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We had heal- ing sessions in the afternoon buy diarex visa gastritis diet beverages, and in the night times we had open air meetings 30 caps diarex mastercard gastritis acid diet. On Sunday afternoon 30caps diarex sale gastritis acid reflux diet, while pre- paring for the healing service discount 30 caps diarex free shipping gastritis diet öööžķōņāó÷žźć, I looked through the window and I saw a man going into the hall, who was bowed over and couldnāt walk. As I saw them take him into the hall, I prayed that he would receive his healing that afternoon. Later while I was ministering (by then I had actually forgotten about him), I noticed he was sit- ting in the front row. That was when I spotted him and remembered he was the one I had seen coming into the meeting earlier on. The man who was formerly bound over, straightened up and started walking, though shakily at first. Elephantiasis Healed I also remember the case of a guy who came nto a meeting with two very big legs. I spoke to the legs in the Name of Jesus and commanded them to return to normal, and for whatever was causing the Authority of The Name of Jesus swelling to come out. Right there it looked as though nothing had happened but I knew the man was healed. He also went back to the native doctor who had been treating him to share his testimony and to testify of the power in the Name of Jesus. The Boy With The Devil There was a young boy who was brought into a meeting we were holding. When they took their hands off, I said to him, āGo on your knees in the Name of Jesusā and he went straight on his knees, just like that! Then I spoke to the devil and commanded him to let go of the boy and come out of him in the Name of Jesus. What Godās children need to do is under- stand the power behind the name, and how to apply that Name. Jesus gave us the right to reign over devils, and the earlier we realize this, the better. Then Peter said, Silver and gold have I none; but such as I have give I thee: In the name of Jesus Christ of Nazareth rise up and walk. He said, āā¦such as I have give I thee: In the name of Jesus Christ of Nazareth rise up and walk. Making Demands In The Name of Jesus John 14:13,14, āAnd whatsoever ye shall ask in my name, that will I do, that the Father may be glori- fied in the Son. In the Greek lan- guage, one of the synonyms for the word āaskā is āde- mand,ā and that is the synonym used here. He is saying here, āWhatever you demand to be done in my Name, Iāll ensure itās done. We can pray in the Name of Jesus, as well as Using The Name of Jesus make demands in the Name of Jesus, but what He said we should do in John 14:14 is to make demands in His name. A proper study will reveal this doesnāt mean weāre making a demand of the Father or of Jesus, but that He would back up our demand with His author- ity. He said, āSilver and gold have I none; but such as I have give I thee: In the name of Jesus Christ of Nazareth rise up and walkā (Acts 3:6). Later Peter testified that faith in the Name of Jesus made the man strong (Acts 3:16). If youāre not in good health, you can make a demand on your body to be- come well in the Name of Jesus. I told her to put her hand on the tumor and as she did, I pointed to the tumor and commanded it to leave in the Name of Jesus. I spoke to the tumor again, āIn the Name of Jesus, youāre not allowed to move around in her,ā and commanded it to come out of her body. Growth Bows To The Name of Jesus There was a man who had a growth sticking out of his back. Then I spoke to it again to leave in the Name of Jesus and pushed it in, and it was gone. The place where the growth was formerly became flat; I could rub my palm against it. They hadnāt had water running in their compound for a long time; actually for years. He went straight to the tap outside, laid hands on it and said, āI command water to come through this tap in the Name of Jesus! You know, when you learn to see in the realm of the spirit, things become differ- ent. That guy just looked at the tap, and thought, If I use this Name it will draw out water for me. Working Miracles In The Name of Jesus Mark 16:15-18, āAnd he said unto them, Go ye into all the world, and preach the gospel to every crea- ture. He that believeth and is Baptized shall be saved; but he that believeth not shall be damned. If this is the way youāve been thinking, then you need to read Mark 16:15-18 again. The signs shall follow them that believe - everyone who has confessed Jesus and believed on His Name; every Christian is qualified! My question is this: If you can lay hands on the sick to heal them, how about your own body? If some other personās body will listen to you, of course your body will listen to you. Some- times devils frustrate peopleās businesses, their fami- lies, their finances, and their bodies too. He Using The Name of Jesus wants us to know the exceeding greatness of His power toward those of us who believe. This power that is directed towards us is the same power He dem- onstrated in Christ when He raised Him from the dead and set Him on His own right hand in the heav- enly realms. And when God directed His power toward