Infectious Diseases Flashcards
1
Q
Define Viruses
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Viruses are small pathogens with a bit of genetic material (DNA or RNA, but not both) enclosed in a protein coat. They can’t reproduce independently and need to invade a living cell (plant or animal) to make copies of themselves. This invasion can harm or destroy the infected cell.
2
Q
What is Filoviruses?
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Filoviruses are virus types that resemble threads and are extremely lethal.
3
Q
What is Hepatitis Viruses?
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Hepatitis viruses cause various forms of liver infection, ranging from mild to life-threatening.
4
Q
What is Herpes Viruses?
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Herpes viruses establish permanent residence in cells and periodically cause flare-ups of symptoms.
5
Q
What is Influenza Viruses?
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Influenza viruses cause the flu and can change their outer protein coats dramatically, making individuals resistant to one strain susceptible to a new one.
6
Q
What is Noroviruses?
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Noroviruses, part of the calicivirus family, cause gastroenteritis in people.
7
Q
What is Papillomaviruses?
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Papillomaviruses may cause few symptoms in women and men but are associated with a rise in cervical cancer among younger women.
8
Q
What is Retroviruses?
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Retroviruses replicate their genetic material in a backward (retro) sequence compared to other viruses. The human immunodeficiency virus (HIV) is a retrovirus that causes acquired immune deficiency syndrome (AIDS).
9
Q
What is Rhinoviruses and Adenoviruses?
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Rhinoviruses and adenoviruses infect mucous membranes, leading to upper respiratory tract infections and colds.
10
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What is Slow Viruses?
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Slow viruses may not show early symptoms but can lead to fatal illnesses within a few years.
11
Q
Can Antibiotics treat viruses?
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Antibiotics are drugs that inhibit or kill bacteria and have no effect on viruses.
12
Q
How do you treat viruses?
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Antiviral drugs can’t completely eradicate a viral infection but can reduce its severity and duration. They are most effective when taken before an infection develops or in its early stages.
13
Q
What is bacteria?
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Bacteria are single-celled organisms with a firm cell wall and a flexible cell membrane enclosing cytoplasm. They possess all the genetic information (DNA) required for replication within a structure known as a chromosome.
14
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Abundance of Bacteria
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Bacteria are the most abundant microorganisms, and they can be either helpful or harmful. Many do not cause diseases and serve important roles in the body.
15
Q
What is Friendly Bacteria?
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Some bacteria, known as friendly bacteria, aid in digestion and perform essential functions in the body. However, even friendly bacteria can become problematic, leading to conditions like acne, urinary tract infections, and vaginal infections.
16
Q
What is Harmful Bacteria?
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Bacteria that harm the body do so by releasing enzymes that digest body cells or toxins that cause specific diseases, such as diphtheria or toxic shock syndrome.
17
Q
What are Antibodies?
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In response to bacterial invasion, the body produces antibodies, which are special proteins that attack and neutralize the bacteria.
18
Q
What are examples of Bacterial Diseases?
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Examples of bacterial diseases include tuberculosis, tetanus, gonorrhea, scarlet fever, and diphtheria.
19
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What are Antibiotics (in relation to bacteria)?
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Antibiotics are drugs that can kill bacteria without harming the body’s own cells. They work against specific types of bacteria.
20
Q
How can you identify bacteria?
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Specific bacterial strains can be identified through tests of blood, pus, sputum, urine, or stool samples.
21
Q
Define Fungi
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Fungi are eukaryotic organisms that vary in shape and size. They can be single-celled (yeasts) or form long chains of cells (moulds or mushrooms).
22
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Describe Reproduction in Fungi
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Fungi reproduce by releasing spores or by growing threadlike fibres.
23
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Describe fungi Nutrient Absorption
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Fungi lack chlorophyll and, therefore, do not make their own food from sunlight. Instead, they absorb nutrients from organic material, including human tissue.
24
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Describe Uses of Fungi
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Fungi can be beneficial as they produce natural compounds used in antibiotics, help bread rise, and contribute to beer brewing. They also play a role in breaking down dead plants and animals.
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Describe fungi as a nuisance
Fungi can be a nuisance to humans by releasing enzymes that digest cells, leading to issues like athlete's foot and infections in hair-covered areas like the scalp, beard, groin, and external ear canals.
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What is Antifungal Treatment?
