Clinical Manifestation of Polio

The following phases of the virus infection:
 A. Acute Stage
 That phase since the clinical symptoms up to 2 weeks. Characterized by increased body temperature. Sometimes accompanied by headache and vomiting. Paralysis caused by damage to the motor neuron cells in the spinal cord (spinal cord) due to a virus invasion. This paralysis is asymmetrical so it tends to cause a disturbance in body shape (deformity) that persist or even become more severe. Paralysis that occurs mostly in the legs (78.6%), whereas 41.4% in arm. Gradual paralysis lasted until about 2 months after the initial illness.

B. Subacute Stage
 That phase of 2 weeks to 2 months. Characterized by the disappearance of fever within 24 hours. Sometimes accompanied by muscle stiffness and mild muscle aches. Paralysis of limbs paralyzed and usually one side only.

 C. Stadium Konvalescent
Long the phase at 2 months to 2 years. Characterized by the recovery of a previously weak muscle strength. Approximately 50-70 percent of muscle function to recover within 6-9 months after the acute phase. Furthermore, after 2 years is not expected to occur again in muscle strength recovery.

 D. Chronic Stadium
 That is more than 2 years. Muscle paralysis that occurs is permanent.

       Clinical picture which occur very varied ranging from the lightest to the heaviest, among other things: 
a. Infection without symptoms. 
 Incidence of asymptomatic infection, is difficult to know, but it is usually quite high, especially in areas that are poor cleanliness standards. At an endemic polio are estimated at 9-95% of the population and lead to immunity against polio. Newborns protected at first because of maternal antibodies which then would disappear after the age of 6 months. The disease is only known by a virus found in feces or elevated antibody titers.
 b. Abortive infection It was estimated 4-8% of the population in a region where the incidence is quite high. Not present the typical symptoms of poliomyelitis. Begins suddenly and lasts 1-3 days with symptoms of minor illness such as fever may reach 39.5 ° C, malaise, headache, sore throat, anorexia, vomiting, muscle pain and abdominal pain and sometimes diarrhea. The disease is difficult to distinguish from other viral diseases, only to be expected in case of polio epidemic in the region. Definitive diagnosis only by finding the virus in tissue culture. Differential diagnosis is influenza or other throat infections.

 Non-paralytic poliomyelitis        
This disease occurs in about 1% of all infections. Clinical symptoms similar to abortive infection that lasts 1-2 days. After the temperature became normal, but then increases again (dromarychart), accompanied by symptoms of headache, nausea and vomiting is more severe, and found the back muscle stiffness in the neck, back and legs. Kernig's sign and positive brudzinsky. Another sign is when the child tried to sit down with sleeping position, then he would bend his knees up, while two support arms back on the bed. Head drop is established when the patient's body by pulling on both armpits, will cause the head fall back. Tendon reflexes are usually normal. When the tendon reflex changes, it is likely to occur paralytic poliomyelitis. The differential diagnosis of serous meningitis and meningismus are.

Paralytic poliomyelitis       
Clinical picture similar to paralytic poliomyelitis is accompanied by non weaknesses in one or more of the collection or the cranial skeletal muscles. These symptoms may disappear for several days and then comes back accompanied by paralysis (paralytic) is a flaccid paralysis' which is usually unilateral and symmetrical that is most often affected are the limbs. This may be accompanied by paralysis of the urinary vesicles, intestinal atony and sometimes paralytic ileus. In case of severe respiratory muscle paralysis can occur.

  Clinically can be divided into four forms according to the height of lesions in the central nervous system are:

 a. Form of spinal muscular neck with symptoms of weakness, stomach, back, diaphragm, there is a limb where the majority of the lower limb. Common is the large muscles, quadriceps femoral in the leg, the arm of the deltoid. The nature of this paralysis is asymmetrical. Tendon reflexes decreases until it disappears and no disturbance of sensibility.

b. Bulbospinal form of a mixture of symptoms found between spinal and bulbar form. 

c. Bulbar form characterized by motor weakness of one or more cranial nerves with or without disruption of vital centers such as breathing, circulation and body temperature. If the weakness involves cranial nerves IX, X and XII, it will cause paralysis of the pharynx, tongue and fangs with the consequences of airway obstruction occurs.

d. Encephalytic form is characterized by a decreased consciousness, tremors and sometimes convulsions





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2. How to prevent Polio
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Therapy of Polio

 

