Erythromycin Health Dictionary

Erythromycin: From 3 Different Sources


An antibiotic drug used to treat infections of the skin, chest, throat, and ears.

Erythromycin is useful in the treatment of pertussis and legionnaires’ disease.

Adverse effects include nausea, diarrhoea, and an itchy rash.

Health Source: BMA Medical Dictionary
Author: The British Medical Association
One of the MACROLIDES, it has an antibacterial spectrum similar, but not identical, to that of penicillin. The drug is a valuable alternative for patients who are allergic to penicillin. Erythromycin is used for respiratory infections, including spread within a family of WHOOPINGCOUGH, and also CHLAMYDIA, LEGIONNAIRE’S DISEASE, SYPHILIS and enteritis caused by CAMPYLOBACTER. It is also used with neomycin when preparing for bowel surgery. Though often active against penicillin-resistant staphylococci, these bacteria are now sometimes resistant to erythromycin. The drug may be given orally, intravenously or topically (for acne).
Health Source: Medical Dictionary
Author: Health Dictionary
n. an antibiotic used to treat respiratory and other infections caused by a wide range of bacteria. Side-effects are rare and mild, though nausea, vomiting, and diarrhoea occur occasionally.
Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Erythrasma

A super?cial mild infection of the skin caused by CORYNEBACTERIA. It produces pink or slightly brown ?aky areas of skin usually on the upper inner thighs or axillae. Toe clefts may be affected with thickened, white, macerated skin. The affected areas ?uoresce coral pink under ultraviolet light. CLOTRIMAZOLE or KETOCONAZOLE cream clears the rash rapidly. Very extensive erythrasma responds to oral ERYTHROMYCIN given for seven days.... erythrasma

Acne

A common skin condition starting after puberty, and which may persist for many years. It involves plugged pores (blackheads and whiteheads), pimples and deeper nodules on the face, neck, trunk and even the upper arms. It arises from pilosebaceous glands (relating to hair follicles and associated SEBACEOUS GLANDS). SEBUM production is increased and bacterial proliferation causes in?ammation with PAPULE and PUSTULE formation. Plugs of sebum and epidermal cells form blackheads (comedones); the colour is not due to dirt but to dried oil and shed skin cells in the hair-follicle openings.

Treatment Twice-daily washing with a salicylic-acid cleanser can help remove the pore-blocking debris, as can daily shampooing. Use only oil-free cosmetics and hide blackheads with a ?esh-tinted acne lotion containing benzoyl peroxide, acid or sulphur. Never squeeze blackheads, however tempting; ask a skin specialist how to do this properly. Other treatments include microdermabrasion, and the antibiotic lotions erythromycin and clindamycin may be e?ective. Tretinoin and adapilene can be used on the skin but are not permitted in pregnancy and may cause problems such as hypersensitivity to sunlight, so medical advice is essential. In resistant cases, long-term suppressive oral therapy with one of the TETRACYCLINES or with ERYTHROMYCIN may be necessary. In females a combined oestrogenantiandrogen ‘pill’ is an alternative. Severe resistant acne can be cleared by a 16- to 24week course of oral isotretinoin, but this drug is teratogenic (see TERATOGENESIS) and can cause many side-effects including depression, so its use requires specialist supervision.

See www.skincarephysicians.com/acnenet/... acne

Coffee

Nutritional Profile Energy value (calories per serving): Low Protein: Trace Fat: Trace Saturated fat: None Cholesterol: None Carbohydrates: Trace Fiber: Trace Sodium: Low Major vitamin contribution: None Major mineral contribution: None

About the Nutrients in This Food Coffee beans are roasted seeds from the fruit of the evergreen coffee tree. Like other nuts and seeds, they are high in proteins (11 percent), sucrose and other sugars (8 percent), oils (10 to 15 percent), assorted organic acids (6 percent), B vitamins, iron, and the central nervous system stimulant caffeine (1 to 2 percent). With the exceptions of caffeine, none of these nutrients is found in coffee. Like spinach, rhubarb, and tea, coffee contains oxalic acid (which binds calcium ions into insoluble compounds your body cannot absorb), but this is of no nutritional consequence as long as your diet contains adequate amounts of calcium-rich foods. Coffee’s best known constituent is the methylxanthine central ner- vous system stimulant caffeine. How much caffeine you get in a cup of coffee depends on how the coffee was processed and brewed. Caffeine is Caffeine Content/Coffee Servings Brewed coffee 60 mg/five-ounce cup Brewed/decaffeinated 5 mg/five-ounce cup Espresso  64 mg/one-ounce serving Instant  47 mg/rounded teaspoon

The Most Nutritious Way to Serve This Food In moderation, with high-calcium foods. Like spinach, rhubarb, and tea, coffee has oxalic acid, which binds calcium into insoluble compounds. This will have no important effect as long as you keep your consumption moderate (two to four cups of coffee a day) and your calcium consumption high.

