Bronchitis

Bronchitis is an inflammation of the large bronchi (medium-size airways) in the lungs. It can lead to pneumonia.

Acute bronchitis is usually caused by viruses or bacteria and may last several days or weeks. Acute bronchitis is characterized by cough and sputum (phlegm) production and symptoms related to the obstruction of the airways by the inflamed airways and the phlegm, such as shortness of breath and wheezing. Diagnosis is by clinical examination and sometimes microbiological examination of the phlegm. Treatment may be with antibiotics (if a bacterial infection is suspected), bronchodilators (to relieve breathlessness) and other treatments.

Chronic bronchitis is not necessarily caused by infection and is generally part of a syndrome called chronic obstructive pulmonary disease (COPD); it is defined clinically as a persistent cough that produces sputum (phlegm) and mucus, for at least three months in two consecutive years.

Causes:
bronchitis can be contagious. In about half of instances of acute bronchitis a bacterial or viral pathogen is identified. Typical viruses include respiratory syncytial virus, rhinovirus, influenza, and others.
Acute bronchitis can result from breathing irritating fumes, such as those of tobacco smoke or polluted air.

Symptoms:
Bronchitis may be indicated by an expectorating cough, shortness of breath (dyspnea) and wheezing. Occasionally chest pains, fever, and fatigue or malaise may also occur. Additionally, Bronchitis caused by Adenoviridae may cause systemic and gastrointestinal symptoms as well. However the coughs due to bronchitis can continue for up to three weeks or more even after all other symptoms have subsided.

Diagnosis:
A physical examination will often reveal decreased intensity of breath sounds, wheezing, rhonchi and prolonged expiration. Most doctors rely on the presence of a persistent dry or wet cough as evidence of bronchitis.

A variety of tests may be performed in patients presenting with cough and shortness of breath:

* A chest X-ray that reveals hyperinflation; collapse and consolidation of lung areas would support a diagnosis of pneumonia. Some conditions that predispose to bronchitis may be indicated by chest radiography.
* A sputum sample showing neutrophil granulocytes (inflammatory white blood cells) and culture showing that has pathogenic microorganisms such as Streptococcus species.
* A blood test would indicate inflammation (as indicated by a raised white blood cell count and elevated C-reactive protein).
* Neutrophils infiltrate the lung tissue, aided by damage to the airways caused by irritation.
* Damage caused by irritation of the airways leads to inflammation and leads to neutrophils being present.
* Mucosal hypersecretion is promoted by a substance released by neutrophils.
* Further obstruction to the airways is caused by more goblet cells in the small airways. This is typical of chronic bronchitis.

Treatment:
Antibiotics-In most cases, acute bronchitis is caused by viruses, not bacteria and it will go away on its own without antibiotics. To treat acute bronchitis that appears to be caused by a bacterial infection, or as a precaution, antibiotics may be given. However, a meta-analysis found that antibiotics may reduce symptoms by one-half day.

Smoking cessation-To help the bronchial tree heal faster and not make bronchitis worse, smokers should cut back on the number of cigarettes smoked daily or quit smoking completely to allow their lungs to recover from the layer of tar that often builds up over time.

Antihistamines-Using over-the-counter antihistamines may be harmful in the self-treatment of bronchitis. An effect of antihistamines is to thicken mucus secretions. Expelling infected mucus via coughing can be beneficial in recovering from bronchitis. Expulsion of the mucus may be hindered if it is thickened. Antihistamines can help bacteria to persist and multiply in the lungs by increasing its residence time in a warm, moist environment of thickened mucus.

Bronchiolitis

Bronchiolitis is an infection of the lungs airways. It most often occurs in young children, commonly between 3 and 6 months of age. About one in nine babies gets bronchiolitis in his or her first year of life, usually during the fall and winter months.

Bronchiolitis starts out with signs and symptoms similar to those of a common cold but then progresses to coughing and wheezing.

