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Infectious Diseases

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Our Infectious Diseases team treats the entire spectrum of infections in adults, including MRSA infections, meningitis, encephalitis, head and neck infections, osteomyelitis and other bone and joint infections, pneumonia, tuberculosis, HIV, hepatitis, gastroenteritis, herpes, tick-borne illnesses, tropical diseases such as malaria, and others. The team also routinely manages patients who require outpatient intravenous antibiotic therapy.

All of our physicians are board certified in internal medicine and infectious diseases. Our team collaborates with primary care and other specialty physicians to ensure that patients receive the highest level of care.

The team also partners with the Public Health Department, CDC, local hospitals, and news/media outlets in regards to community support, providing educational expertise and control and prevention tactics.

For those needing Travel Clinic services including vaccines and guidance, please contact the New Hanover County Health Department at 910-798-6500 or

Infectious Diseases Services

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Gastroenteritis is an inflammation of the gastrointestinal tract. (Read about “Digestive System“) Symptoms include:

  • diarrhea (Read about “Diarrhea“)
  • nausea
  • abdominal cramps
  • vomiting
  • fatigue
  • fever
  • muscle aches

For healthy adults, gastroenteritis may cause only discomfort and inconvenience. But it can be dangerous in the very ill, the very young and the very old.

The most common cause of gastroenteritis is infection. Infectious gastroenteritis may be caused by viruses, bacteria or parasites. (Read about “Microorganisms“)

  • Viruses – Viral gastroenteritis is highly contagious. It is also the second most common illness in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Viral gastroenteritis causes millions of cases of diarrhea each year. Viral gastroenteritis is often mistakenly called “stomach flu,” but it is not caused by the influenza virus. (Read about “Influenza“) Some of the most common viruses that do cause gastroenteritis include:
    • Rotavirus – typically causes vomiting and watery diarrhea for 3 to 8 days, along with fever and abdominal pain. (Read about “Rotavirus“)
    • Adenovirus – occurs mainly in children under the age of 2 years. It causes 5-20 percent of the gastroenteritis in young children, and is the second most common cause of gastroenteritis in this age group. By 4 years of age, 85 percent of all children have developed immunity to the disease.
    • Caliciviruses – cause infection in people of all ages. This family of viruses is divided into 4 types, the noroviruses being the most common and most responsible for infecting people. (Read about “Noroviruses“)
    • Astrovirus – also infects primarily infants, young children and the elderly. Astroviruses cause sporadic gastroenteritis in children under 4 years of age and account for about 4 percent of the children hospitalized for diarrhea. Most American children over 10 years of age have antibodies to the virus.
  • Bacteria – Bacteria can also lead to gastroenteritis. Examples include:
    • E.coli – Infection with this microorganism often leads to bloody diarrhea, and occasionally to kidney failure. (Read about “Kidney Disease“) It’s often associated with eating undercooked and/or contaminated ground beef. This is often called “travelers diarrhea.” (Read about “E. coli“)
    • Shigella – Most who are infected with shigella develop diarrhea, fever and stomach cramps starting a day or two after they are exposed to the bacterium. (Read about “Shigellosis“)
    • Salmonella – Salmonella bacteria are usually transmitted to humans by eating foods contaminated with feces. (Read about “Salmonella“)
    • Campylobacter – Most people who become ill with campylobacteriosis get diarrhea, cramping, abdominal pain and fever within 2 to 5 days after exposure to the organism. (Read about “Campylobacter“)
  • Parasites – Some intestinal parasites can also lead to gastroenteritis. Examples include:
    • Giardia lamblia – This parasite is often passed from child to child in day-care centers. It is also spread through contaminated water supplies. (Read about “Giardiasis“)
    • Cryptosporidium – Cryptosporidiosis is a diarrheal disease caused by a microscopic parasite, cryptosporidium parvum. It can live in the intestine of humans and animals and is passed in the stool of an infected person or animal. (Read about “Cryptosporidiosis“)

Diagnosis, treatment and prevention

In diagnosing gastroenteritis, your doctor will first try to rule out other conditions that could be causing the symptoms, such as Crohn’s Disease. (Read about “Crohn’s Disease“) Lab tests (Read about “Laboratory Testing“) may also be run on a sample of feces to determine the specific virus or germ that is causing gastroenteritis.

