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Infectious and parasitic causes of hypopigmentation
Published in Electra Nicolaidou, Clio Dessinioti, Andreas D. Katsambas, Hypopigmentation, 2019
Serena Gianfaldoni, Aleksandra Vojvodic, Nooshin Bagherani, Bruce R. Smoller, Balachandra Ankad, Leon Gilad, Arieh Ingber, Fabrizio Guarneri, Uwe Wollina, Torello Lotti
For the treatment of yaws, the WHO recommends a single oral dose of azithromycin (30 mg/kg, with a maximum of 2 g). Benzathine penicillin as a single intramuscular dose of 1.2 million units (MU) of BPG for people aged over 10 years, and 0.6 MU for children less than 10 years of age, for those patients who “clinically fail on azythromycin” or are allergic to azithromycin.60
Pharyngitis
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
When sore throat recurs in patients who have received antibiotic treatment, the reasons may include inappropriate antibiotic therapy, inadequate dose or duration of previous therapy, patient non-compliance/non-concordance, reinfection and local breakdown of penicillin by beta-lactamase producing commensals. Benzathine penicillin, cefuroxime and clindamycin have been shown to be superior to penicillin V in the management of children with this problem, and they may reduce the frequency of episodes.
Medical management
Published in Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi, Mitral Stenosis, 2018
Since rheumatic heart disease is the most common etiology for MS, secondary prevention for rheumatic fever is an essential part of treatment. It is unclear how much MS progression can be delayed by regular secondary prophylaxis. Regular secondary prophylaxis reduces the clinical severity and mortality of mitral regurgitation (MR), prevents involvement of other valves, and decreases the chance of developing MR over pre-existent MS. The progression of MS is a complex process related mostly to the turbulence generated at the valve and subvalvular level. Progressive subvalvular disease and calcification could be related to rheumatic fever recurrence, but there is a lack of clear documentation in prospective studies. Intramuscular benzathine penicillin reduces streptococcal pharyngitis by 71%–91% and reduces recurrent rheumatic fever by 87%–96%.9Table 11.2 describes various antibiotic regimens for secondary prevention of rheumatic fever. Patients with persistent valvular disease should receive prophylaxis for 10 years after the last episode of acute rheumatic fever or until 40 years of age, whichever is longer. Some high-risk patients may require longer (even lifelong) prophylaxis, depending upon the severity of valvular disease and the potential for exposure to group A streptococci.
Treatment outcomes of acute streptococcal tonsillitis according to antibiotic treatment. A retrospective analysis of 242,366 cases treated in the community
Published in European Journal of General Practice, 2022
Mattan Bar-Yishay, Ilan Yehoshua, Avital Bilitzky, Yan Press
Various studies have shown similar efficacy of amoxicillin and penicillin-V in successfully treating GABHS pharyngitis [14–16]. Since then, once-daily amoxicillin has been prescribed often [6], especially among children, presumably due to ease of administration and preferably tasting formulation. By comparison, IM benzathine penicillin is administered far less frequently. A single IM injection of benzathine penicillin is a long-acting treatment, with detectable levels of penicillin found in serum and tonsils for up to four weeks following injection [17]. Interestingly, benzathine penicillin is the only antibiotic therapy that has been shown to prevent acute rheumatic fever in controlled studies [18–20]; however, these were conducted in the 1950s. The few studies that have compared IM benzathine penicillin treatment to oral amoxicillin have reported superior GABHS eradication rates among children in low-resource countries [21,22], presumably due to increased compliance. Additional studies comparing benzathine penicillin to other antibiotics demonstrated similar clinical and biological cure rates between treatment groups [23,24]. However, despite efficiency, wide availability and low cost, benzathine penicillin is rarely utilised in the primary treatment of acute GABHS pharyngitis in high-resource community settings. The discomforts to patient, physician and parent associated with an IM injection are assumed to be the cause of low utilisation in high-resource countries, where compliance and rheumatic sequels are of less concern.
Vasculitis in a case of rupioid syphilis in HIV
Published in Baylor University Medical Center Proceedings, 2022
Connor Rodriguez, Parneet Dhaliwal, Allison Readinger
Aspiration of the left knee was initially concerning for infection, and the patient was started on empiric antibiotics, but routine cultures were later determined to be negative. Dermatology was consulted and performed a punch biopsy of the skin. Histology demonstrated an abscess with medium- to large-sized blood vessels with fibrinoid necrosis of the vessel wall and neutrophilic infiltrate in and around the vessel walls (Figure 1b). Grocott methenamine silver, acid-fast bacilli, and Gram stains were negative for organisms as well as spirochete immunostain and human herpesvirus-8, likely due to treatment with empiric antibiotics. After communication between the clinician and the pathologist, with review of clinical lesions and pathologic findings, serologic testing was performed, showing a positive rapid plasma reagin (RPR) (1:128 titer), consistent with syphilis. The patient was started on intravenous benzathine penicillin G. He was continued on penicillin at his 4-week follow-up visit. The patient’s lesions resolved the next month with no recurrence.
Epithelial dysfunction, respiratory infections and asthma: the importance of immunomodulation. A focus on OM-85
Published in Expert Review of Respiratory Medicine, 2020
Fabio Cardinale, Enrico Lombardi, Oliviero Rossi, Diego Bagnasco, Aldo Bellocchi, Francesco Menzella
Children with recurrent RTIs commonly are not affected by immune defects and these infections may simply represent increased exposure to infectious agents during the first years of life, when immune function is still immature [19]. However, children with selective antibody deficiency may be at higher risk for recurrent infection [20]. In 87 children with IgA and IgG subclass deficiencies, 76% presented with recurrent upper RTIs. A number of 68 (78%) of patients received prophylactic treatment with benzathine penicillin, prophylactic oral antibiotic, or oral bacterial extract and these patients suffered 2.5 ± 2.3 infections/year compared to 7.9 ± 4.9 infections/year in children without any prophylactic regimen [21]. This decrease in frequency did not show any significant difference between different prophylactic groups. Serum IgA recovered to normal range in 52% of children with partial IgA deficiency and serum IgG recovered to of normal range in 67% of children with IgG plus IgA subclass deficit and 30% of children with isolated subclass deficits.