Although a child's bout of bronchiolitis may be scary, particularly for parents, signs and symptoms typically last for about a week and then go away. In the meantime, you can take a number of self-help measures to make your child more comfortable.

Causes:
Bronchiolitis occurs when an infectious agent — usually a virus — enters the respiratory system and makes its way to the bronchioles, causing them to become inflamed and swollen. As a result, mucus often collects in these airways, which can make it difficult for air to flow freely through your lungs.

In older children and adults, the resulting signs and symptoms are generally mild. But an infant's bronchioles are much narrower than are an adult's and are more easily blocked, leading to greater difficulty breathing.

The respiratory syncytial virus (RSV), a common virus, causes more than half of all childhood bronchiolitis cases. The rest are caused by infectious agents such as parainfluenza viruses, the influenza (flu) virus, some adenoviruses, Mycoplasma pneumoniae organisms or human metapneumovirus. Severe cases of bronchiolitis may reflect multiple infections, such as a combination of RSV and metapneumovirus.

Bronchiolitis is a contagious condition. You contract the infectious virus just like you would a cold or the flu — by inhaling airborne droplets of infected mucus or other respiratory secretions or by touching objects contaminated by these secretions and then touching your eyes, the inside of your nose or mouth.

Symptoms:
For the first two or three days, the signs and symptoms of bronchiolitis are similar to those of a common cold:

* Runny nose
* Stuffy nose
* Slight fever (may or may not occur)

After this, there may be two or three days of:

* Wheezing — breathing seems more difficult or noisy when breathing out
* Coughing — tends to be harsh, comes in fits and doesn't produce any phlegm
* Rapid or difficult breathing
* Rapid heartbeat

Severe bronchiolitis may cause your child to have difficulty breathing or develop bluish-looking skin (cyanosis) — a sign that he or she isn't getting enough oxygen. This requires emergency medical care.

Diagnosis:
Your doctor will likely listen to your child's lungs with a stethoscope to check for wheezing and prolonged breathing out (exhaling). These may indicate obstructed airflow in the bronchioles. The doctor may consider specific risk factors for bronchiolitis as well.

Sometimes other tests are recommended, including:

* Chest X-ray-In severe or uncertain cases, your doctor may request that a chest X-ray be taken to visually check for inflammation of the airways in the lungs and any signs of pneumonia. Your doctor may also check for the presence of a foreign object, such as a peanut or small piece of plastic, that your baby or toddler may have inhaled.
* Mucus sample test-In addition, your doctor may collect a sample of mucus from your child — using a nasal pharyngeal swab or a suction catheter that's gently inserted into the nose — to test for the virus that may be causing the bronchiolitis.

Treatment:
You can treat most cases of bronchiolitis at home with self-care steps. Because a virus is usually the cause of bronchiolitis, antibiotics — which are used to treat infections caused by bacteria — aren't effective against it. If your child has an associated bacterial infection, such as pneumonia, your doctor may prescribe antibiotics for that.

In more severe cases, doctors may prescribe a bronchodilator, a medication to open up the airways in the lungs, such as albuterol or albuterol inhalers (Proventil, Ventolin, others). Inhaled antiviral drugs may also be used, although they may not always be as effective as desired.

Ribavirin is an antiviral drug which has a controversial role in treating RSV infection. There is no proven benefit but it is used sometimes for infants with pre-existing lung, heart or immune disease.

Bronchiectasis

Bronchiectasis is a disease that causes localized, irreversible dilatation of part of the bronchial tree. Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airflow obstruction and impaired clearance of secretions. Bronchiectasis is associated with a wide range of disorders, but it usually results from necrotizing bacterial infections, such as infections caused by the Staphylococcus or Klebsiella species or Bordetella pertussis.

Rene Theophile Hyacinthe Laënnec, the man who invented the stethoscope, used his creation to first discover bronchiectasis in 1819. The disease was researched in greater detail by Sir William Osler in the late 1800s; in fact, it is suspected that Osler actually died of complications from undiagnosed bronchiectasis.

