I
nf
ec
tion in um
b
ili
c
us
Hea
lth pro
b
l
e
ms
T
h
e c
or
d
'
s
c
or
d
is usu
a
lly off on th
e
7
th
da
y
a
ft
e
r
b
irth
a
n
d a
n
e
w woun
d
h
ea
l
ed
O
n th
e
15
th
da
y
.
I
nf
ec
tion on th
e c
or
d
or skin tissu
e a
roun
d
it is n
ece
ss
a
ry
Rec
ogniz
e
s
ea
rly in or
de
r to pr
e
v
e
nt s
e
psis
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
H
ot
,
fussy
,
d
on
'
t w
a
nt to su
c
kl
e
.
R
isk f
ac
tor
1
.
Ce
llul
a
r
a
n
d
humor
a
l immunity is not p
e
rf
ec
t
2
.
U
mili
c
us woun
d
s
3
.
thin skin so it
'
s
ea
sy to s
c
r
a
t
c
h
P
r
ed
isposition f
ac
tor
C
utting
a
n
d
m
a
int
e
n
a
n
ce
of
c
or
d
s th
a
t
a
r
e
not st
e
ril
e
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
T
h
e
r
e a
r
e
signs of inf
ec
tion
a
roun
d
th
e c
or
d
lik
e
r
ed
n
e
ss
,
h
ea
t
,
sw
e
lling
,
p
a
in
,
a
n
d
r
e
moving foul
-
sm
e
lling pussy
.
2
.
L
o
ca
l or limit
ed c
or
d
inf
ec
tion
:
if r
ed
n
e
ss
a
n
d
swoll
e
n
a
r
e
limit
ed
I
n th
e a
r
ea
l
e
ss th
a
n
1
c
m
a
roun
d
th
e ba
s
e
of th
e c
or
d
.
3
.
Hea
vy or wi
de
spr
ead c
or
d
inf
ec
tion
:
if r
ed
n
e
ss or sw
e
lling on th
e
rop
e
T
h
e ce
nt
e
r
e
xt
e
n
d
s mor
e
th
a
n
1
c
m or th
e
skin
a
roun
d
th
e bab
y
'
s
c
or
d
h
a
r
de
n
a
n
d
flush
ed a
n
d
th
e bab
y
e
xp
e
ri
e
n
ce
s stom
ac
h sw
e
lling
.
4
.
S
yst
e
mi
c
sign
:
f
e
v
e
r
,
t
ac
hy
ca
r
d
i
a
,
hypot
e
nsion
,
l
e
t
a
rgi
,
somnol
e
n
,
j
a
un
d
i
ce
S
upporting
c
h
ec
ks
: -
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
D
i
a
gnosis is
e
nfor
ced ba
s
ed
on
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
.
T
h
e
signs of inf
ec
tion
a
roun
d
um
b
likus su
c
h
a
s swoll
e
n
,
r
edd
ish
a
n
d
stiffn
e
ss
.
I
n
ce
rt
a
in
c
ir
c
umst
a
n
ce
s th
e
r
e a
r
e b
ullin
e
imp
e
tigo l
e
sions
.
D
i
a
gnosis of
A
pp
ea
l
1
.
N
orm
a
l
c
or
d
with
acc
umul
a
tion of foul
-
sm
e
lling liqui
d
,
no sign
sign of inf
ec
tion
(
tr
ea
tm
e
nt is quit
e c
l
ea
n
ed
with
a
l
c
ohol
)
2
.
G
r
a
nulom
a
-
de
l
a
y
ed e
pith
e
li
a
liz
a
tion
/
gr
a
nulom
a de
l
a
y pro
ce
ss
e
pith
e
li
a
lism
beca
us
e
you
ca
n
'
t
C
ompli
ca
tions
1
.
Nec
rotizing f
a
s
c
iitis with signs
:
Ede
m
a
,
th
e
skin looks lik
e
or
a
ng
e
(
p
ea
u
d
'
or
a
ng
e a
pp
ea
r
a
n
ce
)
a
roun
d
th
e
pl
ace
of inf
ec
tion
,
f
a
st progr
e
ssiv
e
n
e
ss
a
n
d ca
n
ca
us
e dea
th th
e
n th
e
possi
b
ility of suff
e
ring
2
.
Pe
ritonitis
3
.
PORTA VENA T
hrom
b
osis
4
.
Ab
s
ce
ss
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
L
o
ca
l
ca
r
e
a
.
