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Conjunctivitis: Treatment and Prevention

Conjunctivitis commonly known as "pink eye," is an inflammation of the membrane (conjunctiva) that covers the eye and lines the inner surface of the eyelid. There are four main causes of conjunctivitis.

One cause involves the introduction of either bacterial or viral microorganisms into the eye. These may be transmitted to the eye by contaminated hands, washcloths or towels, cosmetics (particularly eye makeup), false eyelashes or extended wear contacts.

Minor conjunctivitis can accompany a viral cold or flu. Although bacterial and some of the viral infections (particularly herpes) are not very common, they are potentially serious. Both types of infection are contagious.

Irritants are another cause of conjunctivitis. Offenders of this type include air pollutants, smoke, soap, hairspray, makeup, chlorine, cleaning fluids, etc.

Seasonal allergic response to grass and other pollens can cause some individuals to acquire conjunctivitis.

Pink eye may be more serious if you: has a condition that decreases your ability to fight infection (impaired immune system), have vision in only one eye or you wear contact lenses.

Various combinations of the following symptoms may be present: itching, redness, sensitivity to light, feeling as if something is in the eye, swelling of the lids and/or discharge from the eyes. The consistency of possible discharge may range from watery to pus-like, depending on the specific cause of the conjunctivitis.

It usually takes from a few days to two weeks for mo s t types of conjunctivitis to clear. Conjunctivitis due to an allergy may continue as long as the offending pollen is present. Under such conditions, symptoms are likely to recur each year.

Diagnosis consists of physical examination of the eye by the clinician. If a discharge is present, a culture for bacteria may be warranted.

Treatment varies depending on the cause. Medications in the form of ointments, drops or pills may be recommended to help kill the germ infecting the eye, relieve allergic symptoms and/or decrease discomfort. In the case of conjunctivitis due to a viral cold or flu, the practitioner may recommend that you be patient and let it run its course.

Apply cool compresses to the infected eye(s) three to four times per a for 1015 minutes using a clean washcloth each time. This should help reduce itching and swelling and provide some comfort.

Wash your hands frequently and keep them away from your eyes In order to reduce or prevent recontamination.

A void rubbing your eyes to decrease irritation of the area. Wear sunglasses if your eyes are sensitive to the light.

Avoid exposure to the irritants that may be causing the conjunctivitis.

Dispose of old eye makeup if the culture for bacteria is positive.

Use a clean pillowcase each night. (Pillowcase can be changed every other day and turned over nightly).

Avoid wearing contact lenses while you are using medications or if your eyes are uncomfortable. Cleanse contact lenses thoroughly.

Although many kinds of conjunctivitis are hard to prevent, there are measures that can be taken to decrease your risk of reacquiring or spreading it to someone else. These are listed below:

Do not share eye makeup or cosmetics of any kind with anyone. Avoid sharing washcloths or towels.

Wash hands frequently and keep away from the eyes.

Wear protective goggles (i.e., for swimming or working) if you must be exposed to chemicals that are irritating.

Do not use medication (eye drops, ointment, etc.) that has been prescribed for someone else.

A void swimming in non-chlorinated pools or stagnant lakes or ponds. Do not save medication - dispose of it when treatment is completed.

If any of the following problems should occur, notify your clinician:

Visual changes; Severe eye pain; Pain when moving eyes; Fever; No improvement with medication within 48-72 hours; Drainage continues after you have completed full course of medication; Roommates or other family members develop symptoms; Eyes become very sensitive to light.

Wash your hands before touching your eyes or your medications. Gently, pull your lower lid down with your finger. Look up toward the ceiling.

To instil drops: Drop medicine inside centre of your lower lid. Do not drop it on your eyeball. Close your eyes gently without squeezing the lids shut. Blink to distribute medication over the eye. To instil ointment: Starting in the corner of your eye closest to the nose, squeeze a thin ribbon of ointment along the inside of the lower lid. Close eyes gently without squeezing the lids shut. Roll eyes to distribute the medication over them.

Remove excess solution or ointment outside your eye with a clean tissue, using a separate tissue for each eye.

Wash hands after you have finished your medication, to avoid transmitting the infection to others.

Paratyphoid: Avoid self-medication

Typhoid fever is an infectious feverish disease with severe symptoms in the digestive system in the second phase of the illness.

Classic typhoid fever is a serious disease. It can be life-threatening, but antibiotics are an effective treatment. The disease lasts several weeks and convalescence takes some time.

