Bacteria Including Mycobacteria

Bacterial esophagitis is very rare and has been described almost exclusively in patients with hematologic malignancies complicated by severe granulocytopenia. Single case reports have described actinomycosis and nocardiosis of the esophagus in patients with AIDS. Given the microbiology of bacterial esophagitis, these mixed infections require broad spectrum antibiotics with agents effective for both oral flora and gram-negative enteric pathogens. A second or third generation cephalosporin plus vancomycin is an appropriate initial therapy pending culture results.

Mycobacterial involvement of the esophagus remains uncommon regardless of the cause of immunosuppres-sion, but can rarely also be observed in normal hosts, especially in areas of the world with high prevalence rates of tuberculosis. Mycobacterium tuberculosis causes esophageal disease usually through contiguous involvement by infected mediastinal lymph nodes. Tracheoesophageal fistula or traction diverticulum is often the result. Despite the prevalence of intestinal and systemic disease with Mycobacterium avium complex in AIDS, esophageal involvement is still very rare.

Regardless of the cause of immunodeficiency, 9-month multidrug regimens are usually curative for tuberculosis, provided drug resistance is not present. Closure of tracheoesophageal fistula has also been documented following anti-tuberculous therapy alone. Therefore, before considering surgical repair of a fistula or even endoscopic stenting, a prolonged trial of medical therapy should be undertaken. Long-term therapy for Mycobacterium avium complex can only be considered suppressive. The most effective agents for this infection are clarithromycin and ethambutol (Wilcox et al, 1996). Use of HAART can also limit the need for long term suppressive therapy.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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