Jesus to raise Him up from the dead, He directed His power toward us at the same time. He raised us up together with Christ Jesus, far above principalities and power and might and dominion and every name that is named. No wonder the Bible says He has made us Kings and Priests unto His Father (Revelation 1:6). T The life of dominion implies that youāre reign- ing, dictating the circumstances of your life through Jesus Christ. Genesis 1:28, āAnd God blessed them, and God said unto them, Be fruitful, and multiply, and replen- ish the earth, and subdue it: and have dominion over the fish of the sea, and over the fowl of the air, and over every living thing that moveth upon the earth. For thou hast made him a little lower than the an- gels, and hast crowned him with glory and honour. Thou madest him to have dominion over the works of thy hands; thou hast put all things under his feet:ā Itās because of this that after the Fall, you still see man being able to tame all kinds of animals. In fact, the Bible testifies that thereās no animal that hasnāt been tamed by man (James 3:7).
This elastotic degeneration is digital arteries causing Raynaudās phenomenon proven 30caps diarex gastritis child, in responsible for many of the appearances of ageing cheap 30caps diarex otc gastritis burning stomach, which the ļ¬ngers go white proven 30 caps diarex gastritis symptoms spanish, pink and blue in including wrinkling and telangiectasia 30caps diarex for sale gastritis celiac. The condition may occur for no obvious ā Solar damage can be prevented by avoiding exposure reason or be the result of an underlying disorder at times of maximum irradiation and by the use of such as the carpal tunnel syndrome, cervical rib or sunscreens. The skin surface and its adnexal structures harbour a stable microļ¬ora, which lives in symbiosis with skin and may indeed be beneļ¬cial. Gram-positive cocci (Staphylococcus epidermidis), Gram-positive lipophilic microaerophilic rods (Propionibacterium acnes) and a Gram-positive yeast-like organism (Pityrosporum ovale or Malassezia furfur) live in the follicular lumina without normally causing much in the way of harm. Infection of the skin only occurs when the skin encounters a pathogen that its defences can- not eliminate or control. Fungal disease of the skin/the superļ¬cial mycoses/infections with ringworm fungi (dermatophyte infections) Dermatophyte infections are restricted to the stratum corneum, the hair and the nails (i. This microaerophilic, lipophilic denizen of the normal follicle only occasionally becomes pathogenic when its growth is encouraged by heightened rates of sebum secretion or there is depressed immunity. Diagnosis is made by identiļ¬cation microscopically of grape-like clusters of spores and a mesh- work of pseudomycelium in skin scrapings made more transparent by soaking the scales for 20 minutes in 20 per cent potassium hydroxide. A more elegant and per- manent preparation can be made using cyanoacrylate adhesive (crazy glue) to remove a strip of superļ¬cial stratum corneum from the skin surface on a glass slide. The slide is ārolled offā the skin after 20 seconds and then stained with periodic acid- Schiff reagent (Fig. Older remedies such as 20 per cent sodium thiosulphate solution and selenium disulphide shampoo are also effective, as is oral itraconazole (1ā200 mg/day) for 7ā15 days. Microsporon canis caught from dogs, cats or children causes tinea capitis in children and, uncommonly, other types of ringworm infection. The diagnosis is conļ¬rmed by microscopy of skin scrapings, hair or nail clip- pings treated with 20 per cent potassium hydroxide for 20 minutes and identiļ¬- cation of fungal hyphae. Use of the cyanoacrylate āskin surface biopsy techniqueā described above makes identiļ¬cation quite easy (Fig. Culture may be positive when direct microscopy is not, but it takes 2ā3 weeks or longer before the culture is ready to read. Clinical features of ringworm infection Tinea corporis This is ringworm of the skin of the body or limbs. Pruntic, round or annular, red, scaling, well-marginated patches are typical (Fig. Tinea cruris Tinea cruris or groin ringworm is very itchy and is for the most part a disorder of young men. Well-deļ¬ned, itchy, red scaling patches occur asymmetrically on the medial aspects of both groins (Fig. Differential diagnosis includes seborrhoeic dermatitis or intertrigo (see page 116) where the rash is symmetrical and does not have a well-deļ¬ned border, and ļ¬exural psoriasis. Tinea pedis Ringworm infection of the feet may be: 1 vesicular, with itchy vesicles occurring on the sides of the feet on a background of erythema; 2 plantar, in which the sole is red and scaling; or 3 interdigital, in which the skin between the fourth and ļ¬fth toes in particular is scaling and macerated. Tinea pedis is very common and particularly so in young and middle-aged men, who often contract it from communal changing rooms. Tinea manuum This less common, chronic form of ringworm usually involves one palm only, which is usually dull red with silvery scales in the palmar creases. Tinea capitis Ringworm of the scalp occurs in children exclusively and is mainly due to M. It invades