Tetracyclines Health Dictionary

Oxytetracycline is an antibiotic derived from a soil organism, Streptomyces rimosus. Its range of antibacterial activity is comparable to that of tetracycline (see TETRACYCLINES).... oxytetracycline

Common chronic in?ammation of the facial skin, this condition is seen in middle and late life. Redness, obvious dilatation of venules and crops of ACNE-like papules and pustules affect mainly the central forehead, cheeks, nose and chin. A keratoconjunctivitis (combined in?ammation of the cornea and conjunctiva of the EYE) may be associated. Subjects ?ush easily, especially after alcohol or hot drinks. Eventually the affected areas may become thickened and oedematous, and in men, proliferation of ?brous and sebaceous tissue may lead to gross thickening and enlargement of the nose (RHINOPHYMA).

Treatment Long-term, low-dose, oral tetracycline (see ANTIBIOTICS; TETRACYCLINES) is the treatment of choice. In mild cases, METRONIDAZOLE gel can be helpful. Potent topical CORTICOSTEROIDS are contraindicated and make rosacea worse.... rosacea

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

A chronic infectious condition caused by an anaerobic micro-organism, Actinomyces israelii, that often occurs as a COMMENSAL on the gums, teeth and tonsils. Commonest in adult men, the sites most affected are the jaw, lungs and intestine, though the disease can occur anywhere. Suppurating granulomatous tumours develop which discharge an oily, thick pus containing yellowish (‘sulphur’) granules. A slowly progressive condition, actinomycosis usually responds to antibiotic drugs but improvement may be slow and surgery is sometimes needed to drain infected sites. Early diagnosis is important. Treatment is with antibiotics such as penicillin and tetracyclines. The disease occurs in cattle, where it is known as woody tongue.... actinomycosis

A group of drugs, which include ANTIBIOTICS, used to treat infections caused by BACTERIA. Drugs include CEPHALOSPORINS and cephamycins, TETRACYCLINES, AMINOGLYCOSIDES, MACROLIDES, and antituberculous compounds.... antibacterial drugs

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: Moderate Saturated fat: High Cholesterol: Moderate Carbohydrates: None Fiber: None Sodium: Low Major vitamin contribution: B vitamins Major mineral contribution: Iron, phosphorus, zinc

About the Nutrients in This Food Like fish, pork, poultry, milk, and eggs, beef has high-quality proteins, with sufficient amounts of all the essential amino acids. Beef fat is slightly more highly saturated than pork fat, but less saturated than lamb fat. All have about the same amount of cholesterol per serving. Beef is an excellent source of B vitamins, including niacin, vitamin B6, and vitamin B12, which is found only in animal foods. Lean beef pro- vides heme iron, the organic iron that is about five times more useful to the body than nonheme iron, the inorganic form of iron found in plant foods. Beef is also an excellent source of zinc. One four-ounce serving of lean broiled sirloin steak has nine grams fat (3.5 g saturated fat), 101 mg cholesterol, 34 g protein, and 3.81 mg iron (21 percent of the R DA for a woman, 46 percent of the R DA for a man). One four-ounce serving of lean roast beef has 16 g fat (6.6 g saturated fat), 92 mg cholesterol, and 2.96 mg iron (16 percent of the R DA for a woman, 37 percent of the R DA for a man).

The Most Nutritious Way to Serve This Food With a food rich in vitamin C. Ascorbic acid increases the absorption of iron from meat. * These values apply to lean cooked beef.

Diets That May Restrict or Exclude This Food Controlled-fat, low-cholesterol diet Low-protein diet (for some forms of kidney disease)

Buying This Food Look for: Fresh, red beef. The fat should be white, not yellow. Choose lean cuts of beef with as little internal marbling (streaks of fat) as possible. The leanest cuts are flank steak and round steak; rib steaks, brisket, and chuck have the most fat. USDA grading, which is determined by the maturity of the animal and marbling in meat, is also a guide to fat content. U.S. prime has more marbling than U.S. choice, which has more marbling than U.S. good. All are equally nutritious; the difference is how tender they are, which depends on how much fat is present. Choose the cut of meat that is right for your recipe. Generally, the cuts from the cen- ter of the animal’s back—the rib, the T-Bone, the porterhouse steaks—are the most tender. They can be cooked by dry heat—broiling, roasting, pan-frying. Cuts from around the legs, the underbelly, and the neck—the shank, the brisket, the round—contain muscles used for movement. They must be tenderized by stewing or boiling, the long, moist cooking methods that break down the connective tissue that makes meat tough.

Storing This Food Refrigerate raw beef immediately, carefully wrapped to prevent its drippings from contami- nating other foods. Refrigeration prolongs the freshness of beef by slowing the natural multi- plication of bacteria on the meat surface. Unchecked, these bacteria will convert proteins and other substances on the surface of the meat to a slimy film and change meat’s sulfur-contain- ing amino acids methionine and cystine into smelly chemicals called mercaptans. When the mercaptans combine with myoglobin, they produce the greenish pigment that gives spoiled meat its characteristic unpleasant appearance. Fresh ground beef, with many surfaces where bacteria can live, should be used within 24 to 48 hours. Other cuts of beef may stay fresh in the refrigerator for three to five days.

Preparing This Food Trim the beef carefully. By judiciously cutting away all visible fat you can significantly reduce the amount of fat and cholesterol in each serving. When you are done, clean all utensils thoroughly with soap and hot water. Wash your cutting board, wood or plastic, with hot water, soap, and a bleach-and-water solution. For ultimate safety in preventing the transfer of microorganisms from the raw meat to other foods, keep one cutting board exclusively for raw meats, fish, and poultry, and a second one for everything else. Finally, don’t forget to wash your hands.