      The management of poliomyelitis Treatment in patients with polio is not specific. Treatment aims to relieve symptoms and supportive treatment to improve the stamina of the patient. Physiotherapy services need to be given to minimize the paralysis and make sure to avoid muscle atrophy. Orthopedic treatments available for those who experience persistent paralysis. The most effective disease control is prevention through vaccination and surveillance of AI P. Do rehabilitation patients to rest and put to bed, allowing the affected limb to be really comfortable. If exposed to the respiratory organs, respiratory physical therapy may be needed. If paralysis or weakness since the respiratory intensive care is required. There is no effective antiviral drugs for poliovirus, so the main therapy is to reduce complaints (supportive). Analgetic given for headache complaints. The use of ventilators in patients with respiratory muscle impairment, and an expected long-standing use of the ventilator will be performed tracheotomy. Rehabilitation therapy in patients with muscle paralysis and the wounds caused by pressure (decubitus). Giving a laxative is needed because of the lack of mobilization so that digestion will be impaired and also the provision of software and high-fiber diit. Surgical therapy in the form of merging the hip joint is required in patients with side effects of the shape or thinning disorder of the hip joint.

How to Prevent Polio

Prevention Efforts
 There are some preventive measures this spread of polio, which are:

1. Polio eradication
 World Health Assembly in 1988 which was followed by most countries around the world made an agreement to conduct Polio Eradication (ERAPO) in 2000, meaning that a polio-free world in 2000. ERAPO the first program is to do with the overall immunization coverage.

Polio immunization should be given in accordance with WHO recommendations are given at birth, 4 times at intervals of 6-8 weeks. Then repeated at the age of 1.5 years; 5tahun, and the age of 15 years. Repeated immunization efforts this would not have a negative impact. In fact it is the only program in an efficient and effective in the prevention of polio.

2. Survailance acute flaccid paralysis

 Is looking for people with suspected paralytic paralyzed at age below 15 years. They should be checked to ascertain whether the stool because of polio or not. Suspected cases of polio infection should be thoroughly checked in the laboratory because it could have happened not because of paralysis of polio.

3. Mopping Up

  This means That measures the mass vaccination of children aged under 5 years in the discovery of polio without polio Immunization previous status. It seems that in the era of globalization where the mobility of people Between countries is very high and rapid, Difficulties Arise in controlling the spread of this virus. In Addition to the prevention of polio vaccination course should be accompanied by an increase of in environmental sanitation and personal sanitation. The use of family latrines, clean water meets health requirements That, and maintain food hygiene is an effort to Prevent and Reduced the risk of transmission of polio virus That is alarming again. Being one of the world's concern That the disability Caused by polio persist can not be cured. Healing can do very little alias no cure for polio. However, the actual parents should not panic if the baby and his son had obtained a complete polio vaccination.

Polio vaccine
There are two kinds of polio vaccine, oral polio vaccine were found Albert Sabin and the polio vaccine developed by Jonas Salk is disabled, which is as follows
.
a. Oral polio vaccine
→ Cast into the mouth. Contains live polio virus that had been weakened ..

Polio Oral Vaccine

b. Inactivated polio vaccine
→ administration by injection. Contains a killed polio virus. Virus polio (poliomyelitis) is highly contagious and incurable. This virus attacks the entire body (including muscles and nervous system) and can cause permanent muscle weakness and total paralysis in a matter of hours. Even sekitar10-15 percent of those affected eventually died of polio that attacked the respiratory muscles. Until now has not found a way of treatment of poliomyelitis. The most effective way of prevention is immunization.

Polio Injection Vaccine

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2. Clinical Manifestation of Polio
3. How Polio Transmitted
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How Polio Transmited

Poliomyelitis caused by polio virus. One in 200 infections develop into paralysis. A total of 5-10 percent of patients paralyzed, died when his breathing muscles become paralyzed. Mostly affects children under the age of three years (more than 50 percent of cases), but can also affect adults. Prevention by vaccination at regular intervals, ideally in childhood.

Viruses enter through the mouth and nose and then multiply in the throat and digestive tract or gut. Furthermore, absorbed and spread through the blood vessels and lymph vessels.

Direct transmission of the virus occurs in several ways, namely:

a. faecal-oral route (from feces to mouth)

 Through drink or food contaminated polio virus from stool of patients and into the mouth of healthy individuals.

b. Oral-oral (from mouth to mouth)

transmission through saliva splashes into the mouth of the patient that other healthy people. Actually, the high temperature conditions can quickly turn off the virus. Conversely, in a frozen state or a low temperature it can survive the virus for years.

