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Sars : a respiratory disease of unknown etiology that apparently originated in mainland China in 2003.

Celiac Disease

Celiac disease is an inherited auto-immune disease that is characterized by diffused damage to the small intestinal mucosa leading to malabsorption of nutrients. The development of Celiac disease is attributed to a combination of genetic (HLA alleles) and environmental (gluten ingestion) factors. Celiac disease patients carry the gene identified as HLA DQ2 and/or HLA DQ8. Approximately 30% - 40% of the population in general carry one or both of these genes out of which about 1-5% are expected to develop Celiac disease. The incidence of disease is on the rise, and September 13 is observed as Celiac Awareness Day across the world.


The damage and the discomfort associated with Celiac disease is triggered by consumption of gluten. Gluten is a protein that is present in certain grains such as wheat, rye, barley but absent in rice, oats and corns. In a genetically susceptible host, gluten stimulates autoimmune responses wherein the body's immune system mounts an attack on its own tissues. Due to damage to the villi in the intestines, there is malabsorption of nutrients from food.


Celiac disease is not the same as gluten intolerance. Celiac disease involves autoimmune reaction to gluten and begins to target its own tissue, whereas gluten intolerance is when ingestion of gluten causes the body to have a stress response that does not involve the immune system. The symptoms of both the conditions may appear identical. However, Celiac disease has severe manifestations and may involve hives and rashes.

In case of Celiac disease, blood test shows the higher the levels of class IgA anti-tissue transglutaminase (anti-tTG) and anti-endomysial antibodies. Gluten intolerance is marked by gastrointestinal symptoms and no specific immunological mechanisms or serological markers are identified for this condition.


Risk factors

Celiac disease is partly a genetic condition and hence tends to run in families. Individuals with Celiac patient in their immediate family have a higher chance of developing Celiac disease. People with other autoimmune conditions like Type 1 diabetes, Thyroid disorders, Addison's disease and Autoimmune hepatitis are more likely to develop Celiac disease. People with other genetic conditions like Down's syndrome, Williams syndrome and Turner's syndrome are also at higher risk of developing Celiac disease.


Signs and symptoms of Celiac disease

Symptoms range from mild to severe manifestations and vary from adult patients to children. Celiac disease presents itself with both gastrointestinal and extra-intestinal symptoms. Abdominal pain, Type I diabetes, chronic constipation, recurrent non-bloody diarrhea, anemia, delayed puberty are some of the prominent symptoms noticed in children with Celiac disease. Intussusceptions, mouth ulcers, osteoporosis, brain fog, neurological dysfunction, unexpected weight and hair loss, nausea, bloating, anemia, inability to retain the pregnancy, migraines are the signs and symptoms identified with adult Celiac patients.


Diagnosis

Diagnosis of Celiac disease is always a two step procedure - beginning with tTG-IgA and total serum IgA tests and conforming it with intestinal biopsy. The diagnosis is never based only on serology as anti tTG may be high in others diseases like inflammatory bowel disease and chronic liver disease. In addition, serology may be negative in patients with low IgA levels, or in children less than 2-3 years. Along with blood tests, genetic tests may also be ordered to check for the presence of the gene HLA DQ2 or HLA DQ8 in an individual. Almost all Celiac disease patients carry one of these genes. Finally the disease is confirmed by performing intestinal biopsy.


There have been recent guidelines by world renowned medical institutions that immediate family members should be screened for the disease as Celiac disease is genetic and other immediate blood relations in the family have a higher probability of developing Celiac disease than the general population. They should be screened at the time the index patient is diagnosed and thereafter, if they exhibit any symptoms, or at least annually. Early diagnosis can help prevent complications.


Treating Celiac disease

Right now, the only treatment for Celiac disease is to strictly adhere to lifelong gluten-free diet. Fruits, vegetables, dairy, fish and other seafood, beans, legumes can be safely consumed as all of these are gluten-free food groups. Grains such as rice, corn, quinoa, millet, teff, flax, chia and starchy roots like tapioca, potato are all gluten-free.


Avoiding gluten completely is not easy. Any occasional slip leads to a flare-up of symptoms instantly. Considering the fact that there are numerous cases of Celiac disease every year and the increasing numbers, there is serious research being conducted to come up with drug therapy. New drug treatments for Celiac disease are now being tested in clinical trials - some are designed to be taken alongside a gluten-free diet, whereas other set of medicines free the patient from all diet restrictions. Three main approaches have been proposed as new therapeutic modalities that include: gluten detoxification, inhibition of intestinal permeability and modulation of immune response.


