disseminated-gonococcal-gonorrhea-clinical-rash-original

Disseminated Gonorrhea

Disseminated Gonorrhea or Neisseria Gonorrhoeae. Disseminated gonococcal infection (DGI)

Many of my patients with Gonorrhea( pus per urethra) present with rash , some have joint pain (Gonococcal arthritis)

(DGI) follows untreated mucosal infection in about 0.5-3 per- cent of patients. Skin lesions are the most common manifestation of DGI and occur in 50-70 percent of patients. The eruption typically appears during the first day of symptoms and may recur with each bout of fever. The skin lesions associated with DGI begin as tiny red papules or petechiae 1-5 mm in diameter, many of which evolve rapidly through vesicular or pustular stages to develop a gray necrotic center, often on a hemorrhagic base. Papules, bullae, pustules, and hemorrhagic lesions may all be present simultaneously. The lesions tend to be scanty but widely distributed. The distal portions of the extremities are most commonly involved, with sparing of the scalp, face, trunk, and oral mucous membranes. Histologic examination will reveal local vasculitis, fibrin deposition, necro- sis, and neutrophil infiltration. Gram-stained smears of material from skin lesions infrequently reveal organisms, although most smears are positive for gonococci when examined by immunofluorescence techniques. Circulating immune complexes may play a role in the pathogenesis.

fever

Fever and rash in Thailand

Fever and rash in Thailand (part1/2)

If you have fever while traveling in Thailand or fever with a rash in a tropical country , what can you do? and what’s possible cause? Today I will give you some ideas.
Fever can be caused by various infectious and non-infectious conditions. The possibilities depend on factors like how many days of the illness (acute or chronic), type of rash, other associate symptoms, and exposure or traveling history. Below are common causes:

Infections

Infection can be virus , bacteria or other but most common is virus. in my experience here in Pattaya , tourists concern about Dengue fever but it’s not common one .


Dengue Fever :

I will give more details in another post , but if you were here in rainy season ( Approx June till October ) And you had exposed to mosquito , it can be Dengue. Remember that in typical case the fever comes before the rash for 3-4 days.

Rash: Blotchy or pinpoint red spots (petechiae), often appears after fever subsides.
Other symptoms: High fever, severe headache, muscle/joint pain, eye globe pain, and bleeding tendencies , poor appetite or even vomiting, tiredness.
Chikungunya Virus:

Chikungunya also a virus transmitted by mosquito .

Rash: Maculopapular rash, usually widespread. Sometimes at the same time of fever , or after few days.
Other symptoms: High fever, severe joint pain, fatigue, and headache.


Corona and other Virus

Many viral disease including Covid and coronavirus , can cause fever with rash

Rash: Maculopapular, often accompanied by conjunctivitis.
Other symptoms: Mild fever, muscle pain, headache, and malaise.


Rubella (german measles)

Rash: Fine maculopapular rash evenly distributed all body.
Other symptoms: fever (usually low grade)and rash appear simultaneously at the first day , or no fever , malaise .


Typhus (Scrub Typhus)

Rash: Starts on the trunk and spreads to extremities, maculopapular or petechial.
Other symptoms: Fever, headache, and swollen lymph nodes; eschar at the bite site.


Measles

Rash: Starts on the face and spreads downward, blotchy and red.
Other symptoms: High fever, cough, conjunctivitis, and Koplik spots in the mouth.

virus2

Norovirus outbreaks in 2024

In 2024, there has been a notable increase in norovirus outbreaks across various regions of the world , USA , Europe and China:

United Kingdom: Health officials observed a 33% increase in norovirus cases from mid-November to early December 2024, with the total number of infections more than doubling compared to previous years.
(THE SUN)

United States: The Centers for Disease Control and Prevention (CDC) reported 495 norovirus outbreaks between August 1 and December 11, 2024, a significant rise from 363 outbreaks during the same period in the previous year.
(CDC)

Students from various schools in China reported symptoms such as vomiting and abdominal pain, which were later confirmed as Norovirus infections. In one case, 18 students were affected. Similarly, 48 children at a kindergarten in Xi’an, Shaanxi Province, tested positive for the virus, experiencing vomiting and diarrhoea.(TheNation)

Foodborne Outbreaks: In December 2024, the U.S. Food and Drug Administration (FDA) issued advisories regarding norovirus contamination in certain oyster and clam products distributed nationwide.
(EATINGWELL)

Norovirus is highly contagious, leading to symptoms such as vomiting, diarrhea, nausea, and stomach pain. It spreads through direct contact with infected individuals, consumption of contaminated food or water, and touching contaminated surfaces. Preventive measures include thorough handwashing with soap and water, proper food handling, and disinfecting contaminated surfaces. Individuals experiencing symptoms are advised to stay home and avoid preparing food for others until at least 48 hours after symptoms subside.