Diets That May Restrict or Exclude This Food Bland diet Gout diet Diet for people with heart disease (regular coffee)

Buying This Food Look for: Ground coffee and coffee beans in tightly sealed, air- and moisture-proof containers. Avoid: Bulk coffees or coffee beans stored in open bins. When coffee is exposed to air, the volatile molecules that give it its distinctive flavor and richness escape, leaving the coffee flavorless and/or bitter.

Storing This Food Store unopened vacuum-packed cans of ground coffee or coffee beans in a cool, dark cabinet—where they will stay fresh for six months to a year. They will lose some flavor in storage, though, because it is impossible to can coffee without trapping some flavor- destroying air inside the can. Once the can or paper sack has been opened, the coffee or beans should be sealed as tight as possible and stored in the refrigerator. Tightly wrapped, refrigerated ground coffee will hold its freshness and flavor for about a week, whole beans for about three weeks. For longer storage, freeze the coffee or beans in an air- and moistureproof container. ( You can brew coffee directly from frozen ground coffee and you can grind frozen beans without thawing them.)

Preparing This Food If you make your coffee with tap water, let the water run for a while to add oxygen. Soft water makes “cleaner”-tasting coffee than mineral-rich hard water. Coffee made with chlorinated water will taste better if you refrigerate the water overnight in a glass (not plastic) bottle so that the chlorine evaporates. Never make coffee with hot tap water or water that has been boiled. Both lack oxygen, which means that your coffee will taste flat. Always brew coffee in a scrupulously clean pot. Each time you make coffee, oils are left on the inside of the pot. If you don’t scrub them off, they will turn rancid and the next pot of coffee you brew will taste bitter. To clean a coffee pot, wash it with detergent, rinse it with water in which you have dissolved a few teaspoons of baking soda, then rinse one more time with boiling water.

What Happens When You Cook This Food In making coffee, your aim is to extract flavorful solids (including coffee oils and sucrose and other sugars) from the ground beans without pulling bitter, astringent tannins along with them. How long you brew the coffee determines how much solid material you extract and how the coffee tastes. The longer the brewing time, the greater the amount of solids extracted. If you brew the coffee long enough to extract more than 30 percent of its solids, you will get bitter compounds along with the flavorful ones. (These will also develop by let- ting coffee sit for a long time after brewing it.) Ordinarily, drip coffee tastes less bitter than percolator coffee because the water in a drip coffeemaker goes through the coffee only once, while the water in the percolator pot is circulated through the coffee several times. To make strong but not bitter coffee, increase the amount of coffee—not the brewing time.

How Other Kinds of Processing Affect This Food Drying. Soluble coffees (freeze-dried, instant) are made by dehydrating concentrated brewed coffee. These coffees are often lower in caffeine than regular ground coffees because caffeine, which dissolves in water, is lost when the coffee is dehydrated. Decaffeinating. Decaffeinated coffee is made with beans from which the caffeine has been extracted, either with an organic solvent (methylene chloride) or with water. How the coffee is decaffeinated has no effect on its taste, but many people prefer water-processed decaf- feinated coffee because it is not a chemically treated food. (Methylene chloride is an animal carcinogen, but the amounts that remain in coffees decaffeinated with methylene chloride are so small that the FDA does not consider them hazardous. The carcinogenic organic sol- vent trichloroethylene [TCE], a chemical that causes liver cancer in laboratory animals, is no longer used to decaffeinate coffee.)

Medical Uses and/or Benefits As a stimulant and mood elevator. Caffeine is a stimulant. It increases alertness and concentra- tion, intensifies muscle responses, quickens heartbeat, and elevates mood. Its effects derive from the fact that its molecular structure is similar to that of adenosine, a natural chemical by-product of normal cell activity. Adenosine is a regular chemical that keeps nerve cell activ- ity within safe limits. When caffeine molecules hook up to sites in the brain when adenosine molecules normally dock, nerve cells continue to fire indiscriminately, producing the jangly feeling sometimes associated with drinking coffee, tea, and other caffeine products. As a rule, it takes five to six hours to metabolize and excrete caffeine from the body. During that time, its effects may vary widely from person to person. Some find its stimu- lation pleasant, even relaxing; others experience restlessness, nervousness, hyperactivity, insomnia, flushing, and upset stomach after as little as one cup a day. It is possible to develop a tolerance for caffeine, so people who drink coffee every day are likely to find it less imme- diately stimulating than those who drink it only once in a while. Changes in blood vessels. Caffeine’s effects on blood vessels depend on site: It dilates coronary and gastrointestinal vessels but constricts blood vessels in your head and may relieve headache, such as migraine, which symptoms include swollen cranial blood vessels. It may also increase pain-free exercise time in patients with angina. However, because it speeds up heartbeat, doc- tors often advise patients with heart disease to avoid caffeinated beverages entirely. As a diuretic. Caffeine is a mild diuretic sometimes included in over-the-counter remedies for premenstrual tension or menstrual discomfort.

