Tag Archives: Infectious disease



This deadly disease was first described gin the 1500s. Due to its contagious nature and debilitating, if not deadly, effects, outbreaks of scarlet fever were greatly feared.

Charles Dickens knew more than he would have wished about scarlet fever. His son, Charley, was afflicted by it, causing the family to leave Paris hurriedly and return to London in 1847, and it featured in several of his novels. It was a much-feared disease that caused devastating epidemics through the 19th and early 20th centuries, resulting in thousands of deaths.


The boy in this story is suffering from scarlet fever. Because the disease was so infectious, it was not uncommon for all the children in a family to contract scarlet fever and for none to survive.

I can remember my grandmother telling about the carts that rolled down the streets to remove infected people to take them to the fever isolation hospitals outside the towns during epidemics of scarlet fever or other infectious diseases.

Over the years scarlet fever has naturally declined over the past  200 years probably largely due to intake of  better food and clean drinking water, improved sanitation, less overcrowding and better living conditions generally. Also, I suspect that accuracy in diagnosing scarlet fever was more difficult as diseases with rashes such as smallpox, meningococcal meningitis and measles were very common.

Fans of the Little House on the Prairie series will remember that it was scarlet fever was thought to have that resulted in Mary’s blindness. However, as there was no record of a sore throat it was more likely to have been caused by meningococcal meningitis. Both scarlet fever and meningitis have a widespread rash but they are differentiated by performing the ‘glass test’. The rash of scarlet fever becomes white with the glass test.


When penicillin was widely available in 1942 this made significant difference to the course of the diseases in that severe complications such as Rheumatic Fever with serious heart problems, Glomerulonephritis with severe kidney problems, osteomyelitis ( bone infection ) and blood borne infections are now very rare.

Now, 160 years later, it is making a comeback. Almost 3,000 cases were recorded in 2008, the highest total for a decade, and doctors fear a dangerous strain of the infection is becoming more widespread. If seems scarlet fever follows a cycle rising and falling roughly every four years – and is currently on a rising trend.

What is Scarlet Fever (Scarletina)?

Scarlet fever (sometimes called scarlatina) is an infectious disease caused by the bacteria Streptococcus pyogenes, which is commonly found on the skin or in the throat, where it can live without causing problems. However, under some circumstances, they can also cause diseases like scarlet fever.

It is most common in children between the ages of 2 and 8 years of age. I remember one Sunday evening last year I saw 6 children from the same reception  class at school attend with classical signs of scarlet fever.

What are the symptoms and signs?

Symptoms include a fever, tiredness, nausea and vomiting and may be headache aswell as feeling generally unwell.

Red blotches are the first sign of the rash. These turn into a fine pink-red rash that feels like sandpaper to touch and looks like sunburn.
The rash usually starts in one place, but soon spreads to other parts of the body. It commonly affects the ears, neck, chest, elbows, inner thighs and groin, and may be itchy.

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The rash blanches with the ‘glass test’ and does does not normally spread to the face.

However, the cheeks become flushed and the area just around the mouth stays quite pale ( circumoral pallor) The rash will turn white if you press a glass on it. The tongue becomes swollen and red and is often called a ‘strawberry tongue’

The rash usually fades after about a week, but the outer layers of skin, usually on the hands and feet, may peel for several weeks afterwards.

In milder cases, sometimes called scarlatina, the rash may be the only symptom.i

How do you protect yourself from scarlet fever?

The risk of infection can be reduced through general good hygiene and cleanliness, including:

•Washing your hands often, using alcohol hand rub

•Not sharing eating utensils with someone who has the infection

•Disposing of tissues promptly

What should I do if I think my child has scarlet fever?

•See their GP as soon as possible

•Make sure that your child takes the full course of any antibiotics prescribed. Although your child will feel better very quickly after starting the course of antibiotics, you must complete the course of treatment to ensure that you don’t carry the germs after you’ve recovered.

•Stay at home, away from nursery, school or work for at least 24 hours after starting the antibiotic treatment to avoid spreading the infection.

•You can help stop the spread of infection through frequent hand-washing and by not sharing eating utensils, clothes, bedding or towels.

