Course Of Tetracycline Research Articles

Severe Enteropathy in a Patient on Valsartan

Purpose: This is a first case report of severe enteropathy masquerading as refractory celiac disease that resolved after suspension of valsartan. A recent case series described 22 patients with olmesartan associated enteropathy. Valsartan and olmesartan are angiotensin II receptor blockers with shared properties. A 71-year-old female presented with a five-year history of malabsorption. Symptoms began with sudden onset of nausea, vomiting and diarrhea. Watery and malodorous diarrhea, nighttime fecal incontinence, and abdominal pain persisted for five years, resulting in severe weight loss (27 kg). Celiac disease was diagnosed. Duodenal biopsies showed villous atrophy, intraepithelial lymphocytosis and crypt hyperplasia. Celiac serologies were negative. Symptoms did not improve despite strict adherence to a glutenfree diet. Her exam was significant for low BMI of 19 mg/m2. Diffuse muscle wasting, minimal adipose tissue, hyperactive bowel sounds and bilateral pitting edema to the knees. Labs demonstrated anemia of chronic inflammation, Vitamin A, carotene, and zinc deficiencies, hypoalbuminemia and hypomagnesemia. Transaminases were mildly elevated. Inflammatory markers were normal. Celiac serologies were negative at multiple time points. HLA genotype was DQ8. Duodenal aspirate contained >100,000 CFU of gram negative bacteria. CT enterography showed diffuse small bowel dilatation and mesenteric adenopathy; idiopathic biliary dilatation and edema in subcutaneous fat. Esophagogastroduodenoscopy demonstrated duodenal scalloping and prominence of submucosal vasculature. Capsule endoscopy showed villous atrophy affecting 75-90% of small intestinal mucosa. Duodenal biopsies had a malabsorption pattern with partial villous atrophy, crypt hyperplasia and inflammation (100 intraepithelial lymphocytes per 100 epithelial cells). The patient was treated with a 10-day course of tetracycline for small intestinal bacterial overgrowth, and although diarrhea improved slightly, most symptoms persisted. Repeat biopsies at 1 and 2.5 years of follow-up were unchanged. Cessation of valsartan was advised and within days, bloating, diarrhea and abdominal pain resolved. Gluten challenge for several months was followed by duodenal biopsies at 1-year following valsartan cessation. Villous architecture had normalized. Correction of anemia, transaminases and nutrient deficiencies was documented. While causality cannot be proven in this case, there is suspicion of a medication induced enteropathy secondary to the use of valsartan. This case represents a unique observation that other angiotensin II receptor blockers may be associated with a similar celiac-mimicking enteropathy as described previously with olmesartan.

White sponge naevus: improvement with tetracycline mouth rinse: report of four cases

Conflict of interest: none declared. White sponge naevus (WSN) is a rare condition affecting the mucous membranes, especially the oral mucosa. WSN appears to follow a hereditary pattern, although cases with no family history have been reported.1 Genetic studies have associated the development of WSN with mutations in keratins 4 and 13.2 Treating WSN is still a challenge. Some benefits have been reported with the use of antibiotics such as penicillin and tetracycline.1, 3, 4 This study assessed the clinical response of WSN to 0.25% aqueous tetracycline mouth rinse. Four cases of WSN affecting three women (aged 23, 27 and 46 years) and one man (aged 24 years) were evaluated Bilateral involvement of the buccal mucosa was seen in three patients, and the fourth presented lesions only of the labial mucosa. WSN diagnosis was based on clinical and histopathological findings (Fig. 1a,b). Treatment consisted of 0.25% aqueous tetracycline mouth rinse (5 mL for 1 min) twice daily for up to 12 weeks. Responses to the treatment are summarized in Table 1. Patients 1 and 2 were more resistant to treatment, showing only partial improvement (Fig. 2a,b). The other two patients, who had no familial members affected (cases 3 and 4), showed excellent response (Fig. 3a,b). During this treatment, one patient tested positive for Candida and was treated with nystatin. Mild recurrence was observed in one patient and was given a further short course of tetracycline, which promptly resolved the lesions.