Adverse Effects Associated with This Food Stimulation of acid secretion in the stomach. Both regular and decaffeinated coffees increase the secretion of stomach acid, which suggests that the culprit is the oil in coffee, not its caffeine. Elevated blood levels of cholesterol and homocysteine. In the mid-1990s, several studies in the Netherlands and Norway suggested that drinking even moderate amounts of coffee (five cups a day or less) might raise blood levels of cholesterol and homocysteine (by-product of protein metabolism considered an independent risk factor for heart disease), thus increas- ing the risk of cardiovascular disease. Follow-up studies, however, showed the risk limited to drinking unfiltered coffees such as coffee made in a coffee press, or boiled coffees such as Greek, Turkish, or espresso coffee. The unfiltered coffees contain problematic amounts of cafestol and kahweol, two members of a chemical family called diterpenes, which are believed to affect cholesterol and homocysteine levels. Diterpenes are removed by filtering coffee, as in a drip-brew pot. Possible increased risk of miscarriage. Two studies released in 2008 arrived at different conclusions regarding a link between coffee consumption and an increased risk of miscar- riage. The first, at Kaiser Permanente (California), found a higher risk of miscarriage among women consuming even two eight-ounce cups of coffee a day. The second, at Mt. Sinai School of Medicine (New York), found no such link. However, although the authors of the Kaiser Permanente study described it as a “prospective study” (a study in which the research- ers report results that occur after the study begins), in fact nearly two-thirds of the women who suffered a miscarriage miscarried before the study began, thus confusing the results. Increased risk of heartburn /acid reflux. The natural oils in both regular and decaffeinated coffees loosen the lower esophageal sphincter (LES), a muscular valve between the esopha- gus and the stomach. When food is swallowed, the valve opens to let food into the stomach, then closes tightly to keep acidic stomach contents from refluxing (flowing backwards) into the esophagus. If the LES does not close efficiently, the stomach contents reflux and cause heartburn, a burning sensation. Repeated reflux is a risk factor for esophageal cancer. Masking of sleep disorders. Sleep deprivation is a serious problem associated not only with automobile accidents but also with health conditions such as depression and high blood pres- sure. People who rely on the caffeine in a morning cup of coffee to compensate for lack of sleep may put themselves at risk for these disorders. Withdrawal symptoms. Caffeine is a drug for which you develop a tolerance; the more often you use it, the more likely you are to require a larger dose to produce the same effects and the more likely you are to experience withdrawal symptoms (headache, irritation) if you stop using it. The symptoms of coffee-withdrawal can be relieved immediately by drinking a cup of coffee.

Food/Drug Interactions Drugs that make it harder to metabolize caffeine. Some medical drugs slow the body’s metabolism of caffeine, thus increasing its stimulating effect. The list of such drugs includes cimetidine (Tagamet), disulfiram (Antabuse), estrogens, fluoroquinolone antibiotics (e.g., ciprofloxacin, enoxacin, norfloxacin), fluconazole (Diflucan), fluvoxamine (Luvox), mexi- letine (Mexitil), riluzole (R ilutek), terbinafine (Lamisil), and verapamil (Calan). If you are taking one of these medicines, check with your doctor regarding your consumption of caf- feinated beverages. Drugs whose adverse effects increase due to consumption of large amounts of caffeine. This list includes such drugs as metaproterenol (Alupent), clozapine (Clozaril), ephedrine, epinephrine, monoamine oxidase inhibitors, phenylpropanolamine, and theophylline. In addition, suddenly decreasing your caffeine intake may increase blood levels of lithium, a drug used to control mood swings. If you are taking one of these medicines, check with your doctor regarding your consumption of caffeinated beverages. Allopurinol. Coffee and other beverages containing methylxanthine stimulants (caffeine, theophylline, and theobromine) reduce the effectiveness of the antigout drug allopurinol, which is designed to inhibit xanthines. Analgesics. Caffeine strengthens over-the-counter painkillers (acetaminophen, aspirin, and other nonsteroidal anti-inflammatories [NSAIDS] such as ibuprofen and naproxen). But it also makes it more likely that NSAIDS will irritate your stomach lining. Antibiotics. Coffee increases stomach acidity, which reduces the rate at which ampicillin, erythromycin, griseofulvin, penicillin, and tetracyclines are absorbed when they are taken by mouth. (There is no effect when the drugs are administered by injection.) Antiulcer medication. Coffee increases stomach acidity and reduces the effectiveness of nor- mal doses of cimetidine and other antiulcer medication. False-positive test for pheochromocytoma. Pheochromocytoma, a tumor of the adrenal glands, secretes adrenalin, which is converted to VM A (vanillylmandelic acid) by the body and excreted in the urine. Until recently, the test for this tumor measured the levels of VM A in the patient’s urine and coffee, which contains VM A, was eliminated from patients’ diets lest it elevate the level of VM A in the urine, producing a false-positive test result. Today, more finely drawn tests make this unnecessary. Iron supplements. Caffeine binds with iron to form insoluble compounds your body cannot absorb. Ideally, iron supplements and coffee should be taken at least two hours apart. Birth control pills. Using oral contraceptives appears to double the time it takes to eliminate caffeine from the body. Instead of five to six hours, the stimulation of one cup of coffee may last as long as 12 hours. Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. Caffeine is a substance similar to tyramine. If you consume excessive amounts of a caffeinated beverage such as coffee while you are taking an M AO inhibitor, the result may be a hypertensive crisis. Nonprescription drugs containing caffeine. The caffeine in coffee may add to the stimulant effects of the caffeine in over-the-counter cold remedies, diuretics, pain relievers, stimulants, and weight-control products containing caffeine. Some cold pills contain 30 mg caffeine, some pain relievers 130 mg, and some weight-control products as much as 280 mg caffeine. There are 110 –150 mg caffeine in a five-ounce cup of drip-brewed coffee. Sedatives. The caffeine in coffee may counteract the drowsiness caused by sedative drugs; this may be a boon to people who get sleepy when they take antihistamines. Coffee will not, however, “sober up” people who are experiencing the inebriating effects of alcoholic beverages. Theophylline. Caffeine relaxes the smooth muscle of the bronchi and may intensif y the effects (and/or increase the risk of side effects) of this antiasthmatic drug.... coffee