More information about scarlet fever:-






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Posted by on February 14, 2015 in Training and Advice


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When anyone hears this name they immediately associate it with death and tradegy. It is not surprising that on several occasions I have seen a child in surgery with a fever and they have been unusually fearful because they are frightened they have contracted Ebola.
We can reassure, act appropriately and educate our children in so many ways:-

* Remind our children that we live in a country that has clean running water and an excellent sewage system which saves countless lives especially from infections. Did we not see the adverts on the TV at Christmas asking us to contribute to a provision of a pump in a bush village which had no running water?

* Educate our children to wash their hands before meals and after using the toilet and put our hands to our mouths or turn away when we have cough?

* Make sure you are up to date with immunisation and seek advice when travelling for recommended immunisations and health care with the practise nurse or local travel clinic

Travel clinic

* Encourage healthy living especially with regards diet and exercise.

* Appreciate and treasure our health service and not take it for granted that we have a service which is accessible, free and can offer a comprehensive range of treatments comparable to any country in the World.

Expectations are high – I can be sure that at least 50% of patients attending on Monday morning will have minor ailments which could be treated with Over The Counter remedies or just reassurance. If I sit in out of hours clinics the story is much the same!
Nevertheless, when I have had to admit or refer a patient with a serious illness for the most part I am pleased with the prompt response and standard of care. Moreover, if the outcomes are not satisfactory as a GP I have a voice to be able communicate dissatisfaction and facilitate change and as a patient there is also the same opportunity through PALS our Patient Liaison Service (details obtained at the surgery or on the website NHS choices)

More about Ebola
Nearly 40 years after Peter Piot was first dispatched to investigate a mysterious new virus.

He was 27 and still in training, he had one of the greatest opportunities an aspiring microbiologist could dream of: the chance to discover a new virus, investigate its mode of transmission and stop the outbreak. It all started when his laboratory at the Institute of Tropical Medicine in Antwerp received a thermos from what was then called Zaire. It contained the blood of a Flemish nun who had died of what was thought to be yellow fever.

From that sample, however, his lab isolated a new virus, confirmed by the Centers for Disease Control in Atlanta and subsequently called Ebola, after a river about 100km north of Yambuku, the centre of the epidemic. It turned out to be one of the most deadly viruses known.

In early September 1976, Mabalo Lokela, the headmaster of the local school, had died with a high fever, intractable diarrhoea and bleeding. His death sent a shockwave through the small mission community. Soon the hospital was full of patients with a similar illness and nearly all died within a week.
There have been several outbreaks since that time but the present outbreak is the worst.

How is it transmitted?

It is believed that the virus originates in fruit bats. It circulates in populations of wild animals including gorillas, fruit bats, monkeys, antelopes and even porcupines.
It is transmitted through contact with bodily fluids. Eating fruit collected from the forest floor, that an infected fruit bat had bitten, could spread it. So could contact with the blood of an infected animal that had been butchered for bush meat.


Monkeys, apes and antelopes are commonly eaten in the areas where the outbreak began. If someone were handling the raw meat and had an open cut on their hand, that could transmit the virus.

Once the virus is in human circulation, it becomes far harder to contain. Health care workers have been at particular risk because they have come into direct, close contact with victims.

Traditional burial ceremonies among many of the communities affected involve direct contact with the body of the dead, and this is believed to have been a major factor in the early spread of the virus, before public safety messages began to get through to people.

The virus can also be transmitted through sex. The WHO says that even men who have recovered from the virus can still transmit it through their semen for up to seven weeks after recovery.

Signs and Symtoms of Ebola

Severe headache
Muscle pain
Abdominal (stomach) pain
Unexplained hemorrhage (bleeding or bruising)
Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.

Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.

The latest advise from NHS England is illustrated below:-



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This week I had an email from one of 3rd year medical students requesting topics that her student and her partner would like to concentrate on during the next teaching session. I was a bit surprised when she requested this but apparently she had failed this in a previous examination.

