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Sample records for agranulocytosis

  1. Pentazocine-induced agranulocytosis.

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    Sheehan, Meg; Hyland, Robert H; Norman, Conolly

    1984-01-01

    A 46-year-old man with pentazocine-induced agranulocytosis is described. In previously reported cases of a complete absence of mature neutrophils in the peripheral blood and bone marrow the patients had undergone marrow-depressing treatment with radiation and antineoplastic drugs. This case is unique in that the patient had complete agranulocytosis without predisposing factors.

  2. Late onset clozapine induced agranulocytosis

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    Rajmohan Velayudhan

    2014-01-01

    Full Text Available Agranulocytosis is defined as an absolute neutrophil count less than 100/mm 3 in association with infectious disease. The risk of agranulocytosis is 0.38% of all clozapine treated cases and there is a relatively lesser incidence in Indian population. The risk of clozapine-induced agranulocytosis and neutropenia is highest in the first 6 months and higher in the initial 18 months after the onset of treatment. There have been very few reports of neutropenia and agranulocytosis after this period. There have so far been no reports of late onset clozapine induced agranulocytosis has been reported from India. A case of late onset clozapine induced agranulocytosis with possible mechanism of the same is reported.

  3. Carbimazole-induced agranulocytosis

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    Anisha Mohan

    2015-01-01

    Full Text Available A 47 year old lady with hyperthyroidism for past 1½ years was initially on Carbimazole 20 mg orally then changed to 30 mg (during Hysterectomy but was taking 10 mg for last 1 year. She had intermittent fever with severe B/L bifrontal headache since 3 weeks. Routine investigations showed anaemia, neutropenia, leucopenia and CRP elevation. Peripheral smear showed normocytic normochromic anaemia with Rouleaux formation, leucopenia with 2% atypical cells and mild thrombocytosis. Widal test, RA factor (Rheumatoid factor test, Ig M (Immunoglobulin M dengue, Ig M Lepto, TORCH infections (Toxoplasmosis, Other (Syphilis, varicella-zoster, parvovirus B19, Cytomegalovirus and Herpes infections, ANA (Antinuclear antibody screen cANCA (Cytoplasmic antineutrophil cytoplasmic antibodies and pANCA (Perinuclear Anti-Neutrophil Cytoplasmic Antibodies tests were negative. Bone marrow aspiration showed normo to hypercellular marrow with 15% atypical cells and plasma cells. Multiple myeloma workup was done. Carbimazole was withheld. Conclusion: Drug induced agranulocytosis occurs with in 1-2 months of taking the antithyroid medication but onset delayed by 1½ year. De-challenge resulted normalization of blood parameters.

  4. Agranulocytosis after Metamizole Sodium Use

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    Eren Cagan

    2015-09-01

    Full Text Available Metamizole sodium (Novalgine is commonly used as an antipyretic, analgesic, and spasmolytic agent in some parts of the world and our country; however, it is banned in developed countries because of severe side effects. Here we present a case of a three-years- four- months-old girl who developed life-threatening agranulocytosis in his bone marrow after metamizole sodium use for fever, which resolved with granulocyte colony-stimulating factor therapy. [Cukurova Med J 2015; 40(3.000: 580-583

  5. A case of recurrent agranulocytosis due to levamisole.

    Science.gov (United States)

    Ittyachen, Abraham M; Jose, Mohan B; Benjamin, Jobin R

    2015-01-01

    Agranulocytosis is a rare complication of levamisole. We report a 22-year-old female who developed agranulocytosis due to levamisole. The patient initially presented with salmonellosis and agranulocytosis, and then she recovered with treatment. However, 2 months after discharge, she again presented with tonsillitis and agranulocytosis. This time the family revealed that she had been taking levamisole. Though Salmonella infection is a recognized cause of agranulocytosis, any patient presenting with repeated agranulocytosis after an initial recovery should make the clinician suspect another cause, especially drug-induced. A case of Salmonella infection where levamisole was an unsuspecting cause of agranulocytosis has not been described in indexed literature. Recurrent agranulocytosis due to repeated exposure to levamisole has also not been described. PMID:26600651

  6. A case of recurrent agranulocytosis due to levamisole

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    Abraham M Ittyachen

    2015-01-01

    Full Text Available Agranulocytosis is a rare complication of levamisole. We report a 22-year-old female who developed agranulocytosis due to levamisole. The patient initially presented with salmonellosis and agranulocytosis, and then she recovered with treatment. However, 2 months after discharge, she again presented with tonsillitis and agranulocytosis. This time the family revealed that she had been taking levamisole. Though Salmonella infection is a recognized cause of agranulocytosis, any patient presenting with repeated agranulocytosis after an initial recovery should make the clinician suspect another cause, especially drug-induced. A case of Salmonella infection where levamisole was an unsuspecting cause of agranulocytosis has not been described in indexed literature. Recurrent agranulocytosis due to repeated exposure to levamisole has also not been described.

  7. [Acute airway obstruction during chemotherapy-induced agranulocytosis with fever].

    Science.gov (United States)

    Vandenbos, F; Deswardt, Ph; Hyvernat, H; Burel-Vandenbos, F; Bernardin, G

    2006-02-01

    Acute airway obstruction caused by mucoid impaction can cause sometimes life-threatening respiratory distress. Bronchial plugging is usually observed in subjects with chronic diseases such as asthma, allergic bronchopulmonary aspergillosis, or cystic fibrosis. In children, it can be related to heart failure. Acute airway obstruction in a patient without a chronic respiratory disease is exceptional. We report the case of a patient who developed bronchial plugs obstructing the bronchi during a period of agranulocytosis induced by chemotherapy. The patient experienced acute respiratory distress with asphyxia. The plugs were composed of fibrin and required several fibroscopic procedures for clearance. To our knowledge, this is the first case report of acute airway obstruction by plugging during a period of agranulocytosis. PMID:16604039

  8. Toxic epidermal necrolysis and agranulocytosis: Rare adverse effects of ciprofloxacin

    OpenAIRE

    Upadya Gatha; Ruxana K

    2009-01-01

    Ciprofloxacin is one of the most commonly used antibacterial agents with relatively few side effects. Serious adverse reactions reported with ciprofloxacin are rare with an incidence of 0.6%. Recently we came across two rare adverse effects of ciprofloxacin, viz. toxic epidermal necrolysis and agranulocytosis. To our knowledge, a total of seven cases have been reported in the literature documenting an association between oral ciprofloxacin administration and toxic epidermal necrolysis....

  9. Agranulocytosis and hepatic toxicity with ticlopidine therapy: a case report

    OpenAIRE

    Previtera Antonino M; Pagani Rossella

    2010-01-01

    Abstract Introduction Ticlopidine is a platelet inhibitor used to prevent thrombosis in patients with cerebrovascular or coronary artery disease. The most common side effects are mild and transitory: diarrhea, dyspepsia, nausea and rashes. More serious, but less frequent, adverse effects are hematological dyscrasia and cholestatic hepatitis. We report a rare case of agranulocytosis associated with hepatic toxicity, probably related to the use of ticlopidine. Case presentation A 70-year-old Ca...

