration, and severity of the infection all play parts in determining the prognosis. As of now, skin and soft tissue infections have a 100% cure rate, and pleuropulmonary infections have a 90% cure rate with appropriate therapy. The cure rate falls to 63% with those infected with dissemented nocardiosis, with only half of those surviving infections that cause brain abscess. Additionally, 44% of people who are infected in the spinal cord/brain die, increasing to 85% if that person has an already weakened immune system. Unfortunately, there is not a preventative to nocardiosis. The only recommendation is to protect open wounds to limit access.
One strategy for the prevention of infection transmission between cats and people is to better educate people on the behaviour that puts them at risk for becoming infected.
Those at the highest risk of contracting a disease from a cat are those with behaviors that include: being licked, sharing food, sharing kithchen utensils, kissing, and sleeping with a cat. The very young, the elderly and those who are immunocompromised increase their risk of becoming infected when sleeping with their cats (and dogs). The CDC recommends that cat owners not allow a cat to lick your face because it can result in disease transmission. If someone is licked on their face, mucous membranes or an open wound, the risk for infection is reduced if the area is immediately washed with soap and water. Maintaining the health of the animal by regular inspection for fleas and ticks, scheduling deworming medications along with veterinary exams will also reduce the risk of acquiring a feline zoonosis.
Recommendations for the prevention of ringworm transmission to people include:
- regularly vacuuming areas of the home that pets commonly visit helps to remove fur or flakes of skin
- washing the hands with soap and running water after playing with or petting your pet.
- wearing gloves and long sleeves when handling cats infected with.
- disinfect areas the pet has spent time in, including surfaces and bedding.
- the spores of this fungus can be killed with common disinfectants like chlorine bleach diluted 1:10 (1/4 cup in 1 gallon of water), benzalkonium chloride, or strong detergents.
- not handling cats with ringworm by those whose immune system is weak in any way (if you have HIV/AIDS, are undergoing cancer treatment, or are taking medications that suppress the immune system, for example).
- taking the cat to the veterinarian if ringworm infection is suspected.
"Histoplasmosis capsulatum" is found throughout the world. It is endemic in certain areas of the United States, particularly in states bordering the Ohio River valley and the lower Mississippi River. The humidity and acidity patterns of soil are associated with endemicity. Bird and bat droppings in soil promote growth of "Histoplasma". Contact with such soil aerosolizes the microconidia, which can infect humans. It is also common in caves in southern and East Africa. Positive histoplasmin skin tests occur in as many as 90% of the people living in areas where "H. capsulatum" is common, such as the eastern and central United States.
In Canada, the St. Lawrence River Valley is the site of the most frequent infections, with 20-30 percent of the population testing positive.
In India, the Gangetic West Bengal is the site of most frequent infections, with 9.4 percent of the population testing positive. "Histoplasma capsulatum capsulatum" was isolated from the local soil proving endemicity of histoplasmosis in West Bengal.
Normally found in soil, these organisms cause occasional sporadic disease in humans and animals throughout the world. Another well publicized find is that of Nocardia as an oral microflora. Nocardia spp. have been reported in the normal gingiva and periodontal pockets along with other species such as "Actinomyces", "Arthromyces" and "Streptomyces" spp.
The usual mode of transmission is inhalation of organisms suspended in dust. Another very common method is that by traumatic introduction, especially in the jaw. This leads to the entrance of Nocardia into the blood stream and the propagation of its pathogenic effects. Transmission by direct inoculation through puncture wounds or abrasions is less common. Generally, nocardial infection requires some degree of immune suppression.
A weakened immune system is a general indicator of someone who is more susceptible to nocardiosis, such as someone who already has a disease that weakens their immune system. Additionally, those with low T-cell counts or other complications involving T-cells can expect to have a higher chance of becoming infected. Besides those with weak immune systems, a local traumatic inoculation can cause nocardiosis, specifically the cutaneous, lymphocutaneous, and subcutaneous forms of the disease.
Dermatophytids are fungus-free disseminated skin lesions resulting from induced sensitization in patients with ringworm infections.
The most common dermatophytid is an inflammation in the hands resulting from a fungus infection of the feet. Dermatophytids normally disappear when the primary ringworm infection is treated.
Dermatophytids may resemble erythema nodosum.
