Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders characterized by impaired cortisol synthesis. It results from the deficiency of one of the five enzymes required for the synthesis of cortisol in the adrenal cortex. Most of these disorders involve excessive or deficient production of hormones such as glucocorticoids, mineralocorticoids, or sex steroids, and can alter development of primary or secondary sex characteristics in some affected infants, children, or adults. It is one of the most common autosomal recessive disorders in humans. Types
CAH can occur in various forms. The clinical presentation of each form is different and depends to a large extent on the underlying enzyme defect, its precursor retention, and deficient products. Classical forms appear in infancy, and nonclassical forms appear in late childhood. The presentation in patients with classic CAH can be further subdivided into two forms: salt-wasting and simple-virilizing, depending on whether mineralocorticoid deficiency presents or absents, respectively (you should put absents before presents to straight the meaning of respectively). This subtyping is often not clinically meaningful, though, because all patients lose salt to some degree, and clinical presentations may overlap. Classic
Salt-wasting
In 75% of cases of severe enzyme deficiency, insufficient aldosterone production can lead to salt wasting, failure to thrive, and potentially fatal hypovolemia and shock. A missed diagnosis of salt-loss CAH is related to the increased risk of early neonatal morbidity and death. Simple-virilizing
The main feature of CAH in newborn females is the abnormal development of the external genitalia, which has varying degrees of virilization.
Transmission occurs by direct contact with infected animals  body fluid and tissues and entry is through skin abrasions, nasal and oral mucosal surfaces, or inhalation. Diagnosis
The mallein test is a sensitive and specific clinical test for glanders. Mallein (ATCvet code: QI05AR01 (WHO)), a protein fraction of the glanders organism (B. mallei), is injected intradermopalpebrally or given by eye drop. In infected animals, the eyelid swells markedly in 1 to 2 days. Historical cases and potential use in war
Glanders has been known since antiquity, with a description by Hippocrates around 425 BCE. However, historian Lise Wilkinson has described the incredible difficulty of studying outbreaks of glanders in history.From the Middle Ages to the 1900s, glanders was a significant threat to armies. Before the Battle of Blenheim in 1704, glanders may have afflicted and greatly diminished the horses of Marshal Tallards cavalry, helping the Duke of Marlborough win the battle.Glanders was a significant problem for civilian use of horses, as well. In the 18th-century veterinary hospital at the École Nationale Vétérinaire dAlfort, glanders was the most common disease among their equine patients and the one most likely to cause death.Due to the high mortality rate in humans and the small number of organisms required to establish infection, B. mallei is regarded as a potential biological warfare or bioterrorism agent, as is the closely related organism, B. pseudomallei, the causative agent of melioidosis.