  10. Toxic epidermal necrolysis and agranulocytosis: Rare adverse effects of ciprofloxacin

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    Upadya Gatha

    2009-10-01

    Full Text Available Ciprofloxacin is one of the most commonly used antibacterial agents with relatively few side effects. Serious adverse reactions reported with ciprofloxacin are rare with an incidence of 0.6%. Recently we came across two rare adverse effects of ciprofloxacin, viz. toxic epidermal necrolysis and agranulocytosis. To our knowledge, a total of seven cases have been reported in the literature documenting an association between oral ciprofloxacin administration and toxic epidermal necrolysis. One case of granulocytopenia, four of pancytopenia and fifteen of leucopenia worldwide have been reported. With the use of ciprofloxacin becoming more and more widespread, these two rare but fatal complications of ciprofloxacin should be borne in mind.

  11. Agranulocytosis and hepatic toxicity with ticlopidine therapy: a case report

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    Previtera Antonino M

    2010-08-01

    Full Text Available Abstract Introduction Ticlopidine is a platelet inhibitor used to prevent thrombosis in patients with cerebrovascular or coronary artery disease. The most common side effects are mild and transitory: diarrhea, dyspepsia, nausea and rashes. More serious, but less frequent, adverse effects are hematological dyscrasia and cholestatic hepatitis. We report a rare case of agranulocytosis associated with hepatic toxicity, probably related to the use of ticlopidine. Case presentation A 70-year-old Caucasian woman, with no previous history of hematological or liver diseases, was treated with ticlopidine 250 mg twice daily immediately after a vertebrobasilar stroke. Upon admission, her blood tests were normal. About four weeks later she developed agranulocytosis and hepatic toxicity. Ticlopidine was discontinued immediately, and aspirin 25 mg and dipyridamole 200 mg were given twice daily. She was treated with hematopoietic growth factors (granulocyte colony stimulating factor, with a rapidly increased white blood count and progressive normalization of liver tests as a result. Conclusion In the first three months following initiation of ticlopidine therapy, regular monitoring of complete blood cell count and of liver function tests is essential for the early detection of serious and unpredictable side effects.

  12. Failure of filgrastim to prevent severe clozapine-induced agranulocytosis.

    Science.gov (United States)

    Majczenko, Tricia G; Stewart, Jonathan T

    2008-06-01

    Although a highly effective medication, the usage of clozapine is limited mostly by its 2.7% incidence of neutropenia. It is often a treatment of last resort for patients with severe psychiatric illnesses, and therefore often the only medication to which a patient has responded. There has thus been a great deal of interest in ways to continue the medication in spite of emergent blood dyscrasias. There have been several reports documenting the successful continuation of clozapine in spite of neutropenia by adding granulocyte colony-stimulating factors such as filgrastim. This strategy was unsuccessful for a 63-year-old man, resulting in severe, prolonged agranulocytosis. Although a promising strategy for such refractory patients, its inherent dangers should not be underestimated. PMID:18475227

  13. THE APPLICATION OF HEMATOPOIETIC GROWTH-FACTORS IN DRUG-INDUCED AGRANULOCYTOSIS - A REVIEW OF 70 CASES

    NARCIS (Netherlands)

    SPRIKKELMAN, A; DEWOLF, JTM; VELLENGA, E

    1994-01-01

    Since 1989, granulocyte-macrophage and granulocyte colony-stimulating factors (GM-CSF, G-CSF) have been increasingly applied in the treatment of drug-induced agranulocytosis. In order to evaluate the effectiveness of GM-CSF and G-CSF in the treatment of drug-induced agranulocytosis, we have studied

  14. Agranulocytosis and acute coronary syndrom in apathetic hyperthyreoidism

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    Ivović Miomira

    2003-01-01

    Full Text Available INTRODUCTION Tissue expose to excessive levels of circulating thyroid hormones results in thyrotoxicosis. In most cases, thyrotoxicosis is due to hyper-activity of the thyroid gland. Cardiovascular and myopathic manifestations are predominant clinical features in most hyperthyroid patients, aged 60 years and older. Some of patients have apathetic hyperthyreoidism which presents with weight loss, small goiter, severe depression and without clinical features of increased sympathetic activity [3, 6]. About 50% of patients with cardiovascular manifestations have no evidence of underlying heart disease. Cardiac problems resolve when euthyreoid state is established [3]. Three treatment modalities are available in hyperthyreodism, namely medicament therapy, surgery and radioactive iodine. Antithyroid drug therapy complications, can be mild such as rash, which is managed without cessation of therapy by antihistamines administration. On the other hand, very serious complications such as agranulocytosis, necessitate immediate discontinuation of the medication and appropriate treatment. Although extremely rear, it is life-threatening with highly variable recovery time. CASE REPORT A 62-year-old woman with recurrent hyperthyroidism was admitted after treatment of agranu locytosis due to antithyroid drugs in another institution with G-CSF. The patient presented with clinical features of apathetic hyperthyroidism with extremely elevated thyroid hormone levels (total and free T4 and suppressed TSH. Radioactive iodine (5 mCi was administered after increased thyroid uptake was confirmed. Echocardiography on admission was normal. ECG revealed moderately inverted T waves in standard and V1, V2 precordial leads. Laboratory analysis revealed mild normocytic anemia with normal white blood cell count, hypokaliemia and normal concentration of creatine phosphokinase lactic dehidrogenase and mildly elevated aspartate transaminase in sera. Chest X-ray was consistent with

  15. Recombinant human granulocyte colony-stimulating factor (rhG-CSF; filgrastim) treatment of clozapine-induced agranulocytosis

    DEFF Research Database (Denmark)

    Nielsen, H

    1993-01-01

    After 10 weeks of treatment with clozapine, severe agranulocytosis was diagnosed in a 33-year-old female. The patient was treated with filgrastim (granulocyte colony-stimulating factor [G-CSF]) 5 micrograms kg-1 day-1. The neutrophil count was 0.234 x 10(9) l-1 on admission, with a further decrease...

  16. Clozapine-induced agranulocytosis is associated with rare HLA-DQB1 and HLA-B alleles

    DEFF Research Database (Denmark)

    Goldstein, Jacqueline I; Fredrik Jarskog, L; Hilliard, Chris;

    2014-01-01

    Clozapine is a particularly effective antipsychotic medication but its use is curtailed by the risk of clozapine-induced agranulocytosis/granulocytopenia (CIAG), a severe adverse drug reaction occurring in up to 1% of treated individuals. Identifying genetic risk factors for CIAG could enable saf...

  17. Agranulocitose e tonsilite associadas ao uso de metimazol Agranulocytosis with tonsillitis associated with methimazole therapy

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    Jorge T. Zambrana

    2005-06-01

    Full Text Available O tratamento do hipertireoidismo com drogas antitireoidianas pode provocar, em 0,2 a 0,3% dos casos, um importante efeito colateral: a agranulocitose. As complicações infecciosas decorrentes desta condição afetam principalmente a orofaringe, sendo a tonsilite uma de suas manifestações. No presente trabalho, é relatado o caso de uma paciente do sexo feminino, com 33 anos, apresentando odinofagia e febre resistentes à vários antibióticos. A paciente era portadora de hipertireoidismo e estava em uso de metimazol há dois meses. Com o diagnóstico de angina agranulocítica, foi suspensa a droga e iniciado tratamento com ciprofloxacina, sintomáticos e estimulador de colônias granulocíticas, além de fluconazol. A paciente evoluiu satisfatoriamente, recebendo alta dez dias após o início do tratamento. Quinze dias depois, uma tireoidectomia total foi realizada. O objetivo deste relato é ressaltar a importância de se conhecer os efeitos colaterais dos medicamentos, advertir os pacientes sobre os mesmos e alertar os médicos quanto à necessidade de se avaliar o paciente como um todo, investigando sobre outras doenças existentes e medicamentos em uso.The treatment of hyperthyroidism with antithyroid drugs can cause a significant side effect in 0.2 to 0.3% of the cases: agranulocytosis. Infectious complications caused by this condition affect mainly the throat, and tonsillitis is one of its manifestations. The present study reported the case of a female patient, 33 years old, manifesting odynophagia and fever resistant to many antibiotics. The patient showed hyperthyroidism and had been using methimazole for two months. With the diagnoses of agranulocytic angina, the drug was withdrawn and treatment with ciprofloxacin, symptomatic drugs and granulocytic-colony stimulator, besides fluconazol was started. The patient developed satisfactorily, being discharged ten days after the beginning of the treatment. Fifteen days later, total

  18. Exploring off-targets and off-systems for adverse drug reactions via chemical-protein interactome--clozapine-induced agranulocytosis as a case study.

