Smileband health topics

What is cherubism?

Cherubism is a rare genetic condition that affects the bones of your lower jaw and sometimes upper jaw. The bones are replaced with cyst-like tissue growths that are not as dense. This makes the cheeks look round and swollen, but it is usually painless. 

About 200 cases of cherubism have been reported worldwide. The condition is usually discovered during early childhood, though symptoms may get better after puberty. 

Keep reading to learn more about how this condition presents, what causes it, and more.  Symptoms

The most common symptoms of cherubism are:

• round, swollen-looking cheeks
• a wide jaw
• loose, misplaced, or missing teeth
• eyes that turn slightly upward (in advanced stages)

People with cherubism show no signs of it at birth. It starts to appear in early childhood, usually between the ages of 2 and 5 years. The tissue growths in the jaw grow rapidly until the child is about 7 or 8 years old. At that point, the tissue usually stops growing or grows more slowly for several years.

When someone with cherubism reaches puberty, the effects of the condition usually begin to reverse. For many people, the cheeks and jaw start to return to their typical size and shape in early adulthood. When this happens, normal bone replaces the tissue growths again. 

Many people show little or no outward sign of cherubism by their 30s or 40s. In some rare cases, though, the symptoms last throughout adulthood and don’t reverse. Causes

Cherubism is a genetic disorder. This means there’s a mutation, or permanent change, to the DNA pattern of at least one gene. Mutations can affect a single gene or multiple genes. 

About 80 percent  of people with cherubism have a mutation to the same gene, called SH3BP2. Studies suggest this gene is involved in creating cells that break down bone tissue. That could be why when this particular gene is mutated, it affects bone growth in the jaws.

In the remaining 20 percent of people with cherubism, the cause is most likely a genetic disorder, too. However, it isn't known which gene is affected.

Smileband health topics

Q fever is caused by the bacterium Coxiella burnetii. The organism is very hardy and is resistant to heat, drying, and many disinfectants, so it is able to survive in the environment for long periods. Q fever can result in acute or chronic illness. Symptoms vary greatly between individuals, and about half of the people with Q fever will not show any symptoms. Acute cases of Q fever begin with a sudden onset of one or more of the following:

• high fevers (up to 104°-105°F)
• severe headache
• general discomfort and fatigue
• muscle pain, confusion
• sore throat
• chills, sweats
• dry cough
• nausea
• vomiting
• diarrhea
• stomach pain
• chest pain.

Fever usually lasts for 1 to 2 weeks. Chronic Q fever may result in less than 5% of acutely infected patients, presenting within six weeks of acute infection, up to many years later.

 

Those at highest risk for chronic Q fever are pregnant women, immunosuppressed persons, and patients with pre-existing heart valve defects. Endocarditis is the most common manifestation of chronic Q fever.

 

Over the last 5 years, there have been approximately 8 cases of Q fever reported yearly.

 

Arizona 5 year median: 7 cases

 

Transmission
People usually become infected with Q fever through inhalation of dust contaminated with dried placental material, birth fluids, and excreta of infected herd animals. Other modes of transmission, such as tick bites and human-to-human transmission, are very rare. Consumption of raw or unpasteurized dairy products from infected animals is another method of exposure.

Incubation period is 2 to 3 weeks.

Lab Tests & Specimen Info

Test*	Specimen
IgG/IgM Serology (The convalescent specimen should be taken 2-4 weeks after the acute)	Serum (acute and convalescent)
PCR	Serum

Smileband health topics

Pertussis or whooping cough is a highly contagious respiratory disease that is caused by the bacteria Bordetella pertussis.

 

The disease generally goes through three stages: catarrhal stage, paroxysmal stage, and convalescent stage. In the catarrhal stage, the individual has a runny nose, mild cough and low-grade fever which usually lasts 1-2 week. This is when the individual is the most contagious. The paroxysmal stage is when the paroxysms and posttussive vomiting can occur. This can last 1-6 weeks. The convalescent stage is when coughing lessens and the individual begins to recover gradually.

 

In Arizona, there has been a general increase in the number of pertussis cases reported each year.

 

Arizona 5 year median: 580 cases

 

Transmission
Pertussis is transmitted person to person by contact with aerosolized droplets from an infected person.

The incubation period is 7-10 days with a range of 5 to 21 days.