C
l
ea
nsing th
e c
or
d
with
a
n
a
ntis
e
pti
c
solution
(
C
hlorh
e
xi
d
in
e
or io
d
in
e
povi
d
on
2
.
5
%
)
with
c
l
ea
n g
a
uz
e c
loth
E
ight tim
e
s
a da
y until th
e
r
e
is no pus
a
nymor
e
on th
e c
or
d
.
b
r
ea
kf
a
st
.
A
ft
e
r
c
l
ea
ning
,
th
e c
or
d
is
a
ppli
ed
with
a
n
a
nti
b
ioti
c
ointm
e
nt
3
-
4
tim
e
s
a da
y
.
2
.
S
yst
e
mi
c ca
r
e
I
f without syst
e
mi
c
symptoms
,
p
a
ti
e
nts
a
r
e
giv
e
n
a
nti
b
ioti
c
s su
c
h
a
s kloks
a
sillin
O
r
a
l for fiv
e da
ys
.
I
f th
e c
hil
d
looks si
c
k
,
must
be c
h
ec
k
ed
first
T
h
e
r
e
is no sign of s
e
psis
.
C
hil
d
r
e
n
ca
n
be
giv
e
n
c
om
b
in
a
tion
a
nti
b
ioti
c
s
with
a
minogly
c
osi
de
s
.
I
f th
e
r
e a
r
e
no improv
e
m
e
nts
,
c
onsi
de
r
P
ossi
b
l
e Me
ti
c
illin
Re
sist
a
n
ce S
t
a
phylo
c
o
cc
us
a
ur
e
us
(
MRSA
).
C
ontrol
bac
k if th
e
r
e a
r
e
no improv
e
m
e
nts or th
e
r
e
is
a
n
e
xp
a
nsion of signs
I
nf
ec
tions
a
n
d c
ompli
ca
tions su
c
h
a
s hot
bab
i
e
s
,
fussy
a
n
d
st
a
rt not to
ea
t
.
F
ollow
-
up pl
a
n
: -
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
I
f th
e
int
a
k
e
is insuffi
c
i
e
nt
a
n
d
th
e c
hil
d
st
a
rts to
a
pp
ea
r
a de
hy
d
r
a
tion
2
.
T
h
e
r
e a
r
e Se
psis
C
ompli
ca
tions
S
igns
E
quipm
e
nt
N
o sp
ec
i
a
l
e
quipm
e
nt is n
eeded
to
d
i
a
gnos
e
inf
ec
tious
d
is
ea
s
e
s on
um
b
ilikus
.
P
rognosis
P
rognosis
I
f th
e
p
a
ti
e
nt
d
o
e
s not
e
xp
e
ri
e
n
ce c
ompli
ca
tions g
e
n
e
r
a
lly
D
u
b
i
a Ad B
on
a
m
.
Ma
lign
a
nt
Hea
lth pro
b
l
e
ms
Ca
n
d
i
da a
l
b
i
ca
ns inf
ec
tion
a
tt
ac
ks th
e
skin
,
mu
c
os
a a
n
d
int
e
rn
a
l org
a
ns
,
wh
e
r
ea
s in inf
a
nts
ca
n
be
inf
ec
t
ed
through th
e
v
a
gin
a
wh
e
n
b
orn
,
or
beca
us
e
th
e d
ot is not st
e
ril
e
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
C
ompl
a
ints
:
I
t
c
hing
a
n
d
p
a
in in th
e
mouth mu
c
os
a
,
m
e
t
a
l fl
a
vor
,
a
n
d
soy s
a
u
ce
pow
e
r
r
ed
u
ced
R
isk f
ac
tors
:
immuno
de
fi
c
i
e
n
c
y
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
Red
spots
,
with m
ace
r
a
tion in th
e a
r
ea a
roun
d
th
e
mouth
,
on fol
d
s
(
I
nt
e
rtriginos
a
)
acc
omp
a
ni
ed b
y s
e
p
a
r
a
t
e
r
ed
spots
a
roun
d
it
(
s
a
t
e
llit
e
).
2
.
G
u
a
m or
O
r
a
l
T
hrush who w
a
s wr
a
pp
ed
in ps
e
u
d
om
e
m
b
r
a
n
e
s on th
e
mu
c
os
a
mouth
.