What Happens When You Cook This Food Cooking changes the appearance and flavor of beef, alters nutritional value, makes it safer, and extends its shelf life. Browning meat after you cook it does not “seal in the juices,” but it does change the fla- vor by caramelizing sugars on the surface. Because beef’s only sugars are the small amounts of glycogen in the muscles, we add sugars in marinades or basting liquids that may also con- tain acids (vinegar, lemon juice, wine) to break down muscle fibers and tenderize the meat. (Browning has one minor nutritional drawback. It breaks amino acids on the surface of the meat into smaller compounds that are no longer useful proteins.) When beef is cooked, it loses water and shrinks. Its pigments, which combine with oxygen, are denatured (broken into fragments) by the heat and turn brown, the natural color of well-done meat. At the same time, the fats in the beef are oxidized. Oxidized fats, whether formed in cooking or when the cooked meat is stored in the refrigerator, give cooked meat a character- istic warmed-over flavor. Cooking and storing meat under a blanket of antioxidants—catsup or a gravy made of tomatoes, peppers, and other vitamin C-rich vegetables—reduces the oxidation of fats and the intensity of warmed-over flavor. Meat reheated in a microwave oven also has less warmed-over flavor. An obvious nutritional benefit of cooking is the fact that heat lowers the fat content of beef by liquif ying the fat so it can run off the meat. One concrete example of how well this works comes from a comparison of the fat content in regular and extra-lean ground beef. According to research at the University of Missouri in 1985, both kinds of beef lose mass when cooked, but the lean beef loses water and the regular beef loses fat and cholesterol. Thus, while regular raw ground beef has about three times as much fat (by weight) as raw ground extra-lean beef, their fat varies by only 5 percent after broiling. To reduce the amount of fat in ground beef, heat the beef in a pan until it browns. Then put the beef in a colander, and pour one cup of warm water over the beef. Repeat with a second cup of warm water to rinse away fat melted by heating the beef. Use the ground beef in sauce and other dishes that do not require it to hold together. Finally, cooking makes beef safer by killing Salmonella and other organisms in the meat. As a result, cooking also serves as a natural preservative. According to the USDA, large pieces of fresh beef can be refrigerated for two or three days, then cooked and held safely for another day or two because the heat of cooking has reduced the number of bacteria on the surface of the meat and temporarily interrupted the natural cycle of deterioration.

How Other Kinds of Processing Affect This Food Aging. Hanging fresh meat exposed to the air, in a refrigerated room, reduces the moisture content and shrinks the meat slightly. As the meat ages enzymes break down muscle pro- teins, “tenderizing” the beef. Canning. Canned beef does not develop a warmed-over flavor because the high tempera- tures in canning food and the long cooking process alter proteins in the meat so that they act as antioxidants. Once the can is open, however, the meat should be protected from oxygen that will change the flavor of the beef. Curing. Salt-curing preserves meat through osmosis, the physical reaction in which liquids flow across a membrane, such as the wall of a cell, from a less dense to a more dense solution. The salt or sugar used in curing dissolves in the liquid on the surface of the meat to make a solution that is more dense than the liquid inside the cells of the meat. Water flows out of the meat and out of the cells of any microorganisms living on the meat, killing the microor- ganisms and protecting the meat from bacterial damage. Salt-cured meat is much higher in sodium than fresh meat. Freezing. When you freeze beef, the water inside its cells freezes into sharp ice crystals that can puncture cell membranes. When the beef thaws, moisture (and some of the B vitamins) will leak out through these torn cell walls. The loss of moisture is irreversible, but some of the vitamins can be saved by using the drippings when the meat is cooked. Freezing may also cause freezer burn—dry spots left when moisture evaporates from the surface of the meat. Waxed freezer paper is designed specifically to hold the moisture in meat; plastic wrap and aluminum foil are less effective. NOTE : Commercially prepared beef, which is frozen very quickly at very low temperatures, is less likely to show changes in texture. Irradiation. Irradiation makes meat safer by exposing it to gamma rays, the kind of high- energy ionizing radiation that kills living cells, including bacteria. Irradiation does not change the way meat looks, feels or tastes, or make the food radioactive, but it does alter the structure of some naturally occurring chemicals in beef, breaking molecules apart to form new com- pounds called radiolytic products (R P). About 90 percent of R Ps are also found in nonirradiated foods. The rest, called unique radiolytic products (UR P), are found only in irradiated foods. There is currently no evidence to suggest that UR Ps are harmful; irradiation is an approved technique in more than 37 countries around the world, including the United States. Smoking. Hanging cured or salted meat over an open fire slowly dries the meat, kills micro- organisms on its surface, and gives the meat a rich, “smoky” flavor that varies with the wood used in the fire. Meats smoked over an open fire are exposed to carcinogenic chemicals in the smoke, including a-benzopyrene. Meats treated with “artificial smoke flavoring” are not, since the flavoring is commercially treated to remove tar and a-benzopyrene.

Medical Uses and/or Benefits Treating and/or preventing iron deficiency. Without meat in the diet, it is virtually impossible for an adult woman to meet her iron requirement without supplements. One cooked 3.5- ounce hamburger provides about 2.9 mg iron, 16 percent of the R DA for an adult woman of childbearing age. Possible anti-diabetes activity. CLA may also prevent type 2 diabetes, also called adult-onset diabetes, a non-insulin-dependent form of the disease. At Purdue University, rats bred to develop diabetes spontaneously between eight and 10 weeks of age stayed healthy when given CLA supplements.

Adverse Effects Associated with This Food Increased risk of heart disease. Like other foods from animals, beef contains cholesterol and saturated fats that increase the amount of cholesterol circulating in your blood, raising your risk of heart disease. To reduce the risk of heart disease, the National Cholesterol Education Project recommends following the Step I and Step II diets. The Step I diet provides no more than 30 percent of total daily calories from fat, no more than 10 percent of total daily calories from saturated fat, and no more than 300 mg of cholesterol per day. It is designed for healthy people whose cholesterol is in the range of 200 –239 mg/dL. The Step II diet provides 25– 35 percent of total calories from fat, less than 7 percent of total calories from saturated fat, up to 10 percent of total calories from polyunsaturated fat, up to 20 percent of total calories from monounsaturated fat, and less than 300 mg cho- lesterol per day. This stricter regimen is designed for people who have one or more of the following conditions: •  Existing cardiovascular disease •  High levels of low-density lipoproteins (LDLs, or “bad” cholesterol) or low levels of high-density lipoproteins (HDLs, or “good” cholesterol) •  Obesity •  Type 1 diabetes (insulin-dependent diabetes, or diabetes mellitus) •  Metabolic syndrome, a.k.a. insulin resistance syndrome, a cluster of risk fac- tors that includes type 2 diabetes (non-insulin-dependent diabetes) Increased risk of some cancers. According the American Institute for Cancer Research, a diet high in red meat (beef, lamb, pork) increases the risk of developing colorectal cancer by 15 percent for every 1.5 ounces over 18 ounces consumed per week. In 2007, the National Can- cer Institute released data from a survey of 500,000 people, ages 50 to 71, who participated in an eight-year A AR P diet and health study identif ying a higher risk of developing cancer of the esophagus, liver, lung, and pancreas among people eating large amounts of red meats and processed meats. Food-borne illness. Improperly cooked meat contaminated with E. coli O157:H7 has been linked to a number of fatalities in several parts of the United States. In addition, meats con- taminated with other bacteria, viruses, or parasites pose special problems for people with a weakened immune system: the very young, the very old, cancer chemotherapy patients, and people with HIV. Cooking meat to an internal temperature of 140°F should destroy Salmo- nella and Campylobacter jejuni; 165°F, the E. coli organism; and 212°F, Listeria monocytogenes. Antibiotic sensitivity. Cattle in the United States are routinely given antibiotics to protect them from infection. By law, the antibiotic treatment must stop three days to several weeks before the animal is slaughtered. Theoretically, the beef should then be free of antibiotic residues, but some people who are sensitive to penicillin or tetracycline may have an allergic reaction to the meat, although this is rare. Antibiotic-resistant Salmonella and toxoplasmosis. Cattle treated with antibiotics may pro- duce meat contaminated with antibiotic-resistant strains of Salmonella, and all raw beef may harbor ordinary Salmonella as well as T. gondii, the parasite that causes toxoplasmosis. Toxoplasmosis is particularly hazardous for pregnant women. It can be passed on to the fetus and may trigger a series of birth defects including blindness and mental retardation. Both Salmonella and the T. gondii can be eliminated by cooking meat thoroughly and washing all utensils, cutting boards, and counters as well as your hands with hot soapy water before touching any other food. Decline in kidney function. Proteins are nitrogen compounds. When metabolized, they yield ammonia, which is excreted through the kidneys. In laborator y animals, a sustained high-protein diet increases the flow of blood through the kidneys, accelerating the natural age-related decline in kidney function. Some experts suggest that this may also occur in human beings.