Virus resistance in soil and water depends on temperature and humidity of other microbes. The virus can survive longer in the waste water and surface water, even up to miles and miles from the source of infection. Polio virus is highly resistant to alcohol and lisol, but sensitive to formaldehyde and chlorine solution. High temperatures quickly kill viruses, but in a frozen state can last for years. Virus resistance in soil and water depends on temperature and humidity of other microbes. The virus can survive for long in the waste water and surface water, even up to miles and miles from the source of infection. Although the infection is mainly due to environmental contamination by the polio virus from patients with infectious, the virus that lives in a limited environment. One of the intermediate host or organism that can be demonstrated to date is a human.





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Types of Polio

Polio

        Poliomyelitis, or polio, is a paralysis or paralytic disease caused by viruses. Carrier agent, the disease is a virus called poliovirus (PV), enters the body through the mouth, infecting the intestinal tract. The virus can enter the bloodstream and flows into the central nervous system causing muscle weakness and sometimes paralysis.

The word "polio" is derived from [Greek] or its more recent, from the "gray" and "spotting". Polio disease caused by infection with polio virus derived from the genus Enterovirus and the family Picorna viridae. The virus is transmitted through the feces (stool) or throat secretions of infected people. Polio virus entered through saliva causing infection.
This can happen easily if hands are contaminated or contaminated objects inserted into the mouth and throat and multiply in the gut. Proliferated for 4 to 35 days, then issued through the feces for several weeks later.

Polio

Types of Polio
 1. Non-polio paralysis
      Non-polio paralysis causes fever, vomiting, abdominal pain, lethargy, and sensitive. Muscle cramps occur in the neck and back, the muscles are soft to the touch.

2. Polio paralysis spinal
      Strain of poliovirus attacks the spinal cord, destroying the anterior horn cells which control movement of the trunk and limb muscles. Although this strain can cause permanent paralysis, less than one in 200 people will experience paralysis. Paralysis occurs most often found in the legs to the feet.
      After the polio virus attacks the intestines, the virus will be absorbed by the capillary blood vessels in the intestinal walls and transported throughout the body. Polio virus attacks the spinal cord and motor neurons - which control the physical movement. At this period, like-iflu symptoms appear. However, in patients who have no immunity or has not been vaccinated, the virus usually will attack all parts of the trunk spinal cord and brain stem. This infection affects the central nervous system - spreading along nerve fibers. Along with the proliferation of virus in the central nervous system, the virus destroys motor neurons. Motor neurons do not have the ability to regenerate and muscles associated with it will not react to commands from the central nervous system. Paralysis in the legs causes the legs to be weak - a condition called acute flaccid paralysis (AFP). Severe infection of the central nervous system can cause paralysis of the trunk and muscles of the thorax (chest) and abdomen (stomach), is called quadriplegia.

3. Bulbar polio
       Caused by the lack of natural immunity to develop part of the brain stem. The brain stem contains motor neurons that regulate breathing and cranial nerves, which send signals to various nerves that control eye movement; trigeminal nerve and facial nerve associated with the cheeks, tear glands, gums, and muscles of the face; auditory nerves that regulate hearing; glossofaringeal nerve that helps the process of swallowing and the various functions of the esophagus; movement of the tongue and taste, and the nerves that send signals to the heart, intestines, lungs, and additional nerve that regulates the movement of the neck. Without a ventilator, bulbar polio can cause death. Five to ten percent of patients suffering from bulbar polio will die when their breathing muscles, can not work. Death usually occurs after damage to the cranial nerves are on duty to send 'command breathed' into the lungs. Patients can also die because of damage to the swallowing function; victim can 'sink' in his own secretions unless carried out or were subjected to tracheostomy suction to suck up the fluid that is secreted before it goes into the lungs
         However, tracheostomy is also hard to do if the patient has been using the iron lung.  This tool helps the weak lungs by increasing and reducing the air pressure inside the tube. If the air pressure increased, the lung will deflate, if air pressure is reduced, the lungs will expand. Thus the air pumped out of the lungs. A much more severe infection in the brain can lead to coma and death. Bulbar polio death rate ranges from 25-75% depending on the age of the patient. Until now, those who survive this type of polio have to live with an iron lung or respirator. Bulbar and spinal polio often attacked simultaneously and is a subclass of polio paralysis. Polio paralysis is permanent. Patients who recover may have near-normal body functions.





