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12 Shevat 5763 - January 15, 2003 | Mordecai Plaut, director Published Weekly
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Home and Family


Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

Finishing up with fever. Dysentery is not much of a problem in the West, but still plagues us in the Holy Land. This disease, which classically has diarrhea, fever, and bloody stool, is a disease of poor hygiene and poor food preparation. It is caused mainly by two organisms -- shigella and salmonella -- the latter the same family as typhoid fever.

Another cause of diarrhea and fever in infants is the notorious rotovirus. It can cause a bad dehydration.

A vaccine was produced in the USA, but has since been removed from the market because of side effects.

To prevent the spread of these diseases, good hygiene is essential. Separate bathrooms for those affected and meticulous hand washing are necessary. Perishable food must be refrigerated, in particular eggs. Saving money by buying eggs from someone's car or home that are stored outside is a setup for an epidemic.

Another cause of fever that may be hard to pick up is also spread through poor hygiene. Hepatitis A is rarely a bad disease, but it can be very debilitating. One can expect three weeks of weakness and inability to function. Getting vaccinated will save you a lot of grief.

Fever can sometimes persist without a source. Some sources take a few days to show themselves -- like mastitis in a nursing woman and erysipelas a skin infection in overweight individuals. However, most bacteria show a source by one week, and most viruses get better in the same time period.

Rarer causes must be considered such as festering infections - - abscesses; rheumatic diseases such as lupus and rheumatoid arthritis, and cancer lo oleinu. In kids Kawasaki Syndrome, Juvenile Rheumatoid Arthritis and Periodic Fever syndrome must be considered.

Two interesting diseases that can give a strange cause of fever are Henoch Scholein purpura and Familial Mediterranean Fever. The first, HSP, is not uncommon in kids and results in a characteristic rash that starts as little red pocks. It usually has stomach pain and fever. Most of the time it resolves on its own, but one much watch out for the kidneys. FMF, the second, has fever and abdominal pain that can be quite severe. Israel is the leader in treatment for this disease. Colchinine a drug that in the past was used for gout is quite effective.

Viral meningitis is common in our country. In patients with a suspicion of this disease I have stopped doing spinal taps. This disease gets better and in any case there is no treatment. Spinal taps can be very painful for a week afterwards. I hope you now have a better understanding of fever. Any questions? Write me in care of the Yated.

A message from Glaxo, sponsor of this column. We spoke about Hepatitis A and this is a case that I believe so much in the vaccination that all my family are vaccinated. Having seen people with this malady, I am glad I made this decision. Ask in Kupat Cholim -- this Glaxo product is well worth it.

 

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