EBV-induced erythema multiforme: a case report

To the Editor, Erythema multiforme (EM) is a type of dermatosis That OCCURS as a hypersensitivity reaction in response to medications or infections. Erythema multiforme is mostly Associated With The herpes simplex virus (HSV) or mycoplasma infections, 1-but it is rare EM That is the Epstein Barr Associated With Virus (EBV). We report on an 11-year-old male patient to our hospital ADMITTED With redness, swelling, burning sensation, an itchy rash on hands and feet, and a rash on the body That HAD Begun four days with previously. The patient Suffered fever, sore throat and running a day donot Before These complaints Manifested. The skin rash Began on the sole of the right foot, Which was noticed upon a sensation of something stuck on the right sole, and then a spread to the left sole and the hands. At the outset, the skin rash was pinhead sized, then a Increased in size, and swelling in the hands and feet occurred. Consulted The first physician wrote a prescription for cefuroxime, cetirizine and feniramine. However, the patient’s complaints Were not resolved after one day of using esta medication, and so I was Referred to our hospital. In our physical examination of the patient, to maculopapuler That included rash desquamation Which regions paled under pressure, was Observed on Both palms, soles, arms and legs. His body temperature was 37 ° C. Other system examinations revealed no abnormal findings (Figure 1, Figure 2). Face, body and Mucosal Involvement was not noted.

Figure 1. A red-purple dispersed colored maculopapular rash That pales under pressure was shown around ankle and medial side of the foot. Figure 2. Red-purple erythematous maculopapular lesions colored show desquamation That Were seen in patches on bilateral palmar regions. Laboratory examination revealed leukocyte count: 9900 / mm3, hemoglobin: 14. 1 g / dl, platelet count: 214,000 / mm3, erythrocyte sedimentation rate: 22mm / hour, urea: 32mg / dl, creatinine: 0. 8mg / dl, serum sodium: 134 MEq / L, potassium: 4. 5 mEq / L, AST 31 IU / L, ALT: 22 IU / L. The patient was Also tested for the Rickettsia IgG, HSV type I IgM, HSV type II IgM, EBV VCA IgM, CMV IgM, the Parvovirus IgM, and Mycoplasma pneumoniae IgM antibodies in order to rule out rickettsial diseases and other infectious skin eruptions Because of the symmetrical maculopapular rash Involving the Hands and Feet. Doxycycline treatment was subsequently Initiated with a presumptive clinical diagnosis of rickettsial diseases. On the second day following the patient’s admission to hospital, Appeared typical target lesions, the largest of Which was 2cm in diameter, on the proximal Both thighs and area of ​​the forearms (Figure 3). EBV VCA IgM and IgG Rickettsia Were positive at a titer of 1/10 and 1/64 respectively. Repeated tests in the week and one Performed one month later, there was no Increase in the Rickettsia IgG titres.


Doxycycline treatment was halted on day seven, and EBV infection was thought to be responsible for EM in our patient. Other viral markers and examinations for mycoplasma Were found to be negative. On the fifth day of admission, the patient was discharged from the hospital as the rash had a tendency to pale. The rash Disappeared on the 14th day from the beginning and the patient was cured without sequela. Figure 3. Were Dispersed target lesions shown on the proximal part of the fore arm. One month later, in order to rule out a possible adverse drug reaction due to cefuroxime Reported use in the patient’s history, a patch test (10 mg / ml) was done, Which came out negative. Then a prick test and an intradermal test using cefuroxime Were applied. These tests since turned out negative Also, an oral provocation test was Performed using cefuroxime, Which turned out negative too. Erythema multiforme is acute, self-limited and Usually at times life threatening dermatosis With Which May multiforme lesions present. They include multiple, symmetric, persistent macules, papules, vesicles, and bullae. What has pathognomonic for erythema multiforme Become is the so-called iris or targetoid lesions, plaques Representing center of duskiness in expanding erythematous macules and papules. Commonly Involved areas are extensor surfaces: the palms, the soles, and sites of trauma.

1 The appearance of the rash in our patient shortly after pricking Caused us to think That trauma played a role in esta Facilitating case. In MS, aetiology of herpes simplex mostly Consist and mycoplasma. Medications and some vaccines Also Participate in the aetiology, but in half of the cases an underlying cause can not be found. 2 EBV VCA IgM, tested in our patient was found to be positive. Erythema multiforme occurring EBV infection is Dramatically During rare. 2,3,4,5,6 Certain it is not, Although, the pathophysiological mechanism for the EBV-related MS is thought to be immunocomplex mediated. 4 Hughes et al. Demonstrated perivascular IgM and C3 deposition in direct immunofluorescent examination. 2 In Addition, Carrera et al. Investigated the presence of specific gene sequence of EBV and Herpes simplex by PCR in a tissue biopsy of a Case with cholestatic hepatitis and acute MS; however the result was negative. 5 On the other hand, Chen et al. detected an EBV specific gene sequence in two cases by 32 EM PCR.