Diphtheria

Diphtheria is an acute infectious disease of the respiratory tract. Rarely seen in the UK since the introduction of inoculation in 1940, it is still an important cause of disease in many parts of the world. The infection is caused by the Corynebacterium diphtheriae and is spread by water droplets. It usually presents with a sore throat, and there is a slightly raised membrane on the tonsils surrounded by an in?ammatory zone. There may be some swelling of the neck and lymph nodes, though the patient’s temperature is seldom much raised. Occasionally the disease occurs in the eye or genital tract, or it may complicate lesions of the skin. More serious consequences follow the absorption of TOXINS which damage the heart muscle and the nervous system.

Treatment Provided that the patient is not allergic to horse serum, an injection of the antitoxin is given immediately. A one-week course of penicillin is started (or erythromycin if the patient is allergic to penicillin). Diphtheria may cause temporary muscle weakness or paralysis, which should resolve without special treatment; if the respiratory muscles are involved, however, arti?cial respiration may be necessary.

All infants should be immunised against diphtheria; for details see table under IMMUNISATION.... diphtheria

Erysipelas

A streptococcal infection (see STREPTOCOCCUS) of the skin characterised by an acute onset with fever, malaise and a striking, usually unilateral, rash (see ERUPTION) almost always on a lower leg or the face. Shivering, local pain and tenderness are associated with a sharply de?ned, spreading, bright red swollen zone of skin in?ammation. On the leg, blistering and PURPURA may follow. The bacteria enter the skin through a ?ssure in a toe cleft (often associated with tinea pedis [RINGWORM]) or via a crack in the skin behind an ear or in a nostril.

Treatment PENICILLIN in full dosage should be given orally for ten days. In those allergic to penicillin, ERYTHROMYCIN can be substituted. Recurrent attacks are common and may cause progressive lymphatic damage leading to chronic OEDEMA. Such recurrences can be prevented by long-term prophylactic oral penicillin.... erysipelas

Cellulitis

A bacterial infection of the skin and the tissues beneath it, usually affecting the face, neck, or legs. Cellulitis is most commonly caused by streptococci bacteria, which enter the skin via a wound. The affected area is hot, tender, and red, and there may be fever and chills. Untreated cellulitis at the site of a wound may progress to bacteraemia and septicaemia or, occasionally, to gangrene. Cellulitis is usually more severe in people with reduced immune response, such as those with diabetes mellitus or an immunodeficiency disorder. Treatment is with an antibiotic such as a penicillin drug or erythromycin. (See also erysipelas.)... cellulitis

Granuloma Inguinale

A sexually transmitted infection that causes ulceration of the genitals. The infection is caused by CALYMMATOBACTERIUM GRANULOMATIS, also known as Donovan’s bodies. Granuloma inguinale is common in parts of the tropics but is rare in developed countries. The antibiotics tetracycline or erythromycin are effective treatments.... granuloma inguinale

Legionnaires’ Disease

A form of pneumonia that is caused by LEGIONELLA PNEUMOPHILA, a bacterium that breeds in warm, moist conditions. The source of infection is often an air-conditioning system in a large, public building.