The main medical purpose of washing hands is to cleanse the hands of pathogens (including bacteria or viruses) and chemicals which can cause personal harm or disease. As a general rule, handwashing protects people ill or not at all from droplet and airborne diseases, such as measles, chickenpox, influenza, and tuberculosis. It protects best against diseases transmitted through fecal-oral routes (such as many forms of diarrhoea and vomiting) and direct physical contact (such as impetigo). When visiting hospitals there is also the need to wash hands is to prevent the spread of the ‘super bug’ MRSA and Clostridium Difficile a bacteria responsible for severe diarrhoea which is life threatening particularly in the elderly.

“It is well documented that one of the most important measures for preventing the spread of infectious disease is effective hand washing.”

With the students I then went through the procedure very carefully as it has been established that doctors are probably culpable for the spread of infection in hospitals. We certainly were not taught hand washing formally let alone as part of our examinations and it is only in recent years probably since the swine flu epidemic has there been the stress on prevention of the spread of infection and emphasis of handwashing and using hand rub.

• Use warm running water
• Wet the hands before applying soap
• Ensure you create a good lather
• Follow the correct hand washing technique to ensure all areas are covered as shown below.
• Hand washing should take at least 15 seconds, but no longer than 3 minutesAll hand basins in surgeries and hospitals have instructions of how to wash hands correctly as below.
• Rinse well with the hands uppermost so that the water runs off the elbow
• Use a ‘hands-free’ (e.g. elbows) technique to turn off taps. Where ‘hands free’ tap
systems are not in place, dry the hands first with paper towels and use these to turn off
the taps
• Dry each part of the hands properly and dispose of paper towels in the appropriate waste
bin without re-contaminating your hands (e.g. use the foot pedal). Do not touch the bin lids

Effective drying of the hands is an essential part of the hand hygiene process, but there is some debate over the most effective form of drying in washrooms. A growing volume of research suggests paper towels are much more hygienic than the electric hand dryers found in many washrooms.

hand washing

Removal of microorganisms from skin is enhanced by the addition of soaps or detergents to water.The main action of soaps and detergents is to reduce barriers to solution, and increase solubility. Water is an inefficient skin cleanser because fats and proteins, which are components of organic soil, are not readily dissolved in water. Cleansing is, however, aided by a reasonable flow of water.

Water temperature
Hot water that is comfortable for washing hands is not hot enough to kill bacteria. Bacteria grows much faster at body temperature (37 C). However, warm, soapy water is more effective than cold, soapy water at removing the natural oils on your hands which hold soils and bacteria. Contrary to popular belief however, scientific studies have shown that using warm water has no effect on reducing the microbial load on hands.

Solid soap
Solid soap, because of its reusable nature, may hold bacteria acquired from previous uses. Yet, it is unlikely that any bacteria are transferred to users of the soap, as the bacteria are rinsed off with the foam.

Antibacterial soap
Antibacterial soaps have been heavily promoted to a health-conscious public. To date, there is no evidence that using recommended antiseptics or disinfectants selects for antibiotic-resistant organisms in nature. However, antibacterial soaps contain common antibacterial agents such as Triclosan, which has an extensive list of resistant strains of organisms. So, even if antibiotic resistant strains aren’t selected for by antibacterial soaps, they might not be as effective as they are marketed to be.

Besides this on entering a hospital and individual wards and now in GP surgeries there are facilities to use hand antiseptic and this also must be carried out on entry.

Hand antiseptic
A hand sanitizer or hand antiseptic is a non-water-based hand hygiene agent. In the late 1990s and early part of the 21st century, alcohol rub non-water-based hand hygiene agents (also known as alcohol-based hand rubs, antiseptic hand rubs, or hand sanitizers) began to gain popularity.

Most are based on isopropyl alcohol or ethanol formulated together with a thickening agent such as Carbomer into a gel, or a humectant such as glycerin into a liquid, or foam for ease of use and to decrease the drying effect of the alcohol.

Hand sanitizers containing a minimum of 60 to 95% alcohol are efficient germ killers. Alcohol rub sanitizers kill bacteria, multi-drug resistant bacteria (MRSA and VRE), tuberculosis, and some viruses (including HIV, herpes, RSV, rhinovirus, vaccinia, influenza,and hepatitis) and fungus. Alcohol rub sanitizers containing 70% alcohol kill 99.97% of the bacteria on hands 30 seconds after application and 99.99% to 99.999% of the bacteria on hands 1 minute after application.

