Archive for the ‘E:Diseases with E’ Category

Treatment of Epididymitis

Monday, January 25th, 2010

Epididymitis is a sexually transmitted infection in men. Most of the sexually transmitted epididymitis are acute and generally affect only on one side. Epididymitis causes pain, tenderness (pain on pressure to that part), swelling of epididymis and these symptoms may or may not be accompanied by signs and symptoms of urethritis (infection/inflammation of urethra).

What are the causative organisms of acute sexually transmitted epididymitis?

Most commonly the causative organisms of acute sexually transmitted epididymitis is Clamydia trachomatis and less commonly due to N. gonorrhea, especially in case of males below 35 years of age and sexually active.

Other conditions which should be differentiated from acute epididymitis are torsion of testis, trauma or due to tumor. In torsion of testis, which is a surgical emergency there is sudden onset of pain, the testicle is located in the scrotal sac, there is rotation of the epididymis from a posterior to an anterior position. In torsion of testis on Doppler study there is absence of blood flow to the testis. If symptoms do not subside after complete treatment with appropriate antibiotics, it suggests tumor or a granulomatous disease like tuberculosis. In trauma there is history of trauma.

Treatment of epididymitis:

The treatment of choice for acute epididymitis is ceftriaxone 250 mgs single dose intramuscularly followed by doxycycline 100 mg orally two times a day for next 10 days. This regime cures acute epididymitis due to Clamydia trachomatis as well as due to N. gonorrhea. Previously fluoroquinolones like ciprofloxacin were used, but at present not recommended due to emergence of resistance against fluoroquinolones.  Levofloxacin is used sometimes if the causative organism of epididymitis is found to be Enterobacteriaceae, but it is not useful if epididymitis is due to other organisms.

Treatment of Dark Circles Around Eye

Thursday, January 1st, 2009

Skin care is an important branch of medicine and it is an emerging branch. Due to peoples awareness on cosmetics and skin care the branch is growing very fast. Many skin products are available for treatment of skin problems. Skin products are mainly of herbal in nature and aloe vera is one of the main ingredients. Aloe vera based skin care products are very much essential in maintaining healthy skin. For healthy and glowing skin there are many skin care products like anti wrinkle cream, creams for removing dark circles around eyes, moisturizers, puffy eye creams, vitamin C renewal cream, stretch marks, skin rashes, eczema, spider veins creams, etc. to name a few.

Among the skin care products cream for removing dark circles under eyes is worth mentioning. The dark circles under eyes are due to discoloration of the skin (mainly to dark or pink color discoloration) in that area which is very richly supplied by blood vessels. The cream for removing the dark circles under eyes is based on natural ingredients and is devoid of substances/chemicals (mineral oil) that can clog the pores of the skin around the eyes. Mineral oil based products can make the problem worse by blocking the pores of the skin and making it a rich medium for growth of harmful bacteria. The ingredients of natural based creams for removal of dark circles under eyes can increase blood flow in that area and reduce pooling of blood in the area around the skin of the eyes.

Almost all the skin care products takes some time (about a month) to act and another month to get maximum result, that is why many products are available as one moth pack and another month’s pack is provided free of cost.      

Ehrlichiosis: Human Monocytotropic Ehrlichiosis

Sunday, October 5th, 2008

Human Monocytotropic Ehrlichiosis (HME) is caused by Ehrlichia chaffeensis. In the year 2006 more than 2657 cases were reported to the Centers for Disease Control and Prevention (CDC), Atlanta, USA. But active prospective studies indicate an incidence of as high as 414 cases per 100,000 populations in some regions of the United States. White tailed deer is the major reservoir and Lone Star tick (A. americanum), the main vector feed on them (all life stages feed on white tailed deer).

Clinical manifestations: Illness develops after about 8 days (incubation period). The organisms spread through blood pool which is created by the feeding tick. Clinical manifestations are fever (97% of cases), headache (80% of cases), malaise (82% of cases) and myalgia (57% of cases). Symptoms like nausea, vomiting, and diarrhea, cough and rash are less frequent.

Severe complications include toxic shock like or septic shock like syndromes, adult respiratory distress syndrome (ARDS), cardiac failure, meningoencephalitis, hepatitis and hemorrhage. In immunocompromised patients an overwhelming infection may be seen.

Human Monocytotropic Ehrlichiosis can be severe. 62% of patients with documented cases are hospitalized, and about 3% die.

Diagnosis: HME can be fatal; so empirical antibiotic therapy based on clinical diagnosis is required. Diagnosis is suggested by fever with a known tick exposure during the preceding 3 weeks, thrombocytopenia and/or leukopenia, and increased serum aminotransferase activities. HME can be confirmed by PCR amplification of E. chaffeensis nucleic acids in blood which is obtained before the start of antibiotic therapy. It should be differentiated from Human Granulocytotropic Anaplasmosis (HGA).

Treatment: Treatment is with doxycycline 100 mg given orally or intravenously twice daily or tetracycline 250–500 mg given orally every 6 hourly and continued for 3-5 day after symptoms subside.