Food/Drug Interactions Tetracycline antibiotics (demeclocycline [Declomycin], doxycycline [ Vibtamycin], methacycline [Rondomycin], minocycline [Minocin], oxytetracycline [Terramycin], tetracycline [Achromycin V, Panmycin, Sumycin]). Because meat contains iron, which binds tetracyclines into com- pounds the body cannot absorb, it is best to avoid meat for two hours before and after taking one of these antibiotics. Monoamine oxidase (MAO) inhibitors. Meat “tenderized” with papaya or a papain powder can interact with the class of antidepressant drugs known as monoamine oxidase inhibi- tors. Papain meat tenderizers work by breaking up the long chains of protein molecules. One by-product of this process is tyramine, a substance that constructs blood vessels and raises blood pressure. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine. If you eat a food such as papain-tenderized meat, which is high in tyramine, while you are taking a M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. Theophylline. Charcoal-broiled beef appears to reduce the effectiveness of theophylline because the aromatic chemicals produced by burning fat speed up the metabolism of the- ophylline in the liver.... beef

Bio-availability refers to the proportion of a drug reaching the systemic circulation after a particular route of administration. The most important factor is ?rst-pass metabolism – that is, pre-systemic metabolism in either the intestine or the liver. Many lipid-soluble drugs such as beta blockers (see BETAADRENOCEPTOR-BLOCKING DRUGS), some tricyclic ANTIDEPRESSANT DRUGS, and various opiate ANALGESICS are severely affected. Food may affect bio-availability by modifying gastric emptying, thus slowing drug absorption. Ingested calcium may combine with drugs such as tetracyclines, further reducing their absorption.... bio-availability

Also known as undulant fever, or Malta fever.

Causes In Malta and the Mediterranean littoral, the causative organism is the bacterium Brucella melitensis which is conveyed in goat’s milk. In Great Britain, the US and South Africa, the causative organism is the Brucella abortus, which is conveyed in cow’s milk: this is the organism which is responsible for contagious abortion in cattle. In Great Britain brucellosis is largely an occupational disease and is now prescribed as an industrial disease (see OCCUPATIONAL DISEASES), and insured persons who contract the disease at work can claim industrial injuries bene?t. The incidence of brucellosis in the UK has fallen from more than 300 cases a year in 1970 to single ?gures.

Symptoms The characteristic features of the disease are undulating fever, drenching sweats, pains in the joints and back, and headache. The liver and spleen may be enlarged. The diagnosis is con?rmed by the ?nding of Br. abortus, or antibodies to it, in the blood. Recovery and convalescence tend to be slow.

Treatment The condition responds well to one of the tetracycline antibiotics, and also to gentamicin and co-trimoxazole, but relapse is common. In chronic cases a combination of streptomycin and one of the tetracyclines is often more e?ective.

Prevention It can be prevented by boiling or pasteurising all milk used for human consumption. In Scandinavia, the Netherlands, Switzerland and Canada the disease has disappeared following its eradication in animals. Brucellosis has been eradicated from farm animals in the United Kingdom.... brucellosis

A yeast-like fungus which comprises part of the normal flora of the gut but which can cause candidiasis (which includes oral and vaginal thrush) usually as an overgrowth syndrome in diabetics, the immunologicallycompromised, or as a result of the use of broad spectrum antibiotics (e.g. tetracyclines) and the contraceptive pill.... candida

Nutritional Profile Energy value (calories per serving): Moderate to high Protein: Moderate to high Fat: Low to high Saturated fat: High Cholesterol: Low to high Carbohydrates: Low Fiber: None Sodium: High Major vitamin contribution: Vitamin A, vitamin D, B vitamins Major mineral contribution: Calcium

About the Nutrients in This Food Cheese making begins when Lactobacilli and/or Streptococci bacteria are added to milk. The bacteria digest lactose (milk sugar) and release lactic acid, which coagulates casein (milk protein) into curds. Rennet (gastric enzymes extracted from the stomach of calves) is added, and the mixture is put aside to set. The longer the curds are left to set, the firmer the cheese will be. When the curds are properly firm, they are pressed to squeeze out the whey (liquid) and cooked. Cooking evaporates even more liquid and makes the cheese even firmer.* At this point, the product is “fresh” or “green” cheese: cottage cheese, cream cheese, farmer cheese. Making “ripe” cheese requires the addition of salt to pull out more moisture and specific organisms, such as Penicil- lium roquefort for Roquefort cheese, blue cheese, and Stilton, or Penicillium cambembert for Camembert and Brie. The nutritional value of cheese is similar to the milk from which it is made. All cheese is a good source of high quality proteins with sufficient amounts of all the essential amino acids. Cheese is low to high in fat, mod- erate to high in cholesterol. * Natural cheese is cheese made direct ly from milk. Processed cheese is natural cheese melted and combined wit h emulsifiers. Pasteurized process cheese foods contain ingredients t hat allow t hem to spread smoot hly; t hey are lower in fat and higher in moisture t han processed cheese. Cholesterol and Saturated Fat Content of Selected Cheeses Mozzarella Source: USDA, Nutritive Value of Foods, Home and Garden Bullet in No. 72 (USDA, 1989). All cheeses, except cottage cheese, are good sources of vitamin A. Orange and yellow cheeses are colored with carotenoid pigments, including bixin (the carotenoid pigment in annatto) and synthetic beta-carotene. Hard cheeses are an excellent source of calcium; softer cheeses are a good source; cream cheese and cottage cheese are poor sources. The R DA for calcium is 1,000 mg for a woman, 1,200 mg for a man, and 1,500 mg for an older woman who is not on hormone- replacement therapy. All cheese, unless otherwise labeled, is high in sodium.

