Pathological Processes Of Erysipelas Biology Essay

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Erysipelas is predominately caused by a Streptococcus bacterium known as Group A Streptococcus. However, it can triggered by other forms of non-group A Streptococcus. The bacterium is known to enter the superficial layers of the skin after some form of trauma and is known to commonly affect the cutaneous lymphatic system. People at high risk for infection are commonly children, the elderly and people with immune deficiently (i.e. HIV), eczema, fungal infections, diabetes (Ulcers), alcoholism and particularly lymphatic conditions.

Symptoms tend to be acute and generally start with small localized rashes that rapidly spread within a few hours. The appearance of the rash can look raised and inflamed and as can be seen on the image which was taken from JM University (2010), the rash can have clearly defined boarders because raised boarders tends to occur between health tissue and the infected area.

As the infection develops it can be accompanied by chills, high fever, fatigue, headaches and vomiting.

c) Name a warning feature which might indicate a serious outcome for a person with this condition.

A rapid spreading rash on the any part of the body (particularly with clear boarders), that is accompanied by fever and vomiting would be a warning signs.

d) Describe the nature of the possible serious outcomes of the person with the condition

Complications of infection are rare due to modern use of Antibiotic. However infections can spread from the original site of infection (via bloodstream spread) and can cause further problems such as:

heart valve infection

Infected joints

Post-streptococcal glomerulonephritis ( which is a kidney condition affecting children)

Blood clots that can spread to the brain. (Cavernous sinus thrombosis)

e) Conventional Treatment

Antibiotics are used to treat the bacterial infection. These can commonly include Penicillin V, Benzylpenicillin injection, Flucloxacillin (eg. Floxapen), Erythromycin (eg. Erythroped) (Netdoctor 2010)

f) Chinese medical diagnosis for a patient with this condition

Invasion of Wind-Heat with Internal Heat and Blood, Qi or Yin Xu

Contact Dermatitis

A) Describe the pathological processes.

Contact dermatitis (CD) is inflammation of the skin (or rash) which has occurred because of contact from an external substance. This is generally split into two categories which are irritant CD and allergic CD.

Irritant CD is generally seen to be either acute or chronic. With acute CD, exposure to a substance that penetrates the skin causes a relatively sudden immune inflammatory response. In chronic CD, multiple exposures to irritant over many years cause mediators (such as lysozymes, prostaglandins, histamine and kinins) to trigger inflammatory response each time they are exposed. After many years the epidermis of the skin can start to thicken, dry out and become cracked.

Allergic CD is an immune reaction known as 'type IV' or 'delayed hypersensitivity' reaction (NetDoctor 2010). Allergic CD tends to occur in two phases .

Sensitization phase - External substance penetrates the skin and binds with immune cells (known as Langerhans' cells) which carries it to lymph nodes. Within the lymph node, the allergen is introduced to T-lymphocytes (another type of immune cell), which produce a memory of that particular allergen.

Elicitation phase - Once sensitization has occurred, further exposure to the allergen identified/memorized by the T-lymphocytes Cells cause them to multiply and release Inflammatory mediators that induce inflammation and activate more T-lymphocytes. Thus creating a viscous circle in inflammatory response.

B) Symptoms and signs of the condition.

Acute irritant dermatitis can have differing appearances depending of the level of immune response. This can range from a mild redness to severe blistering of the skin.

Chronic irritant CD tends to have dry patches of skin, followed by inflamed skin that thickens over time.

Allergic CD can initially appear as inching that then develops into areas of redness or blisters that weep. Can also develop into red wheals that are raised at the surface. Symptoms do not always occur in the area where contact was made with allergen.

C) Name a warning feature which might indicate a serious outcome for a person with this condition.

Any redness or swelling around the face and mouth could indicate a warning feature

D) Describe the nature of the possible serious outcomes of the person with the condition

Allergic CD may cause swelling of the mouth and upper airways (known as angioedema). This needs urgent medical attention as may cause asphyxiation

E) Conventional Treatment

Advise on how to avoid irritant and substances that could cause the allergy.

Allergy testing may support this or process of elimination

Corticosteroids (type of steroid) creams are generally prescribed to reduce inflammation.

Antihistamine is prescribes to reduce redness and itching.

F) Chinese medical diagnosis for a patient with this condition

Toxic Heat with Accumulation of Dampness

Uveitis (includes iritis)

A) Describe the pathological processes.

