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Swine Flu In detail Fact Sheet

2009-08-10T11:30:00.000-07:00

SWINE FLU
Dr.T.V.Rao MD

What is Swine Flu

Swine influenza virus (referred to as SIV) refers to influenza cases that are caused by Orthomyxovirus endemic to pig populations. SIV strains isolated to date have been classified either as Influenza(virus C or one of the various subtypes of the genus Influenza virus A)

Different Strains circulate Periodically
 In the United States the H1N1 subtype was exclusively prevalent among swine populations before 1998; however, since late August 1998, H3N2 subtypes have been isolated from pigs. As of 2004, H3N2 virus isolates in US swine and turkey stocks were triple reassortants, containing genes from human (HA, NA, and PB1), swine (NS, NP, and M), and avian (PB2 and PA) lineages.

Swine Influenza (Flu)

 Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs. Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented.
Pigs can harbour influenza viruses can be adapted to Humans
Swine Flu-Present Status
 From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States. Since March 2009, a number of confirmed human cases of a new strain of swine influenza A (H1N1) virus infection in the U.S. and internationally have been identified. An investigation into these cases is ongoing.
Swine Flu 2009
 In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near San Antonio, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well.
Update - Status Swine Flu
 The United States Government has reported seven confirmed human cases of Swine Influenza A/H1N1 in the USA (five in California and two in Texas) and nine suspect cases. All seven confirmed cases had mild Influenza-Like Illness (ILI), with only one requiring brief hospitalization. No deaths have been reported.
Swine Flu in Mexico
 In the Federal District of Mexico, surveillance began picking up cases of ILI starting 18 March. The number of cases has risen steadily through April and as of 23 April there are now more than 854 cases of pneumonia from the capital. Of those, 59 have died. In San Luis Potosi, in central Mexico, 24 cases of ILI, with three deaths, have been reported.
Swine Flu and Virus
 Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.
Cause by Reassortment of different strains
 Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge
Swine Flu differs from Human Flu
 The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses
Out breaks among Pigs
 Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection.
Present Swine Flu strains
 At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.
How man is exposed
 Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others.
How Swine Flu presents in Humans
 The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea
Is the eating Pork infects ?
 No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses
Close proximity with PIGS spread the Infections
 Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur.
How Swine flu spread among Pigs
 Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.
Seek emergency medical care.
IF - in Children
 In children emergency warning signs that need urgent medical attention include:
 Fast breathing or trouble breathing Bluish skin color.Not drinking enough fluids
 Not waking up or not interacting
 Being so irritable that the child does not want to be held
 Flu-like symptoms improve but then return with fever and worse cough
 Fever with a rash

Adults Need attention if Present with
 Difficulty breathing or shortness of breath
 Pain or pressure in the chest or abdomen
 Sudden dizziness
 Confusion
 Severe or persistent vomiting
Diagnosis
 To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus
CDC helps in Diagnosis
 Requires sending the specimen to CDC for laboratory testing as many laboratories in Developing world do not have facilities
Drugs which are effective in Swine Flu
 There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: Amantidine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs
Drugs proved resistant at Present
 Most recent swine influenza viruses isolated from humans are resistant to Amantidine and Rimantadine
CDC recommends at Present
 CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses
How long can an infected person spread swine flu to others?
 People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.
How long can viruses live outside the body?
 We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent hand washing will help you reduce the chance of getting contamination from these common surfaces.
No Vaccines to Humans
But available to PIGS
 Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.
Avoid close contact

 Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
 Aerosols spread the virus in any environment
Stay home when you are sick.

 If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.
Cover your mouth and nose.

 Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick
Clean your hands.

 Washing your hands often will help protect you from germs.
 Hand washing proved to be best procedure in prevention of Majority of Communicable diseases.
Avoid touching your eyes, nose or mouth.

 Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
Practice other good health habits.

 Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious.
 Unnecessary Migration of people from epidemic and endemic areas to be reduced.
Is eating Pork meat safe during Epidemics
 Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.
Healthy Habits reduces the Attacks
Simple measures carry get good Benefits
 Cover your mouth and nose. Use a tissue when you cough or sneeze and drop it in the trash. If you don’t have a tissue, cover your mouth and nose as best you can.