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    Lun Yang

    2011-03-01

    Full Text Available In the era of personalized medical practice, understanding the genetic basis of patient-specific adverse drug reaction (ADR is a major challenge. Clozapine provides effective treatments for schizophrenia but its usage is limited because of life-threatening agranulocytosis. A recent high impact study showed the necessity of moving clozapine to a first line drug, thus identifying the biomarkers for drug-induced agranulocytosis has become important. Here we report a methodology termed as antithesis chemical-protein interactome (CPI, which utilizes the docking method to mimic the differences in the drug-protein interactions across a panel of human proteins. Using this method, we identified HSPA1A, a known susceptibility gene for CIA, to be the off-target of clozapine. Furthermore, the mRNA expression of HSPA1A-related genes (off-target associated systems was also found to be differentially expressed in clozapine treated leukemia cell line. Apart from identifying the CIA causal genes we identified several novel candidate genes which could be responsible for agranulocytosis. Proteins related to reactive oxygen clearance system, such as oxidoreductases and glutathione metabolite enzymes, were significantly enriched in the antithesis CPI. This methodology conducted a multi-dimensional analysis of drugs' perturbation to the biological system, investigating both the off-targets and the associated off-systems to explore the molecular basis of an adverse event or the new uses for old drugs.

  19. Clozapine-induced agranulocytosis is associated with rare HLA-DQB1 and HLA-B alleles

    Science.gov (United States)

    Goldstein, Jacqueline I; Jarskog, L Fredrik; Hilliard, Chris; Alfirevic, Ana; Duncan, Laramie; Fourches, Denis; Huang, Hailiang; Lek, Monkol; Neale, Benjamin M; Ripke, Stephan; Shianna, Kevin; Szatkiewicz, Jin P; Tropsha, Alexander; van den Oord, Edwin JCG; Cascorbi, Ingolf; Dettling, Michael; Gazit, Ephraim; Goff, Donald C; Holden, Arthur L; Kelly, Deanna L; Malhotra, Anil K; Nielsen, Jimmi; Pirmohamed, Munir; Rujescu, Dan; Werge, Thomas; Levy, Deborah L; Josiassen, Richard C; Kennedy, James L; Lieberman, Jeffrey A; Daly, Mark J; Sullivan, Patrick F

    2014-01-01

    Clozapine is a particularly effective antipsychotic medication but its use is curtailed by the risk of clozapine-induced agranulocytosis/granulocytopenia (CIAG), a severe adverse drug reaction occurring in up to 1% of treated individuals. Identifying genetic risk factors for CIAG could enable safer and more widespread use of clozapine. Here we perform the largest and most comprehensive genetic study of CIAG to date by interrogating 163 cases using genome-wide genotyping and whole-exome sequencing. We find that two loci in the major histocompatibility complex are independently associated with CIAG: a single amino acid in HLA-DQB1 (126Q) (P=4.7×10−14, odds ratio, OR=0.19, 95% CI 0.12–0.29) and an amino acid change in the extracellular binding pocket of HLA-B (158T) (P=6.4×10−10, OR=3.3, 95% CI 2.3–4.9). These associations dovetail with the roles of these genes in immunogenetic phenotypes and adverse drug responses for other medications, and provide insight into the pathophysiology of CIAG. PMID:25187353

  20. Clozapine-Induced Late Agranulocytosis and Severe Neutropenia Complicated with Streptococcus pneumonia, Venous Thromboembolism, and Allergic Vasculitis in Treatment-Resistant Female Psychosis

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    Christina Voulgari

    2015-01-01

    Full Text Available Clozapine is a second-generation antipsychotic agent from the benzodiazepine group indicated for treatment-resistant schizophrenia and other psychotic conditions. Using clozapine earlier on once a case appears to be refractory limits both social and personal morbidity of chronic psychosis. However treatment with second-generation antipsychotics is often complicated by adverse effects. We present a case of a 33-year-old Caucasian woman with a 25-year history of refractory psychotic mania after switching to a 2-year clozapine therapy. She presented clozapine-induced absolute neutropenia, agranulocytosis, which were complicated by Streptococcus pneumonia and sepsis. Clozapine-induced thromboembolism of the common femoral and right proximal iliac vein, as well as allergic vasculitis, was diagnosed. She achieved full remission on granulocyte-colony stimulating factor and specific antibiotic treatment. Early detection of severe clozapine-induced absolute neutropenia and agranulocytosis enabled the effective treatment of two among its most severe complications. Additional evidence to the previously reported possible causal relation between clozapine and venous thromboembolism is offered. Finally, clozapine-induced allergic vasculitis is confirmed as a late adverse effect of clozapine therapy.

  1. 药物性白细胞减少和粒细胞缺乏症临床分析%Clinical analysis of pharmacologic leukopenia and agranulocytosis

    Institute of Scientific and Technical Information of China (English)

    蔡成才

    2012-01-01

    目的 分析一组临床常用药物致白细胞减少和粒细胞缺乏的临床表现,提高对药物所致血液系统损害的认识,促进合理用药,提高临床用药安全性.方法 收集1990年1月至2010年12月经我院血液科诊治的66例药物性白细胞减少和粒细胞缺乏患者的临床资料进行回顾性分析.结果 66例药物性白细胞减少和粒细胞缺乏患者中,抗甲状腺功能亢进药所致者16例,占24.2%,抗菌药物9例,占13.6%;抗精神病药物9例,占13.6%;抗癫痫病药物9例,占13.6%;抗类风湿性关节炎药物6例,占9.1%;抗痛风药物4例,占6.1%;降糖药物3例,占4.5%;治疗系统性红斑狼疮皮肤损害的药物3例,占4.5%;治疗胃、十二指肠球部溃疡的药物2例,占3.0%;解热镇痛药物2例,占3.0%;预防乳腺癌根治术后复发的抗雌激素药物2例,占3.0%;口腔科治疗牙痛的中成药制剂1例,占1.5%.临床表现有:白细胞下降(54例,81.8%),粒细胞缺乏(12例,18.2%),骨髓造血功能停滞(3例,4.5%),高热(23例,34.8%),皮肤损害(10例,15.1%),继发各种感染(58例,89%),重症感染(10例,15.1%),感染性休克(3例,4.5%),真菌性败血症(2例,3%),肝功能衰竭(1例,1.5%),肾功能衰竭(1例,1.5%),死亡(3例,4.5%).结论 临床部分常用药物可致白细胞减少、粒细胞缺乏而继发各种感染,可导致病情急剧变化,甚至危及生命,所以要高度重视药物使用的安全性.%Objective By describing the clinical manifestation of a group of commonly used medicines causing pharmacologic leukopenia and agranulocytosis,obtain a better understanding of damage to the blood system by medicines,call attention to rational medication and increase the pharmic safety.Methods Retrospectively analyze the clinical data of the 66 patients of the Department of Hematology in my working hospital from January 1990 to December 2010.Results Among the 66 patients,ADR of 16(24.2