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Carbuncle

Carbuncle

Indonesian name for Carbuncle is BISUL, so what is Carbuncle? Carbuncle is an abscess larger than a boil, usually with one or more openings draining pus onto the skin. It is usually caused by bacterial infection. Most carbuncles are caused by the bacteria Staphylococcus aureus. The infection is contagious and may spread to other areas of the body or other people. A carbuncle is made up of several skin boils.

The infected mass is filled with fluid, pus, and dead tissue. Fluid may drain out of the carbuncle, but sometimes the mass is so deep that it cannot drain on its own. Carbuncles  may develop anywhere, but they are most common on the back and then ape of the neck. Men get carbuncles more often than women. Because the condition is contagious, family members may develop carbuncles at the same time. Often, the direct cause of a carbuncle cannot be determined. Things that make carbuncle infections more likely include friction from clothing or shaving, generally poor hygiene and weakening of immunity. For example, persons with diabetes  and immune system diseases are more likely to develop staphylococcal infections.

 

Carbuncle

The carbuncle may be the size of a pea or as large as a golf  ball. It may be red and irritated and might hurt when touched. It may also grow very fast and have a white or yellow center. It may crust or spread to other skin areas. Sometimes, other symptoms may occur. These may include fatigue, fever and general discomfort or sick feeling. Sometimes an itching occurs before the carbuncle develops.

Abcess Carbuncle

How to threat Carbuncle?
Carbuncles usually must drain before they will heal. This most often occurs on its own in less than 2 weeks. Placing a warm moist cloth on the carbuncle helps it to drain, which speeds healing. The affected area should be soaked with a warm, moist cloth several times each day. The carbuncle should not be squeezed, or cut open without medical supervision, as this can spread and worsen the infection. Treatment is needed if the carbuncle lasts longer than 2weeks, returns frequently, is located on the spine or the middle of the face, or occurs along with a fever or other symptoms. Treatment helps reduce complications related toan infection. A doctor may prescribe antibacterial soaps and antibiotics applied to the skin or taken by mouth. Deep orlarge lesions may need to be drained by a health professional. Proper hygiene is very important to prevent the spread of infection. Hands should always be washed thoroughly after touching a carbuncle. Washcloths and towels should not be shared or reused. Clothing, washcloths, towels, and sheets or other items that contact infected areas should be washed in very hot (preferably boiling) water. Bandages should be changed frequently and thrown away in a tightly-closed bag.

HENOCH-SCHÖNLEIN PURPURA

DEFINITION
       Is a clinical syndrome caused by systemic vasculitis of small blood vessels are characterized by specific lesions of nontrombositopenik purpura, arthritis or arthralgia, abdominal pain or gastrointestinal bleeding, and sometimes nephritis or haematuria. Another name of this disease is anaphylactoid purpura, allergic purpura and allergic vasculitis.

 

EPIDEMIOLOGY
         The disease is mainly found in children aged 2-15 years (school age children) with a peak at age 4-7 years. There is more on boys than girls (1.5: 1)

ETIOLOGY
        Until now the cause of this disease is unknown. Allegedly several factors play a role, among other genetic factors, upper respiratory tract infection, food, insect bites, exposure to cold, immunization (vaccine varicella, rubella, rubeolla, hepatitis A and B, paratyphoid A and B, typhoid, cholera) and antibiotics (ampisillin, erythromycin, quinine, penicillin, quinidin, quinine). Infection can be caused by bacteria (species of Haemophilus, Mycoplasma, Parainfluenzae, Legionella, Yersinia, Shigella and Salmonella) or viruses (adenovirus, varicella, parvovirus, Epstein-Barr virus). Vasculitis can also develop after therapy antireumatik, including the use of methotrexate and anti-TNF agent (Tumour Necrosis Factor). However, IgA clearly has an important role, characterized by increased concentrations of serum IgA, IgA immune complexes and deposit in blood vessel walls and renal mesangium. HSP is a disorder that is almost always associated with abnormalities in IgA1 than IgA2

PATHOPHYSIOLOGY
       From biopsies of lesions on the skin or kidneys, there are known deposits of immune complexes containing IgA. Note also the existence of alternative pathway complement activation. Deposits of immune complexes and complement activation resulting in activation of inflammatory mediators including vascular prostaglandins such as prostacyclin, causing inflammation in small blood vessels in the skin, kidneys, joints and abdomen and occurs in the skin purpura, nephritis, arthritis and gastrointestinal bleeding.