The treatment for fungal infections typically involves antifungal drugs.
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What is Protozoa?
Protozoa are single-celled, microscopic animals that release enzymes and toxins capable of destroying cells or interfering with their function.
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Protozoa- What is malaria?
Malaria is a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness.
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Protozoa- What is Amoebic Dysentery?
Protozoa can also cause amoebic dysentery, affecting many people worldwide. Treatment typically involves medical care, blood or fluid replacement, and drugs targeting the specific protozoan.
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What is Giardiasis?
Giardiasis is the most common protozoa-caused disease in Canada, caused by microorganisms in human and animal feces. It's a threat in places like daycare centers and among campers and hikers who drink contaminated water.
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What are Giardiasis Symptoms?
Symptoms of giardiasis include nausea, lack of appetite, gas, diarrhea, fatigue, abdominal cramps, and bloating. While many recover without treatment, some may experience recurring attacks over many years.
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What is the treatment for Giardiasis?
Giardiasis can be life-threatening, especially in small children and the elderly who are prone to severe dehydration from diarrhea. Treatment typically involves antibiotics.
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What are Helminths?
Helminths are small parasitic worms that attack specific tissues or organs, competing with the host for nutrients.
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What is Schistosomiasis?
Schistosomiasis is a major worldwide health problem caused by a parasitic worm that burrows through the skin and enters the circulatory system.
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What are Tapeworms?
Infection with a tapeworm, another type of helminth, can occur from consuming undercooked beef, pork, or fish containing larval forms of the tapeworm.
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Describe Transmission of Helminths
Helminths can be transmitted through various means, such as skin penetration or ingestion of contaminated food.
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Describe Treatment of Helminthic Diseases
Helminthic diseases are typically treated with appropriate medications designed to target and eliminate the parasitic worms.
38
Define Reservoir
A reservoir is a place where any infectious agent can live, grow, and multiply. Reservoirs can include animals or insects, people, food, or water.
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What are types of reservoirs?
Reservoirs can take various forms, such as animals, insects, humans, food, or water. They serve as sources where infectious agents can persist and proliferate.
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Describe Animals and Disease Transmission
House pets, livestock, and wild animals have the potential to transmit diseases to humans. They can act as carriers of various infectious agents.
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Describe Insects and Disease Transmission
Insects play a significant role in the transmission of diseases.
Houseflies can spread diseases like dysentery, diarrhea, typhoid fever, or trachoma.
Mosquitoes, ticks, mites, fleas, and lice can transmit diseases like malaria, yellow fever, encephalitis, dengue fever, and Lyme disease.
42
Describe Food-borne Illnesses
Every year, food-borne illnesses affect many Canadians, sometimes leading to fatal consequences. These illnesses are often caused by consuming contaminated food.
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What role does bacteria play in food-borne illnesses?
Bacteria are responsible for approximately two-thirds of food-borne infections, making them a significant source of these illnesses.
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What is E. coli?
Escherichia coli (E. coli) infections are a notable public health concern worldwide. Thousands of suspected cases of E. coli infection due to undercooked or inadequately washed food are reported annually. Symptoms can range from mild to severe diarrhea, sometimes with no blood to high levels of blood in the stools.
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What is Pathogen Transmission by People?
Pathogens can be transmitted by people through various means, including the air, touch, or sexual contact. It's important to be aware of these routes to prevent infection.
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How do you prevent airborne transmission?
To avoid infection, stay out of the range of anyone who is coughing, sniffling, or sneezing, as these actions can release pathogens into the air.
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How do you prevent contact transmission?
Prevent contact transmission by not sharing food or dishes with others. Carefully wash your dishes, utensils, and hands to reduce the risk of pathogen transmission.
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How do you prevent sexual transmission?
To prevent sexual transmission of pathogens, it's essential to abstain from sex or make self-protective decisions about sexual partners. Safe sex practices and awareness are crucial in this context.
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What is Pathogen Transmission?
Microorganisms cannot move on their own and require a mode of transmission to go from a reservoir to a host. Direct and indirect human contact offers opportunities for disease-producing organisms to be transmitted
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What is Vector-Borne Transmission?
When an insect or animal transmits a disease to a human, it is known as vector-borne transmission. This can play a significant role in the spread of infectious diseases.