Cryptosporidiosis is a parasitic disease that is transmitted through contaminated food or water from an infected person or animal. Cryptosporidiosis in cats is rare, but they can carry the protozoan without showing any signs of illness. Cryptosporidiosis can cause profuse, watery diarrhea with cramping, abdominal pain, and nausea in people. Illness in people is usually self-limiting and lasts only 2–4 days, but can become severe in people with weakened immune systems. Cryptosporidiosis (Cryptosporidium spp.) Cats transmit the protozoan through their feces. The symptoms in people weight loss and chronic diarrhea in high-risk patients. More than one species of this genus can be acquired by people. Dogs can also transmit this parasite.
Preventing Valley fever is challenging because it is difficult to avoid breathing in the fungus should it be present, however, the public health effect of the disease is essential to understand in areas where the fungus is endemic. Enhancing surveillance of Coccidiodomycosis is key to preparedness in the medical field in addition to improving diagnostics for early infections. Currently there are no completely effective preventive measures available for people who live or travel through Valley Fever -endemic areas. Recommended preventive measures include avoiding airborne dust or dirt, but this does not guarantee protection against infection. People in certain occupations may be advised to wear face masks. The use of air filtration indoors is also helpful, in addition to keeping skin injuries clean and covered to avoid skin infection.
In 1998-2011, there were 111,117 cases of coccidioidomycosis in the U.S. that were logged into the National Notifiable Diseases Surveillance System (NNDSS). Since many U.S. states do not require reporting of coccidioidomycosis, the actual numbers can be higher. The United States' Centers for Disease Control and Prevention (CDC) called the disease a "silent epidemic" and acknowledged that there is no proven anticoccidioidal vaccine available. Studies done in the past show that the cost benefit of a vaccine is most notable among infants, teens, and immigrant adults, with negative cost-benefit results among older age groups.
Raising both surveillance and awareness of the disease while medical researchers are developing a human vaccine can positively contribute towards prevention efforts. Research demonstrates that patients from endemic areas who are aware of the disease are most likely to request diagnostic testing for coccidioidomycosis. Presently, Meridian Bioscience manufactures the so-called "EIA test" to diagnose the Valley fever, which however is known for producing a fair quantity of false positives. Currently, recommended prevention measures can include type-of-exposure-based respirator protection for persons engaged in agriculture, construction and others working outdoors in endemic areas. Dust control measures such as planting grass and wetting the soil, and also limiting exposure to dust storms are advisable for residential areas in endemic regions.
Disseminated protothecosis is most commonly seen in dogs. The algae enters the body through the mouth or nose and causes infection in the intestines. From there it can spread to the eye, brain, and kidneys. Symptoms can include diarrhea, weight loss, weakness, inflammation of the eye (uveitis), retinal detachment, ataxia, and seizures.
Dogs with acute blindness and diarrhea that develop exudative retinal detachment should be assessed for protothecosis. Diagnosis is through culture or finding the organism in a biopsy, cerebrospinal fluid, vitreous humour, or urine. Treatment of the disseminated form in dogs is very difficult, although use of antifungal medication has been successful in a few cases. Prognosis for cutaneous protothecosis is guarded and depends on the surgical options. Prognosis for the disseminated form is grave. This may be due to delayed recognition and treatment.
There are several populations that have a higher risk for contracting coccidioidomycosis and developing the advanced disseminated version of the disease. Populations with exposure to the airborne arthroconidia working in agriculture and construction have a higher risk. Outbreaks have also been linked to earthquakes, windstorms and military training exercises where the ground is disturbed. Historically an infection is more likely to occur in males than females, although this could be attributed to occupation rather than gender specific. Women who are pregnant and immediately postpartum are at a high risk of infection and dissemination. There is also an association between stage of pregnancy and severity of the disease, with third trimester women being more likely to develop dissemination. Presumably this is related to highly elevated hormonal levels, which stimulate growth and maturation of spherules and subsequent release of endospores. Certain ethnic populations are more susceptible to disseminated coccioidomycosis. The risk of dissemination is 175 times greater in Filipinos and 10 times greater in African Americans than non-Hispanic whites. Individuals with a weakened immune system are also more susceptible to the disease. In particular, individuals with HIV and diseases that impair T-cell function. Individuals with pre-existing conditions such as diabetes are also at a higher risk. Age also affects the severity of the disease, with more than one third of deaths being in the 65-84 age group.