Lab Tests & Specimen Info

Test*	Specimen
Culture (Culture is not as likely to be positive if > 2 weeks since cough onset)	NP Swab (synthetic swabs only)
PCR (PCR is not as likely to be positive if > 4 weeks since cough onset)	NP Swab (synthetic swab on

  Isolation Precautions

Standard and droplet precautions are recommended for 5 days after initiation of therapy or until 3 weeks after cough onset.

Prevention for Patients
Vaccination is the best prevention method. Tdap vaccine is recommended for pregnant women during their third trimester to help protect the infant. Also, it is recommended for anyone who will be caring for the infant to also have a Tdap vaccine.

Public Health Actions
Untreated individuals should be excluded from school or childcare for 3 weeks following the onset of a cough and treated individuals should be excluded until 5 days of antibiotic treatment is completed. 

Public health will conduct an epidemiological investigation on a case or suspect case.

Smileband health topics

Methycillin-resistant Staphylococcus aureus(MRSA) is a type of staph bacteria resistant to beta-lactam antibiotics. Anyone can get MRSA and infections range from mild to life-threatening. Individuals may be carriers of MRSA and have it on their skin or in their nose but still be asymptomatic. These individual can still infected others with MRSA even though they are asymptomatic.

 

In the community, most MRSA infections are skin infections and are generally mild. Skin infections often look like a boil, pimple, or spider bite.

 

The more serious MRSA infections often occur in healthcare settings. In a healthcare setting, such as a hospital or nursing home, MRSA can cause severe problems such as bloodstream infections, pneumonia and surgical site infections.

 

In Arizona over the last 10 years there have been a range of 1,000 to 1,400 cases of invasive MRSA reported each year.

 

Arizona 5 year median: 1,155 cases

 

Transmission
Infections occur due to direct contact with contaminated surfaces or skin.

In the community, MRSA easily spreads in settings such as daycare, correctional facilities, or sport camps by frequent skin-to-skin contact, crowding, compromised skin, contaminated items and surfaces and lack of cleanliness.

In health care settings, poor adherence to standard infection control precautions (e.g. hand hygiene) can lead to transmission between patients and to clusters of infections.

Lab Tests & Specimen Info

Test*	Specimen
Culture	Specimen from a normally sterile site
Susceptibility testing	Isolate

  Isolation Precautions

Patients with MRSA should be put on standard and contact precautions.

Prevention for Patients
Maintaining good hand and body hygiene is the best prevention method.

• Washing hands often, and cleaning body regularly, especially after exercise.
• Keeping cuts, scrapes, and wounds clean and covered until healed.
• Avoid sharing personal items such as towels, washcloths, razors, clothing, and uniforms.

Individuals are infectious as long as the sores are draining.

Public Health Actions
Cases should be excluded from school or child care only if the sores cannot be covered.

Public health will conduct an epidemiological investigation on an outbreak.

Smileband Health issues

Diphtheria is an infection caused by toxigenic strains of the bacteria Corynebacterium diphtheriae.

Initial symptoms consist of:

• sore throat
• difficulty swallowing
• malaise
• low-grade fever

The pathogen produces a toxin that interferes with cellular processes causing tissue destruction, which in turn causes the most notable symptom of diphtheria, a grayish-white pseudomembrane over the tonsils, pharynx, or larynx. The membrane can cause the airway to become obstructed which can be fatal. The toxin can be absorbed into the bloodstream and can cause damage to tissue throughout the body.

Cases of diphtheria are still seen throughout the world and many of those cases are from southeast Asia.

There has not been a case of diphtheria reported in Arizona in the last 10 years.

Transmission

Diphtheria is spread by respiratory tract droplets and contact with skin lesions. Rarely, fomites and raw milk or milk products can act as a mode of transmission. Fully immunized individuals can act as carriers. 

Test*	Specimen
Culture	NP swab (synthetic only), Throat swab (synthetic only)

 Isolation Precautions

Isolate and institute droplet precautions for a pharyngeal diphtheria case or a suspect case.

Isolate and institute contact precautions for a cutaneous diphtheria case or suspect case. 

Prevention for Patients
Vaccination is the best prevention method. >95% of healthy adults and infants, children, and adolescents develop adequate antibody response after a 3-dose series. Tdap booster is recommended for adults in place of the Td booster

In untreated individuals, the pathogen can be present in discharges for 2 – 6 weeks after infection. In properly treated individuals they will no longer be contagious 48 hours after the treatment

Public Health Actions
Antitoxin is available through the CDC and should be given as soon as possible after diagnosis, even before culture results are determined. 