The first symptoms include headache, muscular and abdominal pain, diarrhoea, and a dry cough.

Over the next few days, pneumonia develops, resulting in a high fever, shaking chills, coughing up of thick sputum (phlegm), drowsiness, and sometimes delirium.

Treatment is with the antibiotic drug erythromycin.... legionnaires’ disease

Macrolide Drugs

A class of antibiotic drugs used to treat a wide range of infections including those of the ear, nose, throat, respiratory and gastrointestinal tracts, and skin.

Common macrolides include azithromycin and erythromycin.... macrolide drugs

Atypical Pneumonia

any one of a group of community-acquired *pneumonias that do not respond to penicillin but do respond to such antibiotics as tetracycline and erythromycin. They include infection with Mycoplasma pneumoniae, Chlamydia psittaci (see psittacosis), and Coxiella burnetii (see Q fever).... atypical pneumonia

Impetigo

An infectious skin disease caused usually by Staphylococcus aureus and less often by Streptococcus pyogenes. The itching rash is seen especially on the face but may spread widely. Vesicles and pustules erupt and dry to form yellow-brown scabs. Untreated, the condition may last for weeks. In very young infants, large blisters may form (bullous impetigo).

Treatment Crusts should be gently removed with SALINE. Mild cases respond to frequent application of mupiricin or NEOMYCIN/BACITRACIN ointment; more severe cases should be treated orally or, sometimes, intravenously with FLUCLOXACILLIN or one of the CEPHALOSPORINS. If the patient is allergic to penicillin, ERYTHROMYCIN can be used.

For severe, intractable cases, an oral retinoid drug called isotretinoin (commercially produced as Roaccutane®) can be used. It is given systemically but treatment must be supervised by a consultant dermatologist as serious side-effects, including possible psychiatric disturbance, can occur. The drug is also teratogenic (see TERATOGENESIS), so women who are, or who may become, pregnant must not take isotretinoin. It acts mainly by suppressing SEBUM production in the sebaceous glands and can be very e?ective. Recurrent bouts of impetigo should raise suspicion of underlying SCABIES or head lice. Bactericidal soaps and instilling an antibiotic into the nostrils may also help.... impetigo

Legionnaire’s Disease

A form of PNEUMONIA due to a bacterium known as Legionella pneumophila, so-called because the ?rst identi?ed outbreak was in a group of US ex-servicemen (members of the American Legion). Inhalation of water aerosols seems the most likely way that people acquire the disease, for example from air-conditioning outlets. Some rubber outlets in showers and taps are able to support the growth of legionnellae so that high concentrations of the organism are released when the tap is ?rst used in the morning. In the presence of the disease, the treatment of infected water systems is essential by cleaning, chlorination, heating or a combination of all three.

The pneumonia caused by legionnellae has no distinctive clinical or radiological features, so that the diagnosis is based on an antibody test performed on a blood sample. There is no evidence that the disease is transmitted directly from person to person. The incubation period is 2–10 days; the disease starts with aches and pains followed rapidly by a rise in temperature, shivering attacks, cough and shortness of breath. The X-ray tends to show patchy areas of consolidation in the lungs. Erythromycin and rifampicin are the most useful antibiotics, although rifampicin should never be given alone because of the rapid development of drug resistance.... legionnaire’s disease

Macrolides

A group of ANTIBIOTICS. The original macrolide, ERYTHROMYCIN, was discovered in the early 1950s and used successfully as an alternative to PENICILLIN. The name ‘macrolide’ derives from the molecular structure of this group, three others of which are clarithromycin, azithromycin and spiramycin. Macrolides check PROTEIN synthesis in BACTERIA and the latest ones are, like erythromycin, active against several bacterial species including gram-positive COCCI and rods. In addition, they act against Haemophilus in?uenzae. Clarithromycin is potent against Helicobacter pylori; azithromycin is e?ective against infections caused by Legionella spp. (see LEGIONNAIRE’S DISEASE) and GONOCOCCI. Spiramycin is a restricted-use macrolide prescribed for pregnant patients with TOXOPLASMOSIS.... macrolides

Polyscias Fruticosa

(L.) Harms.

Synonym: Nothopanaxfruticosum (L.) Miq.

Panax fruticosus L.

Family: Araliaceae.

Habitat: Cultivated in gardens all over India.

Action: Leaf—used in sinusitis, headache, migraine, tonsillitis. Stem bark—used for promoting expulsion of placenta after child birth. Root— antibacterial, antifungal, diuretic. Leaf and root—used in dysuria.