The disease is transmitted from human to human via food or drinking water, and it is therefore mainly hygiene and sanitary conditions that determine its spread. It is primarily for this reason that it is no longer so commonly seen in Europe.

What causes typhoid fever and paratyphoid fever

Typhoid fever is caused by an infection with the bacterium Salmonella typhi, which is only found in humans and may lead to serious illness.

When the bacterium passes down to the bowel, it penetrates through the intestinal mucosa (lining) to the underlying tissue.

If the immune system is unable to stop the infection here, the bacterium will multiply and then spread to the bloodstream, after which the first signs of disease are observed in the form of fever.

The bacterium penetrates further to the bone marrow, liver and bile ducts, from which bacteria are excreted into the bowel contents.

In the second phase of the disease the bacterium penetrates the immune tissue of the small intestine, and the often violent small-bowel symptoms begin.

Paratyphoid fever is caused by Salmonella paratyphi, a similar and generally milder disease.

How is typhoid fever spread

Salmonella typhi can only attack humans, so the infection always comes from another human, either an ill person or a healthy carrier of the bacterium. The bacterium is passed on with water and foods and can withstand both drying and refrigeration.

As it is necessary for someone to be exposed to a certain quantity of bacteria before symptoms occur, the storage of foods is also of great significance. They must be kept refrigerated and prepared correctly, as required by general hygiene, so that any bacteria present are not able to multiply significantly.

Where does typhoid fever occur

Typhoid fever is not a tropical disease and is related to hygiene and sanitary conditions rather than the climate itself.

Typhoid fever is found in large parts of Asia, Africa, Central and South America, where it occasionally causes epidemics. The WHO estimates that there are approximately 16 million cases a year, which result in 600,000 deaths. Many of those infected get the disease in Asian countries.

What are the symptoms of the disease

The incubation period is 10 to 20 days and depends on, among other things, how large a dose of bacteria has been taken in.

In the mild disease, the bacterium is eliminated very early in the course of the disease and there are perhaps only mild symptoms. It is possible to become a healthy carrier of infection.

There are two phases of classic typhoid fever:

1st phase: the patient's temperature rises gradually to 40ºC (1040F) and the general condition becomes very poor with bouts of sweating, no appetite, coughing and headache. Constipation and skin symptoms may be the clearest symptoms. Children often vomit and have diarrhoea. The first phase lasts a week and towards the end the patient shows increasing listlessness and clouding of consciousness.

2nd phase: in the second to third weeks of the disease, symptoms of intestinal infection are manifested and the fever remains very high and the pulse becomes weak and rapid. In the third week the constipation is replaced by severe pea-soup-like diarrhoea. The faeces may also contain blood. It is not until the fourth or fifth week that the fever drops and the general condition slowly improves.

Complications

Intestinal perforation or profuse bleeding from the intestinal mucosa may occur if typhoid fever is left untreated.

Outlook

There are good prospects of cure with antibiotics and the patient can be discharged from hospital when the general condition is stable. However, good general hygiene (as always) should be maintained in the home, as bacteria may continue to be excreted for several more weeks. If the patient is a food handler then they will need to stay off work until at least two stool samples show absence of the infection.

What can you do yourself: There are several forms of vaccine that protect against Salmonella typhi. Most travel clinics use the injectable form (Typherix or Typhim Vi) rather than the oral form (Vivotif). The injectable vaccine is easier to administer since it only requires one dose and has less side effects. It should be administered at least two weeks prior to potential typhoid exposure and is effective for three years.

The routes of infection depend on hygiene conditions and general kitchen hygiene should be maintained to prevent infection. For travel, the same precautions can be taken as described under cholera.

How is the disease diagnosed

The clinical picture together with information on travel may be a good pointer for the doctor in moderate to severe cases. For the final diagnosis to be established, the bacteria have to be detected in samples from the stool, blood or other tissue.

How is typhoid fever treated?

Treatment requires admission to hospital and loss of fluid and salt is treated with fluid therapy as appropriate.

The bacterium is controlled with antibiotics, and in very rare cases steroid medicines are also included in the treatment.

Prevention: Within the hospital setting, infected people are cared for in isolation. Proper hand hygiene is the most important way of preventing further spread in hospital.

Stool samples are also taken from members of the patient's family to identify any 'healthy' carriers.