CLINICAL
          HSP usually appears with a rash triad of purpura on the lower extremities, abdominal pain or kidney disorders and arthritis. But the triad is not always there, so that often lead to incorrect diagnosis. Clinical symptoms early - the early form of eritomatosa macular rash on the skin of the lower limb which continues to be a symmetric palpable purpura without thrombocytopenia. The rash was initially limited to the skin but usually malleolus will then be extended to the dorsal surface of the legs, buttocks and outer sleeve. Within 12-24 hours macular purpuric lesions will turn into a dark red and has a diameter of 0.5 to 2 cm. Lesions may coalesce into larger plaques that resemble echimosis which can then be ulcerated.
           Purpura mainly found on the skin that are often exposed to pressure (pressure-bearing surfaces). This skin disorder is found at 100% of cases and represents 50% of complaints patients at the time of treatment. Skin disorders can also be found on the face and body. Abnormalities of the skin can be itchy. In the form that is not classical, the existing skin disorders can form vesicles to resemble erythema multiform. Acute disorders of the skin can last several weeks and disappear, but can also be recurrent. Scrotal Edema can also occur and the symptoms are similar to testicular torsion. Prodromal symptoms can include fever with a temperature of not more than 38 ° C, headache and anorexia.
         HSP usually appears with a rash triad of purpura on the lower extremities, abdominal pain or kidney disorders and arthritis. But the triad is not always there, so that often lead to incorrect diagnosis.

HENOCH-SCHÖNLEIN PURPURA

            Clinical symptoms early - the early form of eritomatosa macular rash on the skin of the lower limb which continues to be a symmetric palpable purpura without thrombocytopenia. The rash was initially limited to the skin but usually malleolus will then be extended to the dorsal surface of the legs, buttocks and outer sleeve. Within 12-24 hours macular purpuric lesions will turn into a dark red and has a diameter of 0.5 to 2 cm. Lesions may coalesce into larger plaques that resemble echimosis which can then be ulcerated.
             Purpura mainly found on the skin that are often exposed to pressure (pressure-bearing surfaces). This skin disorder is found at 100% represents 50% of cases and complaints of patients at the time of treatment. Skin disorders can also be found on the face and body. Abnormalities of the skin can be itchy. In the form that is not classical, the existing skin disorders can form vesicles to resemble erythema multiform. Acute disorders of the skin can last several weeks and disappear, but can also be recurrent. Scrotal Edema can also occur and the symptoms are similar to testicular torsion. Prodromal symptoms can include fever with a temperature of not more than 38 ° C, headache and anorexia.
        In children aged less than 2 years, the clinical picture is dominated oelh sinfulness scalp edema, periorbital, hands and feet. This picture is called AHEI (Acute Hemorrhagic Edema of Infancy).
         In addition to purpura, also found that symptoms of arthralgia and arthritis tend to be migrants and about the joints of the lower extremities such as knees and ankles, but can also on the wrist, elbow and finger joints in the hand. This disorder arises first (1-2 days) of skin disorders. Affected joints may become swollen, painful and sore when actuated, usually without effusion, redness or heat. Abnormalities teutama periartrikular and temporary, may also recurrent during active disease but does not cause permanent deformity.
        In this disease can be found in the form of abdominal discomfort abdominal pain or gastrointestinal bleeding. Abdominal complaints usually arise after the onset of disorders of the skin (1-4 weeks after onset). The organ most frequently involved are the duodenum and small intestine. Abdominal pain can be severe abdominal colic, location in periumbilikal and accompanied by nausea, vomiting, vomiting blood and even sometimes there is a bowel perforation and intussusception is more common than ileoileal ileokolonal. Intussusception or perforation caused by vasculitis that causes the intestinal wall edema and submucosal and intramural hemorrhage. Sometimes it can also occur with a perforated bowel infarction or not.
          Moreover, it can also be found renal abnormalities, including hematuria, proteinuria (<2g / d), nephrotic syndrome (proteinuria> 40mg/m2 / hour) or nephritis. Diseases of the kidney is also usually appear 1 month after the onset of skin rash. The existence of a persistent skin disorder until 2-3 months, usually associated with nephropathy or severe kidney disease. Increased risk of nephritis at the age of 7 years, persistent purpura lesions, severe abdominal complaints funds decreased factor XIII activity. Renal impairment is usually mild, although some will become chronic. Often the severity of nephritis is not related to the severity of other symptoms of HSP. In patients with HSP may arise of edema. Edema does not depend on the degree of proteinuria but rather on the degree of vasculitis that occur. However, edema is indeed associated with the incidence of proteinuria in patients.
          Sometimes, HSP may be accompanied by symptoms of central nervous system disorders, especially headaches. HSP can be found on the existence of cerebral vasculitis. In some rare cases, HSP allegedly can cause serious disorders such as seizures, paresis, or coma. The symptoms of other neurological disorders that may arise, among others, changes in the level of awareness, apathy, somnolence, hyperactivity, irritability, emotional instability, seizures (partial, complex partial, generalized, status epilepticus), and focal neurologic deficits (aphasia, ataxia, khorea, hemiparese, paraparese, quadraparese. It can also happen poliradikuloneuropathy (Guillain-Barré syndrome) and mononeuropathy (facial nerve, femoral, ulnar).
Liver and gall bladder symptoms may also be involved with hepatomegaly, hydrops of the gallbladder, cholecystitis. All this can lead to complaints of abdominal pain in patients. Acute appendicitis has also been reported in patients with HSP.
        Symptoms - other symptoms that have been reported but are rare among other miokardia vasculitis, pulmonary vasculitis that causes pulmonary hemorrhage bilaterally, ureteritis stenosis, penile edema, orchitis, priapism, intracranial hemorrhage, subperiosteal orbital hematoma bilateral adrenal hematoma and acute pancreatitis.