The root contains polyacetylenes, falcarinol and heptadeca derivatives. Falcarinol and heptadeca exhibited strong antibacterial activity against Gram-positive bacteria and the der- matophytic bacteria, also showed an- tifungal activity. The antibacterial activity of falcarinol was found to be 15 to 35 times stronger than that of erythromycin, chloramphenicol and oxytetracyclin.

Polyscias scutellaria (Burm. f.) F. R. Fosberg (commonly grown in Indian gardens) exhibits anti-inflammatory activity. The leaves contain several tri- terpenoid saponins, polyscisaponins, oleanolic acid derivatives.... polyscias fruticosa

Bacteriostatic

adj. capable of inhibiting or retarding the growth and multiplication of bacteria. Erythromycin is bacteriostatic. Compare bactericidal.... bacteriostatic

Inclusion Conjunctivitis

a sexually transmitted disease caused by Chlamydia trachomatis. It can be transmitted to infants at birth, with the disease clinically apparent 5–13 days after birth. Diagnosis is by cell culture. Treatment in the newborn is with topical erythromycin; adults require oral tetracycline or doxycycline for three weeks.... inclusion conjunctivitis

Legionnaires’ Disease

an infection of the lungs caused by the bacterium Legionella pneumophila, named after an outbreak at the American Legion convention in Pennsylvania in 1976. Legionella organisms are widely found in water; outbreaks of the disease have been associated with defective central heating, air conditioning, and other ventilating systems. Symptoms appear after an incubation period of 2–10 days: malaise and muscle pain are succeeded by a fever, dry cough, chest pain, and breathlessness. X-ray of the lungs shows patchy consolidation. Erythromycin provides the most effective therapy.... legionnaires’ disease

Psittacosis

(parrot disease, ornithosis) n. an endemic infection of birds, especially parrots, budgerigars, canaries, finches, pigeons, and poultry, caused by a small intracellular bacterium, Chlamydia psittaci. The birds are often asymptomatic carriers. The infection is transmitted to humans by inhalation from handling the birds or by contact with feathers, faeces, or cage dust, but person-to-person transmission also occurs. The symptoms include fever, dry cough, severe muscle pain, and headache; occasionally a severe generalized systemic illness results. The condition responds to tetracycline or erythromycin.... psittacosis

Pneumonia

Pneumonia is an in?ammation of the lung tissue (see LUNGS) caused by infection. It can occur without underlying lung or general disease, or in patients with an underlying condition that makes them susceptible.

Pneumonia with no predisposing cause – community-acquired pneumonia – is caused most often by Streptococcus pneumoniae (PNEUMOCOCCUS). The other most common causes are viruses, Mycoplasma pneumoniae and Legionella species (Legionnaire’s disease). Another cause, Chlamydia psittaci, may be associated with exposure to perching birds.

In patients with underlying lung disease, such as CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) or BRONCHIECTASIS as in CYSTIC FIBROSIS, other organisms such as Haemophilus in?uenzae, Klebsiella, Escherichia coli and Pseudomonas aeruginosa are more prominent. In patients in hospital with severe underlying disease, pneumonia, often caused by gram-negative bacteria (see GRAM’S STAIN), is commonly the terminal event.

In patients with an immune system suppressed by pregnancy and labour, infection with HIV, CHEMOTHERAPY or immunosuppressive drugs after organ transplantation, a wider range of opportunistic organisms needs to be considered. Some of these organisms such as CYTOMEGALOVIRUS (CMV) or the fungus Pneumocystis carinii rarely cause disease in immunocompetent individuals – those whose body’s immune (defence) system is e?ective.

TUBERCULOSIS is another cause of pneumonia, although the pattern of lung involvement and the more chronic course usually di?erentiate it from other causes of pneumonia.

Symptoms The common symptoms of pneumonia are cough, fever (sometimes with RIGOR), pleuritic chest pain (see PLEURISY) and shortness of breath. SPUTUM may not be present at ?rst but later may be purulent or reddish (rusty).

Examination of the chest may show the typical signs of consolidation of an area of lung. The solid lung in which the alveoli are ?lled with in?ammatory exudate is dull to percussion but transmits sounds better than air-containing lung, giving rise to the signs of bronchial breathing and increased conduction of voice sounds to the stethoscope or palpating hand.

The chest X-ray in pneumonia shows opacities corresponding to the consolidated lung. This may have a lobar distribution ?tting with limitation to one area of the lung, or have a less con?uent scattered distribution in bronchopneumonia. Blood tests usually show a raised white cell (LEUCOCYTES) count. The organism responsible for the pneumonia can often be identi?ed from culture of the sputum or the blood, or from blood tests for the speci?c ANTIBODIES produced in response to the infection.