Treatment, of course, depends on the cause. If it is caused by a parasite, such as with giardiasis and cryptosporidiosis, there are antimicrobial medications that can be used. The Centers for Disease Control and Prevention (CDC) say antibiotics are not useful in many cases. That’s because many times gastroenteritis is caused by viruses, which don’t respond to antibiotics. (Read about “Antibiotics“)

The biggest danger for anyone with gastroenteritis, especially children and seniors, is dehydration as a result of diarrhea. (Read about “Dehydration“) This happens if the body loses more fluids and salts (electrolytes) than it takes in. Signs of dehydration include a decrease in urine production (Read about “The Urinary System“), extreme thirst, dry mouth and unusual drowsiness. Severe dehydration is a medical emergency and requires immediate care.

CDC says special oral rehydration fluids can be purchased at drugstores, and can be used according to the package directions. You should ask your pediatrician what’s best in your child’s case.

If you have any concerns about dehydration or about a child’s or your own diarrhea, contact your doctor at once. It’s also important to call your doctor if someone with diarrhea is also experiencing any of the following:

  • high fever
  • blood in stools (Read about “Gastrointestinal Bleeding“)
  • prolonged vomiting that prevents keeping liquids down

Perhaps the best course is to develop (and help children develop) habits that can reduce the risk of infections that lead to gastroenteritis. The following are suggestions from CDC and the International Food Information Council:

  • Wash hands carefully and often. Adults should wash their hands after using the toilet, helping a child use the toilet, diapering a child and before preparing, serving or eating food. Children should wash their hands after using the toilet, after having their diapers changed (an adult should wash infant’s or small child’s hands) and before eating snacks or meals.
  • Disinfect toys, bathrooms and food preparation surfaces frequently, especially if a sick child has been in the home.
  • Use diapers with waterproof outer covers that can contain liquid stool or urine or use plastic pants and make sure that children wear clothes over diapers.
  • Wash fruits and vegetables thoroughly before eating. Cook meats, fish and poultry thoroughly (Read about “Food Safety“)
  • Avoid raw eggs; in recipes using eggs that aren’t cooked, such as eggnog, you can substitute pasteurized eggs, sold in the grocery dairy case or freezer

Although you can’t guarantee you or your family will never get diarrhea or gastroenteritis, you can at least help reduce your risk.

Related Information:

    Animal & Insect Borne Diseases


    Food Safety

    Travel and Health

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

Encephalitis and meningitis are serious conditions that affect the brain and/or its surrounding tissue. Meningitis is an infection of the membranes surrounding the brain and spinal cord. (Read about “Nervous System“) Encephalitis is an inflammation of the brain. (Read about “The Brain“) Symptoms of both may appear suddenly and can require emergency treatment.

Below find more information on encephalitis and meningitis.


Encephalitis is an inflammation of the brain. (Read about “The Brain“) According to the National Institute of Neurological Disorders and Stroke (NINDS), there are many types of encephalitis, the majority of which are caused by viral infection. Symptoms can include:

  • sudden fever
  • headache
  • vomiting
  • photophobia, which is abnormal visual sensitivity to light
  • stiff neck and back
  • confusion and drowsiness
  • clumsiness or unsteady gait
  • irritability

In addition, there may be loss of consciousness, poor responsiveness, seizures (Read about “Seizures“), muscle weakness, sudden severe dementia (Read about “Dementia“), and loss of memory or judgment. Anyone with suspicious symptoms should seek medical help at once.