Choice of Drug: Ciprofloxacin (Xirocip 500 mg Tablet, Xirocip Suspension 250 mg Ciprofloxacin/5 ml)

Azithromycin (Thromax 500 mg Tablet, Thromax Suspension 200 mg Azithromycin/5 ml).

Guava leaf: A good anti-diarrhoea agent

Jamayet Ali

Guava (peyara) is a very popular fruit to the people of all ages. It is often referred to as the apple of the tropics. This fruit is a native of tropical America probably from Mexico to Peru, and has long been naturalised in Bangladesh and India. Many varieties are known in cultivation, but a detailed horticultural and a systematic study of the species and its varieties is still lacking. Sometimes two varieties are broadly distinguished var, pyriferum and var, pomiferum based on the shape of the fruits. Fruits become green to light yellow, but in some varieties, red, varying in shape and size to a great extent; flesh creamish white to yellow and in some red. Guava grows nearly throughout the country from hilly areas Chittagong to Rangpur. The important guava growing areas are: Gazipur, Capasia, Ghorasal, Narsingdi, Jessore, Khulna and Satkhira. Kazi peyara is also very popular side by side with Deshi peyara. It can be grown on a variety of soils, from heavy clay to very light soils. It thrives best on sandy loam.

Botanical name of guava is Psidium guyava Linn. The tree begins to bear small crops from its fourth year . It reaches full maturity and starts bearing large crops in its eighth year and may continue to bear heavily for thirty years or more. It is a very hardy tree, and given good care may flourish for over fifty years. The guava tree takes nearly 5 months from flowering time to maturation of fruit. Fruits attaining maturity show signs of changing their colour from dark green to yellow green. This is the right stage for harvesting them for the market. Inarching or grafting by approach is the commercial method adopted for improvement of guava. The best time for this operation is the rainy season.

Sour-sweet, juicy and highly flavoured fruit guava is eaten mostly as fresh fruit. It may also be canned, preserved, spiced or made into jam, butter, marmalades, pies, ketchups, and chutneys. In Hawaii, guava juice is said to make an excellent substitute for orange or tomato juice in child feeding. Guava cheese is prepared from ripe and firm fruits. The fruits are washed and cut into small pieces, boiled in water and the pulp after straining to remove seeds and peels, is mixed with sugar and butter and heated until the mass becomes sufficiently thick. Cytric acid, common salt and colouring matter are added. For the preparation of guava jelly, healthy and rather tart fruits are preferred; they are washed, cut into small pieces, and after the addition of citric acid, boiled in water for about an hour. The juice is pressed out with a muslin cloth, and examined for the degree of richness in pectin content. It is cooked with an equal quantity of sugar till the resulting jelly boils at 105°.

Guava is one of the richest natural sources of vitamin C and contains 4 to 10 times more of this vitamin than the citrus fruits. It also contains considerable amount of pectin. As compared to mango and apricot, guava is deficient in vitamin A but superior in most of the other major nutrients. A typical analysis of guava (as per 100grms. edible) is as follows: moisture, 82.8; mineral matter, 0.6; fibre, 5.2; calorie, 76; protein, 1.4; fat, 1.1; carbohydrate, 15.2 grms.; calcium, 20; iron, 1.4; vitamin B-1, 0.21: vitamin B-2, 0.09; and vitamin C 210 mg and carotene, 100fl/100g. The vitamin C value increases with maturity and is maximum when the fruit is fully mature, but declines when the fruit becomes over-ripe and soft. The vitamin C potency is probably a type characteristic not associated with colour.

Medicinal Properties: The guava plant as well as its fruits are of considerable medicinal importance. The guava leaves are used for wounds, ulcers and as an astringent for bowels. The young leaves are used as a tonic in the diseases of the digestive functions. The decoction of leaves has been used in cholera with some success in arresting vomiting and diarrhoea. An infusion of the leaves and roots is a popular astringent drink in Ghana. A decoction of the young leaves and shoots is prescribed in febrifuge and antispasmodic baths. Infusion of leaves is used in cerebral affections, nephritis and cochexia. The pounded leaves are locally applied in rheumatism and an extract is used in epilepsy and chorea; the tincture is rubbed over the spine of children suffering from convulsions. A decoction of the leaves when gargled relieves toothache and gum boils. The bark is valued for its astringent properties, and has been employed in diarrhoea in children. it is generally administered in the form of a decoction. The bark is tonic and the ash caustic. The flowers are said to cool the body and are used in bronchitis. They are also applied to eye sores. The fruit is tonic, cooling and laxative. It is good in colic and for bleeding gums. The fruit and its conserve are astringent and used in diarrhoea and dysentery (The Wealth Of India, Raw Materials, Psidium, 293 )