Clean Hands saves you
 Clean your hands often. Clean your hands every time you cough or sneeze. Hand washing stops germs. Alcohol-based gels and wipes also work well.

Cartoonists Imagination on
Swine Flu
Visit for Updates
CDC
 CDC ( Center of Disease) control updates the current information.
The topic made as per guidelines of CDC
Created for Awarness on Swine Flu

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2009-08-10T07:31:00.000-07:00

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2009-08-06T05:36:00.000-07:00

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http://rapidshare.com/files/192376540/Practice_of_Geriatrics.pdb

http://rapidshare.com/files/192376548/Practical_Guide_to_the_Care_of_the_Medical_Patient.pdb

http://rapidshare.com/files/192376708/Primary_Immunodeficiency_Diseases.pdf

http://rapidshare.com/files/192378266/Sexually_Transmitted_Diseases.rgo

http://rapidshare.com/files/192378279/Short_Course_in_Medical_Terminology.pdb

http://rapidshare.com/files/192378636/Surgery_at_a_Glance.pdf

http://rapidshare.com/files/196589950/EssentialMedicalPhysiologyThirdEdition2003070123875846LeonardR.JohnsonAcademicPress.pdf

http://rapidshare.com/files/196953110/Rang._.Dale_s.Pharmacology.CHM

http://rapidshare.com/files/196959616/Ophthalmology_At_a_Glance.pdf

http://rapidshare.com/files/196959618/Lippincott_-_Medical_Physiology_2E.pdf

http://rapidshare.com/files/196959628/GANONG.CHM

http://rapidshare.com/files/196959639/Robbins.Pathologic.Basis.of.Disease.7th.ed.2005.Kumar.pdf

http://rapidshare.com/files/197739504/Microbiology_and_Immunology.pdf

http://rapidshare.com/files/197739233/Medical_Microbiology_And_Infection_At_a_Glance.pdf

http://rapidshare.com/files/197739036/Blueprints_Notes__26_Cases_-_Microbiology_and_Immunology.djvu
Medical Microbiology

http://rapidshare.com/files/197738981/medmicrb.pdf
Board Review Microbiology

http://rapidshare.com/files/197738724/BRSMI.CHM
ENT Colour Atlas

http://rapidshare.com/files/197738564/color_atlas_of_oto.pdf
Middle Ear Surgery

http://rapidshare.com/files/197738515/MES.pdf

http://rapidshare.com/files/197736758/History_and_Examination_at_a_Glance_1st_ed.pdf

http://rapidshare.com/files/197736284/Clinical_Examination2006.CHM

http://rapidshare.com/files/197735679/RobbinsReviewOfPathology.djvu

http://rapidshare.com/files/197735548/Microcirculation_2C_Second_Edition.pdf

http://rapidshare.com/files/197734932/Manual_of_Surgery_Volume_First.pdf

http://rapidshare.com/files/197734711/ANAT.pdf

http://rapidshare.com/files/197661646/Harrison_27s_20Principles_20of_20Internal_20Medicine_2017ed.rar

http://rapidshare.com/files/197659966/Harrisons.Manual.of.Medicine.16th.Edition.rar

VIDEOS

http://rapidshare.com/files/197407885/Examination_of_Inguino_Scrotal_Swelling.wmv
http://rapidshare.com/files/197407928/Examination_of_Scrotal_Swelling.wmv
http://rapidshare.com/files/197407983/Methods_to_Examine_Swelling.wmv
http://rapidshare.com/files/197407983/Methods_to_Examine_Swelling.wmv
http://rapidshare.com/files/197408016/Peripheral_Vascular_Disease.wmv
http://rapidshare.com/files/197408069/Examination_of_Thyroid_Swelling.wmv
http://rapidshare.com/files/197408089/Examination_of_Varicose_Veins.wmv
http://rapidshare.com/files/197408123/Examination_of_ULCER.wmv
http://rapidshare.com/files/197408404/Examination_of_Breast_Lump.wmv
http://rapidshare.com/files/197408476/Examination_of_An_Intra-abdominal_Lump.wmv
http://rapidshare.com/files/197408526/Shoulder.wmv
http://rapidshare.com/files/197408532/Hand_Wrist.wmv
http://rapidshare.com/files/197408534/cervical_spine.wmv
http://rapidshare.com/files/197408595/Foot_Ankle.wmv
http://rapidshare.com/files/197408607/knee.wmv
http://rapidshare.com/files/197408654/Gait.wmv
http://rapidshare.com/files/197408740/knee.wmv
http://rapidshare.com/files/197408793/hip.wmv
http://rapidshare.com/files/197408953/lumbar_spine.wmv
http://rapidshare.com/files/197409305/Shoulder_elbow.wmv

