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Aung-Thu et al Gastrointestinal manifestations of septic patients with scrub typhus in Maharat Nakhon Ratchasima Hospital Southeast Asian J Trop Med Public Health 2004 Dec;35(4):845 51 [PMID: 15916079] Blacksell SD Scrub typhus serologic testing with the indirect immunofluorescence method as a diagnostic gold standard: a lack of consensus leads to a lot of confusion Clin Infect Dis 2007 Feb 1;44(3):391 401 [PMID: 17205447] Parola P et al Tropical rickettsioses Clin Dermatol 2006 May Jun;24(3):191 200 [PMID: 16714200]

After a 1- to 3-week incubation period, malaise, chills, severe headache, and backache develop At the site of the bite, a papule evolves into a flat black eschar The regional lymph nodes are enlarged and tender, and there may be generalized adenopathy Fever rises gradually, and a macular rash appears primarily on the trunk after a week of fever and may be fleeting or may last a week The patient may become obtunded During the second or third week, pneumonitis, myocarditis and cardiac failure, encephalitis or meningitis, acute abdominal pain, granulomatous hepatitis, disseminated intravascular coagulation, or acute renal failure may develop Gastrointestinal symptoms including nausea, vomiting, and diarrhea occur in nearly two-thirds

Dog milo = new Dog( );

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Thrombocytopenia, hyponatremia, elevated aminotransferases, and hyperbilirubinemia are common Cerebrospinal fluid may show hypoglycorrhachia and mild pleocytosis Disseminated intravascular coagulation is observed in severe cases Diagnosis during the acute phase of the illness can be made by immunohistologic demonstration of R rickettsiae in skin biopsy specimens, but this must be performed as soon as skin lesions become apparent to achieve maximum sensitivity Isolation of the organism using the shell-vial technique is available in some laboratories but is hazardous Serologic studies confirm the diagnosis, but most patients do not mount an antibody response until the second week of illness The indirect fluorescent antibody test is most commonly used

Exposure to tick bite in an endemic area An influenza-like prodrome followed by chills, fever, severe headache, myalgias, restlessness, and prostration; occasionally, delirium and coma Red macular rash appears between the second and sixth days of fever, first on the wrists and ankles and then spreading centrally; it may become petechial Serial serologic examinations by indirect fluorescent antibody (IFA) confirm the diagnosis retrospectively

Despite its name, most cases occur outside the Rocky Mountain area, with cases in the United States concentrated along the Middle and Southern Atlantic seaboard and in the central Mississippi valley (Table 32 3) The causative agent, R rickettsii, is transmitted to humans by the bite of ticks, including the Rocky Mountain wood tick, D andersoni, in the western United States, and by the bite of the American dog tick, Dermacentor variabilis, in the eastern United States The brown dog tick, Rhipicephalus sanguineus, recently was identified as a vector in eastern Arizona Other hard ticks transmit the organism in the southern United States and in Central and South America and are responsible for transmitting it among rodents, dogs, porcupines, and other animals Most human cases occur in late spring and summer In the United States, most cases occur in the eastern third of the country, with about 1000 cases reported per year, primarily from April through September, and with a higher incidence among children and men

This code declares milo to be an object of type Dog and also creates a new instance of Dog. You ll see what the parentheses are for in Constructors later in this chapter. In C#, everything happens within a class. No methods can run outside a class, not even Main( ). The Main( ) method is the entry point for your program; it is called by the operating system, and it is where execution of your program begins. Typically, you ll create a small class to house Main( ), because like every method, Main( ) must live within a class. Some of the examples in this book use a class named Tester to house Main( ):

The diagnosis is challenging Up to 40% of patients do not recall a tick bite, and initial diagnosis is made clinically The early symptoms and signs of Rocky Mountain spotted fever resemble those of many other infections The rash may be confused with that of measles, typhoid, and ehrlichiosis, or most importantly meningococcemia Blood cultures and examination of cerebrospinal fluid establish the latter

Protective clothing, tick-repellent chemicals, and the removal of ticks at frequent intervals are helpful measures Prophylactic therapy after a tick bite is not currently recommended

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