Calcium Content of Cheese
Cheese	Serving	Calcium (mg)
Blue	oz.	150
Camembert	wedge	147
Cheddar	oz.	204
Cottage cheese
creamed	cup	135
uncreamed	cup	46
Muenster	oz.	203
Pasteurized processed American	oz.	174
Parmesan grated	tbsp.	69
Provolone	oz.	214
Swiss	oz.	272

  Source: Nutritive Value of Foods, Home and Gardens Bullet in No. 72 (USDA, 1989).

The Most Nutritious Way to Serve This Food With grains, bread, noodles, beans, nuts, or vegetables to add the essential amino acids miss- ing from these foods, “complete” their proteins, and make them more nutritionally valuable.

Diets That May Restrict or Exclude This Food Antiflatulence diet Controlled-fat, low-cholesterol diet Lactose- and galactose-free diet (lactose, a disaccharide [double sugar] is composed of one unit of galactose and one unit of glucose) Low-calcium diet (for patients with kidney disease) Sucrose-free diet (processed cheese)

Buying This Food Look for: Cheese stored in a refrigerated case. Check the date on the package. Avoid: Any cheese with mold that is not an integral part of the food.

Storing This Food Refrigerate all cheese except unopened canned cheeses (such as Camembert in tins) or grated cheeses treated with preservatives and labeled to show that they can be kept outside the refrigerator. Some sealed packages of processed cheeses can be stored at room temperature but must be refrigerated once the package is opened. Wrap cheeses tightly to protect them from contamination by other microorganisms in the air and to keep them from drying out. Well-wrapped, refrigerated hard cheeses that have not been cut or sliced will keep for up to six months; sliced hard cheeses will keep for about two weeks. Soft cheeses (cottage cheese, ricotta, cream cheese, and Neufchatel) should be used within five to seven days. Use all packaged or processed cheeses by the date stamped on the package. Throw out moldy cheese (unless the mold is an integral part of the cheese, as with blue cheese or Stilton).

Preparing This Food To grate cheese, chill the cheese so it won’t stick to the grater. The molecules that give cheese its taste and aroma are largely immobilized when the cheese is cold. When serving cheese with fruit or crackers, bring it to room temperature to activate these molecules.

What Happens When You Cook This Food Heat changes the structure of proteins. The molecules are denatured, which means that they may be broken into smaller fragments or change shape or clump together. All of these changes may force moisture out of the protein tissue, which is why overcooked cheese is often stringy. Whey proteins, which do not clump or string at low temperatures, contain the sulfur atoms that give hot or burned cheese an unpleasant “cooked” odor. To avoid both strings and an unpleasant odor, add cheese to sauces at the last minute and cook just long enough to melt the cheese.

How Other Kinds of Processing Affect This Food Freezing. All cheese loses moisture when frozen, so semisoft cheeses will freeze and thaw better than hard cheeses, which may be crumbly when defrosted. Drying. The less moisture cheese contains, the less able it is to support the growth of organ- isms like mold. Dried cheeses keep significantly longer than ordinary cheeses.

Medical Uses and/or Benefits To strengthen bones and reduce age-related loss of bone density. High-calcium foods protect bone density. The current recommended dietary allowance (R DA) for calcium is still 800 mg for adults 25 and older, but a 1984 National Institutes of Health (NIH) Conference advisory stated that lifelong protection for bones requires an R DA of 1,000 mg for healthy men and women age 25 to 50 ; 1,000 mg for older women using hormone replacement therapy; and 1,500 mg for older women who are not using hormones, and these recommendations have been confirmed in a 1994 NIH Consensus Statement on optimal calcium intake. A diet with adequate amounts of calcium-rich foods helps protect bone density. Low-fat and no-fat cheeses provide calcium without excess fat and cholesterol. Protection against tooth decay. Studies at the University of Iowa (Iowa City) Dental School confirm that a wide variety of cheeses, including aged cheddar, Edam, Gouda, Monterey Jack, Muenster, mozzarella, Port Salut, Roquefort, Romano, Stilton, Swiss, and Tilsit—limit the tooth decay ordinarily expected when sugar becomes trapped in plaque, the sticky film on tooth surfaces where cavity-causing bacteria flourish. In a related experiment using only cheddar cheese, people who ate cheddar four times a day over a two-week period showed a 20 percent buildup of strengthening minerals on the surface of synthetic toothlike material attached to the root surfaces of natural teeth. Protection against periodontal disease. A report in the January 2008 issue of the Journal of Periodontology suggests that consuming adequate amounts of dairy products may reduce the risk of developing periodontal disease. Examining the dental health of 942 subjects ages 40 to 79, researchers at Kyushu University, in Japan, discovered that those whose diets regularly included two ounces (55 g) of foods containing lactic acid (milk, cheese, and yogurt) were significantly less likely to have deep “pockets” (loss of attachment of tooth to gum) than those who consumed fewer dairy products.

Adverse Effects Associated with This Food Increased risk of heart disease. Like other foods from animals, cheese is a source of choles- terol and saturated fats, which increase the amount of cholesterol circulating in your blood and raise your risk of heart disease. To reduce the risk of heart disease, the USDA /Health and Human Services Dietary Guidelines for Americans recommends limiting the amount of cholesterol in your diet to no more than 300 mg a day. The guidelines also recommend limit- ing the amount of fat you consume to no more than 30 percent of your total calories, while holding your consumption of saturated fats to more than 10 percent of your total calories (the calories from saturated fats are counted as part of the total calories from fat). Food poisoning. Cheese made from raw (unpasteurized) milk may contain hazardous microorganisms, including Salmonella and Listeria. Salmonella causes serious gastric upset; Lis- teria, a flulike infection, encephalitis, or blood infection. Both may be life-threatening to the very young, the very old, pregnant women, and those whose immune systems are weakened either by illness (such as AIDS) or drugs (such as cancer chemotherapy). In 1998, the Federal Centers for Disease Control (CDC) released data identif ying Listeria as the cause of nearly half the reported deaths from food poisoning. Allergy to milk proteins. Milk is one of the foods most frequently implicated as a cause of allergic reactions, particularly upset stomach. However, in many cases the reaction is not a true allergy but the result of lactose intolerance (see below). Lactose intolerance. Lactose intolerance—the inability to digest the sugar in milk—is an inherited metabolic deficiency that affects two thirds of all adults, including 90 to 95 percent of all Orientals, 70 to 75 percent of all blacks, and 6 to 8 percent of Caucasians. These people do not have sufficient amounts of lactase, the enzyme that breaks the disaccharide lactose into its easily digested components, galactose and glucose. When they drink milk, the undi- gested sugar is fermented by bacteria in the gut, causing bloating, diarrhea, flatulence, and intestinal discomfort. Some milk is now sold with added lactase to digest the lactose and make the milk usable for lactase-deficient people. In making cheese, most of the lactose in milk is broken down into glucose and galactose. There is very little lactose in cheeses other than the fresh ones—cottage cheese, cream cheese, and farmer cheese. Galactosemia. Galactosemia is an inherited metabolic disorder in which the body lacks the enzymes needed to metabolize galactose, a component of lactose. Galactosemia is a reces- sive trait; you must receive the gene from both parents to develop the condition. Babies born with galactosemia will fail to thrive and may develop brain damage or cataracts if they are given milk. To prevent this, children with galactosemia are usually kept on a protective milk- free diet for several years, until their bodies have developed alternative pathways by which to metabolize galactose. Pregnant women who are known carriers of galactosemia may be advised to give up milk and milk products while pregnant lest the unmetabolized galactose in their bodies cause brain damage to the fetus (damage not detectable by amniocentesis). Genetic counseling is available to identif y galactosemia carriers and assess their chances of producing a baby with the disorder. Penicillin sensitivity. People who experience a sensitivity reaction the first time they take penicillin may have been sensitized by exposure to the Penicillium molds in the environment, including the Penicillium molds used to make brie, blue, camembert, roquefort, Stilton, and other “blue” cheeses.