Currently there are three drugs that are under clinical trails and seem to be successful in treating the condition.:

ALV003: It contains the enzymes that chop up gluten before it starts to activate the immune system.

AN-PEP: An enzyme that breaks down the residual gluten in the stomach.

Larazotide Acetate: May help inhibit immune reaction by blocking a protein that carries pieces of gluten across the gut.

However these drugs still require medical approval to be commercially available in the market.


Hansen's Disease

Hansen's disease is an infectious skin disease that is chronic which affects the peripheral nerves, nasal mucosa, skin, eyes and upper respiratory tract. Hansen's disease, also known as Leprosy an infectious disease causes severe skin sores that can be disfiguring and may also cause nerve damage in the arms and legs. The disease is assumed to spread via nasal droplets or through broken skin or through secretions from the infected person's body that may contain the bacteria. Hansen's disease is not contagious and does not spread by merely coming in contact with the infected person.


Hansen's disease has been reported since ancient times and each culture across the world had a different understanding of the condition. Indians, Chinese and the Egyptians felt it was a contagious disease that was incurable. The outlook towards the disease has changed in the recent past. If the condition is diagnosed at an early stage and treated, it is curable. Though not completely eradicated, the disease has become rare and the number of cases of leprosy have reduced. Reported cases are from parts of Africa, Asia and very few cases in America.


Hansen's disease cause

A slow growing bacterium called Mycobacterium Leprae causes the condition. Leprosy is also called Hansen's disease named after the scientist who discovered the bacteria that caused the condition.


Hansen's disease symptoms

The skin and the peripheral nerves (nerves outside the brain and spinal cord) are largely affected by this condition. The nasal mucosa, eyes and upper respiratory tract also get affected. It takes about 3-5 years for symptoms to appear from when the person has come in contact with the bacteria.


  • Disfiguring skin sores that are pale in color
  • Lumps or bumps on skin
  • Thick, stiff and dry skin
  • Numbness in affected part of the skin
  • Eye problems like reduced blinking and dryness
  • Nosebleeds
  • Ulcers on sole of feet
  • Enlarged nerves

Hansen's Disease Types

Depending on the number of skin sores and its type, leprosy can be classified into the following types:

Lepromatus: A severe form of the disease that has extensive skin bumps and rashes. Kidneys, nose and male reproductive organs get affected. Muscle weakness and numbness is also felt. This type is more contagious.

Tuberculoid: This is a mild form of leprosy; people with this type have flat and pale colored patches on the skin. The pale colored patches on the skin may feel numb due to the nerve damage beneath the skin. This type of leprosy is less contagious.

Borderline: People suffering from this type of leprosy have symptoms of both lepromatus and tuberculoid.

Mid-borderline: Asymmetrically distributed reddish plaques can be seen. Swollen lymph nodes may also be seen; they either regress or progress to other forms of leprosy.

Indeterminate: A few hypo-pigmented macules may be seen; they either heal or progress to become other forms of leprosy.


Hansen's disease diagnosis

Diagnosis is based on the clinical symptoms such as localized skin lesions and sensory loss. Skin biopsy is done. A skin smear test may also be done. Without taking proper treatment, this disease can cause severe complications like:


  • Glaucoma or blindness
  • Infertility in men
  • Kidney failure
  • Disfiguration of the face
  • Nerve damage
  • Muscle weakness
  • Damage to nasal mucosa

Hansen's disease treatment

It is a myth that leprosy cannot be treated. For the past two decades, over 16 million people with leprosy have been treated. WHO offers free treatment for people suffering from leprosy. Treatment of leprosy depends upon the type. Treatment includes:


Antibiotics: Antibiotics cannot cure the nerve damage caused from the disease.

Thalidomide, a potent medicine is prescribed to suppress the immune system of the body. This drug helps to treat the skin nodules in leprosy. Anti-inflammatory drugs are provided to combat inflammation and pain.


Hansen's disease Facts


  • Hansen's disease progresses slowly - however progressively to affect the skin and nervous system.
  • Leprosy is not contagious and is not acquired by sitting next to the affected person.
  • Early symptoms of the disease begin in the cooler areas of the body (eyes, earlobes, nose) and later go on to cause loss of sensation.
  • Leprosy can get very damaging if left untreated; it can disfigure the face too.
  • Some people are genetically vulnerable to this disease.
  • There is no commercially available vaccine that can prevent leprosy.
  • 500,000 to 700,000 new leprosy cases are reported every year worldwide. Most of the cases are found in the tropics and the sub-tropics like Indonesia, Brazil, India.
  • The incubation period of the disease may vary from 6 months to 40 years.
  • Apart from humans chimpanzees, mangabey monkeys and nine-banded armadillos may also transmit the infection.
  • More than 95% of the human population has a natural immunity to the disease.
  • When treated at the right time, most cases of Hansen's disease respond to the treatment and become non-infectious within a short span of time.