Most cases of encephalitis are viral. Potential viral causes can include:

  • Arboviruses – An arbovirus is transmitted by the bite of an infected mosquito or tick. Examples include West Nile virus or St. Louis encephalitis virus. (Read about “Arboviral Encephalitides” “West Nile Virus“)
  • Herpes simplex virus (HSV) – The two forms of this herpes virus are HSV type 1 (generally associated with cold sores) and HSV type 2 (generally associated with genital herpes). (Read about “Herpes“)
  • Varicella-zoster virus – This is the virus responsible for chicken pox and shingles. (Read about “Childhood Illnesses” “Shingles“)
  • Epstein-Barr virus – This herpes virus is a common cause of mononucleosis. (Read about “Mononucleosis“)

Encephalitis can also develop as a complication to other viral infections such as measles, mumps or chicken pox for example. (Read about “Childhood Illnesses“)

Encephalitis can be diagnosed by analyzing the cerebrospinal fluid surrounding your brain and spinal cord. This is called a spinal tap or lumbar puncture. Brain imaging scans can also be used, such as electroencephalography (EEG), CT scan or MRI. (Read about “EEG – Electroencephalograph” “CT Scan – Computerized Tomography” “MRI – Magnetic Resonance Imaging“)

Most cases of encephalitis are mild, and patients have full recovery with rest, a healthy diet and plenty of fluids. But other cases are severe, and can even be fatal. NINDS says antiviral medications may be prescribed for some cases of encephalitis. Depending on the severity of the individual case, the acute phase of encephalitis may last up to two weeks, but the lingering neurological symptoms may require many months before full recovery. One of the best ways to protect yourself and your family from contracting encephalitis is by taking precautions against insect bites. (Read about “Insect Bites“)


Meningitis is an inflammation of the membranes (called meninges) that surround the brain and spinal cord. (Read about “The Brain” “Nervous System“) The National Institute of Neurological Disorders and Stroke (NINDS) says that symptoms often include:

  • high fever
  • stiff neck
  • severe and persistent headache
  • nausea
  • vomiting

There may also be changes in behavior such as confusion, sleepiness and difficulty waking.

Young children and infants with meningitis may show signs of irritability, extreme sleepiness, poor appetite and fever, along with other symptoms.

Meningitis can be very fast moving, so if you or your child develop suspicious symptoms, seek help at once. The complications of meningitis can be very serious and the risk of developing complications increases the longer you got without treatment. Complications can include loss of hearing, loss of sight, learning disabilities and brain damage. (Read about “Hearing Loss” “The Eye“)

Meningitis may develop in response to a number of causes, usually bacteria or viruses, but meningitis can also be caused by parasites, fungus, physical injury, lupus, cancer or certain drugs. (Read about “Microorganisms“)

  • Viral – The American Medical Association says viral meningitis is far more common in the United States than bacterial meningitis. It often occurs in epidemics in the winter months, especially in closed living communities such as dormitories or barracks, and usually lasts about ten days, according to NINDS.
  • Bacterial – Bacterial meningitis is less common, but much more serious. The American Academy of Pediatrics says bacterial meningitis poses a particular danger to children under the age of two.
  • Parasitic – CDC says primary amebic meningoencephalitis (PAM) is a very rare form of parasitic meningitis that causes a brain infection that is usually fatal. The parasite enters the body through the nose and is caused by the microscopic ameba (a single-celled living organism) Naegleria fowleri. Naegleria fowleri is found around the world. In the United States, the majority of infections have been caused by Naegleria fowleri from warm freshwater located in southern-tier states.
  • Fungal – Fungal meningitis is rare and usually the result of spread of a fungus through blood to the spinal cord. Although anyone can get fungal meningitis, people with weakened immune systems, like those with HIV infection or cancer, are at higher risk. CDC says fungal meningitis is not contagious.
  • Non-infectious meningitis causes, according to CDC, can include cancers, systemic lupus erythematosus (lupus), certain drugs, head injury or brain surgery. (Read about “Cancer: What It Is” “Lupus” “Head Injury” “Neurosurgery“)

There are some things that put you more at risk of meningitis. Young children have a greater risk. People with compromised immune systems (Read about “The Immune System“) face a higher risk. Seniors are also more at risk.

People living in community settings face a higher risk too. This includes military personnel, children in day care and college students. American College Health Association (ACHA) officials say young adults account for nearly 30 percent of all cases of meningitis in the United States. In addition, approximately 100 to 125 cases of meningococcal disease occur on college campuses each year, and five to 15 students will die as a result.