Food/Drug Interactions Tetracycline. The calcium ions in milk products, including cheese, bind tetracyclines into insoluble compounds. If you take tetracyclines with cheese, your body may not be able to absorb and use the drug efficiently. 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 ves- sels and increases blood pressure. If you eat a food such as aged or fermented cheese which is high in tyramine while you are taking an M AO inhibitor, your body may not be able to eliminate the tyramine. The result may be a hypertensive crisis.

Tyramine Content of Cheeses High Boursault, Camembert, Cheddar, Emmenthaler, Stilton Medium to high Blue, brick, Brie, Gruyère, mozzarella, Parmesan, Romano, Roquefort Low Processed American cheese Very little or none Cottage and cream cheese Sources: The Medical Letter Handbook of Adverse Drug Interactions (1985); Handbook of Clinical Dietetics ( The A merican Dietet ic Associat ion, 1981). False-positive test for pheochromocytoma. Pheochromocytomas (tumors of the adrenal glands) secrete adrenalin that is converted by the body to vanillyl-mandelic acid ( VM A) and excreted in the urine. Tests for this tumor measure the level of VM A in the urine. Since cheese contains VM A, taking the test after eating cheese may result in a false-positive result. Ordinarily, cheese is prohibited for at least 72 hours before this diagnostic test.... cheese

See TETRACYCLINES.... chlortetracycline

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

One of the tetracycline broad-spectrum antibiotic drugs (see TETRACYCLINES). Minocycline has a broader spectrum than the others and is e?ective against Neisseria meningitidis, which causes bacterial MENINGITIS. It should not be prescribed for patients with kidney disease.... minocycline

A genus of micro-organisms which di?er from bacteria in that they lack a rigid cell wall. They are responsible for widespread epidemics in cattle and poultry. For a long time the only member of the genus known to cause disease in humans was Mycoplasma pneumoniae which is responsible for the form of PNEUMONIA known as primary atypical pneumonia – particularly common in children, for whom it is the single most common cause of the diseaase when contracted out of hospital. Another, Mycoplasma genitalium, has now been isolated which is responsible for certain cases of non-gonococcal urethritis. Mycoplasma infections respond to TETRACYCLINES.... mycoplasma

The prevention or treatment of disease by chemical substances. The term is generally used in two senses: the use of antibacterial and other drugs to treat infections; and the administration of ANTIMETABOLITES and other drugs to treat cancer. The discovery by Paul Ehrlich in 1910 of the action of Salvarsan in treating syphilis led to the introduction of sulphonamides in 1935, followed by PENICILLIN during World War II, which revolutionised the treatment of common infections. Many ANTIBACTERIAL DRUGS have been developed since then: these include CEPHALOSPORINS, cephamycins, TETRACYCLINES, AMINOGLYCOSIDES, MACROLIDES and CLINDAMYCIN as well as antituberculous drugs such as STREPTOMYCIN and METRONIDAZOLE. Unfortunately, overuse of chemotherapeutic drugs in medicine and in animal husbandry has stimulated widespread resistance among previously susceptible pathogenic microorganisms. Chemotherapy also plays an important role in treating tropical diseases, especially MALARIA, SLEEPING SICKNESS and LEPROSY.

Recently chemotherapy has become increasingly e?ective in the treatment of cancer. Numerous drugs, generally CYTOTOXIC, are available; great care is required in their selection and to minimise side-effects. Certain tumours are highly sensitive to chemotherapy

– especially testicular tumours, LEUKAEMIA, LYMPHOMA and various tumours occurring in childhood (e.g. Wilm’s tumour – see NEPHROBLASTOMA) – and may even be cured.... chemotherapy

The disease caused by infection with LEPTOSPIRA. The three most common members of this group in the United Kingdom are L. icterohaemorrhagiae, L. cani-cola, and L. hebdomadis. It is an occupational hazard of farmers, sewage and abattoir workers, ?sh cutters and veterinary surgeons, but the infection can also be acquired from bathing in contaminated water. The disease varies in intensity from a mild in?uenza-like illness to a fatal form of JAUNDICE due to severe liver disease. The kidneys are often involved and there may be MENINGITIS. Penicillin or tetracycline are the usual treatment, but unless they are given early in the disease their e?ect is limited. The tetracycline antibiotic doxycycline (see TETRACYCLINES) given once weekly during periods of exposure prevents infection.... leptospirosis

An in?ammatory condition of the URETHRA due to a cause or causes other than GONORRHOEA. The most common is CHLAMYDIA trachomatis – there has been a rise of over 75 per cent in the incidence in the UK over the past ?ve years to around 70,000 a year. It produces pelvic in?ammatory disease in women, which often results in sterility, the risk of ECTOPIC PREGNANCY, and recurrent pelvic pain. Most cases respond well to TETRACYCLINES. Abstinence from sexual intercourse should be observed during treatment and until cure is complete. Children born to infected mothers may have their eyes infected during birth, producing the condition known as ophthalmia neonatorum. This is treated by the application to the eye of chlortetracycline eye ointment. The lungs of such a child may also be infected, resulting in pneumonia.... non-specific urethritis (nsu)

Diseases of the SKIN for which sunlight is partially or wholly responsible. In su?cient dosage, short-wave ultraviolet light (UVB – see ULTRAVIOLET RAYS (UVR)) always causes ERYTHEMA. Higher doses progressively cause OEDEMA and blistering; this is acute sunburn. Graduated exposure to UVB causes pigmentation (tanning). Prolonged chronic exposure to sunlight eventually accelerates ageing of the exposed skin with LENTIGO formation and loss of COLLAGEN and elastic tissue. After decades of such exposure, epidermal DYSPLASIA and CANCER may supervene.

