zithromax and Exanthema

To provide an extensive review of case reports, epidemiological data, and the underlying mechanism of antibiotic-induced skin rash in patients with concurrent infectious mononucleosis (IM).. A MEDLINE literature search inclusive of the dates 1946 to June 2016 was performed using the search terms anti-bacterial agents and infectious mononucleosis. EMBASE (1980 to June 2016) was searched using the terms mononucleosis and antibiotic agent and drug eruption. References of all relevant articles were reviewed for additional citations and information.. We selected English-language, primary literature, review articles, and mechanistic articles that addressed antibiotic-induced skin rash in patients with concurrent IM. We assessed all case reports available for causality utilizing a modified Naranjo nomogram specifically designed for this subject. We assembled the available epidemiological data into tables to identify trends in incidence rates over the years.. We identified 17 case reports of antibiotic-associated rash in patients with IM. The median Naranjo score was 6 (range = 1 to 8). The top 3 reported drugs were ampicillin, azithromycin, and amoxicillin. Incidence of this adverse effect was higher in the 1960s (55.6%, 45%, and 33%) than in 2013 (33% and 15%). The mechanism most commonly proposed is a transient virus-mediated immune alteration that sets the stage for loss of antigenic tolerance and the development of a reversible, delayed-type hypersensitivity reaction to the antibiotic.. A reassessment of the long-held belief of the high incidence (80%-100%) of antibiotic-induced skin rash in patients with IM seems prudent. Additional studies will be necessary to clarify this issue.

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Azithromycin; Drug Eruptions; Exanthema; Humans; Incidence; Infectious Mononucleosis

The exact aetiology of pityriasis lichenoides chronica (PLC) remains unknown. While phototherapy is the most investigated therapeutic modality, azithromycin has been used scarcely. The aim of this study is to evaluate the therapeutic efficacy of azithromycin in the treatment of PLC compared to NB-UVB and evaluating the presence of streptococcal infection as a possible etiological factor in PLC patients. The study was designed as a randomised controlled trial. Twenty-four patients with PLC were randomly allocated into either azithromycin (n = 13, standard dose every 10 days) or NB-UVB (n = 11, thrice weekly) groups. End of study (EOS) was either complete clearance of lesions or a maximum of 8 weeks. Therapeutic efficacy was defined as percent reduction in lesions and was calculated for the rash as a whole, erythematous papules alone, and hypopigmented lesions alone and graded into complete, very-good, good, poor or no response. Anti-streptolysin O titre (ASOT), anti-deoxyribonuclease B titre (anti-DNaseB) and throat culture were evaluated at day 0. No significant difference existed between both groups as regards therapeutic efficacy. At EOS, NB-UVB achieved significantly more percent reduction in the extent of hypopigmented lesions and consequently in the rash as a whole (p = 0.001, p = 0.034, respectively). The extent of the rash as a whole was significantly less in the NB-UVB at EOS (p = 0.029, respectively). The effect of NB-UVB on hypopigmented lesions appeared early at week 4 of treatment. Only two patients, one from each group, relapsed during the 3 month follow-up. Evidence of recent streptococcal infection was present in 79% of the cases, mainly in the form of elevated ASOT (94.7%). It was significantly more encountered in young children (< 13 years) (p = 0.03) and was associated with more extent of erythematous papules and consequently with more extent of the rash as a whole (p = 0.05 and p = 0.01, respectively). It did not affect outcome of therapy at EOS. Azithromycin did not show more favorable response in patients with recent streptococcal infection. Therapeutic efficacy of azithromycin is comparable to NB-UVB in treatment of PLC; however, NB-UVB is superior in management of hypopigmented lesions. It is highly suggested that PLC could be a post streptococcal immune mediated disorder.Registration number: ClinicalTrials.gov, NCT03831269.

Topics: Antibodies; Azithromycin; Child; Child, Preschool; Exanthema; Humans; Pityriasis Lichenoides; Streptococcal Infections; Treatment Outcome; Ultraviolet Therapy

Coronavirus disease (COVID-19) infection attacks the mucosal structures of the respiratory tract, especially the bronchial mucosa and immune cells. The skin changes and manifestations related to COVID-19 infection remain not clearly understood. Cutaneous manifestations related to COVID-19 had been reported. Our patient manifested atypical cutaneous exanthem on her legs, with no other abnormalities found. We used oral azithromycin 500 mg, dexamethasone 0.5 mg, vitamin C 100 mg, and paracetamol 500 mg, which are available at Badak Baru Primary Health Care. The exanthem has improved after 10 days of treatment.