Uveitis is a condition where the middle layer of the eye (the uvea) becomes inflamed. The cause is frequently unknown, but certain event or conditions are thought to increase the risk:

An injury to the eye (traumatic iritis), for example, a squash ball hitting the eye

Recent or previous eye surgery,

Certain types of infection, or

A health condition (autoimmune conditions, immune-deficiency disease, bacterial, viral, fungal or parasitic infection)

(NHS Choices 2010)

B) Symptoms and signs of the condition.

Symptoms depend on location within the eye but generally include:

Aching and pain,

Redness in eye,

blurred vision,

a small pupil,

sensitivity to light



C) Name a warning feature which might indicate a serious outcome for a person with this condition.

Uveitis needs to be closely monitored because complications may develop and lead to loss of vision. Possible complications are outlined below.

Raised eye pressure and glaucoma

Untreated uveitis can cause the iris to stick to the front surface of the lens. This prevents fluid draining through the pupil and increases pressure inside the eye. It can lead to visual loss and glaucoma (damage to the optic nerve). See Useful links for more information on glaucoma.

Raised eye pressure can be a side effect of steroid eye drops, so it is important to use the lowest possible dose of these.


Untreated uveitis can cause cataracts (cloudiness in your lens that can lead to visual loss). See Useful links for more information on cataracts.

Macular oedema

Macular oedema is fluid that collects in a part of the retina called the macula. It can result from untreated posterior uveitis and may lead to loss of vision.

d) describe the nature of the possible serious outcomes of the person with the condition

e) describe the conventional treatment offered for the condition

Treatment of uveitis will depend on the type of uveitis, how serious it is and the cause. Some cases will clear up with the use of eyedrops. Others may need steroid injections into the eye.

The aim of treatment is to:

control the inflammation,

relieve any pain,

treat any underlying condition, and

treat any complications that may cause visual loss.

If you have recurrent uveitis, it is important to get it treated quickly. You may be advised to keep steroid eyedrops to hand at all times.

The different treatments are outlined below.

Mydriatic eyedrops

Mydriatic eye drops, such as atropine or cyclopentolate, dilate (widen) the pupil. This helps the eye to heal, prevents the pupil from getting stuck to the lens and decreases the eye pain. Your doctor will advise how often you should use these.

Mydriatic eye drops may cause blurred vision, difficulty focusing and an increased sensitivity to light, but they are a vital part of treatment.

If the condition is diagnosed early and treated with eye drops, no visual loss should occur.

Steroid eyedrops

Steroid eyedrops help decrease the inflammation of the iris. They will be used frequently at first and then tapered off, to prevent the uveitis recurring.

Steroid eyedrops are usually not used if a virus or bacteria caused the condition.

Steroid tablets or steroid injections to the eye

Steroid tablets (such as prednisolone) or a steroid injection into the eye may be recommended in severe cases of uveitis, when eye drops have no effect. The injection is done under local anaesthetic and you can go home on the same day.

In some cases, a steroid drip (methylprednisolone) may be given in hospital.

Prolonged steroid treatment needs to be carefully monitored for side effects (see Complications).


Immunosuppressants are drugs that suppress the body's immune system. Examples are:


azathioprine, and


These tablets can be used alongside steroids to treat some types of uveitis.

f) give a possible Chinese medical diagnosis for a patient with this condition

(NHS Choices, 2010)

What is Acute Otitis Media (no more than 320 words

AOM is part of a progressive disease which can develop into Otitis Media with Effusion (OME) which is an asymptomatic condition in which loss of hearing and speech impairment can occur as a result. Differentiation between the two can sometimes be difficult to ascertain.

a) describe the underlying pathological processes which might have led to the condition

Acute Otitis Media (AOM) is the name given to a symptomatic self-limiting ear infection; a common problem, particularly arising (but not exclusively) in childhood with 75% of cases appearing in children under 10 years of age. The infection occurs in the middle ear between the ear drum and the inner ear. The middle ear is usually filled with a pocket of air, but during a cold for example this pocket becomes filled wih mucus or fluid. If this mucus or fluid develops bacteria, then an ear infection is likely to occur.

The main pathological processes that may lead to the onset of AOM are thought to derive from viral and bacterial infections starting in the upper respiratory tract, usually following a cold. A non-conventional view amongst cranial osteopaths is that there is some indication that factors such as difficult births involving excessive pressure of the skull through the birth canal, or conversely a quick birth process, or the use of forceps/ventouse may increase the likelihood of AOM occurring.

b) Describe the symptoms and signs of the condition

One of the common signs of AOM can be an ear ache; however ear ache may not necessarily indicate an ear infection, as this symptom may present itself when for example a baby/child is teething. Other symptoms can include; loss of sleep rubbing or tugging of the ear, temporary dulled hearing, a fever, a general feeling of unwellness accompanied by vomiting; particularly in children. In babies, unexplained and prolonged irritability and crying and may indicate an ear infection. Acute Otitis Media is also often preceded by upper respiratory symptoms such as a cough or rhinorrhoea.