6 Due to a lack of the facilities for investigating EBV in tissue With PCR, since we clinically diagnosed MS, and Also for ethical issues, we did not perform a tissue biopsy in our patient. It is well Known viral infections During That, drug-related allergic reactions Rashes increase. 7 related to infectious mononucleosis are aminopenicillins During Often seen; however, serious cutaneous lesions: such as MS and Stevens Johnson Syndrome (SJS) are rare. 8 Our patient was EVALUATED for cephalosporin-related drug reaction due to previous cefuroxime use, but skin tests and oral provocation test results came out negative. Delgado et al. Reported a case of MS due to aminopenicillin use EBV infection. 8 During Contrary to our patient, They found a positive patch test and a delayed reading of an intradermal test Performed for an evaluation of drug sensitivity. They Claimed That cell-mediated hypersensitivity was responsible for the development of drug-related MS. In research Conducted by Jappe, WHO EVALUATED 41 Patients With drug eruptions following the intake of amino-penicillins, 20% of Patients had a florid infectious mononucleosis at the time of the drug eruption. 9 In our case, in terms of explaining aetiology, EBV was determined to infection and an evaluation was made due to drug allergy to cefuroxime in light of Existing Knowledge About virus-drug interaction, and the result was determined to be negative to. 80% of erythema multiforme is classified as minor, is postinfectious Usually, the skin and Primarily Affects more than one and no mucosal surface. 1 It is thought That there is a relationship Between the severity of the disease and factors in aetiology That exist. While viral infections cause erythema multiforme minor Usually and major, medications cause SJS Which progresses with a more serious clinical course.

10 Our patient was diagnosed as erythema multiforme minor, Because there was no mucosal Involvement. The drug allergy tests Were case of the negative and the viral infection was mostly related EM Encountered in minor form. Consequently, our patient was diagnosed as EBV related MS. The prognosis is quite good in EM minor, and it can be cured without sequela in 2-4weeks by Eliminating the triggering cause or by treatment of the underlying infection. Progression to SJS does not Occur In These Cases. Our patient was closely for six weeks Monitored With only the first five days in hospital, and it was Observed That His injuries healed completely. As a result, even though HSV is the MOST Observed of viral infections in the aetiology MS, EBV Might be a rare but a causative factor. Corresponding author. drpinar1975@hotmail. com

Contact Chickenpox and pregnancy

What are chickenpox and shingles? Chickenpox and shingles are infections that are caused by the varicella-zoster virus. When you have chickenpox, your immune system makes antibodies. Most people are immune to further infection after chickenpox during the rest of his life. About 1 person in 8 is not enough antibodies develop that first time and you can catch it again. The virus remains dormant in the body. It can, in some people, reappear later in life to cause a localized rash called shingles. Most people have chickenpox as a child. It comes in a small number of adults is not like a child. If you get chickenpox in adulthood, the disease is usually more severe than in children, and complications are more common, especially when you are pregnant. There are other separate leaflets called varicella in children under 12 years chickenpox in adults and adolescents and shingles that give details of these diseases. This booklet is intended primarily to pregnant women who have been in contact with someone with chickenpox or shingles. What does “contact with chickenpox or shingles” mean?

Chickenpox A person with chickenpox is highly contagious. The virus spreads through the air from person to person. For example, if you have not had chickenpox, it is a good opportunity to catch him if: You are in the room with someone with chickenpox for more than 15 minutes, or You have any face to face contact with someone with chickenpox, as a conversation. Contact Chickenpox and pregnancy. If you have had chickenpox in the past. Chickenpox is contagious from two days before the rash first appears until all the spots have crusted over (usually about five days after the onset of the rash). For example, if you talked to someone yesterday who developed the chickenpox rash today, you are at risk of developing chickenpox if you are not immune. Herpes Shingles is caused by the same virus that causes chickenpox. It is contagious from the onset of the rash until all scabs have crusted over.

Unlike chickenpox, shingles is not a person with the virus coughs out. The virus is shed just the eruption. Most people with herpes have a rash on the chest or abdomen and usually is covered by clothing or bandages. Therefore, they are not likely to get chickenpox from someone with shingles if the rash is covered. Some people have herpes on exposed skin such as the face to be more infectious than if the rash is covered. In addition, someone who has herpes and have a weakened immune system (eg, chemotherapy someone who has shingles) virus sheds much more than normal. Even if your rash is covered, which they can be considered as infectious as someone with shingles uncovered. Therefore, it is difficult to give clear rules about contact with a person with shingles. If in doubt, talk about any contact with your doctor. I am pregnant and I have been in contact with chickenpox or shingles If you have had chickenpox in the past, it is likely to be immune. It is less likely to be at risk. You do not have to worry or do anything, but you may want to check with your doctor or midwife.


About 9 of every 10 pregnant women who have already had chickenpox as a child and are likely to be immune. If you have not had chickenpox or are unsure, consult a doctor urgently. A blood test may be advised to detect antibodies to see if you are immune. About 1 in 10 pregnant women who have not previously had chickenpox and is not immune. What is the blood? Controls blood test for antibodies against chickenpox virus: If you have antibodies in the blood, it means you have had chickenpox in the past, or have received the vaccine. It is then necessary to take additional measures. If you have no antibody then you are at risk of developing chickenpox. What I can do if I do not have the antibodies? They may be given an injection of immunoglobulin containing antibodies against chickenpox virus. This can prevent chickenpox developing, or is a more serious infection if it develops. It is best to have the immunoglobulin injection within four days of contact with the virus.

However, there may be some protection, even if it is given immunoglobulin to 10 days after contact with the virus. (It takes 7 to 21 days (usually 10 to 14 days) for varicella disease to develop after contact with an infected person. This is the incubation period. ) What are chickenpox and shingles? If you have not had chickenpox or are not sure. If you come into contact with chickenpox again later in your pregnancy, you can have a repeat dose of immunoglobulin whenever at least three weeks after the first dose. Why is it important to prevent chickenpox during pregnancy? For mother Chickenpox is usually a nasty disease while pregnant, even without complications. It tends to be much more serious than the children get the disease. In addition, about 1 in 10 pregnant women with chickenpox develop inflamed lungs (pneumonia). This is sometimes severe.

