Many centres are shifting from ciprofloxacin to ceftriaxone as the first line for treating suspected typhoid originating in South America, India, Pakistan, Bangladesh, Thailand, or Vietnam. Also, it has been suggested that azithromycin is better at treating resistant typhoid than both fluoroquinolone drugs and ceftriaxone. Azithromycin can be taken by mouth and is less expensive than ceftriaxone, which is given by injection.A separate problem exists with laboratory testing for reduced susceptibility to ciprofloxacin; current recommendations are that isolates should be tested simultaneously against ciprofloxacin (CIP) and against nalidixic acid (NAL), that isolates sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin", and that isolates sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin". But an analysis of 271 isolates found that around 18% of isolates with a reduced susceptibility to fluoroquinolones, the class which CIP belongs (MIC 0.125–1.0 mg/L), would not be detected by this method. Epidemiology
In 2000, typhoid fever caused an estimated 21.7 million illnesses and 217,000 deaths. It occurs most often in children and young adults between 5 and 19 years old. In 2013, it resulted in about 161,000 deaths – down from 181,000 in 1990. Infants, children, and adolescents in south-central and Southeast Asia have the highest rates of typhoid. Outbreaks are also often reported in sub-Saharan Africa and Southeast Asia. In 2000, more than 90% of morbidity and mortality due to typhoid fever occurred in Asia.
Acne keloidalis nuchae (also known as "acne keloidalis", "dermatitis papillaris capillitii", "folliculitis keloidalis", "folliculitis keloidis nuchae", and "nuchal keloid acne": 526 ) is a destructive scarring folliculitis that occurs almost exclusively on the occipital scalp of people of African descent, primarily men.AKN is characterized by firm pink or flesh-colored hyperpigmented bumps in the skin, which are usually located on the back of the neck. This is mainly because men often cut their hair very low as opposed to women, allowing the hair to prick the occipital scalp thereby causing irritation. Acne keloidalis nuchae most commonly presents itself in individuals aged 13 to 25. The disease is closely related to pseudofolliculitis barbae and both occur frequently in black men in the military, where it is so common that the US Army has developed official protocols for management. Prolonged cases of AKN can cause keloid formation due to chronic irritation from folliculitis. Bacterial folliculitis and acne can mimic the appearance of AKN; however, unlike acne, comedones are not seen with AKN. Treatments for AKN aim to reduce inflammation and prevent infections and scarring. Therapies for AKN may include topical antibiotics, topical or intralesional corticosteroids, and laser hair removal. Recommended modifications to shaving habits include liberal use of shaving cream, avoidance of stretching the skin while shaving, and use of a single-blade razor rather than a razor with multiple blades. See also
List of cutaneous conditions

References


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