Amoxicillin is one of the commonly prescribed antibiotics. It belongs to the penicillin family. Unfortunately, some people develop an allergic reaction to penicillin. Amoxicillin, in particular, causes frequent allergic reaction than other antibiotics that belong to the penicillin family.

One of the common signs of allergic reaction is the formation of rashes. However, you need to know how to differentiate a typical rash and an allergic rash. ^{(1, 2, 3)}

Amoxicillin Rash Pictures

Image 1: A typical characteristic of amoxicillin rash on the patient’s back.
Picture Source: www.healthline.com

Picture 2: Rashes on the patient’s arm secondary to amoxicillin use.
Photo Source: www.hxbenefit.com

Photo 3: Amoxicillin rash on the patient’s face.
Image Source: usercontent2.hubstatic.com

The characteristics of amoxicillin rash

An allergic reaction to amoxicillin can be in the form of hives. What exactly are hives? They are raised and itchy bumps that can be white to red in color. If you notice hives after a dose of amoxicillin, then they’re definitely an allergy to amoxicillin.

Another type of rash is maculopapular rash, which could appear later on. The typical characteristics are red and flat patches on the skin. It usually occur several days after taking amoxicillin. The rash typically appears in a symmetrical fashion and usually affects the trunk. The rashes can spread to other parts of the body such as the arms, legs, and face. ^{(3, 4, 5)}

Image 4: Amoxicillin rash all over the infant’s body more prominently on the trunk and inner thighs.
Picture Source: 3.bp.blogspot.com

Picture 5: A severe allergic reaction to amoxicillin with blister formation.
Photo Source: infectionnet.org

How long does the amoxicillin rash last?

The rash usually develops on the third day after taking amoxicillin. However, rash of the rash, especially maculopapular rash can appear later, usually 10 to 15 days after taking amoxicillin. The rashes could last for three to seven days depending on the patient’s respond to amoxicillin. ^{(3, 5)}

Is amoxicillin rash harmful?

The rash alone is not harmful but the allergic reaction, if not managed right away, could be potentially life-threatening. So, apart from the rashes, you need to be aware of other symptoms, especially symptoms that suggest a life-threatening situation such as swelling of the face, difficulty breathing, and the presence of wheezing sound.

Some patients complain of fever and chills, body ache, dizziness, flu-like symptoms, and nausea and vomiting. ^{(4, 5, 6)}

Who are prone to having amoxicillin rash?

Photo 6: An infant with a severe allergic reaction to amoxicillin.
Image Source: 4.bp.blogspot.com

Children are prone to having an allergic reaction to amoxicillin. However, the presence of rashes after taking amoxicillin does not always mean an allergic reaction. It could be that the body is slightly reacting to the drug and the rashes are not really a true allergy. According to the statistics, women are more likely to develop amoxicillin allergy than men.

The very first case of an allergic reaction to amoxicillin was in 1960 and it was children who are being treated for mono infection. As the years passed by, various modifications in the treatment were implemented. Amoxicillin is no longer used in the treatment of mono given that mono is a viral disease and not bacterial in nature. ^{(4, 5, 6, 7)}

Amoxicillin rash Treatment

How to get rid of amoxicillin rash?

For an allergic reaction to amoxicillin, the patient should immediately stop taking the drug and switch over to over the counter Benadryl to counteract the allergic reaction. It is also important to seek the advice of your doctor as soon as possible.

In most cases, treatment is no longer needed as the rash subsides as soon as you stop taking amoxicillin. If the rash is not causing any sort of discomfort, then there is really no need to take any measures to treat the rash. However, if the rashes get worst even if you stop taking amoxicillin, then it is an indicator that you need to see your doctor.

