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{{Infobox Disease | |||
| Name = Cervical intraepithelial neoplasia | |||
| Image = | |||
| Caption = | |||
| DiseasesDB = | |||
| ICD10 = {{ICD10|D|06||d|00}}, {{ICD10|N|87||n|80}} | |||
| ICD9 = {{ICD9|233.1}}, {{ICD9|622.10}} | |||
| ICDO = | |||
| OMIM = | |||
| MedlinePlus = 001491 | |||
| MeshID = D018290 | |||
}} | |||
==Pap Smear== | |||
Cervical dysplasia that is seen on a Pap smear is called squamous intraepithelial lesion (SIL). These changes may be graded as: | |||
*Low-grade (LSIL) | |||
*High-grade (HSIL) | |||
*Possibly cancerous (malignant) | |||
If a Pap smear shows abnormal cells or cervical dysplasia, further testing or monitoring will be recommended: | |||
*Follow-up Pap smears may be recommended for mild cases | |||
*Colposcopy-directed biopsy can confirm the condition | |||
*Cone biopsy may be done after colposcopy | |||
Dysplasia that is seen on a biopsy of the cervix is called cervical intraepithelial neoplasia (CIN). It is grouped into three categories: | |||
*CIN I -- mild dysplasia | |||
*CIN II -- moderate to marked dysplasia | |||
*CIN III -- severe dysplasia to carcinoma in situ | |||
Some strains of human papillomavirus (HPV) are known to cause cervical cancer. An HPV DNA test can identify the high-risk types of HPV linked to such cancer. This may be done: | |||
*As a screening test for women over age 30 | |||
*For women of any age who have a slightly abnormal Pap test result | |||
HPV subtypes 16 and 18 deregulate the genes E6 and E7 which code for proteins that inhibit [[p53]] and [[Retinoblastoma protein]] (Rb), which are two important tumor suppressor genes in humans. The p53 gene product is involved in regulation of [[apoptosis]] (cell suicide), and Rb is responsible for halting the [[cell cycle]] at the G1-phase. When Rb function is impaired, the cell is allowed to progress to S-phase and complete mitosis, resulting in proliferation and hence neoplastic transformation. | |||
===Hysterectomy=== | |||
Microinvasive cancer (stage IA) is usually treated by [[hysterectomy]] (removal of the whole uterus including part of the [[vagina]]). For stage IA2, the [[lymph node]]s are removed as well. An alternative for patients who desire to remain fertile is a local surgical procedure such as a [[loop electrical excision procedure]] (LEEP) or [[Cervical conization|cone biopsy]]. | |||
===Trachelectomy=== | |||
*If a cone biopsy does not produce clear margins,<ref>[http://www.meb.uni-bonn.de/cgi-bin/mycite?ExtRef=MEDL/94063663]</ref> one more possible treatment option for patients who want to preserve their fertility is a [[trachelectomy]].<ref>[http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm]</ref> | |||
*This attempts to surgically remove the cancer while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy. | |||
*It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care,<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16493253&query_hl=2&itool=pubmed_docsum]</ref> as few doctors are skilled in this procedure. | |||
*Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown. | |||
*If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the patient is under general anesthesia in the operating room, a hysterectomy may still be needed. This can only be done during the same operation if the patient has given prior consent. | |||
*Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the womb for pathologic evaluation. | |||
===Radical Trachelectomy=== | |||
A radical trachelectomy can be performed abdominally<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15918265&query_hl=8&itool=pubmed_docsum]</ref> or vaginally<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15936061&query_hl=5&itool=pubmed_docsuminstead]</ref> and there are conflicting opinions as to which is better.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8812529&query_hl=13&itool=pubmed_docsum]</ref> A radical abdominal trachelectomy with lymphadenectomy usually only requires a two to three day hospital stay, and most women recover very quickly (approximately six weeks). Complications are uncommon, although women who are able to conceive after surgery are susceptible to preterm labor and possible late miscarriage.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=10760765&dopt=Abstract]</ref> It is generally recommended to wait at least one year before attempting to become pregnant after surgery.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=12548192&dopt=Abstract]</ref> Recurrence in the residual cervix is very rare if the cancer has been cleared with the trachelectomy.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16493253&query_hl=4&itool=pubmed_docsum]</ref> Yet, it is recommended for patients to practice vigilant prevention and follow up care including pap screenings/[[colposcopy]], with biopsies of the remaining lower uterine segment as needed (every 3-4 months for at least 5 years) to monitor for any recurrence in addition to minimizing any new exposures to HPV through [[safe sex]] practices until one is actively trying to conceive. | |||
===Radical Hysterectomy=== | |||
Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or [[radiation therapy]]. Radiation therapy is given as external beam radiotherapy to the pelvis and [[brachytherapy]] (internal radiation). Patients treated with surgery who have high risk features found on pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse. | |||
* Precancerous changes of the cervix and early stage cervical cancer,physical examination findings can be normal. Special tests and tools are needed to spot such conditions: | |||
:* A Pap smear is used for screening precancers and cervical cancer, but final diagnosis cannot be made. | |||
:* The human papillomavirus ([[HPV]]) DNA test may be done along with a [[pap test]]. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as a main test. | |||
:* If abnormal changes are found, the cervix is usually examined using [[colposcope]].cervical biopsy can be taken form tissue and examined. | |||
===Radiation and Chemotherapy=== | |||
Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and [[cisplatin]]-based chemotherapy, hysterectomy (which then usually requires [[adjuvant]] radiation therapy), or cisplatin chemotherapy followed by hysterectomy. | |||
Advanced stage tumors (IIB-IVA) are treated with radiation therapy and [[cisplatin]]-based chemotherapy. | |||
On June 15, 2006, the US [[Food and Drug Administration]] approved the use of a combination of two chemotherapy drugs, [[hycamtin]] and [[cisplatin]] for women with late-stage (IVB) cervical cancer treatment.<ref>[http://www.fda.gov/bbs/topics/NEWS/2006/NEW01391.html]</ref> Combination treatment has significant risk of [[neutropenia]], [[anemia]], and [[thrombocytopenia]] side effects. Hycamtin is manufactured by GlaxoSmithKline. | |||
====Contraindicated medications==== | |||
{{MedCondContrRel|MedCond =Invasive cervical carcinoma|Oxytocin}} | |||
According to the International Federation of Gynecology and Obstetrics, survival improves when radiotherapy is combined with cisplatin-based chemotherapy.<ref>{{cite journal |author=Committee on Practice Bulletins-Gynecology |title=ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas, number 35, May 2002 |journal=Obstetrics and gynecology |volume=99 |issue=5 Pt 1 |pages=855-67 |year=2002 |pmid=11978302 |doi=}}</ref> | |||
As the cancer metastasizes to other parts of the body, prognosis drops dramatically because treatment of local lesions is generally more effective than whole body treatments such as chemotherapy. | |||
Regular screening has meant that pre cancerous changes and early stage cervical cancers have been detected and treated early. Figures suggest that cervical screening is saving 5,000 lives each year in the UK by preventing cervical cancer.<ref name=chelp>{{cite web | title =Cervical cancer statistics and prognosis | url=http://www.cancerhelp.org.uk/help/default.asp?page=9260 | publisher=Cancer Research UK | accessdate=2007-03-24}}</ref> | |||
Interval evaluation of the patient after therapy is imperative. Recurrent cervical cancer detected at its earliest stages might be successfully treated with surgery, radiation, chemotherapy, or a combination of the three. Thirty-five percent of patients with invasive cervical cancer have persistent or recurrent disease after treatment.<ref name=AMN>{{cite web | title =Cervical Cancer| work =Cervical Cancer: Pathology, Symptoms and Signs, Diagnosis, Prognosis and Treatment | url=http://www.health.am/cr/cervical-cancer/ | publisher=Armenian Health Network, Health.am }}</ref>In screening a general or low-risk population, most Pap results are normal. | |||
In the United States, about 2–3 million abnormal Pap smear results are found each year.<ref>{{cite web | title = Pap Smear | |||
| url=http://www.emedicinehealth.com/pap_smear/article_em.htm| accessdate = 2008-12-27}}</ref> Most abnormal results are mildly abnormal (ASC-US (typically 2–5% of Pap results) or low-grade squamous intraepithelial lesion ([[Bethesda System#LSIL|LSIL]]) (about 2% of results)), indicating HPV infection.{{Citation needed|date=January 2009}} Although most low-grade cervical dysplasias spontaneously regress without ever leading to [[cervical cancer]], dysplasia can serve as an indication that increased vigilance is needed. | |||
In a typical scenario, about 0.5% of Pap results are high-grade SIL ([[Bethesda System#HSIL|HSIL]]), and less than 0.5% of results indicate cancer; 0.2 to 0.8% of results indicate Atypical Glandular Cells of Undetermined Significance (AGC-NOS). | |||
As liquid based preparations (LBPs) become a common medium for testing, atypical result rates have increased. The median rate for all preparations with low-grade squamous intraepithelial lesions using LBPs was 2.9% compared with a 2003 median rate of 2.1%. Rates for high-grade squamous intraepithelial lesions (median, 0.5%) and atypical squamous cells have changed little.<ref>{{cite journal|pmid=20196659|year=2010|last1=Eversole|first1=GM|last2=Moriarty|first2=AT|last3=Schwartz|first3=MR|last4=Clayton|first4=AC|last5=Souers|first5=R|last6=Fatheree|first6=LA|last7=Chmara|first7=BA|last8=Tench|first8=WD|last9=Henry|first9=MR|title=Practices of participants in the college of american pathologists interlaboratory comparison program in cervicovaginal cytology, 2006|volume=134|issue=3|pages=331–5|doi=10.1043/1543-2165-134.3.331|journal=Archives of pathology & laboratory medicine}}</ref> | |||
It's important for you to take care of yourself by eating well and staying as active as you can during the sometimes rough treatment of cervical cancer. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy. However, you may not feel like eating during or soon after treatment. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to cope with these problems. Research shows that people with cancer feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. | |||
You'll need regular checkups after treatment for cervical cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor. Your doctor will check for the return of cancer. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Checkups may include a physical exam, Pap tests, and chest x-rays. | |||
It is often located in the chest area. Most malignant teratomas can spread throughout the body, and have spread by the time of diagnosis. | |||
A number of other cancers are often associated with these tumors, including: | |||
*[[Acute myelogenous leukemia]] (AML) | |||
*Embryonal [[rhabdomyosarcoma]] | |||
*Malignant [[histiocytosis]] | |||
*[[Myelodysplasia]] (MDS) | |||
*[[Small cell carcinoma|Small cell undifferentiated carcinoma]] | |||
{{CMG}} | |||
{{Teratoma}} | |||
__NOTOC__ | |||
{{Infobox_Disease | | |||
Name = {{PAGENAME}} | | |||
}} | |||
==Overview== | |||
DiseasesDB = 3604 | | |||
DiseasesDB_mult = {{DiseasesDB2|12952}} {{DiseasesDB2|12966}} | | |||
ICD10 = | | |||
ICD9 = | | |||
ICDO = 9080 | | |||
OMIM = | | |||
MedlinePlus = | | |||
MeshID = D013724 | | |||
==Pathology classification of individual teratomas== | |||
Teratomas commonly are classified using the Gonzalez-Crussi grading system: 0 or mature ([[benign]]); 1 or immature, probably benign; 2 or immature, possibly [[malignant]] ([[cancer]]ous); and 3 or frankly malignant. See also [[cancer staging]]. Teratomas are also classified by their content: a solid teratoma contains only tissues (perhaps including more complex structures); a cystic teratoma contain only pockets of fluid or semi-fluid such as [[cerebrospinal fluid]], [[sebum]], or fat; a mixed teratoma contains both solid and cystic parts. Cystic teratomas usually are grade 0 and, conversely, grade 0 teratomas usually are cystic. | |||
Grade 0, 1 and 2 pure teratomas have the potential to become malignant (grade 3), and malignant pure teratomas have the potential to [[metastasize]]. These rare forms of '''teratoma with malignant transformation''' may contain elements of somatic (non germ cell) malignancy such as [[leukemia]], [[carcinoma]] or [[sarcoma]].<ref name="pmid17080330">{{cite journal | |||
|author=Harms D, Zahn S, Göbel U, Schneider DT | |||
|title=Pathology and molecular biology of teratomas in childhood and adolescence. | |||
|journal=Klinische Pädiatrie | |||
|volume=218 | |||
|issue=6 | |||
|pages=296-302 | |||
|year=2006 | |||
|pmid=17080330 | |||
|doi=10.1055/s-2006-942271 | |||
}}</ref> | |||
A teratoma may contain elements of other germ cell tumors, in which case it is not a pure teratoma but rather is a '''mixed''' [[germ cell tumor]] and is malignant. In infants and young children, these elements usually are [[endodermal sinus tumor]], followed by [[choriocarcinoma]]. Finally, a teratoma can be pure and not malignant yet highly aggressive: this is exemplified by '''growing teratoma syndrome''', in which chemotherapy eliminates the malignant elements of a mixed tumor, leaving pure teratoma which paradoxically begins to grow very rapidly. | |||
=== "Benign" teratoma may prove to be malignant === | |||
A "benign" grade 0 (mature) teratoma nonetheless has a non-zero risk of malignancy. Recurrence with malignant [[endodermal sinus tumor]] has been reported in cases of formerly benign mature teratoma,<ref name="pmid9781660">{{cite journal | |||
| author = Ohno Y, Kanematsu T | |||
| title = An endodermal sinus tumor arising from a mature cystic teratoma in the retroperitoneum in a child: is a mature teratoma a premalignant condition? | |||
| journal = Hum. Pathol. | |||
| volume = 29 | |||
| issue = 10 | |||
| pages = 1167-9 | |||
| year = 1998 | |||
| pmid = 9781660 | |||
| doi = | |||
| issn = | |||
}}</ref> even in fetiform teratoma and fetus in fetu.<ref name="pmid17561476">{{cite journal | |||
| author = Chen YH, Chang CH, Chen KC, Diau GY, Loh IW, Chu CC | |||
| title = Malignant transformation of a well-organized sacrococcygeal fetiform teratoma in a newborn male. | |||
| journal = J. Formos. Med. Assoc. | |||
| volume = 106 | |||
| issue = 5 | |||
| pages = 400-2 | |||
| year = 2007 | |||
| pmid = 17561476 | |||
| doi = | |||
| issn = | |||
}} (publisher offers free full text PDF to registered users)</ref><ref name="pmid9349774">{{cite journal | |||
| author = Hopkins KL, Dickson PK, Ball TI, Ricketts RR, O'Shea PA, Abramowsky CR | |||
| title = Fetus-in-fetu with malignant recurrence. | |||
| journal = J. Pediatr. Surg. | |||
| volume = 32 | |||
| issue = 10 | |||
| pages = 1476-9 | |||
| year = 1997 | |||
| pmid = 9349774 | |||
| doi = | |||
| issn = | |||
}}</ref> A grade 1 immature teratoma that appears to be benign (e.g., because AFP is not elevated) has a much higher risk of malignancy, and requires '''adequate follow-up'''.<ref name="pmid15895292">{{cite journal | |||
| author = Muscatello L, Giudice M, Feltri M | |||
| title = Malignant cervical teratoma: report of a case in a newborn. | |||
| journal = European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery | |||
| volume = 262 | |||
| issue = 11 | |||
| pages = 899-904 | |||
| year = 2005 | |||
| pmid = 15895292 | |||
| doi = 10.1007/s00405-005-0917-2 | |||
| issn = | |||
}}</ref><ref name="pmid15928937">{{cite journal | |||
| author = Ukiyama E, Endo M, Yoshida F, Tezuka T, Kudo K, Sato S, Akatsuka S, Hata J | |||
| title = Recurrent yolk sac tumor following resection of a neonatal immature gastric teratoma. | |||
| journal = Pediatr. Surg. Int. | |||
| volume = 21 | |||
| issue = 7 | |||
| pages = 585-8 | |||
| year = 2005 | |||
| pmid = 15928937 | |||
| doi = 10.1007/s00383-005-1404-y | |||
| issn = | |||
}}</ref><ref name="pmid7508500">{{cite journal | |||
| author = Bilik R, Shandling B, Pope M, Thorner P, Weitzman S, Ein SH | |||
| title = Malignant benign neonatal sacrococcygeal teratoma. | |||
| journal = J. Pediatr. Surg. | |||
| volume = 28 | |||
| issue = 9 | |||
| pages = 1158–60 | |||
| year = 1993 | |||
| pmid = 7508500 | |||
| doi = | |||
| issn = | |||
}}</ref><ref name="pmid7692755">{{cite journal | |||
| author = Hawkins E, Issacs H, Cushing B, Rogers P | |||
| title = Occult malignancy in neonatal sacrococcygeal teratomas. A report from a Combined Pediatric Oncology Group and Children's Cancer Group study. | |||
| journal = The American journal of pediatric hematology/oncology | |||
| volume = 15 | |||
| issue = 4 | |||
| pages = 406–9 | |||
| year = 1993 | |||
| pmid = 7692755 | |||
| doi = | |||
| issn = | |||
}}</ref> | |||
=== Teratoma with malignant transformation=== | |||
A '''teratoma with malignant transformation''' or '''TMT''' is a very rare form of teratoma that may contain elements of somatic (non germ cell) malignant tumors such as [[leukemia]], [[carcinoma]] or [[sarcoma]].<ref name="pmid17080330">{{cite journal | |||
|author=Harms D, Zahn S, Göbel U, Schneider DT | |||
|title=Pathology and molecular biology of teratomas in childhood and adolescence. | |||
|journal=Klinische Pädiatrie | |||
|volume=218 | |||
|issue=6 | |||
|pages=296-302 | |||
|year=2006 | |||
|pmid=17080330 | |||
|doi=10.1055/s-2006-942271 | |||
}}</ref> Of 641 children with pure teratoma, 9 developed TMT<ref>{{cite journal | |||
| author = Biskup W, Calaminus G, Schneider DT, Leuschner I, Göbel U | |||
| title = Teratoma with malignant transformation: experiences of the cooperative GPOH protocols MAKEI 83/86/89/96. | |||
| journal = Klinische Pädiatrie | |||
| volume = 218 | |||
| issue = 6 | |||
| pages = 303-8 | |||
| year = 2006 | |||
| pmid = 17080331 | |||
| doi = 10.1055/s-2006-942272 | |||
| issn = | |||
}}</ref>: 5 [[carcinoma]], 2 [[glioma]], and 2 embryonal (here, these last are classified among germ cell tumors). | |||
=== Extraspinal ependymoma === | |||
[[ependymoma|Extraspinal ependymoma]], usually considered to be a [[glioma]] (a type of non-germ cell tumor), may be an unusual form of mature teratoma.<ref>Aktuğ T, Hakgüder G, Sarioğlu S, Akgür FM, Olguner M, Pabuçcuoğlu U. (2000) Sacrococcygeal extraspinal ependymomas: the role of coccygectomy. J Pediatr Surg. 35(3):515-518. [http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=10726703&dopt=AbstractPlus PubMed]</ref> | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Needs content]] | |||
[[Category:Disease]] | |||
[[Category:Congenital disorders]] | |||
[[Category:Obstetrics]] | |||
[[Category:Pediatrics]] | |||
[[Category:Gynecology]] | |||
[[Category:Proctology]] | |||
[[Category:Pathology]] | |||
[[Category:Surgery]] | |||
[[Category:Types of cancer]] | |||
[[Category:Rare diseases]] | |||
[[Category:Pediatric cancers]] | |||
[[Category:Endocrinology]] | |||
{{Infobox_Company | | |||
company_name = Geron Corporation | | |||
company_logo = [[Image:GERN.gif]] | | |||
company_type = [[Public company|Public]] {{NASDAQ|GERN}}| | |||
foundation = [[1990]] | | |||
location = [[Menlo Park, CA]] | | |||
key_people = [[Thomas Okarma|Dr. Thomas B. Okarma]]: President and CEO; [[David L. Greenwood]]: CFO | | |||
num_employees = 103<ref>[http://finance.yahoo.com/q/pr?s=GERN GERN: Profile for GERON CORP - Yahoo! Finance<!-- Bot generated title -->]</ref> | | |||
industry = [[Biotechnology]]| | |||
products = Cancer drugs (currently in human trials); Stem cell therapies for spinal cord injuries (human trials planned for early 2008) | | |||
revenue = {{profit}} $3.277 Million [[U.S. dollar|USD]] ([[2006]])| | |||
net_income = {{loss}}-$31.365 Million [[U.S. dollar|USD]] ([[2006]])| | |||
homepage = [http://www.geron.com/ www.geron.com] | | |||
}} | |||
{{SI}} | |||
See Ben Underwood for a case who compensated for the resulting blindness by developing [[human echolocation]]. | |||
In October 2007, researchers have identified the specific cell that causes retinoblastoma.[http://www.sciencedaily.com/releases/2007/10/071018123509.htm]old daughter had the condition. Fisher missed Game 1 and half of Game 2 of the 2007 NBA playoff series versus the Golden State Warriors to be with his daughter for her surgery in New York City | |||
'''Retinoblastoma''' is a [[cancer]] of the [[retina]]. Development of this tumor is initiated by [[mutation]]s<ref>{{cite journal |author=Knudson A |title=Mutation and cancer: statistical study of retinoblastoma |journal=Proc Natl Acad Sci U S A |volume=68 |issue=4 |pages=820-3 |year=1971 |pmid=5279gadgqetqer523}}</ref> that inactivate both copies of the ''[[RB1]]'' gene, which codes for the [[retinoblastoma protein]].<ref>{{cite journal |author=Friend S, Bernards R, Rogelj S, Weinberg R, Rapaport J, Albert D, Dryja T |title=A human DNA segment with properties of the gene that predisposes to retinoblastoma and osteosarcoma |journal=Nature |volume=323 |issue=6089 |pages=643-6 |year= |pmid=2877398}}</ref> | |||
