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Mycoplasmal pneumonia, tularemic pneumonia, Q fever pneumonia, psittacosis, and Legionnaires' disease are the most frequently encountered treatable atypical pneumonias. Mycoplasmal pneumonia, the most common, is often accompanied by nonexudative pharyngitis, conjunctivitis, or otitis. The nonproductive cough is characteristic. Tularemic pneumonia is characterized by substernal chest pain, bloody pleural effusion, and bilateral hilar adenopathy. Although the clinical presentation is mild, roentgenographic findings are impressive. Q fever pneumonia resembles psittacosis but is less serious; it may be accompanied by subacute bacterial endocarditis, hepatitis, or both. Psittacosis is characterized by prominent headache, bloody sputum, and relative bradycardia. Tetracycline is the drug of choice for either. In Legionnaires' disease, pneumonia is accompanied by prominent extrapulmonary symptoms. The most important diagnostic clues include diarrhea and mental confusion. Relative bradycardia and laboratory abnormalities are also helpful. Erythromycin is the drug of choice unless doubt exists as to the diagnosis.
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PMID:The atypical pneumonias: a diagnostic and therapeutic approach. 47 55

During the winter months 1974/75 we were able to observe a number of unusual respiratory tract infections particularly in children over 6 years of age which appeared as pneumonias. Characteristic clinical findings included a dry, hacky cough, refractive to the usual antitussives, starting 1--2 weeks prior to admission, fever up to 104, malaise, headache, anorexia, shortness of breath and cyanosis. Several Pts were treated prior to admission with a number of antibiotics and failed to respond. Laboratory findings showed a peripheral polymorphonuclear leucocytosis with toxic granulations of neutrophiles. A sedimentation rate above 40 in the first hour occurred in most Pts. X Ray of the lung revealed a characteristic mottled appearance with patchy infiltrations, atelectasis and nodular densities. Frequently a shift of the mediastinum towards the infiltrate was seen. One of the hallmarks on physical examination was the discrepancy between the severity of the clinical illness and the paucity of physical findings. Decreased breath sounds over affected lung areas were often the only findings on auscultation; find rales, rhonchi or dullness on percussion were less often heard. The combination of a typical history, physical examination, laboratory tests and X Ray findings enabled us to make a presumptive clinical diagnosis of Mycoplasma pneumonia before serologic test results were available and to start with the appropriate antibiotic (Erythromycin, Tetracycline) early in the course of the disease. Complement fixation tests with a titer of 1 : 20 and a fourfold rise over the next two weeks or an initial titer of 1 : 80 and above were considered significant for acute disease.
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PMID:[Mycoplasma pneumonias in childhood (author's transl)]. 83 54

Scrub typhus rarely figures among the imported tropical diseases in western Europe. Rickettsia tsutsugamushi is transmitted by larval mites. A typical eschar develops at the site of the mite bite during the incubation period, after which systemic symptoms (remittent or continuous high fever, severe headache, tender lymphatic glands and symptoms of bronchitis) develop with sudden onset. Antibodies appear during the second week and can be shown by a positive and increasing titer against Prot. OXK (Weil-Felix) or by specific rickettsial agglutination. The Weil-Felix reaction is neither very sensitive nor very specific. Therefore, treatment should be started as soon as suspicion arises whether a positive serology is available or not. Tetracycline drugs are effective treatment and fever subsides in less than 24 hours in most patients. - We report the rare observation of a tourist who imported tsutsugamushi fever from India.
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PMID:[Imported tsutsugamushi fever]. 239 62

Benign intracranial hypertension with papilloedema developed in a 18-year-old woman following Minocycline administration. Tetracycline therapy was prescribed for acne vulgaris. One month after the beginning of the treatment, she presented with headache, nausea and vomiting; there were no visual symptoms. Visual acuity and visual field were normal, fundus examination showed bilateral papilloedema. After Minocycline was discontinued and steroid therapy was administrated, symptoms rapidly resolved and papilloedema disappeared. Minocycline is known to penetrate into the central nervous system more effectively and to have a greater lipoid solubility than the other antibiotics of the same group. However the pathogenesis of benign intracranial hypertension after Minocycline therapy remains unknown.
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PMID:[Papilledema caused by minocycline: apropos of a case]. 297 95