Folliculitis and perionyxis associated with the EGFR inhibitor erlotinib

Epidermal growth factor receptor (EGFR) is widely expressed in the skin, and therefore, cutaneous side effects are not surprising in the context of systemic EGFR inhibition. Indeed, skin adverse reactions are the most frequent side effects observed with these drugs. This case report is typical of the cutaneous side effects observed with EGFR inhibitors, i.e., folliculitis and perionyxis. A 68-year-old patient was treated with 150 mg of erlotinib for a stage-IIIb nonresectable non-small cell lung carcinoma (T4NXM0) as first-line chemotherapy. One week later, he presented with a papulopustular follicular rash on his face and trunk, which rapidly worsened over the following weeks. Doxycycline was prescribed, and the cutaneous lesions improved although erlotinib treatment was continued. Further on in the treatment, the patient presented a relapse of the cutaneous folliculitis along with painful perionyxis, with an appearance of pyogenic granulomas surrounding several toenails and fingernails. Erlotinib treatment was withdrawn and an additional course of tetracycline was prescribed, associated with local antiseptic treatment on the face, and silver nitrate on the perionyxis. One week later, the cutaneous lesions had greatly improved and erlotinib was reintroduced. The patient’s lung tumor was stabilized for 10 months under the therapy. Clear information regarding skin-related side effects should be given to the patients before treatment onset. Physicians also have to adapt the management of these cutaneous side effects to the context of long-term prescriptions of these new drugs. Because folliculitis severity is now recognized as a surrogate marker for treatment efficacy, exploration of the connection between skin reaction and tumor response opens the way for new challenging research perspectives.

The outcome of pseudotumor cerebri induced by tetracycline therapy

To demonstrate the association between tetracycline treatment and pseudotumor cerebri (PTC). Consecutive patients from two neuro-ophthalmic referral centers, who developed PTC syndrome post-treatment with tetracycline, were enrolled and followed for a minimum of 2 years after cessation of tetracycline. A total of 243 consecutive patients were diagnosed with PTC; 18 had concurrent history of tetracycline treatment; a third experienced a limited course of illness with no relapses; 12 had a variable course with a prolonged relapsing illness. Mean duration of tetracycline treatment prior to diagnosis was 2.73 months. Tetracycline, and especially minocycline, is currently considered a cause or a precipitating factor for PTC. Although there is little information on the natural course of tetracycline induced PTC, the present cases demonstrate that drug withdrawal is curative only in some patients.

A 58-Year-Old Man With a Diagnosis of Chronic Lyme Disease

DR BURNS: Mr C is a 58-year-old man diagnosed as having chronic Lyme disease. He lives in a suburb of Boston and works as a consultant. He has managed care insurance. Mr C had an episode of Bell’s palsy on the left side of his face in August 1992 and reported that he spent a lot of time on Martha’s Vineyard, an endemic area for Lyme disease. Subsequently, he noticed that he became less competent mentally. He could not do simple math and he became depressed. In 1994, he was diagnosed as having Lyme disease. At that time, he complained of neck pain radiating to his left shoulder and hand, with numbness and tingling in his hand; back pain that radiated down his left leg; bilateral joint aches in both elbows and, to a lesser extent, his shoulders; bilateral tinnitus; periodic blurred vision (worse in the right eye than the left); difficulty concentrating and word finding; and periodic sweats. Results of his physical examination were normal with the exception of having difficulty spelling “world” backward and subtracting 7 serially. In October 1994, his Lyme (IgM/IgG) antibody titer was positive at 1:4. He was treated with tetracycline, 500 mg 3 times daily for 1 year. Following the initial course of tetracycline, his symptoms improved. However, in July 1996, Mr C restarted tetracycline 500 mg 3 times daily, for complaints of generalized aches and pains, hot flashes, nausea, sweats, dizziness, and a general uneasy feeling. Since then, persistent symptoms have included fatigue, sweats, slight memory loss, generalized aches and pains, headache, facial flushing, numbness of his left thumb, altered sensation on the left side of his face, and weight gain. Mr C was treated with repeated courses of tetracycline as well as several courses of clarithromycin, 500 mg twice daily, combined with hydroxychloroquine, 200 mg twice daily. His last course of tetracycline was in early 1999, at which time a Lyme Western blot assay showed an IgM reaction to the 83-kd protein and IgG reactions to the 41and 62-kd proteins. In the fall of 1999, due to a change in his insurance, Mr C transferred to a new primary care physician, Dr N. His new physician was not convinced of the benefit of recurrent courses of antibiotics. In the fall of 2001, Mr C returned with multiple concerns including difficulty sleeping, forgetfulness, cognitive difficulties especially with calculations, decreased libido, anxious feelings, facial stiffness, puffy eyes, and cracking in his neck and shoulder. Mr C was concerned that some of his symptoms may be related to Lyme disease. At that time, physical examination findings were normal. Dr N thought that Mr C might have a mild depression and prescribed paroxetine, 10 mg/d, which was later increased to 20 mg/d. With this regimen, Mr C reported that he noticed less anxiety, less joint pain, and improved cognition. He also was sleeping better. His current medications include paroxetine, 20 mg/d, quinapril, 10 mg/d, and atorvastatin, 10 mg/d. Mr C has no known drug allergies. He exercises regularly and rarely drinks. He previously smoked about 1 pack per day but quit smoking about 7 years ago. Mr C has a past medical history of hypertension, hyperlipidemia, seborrheic dermatitis, and chronic Lyme disease. His father died of “natural causes” and his mother of ovarian cancer. He has one brother who recently underwent coronary artery bypass graft surgery.