It occurs mostly in children younger than 5 years and accounts for about 3% of the cancers occurring in children younger than 15 years. Adult cases have also been clinically recorded.<ref>{{cite journal |author=Takahashi T, Tamura S, Inoue M, Isayama Y, Sashikata T |title=Retinoblastoma in a 26-year-old adult |journal=Ophthalmology |volume=90 |issue=2 |pages=179-83 |year=1983 |pmid=6856254}}</ref> The estimated annual incidence is approximately 4 per million children.<ref>[http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_retinoblastoma_37.asp?sitearea= cancer.org]</ref> It begins with white blotches in one or both eyes ([[leukocoria]]) which can be seen in photographs (this is distinct from the [[red-eye effect]] which is normal); or when light reflects off the eye, as when watching television | |||
The term uterine cancer may refer to one of several different types of cancer which occur in the [[uterus]]. These include: | |||
*[[Endometrial cancer]]s | |||
:*''Endometrial carcinomas'' originate from cells in the glands of the [[endometrium]] (uterine lining). These include the common and readily treatable ''well-differentiated endometrioid adenocarcinoma,'' as well as the more aggressive ''uterine papillary serous carcinoma'' and ''uterine clear-cell carcinoma''. | |||
:*''Endometrial stromal sarcomas'' originate from the [[connective tissue]]s of the [[endometrium]], and are far less common than endometrial carcinomas | |||
:*''Malignant mixed müllerian tumors'' are rare endometrial tumors which show both glandular ([[carcinoma|carcinomatous]]) and stromal ([[sarcoma|sarcomatous]]) differentiation - their true cell of origin is unknown. | |||
*[[Cervical cancer]] arises from the transitional zone of the [[cervix]], the lower portion of the uterus which lies at the upper aspect of the [[vagina]] | |||
*[[uterine sarcoma|Sarcomas]] of the [[myometrium]], or muscular layer of the uterus, are most commonly [[leiomyosarcoma]]s. [[Uterine fibroid]]s are non-cancerous smooth muscle tumors which are vastly more common than [[sarcoma]]s. | |||
A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. | |||
A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). | |||
==Treatment== | |||
There is no specific treatment for [[infectious mononucleosis]], other than treating the symptoms. No antiviral drugs or vaccines are available. Some physicians have prescribed a 5-day course of steroids to control the swelling of the throat and tonsils. The use of steroids has also been reported to decrease the overall length and severity of illness, but these reports have not been published. | |||
===Prevention & Treatment=== | |||
* Epstein-Barr Virus (EBV) <ref name=CDC>{{cite web | title = Epstein-Barr Virus (EBV) center for disease control and prevention| url =http://www.cdc.gov/epstein-barr/about-ebv.html }}</ref> | |||
:* There is no vaccine to protect against EBV infection. You can help protect yourself by not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who have EBV infection. | |||
:* There is no specific treatment for EBV. However, some things can be done to help relieve symptoms, including | |||
::* Drinking fluids to stay hydrated | |||
::* Getting plenty of rest | |||
::* Taking over-the-counter medications for pain and fever | |||
Gas gangrene | |||
Preferred regimen: Penicillin G 3-4 million units IV q4h AND (Clindamycin 900 mg IV q8h OR Tetracycline 500 mg IV q6h)[78] | |||
[[Antibiotics]] are used if an infection is suspected. [[Fluoroquinolone]]s are an option, although resistance of ''[[N. gonorrhoeae]]'' may limit their use. A [[cephalosporin]] (such as [[ceftriaxone]]) combined with [[doxycycline]] is an alternative. [[Azithromycin]] can be used for susceptible strains. In children, quinolones and doxycycline are best avoided. Since bacteria that cause urinary tract infections are often the cause of epididymitis in children, [[co-trimoxazole]] or suited [[penicillin]]s (for example, [[cephalexin]]) can be used. If there is a sexually transmitted disease, the partner should also be treated. | |||
Household remedies such as elevation of the [[scrotum]] and cold compresses applied regularly to the [[scrotum]] may relieve the pain. [[Painkillers]] or [[non-steroidal anti-inflammatory drugs|anti-inflammatory drugs]] are often necessary. Hospitalisation is indicated for severe cases, and check-ups can ensure the [[infection]] has cleared up. | |||
* [[Doxycycline]] is the drug of choice. | |||
* For people allergic to drugs of the [[tetracycline]] class, [[rifampicin]] is an alternative. | |||
* Early clinical experience suggested that [[chloramphenicol]] may also be effective, however in vitro susceptibility testing revealed [[resistance]]. | |||
:* Preferred regimen: [[Doxycycline]] 100 mg IV q12h for 7-14 days | |||
:* Alternative regimen (1): [[Chloramphenicol]] | |||
:* Alternative regimen (2): [[Rifampin]] | |||
:* Pediatric regimen: [[Doxycycline]] 2.2 mg/kg PO bid (Children under 45 kg (100 lbs)) for 7-14 days | |||
:* Note: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement | |||
===Febrile Neutropenia=== | |||
{{Seealso|Febrile neutropenia medical therapy}} | |||
Exception may be made for neutropenic patients in which delayed treatment could lead to serious complications. | |||
After samples for cultures are obtained, febrile neutropenia should be aggressively treated with broad-spectrum antipseudomonal antibiotics. The antimicrobial regimen should be modified in accordance with the culture results.<ref name="Mandell">[http://www.ppidonline.com/ Mandell's Principles and Practices of Infection Diseases] 6th Edition (2004) by Gerald L. Mandell MD, MACP, John E. Bennett MD, Raphael Dolin MD, ISBN 0-443-06643-4 · Hardback · 4016 Pages Churchill Livingstone </ref><ref name="Harrison">[http://books.mcgraw-hill.com/medical/harrisons/ Harrison's Principles of Internal Medicine] 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7</ref><ref name="Oxford"> [http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?ci=0192629220&view=usa The Oxford Textbook of Medicine] Edited by David A. Warrell, Timothy M. Cox and John D. Firth with Edward J. Benz, Fourth Edition (2003), Oxford University Press, ISBN 0-19-262922-0</ref> | |||
===HIV/AIDS patients=== | |||
HIV-infected persons with pyrexia and [[hypoxia (medical)|hypoxia]], should be placed on therapy for [[Pneumocystis pneumonia|''Pneumocystis jirovecii'' infection]] and adjusted once the diagnosis is confirmed.<ref name="Oxford"> [http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?ci=0192629220&view=usa The Oxford Textbook of Medicine] Edited by David A. Warrell, Timothy M. Cox and John D. Firth with Edward J. Benz, Fourth Edition (2003), Oxford University Press, ISBN 0-19-262922-0</ref> | |||
===Giant Cell Arteritis=== | |||
Empiric [[corticosteroids]] may be considered in patients with suspected [[giant cell arteritis]] to prevent vascular complications such as [[stroke]] and [[blindness]]. Giant cell arteritis should be suspected in a patient over the age of 50 with the following symptoms: | |||
* Newly onset [[headaches]] | |||
* Abrupt onset of [[blurry vision]] | |||
* Symptoms of [[polymyalgia rheumatica]] | |||
* [[Jaw claudication]] | |||
* Unexplained [[anemia]] | |||
* Elevated [[ESR|erythrocyte sedimentation rate (ESR)]] and/or [[CRP|C-reactive protein (CRP)]] | |||
====Premenopausal, Nonpregnant Women==== | |||
'''No screening or treatment recommended for healthy, bacteriuric women.'''<br> | |||
Although asymptomatic bacteriuria increases the risk of urinary tract infection but has no effect on the long term adverse outcomes like CKD, genitourinary cancer or overall survival.<ref name="pmid3387908">{{cite journal| author=Tencer J| title=Asymptomatic bacteriuria--a long-term study. | journal=Scand J Urol Nephrol | year= 1988 | volume= 22 | issue= 1 | pages= 31-4 | pmid=3387908 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3387908 }} </ref> <ref name="pmid9764457">{{cite journal| author=Bengtsson C, Bengtsson U, Björkelund C, Lincoln K, Sigurdsson JA| title=Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden. | journal=Scand J Urol Nephrol | year= 1998 | volume= 32 | issue= 4 | pages= 284-9 | pmid=9764457 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9764457 }} </ref> | |||
Studies' results indicated that the treatment wouldn't decrease the frequency for asymptomatic bacteriuria or the risk of developing symptomatic urinary tract infection.<ref name="pmid4886627">{{cite journal| author=Asscher AW, Sussman M, Waters WE, Evans JA, Campbell H, Evans KT et al.| title=Asymptomatic significant bacteriuria in the non-pregnant woman. II. Response to treatment and follow-up. | journal=Br Med J | year= 1969 | volume= 1 | issue= 5647 | pages= 804-6 | pmid=4886627 | doi= | pmc=PMC1982498 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4886627 }} </ref> | |||
====Pregnant Women==== | |||
{| | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: center; width:25em" cellpadding="0" cellspacing="0"; | |||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pregnant women}}'' | |||
|- | |||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Regimen:3-7 day for any of the following'' | |||
|- | |||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin]] 250 mg–1 gm po tid''''' <BR> ''OR'' <BR> '''''[[Cephalosporins|Oral cephalosporins]] <br>[[Cefaclor]]500 mg po q8h or 500 mg extended release q12h<br>[[Cefdinir]] 300 mg po q12h or 600 mg po q24h<br>[[Cefditoren]] 200 mg tabs—2 tabs bid<br>[[Cefixime]] 400 mg po q24h<br>[[Cefpodoxime proxetil]] 200 mg po q12h<br>[[Cefprozil]] 500 mg po q12h<br>[[Ceftibuten]] 400 mg po q24h<br>[[Cefuroxime axetil]] 250 or 500 mg q12h<br>[[Loracarbef]] 400 mg po q12h<BR>''''' <BR> ''OR'' <BR> ▸ '''''[[TMP-SMX]] DS 1 tab bid ''''' <BR> ''OR'' <br> ▸ '''''[[Trimethoprim]] 100 mg po q12h or 200 mg po q24h.''''' | |||
|- | |||
|} | |||
<BR> | |||
'''In early pregnancy, both screening for asymptomatic bacteriuria by urine culture and treatment of positive results are recommended.''' | |||
*Single screening with urine culture<ref name="-1990">{{Cite journal | title = Screening for asymptomatic bacteriuria, hematuria and proteinuria. The U.S. Preventive Services Task Force. | journal = Am Fam Physician | volume = 42 | issue = 2 | pages = 389-95 | month = Aug | year = 1990 | doi = | PMID = 2200247 }}</ref>in the first trimester<ref name="Stenqvist-1989">{{Cite journal | last1 = Stenqvist | first1 = K. | last2 = Dahlén-Nilsson | first2 = I. | last3 = Lidin-Janson | first3 = G. |last4 = Lincoln | first4 = K. | last5 = Odén | first5 = A. | last6 = Rignell | first6 = S. | last7 = Svanborg-Edén | first7 = C. | title = Bacteriuria in pregnancy. Frequency and risk of acquisition. | journal = Am J Epidemiol | volume = 129 | issue = 2 | pages = 372-9 | month = Feb | year = 1989 | doi = | PMID = 2912046 }} | |||
</ref>proved to be effective.<ref name="Wadland-1989">{{Cite journal | last1 = Wadland | first1 = WC. | last2 = Plante | first2 = DA. | title = Screening for asymptomatic bacteriuria in pregnancy. A decision and cost analysis. | journal = J Fam Pract | volume = 29 | issue = 4 | pages = 372-6 | month = Oct | year = 1989 | doi = | PMID = 2794885 }}</ref> | |||
*Antibiotics treatment has shown a significant decrease in the risk of subsequent [[pyelonephritis]](from 25-30% to 1-4%).<ref name="pmid11405965">{{cite journal| author=Smaill F| title=Antibiotics for asymptomatic bacteriuria in pregnancy. | journal=Cochrane Database Syst Rev | year= 2001 | volume= | issue= 2 | pages= CD000490 | pmid=11405965 | doi=10.1002/14651858.CD000490 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11405965 }} </ref> They also reduce the frequency of [[premature birth|preterm deliveries]] and [[low birth weight]].<ref name="pmid1533541">{{cite journal| author=Mittendorf R, Williams MA, Kass EH| title=Prevention of preterm delivery and low birth weight associated with asymptomatic bacteriuria. | journal=Clin Infect Dis | year= 1992 | volume= 14 | issue= 4 | pages= 927-32 | pmid=1533541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1533541 }} </ref> <ref name="pmid2927852">{{cite journal| author=Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins JC, Bracken M| title=Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. | journal=Obstet Gynecol | year= 1989 | volume= 73 | issue= 4 | pages= 576-82 | pmid=2927852 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2927852 }} </ref> | |||
*The duration of antimicrobial therapy is 3-7 days. | |||
*After therapy of recurrent bacteriuria, periodic screening should be considered. | |||
====Diabetic Women==== | |||
'''Asymptomatic bacteriuria screening or treatment is not recommended for diabetic women.''' | |||
*No change in the rate of symptomatic urinary tract infection, diabetes progression and complication or overall mortality in diabetic women<ref name="Geerlings-2001">{{Cite journal | last1 = Geerlings | first1 = SE. | last2 = Stolk | first2 = RP. | last3 = Camps | first3 = MJ. | last4 = Netten | first4 = PM. | last5 = Collet | first5 = JT. | last6 = Schneeberger | first6 = PM. | last7 = Hoepelman | first7 = AI. | title = Consequences of asymptomatic bacteriuria in women with diabetes mellitus. | journal = Arch Intern Med | volume = 161 | issue = 11 | pages = 1421-7 | month = Jun | year = 2001 | doi = | PMID = 11386891 }}</ref> <ref name="Semetkowska-Jurkiewicz-">{{Cite journal | last1 = Semetkowska-Jurkiewicz | first1 = E. | last2 = Horoszek-Maziarz | first2 = S. | last3 = Galiński | first3 = J. | last4 = Manitius | first4 = A. | last5 = Krupa-Wojciechowska | first5 = B. | title = The clinical course of untreated asymptomatic bacteriuria in diabetic patients--14-year follow-up. | journal = Mater Med Pol | volume = 27 | issue = 3 | pages = 91-5 | month = | year = | doi = | PMID = 8935144 }}</ref>, in addition to the adverse effects of antimicrobial therapy.<ref name="Harding-2002">{{Cite journal | last1 = Harding | first1 = GK. | last2 = Zhanel | first2 = GG. | last3 = Nicolle | first3 = LE. | last4 = Cheang | first4 = M. | title = Antimicrobial treatment in diabetic women with asymptomatic bacteriuria. | journal = N Engl J Med | volume = 347 | issue = 20 | pages = 1576-83 | month = Nov | year = 2002 | doi = 10.1056/NEJMoa021042 | PMID = 12432044 }}</ref> | |||
====Older Persons Residing in the Community==== | |||
'''Routine screening and treatment for asymptomatic bacteriuria is not indicated.''' | |||
*Treatment has no effect on decreasing symptomatic urinary tract infections,<ref name="Boscia-1987">{{Cite journal | last1 = Boscia | first1 = JA. | last2 = Kobasa | first2 = WD. | last3 = Knight | first3 = RA. | last4 = Abrutyn | first4 = E. | last5 = Levison | first5 = ME. | last6 = Kaye | first6 = D. | title = Therapy vs no therapy for bacteriuria in elderly ambulatory nonhospitalized women. | journal = JAMA | volume = 257 | issue = 8 | pages = 1067-71 | month = Feb | year = 1987 | doi = | PMID = 3806896 }}</ref> adverse outcomes or survival.<ref name="Nordenstam-1986">{{Cite journal | last1 = Nordenstam | first1 = GR. | last2 = Brandberg | first2 = CA. | last3 = Odén | first3 = AS. | last4 = Svanborg Edén | first4 = CM. | last5 = Svanborg | first5 = A. | title = Bacteriuria and mortality in an elderly population. | journal = N Engl J Med | volume = 314 | issue = 18 | pages = 1152-6 | month = May | year = 1986 | doi = 10.1056/NEJM198605013141804 | PMID = 3960089 }}</ref> <ref name="Heinämäki-1986">{{Cite journal | last1 = Heinämäki | first1 = P. | last2 = Haavisto | first2 = M. | last3 = Hakulinen | first3 = T. | last4 = Mattila | first4 = K. | last5 = Rajala | first5 = S. | title = Mortality in relation to urinary characteristics in the very aged. | journal = Gerontology | volume = 32 | issue = 3 | pages = 167-71 | month = | year = 1986 | doi = | PMID = 3721209 }}</ref> | |||
====Elderly Institutionalized Subjects==== | |||
'''No recommendation for screening for or treatment of asymptomatic bacteriuria.''' | |||
*No reduction in rates of symptomatic infections or survival.<ref name="Nicolle-1987">{{Cite journal | last1 = Nicolle | first1 = LE. | last2 = Mayhew | first2 = WJ. | last3 = Bryan | first3 = L. | title = Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. | journal = Am J Med | volume = 83 | issue = 1 | pages = 27-33 | month = Jul | year = 1987 | doi = | PMID = 3300325 }}</ref> <ref name="Abrutyn-1994">{{Cite journal | last1 = Abrutyn | first1 = E. | last2 = Mossey | first2 = J. | last3 = Berlin | first3 = JA. | last4 = Boscia | first4 = J. | last5 = Levison | first5 = M. | last6 = Pitsakis | first6 = P. | last7 = Kaye | first7 = D. | title = Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women? | journal = Ann Intern Med | volume = 120 | issue = 10 | pages = 827-33 | month = May | year = 1994 | doi = | PMID = 7818631 }}</ref> | |||
*Instead, treatment has increased the risk of adverse effects and reinfections with resistant strains.<ref name="Nicolle-1987">{{Cite journal | last1 = Nicolle | first1 = LE. | last2 = Mayhew | first2 = WJ. | last3 = Bryan | first3 = L. | title = Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. | journal = Am J Med | volume = 83 | issue = 1 | pages = 27-33 | month = Jul | year = 1987 | doi = | PMID = 3300325 }}</ref> | |||
====Subjects with Spinal Cord Injuries==== | |||
'''No benefit from screening for or treatment of asymptomatic bacteriuria''' | |||
Although the high prevalence of asymptomatic bacteriuria in patients with spinal cord injuries<ref name="Erickson-1982">{{Cite journal | last1 = Erickson | first1 = RP. | last2 = Merritt | first2 = JL. | last3 = Opitz | first3 = JL. | last4 = Ilstrup | first4 = DM. | title = Bacteriuria during follow-up in patients with spinal cord injury: I. Rates of bacteriuria in various bladder-emptying methods. | journal = Arch Phys Med Rehabil | volume = 63 | issue = 9 | pages = 409-12 | month = Sep | year = 1982 | doi = | PMID = 7115037 }}</ref>, but antimicrobial therapy harm outweigh benefit because of recurrent infections with more resistant strains.<ref name="Waites-1993">{{Cite journal | last1 = Waites | first1 = KB. | last2 = Canupp | first2 = KC. | last3 = DeVivo | first3 = MJ. | title = Eradication of urinary tract infection following spinal cord injury. | journal = Paraplegia | volume = 31 | issue = 10 | pages = 645-52 | month = Oct | year = 1993 | doi = 10.1038/sc.1993.104 | PMID = 8259327 }}</ref> | |||
====Patients with Indwelling Urethral Catheters==== | |||
'''It is not recommended to screen for or treat asymptomatic bacteriuria or fungiuria for short or long term catheters,<ref name="Sobel-2000">{{Cite journal | last1 = Sobel | first1 = JD. | last2 = Kauffman | first2 = CA. | last3 = McKinsey | first3 = D. | last4 = Zervos | first4 = M. | last5 = Vazquez | first5 = JA. | last6 = Karchmer | first6 = AW. | last7 = Lee | first7 = J. | last8 = Thomas | first8 = C. | last9 = Panzer | first9 = H. | title = Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group. | journal = Clin Infect Dis | volume = 30 | issue = 1 | pages = 19-24 | month = Jan | year = 2000 | doi = 10.1086/313580 | PMID = 10619727 }}</ref> but antimicrobial therapy can be used for women with persistent bacteriuria 48 hours after removal of the urethral catheter. ''' | |||
*No benefit of therapy of asymptomatic bacteriuria due to similar recurrence rates with more resistance to antibiotics.<ref name="Warren-1982">{{Cite journal | last1 = Warren | first1 = JW. | last2 = Anthony | first2 = WC. | last3 = Hoopes | first3 = JM. | last4 = Muncie | first4 = HL. | title = Cephalexin for susceptible bacteriuria in afebrile, long-term catheterized patients. | journal = JAMA | volume = 248 | issue = 4 | pages = 454-8 | month = Jul | year = 1982 | doi = | PMID = 7045440 }}</ref><ref name="Alling-1975">{{Cite journal | last1 = Alling | first1 = B. | last2 = Brandberg | first2 = A. | last3 = Seeberg | first3 = S. | last4 = Svanborg | first4 = A. | title = Effect of consecutive antibacterial therapy on bacteriuria in hospitalized geriatric patients. | journal = Scand J Infect Dis | volume = 7 | issue = 3 | pages = 201-7 | month = | year = 1975 | doi = | PMID = 809837 }}</ref> | |||
*Significant improvement has been shown with women treated for bacteriuria that existed 48 hours after removal of indwelling urethral catheters.<ref name="Harding-1991">{{Cite journal | last1 = Harding | first1 = GK. | last2 = Nicolle | first2 = LE. | last3 = Ronald | first3 = AR. | last4 = Preiksaitis | first4 = JK. | last5 = Forward | first5 = KR. | last6 = Low | first6 = DE. | last7 = Cheang | first7 = M. | title = How long should catheter-acquired urinary tract infection in women be treated? A randomized controlled study. | journal = Ann Intern Med | volume = 114 | issue = 9 | pages = 713-9 | month = May | year = 1991 | doi = | PMID = 2012351 }}</ref> | |||
====Urologic Interventions==== | |||
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: center; width:25em" cellpadding="0" cellspacing="0"; | |||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Urologic Intervention}}'' | |||
|- | |||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Regimen'' | |||
|- | |||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP-SMX]] DS 1 tab bid x 3 days''''' | |||
|} | |||
<BR> | |||