  2. 弥漫性毒性甲状腺肿患者白细胞减少/缺乏的机制及治疗%Pathogenesis and treatment of patients with Graves disease presenting with leucopenia or agranulocytosis

    Institute of Scientific and Technical Information of China (English)

    张荣金; 郝咏梅

    2016-01-01

    ABSTRACT:Graves disease is one of the most common endocrine diseases.Leucopenia or agranulocytosis can be coexistent with Graves'disease in some patients.It can be seen in patients before treatment and after anti-thyroid medication.This phenomenon is often delayed in clinical diagnosis and treatment,which sometimes causes serious infections and makes the disease worse.According to the research progress in the recent years,including the diagnosis, pathogenesis and treatment about the desease,the authors aim to show early discovery and timely treatment in patients with Graves’disease presenting with leucopenia or agranulocytosis.%弥漫性毒性甲状腺肿(Graves 病)是内分泌常见疾病,白细胞减少/缺乏是 Graves 病常见的合并症之一,可以发生在治疗之前和抗甲状腺药物治疗之后,在临床上经常被延误诊断和治疗,有时导致严重感染而使病情加重。本文就近几年来的研究进展,主要对其诊断、发病机制和治疗方面进行综述,着重论述临床如何早期发现与及时治疗。

  3. A clinical analysis of 361 cases of Graves disease combined with neutropenia or agranulocytosis%Graves 病合并粒细胞减少或缺乏361例临床分析

    Institute of Scientific and Technical Information of China (English)

    闫文博; 秦贵军

    2016-01-01

    Objective To explore the prevalence and the correlation factors of neutropenia or agranulocytosis in patients with Graves disease.Methods The clinical data of 361 patients diagnosed as Graves disease in General Hospital of Pingmei Shenma Medical Group from February of 201 0 to February of 201 5 were analyzed retrospectively.Results Among 361 patients,there were altogether 1 27 patients with neutropenia or agranulocytosis(35.1 8%),1 23 with neutropenia(34.07%),4 with agranulocy-tosis(1 .1 1 %).Among the 1 27 cases,72 (56.69%)were caused by Graves disease,and 55 were caused by antithyroid drugs (ATD)(43.31 %).Among neutropenia or agranulocytosis caused by Graves disease itself,the neutrophil count were negatively correlated with age,free triiodothyronine (FT3 ),free thyroxine(FT4 )and TSH receptor stimulation antibody(TSAb).Conclu-sion The incidence of neutropenia was relatively high in patients with Graves disease,and the neutropenia induced by Graves disease itself may be related with the degree of hyperthyroidism.%目的:探讨 Graves 病患者合并粒细胞减少或缺乏的发生率及相关因素。方法对平煤神马医疗集团总医院2010年2月至2015年2月收治的361例 Graves 患者的临床资料进行回顾性分析。结果361例 Graves 患者中,粒细胞减少或缺乏127例(35.18%):粒细胞减少123例(34.07%),粒细胞缺乏4例(1.11%)。其中 Graves 疾病本身导致者72例(56.69%),抗甲状腺药物(ATD)导致者55例(43.31%)。在 Graves 疾病本身所致的粒细胞减少或缺乏中,粒细胞计数与年龄、FT3、FT4、TSH 受体刺激性抗体(TSAb)呈负相关。结论Graves 病患者合并粒细胞减少的发生率较高,其疾病本身所导致的粒细胞减少可能与甲亢的病情程度相关。

  4. 白血病化疗后粒细胞缺乏伴真菌感染患者抗菌药物的应用研究%Study on use of antimicrobial drugs by leukemia patients complicated with agranulocytosis and fungal infections after chemotherapy

    Institute of Scientific and Technical Information of China (English)

    古力巴旦木·艾则孜; 袁海龙; 曹海洲; 陈刚; 曲建华

    2016-01-01

    目的 探讨白血病化疗后粒细胞缺乏伴真菌感染患者抗菌药物的应用,为临床白血病治疗提供药物治疗依据.方法 回顾性分析2013年8月-2014年10月医院收治的120例白血病化疗后粒细胞缺乏伴真菌感染患者临床资料;所有中性粒细胞<0.5×109/L患者均应用粒细胞集落刺激因子,白血病粒细胞缺乏伴发热患者首先经验性抗细菌治疗,直至获得准确的病原学培养结果 选用抗菌药物;对疑似真菌感染的患者,先给予氟康唑治疗5~12 d;拟诊或临床诊断以及确诊真菌感染后分层使用抗真菌药物;调查患者治疗后临床症状改善情况,采用SPSS 20.0软件对数据进行统计分析.结果 120例感染患者检出真菌以白色假丝酵母菌为主,占60.8%;经抗真菌药物治疗后治疗有效112例,有效率为93.3%;治疗24~48 h后体温下降,临床症状有所改善;患者应用粒细胞集落刺激因子3~5 d后,血白细胞升至1.0×109/L以上,中性粒细胞升至0.5×109/L以上;8例患者因感染性休克死亡,病死率6.7%;16例发生不良反应,发生率13.3%.结论 白血病患者化疗后粒细胞缺乏伴真菌感染患者,应根据病原菌鉴定和药敏试验的结果 合理选择抗菌药物,并对真菌感染患者采用预防性抗真菌治疗.%OBJECTIVE To explore the use of antibiotics by leukemia patients complicated with agranulocytosis and fungal infections after chemotherapy so as to provide guidance for drug therapy .METHODS The clinical data of 120 leukemia patients complicated with agranulocytosis and fungal infections after chemotherapy who were treated in the hospital from Aug 2013 to Oct 2014 were retrospectively analyzed .The patients with neutrophils counts less than 0 .5 × 109/L were treated with granulocyte colony stimulating factors ,the leukemia agranulocytosis patients complicated with fever were firstly given the empirical antibacterial treatment and then treated with antibiotics till the

  5. The nationwide case-cohort study in pharmacoepidemiology: a study of iatrogenic anaphylaxis and agranulocytosis

    NARCIS (Netherlands)

    M.M. van der Klauw (Melanie)

    1997-01-01

    textabstractDrug safety is an important palt of postmarketing surveillance. In ancient times, people were already aware of the fact that drugs could have side effects. The oldest drugs were mainly of plant and animal origin, but also mercury, arsenic and antimony were used, the toxic effects of whic

  6. Urinary Tract Infection (UTI) Caused by Fusarium proliferatum in an Agranulocytosis Patient and a Review of Published Reports.

    Science.gov (United States)

    Su, Huilin; Zhang, Qiangqiang; Li, Li; Zhao, Ying; Zhu, Junhao; Zhu, Min

    2016-02-01

    Infections caused by Fusarium species are increasing in frequency among immunocompromised hosts, but urinary tract infection (UTI) due to Fusarium proliferatum has not been reported in the literature so far. We describe a case of UTI caused by F. proliferatum in a 47-year-old man who was diagnosed with rectal cancer and metastasis. He underwent radical resection of rectal carcinoma and local resection of hepatic metastases. After the first adjuvant chemotherapy, the patient presented the obvious high fever, severely diarrhea and progressive decline of the white blood cell count. The direct microscopic examination of fungi in urine was positive, and the fungal cultures showed white, cotton-like colony. After the DNA sequencing, it was identified as F. proliferatum. We gave the patient itraconazole and other antibiotics to fight the infection. A month later, the temperature dropped to normal and the results of the direct microscopic examination and culture of fungi in urine turn negative. The itraconazole is effective against F. proliferatum.