Some meningitis can be prevented with a vaccine. The Centers for Disease Control and Prevention (CDC) recommends routine vaccination with meningococcal conjugate vaccine of children 11-12 years old, previously unvaccinated adolescents at high school entry, new recruits to the military and college freshmen living in dormitories. Vaccination may also be appropriate for younger children with certain health problems. You should talk to your child’s doctor about the issue. The recommendations are designed to help achieve vaccination among those at highest risk for meningococcal disease. (Read about “Immunizations“)

Meningitis can be diagnosed by analyzing the cerebrospinal fluid surrounding your brain and spinal cord. This is called a spinal tap or lumbar puncture. Brain imaging scans can also be used, such as electroencephalography (EEG), CT scan or MRI. (Read about “EEG – Electroencephalograph” “CT Scan – Computerized Tomography” “MRI – Magnetic Resonance Imaging“)

Treatment for meningitis depends on the cause and on the symptoms. Antiviral medications may be used if a virus is involved. Antibiotics may be prescribed for bacterial infections. (Read about “Antibiotics“) In addition, anticonvulsants may be used if there are seizures (Read about “Seizures“); and corticosteroids may be needed to reduce brain swelling and inflammation. (Read about “Hydrocephalus“) In many cases, especially those caused by bacteria, hospitalization is required. NINDS says that with early diagnosis and prompt treatment, most patients, though not all, recover from meningitis. Anyone experiencing symptoms of meningitis or encephalitis should see a doctor immediately.

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

Lyme Disease

Lyme disease got its name after an outbreak of arthritis near Lyme, Connecticut in 1975. Since then Lyme disease has skyrocketed in parts of the country.

The Centers for Disease Control and Prevention (CDC) say there are three hot spots for Lyme disease in the United States:

  • Northeast and mid-Atlantic states from Massachusetts to Maryland, spreading north and south along the coast and inland
  • North-central states especially Wisconsin and Minnesota, spreading in all directions
  • West coast particularly northern California, spreading north

The disease however is not isolated to these areas.


Blame a very small wood tick for a very big disease. Lyme disease is caused by two types of bacteria, Borrelia burgdorferi and another closely related bacterium, Borrelia mayonii. (Read about “Microorganisms“) They are carried by various black-legged ticks. The main culprit in the Northeast and North-central states is the deer tick, which normally feeds on the white-footed mouse and the white tail deer. The mice and deer act as a reservoir for the bacteria, which the ticks pick up and pass on to their next host. The American Lyme Disease Foundation says studies show that it takes a tick 36 to 48 hours to pass the bacteria on to humans.


In its early stages, Lyme disease is diagnosed by symptoms and evidence of a tick bite. According to the American Lyme Disease Foundation, blood tests aren’t always reliable for Lyme disease especially early in the disease’s progress. (Read about “Laboratory Testing“) If you suspect you have been bitten by a tick, it is imperative that you share that with your doctor so he or she can make an informed diagnosis.


If caught in its earliest stages Lyme disease is almost always successfully treated, so it’s important that symptoms not be ignored. The first sign, of course, is a tick that you find that has bitten you. But these ticks are tiny and often go unnoticed. They tend to hide in moist, hairy portions of the body such as armpits, the groin and the scalp.

The first sign most people see is an expanding rash called erythema migrans or EM. B. burgdorferi’s is a bull’s eye rash, it tends to be round and expand from a central spot sometimes with rings. The rash shows up in over 80 percent of the cases according to the Lyme Disease Foundation. It will show 3 to 30 days after the bite by an infected tick. CDC says the rash caused by B. mayonii tends to be more diffused.

The Arthritis Foundation says some of the other early symptoms of Lyme disease are flu like symptoms such as:

  • fatigue
  • chills and fever
  • headache
  • muscle and joint pain
  • swollen lymph nodes
  • nausea and vomiting

These signs don’t necessarily mean you have Lyme disease but they are an important diagnostic tool for your doctor. If treated early with antibiotics, Lyme disease can be successfully treated so do not delay seeing your physician.