Due to high risk of bacteremia (60%) and sepsis(6-10%) because of traumatic genitourinary procedures,<ref name="Grabe-1987">{{Cite journal | last1 = Grabe | first1 = M. | title = Antimicrobial agents in transurethral prostatic resection. | journal = J Urol | volume = 138 | issue = 2 | pages = 245-52 | month = Aug | year = 1987 | doi = | PMID = 3298693 }}</ref> and the effectiveness of antimicrobials to prevent these complications;<ref name="Cafferkey-1982">{{Cite journal | last1 = Cafferkey | first1 = MT. | last2 = Falkiner | first2 = FR. | last3 = Gillespie | first3 = WA. | last4 = Murphy | first4 = DM. | title = Antibiotics for the prevention of septicaemia in urology. | journal = J Antimicrob Chemother | volume = 9 | issue = 6 | pages = 471-7 | month = Jun | year = 1982 | doi = | PMID = 7107549 }}</ref> <ref name="Grabe-1987">{{Cite journal | last1 = Grabe | first1 = M. | last2 = Forsgren | first2 = A. | last3 = Björk | first3 = T. | last4 = Hellsten | first4 = S. | title = Controlled trial of a short and a prolonged course with ciprofloxacin in patients undergoing transurethral prostatic surgery. | journal = Eur J Clin Microbiol | volume = 6 | issue = 1 | pages = 11-7 | month = Feb | year = 1987 | doi = | PMID = 3569248 }}</ref> <ref name="Allan-1985">{{Cite journal | last1 = Allan | first1 = WR. | last2 = Kumar | first2 = A. | title = Prophylactic mezlocillin for transurethral prostatectomy. | journal = Br J Urol | volume = 57 | issue = 1 | pages = 46-9 | month = Feb | year = 1985 | doi = | PMID = 3971104 }}</ref> | |||
'''screening for bacteriuria and antimicrobial therapy is recommended before the initiation of invasive urologic procedures like transurethral resection of prostate.'''<ref name="Cafferkey-1982">{{Cite journal | last1 = Cafferkey | first1 = MT. | last2 = Falkiner | first2 = FR. | last3 = Gillespie | first3 = WA.| last4 = Murphy | first4 = DM. | title = Antibiotics for the prevention of septicaemia in urology.| journal = J Antimicrob Chemother | volume = 9 | issue = 6| pages = 471-7 | month = Jun | year = 1982 | doi = | PMID = 7107549 }}</ref><ref name="Allan-1985">{{Cite journal | last1 = Allan | first1 = WR. | last2 = Kumar | first2 = A. | title = Prophylactic mezlocillin for transurethral prostatectomy. | journal = Br J Urol | volume = 57 | issue = 1 | pages = 46-9 | month = Feb | year = 1985 | doi = | PMID = 3971104 }}</ref> | |||
*Antibiotic therapy usually discontinued after the procedure, unless there is an indwelling urethral catheter until removed. <ref name="Grabe-1987">{{Cite journal | last1 = Grabe |first1 = M. | title = Antimicrobial agents in transurethral prostatic resection. | journal = J Urol | volume = 138 | issue = 2 | pages = 245-52 | month = Aug |year = 1987 | doi = | PMID = 3298693 }}</ref><ref name="Cafferkey-1982">{{Cite journal | last1 = Cafferkey | first1 = MT. | last2 = Falkiner | first2 = FR. | last3 = Gillespie | first3 = WA. | last4 = Murphy | first4 = DM. | title = Antibiotics for the prevention of septicaemia in urology.| journal = J Antimicrob Chemother | volume = 9 | issue = 6 | pages = 471-7 | month = Jun | year = 1982 | doi = | PMID = 7107549 }}</ref> | |||
====Immunocompromised Patients and Other Patients==== | |||
Poor transplant prognosis and complications hasn't been associated with asymptomatic bacteriuria,<ref name="Takai-1998">{{Cite journal | last1 = Takai | first1 = K. | last2 = Tollemar | first2 = J. | last3 = Wilczek | first3 = HE. | last4 = Groth | first4 = CG. | title = Urinary tract infections following renal transplantation. | journal = Clin Transplant | volume = 12 | issue = 1 | pages = 19-23 | month = Feb | year = 1998 | doi = | PMID = 9541418 }}</ref><ref name="Lyerová-2001">{{Cite journal | last1 = Lyerová | first1 = L. | last2 = Lácha | first2 = J. | last3 = Skibová | first3 = J. | last4 = Teplan | first4 = V. | last5 = Vítko | first5 = S. | last6 = Schück | first6 = O. | title = Urinary tract infection in patients with urological complications after renal transplantation with respect to long-term function and allograft survival. | journal = Ann Transplant | volume = 6 | issue = 2 | pages = 19-20 | month = | year = 2001 | doi = | PMID = 11803612 }}</ref>so there is no benefit from screening<ref name="Ghasemian-1996">{{Cite journal | last1 = Ghasemian | first1 = SM. | last2 = Guleria | first2 = AS. | last3 = Khawand | first3 = NY. | last4 = Light | first4 = JA. | title = Diagnosis and management of the urologic complications of renal transplantation. | journal = Clin Transplant | volume = 10 | issue = 2 | pages = 218-23 | month = Apr | year = 1996 | doi = | PMID = 8664523 }}</ref><ref name="Kasiske-2000">{{Cite journal | last1 = Kasiske | first1 = BL. | last2 = Vazquez | first2 = MA. | last3 = Harmon | first3 = WE. | last4 = Brown | first4 = RS. | last5 = Danovitch | first5 = GM. | last6 = Gaston | first6 = RS. | last7 = Roth | first7 = D. | last8 = Scandling | first8 = JD. | last9 = Singer | first9 = GG. | title = Recommendations for the outpatient surveillance of renal transplant recipients. American Society of Transplantation. | journal = J Am Soc Nephrol | volume = 11 Suppl 15 | issue = | pages = S1-86 | month = Oct | year = 2000 | doi = | PMID = 11044969 }}</ref> | |||
for or treatment of asymptomatic bacteriuria in renal transplant or other solid organ<ref name="-2000">{{Cite journal | title = Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. | journal = MMWR Recomm Rep | volume = 49 | issue = RR-10 | pages = 1-125, CE1-7 | month = Oct | year = 2000 | doi = | PMID = 11718124 }}</ref> transplant patients.<ref name="pmid15714408">{{cite journal| author=Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM et al.| title=Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. | journal=Clin Infect Dis | year= 2005 | volume= 40 | issue= 5 | pages= 643-54 | pmid=15714408 | doi=10.1086/427507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15714408 }} </ref> | |||
There is no vaccine against the bacteria. LGV can be treated with three weeks of antibiotics. CDC STD Treatment Guidelines recommend the use of doxycyline, twice a day for 21 days. An alternative treatment is erythromycin base or azithromycin. The health care provider will determine which is best. | |||
Medical Therapy | |||
Acute Pharmacotherapy | |||
Treatment involves antibiotics and may involve drainage of the buboes or abscesses by needle aspiration or incision. Further supportive measure may need to be taken: dilatation of the rectal stricture, repair ofrectovaginal fistulae, or colostomy for rectal obstruction. Common antibiotic treatments include: tetracycline, doxycycline (all tetracyclines, including doxycycline, are contraindicated during pregnancy and in children due to effects on bone development and tooth discoloration), and erythromycin. | |||
If a patient has been treated for LGV, he/she should notify any sex partners they had sex with within 60 days of the symptom onset so they can be evaluated and treated. This will reduce the risk that their partners will develop symptoms and/or serious complications of LGV. It will reducetheir risk of becoming re-infected as well as reduce the risk of ongoing transmission in the community. The patient and all of his/her sex partners should avoid sex until the patient has completed treatment for the infection and symptoms of both the patient and their partners have disappeared. | |||
Note: Doxycycline is not recommended for use in pregnant women. Pregnant and lactating women should be treated with erythromycin. Azythromycin may prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. A health care provider (like a doctor or nurse) can discuss treatment options with patients. | |||
Persons with both LGV and HIV infection should receive the same LGV treatment as those who are HIV-negative. Prolonged therapy may be required, and delay in resolution of symptoms may occur among persons with HIV. | |||
As with all STD's sex partners of patients who have LGV should be examined and tested for urethral or cervical chlamydial infection. After a positive culture for chlamydia, clinical suspicion should be confirmed with testing to distinguish serotype. Antibiotic treatment should be started if they had sexual contact with the patient during the 30 days preceding onset of symptoms in the patient. Patients with a sexually transmitted disease need to be tested for other STD's. Antibiotics are not without risks and prophylaxtic broad antibiotic coverage is not recommended.[1] | |||
==Overview== | |||
Genital warts may disappear without treatment, but sometimes eventually develop a fleshy, small raised growth. There is no way to predict whether they will grow or disappear. | |||
==Medical Treatment== | |||
==Overveiw== | |||
*The primary reason for treating genital warts is the amelioration of symptoms (including relieving cosmetic concerns) and ultimately, removal of the warts. In most patients, treatment can induce wart-free periods. | |||
*If left untreated, visible genital warts can resolve on their own, remain unchanged, or increase in size or number. Available therapies for genital warts likely reduce, but probably do not eradicate, HPV infectivity. | |||
*Whether the reductio==Medical Treatment==n in HPV viral DNA resulting from treatment reduces future transmission remains unclear. No evidence indicates that the presence of genital warts or their treatment is associated with the development of cervical cancer. | |||
*Factors that influence selection of treatment include wart size, wart number, anatomic site of the wart, wart morphology, patient preference, cost of treatment, convenience, adverse effects, and provider experience. | |||
*The treatment modality should be changed if a patient has not improved substantially after a complete course of treatment or if side effects are severe. Most genital warts respond within 3 months of therapy. | |||
{| style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Genital Warts Treatment}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | |||
|- | |||
| style="font-size: 100%; padding: 0 5px; background: #DCDCDC" align=left | '''External genital warts'''(Patient applied) | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Podophyllin|Podofilox]] (0.5% solution or gel): apply 2x/day x 3 days, 4th day no therapy, repeat cycle 4x''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Imiquimod]] 5% cream: apply once daily at bedtime 3x/week x up to 16 weeks''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Sinecatechins]] 15% ointment''''' | |||
|- | |||
| style="font-size: 100%; padding: 0 5px; background: #DCDCDC" align=left | '''External genital warts'''(Provider administered) | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cryotherapy]] with liquid nitrogen; repeat q1-2 weeks'''''<BR> OR <BR> ▸ '''''[[Podophyllin]] resin 10-25% in tincture of benzoin. Repeat weekly as needed'''''<BR> OR <BR> ▸ '''''[[Trichloroacetic acid]](TCA): repeat weekly as needed'''''<BR> OR <BR> ▸ '''''Surgical removal''''' | |||
|- | |||
| style="font-size: 100%; padding: 0 5px; background: #DCDCDC" align=left | '''Vaginal warts''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ ''''' [[Cryotherapy]]with liquid nitrogen'''''<BR> OR <BR> ▸ '''''[[Trichloroacetic acid]] | |||
|- | |||
| style="font-size: 100%; padding: 0 5px; background: #DCDCDC" align=left | '''Urethral warts''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ ''''' [[Cryotherapy]] with liquid nitrogen '''''<BR> OR <BR> ▸ '''''[[Podophyllin]] resin 10-25% in tincture of benzoin.''''' | |||
|- | |||
| style="font-size: 100%; padding: 0 5px; background: #DCDCDC" align=left | '''Anal warts''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cryotherapy]] with liquid nitrogen'''''<BR> OR <BR> ▸ '''''[[Trichloroacetic acid]]'''''<BR> OR <BR> ▸ ''''' surgical removal.<br> Advise anoscopy to look for rectal warts''''' | |||
|- | |||
| style="font-size: 100%; padding: 0 5px; background: #DCDCDC" align=left | '''Skin Papillomas''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Topical α-lactalbumin. Oleic acid (from human milk) applied 1x/day for 3 weeks''''' | |||
|} | |||
|} | |||
* [[Imiquimod]] (Aldara) a topical immune response cream, applied to the affected area | |||
* A 20% podophyllin anti-[[mitosis|mitotic]] solution, applied to the affected area and later washed off | |||
* A 0.5% podofilox solution, applied to the affected area but not to be washed off | |||
* A 5% 5-[[fluorouracil]] (5-FU) cream | |||
* [[Trichloroacetic acid]] (TCA) | |||
* Pulsed [[dye laser]] | |||
* [[Liquid nitrogen]] cryosurgery | |||
* Electric or laser [[cauterization]] | |||
* [[Condylox]] | |||
* Sinecatechins (Veregen) also [[Polyphenon]] E: ointment made of several green-tea-extracted catechines and other components. Mode of action is undetermined.<ref>{{cite web | url=http://www.veregenrx.com/IL331%20Veregen%20PI%20170mm_x_420mm.pdf|title=Veragen package insert|accessdate=2008-08-18}}</ref> It is FDA-approved but very expensive | |||
*Podophyllin and podofilox should not be used during [[pregnancy]], as they are absorbed by the skin and may cause [[birth defect]]s in the [[fetus]]. 5-fluorouracil cream should not be used while trying to become pregnant or if there is a possibility of pregnancy. | |||
Some doctors inject the antiviral drug [[interferon]]-alpha directly into the warts, to treat warts that have returned after removal by traditional means. The drug is expensive, and does not reduce the rate that the warts return. | |||
* In general, warts located on moist surfaces or in intertriginous areas respond best to topical treatment. | |||
*Patients should be warned that persistent hypopigmentation or hyperpigmentation occurs commonly with ablative modalities and has also been described with immune modulating therapies (imiquimod). | |||
==HSV=====Antiviral Drugs=== | |||
[[Aciclovir|Acyclovir]] (an [[antiviral drug]]) inhibits replication of the viral DNA, and is used both as [[prophylaxis]] (''e.g.'', in patients with [[AIDS]]) and as therapy for herpes zoster. Other antivirals are [[valacyclovir]] and [[famciclovir]]. During the [[Acute (medical)|acute phase]], oral acyclovir should be given. Use of acylovir is most effective in moderating the progress of the symptoms, and in preventing post-herpetic neuralgia, if started within 24 to 72 hours of the onset of symptoms, so medical care should be obtained as soon as the condition is recognized. [[Immunocompromised]] patients may respond best to intravenous acyclovir. In patients who are at high risk for recurrences, an oral dose of acyclovir, taken twice daily, is usually effective. It is also reported that the [[amino acid]] [[lysine]] inhibits the replication of herpes zoster.<ref>{{cite journal|last=Griffith|first=RS|coauthors=Walsh DE, Myrmel KH, Thmpson RW, and Behforooz A|title=Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis|journal=Dermatologica|date=1987|volume=175|issue=4|pages=183-190|id=PMID 3115841}}</ref> | |||
===Analgesics=== | |||
People with mild to moderate pain can be treated with [[Over-the-counter drug|over-the-counter]] [[analgesics]]. Topical lotions containing [[calamine]] can be used on the rash or blisters and may be soothing. Occasionally, severe pain may require an opioid medication, such as [[morphine]]. Once the lesions have crusted over, [[capsaicin]] cream (Zostrix) can be used. Topical [[lidocaine]] and nerve blocks may also reduce pain.<ref name=pmid15061819>{{cite journal| author=Baron R| title=Post-herpetic neuralgia case study: optimizing pain control| journal=Eur. J. Neurol| volume=11 Suppl 1| pages=3–11| year=2004| pmid=15061819| doi=10.1111/j.1471-0552.2004.00794.x}}</ref> Administering [[gabapentin]] along with antivirals may offer relief of postherpetic neuralgia<ref name="pmid18021865">{{cite journal| author=Tyring SK| title=Management of herpes zoster and postherpetic neuralgia. | journal=J Am Acad Dermatol | year= 2007 | volume= 57 | issue= 6 Suppl | pages= S136-42 | pmid=18021865 | doi=10.1016/j.jaad.2007.09.016 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18021865 }} </ref>. | |||
===Steroids=== | |||
Orally administered [[glucocorticoid|corticosteroids]] are frequently used in treatment of the infection, despite clinical trials of this treatment being unconvincing. Nevertheless, one trial studying [[immunocompetent]] patients older than 50 years of age with localized herpes zoster, suggested that administration of [[prednisone]] with [[aciclovir]] improved healing time and quality of life.<ref name=pmid8702088>{{cite journal |author=Whitley RJ, Weiss H, Gnann JW, Tyring S, Mertz GJ, Pappas PG, Schleupner CJ, Hayden F, Wolf J, Soong SJ |title=Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group |journal=Ann. Intern. Med. |volume=125 |issue=5 |pages=376–83 |year=1996 |pmid=8702088}}</ref> Upon one-month evaluation, aciclovir with prednisone increased the likelihood of crusting and healing of lesions by about twofold, when compared to placebo. This trial also evaluated the effects of this drug combination on quality of life at one month, showing that patients had less pain, and were more likely to stop the use of [[analgesic]] agents, return to usual activities and have uninterrupted sleep. However, when comparing cessation of herpes zoster-associated pain or post herpetic neuralgia, there was no difference between aciclovir plus prednisone and simply aciclovir alone. Because of the risks of corticosteroid treatment, it is recommended that this combination of drugs only be used in people more than 50 years of age, due to their greater risk of postherpetic neuralgia.<ref name=pmid8702088/> | |||
===Other Drugs=== | |||
[[Cimetidine]], a common component of over-the-counter heartburn medication, has been shown to lessen the severity of herpes zoster outbreaks in several different instances.<ref>{{cite journal|author=Kapinska-Mrowiecka M, &Toruwski G | title=Efficacy of cimetidine in treatment of herpes zoster in the first 5 days from the moment of disease manifestation. | journal= Pol Tyg Lek. | year=1996. | pages=338-339 | volume=51 | issue=23-26 | id=PMID 9273526}}</ref><ref>{{cite journal|author=Hayne ST, & Mercer JB|title=Herpes zoster: treatment with cemetidine|journal=Canadian Medical Association Journal|year=1983|pages=1284-1285| volume=129|issue=12|id=PMID 6652595}}</ref><ref>{{cite journal|author=Notmann J, Arieli J, Hart J, Levinsky H, Halbrecht I, & Sendovsky U | title=In vitro cell-mediated immune reactions in herpes zoster patients treated with cimetidine. | journal=Asian Pacific Journal Allergy and Immunology|year=1994|pages=51-58|volume=12|issue=1|id=PMID 7872992}}</ref> This usage is considered an [[off-label use]] of the drug. In addition, cimetidine and [[probenecid]] have been shown to reduce the renal clearance of aciclovir. <ref>{{cite journal|author=De Bony F, Tod M, Bidault R, On NT, Posner J, & Rolan P| title=Multiple interactions of cimetidine and probenecid with valaciclovir and its metabolite acyclovir |journal=Antimicrobial Agents and Chemotherapy|year=2002|pages=458-463|volume=46 |issue=2|id=PMID 11796358}}</ref> The study showed these compounds reduce the rate, but not the extent, at which valaciclovir is converted into aciclovir. Renal clearance of aciclovir was reduced by approximately 24% and 33% respectively. In addition, respective increases in the peak plasma concentration of acyclovir of 8% and 22% were observed. The authors concluded that these effects were "not expected to have clinical consequences regarding the safety of valaciclovir". Due to the tendency of aciclovir to precipitate in renal tubules, combining these drugs should only occur under the supervision of a physician. | |||
==VZV==[[Image:Disease varicella3.jpg|thumb|right|Transmission electron micrograph of varicella-zoster virions]] | |||
[[Image:Chickenpox-virus.jpg|thumb|right|[[Electron microscope|Electron micrograph]] of [[Varicella zoster virus]]. Approx. 150.000-fold magnification.]] | |||
===Complementary Therapies=== | |||
Digestive Enzymes are available on prescription and in some over the counter preparations. Before the availability of antivirals, oral pancreatic enzyme therapy in shingles was used in some countries and later subjected to clinical and scientific research. A large scale multi-centre clinical study, using an oral preparation of such enzymes, has shown promising results.<ref name="pmid7713467">{{cite journal |author=Billigmann P |title=[Enzyme therapy--an alternative in treatment of herpes zoster. A controlled study of 192 patients] |language=German |journal=Fortschr. Med. |volume=113 |issue=4 |pages=43-8 |year=1995 |pmid=7713467 |doi=}}</ref> <ref name="pmid16813460">{{cite journal |author=Roxas M |title=Herpes zoster and postherpetic neuralgia: diagnosis and therapeutic considerations |journal=Alternative medicine review : a journal of clinical therapeutic |volume=11 |issue=2 |pages=102-13 |year=2006 |pmid=16813460 |doi=}}</ref> The results of another clinical study support the concept that oral enzyme therapy is beneficial in diseases characterized in part by TGF-beta overproduction that included shingles patients. <ref name="pmid11561866">{{cite journal |author=Desser L, Holomanova D, Zavadova E, Pavelka K, Mohr T, Herbacek I |title=Oral therapy with proteolytic enzymes decreases excessive TGF-beta levels in human blood |journal=Cancer Chemother. Pharmacol. |volume=47 Suppl |issue= |pages=S10-5 |year=2001 |pmid=11561866 |doi=}}</ref> TGF-β has also been found to be elevated in instances of VZV infection. <ref name="pmid15547808">{{cite journal |author=Kaygusuz I, Gödekmerdan A, Keleş E, ''et al'' |title=The role of viruses in idiopathic peripheral facial palsy and cellular immune response |journal=American journal of otolaryngology |volume=25 |issue=6 |pages=401-6 |year=2004 |pmid=15547808 |doi=}}</ref> <ref name="pmid11094200">{{cite journal |author=Sato M, Abe T, Tamai M |title=Expression of the Varicella Zoster Virus Thymidine Kinase and Cytokines in Patients with Acute Retinal Necrosis Syndrome |journal= |volume=44 |issue=6 |pages=693 |year=2000 |pmid=11094200 |doi=}}</ref> | |||
