RESUMO
AIM: To report hypoglycaemia, a life-threatening adverse event, associated with trimethoprim-sulfamethoxazole. A sulfonylurea-like effect, leading to insulin raise, was investigated. METHODS: Two cases of trimethoprim-sulfamethoxazole-associated hypoglycaemia in 2 patients with a diagnosis of new HIV-1-infection presenting with Pneumocystis jiroveci pneumonia are reported. The patients had no predisposing factors, such as renal or liver impairment, interfering with trimethoprim-sulfamethoxazole elimination, thus leading to hypoglycaemia. Insulin plasma levels were measured in both patients. RESULTS: Severe hypoglycaemia was associated with increased serum levels of insulin up to 84 microU/ml (normal values < 10 microU/ml). Continuous dextrose infusion was necessary, further suggesting the sulfonylurea-like effect of sulfamethoxazole. Interestingly, plasma levels of insulin progressively raised after trimethoprim-sulfamethoxazole administration. CONCLUSIONS: Only 18 cases of trimethoprim-sulfamethoxazole associated hypoglycaemia are reported in the literature. Hypoglycaemia is a life-threatening condition, likely underreported, to consider when trimethoprim-sulfamethoxazole administration is required, even in the absence of predisposing factors or other hypoglycaemic agents. Physician should bear in mind the potential trimethoprim-sulfamethoxazole-associated adverse event especially when prolonged treatments and elevated dosage are used.
Assuntos
Anti-Infecciosos/efeitos adversos , Glicemia/efeitos dos fármacos , Hipoglicemia/induzido quimicamente , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Feminino , Glucose/administração & dosagem , Humanos , Hipoglicemia/sangue , Hipoglicemia/tratamento farmacológico , Insulina/sangue , Masculino , Pneumocystis carinii/patogenicidade , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/microbiologia , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
The purpose of this study was to verify whether it is possible to use insulin glargine (Lantus) subcutaneously in patients receiving artificial nutrition (AN) and if the analogue is capable of obtaining and maintaining good glycaemic control without inducing hypoglycaemia. The sample considers 25 patients receiving AN, diagnosed diabetics and non-diabetics, who had previously been prescribed traditional insulin therapy. All were to be given subcutaneous insulin glargine at a dosage equal to the average of insulin/day administered in the preceding days spent receiving AN. Twenty-five consecutive patients, not stratified in any way, were judged eligible in the last six months of 2004 and first two months of 2005. Four out of these 25 could not be evaluated, either because they did not begin or complete the treatment with Lantus (3/4) or because the proper number of glycaemic tests were not carried out (1/4); 21/25 patients, 84% of the sample with a mean age of 68.7 years (range 46-91 years), finished the study and could be evaluated. The mean glycaemic values after treatment with glargine were already better on the second day, and on the seventh day the difference was statistically significant. No hypoglycaemia requiring medical intervention occurred. This study confirms the possibility of using insulin glargine in patients receiving AN with hyperglycaemia regardless of the type of nutrition and whether or not the patient is diabetic.
Assuntos
Nutrição Enteral , Hiperglicemia/terapia , Insulina/análogos & derivados , Apoio Nutricional , Idoso , Idoso de 80 Anos ou mais , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Índice de Massa Corporal , Índice Glicêmico , Humanos , Hiperglicemia/sangue , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Insulina Glargina , Insulina de Ação Prolongada , Pessoa de Meia-Idade , Nutrição Parenteral TotalRESUMO
To determine the risk of cohabitant HCV infection, we investigated the sera of 101 family members of 53 anti-HCV antibody positive chronic liver disease patients. Altogether 14.8% of the cohabitants were also anti-HCV antibody positive, compared to a prevalence of 1.4% in the general population. These results suggest that hepatitis-C-virus may spread by person-to-person infection.
Assuntos
Saúde da Família , Hepatite C/transmissão , Doença Crônica , Estudos de Avaliação como Assunto , Anticorpos Anti-Hepatite/sangue , Humanos , Hepatopatias/epidemiologiaRESUMO
Fulminant hepatitis by Epstein-Barr virus is a rare event which is predominantly due to primary infection. We report a rare case of fatal hepatic failure due to Epstein-Barr virus reactivation in a 19-year-old boy who was taking oral steroids. Transaminase peak and the fulminant course of the disease began soon after steroid interruption. Epstein-Barr virus reactivation was diagnosed on the basis of past clinical history of heterophile-positive infectious mononucleosis, a high titer of IgG anti Epstein-Barr virocapsidic antigen, slight elevation of anti-virocapsidic IgM, a high titer of anti-EA IgG antibodies and elevated viral load in serum measured by polymerase chain reaction. It is concluded that Epstein-Barr virus should be considered as a possible etiological agent of fulminant hepatitis.
Assuntos
Encefalopatia Hepática/complicações , Herpesvirus Humano 4/fisiologia , Ativação Viral , Administração Oral , Adulto , Artralgia/tratamento farmacológico , Evolução Fatal , Fadiga/complicações , Humanos , Icterícia/sangue , Icterícia/complicações , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Metilprednisolona/uso terapêuticoAssuntos
Achromobacter denitrificans/isolamento & purificação , Infecções por Bactérias Gram-Negativas/imunologia , Hospedeiro Imunocomprometido , Meningites Bacterianas/imunologia , Achromobacter denitrificans/efeitos dos fármacos , Adulto , Antibacterianos/uso terapêutico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Masculino , Meningites Bacterianas/tratamento farmacológico , Testes de Sensibilidade MicrobianaRESUMO
BACKGROUND: Human enterobiasis is usually mild. Occasionally, however, an "ectopic" disease may occur with a more severe course. Two rare cases of eosinophilic ileocolitis due to Enterobius vermicularis infection are reported here. CASE REPORTS: Case n degree 1 was 46 years old, presenting with fever and bloody diarrhoea. Blood eosinophilia was present. Stool microscopy demonstrated red blood cells and leukocytes. A 2 mm long worm with bilateral cervical wings was found in wet-mount preparations of faecal samples. The Scotch tape test was positive for Enterobius vermicularis eggs. Colon biopsy specimens showed massive eosinophilic infiltration and a typical pinworm section overlying the infiltrated mucosa. Case n degree 2 was a 24-year-old, anti-HIV negative homosexual, presenting with watery diarrhoea. Tests for malabsorption were negative. Three mm long adult male E. vermicularis were found on stool microscopy. Biopsy specimens from the colon showed eosinophilic infiltration. In both cases a 200 mg/day course of oral mebendazole eliminated the symptoms within 3 days. CONCLUSIONS: In these two cases the clinical presentation of enterobiasis was atypical. A common finding was the eosinophilic infiltration of bowel mucosa, although it is still uncertain whether the worm per se may induce mast cell degranulation and eosinophil activation. Nevertheless, the possibility of Enterobius vermicularis infection should be considered in the presence of eosinophilic ileocolitis.