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.