About 1 in every 100 pregnant women who develop varicella-related pneumonia dies from this serious infection. Inflammation of the brain (encephalitis) is a rare but very serious complication. Vary rarely, other serious complications develop. For example: myocarditis (inflammation of the heart muscle), glomerulonephritis (inflammation of the kidneys), appendicitis, hepatitis (inflammation of the liver), pancreatitis (inflammation of the pancreas), Henoch-Schonlein purpura (a condition that can affect kidneys), arthritis, and inflammation of various parts of the eye. For the unborn baby There is a small chance that the fetus a condition called fetal varicella (SVF) syndrome. This can cause the baby to be born with severe abnormalities. If you have chickenpox in the first 12 weeks of pregnancy it is not a 1 in 200 chance of the baby developing FVS. If you have chickenpox between 13 and 20 weeks of pregnancy it is not a 1 in 50 chance that the baby developing FVS. If you have chickenpox after 20 weeks, the risk of the baby developing FVS is very low, with no cases reported in women who developed chickenpox after 28 weeks of pregnancy. If you have chickenpox within seven days before or after birth, your newborn baby may develop a severe form of chickenpox. Some newborn babies who develop chickenpox die from the infection. What if chickenpox development while I’m pregnant?

Most pregnant women who have chickenpox recover completely and the baby is fine. However, as discussed above, the disease tends to be unpleasant and there is some risk of complications. In summary: Consult a doctor immediately if you suspect you have chickenpox during pregnancy or within seven days of giving birth. If you develop chickenpox, you (and your newborn) should be checked daily. You may need an evaluation of the hospital if you have lung disease, is a smoker, or are taking a treatment that affects the immune system (such as steroids). Consult a doctor immediately if you have: a severe skin rash, a rash bleeding problems chest / breathing, drowsiness, vomiting or bleeding. You may need hospital treatment. Antiviral drugs are an option for the treatment of chickenpox, but to be of benefit, should be initiated within 24 hours of the rash appears first. Not cure the disease, but tends to make it less severe. It can help prevent the development of complications in mother and baby (described above). It is likely that you mean a detailed ultrasound 16-20 weeks of pregnancy, or five weeks after the infection has cleared up if the infection was later in pregnancy. The aim of this is to look for signs of fetal varicella syndrome.

If you develop chickenpox within seven days before or after the birth of your baby, the baby can be given immunoglobulin treatment (described above). The aim is to prevent chickenpox developing baby. Avoid other pregnant women and newborns until all the spots have crusted over (usually 5-6 days after onset of the rash). Can I be vaccinated against chickenpox? There is an effective vaccine that protects against the virus that causes chickenpox. Immunization with this vaccine is offered to health workers (doctors, nurses, etc. ) who have not had chickenpox so they are not immune and can get chickenpox. If you are not sure if you have had chickenpox, a blood test can check if you have previously had. (About 1 in 10 adults who have not had chickenpox as a child. ) Workers not immune health should consider being immunized before becoming pregnant. The Royal College of Obstetricians and Gynecologists also recommends varicella vaccination should be considered by all non-immune women before they become pregnant, or shortly after giving birth.

Infections of the tongue.

In medical terms, any infection in the tongue is known as glossitis. The tongue is mainly composed of muscles, which are covered by a mucous membrane. It has taste buds on their surface that allow us to taste the food we eat. The tongue helps us in chewing and tasting food. During communication, the language is spoken along the jaws and lips to produce sounds and words. changes in appearance when the tongue is infected arise, as well as their functions. What causes infections of the tongue? Tongue infections are caused by fungi, bacteria and viruses. Infection with herpes simplex virus type 1 is a common symptom. As a result, blisters appear white or yellow fluid filled with a red base on the surface of the tongue. These are known as canker sores or fever blisters (and are accompanied by fever). Oral thrush is an infection resulting from the accumulation of yeast in the mouth. Staph bacteria is often responsible for infection by bacteria on the tongue.


Sometimes infections develop after the language was slight wound or accidental burns and bites on his tongue. Infections can occur after tongue piercings, if aftercare instructions are correctly followed. Tongue infections in children, can be a sign of other health problems, such as inflammatory bowel disease or deficiency of vitamin B. Symptoms of infection on the tongue. The most obvious symptoms of all kinds of infections són tongue pain and swelling. These two symptoms make activities chewing, swallowing and speech, are a painful issue. If you look at the language in normal conditions, you will notice small bumps on its surface, which are known as papillae. When infected, these bumps disappear and tongue becomes smooth and responsive. Infection with herpes simplex virus can be identified with a painful sores that appear spots on the tongue. There are some differences in the characteristics of cold sores and fever blisters. Canker sores are found only within the oral cavity, while fever blisters appear both in the language, as in the areas surrounding the mouth. Usually, the size of canker sores is comparatively higher and takes longer to heal. In case of oral candidiasis, tongue turns red and creamy white lesions found on its surface.

The white spots caused by the fungus can spread to the throat and esophagus. In some infections, the language is filled spots and stains patterns are changing from time to time. It is mostly accompanied by a burning sensation on the tongue. Sometimes bleeding can occur from an infected tongue. The remedies for infection on the tongue. Canker sores and fever blisters, usually require no treatment. However, there are several ointments containing zinc that can be applied on the wounds of the tongue for faster relief from the painful symptoms. A mild yeast infection can also heal itself. However, if it becomes serious, antifungal drugs are prescribed by doctors to control the growth of fungi. Those who have repeated infections in the language due to vitamin B deficiency should eat dairy products, bananas, fish, liver, etc. , in large quantities. There are some simple remedies you can try at home to get relief from the symptoms of infections in the language. Gargling with warm salt water several times a day is very beneficial in this regard the salt kills the pathogens that cause infection and thrive inside the mouth.