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Modes of Pathogen Transmission (5)
Direct Contact, Indirect Contact, Droplet transmission, Airborne transmission, and Common vehicle transmission
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What is Direct Contact transmission?
Involves body surface to body surface contact, such as through blood-borne or sexual contact.
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What is Indirect Contact transmission?
Occurs when a susceptible host contacts objects or hands that are contaminated, often via items like TV remotes, computer keyboards, or eating utensils.
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What is Droplet transmission?
Involves the contact of mucous membranes with large droplets containing germs from an infected person who is nearby, often through sneezing, coughing, or talking within about three feet.
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What is Airborne transmission?
Involves very small droplets containing germs suspended in the air or dust, which are spread by air currents and enter the respiratory tract. Diseases like measles, chickenpox, and tuberculosis can be transmitted this way.
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What is Common Vehicle transmission?
Occurs through contact with contaminated equipment, food, water, or medications. Examples include contaminated leftover food and a polluted water supply.
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Describe the Process of Infection
Once a pathogen is transmitted to a susceptible host through any of the five routes of transmission, the infection process begins. The susceptibility of the host depends on their health condition and exposure level to the infectious agent.
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What is a Susceptible Host?
Anyone can be a susceptible host, but the degree of susceptibility depends on various factors, including the individual's health, level of exposure to the pathogen, and the presence of protective antibodies.
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What are Factors Influencing Susceptibility?
Factors influencing susceptibility include the absence of antibodies through immunization or prior infection, age, and existing medical conditions. These factors determine the likelihood of an individual becoming ill when exposed to a pathogen.
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What is an Incubation Period?
The incubation period is the time from pathogen invasion to the first symptom, often with the host unaware. It can range from days or weeks to months or even years.
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What is Immunity and Body Protection?
Various parts of your body provide immunity and protection against infectious diseases. Your skin acts as a barrier to most potential invaders, and other bodily fluids and systems have mechanisms to combat pathogens.
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What are Protective Body Fluids?
Tears, sweat, skin oils, saliva, and mucus contain chemicals that can kill bacteria, helping to protect the body from infections.
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What is Cilia and Respiratory Protection?
Cilia, tiny hairs lining your respiratory passages, help move mucus, which traps inhaled bacteria, viruses, dust, and foreign matter. This trapped material is moved to the back of the throat, where it is swallowed, and then destroyed by the digestive system.
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What are Portals of Entry and Exit?
Certain body parts, such as tears, sweat, and mucous membranes, can serve as both entry and exit points for infections. If an infectious agent is present in a reservoir (like another person) and leaves through skin contact or respiratory and gastrointestinal secretions, it can enter a new susceptible host through the same routes. This highlights the significance of hygiene and infection control.
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When these protective mechanisms can't keep you infection free, your body's immune system, which is on constant alert for foreign substances that might threaten the body, swings into action.
The immune system includes structures of the lymphatic system—the spleen, thymus gland, lymph nodes, and lymph vessels—that help filter impurities from the body.
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More than a dozen different types of white blood cells are concentrated in the organs of the lymphatic system or patrol the entire body by way of the blood and lymph vessels.
These white blood cells play a crucial role in the immune system's defense against infections and diseases.
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The two basic types of immune mechanisms are humoral and cell-mediated.
Humoral and cell-mediated immune responses are two fundamental components of the immune system that work together to combat pathogens and maintain overall health.
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What is Humoral Immunity?
Humoral immunity is a form of immune protection provided by antibodies, which are proteins produced by white blood cells called B lymphocytes or B cells. This type of immunity is particularly effective against bacterial or viral infections.
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What are Antibodies and B Lymphocytes?
Antibodies are produced by B lymphocytes (B cells) and play a key role in humoral immunity. They are specific proteins that can neutralize antigens.
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What is an Antigen?
An antigen is any substance that enters the body and triggers the production of an antibody. These antigens can be components of bacteria, viruses, or other foreign substances.
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What is Immune Memory?
The antibodies generated as a result of humoral immunity create immune memory. This memory ensures that the body can rapidly and effectively respond to the same antigen if encountered again in the future, offering long-lasting protection.
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What is vaccination?
Inoculation with a vaccine containing synthetic or weakened antigens can provide protection against specific diseases, essentially mimicking the body's natural immune response.
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What is Active Immunity?
Active immunity is a type of long-lasting immunity in which the body's own immune system produces antibodies in response to exposure to a pathogen, such as through vaccination. This immunity provides protection against future encounters with the same pathogen.
