(including sulfamethoxazole and sulfa-phenazole) are quickly absorbed from the stomach and small intestine and should be taken at regular intervals. Others are long-acting (such as sulfadoxine, used to treat leprosy and malaria) and only need to be taken once a day.
Side effects Side effects may include anemia or jaundice, especially if taken for longer than 10 days. More severe side effects include blood disorders, skin rashes, and fever. These drugs are not given during the last trimester of pregnancy or to young babies because of the risk of mental retardation. The drugs are prescribed with caution to patients with kidney or liver problems. In general, patients using these drugs should avoid exposure to direct sunlight, which could provoke a rash.
sweating sickness, English A contagious disease that appeared in the 15th century that struck and killed victims quickly and violently. It is believed to have been introduced into England by French soldiers recruited by King Henry VII for his army in 1485. Subsequent outbreaks occurred in 1507, 1516, 1529, and 1551. Unlike most other epidemics of infectious diseases, its appearance was relatively brief, and it permanently disappeared in 1551.
Unlike other infectious epidemics of the 14th and 15th centuries, which tended to strike the poor, the English sweating sickness struck the wealthy with equal vengeance. The most famous victim of "the sweat" was Cardinal Thomas Wolsey of England, who came down with the disease tihree times in 1517, but survived each time. Also infected were the aldermen and two lord mayors of London, both of whom died within a week during the epidemic of 1485. During this first epidemic, the royal court issued a decree forbidding anyone from appearing at court except on official business.
While it is difficult to tell for sure how many people died from this epidemic, it is believed that the sweats of 1485 and 1507 each killed 10,000 people throughout England. The sweat of 1551 was particularly severe in Devon and Essex.
Although the sweat resembled influenza, scarlet fever, and the plague, medical historians have not been able to identify it. Although some experts believed it to be a lesser form of plague, it remains an unsolved medical puzzle.
Striking with fearsome rapidity, the disease lasted only about 24 hours and produced a profuse and drenching sweat from head to foot, together with pains in the back, shoulder, arms, legs, and head, as well as intestinal problems and "passion" in the heart. Reportedly, the disease could kill in as little as two hours.
While primarily a disease of England, it also occurred in Germany, Scandinavia, Poland, Lithuania, Russia, and the Netherlands. Angry German Catholics swore the disease was God's retribution for Martin Luther's Protestant heresies. The disease never spread into Spain or Italy.
swimmer's ear See otitis externa.
swimmer's itch The common name for cutaneous schistosomiasis (or cercarial dermatitis), this is an itchy skin inflammation caused by bites from flatworms. It is characterized by a distinctive patchy, red pinpoint skin rash after swimming in or having contact with freshwater populated by ducks and snails. On the saltwater tributaries of Long Island Sound it is known as "clamdigger's itch"; it is called "duck-feces dermatitis" or "sawah itch" in rice paddy workers of China or Malaysia.
This type of dermatitis is a potential risk whenever people use an aquatic area with animals and mollusks who are infested with the flatworms. In the United States, the worst outbreaks occur in the lake regions of Michigan, Wisconsin, and Minnesota, although it may also occur in saltwater areas.
Cause The rash is caused by the flatworm parasites of migrating birds and mammals; the animal defecates the worm into the water; snails ingest the worm; when the larval parasites are released from infected snails, they migrate through water, where they can infect swimmers. Children are most often infected due to their swimming habits. If the victim swims or wades in infested water and then allows water to evaporate off the skin instead of regularly drying off with a towel, the parasites can then burrow under the skin. The problem occurs in summer when the water temperature reaches the right level for snails to reproduce and grow rapidly. At the same time, migrating birds infected with the parasite return from their winter habitats, and swimmers enter the water.
Symptoms After exposure to water affected by the schistosomes, a prickling or itchy feeling begins that can last up to an hour while the flukes enter the skin. Small red macules form, but there may be swelling or wheals among sensitive people. As these lesions begin to disappear, they are replaced after 10 or 15 hours by discrete, very itchy papules surrounded by a red area. Vesicles and pustules form one or two days later; the lesions fade away within a week, leaving small pigmented spots. Different symptoms depend on how sensitive the patient is to the schistosome; each reexposure causes a more severe reaction.
Diagnosis Diagnosis is difficult; skin biopsies are not helpful. There is no widely available blood test that gives a specific indication that cercariae are the source of the itch. Diseases that have been confused with swimmer's itch include IMPETIGO, CHICKENPOX, poison ivy, or HERPES.
Treatment Treatment may not be needed if there are only a few itchy spots. Calamine lotion or oral antihistamines may help control the itch until the lesions begin to disappear on their own. If symptoms persist for more than three days, consult a doctor.
Prevention The best way to alleviate the problem is to destroy the snails by treating the water with copper sulfate and carbonate or with sodium pentachlorophenate. A thick coating of grease or tightly woven clothes can protect against infestation; bathing with a hexachlorophene soap before swimming may help to some degree. Briskly rubbing the skin with a towel after swimming may help remove some organisms.
syphilis A sexually transmitted infection that causes (among other symptoms) a skin sore and rash. Also present as a congenital (at birth) infection, syphilis was first recorded as a major epidemic in Europe during the 15th century, after Columbus returned from his trip to America. Today, the infection is transmitted almost exclusively by sexual contact. Since the 1970s and early 1980s, the incidence of syphilis in the United States has been on the rise.
Cause Syphilis is caused by a spirochete Treponema pallidum that enters broken skin or mucous membranes during sexual intercourse, by kissing, or by intimate bodily contact with an open syphilitic sore. The rate of infection during a single contact with an infected person is about 30 percent.
Symptoms During the first (or primary) stage, a sore (chancre) appears between three to four weeks after contact; the sore has a hard, wet, painless base that heals in about a month. In males, the sore appears on the shaft of the penis. In women it can be found on the labia, although it is often hidden so well that the diagnosis is missed. In both sexes, the sore may be seen on the lips or tongue.
Six to 12 weeks after infection, the patient enters the secondary stage, which features a skin rash that may last for months. The rash has crops of pink or pale red round spots, but in black patients the rash is pigmented and appears darker than normal skin. In addition, the lymph nodes may be enlarged, and there may be backache, headache, bone pain, appetite loss, fever, fatigue, and sometimes meningitis. The hair may fall out and the skin may exhibit gray or pink patches that are highly infectious. The secondary stage may last up to a year.
The latent stage may last for a few years or until the end of a person's life. During this time, the infected person appears normal; about 30 percent of these patients will develop tertiary syphilis.
Tertiary syphilis (end stage) usually begins about 10 years after the initial infection, although it may appear after only about 3 years or as late as 25 years later. The person's tissues may begin to deteriorate (a process called gumma formation), involving the bones, palate, nasal septum, tongue, skin, or any organ of the body. The most serious complications in this stage include heart prob lems, brain damage (neurosyphilis) leading to insanity, and paralysis.
Treatment PENICILLIN is the drug of choice for all forms of the disease; early syphilis can often be cured by a single large injection; later forms of the disease require multiple doses of penicillin over time. More than half of syphilis patients treated with penicillin develop a severe reaction within 6 to 12 hours caused by the body's response to the sudden killing of large numbers of spirochetes.
Prevention Infection can be avoided by maintaining monogamous relationships; condoms offer some protection, but they are not absolutely safe. People with syphilis are infectious during the primary and secondary stages, but not in the latter stages of the latent and tertiary stages.
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