There is something about feet and the toenails that fungi just love.

Sunset boating in Chicago. (Dr. Noorali Bharwani)
Sunset boating in Chicago. (Dr. Noorali Bharwani)

“There are about 80 types of fungi residing on a typical person’s heel, along with 60 between the toes and 40 on the toenails,” says an article in the Globe and Mail (Social Studies May 24, 2013).

It goes on to say that the feet are home to more than 100 types of fungus, more than any other area of the human body, quoting a study published in the journal Nature.

Many of the fungi on our skin are good for us in that they prevent bad fungi adhering to our skin. They protect us from getting athlete’s foot, plantar warts and stubborn toenail problems.

Most problems are not life threatening. Here are some examples:

Plantar warts: These are also known as common warts. They grow on the soles of the feet. They grow into the skin because we walk on them. They can be painful on walking. The virus causing the wart is picked up from walking bear foot in locker rooms and swimming pools.

Treatment: They may spontaneously disappear if you wait long enough – months to years. They can be managed by freezing, scrapping or burning. They can recur.

Callus and corns: These are thickened areas on the hands or feet caused by pressure or friction. This is usually related to work or sporting activities. Uneven pressure of body weight during walking or ill-fitting shoes can cause calluses and corns on the feet.

Treatment: Wear proper fitting shoes and use corn pads to relieve pressure on the corns. Thick calluses can be sliced down to normal skin over a period of time. If the source of friction and pressure is removed then corns and calluses should not recur.

Toenail problems: Mainly involves the big toe. It may be ingrown or overgrown. Ingrown toenails are commonly due to ill-fitting shoes pressing on an incorrectly cut nail. Poor foot hygiene encourages infection.

The problem occurs when sweaty feet are encased in tight shoes. The situation gets worse when the nail is trimmed short and the corners are curved down. The side of the nail curls inwards and grows to form outer spikes. This causes painful infection of the overhanging nail fold.

Treatment: In an acute stage antibiotic, painkillers and bathing the foot in warm salt water are necessary. Surgery is required in most cases. The problem can be prevented from recurring by keeping the feet clean and wear correctly fitting shoes. Cut the nail straight.

Fungus infection of the nails: Usually affects toenails. The nail is thickened and discolored. It is usually yellowish. The nail may grow in a twisted manner. The infection is picked up in a public place where it is transmitted from person to person. Poor feet hygiene does not help.

Treatment: Anti-fungal therapy is required – orally and locally for three months. Cure rate is around 80 percent. Ongoing meticulous foot care is very important to prevent recurrence.

Our feet are subjected to more wear and tear and hence they get more problems than our hands. Our natural tendency is to take care of our hands more than our feet. Many of these problems are preventable.

In my view, walking bear feet is the worst thing you can do for your feet. Wash your feet at least once a day (twice if your feet sweat a lot) with soap and water. Dry them well with a soft towel. Apply some skin lotion or powder. Wear good quality clean socks and proper fitting comfortable shoes.

Have a wonderful Christmas and Holiday Season.

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Measles is a Highly Contagious Viral Infection of the Respiratory Tract

Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)
Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)

Measles is making bad news. It seems to have started in Disneyland. A place where kids go for fun. How ironic and sad. And it has spread to several states in the U.S.

According to Centers for Disease Control and Prevention (CDC) website, 50 people from six states were reported to have had measles in the first two weeks of this month. Most of these cases are part of a large, ongoing outbreak linked to Disneyland in California.

According to CBS news (January 22, 2015), at least 75 people have now been infected with measles virus. The California public health officials are urging those who haven’t been vaccinated against the disease, including children too young to be immunized, to avoid Disney theme parks.

Age of people infected ranges from seven months to 70 years old, including five Disneyland workers.

Measles spreads through the air through coughing and sneezing. It starts with a fever, runny nose, cough, red eyes, and sore throat, and is followed by a rash that spreads all over the body. About three out of 10 people who get measles will develop one or more complications including pneumonia, ear infections, or diarrhea. Complications are more common in adults and young children.

Alberta had a measles outbreak last year. On April 29, 2014, Alberta Health Services declared a measles outbreak in the Calgary, Central and Edmonton Zones of Alberta Health Services (AHS). By July, AHS declared the outbreak to be over.

The best way to prevent measles is to have Measles-Mumps-Rubella (MMR) Vaccine. All health care workers should be vaccinated with two doses of the vaccine. Health care workers are at greater risk of measles infection than the general population because they provide care for ill individuals. A recent review concluded that health care workers were 13 to 19 times more likely to develop measles than other adults.

MMR vaccine is highly effective at preventing measles. One dose is 85-95 per cent effective and the effectiveness of two doses approaches 100 per cent. Two doses provide long-lasting immunity. The vaccines are very safe.