We reviewed retrospectively 135 cases of serologically-confirmed psittacosis that were admitted to Fairfield Hospital between January 1, 1972 and March 31, 1986. The average age of the patients was 46 years. The majority (85%) of patients described a history of recent exposure to birds. The clinical features, investigations, treatment and subsequent response were analysed in 129 patients. Psittacosis was a well-defined illness that was characterized by an abrupt onset of fever, rigors, sweats, and prominent headache, and a mild dry cough which appeared late frequently. However, respiratory symptoms were absent in 18% of patients. Diarrhoea and sore throat were occasional complaints. Over 90% of cases had an abnormal chest x-ray film, or abnormal chest signs, or a combination of both. Most patients had a normal leukocyte count. Tetracycline drugs were used for treatment in 87% of the patients. Defervescence occurred in 92% of patients after 48 h of tetracycline treatment. There were no recrudescences of psittacosis and no fatalities. The clinical diagnosis of psittacosis can be made early usually, particularly in the presence of pneumonitis on a chest x-ray film and a positive history of bird contact. Treatment with doxycycline (100 mg twice a day for 14 days) is recommended.
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PMID:Psittacosis--a review of 135 cases. 334 52

Iatrogenic pathology of the optic nerve is examined according to a framework which distinguishes direct and indirect effects on the optic nerve. Direct effects due to toxic drugs should be suspected when unexplained, usually bilateral loss of visual acuity occurs. The 3 clinical stages of classical optic toxic neuropathy are 1) anomalies of color vision, 2) loss of visual acuity and narrowing field of vision, and 3) papillary palor corresponding to irreversible optic atrophy. Usually only the 1st stages are reversible, but the reversibility may be incomplete. The list of drugs which can cause such effects is lengthy and includes antiinfectious drugs such as sulfamides and derivatives of hydroxyquinoleins, chloramphenicol especially when used to treat cystic fibrosis of the pancreas in children, the antituberculins ethambutol in high doses and isoniazide, which occasion particular risks when combined; antiparasitics such as quinine and its derivatives chloroquine and hydroxychloroquine, which cause optic neuropathy through their effect on the retina; arsenic pentavalents such as tryparsamide, quinacrine, trecator and mystatin; drugs affecting the central nervous system such as monoamineoxydase inhibitors, laroxyl, phenothiazine and the barbituates; anticonvulsants such as phenytoin; antimitotics such as vincristine; digitalics, disulfiram; penicillamines, and pexid. The action of lasers on the optic nerve can have a similar effect. The optic nerve may be indirectly damaged during surgical procedures leading to hypotonia, acute ischemia of the head of the optic nerve or embolic accident after a local or regional injection. Damage may also be caused by radiotherapy of intracranial tumors and certain drugs which cause isolated papillary edema or edema associated with headaches, such as Tetracycline, large doses of vitamin A or D, corticoids, and oral contraceptive (OC) pills, which may cause papillary edema through cerebral pseudo-tumors that regress with discontinuation of treatment. This condition has been observed in women with uncontrolled hyperlipidemia. It is probable that an alteration ofaxonal transport is at the basis of the neuropathic mechanisms. The 1st step in therapy is the suppression of the toxin, or at least its discontinuation. Some success has been obtained with vitamin B therapy, corticotherapy, zinc, or isaxonine, depending on the specific condition.
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PMID:[Iatrogenic pathology of the optic nerve]. 676 92

Human ehrlichiosis is a newly recognized tick-borne disease. Since 1935 Ehrlichia canis has been known as a cause of illness in dogs and other canine species, and for a few years it was related with human disease. In 1990, Ehrlichia chaffeensis was isolated from a man suspected of having ehrlichiosis. Partial sequencing of the rRNAS from the human isolate and E. canis, indicated that they are 98.7% related. More recently (May 1994) an "human granulocytic ehrlichiosis" have been reported in USA. PCR amplification and sequence of 16S rDNA, showed that the human isolate was virtually identical to those reported for E. phagocytophila y E. equi, organisms that cause ehrlichiosis in rumiant and in horses. Most patients shows fever, headache, malaise, nausea or vomiting, anorexia and in a minority of cases rash is present. Some of them have complications such as pulmonary infiltrates, gastrointestinal problems, renal dysfunction or failure, hepatoesplenomegaly, neurologic abnormalities, DIC and some times death. Leucopenia, thrombocytopenia and elevated liver enzyme values have been common findings. Tetracycline and cloramphenicol have been using in adults and children as especific theraphy.
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PMID:[Human ehrlichiosis. Review]. 773 23

