In 1685, Thomas Sydenham, a prominent physician, documented a condition that he called "chorea" (from the Greek word “dance”) to describe patients that exhibited an involuntary movement and twitching of the limbs. Although the primary focus of his study was rheumatism, he ultimately connected this condition with infectious diseases such as scarlet fever and what he called "rheumatism of the heart". He noted that his patients were exhibiting acute pain, redness and swelling in one or more joints, subcutaneous nodules over the knee and elbow joints, an uncontrollable jerking or flailing of the limbs and in many cases, a "weakening of the heart."1 What he was describing has come to be known as Rheumatic Fever. However, the association between strep throat infections and rheumatic fever had not been made until the late 1800’s. Then in 1944, T. Duckett Jones, MD published criteria by which the condition became defined. Rheumatic fever gets its name from its most common symptoms – rheumatism (inflammation of the joints) and fever. Before antibiotic drugs were developed in the 1940’s, rheumatic fever with its resulting valve damage, was a leading cause of heart disease throughout the world.2
Rheumatic fever is a condition which arises as a complication of an untreated or under-treated strep throat infection. It usually affects young people between 5 to 15 years of age. The initial signs of rheumatic fever usually occur within 2-3 weeks following a streptococcal infection. The patient appears to have recovered from the sore throat but suddenly begins to show other symptoms. Common symptoms include fever and pain with swelling in major joints such as the elbows, wrists, knees or ankles. Nodules may develop under the skin over bony areas ...
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...cine (2 ed., Vol. 4, pp. 2897-2898). Farmington Hills, MI: Gale Group.
4 Rheumatic fever. In (2000). B. Gersh (Ed.), Mayo Clinic Heart Book (2 ed., pp. 72-73). New York, NY: William Morrow of Harper Collins Publishers.
5 Burris, M.D., J. O. (2001). Rheumatic fever. In Enclyclopedia Americana (Vol. 23, p. 467). Danbury, CT: Grolier Inc.
6 Adler, R. P. (2011). Rheumatic fever. In D. Dawson (Ed.), Magill's Medical Guide (6 ed., Vol. 5, pp. 2594-2596). Pasedena, CA: Salem Press.
7 Rheumatic Fever Acute Prognosis - Medical Disability Guidelines. (n.d.). Retrieved from http://www.mdguidelines.com/rheumatic-fever-acute/prognosis
8 Draper, R. (n.d.). Retrieved from http://www.patient.co.uk/doctor/Rheumatic-Fever.htm
9 Vijayalakshmi, I. B. (2011). Acute Rheumatic Fever & chronic Rheumatic Heart Disease. (1 ed.). Daryaganj, New Delhi: Jaypee Brothers Medical Publishers.
The guidelines’ first focus is the definition of sepsis, which makes sense, because there is no way to effectively treat sepsis without an accurate and categorical definition of the term. The guidelines define sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection”. Such systemic manifestations can include fever, tachypnea, AMS, WBC >12k, among others; these manifestations are listed in full in Table 1 of the guidelines. The definition for severe sepsis builds on to the definition of sepsis, bringing organ dysfunction and tissue hypoperfusion (oliguria, hypotension, elevated lactate) into the picture; full diagnostic criteria is listed in Table 2. The guidelines recommend that all
Croup: Croup is another common airway inflammation caused by virus that can affect the trachea, larynx and possibility the bronchi (Murray, Sidani, & Zoorob, 2011) thus causing infection in the upper respiratory tract. Murray et al. describes it as the most common illness in children under the age of 6 to 36 months and cause for cough mostly when a child cries; acute stridor and hoarseness in febrile children (Murray et al., 2011). It can be a life-threatening situation in the life of the young infant and the family. Croup symptoms exhibit as hoarseness, barking cough, inspiratory stridor, and respiratory distress. I chose this diagnosis as my first preference because when I read the mother’s subjective report it matches that of croup symptoms: a barking cough, no fever, severe at night and when the baby cries, fatigue due to excessiveness of the tears, pain due to inflames and swollen of the airway. Murray et al., led us to understand that the etiologies of this viral causing agent can be traced to the parainfluenza viruses, type 1. (2011). This virus is commonly spread through contact or droplet secretion.
Streptococcus pyogenes, also known as Group A streptococcus (GAS), is a β-hemolytic, Gram-positive bacterium that most commonly causes respiratory disease, including pharyngitis or tonsillitis, as well as skin infections such as impetigo and cellulitis. The organism is transmitted via respiratory droplets or by contact with fomites, and commonly infects young children. In addition to the common clinical presentations associated with S. pyogenes, some individuals develop the postinfectious sequelae of rheumatic fever and glomerulonephritis. Due to the severity of these medical consequences, prophylactic antibiotic use is often recommended for any patients with otherwise mild S. pyogenes infections (21).