Causes:
There are both congenital and acquired causes of bronchiectasis. Kartagener syndrome, which affects the mobility of cilia in the lungs, aids in the development of the disease. Another common genetic cause is cystic fibrosis, in which a small number of patients develop severe localized bronchiectasis. Young's syndrome, which is clinically similar to cystic fibrosis, is thought to significantly contribute to the development of bronchiectasis. This is due to the occurrence of chronic, sinopulmonary infections. Patients with alpha 1-antitrypsin deficiency have been found to be particularly susceptible to bronchiectasis, for unknown reasons. Other less-common congenital causes include primary immunodeficiencies, due to the weakened or nonexistent immune system response to severe, recurrent infections that commonly affect the lung.

Acquired bronchiectasis occurs more frequently, with one of the biggest causes being tuberculosis. Endobronchial tuberculosis commonly leads to bronchiectasis, either from bronchial stenosis or secondary traction from fibrosis. A especially common cause of the disease in children is Acquired Immune Deficiency Syndrome (AIDS), stemming from the human immunodeficiency virus. This disease predisposes patients to a variety of pulmonary ailments, such as pneumonia and other opportunistic infection. Bronchiectasis can sometimes be an unusual complication of inflammatory bowel disease, especially ulcerative colitis. It can occur in Crohn's disease as well, but does so less frequently. Bronchiectasis in this situation usually stems from various allergic responses to inhaled fungus spores. Recent evidence has shown an increased risk of bronchiectasis in patients with rheumatoid arthritis who smoke. One study stated a tenfold increased prevalence of the disease in this cohort. Still, it is unclear as to whether or not cigarette smoke is a specific primary cause of bronchiectasis.

Other acquired causes of bronchiectasis involving environmental exposures include respiratory infections, obstructions, inhalation and aspiration of ammonia and other toxic gases, pulmonary aspiration, alcoholism, heroin (drug use), and various allergies.

Diagnosis:
The diagnosis of bronchiectasis is based on the review of clinical history and characteristic patterns in high-resolution CT scan findings. Such patterns include "tree-in-bud" abnormalities and cysts with definable borders. In one small study, CT findings of bronchiectasis and multiple small nodules were reported to have a sensitivity of 80%, specificity of 87%, and accuracy of 80% for the detection of bronchiectasis. Bronchiectasis may also be diagnosed without CT scan confirmation if clinical history clearly demonstrates frequent, respiratory infections, as well confirmation of an underlying problem via blood work and sputum culture samples.

Treatment:
Treatment of bronchiectasis is aimed at controlling infections and bronchial secretions, relieving airway obstruction, and preventing complications. This includes the prolonged usage of antibiotics to prevent detrimental infections, as well as eliminating accumulated fluid with postural drainage and chest physiotherapy. Surgery may also be used to treat localized bronchiectasis, removing obstructions that could cause progression of the disease.

Inhaled steroid therapy that is consistently adhered to can reduce sputum production and decrease airway constriction over a period of time, and help prevent progression of bronchiectasis. One commonly used therapy is beclometasone dipropionate, which also used in asthma treatment. Use of inhalers such as albuterol (salbutamol), fluticasone (Flovent/Flixotide) and ipratropium (Atrovent) may help reduce likelihood of infection by clearing the airways and decreasing inflammation.

Mannitol dry inhalation powder, under the name Bronchitol, has been approved by the FDA for use in cystic fibrosis patients with or at risk for bronchiectasis. The original orphan drug indication approved in February 2005 allowed its use for the treatment of bronchiectasis. The original approval was based on the results of Phase II clinical studies showing the product to be safe, well-tolerated, and effective for stimulating mucus hydration/clearance, thereby improving quality of life in patients with chronic obstructive lung diseases like bronchiectasis. Long-term studies are underway as of 2007 to ensure the safety and effectiveness of the treatment.

Advair Diskus is also a commonly used inhaled corticosteroid which has in many cases been effective in clearing the airways, reducing sputum and reducing inflammation.