INVESTIGATION SUPPORTING
      In laboratory tests there have been no specific abnormalities. Normal or elevated platelet counts, distinguishing purpura caused by thrombocytopenia. Can occur moderate leukocytosis and anemia normochromic, usually associated with gastrointestinal bleeding. Usually there are also eosinophilia. Erythrocyte sedimentation rate can be increased or normal. Levels of complement such as C1q, C3 and C4 may be normal or decreased. Examination of IgA levels in the blood may be increased, so did the lymphocytes that contain IgA. Urinalysis may show hematuria, proteinuria and decreased creatinine clearance marks start of kidney damage or because of dehydration, as well as blood in the stool can be found. ANA and RF examination is usually negative, factor VII and XIII can be decreased.
       Biopsy of skin lesion showed leukocytoclastic vasculitis. Immunofluorescence showed deposits of IgA and complement in blood vessel walls. On radiological examination can be found a marked decrease in intestinal motility with intestinal lumen dilation or intussusception by barium examination. Sometimes the barium can also correct the intussusception

DIAGNOSIS
     Diagnosis is confirmed by more specific clinical symptoms rather than with the aid of investigation. Symptoms that may lead to the diagnosis of HSP is purpurik rash on the skin especially in the buttocks and lower extremities with one or more of the following symptoms: abdominal pain or gastrointestinal bleeding, arthralgia or arthritis, and hematuria or nephritis.
          Differential diagnosis of HSP based on symptoms that may arise, among others, acute abdomen, due to meningococcal meningitis, SLE, bacterial endocarditis, ITP, rheumatic fever, Rocky Mountain spotted fever, allergic reaction to medication - drugs, IgA nephropathy, rheumatoid arthritis

TREATMENT
         There is no definitive treatment in patients with HSP. Treatment is supportive and symptomatic, including maintenance of hydration, nutrition, electrolyte balance and overcome the pain with analgesics. For mild arthritis complaints and fever can be used NSAIDs such as ibuprofen. Dose ibuprofen can be given is 10mg/kgweight/6 hours. Edema can be treated with leg elevation. As long as there are complaints of vomiting and abdominal pain, diet is given in the form of soft food. The use of acetyl salicylic acid should be avoided, because it can lead to impaired platelet function is petechiae and gastrointestinal bleeding. When there are symptoms of an acute abdomen, performed the operation. If there is a progressive kidney disorder can be given in combination with immunosuppressant corticosteroids. IV methylprednisolone can prevent worsening of kidney disease when administered early. The dose can be used is methylprednisolone 250-750 mg / day IV for 3-7 days in combination with cyclophosphamide 100-200 mg / hr for severe acute phase of HSP. Continued with corticosteroids (prednisone 100-200 mg orally) and cyclophosphamide hose daily 100-200 mg / hr for 30-75 days before cyclophosphamide was stopped immediately dantappering-off steroids for up to 6 months.
       Prednisone therapy can be administered at a dose of 1-2 mg / kgweight / day orally, divided into 3-4 doses for 5-7 days. Corticosteroids given in a state of disease with very severe symptoms, arthritis, vasculitis of the CNS manifestations, lung and testis, severe abdominal pain, gastrointestinal bleeding, edema and persistent nephrotic syndrome. Giving early in the acute phase may prevent bleeding, obstruction, intussusception and gastrointestinal perforation.