Archive for the “Anti-Infectives” Category
Monday, April 25, 2011 | 8:11 am
Treatment
The main goal in treatment of symptomatic late neurosyphilis is to halt progression of the disease, since much of the damage to the CNS is irreversible. Patients who have neurosyphilis or ocular syphilis should be treated with aqueous crystalline penicillin G, 18 to 24 million units per day, given as 3 to 4 million units intravenously every 4 hours or continuous infusion, for 10 to 14 days. An alternative regimen that requires strict assurance of compliance is procaine penicillin G, 2.4 million units IM once daily plus probenecid 500 mg orally four times daily, both for 10 to 14 days. Since the duration of therapy for neurosyphilis is shorter than the 3-week course recommended for latent syphilis, which theoretically may coexist, many specialists recommend an additional intramuscular dose of benzathine penicillin, 2.4 million units, after completion of the 2-week therapy for neurosyphilis to achieve at least 3 weeks of serum penicillin levels.
Syphilitic otitis should be treated the same way as neurosyphilis, regardless of CSF results. Adjunctive systemic steroids are often used in this setting, but the benefit of such therapy has not been proven.
Penicillin Allergy
Ceftriaxone, 2 g IM or IV daily for 10 to 14 days, is an alternative regimen for patients with a penicillin allergy, although there is potential for cross-reactivity. No other regimen has been adequately evaluated for treatment of neurosyphilis. Therefore, if ceftriaxone is not considered a safe alternative, the patient should undergo skin testing to confirm the penicillin allergy and be desensitized if necessary.
Assessing Response to Therapy
Patients with elevated cell counts in the CSF prior to treatment should have repeated lumbar punctures every 6 months until the pleocytosis resolves. Changes in the VDRL-CSF and protein counts may take longer to occur, and persistent elevations may not be significant. As a general guideline, the cell count should decrease after 6 months and the CSF should normalize after 2 years; otherwise, retreatment should be considered.
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(posted in Anti-Infectives)
Wednesday, December 22, 2010 | 8:59 am
Conjunctivitis due to viral infection is the leading cause of a red eye.
Patients typically present with an acutely red eye, watery discharge, and conjunctival and eyelid swelling. The disorder usually affects one eye first and the other several days later. A tender preauricular lymph node supports the diagnosis but is not present in the majority of cases. Viral conjunctivitis may develop during or after an upper respiratory tract infection and is usually self-limited.
Adenovirus is the most common cause of viral conjunctivitis and is often involved in community epidemics in schools or in the workplace. There are three common presentations of adenoviral conjunctivitis:
- Follicular conjunctivitis – This is the most common type of ocular adenoviral infection (typically due to serotypes 1, 2, 4, 5, and 6), and it affects children more frequently than adults. It is characterized by the presence of follicles – tiny, round, gray-white patches present on the palpebral conjunctiva. In severe cases, follicles may enlarge into papules and resemble cobblestones. The infection is self-limiting and generally resolves within 2 weeks.
- Pharyngoconjunctival fever – This adenoviral conjunctivitis (usually caused by serotypes 3 and 7) is characterized by the abrupt onset of high fever, pharyngitis, and bilateral follicular conjunctivitis. Small petechial hemorrhages can occur on the bulbar conjunctiva. The disease runs a course of 10 to 14 days.
- Epidemic keratoconjunctivitis – A particularly fulminant adenoviral infection (commonly associated with serotype 8), epidemic keratoconjunctivitis involves both the conjunctival and corneal epithelia. It is characterized by prominent conjunctival injection, a severe follicular response, and chemosis. Corneal infiltrates then occur, producing a foreign body sensation and photophobia that can prevent spontaneous opening of the eyes. Affected patients often drop several lines of visual acuity on a Snellen chart. The disease is usually self-limited but may take months to completely resolve.
Herpesviruses, particularly herpes simplex virus, may also cause conjunctivitis, although they typically involve the cornea. Herpes simplex virus can produce vesicular lid lesions, preauricular lymphadenopathy, and transient keratitis. Fluorescein staining of the cornea may reveal the dendritic pattern that is pathognomonic for herpetic keratitis.
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VIRAL CONJUNCTIVITISConjunctivitis due to viral infection is the leading cause of a red eye. Patients typically present with an acutely red eye, watery discharge, and conjunctival and eyelid swelling. The disorder usually affects one eye first and the other several days later. A tender preauricular lymph node supports the diagnosis but is not present in the majority of cases. Viral conjunctivitis may develop during or after an upper respiratory tract infection and is usually self-limited.Adenovirus is the most common cause of viral conjunctivitis and is often involved in community epidemics in schools or in the workplace. There are three common presentations of adenoviral conjunctivitis:- Follicular conjunctivitis – This is the most common type of ocular adenoviral infection (typically due to serotypes 1, 2, 4, 5, and 6), and it affects children more frequently than adults. It is characterized by the presence of follicles – tiny, round, gray-white patches present on the palpebral conjunctiva. In severe cases, follicles may enlarge into papules and resemble cobblestones. The infection is self-limiting and generally resolves within 2 weeks.- Pharyngoconjunctival fever – This adenoviral conjunctivitis (usually caused by serotypes 3 and 7) is characterized by the abrupt onset of high fever, pharyngitis, and bilateral follicular conjunctivitis. Small petechial hemorrhages can occur on the bulbar conjunctiva. The disease runs a course of 10 to 14 days.- Epidemic keratoconjunctivitis – A particularly fulminant adenoviral infection (commonly associated with serotype 8), epidemic keratoconjunctivitis involves both the conjunctival and corneal epithelia. It is characterized by prominent conjunctival injection, a severe follicular response, and chemosis. Corneal infiltrates then occur, producing a foreign body sensation and photophobia that can prevent spontaneous opening of the eyes. Affected patients often drop several lines of visual acuity on a Snellen chart. The disease is usually self-limited but may take months to completely resolve.Herpesviruses, particularly herpes simplex virus, may also cause conjunctivitis, although they typically involve the cornea. Herpes simplex virus can produce vesicular lid lesions, preauricular lymphadenopathy, and transient keratitis. Fluorescein staining of the cornea may reveal the dendritic pattern that is pathognomonic for herpetic keratitis.*31/348/5*
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(posted in Anti-Infectives)
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