S
upport
Yea
st
ce
lls
ca
n
be
s
ee
n un
de
r
a
mi
c
ros
c
op
e
in th
e
10
%
KOB
solv
e
nt or
G
r
a
m
c
oloring
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
T
h
e d
i
a
gnosis is
e
nfor
ced b
y
a
n
a
mn
e
sis
,
physi
ca
l
e
x
a
min
a
tion
,
a
n
d
support
.
D
i
a
gnosis of
A
pp
ea
l
O
r
a
l mu
c
os
a
l infl
a
mm
a
tion
ca
us
ed b
y
bac
t
e
ri
a
or virus
e
s
.
C
ompli
ca
tions
D
i
a
rrh
ea beca
us
e
of
d
ig
e
stiv
e c
h
a
nn
e
l
ca
n
d
i
d
i
a
sis
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
I
mprov
e
nutrition
a
l st
a
tus
a
n
d
m
a
int
a
in or
a
l
c
l
ea
nlin
e
ss
2
.
C
ontrol th
e
pr
ed
ispos
ed d
is
ea
s
e
3
.
Ge
nti
a
n
V
iol
e
t
1
%
(
m
ade
fr
e
sh
/
n
e
w
)
or
100
,
000
nyst
a
tin solution
-
200
,
000
IU
/
ML
whi
c
h is
a
ppli
ed
2
-
3
tim
e
s
a da
y for
3
da
ys
F
ollow up pl
a
n
1
.
Sc
r
ee
ning in th
e
f
a
mily
a
n
d
r
e
p
a
ir of th
e
f
a
mily
e
nvironm
e
nt
T
o k
ee
p it
c
l
ea
n
a
n
d d
ry
.
2
.
Pa
ti
e
nts to
c
ontrol
a
g
a
in if within
3
da
ys h
a
v
e
no improv
e
m
e
nt with
A
nti
-
fung
a
l
d
rug
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
I
f
ca
n
d
i
d
i
a
sis is
a
r
e
sult of oth
e
r
d
is
ea
s
e
s
,
su
c
h
a
s
HIV
.
E
quipm
e
nt
Lab
or
a
tory
E
quipm
e
nt for
K
oh
E
x
a
min
a
tion
P
rognosis
T
h
e
prognosis in p
a
ti
e
nts with immuno
c
omp
e
t
e
nt is g
e
n
e
r
a
lly
b
on
a
m
.
Le
prosy
Hea
lth pro
b
l
e
ms
Le
pr
a
is
a
inf
ec
tious
d
is
ea
s
e
,
c
hroni
c a
n
d ca
us
ed b
y my
c
o
bac
t
e
rium
Le
pr
ae
is intr
ace
llul
a
r o
b
lig
a
t
e
.
T
r
a
nsmission of th
e
possi
b
ility through
th
e
upp
e
r r
e
spir
a
tory tr
ac
t
a
n
d
p
a
ti
e
nt
'
s skin
c
ont
ac
t mor
e
th
a
n
1
month
c
ontinu
e
s
a
n
d a
g
a
in
.
T
h
e a
v
e
r
a
g
e
in
c
u
ba
tion p
e
rio
d
is
2
.
5
y
ea
rs
,
b
ut it
ca
n
a
lso
be
y
ea
rs
y
ea
rs
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
Red
or whit
e
skin spots in th
e
form of pl
aca
r
d
s
,
e
sp
ec
i
a
lly on th
e
f
ace
a
n
d ea
rs
.
Lac
k of l
e
ss
/
num
b
n
e
ss
,
not it
c
hy
.
B
list
e
rs on th
e
skin no
Fee
l
ed
p
a
in
.
S
kin
d
isor
de
rs
d
o not r
ec
ov
e
r with routin
e
tr
ea
tm
e
nt
,
E
sp
ec
i
a
lly if th
e
r
e
is
ed
g
e
n
e
rv
e
involv
e
m
e
nt
.
R
isk f
ac
tor
1
.
L
ow so
c
io
-
ec
onomi
c
so
c
io
2
.
O
l
d c
ont
ac
t with p
a
ti
e
nts
,
su
c
h
a
s f
a
mily m
e
m
be
rs
d
i
a
gnos
ed
with l
e
prosy
3
.
immuno
c
ompromisis
4
.
S
t
a
y in th
e E
n
de
mi
c a
r
ea
of
Le
pr
a
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
Pa
tognomist sign
1
.
