Archive for the ‘Anti-Infectives’ Category

FUNGAL INFECTIONS: TINEA VERSICOLOR

May 9th, 2011 by admin
Tinea versicolor is a misnomer because it is not actually a tinea or dermatophyte. The name pityriasis is more appropriate for this infection, which is caused by Malassezia furfur. Versicolor presents as hypopigmented macules (sometimes hyperpigmented) scattered on the shoulders, upper back, and chest. The macules may be pink, red, light-brown, or white and have a slight scale, which may only be seen after scratching.
The hypopigmentation may only be noted after sun exposure. The macules are sometimes mistaken for vitiligo, but vitiligo is characterized by a complete loss of pigment. Versicolor will fluoresce a gold or orange-brown color under a Wood lamp. KOH preparation of scales reveals non-branching hyphae and clusters of round spores, described as the “spaghetti-and-meatballs” pattern.
Pityriasis versicolor responds well to topical therapy with dandruff shampoos containing selenium sulfide (Selsun) or pyrithione zinc (Head & Shoulders). A lather should be applied to the affected skin and left to sit for 10 minutes daily for 1 week. Ketoconazole shampoo is another option that can be used twice weekly for 4 weeks. Topical antifungal agents are also recommended by some practitioners.
Widespread or persistent cases can be treated with oral ketoconazole. Ketoconazole can be given as 200 mg daily for 7 to 10 days. Another option is 400 mg ketoconazole once, and some practitioners consider this the treatment of choice. This should be followed by exercise to induce sweating, and the patient should wait 1 day before showering. This should be repeated in 1 week. Other oral regimens include fluconazole 300 to 400 mg once or itraconazole 400 g daily for 3 to 7 days.
The discoloration of pityriasis versicolor does not resolve immediately following treatment. Normal pigmentation will not return until the skin is exposed to sunlight. Response to treatment is presumed when the scales disappear.
*115/348/5*

FEVER IN RETURNED TRAVELERS: LABORATORY INVESTIGATION

March 9th, 2011 by admin
The initial laboratory evaluation should focus on diseases that are life-threatening, and the chief considerations are falciparum malaria and typhoid fever. Thick and thin blood films for malaria and blood cultures for typhoid fever are important initial diagnostic steps in the evaluation of febrile travelers. Thick smears for malaria are more sensitive, whereas thin smears are better for the determination of the malaria species. If the initial blood films are negative and malaria is still suspected, smears should be repeated every 8 to 12 hours, particularly during febrile episodes, for several days. Blood cultures for typhoid fever, as well as other enteric infections, are usually positive within the first week of illness.
Other useful screening tests include a complete blood cell count with a differential (paying close attention to eosinophilia), blood chemistries, liver-associated enzymes, and a urinalysis with urine culture. Since most viral and rickettsial infections are diagnosed by demonstrating an antibody response, storing a tube of acute serum when a patient is first evaluated may provide the diagnosis when accompanied with a convalescent sample at a later date.
*201/348/5*

FEVER IN RETURNED TRAVELERS: LABORATORY INVESTIGATIONThe initial laboratory evaluation should focus on diseases that are life-threatening, and the chief considerations are falciparum malaria and typhoid fever. Thick and thin blood films for malaria and blood cultures for typhoid fever are important initial diagnostic steps in the evaluation of febrile travelers. Thick smears for malaria are more sensitive, whereas thin smears are better for the determination of the malaria species. If the initial blood films are negative and malaria is still suspected, smears should be repeated every 8 to 12 hours, particularly during febrile episodes, for several days. Blood cultures for typhoid fever, as well as other enteric infections, are usually positive within the first week of illness.Other useful screening tests include a complete blood cell count with a differential (paying close attention to eosinophilia), blood chemistries, liver-associated enzymes, and a urinalysis with urine culture. Since most viral and rickettsial infections are diagnosed by demonstrating an antibody response, storing a tube of acute serum when a patient is first evaluated may provide the diagnosis when accompanied with a convalescent sample at a later date.*201/348/5*