Topics: Adult; Anti-Inflammatory Agents; Antiviral Agents; Azithromycin; COVID-19; COVID-19 Drug Treatment; COVID-19 Testing; Dexamethasone; Drug Tapering; Exanthema; Female; Humans; Physical Distancing; SARS-CoV-2; Treatment Outcome

Topics: Aged; Antiviral Agents; Azithromycin; Chloroquine; COVID-19 Drug Treatment; Drug Eruptions; Exanthema; Female; Humans; Hydroxychloroquine

The clinical manifestations of the SARS-CoV-2 infection are mainly respiratory but the virus can cause a variety of symptoms. Dermatological findings are less well-characterized. Data is scarce on their timing, type and correlation with the immune response.. We present the case of SARS-CoV-2 infection in a previously healthy woman who presented with respiratory symptoms and developed anosmia, diarrhea, and an erythematous maculo-papular rash on day 15 from symptom onset.. The nasopharyngeal swab tested by real time PCR for COVID-19 was positive. We interpreted this as a viral exanthema likely caused by an immune response to SARS-CoV-2 nucleotides.. She was treated with Hydroxychloroquine, Azithromycin and Lopinavir/Ritonavir, and the rash with topical corticosteroids.. All symptoms resolved except for anosmia which persisted for 6 weeks. At the 4- and 6-weeks follow-up the IgG titers for SARS-CoV-2 were high.. We must consider that SARS-CoV-2 has a multi-organ tropism. In our case, the SARS-CoV-2 infection had lung, nasopharyngeal, neurological, digestive, and skin manifestations. Identifying the different manifestations is useful for understanding the extent of SARS-CoV-2 infection. We not only present a rare manifestation but also suggest that cutaneous manifestations may correlate with immunity.

Topics: Administration, Topical; Adult; Antiviral Agents; Azithromycin; Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Drug Combinations; Exanthema; Female; Glucocorticoids; Humans; Hydroxychloroquine; Lopinavir; Pandemics; Pneumonia, Viral; Ritonavir; SARS-CoV-2; Symptom Assessment; Treatment Outcome

Neonatal tick bites place infants at risk for acquiring infections that have rarely or never been documented in this age group. We describe 2 rare cases of tickborne infection in neonates. The first patient presented with multiple erythema migrans and fever, leading to a diagnosis of early disseminated Lyme disease. The second patient presented with irritability, fever, and worsening anemia due to babesiosis. Both infants had been bitten by arthropods fitting the description of ticks before the onset of symptoms. Our cases demonstrate the clinical course of 2 common tickborne infections occurring at an atypical age, opening the door to new, complex questions for which little guiding data exists. As tickborne infections become more prevalent, we expect other clinicians will be faced with similarly challenging neonatal cases. Providers must use past experience and a keen eye to identify neonates with tickborne infections and sort through their optimal diagnosis and management. In this article, we raise some of the questions we faced and discuss our conclusions.

Topics: Animals; Anti-Bacterial Agents; Antiprotozoal Agents; Atovaquone; Azithromycin; Babesiosis; Ceftriaxone; Erythema Chronicum Migrans; Exanthema; Female; Humans; Infant, Newborn; Parasitemia; Tick Bites

Tropical infections form 20-30% of ICU admissions in tropical countries. Diarrheal diseases, malaria, dengue, typhoid, rickettsial diseases and leptospirosis are common causes of critical illness. Overlapping clinical features makes initial diagnosis challenging. A systematic approach involving (1) history of specific continent or country of travel, (2) exposure to specific environments (forests or farms, water sports, consumption of exotic foods), (3) incubation period, and (4) pattern of organ involvement and subtle differences in manifestations help in differential diagnosis and choice of initial empiric therapy. Fever, rash, hypotension, thrombocytopenia and mild derangement of liver function tests is seen in a majority of patients. Organ failure may lead to shock, respiratory distress, renal failure, hepatitis, coma, seizures, cardiac arrhythmias or hemorrhage. Diagnosis in some conditions is made by peripheral blood smear examination, antigen detection or detection of microbial nucleic acid by PCR. Tests that detect specific IgM antibody become positive only in the second week of illness. Initial therapy is often empiric; a combination of intravenous artesunate, ceftriaxone and either doxycycline or azithromycin would cover a majority of the treatable syndromes. Additional antiviral or antiprotozoal medications are required for some specific syndromes. Involving a physician specializing in tropical or travel medicine is helpful.