...cz-Towalska, O., Rzodkiewicz, P., Maslinska, D., Szukiewicz,D. & Maslinski, S. (2009) “Cryotherapy decreases histamine levels in the blood of patients with rheumatoid arthritis”, Inflammation Research , 59(2), pp.253–255. ResearchGate [Online]. Available at http://www.researchgate.net/publication/40697605_Cryotherapy_decreases_histamine_levels_in_the_blood_of_patients_with_rheumatoid_arthritis (Accessed: 12th May 2014).
25. Dorothy Horstmann, "Three Landmark Articles about Poliomyelitis," Medicine (September 1992): 320-25, at p. 322.
James Parkinson. It’s not certain how long the disease has existed but its probably been around
Mumps is primarily a childhood disease, occurring most frequently between the ages of 5 to 9, although it was also known as a problem for soldiers during war because of the sanitary conditions and close proximity. For instance, in World War I only influenza and gonorrhea were more prevalent among the armies. It replicates inside the nose, throat, and regional lymph nodes. The virus incubates for about 14-18 days, and then a viremia occurs for about 3-5 days. During the viremia it can spread to the meninges, salivary glands, testes, ovaries and pancreas. Out of the infected population, 30 to 40% get swollen parotid salivary glands, with most of the rest being asymptomatic or having only respiratory problems. Around 60% of patients have asymptomatic meningitis, with up to 15% progressing to symptomatic. Encephalitis is also possible, occurring in around 5/100,000 cases. The encephalitis almost always results in some permanent hearing loss, and was historically the leading cause of hearing loss in children. Orchitis (testicular swelling) happens in up to 50% of post-pubertal males, with oophritis (ovarian swelling) happening in only 5% of women. Orchitis often results in testicular atrophy but very rarely in sterility.
The patient presented in the setting of a large epidemiologic study of yellow fever virus;
Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days. His positive result of nasopharyngeal aspirate for Respiratory Syncytial Virus (RSV) indicates that Liam has acute bronchiolitis which is a viral infection (Glasper & Richardson, 2010). “Bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It describes a clinical syndrome of cough tachypnoea, feeding difficulties and inspiratory crackles on chest auscultation” (Fitzgerald, 2011, p.160). Bronchiolitis can cause respiratory distress and desaturation (91% in the room air) to Liam due to airway blockage; therefore the infant appears to have nasal flaring, intercostal and subcostal retractions, and tachypnoea (54 breathes/min) during breathing (Glasper & Richardson, 2010). Tachycardia (152 beats/min) could occur due to hypoxemia and compensatory mechanism for low blood pressure (74/46mmHg) (Fitzgerald, 2011; Glasper & Richardson, 2010). Moreover, Liam has fever and conjunctiva injection which could be a result of infection, as evidenced by high temperature (38.6°C) and bilateral tympanic membra...
Christopher Hamlin, “Edwin Chadwick, ‘Mutton Medicine’, and the Fever Question,” Bulletin of the History of Medicine 70 (1996): 233-265.
This topic came up recently to me because my grandmother was diagnosed with it. She could barely walk and could not do many little things like get out of bed, and tie her shoes. Since my mom is a physical therapist she knew what to do, but I didn’t really know what it was or how to help her. Most of the things I knew about “arthritis” was that it affects your bones, but this was much more than that. I also didn’t realize that it was Rheumatoid Arthritis not just normal arthritis,they are different because Rheumatoid Arthritis has to do with your joints unlike regular arthritis that has to do with the wear and tear of your bones. I wish I had known if I could prevent it or even if it is genetic and if I could develop it too. I also wanted to know what the symptoms were because all I knew about it was that she was in pain. I was scared she wasn’t going to live as long because she got this, so that is why I decided to write this paper.
“Always remember to be an internist, my dear.” This was an invaluable piece of feedback I received on a rheumatology rotation in my first year of internal medicine residency. Truly, I have never learned so much about medicine as I did during this first rotation in rheumatology. I became fascinated by the subtle presentations and cases that posed a diagnostic challenge to multiple subspecialties. I have been inspired by rheumatology as a field where multisystem disease is encountered on a daily basis and rheumatologists must use both general medicine and subspecialty skillsets to diagnose and treat patients. The academic challenges in rheumatology initially attracted me to the field however my subsequent experiences with patients, mentors, and research have made me passionate about pursuing rheumatology as my specialty.
The patient has high temperature-sign of fever, a very fast pulse rate (tachycardia), and chest wheezing when listened to using a stethoscope (Harries, Maher, & Graham, 2004, p.
Medicine presents a myriad of complex puzzles waiting to be solved. Though not for the faint of heart, Internal Medicine allows for a daily dose of these complex diagnostic and treatment problems. During my Internal Medicine rotation, one of my most memorable cases was a 44-year-old who presented with shortness of breath, cough, night sweats, fever, focal neurological