S
igns on th
e
skin
N
ot
e e
v
e
ry spot
,
no
d
ul
e
(
no
d
ul
e
),
spotting th
e
sh
a
p
ed
pl
aca
r
d
with
shiny or
d
ry skin
.
T
h
e
skin is not sw
ea
ting
a
n
d
h
a
ir
ed
.
T
h
e
r
e
is
a baa
l on skin l
e
sions
,
lost p
a
in s
e
ns
a
tion
a
n
d
t
e
mp
e
r
a
tur
e
,
vitiligo
.
O
n th
e
T
h
e
skin
ca
n
a
lso
be
foun
d b
y no
d
ul
e
s
.
2
.
S
igns of n
e
rv
e
s
T
hi
c
k
e
ning p
e
riph
e
r
a
l n
e
rvous
,
t
e
n
de
r
a
n
d
spont
a
n
e
ous p
a
in in th
e
n
e
rv
e
s
,
tingling
,
st
abb
ing
a
n
d
p
a
in in th
e
m
e
m
be
rship
,
w
ea
kn
e
ss
M
ov
e
m
e
nt
a
n
d
or f
ace
,
de
formity
,
d
iffi
c
ult ul
ce
r
r
ec
ov
e
r
.
Ed
g
e
n
e
rv
e da
m
a
g
e
usu
a
lly o
cc
urs in th
e
n
e
rv
e
s shown in
F
igur
e
1
.
4
.
3
.
E
xtr
e
miti
e
s
ca
n o
cc
ur mutil
a
tion
F
or
ab
norm
a
liti
e
s foun
d
on physi
ca
l
e
x
a
min
a
tion
,
sym
b
ols
I
n
F
igur
e
1
.
5
is us
ed
in writing in m
ed
i
ca
l r
ec
or
d
s
.
A
tt
ac
hm
e
nt
D
i
a
gnosis
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
T
h
e d
i
a
gnosis is
e
nfor
ced
if th
e
r
e a
r
e
on
e
of th
e
m
a
in signs or
Ca
r
d
in
a
l
(
Ca
r
d
in
a
l
S
igns
),
n
a
m
e
ly
:
1
.
D
isor
de
rs
(
l
e
sions
)
of skin th
a
t
a
r
e
num
b
2
.
T
hi
c
k
e
ning of th
e ed
g
e
n
e
rv
e acc
omp
a
ni
ed b
y n
e
rv
e
fun
c
tion
d
isor
de
rs
3
.
T
h
e e
xist
e
n
ce
of
ac
i
d
-
r
e
sist
a
nt
ba
sil
(
BTA
)
in th
e
skin tissu
e
sh
a
p
e
(
SLIT S
kin
sm
ea
r
)
M
ost l
e
prosy p
a
ti
e
nts
a
r
e d
i
a
gnos
ed ba
s
ed
on
c
lini
ca
l
e
x
a
min
a
tions
.
T
h
e c
l
a
ssifi
ca
tion of l
e
prosy
c
onsists of
2
typ
e
s
,
n
a
m
e
ly p
a
usi
ba
sil
a
r
(
p
b
)
a
n
d
multi
ba
sil
a
r
(
MB
)
D
i
a
gnosis of
A
pp
ea
l
E
ryth
e
m
ed
1
.
P
sori
a
sis
2
.
T
in
ea C
ir
c
in
a
t
a
3
.
Seb
orrh
e
i
c de
rm
a
titis
W
hit
e
spot
1
.
V
itiligo
2
.
P
itiri
a
sis
Ve
rsikolor
3
.
P
itiri
a
sis
A
l
ba
N
o
d
ul
e
s
1
.
Ne
urofi
b
rom
a
tosis
2
.
Ka
posi s
a
r
c
om
a
3
.
Ve
ruk
a
vulg
a
ris
C
ompli
ca
tions
1
.
A
rthritis
.
2
.
Se
psis
.
3
.
Sec
on
da
ry
a
myloi
d
.
4
.
T
h
e
l
e
prosy r
eac
tion is
a
n int
e
rruption with
a
n
ac
ut
e e
piso
de
on
a
trip
Ve
ry
c
hroni
c
.
T
his r
eac
tion is
a ce
llul
a
r hyp
e
rs
e
nsitivity r
eac
tion
(
typ
e
1
/
Re
v
e
rs
a
l
)
or humor
a
l hyp
e
rs
e
ntitivity
(
typ
e
2
/
e
ryth
e
m
a
no
d
osum l
e
pro
c
rosum
/
e
nl
).