Cases of diphtheria should be excluded from working as a food handler, caring for patients in a healthcare institution, or caring for children in or attending a school or child care establishment until a set of cultures negative for C. diphtheriaeis obtained from the nose and throat specimen.

Public health will conduct an epidemiological investigation on a case or suspect case.

Smileband Health issues

A medieval child whose mummified body was thought to show the earliest known case of smallpox was really suffering from hepatitis, scientists say.  DNA analysis of the 16th century remains, found in the Basilica of Saint Domenico Maggiore in Naples, revealed the child was infected with an ancient strain of the hepatitis B virus (HBV). 

The team believe their findings could help shed new light on the ancient origins of the disease which, according to the World Health Organisation (WHO), kills 1.5 million people a year. Previous scientific analysis of the 16th century remains - which did not include DNA testing - suggested the child was infected with Variola virus, or smallpox. 

In fact, this was the oldest evidence for the presence of smallpox in Medieval remains and a critical time stamp for its origins.

Using advanced sequencing techniques, researchers led by McMaster University now believe child was actually infected by HBV. 

Children infected with HBV infections can develop a facial rash, known as Gianotti-Crosti syndrome.

This may have been misidentified as smallpox and illustrates the trickiness of identifying infectious disease in the past. 

Using small tissue samples of skin and bone, scientists were able to tease out tiny fragments of DNA and then stitch together pieces of genetic information to create a much more complete picture.

While viruses often evolve very rapidly - sometimes in just days - researchers suggest that this ancient strain of HBV has changed little over the last 450 years Researchers suggest this find underlines the importance of studying ancient viruses.  

'These data emphasise the importance of molecular approaches to help identify the presence of key pathogens in the past, enabling us to better constrain the time they may have infected humans,' said Hendrik Poinar, an evolutionary geneticist with the McMaster Ancient DNA Centre and a principal investigator with the Michael G. DeGroote Institute for Infectious Disease Research.

'The more we understand about the behaviour of past pandemics and outbreaks, the greater our understanding of how modern pathogens might work and spread, and this information will ultimately help in their control,' he said.

The findings are published online in the journal PLOS Pathogens. 

Smileband Health issues

What is a psychiatrist?

A psychiatrist is a medically-qualified practitioner who will have spent 5-6 years training to be a doctor. He or she will then have worked as a doctor in general medicine and surgery for at least a year. He or she will then have had at least 6 years of further training in helping people with psychological problems. psychiatrist’s special skills?All psychiatrists will learn how to:

• assess a person's state of mind
• use the “biopsychosocial” model of understanding. This emphasises the importance of a person's past experiences, family, culture, surroundings and work as well as any medical features.
• diagnose a mental illness
• use a range of psychological treatments
• use a range of medications
• help a person recover.

As well as these 'core' skills, a psychiatrist will specialise and develop skills in working with the particular problems that affect different groups of people.

For example:

• a general adult psychiatrist needs to develop skills in talking with people who have disordered thinking and hallucinations.
• a child psychiatrist will usually develop skills in working with families and with the special needs of children.

Where do psychiatryists work?

These days, NHS psychiatrists work across a whole range of places – from the street (literally) to specialist hospital units. However, most work in community mental health teams, out-patient departments and hospital wards. Some do sessions in general practices.

How do they work?

Psychiatrists sometimes see patients on their own in an out-patient clinic. More often, they work as part of a team with colleagues from other professions such as nursing, social work, psychology and occupational therapy.

The team will ask the psychiatrist to see patients, either on their own or with another member of the team present. The psychiatrist will also work as a consultant to the team, discussing people's individual mental health needs and working out how to best manage them.

The psychiatrist will also review patients with other team members in their regular team review meetings.

How would I get to see a psychiatrist?

Usually your GP will need to refer you. Quite often, the first person you will see is a nurse, a social worker or an occupational therapist from the community mental health team. They will usually decide with you whether you need to see the psychiatrist. Some specialist teams accept referrals directly from families, social workers or voluntary groups.

What might a psychiatrist ask me about?

A psychiatrist will ask you about the problem that has brought you to see them. They may also ask about anything that has happened in your life, your thoughts and feelings and your physical health. This is so that he or she can get a thorough understanding of your situation.

What might a psychiatrist recommend?

• Psychological treatments
• Medications
• Practical ways of dealing with an illness
• Practical ways to stay well
• Ways to get active, see other people and get back to things you like doing.