  7. Itraconazole for secondary prophylaxis of invasive fungal infection in patients undergoing chemotherapy and stem cell transplantation

    Institute of Scientific and Technical Information of China (English)

    施继敏

    2013-01-01

    Objective To evaluate the efficacy and safety of itraconazole for secondary prophylaxis of previous proven or probable invasive fungal infection (IFI) in patients undergoing chemotherapy or allogeneic hematopoietic stem cell transplantation (HSCT) in agranulocytosis state.

  8. Omeprazole-induced Blood Dyscrasia in a Clozapine-treated Patient

    OpenAIRE

    Philipps, Robert J.; Lee Demler, Tammie; Lee, Claudia

    2012-01-01

    Proton pump inhibitors are among the world’s most widely used therapeutic classes. Much of their use is attributed to their documented efficacy and apparent safety. For the most part, proton pump inhibitors are well tolerated with very few serious adverse events reported in the literature. Only a few previously identified case reports of severe neutropenia or agranulocytosis attributed to proton pump inhibitors use have been identified in the literature. However, agranulocytosis, neutropenia,...

  9. Respiratory failure caused by intrathoracic amoebiasis

    Directory of Open Access Journals (Sweden)

    Toshinobu Yokoyama

    2010-03-01

    Full Text Available Toshinobu Yokoyama1, Masashi Hirokawa1, Yutaka Imamura2, Hisamichi Aizawa11Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University, Japan; 2Department of Hematology, St. Mary’s Hospital, Kurume, JapanAbstract: A 41-year-old male was admitted to the hospital with symptoms of diarrhea, fever and rapidly progressive respiratory distress. A chest radiograph and computed tomography (CT of the chest and the abdomen showed a large amount of right pleural effusion and a large liver abscess. The patient was thus diagnosed to have amoebic colitis, amoebic liver abscess and amoebic empyema complicated with an HIV infection. The patient demonstrated agranulocytosis caused by the administration of trimethoprim-sulfamethoxazole. However, the administration of granulocyte colony-stimulating factor made it possible for the patient to successfully recover from agranulocytosis, and he thereafter demonstrated a good clinical course.Keywords: amebiasis, amoebic empyema, HIV, agranulocytosis, trimethoprim-sulfamethoxazole

  10. [Hyperthyroid and acute tonsillitis in a 23-year-old woman].

    Science.gov (United States)

    Beyer, G; Küster, I; Budde, C; Wilhelm, E; Hoene, A; Evert, K; Stracke, S; Friesecke, S; Mayerle, J; Steveling, A

    2016-07-01

    A 23-year-old woman with preexisting Graves' disease who received thiamazole treatment presented with fever, dysphagia, hyperthyroidism and leukopenia. With suspicion of thyreotoxicosis accompanied by drug-induced agranulocytosis she was successfully managed by plasmapheresis, G‑CSF administration and inhibition of periphereal conversion of thyroid hormones. In due course she underwent thyroidectomy. Thiamazole is frequently associated with drug-induced agranulocytosis. Long-term therapy with thiamazole requires critical evaluation and alternatives should be considered early. Plasmapheresis is an adequate treatment option to achieve normal thyroid hormonal status. PMID:27075316

  11. Beyond White Blood Cell Monitoring : Screening in the Initial Phase of Clozapine Therapy

    NARCIS (Netherlands)

    Cohen, Dan; Bogers, Jan P. A. M.; van Dijk, Daniel; Bakker, Bert; Schulte, Peter F. J.

    2012-01-01

    Objective: Clozapine is the preferred option for treatment-resistant schizophrenia. However, since 1975, clozapine has been known to cause agranulocytosis. In the clozapine screening guidelines, white blood cell count is mandatory. In the past 20 years, after its reintroduction, 3 other serious side

  12. Haematological toxicity of clozapine and some other drugs used in psychiatry

    NARCIS (Netherlands)

    Nooijen, Patty M. M.; Carvalho, Felix; Flanagan, Robert J.

    2011-01-01

    Objective To review recent work on the haematological toxicity of clozapine and some other drugs used in psychiatry concerning especially (i) the mechanism of antipsychotic-induced neutropenia/agranulocytosis, (ii) criteria for clozapine prescribing in benign ethnic neutropenia, (iii) options in the

  13. Meldingen van vermoedelijke bijwerkingen bij het Bureau Bijwerkingen Geneesmiddelen; onderzoeksactiviteiten in 1993

    NARCIS (Netherlands)

    Stricker, B H; Ottervanger, J P; van der Klauw, M M

    1994-01-01

    In 1993, the Netherlands Centre for Monitoring of Adverse Reactions to Drugs received 1585 reports of suspected adverse reactions. The most important reports concerned myocardial infarction due to sumatriptan, cholestatic hepatitis due to itraconazole, agranulocytosis due to trazodone and bleeding d

  14. 5 CFR 831.2207 - Partial deferred payment of the lump-sum credit if annuity commences after January 3, 1988, and...

    Science.gov (United States)

    2010-01-01

    ...) Separates involuntarily, other than for cause on charges of delinquency or misconduct, or (2) Has, at the...) Aortic stenosis (severe). (C) Class IV cardiac disease with congestive heart failure. (D) Respiratory... encephalopathy. (K) Cardiac aneurysm not amenable to surgical treatment. (L) Agranulocytosis. (M) Severe...

  15. Recombinant TSH and Lithium Overcomes Amiodarone-Induced Low Radioiodine Uptake in a Thyrotoxic Female

    OpenAIRE

    Laplano, Nestor Eric R.; Mercado-Asis, Leilani B.

    2012-01-01

    Introduction: Recombinant human thyroid-stimulating hormone(rhTSH) increases radioactive iodine uptake(RAIU) in selected populations, while lithium is used as an adjunct to radioactive iodine (RAI) therapy in Graves’ disease with low RAIU. In this report, both drugs used in combination, overcame low iodine-131 uptake in a Graves’ patient. Clinical Case: A 39-year old female with Graves’ disease, acquired thionamide-induced agranulocytosis, and severe hypokalemia, subsequently went into cardio...

  16. Development and Evaluation of a Generic HPLC-Tandem MS Screening Method for the Detection of Potential Biomarkers for Reactive Intermediates

    OpenAIRE

    Simon, Karoline

    2007-01-01

    Conjugation of reactive intermediates of drugs with proteins or DNA may result in toxic effects such as hepatotoxicity, agranulocytosis, allergies, tumors, etc. From 1975 to 1999, 2.9% of drugs were withdrawn from the market due to such severe adverse drug reactions. Thus, formation of chemically reactive intermediates is a widely discussed problem in drug development processes. Early detection of potentially toxic compounds is required for drug discovery and drug development. Conjugation of ...

  17. A study of toxicity and differential gene expression in murine liver following exposure to anti-malarial drugs: amodiaquine and sulphadoxine-pyrimethamine

    OpenAIRE

    Rath Srikanta; Singh Prabhat; Mishra Shrawan

    2011-01-01

    Abstract Background Amodiaquine (AQ) along with sulphadoxine-pyrimethamine (SP) offers effective and cheaper treatment against chloroquine-resistant falciparum malaria in many parts of sub-Saharan Africa. Considering the previous history of hepatitis, agranulocytosis and neutrocytopenia associated with AQ monotherapy, it becomes imperative to study the toxicity of co-administration of AQ and SP. In this study, toxicity and resulting global differential gene expression was analyzed following e...