Physical Examination Videos

http://rapidshare.com/files/204762365/01_-_vital_signs.avi
http://rapidshare.com/files/204762231/02_-_head__26_lymph_nodes.avi
http://rapidshare.com/files/204762924/03_-_eye.avi
http://rapidshare.com/files/204762651/04_-_ear__26_nose.avi
http://rapidshare.com/files/204762575/05_-_oral_cavity.avi
http://rapidshare.com/files/204762697/06_-_trachea.avi
http://rapidshare.com/files/204762887/07_-_post._chest.avi
http://rapidshare.com/files/204762883/08_-_heart__26_lungs__28setting_29.avi
http://rapidshare.com/files/204763020/09_-_exam_of_carotid__26_JVP.avi
http://rapidshare.com/files/204763075/10_-_heart__26_lungs__28lying_29.avi
http://rapidshare.com/files/204763322/11-_abdomen.avi
http://rapidshare.com/files/204763190/12_-_perephral_vascular_syst..avi
http://rapidshare.com/files/204763487/13_-_male_genitalia.avi
http://rapidshare.com/files/204765108/14_-_rectum.avi
http://rapidshare.com/files/204766058/15_-_nervous__26_muscloskeletal_syst..avi
http://rapidshare.com/files/204765605/16_-_breast.avi
http://rapidshare.com/files/204765317/17_-_speculum_exam.avi
http://rapidshare.com/files/204765307/18_-_bimanual_exam.avi
http://rapidshare.com/files/204765411/19_-_rectovaginal_exam.avi