Hand sanitizers are most effective against bacteria and less effective against some viruses. Alcohol-based hand sanitizers are almost entirely ineffective against norovirus or Norwalk type viruses, the most common cause of contagious gastroenteritis.


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Last year I wrote about Dengue Fever
and this blog was visited by many readers.
dengue fever
Last weekend I was working in West Middlesex in the PCC at the weekend and a mother came in with her sick child and was very worried as she had just returned from Malaysia and Dengue fever was rife. Her child had a high fever and was very unwell and needed to be referred to the paediatricians promptly.

KUALA LUMPUR, Malaysia—Deaths from dengue in Malaysia shot up last year, doubling that of 2012, as the tropical country battles with a raging mosquito-borne virus that claims hundreds of lives annually in Southeast Asia.

Four patients — three women and one man — died in the week ending Dec. 21, leaving 88 dead in Malaysia in the first 51 weeks of this year. In 2012, 35 people died in Malaysia of dengue, data from the Ministry of Health show.
Malaysia suffered the worst dengue bout on record in 2010, when 134 people died and 46,171 cases were reported. In 2011, 36 people died in Malaysia, with 19,884 people infected.

As of Dec. 21, dengue cases totaled 41,226 , nearly doubling from 21,444 cases in same period in 2012.

“As long as infection and outbreak of dengue fever continues, the risk of death remains,” said Lokman Hakim, deputy director general at Malaysia’s Ministry of Health.

The virus, which is transmitted by the Aedes aegypti mosquito, causes severe fever, headaches, rashes and muscle and joint pain. Severe forms can cause hemorrhagic fever. No vaccine is currently available, and treatment is largely limited to intravenous rehydration.
Dengue fever
Selangor state, which borders the capital city of Kuala Lumpur, has been hit the hardest, reporting 24 deaths, the Ministry said. The southern state of Johor that borders Singapore, has recorded 21 fatalities.

Selangor is home to 88 of the 89 dengue “hotspots,” or areas that have witnessed a jump in outbreaks, with Negeri Sembilan accounting for the other.

refer to the previous blog  for further links and advice.

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Posted by on January 22, 2014 in Training and Advice


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Dengue Fever

DENGUE FEVER (Breakbone Fever)

dengue fever

Increased incidences of this condition has been recorded recently in the press.

My first recollection of this disease was whilst watching the film ‘Bridge over the River Kwai’ many years ago and associating the condition with travel in Thailand under poor social conditions.

In fact, I did see a patient with this condition 1-2 years ago and now that more people are taking holidays or working in these parts of the world, I am not surprised the incidence has increased, as sadly many people are not taking proper travel advice. If you are traveling, it may be appropriate to get advice by contacting :

Dengue fever is a condition caused by an RNA virus (arbovirus), which is common in tropic and subtropical areas, particularly India, South East Asia and the Pacific . An estimated 50 to 100 million dengue infections and 200,000 to 500,000 cases of Dengue hemorrhagic fever (DHF) occur annually. It is transmitted to humans by the bite of infective female mosquitoes of the genus Aedes J.

The incidence of dengue fever has tripled in the past 3 months. Since January, there have been 141 “confirmed and probable” cases of the severe infection among those from this country, among those who have traveled to places such as Thailand, Sri Lanka and Barbados – compared with just 51 during the same period last year.

“The increase in the numbers of people returning with dengue fever is concerning so we want to remind people of the need to practice strict mosquito bite avoidance at all times in order to reduce their risk of becoming unwell,” said Dr Jane Jones, an infection expert at PHE.

If you are traveling to this part of the World you are advised to take care in applying insect repellent and wearing long sleeved clothing at dusk and dawn.
There is no vaccination or preventative medicine available for this condition.

If you develop severe flu-like symptoms including fever, headache and bone, muscle and joint pain during or after your stay you should seek medical advise.

There is no specific treatment and for most people symptoms can be managed by taking paracetamol, drinking fluids, and resting. But some of those infected can develop more serious complications and need to be treated in hospital, and the disease can be fatal.

Further details can be found on:-

Written by Dr Jacqueline Bayer

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Posted by on May 17, 2013 in Training and Advice


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