Osteoid Osteoma of the Scaphoid

A case of osteoid osteoma of the scaphoid documented by polytomograms and CT scan is presented. The case presented as chronic pain. At operation, multiple pathological fractures with auricular surface destruction was noted. Due to the size of the osteoid osteoma and pathology present, the neoplasm was treated by scaphoid excision. A capsular interpositional arthroplasty and mid carpal arthrodesis with radial bone graft was also performed. Prior to surgery, the patient was treated with a 48 hour course of tetracycline to enhance fluorescence of the tumor under Wood’s lamp.

Helicobacter pylori: ENOUGH TO GIVE ANYONE AN ULCER!

SUMMARY Since the early 1980s, research into gastritis and peptic ulcer disease has been dominated by Helicobacter pylori. This is a small, Gram‐negative spiral bacterium which inhabits the mucus layer that coats the gastric mucosa. Colonisation of the human stomach by this bacterium is worldwide and, in certain continents, virtually ubiquitous. While histological gastritis is always the result, H. pylori‐positive individuals are characteristically asymptomatic. Transmission is thought to be via the faecal‐oral route and infection, usually acquired in childhood, will persist unless treatment supervenes. H. pylori is the main causative agent of peptic ulceration, but its role in non‐ulcer dyspepsia is less clearcut. Recently epidemiological, histological and experimental data have been described linking H. pylori to gastric neoplasia — in particular adenocarcinoma and MALT lymphoma. A variety of treatment modalities exists for the eradication of this bacterium, and for adults the recommended drug therapy is a combination course of tetracycline, bismuth and metronidazole. Currently the new combination of omeprazole and amoxycillin is suggested as second‐line treatment after failed triple therapy.

Acral persistent papular mucinosis

blood coagulation factor Xa in the tick Ornithodoros moubata. This factor, tick anticoagulant peptide, is a serine protease inhibitor, specific to factor Xa. It might be the cause of the response in our patients who had been bitten by a similar tick species. Galun and Ben-Chetrit lo prophylactically treated 13 persons with cave tick bites with tetracycline, 1 gin/day, for 3 to 5 days; none of them had symptoms of tick-borne relapsing fever. They suggested that a short-term, low-dose course of tetracycline might prevent the disease. Our treatment with tetracycline was not followed by relapsing fever.

Use of Ciprofloxacin for Successful Eradication of Bacteremia Due to Campylobacter cinaedi in a Human Immunodeficiency Virus-Infected Person

A 36-year-old homosexual man who was infected with human immunodeficiency virus presented with a 2-month history of fever and intermittent diarrhea. Stool cultures were negative for bacterial pathogens, ova, parasites, and acid-fast organisms. An initial blood culture became positive after 5 days for a curved, gram-negative rod that was identified later as Campylobacter cinaedi. The patient received a series of antibiotic regimens, including a 2-week course of erythromycin followed by a 2-week course of tetracycline, but follow-up blood cultures continued to yield C. cinaedi. The patient was then treated with a 2-week course of oral ciprofloxacin; he remained asymptomatic 11 weeks later, at which time a blood culture was negative for C. cinaedi. To the best of our knowledge, this is the first documented case of symptomatic bacteremia due to C. cinaedi that was successfully treated with ciprofloxacin.

Resolution of Early Lesions of Juvenile Periodontitis With Tetracycline Therapy Alone: Long‐Term Observations of 4 Cases

Our previous studies have demonstrated that early-identified lesions of localized juvenile periodontitis (LJP) can be treated by the use of systemically administered tetracycline alone (1 gm/day for 6 weeks). This therapy results in arrest of disease progression, decreased pocket depths, gains in clinical attachment, and significant repair of alveolar defects. This paper reports on the long-term clinical and radiographic improvement in 4 subjects followed for 1 to 4 years after the completion of tetracycline therapy. Four patients (mean age 14 years) were examined 1 to 4 years following the completion of a single 6 week course of tetracycline. Mean pocket depth was reduced from the initial level of 7.1 mm to 3.6 mm. Mean attachment loss was reduced from 3.8 mm to 0.9 mm and angular bone defects had filled by an average of 72%. Pocket depths and attachment loss continued to decrease during the entire study period, while alveolar bone repair continued to increase. The findings support those of our previous investigation and confirm that: 1) early identified lesions of LJP can be effectively treated with 6 weeks of tetracycline therapy alone; 2) decreases in pocket depth, gains in clinical attachment, and repair of alveolar defects remain stable up to 4 years following antibiotic therapy; 3) clinical and radiographic improvement continues over time and may lead to complete resolution of some lesions; and 4) the reparative/regenerative potential of the periodontium in early onset disease in young individuals may exceed that observed in chronic adult periodontitis.