=== Anti-viral medication === | |||
==== Nucleoside analogs ==== | |||
Treatment is available in the form of antiviral medications such as [[Nucleoside analogues|nucleoside analogs]], which reduce the duration of symptoms of a herpex simplex virus outbreak and accelerate healing. [[Nucleoside]] analogs are molecules which possess a similarity to natural [[nucleotide]]s - the building-blocks of [[DNA]] and [[RNA]]. Active herpes simplex virus will [[viral replication|replicate]]; a virus replicating in the presence of these analogs will incorporate them into its DNA, so that its genetic material will contain defects and [[mutations]]. As a result, the next generation of virus will be damaged and reduced in number. | |||
Nucleoside analogs are typically used at the first symptoms of an viral outbreak to reduce the duration of the outbreak and improve healing of the lesion. Treatment taken prior to the appearance of lesions may avert or reduce the symptoms of the outbreak. Occasionally nucleoside analogs are used as a daily suppressive therapy, and taken daily for several years. Suppressive therapy reduces frequency of symptoms and recurrence of outbreaks. In addition, suppressive therapy reduces [[Subclinical infection|subclinical]] [[viral shedding]], lowering the risk of transmission through sexual contact or kissing. | |||
Common nucleoside analogs are listed in the table above. Of these, Ganciclovir is known to have [[cytotoxic]] effects on infected cells but Acyclovir is not known to have this effect.<ref>{{cite journal |author=Rubsam LZ, Davidson BL, Shewach DS |title=Superior cytotoxicity with ganciclovir compared with acyclovir and 1-beta-D-arabinofuranosylthymine in herpes simplex virus-thymidine kinase-expressing cells: a novel paradigm for cell killing |journal=Cancer Res. |volume=58 |issue=17 |pages=3873-82 |year=1998 |pmid=9731497 |doi=}}</ref> | |||
{|padding="6" border="1" | |||
!Oral Prodrug<br> | |||
!Drug | |||
!Analog of [[Nucleoside]] | |||
!Nucleoside Family | |||
|- | |||
|[[Famciclovir]]<ref name=ASHA>{{cite web | title = Learn About Herpes: Treatment | work = | url = http://www.ashastd.org/herpes/herpes_learn_treatment.cfm | publisher = American Social Health Association | accessdate = 2007-07-09}}</ref><br>(bioavailability: 75% oral)<br>(trade names: ''Famvir'') | |||
|[[Penciclovir]]<br>(1.5% oral, IV, locally topical)<br>(''Denavir'', ''Fenistil'') | |||
|rowspan="3"|<math>\Bigg\}</math>[[guanosine]] | |||
|rowspan="3"|[[purine]] | |||
|- | |||
| [[Valaciclovir]]<br>(55% oral)<br>(''Valtrex'') | |||
| [[Aciclovir]]<br>(10-20% oral)<br>(''Zovirax'', ''Zovir'') | |||
|- | |||
| [[Valganciclovir]]<br>(60% oral)<br>(''Valcyte'') | |||
| [[Ganciclovir]]<br>(5% oral, IV, locally intraocular)<br>(''Cytovene'', ''Cymevene'') | |||
|- | |||
| [[Brivudine]]<ref>{{cite journal | author = Ciucci A, Lafrate EM, Manzini S, Giachetti A | title = Mechanism of antiviral action of (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU) : direct evidence with 14-C-BVDU in herpes simplex virus-infected cells | journal = Antiviral Chemistry & Chemotherapy | year = 1997 | volume = 8 | pages = 565–71 | url=http://cat.inist.fr/?aModele=afficheN&cpsidt=2064708 }}</ref> (BVDU) | |||
| | |||
| [[thymidine]] | |||
| [[pyrimidine]] | |||
|} | |||
==== Fusion inhibitors ==== | |||
Fusion inhibitors prevent "fusion" of the viral envelope with the cell membrane. This prevents [[viral entry]] to the cell. | |||
* [[Docosanol]] | |||
==== Helicase-primase inhibitors ==== | |||
One of three key protein structures involved in HSV DNA replication is the [[Helicase]]-[[Primase]] structure. New research compounds which bind to this megamolecule show remarkable effectiveness against HSV. In particular, BAY 57-1293 has shown positive results in animal models of HSV infection.<ref>{{cite journal |author=Crumpacker CS, Schaffer PA |title=New anti-HSV therapeutics target the helicase-primase complex |journal=Nat. Med. |volume=8 |issue=4 |pages=327-8 |year=2002 |pmid=11927930 |doi=10.1038/nm0402-327 |url=http://www.nature.com/nm/journal/v8/n4/full/nm0402-327.html}}</ref> | |||
==== Dietary supplements ==== | |||
The [[amino acid]] [[lysine]] has demonstrated the ability to reduce the duration of infection through inhibiting the replication of the HSV. When foods high in lysine (such as lentils) are consumed in preference to foods high in [[arginine]], HSV replication may be inhibited; conversely, consuming foods high in arginine (such as nuts or peanuts) may interfere with the therapeutic use of lysine.<ref>{{cite web | title = Cold Sores | work = | url = http://www.puritan.com/vf/healthnotes/HN_live/Concern/Cold_Sores.htm | publisher = Healthnotes | accessdate = 2007-07-09}}</ref> However, according to the American Social Health Association: "While some studies have suggested that lysine supplements can reduce the frequency of recurrences or healing time, other trials have been unable to replicate those results. Therefore, there is not sufficient information to discern how effective it may be, in addition to what the effective dosages or frequency of L-lysine may be."<ref name=ASHA /> | |||
==== Other anti-viral medication ==== | |||
[[Undecylenic acid]] (Castor oil derivative) is proven to have anti-bacterial and anti-viral properties that are effective on viral skin infections such as the herpes simplex virus (HSV). | |||
[[Butylated hydroxytoluene]] (BHT), commonly available as a food preservative, has been shown ''in vitro'' to inactivate enveloped viruses including herpes.<ref>{{cite journal |author=Snipes W, Person S, Keith A, Cupp J |title=Butylated hydroxytoluene inactivated lipid-containing viruses |journal=Science |volume=188 |issue=4183 |pages=64-6 |year=1975 |pmid=163494 |doi=}}</ref><ref>{{cite journal |author=Coohill TP, Babich M, Taylor WD, Snipes W |title=A comparison of herpes simplex virus plaque development after viral treatment with anti-DNA or antilipid agents |journal=Biophys. J. |volume=30 |issue=3 |pages=517-21 |year=1980 |pmid=6266532 |doi=}}</ref> ''In-vivo'' studies of topical application to animals confirmed the anti-viral activity of BHT during outbreaks.<ref>{{cite journal |author=Richards JT, Katz ME, Kern ER |title=Topical butylated hydroxytoluene treatment of genital herpes simplex virus infections of guinea pigs |journal=Antiviral Res. |volume=5 |issue=5 |pages=281-90 |year=1985 |pmid=2998276 |doi=}}</ref> BHT has not been clinically tested and approved to treat herpes in humans. | |||
==== Drug Resistance ==== | |||
Resistance of HSVes in cell culture has been reported for nucleosides in the range of 10<sup>-2</sup> to 10<sup>-4</sup> and for [[Helicase]]-[[Primase]] inhibitors in the range of 10<sup>-4</sup> to 10<sup>-6</sup>. | |||
However, in the clinic roughly 1-2% of the patients are infected by nucleoside-resistant HSVes. In the immunocompromised patient population such as transplant, AIDS or cancer patients the resistance rate can reach up to 10%. | |||
==Chlamydia== | |||
Chlamydia is a genus of obligate intracellular bacteria in the family [[Chlamydiaceae]], order [[Chlamydiales]], class and phylum [[Chlamydiae]]. Several species of Chlamydia are pathogenic to humans causing pneumonia, eye infections, and sexually transmitted disease, which is called [[Chlamydia]] | |||
[[Image:ChlamydiaTrachomatisEinschlusskörperchen.jpg|thumb|right|''Chlamydia trachomatis'' inclusion bodies (brown) in a McCoy cell culture.]] | |||
''C. trachomatis'' infection can be effectively cured with [[antibiotic]]s once it is detected. Current [[Centers for Disease Control]] guidelines provide for the following treatments: | |||
* [[Azithromycin]] 1 gram oral as a single dose, or | |||
* [[Doxycycline]] 100 milligrams twice daily for seven days. | |||
* [[Tetracycline]] | |||
* [[Erythromycin]] | |||
Untested Treatments | |||
* [[Ciprofloxacin]] 500 milligrams twice daily for 3 days. (Although this is not an approved method of treatment, as it is shown to be ineffective and may simply delay symptoms.) | |||
[[β-lactams]] are not suitable drugs for the treatment of chlamydia. While they have the ability to halt growth of the organism (i.e. are microbistatic), these antibiotics do not eliminate the bacteria. Once treatment is stopped, the bacteria will begin to grow once more. (See below for Persistence.) | |||
The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine for weeks, plus intensive medical and nursing care. After several weeks, the [[paralysis]] slowly improves. If diagnosed early, foodborne and wound botulism can be treated by inducing [[passive immunity]] with a horse-derived [[antitoxin]], which blocks the action of toxin circulating in the blood.<ref>Shapiro, Roger L. MD; Charles Hatheway, PhD; and David L. Swerdlow, MD [http://www.annals.org/cgi/content/full/129/3/221?ijkey=360c044072fcb6ead39e0866dcdbba9c51784956 ''Botulism in the United States: A Clinical and Epidemiologic Review''] Annals of Internal Medicine. 1 August 1998 Volume 129 Issue 3 Pages 221-228</ref> This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using [[enema]]s. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism. | |||
Besides supportive care, infant botulism can be treated with human botulism immune globulin (BabyBIG), when available. Supply is extremely limited, but is available through the California Department of Health Services. This dramatically decreases the length of illness for most infants. Paradoxically, antibiotics (especially [[aminoglycosides]] or [[clindamycin]]) may cause dramatic acceleration of paralysis as the affected bacteria release toxin. Visual stimulation should be performed during the time the infant is paralyzed as well, in order to promote the normal development of visual pathways in the brain during this critical developmental period. | |||
Furthermore each case of food-borne botulism is a potential public health emergency in that it is necessary to identify the source of the outbreak and ensure that all persons who have been exposed to the toxin have been identified, and that no contaminated food remains. | |||
There are two primary Botulinum Antitoxins available for treatment of wound and foodborne botulism. Trivalent (A,B,E) Botulinum Antitoxin is derived from equine sources utilizing whole [[antibodies]] (Fab & Fc portions). This antitoxin is available from the local health department via the [[Centers for Disease Control|CDC]]. The second antitoxin is heptavalent (A,B,C,D,E,F,G) Botulinum Antitoxin which is derived from "despeciated" equine [[IgG]] antibodies which have had the Fc portion cleaved off leaving the F(ab')2 portions. This is a less immunogenic antitoxin that is effective against all known strains of botulism where not contraindicated. This is available from the US Army. On June 1, 2006 the US Department of Health and Human Services awarded a $363 million contract with Cangene Corporation for 200,000 doses of Heptavalent Botulinum Antitoxin over five years for delivery into the Strategic National Stockpile beginning in 2007.<ref>http://mmrs.fema.gov/news/publichealth/2006/aug/nph2006-08-03a.aspx</ref> | |||
==Antimicrobial regimen== | |||
:*'''1. Antibiotics''' | |||
::* Antibiotics are not recommended in gastrointestinal botulism due to the risk of worsening of neurological symptoms caused by the lysis of the bacteria. For wound botulism antibiotics are indicated with surgical treatment as followed: | |||
::* Preferred regimen: [[Metronidazole]] 500 mg IV q8h | |||
::* Alternative regimen: [[Penicillin G]] 3 million units IV q4h | |||
:*'''2. Antitoxin''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref> | |||
::* Preferred regimen: Trivalent antitoxin (A 7,500 IU, B 5,000 IU, and E 5,000 IU) 1 vial diluted 1:10, IV infusion over 30 min | |||
::* Alternative regimen: Equine antitoxin | |||
:*'''3. General Therapy''' | |||
::* Preferred regimen: Mechanical ventilation; IV hydration; tube feedings | |||
:*'''1. Antibiotics''' | |||
::* Antibiotics are not recommended in gastrointestinal botulism due to the risk of worsening of neurological symptoms caused by the lysis of the bacteria. For wound botulism antibiotics are indicated with surgical treatment as followed: | |||
::* Preferred regimen: [[Metronidazole]] 500 mg IV q8h | |||
::* Alternative regimen: [[Penicillin G]] 3 million units IV q4h | |||
:*'''2. Antitoxin''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref> | |||
::* Preferred regimen: Trivalent antitoxin (A 7,500 IU, B 5,000 IU, and E 5,000 IU) 1 vial diluted 1:10, IV infusion over 30 min | |||
::* Alternative regimen: Equine antitoxin | |||
:*'''3. General Therapy''' | |||
::* Preferred regimen: Mechanical ventilation; IV hydration; tube feedings | |||
===Pharmacotherapy brucella=== | |||
====Acute Pharmacotherapies==== | |||
The gold standard treatment for adults is daily intramuscular injections of [[streptomycin]] 1 g for 14 days and oral [[doxycycline]] 100 mg twice daily for 45 days (concurrently). [[Gentamicin]] 5 mg/kg by [[intramuscular injection]] once daily for 7 days is an acceptable substitute when streptomycin is not available or difficult to obtain.<ref>{{cite journal | title=Efficacy of gentamicin plus doxycycline versus streptomycin plus doxycycline in the treatment of brucellosis in humans | year=2006 | author=Roushan MRH, Mohraz M, Hajiahmadi M, Ramzani A, Valayati AA | journal=Clin Infect Dis | volume=42 | issue=8 | pages=1075–80 }}</ref> | |||
Another widely used regimen is doxycycline plus rifampin twice daily for at least 6 weeks. This regimen has the advantage of oral administration. | |||
A triple therapy of doxycycline, together with [[rifampin]] and [[cotrimoxazole]] has been used succefully to treat neurobrucellosis. <ref>{{cite journal | title= Neurobrucellosis: Clinical and therapeutic features | year=1992 | author=McLean DR, Russell N, Khan MY | journal=Clin Infect Dis | volume=15 | pages=582–90 }}</ref> | |||
Doxycycline is able to cross the blood-brain barrier, but requires the addition of two other drugs to prevent relapse. Ciprofloxacin and co-trimoxazole therapy is associated with an unacceptably high rate of relapse. | |||
In brucellic endocarditis surgery is required for an optimal outcome. | |||
Even with optimal antibrucellic therapy relapses still occur in 5-10 percent of patients with Malta fever. | |||
Experiments have shown that cotrimoxyzol and rifampin are both safe drugs to use in treatment of pregnant women who have Brucellosis. | |||
=== Acute Pharmacotherapies gonorrhea === | |||
<gallery> | |||
Image:PenicillinPSAedit.jpg|Gonorrhea treatment advertisement from 1944, when penicillin became widely available due to mass production. | |||
</gallery> | |||
Several antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhea is becoming more difficult. Because many people with gonorrhea also have chlamydia, another sexually transmitted disease, antibiotics for both infections are usually given together. Persons with gonorrhea should be tested for other STDs. | |||
It is important to take all of the medication prescribed to cure gonorrhea. Although medication will stop the infection, it will not repair any permanent damage done by the disease. People who have had gonorrhea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhea. If a person's symptoms continue even after receiving treatment, he or she should return to a doctor to be reevaluated. | |||
The mainstay of treatment is the appropriate use of [[antibiotic]]s. While penicillin was the most common antibiotic used to treat gonorrhea up until the 1970s, an increase in antibiotic resistance has led to a decline in its use. Recommendations for first choice treatment of gonorrhea must depend on local information on resistance patterns and it is not possible to make treatment recommendations that are applicable to all parts of the world. | |||
The [[Centers for Disease Control and Prevention]] (CDC) released a report on Thursday, April 12, 2007 officially adding gonorrhea to a list of [[Antibiotic resistance| super bugs]] that are now resistant to common antibiotics according to [http://www.cdc.gov/std/Gonorrhea/arg/default.htm CDC]. | |||
Antibiotics that may be used to treat gonorrhea include: | |||
* [[Amoxycillin]] 2 g plus [[probenecid]] 1 g orally | |||
* [[Ampicillin]] 2 to 3 g plus [[probenecid]] 1 g orally | |||
* [[Azithromycin]] 2 g orally | |||
* [[Cefixime]] 400 mg orally | |||
* [[Cefotaxime]] 500 mg by intramuscular injection | |||
* [[Cefoxitin]] 2 g by intramuscular injection, plus [[probenecid]] 1 g orally | |||
* [[Cefpodoxime]] (Vantin) 400 mg orally | |||
* [[Ceftriaxone]] (Rocephin) 125 to 250 mg by intramuscular injection | |||
* [[Ciprofloxacin]] 500 mg orally | |||
* [[Levofloxacin]] 250 mg orally | |||
* [[Ofloxacin]] 400 mg orally | |||
* [[Spectinomycin]] 2 g by intramuscular injection | |||
These drugs are all given as a single dose. | |||
The level of [[tetracycline]] resistance in ''Neisseria gonorrheae'' is now so high as to make it completely ineffective in most parts of the world. | |||
The fluoroquinolones ([[ciprofloxacin]], [[ofloxacin]], [[levofloxacin]]) cannot be used in [[pregnancy]]. It is important to refer all sexual partners to be checked for gonorrhea to prevent spread of the disease and to prevent the patient from becoming re-infected with gonorrhea. Patients should also be offered screening for other sexually transmitted infections. In areas where co-infection with [[chlamydia]] is common, doctors may prescribe a combination of antibiotics, such as [[ceftriaxone]] with [[doxycycline]] or [[azithromycin]], to treat both diseases. | |||
Penicillin is ineffective at treating rectal gonorrhea: this is because other bacteria within the rectum produce β-lactamases that destroy penicillin. All current treatments are less effective at treating gonorrhea of the throat, so the patient must be rechecked by throat swab 72 hours or more after being given treatment, and then retreated if the throat swab is still positive. | |||
Although gonorrhea usually does not require follow-up (with the exception of rectal or pharyngeal disease), patients are usually advised to phone for results five to seven days after diagnosis to confirm that the antibiotic they received was likely to be effective. Patients are advised to abstain from sex during this time. | |||
Drug resistant strains are known to exist. | |||
===United States recommendations=== | |||
The United States does not have a federal system of sexual health clinics, and the majority of infections are treated in family practices. A third-generation [[cephalosporin]] antibiotic such as ceftriaxone is recommended for use in most areas. Since some areas such as Hawaii and California have very high levels of resistance to [[fluoroquinolone]] antibiotics (ciprofloxacin, ofloxacin, [[levofloxacin]]) they are no longer used empirically to treat infections originating in these areas. | |||
===United Kingdom recommendations=== | |||
In the United Kingdom, the majority of patients with gonorrhea are treated in dedicated sexual health clinics. The current recommendation is for ceftriaxone or cefixime as first line therapy; no resistance to either drug has yet been reported in the UK. Levels of spectinomycin resistance in the UK are less than 1%, which would make it a good choice in theory, but intramuscular spectinomycin injection is very painful. | |||
[[Azithromycin]] (given as a single dose of 2 g) is recommended if there is concurrent infection with chlamydia. A single dose of oral ciprofloxacin 500 mg is effective if the organism is known to be sensitive, but fluoroquinolones were removed from the UK recommendations for empirical therapy in 2003 because of increasing resistance rates. In 2005, resistance rates for ciprofloxacin were 22% for the whole of the UK (42% for London, 10% for the rest of the UK).<ref>{{cite web | author=Health Protection Agency | title=The gonococcal resistance to antimicrobials surveillance programme: Annual report 2005 | url=http://www.hpa.org.uk/infections/topics_az/hiv_and_sti/sti-gonorrhea/publications/GRASP_2005_Annual_Report.pdf | accessdate=2006-10-28}}</ref> | |||
==antrax== | |||
{{Taxobox | |||
| color = lightgrey | |||
| name = ''Bacillus anthracis'' | |||
| image = Bacillus_anthracis_01.png | |||
| image_width = 240px | |||
| image_caption = Photomicrograph of ''Bacillus anthracis'' (fuchsin-methylene blue spore stain). | |||
| regnum = [[Bacterium|Bacteria]] | |||
| phylum = [[Firmicutes]] | |||
| classis = [[Bacilli]] | |||
| ordo = [[Bacillales]] | |||
| familia = [[Bacillaceae]] | |||
| genus = ''[[Bacillus]]'' | |||
| species = '''''B. anthracis''''' | |||
| binomial = ''Bacillus anthracis'' | |||
| binomial_authority = Cohn 1872 | |||
}} | |||
[[Image:B_anthracis_diagram_en.png|right|thumb|240px|Structure of ''Bacillus anthracis''.]] | |||
__NOTOC__ | |||
{{CMG}}; {{AE}} {{JH}} | |||
==Overview== | |||