Any sort of discomfort warrants immediate medical attention such as the rash covers a large area of the body, becomes extremely itch, and develop into hives. The same thing goes for rashes that have been around for nearly a week without showing signs of improvement. ^{(5, 7, 8, 9)}

Treating amoxicillin rash at home

There are some home remedies that you can do to significantly get rid of amoxicillin rash and the discomfort it brings. They include the following:

• Drink plenty of water – You can somehow help the body get rid of rashes and toxins by simply drinking plenty of water. By hydrating the body, you are helping it clear the toxins from the bloodstream. At the same time, it also helps remove bacteria from the body, especially the one causing infection.
• Oatmeal bath – Oatmeal has long been used in the treatment of rashes and itching. If after taking amoxicillin, you started to have itchy rashes, then you need to immediately stop taking the drug and take an oatmeal bath. There are readily available pre-mixed oatmeal that you can dilute in warm water. Fill the tub with warm water and dilute a cup of oatmeal and soak in there for about 30 minutes. The warm water and the soothing effect of the oatmeal can help alleviate the discomfort and itching brought about by the rashes.
• Take antihistamines – If the rashes have been around for several days despite stopping the drug, then you definitely need to take antihistamines such as Benadryl. It will alleviate the discomfort and hastens the removal of rashes. ^{(1, 6, 9, 10)}

Although amoxicillin is helpful in the treatment of bacterial infection, there are some people who are highly sensitive to the drug. If you have any allergy to antibiotic before, then you need to inform your doctor right away. Tell to your doctor the kind of allergy you have to a certain medication so that the doctor can modify his/her treatment.

If you have stopped taking the drug and/or you are switched to another drug but the symptoms are still there, then you need to consult your doctor the soonest time possible. It could be an indication of a severe allergic reaction or a more serious underlying medical condition.

References:

1. https://www.healthline.com/health/parenting/amoxicillin-rash
2. http://www.md-health.com/Amoxicillin-Rash.html
3. https://www.hxbenefit.com/amoxicillin-rash.html
4. https://www.aboutkidshealth.ca/penicillinrash
5. http://www.portlandpediatric.com/panw-blog/health-news/rashes-on-amoxicillin-when-is-it-a-true-allergy
6. https://www.doctorshealthpress.com/general-health-articles/the-amoxicillin-rash-allergies-normal-side-effect/
7. https://www.summitmedicalgroup.com/library/pediatric_health/hhg_rash_ampicil/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362637/
9. https://www.healthdiseases.org/amoxicillin-rash/
10. https://diseasespictures.com/amoxicillin-rash-symptoms-causes-pictures-treatment/

What is hypokinesia?

It is the deterioration in the functions of the heart secondary to weakness in some parts of whole parts of the heart.

What is global hypokinesis?

It is a medical condition affecting one of the vital organs of the body, the heart. The condition is described as global because it affects every part of the heart including the arteries, ventricles, and tissue membranes.

It causes the heart to get weak leading to a variety of symptoms that can be felt all over the body. Global hypokinesis is a serious condition and by all means, should not be taken for granted. It usually results in heart failure and could eventually lead to a congestive heart failure. ^{(1, 2, 3)}

Image 1: The anatomical presentation of the human heart.
Picture Source: edc2.healthtap.com

Picture 2: A comparison imaging study of healthy left ventricle and poor left ventricle.
Photo Source: i.ytimg.com

Global hypokinesis symptoms

• Fluid retention – A weak heart cannot thoroughly and efficiently pump blood leading to a decreased blood flow to the kidneys. This leads to fluid retention problems such as bloating, edema, weight gain, and the need to pass urine frequently at night.
• Rapid heartbeat – The heart beats faster in an attempt to supply sufficient blood to the different parts of the body.
• Pulmonary congestion – The fluid goes back up in the lungs causing pulmonary-related issues such as a dry cough, presence of wheezing sound, and a feeling of running out of breath when performing simple physical activities.
• Generalized body weakness – Different parts of the body are not supplied with sufficient amount of blood leading to generalized body weakness, fatigue, lethargy, and dizziness. ^{(3, 4, 5, 6)}

Photo 3: A comparison image of a healthy heart and a heart with dilated cardiomyopathy.
Image Source: edc2.healthtap.com

Image 4: A sudden chest tightness should not be ignored as it can be a warning sign of a heart disease which could eventually lead to global hypokinesis.
Picture Source: medmum.com

What are the causes of global hypokinesis?

