Two Cases of Serotonin Syndrome After Bupropion Overdose Treated With Cyproheptadine.

BACKGROUND: Bupropion is not known to have direct serotonin agonism or inhibit serotonin reuptake. In spite of this, it has been implicated as a causative agent of serotonin syndrome. We highlight two cases of single-agent bupropion overdose that subsequently met the diagnosis of serotonin syndrome by the Hunter criteria, despite the absence of direct serotonergic agents. CASE 1: A 14-year-old boy intentionally ingested an estimated 30 bupropion 75-mg immediate-release tablets. He presented in status epilepticus, was intubated, and was placed on midazolam and fentanyl infusions. He developed tremor, ankle clonus, and agitation. He was administered cyproheptadine for presumed serotonin syndrome with temporal improvement in his symptoms. CASE 2: A 19-year-old woman intentionally ingested an estimated 53 bupropion 150-mg extended-release tablets. She had a seizure and required sedation and intubation. During her course, she developed hyperthermia, inducible clonus, and hyperreflexia. She was treated with cyproheptadine without temporal improvement of symptoms but improved the following day. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although bupropion is not known to be directly serotonergic, it has been implicated as the single causative agent after overdose. This may be due to an indirect increase in activity of serotonergic cells. In these cases, bupropion overdose resulted in a clinical presentation consistent with serotonin syndrome, with the first having a temporal improvement after treatment with cyproheptadine. Physicians need to be aware of the potential serotonergic activity of bupropion for accurate assessment and treatment of this dangerous condition.

THE OCCURRENCE OF PATHOGENS IN AN ENDANGERED POPULATION OF AMERICAN BADGERS (TAXIDEA TAXUS JACKSONI) IN ONTARIO, CANADA.

American badgers ( Taxidea taxus jacksoni) at the periphery of the species' range in Ontario, Canada, are listed as endangered because of an estimated population size of <200 mature individuals. The main threats faced by this population include habitat loss and road mortality. However, on 18 November 2013, a radio-implanted badger was found nonresponsive in an agricultural field with signs consistent with canine distemper virus infection, which was subsequently confirmed. This prompted our investigation into the occurrence of pathogens in this endangered carnivore to better quantify the level of risk infectious disease poses to population persistence. We examined serum samples from nine live-trapped individuals and 27 whole badger specimens submitted for postmortem examination. We found evidence of exposure to canine distemper virus, canine parvovirus, and leptospires. However, infection associated with disease was not the leading cause of mortality. Future research into the effects of disease on kit survival and a comprehensive understanding of disease severity and spread from reservoir populations (e.g., raccoons [ Procyon lotor ] and striped skunks [ Mephitis mephitis ]) to badgers will be of particular importance to the conservation of this endangered population.