Treatment The treatment of pneumonia involves appropriate antibiotics together with oxygen, pain relief and management of any complications that may arise. When treatment is started, the causative organism has often not been identi?ed so that the antibiotic choice is made on the basis of the clinical features, prevalent organisms and their sensitivities. In severe cases of community-acquired pneumonia (see above), this will often be a PENICILLIN or one of the CEPHALOSPORINS to cover Strep. pneumoniae together with a macrolide such as ERYTHROMYCIN. Pleuritic pain will need analgesia to allow deep breathing and coughing; oxygen may be needed as judged by the oxygen saturation or blood gas measurement.

Possible complications of pneumonia are local changes such as lung abscess, pleural e?usion or EMPYEMA and general problems such as cardiovascular collapse and abnormalities of kidney or liver function. Appropriate treatment should result in complete resolution of the lung changes but some FIBROSIS in the lung may remain. Pneumonia can be a severe illness in previously ?t people and it may take some months to return to full ?tness.... pneumonia

Tonsillitis

Tonsillitis is the in?ammation of the TONSILS. The disorder may be the precurosor of a virus-induced infection of the upper respiratory tract such as the COMMON COLD, INFLUENZA or infectious MONONUCLEOSIS, in which case the in?ammation usually subsides as other symptoms develop. Such virus-induced tonsillitis does not respond to treatment with antibiotics. This section describes tonsillitis caused by bacterial infection.

Acute tonsillitis The infection is never entirely con?ned to the tonsils; there is always some involvement of the surrounding throat or pharynx. The converse is true that in many cases of ‘sore throat’, the tonsils are involved in the generalised in?ammation of the throat.

Causes Most commonly caused by the ?haemolytic STREPTOCOCCUS, its incidence is highest in the winter months. In the developing world it may be the presenting feature of DIPHTHERIA, a disease now virtually non-existant in the West since the introduction of IMMUNISATION.

Symptoms The onset is usually fairly sudden with pain on swallowing, fever and malaise. On examination, the tonsils are engorged and covered with a whitish discharge (PUS). This may occur at scattered areas over the tonsillar crypts (follicular tonsillitis), or it may be more extensive. The glands under the jaw are enlarged and tender, and there may be pain in the ear on the affected side: although usually referred pain, this may indicate spread of the infection up the Eustachian tube to the ear, particularly in children. Occasionally an ABSCESS, or quinsy, develops around the affected tonsil. Due to a collection of pus, it usually comes on four to ?ve days after the onset of the disease, and requires specialist surgical treatment.

Treatment Most cases need no treatment. Therefore, it is advisable to take a throat swab to assess the nature of any bacterial treatment before starting treatment. Penicillin or erythromycin are the drugs of choice where betahaemolytic streptococci are isolated, together with paracetamol or aspirin, and plenty of ?uids. Removal of tonsils is indicated: when the tonsils and adenoids are permanently so enlarged as to interfere with breathing (in such cases the adenoids are removed as well as the tonsils); when the individual is subject to recurrent attacks of acute tonsillitis which are causing signi?cant debility, absence from school or work on a regular basis (more than four times a year); when there is evidence of a tumour of the tonsil. Recurrent sore throat is not an indication for removing tonsils.... tonsillitis

Relapsing Fever

an infectious disease caused by bacteria of the genus *Borrelia, which is transmitted by ticks or lice and results in recurrent fever. The first episode of fever occurs about a week after infection: it is accompanied by severe headache and aching muscles and joints and lasts 2–8 days. Subsequent attacks are milder and occur at intervals of 3–10 days; untreated, the attacks may continue for up to 12 weeks. Treatment with antibiotics, such as tetracycline or erythromycin, is effective.... relapsing fever

Rosacea

n. a chronic inflammatory disease of the face in which the skin becomes abnormally flushed. At times it becomes pustular and there may be an associated *keratitis. The disease occurs in both sexes and at all ages but is most common in women in their thirties; the cause is unknown. Treatment is with topical metronidazole; oral tetracyclines, erythromycin, or isotretinoin; or pulsed dye laser.... rosacea

Whooping-cough

Whooping-cough, or pertussis, is a respiratory-tract infection caused by Bordetella pertussis and spread by droplets. It may occur at all ages, but around 90 per cent of cases are children aged under ?ve. Most common during the winter months, it tends to occur in epidemics (see EPIDEMIC), with periods of increased prevalence occurring every three to four years. It is a noti?able disease (see NOTIFIABLE DISEASES). The routine vaccination of infants with TRIPLE VACCINE (see also VACCINE; IMMUNISATION), which includes the vaccine against whooping-cough, has drastically reduced the incidence of this potentially dangerous infection. In the 1990s over 90 per cent of children in England had been vaccinated against whooping-cough by their second birthday. In an epidemic of whooping-cough, which extended from the last quarter of 1977 to mid-1979, 102,500 cases of whooping-cough were noti?ed in the United Kingdom, with 36 deaths. This was the biggest outbreak since 1957 and its size was partly attributed to the fall in vaccination acceptance rates because of media reports suggesting that pertussis vaccination was potentially dangerous and ine?ective. In 2002, 105 cases were noti?ed in England.