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What is Passive Immunity?
Passive immunity is immunity obtained by injecting gamma globulin, which contains antibodies from another person or animal who has developed antibodies to a disease. This form of immunity is temporary and does not involve the body's immune system directly generating antibodies.
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What is Vaccination for Active Immunity?
Vaccination is a common method to induce active immunity, where the body actively produces its own antibodies in response to a vaccine. This helps the body develop immunity to the target disease.
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What is Gamma Globulin for Passive Immunity?
Passive immunity can be acquired by injecting gamma globulin, which provides ready-made antibodies from a donor, temporarily conferring protection against a specific disease.
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What is an immune response within the body
When the body is attacked by pathogens, the immune system mobilizes its various components to defend against the invaders. This collective effort is often compared to an internal police force.
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What are T Cells and Macrophages?
T cells, along with macrophages (large scavenger cells), form the front line of defense against invading antigens. Macrophages are known for their ability to engulf foreign cells, damaged red blood cells, and biological debris.
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What are B Cells and Antibodies?
B cells are responsible for producing antibodies. These antibodies are essential in the immune response, as they can bind to antigens and neutralize them, contributing to the body's defense.
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What role do Lymph Nodes have in immune response?
Lymph nodes, or glands, are small tissue masses where some protective immune cells are stored. When pathogens invade the body, many of them are transported to the lymph nodes for destruction. This is why lymph nodes often become swollen when the body is fighting infections, such as during a cold or flu.
81
What is Antimicrobial Resistance?
Antimicrobial resistance occurs when microbes evolve mechanisms that protect them from the effects of antimicrobials. All classes of microbes can evolve resistance where the drugs are no longer effective. Fungi evolve antifungal resistance. Viruses evolve antiviral resistance.
82
What is Rhinoviruses?
Rhinoviruses are the most common cause of spring, summer, and early fall colds. They often lead to symptoms primarily above the neck, such as a stuffy nose, headache, and runny eyes.
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What viruses impact the lower respiratory system?
Viruses like adenoviruses, parainfluenza viruses, coronaviruses, and influenza viruses that are prevalent in the winter are more likely to infect the bronchi and trachea, leading to symptoms like fever and bronchitis.
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How are cold viruses transmitted?
Cold viruses are typically spread through coughs, sneezes, and physical contact. When cold sufferers sneeze and then touch surfaces like doorknobs or countertops, they can leave behind contagious viruses.
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What is Influenza (Flu)?
Influenza, commonly known as the flu, is a viral infection that leads to more severe and longer-lasting symptoms than the common cold.
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Describe influenza's Highly Contagious Nature
Flu viruses are extremely contagious and can be transmitted through various means, including coughs, sneezes, laughs, and even normal conversation. The highest contagiousness is within the first three days of the disease.
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What are the Influenza Types?
Two main types of influenza viruses, influenza A and influenza B, are responsible for most cases of the flu.
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Describe Flu Vaccination in Canada
The National Advisory Committee on Immunization (NACI) advises all Canadians aged six months and older to get the flu shot. New vaccines are created annually to safeguard against new strains of the influenza virus. The vaccine is most potent when given in October or November, offering full protection approximately two weeks after vaccination.
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What is Avian Influenza (Bird Flu)?
Avian influenza, commonly known as bird flu, is caused by viruses that naturally occur among wild birds. Most strains of bird flu do not affect humans, but a few have the potential to infect humans, albeit with difficulty.
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What is H1N1 Influenza?
H1N1 influenza is a strain of the flu virus that initially affected pigs but emerged in humans in North America in the spring of 2009 and subsequently spread worldwide.
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What is Severe Acute Respiratory Syndrome (SARS)?
SARS is a respiratory illness caused by a previously unknown type of coronavirus, characterized by severe symptoms and respiratory complications.
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Describe the Progression of SARS
SARS typically progresses from symptoms like cough, shortness of breath, and fever higher than 38°C to severe pneumonia and respiratory failure, making it a serious illness.
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What are Risk Factors of SARS?
The known risk factors for developing SARS include recent travel to areas where SARS is spreading locally and recent close contact with individuals who are ill and either have SARS or have been to affected areas.
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Describe SARS Contagiousness and Incubation
People with SARS do not appear to be contagious until they develop symptoms, and this may take up to 10 days from the time they were in close contact with someone affected by SARS.