In Thailand , many experts predict that the transmission will be via children , or people traveling from China , and expecting some outbreak in tourist destinations like in Pattaya , Bangkok , Phuket.

In case you are sick , can come to see our doctor at https://pattayadoctor.com

sinovac sinofarm

How are Chinese Sinovac and Sinopharm Covid vaccines?

How are Chinese Sinovac and Sinopharm Covid vaccines?

China appears to have made two frontier vaccines from two front runners , Sinovac and Sinopharm . What do we know about these firms?

The Beijing-based biopharmaceutical company Sinovac is behind the CoronaVac, an inactivated vaccine. It use killed viral particles to expose the body’s immune system , like old style vaccine such as rabies vaccine , to stimulate the immune without risking a serious disease.

Which , by comparison , the Pfizer and Moderna vaccines being developed by mRNA virus , means that the virus’s genetic part is injected into the body , triggering the body to begin making viral proteins, but not the whole virus , which enough to train the immune system to attack.

The firm said that “”mRNA vaccines are a new type of vaccine and there is [currently] no successful example [of them] being used in the population,”

On paper , one of The Sinovac’s main advantages is that it can be stored in a standard refigerator at 2-8 C , like the vaccine from Oxford , which is made from genetically engineered common cold virus. The other two , Moderna’s vaccine needs -20 C and Pfizer’s vaccine at whopper -70 C .

How effective is it? It’s hard to tell right now.

A Chinese study published in the scientific journal The Lancet only has information from the first and second phase trials of CoronaVac in China. Zhu Fengcai, one of the authors of the article, said those results – based on 144 participants in the phase one trial and 600 in the phase two trial – meant that the vaccine was “suitable for emergency use.” CoronaVac has undergone phase three trials in several countries. Interim data from late-stage trials in Turkey and Indonesia showed that the vaccine was 91.25% and 65.3% effective, respectively.

Researchers in Brazil initially said it was 78% effective in their clinical trials, but in January 2021 they revised that figure to 50.4% after including more data in their calculations.

In early November, this trials were briefly stopped after the death of a volunteer, but resumed after death was not found to have no link to the vaccine. Sinovac has been approved for emergency use in high-risk groups in China since July. In September, Mr. Yin from Sinovac said the tests were conducted on more than 1,000 volunteers, of whom “some showed only minor fatigue or discomfort ,no more than 5%.”

And the Sinopharm vaccine?

Sinopharm, a Chinese state-owned company, is developing two Covid-19 vaccines, which, like Sinovac, are also inactivated vaccines that work in a similar way.

Sinopharm announced on December 30 that trials of the third phase of the vaccine showed it to be 79% effective, lower than that of Pfizer and Moderna. However, the United Arab Emirates, which approved a synopharmaceutical vaccine earlier this month, said the vaccine was 86% effective, based on interim results from its phase three trial.

A company spokeswoman declined to explain the discrepancy, saying detailed results would be released later, a Reuters report said. But even before the results of the third phase trials, the vaccine had already been distributed to nearly a million people in China as part of an emergency program.

Professor Dale Fisher of the National University of Singapore said at the time that it was “unconventional” to step up a vaccine program without going through late-stage trials first. “It is normal to wait for an analysis of the third phase trials before intensifying a vaccine program by authorizing emergency use,” he told the CNBC news site.

In early December, Peru suspended trials for the synopharm vaccine due to a “serious adverse event” that affected a volunteer. It later said it lifted the suspension. A pause in a clinical trial is not unusual. In September, the UK halted trials for another Covid-19 vaccine after a participant had a suspected adverse reaction, resuming after the vaccine was ruled out as the cause.

The spread of the coronavirus within China has for the most part been contained – and life is slowly but surely returning to a “new normal.”

Any other vaccine candidates?

At least two other Covid-19 vaccines are in development in China, according to a recent article in The Conversation. One of them is CanSino Biologics, which is reported in phase three clinical trials in countries including Saudi Arabia. The other is being developed by Anhui Zhifei Longcom. Its vaccine uses a purified piece of the virus to trigger an immune response, and it has recently entered phase three testing, according to the report