FLESH-EATING BACTERIA: VICIOUS ASSAILANTS

December 30th, 2010 by admin
Recently, a woman in Oregon was surprised by the net result of a shopping trip to a toy store. After reaching to a high shelf to get a toy, she noticed that she had cut her arm on the way down. She went home, bandaged it, thought nothing of it, and went about her business. What was to follow was a battle for her life, for unknowingly, she had come in contact with a deadly pathogen, a rare form of flesh-eating strep bacteria known as necrotizing fasciitis. She was one of over 800 cases diagnosed in the United States that year, with over 25 percent resulting in death. Within 24 hours after the infection, she, and others like her, experienced the following symptoms:
- Some minor pain in general area of wound (most dismissed this as insignificant)
- Pain that grew proportionately worse with time
- Flu-like symptoms such as diarrhea, fever, confusion, dizziness, weakness, and general malaise
- Intense thirst due to dehydration
- A combination of all these symptoms, which made the victims feel worse than they had ever felt before
Without treatment, the disease progresses quickly, and within 48 hours the following may occur:
- The infected, painful area begins to swell and may turn from blue to purple to black.
- The area may begin to show large, dark marks that will become blisters filled with black, pus-like fluid that may begin to drain or weep.
- The skin in the area will appear to die, taking on a bluish, white, or dark flaky appearance.
If the disease progresses without effective treatment, the following will occur:
- Blood pressure may drop severely.
- The person may sweat profusely, get the chills, and have clammy, cool skin.
- The body may go into toxic shock.
- The person may lapse into sleep or coma-like state, characterized by unresponsiveness and disorientation.
- The person may finally lapse into unconsciousness as the body becomes too weak to fight the disease.
Early treatments for the disease include antibiotic therapy, treatment in a pure oxygen chamber to speed healing, immuno-boosting therapies, and rest. If victims don’t die, they may be left with a wide range of injuries an deformities, ranging from scarring to amputated limbs.
Because the bacteria is so lethal, it takes only a very small opening, as small as a tiny pin prick or even a bruise, blister, or scrape for the bacteria to take hold. These bacteria are related I germs that cause strep throat and can be passed along even when only а droplet from a sneeze or cough by someone carrying it reaches an open wound. Preventive measures include thorough hand washing, especially after coughing and sneezing or before preparing foods or eating. Because door handles, toilet handles, handles on grocery carts, and other commonly touched items often are teeming with bacteria, hand washing becomes even more important in public places. About 15-30 percent of the population are carriers of strep A bacteria, in most cases with no symptoms and without being contagious.
*25/277/5*

FLESH-EATING BACTERIA: VICIOUS ASSAILANTSRecently, a woman in Oregon was surprised by the net result of a shopping trip to a toy store. After reaching to a high shelf to get a toy, she noticed that she had cut her arm on the way down. She went home, bandaged it, thought nothing of it, and went about her business. What was to follow was a battle for her life, for unknowingly, she had come in contact with a deadly pathogen, a rare form of flesh-eating strep bacteria known as necrotizing fasciitis. She was one of over 800 cases diagnosed in the United States that year, with over 25 percent resulting in death. Within 24 hours after the infection, she, and others like her, experienced the following symptoms:- Some minor pain in general area of wound (most dismissed this as insignificant)- Pain that grew proportionately worse with time- Flu-like symptoms such as diarrhea, fever, confusion, dizziness, weakness, and general malaise- Intense thirst due to dehydration- A combination of all these symptoms, which made the victims feel worse than they had ever felt beforeWithout treatment, the disease progresses quickly, and within 48 hours the following may occur:- The infected, painful area begins to swell and may turn from blue to purple to black.- The area may begin to show large, dark marks that will become blisters filled with black, pus-like fluid that may begin to drain or weep.- The skin in the area will appear to die, taking on a bluish, white, or dark flaky appearance.If the disease progresses without effective treatment, the following will occur:- Blood pressure may drop severely. - The person may sweat profusely, get the chills, and have clammy, cool skin.- The body may go into toxic shock.- The person may lapse into sleep or coma-like state, characterized by unresponsiveness and disorientation.- The person may finally lapse into unconsciousness as the body becomes too weak to fight the disease.Early treatments for the disease include antibiotic therapy, treatment in a pure oxygen chamber to speed healing, immuno-boosting therapies, and rest. If victims don’t die, they may be left with a wide range of injuries an deformities, ranging from scarring to amputated limbs.Because the bacteria is so lethal, it takes only a very small opening, as small as a tiny pin prick or even a bruise, blister, or scrape for the bacteria to take hold. These bacteria are related I germs that cause strep throat and can be passed along even when only а droplet from a sneeze or cough by someone carrying it reaches an open wound. Preventive measures include thorough hand washing, especially after coughing and sneezing or before preparing foods or eating. Because door handles, toilet handles, handles on grocery carts, and other commonly touched items often are teeming with bacteria, hand washing becomes even more important in public places. About 15-30 percent of the population are carriers of strep A bacteria, in most cases with no symptoms and without being contagious.*25/277/5*