Drugs given orally or topically may induce phototoxic reactions of various types. Thus, TETRACYCLINES exaggerate sunburn reactions. and the diuretic FRUSEMIDE may cause blistering reactions. Psoralens induce erythema and pigmentation. AMIODARONE also induces pigmentation. (See also PHOTOCHEMOTHERAPY.)

Phytophotodermatitis is a streaky, blistering photodermatosis typically seen on the limbs of children playing in grassy meadows in summer. The phototoxic reaction is caused by psoralens in weeds.

Berlocque dermatitis is a pattern of streaky pigmentation usually seen on women’s necks, caused by a reaction to psoralens in perfumes.

Certain rare metabolic diseases may lead to photosensitisation. They include the PORPHYRIAS and PELLAGRA. Other skin diseases such as lupus erythematosus (see under LUPUS) and ROSACEA may be aggravated by light exposure. Sometimes, in the absence of any of these factors, some people spontaneously develop a sensitivity to light causing various patterns of DERMATITIS or URTICARIA. The most common pattern is ‘polymorphic light eruption’ which typically appears within a day or two of arrival at a sunny holiday destination and persists until departure. Continuously exposed areas, such as the hands and face, may be ‘hardened’ and unaffected.

Treatment Appropriate clothing and headgear, sunscreen creams and lotions are the main preventative measures.... photodermatoses

A disease of rodents such as rabbits and rats, caused by the bacillus, Francisella tularense, and spread either by ?ies or by direct inoculation – for example, into the hands of a person engaged in skinning rabbits. In humans the disease takes the form of a slow fever lasting several weeks, with much malaise and depression, followed by considerable emaciation. It was ?rst described in the district of Tulare in California, and is found widely spread in North America and in Europe, but not in Great Britain. STREPTOMYCIN, the TETRACYCLINES and CHLORAMPHENICOL o?er e?ective treatment.... tularaemia

A group of antibiotic drugs commonly used to treat bronchitis, acne, syphilis, gonorrhoea, nongonococcal urethritis, and certain types of pneumonia.

If taken with milk, tetracyclines are not absorbed effectively into the intestines.

Possible side effects include nausea, vomiting, diarrhoea, worsening of kidney disorders, rash, and itching.

Tetracyclines may discolour developing teeth and are therefore not usually prescribed for children under age 12 or pregnant women.... tetracycline drugs

n. a *tetracycline antibiotic used to treat infections caused by Chlamydia, rickettsiae, mycoplasmas, and Brucella as well as Lyme disease. It may also be used in the prevention and treatment of malaria and the treatment of mouth ulcers and periodontitis. Side-effects are those of the other tetracyclines.... doxycycline

Pineapple (Ananas comosus).

Plant Part Used: Fruit, fruit rind.

Dominican Medicinal Uses: Fruit: juice, taken orally as a diuretic for urinary tract or kidney disorders, cleansing the body internally, for treating bacterial infection, cancer, high blood pressure, high cholesterol, menopausal hot flashes; fruit rind: fermented in sugar and water for internally cleansing and refreshing the body.

Safety: Commonly consumed as food; relatively nontoxic; repeated exposure can cause hypersensitivity.

Contraindications: Caution advised during pregnancy due to possible abortifacient effects of plant steroids.

Drug Interactions: For bromelain (protease enzymes from stem): antibiotics, tetracyclines (elevated drug serum levels), anticoagulants and thrombocyte aggregation inhibitors (increased bleeding).

Laboratory & Preclinical Data: In vivo: antidiabetic, antioxidant, antidyslipidemic (ethanolic leaf extract); antifertility (unripe fruit juice); burn debridement (bromelain—stem enzymes); diuretic (root extract).

In vitro: antitumor (bromelain—stem enzymes).

* See entry for Piña in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... piña

So-called because of the characteristic temperature chart showing recurring bouts of fever, this is an infectious disease caused by SPIROCHAETE. There are two main forms of the disease.

Louse-borne relapsing fever is an EPIDEMIC disease, usually associated with wars and famines, which has occurred in practically every country in the world. For long confused with TYPHUS FEVER and typhoid fever (see ENTERIC FEVER), it was not until the 1870s that the causal organism was described by Obermeier. It is now known as the Borrelia recurrentis, a motile spiral organism 10–20 micrometres in length. The organism is transmitted from person to person by the louse, Pediculus humanus.

Symptoms The incubation period is up to 12 days (but usually seven). The onset is sudden, with high temperature, generalised aches and pains, and nose-bleeding. In about half of cases, a rash appears at an early stage, beginning in the neck and spreading down over the trunk and arms. JAUNDICE may occur; and both the LIVER and the SPLEEN are enlarged. The temperature subsides after ?ve or six days, to rise again in about a week. There may be up to four such relapses (see the introductory paragraph above).

Treatment Preventive measures are the same as those for typhus. Rest in bed is essential, as are good nursing and a light, nourishing diet. There is usually a quick response to PENICILLIN; the TETRACYCLINES and CHLORAMPHENICOL are also e?ective. Following such treatment the incidence of relapse is about 15 per cent. The mortality rate is low, except in a starved population.

Tick-borne relapsing fever is an ENDEMIC disease which occurs in most tropical and sub-tropical countries. The causative organism is Borrelia duttoni, which is transmitted by a tick, Ornithodorus moubata. David Livingstone suggested that it was a tick-borne disease, but it was not until 1905 that Dutton and Todd produced the de?nitive evidence.

Symptoms The main di?erences from the louse-borne disease are: (a) the incubation period is usually shorter, 3–6 days (but may be as short as two days or as long as 12); (b) the febrile period is usually shorter, and the afebrile periods are more variable in duration, sometimes only lasting for a day or two; (c) relapses are much more numerous.

Treatment Preventive measures are more di?cult to carry out than in the case of the louse-borne infection. Protective clothing should always be worn in ‘tick country’, and old, heavily infected houses should be destroyed. Curative treatment is the same as for the louse-borne infection.... relapsing fever

The general term given to a group of microorganisms which are intermediate between BACTERIA and viruses (see VIRUS). They are the causal agents of TYPHUS FEVER and a number of typhus-like diseases, such as ROCKY MOUNTAIN SPOTTED FEVER, Japanese River fever, and scrub typhus. These micro-organisms are usually conveyed to man by lice, ?eas, ticks, and mites.