Successful management of Mycoplasma hominis septic arthritis involving a cementless prosthesis

Prompt identification of the infectious agent and antibiotic treatment are essential to the prevention of mortality or serious morbidity in patients with septic arthritis. Of concern is the increasing incidence of Mycoplasma hominis saprophytes as a cause of joint infections given the problems in isolating these microbes. The case of a 32-year-old black woman with a 9-year history of systemic lupus erythematous who presented with an M hominis-related septic arthritis involving hip and knee joint protheses offers guidelines on the predisposing factors and characteristic clinical and laboratory findings in such cases. The literature indicates that hypogammaglobulinemia, immunocompromise, postpartum or postabortion fever, and urinary tract manipulation are the risk factors most commonly associated with mycoplasmal septic arthritis. Typical laboratory results include a synovial fluid white blood cell count exceeding 80,000/mm3, a synovial fluid smear greater than 95% neutrophils, negative Gram's stain of synovial fluid smear, positive acridine-orange stain, and slow or absent growth in standard culture media. M hominis infections respond to tetracyclines, lincomycin, and clindamycin, but are resistant to erythromycin. Risk factors in the patient described here included longterm corticosteroid treatment, prior urinary tract infection, and an abortion 2 months prior to presentation for which antibiotic prophylaxis was not administered. The results of synovial tissue, bone, and irrigation fluid cultures were initially negative, but more sophisticated testing ("fried egg" morphology) isolated M hominis. This microorganism was also isolated in endometrial tissue cultures, and retained products of conception are considered the most likely source of the patient's joint infection. A 10-week course of tetracycline eliminated the infection.

The urethral syndrome.

The urethral syndrome is defined as lower urinary tract symptoms in women in the absence of bladder bacteriuria. It is a common disorder in general practice in Saudi Arabia. The aetiology and pathogenic factors involved in its development are still incompletely understood. Many factors have been suggested as causative of this syndrome, including non-specific infections, urethral obstruction and spasm, senile atrophy, psychosomatic and traumatic factors. An aetiological diagnosis should be made if possible and this will depend on clinical examination, mid-stream urine specimen for quantitative culture and microscopy. Cervical and urethral swabs for microscopy and culture are necessary when infection with urethral pathogens such as C. trachomatis and N. gonorrhoea is suspected. Urethral calibration and uroflowmetry may be needed in some patients. Treatment with a course of tetracycline is indicated for patients with urethral syndrome who have pyuria, urethral dilatation for patients with urethral syndrome secondary to stenosis, and skeletal and smooth muscle relaxants when spasm is found to be the cause. Local vaginal oestrogen application is effective in the treatment of urethral syndrome secondary to hypoestrogenaemia.

Failure of tetracycline therapy in early Lyme disease.

We describe the clinical courses of 5 patients with Lyme disease who developed significant late complications, despite receiving tetracycline early in the course of their illness. All 5 patients had been treated for erythema chronicum migrans with a course of tetracycline that met or exceeded current recommendations. The late manifestations of Lyme disease included arthritis, cranial nerve palsy, peripheral neuropathy, chronic fatigue, and changes in mental function. Our findings suggest that the use of tetracycline at a dosage of 250 mg, 4 times a day for 10 days, as a treatment for early Lyme disease should be reconsidered. To determine optimal therapy for early Lyme disease, a study that compares an increased dosage of tetracycline with alternative treatments is indicated.

Genital chlamydial infection--our commonest sexually transmissible disease.

Editorial Comment: This review contains 4 important take away messages about chlamydial infection of the female genital tract that warrant emphasis: The infection is more common than gonorrhoea and often coexists with it. It can cause a frothy vaginal discharge easily mistaken for trichomonal infection, but more often is asymptomatic at first. It can cause tubal damage, chronic pelvic inflammatory disease, pain and sterility. Adequate treatment requires a 10‐day course of tetracycline or erythromycin.