Maintaining good oral hygiene is a must when you are going to do tongue piercings. The injury and inflammation caused by tongue piercing can be relieved after drinking warm water at frequent intervals. Most of the causes of infections of the tongue can be controlled largely with the help of proper oral hygiene. During this time, one should eat soft foods, which can be swallowed easily. Acidic foods or beverages should be strictly avoided as they can aggravate symptoms.

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Herpes

–> Shingles is a viral infection caused by the sensory nerves of the causes of theskin and a painful skin rash. The forshingles medical name is “herpes zoster”. That makes the herpes zoster virus is thesame virus that causes chickenpox (varicella). KEYWORDS to search the Internet and other reference sources Dermatology Infectious diseases Virus zoster What is shingles? A person can not develop shingles unless he or she has had chickenpox. Shingles is caused by the same virus that causes chickenpox, herpes zoster virus.


While chickenpox is a highly contagious disease, shingles usually not spread from one person to another. However, a person can develop chickenpox in direct contact with the blisters in a person with herpes zoster. After recovering from chickenpox, herpes zoster virus may remain in a part of the nervous system for years without causing any disease. Shingles can be the product as a side effect of another condition, such as Hodgkin’s disease (cancer of the lymph system), or treatments that suppress the immune system *. However, most of the time, there is no known cause for the virus to become active and cause shingles. * The immune system fights germs and other foreign substances that enter the body. –> What are the symptoms of shingles? The affected skin feels sensitive area, and then becomes painful. Before the shingles blisters develop, the person may have fever and chills, feel tired and have an upset stomach. These symptoms can last from 3 to 4 days. On the fourth or fifth day of the rash of small red spot appears. Small red spots turn into blisters that are the herpes zoster virus.

After a few days, the blisters turn yellow and October Develop dried crusts on the blisters dry. When They Several weeks after leaving, sometimes leaving small scars. Usually, the rash and blisters involves a limited area of ​​the skin, most often on one side of the chest, abdomen or face. What is the treatment for shingles? Treatment for shingles is directed mainly involved in pain reduction. Medications are used to also attack the virus. Wet compresses applied to affected areas can sometimes relieve pain. mild analgesics such as acetaminophen can be used. Who is at risk for shingles? Shingles occur primarily in older people whose immune systems are no longer able to keep the virus dormant in the nervous system. This age group most often develops herpes zoster, shingles can develop at any age, though. After an attack of shingles, a person can be immune for the rest of your life. Most people recover from the illness without any problems.

However, in elderly patients, the pain can last for months or years after the blisters have healed. This is known as post-herpetic neuralgia (post-her-PET-ik noo-RAL-gee-ah). What other diseases can cause herpes zoster? The herpes zoster virus can cause several other diseases: Chickenpox is usually a mild disease that causes a rash and fever. It is very contagious. Otic herpes zoster, also called Ramsay Hunt syndrome and viral neuritis, causes earache, hearing loss, vertigo (sensation of rotation), and can paralyze the part of the face. ophthalmic herpes zoster involves the eyelid and the eye itself can sometimes be severe if the eye is involved.

Integrated Clinics

Integrated Clinics INTEGRATED COURSE Clinics MEC-251M COURSE OF INFECTIOUS DISEASES PROFESSOR IN CHARGE Dr. Carlos Perez C. SCHEDULE P5 room Monday to Friday from 14:30 to 17:30 Hrs. S. Sem. 8, 7 and 6 on Monday, Tuesday, Thursday and Friday S.

Sem. 8, 7 Wednesday DATES (13 evenings for groups) Group 1: 6/3 to 22/3 Group 2: 19/4 to 8/5 Group 3: 4/6 to 21/6 OBJECTIVES Learn the basics of microbial taxonomy, identification techniques of infectious agents and methods of study of antimicrobial susceptibility. Recognize the clinical and laboratory features for the diagnosis of the most common infections in healthy and immunocompromised host. Knowing the pharmacokinetic and pharmacodynamic characteristics of the main antimicrobial agents and their indications in prevalent infections in ambulatory and hospital practice. Know the main bibliographical sources used in the field. FACULTY

Dr. Guillermo Acuña. Dr. Jaime Labarca Dr. Luis M. Noriega Dr. Carlos Perez Dr. Jorge Pérez Dr. Paul Vial

Dra. Enna Zunino Dr. Mario Salcedo Dra. Marisa Torres Other teachers Hospital Lucio Córdova (Seminars) BIBLIOGRAPHY It will be delivered at the beginning of the course. EVALUATION Seminar notes (20%) and written exam (80%) FIRST GROUP CALENDAR: March 6 to March 22 Tuesday

6 1 Febrile syndrome Dr. Guillermo Acuña 2 Laboratory diagnosis of infectious diseases. Antimicrobial susceptibility studies. Dr. Jaime Labarca Wednesday 7 1

Epidemiology, pathogenesis, evolution and treatment of HIV infection. Dr. Carlos Perez 2 Prevention and treatment of opportunistic infections in HIV infection Dr. Luis M. Noriega Thursday 8 1 Nosocomial infections. Universal Precautions.

Dr. Jaime Labarca 2 Concept of cyclic and noncyclic septicemias. Typhoid fever. Brucellosis. Salmonella enteritidis Dr. Jaime Labarca Friday 9 1 Herpes virus infections: Herpes simplex, Varicella zoster, Epstein Barr, Cytomegalovirus.

