Practical Guide for the Prescription of Malaria Chemoprophylaxis for the Primary Care Physician.

Malaria is considered an important health threat around the world. Travelers from non-endemic countries are at risk of contracting the parasite that causes malaria. Those traveling on humanitarian missions and military personnel are at the greatest risk. Mosquito avoidance is an important intervention, but chemoprophylaxis is the most effective method for the prevention of this infection. The selection of a specific regimen can be a difficult task. It is a decision that is not based solely on the region in which a given patient is traveling but also on that patient's comorbidities and the potential adverse effects of the medications to be used. This review is intended to be a simple guide for the primary care physician. We discuss the selection of chemoprophylaxis for patients in the general population. We also address the specifics of chemoprophylaxis during pregnancy and breast feeding and in people diagnosed with epilepsy.

Prevention of infective endocarditis: a review of the American Heart Association guidelines.

Ever since the last American Heart Association (AHA) publication on prevention of infective endocarditis (IE) many medical societies and physicians have questioned the efficacy of prophylaxis in patients that undergo a dental, genitourinary (GU) or gastrointestinal (GI) procedures. In 1997 AHA recognize that most cases of IE were not related to invasive procedures but as a result of arbitrarily occurring bacteremia from routine daily activities as well as recognition of the possibility of IE prophylaxis failure. This assumptions as well as review of numerous published studies over the past two decades caused that AHA to revise the guidelines of 1997. Based on published series this new guidelines identify the following underlying cardiac conditions with an increase risk of IE and are the ones in which prophylaxis is recommended. They include (1) prosthetic cardiac valve or prosthetic material used for cardiac valve repair, (2) previous IE, (3) Congenital Heart Disease (CHD) including unrepaired cyanotic as well as palliative shunts and conduits, completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure, repaired CHD with residual defects and (4) cardiac transplantation recipients who develop cardiac valvulopathy. All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa will require IE prophylaxis. Patients that undergo respiratory tract procedure that involves incision or biopsy of the respiratory mucosa will also required IE prophylaxis. In contrast to previous AHA guidelines, antibiotic prophylaxis to prevent IE is not recommended for GU or GI procedures. First line therapy recommended includes amoxicillin or ampicillin and if allergic to penicillin, clindamycin 600 mg or azithromycin 500 mg. Antibiotics should be administered in a single dose before the procedure, but the dosage may be administered up to two hours after procedure. This new AHA recommendation are more clear for healthcare providers regarding to which patient should undergo prophylaxis in comparison with previous ones and are expected to reduce antibiotic resistance that increased during the past years as a result of previous antibiotic prophylaxis for IE.

An unusual presentation of actinomycosis in a young woman, after surgery.

Actinomycosis is an unusual, chronic granulomatous disease. Actinomyces israelli has been found to be related to infectious processes in those patients with affected skin integrity leading to abscess formation, fistulae or mass lesions. Actinomycosis mainly presents in three forms cervicofacial (50%), abdominal (20%) and thoracic (15%). Pelvic cases have been rarely reported and are usually associated with the use of intrauterine devices. We describe a case of a 23 y/o female without history of intrauterine device use, who was admitted with an ovarian cyst following an appendectomy. An ovarian abscess was drained. The pathology showed a granuloma and focal sulfur granules like particles compatible with Actinomyces. This is a case of pelvic Actinomyces, not related to the use of an intrauterine device.

Prosthetic valve endocarditis.

Prosthetic valve infective endocarditis represents a defined pathological entity which follows an epidemiological and nosological pattern in accordance to an arbitrary classification. Chronologically it is divided into the entities of early and late prosthetic valve endocarditis, each with its own unique characteristics. The clinical features, complications and diagnosis do not vary much from native valve endocarditis. There are clear and precise indications to aid in the diagnosis and treatment of this entity which differ from native valve endocarditis.