USMLE Clinical examination Videos

http://rapidshare.com/files/212866503/Clip_008_EarWhisper.avi

http://rapidshare.com/files/212866527/Clip_009_Rinne.avi

http://rapidshare.com/files/212866528/Clip_0029_LEcerebellar.avi

http://rapidshare.com/files/212866531/Clip_0031_PronDrift.avi

http://rapidshare.com/files/212866540/Clip_0018_SLR.avi

http://rapidshare.com/files/212866550/Clip_0014_CVAtend.avi

http://rapidshare.com/files/212866551/Clip_0030_Meningeal.avi

http://rapidshare.com/files/212866554/Clip_005_Eye_VisAcuity.avi

http://rapidshare.com/files/212866560/Clip_0015_Pulses.avi

http://rapidshare.com/files/212866562/Clip_0028_UEcerebellar.avi

http://rapidshare.com/files/212866563/Clip_0021_CN8to12.avi

http://rapidshare.com/files/212866564/Clip_0026_KneeReflex.avi

http://rapidshare.com/files/212866571/Clip_0025_LEstrength.avi

http://rapidshare.com/files/212866581/Clip_0019_CTsyn.avi

http://rapidshare.com/files/212866598/Clip_003_HNOropharynx.avi

http://rapidshare.com/files/212866601/Clip_001_Draping.avi

http://rapidshare.com/files/212866604/Clip_0022_UEstrength.avi

http://rapidshare.com/files/212866617/Clip_007_EarWebers.avi

http://rapidshare.com/files/212866621/Clip_0020_CN1to7.avi

http://rapidshare.com/files/212866634/Clip_006_EyeOpthscope.avi

http://rapidshare.com/files/212866643/Clip_0027_LEsensations.avi

http://rapidshare.com/files/212866654/Clip_0010_AntLung.avi

http://rapidshare.com/files/212866661/Clip_0024_UEreflexsensory.avi

http://rapidshare.com/files/212866686/Clip_0016_Shoulder.avi

http://rapidshare.com/files/212866733/Clip_002_HNInsPalp.avi

http://rapidshare.com/files/212866744/Clip_0017_Knee.avi

http://rapidshare.com/files/212866747/Clip_0012_Heart.avi

http://rapidshare.com/files/212866754/Clip_0011_PostLung.avi

http://rapidshare.com/files/212866784/Clip_004_EyeMain.avi

http://rapidshare.com/files/212866889/Clip_0013_Abdomen.avi

3M Littmann Heart sounds educational CD - Introduction To Heart Sounds

http://rapidshare.com/files/216297493/3M.Littmann.MP3.rar

Rheumatoid Arthritis - An Approach To A Case

2009-08-03T13:49:00.000-07:00

What four characteristics of RA help distinguish it from OA?

What constitutional symptoms may be seen in RA?

What are three characteristic physical findings in RA?

What five diseases may mimic RA?

Which serologic tests may be useful in the diagnosis of RA?

Discussion

What four characteristics of RA help distinguish it from OA?

Unlike patients with OA (noninflammatory), those with RA (inflammatory) experience morning stiffness lasting more than 30 minutes plus gel phenomenon (worse stiffness after rest);symmetric joint disease;characteristic bilateral synovitis of the hands and feet (PIPs, MCPs, and MTPs);and an intermittent or waxing and waning course.

What constitutional symptoms may be seen in RA?

Most patients experience generalized malaise or fatigue. Occasionally weight
loss, low-grade fever, sleep disturbance, or mild lymphadenopathy may be
present. These symptoms may be the end result of circulating inflammatory cytokines produced in the inflamed synovial tissue of the affected joints.

What are three characteristic physical findings in RA?

Physical findings encountered in the setting of RA may include swelling and warmth of one or more joints typically in a symmetric distribution, tenderness on palpation of the swollen joints, and the presence of nontender subcutaneous nodules (rheumatoid nodules) over the extensor surface of the forearm, Achilles tendon, and digits of the hands.

What five diseases may mimic RA?

RA may be mimicked by SLE and other CTDs such as mixed connective tissue disease(MCTD), scleroderma, and PMR; polyarticular gout or pseudogout; the arthritis of subacute bacterial endocarditis; the arthritis secondary to malignancy; and the seronegative spondyloarthropathies. The diagnosis of RA is based on the history, physical examination, and laboratory findings.

Which serologic tests may be useful in the diagnosis of RA?

RFs are autoantibodies directed against the Fc portion of IgG. In RA, RF has a sensitivity of approximately 80% and specificity of 80%. Therefore, RF is detected in approximately 80% of patients with RA but it is nonspecific and can be detected in many other disorders such as other CTDs and chronic viral or bacterial infections. Anti-CCP antibodies are directed against citrullinemodified arginine residues in a protein. In RA, anti-CCP antibodies have a sensitivity of 60% to 75% and a high specificity of 90% to 96%. Therefore, anti-CCP antibodies are usually detected only in RA. Patients with RA who have a positive RF and/or anti-CCP antibodies are at a higher risk of developing erosive joint destruction and debility. An elevated ESR or C-reactive protein (CRP) level suggests the presence of an acute inflammatory disease. A complete blood count may show an anemia of chronic (inflammatory) disease. ANAs are found in 30% of patients with RA, usually in a low titer with a negative ANA profile, and are of little diagnostic value.

Vasculitis - A Case Sheet Discussion

2009-08-03T13:09:00.000-07:00

A 45-year-old white man seeks medical care because of hemoptysis of 1-week duration. He has not felt well for approximately 4 months and has lost 10 lb (4.5 kg) during this time. He has been receiving various antibiotics for the treatment of chest radiographic abnormalities thought to represent pneumonia. Although these changes have varied in presentation, they have not disappeared. A few weeks earlier,he noted some bloody nasal discharge. He started coughing up blood 1 week ago but attributed it to his bloody nose. The patient also complains that his
left knee has been hurting and that red spots have appeared on his arms and legs. He denies fever, purulent sputum, allergies or asthma, known tuberculosis, or chest pain.

On physical examination,

there is a curious depression in his upper nose(saddle-nose deformity),
bloody discharge in his nasal cavity,
a painless ulcer on his soft palate,
and
a slightly warm and swollen left knee.

