Conjunctivitis, infective

Clinical Knowledge Summaries (2007b) Conjunctivitis - infective. Available at http // cks.library.nhs.uk/conjunctivitisJnfective [Accessed 4 July 2008],... 

Nonspecific immunosuppressive therapy in an adult patient is usually through cyclosporin (35), started intravenously at the time of transplantation, and given orally once feeding is tolerated. Typically, methylprednisone is started also at the time of transplantation, then reduced to a maintenance dose. A athioprine (31) may also be used in conjunction with the prednisone to achieve adequate immunosuppression. Whereas the objective of immunosuppression is to protect the transplant, general or excessive immunosuppression may lead to undesirable compHcations, eg, opportunistic infections and potential malignancies. These adverse effects could be avoided if selective immunosuppression could be achieved. Suspected rejection episodes are treated with intravenous corticosteroids. Steroid-resistant rejection may be treated with monoclonal antibodies (78,79) such as Muromonab-CD3, specific for the T3-receptor on human T-ceUs. Alternatively, antithymocyte globulin (ATG) may be used against both B- and T-ceUs. 

Physiological Effects. The sulfur and nitrogen mustards act first as cell irritants and finally as a cell poison on all tissue surfaces contacted. The first symptoms usually appear in 4—6 h (4). The higher the concentration, the shorter the interval of time between the exposure to the agent and the first symptoms. Local action of the mustards results in conjunctivitis (inflammation of the eyes) erythema (redness of the skin), which may be followed by blistering or ulceration and an inflammatory reaction of the nose, throat, trachea, bronchi, and lung tissue. Injuries produced by mustard heal much more slowly and are much more Fable to infection than bums of similar intensity produced by physical means or by other chemicals. 

In an unusual variant on the Chichibabin reaction, treatment of 3-hydroxypyridine with sodium amide at 200° affords 2,6-di-aminopyridine (21). Coupling of the product with benzenediazo-nium chloride gives phenazopyridine (22). This drug is used as an analgesic for the urinary tract in conjunction with antibacterial agents for treatment of urinary infections. 

These antibiotics are effective in the treatment of infections caused by a wide range of gram-negative and gram-positive microorganisms. The lincosamides are used for the more serious infections. In serious infections they may be used in conjunction with other antibiotics. 

Antibiotics possess antibacterial activity and are used in the treatment of eye infections. Sulfonamides possess a bacteriostatic effect against a wide range of gram-positive and gram-negative microorganisms. They are used in the treatment of conjunctivitis, comeal ulcer, and other superficial infections of the eye. See the Summary Drug Table Select Ophthalmic Preparations and Chapter 6 for additional information on the sulfonamides. 

It may be possible to increase the utility of our resources to treat influenza virus infection through combinations of antiviral agents with different modes of action (discussed in Cinatl et al. 2007a De Clercq and Neyts 2007). The sialidase inhibitors, for example, may be able to be used in conjunction with the adamantane-based M2 ion channel inhibitors (Govorkova et al. 2004 Ilyushina et al. 2006), with Ribavirin (Smee et al. 2002) or with non-influenza virus specific therapeutics such as anti-inflammatory drugs (Carter 2007). Combination therapy may also reduce the potential of resistance development (Ilyushina et al. 2006). 

The natural killer cells (NK) are the host s primary innate immune responders against viral infections. Studies have shown morphine to suppress the cytolytic activity of NK cells (Shavit et al. 2004). In vivo studies carried out in the Indian rhesus macaques looked at chronic morphine administration and SIV the equivalent of HIV in apes. This group concluded that morphine contributed to the pathogenesis of Simian Immunodeficiency Virus (SIV) infection and that this contribution occurred in conjunction with the replication of viral proteins including Tat (Noel and Kumar 2006 Noel et al. 2006). 

As the name implies, these organisms grow in pairs, otherwise they are similar to streptococci and are now referred to as streptococci. Streptococcus pneumoniae is the causal agent of acute lobar pneumonia and also of meningitis, peritonitis and conjunctivitis. This organism can also initiate an invasive infection. 

The serum concentration of a number of proteins increases dramatically during infection. Their levels can increase by up to 100-fold compared with normal levels. They are known collectively as acute phase proteins and certain of them have been shown to enhance phagocytosis in conjunction with complement. 

Staphylococcus, Moraxella, or other opportunistic bacteria typically cause chronic conjunctivitis.10 Moraxella infections may cluster in groups of women who share makeup.12 Both acute and chronic bacterial conjunctivitis are self-limiting except if caused by staphylococci.13 Because of this, the pathogens are rarely cultured unless the case is unresponsive to treatment. While infection typically begins in one eye, it will often spread to both within 48 hours.11... 

Hyperacute bacterial conjunctivitis is associated with gonococcal infections in sexually active patients. The causative agents are Neisseria gonorrhoeae or N. meningitidis. Prompt work-up and treatment is required, as corneal perforation occurs in 10% of cases within 48 hours.12 An ophthalmologist should complete a conjunctival scraping and susceptibility testing.10... 

Treat acute bacterial conjunctivitis with broad-spectrum antibiotics. Although the condition is usually self-limiting, antibiotic treatment decreases the spread of disease to other people and prevents extraocular infection. Additionally, treatment may help decrease the risk of corneal ulceration or other complications that affect sight. Finally, treatment speeds recovery.14... 

Topical antivirals are not used to treat adenovirus conjunctivitis. Topical antibiotics are often prescribed for viral conjunctivitis, ostensibly to prevent bacterial superinfection. In reality, this is a case of the patient insisting on a medication to speed healing.11 Avoid the use of antibiotics for a viral infection.12 Eliminating superfluous antibiotic use also helps prevent the development of antibiotic resistance. 

If mast cell stabilizers or multiple-action agents are not successful, a trial of a topical NSAID is appropriate. Ketorolac is the only approved topical agent for ocular itching. NSAIDs do not mask ocular infections, affect wound healing, increase intraocular pressure, or contribute to cataract formation like the topical corticosteroids. However, for allergic conjunctivitis, topical ketorolac is not as effective as olopatadine or emedas-tine in trials.15 Full efficacy of ketorolac takes up to 2 weeks.17... 

Previous ocular or eyelid surgery Loose sutures Previous corneal surgery Ocular Surface Disease Misdirection of eyelashes Abnormal lid anatomy or function Tear film deficiencies Ocular infection such as conjunctivitis or blepharitis Systemic Conditions Diabetes mellitus... 

Imaging studies also may help to identify anatomic localization of the infection. These studies usually are performed in conjunction with other tests to establish or rule out the presence of an infection. X-rays are performed commonly to establish the diagnosis of pneumonia, as well as the severity of disease (single versus multilobe involvement). CT scans are a type of x-ray that produces a three-dimensional image of the combination of soft tissue, bone, and blood vessels. In contrast, MRI use electromagnetic radio waves to produce two- or three-dimensional images of soft tissue and blood vessels with... 

The CSFs should not be used routinely for treatment of febrile neutropenia in conjunction with antimicrobial therapy.5 However, the use of CSFs in certain high-risk patients with hypotension, documented fungal infection, pneumonia, or sepsis is reasonable. A recent meta-analysis demonstrated that hospitalization and neutrophil recovery are shortened and that infection-related mortality is marginally improved.14 As with prophylactic use of these agents, cost considerations limit their use to high-risk patients. 

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