Symptoms The ?rst, or catarrhal, stage is characterised by mild, but non-speci?c, symptoms of sneezing, conjunctivitis (see under EYE, DISORDERS OF), sore throat, mild fever and cough. Lasting 10–14 days, this stage is the most infectious; unfortunately it is almost impossible to make a de?nite clinical diagnosis, although analysis of a nasal swab may con?rm a suspected case. This is followed by the second, or paroxysmal, stage with irregular bouts of coughing, often prolonged, and typically more severe at night. Each paroxysm consists of a succession of short sharp coughs, increasing in speed and duration, and ending in a deep, crowing inspiration, often with a characteristic ‘whoop’. Vomiting is common after the last paroxysm of a series. Lasting 2–4 weeks, this stage is the most dangerous, with the greatest risk of complications. These may include PNEUMONIA and partial collapse of the lungs, and ?ts may be induced by cerebral ANOXIA. Less severe complications caused by the stress of coughing include minor bleeding around the eyes, ulceration under the tongue, HERNIA and PROLAPSE of the rectum. Mortality is greatest in the ?rst year of life, particularly among neonates – infants up to four weeks old. Nearly all patients with whooping-cough recover after a few weeks, with a lasting IMMUNITY. Very severe cases may leave structural changes in the lungs, such as EMPHYSEMA, with a permanent shortness of breath or liability to ASTHMA.

Treatment Antibiotics, such as ERYTHROMYCIN or TETRACYCLINES, may be helpful if given during the catarrhal stage – largely in preventing spread to brothers and sisters – but are of no use during the paroxysmal stage. Cough suppressants are not always helpful unless given in high (and therefore potentially narcotic) doses, and skilled nursing may be required to maintain nutrition, particularly if the disease is prolonged, with frequent vomiting.... whooping-cough

Nongonococcal Urethritis

Formerly known as nonspecific urethritis, inflammation of the urethra due to a cause other than gonorrhoea. Worldwide, nongonococcal urethritis is a very common type of sexually transmitted infection.Almost 50 per cent of cases are known to be caused by chlamydia trachomatis (see chlamydial infections); others are caused by the virus that causes herpes simplex, trichomonas vaginalis infections

(see trichomoniasis), or other microorganisms. In the remainder of cases, the cause remains unknown.

In men, the infection usually causes a clear or a purulent urethral discharge, often accompanied by pain or discomfort on passing urine. The equivalent condition in women, called nonspecific genital infection, may not cause symptoms unless there are complications.

Treatment may be difficult if the cause of symptoms cannot be determined. Antibiotic drugs, such as doxycycline and erythromycin, are given. Follow-up visits may be advised after treatment.

In men, epididymitis, prostatitis and urethral stricture (narrowing of the urethra) can occur as complications of nongonococcal urethritis. Reiter’s syndrome (in which there is arthritis and conjunctivitis as well as urethritis) occurs as a complication in some men who develop nongonococcal urethritis.

In women, pelvic inflammatory disease and cysts of the Bartholin’s glands may occur. Ophthalmia neonatorum, a type of conjunctivitis, sometimes develops in babies born to women with chlamydial cervicitis.... nongonococcal urethritis

Pertussis

A highly contagious infectious disease, also called whooping cough, which mainly affects infants and young children. The main features of the illness are bouts of coughing, often ending in a characteristic “whoop”. The main cause is infection with BORDETELLA PERTUSSIS bacteria, which are spread in airborne droplets.

After an incubation period of 7–10 days, the illness starts with a mild cough, sneezing, nasal discharge, fever, and sore eyes. After a few days, the cough becomes more persistent and severe, especially at night. Whooping occurs in most cases. Sometimes the cough can

cause vomiting. In infants, there is a risk of temporary apnoea following a coughing spasm. The illness may last for a few weeks. The possible complications include nosebleeds, dehydration, pneumonia, pneumothorax, bronchiectasis (permanent widening of the airways), and convulsions. Untreated, pertussis may prove fatal.

Pertussis is usually diagnosed from the symptoms. In the early stages, erythromycin is often given to reduce the child’s infectivity. Treatment consists of keeping the child warm, giving small, frequent meals and plenty to drink, and protecting him or her from stimuli, such as smoke, that can provoke coughing. If the child becomes blue or persistently vomits after coughing, hospital admission is needed.

In developed countries, most infants are vaccinated against pertussis in the 1st year of life. It is usually given as part of the DPT vaccination at 2, 3, and 4 months of age. Possible complications include a mild fever and fretfulness. Very rarely, an infant may have a severe reaction, with high-pitched screaming or seizures.... pertussis




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