Topics: Artesunate; Azithromycin; Ceftriaxone; Child; Communicable Diseases; Critical Care; Dengue; Diagnosis, Differential; Doxycycline; Exanthema; Female; Fever; Geography; Humans; Intensive Care Units; Leptospirosis; Malaria; Male; Nervous System Diseases; Pregnancy; Shock, Hemorrhagic; Syndrome; Travel; Tropical Medicine; Typhoid Fever

The timing of a recent prescription for azithromycin and the morphology of this eruption made us suspect a drug reaction. But which type of reaction were we looking at?

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Drug Eruptions; Exanthema; Humans; Male; Psoriasis

After taking azithromycin and prednisone for lower respiratory symptoms, this patient developed a rash. The way it spread provided a diagnostic clue.

Topics: Azithromycin; Exanthema; Humans; Male; Middle Aged; Practice Guidelines as Topic; Prednisone; Prurigo; Respiratory Distress Syndrome; Treatment Outcome

We report the case of a 3-year-old patient with Mediterranean spotted fever (MSF). The patient was infected through a tick bite in the forests surrounding Paris. Treatment with azithromycin was started with good results. MSF is not exceptional and should be considered in patients with fever, rash, and eruptions even outside the usual infested areas.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Boutonneuse Fever; Child, Preschool; Exanthema; Fever; Humans; Male; Paris; Rickettsia conorii; Tick Bites; Treatment Outcome

Topics: Afghanistan; Anti-Bacterial Agents; Azithromycin; Cough; Diagnosis, Differential; Exanthema; Female; Fever; Humans; Infant; Measles; Measles Vaccine; Morbillivirus; Pneumonia, Mycoplasma; Travel; Treatment Outcome; United States; Vaccination; Vitamin A; Vitamins

Papulopustular eruption (PPE) is the most common cutaneous side effect of epidermal growth factor receptor inhibitors (EGFRIs).. To document the efficacy and safety of pulsed azithromycin doses in the treatment of EGFRI-related PPE.. A retrospective analysis of patients under EGFRIs who exhibited at least grade 2 PPE and were intolerant or resistant to tetracyclines was performed. Treatment consisted of pulsed azithromycin doses of 500 mg daily for 3 consecutive days per week for at least 2 weeks.. Treatment with azithromycin showed a significant reduction in the number of lesions in 18/20 patients, with 11 showing complete resolution of the rash. No significant side effects were recorded. We did not observe any interactions with the targeted biological agents or any obvious compromise of the anticancer treatment.. Weekly pulses of azithromycin are effective and promote increased patient adhesion to the treatment. A prospective study is needed to confirm efficacy and safety of this convenient treatment.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Azithromycin; Cetuximab; Drug Eruptions; ErbB Receptors; Erlotinib Hydrochloride; Exanthema; Female; Humans; Male; Middle Aged; Neoplasms; Panitumumab; Pulse Therapy, Drug; Quinazolines; Retrospective Studies; Time Factors

A 33-year-old healthy woman consulted her dermatologist when an acute and painful perioral pustular dermatosis erupted one day after she had taken azitromycin for a throat infection. A preliminary diagnosis of acute localized exanthematous pustulosis (ALEP) was made, which was later confirmed by cultures and histopathological examination. Medication was cessated immediately and the dermatosis disappeared completely afterwards.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Exanthema; Female; Humans; Skin Diseases, Vesiculobullous

Topics: Actinomycetaceae; Actinomycetales Infections; Adult; Anti-Bacterial Agents; Azithromycin; Exanthema; Female; Humans; Pharyngitis

Antibiotic-induced skin eruption in the setting of infectious mononucleosis is a common and well-documented clinical scenario. The skin lesions are non-specific and the mechanisms causing them are unclear. Several reports have described this entity with different antibiotic classes, mainly penicillins. Only 1 case of azithromycin-induced skin eruption has previously been described in this setting. Herein, we report the second case.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Azithromycin; Drug Eruptions; Exanthema; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Male