Name a warning feature which might indicate a serious outcome for a person with this condition

In the case of an individual developing Labryinthitis which is a relatively rare but serious complication resulting from AOM, the individual may exhibit symptoms such as memory loss and fatigue, along with a sense of imbalance, prolonged vertigo and disequilibrium.

d) describe the nature of the possible serious outcomes of the person with the condition

While AOM is a self-limiting condition which usually resolves itself with a few days without any antibiotic intervention, potentially serious complications such as infection spreading to the portion of temporal bone behind the ear called the Mastoid Process (in the case of mastoiditis), infection of the inner ear causing extreme vertigo, memory loss and fatigue (Labryinthitis) and the infection of the brain and surrounding tissue (Meningitis) can present as a result of AOM. Such complications can occur if AOM is left untreated; however they are rare in an otherwise healthy individual.

e) describe the conventional treatment offered for the condition

Since Acute Otitis Media is a self-limiting condition that's usually resolves itself with a few days without the need for medical intervention, in some instances conventional treatment in the form of painkillers such as paracetamol or ibuprofen are prescribed to lower the individuals' temperature and to ease the pain. In general, antibiotics are not routinely prescribed since the infection usually clears quickly and adverse side effects of the antibiotic such as vomiting, rash and diarrhea can occur; however in some instances antibiotics are favored in instances such as; the individual is under 2 years where the risk of greater complications is higher; the infection is severe, there is fluid from the ear, the infection last longer than 2 to 3 days or if further complications arise from the original diagnosis.

If the individual appears to suffer frequently from the same condition, it may be advised that grommets are surgically inserted into the eardrum to assist in draining any fluid from the middle ear thus helping to reduce infection.

f) give a possible Chinese medical diagnosis for a patient with this condition

Otitis Media - acute Ext Inv Wind-Heat/Wind-Cold of Shao Yang (GB/TB)Damp, Heat

Recurrent lingering PF

Chronic Damp-Heat from chronic Xu, esp Spl & Kid, Phl & Kid Yin Xu

In Children Lingering PF, Phl and Obstr of Qi, pre-exis Sp Qi Xu, Damp, Phl

Or underlying Liv & Kid Yin Xu

MeReC Bulletin Volume 17, Number 3 9

Long Answer Question Q6.b

This assignment question is a practical exercise relating to Lessons 6.3b and 6.3d; "Warning

features of disease" and "Professional communications".

In the answer to part (iv) of this question you are required to reproduce a professional letter

to be sent to a patient's doctor. Take this opportunity to design your own letter head and to

produce a typed letter which follows a professionally recognised style.

Case history: You have a patient called Jane Gardener who is a cause for concern in

that she has persisted in experiencing inter-menstrual bleeding despite treatment for

over three months. She came to see you three months ago complaining of irregular

periods which had got worse over the past 3 years.

She was complaining that the periods were heavy, and left her feeling tired. The

problem started when she was 45, and she is now 48. The periods themselves come at

intervals which vary between 25 and 32 days, and usually for one or two days between

the periods she suffers from a slight bleed. Initially you thought that this bleed

occurred at mid cycle, but you have now realised that it is very irregular in timing, and

also in character. Last week Jane mentioned that having sex with her husband set off

a bleed. Since you have seen Jane, she is saying that she has more energy, and her

periods are less heavy, but the inter-menstrual bleeding has not changed.

Jane is a smoker, but takes no medication. She suffers from occasional irritable bowel

symptoms, but these also have responded well to acupuncture. She generally is

feeling "alright", although still not back to how she felt 3 years ago.

You should be thinking in terms of making a non-urgent referral for this woman.

(i) What is (are) the warning feature(s) of serious diseases in this case, and what are the

possible underlying diseases which might account for this (these) warning feature(s)?

Explain how these diseases might give rise to the warning features you have


(ii) Describe how you might explain the need for referral to Jane herself, and also how

you might deal with any questions she might have about this.

(iii) How you would set about the practicalities of making the referral?

(iv) Draw up a referral letter for Jane's doctor. You can add in your own interpretation of

any details which have not been covered by this brief case history (e.g. the doctor's

name and address).

Hints for answering this question: Don't forget to reference your source texts throughout

sections i) to iii). The letter should be included in your word count.