Dr. Paul Vial 2 Seminar: mononucleosis syndrome Dr. Jaime Labarca Dr. Carlos Perez Dr. Paul Vial Monday 12 1

Antibiotics Class: General highlights pharmacokinetic, pharmacodynamic and indications of major groups Dr. Carlos Perez 2 Upper respiratory infections: Tonsillopharyngitis, otitis, sinusitis. Dr. Paul Vial Tuesday 13 *1 Infections of the central nervous system (CNS) Dr. Luis M.

Noriega I: Meningitis clear liquid, purulent meningitis. *2 Seminar: lower respiratory infections: Dr. Luis M. Noriega Classical and atypical bacterial pneumonia. Dr. Carlos Perez Dra. Patricia González Wednesday

14 1 bone and joint infections Dr. Guillermo Acuña 2 Sexually transmitted infections. Dr. Guillermo Acuña Thursday fifteen 1 Streptococcus and staphylococcus infections.

Dr. Jorge Pérez 2 rash diseases and more frequent in the adult Vesicular: Measles, Rubella, Varicella. Dra. Marcela Ferres Friday 16 1 CNS infections II: encephalitis, brain abscess. Dr. Carlos Perez 2

Seminar: Clinical cases on use of antibiotics Dr. Carlos Perez Dr. Jaime Labarca Monday 19 *1 Infections of skin and soft tissue Dr. Carlos Perez *2 Seminar: Intra-abdominal infections

Dr. Carlos Perez Tuesday twenty 1 Infections in immunosuppressed Dr. Jaime Labarca 2 Seminar: Infections in immunosuppressed Dr. Jaime Labarca Dr.

Carlos Perez Wednesday twenty-one 1 Fascioliasis, hydatidosis, trichinosis, cysticercosis, toxocariasis, toxoplasmosis: frequently in clinical practice Histoparasitosis. Dra. Marisa Torres Thursday 22 1 Evaluation Dr. Carlos Perez

* Module Teaching Hospital Sotero del Rio UDA SECOND GROUP CALENDAR: April 19 to May 8 Thursday 19 1 Febrile syndrome Dr. Guillermo Acuña 2 Laboratory diagnosis of infectious diseases. Antimicrobial susceptibility studies. Dr. Jaime Labarca

Friday twenty 1 Epidemiology, pathogenesis, evolution and treatment of HIV infection. Dr. Carlos Perez 2 Prevention and treatment of opportunistic infections in HIV infection Dr. Luis M. Noriega Monday 2.

3 1 Nosocomial infections. Universal Precautions. Dr. Jaime Labarca 2 Concept of cyclic and noncyclic septicemias. Typhoid fever. Brucellosis. Salmonella enteritidis Dr. Jaime Labarca


Tuesday 24 1 Herpes virus infections: Herpes simplex, Varicella zoster, Epstein Barr, Cytomegalovirus. Dr. Paul Vial 2 Seminar: mononucleosis syndrome Dr. Jaime Labarca Dr. Carlos Perez Dr.

Paul Vial Wednesday 25 1 Antibiotics Class: General highlights pharmacokinetic, pharmacodynamic and indications of major groups Dr. Carlos Perez 2 Upper respiratory infections: Tonsillopharyngitis, otitis, sinusitis. Dr. Paul Vial Thursday 26

*1 Infections of the central nervous system (CNS) Dr. Luis M. Noriega I: Meningitis clear liquid, purulent meningitis. *2 Seminar: lower respiratory infections: Dr. Luis M. Noriega Classical and atypical bacterial pneumonia. Dr.

Carlos Perez Dra. Patricia González Friday 27 1 bone and joint infections Dr. Guillermo Acuña 2 Sexually transmitted infections. Dr. Guillermo Acuña

Monday 30 1 Streptococcus and staphylococcus infections. Dr. Jorge Pérez 2 rash diseases and more frequent in the adult Vesicular: Measles, Rubella, Varicella. Dra. Marcela Ferres Wednesday 2 1

CNS infections II: encephalitis, brain abscess. Dr. Carlos Perez 2 Seminar: Clinical cases on use of antibiotics Dr. Carlos Perez Dr. Jaime Labarca Thursday 3 *1 Infections of skin and soft tissue

Dr. Carlos Perez *2 Seminar: Intra-abdominal infections Dr. Carlos Perez Friday 4 1 Infections in immunosuppressed Dr. Jaime Labarca 2

Seminar: Infections in immunosuppressed Dr. Jaime Labarca Dr. Carlos Perez Monday 7 1 Fascioliasis, hydatidosis, trichinosis, cysticercosis, toxocariasis, toxoplasmosis: frequently in clinical practice Histoparasitosis. Dra. Marisa Torres Tuesday 8

1 Evaluation Dr. Carlos Perez * Module Teaching Hospital Sotero del Rio UDA SCHEDULE THIRD GROUP: June 4 to June 21 Monday 4 1 Febrile syndrome Dr. Guillermo Acuña 2

Laboratory diagnosis of infectious diseases. Antimicrobial susceptibility studies. Dr. Jaime Labarca Tuesday 5 1 Epidemiology, pathogenesis, evolution and treatment of HIV infection. Dr. Carlos Perez 2 Prevention and treatment of opportunistic infections in HIV infection Dr.

Luis M. Noriega Wednesday 6 1 Nosocomial infections. Universal Precautions. Dr. Jaime Labarca 2 Concept of cyclic and noncyclic septicemias. Typhoid fever. Brucellosis.