Visceral rickettsia is a disease transmitted by mites from an infected house mouse, which occurs in the USA, South Africa, Korea and the former Soviet Union. The causal organism is Rickettsia akari. The incubation period is 7–14 days and the characteristic features are fever, headache, and a non-irritating rash on the face, trunk and extremities. The disease is non-fatal and responds rapidly to TETRACYCLINES.... rickettsia

an infectious disease caused by Calymmatobacterium granulomatis, which is transmitted during sexual intercourse. A pimply rash on and around the genital organs develops into a granulomatous ulcer. The disease responds to treatment with tetracyclines and streptomycin.... granuloma inguinale

a sexually transmitted disease that is caused by *Chlamydia and is most common in tropical regions. An initial lesion on the genitals is followed by swelling and inflammation of the lymph nodes in the groin; the lymph vessels in the genital region may become blocked, causing thickening of the skin of that area. Early treatment with sulphonamides or tetracyclines is usually effective.... lymphogranuloma venereum

an acute infectious disease of many animals, including cattle, sheep, goats, deer, and dogs, that is caused by a *rickettsia, Coxiella burnetii; it can be transmitted to humans primarily through inhalation of infected particles or consumption of contaminated unpasteurized milk but also via ticks, which can act as vectors. After an incubation period of up to three weeks a severe influenza-like illness develops, sometimes with pneumonia. The disease lasts about two weeks; treatment with tetracyclines or chloramphenicol is effective. See also typhus.... q fever

n. a chronic contagious eye disease – a severe form of *conjunctivitis – caused by the bacterium Chlamydia trachomatis; it is common in some hot countries. The conjunctiva of the eyelids becomes inflamed, leading to discharge of pus. If untreated, the conjunctiva becomes scarred and shrinks, causing the eyelids to turn inwards so that the eyelashes scratch the cornea (*trichiasis); blindness can be a late complication. Treatment with tetracyclines is effective in the early stages of the disease.... trachoma

An infective disease of worldwide distribution, the manifestations of which vary in di?erent localities. The causative organisms of all forms of typhus fever belong to the genus RICKETTSIA. These are organisms which are intermediate between bacteria and viruses in their properties, and measure 0·5 micrometre or less in diameter.

Louse typhus, in which the infecting rickettsia is transmitted by the louse, is of worldwide distribution. More human deaths have been attributed to the louse via typhus, louse-borne RELAPSING FEVER and trench fever, than to any other insect with the exception of the MALARIA mosquito. Louse typhus includes epidemic typhus, Brill’s disease – which is a recrudescent form of epidemic typhus – and TRENCH FEVER.

Epidemic typhus fever, also known as exanthematic typhus, classical typhus, and louse-borne typhus, is an acute infection of abrupt onset which, in the absence of treatment, persists for 14 days. It is of worldwide distribution, but is largely con?ned today to parts of Africa. The causative organism is the Rickettsia prowazeki, so-called after Ricketts and Prowazek, two brilliant investigators of typhus, both of whom died of the disease. It is transmitted by the human louse, Pediculus humanus. The rickettsiae can survive in the dried faeces of lice for 60 days, and these infected faeces are probably the main source of human infection.

Symptoms The incubation period is usually 10–14 days. The onset is preceded by headache, pain in the back and limbs and rigors. On the third day the temperature rises, the headache worsens, and the patient is drowsy or delirious. Subsequently a characteristic rash appears on the abdomen and inner aspect of the arms, to spread over the chest, back and trunk. Death may occur from SEPTICAEMIA, heart or kidney failure, or PNEUMONIA about the 14th day. In those who recover, the temperature falls by CRISIS at about this time. The death rate is variable, ranging from nearly 100 per cent in epidemics among debilitated refugees to about 10 per cent.

Murine typhus fever, also known as ?ea typhus, is worldwide in its distribution and is found wherever individuals are crowded together in insanitary, rat-infested areas (hence the old names of jail-fever and ship typhus). The causative organism, Rickettsia mooseri, which is closely related to R. prowazeki, is transmitted to humans by the rat-?ea, Xenopsyalla cheopis. The rat is the main reservoir of infection; once humans are infected, the human louse may act as a transmitter of the rickettsia from person to person. This explains how the disease may become epidemic under insanitary, crowded conditions. As a rule, however, the disease is only acquired when humans come into close contact with infected rats.

Symptoms These are similar to those of louse-borne typhus, but the disease is usually milder, and the mortality rate is very low (about 1·5 per cent).

Tick typhus, in which the infecting rickettsia is transmitted by ticks, occurs in various parts of the world. The three best-known conditions in this group are ROCKY MOUNTAIN SPOTTED FEVER, ?èvre boutonneuse and tick-bite fever.

Mite typhus, in which the infecting rickettsia is transmitted by mites, includes scrub typhus, or tsutsugamushi disease, and rickettsialpox.

Rickettsialpox is a mild disease caused by Rickettsia akari, which is transmitted to humans from infected mice by the common mouse mite, Allodermanyssus sanguineus. It occurs in the United States, West and South Africa and the former Soviet Union.

Treatment The general principles of treatment are the same in all forms of typhus. PROPHYLAXIS consists of either avoidance or destruction of the vector. In the case of louse typhus and ?ea typhus, the outlook has been revolutionised by the introduction of e?cient insecticides such as DICHLORODIPHENYL TRICHLOROETHANE (DDT) and GAMMEXANE.

The value of the former was well shown by its use after World War II: this resulted in almost complete freedom from the epidemics of typhus which ravaged Eastern Europe after World War I, being responsible for 30 million cases with a mortality of 10 per cent. Now only 10,000–20,000 cases occur a year, with around a few hundred deaths. E?cient rat control is another measure which reduces the risk of typhus very considerably. In areas such as Malaysia, where the mites are infected from a wide variety of rodents scattered over large areas, the wearing of protective clothing is the most practical method of prophylaxis. CURATIVE TREATMENT was revolutionised by the introduction of CHLORAMPHENICOL and the TETRACYCLINES. These antibiotics altered the prognosis in typhus fever very considerably.... typhus fever

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

An estimated 15 per cent of the female population suffers from this form of anaemia. A deficiency of nutritional iron is responsible for oxygen starvation of the blood due to insufficient haemoglobin. Number of red cells is reduced.

Aetiology: heavy menstrual loss, feeble constitution from hereditary weakness, poor diet, hidden or known blood loss from gastric ulcer, pregnancy, bleeding piles or insufficient food minerals: iron, copper, calcium, etc, chronic liver or kidney disease, worms, anorexia nervosa, rheumatoid arthritis, tuberculosis. Symptoms. Tiredness, dizziness, breathlessness, palpitations, pale face and mucous membranes. White of eyes may be blue. Enlarged flabby tongue often bears impression of teeth marks. Hair lifeless, fingernails brittle and ridged. There may be angina, tinnitus and general reduced efficiency.