Brain Tumor

A Brain Tumor is any intracranial tumor created by abnormal and uncontrolled cell division, normally either in the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells), lymphatic tissue, blood vessels), in the cranial nerves (myelin-producing Schwann cells), in the brain envelopes (meninges), skull, pituitary and pineal gland, or spread from cancers primarily located in other organs (metastatic tumors). Primary (true) brain tumors are commonly located in the posterior cranial fossa in children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can affect any part of the brain. In the United States in the year 2005, it was estimated that there were 43,800 new cases of brain tumors (Central Brain Tumor Registry of the United States, Primary Brain Tumors in the United States, Statistical Report, 2005 - 2006), which accounted for 1.4 percent of all cancers, 2.4 percent of all cancer deaths, and 20–25 percent of pediatric cancers. Ultimately, it is estimated that there are 13,000 deaths/year as a result of brain tumors.

Classification:
Most primary brain tumors originate from glia (gliomas) such as astrocytes (astrocytomas), oligodendrocytes (oligodendrogliomas), or ependymal cells (ependymoma). There are also mixed forms, with both an astrocytic and an oligodendroglial cell component. These are called mixed gliomas or oligoastrocytomas. Plus, mixed glio-neuronal tumors (tumors displaying a neuronal, as well as a glial component, e.g. gangliogliomas, disembryoplastic neuroepithelial tumors) and tumors originating from neuronal cells (e.g. gangliocytoma, central gangliocytoma) can also be encountered.

Other varieties of primary brain tumors include: primitive neuroectodermal tumors (PNET, e.g. medulloblastoma, medulloepithelioma, neuroblastoma, retinoblastoma, ependymoblastoma), tumors of the pineal parenchyma (e.g. pineocytoma, pineoblastoma), ependymal cell tumors, choroid plexus tumors, neuroepithelial tumors of uncertain origin (e.g. gliomatosis cerebri, astroblastoma), etc.

Secondary or metastatic brain tumors originate from malignant tumors (cancers) located primarily in other organs. Their incidence is higher than that of primary brain tumors. The most frequent types of metastatic brain tumors originate in the lung, skin (malignant melanoma), kidney (hypernephroma), breast (breast carcinoma), and colon (colon carcinoma). These tumor cells reach the brain via the blood-stream.

Some non-tumoral masses and lesions can mimic tumors of the central nervous system. These include tuberculosis of the brain, cerebral abscess (commonly in toxoplasmosis), and hamartomas (for example, in tuberous sclerosis and von Recklinghausen neurofibromatosis).

Diagnosis:
Although there is no specific clinical symptom or sign for brain tumours, slowly progressive focal neurologic signs and signs of elevated intracranial pressure, as well as epilepsy in a patient with a negative history for epilepsy should raise red flags. However, a sudden onset of symptoms, such as an epileptic seizure in a patient with no prior history of epilepsy, sudden intracranial hypertension (this may be due to bleeding within the tumour, brain swelling or obstruction of cerebrospinal fluid's passage) is also possible.

Imaging plays a central role in the diagnosis of brain tumours. Early imaging methods—invasive and sometimes dangerous—such as pneumoencephalography and cerebral angiography, have been abandoned in recent times in favour of non-invasive, high-resolution modalities, such as computed tomography (CT) and especially magnetic resonance imaging (MRI). Benign brain tumours often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans. On MRI, they appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted MRI. Perifocal edema also appears hyperintense on T2-weighted MRI. Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and metastatic brain tumours. This is due to the fact that these tumours disrupt the normal functioning of the blood-brain barrier and lead to an increase in its permeability.

Electrophysiological exams, such as electroencephalography (EEG) play a marginal role in the diagnosis of brain tumours.

The definitive diagnosis of brain tumour can only be confirmed by histological examination of tumour tissue samples obtained either by means of brain biopsy or open surgery. The histologic examination is essential for determining the appropriate treatment and the correct prognosis.