Salmonella enteritidis Dr. Jaime Labarca Thursday 7 1 Herpes virus infections: Herpes simplex, Varicella zoster, Epstein Barr, Cytomegalovirus. Dr. Paul Vial 2 Seminar: mononucleosis syndrome Dr. Jaime Labarca

Dr. Carlos Perez Dr. Paul Vial Friday 8 1 Antibiotics Class: General highlights pharmacokinetic, pharmacodynamic and indications of major groups Dr. Carlos Perez 2 Upper respiratory infections: Tonsillopharyngitis, otitis, sinusitis. Dr.

Paul Vial Tuesday 12 *1 Infections of the central nervous system (CNS) Dr. Luis M. Noriega I: Meningitis clear liquid, purulent meningitis. *2 Seminar: lower respiratory infections: Dr. Luis M.

Noriega Classical and atypical bacterial pneumonia. Dr. Carlos Perez Dra. Patricia González Wednesday 13 1 bone and joint infections Dr. Guillermo Acuña 2

Sexually transmitted infections. Dr. Guillermo Acuña Thursday 14 1 Streptococcus and staphylococcus infections. Dr. Jorge Pérez 2 rash diseases and more frequent in the adult Vesicular: Measles, Rubella, Varicella. Dra. Marcela Ferres

Friday fifteen 1 CNS infections II: encephalitis, brain abscess. Dr. Carlos Perez 2 Seminar: Clinical cases on use of antibiotics Dr. Carlos Perez Dr. Jaime Labarca Monday

18 *1 Infections of skin and soft tissue Dr. Carlos Perez *2 Seminar: Intra-abdominal infections Dr. Carlos Perez Tuesday 19 1 Infections in immunosuppressed

Dr. Jaime Labarca 2 Seminar: Infections in immunosuppressed Dr. Jaime Labarca Dr. Carlos Perez Wednesday twenty 1 Fascioliasis, hydatidosis, trichinosis, cysticercosis, toxocariasis, toxoplasmosis: frequently in clinical practice Histoparasitosis. Dra.

Marisa Torres Thursday twenty-one 1 Evaluation Dr. Carlos Perez * Module Teaching Hospital Sotero del Rio UDA

IntraMed – Articles – Treatment with valacyclovir to reduce recurrent genital herpes

It is one of the diseases most common sexually transmitted diseases and is characterized by a latent and recurrent mucocutaneous infection. A major concern regarding maternal infection with HSV during pregnancy is the potential for vertical transmission to the fetus and / or newborn. To reduce vertical transmission, current management guidelines recommend cesarean delivery for women with active HSV lesions perineal or prodromal symptoms at delivery. Several investigations explored the potential use of antiviral acyclovir treatment late in the third trimester of pregnancy to prevent recurrences of HSV at delivery. The results of these investigations suggest that acyclovir, started at 36 weeks gestation, can reduce clinical recurrences and may reduce the need for caesarean sections as a result of active HSV lesions become evident. Valacyclovir is absorbed from the gastrointestinal tract and converted to acyclovir in the hepatic first pass. Bioavailability of this transformation is 3 to 5 times higher than after oral administration of acyclovir, allowing a lower dose interval. Thanks to these favorable attributes, suppressive treatment with valaciclovir in late pregnancy could significantly reduce both the frequency of clinical relapses, as viral lesions at delivery, thereby reducing the need for caesarean sections and the risk of vertical transmission. Currently, however, no published data indicates safety or clinical efficacy of valaciclovir in pregnant women or their babies. Therefore, our objective was to evaluate the efficacy of valaciclovir suppressive therapy initiated 36 weeks of gestation to reduce recurrent genital herpes and to assess preliminarily security in the mother and her child. The medication was suspended after birth, and postpartum mothers received routine care. One of the results was observed that the number of women with clinical recurrences of HSV between the time they started the suppressive treatment and delivery was significantly lower in the group treated with valacyclovir versus placebo. Something important in this study is that there were no significant differences between the valacyclovir and placebo, in mothers and infants, among the variables evaluated to measure the safety of the use of valaciclovir during pregnancy.


Especially, no significant differences between the groups in perinatal outcomes were observed, including birth weight, frequency of hospitalizations in the neonatal intensive care and Apgar score at 5 minutes less than 7. There were also no significant differences regarding the frequency of oligohydramnios, maternal or neonatal renal function. In conclusion we can summarize that the treatment suppressive daily valacyclovir initiated 36 weeks of pregnancy and continuing until delivery in women with documented history of infection recurrent HSV, significantly reduces the number of women with subsequent clinical recurrences of HSV after the start treatment. However, the suppression did not decrease the number of women with viral lesions close to delivery, active HSV lesions at the time of delivery, or the number requiring cesarean active HSV lesions. Although not statistically significant, both the percentage of women with active HSV lesions, as the percentage of women requiring cesarean active lesions was lower in the group treated with valacyclovir group compared to the placebo group. The onset of spontaneous labor is unpredictable, so is also the onset and duration of active genital HSV recurrent. Thus, we believe that an important observation in this study was noted when the entire time between the start of suppressive treatment to 36 weeks to the time of delivery was considered. During this period of approximately 3 weeks, we observed a statistically significant decrease in recurrent HSV lesions active genital among women treated with valaciclovir compared to those treated with placebo. Thus, in the general population of pregnant women with a history of infections recurrent genital HSV, it is reasonable to anticipate that such a reduction in clinical relapses between weeks 36 and childbirth in women receiving suppression with valaciclovir antiviral, could eventually lead a reduction of caesarean sections performed especially for the indication of active HSV lesions at delivery. In future studies, quantitative PCR rather than qualitative detection of the herpes simplex virus, could be useful in determining whether the antiviral suppressive therapy in late pregnancy reduces the viral inoculum that predisposes vertical transmission. Previous studies have investigated the use of suppressive therapy with acyclovir for pregnant women at risk of recurrent HSV infection. The results of our research with valaciclovir are similar to these previous reports where using acyclovir. In addition, physicians who chose to use the antiviral for HSV suppression in late pregnancy, may be encouraged by the improved bioavailability and lower daily dose of valacyclovir compared with acyclovir.