'''''Bacillus anthracis''''' is a [[Gram-positive]], [[Facultative anaerobic organism|facultatively anaerobic]], rod-shaped [[bacterium]] of the genus ''[[Bacillus]]''. An [[endospore]] forming bacterium, ''B. anthracis'' is a natural soil-dwelling organism, as well as the causative agent of [[anthrax disease|anthrax]].<ref name=Sherris>{{cite book | author = Ryan KJ, Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | publisher = McGraw Hill | year = 2004 | isbn = 0-8385-8529-9 }}</ref> | |||
Each cell is about 1 by 6 [[micrometre|μm]] in size. | |||
==Historical background== | |||
''B. anthracis'' was the first bacterium conclusively demonstrated to cause disease, by [[Robert Koch]] in 1877.<ref name=Brock>{{cite book | author = Madigan M, Martinko J (editors). | title = Brock Biology of Microorganisms | edition = 11th ed. | publisher = Prentice Hall | year = 2005 | isbn = 0-13-144329-1 }}</ref> The species name ''anthracis'' is from the [[Greek language|Greek]] ''anthrakis'' (ἄνθραξ), meaning ''coal'' and referring to the most common form of the disease, [[cutaneous]] anthrax, in which large black skin [[lesion]]s are formed. | |||
==Pathogenicity== | |||
Under conditions of environmental stress, ''B. anthracis'' bacteria naturally produce endospores which rest in the soil and can survive for decades in this state. When ingested by a cattle, sheep, or other [[herbivore]]s, the bacteria begin to reproduce inside the animal and eventually kill it, then continue to reproduce in its carcass. Once the nutrients are exhausted, new endospores are produced and the cycle repeats.<ref name=Baron>{{cite book | author = Turnbull PCB | title = Bacillus. ''In:'' Barron's Medical Microbiology ''(Baron S ''et al'', eds.)| edition = 4th ed. | publisher = Univ of Texas Medical Branch | year = 1996 | url = http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.925 | isbn = 0-9631172-1-1}}</ref> | |||
''B. anthracis'' has at least 89 known [[strain (biology)|strains]], ranging from highly virulent strains with [[biological warfare]] and [[bioterrorism]] applications ([[Ames strain|Ames]] and ''Vollum'') to benign strains used for [[inoculation]]s (''Sterne''). The strains differ in presence and activity of various [[gene]]s, determining their [[virulence]] and production of [[antigen]]s and [[toxin]]s. The form associated with the [[2001 anthrax attacks]] produced both [[anthrax toxin|toxin]] (consisting of three [[protein]]s: [[anthrax toxin|the protective antigen, the edema factor and the lethal factor]]) and a [[Capsule_(microbiology)|capsule]] (consisting of a polymer of glutamic acid). Infection with anthrax requires the presence of all three of these exotoxins.<ref>{{cite journal |author=Dixon TC, Meselson M, Guillemin J, Hanna PC |title=Anthrax |journal=N. Engl. J. Med. |volume=341 |issue=11 |pages=815-26 |year=1999 |pmid=10477781 |doi=}}</ref> | |||
The bacterium can be cultivated in ordinary nutrient medium under aerobic or anaerobic conditions. | |||
==Treatment== | |||
{{main|Anthrax}} | |||
Infections with ''B. anthracis'' can be treated with [[Beta-lactam|β-lactam]] [[antibiotic]]s such as [[penicillin]], and others which are active against Gram-positive bacteria.<ref>{{cite journal |author = Barnes JM |title=Penicillin and ''B. anthracis''. |journal= J Path Bacteriol |volume=194|year=1947|pages=113}}</ref> | |||
==References== | |||
{{reflist|2}} | |||
==Gallery== | |||
<gallery> | |||
Image: Bacillus_anthracis01.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis02.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis03.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis05.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis06.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis07.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis08.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis09.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis10.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis11.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis12.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis13.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis14.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis15.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis16.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis17.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis18.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis19.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis20.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis21.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
Image: Bacillus_anthracis22.jpeg| Bacillus anthracis. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | |||
</gallery> | |||
==References== | |||
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{{Reflist}} | |||
[[Category:Bacillaceae]] | |||
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==Antibiotic Treatment== | |||
===Cutaneous Anthrax without Systemic Involvement=== | |||
====Choice of Antibiotics==== | |||
* Uncomplicated cutaneous anthrax has been successfully treated with a '''single oral antimicrobial drug'''. | |||
* Oral [[fluoroquinolone]]s ([[ciprofloxacin]], [[levofloxacin]], and [[moxifloxacin]]) and [[doxycycline]] are equivalent first-line agents. | |||
* [[Clindamycin]] is an alternative option if [[fluoroquinolone]]s and [[doxycycline]] are contraindicated or unavailable. | |||
* Given the long history of successful treatment of localized uncomplicated cutaneous anthrax with [[penicillin]], [[amoxicillin]] and [[penicillin]] VK are also alternative therapeutic options if the isolate is known to be susceptible to [[penicillin]]. However, adequate dosages must be used because of the potential for development of drug resistance during treatment with subtherapeutic dosing.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
====Duration of Treatment==== | |||
* Duration of treatment for localized or uncomplicated cutaneous disease depends on the [[B. anthracis]] exposure source:<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
** Naturally acquired (e.g., animals with anthrax, products such as hides from animals with anthrax): 7–10-day course | |||
** Bioterrorism-related exposure or an aerosol exposure is suspected: 60 days (because the patient is likely to have also inhaled spores.) | |||
===Systemic Anthrax When Meningitis Has Been Excluded=== | |||
====Choice of Antibiotics==== | |||
* The initial treatment should include '''≥2 antimicrobial drugs''' with activity against B. anthracis:<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
** ≥1 should have bactericidal activity, and | |||
** ≥1 should be a protein synthesis inhibitor | |||
* Intravenous ciprofloxacin is preferred as the primary bactericidal component in the treatment of systemic disease. [[Linezolid]] or [[clindamycin]] are the preferred as the first-line protein synthesis inhibitor.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
* If the [[B. anthracis]] strain is susceptible to [[penicillin]], then [[penicillin G]] is considered equivalent to the [[fluoroquinolone]] options for primary bactericidal treatment.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
* Treatment with antimicrobial drugs that have good central nervous system (CNS) penetration is not a crucial factor. Thus, [[meropenem]] is recommended as an acceptable alternative option than as a first-line antimicrobial drug, and [[vancomycin]] is also an acceptable alternative. [[Clindamycin]] and [[linezolid]] are considered equivalent first-line choices for protein synthesis inhibitors. [[Doxycycline]] is added as an alternative protein synthesis inhibitor option if [[linezolid]] or [[clindamycin]] are contraindicated or unavailable.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
====Duration of Treatment==== | |||
* Initial intravenous combination treatment should be given for ≥2 weeks or until the patient is clinically stable, whichever is longer.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
====Follow–up Oral Treatment for Systemic Disease==== | |||
Once patients with systemic illness who were exposed to aerosolized [[spore]]s have completed initial combination treatment, they should be transitioned to '''single-agent oral treatment''' to prevent relapse from surviving [[B. anthracis]] spores.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
===Systemic Anthrax with Possible/Confirmed Meningitis=== | |||
====Choice of Antibiotics==== | |||
* Empiric treatment for anthrax in which anthrax meningitis is suspected or cannot be ruled out should include '''≥3 antimicrobial drugs''' with activity against B. anthracis:<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
** ≥1 drug should have bactericidal activity | |||
** ≥1 should be a protein synthesis inhibitor | |||
** All should have good CNS penetration | |||
* Hospitalized patients for systemic [[anthrax]] should be immediately treated with a combination of [[broad-spectrum]] [[intravenous]] [[antibiotic]] drug treatment pending confirmatory test results because any delay may prove fatal. Because [[meningitis]] and hemorrhagic brain parenchymal [[infection]] was observed in ≤50% of cases, [[meningitis]] must be considered in all cases of systemic [[anthrax]]. Therefore [[antibiotics]] to treat possible [[meningitis]] must have good penetration of the [[central nervous system]] (CNS).<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
* Intravenous [[ciprofloxacin]] is preferred as the primary bactericidal component in the treatment of systemic disease on the basis of efficacy in non-human primates (NHP) infection models and recent use for anthrax cases. [[Levofloxacin]] and [[moxifloxacin]] are considered equivalent alternatives to [[ciprofloxacin]]. The [[fluoroquinolone]]s have adequate CNS penetration and there are no reports of natural resistance.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
* The [[carbapenem]] class of antimicrobial drugs is highly resistant to [[β-lactamase]]s and provides good [[CNS]] penetration. [[Meropenem]] is preferred as the second antimicrobial drug in the combination antimicrobial drug regimen for anthrax meningitis. If [[meropenem]] is unavailable, [[doripenem]] and [[imipenem]]/[[cilastatin]] are considered equivalent alternatives. [[Imipenem]]/[[cilastatin]] is associated with increased [[seizure]] risk and should be used with caution in patients with suspected meningitis. If the [[B. anthracis]] strain is susceptible to [[penicillin]] ([[MIC]] <0.125 µg/mL), [[penicillin G]] or [[ampicillin]] are acceptable alternatives to [[carbapenem]]s.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
* At least 1 antimicrobial drug that inhibits protein synthesis should be used to reduce [[exotoxin]] production. [[Linezolid]] is preferred as the first-line protein synthesis inhibitor. It is preferred over [[clindamycin]] because it is likely to provide better [[CNS]] penetration, although [[randomized controlled trial]]s on treatment for [[CNS]] infections with either agent are lacking. However, [[linezolid]] toxicity issues must be taken into consideration. Myelosuppression, peripheral and optic neuropathies, and [[serotonin syndrome]] have been reported in patients receiving [[linezolid]]. [[Linezolid]] should be used cautiously in patients with pre-existing [[myelosuppression]]. In patients receiving [[monoamine oxidase inhibitor]]s or [[serotonin reuptake inhibitor]]s, the benefit of [[linezolid]] treatment should be weighed against the risk for [[serotonin]] toxicity and an alternative should be considered. If patients experience visual impairment, prompt ophthalmic evaluation is recommended. If patients have contraindications to [[linezolid]] use or it is unavailable, [[clindamycin]] is an acceptable alternative. [[Rifampin]], although not a protein synthesis inhibitor, has been widely used for its synergistic effect with a primary drug and could also be used in this capacity if [[linezolid]] or [[clindamycin]] are unavailable. The protein synthesis inhibitor [[chloramphenicol]] has good CNS penetration and has historically been used to successfully treat anthrax. Where available, it could be an acceptable alternative if [[linezolid]], [[clindamycin]], and [[rifampin]] are unavailable. [[Doxycycline]] should not be used if [[meningitis]] is suspected because it does not adequately penetrate the CNS.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
====Duration of Treatment==== | |||
* Intravenous combination treatment for systemic anthrax with possible meningitis should be provided for ≥2 weeks or until the patient is clinically stable, whichever is longer. | |||
* Given the high mortality rate associated with meningitis, some expert panelists favored 3 weeks of treatment for patients in whom meningitis could not be ruled out.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref> | |||
====Follow–up Oral Treatment for Systemic Disease==== | |||
Once patients with systemic illness who were exposed to aerosolized [[spore]]s have completed initial combination treatment, they should be transitioned to '''single-agent oral treatment''' to prevent relapse from surviving [[B. anthracis]] spores. | |||
===Dosage of Antibiotics=== | |||
<!-- | |||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL><ref>{{Cite journal | doi = 10.3201/eid2002.130687 | issn = 1080-6059 | volume = 20 | issue = 2 | last = Hendricks | first = Katherine A. | coauthors = Mary E. Wright, Sean V. Shadomy, John S. Bradley, Meredith G. Morrow, Andy T. Pavia, Ethan Rubinstein, Jon-Erik C. Holty, Nancy E. Messonnier, Theresa L. Smith, Nicki Pesik, Tracee A. Treadwell, William A. Bower, Workgroup on Anthrax Clinical Guidelines | title = Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults | journal = Emerging Infectious Diseases | date = 2014-02 | pmid = 24447897 | pmc = PMC3901462 }}</ref><ref>{{Cite journal | doi = 10.1542/peds.2014-0563 | issn = 1098-4275 | last = Bradley | first = John S. | coauthors = Georgina Peacock, Steven E. Krug, William A. Bower, Amanda C. Cohn, Dana Meaney-Delman, Andrew T. Pavia, AAP COMMITTEE ON INFECTIOUS DISEASES and DISASTER PREPAREDNESS ADVISORY COUNCIL | title = Pediatric Anthrax Clinical Management | journal = Pediatrics | date = 2014-04-28 | pmid = 24777226 }}</ref><ref>{{Cite journal | doi = 10.3201/eid2002.130611 | issn = 1080-6059 | volume = 20 | issue = 2 | last = Meaney-Delman | first = Dana | coauthors = Marianne E. Zotti, Andreea A. Creanga, Lara K. Misegades, Etobssie Wako, Tracee A. Treadwell, Nancy E. Messonnier, Denise J. Jamieson, Workgroup on Anthrax in Pregnant and Postpartum Women | title = Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women | journal = Emerging Infectious Diseases | date = 2014-02 | pmid = 24457117 | pmc = PMC3901460 }}</ref> | |||
--> | |||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL><ref>{{Cite journal | doi = 10.3201/eid2002.130687 | issn = 1080-6059 | volume = 20 | issue = 2 | last = Hendricks | first = Katherine A. | coauthors = Mary E. Wright, Sean V. Shadomy, John S. Bradley, Meredith G. Morrow, Andy T. Pavia, Ethan Rubinstein, Jon-Erik C. Holty, Nancy E. Messonnier, Theresa L. Smith, Nicki Pesik, Tracee A. Treadwell, William A. Bower, Workgroup on Anthrax Clinical Guidelines | title = Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults | journal = Emerging Infectious Diseases | date = 2014-02 | pmid = 24447897 | pmc = PMC3901462 }}</ref><ref>{{Cite journal | doi = 10.1542/peds.2014-0563 | issn = 1098-4275 | last = Bradley | first = John S. | coauthors = Georgina Peacock, Steven E. Krug, William A. Bower, Amanda C. Cohn, Dana Meaney-Delman, Andrew T. Pavia, AAP COMMITTEE ON INFECTIOUS DISEASES and DISASTER PREPAREDNESS ADVISORY COUNCIL | title = Pediatric Anthrax Clinical Management | journal = Pediatrics | date = 2014-04-28 | pmid = 24777226 }}</ref><ref>{{Cite journal | doi = 10.3201/eid2002.130611 | issn = 1080-6059 | volume = 20 | issue = 2 | last = Meaney-Delman | first = Dana | coauthors = Marianne E. Zotti, Andreea A. Creanga, Lara K. Misegades, Etobssie Wako, Tracee A. Treadwell, Nancy E. Messonnier, Denise J. Jamieson, Workgroup on Anthrax in Pregnant and Postpartum Women | title = Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women | journal = Emerging Infectious Diseases | date = 2014-02 | pmid = 24457117 | pmc = PMC3901460 }}</ref> | |||
{| | |||
| valign=top | | |||
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #A1BCDD; text-align: center;"> | |||
<font color="#FFF"> | |||
'''Cutaneous Anthrax Without Systemic Involvement''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''Adult Patients''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''Pediatric Patients''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''Pregnant Patients''' | |||
</font> | |||
</div> | |||
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #A1BCDD; text-align: center;"> | |||
<font color="#FFF"> | |||
'''Systemic Anthrax with Possible/Confirmed Meningitis''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''Adult Patients''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''Pediatric Patients''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''Pregnant Patients''' | |||
</font> | |||
</div> | |||
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #A1BCDD; text-align: center;"> | |||
<font color="#FFF"> | |||
'''Systemic Anthrax Without Meningitis''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''Adult Patients''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''Pediatric Patients''' | |||
</font> | |||
</div> | |||
<div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;"> | |||
<font color="#FFF"> | |||
▸ '''Pregnant Patients''' | |||
</font> | |||
</div> | |||
<!--COLLECT ALL THE BOXES BELOW--> | |||
| valign=top | | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Cutaneous Anthrax, Adult Patients}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg PO q24h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg PO q24h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 100 mg PO q12h''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 600 mg PO q8h'''''<BR> OR <BR> ▸ '''''[[Penicillin VK]] 500 mg PO q6h'''''<BR> OR <BR> ▸ '''''[[Amoxicillin]] 1 g PO q8h''''' | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Cutaneous Anthrax, Pediatric Patients}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 30 mg/kg/day PO q12h, max: 500 mg/dose'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 16 mg/kg/day PO q12h, max: 250 mg/dose (<50 kg)'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 500 mg PO q24h (≥50 kg)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 4.4 mg/kg/day PO q12h, max: 100 mg/dose (<45 kg)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 100 mg/dose PO q12h (≥45 kg)''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 30 mg/kg/day PO q8h, max: 600 mg/dose'''''<BR> OR <BR> ▸ '''''[[Penicillin VK]] 50–75 mg/kg/day PO q6–8h'''''<BR> OR <BR> ▸ '''''[[Amoxicillin]] 75 mg/kg/day PO q8h, max: 1 g/dose''''' | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Cutaneous Anthrax, Pregnant Patients}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h''''' | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax with Meningitis, Adult Patients}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Imipenem]] 1 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Doripenem]] 500 mg IV q8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1 g IV q6–8h''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 3 g IV q6h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1 g IV q6–8h''''' | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax with Meningitis, Pediatric Patients}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 30 mg/kg/day IV q8h, max: 400 mg/dose'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 20 mg/kg/day IV q12h, max: 250 mg/dose (<50 kg)'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 500 mg IV q24h (≥50 kg)'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 60 mg/kg/day IV q12h, max: 2 g/dose'''''<BR> OR <BR> ▸ '''''[[Imipenem/Cilastatin]] 100 mg/kg/day IV q6h, max: 1 g/dose'''''<BR> OR <BR> ▸ '''''[[Vancomycin]] 60 mg/kg/day IV q8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 30 mg/kg/day PO q8h, max: 600 mg/dose'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q8h, max: 1 g/dose (<12 yr)'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 4.4 mg/kg/day IV q12h, max: 100 mg/dose (<45 kg)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 200 mg IV x1 then 100 mg IV q12h, max: 200 mg/dose (≥45 kg)'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 20 mg/kg/day IV q12h, max: 300 mg/dose''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 0.4 MU/kg/day IV q4h, max: 4 MU/dose'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6h, max: 900 mg/dose''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 30 mg/kg/day PO q8h, max: 600 mg/dose'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q8h, max: 1 g/dose (<12 yr)'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 4.4 mg/kg/day IV q12h, max: 100 mg/dose (<45 kg)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 200 mg IV x1 then 100 mg IV q12h, max: 200 mg/dose (≥45 kg)'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 20 mg/kg/day IV q12h, max: 300 mg/dose''''' | |||
|} | |||
|} | |||
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;" | |||
| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax with Meningitis, Pregnant Patients}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 3 g IV q6h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h''''' | |||
|} | |||
|} | |||
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{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax Without Meningitis, Adult Patients}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg q8h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg q24h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg PO q24h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g q8h'''''<BR> OR <BR> ▸ '''''[[Imipenem]] 1 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Doripenem]] 500 mg q8h'''''<BR> OR <BR> ▸ '''''[[Vancomycin]] 60 mg/kg/day IV q8h, trough: 15–20 μg/mL''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg q8h'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg q12h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 200 mg x1 then 100 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg q12h''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 3 g IV q6h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg q8h'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg q12h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]] 200 mg x1 then 100 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg q12h''''' | |||
|} | |||
|} | |||
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| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax Without Meningitis, Pediatric Patients}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 30 mg/kg/day IV q8h, max: 400 mg/dose'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 16 mg/kg/day IV q12h, max: 250 mg/dose (<50 kg)'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 500 mg IV q24h (≥50 kg)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 12 mg/kg/day IV q12h, max: 200 mg/dose (3 mo–2 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 10 mg/kg/day IV q12h, max: 200 mg/dose (2 yr–5 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 8 mg/kg/day IV q12h, max: 200 mg/dose (6 yr–11 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 8 mg/kg/day IV q12h, max: 200 mg/dose (12 yr–17 yr, <45 kg)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h (12 yr–17 yr, ≥45 kg)''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 120 mg/kg/day IV q8h, max: 2 g/dose'''''<BR> OR <BR> ▸ '''''[[Imipenem/Cilastatin]] 100 mg/kg/day IV q6h, max: 1 g/dose'''''<BR> OR <BR> ▸ '''''[[Doripenem]] 120 mg/kg/day IV q8h, max: 1 g/dose'''''<BR> OR <BR> ▸ '''''[[Vancomycin]] 60 mg/kg/day IV q8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 30 mg/kg/day IV q8h, max: 600 mg/dose (<12 yr)'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr)'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 40 mg/kg/day IV q8h, max: 900 mg/dose'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 20 mg/kg/day IV q12h, max: 300 mg/dose'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 100 mg/kg/day IV q6h''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 30 mg/kg/day IV q8h, max: 400 mg/dose'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 16 mg/kg/day IV q12h, max: 250 mg/dose (<50 kg)'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 500 mg IV q24h (≥50 kg)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 12 mg/kg/day IV q12h, max: 200 mg/dose (3 mo–2 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 10 mg/kg/day IV q12h, max: 200 mg/dose (2 yr–5 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 8 mg/kg/day IV q12h, max: 200 mg/dose (6 yr–11 yr)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 8 mg/kg/day IV q12h, max: 200 mg/dose (12 yr–17 yr, <45 kg)'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h (12 yr–17 yr, ≥45 kg)''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 0.4 MU/kg/day IV q4h, max: 4 MU/dose'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 400 mg/kg/day IV q6h, max: 3 g/dose''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 30 mg/kg/day IV q8h, max: 600 mg/dose (<12 yr)'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 30 mg/kg/day IV q12h, max: 600 mg/dose (≥12 yr)'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 40 mg/kg/day IV q8h, max: 900 mg/dose'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 20 mg/kg/day IV q12h, max: 300 mg/dose'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 100 mg/kg/day IV q6h''''' | |||
|- | |||
|} | |||
|} | |||
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| valign=top | | |||
{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;" | |||
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Anthrax Without Meningitis, Pregnant Patients}} | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 3 g IV q6h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Rifampin]] 600 mg IV q12h''''' | |||
|} | |||
|} | |||
|} | |||
==piss== | |||
__NOTOC__ | |||
{{Psittacosis}} | |||
{{CMG}}; {{AE}} {{ADI}} | |||
==Overview== | |||
[[Psittacosis]] is an infection caused by the obligatory intracellular bacterium '''Chlamydia psittaci'''. It is apparently acquired from the birds (parrots). | |||
==Causes== | |||
Psittacosis is an infection caused by the obligatory intracellular bacterium '''Chlamydia psittaci'''. It is apparently acquired from the birds (parrots). Ornithosis is infection from any kind bird. | |||
==References== | |||
{{reflist|2}} | |||
[[Category:Pulmonology]] | |||
[[Category:Zoonoses]] | |||
[[Category:Bacterial diseases]] | |||
[[Category:Infectious diseases]] | |||
[[Category:Disease]] | |||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} | |||
==plam== | |||
__NOTOC__ | |||
{{Malaria}}__NOTOC__ | |||
{{About1| Plasmodium}} | |||
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]], {{AJL}} | |||
==Overview== | |||
Malaria is a [[Vector (biology)|vector]]-borne [[infectious disease]] caused by [[protozoan]] parasites. '' [[P. vivax]]'' is the most common cause of infection, responsible for about 80% of all malaria cases. ''P. falciparum'', the most significant cause of disease, is responsible for about 15% of infections and 90% of deaths.<ref>{{cite journal | author = Mendis K, Sina B, Marchesini P, Carter R |title = The neglected burden of Plasmodium vivax malaria. |url=http://www.ajtmh.org/cgi/reprint/64/1_suppl/97.pdf | journal = Am J Trop Med Hyg |volume = 64 | issue = 1-2 Suppl | pages = 97-106 | year = 2001 | pmid = 11425182}}</ref><ref>{{cite journal | author = Mendis K, Sina B, Marchesini P, Carter R | title = The neglected burden of Plasmodium vivax malaria. | url=http://www.ajtmh.org/cgi/reprint/64/1_suppl/97.pdf | journal = Am J Trop Med Hyg | volume = 64 | issue = 1-2 Suppl | pages = 97-106 | year = 2001 | pmid = 11425182}}</ref> | |||
==Causes== | |||
'' [[P. vivax]]'' is the most common cause of infection, responsible for about 80% of all malaria cases. ''[[P. falciparum]]'', the most significant cause of disease, is responsible for about 15% of infections and 90% of deaths.<ref>{{cite journal | author = Mendis K, Sina B, Marchesini P, Carter R | title = The neglected burden of Plasmodium vivax malaria. | url=http://www.ajtmh.org/cgi/reprint/64/1_suppl/97.pdf | journal = Am J Trop Med Hyg | volume = 64 | issue = 1-2 Suppl | pages = 97-106 | year = 2001 | pmid = 11425182}}</ref> The remainder of human malaria infections are caused by ''[[P. ovale]]'', ''[[P. malariae]]'', and ''[[P. knowlesi]].'' | |||
The following table distinguishes between the different strains of ''[[Plasmodium]]'' species, all of which are causative agents of malarial infection. | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center | |||
|+'''''Comparison of ''Plasmodium'' Species Implicated in Human Malaria''''' ({{cite web |url=http://www.cdc.gov/dpdx/malaria/dx.html |title= Malaria |date= Nov. 29 2013 |website= Center for Disease Control and Prevention|publisher= Center for Disease Control and Prevention (CDC)|accessdate=Jul 24 2014}}) | |||
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Strain}} | |||
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Clinical Significance}} | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" |'''''P. falciparum''''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Tertian/subtertian [[fever]] (every 48 hours), causes severe malaria in up to 24% of cases, and is frequently drug resistant. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" |'''''P. vivax''''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
Tertian fever (every 48 hours), results in severe malaria in up to 22% of cases, and is frequently drug resistant. Relapse is common due to the dormant liver phase. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" |'''''P. ovale''''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Tertian fever (every 48 hours), rarely causes severe malaria or drug resistance. Relapse is common due to dormant liver phase. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" |'''''P. malariae''''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Quartan [[fever]] (every 72 hrs), rarely results in severe malaria or drug resistance. Although dormant liver phase is uncommon, infection persistence is frequently demonstrated. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" |'''''P. knowlesi''''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | Daily fevers, may result in severe malaria in up to 10% of cases, although resistance is rare. | |||
|- | |||
|} | |||
<sup><center>Adapted from Center for Disease Control and Prevention (CDC) - Malaria </center></sup> | |||
==References== | |||
{{reflist|2}} | |||
[[Category:Apicomplexa]] | |||
[[Category:Insect-borne diseases]] | |||
[[Category:Malaria]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Parasitic diseases]] | |||
[[Category:Tropical disease]] | |||
[[Category:Deaths from malaria]] | |||
[[Category:Disease]] | |||
[[Category:Needs content]] | |||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} | |||
==q fever microb== | |||
{{Taxobox | |||
| color = lightgrey | |||
| name = ''Coxiella burnetii'' | |||
| image = Coxiella_burnetii_01.JPG | |||
| image_width = 240px | |||
| image_caption = ''C. burnetii'', the causative agent of [[Q fever]] | |||
| regnum = [[Bacterium|Bacteria]] | |||
| phylum = [[Proteobacteria]] | |||
| classis = Gamma Proteobacteria | |||
| ordo = [[Legionellales]] | |||
| familia = [[Coxiellaceae]] | |||
| genus = ''[[Coxiella]]'' | |||
| species = '''''C. burnetii''''' | |||
| binomial = ''Coxiella burnetii'' | |||
| binomial_authority = (Derrick 1939)<br>Philip 1948 | |||
}} | |||
'''''Coxiella burnetii''''' is a species of [[intracellular]], pathogenic [[bacterium|bacteria]], and is the causative agent of [[Q fever]]. The genus ''Coxiella'' is morphologically similar to the [[rickettsia]], but with a variety of genetic and physiological differences. ''C. burnetii'' are small [[Gram negative]] bacteria with two growth phases, as well as a [[endospore|spore]] form which lies idle in soil.<ref>{{cite book | author = Ryan KJ; Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | publisher = McGraw Hill | year = 2004 | id = ISBN 0-8385-8529-9 }}</ref> It can survive standard disinfectants, and is resistant to many other environmental changes.<ref>{{cite encyclopedia | last = Sankaran | first = Neeraja | encyclopedia = Microbes and people : an A-Z of microorganisms in our lives | title = Coxiella burnetii | year = 2000 | publisher = The Oryx Press | location = Phoenix, Arizona | id = ISBN 1-57356-217-3 | pages = 72}} "In contrast to other rickettsiae, which are highly sensitive and easily killed by chemical disinfectants and changes in their surroundings, C. burnetii is highly resistant" & {{cite web | date=2003-02013 | url=http://www.cdc.gov/ncidod/dvrd/qfever/index.htm |title=Q fever | publisher=Centers for Disease Control and Prevention; National Center for Infectious Diseases; Division of Viral and Rickettsial Diseases; Viral and Rickettsial Zoonoses Branch | accessdate=2006-05-24}} | |||
"The organisms are resistant to heat, drying, and many common disinfectants."</ref> | |||
==Pathogenesis== | |||
The ID<sub>50</sub> (the dose needed to infect 50% of experimental subjects) is one via inhalation— i.e. inhalation of one organism will yield disease in 50% of the population. Disease occurs in two states: An acute state presents with headaches, chills, and respiratory symptoms, and an insidious chronic stage. | |||
While most infections clear up spontaneously, treatment with [[tetracycline]] or [[doxycycline]] appears to reduce the symptomatic duration and reduce the likelihood of chronic infection. A combination of erythromycin and rifampin is highly effective in curing and prevention of disease and so is vaccination with Q-vax vaccine (CSL). | |||
==References== | |||
<references/> | |||
[[Category:Proteobacteria]] | |||
[[Category:Infectious Disease Project]] | |||
===Anti-malarial Agents=== | ===Anti-malarial Agents=== | ||
{| border="1" style="border-collapse:collapse; text-align:center;" cellpadding="5" align="center" | {| border="1" style="border-collapse:collapse; text-align:center;" cellpadding="5" align="center" | ||
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<sup>*Used in combination with quinine or quinidine</sup> | <sup>*Used in combination with quinine or quinidine</sup> | ||
mx | |||
The treatment approach in patients with suspected or confirmed malaria varies according to several factors namely travel history, species of Plasmodium, severity of presentation, and availability of certain therapeutic agents. | |||
===Initial Assessment & Severe Malaria=== | |||
The first step in the management of patients with malaria is to conduct a clinical assessment of status and disease severity, as well as determination of the degree of parasitemia. | |||
Signs of severe malarial disease include any of the following: Prostration, impaired consciousness/coma, respiratory distress, convulsions, shock, pulmonary edema, acute respiratory distress syndrome (ARDS), jaundice, abnormal bleeding, severe anemia, hemolysis, hemoglobinuria, acute kidney injury, metabolic acidosis, disseminated intravascular coagulopathy, parasitemia >5%. Patients with severe disease require rapid resuscitation and medical therapy. The most vital step in the management is immediate initiation of appropriate parenteral treatment. Unlike patients who appear stable clinically, patients with severe malaria do not require speciation prior to initiation of medical therapy. | |||
The therapeutic regimen in patients with severe malaria consists of '''intravenous quinidine gluconate plus either tetracycline, doxycycline, or clindamycin'''.<ref name="pmid17519416">{{cite journal| author=Griffith KS, Lewis LS, Mali S, Parise ME| title=Treatment of malaria in the United States: a systematic review. | journal=JAMA | year= 2007 | volume= 297 | issue= 20 | pages= 2264-77 | pmid=17519416 | doi=10.1001/jama.297.20.2264 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17519416 }} </ref> Other supportive measures include admission to the intensive care unit, continuous monitoring of cardiac function, glycemia, parasitemia, hemoglobin and electrolytes. Exchange transfusions may also be considered in patients with a degree of parasitemia >10%. | |||
===Uncomplicated Malaria=== | |||
In patients with clinically and bacteriologically uncomplicated malaria, speciation is required to tailor medical therapy. For most non-falciparum species, chloroquine remains the first line therapeutic agent. It is important to add '''primaquine''' to the treatment regimen in patients with documented P. vivax and P. ovale infections to eradicate liver hypnozoites (dormant liver spores that are responsible for recurrence). Care should be taken in patients with G6PD deficiency as large doses of primaquine can cause significant hemolysis. Patients infected with P. malaria do not require primaquine as the species is not capable of forming hypnozoites.<ref name="pmid23953767">{{cite journal| author=White NJ, Pukrittayakamee S, Hien TT, Faiz MA, Mokuolu OA, Dondorp AM| title=Malaria. | journal=Lancet | year= 2014 | volume= 383 | issue= 9918 | pages= 723-35 | pmid=23953767 | doi=10.1016/S0140-6736(13)60024-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23953767 }} </ref> Patients diagnosed with P. falciparum malaria require hospitalization given the risk of progression to severe malaria. These patients have to be monitored on daily basis with a blood film and a full physical exam. The choice of drug in these patients depends on two main factors: the area of acquisition of the parasite, and the center at which the patient is being treated.<ref name="pmid17519416">{{cite journal| author=Griffith KS, Lewis LS, Mali S, Parise ME| title=Treatment of malaria in the United States: a systematic review. | journal=JAMA | year= 2007 | volume= 297 | issue= 20 | pages= 2264-77 | pmid=17519416 | doi=10.1001/jama.297.20.2264 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17519416 }} </ref> | |||
Despite being the mainstay of therapy since its introduction, empiric treatment with chloroquine in patients with P. falciparum is no longer recommended due to a sharp increase in resistance. A detailed travel history is important to determine where the infection was acquired. Most malaria endemic countries have reported chloroquine resistant strains, with the exception of Central America west of Panama Canal, Mexico, Hispaniola, certain parts of China, and the Middle East (see figure below). If acquired in any of the latter sites then treatment with chloroquine is adequate. Acquisition from all other endemic countries requires other therapeutic regimens such as '''oral quinine with either tetracycline, doxycycline, or clindamycin''' as a first line therapy in the United States, otherwise atovaquone-proguanil or mefloquine if the primary regimen is unavailable. | |||
Worldwide, the treatment of both complicated and uncomplicated P. falciparum malaria requires a combination therapy that includes artemisinin derivatives. According to the 2010 WHO guidelines on the treatment of malaria, the following regimens are first line for the treatment of uncomplicated P. falciparum: '''artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, and artesunate plus sulfadoxine-pyrimethamin'''. It is important to note that artemisin monotherapy in not recommended due to increasing resistance. For patients with severe P. falciparum malaria, '''artesunate IV or IM''' is first line followed by IV quinidine. The artemisinin derivatives clear parasites very rapidly have been shown to reduce mortality in severe malaria compared with parenteral quinine. Artemisins are not widely available in the United States and their use is not common practice. Only oral '''artemether plus lumefantrine''' is available, while IV atresunate can be obtained through the CDC part of an investigational drug protocol. <ref name="CDC2012artemisin">{{cite website| author=Centers for Disease Control and Prevention | title=Artesunate is available to treat severe malaria in the United States | url=http://www.cdc.gov/malaria/diagnosis_treatment/artesunate.html }} </ref> | |||
[[Image:Malaria_management.png|1100px|center]] |
Latest revision as of 18:42, 18 September 2017
Cervical intraepithelial neoplasia | |
ICD-10 | D06, N87 |
---|---|
ICD-9 | 233.1, 622.10 |
MedlinePlus | 001491 |
MeSH | D018290 |
Pap Smear
Cervical dysplasia that is seen on a Pap smear is called squamous intraepithelial lesion (SIL). These changes may be graded as:
- Low-grade (LSIL)
- High-grade (HSIL)
- Possibly cancerous (malignant)
If a Pap smear shows abnormal cells or cervical dysplasia, further testing or monitoring will be recommended:
- Follow-up Pap smears may be recommended for mild cases
- Colposcopy-directed biopsy can confirm the condition
- Cone biopsy may be done after colposcopy
Dysplasia that is seen on a biopsy of the cervix is called cervical intraepithelial neoplasia (CIN). It is grouped into three categories:
- CIN I -- mild dysplasia
- CIN II -- moderate to marked dysplasia
- CIN III -- severe dysplasia to carcinoma in situ
Some strains of human papillomavirus (HPV) are known to cause cervical cancer. An HPV DNA test can identify the high-risk types of HPV linked to such cancer. This may be done:
- As a screening test for women over age 30
- For women of any age who have a slightly abnormal Pap test result
HPV subtypes 16 and 18 deregulate the genes E6 and E7 which code for proteins that inhibit p53 and Retinoblastoma protein (Rb), which are two important tumor suppressor genes in humans. The p53 gene product is involved in regulation of apoptosis (cell suicide), and Rb is responsible for halting the cell cycle at the G1-phase. When Rb function is impaired, the cell is allowed to progress to S-phase and complete mitosis, resulting in proliferation and hence neoplastic transformation.
Hysterectomy
Microinvasive cancer (stage IA) is usually treated by hysterectomy (removal of the whole uterus including part of the vagina). For stage IA2, the lymph nodes are removed as well. An alternative for patients who desire to remain fertile is a local surgical procedure such as a loop electrical excision procedure (LEEP) or cone biopsy.
Trachelectomy
- If a cone biopsy does not produce clear margins,[1] one more possible treatment option for patients who want to preserve their fertility is a trachelectomy.[2]
- This attempts to surgically remove the cancer while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy.