The National Institute of Neurological Disorders and Stroke (NINDS) says, if untreated in its early stages, Lyme disease can affect the brain and the rest of the nervous system. (Read about “The Brain” “Nervous System“) Neurological complications most often occur in the second stage of Lyme disease, with numbness, pain, weakness, Bell’s palsy (paralysis of the facial muscles), visual disturbances, and meningitis symptoms such as fever, stiff neck, and severe headache. (Read about “Bell’s Palsy” “Encephalitis & Meningitis“) Other problems, which may not appear until weeks, months, or years after a tick bite, include decreased concentration, irritability, memory and sleep disorders (Read about “Sleep“) and nerve damage in the arms and legs. (Read about “Peripheral Neuropathy“)

Treatments & complications

Treatment of early stage Lyme disease – that means in the first few weeks after infection – is pretty routine. Oral antibiotics (Read about “Antibiotics“) almost always result in a successful treatment, according to the American Lyme Disease Foundation. Patients diagnosed with later stage Lyme disease also often respond to antibiotics. Some patients continue to have problems after being treated because of damage caused by the disease. There can also be heart problems including inflammation and heart rate irregularities. (Read about “Arrhythmia“)

Arthritis may also develop if Lyme disease is not treated. (Read about “Arthritis and Rheumatic Diseases“) According to the Arthritis Foundation, pain and swelling may occur in a few large joints. The most common joint to be affected by arthritis is the knee. (Read about “The Knee“) The arthritis is often temporary, but some people with Lyme disease will develop chronic Lyme arthritis if untreated. According to the Food and Drug Administration (FDA) there is some evidence that these people are genetically (Read about “Genetics“) predisposed to overreact to the Lyme bacterium, extending the normal inflammatory response to infection or injury. Lyme arthritis differs from rheumatoid arthritis (Read about “Rheumatoid Arthritis“) in that it tends to come and go and affects two or three joints, rather than producing an all-over effect. FDA says new skin outbreaks, usually smaller than the first, may appear in the later stages too.

Prevention and control

The best thing of course is never to get the disease. You do that by avoiding ticks, where they live, and by being vigilant.

The first thing to do is don’t give ticks an inviting place around your home. That means clearing brush, low hanging branches and tall grass from near your house, yard and garden. When you are outdoors, CDC says there are precautions to take:

  • Wear shoes, socks and light colored clothing to spot ticks easily
  • Tuck long pants into socks and your shirt into your pants
  • Scan your clothing and exposed skin, especially if you are wearing shorts, frequently looking for ticks
  • Careful use of an insect repellent is often recommended; ask your doctor about this, especially as far as children are concerned (For more on repellents, read about “Insect Bites“)
  • Wear a hat and a long sleeve shirt if possible
  • Avoid sitting on the ground or stone walls
  • Stay in the center of hiking trails avoiding tall grass and open fields
  • Do a full body check at the end of the day for ticks, paying particular attention to scalp and other hairy portions of the body

Wash and dry the clothes you had on at high temperatures to kill any hidden ticks. Also, remember that a tick will climb up looking for exposed skin. That’s why you need to keep them off your clothes.

Finding a tick

Finding a tick isn’t a reason to panic. The National Institutes of Health (NIH) say studies show it takes 36 to 48 hours for the bacteria to be passed on; therefore if you are checking yourself and your family carefully everyday, you are going a long way to protecting them from Lyme disease. If you do find a tick, CDC says to use a pair of tweezers to grasp the tick as close to the skin as possible and pull back slowly and steadily. Avoid grabbing and crushing the tick by its body. Place the tick in a vial or jar of alcohol to kill it. Then, watch for other signs (see symptoms above).

NIH says the risk of developing Lyme disease from a tick bite is small, since not all ticks are carriers. According to NIH, most physicians prefer not to treat patients bitten by ticks with antibiotics unless they develop symptoms of Lyme disease. On the other hand, NIH says one-fourth of the people who become infected with Lyme disease do not develop the characteristic bull’s eye rash, and many may not even recall having been bitten recently by a tick. So if you have concerns about Lyme disease, or if you do have suspicious symptoms, see your doctor immediately.

Related Information:

    Blood Donation Guidelines

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

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