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
Pa
ti
e
nts
a
r
e
giv
e
n inform
a
tion
ab
out th
e c
urr
e
nt p
a
ti
e
nt
'
s
c
on
d
ition
,
a
s w
e
ll
a
s
Re
g
a
r
d
ing th
e
tr
ea
tm
e
nt
a
n
d
import
a
n
ce
of
c
ompli
a
n
ce
for
e
limin
a
tion of th
e d
is
ea
s
e
.
2
.
Se
lf
c
l
ea
ning
a
n
d a
goo
d d
i
e
t n
eed
to
be d
on
e
.
3
.
T
h
e
p
a
ti
e
nt is motiv
a
t
ed
to st
a
rt th
e
r
a
py until th
e
th
e
r
a
py h
a
s
bee
n
ca
rri
ed
out
.
4
.
T
h
e
r
a
py using
M
ulti
D
rug
T
h
e
r
a
py
(
MDT
)
on
:
a
.
Ne
w p
a
ti
e
nts
d
i
a
gnos
ed
l
e
prosy
a
n
d
h
a
v
e
n
e
v
e
r gott
e
n
MDT
.
b
r
ea
kf
a
st
.
De
ut
e
ronomy
,
n
a
m
e
ly p
a
ti
e
nts who
e
xp
e
ri
e
n
ce
th
e
things
be
low
:
Re
l
a
ps
e
Re
-
e
nt
e
r
a
ft
e
r
de
f
a
ult
(
g
e
t
PB
or
MB
))
M
oving
(
M
oving in
)
C
h
a
ng
e c
l
a
ssifi
ca
tion
/
typ
e
5
.
T
h
e
r
a
py in
PB
p
a
ti
e
nts
:
a
.
M
onthly
Med
i
ca
tion
:
T
h
e
first
da
y of
eac
h month
(
th
e d
rug is t
a
k
e
n
a
t
T
h
e
front of th
e c
l
e
rk
)
c
onsists of
:
2
ca
psul
e
s rif
a
mpi
c
in
@
300
mg
(
600
mg
)
a
n
d
1
Da
ps
a
n
d DDS
100
mg t
ab
l
e
t
.
b
r
ea
kf
a
st
.
Da
ily
T
r
ea
tm
e
nt
:
Da
y
2
-
28
E
v
e
ry month
:
1
t
ab
l
e
t
Da
pson
/
DDS
100
mg
.
1
d
rug
b
list
e
r for
1
month
.
C
..
Pa
ti
e
nts t
a
k
e
m
ed
i
c
in
e
for
6
-
9
months
(±
6
b
list
e
rs
).
d
.
I
n
c
hil
d
r
e
n
10
-
15
y
ea
rs
,
a d
os
e
of rif
a
mpi
c
in
450
mg
,
a
n
d DDS
50
mg
.
6
.
T
h
e
r
a
py in
Pa
ti
e
nts
MB
:
a
.
M
onthly
Med
i
ca
tion
:
T
h
e
first
da
y of
eac
h month
(
th
e d
rug is t
a
k
e
n
a
t
T
h
e
front of th
e c
l
e
rk
)
c
onsists of
:
2
rif
a
mpi
c
in
ca
psul
e
s
@
300
mg
(
600
mg
),
3
La
mpr
e
n
Tab
l
e
t
(
K
lof
a
zimin
)
@
100
mg
(
300
mg
)
a
n
d
1
t
ab
l
e
t
Da
pson
/
DDS
100
mg
.
b
r
ea
kf
a
st
.
Da
ily
T
r
ea
tm
e
nt
:
Da
y
2
-
28
E
v
e
ry month
:
1
La
mpr
e
n
Tab
l
e
t
50
mg
a
n
d
1
t
ab
l
e
t
Da
ps
a
n
d DDS
100
mg
.
1
d
rug
b
list
e
r for
1
month
.
C
..
Pa
ti
e
nts t
a
k
e
m
ed
i
c
in
e
for
12
-
18
months
(±
12
b
list
e
rs
).
d
.
I
n
10
-
15
y
ea
rs ol
d c
hil
d
r
e
n
,
th
e d
os
e
of
R
if
a
mpisin
450
mg
,
La
mpr
e
n
150
mg
a
n
d DDS
50
mg for its monthly
d
os
e
,
whil
e da
ily
d
os
e
s
F
or
La
mpr
e
n
50
mg it is
1
da
y
.
