Acute otitis externa

What is Acute otitis externa?

Acute otitis externa is a common condition involving inflammation of the ear canal. It is caused by bacteria such as Pseudomonas aeruginosa and Staphylococcus aureus. Acute otitis externa often occurs following swimming or minor trauma from inappropriate cleaning.

What are the symptoms of Acute otitis externa?

The rapid onset of ear canal inflammation leads to otalgia (earache), itching, canal edema, erythema, and otorrhea. Tenderness with movement of the tragus or pinna is a classic finding.

What is the treatment for Acute otitis externa?

For uncomplicated cases, use topical antimicrobials or antibiotics such as acetic acid, aminoglycosides, polymyxin B, and quinolones. Some of these agents come in preparations with topical corticosteroids which may help resolve symptoms more quickly.

There is no evidence that any one antimicrobial or antibiotic preparation is clinically superior to another. Here two suggested approaches:

- Neomycin/polymyxin B/hydrocortisone preparations are a reasonable first-line therapy when the tympanic membrane is intact.

- Oral antibiotics are used when the infection has spread beyond the ear canal or in patients at risk of a rapidly progressing infection.

References:

Acute otitis externa: an update. Schaefer P, Baugh RF. Am Fam Physician. 2012 Dec 1;86(11):1055-61.
Image source: Wikipedia, a GNU Free Documentation License.

Hepatitis A

Excerpts from a recent review in Am Fam Physician:

Hepatitis A is a common viral illness worldwide. It incidence in the U.S. has diminished as a result of immunization.

How is Hepatitis A transmitted?

Hepatitis A virus is transmitted through fecal-oral contamination, and there are occasional outbreaks through food sources.

What are the symptoms of Hepatitis A?

Young children are usually asymptomatic, although the likelihood of symptoms tends to increase with age.

What is the prognosis of Hepatitis A?

Most patients recover within 2 months of infection. However, 10-15% of patients will experience a relapse in the first 6 months. Hepatitis A virus does not usually result in chronic infection or chronic liver disease.

What is the treatment for Hepatitis A?

Supportive care is the mainstay of treatment, for example, PO and IV fluids if nausea and vomiting are severe, etc.

How to prevent Hepatitis A?

The CDC recommends routine vaccination of all children 12-23 months of age, as well as certain vulnerable populations.

What to do if you have just been exposed to Hepatitis A?

Hepatitis A vaccine is also recommended for most cases of postexposure prophylaxis. Immunoglobulin is an acceptable alternative.

References:

Hepatitis A. Matheny SC, Kingery JE. Am Fam Physician. 2012 Dec 1;86(11):1027-34.

Seasonal affective disorder (SAD)

What is seasonal affective disorder?

Seasonal affective disorder is a combination of biologic and mood disturbances with a seasonal pattern. It typically occurs in the autumn (fall) and winter, with remission in the spring or summer.

How common is seasonal affective disorder?

5% of the U.S. population experiences seasonal affective disorder. Because the symptoms are seasonal, they are present for 40% of the year. Although the condition is seasonally limited, patients may have associated depression which would last longer.

What is the treatment for seasonal affective disorder?

Light therapy is well tolerated. Most patients improve within 1-2 weeks. To avoid relapse, light therapy should continue through the end of the winter season until spontaneous remission of symptoms in the spring or summer.

Antidepressant medications and cognitive behavior therapy are as effective as light therapy.

How to prevent seasonal affective disorder?

Light treatment may be used as prophylaxis before the subsequent autumn and winter seasons.

There are many devices available on Amazon, for example:



References:

Seasonal affective disorder. Kurlansik SL, Ibay AD. Am Family Physician, Dec 2012.
Image sources: Record breaking snowfall March 2008 at Aubrey, Texas, Wikipedia, public domain

Genital ulcers - 2012 review from Am Fam Physician

Here is an excerpt from a review article in the official AAFP journal American Family Physician:

Causes of genital ulcers

Herpes simplex virus (HSV) infection and syphilis are the most common causes of genital ulcers in the U.S.

Other infectious causes include:

- chancroid
- lymphogranuloma venereum (LGV)
- granuloma inguinale (donovanosis)
- secondary bacterial infections
- fungi

Noninfectious etiologies of genital ulcers include:

- sexual trauma
- psoriasis
- Behçet syndrome
- fixed drug eruptions



CDC Streaming Health | This video, produced by Be Smart. Be Well., raises awareness of Sexually Transmitted Diseases (STDs): 1) What are they? 2) Why they matter? and, 3) What can I do about them? Footage courtesy of Be Smart. Be Well. http://www.besmartbewell.com, featuring CDC's Dr. John Douglas, Division of Sexually Transmitted Disease Prevention.

Diagnosis

The following tests should be considered in all patients:

- serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum
- culture or polymerase chain reaction test for herpes simplex virus (HSV)
- culture for Haemophilus ducreyi in settings with a high prevalence of chancroid

No pathogen is identified in up to 25% of patients with genital ulcers.

Treatment

The first episode of herpes simplex virus infection is usually treated with 7-10 days of oral acyclovir (5 days for recurrent episodes). Famciclovir and valacyclovir are alternative therapies.

One dose of intramuscular penicillin G benzathine is recommended to treat genital ulcers caused by primary syphilis.

Treatment options for chancroid include a single dose of intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin.

Lymphogranuloma venereum and donovanosis are treated with 21 days of oral doxycycline.

Treatment of noninfectious causes of genital ulcers varies by etiology, of course. Topical wound care for ulcers caused by sexual trauma. Subcutaneous pegylated interferon alfa-2a is considered for ulcers caused by Behçet syndrome.

References:

Diagnosis and management of genital ulcers. Roett MA, Mayor MT, Uduhiri KA. Am Fam Physician. 2012 Feb 1;85(3):254-62.