Behcet's Syndrome

Turkish dermatologist, Hulusi Behcet (1889-1948) recognized and reported in 1937 symptoms of Behcet's syndrome. A dental infection is attributed as the etiology of the disease. The American Behcet's Disease Foundation (ABDA) was founded in 1978 with the objective to provide support to patients and family as well the caregivers. In the absence of a cure or a single test to definitely determine Behcet's syndrome or Behcet's disease, educate about the syndrome to seek prompt medical attention for treatment.


Morbus Behcet or Silk Road disease is the other name for Behcet Syndrome or disease. Month of May is Behcet's Awareness month and May 20th is Behcet's awareness day. The focus is on spreading awareness and stress the importance of self-help.


Behcet's syndrome facts


  • Non-contagious
  • Exact cause is unknown
  • Genetic predisposition is high.
  • Symptoms are similar to other disease of the digestive tract, Ulcerative Colitis and Crohn's Disease
  • No single test to confirm diagnosis.
  • No cure available.
  • Disease affects different parts of the body.
  • Men and women are equally prone but more severe in men.
  • In the US, affects more women.
  • More prevalent in Middle East, Mediterranean and Eastern Asia.
  • Turkey has the highest prevalence.
  • Leading cause of blindness in Japan.
  • Most common among age group 20-30.
  • Treatment requires more than one specialist.
  • Continued, extensive research to explore possible genetic, bacterial and viral cause.
  • Research is on to identify medicines to better treat Behcet's disease.

Behcet's syndrome – Autoimmune disease

There are over 14, 000 auto-immune diseases and 7000 plus are rare. Behcet's syndrome is rare. Autoimmune disease occurs when the body's immune system mistakenly attacks its own healthy tissues. Though the clinical feature of auto immunity is absent, Behcet's syndrome is classified as an autoimmune disease as it has various aspects related to autoimmune disease. Enhanced inflammatory response (inflammation of blood vessels) is one such aspect. Significant number of women as compared to men are more likely to be affected by autoimmune disease. Estrogen predisposes women to autoimmune disease.


Behcet's syndrome symptoms

The inflammation of blood vessels, particularly veins causes symptoms in many parts of the body. Swelling, redness, heat and pain are select features of an inflammation. Though Behcet's disease can affect any part of the body, involvement of the neurological system is known as neuro-Behcet's disease and is rated the most disabling complication of the disease. Not that common, neuro-Behcet's disease affects about 10 per cent of people with Behcet's disease.


The most common symptom of Behcet's syndrome is the regular occurrence of ulcers in the mouth and genitals. The symptoms are an off-shoot of inflammation of the eyes, skin, arteries, veins, joints, nervous and digestive systems and heart. Symptoms can be mild or severe. Symptoms can be noticed between ages 20-30 years.

Mouth ulcers: May look like normal mouth ulcers but are more painful and numerous in number. Ulcers develop in the tongue, lips, and gums and inside of the cheeks. Even if the ulcers heal within a couple of weeks, they recur.


Genital ulcers: In men, though genital ulcers can appear anywhere in the groin area, including the penis, it is more common on the scrotum. In women, the ulcers appear on the cervix (neck of the womb), vulva or vagina. The ulcers are usually painful and scars appear around the area.

Skin lesions: Resembling acne, pustular skin lesions can appear anywhere on the body. Erythema nodosum results in red, painful, tender lumps that can measure one to five centimeters. It is the result of inflammation in the fatty layer of the skin. It can appear on the legs and ankles but can also appear on the face, neck or arms. Erythema nodosum related to other disease heal without scars but if related to Behcet's disease, leaves the skin totally discolored.


Inflammation of the eyes: Sudden inflammation of the eyes is a common symptom of Behcet's syndrome. A group of connected tissues, uveal tract is inside the eye. This uveal tract gets inflamed. Uveitis as it is named can cause symptoms such as, painful red eyes, blurred vision and floaters (dots that move across the field of vision). With a possibility of permanent visual impairment, it is best to seek medical attention for appropriate treatment without any delay.