Chestfindings are normal.

There are many small, purpuric, raised lesions on the skin of his lower extremities that are painless.

What are four possible diagnoses in this patient?

What diagnostic studies or procedures might be of value in this patient?

Which disorders are associated with p-ANCA?

What constitutes appropriate therapy for this patient with Wegener's
granulomatosis?

Case Discussion

What are four possible diagnoses in this patient?

Four possible diagnoses in this patient are Wegener's granulomatosis, Churg-Strauss syndrome (allergic granulomatosis), intranasal drug abuse, or a lung tumor. Churg-Strauss syndrome occurs primarily in patients with a history of allergies or asthma and is often associated with peripheral eosinophilia. ANCA reacting with human neutrophil elastase can occur in cocaine-induced midline
destructive lesions. The saddle-nose deformity and palpable purpura would be uncommon manifestations of a primary lung carcinoma.

What diagnostic studies or procedures might be of value in this patient?

Nasopharyngeal examination with biopsy, CT scan of the sinuses and chest,creatinine and urinalysis, and bronchoscopy with biopsy or open lung biopsy would all be helpful in the evaluation of this patient's disorder. An ANCA should be ordered because most patients with systemic Wegener's granulomatosis are c-ANCA positive and have antiproteinase 3 antibodies. In approximately 60% of patients, c-ANCA titers correlate with Wegener's disease activity.

Which disorders are associated with p-ANCA?

A p-ANCA may be present due to a variety of different antibodies directedagainst myeloperoxidase, elastase, cathepsin, and lactoferrin, and can occur in many different diseases. Diseases associated with p-ANCA directed against myeloperoxidase include Wegener's granulomatosis (10%), Churg-Strauss syndrome (50%), MPA (50% to 80%), and idiopathic crescentic
glomerulonephritis (65%). Nonspecific p-ANCAs directed against other various proteins can occur in CTDs, Crohn's disease, ulcerative colitis, sclerosing cholangitis, cystic fibrosis, chronic infections, and rare drug-induced vasculitic syndromes associated with propylthiouracil, hydralazine, and minocycline.

What constitutes appropriate therapy for this patient with Wegener's granulomatosis?

Standard therapy for Wegener's granulomatosis includes both high doses of corticosteroids and oral cyclophosphamide. Oral trimethoprim/sulfamethoxazole prophylaxis against Pneumocystis carinii should be considered while on the above therapy.

Vasculitis - How To Approach A Case

2009-08-03T12:56:00.000-07:00

Discussion On Following Headings

Vasculitis should be suspected in patients presenting with any combination of
what clinical manifestations?

Name the primary vasculitic disorders based on the dominant vessel size and
antineutrophil cytoplasmic antibodies (ANCA).

What serologic tests or diagnostic procedures should be performed in patients
with suspected vasculitis?

What more extensive procedures may be of value in helping to establish the
diagnosis of a specific form of vasculitis?

Vasculitis should be suspected in patients presenting with any combination of
what clinical manifestations?
Vasculitis comprises a heterogeneous group of diseases characterized by
inflammatory changes in the blood vessels with subsequent impairment of flow
and tissue/organ ischemia. Patients present with a multisystem inflammatory
disease often with fever of unknown origin and/or unexplained constitutional
symptoms; suspicious skin lesions such as ulcers, livedo reticularis, and
palpable purpura; ischemic neuropathies; and rapidly progressive organ
dysfunction such as strokes, pulmonary–renal syndromes, and other organ
ischemia.

Name the primary vasculitic disorders based on the dominant vessel size and
ANCA.

Vasculitides affecting large arteries:

Takayasu's arteritis: aortic arch and its branches, can involve any part of
the aorta; more claudication of upper than lower extremities, central
nervous system events; granulomatous panarteritis.

Giant cell (temporal) arteritis (GCA): temporal arteries, vessels
originating from the aortic arch, other arteries less common; temporal
headache, jaw claudication, scalp tenderness, visual loss; arteritis with
giant cells and disruption of the internal elastic lamina.
Vasculitides affecting predominantly medium-sized arteries:

Polyarteritis nodosa (PAN): small- and medium-sized arteries; may
affect any organ, but skin, joints, peripheral nerves, gut, and kidney are
most commonly involved; focal but panmural necrotizing arteritis with a
predilection for involvement at the vessel bifurcation.