Treatment. The object is to achieve absorption of iron to raise normal haemoglobin levels and increase red cells. Echinacea has a reputation for regeneration of red cells. Herbs used with success: Echinacea, Gentian, Motherwort, Mugwort, Barberry, Hops, Nettles, Saw Palmetto, Chaparral, Red Clover, Dandelion.

Bitter herbs stimulate absorption of vital nutrients from the stomach, toning liver and pancreas, increasing the appetite; usually given half hour before meals. See: BITTERS.

Gentian. 1 teaspoon fine-cut chips to 2 cups cold water steeped 8 hours (overnight). Dose: Half-1 cup thrice daily before meals.

Tea. Formula. Combine: Agrimony 1; Barberry bark 1; Nettles 2; White Poplar bark half. Place 1oz (30g) in 1 pint (500ml) cold water and bring to boil. Simmer 10 minutes. Drink cold: Half-1 cup thrice daily, before meals.

Powders. Formula. Echinacea 2; Gentian 1; Kelp 1; pinch Red Pepper. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily, before meals.

Liquid extracts. Formula: Echinacea 1; Queen’s Delight 1; Ginseng 1; Ginger quarter. Dose: 30-60 drops in water, thrice daily, before meals.

Infusion Gentian Co Conc BP (1949). Dose: 30-60 drops.

Diet. Dandelion coffee, as desired. Molasses. Desiccated liver.

Floradix. A pre-digested iron preparation. Readily assimilable by the body. Compounded by Dr Otto Greither (Salus Haus). Iron is fed onto yeast which breaks down the metal and absorbs its cells. Other tonic ingredients include extracts of nettles, carrots, spinach, fennel, Vitamin C plus supplements;

Angelica root, Mallow, Horsetail, Yarrow, Juniper and Rosehips. Not chemically preserved.

Avoid chocolate, egg yolk, tea, coffee, wheat bran.

Supplements. Daily. Vitamin C (1g morning and evening). Vitamin B12, Folic acid 400mcg. Vitamin C is the most potent enhancer of iron absorption. Multivitamin containing iron.

Note: Iron absorption is decreased by antacids, tetracyclines, phosphates, phytates (phytic acid from excessive intake of wholewheat bread), and excessive calcium supplements. Lack of stomach hydrochloric acid impairs iron absorption, especially in the elderly. ... anaemia: iron deficiency

A group of drugs used to treat infections caused by bacteria and to prevent bacterial infection in cases of immune system impairment.

Most of the commonly used antibiotic drugs belong to one of the following classes: penicillins, quinolones, aminoglycosides, cephalosporins, macrolides, and tetracyclines. Some antibiotics are effective against only certain types of bacteria; others, which are known as broad-spectrum antibiotics, are effective against a wide range.

Some bacteria develop resistance to a previously effective antibiotic drug. This is most likely to occur during long-term treatment. Some alternative antibiotics are available to treat bacteria that have become resistant to the more commonly prescribed drugs.

Most antibiotic drugs can cause nausea, diarrhoea, or a rash. Antibiotics may disturb the normal balance between certain types of bacteria and fungi in the body, leading to proliferation of the fungi that cause candidiasis (thrush). Some people experience a severe allergic reaction to the drugs, resulting in facial swelling, itching, or breathing difficulty.... antibiotic drugs

Any of a group of uncommon and usually inherited disorders caused by the accumulation of substances called porphyrins. Sufferers often have a rash or blistering brought on by sunlight, and certain drugs may cause abdominal pain and nervous system disturbances. Porphyrins are formed in the body during the manufacture of haem (a component of haemoglobin). A block in this manufacture causes a build-up of porphyrins. Such blocks are the result of various enzyme deficiencies, which are genetic disorders. Porphyria may also be due to poisoning.

There are 6 types of porphyria. Acute intermittent porphyria usually appears in early adulthood, causing abdominal pain, and often limb cramps, muscle weakness, and psychiatric disturbances. The patient’s urine turns red when left to stand. Barbiturate drugs, phenytoin, oral contraceptives, and tetracyclines precipitate attacks.

Variegate porphyria has similar effects but also causes blistering of sun-exposedskin. Hereditary coproporphyria also has similar effects and may cause additional skin symptoms.

Protoporphyria usually causes skin symptoms after exposure to sunlight, as does porphyria cutanea tarda. In this type, wounds are slow to heal, and urine is sometimes pink or brown. Many cases are precipitated by liver disease.

The rarest and most serious form, congenital erythropoietic porphyria, causes red discoloration of urine and the teeth, excessive hair growth, severe skin blistering and ulceration, and haemolytic anaemia. Death may occur in childhood. Diagnosis is made from abnormal levels of porphyrins in the urine and faeces. Treatment is difficult. Avoiding sunlight and/or precipitating drugs is the most important measure. Acute intermittent porphyria, variegate porphyria, and hereditary coproporphyria may be helped by administration of glucose or haematin. Cases of porphyria cutanea tarda may be helped by venesection.... porphyria

n. a substance, produced by or derived from a microorganism, that destroys or inhibits the growth of other microorganisms. Antibiotics are used to treat infections caused by organisms that are sensitive to them, usually bacteria or fungi. They may alter the normal microbial content of the body (e.g. in the intestine, lungs, bladder) by destroying one or more groups of harmless or beneficial organisms, which may result in infections (such as thrush in women) due to overgrowth of resistant organisms. These side-effects are most likely to occur with broad-spectrum antibiotics (those active against a wide variety of organisms). Resistance may also develop in the microorganisms being treated; for example, through incorrect dosage or overprescription (see also superinfection). Antibiotics should not be used to treat minor infections, which will clear up unaided. Some antibiotics may cause allergic reactions. There is now a rising concern that many infectious organisms have developed resistance to the commonly used antibiotics, and that the world is in danger of running out of effective new pharmaceutical agents to take their place. See also aminoglycosides; antifungal; antiviral drug; cephalosporin; penicillin; quinolone; tetracyclines.... antibiotic

(spotted fever) n. any one of a group of infections caused by *rickettsiae and characterized by severe headache, a widespread rash, prolonged high fever, and delirium. They all respond to treatment with chloramphenicol or tetracyclines. Epidemic typhus (also known as classical or louse-borne typhus) is caused by infection with Rickettsia prowazekii transmitted by lice. It was formerly very prevalent in overcrowded insanitary conditions (as during wars and famines), with a mortality rate approaching 100%. Endemic typhus (murine or flea-borne typhus) is a disease of rats due to Rickettsia mooseri; it can be transmitted to humans by rat fleas, causing a mild typhus fever. There are in addition several kinds of tick typhus (in which the rickettsiae are transmitted by ticks), including *Rocky Mountain spotted fever, and typhus transmitted by mites (see rickettsial pox; scrub typhus).... typhus