• Coronary artery disease – A heart disease that affects the arteries, specifically the one that supplies blood and oxygen to the heart. It is caused by a blockage in the artery or narrowing of the artery causing the heart to not receive all the essential nutrients it needs to function normally.
• Cardiomyopathy – Damage to the heart secondary to conditions not related to insufficient blood supply such as an illegal drug use, alcohol abuse, and/or underlying medical conditions.
• Cardiac system overload – If the patient is suffering from a multitude of medical conditions, especially the severe ones, there is a tendency that the heart becomes weak secondary to overloaded work. Examples are kidney-related diseases, congenital heart defects, valve-related diseases, thyroid diseases, high blood pressure, and diabetes mellitus.
• Previous cardiac arrest – A previous heart attack increases the chances of having global hypokinesis. Someone who has had a heart attack has a weak heart secondary to the damage to the heart structures.
• Genetics – Those who have a family history of a heart-related disease might also have global hypokinesis, especially if the person has sedentary lifestyle such as excessive drinking of alcoholic beverages, chronic tobacco smoking, illegal drug use, unhealthy eating habits, and the likes. ^{(3, 4, 6, 7)}

Global hypokinesis treatment

Is global hypokinesis curable? It is curable but the success rate depends on the severity of the patient’s condition. There is no single treatment approach. The patient should receive a holistic approach which includes careful monitoring, use of prescription medication, surgical procedures when deemed necessary and lifestyle modification.

Take a look at the following treatment approach based on the severity of the patient’s condition.

#1 – Mild global hypokinesis as well as those patients susceptible to having a heart failure

• Lifestyle modification such as quitting smoking, not taking any types and forms of illegal drugs, moderate alcohol use, and regular exercise.
• Prescription drugs such as beta-blockers and ACE inhibitors. ^{(5, 6, 7)}

#2 – Patients with systolic left ventricular dysfunction without prior heart failure symptoms and patients with heart-related conditions (valve disease, cardiomyopathy, and previous heart attack).

• Lifestyle modification.
• Use of prescription drugs such as ACE inhibitors and beta-blockers.
• Use of prescription aldosterone inhibitor drugs.
• Surgical repair and replacement of damaged parts of the heart such as the artery and/or valve.

#3 – Patients with systolic heart failure with relevant symptoms like restlessness, breathlessness, and fatigue.

• Lifestyle modification.
• Use of prescription drugs such as ACE inhibitors and beta-blockers.
• Use of prescription aldosterone inhibitor drugs.
• For chronic symptoms, digoxin and diuretics are prescribed.
• ICD use and/or cardiac resynchronization therapy such as placing the pacemaker.
• Restrict the intake of sodium and fluid.
• Strict weight monitoring. ^{(7, 8, 9)}

#4 – Patients with systolic heart failure and advanced persistent symptoms even after medical care

• Lifestyle modification.
• Use of prescription drugs such as ACE inhibitors and beta-blockers.
• Use of prescription aldosterone inhibitor drugs.
• For chronic symptoms, digoxin and diuretics are prescribed.
• ICD use and/or cardiac resynchronization therapy such as placing the pacemaker.
• Restrict the intake of sodium and fluid.
• Strict weight monitoring.
• Use of ventricular assist devices when needed.
• Intravenous inotropic drug administration.
• Heart transplant when necessary.
• Palliative/hospice care. ^{(6, 9, 10)}

What can you do to prevent global hypokinesis?

