ABSTRACT
We present this rare occurrence of a 17 yr old boy, a known case of congenital hypoparathyroidism, who presented with fever and jaundice for 8 days and 2 episodes of generalised tonic-clonic seizures. Premorbidly patient was on regular oral calcium supplementations with normal serum calcium levels. Investigations revealed severe hypocalcaemia (3.2 mg/dL), low 25 hydroxyvitamin D levels and hypomagnesaemia. The marked elevation of serum bilirubin was accompanied by derangement of liver enzymes. Microbiological investigations were confirmatory for both hepatitis A and typhoid fever. In spite of the aggressive management with intravenous calcium gluconate infusion, refractory hypocalcaemia persisted with recovery only after gradual decline in the bilirubin levels. We inferred that the cholestatic process produced by both acute viral hepatitis A and typhoid fever precipitated this state of refractory hypocalcaemia in the previously well preserved patient.
Subject(s)
Coinfection/diagnosis , Hepatitis A/diagnosis , Hypocalcemia/etiology , Hypoparathyroidism/complications , Typhoid Fever/diagnosis , Adolescent , Coinfection/complications , Hepatitis A/complications , Humans , Hypocalcemia/diagnosis , Hypocalcemia/microbiology , Hypoparathyroidism/congenital , Male , Typhoid Fever/complicationsABSTRACT
A young infant presented with a febrile respiratory illness, irritability, and failure to thrive. Clinical evaluation identified that he had profound hypovitaminosis D with severe hypocalcemia and active pulmonary tuberculosis. We review the literature and discuss the current state of knowledge of the interrelationship between Mycobacterium infection and vitamin D status, and its implication to pediatricians.
Subject(s)
Antitubercular Agents/administration & dosage , Hypocalcemia/blood , Mycobacterium tuberculosis/drug effects , Tuberculosis, Pulmonary/microbiology , Vitamin D Deficiency/blood , Vitamin D/metabolism , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Antitubercular Agents/therapeutic use , Humans , Hypocalcemia/drug therapy , Hypocalcemia/ethnology , Hypocalcemia/microbiology , Hypocalcemia/pathology , Infant , Male , Mycobacterium tuberculosis/physiology , Sudan/ethnology , Tuberculosis, Pulmonary/blood , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/ethnology , Tuberculosis, Pulmonary/pathology , United States/epidemiology , Vitamin D/administration & dosage , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/ethnology , Vitamin D Deficiency/microbiology , Vitamin D Deficiency/pathologyABSTRACT
While chlamydial infections cause abortions in cattle, its role in other reproductive disorders is uncertain. This study identified the risk factors for chlamydial infection in herds with history of subfertility. We investigated the possible effects of coinfections, different metabolic parameters, abortion, ovarian cysts, pathological vaginal discharge, length of the open period, milk yield, housing conditions and age. In cows from 34 farms with elevated reproductive disorders, 41.5% had antibodies against chlamydia, while chlamydia antigen was detected in the vagina and uterus of 46.7%. A statistical relationship between seropositivity and antigen positivity was not found. Abortion (OR = 6.6) and loose housing (OR = 2.3) were risk factors for the presence of chlamydia antibodies. Furthermore, there were significant relationships between metabolic disorders and chlamydial infections. Increased levels of beta-hydroxybutaric acid (OR = 6.8) and hypocalcaemia (OR = 6.0) often accompanied chlamydia antigen in the vagina. Increased age (OR = 1.2) and pathological vaginal discharge (OR = 2.4) were identified as risk factors for chlamydia antigen in the vagina. The largest risk factor was for the association of ovarian cysts (OR = 21.5) with uterine antigen. In conclusion, chlamydial infection in dairy herd cows is best understood as a multifactorial disease.
Subject(s)
Antibodies, Bacterial/blood , Antigens, Bacterial/analysis , Cattle Diseases/microbiology , Chlamydia/immunology , Infertility, Female/veterinary , Uterus/microbiology , 3-Hydroxybutyric Acid/blood , Abortion, Veterinary/microbiology , Animals , Cattle , Female , Housing, Animal , Hypocalcemia/microbiology , Hypocalcemia/veterinary , Infertility, Female/microbiology , Logistic Models , Ovarian Cysts/microbiology , Ovarian Cysts/veterinary , Risk Factors , Vagina/microbiologyABSTRACT
AIM: To determine the incidence of hypocalcaemia in critically ill children with meningococcal disease. METHODS: In a prospective cohort study, 70 of 80 patients admitted consecutively with a clinical diagnosis of meningococcal disease to intensive care had measurements of total and ionised calcium on admission. Parathormone and calcitonin were measured in a proportion of the children. RESULTS: Total and ionised calcium concentrations were low in 70% of the children. There was a weak relation of calcium concentration to the volume of blood derived colloid which had been given, but a good relation to disease severity, where sicker children had lower calcium concentrations. Although the parathormone concentration was higher in children with lower calcium concentrations, some children had low ionised calcium concentrations, without an increase of parathormone concentration. Serum calcitonin concentration was not related to calcium concentrations. CONCLUSION: Hypocalcaemia is common in meningococcal disease.