the scalp stratum corneum and the hair cuticle (ectothrix infection), causing pink, scaling patches on the scalp skin and areas of hair loss due to the breakage of hair shafts (Fig. Tinea unguium This condition is due to ringworm infection of the nail plate and the nail bed. He was fed up with having itchy, scaly feet and ugly, thickened toenails and sought treatment. Tinea incognito This is extensive ringworm with an atypical appearance due to the inappropri- ate use of topical corticosteroids (Fig. The corticosteroids suppress the protective inļ¬ammatory response of the skin to the ringworm fungus, allowing it to spread and altering its appearance. Treatment For ordinary ringworm of the hairy skin, an imidazole-containing preparation (such as miconazole, econazole and clotrimazole) used twice daily for a 3ā4-week period is usually adequate. When multiple areas are affected in tinea unguium and tinea capitis and when topical treatment has failed for some reason, one of the following systemic drugs needs to be used. These agents are administered for 2ā6 weeks except for griseofulvin, which, when given for tinea unguium of the toenails, may need to be given for 6ā12 months. Candidiasis (moniliasis, thrush) This common infection is due to a yeast pathogen (Candida albicans) that resides in the gastrointestinal tract as a commensal. It is a not infrequent cause of vulvo- vaginitis in pregnant women, in women taking oral contraceptives and in those taking broad-spectrum antibiotics for acne. It is also responsible for some cases of stomatitis in infants and the cause of infection of the gastrointestinal tract and elsewhere in immunosuppressed people. It may contribute to the clinical picture in the intertrigo seen in the body folds of the obese and in the napkin area in infancy. Oral and vaginal moniliasis responds to preparations of nystatin and amiphenazole as well as to the imidazoles. Some, such as histoplasmosis, cryptococcosis and coccidioidomycosis, are widespread systemic infections, which only occasionally involve the skin. Actinomycosis, sporotrichosis and blastomycosis infect the skin and subcuta- neous tissues, causing chronically inļ¬amed hyperplastic and sometimes eroded lesions. Sporotrichosis may produce a series of inļ¬amed nodules along the line of lymphatic drainage. Deep fungus infections of this type produce a granulomatous type of inļ¬ammation, with many giant cells and histiocytes as well as polymorphs and lymphocytes. Madura foot is a deep fungus infection of the foot and is seen in various coun- tries of the African continent and India. The affected foot is swollen and inļ¬l- trated by inļ¬ammatory tissue, with many sinuses. The infection spreads throughout the foot, invades bone and is very destructive and disabling. Clinical features Red, sore areas, which may blister, appear on the exposed skin surface (see Fig. Yellowish gold crust surmounts the lesions that appear and spread within a few days. It is, however, not uncommon for the signs of the lesions to appear over an area of eczema. In tropical and subtropical areas, an impetigo-like disorder is spread by ļ¬ies and biting arthopods. This disorder is more destructive than ordinary impetigo and produces deeper, oozing and crusted sores and is caused mostly by beta- haemolytic streptococci.
It was soon realised that characteristics for classification should be as correlated with other characteristics as possible effective diarex 30 caps gastritis disease definition. This means that some characteristics can be used as key characteristics to rapidly identify an organismāeg purchase diarex with a visa chronic gastritis support group, rapid indole production for Escherichia coli order genuine diarex gastritis diet foods list. However trusted diarex 30caps gastritis diet īäķąźėąńķčźč, this approach has its problems: real exceptions occur to most characteristics for most organisms, supposed key characteristics may be shared by quite dissimilar organisms while varying for quite similar ones, and slight variation in technique can cause wrong results and wildly incorrect identifications. Numerical taxonomy takes an entirely different tack: testing organisms for a large number of characteristics, each of which is given equal weight, and classifying them in clusters of similarity, which form natural taxons. The 20 or so characteristics chosen for each system were those which had been found to be both highly correlative and most constant for the group of organisms for which the system was designed. These systems now constitute the mainstay of bacterial identifications in the clinical laboratory, but key reactions, many using commercial packages, are also frequently used. For many of those organisms for which no simple packaged system exists, tables and/or keys are available which enable identification. Unfortunately, however, genetic classifications are often not very useful clinically. For example, genetically, Escherichia coli and Shigella should be in the same species. If you know the growth characteristics of an organism, its appearance, smell (if any), perhaps a few key biochemical reactions, likely antibiogram, its usual habitat and the