Although valaciclovir is more expensive than acyclovir, a recent cost-effectiveness analysis, it was shown that the suppressive treatment with valaciclovir was economically favorable compared with acyclovir, or no treatment. Another important contribution of this study is to secure information related to the use of valaciclovir in pregnant women. No safety problems in mothers, fetuses or neonates exposed to valacyclovir were identified. Since valacyclovir becomes acyclovir after the first liver passage, the safety profile could also be applied to acyclovir. Some authors might argue that greater experience objectively examined with the use of valaciclovir and / or acyclovir in pregnant before can be established with certainty, the safety of these medications is needed. Despite sharing this position, we are proud of the favorable toxicity profile observed is this study. In addition, no significant adverse effects were reported in previous studies on prophylaxis with acyclovir in late pregnancy. However, in the absence of definitive data regarding safety, universal use of valaciclovir for viral suppression in all women with a history of genital HSV infection, it may not be prudent. Highlights: What question does this work? It shows the experience of the use of valaciclovir to 36 weeks of gestation in women with a history of recurrent genital herpes, reducing the number of subsequent clinical lesions. What adds to what was already known about it? Quantitative PCR rather than qualitative detection of the herpes simplex virus, could be useful in determining whether the antiviral suppressive therapy in late pregnancy reduces the viral inoculum that predisposes vertical transmission.

Further studies to ensure the safety of such treatment are awaited. How does my daily practice? With the introduction of this treatment the number of caesarean sections for active genital herpes lesions, vertical transmission and the number of clinical recurrences of the disease would be reduced.

Therapeutic dermatologic and aesthetic updates

Tips therapeutic. Common in children and adults mild and tolerable itch limiting Auto The best treatment is Watchful antibiotics Some studies suggest that erythromycin may shorten the course of the rash and relieve itching, though oreos have found no significant differences versus placebo. In a nonrandomized study it has reported a cure rate of 73%, but with poor intestinal tolerance in 12%. Nor they have noted significant differences between placebo and azitromcina. Clarithromycin 250 mg twice daily for two weeks has been obtained healing in 50/52 cases in the 1st week. antivirals The indication would be justified by the frequent presence of herpes virus 6 and 7 in pink rosea. One study randomized, open-label, has shown good results with a dose of 800 mg 5 times daily.

The authors suggest that the effectiveness of antiviral maximum serious if treatment is indicated in the 1st week of disease onset. Phototherapy In a nonrandomized study exposure to UVB doses eritematogénicas for 10 days resulted in a decrease in severity of lesions in 15/17 patients. systemic treatment The oral methylprednisolone at a rate of 16 mg / day is indicated in children with severe itching, suberitrodérmicas scattered shapes and forms. But it should be given with caution because in some cases it can exacerbate itching. Acyclovir can be used in disseminated forms during pregnancy to prevent abortion or premature birth, with the warning that has not yet been confirmed the safety and efficacy of this treatment. conclusions Watchful waiting is the most common Topical remedies often induce itching The evidence from the accumulated experience is not enough to sustain prescription topical therapies: emollients, antihistamines, corticosteroids Nor it has established the efficacy of exposure to sunlight, artificial UV, antihistamines or systemic corticosteroids, antiviral Systemic therapy has limited indications.

Bibliography:  Drago F, Rebora A. Treatments for pityriasis rosea. Skin Therapy Letter 2009; 14 (3). . . . . . . . . .

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. . . . Keywords: pink rosea. Click image to enlarge

COMPEED Calenturas 15 PATCHES – Compeed Cold sores Calenturas 15 Patches

7 Benefits of COMPEED® Total Care Invisible: It is acting with maximum speed instantly protects injuries Reduces itching, stinging and burning Reduces redness and inflammation Relieves pain It reduces blistering and helps prevent scabbing significantly reduces the risk of contagion In addition they remain in place an average of 8 hours and are clinically tested. HOW TO USE The first step before applying the patch for cold sores is to wash your hands. 1. Make sure the skin is clean and dry.


Do not use the patch together with any cream. If you did, when you apply the patch to the fever would not get that perfectly adheres to the skin, and therefore would not get all their benefits. Wash hands before applying the patch Compeed Calenturas 2. The following is removing the applicator wrap and hold the ends with both hands. Remove the applicator Compeed 3. Then should gently pull each end of the applicator, following the arrows on it, until the half of the adhesive patch area is exposed. One of the things you should consider when applying the patch for cold sores is not reach out and touch the adhesive area of ​​the patch, because it would lose adhesion. Pull each end to have the adhesive Compeed 4. Press gently with a finger half of the patch to ensure proper application of the injury of cold sores. Press gently with your finger pad on horniness

5. Gently press the entire surface of the patch to proper placement on the hotness. Press gently until the correct placement of the dressing on the hotness How to remove the patch COMPEED® cold sores? COMPEED® patches emerge naturally. When the patch begins to peel, must be removed and apply a new patch COMPEED® cold sores. 1. To remove the patch, gently pull the edge. 2. Pass two hands to pull the edge parallel to the skin sense. 3. Pull the patch until off completely. RECOMMENDATIONS FOR USE

