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When NASA first started sending up astronauts, they quickly discovered that ballpoint pens would not work in zero gravity. To combat the problem, NASA scientists spent a decade and $12 Billion to develop a pen that writes in zero gravity, upside down, underwater, on almost any surface including glass and at temperatures ranging from below freezing to 300C.

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A woman is shopping for a pet as a gift for her husband, but she is concerned that the prices that the Pet Shop are charging are very high. She goes to the clerk and explains her concern. "Well, I have a frog in the back that I can let you have for $50," the clerk says.

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When NASA first started sending up astronauts, they quickly discovered that ballpoint pens would not work in zero gravity. To combat the problem, NASA scientists spent a decade and $12 Billion to develop a pen that writes in zero gravity, upside down, underwater, on almost any surface including glass and at temperatures ranging from below freezing to 300C.

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A man and a woman who have never met before find themselves in the same sleeping carriage on a train. After the initial embarrassment they both go to sleep -- the man on the top bunk, and the woman on the lower.

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The lymphadenitis of plague is most commonly mistaken for the lymphadenitis accompanying staphylococcal or streptococcal infections of an extremity, sexually transmitted diseases such as lymphogranuloma venereum or syphilis, and tularemia. The systemic manifestations resemble those of enteric or rickettsial fevers, malaria, or influenza. The pneumonia resembles other bacterial pneumonias, and the meningitis is similar to those caused by other bacteria.

The presentation of chronic meningitis is less acute than purulent meningitis. Patients with chronic meningitis usually have a history of symptoms lasting weeks to months. The most common pathogens are Mycobacterium tuberculosis, atypical mycobacteria, fungi (Cryptococcus, Coccidioides, Histoplasma), and spirochetes (Treponema pallidum and Borrelia burgdorferi, the cause of Lyme disease). The diagnosis is made by culture or in some cases by serologic tests (cryptococcosis, coccidioidomycosis, syphilis, Lyme disease).

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The diagnosis of tetanus is made clinically.

These infections are caused by free-living amebas and present as two distinct syndromes. The diagnosis is confirmed by culture (Acanthamoeba spp. and Balamuthia mandrillaris) or identification of the organism in a wet mount of cerebrospinal fluid (Naegleria fowleri) or on biopsy specimens. No effective therapy is available.

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A variety of vaccines, involving attenuated or genetically modified virus, are under study including combinations of attenuated dengue strains.
Given that over 95% of patients recover without specific antiviral therapy, treatment is largely symptomatic. Acyclovir decreases viral shedding but does not have verified clinical benefit. Efforts to sensitize the virus to nucleoside analogs have yet to be proved beneficial. Symptomatic relief can be achieved with acetaminophen or other nonsteroidal anti-inflammatory drugs and warm saline throat irrigations or gargles three or four times daily. Corticosteroid therapy, although widespread, is not recommended in uncomplicated cases; its use is reserved for impending airway obstruction from enlarged lymph nodes, hemolytic anemia, and severe thrombocytopenia. The value of corticosteroid therapy in impending splenic rupture, pericarditis, myocarditis, and nervous system involvement is less well defined. If a throat culture grows -hemolytic streptococci, a 10-day course of penicillin or erythromycin is indicated. Ampicillin and amoxicillin are avoided because of the frequent association with rash.

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In a person who recovers from clinical or subclinical typhus infection, R prowazekii may survive in lymphoid tissues. Years later, there may be a recrudescence of disease (Brill-Zinsser disease) without exposure to infected lice, which can serve as a point source for future outbreaks.
Initially, EBV infection is associated with granulocytopenia followed within 1 week by a lymphocytic leukocytosis. Many lymphocytes atypical; specifically, they are larger than normal mature lymphocytes, stain more darkly, and show vacuolated, foamy cytoplasm and dark chromatin in the nucleus. Hemolytic anemia, usually secondary to anti-i antibodies, is occasionally encountered, as is thrombocytopenia (at times marked).

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Immunization is not always effective but should be considered for household contacts of a typhoid carrier, for travelers to endemic areas, and during epidemic outbreaks. A multiple-dose oral vaccine and a single-dose parenteral vaccine are available. Their efficacies are similar, but oral vaccine causes fewer side effects. Boosters, when indicated, should be given every 5 years and 3 years for oral and parenteral preparations, respectively.
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Brouwer AE et al: Combination antifungal therapies for HIV-associated cryptococcal meningitis: a randomized trial. Lancet 2004;363:1764. [PMID: 15172774]
Prabhu RM et al: Mucormycosis and entomophthoramycocis: a review of the clinical manifestations, diagnosis, and treatment. Clin Microbiol Infect 2004;10(Suppl 1):31. [PMID: 14748801]

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HIV can be transmitted from bites (either from biting or receiving a bite from an HIV-infected patient) but has rarely been reported.