7
.
MDT d
os
e
s in
c
hil
d
r
e
n
<
10
y
ea
rs
ca
n
be ad
just
ed
with w
e
ight
:
a
.
R
if
a
mpisin
:
10
-
15
mg
/
kg
BB
b
r
ea
kf
a
st
.
Da
pson
:
1
-
2
mg
/
kg
bb
C
..
La
mpr
e
n
:
1
mg
/
kg
bb
8
.
S
upporting
d
rugs
(
vit
a
mins
/
ro
b
ipsi
a
)
ca
n
be
giv
e
n vit
a
min
B
1
,
B
6
,
a
n
d
B
12
.
9
.
MDT
t
ab
l
e
ts
ca
n
be
provi
ded
in pr
e
gn
a
nt
a
n
d
l
ac
t
a
ting p
a
ti
e
nts
.
I
f th
e
p
a
ti
e
nt
a
lso
e
xp
e
ri
e
n
ce
tu
be
r
c
ulosis
,
R
if
a
mpi
c
in th
e
r
a
py is
ad
just
ed
to
tu
be
r
c
ulosis
.
10
.
F
or p
a
ti
e
nts who
a
r
e a
ll
e
rgi
c da
pson
,
ca
n
be
r
e
pl
aced
with l
a
mpr
e
n
,
for
MB
with
a
ll
e
rgi
e
s
,
only
2
kin
d
s of
d
rugs
(
dd
s minus
).
T
h
e
r
a
py for mil
d
l
e
prosy r
eac
tions
,
ca
rri
ed
out
b
y
ad
ministr
a
tion of
P
r
ed
nison
b
y giving
:
1
.
T
h
e
first
2
w
ee
ks
40
mg
/
da
y
(
1
x
8
t
ab
)
morning
a
ft
e
r m
ea
ls
2
.
2
w
ee
ks th
e
s
ec
on
d
30
mg
/
da
y
(
1
x
6
t
ab
)
morning
a
ft
e
r m
ea
ls
3
.
2
T
hir
d Wee
k
20
mg
/
da
y
(
1
x
4
t
ab
)
morning
a
ft
e
r m
ea
ls
4
.
F
ourth four w
ee
ks
15
mg
/
da
y
(
1
x
3
t
ab
)
morning
a
ft
e
r m
ea
ls
5
.
2
w
ee
ks fifth
10
mg
/
da
y
(
1
x
2
t
ab
)
morning
a
ft
e
r m
ea
ls
6
.
2
six w
ee
ks
5
mg
/
da
y
(
1
x
1
t
ab
)
morning
a
ft
e
r m
ea
ls
7
.
I
f th
e
r
e
is
de
p
e
n
de
n
ce
on
P
r
ed
nison
,
it
ca
n
be
giv
e
n
La
n
ce
n
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
I
n
d
ivi
d
u
a
ls
a
n
d
f
a
mili
e
s
a
r
e
giv
e
n
a
n
e
xpl
a
n
a
tion of l
e
prosy
,
e
sp
ec
i
a
lly th
e
w
a
y
T
r
a
nsmission
a
n
d
tr
ea
tm
e
nt
.
2
.
F
rom th
e
f
a
mily
a
sk
ed
to h
e
lp monitor p
a
ti
e
nt tr
ea
tm
e
nt
so it
ca
n
be c
ompl
e
t
e acc
or
d
ing to tr
ea
tm
e
nt tim
e
.
3
.
I
f th
e
r
e a
r
e
simil
a
r signs
a
n
d
symptoms in oth
e
r f
a
mily m
e
m
be
rs
,
Need
to
be b
rought
a
n
d c
h
ec
k
ed
into h
ea
lth s
e
rvi
ce
s
.
F
ollow
-
up pl
a
n
:
1
.
Eac
h offi
ce
r must monitor th
e da
t
e
of
d
rug r
e
tri
e
v
a
l
.
2
.
I
f it
'
s too l
a
t
e
,
th
e
long
e
st in
1
month must
be
tr
ac
k
ed
.
3
.
Re
l
ea
s
e
from tr
ea
tm
e
nt
(
RFT
)
ca
n
be
st
a
t
ed a
ft
e
r th
e d
os
e
is fulfill
ed
W
ithout
a
l
ab
or
a
tory
c
h
ec
k
.
4
.
