Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Tetanus, sometimes called lockjaw, is a rare disease
caused by bacteria known as Clostridium tetani. A toxin produced by the
bacteria affects the function of the nerves and leads to severe muscle spasms in
the abdomen, neck, stomach, and extremities. Tetanus can either be localized to
one part of the body or generalized, with muscle spasms throughout the body. The
disease has been called lockjaw since the muscle spasms in the face and neck can
lead to the inability to open the mouth, and this is one of the most common symptoms of
tetanus. Tetanus is a serious illness that is fatal in up to 30% of cases.
The bacteria that cause tetanus can be found in soil,
manure, or dust. They infect humans by entering the body through cuts or
puncture wounds, particularly when the wound area is dirty. Animal bites, burns,
and non-sterile injection of drugs can also lead to infection with Clostridium
tetani. The first symptoms of tetanus can appear any time from three days to
weeks after infection, but the average time until symptom onset is eight days. Tetanus is not contagious, so
you cannot acquire the disease from someone who has it.
Tetanus is caused by a type of bacteria (Clostridium tetani).
The tetanus bacteria often enter the body through a puncture wound, which can be caused by nails, splinters, insect bites, burns, any skin break, and injection-drug sites.
All children and adults should be immunized against tetanus by receiving vaccinations.
A tetanus booster is needed every 10 years after primary immunization or after a puncture or other skin wound which could provide the tetanus bacteria an opportunity to enter the body.
What is tetanus?
Tetanus is an acute, often-fatal disease of the nervous system that is caused by nerve toxins produced by the bacterium
Clostridium tetani. This bacterium is found throughout the world in the soil and in animal and human intestines.
Where do tetanus bacteria grow in the body?
Contaminated wounds are the sites where tetanus bacteria
multiply. Deep wounds or those with devitalized (dead) tissue are particularly
prone to tetanus infection.
Puncture
wounds, such as those caused by nails, splinters, or insect bites, are favorite
locations of entry for the bacteria. The bacteria can also be introduced through
burns, any break in the skin, and injection-drug sites. Tetanus can also be a
hazard to both the mother and newborn child (by means of the uterus after
delivery and through the umbilical cord stump).
The potent toxin that is produced when the tetanus bacteria multiply is the major cause of harm in this disease.
How does the tetanus toxin cause damage to the body?
The tetanus toxin affects the site of interaction between the nerve and the muscle that it stimulates. This region is called the neuromuscular junction. The tetanus toxin amplifies the chemical signal from the nerve to the muscle, which causes the muscles to tighten up in a continuous ("tetanic" or "tonic") contraction or spasm. This results in either localized or generalized muscle spasms. Tetanus toxin can affect neonates to cause muscle spasms, inability to nurse, and seizures. This typically occurs within the first two weeks after birth and can be associated with poor sanitation methods in caring for the umbilical cord stump of the neonate. Of note, because of tetanus vaccination programs, there have only be a few cases of neonatal tetanus reported in the U.S. since 1990, and in each of these cases, the mothers were incompletely immunized. Worldwide, however, neonatal tetanus is still, unfortunately, common.
What is the incubation period for tetanus?
The incubation period between exposure to the bacteria in a contaminated wound and
development of the initial symptoms of tetanus
ranges from two days to two months, but it's commonly within 14 days of injury.
What is the course of the tetanus disease? What are the symptoms and signs of tetanus?
During a one- to seven-day period, progressive muscle spasms caused by the tetanus toxin in the
immediate wound area may progress to involve the entire body in a set of
continuous muscle contractions. Restlessness, headache, and irritability are common.
The tetanus neurotoxin causes the muscles to
tighten up into a continuous ("tetanic" or "tonic") contraction or spasm. The
jaw is "locked" by muscle spasms, giving the name "lockjaw" (also called
"trismus"). Muscles throughout the body are affected, including the vital
muscles necessary for normal breathing. When the breathing muscles lose their
power, breathing becomes difficult or impossible and death can occur without
life-support measures. Even with breathing support, infections of the airways
within the lungs can lead to death.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Whooping cough (pertussis) is highly contagious respiratory infection that is caused by the bacteria Bordetella pertussis. There are an estimated 300,000 plus deaths annually from whooping cough (pertussis). Whopping cough commonly affects infants and young children, but can be prevented with immunization with the vaccine. First stage whooping cough symptoms are a runny nose, sneezing, low-grade fever, a mild cough with the cough gradually becoming more severe. After one to two weeks, the second stage of whooping cough begins.
Rabies is a potentially fatal viral infection. Rabies symptoms include fever, headache, myalgia, and can progress to more serious symptoms such as seizures, coma and death. The rabies vaccine (rabies treatment) should be administered immediately after the person or pet has been bitten.
Burns are categorized by severity as first, second, or third degree. First degree burns are similar to a painful sunburn. The damage is more severe with second degree burns, leading to blistering and more intense pain. The skin turns white and loses sensation with third degree burns. Burn treatment depends upon the location, total burn area, and intensity of the burn.
Cuts, scrapes, and puncture wounds are common, and most people will experience one of these in their lifetime. Evaluating the injury, and thoroughly cleaning the injury is important. Some injuries should be evaluated by a doctor, and a tetanus shot may be necessary. Treatment will depend upon the severity of the injury.
Rickets is caused by a deficiency of vitamin D, calcium or phosphate. Infants and children who are exclusively breastfed, have dark skin, and infants born to mothers who are vitamin D deficient are most at risk for developing rickets. Symptoms and signs of rickets include bone pain, delayed teeth formation, short stature, skeletal deformities (bowlegs, abnormally shaped skull), and decreased muscle strength. Treatment of rickets depends upon the cause, but the first step usually involves correcting any abnormal levels of calcium, phosphate, or vitamin D with supplements.
Natural diasters such as a hurricane can take a toll on family, friends, and neighbors. Both physiological and psychological stresses can be devastating. Learn how to prepare for a hurricane like food storage, safe water, first aid measures, cleaning mold, wearing protective gear, preparing for electrical hazards, avoiding carbon monoxide, avoiding physical injuries and hazardous materials, preventing drowning, reducing the risk of thermal stress, and preventing fatigue related injuries.
Rickets is a disorder caused by a deficiency of vitamin D,
calcium, or phosphate.
Rickets leads to softening and weakening of the bones and is
seen most commonly in children 6-24 months of age. There are several subtypes of
rickets, including hypophosphatemic rickets (vitamin-D-resistant rickets), kidney
rickets (renal osteodystrophy), and, most commonly, nutritional rickets (caused
by dietary deficiency of vitamin D, calcium, or phosphate). Classic nutritional
rickets is also medically termed osteomalacia.
What is the history of rickets?
Roman descriptions of individuals with rickets can be found as early as the second century, and in the 1640s, the condition was well documented as a common bone ailment across England. Unfortunately, the scientifically proven cause of rickets was not identified until the 1920s, and by the 1930s, public-health initiatives recommend fortifying milk with vitamin D and cod-li...
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