  18. Dapsone and sulfapyridine.

    Science.gov (United States)

    Paniker, U; Levine, N

    2001-01-01

    Dapsone and sulfapyridine are structurally related compounds with anti-microbial and anti-inflammatory effects. Dapsone remains the most important drug for leprosy and is useful in the prophylaxis of Pneumocystis pneumonia in patients with HIV disease. The medical treatment of choice for dermatitis herpetiformis is dapsone; and sulfapyridine also can be used for those patients who are intolerant of dapsone. Other neutrophilic disorders also may respond to these drugs. Toxic side effects of both dapsone and sulfapyridine are mediated through the hydroxylamine metabolite. These include hemolysis, methemoglobinemia, and agranulocytosis. Careful monitoring for possible adverse reactions includes frequently performing complete blood counts and regular blood chemistry profile determinations.

  19. Clozapine-Induced Myocarditis: Is Mandatory Monitoring Warranted for Its Early Recognition?

    Directory of Open Access Journals (Sweden)

    T. A. Munshi

    2014-01-01

    Full Text Available Clozapine is an atypical antipsychotic used for treatment resistant schizophrenia. Its potential to induce agranulocytosis is well known but it can also cause myocarditis. Clozapine is the only antipsychotic known to induce this side effect, typically early in the treatment, and literature is scarce on this condition. We are presenting a case report of a 21-year-old schizophrenic male who developed myocarditis within 3 weeks of starting on clozapine for his treatment resistant psychosis. We then aim to review some of the available literature and raise awareness among physicians as this condition can potentially be fatal if not detected early.

  20. Proportion of drug-related serious rare blood dyscrasias: estimates from the Berlin Case-Control Surveillance Study.

    Science.gov (United States)

    Andersohn, Frank; Bronder, Elisabeth; Klimpel, Andreas; Garbe, Edeltraut

    2004-11-01

    Drugs are an important cause of serious rare blood dyscrasias. To estimate the proportion of drug-related cases, we used data from the ongoing Berlin Case-Control Surveillance Study. The analysis included a total of 171 cases. The number of cases in which a drug etiology was assessed as at least "possible" was n = 29 (97%) for acute agranulocytosis, n = 4 (0.21%) for aplastic anemia, n = 8 (26%) for immune hemolytic anemia, n = 20 (25%) for immune thrombocytopenia, and n = 2 (20%) for thrombotic thrombocytopenic purpura/hemolytic uremic syndrome. Our analysis suggests that a substantial fraction of blood dyscrasias may be attributable to drug therapy. PMID:15495238

  1. Carbamazepine-induced Stevens Johnson syndrome: a case series of three case reports

    Directory of Open Access Journals (Sweden)

    Arvind Kumar

    2015-08-01

    Full Text Available Carbamazepine is an iminostilbene derivative that was initially used as an antiepileptic but has been used with increased frequency for different indications including chronic pain, trigeminal neuralgia, and herpetic neuralgias. This has resulted in increased incidence of carbamazepine related adverse effects such as nausea, vomiting, and serious hematological toxicities such as aplastic anemia, agranulocytosis, eosinophilia, lymphadenopathy, and splenomegaly. Life-threatening hypersensitivity reactions such as Steven Johnson syndrome (SJS and toxic epidermal necrolysis can also occur. We hereby present a series of three cases that were prescribed carbamazepine for different indications and presented with SJS. [Int J Basic Clin Pharmacol 2015; 4(4.000: 797-801

  2. Biological and haematological safety profile of oral amodiaquine and chloroquine in healthy volunteers with or without Plasmodium falciparum infection in northeast Tanzania

    DEFF Research Database (Denmark)

    Massaga, J J; Lusingu, J P; Makunde, R;

    2008-01-01

    -immune healthy adult male volunteers with and without malaria parasites. The objective was to collect data on biological and haematological safety, tolerability, and parasitological efficacy to serve as baseline in the evaluation of the effectiveness of AQ preventive intermittent treatment against malaria......Amodiaquine (AQ), an effective antimalarial drug for uncomplicated malaria, has been greatly restricted after cases of life-threatening agranulocytosis and hepatic toxicity during prophylactic use. We conducted a hospital based open-label randomised clinical trial in 40 indigenous semi...

  3. Antipsychotic drug-induced hematologic disorders

    Directory of Open Access Journals (Sweden)

    Theocharis Kyziridis

    2014-01-01

    Full Text Available Over half a century after the discovery of chlorpromazine and haloperidol, antipsychotic drugs showed a true evolutionary revolution. The knowledge of their adverse effects is of outmost importance as it may contribute to the prevention of unwanted sequelae, to the decrease of the duration and cost of hospitalization, it may improve the quality of life of patients, minimize the problems and maximize the therapeutic gain. Aim: The aim of this review was the presentation of the hematologic side-effects of antipsychotic drugs, and most particularly their frequency and association with the different classes of these drugs, their clinical picture and their pathophysiologic mechanisms. Material-method: This paper is a review of the literature (mainly articles from journals, PubMed, as well as books and monographs of the period 1978-2012. Key-words used included antipsychotics, hematologic adverse effects, drug-induced adverse effects. Results: Antipsychotic-drug induced hematologic side-effects are not particularly highly prevalent, while many of them are found in case reports. For this reason they have not drawn much of attention. These hematologic dyscrasias may concern all the blood cell series as well as the coagulation mechanism. Excluded from this rule is the case of clozapine-induced agranulocytosis, which demands increased clinical vigilance. In fact, agranulocytosis was the reason why the drug was drawn away from circulation approximately 35 years ago. Conclusions: In any case the appearance of a hematologic disorder in a patient receiving antipsychotic medications should prompt careful evaluation.

  4. [Successful second cord blood transplantation (CBT) for late graft failure associated with several immune disorders after the initial CBT in a patient with acute myeloid leukemia].

    Science.gov (United States)

    Mori, Minako; Yonezawa, Akihito; Kitagawa, Tomoya; Sasaki, Yuya; Onaka, Takashi; Imada, Kazunori

    2015-07-01

    A 64-year-old woman underwent reduced-intensity conditioning cord blood transplantation (RIC-CBT) for refractory acute myeloid leukemia (AML). A 6/6 antigen-level HLA-identical cord blood from a male infant was transfused. After successful engraftment with complete donor chimerism, the patient developed mixed chimera (XX 8.8%) on day 82. Tapering of tacrolimus was started on day 96. Bone marrow chimerism analysis showed a decreasing recipient cell population (XX 2.2%) on day 117 and tacrolimus was discontinued with no clinical signs of GVHD on day 123. However, pancytopenia with agranulocytosis was detected on day 138. She was diagnosed as having secondary graft failure associated with Coombs-positive immune hemolytic anemia and immune thrombocytopenia (ITP). At the same time, the percentage of recipient T cell chimerism in peripheral blood was about 50% and the B cell population showed lambda light chain restriction. On day 180, she received a second RIC-CBT due to lack of improvement of agranulocytosis. A single dose of rituximab was administered on day - 11 before the second CBT to eliminate the activated B cells. Prompt neutrophil engraftment was achieved and both hemolytic anemia and ITP also showed resolution. She is currently well (30 months after the second CBT), showing normal blood cell counts and complete second donor chimerism of marrow cells.

