ABSTRACT
"Purple drank" is a dangerous hallucinogenic cocktail commonly used by teenagers, made popular by American rappers and social networks. It combines codeine-based cough syrup, antihistamines such as promethazine, and soda. Unknown by caregivers, it may be responsible for serious neuropsychological complications. We report the effects of this new risky behavior in three patients: a 14-year-old girl and her boyfriend, both found in an initial state of drowsiness, followed by hallucinations and anticholinergic toxidrome; and another teenager whose chronic use led to addiction with increasing doses. It is important to identify signs of such intoxication and to inform patients about the risks of respiratory depression, drowsiness, and delirium linked to acute medication misuse.
Subject(s)
Antitussive Agents/adverse effects , Beverages/adverse effects , Codeine/adverse effects , Histamine Antagonists/adverse effects , Opioid-Related Disorders/complications , Adolescent , Anticholinergic Syndrome/etiology , Female , Hallucinations/chemically induced , Humans , MaleABSTRACT
A number of previous studies have suggested that the fat emulsion, Intralipid, might compromise human host defenses, due mainly to impairment of neutrophil functions. The aim of this study was to evaluate the effects of Intralipid on neutrophil chemotaxis in cancer patients receiving total parenteral nutrition including 500 ml of 20% Intralipid over 6 hours (83 ml/hr). No impairment of neutrophil chemotaxis was found during or after lipid infusion. Further investigations are necessary to determine whether, in routine clinical practice, intralipids are responsible for impairment of other neutrophil functions and whether side treatments have a protective effect for neutrophil functions.
Subject(s)
Chemotaxis, Leukocyte/drug effects , Fat Emulsions, Intravenous/pharmacology , Parenteral Nutrition, Total , Colonic Neoplasms/therapy , Female , Granulocytes/drug effects , Humans , Leukocyte Count , Male , Middle Aged , Neutrophils/drug effects , Rectal Neoplasms/therapy , Triglycerides/bloodABSTRACT
AIM: Insulin allergy is a rare but serious and challenging condition in patients with type 1 diabetes (T1D). This is a case report of an 8-year-old boy with T1D and an allergy to insulin. CASE REPORT: Three months after being diagnosed with T1D, the patient developed progressive skin reactions to insulin, characterized by small 1.5-cm pruritic wheals at injection sites that persisted for several days. Seven months after diagnosis, he experienced two episodes of generalized urticaria with systemic symptoms that were seen within a few seconds of insulin injection. Examination revealed lipoatrophy of the thighs. Intradermal skin tests were positive for protamine, glargine and lispro. The patient was started on a continuous subcutaneous insulin infusion (CSII) tolerance induction protocol, consisting of a very low basal rate that was progressively increased, with the first bolus given under medical supervision, and was well tolerated for 4 months. After this period of time, the skin wheals reappeared, localized to the infusion sites, but without urticaria or any other generalized reactions. Intradermal skin tests were repeated and were again positive. Serum insulin-specific IgE measured 30 months after the first allergic reactions were positive. After 3 years, pump therapy is ongoing and blood glucose control has remained relatively good (HbA1c 7.6%). CONCLUSION: In T1D children with insulin allergy, CSII can successfully be used to both induce insulin tolerance and allow diabetes insulin therapy, although insulin desensitization cannot always be fully achieved. The induction protocol was easily manageable partly due to the "honeymoon" period that the patient was still in, but it should nonetheless be used even when the patient has higher insulin requirements.
Subject(s)
Diabetes Mellitus, Lipoatrophic/immunology , Diabetes Mellitus, Type 1/immunology , Drug Hypersensitivity/immunology , Hypoglycemic Agents/immunology , Infusions, Subcutaneous/adverse effects , Insulin/immunology , Blood Glucose , Child , Diabetes Mellitus, Lipoatrophic/drug therapy , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Drug Hypersensitivity/drug therapy , Humans , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/adverse effects , Insulin/administration & dosage , Insulin/adverse effects , Insulin Infusion Systems , Male , Thigh , Treatment Outcome , UrticariaSubject(s)
Drug Eruptions/etiology , Minocycline/adverse effects , Adolescent , Female , Humans , Male , Severity of Illness IndexSubject(s)
HIV Infections/therapy , Immunization, Passive , Immunoglobulins/administration & dosage , Mucocutaneous Lymph Node Syndrome/therapy , Purpura, Thrombocytopenic/therapy , Virus Diseases/therapy , HIV Infections/immunology , Humans , Injections, Intravenous , Mucocutaneous Lymph Node Syndrome/immunology , Purpura, Thrombocytopenic/immunology , Virus Diseases/immunologyABSTRACT
A 15 month old child with a history of multiple infectious diseases was admitted to hospital for investigation of pyrexia and general ill health. She was anaemic with a persistent neutropaenia associated with hypergamma globulinemia, indicating intense autoimmune activity: cellular immunity was abnormal with a normal total lymphocyte count but a very low T4/T8 ratio. HIV serology was positive; the virus was isolated from a lymph node biopsy specimen. The parents for the child were HIV positive and the father went on to develop full blown AIDS. The neutropaenia was constant over the two years of follow-up and granulo-immunofluorescence studies suggested an autoimmune origin. In contrast to autoimmune thrombocytopaenia and haemolytic anaemia, autoimmune neutropaenia is a rare condition. A few cases have been reported in adult AIDS. Our case is of additional interest as it illustrates the vertical mode of transmission of AIDS.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Agranulocytosis/etiology , Autoimmune Diseases/etiology , Neutropenia/etiology , Acquired Immunodeficiency Syndrome/immunology , Acquired Immunodeficiency Syndrome/transmission , Antibody Formation , Female , HIV Seropositivity/immunology , Humans , Immunity, Cellular , InfantABSTRACT
Epstein-Barr virus infection is one of the etiologies that should be discussed in patients with macrophage activation syndrome. We report a case that is consistent with this diagnosis. The role of the Epstein-Barr virus in the etiologic diagnosis of VAHS (virus-associated hemophagocytic syndrome) is specified. In pediatric patients with VAHS, the other causes of macrophage activation should also be discussed.
