Myalgia

Myalgia is a common clinical symptom of many patients especially in adults. The occurrence of muscular pain - Myalgia has predisposing factors such as viral infections, trauma or even conditions that are related to muscular dystrophy and dehydration. The identification of myalgia in association with other symptoms paves a clear diagnostic path to treat this disease.

Myalgia in some cases if untreated can be fatal as it is closely associated with the motor and sensory response of the patient. Consistent muscular weakness in a person can lead to a variety of medical complications. Myalgia associated with viral infections has to be treated immediately as it may interfere with day to day activities of the person. The etiologies related to myalgia can be of various types such as myopathy and myositis respectively. Fibromyalgia can lead to morbidity if not diagnosed and treated at an early stage. In many cases antimalarial drugs, corticosteroids have also been reported to cause myalgia. The most common group of drugs recommended for myalgia are analgesics such as acetaminophen.

Herpes Zoster Ophthalmicus

Herpes zoster ophthalmicus  HZO, also known as Ocular Shingles, is a painful dermatomal rash around the eye region and forehead caused by the reactivation of the Varicella Zoster Virus (VZV). It affects the trigeminal nerve of the ophthalmic division and eventually spreads to the other structures of the eye. The first division of the trigeminal nerve is the most common site for the development of acute herpes zoster.

Varicella-zoster virus manifests at two different stages in humans. At primary level the virus causes chicken pox after which it remains dormant for several years and reappears as herpes zoster later in the patient’s life. Aging, poor nutrition and low immunity are some of the risk factors that leads to the outbreak of Herpes zoster ophthalmic us (HZO).

Symptoms

HZO begins with flu-like symptoms including fever, Myalgia, and malaise for nearly a week. Typically, patients then develop tingling sensation and painful rash on the forehead and ocular symptoms such as eyelid edema; conjunctival, episcleral and circumcorneal conjunctival hyperemia; corneal edema and light sensitivity. All these symptoms are unilateral - occurring on one side of the face. 

Diagnosis

Herpes zoster ophthalmicus (HZO) is diagnosed clinically by mere observation of the symptoms. During a clinical visit, the ophthalmologist conducts a detailed examination of  visual acuity, visual fields, extra ocular movements, pupillary response, corneal function, Intraocular Pressure and anterior chamber. Doctor also makes a note of past history of chicken pox infection along with clinical examination. Viral culture, direct immunofluorescence assay, or Polymerase chain reaction (PCR) may also be used to confirm the diagnosis. Any signs of Hutchinson disease strongly indicates ocular complications such as inflammation and corneal denervation and forms the basis for diagnosis of herpes zoster ophthalmicus.

Treatment

Herpes zoster ophthalmicus is a medical emergency and should be treated promptly to avoid vision loss. The disease leads to many ocular conditions such as dermatitis, corneal pseudo-dendrites, uveitis, retinitis, and in rare cases it also causes cranial nerve palsies. Oral anti viral medicines like Acyclovir and Famcyclovir play a major role in treating herpes zoster ophthalmicus. Atropine eye drops are also prescribed to alleviate the painful symptoms. In case keratitis develops, Corticosteroid drops along with Cycloplegics (eye drops to induce ciliary muscle paralysis) may also be considered.

Bronchitis

Bronchitis is an inflammatory disease caused in the bronchi or airways of the lungs. It is one of the most commonly diagnosed inflammatory diseases of the lung. The exact description of bronchitis is the consistent onset of productive cough throughout the year at regular intervals. Exceptions for the occurrence of bronchitis include children and infants. In most cases, the diagnosis of bronchitis becomes a challenge as many other pulmonary diseases mimic the symptoms associated with bronchitis. The obstruction of large airways is the specific cause for bronchitis.

The etiologies associated with bronchitis are categorized as bacterial and viral origins. In many cases, the disease is caused by respiratory syncytial viruses, influenza viruses and adeno viruses. Bacterial agents such as Bordatella pertussis and Mycoplasma are causative agents for bronchitis. In these cases, the occurrence of purulent cough is not a significant diagnostic factor of Pneumonia.

Symptoms of bronchitis

The most frequent incidences of bronchitis are during the onset of winter season. This is because of the high volume of viral particles in the atmosphere which attack the host for their mode of survival during unfavorable conditions. Bronchitis can cause much discomfort as it weakens the infected person. Some of the common symptoms of bronchitis include dry cough leading to productive cough which contains greenish yellow phlegm, chest pain, breathlessness, Myalgia, fatigue and headache.

Diagnosis and Treatment of bronchitis

Bronchitis in many cases is self-limiting in origin. Most physicians recommend fluid intake and rest. The key to effective treatment for bronchitis lies in differentiating it from other diseases such as tuberculosis, carcinoma, mycotic infections of the lungs and asthma. Chest x- rays and blood tests are recommended to analyze the toxicity and the inflammation caused. Antibiotics are usually not recommended. However, in case of increased white blood cell count, patient is given intravenous fluids along with antibiotics.