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What is Meningitis?
Meningitis, or invasive meningococcal disease, is an infection that affects the fluid and membranes surrounding the brain and spinal cord. It can be caused by bacteria, viruses, or fungi.
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What are Common Bacterial Causes of meningitis?
Two common bacterial causes of meningitis are Neisseria meningitidis, responsible for meningococcal meningitis, and Streptococcus pneumoniae, which leads to pneumococcal meningitis.
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What are Common Symptoms of meningitis?
Symptoms of meningitis, which are similar across different types, include fever, drowsiness or confusion, severe headache, stiff neck, nausea, and vomiting.
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Meningitis progression and treatment
Meningitis can progress rapidly, often within as little as 12 hours. Without treatment, it can lead to severe complications such as permanent hearing loss, brain damage, seizures, or even death.
When detected early and treated with antibiotics, meningitis is usually curable. Timely medical intervention is crucial in managing this potentially life-threatening condition.
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What is Hepatitis?
Hepatitis is an inflammation of the liver, often caused by viral infections. Several different viruses, including hepatitis A, B, C, Delta, and E, can target the liver.
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What are Types of Hepatitis?
Hepatitis is categorized into several types, including hepatitis A, B, C, Delta, and E. Each type is caused by a specific virus and may have different transmission methods and symptoms.
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What are Common Symptoms of Hepatitis?
Common symptoms of hepatitis include headaches, fever, fatigue, joint pain, nausea, vomiting, diarrhea, and the enlargement and tenderness of the liver. Jaundice, characterized by yellowish skin and eyes, may also develop.
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How do you treat Hepatitis?
Treatment for hepatitis often involves rest, a high-protein diet, and the avoidance of alcohol and drugs that may stress the liver. In some cases, alpha interferon, a protein that enhances immunity and inhibits viral replication, may be used as a treatment option.
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What is Mononucleosis (Mono)?
Mononucleosis, commonly known as "Mono," is a viral disease that is most common among individuals aged 15 to 24. It is typically transmitted through close contact, such as kissing.
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What are Mono Symptoms?
Symptoms of mono include a sore throat, headache, fever, nausea, and prolonged weakness. The spleen becomes swollen, and lymph nodes are enlarged. Jaundice or a skin rash similar to German measles may also develop.
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Risks of Physical Activity with Mono?
The greatest danger of mono is the risk of engaging in physical activities that might rupture the spleen, leading to internal bleeding. Inflammation of the liver can also occur.
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How do you diagnose Mono?
Mono can be diagnosed through a blood test, which can confirm the presence of the Epstein-Barr virus (EBV), the common cause of mononucleosis.
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What is West Nile Virus?
West Nile virus is a mosquito-borne virus. Mosquitoes become infected by feeding on the blood of birds carrying the virus and can transmit the virus by biting other birds, animals, or people.
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What is Tuberculosis (TB)?
Tuberculosis is an infectious disease caused by bacteria that spread through the air when an infected person coughs, sneezes, or talks. It primarily affects the lungs but can also affect other parts of the body, such as the lymph nodes, kidneys, urinary tract, and bones.
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What is Pulmonary Tuberculosis?
More than half of TB cases reported in Canada are pulmonary tuberculosis, which means the infection occurs in the lungs, larynx, or airways.
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What is Latent TB Infection (LTBI)?
TB that remains contained or inactive in the body is called Latent TB Infection (LTBI). It doesn't make a person feel sick and cannot be spread to others. LTBI can become active at any time, with the risk of activation being highest in the first two years following infection.
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What are Risk Factors for Active TB?
The risk of developing active TB disease is increased in people with diseases or conditions that weaken the immune system, such as HIV/AIDS. Living in overcrowded housing, having limited access to healthcare, and certain population groups are also at higher risk of TB infection.
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TB in Canada
Certain populations in Canada, including Aboriginals, are disproportionately affected by TB. While TB rates have reduced in Aboriginal communities, they remain higher than those of non-Aboriginal Canadian-born populations. Factors like diabetes, HIV/AIDS, poverty, and limited access to healthcare contribute to the risk.
113
TB and HIV
TB is considered an "opportunistic" disease and is more likely to develop in individuals with reduced immunity. A healthy person exposed to TB has about a 10% chance of developing the disease, while a person with HIV has a 50% chance. TB and HIV co-infection is a significant health concern.