Treatment and Prognosis:
Meningiomas, with the exception of some tumors located at the skull base, can be successfully removed surgically, but the chances are less than 50%. In more difficult cases, Stereotactic radiosurgery, such as Gamma Knife radiosurgery, remains a viable option.

Most pituitary adenomas can be removed surgically, often using a minimally invasive approach through the nasal cavity and skull base (trans-nasal, trans-sphenoidal approach). Large pituitary adenomas require a craniotomy (opening of the skull) for their removal. Radiotherapy, including stereotactic approaches, is reserved for the inoperable cases.

Although there is no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at least cytoreduction (that is, removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is considered in most cases. However, due to the infiltrative nature of these lesions, tumor recurrence, even following an apparently complete surgical removal, is not uncommon. Postoperative radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-grade" gliomas, when a significant tumor burden reduction could not be achieved surgically.

Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical tumor removal, to mention just a few factors.

Patients with benign gliomas may survive for many years while survival in most cases of glioblastoma multiforme is limited to a few months after diagnosis.

The main treatment option for single metastatic tumors is surgical removal, followed by radiotherapy and/or chemotherapy. Multiple metastatic tumors are generally treated with radiotherapy and chemotherapy. Stereotactic radiosurgery, such as Gamma Knife radiosurgery, remains a viable option. However, the prognosis in such cases is determined by the primary tumor, and it is generally poor.

A shunt operation is used not as a cure but to relieve the symptoms. The hydrocephalus caused by the blocking drainage of the cerebrospinal fluid can be removed with this operation.

Research to treatment with the VSV-virus:
In 2008, Researchers of the Yale University, lead by Dr. Anthony van den Pol, have discovered that the Vesicular stomatitis virus, or VSV-virus, can infect and kill brain tumors, without affecting the other brain cells. The oncolytic properties of the virus, which normally applies to cancer cells, have shown to apply to brain tumors as well.

In the research, a human brain tumor was implanted into mice brains. The VSV-virus was injected via its tail and within 3 days all tumor cells were either killed or dying. On the 10,000 infected tumor cells, only one healthy brain cell was affected 'on accident'.

Research to virus-treatment like this has been some years old, but no other virusses has shown to be as efficient or specific as the VSV-virus. Future research will focus on the risks of this treatment, before it can be applied to humans.

Botulism

Botulism is a rare, but serious paralytic illness caused by a toxin, botulin, that is produced by the bacteria Clostridium botulinum. Botulinic toxin is one of the most powerful known toxins: about one microgram is lethal to humans. It acts by blocking nerve function and leads to respiratory and musculoskeletal paralysis. There are three main kinds of botulism:

* Infant botulism is caused by swallowing the spores of the botulinum bacteria, which then grow inside of the infant's intestines and release toxin.
* Foodborne botulism is caused by eating foods that contain the rare botulinum toxin.
* Wound botulism is caused by a nerve toxin produced from a wound infected with Clostridium botulinum. This is the rarest type of botulism. It is very difficult to obtain it this way.


All forms of botulism can be lethal and are always considered medical emergencies. Foodborne botulism can be extremely dangerous as a public health risk because multiple persons can consume the poison from a single contaminated food source.

Symptoms:
Normal symptoms of Foodborne and Wound botulism, usually including dry mouth, double and/or blurred vision, difficulty swallowing, muscle weakness, drooping eyelids, difficult breathing, slurred speech, vomiting, urinary incontinence and sometimes diarrhea. These symptoms may continue to cause paralytic ileus with severe constipation, and will lead to body paralysis. The respiratory muscles are affected as well, which may cause death due to respiratory failure. These are all symptoms of the muscle paralysis caused by the bacterial toxin.

The mode of action of Infant botulism is through colonization by germinating spores in the gut of an infant. The first symptom is usually constipation, followed by generalized weakness, loss of head control and difficulty feeding. Like the other forms of botulism, the symptoms are caused by the absorption of botulinum toxin, and typically progress to a symmetric descending flaccid paralysis. Death is often the eventual outcome unless the infant receives artificial ventilation.