• Maintain a healthy lifestyle.
• Do not do things that can be extremely harmful to your health such as chronic smoking of tobacco, drinking alcoholic beverages, and illegal drug use.
• Keep your body fit and healthy by engaging in regular exercises.
• Keep your lipid profile to a healthy level. Make sure that your blood pressure is within the normal range. Limit the intake of bad cholesterol and increase the intake of healthy and nutritious foods such as fruits and vegetables.
• Maintain a healthy weight. If you are overweight or obese, you need to take active measures to lose some weight.
• If you have an existing medical condition that can trigger global hypokinesis, then you need to make it a point to manage it. Examples are diabetes, thyroid-related disease, and hypertension.
• If you have a family history of a heart-related disease, then the more you need to be extra careful with your health. ^{(1, 4, 9, 10)}

References:

1. http://medicaltreasure.com/global-hypokinesis/
2. https://doctordecides.com/what-is-global-hypokinesis/
3. https://www.medhelp.org/posts/Heart-Disease/mild-global-hypokinesis/show/1471777
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767210/
5. https://www.healthtap.com/topics/severe-global-hypokinesis
6. http://medmum.com/global-hypokinesis/
7. http://cds.ismrm.org/protected/09MProceedings/files/03747.pdf
8. https://www.healthboards.com/boards/heart-disorders/913591-cardiomyopathy-global-hypokinesis.html
9. http://www.valvereplacement.org/forums/forum/heart-talk/1480-global-hypokinesis
10. https://www.healthcentral.com/article/what-implication-dilated-global-hypokinesia-lv-grade-lv-diastolic-dysfunctin

What is a Fatal Familial Insomnia?

It is a rare genetic sleep disorder affecting the thalamus. The human brain is a powerful organ responsible for various bodily activities including emotions and sleep.

Why is it fatal? Fatal familial insomnia can lead to death within a year after the symptoms become noticeable. Some people can last for two years. It varies from one person to another. ^{(1, 2)}

Image 1: Fatal familial insomnia targets the thalamus part of the brain and affects the person’s sleep-wake cycle.
Picture Source: i.ytimg.com

Image 2: Fatal familial insomnia can lead to progressive deterioration and in a matter of months the patient could die.
Photo Source: www.medindia.net

What happens with fatal familial insomnia?

Fatal familial insomnia belongs to the prion group of diseases. Prior diseases mean that the brain contains a lot of misfolded prion proteins. Although rare, it can cause nerve cell degeneration in the brain. Of all diseases that belong in the prion category, the fatal familial insomnia is the rarest.

The thalamus part of the brain is the one affected. The thalamus is the one responsible for controlling the sleep-wake cycle. The thalamus is the relay center of the brain as it enables various parts of the brain to communicate well with each other. ^{(1, 2, 3)}

Symptoms

The symptoms of fatal familial insomnia usually start once a person reaches 32 years old, although there are reported cases of early symptoms in patients 18 years old. The age range is 18 to 72 years old.

• Progressive insomnia
• Weight loss
• Speech problems
• Lack of appetite
• Too low/too high body temperature
• Panic attack ⁽⁵⁾
• Phobia
• High blood pressure
• Excessive sweating and salivation
• Hyperventilation ⁽⁴⁾
• Erectile dysfunction
• Ataxia (uncoordinated movements)
• Delirium (severe confusion)
• Hallucinations
• Myoclonus (muscle twitching and jerking)
• Problems with walking and talking
• Dementia ⁽³⁾

The presentation of symptoms is divided into four stages:

1. Insomnia phase – The patient is unable to sleep soundly at night. An abnormal sleep pattern can lead to a feeling of discomfort, paranoia, panic attack, and phobia, which could last for three to four months.
2. Hallucination phase – The patient tends to see, hear, and smell things which are not really there. As hallucination becomes intense, panic attack becomes imminent.
3. Progressive insomnia – The patient finds it extremely difficult to sleep as the hallucination and discomfort get severe. Activities of daily living are affected and the patient can’t even eat normally which leads to rapid weight loss.
4. Dementia – In this phase, the patient becomes unresponsive to stimuli. Once the patient is already in this phase, it indicates that the patient is nearing death. ^{(4, 5, 6, 8)}

What causes fatal familial insomnia?