Measles was eradicated by year 2000 because of vaccination. But the virus has made a comeback in recent years, in part because of people obtaining “personal belief exemptions” from rules that say children must get their shots to enroll in school. Others still believe in now-discredited research linking the measles vaccine to autism.

Who started the current outbreak? Should we blame people who refuse to get vaccinated because they believe it is harmful to their children? Apparently, a small number of those stricken had been fully vaccinated. It is also reported the outbreak was triggered by a measles-stricken visitor to one of the Disney parks who brought the virus from abroad last month.

Coughing and sneezing spreads the highly contagious virus. Deaths are caused by complications associated with the disease. Complications are more common in children under the age of five or adults over the age of 20.

There is no specific antiviral treatment. Mostly symptomatic treatment is provided for symptoms and complications. The measles vaccine has been in use for 50 years. It is safe, effective and inexpensive. It costs approximately one U.S. dollar to immunize a child against measles. And it saves lives.

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Ebola Virus Disease has a High Fatality Rate

Robin building nest. (Dr. Noorali Bharwani)
Robin building nest. (Dr. Noorali Bharwani)

Ebola virus disease (EVD), as it is known now, was formerly known as Ebola haemorrhagic fever. It is a severe, often fatal illness in humans. It is a disease of the wild animals and then it is transmitted to people. It spreads in the human population through human-to-human transmission.

The Ebola virus causes an acute, serious illness, which is often fatal if untreated, says WHO website. Ebola virus disease first appeared in 1976 in two simultaneous outbreaks, one in Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.

Previously the disease was confined to small villages near tropical rainforests. The most recent outbreak in West Africa has involved major urban as well as rural areas. The case fatality rates have varied from 25 to 90 per cent in past outbreaks.

Controlling the disease has been difficult. According to the WHO website, community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilization.

Currently there is no licensed treatment for the disease. Treatment is base on providing rehydration with fluids and treat any other symptoms that the patient presents with. A range of blood, immunological and drug therapies are under development.

The current outbreak started in March 2014 in West Africa. WHO calls this the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (one traveller only) to Nigeria, and by land (one traveller) to Senegal. Latest report has confirmed a case in the US. By the time you read this the numbers may change.

How does a person get infected with Ebola virus?

It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

How does it spread among humans?

Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.

WHO says people remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to seven weeks after recovery from illness.

First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

Confirming the diagnosis and providing treatment continues to be a challenge. There is lot more information available on the WHO website.

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Listeria Infection and the Food We Eat

Birds In Love (Dr. Noorali Bharwani)
Birds In Love (Dr. Noorali Bharwani)

On July 19, 2014, Wawona Packing Company of Cutler, California voluntarily recalled certain lots of whole peaches (white and yellow), nectarines (white and yellow), plums and pluots packed between June 1, 2014 and July 12, 2014 due to the potential for contamination of the products with Listeria monocytogenes.

This was a precautionary action. Reports indicate to date, no illnesses have been linked to this recall. The health providers are advised to keep Listeria in mind when anybody presents with symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea.

Patients presenting with these symptoms should be asked if they have been exposed to Wawona Packing Co.’s fresh whole peaches, plums, nectarines, and pluots. For patients with illness suggestive of invasive listeriosis, testing should include blood culture and other tests, such as culture of cerebrospinal fluid, as indicated by the clinical presentation.

According to New York State Department of Health (NYSDOH) Bureau of Communicable Disease Control (BCDC), to date, no illnesses have been linked to the recalled fruits. So, that is good news.

The Canadian experience:

According to Health Canada website, the listeriosis outbreak in the summer/fall of 2008 linked to ready-to-eat meats produced at a Maple Leaf plant in Ontario was a significant public health event. As of December 10, 2008, there were 20 deaths across five provinces where listeriosis was the underlying or contributing cause of death and the outbreak generated high media and public interest.

The bacteria are found in food and elsewhere in nature. It can cause a rare but serious disease called listeriosis. Pregnant women, the elderly and individuals with weakened immune systems are at higher risk than others. In serious cases, listeriosis can lead to brain infection and even death.

Listeria is found in soil, vegetation, water, sewage, some types of livestock feed and in the feces of humans and animals. Animals and humans can carry the bacteria without knowing it.

Plants and vegetables can become contaminated with Listeria from soil, water and manure-based fertilizers. Farm animals that appear healthy may also carry Listeria and contaminate foods such as meats and dairy products.

The Health Canada website says that unlike most bacteria, Listeria can survive and sometimes grow on foods being stored in the refrigerator. Moreover, foods that are contaminated with these bacteria look, smell and taste normal. About five per cent of healthy adults are carriers of Listeria and have no symptoms. The good news is Listeria can be killed by pasteurization and proper cooking procedures.

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