The fruit is acrid and sour, with a flvour; cooling, aphrodisiac; causes "kapha"; cures "vata", "tridosha", and biliousness (Ayurveda). The leaves are used for wounds and ulcers, and as an astringent for bowels. The flower cools the body; used in bronchitis; applied to sore eyes. The anthers dry wounds; cool and heated brain. The fruit is sweet or sour; tonic, cooling, laxative after food; used in thirst, heat of the body; good in colic, and for bleeding gums. The gum is tonic; the ash caustic (Yunani).

The bark of the root a is valued for its astringent properties, and has been employed with success in the diarrhoea of children. It is generally administered in the form of a decoction. The decoction serves a good deal in the prolapsus ani of children. The young leaves are used as a tonic in the diseases of the digestive functions, The bark of the var, pomiferum possesses similar properties. The decoction of the leaves has been used in cholera with some success, in arresting vomiting and diarrhoea. The leaves when chewed are said to be a remedy in toothache. In the Gold Coast, the roots are beaten and mixed with water and used in curing diarrhoea and dysentery. The leaves are said to relieve toothache when chewed. In Guiana, the roots, the leaves, and the buds are considered astringent and antidysenteric; an infusion of the roots and leaves is a popular astringent drink.

A decoction of the young leaves and shoots is prescribed in the West Indies in febrifuge and antispasmodic baths; an infusion of the leaves in cerebral affections, nephritis, and cachexia; the pounded leaves are locally applied in rheumatism; an extract is used in epilepsy and chorea; the tincture is rubbed into the spine of children suffering from convulsions. The fruit and its conserve are astringent and suitable to those suffering from diarrhoea and dysentery. The leaves (Joum, Chern, Soc., 1905) and the oil they yield (Schimmel, April, 1910) have been examined chemically (Indian Medicinal Plant, Kirtikar & B.D. Basu, Vol. 11, 1047).

Medicine: The fruit is astringent, and is employed by natives as a cure for diarrhoea. The bark, especially that of the root, is noticed in the Pharmacopoeia of India as an astringent worthy of notice. Dr. Waitz states that he employed it with much success in chronic infantile diarrhoea. He administered it as a decoction (1/2 oz. of the root bark, with 6 ozs. water, boiled down to 3 ozs.) in doses of one or more teaspoonfuls three times a day. He also recommends this preparation as a local application in the prolapsus ani of children. Many other writers have noticed the astringent properties of the bark, which appears to be worthy of more extended utilisation. The leaves possess similar qualities, through perhaps to a less marked extent, and are also said, when pounded down, to make an excellent poultice. In cases of scurvy, a decoction is employed as a mouth-wash for swollen gums, and has been used in cholera with some success, for arresting the vomiting and diarrhoeaic symptoms.

Special Opinions: "The unripe fruit has been found serviceable in diarrhoea" (Surgeon R. Gray, Lahore.) "As a poultice, leaves are useful in unhealthy ulcers" (Surgeon A.C Mukerji, Noakhally)." While the bark and leaves act as an astringent, the ripe fruit is generally used as a good aperient" (Assistant Surgeon N.L. Ghose, Bankipore). " A decoction of the root bark, and of the young leaves, is a useful astringent in chronic diarrhoea complicated with dyspepsia. It may be specially recommended for charitable dispensary practice, because it can be obtained without cost in any part of Bengal" (Civil Surgeon S.M. Shircore, Murshedabad). " The young leaves with the bud of the pomegranate and babul leaves, given in the form of a cold infusion, are useful in diarrhoea of children. A decoction of the unripe fruit is used with benefit in the diarrhoea of adults" (Hospital Assistant Lal Mohamed, Hoshangabad) (Dictionary of The Economic Products of India, psidium, 353,)

Properties and Uses: Leaves are used as astringent for bowels, wounds and ulcers; decoction of leaves is used in cholera for arresting vomiting and diarrhoea and as a gargle in bleeding gums, flowers are used in bronchitis and eye sores, fruits are astringent, tonic, cooling and laxative, and used in colic, diarrhoea and dysentery. Root bark is astringent and used in diarrhoea. Mature fruits are commonly eaten as nutritious and source of vitamin 'C'. (Medicinal Plants of Bangladesh, Abdul Ghani, Second Edition).