The bone biopsy protocol for evaluating osteoporosis and osteomalacia

Although this paper has dealt with well-established diagnostic procedures, I have attempted to present a practical summary based on experience with over 400 cases. A complete and modern approach to the evaluation of the bone biopsy for metabolic bone disease may be summarized as follows: Preoperative double labeling with tetracycline (two 3-day courses of tetracycline separated by 12 days); Full-thickness iliac bone biopsy yielding a 5- to 6-mm diameter specimen; Undecalcified sectioning (5-10 mu) processed in glycol or methyl methacrylate; Histomorphometric analysis with light microscope and planimeter; Tetracycline analysis with fluorescent microscope.

Advantages of adding a course of tetracycline to single dose ampicillin and probenecid in the treatment of gonorrhoea.

Chlamydia trachomatis was reisolated from 11 of 12 men with gonorrhoea who had initially yielded chlamydiae and who had been treated with ampicillin and probenecid (AMP) only, but from none of five such men treated with ampicillin and probenecid followed by tetracycline (AMPT). These results correlated with the absence of postgonococcal urethritis (PGU) in the group treated with AMPT. C trachomatis was isolated or reisolated from 20 of 25 women after treatment with AMP, compared with none of 14 women treated with AMPT. We recommend the addition of a course of tetracycline to the routine single dose treatment for gonorrhoea in men and women.

Tetracycline syrups and children’s teeth

It has been known for over 25 years that treatment with oral tetracyclines can permanently stain children’s teeth1 yet these drugs are still needlessly being prescribed for children. In 1982 over 75,000 prescriptions for a liquid tetracycline preparation were dispensed, most of which were probably for children; up to one third of paediatric patients have been affected,2–6 although the proportion has fallen over the last 10 years.7 Even a short course of tetracycline can stain both the permanent3,8 and deciduous teeth9 a disfiguring greyish-brown or yellow colour. Children are at risk from the 14th week in utero, when calcification of deciduous teeth begins, to their 7th year when calcification of the permanent teeth is complete. Whether tetracyclines produce enamel hypoplasia10 or promote caries11 is disputed.12

The Effect of Protracted Tetracycline Treatment on Bone Growth and Maturation

Mature female rhesus monkeys were used to evaluate the effects of a one-year course of tetracycline (50 mg/kg/day, intramuscularly) on the formation, maturation, and mineralization of mandibular bone. The bones from the treated group contained normal concentrations of calcium (Ca), inorganic phosphorus (Pi), and hydroxyproline (HO-Pr), and the treatment schedule did not alter the distribution (percentage) of total osteons into slightly, moderately, and highly mineralization classes. Tetracycline impairs bone mineralization and the subsequent maturation of the mineral and matrix moieties. The percentage of highly mineralized osteons labeled with tetracycline is subnormal. Density gradient fractionation studies indicate the presence of abnormally high Ca/Pi ratios in the temporally young newly formed bone mineral and somewhat higher ratios in the most mature bone fraction. Protracted tetracycline treatment at high dosages impairs bone growth and maturation in adult rhesus monkeys.

Single dose doxycycline therapy for scrub typhus

A single dose of 200 mg of doxycycline was shown to be as effective as a seven day course of tetracycline, in patients suspected of having scrub typhus. 65 (44%) of the 149 patients studied fulfilled the criteria for definite diagnosis of scrub typhus; 10 had an additional diagnosis. Rickettsia tsutsugamushi was isolated from 49 (75%) patients. There was no difference between the two treatment groups in time to defervescence, abolition of cough and headache, or in the time taken to recover well-being. There were no relapses in either group. Of the remaining 84 patients, a causal diagnosis was achieved in 52. Irrespective of a diagnosis there was no difference in apparent response to either doxycycline or tetracycline.

Prolonged eradication of urogenital mycoplasmas after administration of tetracycline to men in the Antarctic.

Meatal swabs were obtained at intervals over 1 year from 23 men in the Antarctic. A 5-day course of tetracycline was given to twelve of them. In retrospect it was found that the antibiotic had been received by two men who were harbouring ureaplasmas, one of whom also had M. hominis. After treatment, these organisms were not found in any of the swabs taken over the next year, except in a swab from one of the men following sexual contact after this time. One of the twelve men developed N.S.U. just before arriving in the Antarctic. He responded clinically to a shorter course of tetracycline and ureplasmas were not recovered from a meatal swab immediately thereafter. However, without further sexual contact, ureaplasmas and disease recurred about a month later. This time, after a 5-day course of tetracycline, disease was not seen, and ureaplasmas were not isolated, over the next year. In contrast, ureaplasmas were isolated consistently over a year from two men who were not given the antibiotic. The evidence strongly suggests that, under natural conditions, the most likely cause of mycoplasmas, particularly ureaplasmas, recurring in the genital tract after apparently adequate tetracycline therapy, is re-infection as a result of sexual re-exposure.