Rickettsialpox is a member of the spotted-fever group of the rickettsioses and results from an infection with Rickettsia akari. This microbe is transmitted by the bite of the house-mouse mite Liponyssoides sanguineus. Patents experience fevers, sweats, headaches, and a vesicular eruption over the trunk and extremities. The palms and soles are spared. An eschar results at the spot of the mite bite. Tetracycline is the treatment of choice.
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PMID:Rickettsialpox. 909 40

Chlamydia trachomatis is the most frequent sexually transmitted bacterial pathogen in developed countries [3, 12, 13]. The position is similar in the Czech Republic. Depending on the group of examined women active Chlamydia infection varies between 10 and 23%. The increasing incidence of urogenital Chlamydia infections and improving diagnostic possibilities call for adequate treatment. Correct treatment of urogenital infections caused by Chlamydia trachomatis is very important for the prevention of undesirable sequelae of inflammations of the lesser pelvis, subsequent risk of GEU, sterility, prevention of premature delivery and possible infection of the neonate. When starting treatment, selecting a suitable antibiotic and deciding on the therapeutic strategy it is important to select an antibiotic with regard to its efficacy, the epidemiological situation, regional sensitivity of the infectious agent, toxicity and tolerance of the antibiotic, to its bacteriostatic or bactericide action, and last not least, also its price. Despite selection of a suitable antibiotic sometimes treatment fails. For treatment of urogenital chlamydial infections tetracyclin and macrolid antibiotics are recommended or quinolone chemotherapeutic agents of the third generation. Tetracyclines are broad spectrum antibiotics with bacteriostatic action. As to oral forms doxycycline, tetracycline and oxytetracycline are used. The most frequent undesirable effects during treatment are nausea, vomiting, diarrhoea and abdominal pain. Tetracycline antibiotics are contraindicated in children under 8 years, during pregnancy and lactation and in case of sensitivity to this group of drugs. Macrolids are antibiotics with a medium broad antibacterial spectrum with bacteriostatic action. Macrolids of the first generation have a low antibacterial activity. They have a short biological half-life, not always a good tolerance, and serious clinically important drug interactions may develop. The most frequently used preparations of the first generation include erythromycin, josamycina and spiramycin. Macrolids of the second generation, azitromycin, roxitromycin and claritromycin lack the above negative properties. The most frequent undesirable effects after administration of macrolids include nausea and vomiting. Considerable differences were found in particular between different preparations containing erythromycin. Macrolids of the second generation have only slight undesirable gastrointestinal effects. Macrolid antibiotics are contraindicated in case of sensitization to this group, in severe hepatic disorders and great care must be taken in the treatment of pregnant women. Quinolone chemotherapeutic agents of the third generation, ciprofloxacine, enoxacine, ofloxacine and pefloxacine are synthetic drugs with a broad antibacterial spectrum which act on systemic infections. On oral administration they are rapidly absorbed and the blood and tissue concentrations are sufficiently effective. In the treatment of urogenital Chlamydia infections they are useful in the treatment of chronic infections after failure of previous macrolid and tetracycline therapy. The most frequent undesirable side-effects include nausea, vomiting, meteorism, diarrhoea, tinnitus, headache, changes of mood, allergic skin reaction. They are contraindicated in hypersensitivity to quinolone chemotherapeutic preparations, in children and adolescents under 18 years, during pregnancy and lactation. The objective of the present study was to evaluate different therapeutic patterns, their efficacy and tolerance.
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PMID:[Treatment of chlamydial urogenital infections]. 975 Apr 1

We have previously reported the reduction of cicatricial pemphigoid orodynia with minocycline. Tetracycline combined with high dose nicotinamide has also been beneficial in a number of cutaneous immunological disorders. We now report a series of eight cases in whom further subjective or clinical improvement accrued in five, after the addition of high dose (2.5 or 3 g) nicotinamide to minocycline; however, one of these then discontinued the nicotinamide because of headache and nausea, another was withdrawn from the study because of progressive upper respiratory tract mucosal involvement, and two were changed from minocycline to tetracycline because they developed minocycline-induced hyperpigmentation.
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PMID:Combination therapy with nicotinamide and tetracyclines for cicatricial pemphigoid: further support for its efficacy. 1023 19


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