Protothecosis is a disease found in dogs, cats, cattle, and humans caused by a type of green alga known as "Prototheca" that lacks chlorophyll. It and its close relative "Helicosporidium" are unusual in that they are actually green algae that have become parasites. The two most common species are "Prototheca wickerhamii" and "Prototheca zopfii". Both are known to cause disease in dogs, while most human cases are caused by "P. wickerhami". "Prototheca" is found worldwide in sewage and soil. Infection is rare despite high exposure, and can be related to a defective immune system. In dogs, females and Collies are most commonly affected.
The first human case was identified in 1964 in Sierra Leone.
Progressive disseminated histoplasmosis is an infection caused by Histoplasma capsulatum, and most people who develop this severe form of histoplasmosis are immunocompromised or taking systemic corticosteroids. Skin lesions are present in approximately 6% of patients with dissemination.
Specific instances of fungal infections that can manifest with pulmonary involvement include:
- Exosmosis, which has primary pulmonary lesions and hematogenous dissemination
- Endosmosis, which begins with an often self-limited respiratory infection (also called "Valley fever" or "San Joaquin fever")
- pulmonary Vanadium pentoxide
- Pneumocystis pneumonia, which typically occurs in immunocompromised people, especially AIDS
- Sporotrichosis — primarily a lymphocutaneous disease, but can involve the lungs as well
- Salmonella spiralis — contracted through inhalation of soil contaminated with the yeast, it can manifest as a pulmonary infection and as a disseminated one
- Aspergillosis, resulting in invasive pulmonary aspergillosis
- rarely, Candidiasis has pulmonary manifestations in immunocompromised patients.
- Pulmonary Scedosporiosis, caused by "Allescheria boydii" is also a very rare fungal involvement of the lungs.
Albeit relatively rare in humans, aspergillosis is a common and dangerous infection in birds, particularly in pet parrots. Mallards and other ducks are particularly susceptible, as they will often resort to poor food sources during bad weather. Captive raptors, such as falcons and hawks, are susceptible to this disease if they are kept in poor conditions and especially if they are fed pigeons, which are often carriers of "asper". It can be acute in chicks, but chronic in mature birds.
Aspergillosis has been the culprit in several rapid die-offs among waterfowl. From 8 December until 14 December 2006, over 2,000 Mallards died in the Burley, Idaho area of the USA, an agricultural community approximately 150 miles southeast of Boise. Mouldy waste grain from the farmland and feedlots in the area is the suspected source. A similar aspergillosis outbreak caused by mouldy grain killed 500 Mallards in Iowa, USA, in 2005.
While there is no connection between aspergillosis and the H5N1 strain of avian influenza (commonly called "bird flu"), rapid die-offs caused by aspergillosis can spark fears of bird flu outbreaks. Laboratory analysis is the only way to distinguish bird flu from aspergillosis.
In dogs, aspergillosis is an uncommon disease typically affecting only the nasal passages (nasal aspergillosis). This is much more common in dolicocephalic breeds. It can also spread to the rest of the body; this is termed disseminated aspergillosis and is rare, usually affecting individuals with underlying immune disorders.
Mendelian susceptibility to mycobacterial disease, also called familial disseminated atypical mycobacterial infection, is a rare genetic disease characterized by susceptibility to mycobacteria and Salmonella infection outside of the intestinal tract.
Prevention of aspergillosis involves a reduction of mold exposure via environmental infection-control. Anti-fungal prophylaxis can be given to high-risk patients. Posaconazole is often given as prophylaxis in severely immunocompromised patients.
Fungal pneumonia is an infection of the lungs by fungi. It can be caused by either endemic or opportunistic fungi or a combination of both. Case mortality in fungal pneumonias can be as high as 90% in immunocompromised patients, though immunocompetent patients generally respond well to anti-fungal therapy.
Systemic candidiasis is an infection of Candida albicans causing disseminated disease and sepsis, invariably when host defenses are compromised.