Skin sensitivity: Pathergy is a condition signifying sensitivity of the skin, particularly injury or irritation. Even a needle prick can lead to developing a large red lump in a day or two.


Gastrointestinal symptoms: Inflammation of the stomach and intestines causes symptoms such as loss of appetite, stomach pain, indigestion, diarrhea, feeling sick and vomiting. There is a possibility of damage to the bowel resulting in bleeding. Blood in stools suggests inflammation of the internal lining of the bowel.


Blood clots: Inflammation of the veins can lead to formation of blood clots or thrombosis.

Joint pain: Joint pain in ankles, wrists, knees, elbows and hips is common. Inflammation in the joint can cause swelling, redness and tenderness.

Brain: Meninges is the coverage of the brain. Inflammation of the brain or tissue that covers the brain (meninges) causes symptoms like headache, neck stiffness along with high body temperature. In severe cases, it can damage the nervous tissue and lead to extreme weakness or impaired function of the body.

Aneurysms: Aneurysms are outpouchings of blood vessel walls due to inflammation of arteries in the lungs. This can lead to massive lung hemorrhage. Symptoms include pain in the limbs, severe headache, feeling dizzy, and breathlessness, coughing up blood, confusion and loss of consciousness.

Inflammation of the nervous system: Inflammation of the central nervous system occurs in 5%-10% of reported cases. This is regarded as the most serious symptom. Typical symptoms include headache, double vision, loss of balance, seizures, partial paralysis on one side of the body, personality changes. Any of these are noticeable within the first five years of recognizing initial symptoms.

General symptoms: Experiencing extreme fatigue to the extent that it interrupts with everyday routine is a general symptom of Behcet's syndrome.


Behcet's Syndrome Causes

The exact cause remains unclear. Though regarded as an autoimmune disorder, it is unclear what triggers the autoimmune disorder. Other possible association is genetics. Certain ethnic groups or a family member with the disease increases chances of developing Behcet's syndrome. People with gene HLA B51, variations in other genes like IL10, IL23R-IL2RB2 increases the risk of developing the disease considerably. However, the condition does not have a clear pattern of incidence.


Risk factors identified include:

Age: Children and older adults can develop the condition. But men and women in the age group of 20-3 are more likely to be affected.

Location: People from countries in the Middle East and Far East, including Turkey, Iran, Japan and China are more likely to develop Behcet's syndrome.

Sex: The disease is more severe in men.

Genes: Having certain genes increases the risk of developing the syndrome.


Behcet's Syndrome Diagnosis

In the absence of a single test to diagnose Behcet's syndrome, doctors look out for symptoms. Blood tests or other laboratory tests are recommended to rule out other disease or illness. The criteria include:

Mouth sores: Mouth sores are very common. Many disorders are related to mouth sores. If the mouth sores recur every three months in 12 months, it is regarded as criteria for evaluating the disease.

Doctors look for two additional signs.



Behcet's Syndrome - time to seek help

Recognizing symptoms and relating the symptoms to Behcet's disease is essential. Note down symptoms being experienced and add related information that affects normal routine. Seek appointment with a doctor. If medical attention is delayed, the condition can worsen and lead to losing eye sight or a stroke. At the meeting, divulge family history and inform about medications for any other health issue or supplements being taken.


You are most likely to seek specialist help. Rheumatologist for arthritis, joint pain etc, Ophthalmologist for eye problems, gynecologist or an urologist for genital sores, dermatologist for skin issues, Gastroenterologist for digestive difficulties or neurologist for symptoms related to CNS (central nervous system).


Behcet's Syndrome Treatment

There is no cure for Behcet's syndrome. The treatment is aimed at alleviating the symptoms, reducing the frequency and intensity, put the disease into remission and prevent serious complications. Medicines for controlling the individual symptoms are prescribed. Some medicines are prescribed with other medicines to suppress the activity of immune system. Some medicines can have side effects too.

For the skin: gels, creams and ointment that contain a Corticosteroid to reduce the inflammation.


For mouth sores: Special mouth washes with Corticosteroid to reduce the pain and associated discomfort.

For the eyes: Eye drops with Corticosteroid to relieve pain and redness in the eye.


Coping with Behcet's syndrome


  • Take ample rest in between flares.
  • Pay attention to diet and exercise.
  • Find support groups and connect.
  • Login to American Behcet's Disease Association.
  • Read message boards and engage in chat sessions.

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Collection of Pages - Last revised Date: November 11, 2019