circumstances under which it is likely to be isolated in a clinical laboratory, the identification can be rapid and you are unlikely to be misled into error. Most clinical specimens are seeded to a number of different types of media and it is important to compare the growth on the different media. For example, an organism growing on blood agar but not enriched chocolate agar with bacitracin is probably Gram positive; one growing on enriched chocolate agar with bacitracin but not on blood agar (except, perhaps, as pinpoint colonies) is probably Haemophilus; one growing on blood agar and colistin nalidixic acid agar but not MacConkey is Gram positive; one growing on blood agar, colistin nalidixic acid agar and MacConkey is likely to be either Enterococcus faecalis (tiny colonies) or a Pseudomonas species; one growing on blood agar but not colistin nalidixic acid agar or MacConkey is probably a non-Enterobacteriaceae Gram negative; etc. A Gram positive rod appearing overnight, or even in 48 hours, is definitely not a Mycobacterium. On the other hand, a Haemophilus that takes 48 hours to make a feeble growth on enriched chocolate agar from an eye swab may well be suspected of being Haemophilus aegyptius rather than Haemophilus influenzae. Use of colonial characteristics as a criterion has fallen into disfavour in many identification systems. This is largely because such characteristics are difficult to describe in terms that mean the same to all observers, impossible to include in numerical type taxonomies and even difficult to incorporate into keys and tables. However, many bacteria regularly produce colonies that are typical and almost instantly recognisable, reducing identification procedures to one or two simple confirmatory tests, such as Staphyslide for Staphylococcus aureus and indole for Escherichia coli. Equally, if an identification system gives you an identification which does not accord with the appearance of the organism as you know it or as it is described in the texts, you should seriously question that identification. As proved in a survey with Streptococcus milleri, the smell of the growth of some organisms is so characteristic as to approach an absolutely reliable identification procedure. The Gram stain reaction remains probably the single most correlative characteristic of an organism. This is despite the fact that isolates of some supposedly Gram positive species frequently stain Gram negative. Correlation with the colonial appearance and with the type of media on which the organism is growing may prevent an error in some cases. Also, in many cases, one can learn to recognise microscopically the morphology of species such as Bacillus and Lactobacillus which Diagnosis and Mangement of Infectious Diseases Page 416 Identification of Isolates frequently overdecolorise, and even to detect the minute difference in the appearance of the cell wall in Gram positive and Gram negative species. The potassium hydroxide string test [Place colony in 3% potassium hydroxide and lightly emulsify. Unfortunately, it is not infallible, and Achromobacter, Acinetobacter, Agrobacterium and Moraxella regularly give false negative reactions, while Bacillus species may give a false positive. Where suspicion still exists, vancomycin susceptibility may settle the question; all Gram positives except Lactobacillus, Leuconostoc, Pediococcus and rare strains of Enterococcus are sensitive, while Acinetobacter and Moraxella are the only Gram negatives which may show sensitivity. Nalidixic acid and polymyxin susceptibility also correlate very well (though not perfectly) with ātrueā Gram stain reactionāGram positives are resistant, and Gram negatives susceptible, to both. Again, an oxidase negative and/or large-celled Gram negative bacillus which is penicillin susceptible should be viewed with suspicion unless it has been identified as belonging to a species which includes penicillin susceptible strains. Slow-growing Gram positive bacilli of fine morphology should be subjected to a modified Ziehl-Neelsen stain. The actual morphology of an organism is frequently characteristic and can sometimes be virtually diagnostic. The appearance of cells grown in the presence of a ļ¢-lactam to which they are susceptible (eg, from the zone edge around a penicillin disc) can often be useful in deciding this; cocci tend to enlarge and disrupt spherically, while rods are prone to elongate. Other important properties that can be almost instantly determined are the catalase and oxidase (Kovacs method using a platinum (never nichrome) loop to inoculate an 18-24 hours old colony from a non-selective and non-differential medium to freshly prepared 1% tetramethyl-p-phenyldiamine dihydrochloride (reacts with cytochrome c to form a blue coloured compound; positive reaction must occur in 10 seconds) is the most satisfactory method) reactions. The single most important biochemical characteristic is undoubtedly the O-F reaction. Whether an organism utilises glucose fermentatively, oxidatively or not at all is a highly correlative criterion. It is important to realise that nonfermentative organisms are strict aerobes and vice versa. Given just the above criteria, Cowan