- It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care,[3] as few doctors are skilled in this procedure.
- Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown.
- If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the patient is under general anesthesia in the operating room, a hysterectomy may still be needed. This can only be done during the same operation if the patient has given prior consent.
- Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the womb for pathologic evaluation.
Radical Trachelectomy
A radical trachelectomy can be performed abdominally[4] or vaginally[5] and there are conflicting opinions as to which is better.[6] A radical abdominal trachelectomy with lymphadenectomy usually only requires a two to three day hospital stay, and most women recover very quickly (approximately six weeks). Complications are uncommon, although women who are able to conceive after surgery are susceptible to preterm labor and possible late miscarriage.[7] It is generally recommended to wait at least one year before attempting to become pregnant after surgery.[8] Recurrence in the residual cervix is very rare if the cancer has been cleared with the trachelectomy.[9] Yet, it is recommended for patients to practice vigilant prevention and follow up care including pap screenings/colposcopy, with biopsies of the remaining lower uterine segment as needed (every 3-4 months for at least 5 years) to monitor for any recurrence in addition to minimizing any new exposures to HPV through safe sex practices until one is actively trying to conceive.
Radical Hysterectomy
Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy. Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy (internal radiation). Patients treated with surgery who have high risk features found on pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse.
- Precancerous changes of the cervix and early stage cervical cancer,physical examination findings can be normal. Special tests and tools are needed to spot such conditions:
- A Pap smear is used for screening precancers and cervical cancer, but final diagnosis cannot be made.
- The human papillomavirus (HPV) DNA test may be done along with a pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as a main test.
- If abnormal changes are found, the cervix is usually examined using colposcope.cervical biopsy can be taken form tissue and examined.
Radiation and Chemotherapy
Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and cisplatin-based chemotherapy, hysterectomy (which then usually requires adjuvant radiation therapy), or cisplatin chemotherapy followed by hysterectomy.
Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy.
On June 15, 2006, the US Food and Drug Administration approved the use of a combination of two chemotherapy drugs, hycamtin and cisplatin for women with late-stage (IVB) cervical cancer treatment.[10] Combination treatment has significant risk of neutropenia, anemia, and thrombocytopenia side effects. Hycamtin is manufactured by GlaxoSmithKline.
Contraindicated medications
Invasive cervical carcinoma is considered a relative contraindication to the use of the following medications:
According to the International Federation of Gynecology and Obstetrics, survival improves when radiotherapy is combined with cisplatin-based chemotherapy.[11]
As the cancer metastasizes to other parts of the body, prognosis drops dramatically because treatment of local lesions is generally more effective than whole body treatments such as chemotherapy. Regular screening has meant that pre cancerous changes and early stage cervical cancers have been detected and treated early. Figures suggest that cervical screening is saving 5,000 lives each year in the UK by preventing cervical cancer.[12] Interval evaluation of the patient after therapy is imperative. Recurrent cervical cancer detected at its earliest stages might be successfully treated with surgery, radiation, chemotherapy, or a combination of the three. Thirty-five percent of patients with invasive cervical cancer have persistent or recurrent disease after treatment.[13]In screening a general or low-risk population, most Pap results are normal.
In the United States, about 2–3 million abnormal Pap smear results are found each year.[14] Most abnormal results are mildly abnormal (ASC-US (typically 2–5% of Pap results) or low-grade squamous intraepithelial lesion (LSIL) (about 2% of results)), indicating HPV infection.[citation needed] Although most low-grade cervical dysplasias spontaneously regress without ever leading to cervical cancer, dysplasia can serve as an indication that increased vigilance is needed.
In a typical scenario, about 0.5% of Pap results are high-grade SIL (HSIL), and less than 0.5% of results indicate cancer; 0.2 to 0.8% of results indicate Atypical Glandular Cells of Undetermined Significance (AGC-NOS).
As liquid based preparations (LBPs) become a common medium for testing, atypical result rates have increased. The median rate for all preparations with low-grade squamous intraepithelial lesions using LBPs was 2.9% compared with a 2003 median rate of 2.1%. Rates for high-grade squamous intraepithelial lesions (median, 0.5%) and atypical squamous cells have changed little.[15]
It's important for you to take care of yourself by eating well and staying as active as you can during the sometimes rough treatment of cervical cancer. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy. However, you may not feel like eating during or soon after treatment. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to cope with these problems. Research shows that people with cancer feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start.
You'll need regular checkups after treatment for cervical cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor. Your doctor will check for the return of cancer. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Checkups may include a physical exam, Pap tests, and chest x-rays.
It is often located in the chest area. Most malignant teratomas can spread throughout the body, and have spread by the time of diagnosis.
A number of other cancers are often associated with these tumors, including:
- Acute myelogenous leukemia (AML)
- Embryonal rhabdomyosarcoma
- Malignant histiocytosis
- Myelodysplasia (MDS)
- Small cell undifferentiated carcinoma
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [11]
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DiseasesDB = 3604 |
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Pathology classification of individual teratomas
Teratomas commonly are classified using the Gonzalez-Crussi grading system: 0 or mature (benign); 1 or immature, probably benign; 2 or immature, possibly malignant (cancerous); and 3 or frankly malignant. See also cancer staging. Teratomas are also classified by their content: a solid teratoma contains only tissues (perhaps including more complex structures); a cystic teratoma contain only pockets of fluid or semi-fluid such as cerebrospinal fluid, sebum, or fat; a mixed teratoma contains both solid and cystic parts. Cystic teratomas usually are grade 0 and, conversely, grade 0 teratomas usually are cystic.
Grade 0, 1 and 2 pure teratomas have the potential to become malignant (grade 3), and malignant pure teratomas have the potential to metastasize. These rare forms of teratoma with malignant transformation may contain elements of somatic (non germ cell) malignancy such as leukemia, carcinoma or sarcoma.[16] A teratoma may contain elements of other germ cell tumors, in which case it is not a pure teratoma but rather is a mixed germ cell tumor and is malignant. In infants and young children, these elements usually are endodermal sinus tumor, followed by choriocarcinoma. Finally, a teratoma can be pure and not malignant yet highly aggressive: this is exemplified by growing teratoma syndrome, in which chemotherapy eliminates the malignant elements of a mixed tumor, leaving pure teratoma which paradoxically begins to grow very rapidly.
"Benign" teratoma may prove to be malignant
A "benign" grade 0 (mature) teratoma nonetheless has a non-zero risk of malignancy. Recurrence with malignant endodermal sinus tumor has been reported in cases of formerly benign mature teratoma,[17] even in fetiform teratoma and fetus in fetu.[18][19] A grade 1 immature teratoma that appears to be benign (e.g., because AFP is not elevated) has a much higher risk of malignancy, and requires adequate follow-up.[20][21][22][23]
Teratoma with malignant transformation
A teratoma with malignant transformation or TMT is a very rare form of teratoma that may contain elements of somatic (non germ cell) malignant tumors such as leukemia, carcinoma or sarcoma.[16] Of 641 children with pure teratoma, 9 developed TMT[24]: 5 carcinoma, 2 glioma, and 2 embryonal (here, these last are classified among germ cell tumors).
Extraspinal ependymoma
Extraspinal ependymoma, usually considered to be a glioma (a type of non-germ cell tumor), may be an unusual form of mature teratoma.[25]
References
- ↑ [1]
- ↑ [2]
- ↑ [3]
- ↑ [4]
- ↑ [5]
- ↑ [6]
- ↑ [7]
- ↑ [8]
- ↑ [9]
- ↑ [10]
- ↑ Committee on Practice Bulletins-Gynecology (2002). "ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas, number 35, May 2002". Obstetrics and gynecology. 99 (5 Pt 1): 855–67. PMID 11978302.
- ↑ "Cervical cancer statistics and prognosis". Cancer Research UK. Retrieved 2007-03-24.
- ↑ "Cervical Cancer". Cervical Cancer: Pathology, Symptoms and Signs, Diagnosis, Prognosis and Treatment. Armenian Health Network, Health.am.
- ↑ "Pap Smear". Retrieved 2008-12-27.
- ↑ Eversole, GM; Moriarty, AT; Schwartz, MR; Clayton, AC; Souers, R; Fatheree, LA; Chmara, BA; Tench, WD; Henry, MR (2010). "Practices of participants in the college of american pathologists interlaboratory comparison program in cervicovaginal cytology, 2006". Archives of pathology & laboratory medicine. 134 (3): 331–5. doi:10.1043/1543-2165-134.3.331. PMID 20196659.
- ↑ 16.0 16.1 Harms D, Zahn S, Göbel U, Schneider DT (2006). "Pathology and molecular biology of teratomas in childhood and adolescence". Klinische Pädiatrie. 218 (6): 296–302. doi:10.1055/s-2006-942271. PMID 17080330.
- ↑ Ohno Y, Kanematsu T (1998). "An endodermal sinus tumor arising from a mature cystic teratoma in the retroperitoneum in a child: is a mature teratoma a premalignant condition?". Hum. Pathol. 29 (10): 1167–9. PMID 9781660.
- ↑ Chen YH, Chang CH, Chen KC, Diau GY, Loh IW, Chu CC (2007). "Malignant transformation of a well-organized sacrococcygeal fetiform teratoma in a newborn male". J. Formos. Med. Assoc. 106 (5): 400–2. PMID 17561476. (publisher offers free full text PDF to registered users)
- ↑ Hopkins KL, Dickson PK, Ball TI, Ricketts RR, O'Shea PA, Abramowsky CR (1997). "Fetus-in-fetu with malignant recurrence". J. Pediatr. Surg. 32 (10): 1476–9. PMID 9349774.
- ↑ Muscatello L, Giudice M, Feltri M (2005). "Malignant cervical teratoma: report of a case in a newborn". European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 262 (11): 899–904. doi:10.1007/s00405-005-0917-2. PMID 15895292.
- ↑ Ukiyama E, Endo M, Yoshida F, Tezuka T, Kudo K, Sato S, Akatsuka S, Hata J (2005). "Recurrent yolk sac tumor following resection of a neonatal immature gastric teratoma". Pediatr. Surg. Int. 21 (7): 585–8. doi:10.1007/s00383-005-1404-y. PMID 15928937.
- ↑ Bilik R, Shandling B, Pope M, Thorner P, Weitzman S, Ein SH (1993). "Malignant benign neonatal sacrococcygeal teratoma". J. Pediatr. Surg. 28 (9): 1158–60. PMID 7508500.
- ↑ Hawkins E, Issacs H, Cushing B, Rogers P (1993). "Occult malignancy in neonatal sacrococcygeal teratomas. A report from a Combined Pediatric Oncology Group and Children's Cancer Group study". The American journal of pediatric hematology/oncology. 15 (4): 406–9. PMID 7692755.
- ↑ Biskup W, Calaminus G, Schneider DT, Leuschner I, Göbel U (2006). "Teratoma with malignant transformation: experiences of the cooperative GPOH protocols MAKEI 83/86/89/96". Klinische Pädiatrie. 218 (6): 303–8. doi:10.1055/s-2006-942272. PMID 17080331.
- ↑ Aktuğ T, Hakgüder G, Sarioğlu S, Akgür FM, Olguner M, Pabuçcuoğlu U. (2000) Sacrococcygeal extraspinal ependymomas: the role of coccygectomy. J Pediatr Surg. 35(3):515-518. PubMed
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See Ben Underwood for a case who compensated for the resulting blindness by developing human echolocation.
In October 2007, researchers have identified the specific cell that causes retinoblastoma.[12]old daughter had the condition. Fisher missed Game 1 and half of Game 2 of the 2007 NBA playoff series versus the Golden State Warriors to be with his daughter for her surgery in New York City
Retinoblastoma is a cancer of the retina. Development of this tumor is initiated by mutations[1] that inactivate both copies of the RB1 gene, which codes for the retinoblastoma protein.[2]
It occurs mostly in children younger than 5 years and accounts for about 3% of the cancers occurring in children younger than 15 years. Adult cases have also been clinically recorded.[3] The estimated annual incidence is approximately 4 per million children.[4] It begins with white blotches in one or both eyes (leukocoria) which can be seen in photographs (this is distinct from the red-eye effect which is normal); or when light reflects off the eye, as when watching television
The term uterine cancer may refer to one of several different types of cancer which occur in the uterus. These include:
- Endometrial carcinomas originate from cells in the glands of the endometrium (uterine lining). These include the common and readily treatable well-differentiated endometrioid adenocarcinoma, as well as the more aggressive uterine papillary serous carcinoma and uterine clear-cell carcinoma.
- Endometrial stromal sarcomas originate from the connective tissues of the endometrium, and are far less common than endometrial carcinomas
- Malignant mixed müllerian tumors are rare endometrial tumors which show both glandular (carcinomatous) and stromal (sarcomatous) differentiation - their true cell of origin is unknown.
- Cervical cancer arises from the transitional zone of the cervix, the lower portion of the uterus which lies at the upper aspect of the vagina
- Sarcomas of the myometrium, or muscular layer of the uterus, are most commonly leiomyosarcomas. Uterine fibroids are non-cancerous smooth muscle tumors which are vastly more common than sarcomas.
A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Treatment
There is no specific treatment for infectious mononucleosis, other than treating the symptoms. No antiviral drugs or vaccines are available. Some physicians have prescribed a 5-day course of steroids to control the swelling of the throat and tonsils. The use of steroids has also been reported to decrease the overall length and severity of illness, but these reports have not been published.
Prevention & Treatment
- Epstein-Barr Virus (EBV) [5]
- There is no vaccine to protect against EBV infection. You can help protect yourself by not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who have EBV infection.
- There is no specific treatment for EBV. However, some things can be done to help relieve symptoms, including
- Drinking fluids to stay hydrated
- Getting plenty of rest
- Taking over-the-counter medications for pain and fever
Gas gangrene
Preferred regimen: Penicillin G 3-4 million units IV q4h AND (Clindamycin 900 mg IV q8h OR Tetracycline 500 mg IV q6h)[78]
Antibiotics are used if an infection is suspected. Fluoroquinolones are an option, although resistance of N. gonorrhoeae may limit their use. A cephalosporin (such as ceftriaxone) combined with doxycycline is an alternative. Azithromycin can be used for susceptible strains. In children, quinolones and doxycycline are best avoided. Since bacteria that cause urinary tract infections are often the cause of epididymitis in children, co-trimoxazole or suited penicillins (for example, cephalexin) can be used. If there is a sexually transmitted disease, the partner should also be treated.
Household remedies such as elevation of the scrotum and cold compresses applied regularly to the scrotum may relieve the pain. Painkillers or anti-inflammatory drugs are often necessary. Hospitalisation is indicated for severe cases, and check-ups can ensure the infection has cleared up.
- Doxycycline is the drug of choice.
- For people allergic to drugs of the tetracycline class, rifampicin is an alternative.
- Early clinical experience suggested that chloramphenicol may also be effective, however in vitro susceptibility testing revealed resistance.
- Preferred regimen: Doxycycline 100 mg IV q12h for 7-14 days
- Alternative regimen (1): Chloramphenicol
- Alternative regimen (2): Rifampin
- Pediatric regimen: Doxycycline 2.2 mg/kg PO bid (Children under 45 kg (100 lbs)) for 7-14 days
- Note: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement
Febrile Neutropenia
Exception may be made for neutropenic patients in which delayed treatment could lead to serious complications.
After samples for cultures are obtained, febrile neutropenia should be aggressively treated with broad-spectrum antipseudomonal antibiotics. The antimicrobial regimen should be modified in accordance with the culture results.[6][7][8]
HIV/AIDS patients
HIV-infected persons with pyrexia and hypoxia, should be placed on therapy for Pneumocystis jirovecii infection and adjusted once the diagnosis is confirmed.[8]
Giant Cell Arteritis
Empiric corticosteroids may be considered in patients with suspected giant cell arteritis to prevent vascular complications such as stroke and blindness. Giant cell arteritis should be suspected in a patient over the age of 50 with the following symptoms:
- Newly onset headaches
- Abrupt onset of blurry vision
- Symptoms of polymyalgia rheumatica
- Jaw claudication
- Unexplained anemia
- Elevated erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP)
Premenopausal, Nonpregnant Women
No screening or treatment recommended for healthy, bacteriuric women.
Although asymptomatic bacteriuria increases the risk of urinary tract infection but has no effect on the long term adverse outcomes like CKD, genitourinary cancer or overall survival.[9] [10]
Studies' results indicated that the treatment wouldn't decrease the frequency for asymptomatic bacteriuria or the risk of developing symptomatic urinary tract infection.[11]
Pregnant Women
Diabetic WomenAsymptomatic bacteriuria screening or treatment is not recommended for diabetic women.
Older Persons Residing in the CommunityRoutine screening and treatment for asymptomatic bacteriuria is not indicated.
Elderly Institutionalized SubjectsNo recommendation for screening for or treatment of asymptomatic bacteriuria.
Subjects with Spinal Cord InjuriesNo benefit from screening for or treatment of asymptomatic bacteriuria Although the high prevalence of asymptomatic bacteriuria in patients with spinal cord injuries[26], but antimicrobial therapy harm outweigh benefit because of recurrent infections with more resistant strains.[27] Patients with Indwelling Urethral CathetersIt is not recommended to screen for or treat asymptomatic bacteriuria or fungiuria for short or long term catheters,[28] but antimicrobial therapy can be used for women with persistent bacteriuria 48 hours after removal of the urethral catheter.
Urologic Interventions
Immunocompromised Patients and Other PatientsPoor transplant prognosis and complications hasn't been associated with asymptomatic bacteriuria,[35][36]so there is no benefit from screening[37][38] for or treatment of asymptomatic bacteriuria in renal transplant or other solid organ[39] transplant patients.[40] There is no vaccine against the bacteria. LGV can be treated with three weeks of antibiotics. CDC STD Treatment Guidelines recommend the use of doxycyline, twice a day for 21 days. An alternative treatment is erythromycin base or azithromycin. The health care provider will determine which is best. Medical Therapy Acute Pharmacotherapy Treatment involves antibiotics and may involve drainage of the buboes or abscesses by needle aspiration or incision. Further supportive measure may need to be taken: dilatation of the rectal stricture, repair ofrectovaginal fistulae, or colostomy for rectal obstruction. Common antibiotic treatments include: tetracycline, doxycycline (all tetracyclines, including doxycycline, are contraindicated during pregnancy and in children due to effects on bone development and tooth discoloration), and erythromycin. If a patient has been treated for LGV, he/she should notify any sex partners they had sex with within 60 days of the symptom onset so they can be evaluated and treated. This will reduce the risk that their partners will develop symptoms and/or serious complications of LGV. It will reducetheir risk of becoming re-infected as well as reduce the risk of ongoing transmission in the community. The patient and all of his/her sex partners should avoid sex until the patient has completed treatment for the infection and symptoms of both the patient and their partners have disappeared. Note: Doxycycline is not recommended for use in pregnant women. Pregnant and lactating women should be treated with erythromycin. Azythromycin may prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. A health care provider (like a doctor or nurse) can discuss treatment options with patients. Persons with both LGV and HIV infection should receive the same LGV treatment as those who are HIV-negative. Prolonged therapy may be required, and delay in resolution of symptoms may occur among persons with HIV. As with all STD's sex partners of patients who have LGV should be examined and tested for urethral or cervical chlamydial infection. After a positive culture for chlamydia, clinical suspicion should be confirmed with testing to distinguish serotype. Antibiotic treatment should be started if they had sexual contact with the patient during the 30 days preceding onset of symptoms in the patient. Patients with a sexually transmitted disease need to be tested for other STD's. Antibiotics are not without risks and prophylaxtic broad antibiotic coverage is not recommended.[1] OverviewGenital warts may disappear without treatment, but sometimes eventually develop a fleshy, small raised growth. There is no way to predict whether they will grow or disappear. Medical TreatmentOverveiw
Some doctors inject the antiviral drug interferon-alpha directly into the warts, to treat warts that have returned after removal by traditional means. The drug is expensive, and does not reduce the rate that the warts return.