Diagnosis:
Physicians may consider the diagnosis if the patient's history and physical examination suggest botulism. However, these clues are often not enough to allow a diagnosis of botulism. Other diseases such as Guillain-Barré syndrome, stroke, and myasthenia gravis can appear similar to botulism, and special tests may be needed to exclude these other conditions. These tests may include a brain scan, cerebrospinal fluid examination, nerve conduction test (electromyography, or EMG), and an Edrophonium Chloride (Tensilon) test for myasthenia gravis. The most practical way to confirm the diagnosis is to demonstrate the botulinum toxin in the patient's serum or stool by injecting serum or stool extract into mice and looking for signs of botulism that can be blocked by specific antisera.

Treatment:
Infant botulism can be treated with human botulism immune globulin (BabyBIG), when available. Supply is extremely limited. This dramatically decreases the length of illness for most infants. Paradoxically, antibiotics (especially aminoglycosides or clindamycin) may cause dramatic acceleration of paralysis as the affected bacteria release toxin. Visual stimulation should be performed during the time the infant is paralyzed as well, in order to promote the normal development of visual pathways in the brain during this critical developmental period.

Furthermore each case of food-borne botulism is a potential public health emergency in that it is necessary to identify the source of the outbreak and ensure that all persons who have been exposed to the toxin have been identified, and that no contaminated food remains.

There are two primary Botulinum Antitoxins available for treatment of Wound and Foodborne botulism. Trivalent (A,B,E) Botulinum Antitoxin is derived from equine sources utilizing whole antibodies (Fab & Fc portions). This antitoxin is available from the local health department via the CDC. The second antitoxin is heptavalent (A,B,C,D,E,F,G) Botulinum Antitoxin which is derived from "despeciated" equine IgG antibodies which have had the Fc portion cleaved off leaving the F(ab')2 portions. This is a less immunogenic antitoxin that is effective against all known strains of botulism where not contraindicated.

Blepharitis

Blepharitis is inflammation of the eyelids. It is characterized by inflammation of the eyelid margins. Blepharitis usually causes redness of the eyes and itching and irritation of the eyelids in both eyes. Its appearance is often confused with conjunctivitis and due to its recurring nature it is the most common cause of "recurrent conjunctivitis" in older people. It is also often treated as "dry eye" by patients due to the gritty sensation it may give the eyes - although lubricating drops do little to improve the condition.

There are 3 forms of blepharitis (staphylococcal, seborrheic and MGD). All three forms of blepharitis are chronic in nature. Patients with staphylococcal blepharitis are relatively young (mean age 42 years) with a short history of ocular symptoms (mean 1.8 years). Patients with seborrheic blepharitis and MGD blepharitis are generally older and have a longer history of ocular symptoms.

Staphlycoccal blepharitis is a type of external eye inflammation. As with dandruff, it is usually asymptomatic until the disease progresses. As it progresses, the sufferer begins to notice a foreign body sensation, matting of the lashes, and burning. Usually, the primary care physician will prescribe topical antibiotics for staphylococcal blepharitis. Unfortunately this is not an effective treatment.

Seborrheic blepharitis, the most common type of blepharitis, is usually one part of the spectrum of seborrheic dermatitis seborrhea which involves the scalp, lashes, eyebrows, nasolabial folds and ears. Treatment is best accomplished by a dermatologist.

In Meibomian gland dysfunction (MGD) there are prominent blood vessels crossing the eyelid margin. In addition there is pouting or plugging of meibomian gland openings, and poor expressibility and/or turbidity of the oily meibomian secretions. Patients with MGD frequently are noted to have coexisting rosacea and seborrheic dermatitis (Rosacea's Red Face). Use of isotretinoin (Accutane), an oral medication for severe cystic acne, has also been implicated as a cause of blepharitis.

