GILBERT'S SYNDROME

This common benign condition is usually first recognized in adolescents or young adults. It is more common in men and occurs in about 5% of the population.

CHRONIC PERSISTENT HEPATITIS (CPH)

Chronic persistent hepatitis is a mild illness comprising fatigue, poor appetite, fatty food intolerance and upper abdominal discomfort, especially over the liver.

INFLUENZA

Influenza is a specific acute illness caused by a group of myxoviruses. It occurs in epidemics, and occasionally pandemics, often explosive in nature.

CHOLEDOCHOLITHIAISIS

Stones in the common bile duct occur in 10-155 of patients with gallstones.

POSTCHOLECYSTECTOMY SYNDROME

Symptoms following cholecystectomy occur in 12-68% of patients depending on how thecondition is defined, how actively symptoms are sought, and the indications for cholecystectomy.

ACUTE MOUNTAIN SICKNESS

This is experienced by people who go up too high too quickly; some suffer at 2500m, other reach 5500m without trouble. The cause of the syndrome is unknown.

PULMONARY OVERINFLATION

This occurs in scuba divers breathing compressed air.

SHALLOW WATER BLACKOUT

Swimmers and free divers (snorkling without compressed air) may hyperventilate before submerging in order to drive off carbon di oxide and so reduce the stimulus to breathe. The raised ambient pressure maintains a high diver is eventually forced to surface. The resulting cerebral hypoxia is made worse by cerebral vaso construction induced by the low partial pressure of carbon di oxide, and can result in unconsciousness and drowning

MIDDLE EAR 'SQUEEZE'

Middle ear 'squeeze' is the commonest injury of divers. Sinus squeeze is less common.

CHRONIC MOUNTAIN SICKNESS

This is due to alveolar hypo ventilation and chronic hypoxia brought about by inappropriate polycythaemia,

ANISAKIASIS (HERRING WORM DISEASE)

Anisarkis marina parasites herrings and other marine animals. Human infections occur in Holland and Japan from the consumption of raw herrings.
An eosinophilic granuloma forms in the intestine and may give rise to colic, fever and intestinal obstruction.
An indirect haemagglutination test has been used for diagnosis.
Surgery may be required.

GNATHOSTOMIASIS

Gnasthostoma is a nematode of digs and cats in Bangladesh, South East Asia and Far EAST.

TRICHNELLA SPIRALIS

This parasite of rats and pigs is transmitted to man by eating partially cooked infected pork

ANGIOSTRONGYLUS

Angiostrongylus, a nematode affecting the lungs of rodents, has a larval stage in molluscus and fresh water shrimps. In the Far East and the Pacific, where infected crustacea are eaten or infected slugs on vegetables are inadvertently swallowed, the larvae may cause a serious eosinophilic meningitis and immature worms may be found in CSF, Thiabendazole is effective but patients often recover spontaneously.

ANCYLOSTOMA BRASILIENSE AND ANCYLOSTOMA CANINUM

These are intestinal parasites of dogs with a similar life cycle to A.duodenale, but in man they cause a creeping. eruption or cutaneous larva migrans. The larva burrows between the corium and stratum granulosum and progresses irregularly at about 1cm in 24 hours.

Clinical features
The skin at the advancing end is erythematous and may vesiculate while that over the older part of the burrow is discoloured and scaly. Itching may be intense. The larva may remain active for months.

Management
Treatment is tropical. One 0.5 g tablet of thiabendazole is ground in to 5g petroleum jelly rubbed into affected site twice daily for a few days.

TOXOCARA CANIS

This is common intestinal worms of dogs. The ova are passed in the animal's faeces.

ENTEROBIUS VERMICULARIS (THREADWORM)

This helminth is common throughout the world, It affects children especially.

CANCRUM ORIS

Cancrum oris is rare except in poorly nourished children in the tropics.

MELIOIDOSIS

Meliodosis is caused by Pseudomonas pseudomallei, a micro organism closely related to P.mallei, the cause of glanders, which is a rare disease of horses and rarely their grooms.

TULARAEMIA

Tularaemia is an infection due to Francisella tularensis transmitted to mammals and birds by the bites of infected blood-sucking flies and ticks.

SCARLET FEVER

Although scarlet fever is at present a mild disease, it may not necessarily remain so, as fluctuations in its severity have been record for the past 300 years.

ERYSIPELAS

Erysipelas is an acute streptococcal infection of the skin, commoner in the elderly.

DERMATOPHYTES

This large group of fungi infect keratinised tissues and are responsible for ringworm of the body and scalp,

TICK-BORNE TYPHUS FEVERS (Rocky mountain spotted fever)

The casual organism, R.rickettsii is transmitted by the bite of hard (Ixodid) ticks which carry the infection to rodents and dogs and on occasion to man. It is widely distributed througout the world but now decreasing in Western and South-eastern states of the USA and also in South America.

COCCIDIOIDOMYCOSIS

This is caused by Coccidioides immitis and found in Southern United States, and Central and South America. The disease is acquired by inhalation.