Apply lipstick dressing from the first symptoms of itching or burning. When you start to feel the tingling usually felt just before the fever outbreak, apply the dressing without hesitation and have it give more controlled. The dressing for cold sores can use it anyone suffering an outbreak of cold sores. The only precaution you must take with lipstick dressing is if you are or think you may be pregnant. In that case, see your doctor before. Children should only use the dressing calenturas under parental supervision. Remember to change the dressing lip where it appears approximately every 8 hours. For maximum effectiveness lip dressing, take it 24 hours a day. Some people think that needs to be withdrawn from time to time for the fever to “breathe”, but in reality, all we’d get is to lengthen the healing process, so we recommend bringing the dressing throughout the day. The lip dressing should be used until the end of the outbreak of herpes. Change them when arising a new one until the fever disappears.

¿Mysterious pimple on your lip? Here it is what could be – Health Blog |

A grain growth or lip is distressing, because it affects their appearance, but never think of it as potentially dangerous. Here are some common things you should consider about that cause this type of growth. ¿Mysterious pimple on your lip? Here it is what could be There are a number of reasons that can cause an increase in the lip, ranging from something that is largely cosmetic in nature to something that requires a much closer look at things. Its appearance and the social stigma associated with their presence means that most people are looking for a quick solution to the problem and is likely to resort to acne medication shelf. Here are some other things that can cause pimple on the lip mystery. Herpes labialis This is one of the most common types of infection seen in the world. It is caused by herpes simplex virus type 1 herpes simplex virus type 2 is associated with sexually transmitted diseases and it is rare to find that affects the upper body. Cold sores are usually self-limiting in nature and require no treatment. In some cases, when individuals are immunocompromised, these mouth sores can fester for a long time and require antiviral drugs. The typical lesion is a small group of blisters that burst over the course of a few days.

The underlying skin is red and tender for a period of a week to ten days. The only treatment needed is topical in nature with an antiseptic gel and analgesic enough to do the job. Patients should avoid scratching the area, the intimate physical contact, dental treatment, makeup application on the area, as it can contribute to the spread of infection to others. allergic reactions This is probably the most common reason for sudden growth or lesion on the lip. There are a number of chemicals and ingredients in different types of cosmetics, toothpastes and mouthwashes, we use everyday. The best brands are proven to be hypoallergenic to the vast majority of the population, but that does not mean they will not cause an allergic reaction in anyone. If you have noticed the lump on the lip having recently changed any particular product, then it is probably an allergic reaction. The best way is to stop using the product completely and return to their original choice. Allergy medications may be all it takes to get rid of that growth was concerned. Acne It is a popular myth that acne is only seen during adolescence. The truth is seen in people of all ages.

The most common acne obstruction of sebaceous glands beneath the surface of the skin and lips leading to a localized bacterial infection occurs right. The growth seems to be filled with pus of greenish-white, as the material and will usually be solitary in nature. A visit to the dermatologist is a good idea so that you can get your skin type and the most effective management of a professional method. Some common sense tips include washing your face with a face wash repeatedly not dehydrating, the application of anti-acne gels and avoid too much makeup. Your dermatologist can also choose to prescribe a course of doxycycline to help fight the outbreak. Pimple on your lips infection sunburn, cancer and bacterial Sunburn The skin of each person is a little different, and therefore require different care. A result of a fall or growth on the lip could be overexposure to the sun. If you are an athlete or in a profession where you have to spend large amounts of time in the sun, then the use of a zinc-based cream for protection may be a good idea. A sunscreen with a high SPF factor should be a given for anyone with sensitive skin spend much time outdoors. Sunburn can be painful and leave the affected part raw and inflamed. topical medication and protection from the sun is the required treatment.

Cancer Any sudden growth that does not shrink on their own, shows an increase in size or unhealthy is a warning sign that should be looked at closely immediately. The squamous cell carcinoma often found to occur in the region of the lip. One of the risk factors associated with its occurrence is excessive sun exposure. Other risk factors include smoking, family history of recurrent disease and other types of trauma in the region. Cancer in the region of the lip can metastasize rapidly due to the region being close to the lymph nodes of the lymphatic vessels communicate with different body parts. It can also invade surrounding tissues extending in the underlying alveolar bone, gingiva and muscles of the oral cavity. A biopsy (excision / incisional) may be necessary to confirm the diagnosis. If confirmed, the treatment is usually radiation therapy involving aggressive surgical excision with a margin of normal tissue affected, the chemotherapy alone or in combination with each other. The earlier tumor detection, the best possible treatment outcomes with reduced morbidity in question. Also remember that skin cancer is one of the fastest growing cancers in the world. Bacterial infection A bacterial infection is also a common cause of infection in the region of the lip.

It may due to a cut, scrape, or even share cosmetics infected. A bacterial infection is almost never anything to fear about, however, there are certain cases in which retrograde infection from the area can spread to the brain. This is due to the anatomical connections that exist in the circulatory system. A bacterial infection was associated with a slight fever, elevated white cell count, redness, itching and a certain amount of pain. It is not uncommon for the affected area to be swollen as well. Your doctor will probably put on a course of antibiotics and perhaps even an anti-inflammatory to help relieve symptoms. conclusion A seemingly simple pimple on the lip may be something far more sinister and it is always better to take a professional medical opinion if you are sure what the exact nature of your problem. you’ll also like