Treatment:
Blepharitis is a chronic disease for which there is no cure, and requires long-term treatment to keep it under control. Treatment consists of 2 phases (Acute phase and Maintenance phase). Acute phase treatment involves intensive therapy to rapidly bring the disease under control. In the maintenance phase the goal is to indefinitely continue the minimum amount of therapy that is necessary to keep the disease quiet. Herein we will not focus on the treatment of specific steroid responsive complications of blepharitis like marginal ulcers and phlyctenules, as they are less common and require specific diagnosis. We will focus on the treatments that help control the blepharitis process itself. Needless to say, controlling blepharitis itself, will reduce all the other blepharitis related complications.

Warm Compresses followed by Lid Scrubs is the most critical element of effective blepharitis control. This therapy removes the eyelid debris (which can be colonized by bacteria), reduces the bacterial load (mechanically as well as by lysis of bacteria due to detergent action of the soap in lid scrubbing) and stabilizes the tear film by releasing oily secretions from the meibomian glands, thus reducing tear evaporation (so the dry eye symptoms are also reduced).

Antibiotic treatment
The use of an ointment on the eyelid margin immediately after lid scrubbing may help to increase patient comfort. The choice here is usually Erythromycin eye ointment or Tobradex eye ointment (steroid-antibiotic combination). In addition, the antibiotics help to further reduce the bacterial load on the eyelids.
Oral tetracyclines (doxycycline or minocycline) for about 3 months can be used in recalcitrant Meibomian Gland Dysfunction (MGD) cases. Tetracycline antibiotics affect the meibomian gland secretions, inhibit bacterial lipases as well as reduce the eyelid bacterial load.

Anti-Inflammatory treatment
Castor oil has been used traditionally in folk medicine as an anti-inflammatory remedy for treatment of blepharitis. The main ingredient in Castor oil is ricinoleic acid. Castor oil could either increase or decrease eyelid inflammation depending upon whether it is used only once or is used several times for many days. Eyelid inflammation may increase initially after starting treatment but with repeated use over a week, the blepharitis inflammation will be reduced.

Antioxidant treatment
Eating more grapes may help blepharitis patients. The formation of oxidants like nitric oxide in the involved eyelid margin have been speculated to play a role in blepharitis. The substance, known as resveratrol is an anti-oxidant that is very effective against these nitrite type of oxidants. Grapes are particularly good sources of resveratrol. Resveratrol is found in the skin (not flesh) of grapes. Fresh grape skin contains about 50 to 100 micrograms of resveratrol per gram and red wine (also rich in resveratrol) contains about 1.5 to 3 milligrams per liter.

Blastomycosis

Blastomycosis (Gilchrist's disease) is a fungal infection caused by the organism Blastomyces dermatitidis. Endemic to portions of North America, blastomycosis causes clinical symptoms similar to histoplasmosis.

Causes:

Blastomycosis occurs in people living in the south-central and midwestern United States and Canada. The infection is seen in 1-2 out of every 100,000 people in areas where the fungus most frequently occurs. It is even less common outside those areas.
Being around infected soil is the key risk factor.
The disease usually affects people with weakened immune systems, such as those with HIV or organ transplant recipients. Men are more likely to be affected than women.
Lung infection may produce no symptoms, but when the infection spreads, skin lesions or bone lesions may appear and the bladder, kidney, prostate, and testes may be affected.

Symptoms:

* Cough (may produce brown or bloody mucus)
* Shortness of breath
* Sweating
* Fever
* Fatigue
* General discomfort, uneasiness, or ill-feeling (malaise)
* Unintentional weight loss
* Joint stiffness and joint pain
* Muscle stiffness and pain
* Rash
* Skin lesions
* Chest pain

Diagnosis:

* History of living in an area where the fungus is commonly found
* Chest x-ray
* Tissue biopsy
* Skin biopsy
* Sputum culture and special stains

Treatment:
Itraconazole given orally is the treatment of choice for most forms of the disease. Cure rates are high, and the treatment over a period of months is usually well tolerated. Amphotericin B is considerably more toxic, and is usually reserved for critically ill patients and those with central nervous system disease.