RFT
p
a
ti
e
nts
b
ut h
a
v
e
risk f
ac
tors
:
de
f
ec
ts of l
e
v
e
l
1
or
2
,
on
ce e
xp
e
ri
e
n
ced a
r
eac
tion
,
BTA a
t th
e be
ginning of tr
ea
tm
e
nt
>
3
(
th
e
r
e
w
a
s
a
no
d
ul
e
or infiltr
a
t
e
s
),
it is n
ece
ss
a
ry to
d
o s
e
mi
-
ac
tiv
e
o
b
s
e
rv
a
tions
.
5
.
PB
p
a
ti
e
nts who h
a
v
e
r
ece
iv
ed
tr
ea
tm
e
nt
6
d
os
e
s
(
b
list
e
r
)
in tim
e
6
-
9
months
dec
l
a
r
ed RFT
,
without h
a
ving
a
l
ab
or
a
tory
e
x
a
min
a
tion
.
6
.
MB
p
a
ti
e
nts who h
a
v
e
r
ece
iv
ed
12
d
os
e MDT
tr
ea
tm
e
nt
(
b
list
e
r
)
12
-
18
months
dec
l
a
r
ed RFT
,
without h
a
ving to
c
h
ec
k
l
ab
or
a
tory
.
7
.
De
f
a
ult
I
f
PB
p
a
ti
e
nts
d
o not t
a
k
e
/
t
a
k
e
th
e
m
ed
i
c
in
e
for mor
e
th
a
n
3
months
a
n
d
MB
p
a
ti
e
nts mor
e
th
a
n
6
months
c
umul
a
tiv
e
ly
(
not possi
b
l
e
for him
T
o
c
ompl
e
t
e
tr
ea
tm
e
nt
acc
or
d
ing to th
e
s
e
t tim
e
),
th
e
n
T
h
e
p
e
rson
c
on
ce
rn
ed
is
dec
l
a
r
ed de
f
a
ult
.
De
f
a
ult
e
r p
a
ti
e
nts
a
r
e
not tr
ea
t
ed
bac
k if th
e
r
e a
r
e
no
ac
tiv
e c
lini
ca
l signs
.
B
ut if you h
a
v
e
ac
tiv
e c
lini
ca
l signs
(
e
ryth
e
m
a
from ol
d
l
e
sions on th
e
skin
/
th
e
r
e a
r
e
n
e
w l
e
sions
/
e
xists
n
e
w n
e
rv
e e
nl
a
rg
e
m
e
nt
).
I
f
a
ft
e
r th
e
th
e
r
a
py r
e
turns to th
e de
f
a
ult
e
r it turns out to stop
a
ft
e
r mor
e
F
rom
3
months
,
it w
a
s
dec
l
a
r
ed
th
e
s
ec
on
d de
f
a
ult
.
W
h
e
n
de
f
a
ult mor
e
th
a
n
2
tim
e
s
,
A
sp
ec
i
a
l
ac
tion
a
n
d
h
a
n
d
ling n
eed
to
be d
on
e
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
T
h
e
r
e a
r
e
s
e
rious
d
rug si
de e
ff
ec
ts
.
2
.
Le
prosy r
eac
tions with
c
on
d
itions
:
a
.
E
nl
b
list
e
r
,
b
r
ea
k
(
ul
ce
r
a
tion
),
high
b
o
d
y t
e
mp
e
r
a
tur
e
,
n
e
uritis
.
b
r
ea
kf
a
st
.
T
yp
e
1
r
eac
tion is
acc
omp
a
ni
ed b
y ul
ce
r
a
tion or n
e
uritis spots
.
C
..
Reac
tion
acc
omp
a
ni
ed b
y
c
ompli
ca
tions of oth
e
r s
e
v
e
r
e d
is
ea
s
e
s
,
for
e
x
a
mpl
e
He
p
a
titis
,
DM
,
hyp
e
rt
e
nsion
,
a
n
d
h
ea
vy stom
ac
h ul
ce
rs
.
E
quipm
e
nt
S
impl
e Lab
or
a
tory for
BTA E
x
a
min
a
tion
P
rognosis
P
rognosis for
V
it
a
m is g
e
n
e
r
a
lly
B
on
a
m
,
b
ut
D
u
b
i
a AD
is night on fun
c
tion
e
xtr
e
miti
e
s
,
beca
us
e
mutil
a
tion
ca
n o
cc
ur
,
so is th
e
in
c
i
de
nt
r
ec
urr
e
n
ce
.