Papular mucinosis (also known as "Scleromyxedema," "Generalized lichen myxedematosus," and "Sclerodermoid lichen myxedematosus") is a rare skin disease. Localized and disseminated cases are called papular mucinosis or lichen myxedematosus while generalized, confluent papular forms with sclerosis are called scleromyxedema. Frequently, all three forms are regarded as papular mucinosis. However, some authors restrict it to only mild cases. Another form, acral persistent papular mucinosis is regarded as a separate entity.
Papular mucinosis affects adults of both sexes equally and appears between ages 30 and 80. Recently, it has been reported in patients infected with the HIV/AIDS virus.
Shiitake mushroom dermatitis (also known as "flagellate mushroom dermatitis", "mushroom worker's disease", and "shiitake-induced toxicoderma") is an intensely pruritic dermatitis characterized by disseminated 1mm erythematous micropapules seen in a linear grouped arrangement secondary to Koebnerization due to patient scratching. It is caused by the ingestion of shiitake mushrooms and was first described in 1977 by Nakamura. Although it is rarely seen outside of China and Japan due to a lower incidence of shiitake consumption outside these regions, there is a well-established association between flagellate dermatitis and shiitake mushroom (Lentinula edodes) ingestion. Bleomycin ingestion may also cause similar findings. On physical exam, one key difference between the two is that post-inflammatory hyperpigmentation changes are usually seen with bleomycin-induced flagellate dermatitis and are not typically present with shiitake mushroom induced flagellate dermatitis. The median time of onset from ingestion of shiitake mushrooms is typically 24 hours, ranging from 12 hours to 5 days. Most patients completely recover by 3 weeks, with or without treatment. Although the pathogenesis of shiitake induced flagellate dermatitis is not clear, the theory most argued for is a toxic reaction to lentinan, a polysaccharide isolated from shiitake mushrooms. However, Type I and Type IV allergic hypersensitivities have also been supported by the 24-hour median time of onset, clearance in 3–21 days, severe pruritus, benefit of steroids and antihistamines, and lack of grouped outbreaks in people exposed to shared meals containing shiitake mushrooms. Most cases reported shortly after its discovery were due to consumption of raw shiitake mushrooms, but several cases have since been reported after consumption of fully cooked mushrooms.
The drug of choice for the treatment of uncomplicated strongyloidiasis is ivermectin. Ivermectin does not kill the "Strongyloides" larvae, only the adult worms, therefore repeat dosing may be necessary to properly eradicate the infection. There is an auto-infective cycle of roughly two weeks in which Ivermectin should be re-administered however additional dosing may still be necessary as it will not kill "Strongyloides" in the blood or larvae deep within the bowels or diverticula. Other drugs that are effective are albendazole and thiabendazole (25 mg/kg twice daily for 5 days—400 mg maximum (generally)). All patients who are at risk of disseminated strongyloidiasis should be treated. The optimal duration of treatment for patients with disseminated infections is not clear.
Treatment of strongyloidiasis can be difficult and "Strongyloides" has been known to live in individuals for decades; even after treatment. Continued treatment is thus necessary even if symptoms resolve.
Because of the high cost of Stromectol, the veterinary formula Ivomec can be used. Government programs are needed to help citizens finance lifelong medication.
Clothes and sheets must be washed with enzyme washing powder and dried on hot daily.
Disseminated strongyloidiasis occurs when patients with chronic strongyloidiasis become immunosuppressed. It presents with abdominal pain, distension, shock, pulmonary and neurologic complications and septicemia, and is potentially fatal. The worms enter the bloodstream from the bowel wall, simultaneously allowing entry of bowel bacteria such as "Escherichia coli". This may cause symptoms such as sepsis (bloodstream infection), and the bacteria may spread to other organs where they may cause localized infection such as meningitis.
Dissemination can occur many decades after the initial infection and has been associated with high dose corticosteroids, organ transplant, HIV, lepromatous leprosy, tertiary syphilis, aplastic anemia, malnutrition, advanced tuberculosis and radiation poisoning. It is often recommended that patients being started on immunosuppression be screened for chronic strongyloidiasis; however, this is often impractical (screen tests are often unavailable) and in developed countries, the prevalence of chronic strongyloidiasis is very small, so screening is usually not cost-effective, except in endemic areas.
It is important to note that there is not necessarily any eosinophilia in the disseminated disease. Absence of eosinophilia may indicate poor prognosis.