and Steeleās initial tables purport to group all the bacteria one is likely to encounter in a clinical microbiology into a number of groups which lead on to further tables eventually allowing a firm identification. This is because of the broad groupings, with lack of due notice given to important exceptions; the fact that absolute positive and negative values of characteristics are given at the 85% level, which gives a fairly high probability of encountering an exception; because descriptions of genera are sketchy and sometimes wrong in failing to note important exceptions, while descriptions of species are virtually nonexistent; such basic properties as colonial and cellular morphology are rarely mentioned. So, anyone using Cowan and Steel should check the identification carefully against a description in Balows or Bergey. The tables in Balows are more complete, frequently quote percentages, and are usually accompanied by clear descriptions of species. The problem with Balows is that it largely presupposes enough knowledge to be able to get to the right table. The three keysāāNonenterobacteriaceae Fermentative Gram Negative Bacilliā, āNon-fermenting Gram Negative Bacilliā and āFastidious Gram Negative Bacilliāārequire only urea, indole, nitrate and lactose as additional tests and are very useful but there are problems getting there: How do you know a fermentative Gram negative bacillus is non- Enterobacteriaceae? Why does āFastidious Gram Negative Bacilliā not include Haemophilus, Brucella, etc? Probably the best scheme for identification of nonfermenting and fastidious Gram negative bacilli is the Weaver- Hollis scheme. However, even here there are problems: misread any one of the three prime separating criteria (O-F, MacConkey, oxidase) and youāll quickly be right off the track; many of the tests are not ones normally used in the laboratory; some organisms are far more quickly and definitively identified by alternative procedures; referral to fuller descriptions of organisms is still required. These limitations can arise because the necessary data are not in the data base, because the tests employed have insufficient discrimination for particular organisms, or because a test gives incorrect results. It is possible to use reactions obtained in these systems to āmanuallyā identify organisms. However, a great deal of caution must Diagnosis and Management of Infectious Diseases Page 417 Identification of Isolates be applied here since different results may well be obtained using different methodsāsomething that must be borne in mind whatever method you are using. It is always wise to set up the standard extra tests (motility, nitrate, O-F glucose, MacConkey) on any oxidase positive organism; also, any organism which shows only a few reactions after overnight incubation should be reincubated for a further 24 hours and the extra tests set up.
Infectious agentsāColorado tick fever buy diarex 30 caps gastritis gastroenteritis, Nairobi sheep disease (Ganjam) purchase diarex online pills gastritis diet ķąļ, Kemerovo cheap diarex master card gastritis diet ąāčņī, Lipovnik effective 30 caps diarex gastritis and esophagitis, Quaranļ¬l, Bhanja, Thogoto and Dugbe viruses. Virus has been isolated from Dermacentor andersoni ticks in Alberta and British Columbia (Canada). Period of communicabilityāNot directly transmitted from per- son to person except by transfusion. The wildlife cycle is maintained by ticks, which remain infective throughout life. Preventive measures: Personal protective measures to avoid tick bites; control of ticks and rodent hosts (see Lyme disease, 9A). A presumptive diagnosis is based on the clinical picture and the occurrence of multiple similar cases. Infectious agentsāThe sandļ¬y fever group of viruses (Bunyaviri- dae, Phlebovirus); several related immunological types have been isolated from humans and differentiated. OccurrenceāA disease of subtropical and tropical areas with long periods of hot, dry weather in Europe, Asia and Africa, and rainforests in Western Hemisphere tropics, distributed in a belt extending around the Mediterranean and eastward into China and Myanmar. The disease is seasonal in temperate zones north of the equator, occurring between April and October, and is prone to affect military personnel and travellers from nonendemic areas. ReservoirāThe main reservoir is the sandļ¬y, in which the virus is maintained transovarially. Rodents (gerbils) have been implicated as a reservoir for Eastern Hemisphere sandļ¬y viruses. The vector of the classic virus is a small, hairy, blood-sucking midge (Phlebotomus papatasi, the common sandļ¬y), which bites at night and has a limited ļ¬ight range. Sandļ¬ies of the genus Sergentomyia have also been found to be infected and may be vectors. Period of communicabilityāVirus is present in the blood of an infected person at least 24 hours before and 24 hours after onset of fever. Phlebotomines become infective about 7 days after biting an infected person and remain so for their normal life span of about 1 month. SusceptibilityāSusceptibility is universal; homologous acquired immunity is probably lasting. Relative resistance of native populations