114
What are Sexually Transmitted Infections (STIs) or Diseases (STDs)?
STIs were once collectively known as venereal diseases (VD). The current terminology reflects the fact that many infected individuals display no symptoms and, therefore, cannot be said to have a disease. STIs include a range of infections transmitted through sexual contact.
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Testing for HIV in Canada
In Canada, all pregnant women are tested for HIV during pregnancy. The diagnosis for AIDS in Canada may differ from that in the U.S., depending on specific criteria.
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How to prevent against STIs
To protect against STIs during oral sex, individuals can use a dental dam, condom, or plastic wrap. A Pap test does not screen for STIs, and all sexually active people should be tested once a year for STIs.
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What is Lymphogranuloma Venereum (LGV)?
caused by bacteria that are a subtype of Chlamydia. LGV is more invasive than typical Chlamydia infections and is transmitted through unprotected oral, vaginal, and anal sex.
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LGV Symptoms and Treatment
Symptoms of LGV can include painless sores, lumps, fever, chills, fatigue, and swollen lymph nodes. Left untreated, it can lead to scarring, deformity, and in rare cases, more severe conditions. Treatment involves a three-week course of antibiotics.
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What are the ages with Highest STI Rates?
The highest rates of sexually transmitted infections (STIs) occur among 16- to 24-year-olds, particularly older teenagers.
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Describe STIs and Sterility
STIs are a major cause of preventable sterility. They have tripled the rate of ectopic (tubal) pregnancies, which can be fatal if not detected early.
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Describe STI Complications
STI complications can include miscarriage, premature delivery, and uterine infections after delivery. Infection with an STI greatly increases the risk of HIV transmission.
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Describe Transmission of STIs to Unborn and Newborn Children
Unborn and newborn children can be affected by STIs in the womb or during birth.
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Describe STI Pathogens environment
Although each STI is a distinct disease, all STI pathogens thrive in dark, warm, moist body surfaces, particularly the mucous membranes that line the reproductive organs. They are sensitive to light, cold, and dryness.
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Describe Asymptomatic STIs
Many STIs, including early HIV infection and gonorrhea in women, may not cause any symptoms. Infected individuals may unknowingly continue sexual activity, jeopardizing others' well-being.
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What is Trichomoniasis?
Trichomoniasis is a common vaginal infection caused by the protozoa Trichomonas vaginalis.
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What are the symptoms of Trichomoniasis?
It can lead to itching, burning, and abnormal vaginal discharge. Male carriers may have no symptoms but can develop urethritis or prostate inflammation.
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How do you treat Trichomoniasis?
Screening for syphilis, gonorrhea, chlamydia, and HIV is recommended for anyone with this infection. Both sexual partners should be treated with metronidazole (Flagyl™) to prevent reinfection
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What is Candidiasis (Yeast Infection)?
Candidiasis, commonly known as a yeast infection, is caused by the yeast Candida albicans.
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What are the symptoms of Candidiasis (Yeast Infection)?
It can result in burning, itching, whitish discharge, and typically affects the vagina, vulva, penis, and mouth
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What are risk factors of Candidiasis (Yeast Infection)?
Risk factors include no prior pregnancies, condom use for birth control, frequent sexual intercourse, recent antibiotic use (within 15 to 30 days), and stress
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How do you treat and prevent Candidiasis (Yeast Infection)?
Non-prescription vaginal medications like GyneLotrimin and Monistat are effective treatments. Male partners may be advised to use condoms during outbreaks, and women should keep the genital area dry and wear cotton underwear.
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What is Bacterial Vaginosis (BV)?
Bacterial vaginosis (BV) is characterized by changes in vaginal microorganisms, including depletion of certain bacteria and overgrowth of others. It leads to a white or grey vaginal discharge with a strong odor. The exact cause is unknown, but it's more common in women with multiple sex partners.
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What are symptoms of BV?
BV can lead to long-term complications like pelvic inflammatory disease and pregnancy issues. Diagnosis is based on symptoms, pelvic examination, and a whiff test using a potassium hydroxide (KOH) solution.
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How do you treat BV?
Metronidazole (Flagyl™) in pill or vaginal gel form is the primary treatment. Treating male partners may offer limited benefits, but some health practitioners recommend it for recurrent cases.