Fatal familial insomnia is caused by a mutation in the PRNP gene and it can be passed on to the offspring. The mutation of genes affects the thalamus area of the brain.

As time passes by, the thalamus loses nerve cells leading to a variety of symptoms like the ones mentioned above. Fatal familial insomnia does not only affect the thalamus but also other areas of the brain like the inferior olives, a part of the medulla oblongata responsible for motor control.

In extremely rare cases, the PRPN gene in patients with fatal familial insomnia occurs without a family history at all. The condition is called new or de novo variant. The problem in the gene takes place during the formation of the egg or sperm. It is not an inherited type of fatal familial insomnia.

However, the parent with the de novo variant can still pass on the condition to his/her offspring. ^{(5, 7, 8)}

Epidemiology

In 1998, 25 families were reported to carry the genes for fatal familial insomnia. Those families belong to Italian, German, French, American, Japanese, Austrian, and British.

Photo 3: Neurologic images of a person with fatal familial insomnia.
Image Source: upload.wikimedia.org

Image 4: A sleep study is one of the tests used by doctors to detect the presence of fatal familial insomnia.
Picture Source: nosleeplessnights-o9omstpxiddhnwzt.stackpathdns.com

Diagnosis

There are some procedures the doctor will ask you to do to confirm the diagnosis of fatal familial insomnia.

• Sleep study – The doctor will ask you to note your sleeping habit. If possible, the doctor will conduct a sleep study wherein the doctor records the activity of the brain and heart while you are asleep.
• PET scan – It is done to check the functioning of the thalamus.
• Genetic testing – This test is only performed if you have a family history of fatal familial insomnia. The Genetic Testing Registry is the one that provides information about genetic testing for fatal familial insomnia. ^{(8, 9, 10)}

Treatment and Cure

Unfortunately, there is no cure for fatal familial insomnia. As a matter of fact, there are no remedies that can slow down the progression of the disease. What the medical team can do is to offer supportive management. They treat the symptoms as they appear so as to keep the patient comfortable.

For insomnia, a sleep medication is prescribed to induce sleep. Various research studies are currently made to find cure and prevention for fatal familial insomnia. An animal study suggests that immunotherapy can help but is to be tested in human first. The use of antibiotic like doxycycline is also currently investigated as some researchers suggest that it can help in the prevention of fatal familial insomnia. ^{(2, 5, 8, 10)}

Talk to a healthcare professional

If fatal familial insomnia runs in your family or you are suspecting that you have one, then the best thing to do is to consult a doctor who has a vast experience in dealing with fatal familial insomnia and other conditions that belong to the prion category. Only a few doctors handle cases that have something to do with the prion disease category.

If you can’t find one, then try contacting national specialist as they might recommend someone for you. ^{(1, 4, 5)}

What is the prognosis?

Until a treatment becomes available, the prognosis remains poor. The patient could eventually die within 12 months to 18 months after the symptoms appear. Research and studies are still ongoing to find cure and remedy for fatal familial insomnia.

Hopefully, the current research and studies could lead to the formulation of treatment and prevention of fatal familial insomnia. ^{(5, 7)}

References:

1. https://en.wikipedia.org/wiki/Fatal_insomnia
2. https://rarediseases.info.nih.gov/diseases/6429/fatal-familial-insomnia
3. https://www.msdmanuals.com/en-kr/home/brain,-spinal-cord,-and-nerve-disorders/prion-diseases/fatal-insomnia
4. https://www.healthline.com/health/fatal-familial-insomnia
5. https://medium.com/@arifakhtar/dying-to-sleep-the-waking-nightmare-of-fatal-familial-insomnia-874126b43c3a
6. https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=466
7. https://www.nejm.org/doi/full/10.1056/NEJM199202133260704
8. http://www.world-of-lucid-dreaming.com/fatal-familial-insomnia.html
9. https://www.sciencedirect.com/topics/neuroscience/fatal-familial-insomnia
10. https://gizmodo.com/fatal-familial-insomnia-the-brain-disease-that-stops-y-1695446513