  5. Beneficial Effects of Lithium and Radioiodine Therapy in the Treatment of Hyperthyroidism

    Directory of Open Access Journals (Sweden)

    Wojciech Barud

    2014-09-01

    Full Text Available Intravenous contrast media used for coronary angiography are iodine-based and could induce thyroid gland dysfunction. We present the case of a 58-year-old woman with coronary artery disease who developed hyperthyroidism after percutaneus coronary intervention. Treatment with thiamazole induced agranulocytosis, complicated with severe tonsillitis. During recurrence of hyperthyroidism, after careful assessment of available methods of treatment, she was recommended to undergo radioiodine therapy (131I. The patient received lithium carbonate as pre-treatment. After 13 days of pre-treatment, patient received the therapeutic dose of 131I. Neither thyrotoxicosis progression nor acute coronary syndrome occurred. After 3 weeks, her thyroid hormones were found to be within normal ranges. Lithium therapy could be used as an effective treatment in patients who developed serious side-effects due to previous treatment with thionamides. Turk Jem 2014; 18: 92-94

  6. Autoimmune Cytopenias in Chronic Lymphocytic Leukemia

    Directory of Open Access Journals (Sweden)

    Giovanni D'Arena

    2013-01-01

    Full Text Available The clinical course of chronic lymphocytic leukemia (CLL may be complicated at any time by autoimmune phenomena.The most common ones are hematologic disorders, such as autoimmune hemolytic anemia (AIHA and immune thrombocytopenia (ITP. Pure red cell aplasia (PRCA and autoimmune agranulocytosis (AG are, indeed, more rarely seen. However, they are probably underestimated due to the possible misleading presence of cytopenias secondary to leukemic bone marrow involvement or to chemotherapy cytotoxicity. The source of autoantibodies is still uncertain, despite the most convincing data are in favor of the involvement of resting normal B-cells. In general, excluding the specific treatment of underlying CLL, the managementof these complications is not different from that of idiopathic autoimmune cytopenias or of those associated to other causes. Among different therapeutic approaches, monoclonal antibody rituximab, given alone or in combination, has shown to be very effective.

  7. Diagnosis of bone marrow lesions in the MR tomogram in children suffering from diseases of the haematopoietic system with special reference to post-therapy changes

    International Nuclear Information System (INIS)

    119 MR-examinations of both tibiae, knees and the lower part of both femura were performed in 41 children suffering from bone marrow disease (27 ALL, 4 AML, 3 NHL, 1 agranulocytosis, 6 anaemia). T1- and T2-spinecho sequences and a T2-gradientecho sequence were used. Bone marrow changes in leukaemia were diffuse before therapy and patchy after therapy. Due to their different signal in T2-weighted images, differentitation of the post-therapeutic patchy findings into infiltrations, fibrosis, necrosis and siderosis seems to be possible. In future, MRI will be the method of choice for screening and controlling bone marrow disease if the examination time is shortened by using only a T1-spinecho sequence and a T2-gradient-echo sequence. (orig.)

  8. Clozapine: A new revolt in treatment of Schizophrenia

    Directory of Open Access Journals (Sweden)

    Maleki H

    1994-04-01

    Full Text Available Clozapine is the first antipsycotic drug with a great efficacy. Thirty to fifty percent of treatment-resistant schizophrenics markedly improved with clozapine. Approximately, 25% of long-term patients, treated with clozapine, could be discharged. This improvement included negative as well as positive symptom areas. Clozapine produced no extrapyramidal side effects. Tardive dyskinesia, a major side effect of antipsychotics is not probably induced by the drug. Agranulocytosis that occurs in 1-2% of patients treated with clozapine is the most dangerous side effect with a high mortality rate. So, weekly monitoring of white blood cell count is necessary for safe and effective use of clozapine because fatal outcomes can be reduced and even completely prevented by the early detection of the reduction in white blood cell count. Clozapine offers considerable promise for better antipsychotic effect than currently available drugs, but its high cost causes substantial problems for patients with limited financial income

  9. Low back pain after a dental procedure: a case of Streptococcus viridans vertebral osteomyelitis.

    Science.gov (United States)

    Nazir, Salik; Lohani, Saroj; Tachamo, Niranjan; Rajagopalan, Priya

    2016-01-01

    Vertebral osteomyelitis due to Streptococcus viridans following a dental procedure is a rarely reported phenomenon. We discuss the case of a 67-year-old immunocompetent woman who presented with low back pain of 3 weeks duration associated with subjective fever and chills. On admission, the MRI of the lumbar spine showed L5-S1 vertebral osteomyelitis with associated paravertebral and epidural abscesses. Subsequently, detailed history was retaken and the patient reported having had a maxillary tooth extraction followed by a dental implant 2 months prior to the onset of her symptoms. Blood and abscess fluid cultures grew S. viridans Transthoracic echocardiogram showed no evidence of endocarditis. The patient was started on intravenous ceftriaxone but her treatment course was complicated by agranulocytosis requiring a switch to vancomycin. She required a total of 9 weeks of intravenous antibiotics for complete clinical cure. PMID:27268493

  10. Evidence for the use of pimavanserin in the treatment of Parkinson’s disease psychosis

    Science.gov (United States)

    Sarva, Harini; Henchcliffe, Claire

    2016-01-01

    Parkinson’s disease (PD) is a progressive neurodegenerative disorder with both motor and nonmotor symptoms (NMS), leading to significant morbidity and caregiver burden. Psychosis is common but is under recognized by physicians. When present, it increases the patient’s risk of hospitalization and nursing home placement and caregiver burden. Although the atypical antipsychotic agent, clozapine, has been considered the gold standard treatment, severe agranulocytosis in 0.38% of patients and more commonly milder leukopenia, resulting in frequent blood testing, limit its use. Pimavanserin, a 5HT2A receptor inverse agonist, has been shown to reduce psychosis in PD without worsening motor symptoms. It is therefore a welcome therapeutic option for this devastating NMS. PMID:27800022

  11. Invasive aspergillosis: results of multicenter study

    Directory of Open Access Journals (Sweden)

    N. N. Klimko

    2014-01-01

    Full Text Available We present the results of a multicenter study of 445 patients with “proven” and “probable” invasive aspergillosis (EORTC/MSG, 2008. Invasive aspergillosis usually occurs in patients with hematological malignancies (88 %, main underlying diseases were acute myeloid and acute lymphoblastic leukemia. The risk factors: prolonged agranulocytosis (64 %, cytostatic chemotherapy (57 %, corticosteroid treatment (45 %, and allogeneic hematopoietic stem cells transplantation (29 %. The pathogens – A. fumigatus (42 %, A. niger (33 %, and A. flavus (21 %. The main site of infection were lungs (86 %. 12 week overall survival was 83 %. Bronchoscopy use for the early diagnosis (p = 0.01, adequatetherapy with voriconazole (p = 0.002 and secondary antifungal prophylaxis (p = 0.0003 were positive prognostic factors for survival of patients with invasive aspergillosis.

