Successful treatment of cat-scratch disease with ciprofloxacin

Article Abstract:

Occasionally a cat scratch or other minor wound will result in cat-scratch disease (CSD), caused by gram-negative bacteria. It is not usually serious and goes away after a few months. CSD may produce no symptoms, but sometimes causes painful, localized infection, and inflammation of the lymph nodes, malaise, low-grade fever, and lethargy. There have been recent reports of life-threatening CSD in patients with compromised immune response. Antibiotics are not effective, so treatment is usually directed at alleviating the symptoms. Five cases of patients with severe CSD are described, all of which responded very well to oral ciprofloxacin, an antibacterial drug, without relapse. There was one report of successful therapy using intravenous gentamicin, an antibiotic, given for one to two weeks, and another reported success using trimethoprim-sulfamethoxazole, an antibacterial drug. Immunocompromised patients have been treated successfully with a combination of antibiotics, but gentamicin and trimethoprim-sulfamethoxazole have not been effective. Ciprofloxacin is effective against a wide range of gram-negative bacteria, and if it is found that it kills the CSD bacillus, it may be useful in curing the disease in immunocompromised patients. Ciprofloxacin cannot be used in children because it has caused arterial disease and irreversible cartilage damage in studies of young animals. It also cannot be used by pregnant or nursing mothers. Trimethoprim-sulfamethoxazole is an alternative for use in children. The duration of treatment has not been fixed for CSD at different clinical stages. Another drawback to ciprofloxacin is the cost of treatment, which is three to seven times that of trimethoprim-sulfamethoxazole. The author notes that his patients felt that their improvement was worth the cost. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Drug therapy, Co-trimoxazole, Trimethoprim-sulfamethoxazole (Drug combination), Gentamicin, Gentamicins, Ciprofloxacin, Lymphadenitis

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Van Gogh had Meniere's disease and not epilepsy

Article Abstract:

For many years, Vincent Van Gogh was believed to have epilepsy; however, examination of the artist's personal notes reveals that he had Meniere's disease. Classified as a genius, yet described as being mad, Van Gogh had an illness characterized by attacks separated by symptom-free periods, and when he was institutionalized, Van Gogh compared himself to others having similar symptoms. The attacks of vertigo (dizziness) were described by Van Gogh as either major or minor depending on the severity. In addition, he described accompanying episodes of stomach weakness, hearing strange sounds, and changes in vision. These symptoms are classified medically as nausea, visual hallucinations, and nystagmus and are characteristic of Meniere's disease. Patients with Meniere's disease often experience overwhelming tinnitus (ringing in the ears) and auditory hallucinations, and many patients, like Van Gogh, cut off an ear, since it is considered the source of the problem. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Diagnosis, Ear diseases, Gogh, Vincent van, Meniere's disease

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Treatment of convulsive status epilepticus: recommendations of the Epilepsy Foundation of America's Working Group on Status Epilepticus

Article Abstract:

The Epilepsy Foundation of America has made recommendations for the treatment of convulsive status epilepticus. Status epilepticus is a single seizure or a series of seizures that continue for more than 30 minutes without full recovery of consciousness. The risk of death or serious complications increases with the duration of a seizure. Patients who have a seizure that lasts more than 10 minutes should be treated with antiepileptic drugs. It is important to maintain the oxygen supply to the brain and to prevent a large drop in blood pressure during the seizure. Other metabolic imbalances should also be prevented. Patients with status epilepticus should be evaluated to determine the underlying cause of the seizure. Some patients may require long-term treatment with antiepileptic drugs. The cause of status epilepticus may be different in children than in adults.

Care and treatment, Prevention, Epilepsy, Convulsions

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