HSV=====Antiviral Drugs=Acyclovir (an antiviral drug) inhibits replication of the viral DNA, and is used both as prophylaxis (e.g., in patients with AIDS) and as therapy for herpes zoster. Other antivirals are valacyclovir and famciclovir. During the acute phase, oral acyclovir should be given. Use of acylovir is most effective in moderating the progress of the symptoms, and in preventing post-herpetic neuralgia, if started within 24 to 72 hours of the onset of symptoms, so medical care should be obtained as soon as the condition is recognized. Immunocompromised patients may respond best to intravenous acyclovir. In patients who are at high risk for recurrences, an oral dose of acyclovir, taken twice daily, is usually effective. It is also reported that the amino acid lysine inhibits the replication of herpes zoster.[42] AnalgesicsPeople with mild to moderate pain can be treated with over-the-counter analgesics. Topical lotions containing calamine can be used on the rash or blisters and may be soothing. Occasionally, severe pain may require an opioid medication, such as morphine. Once the lesions have crusted over, capsaicin cream (Zostrix) can be used. Topical lidocaine and nerve blocks may also reduce pain.[43] Administering gabapentin along with antivirals may offer relief of postherpetic neuralgia[44]. SteroidsOrally administered corticosteroids are frequently used in treatment of the infection, despite clinical trials of this treatment being unconvincing. Nevertheless, one trial studying immunocompetent patients older than 50 years of age with localized herpes zoster, suggested that administration of prednisone with aciclovir improved healing time and quality of life.[45] Upon one-month evaluation, aciclovir with prednisone increased the likelihood of crusting and healing of lesions by about twofold, when compared to placebo. This trial also evaluated the effects of this drug combination on quality of life at one month, showing that patients had less pain, and were more likely to stop the use of analgesic agents, return to usual activities and have uninterrupted sleep. However, when comparing cessation of herpes zoster-associated pain or post herpetic neuralgia, there was no difference between aciclovir plus prednisone and simply aciclovir alone. Because of the risks of corticosteroid treatment, it is recommended that this combination of drugs only be used in people more than 50 years of age, due to their greater risk of postherpetic neuralgia.[45] Other DrugsCimetidine, a common component of over-the-counter heartburn medication, has been shown to lessen the severity of herpes zoster outbreaks in several different instances.[46][47][48] This usage is considered an off-label use of the drug. In addition, cimetidine and probenecid have been shown to reduce the renal clearance of aciclovir. [49] The study showed these compounds reduce the rate, but not the extent, at which valaciclovir is converted into aciclovir. Renal clearance of aciclovir was reduced by approximately 24% and 33% respectively. In addition, respective increases in the peak plasma concentration of acyclovir of 8% and 22% were observed. The authors concluded that these effects were "not expected to have clinical consequences regarding the safety of valaciclovir". Due to the tendency of aciclovir to precipitate in renal tubules, combining these drugs should only occur under the supervision of a physician. ==VZV==![]() ![]()
Complementary TherapiesDigestive Enzymes are available on prescription and in some over the counter preparations. Before the availability of antivirals, oral pancreatic enzyme therapy in shingles was used in some countries and later subjected to clinical and scientific research. A large scale multi-centre clinical study, using an oral preparation of such enzymes, has shown promising results.[50] [51] The results of another clinical study support the concept that oral enzyme therapy is beneficial in diseases characterized in part by TGF-beta overproduction that included shingles patients. [52] TGF-β has also been found to be elevated in instances of VZV infection. [53] [54] Anti-viral medicationNucleoside analogsTreatment is available in the form of antiviral medications such as nucleoside analogs, which reduce the duration of symptoms of a herpex simplex virus outbreak and accelerate healing. Nucleoside analogs are molecules which possess a similarity to natural nucleotides - the building-blocks of DNA and RNA. Active herpes simplex virus will replicate; a virus replicating in the presence of these analogs will incorporate them into its DNA, so that its genetic material will contain defects and mutations. As a result, the next generation of virus will be damaged and reduced in number. Nucleoside analogs are typically used at the first symptoms of an viral outbreak to reduce the duration of the outbreak and improve healing of the lesion. Treatment taken prior to the appearance of lesions may avert or reduce the symptoms of the outbreak. Occasionally nucleoside analogs are used as a daily suppressive therapy, and taken daily for several years. Suppressive therapy reduces frequency of symptoms and recurrence of outbreaks. In addition, suppressive therapy reduces subclinical viral shedding, lowering the risk of transmission through sexual contact or kissing. Common nucleoside analogs are listed in the table above. Of these, Ganciclovir is known to have cytotoxic effects on infected cells but Acyclovir is not known to have this effect.[55]
Fusion inhibitorsFusion inhibitors prevent "fusion" of the viral envelope with the cell membrane. This prevents viral entry to the cell. Helicase-primase inhibitorsOne of three key protein structures involved in HSV DNA replication is the Helicase-Primase structure. New research compounds which bind to this megamolecule show remarkable effectiveness against HSV. In particular, BAY 57-1293 has shown positive results in animal models of HSV infection.[58] Dietary supplementsThe amino acid lysine has demonstrated the ability to reduce the duration of infection through inhibiting the replication of the HSV. When foods high in lysine (such as lentils) are consumed in preference to foods high in arginine, HSV replication may be inhibited; conversely, consuming foods high in arginine (such as nuts or peanuts) may interfere with the therapeutic use of lysine.[59] However, according to the American Social Health Association: "While some studies have suggested that lysine supplements can reduce the frequency of recurrences or healing time, other trials have been unable to replicate those results. Therefore, there is not sufficient information to discern how effective it may be, in addition to what the effective dosages or frequency of L-lysine may be."[56] Other anti-viral medicationUndecylenic acid (Castor oil derivative) is proven to have anti-bacterial and anti-viral properties that are effective on viral skin infections such as the herpes simplex virus (HSV). Butylated hydroxytoluene (BHT), commonly available as a food preservative, has been shown in vitro to inactivate enveloped viruses including herpes.[60][61] In-vivo studies of topical application to animals confirmed the anti-viral activity of BHT during outbreaks.[62] BHT has not been clinically tested and approved to treat herpes in humans. Drug ResistanceResistance of HSVes in cell culture has been reported for nucleosides in the range of 10-2 to 10-4 and for Helicase-Primase inhibitors in the range of 10-4 to 10-6. However, in the clinic roughly 1-2% of the patients are infected by nucleoside-resistant HSVes. In the immunocompromised patient population such as transplant, AIDS or cancer patients the resistance rate can reach up to 10%.
ChlamydiaChlamydia is a genus of obligate intracellular bacteria in the family Chlamydiaceae, order Chlamydiales, class and phylum Chlamydiae. Several species of Chlamydia are pathogenic to humans causing pneumonia, eye infections, and sexually transmitted disease, which is called Chlamydia ![]() C. trachomatis infection can be effectively cured with antibiotics once it is detected. Current Centers for Disease Control guidelines provide for the following treatments:
Untested Treatments
β-lactams are not suitable drugs for the treatment of chlamydia. While they have the ability to halt growth of the organism (i.e. are microbistatic), these antibiotics do not eliminate the bacteria. Once treatment is stopped, the bacteria will begin to grow once more. (See below for Persistence.)
Besides supportive care, infant botulism can be treated with human botulism immune globulin (BabyBIG), when available. Supply is extremely limited, but is available through the California Department of Health Services. This dramatically decreases the length of illness for most infants. Paradoxically, antibiotics (especially aminoglycosides or clindamycin) may cause dramatic acceleration of paralysis as the affected bacteria release toxin. Visual stimulation should be performed during the time the infant is paralyzed as well, in order to promote the normal development of visual pathways in the brain during this critical developmental period. Furthermore each case of food-borne botulism is a potential public health emergency in that it is necessary to identify the source of the outbreak and ensure that all persons who have been exposed to the toxin have been identified, and that no contaminated food remains. There are two primary Botulinum Antitoxins available for treatment of wound and foodborne botulism. Trivalent (A,B,E) Botulinum Antitoxin is derived from equine sources utilizing whole antibodies (Fab & Fc portions). This antitoxin is available from the local health department via the CDC. The second antitoxin is heptavalent (A,B,C,D,E,F,G) Botulinum Antitoxin which is derived from "despeciated" equine IgG antibodies which have had the Fc portion cleaved off leaving the F(ab')2 portions. This is a less immunogenic antitoxin that is effective against all known strains of botulism where not contraindicated. This is available from the US Army. On June 1, 2006 the US Department of Health and Human Services awarded a $363 million contract with Cangene Corporation for 200,000 doses of Heptavalent Botulinum Antitoxin over five years for delivery into the Strategic National Stockpile beginning in 2007.[64] Antimicrobial regimen
Pharmacotherapy brucellaAcute PharmacotherapiesThe gold standard treatment for adults is daily intramuscular injections of streptomycin 1 g for 14 days and oral doxycycline 100 mg twice daily for 45 days (concurrently). Gentamicin 5 mg/kg by intramuscular injection once daily for 7 days is an acceptable substitute when streptomycin is not available or difficult to obtain.[67] Another widely used regimen is doxycycline plus rifampin twice daily for at least 6 weeks. This regimen has the advantage of oral administration. A triple therapy of doxycycline, together with rifampin and cotrimoxazole has been used succefully to treat neurobrucellosis. [68] Doxycycline is able to cross the blood-brain barrier, but requires the addition of two other drugs to prevent relapse. Ciprofloxacin and co-trimoxazole therapy is associated with an unacceptably high rate of relapse. In brucellic endocarditis surgery is required for an optimal outcome. Even with optimal antibrucellic therapy relapses still occur in 5-10 percent of patients with Malta fever. Experiments have shown that cotrimoxyzol and rifampin are both safe drugs to use in treatment of pregnant women who have Brucellosis.
Acute Pharmacotherapies gonorrhea
Several antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhea is becoming more difficult. Because many people with gonorrhea also have chlamydia, another sexually transmitted disease, antibiotics for both infections are usually given together. Persons with gonorrhea should be tested for other STDs. It is important to take all of the medication prescribed to cure gonorrhea. Although medication will stop the infection, it will not repair any permanent damage done by the disease. People who have had gonorrhea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhea. If a person's symptoms continue even after receiving treatment, he or she should return to a doctor to be reevaluated. The mainstay of treatment is the appropriate use of antibiotics. While penicillin was the most common antibiotic used to treat gonorrhea up until the 1970s, an increase in antibiotic resistance has led to a decline in its use. Recommendations for first choice treatment of gonorrhea must depend on local information on resistance patterns and it is not possible to make treatment recommendations that are applicable to all parts of the world. The Centers for Disease Control and Prevention (CDC) released a report on Thursday, April 12, 2007 officially adding gonorrhea to a list of super bugs that are now resistant to common antibiotics according to CDC. Antibiotics that may be used to treat gonorrhea include:
These drugs are all given as a single dose. The level of tetracycline resistance in Neisseria gonorrheae is now so high as to make it completely ineffective in most parts of the world. The fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) cannot be used in pregnancy. It is important to refer all sexual partners to be checked for gonorrhea to prevent spread of the disease and to prevent the patient from becoming re-infected with gonorrhea. Patients should also be offered screening for other sexually transmitted infections. In areas where co-infection with chlamydia is common, doctors may prescribe a combination of antibiotics, such as ceftriaxone with doxycycline or azithromycin, to treat both diseases. Penicillin is ineffective at treating rectal gonorrhea: this is because other bacteria within the rectum produce β-lactamases that destroy penicillin. All current treatments are less effective at treating gonorrhea of the throat, so the patient must be rechecked by throat swab 72 hours or more after being given treatment, and then retreated if the throat swab is still positive. Although gonorrhea usually does not require follow-up (with the exception of rectal or pharyngeal disease), patients are usually advised to phone for results five to seven days after diagnosis to confirm that the antibiotic they received was likely to be effective. Patients are advised to abstain from sex during this time. Drug resistant strains are known to exist. United States recommendationsThe United States does not have a federal system of sexual health clinics, and the majority of infections are treated in family practices. A third-generation cephalosporin antibiotic such as ceftriaxone is recommended for use in most areas. Since some areas such as Hawaii and California have very high levels of resistance to fluoroquinolone antibiotics (ciprofloxacin, ofloxacin, levofloxacin) they are no longer used empirically to treat infections originating in these areas. United Kingdom recommendationsIn the United Kingdom, the majority of patients with gonorrhea are treated in dedicated sexual health clinics. The current recommendation is for ceftriaxone or cefixime as first line therapy; no resistance to either drug has yet been reported in the UK. Levels of spectinomycin resistance in the UK are less than 1%, which would make it a good choice in theory, but intramuscular spectinomycin injection is very painful. Azithromycin (given as a single dose of 2 g) is recommended if there is concurrent infection with chlamydia. A single dose of oral ciprofloxacin 500 mg is effective if the organism is known to be sensitive, but fluoroquinolones were removed from the UK recommendations for empirical therapy in 2003 because of increasing resistance rates. In 2005, resistance rates for ciprofloxacin were 22% for the whole of the UK (42% for London, 10% for the rest of the UK).[69]
antrax
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [13]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [14] OverviewBacillus anthracis is a Gram-positive, facultatively anaerobic, rod-shaped bacterium of the genus Bacillus. An endospore forming bacterium, B. anthracis is a natural soil-dwelling organism, as well as the causative agent of anthrax.[70] Each cell is about 1 by 6 μm in size. Historical backgroundB. anthracis was the first bacterium conclusively demonstrated to cause disease, by Robert Koch in 1877.[71] The species name anthracis is from the Greek anthrakis (ἄνθραξ), meaning coal and referring to the most common form of the disease, cutaneous anthrax, in which large black skin lesions are formed. PathogenicityUnder conditions of environmental stress, B. anthracis bacteria naturally produce endospores which rest in the soil and can survive for decades in this state. When ingested by a cattle, sheep, or other herbivores, the bacteria begin to reproduce inside the animal and eventually kill it, then continue to reproduce in its carcass. Once the nutrients are exhausted, new endospores are produced and the cycle repeats.[72] B. anthracis has at least 89 known strains, ranging from highly virulent strains with biological warfare and bioterrorism applications (Ames and Vollum) to benign strains used for inoculations (Sterne). The strains differ in presence and activity of various genes, determining their virulence and production of antigens and toxins. The form associated with the 2001 anthrax attacks produced both toxin (consisting of three proteins: the protective antigen, the edema factor and the lethal factor) and a capsule (consisting of a polymer of glutamic acid). Infection with anthrax requires the presence of all three of these exotoxins.[73] The bacterium can be cultivated in ordinary nutrient medium under aerobic or anaerobic conditions. TreatmentInfections with B. anthracis can be treated with β-lactam antibiotics such as penicillin, and others which are active against Gram-positive bacteria.[74] References
Gallery
ReferencesAntibiotic TreatmentCutaneous Anthrax without Systemic InvolvementChoice of Antibiotics
Duration of Treatment
Systemic Anthrax When Meningitis Has Been ExcludedChoice of Antibiotics
Duration of Treatment
Follow–up Oral Treatment for Systemic DiseaseOnce patients with systemic illness who were exposed to aerosolized spores have completed initial combination treatment, they should be transitioned to single-agent oral treatment to prevent relapse from surviving B. anthracis spores.[1] Systemic Anthrax with Possible/Confirmed MeningitisChoice of Antibiotics
Duration of Treatment
Follow–up Oral Treatment for Systemic DiseaseOnce patients with systemic illness who were exposed to aerosolized spores have completed initial combination treatment, they should be transitioned to single-agent oral treatment to prevent relapse from surviving B. anthracis spores. Dosage of Antibiotics▸ Click on the following categories to expand treatment regimens.[2][3][4]
piss
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [15]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [16] OverviewPsittacosis is an infection caused by the obligatory intracellular bacterium Chlamydia psittaci. It is apparently acquired from the birds (parrots). CausesPsittacosis is an infection caused by the obligatory intracellular bacterium Chlamydia psittaci. It is apparently acquired from the birds (parrots). Ornithosis is infection from any kind bird. References
plam
This page is about clinical aspects of the disease. For microbiologic aspects of the causative organism(s), see Plasmodium.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [17]; Associate Editor(s)-In-Chief: Yazan Daaboul, Serge Korjian, Alison Leibowitz [18] OverviewMalaria is a vector-borne infectious disease caused by protozoan parasites. P. vivax is the most common cause of infection, responsible for about 80% of all malaria cases. P. falciparum, the most significant cause of disease, is responsible for about 15% of infections and 90% of deaths.[1][2] CausesP. vivax is the most common cause of infection, responsible for about 80% of all malaria cases. P. falciparum, the most significant cause of disease, is responsible for about 15% of infections and 90% of deaths.[3] The remainder of human malaria infections are caused by P. ovale, P. malariae, and P. knowlesi.
References
q fever microb
Coxiella burnetii is a species of intracellular, pathogenic bacteria, and is the causative agent of Q fever. The genus Coxiella is morphologically similar to the rickettsia, but with a variety of genetic and physiological differences. C. burnetii are small Gram negative bacteria with two growth phases, as well as a spore form which lies idle in soil.[1] It can survive standard disinfectants, and is resistant to many other environmental changes.[2] PathogenesisThe ID50 (the dose needed to infect 50% of experimental subjects) is one via inhalation— i.e. inhalation of one organism will yield disease in 50% of the population. Disease occurs in two states: An acute state presents with headaches, chills, and respiratory symptoms, and an insidious chronic stage. While most infections clear up spontaneously, treatment with tetracycline or doxycycline appears to reduce the symptomatic duration and reduce the likelihood of chronic infection. A combination of erythromycin and rifampin is highly effective in curing and prevention of disease and so is vaccination with Q-vax vaccine (CSL).
References
Anti-malarial Agents
*Used in combination with quinine or quinidine
Initial Assessment & Severe MalariaThe first step in the management of patients with malaria is to conduct a clinical assessment of status and disease severity, as well as determination of the degree of parasitemia. Signs of severe malarial disease include any of the following: Prostration, impaired consciousness/coma, respiratory distress, convulsions, shock, pulmonary edema, acute respiratory distress syndrome (ARDS), jaundice, abnormal bleeding, severe anemia, hemolysis, hemoglobinuria, acute kidney injury, metabolic acidosis, disseminated intravascular coagulopathy, parasitemia >5%. Patients with severe disease require rapid resuscitation and medical therapy. The most vital step in the management is immediate initiation of appropriate parenteral treatment. Unlike patients who appear stable clinically, patients with severe malaria do not require speciation prior to initiation of medical therapy. The therapeutic regimen in patients with severe malaria consists of intravenous quinidine gluconate plus either tetracycline, doxycycline, or clindamycin.[1] Other supportive measures include admission to the intensive care unit, continuous monitoring of cardiac function, glycemia, parasitemia, hemoglobin and electrolytes. Exchange transfusions may also be considered in patients with a degree of parasitemia >10%. Uncomplicated MalariaIn patients with clinically and bacteriologically uncomplicated malaria, speciation is required to tailor medical therapy. For most non-falciparum species, chloroquine remains the first line therapeutic agent. It is important to add primaquine to the treatment regimen in patients with documented P. vivax and P. ovale infections to eradicate liver hypnozoites (dormant liver spores that are responsible for recurrence). Care should be taken in patients with G6PD deficiency as large doses of primaquine can cause significant hemolysis. Patients infected with P. malaria do not require primaquine as the species is not capable of forming hypnozoites.[2] Patients diagnosed with P. falciparum malaria require hospitalization given the risk of progression to severe malaria. These patients have to be monitored on daily basis with a blood film and a full physical exam. The choice of drug in these patients depends on two main factors: the area of acquisition of the parasite, and the center at which the patient is being treated.[1] Despite being the mainstay of therapy since its introduction, empiric treatment with chloroquine in patients with P. falciparum is no longer recommended due to a sharp increase in resistance. A detailed travel history is important to determine where the infection was acquired. Most malaria endemic countries have reported chloroquine resistant strains, with the exception of Central America west of Panama Canal, Mexico, Hispaniola, certain parts of China, and the Middle East (see figure below). If acquired in any of the latter sites then treatment with chloroquine is adequate. Acquisition from all other endemic countries requires other therapeutic regimens such as oral quinine with either tetracycline, doxycycline, or clindamycin as a first line therapy in the United States, otherwise atovaquone-proguanil or mefloquine if the primary regimen is unavailable. Worldwide, the treatment of both complicated and uncomplicated P. falciparum malaria requires a combination therapy that includes artemisinin derivatives. According to the 2010 WHO guidelines on the treatment of malaria, the following regimens are first line for the treatment of uncomplicated P. falciparum: artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, and artesunate plus sulfadoxine-pyrimethamin. It is important to note that artemisin monotherapy in not recommended due to increasing resistance. For patients with severe P. falciparum malaria, artesunate IV or IM is first line followed by IV quinidine. The artemisinin derivatives clear parasites very rapidly have been shown to reduce mortality in severe malaria compared with parenteral quinine. Artemisins are not widely available in the United States and their use is not common practice. Only oral artemether plus lumefantrine is available, while IV atresunate can be obtained through the CDC part of an investigational drug protocol. [3] ![]() |
- ↑ 1.0 1.1 Griffith KS, Lewis LS, Mali S, Parise ME (2007). "Treatment of malaria in the United States: a systematic review". JAMA. 297 (20): 2264–77. doi:10.1001/jama.297.20.2264. PMID 17519416.
- ↑ White NJ, Pukrittayakamee S, Hien TT, Faiz MA, Mokuolu OA, Dondorp AM (2014). "Malaria". Lancet. 383 (9918): 723–35. doi:10.1016/S0140-6736(13)60024-0. PMID 23953767.
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