Enteral nutrition has been found to be efficient to improve hemoglobin level in patients with inflammatory bowel disease, especially combined with erythropoietin. Microbiome
There is preliminary evidence of an infectious contribution to inflammatory bowel disease in some patients that may benefit from antibiotic therapy, such as with rifaximin. The evidence for a benefit of rifaximin is mostly limited to Crohns disease with less convincing evidence supporting use in ulcerative colitis.Fecal microbiota transplant is a relatively new treatment option for IBD which has attracted attention since 2010. Some preliminary studies have suggested benefits similar to those in Clostridium difficile infection but a review of use in IBD shows that FMT is safe, but of variable efficacy. A 2014 review stated that more randomized controlled trials were needed. Alternative medicine
Complementary and alternative medicine approaches have been used in inflammatory bowel disorders. Evidence from controlled studies of these therapies has been reviewed; risk of bias was quite heterogeneous. The best supportive evidence was found for herbal therapy, with Plantago ovata and curcumin in UC maintenance therapy, wormwood in CD, mind/body therapy and self-intervention in UC, and acupuncture in UC and CD. Novel approaches
Stem cell therapy is undergoing research as a possible treatment for IBD. A review of studies suggests a promising role, although there are substantial challenges, including cost and characterization of effects, which limit the current use in clinical practice. Psychological interventions
Currently, there is no evidence to recommend psychological treatment, such as psychotherapy, stress management and patients education, to all adults with IBD in general.
A biopsy of the retina and choroid layer may be performed. In affected liver, biopsy shows focal areas of necrosis and sinusoidal widening. H&E staining show extracellular frothy pink material. Typical cysts with a solid dark dot can be seen using a Grocott silver stain. Differential diagnosis
Pneumocystosis may appear similar to pulmonary embolism or adult respiratory distress syndrome. Other infections can present similarly such as tuberculosis, Legionella, and severe flu. Prevention
There is no vaccine that prevents pneumocystosis. Trimethoprim/sulfamethoxazole (co-trimoxazole) might be prescribed for people at high risk. Treatment
Treatment is usually with co-trimoxazole. Other options include pentamidine, dapsone and atovaquone. Outcomes
It is fatal in 10-20% of people with HIV/AIDS. Pneumocystosis in people without HIV/AIDS is frequently diagnosed late and the death rate is therefore higher; 30-50%. Epidemiology
The exact number of people in the world affected is not known. Pneumocystosis affects lungs in around 97% of cases and is often fatal without treatment. History
The first cases of pneumocystosis affecting lungs were described in premature infants in Europe following the Second World War. It was then known as plasma cellular interstitial pneumonitis of the newborn.Pneumocystis jirovecii (previously called Pneumocystis carinii) is named for Otto Jírovec, who first described it in 1952. == References ==