in sandļ¬y areas is probably attributable to infection early in life. Preventive measures: Personal protective measures to prevent sandļ¬y feeding; control of sandļ¬ies is the principal objective (see Leishmaniasis, cutaneous and mucosal, 9A2). Control of patient, contacts and the immediate environment: 1) Report to local health authority: In selected endemic areas; in most countries, not a reportable disease, Class 3 (see Report- ing). Epidemic measures: 1) Educate the public about conditions leading to infection and the importance of preventing sandļ¬y bites by use of repel- lents, particularly after sundown. Identiļ¬cationāA viral disease with sudden onset of fever, malaise, weakness, irritability, headache, severe pain in limbs and loins and marked anorexia. There may be bleeding from gums, nose, lungs, uterus and intestine, but only in serious or fatal cases does this occur in large amounts, often associated with severe liver damage. Fever is constantly elevated for 5ā12 days or may be biphasic; it falls rapidly by lysis. In the Russian Federation, an estimated 5 infections occur for each hemorrhagic case. Speciļ¬c IgM may be present during the acute phase; conva- lescent sera often have low neutralization antibody titres. Infectious agentāThe Crimean-Congo hemorrhagic fever virus (Bunyaviridae, Nairovirus). OccurrenceāObserved in the steppes of western Crimea and in the Rostov and Astrakhan regions of the Russian Federation, as well as in Afghanistan, Albania, Bosnia and Herzegovina, Bulgaria, western China, the Islamic Republic of Iran, Iraq, Kazakhstan, Pakistan, South Africa, Turkey, Uzbekistan, the Arabian Peninsula and sub-Saharan Africa. Seasonal occurrence in the Russian Federation is from June to September, the period of vector activity. Immature ticks are believed to acquire infection from the animal hosts and by transovarian transmission. Nosocomial infection of medical workers, occurring after exposure to blood and secretions from patients, has been important in recent outbreaks; tertiary cases have occurred in family members of medical workers. Control of patient, contacts and the immediate environment: 1) Report to local health authority: In selected epidemic areas; in most countries, not a reportable disease, Class 3 (see Reporting). Identiļ¬cationāThese two viral diseases have marked similarities: Onset is sudden with chills, headache, fever, pain in lower back and limbs and severe prostration, often associated with conjunctivitis, diarrhea and vomiting by the 3rd or 4th day. A papulovesicular eruption on the soft palate, cervical lymphadenopathy and conjunctival suffusion are usually present. The febrile period ranges from 5 days to 2 weeks, at times with a secondary rise in the third week. Diagnosis is made through isolation of virus from blood in suckling mice or cell cultures (virus may be present up to 10 days following onset) or through serological tests. OccurrenceāIn the Kyasanur Forest of the Shimoga and Kanara districts of Karnataka, India, principally in young adult males exposed in the forest during the dry season, from November to June. The Novosibirsk district reported 2 to 41 cases per year between 1989 and 1998, mostly in muskrat trappers. Susceptibility and resistanceāMen and women of all ages are probably susceptible; previous infection leads to immunity. Identiļ¬cationāA helminthic infection of the small intestine gen- erally associated with few or no overt clinical symptoms. Live worms, passed in stools or occasionally from the mouth, anus, or nose, are often the ļ¬rst recognized sign of infection. Some patients have pulmonary manifestations (pneumonitis, LoĀØfļ¬er syndrome) caused by larval migration (mainly during reinfections) and characterized by wheezing, cough, fever, eosinophilia and pulmonary inļ¬ltration. Heavy parasite burdens may aggravate nutritional deļ¬ciency and, if chronic, may affect work and school performance. Serious complications, sometimes fatal, include bowel obstruction by a bolus of worms, particularly in children; or obstruction of bile duct, pancreatic duct or appendix by one or more adult worms. Diagnosis is made by identifying eggs in feces, or adult worms passed from the anus, mouth or nose. Intestinal worms may be visualized by radiological and sonographic techniques; pulmonary involvement may be conļ¬rmed by identifying ascarid larvae in sputum or gastric washings. Infectious agentāAscaris lumbricoides, the large intestinal round- worm of humans. OccurrenceāCommon and worldwide, with greatest frequency in moist tropical countries where prevalence often exceeds 50%. Prevalence and intensity of infection are usually highest in children between 3 and 8 years. Mode of transmissionāIngestion of infective eggs from soil contaminated with human feces or from uncooked produce contaminated with soil containing infective eggs, but not directly from person to person or from fresh feces. Transmission occurs mainly in the vicinity of the home, where children, in the absence of sanitary facilities, fecally pollute the area; heavy infections in children are frequently the result of ingesting soil (pica).
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