Subject(s)
Herpesviridae Infections/complications , Macrophage Activation , Child, Preschool , Female , Herpesvirus 4, Human , Humans , SyndromeABSTRACT
The aim of this study was to assess the efficacy and safety of teicoplanin in combination with other antimicrobial agents for therapy of severe suspected or proven Gram-positive infection in children and also to determine a dosage regimen for paediatric patients. Twenty children were given 23 courses of teicoplanin therapy for 11 septicaemias, one erysipelas, one cellulitis and 11 cases of fever of unknown origin. Eighteen of the 20 patients had severe underlying disease: one solid tumour, 15 acute lymphoblastic leukaemias, two acute myeloblastic leukaemias; 15 were neutropenic; 19 had a central line. Thirteen Gram-positive bacteria were isolated from the blood cultures in eleven patients. There were eight coagulase-negative staphylococci (CNS), (five methicillin-resistant) and four Staphylococcus aureus isolates. Teicoplanin was given as a 30 min infusion twice on the first day then once a day. The mean unit dose was 6 mg/kg for first eight patients. One clinical failure and lower serum concentrations than expected led us to increase the dosage to 10 mg/kg daily for the remaining patients. Tolerability remained excellent. It is concluded that antistaphylococcal treatment for febrile episodes in neutropenic patients can be satisfactorily provided by teicoplanin 10 mg/kg iv daily with a second loading dose on the first day. One injection a day is a convenient schedule in paediatrics.
Subject(s)
Agranulocytosis/complications , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Fever/drug therapy , Neutropenia/complications , Adolescent , Anti-Bacterial Agents/pharmacokinetics , Bacterial Infections/complications , Bacterial Infections/microbiology , Child , Drug Therapy, Combination , Female , Fever/etiology , Glycopeptides/pharmacokinetics , Glycopeptides/therapeutic use , Humans , Male , Neoplasms/complications , Sepsis/drug therapy , Staphylococcal Infections/drug therapy , Streptococcal Infections/drug therapy , Streptococcus agalactiae , TeicoplaninABSTRACT
The high incidence of bacterial super-infection in atopic individuals has long been known, especially in asthma and atopic dermatitis. In recurrent ENT infections in children, increased IgE levels are found in half the cases; this increase results from two main mechanisms: a predisposition to allergy (often with positive RASTs), and certain viral infections: respiratory syncytial virus, para-influenzae, and measles, that trigger production of partly non-specific serum IgEs. In the latter situation, the increased IgE levels are both a cause and a consequence of recurrent infections. More recently, in some forms of atopic dermatitis (infant and Buckley syndrome), attention has been drawn to the severity of viral superinfections (herpes, chickenpox, vaccine), which is directly correlated with the IgE levels. The mechanism of such infections is unclear: the local increase in IgE levels is responsible for degranulation of mastocytes which in turn results in edema, fissures of mucosae and congestion; an effect on the lymphocytic response is possible, with inhibition of the production of certain lymphokines, especially interleukins.
Subject(s)
Bacterial Infections/metabolism , Immunoglobulin E/metabolism , Otorhinolaryngologic Diseases/metabolism , Air Pollutants , Bacterial Infections/etiology , Child, Preschool , Female , Humans , Infant , Male , Otorhinolaryngologic Diseases/etiology , Prospective Studies , RecurrenceABSTRACT
Relapses of herpes simplex encephalitis (HSE) occurring after the completion of antiviral treatment have been reported repeatedly in children. The authors report data on six children who had at least one relapse of HSE. Two different mechanisms may account for these relapses, including viral replication or an immuno-inflammatory process, with different therapeutic attitudes. Relapses with viral replication may reveal host susceptibility to herpes simplex virus infection.