Kawasaki disease: small- and medium-sized arteries; acute febrile
illness primarily affecting infants and young children; fever, prominent
mucocutaneous changes, cervical lymphadenopathy, polymorphous
rash, erythema and edema of hands and feet, desquamation,
myocarditis, coronary vasculitis; probable infectious vector resulting in
cytokine-mediated endothelial damage.
Vasculitides affecting predominantly small vessels (ANCA-positive):

Wegener's granulomatosis: small- and medium-sized arteries; upper
respiratory tract (sinuses), lungs, and kidneys, may affect other organs;
pauciimmune, necrotizing, granulomatous arteritis usually associated
with serum cytoplasmic–antineutrophil cytoplasmic antibodies (c-ANCA)
usually directed against proteinase 3 in the primary granules of neutrophils.

Microscopic polyangiitis (MPA): arterioles, capillaries, and venules;
pulmonary hemorrhage, glomerulonephritis, palpable purpura,
peripheral neuropathy, joint and abdominal pain; pauciimmune,
necrotizing vasculitis, serum perinuclear–antineutrophil cytoplasmic
antibodies usually directed against myeloperoxidase in the primary
granules of neutrophils.

Churg-Strauss syndrome: small arteries and venules; asthma,
eosinophilia, multiorgan involvement [lungs, skin, peripheral nerves,
gut, heart, and kidneys (rare)]; necrotizing extravascular granulomas
and vasculitis of small arteries and venules, eosinophils present in early
stage.
Vasculitides affecting predominantly small vessels (ANCA-negative):

Henoch-Schönlein purpura (HSP): arterioles and venules; palpable
purpuric skin lesions on lower extremities, arthritis, abdominal pain,
hematuria; leukocytoclastic (neutrophilic perivascular/transmural
infiltrate) or necrotizing vasculitis often with IgA deposition.

Cutaneous leukocytoclastic angiitis: arterioles and venules; palpable
purpuric skin lesions, arthralgias, systemic symptoms may be present,
usually secondary to immune complexes [drugs, bugs (infections), CTD
or malignancy]; leukocytoclastic vasculitis.

Cryoglobulinemic vasculitis: cryoglobulins are immunoglobulins that are
reversibly precipitated by reduced temperatures; cryoglobulins are
deposited in small vessels including glomerulocapillaries; purpura,
arthralgias, peripheral neuropathy, Raynaud's phenomenon, pulmonary
hemorrhage, glomerulonephritis are possible; often RF and hepatitis C
antibody positive

What serologic tests or diagnostic procedures should be performed in patients
with suspected vasculitis?

The diagnostic evaluation of a patient with suspected vasculitis should be
based on the clinical situation but often includes a chest radiographic study,
ESR, CRP, a complete blood count with differential, liver function tests, CPK,
creatinine and urinalysis, tests for the presence of ANAs, ANCAs and RF,
cryoglobulins, and biopsy of a skin lesion or an involved organ. In some types
of vasculitis, complement levels may be low secondary to consumption. An
ESR greater than 100 mm per hour and a CRP greater than 10 mg/dL in the
absence of a widespread malignancy or bacterial infection should suggest a
vasculitic process.

What more extensive procedures may be of value in helping to establish the
diagnosis of a specific form of vasculitis?

More extensive diagnostic procedures for establishing the diagnosis of a
specific form of vasculitis include arteriography of the mesenteric vessels if a
tissue biopsy is inaccessible, and an electromyography with evaluation of
nerve conduction velocities to evaluate a peripheral neuropathy or a
mononeuritis multiplex. A computed tomography (CT) scan of the sinuses and
chest is indicated if a diagnosis of Wegener's granulomatosis is being
considered.

Site Construction Updates

2009-08-02T15:25:00.000-07:00

Here I post my progress with site building..

You can provide your sugesstions here.
I'll do it for a week then start posting..

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2005-08-13T11:01:00.000-07:00

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