  12. Invasive aspergillosis: results of multicenter study

    Directory of Open Access Journals (Sweden)

    N. N. Klimko

    2014-09-01

    Full Text Available We present the results of a multicenter study of 445 patients with “proven” and “probable” invasive aspergillosis (EORTC/MSG, 2008. Invasive aspergillosis usually occurs in patients with hematological malignancies (88 %, main underlying diseases were acute myeloid and acute lymphoblastic leukemia. The risk factors: prolonged agranulocytosis (64 %, cytostatic chemotherapy (57 %, corticosteroid treatment (45 %, and allogeneic hematopoietic stem cells transplantation (29 %. The pathogens – A. fumigatus (42 %, A. niger (33 %, and A. flavus (21 %. The main site of infection were lungs (86 %. 12 week overall survival was 83 %. Bronchoscopy use for the early diagnosis (p = 0.01, adequatetherapy with voriconazole (p = 0.002 and secondary antifungal prophylaxis (p = 0.0003 were positive prognostic factors for survival of patients with invasive aspergillosis.

  13. Hematological Side Effects of Atypical Antipsychotic Drugs

    Directory of Open Access Journals (Sweden)

    Serap Erdogan

    2009-10-01

    Full Text Available Atypical antipsychotics cause less frequently extrapyramidal system symptoms, neuroleptic malignant syndrome and hyperprolactinemia than typical antipsychotics. However hematological side effects such as leukopenia and neutropenia could occur during treatment with atypical antipsychotics. These side effects could lead to life threatening situations and the mortality rate due to drug related agranulocytosis is about 5-10%. There are several hypothesis describing the mechanisms underlying drug induced leukopenia and/or neutropenia such as direct toxic effects of these drugs upon the bone marrow or myeloid precursors, immunologic destruction of the granulocytes or supression of the granulopoiesis. Clozapine is the antipsychotic agent which has been most commonly associated with agranulocytosis. A nitrenium ion which is formed by the bioactivation of clozapine is thought to have an important role in the pathophysiogy of this adverse effect. Aside from clozapine, there are several case reports reporting an association between olanzapine, quetiapine, risperidone, ziprasidone, aripiprazole and leukopenia. We did not find any study or case report presenting amisulpride or sulpride related hematological side effects in our literature search. Patients who had hematological side effects during their previous antipsychotic drug treatments and who had lower baseline blood leukocyte counts, have higher risk to develop leukopenia or neutropenia during their current antipsychotic treatment. Once leukopenia and neutropenia develops, drugs thought to be responsible for this side effect should be discontinued or dosages should be lowered. In some cases iniatition of lithium or G-CSF (granulocyte colony-stimulating factor therapy may be helpful in normalizing blood cell counts. Clinicans should avoid any combination of drugs known to cause hematological side effects. Besides during antipsychotic treatment, infection symptoms such as fever, cough, sore throat or

  14. A Questionnaire-based Study of the Views of Schizophrenia Patients and Psychiatric Healthcare Professionals in Japan about the Side Effects of Clozapine

    Science.gov (United States)

    Takeuchi, Ippei; Hanya, Manako; Uno, Junji; Amano, Yuhei; Fukai, Keiko; Fujita, Kiyoshi; Kamei, Hiroyuki

    2016-01-01

    Objective It is well documented that clozapine treatment causes agranulocytosis, but it can also induce drowsiness, constipation, and hypersalivation; however, these symptoms are usually less severe. It has been reported that clozapine-treated patients with schizophrenia and psychiatric healthcare professionals consider different side effects to be important. The aim of this study was to assess current practice related to the side effects of clozapine in clozapine-treated patients with schizophrenia and psychiatric healthcare professionals in Japan. Methods Data were collected from January 2014 to August 2015 in Okehazama Hospital, Kakamigahara Hospital, and Numazu Chuo Hospital. Clozapine-treated patients with schizophrenia and psychiatric healthcare professionals (psychiatrists and pharmacists) were enrolled in this study. Results Of the 106 patients and 120 psychiatric healthcare professionals screened, 100 patients and 104 healthcare professionals were included in this study. We asked the patients what side effects caused them trouble and we asked psychiatric healthcare professionals what side effects caused them concern. The patients and psychiatrists held similarly positive views regarding the efficacy of clozapine. The healthcare professionals were concerned about agranulocytosis (92.4%), blood routines (61.3%). On the other hand, the patients experienced hypersalivation (76.0%), sleepiness (51.0%). A positive correlation (R=0.696) was found between patient satisfaction and DAI-10 score. Conclusion Patients experienced more problems than healthcare professionals expected. However, usage experience of clozapine healthcare professionals tended to have similar results to patients. It is necessary that all healthcare professionals fully understand the efficacy and potential side effects of clozapine. This is very important for promoting clozapine treatment in Japan. PMID:27489383

  15. Efficacy of voriconazole in treatment of invasive fungal infections in elderly patients with hematological malignancies%伏立康唑治疗老年恶性血液病侵袭性真菌感染疗效分析

    Institute of Scientific and Technical Information of China (English)

    陆敏秋; 白砚霞; 李真; 左杏果; 吴梦青; 石磊; 褚彬

    2012-01-01

    OBJECTIVE To clarify the efficacy of voriconazole for the invasive fungal infections (IFI) in the elderly patients with hematological malignancies and observe the adverse reactions. METHODS The clinical data of 50 elderly IFI patients with hematological malignancies who were treated with voriconazole from May 2007 to Dec 2011 were analyzed retrospectively. RESULTS There were 4 cases confirmed, 20 cases clinically diagnosed, and 26 cases suspected; there were 14 cases treated with initial therapy, 36 cases with rescue therapy; the total effective rate was 74. 0%, 4 confirmed cases were proven effective to voriconazok, the effective rate of the clinically . diagnosed cases was 70. 0 %, the suspected diagnosis group 73. 1 %; the effective rate of the initial therapy was 85. 7 % , the rescue therapy 89. 4 % ; the effective rate of the patients receiving intravenous injection was 76. 3 %, the patients treated with simple oral administration 66. 7% , the differences were not statistically significant; there were totally 10 patients infected with Aspergillus, 5 cases were effective and Aspergillus were eradicated. Agranulocytosis affected the efficacy of voriconazole, the response rate of agranulocytosis group was 58. 4% , lower than 88. 5% of the non-agranulocytosis group (P<0. 05) ; the abnormal liver function, visual impairment,and hallucination were the main adverse reactions, which disappeared as drugs were withdrawn, the renal toxicity and cardiac toxicity were not observed. CONCLUSION Voriconazole is effective and safe, as is applied for the treatment of invasive fungal infections in elderly patients with hematologic malignancies.%目的 探讨伏立康唑在老年恶性血液病侵袭性真菌感染患者中的临床疗效及不良反应.方法 对2007年5月-2011年12月的50例老年恶性血液病侵袭性真菌感染患者的临床资料进行回顾性分析.结果 确诊4例,临床诊断20例,拟诊26例;14例患者为初始治疗,36例患者为挽

  16. Research of Procalcitonin in Early Diagnosis of Infection in Breast Cancer Patients with Neutropenia after Chemotherapy%降钙素原早期诊断乳腺癌化疗后粒细胞减少伴感染的研究

    Institute of Scientific and Technical Information of China (English)

    郭满; 张浩; 李伟汉; 刘平贤; 杜新峰; 翟晓健

    2014-01-01

    目的:探讨降钙素原在乳腺癌化疗后粒细胞减少伴发热患者中的临床应用价值。方法:回顾性分析2008年3月-2012年9月本院收治的118例乳腺癌化疗后中性粒细胞减少伴发热患者临床资料,根据患者临床症状、体征、病原及影像学资料,将患者分为感染组和发热原因不详组,分析两组血清降钙素原水平差异及血清降钙素原水平与患者年龄、化疗方案、发热程度和粒细胞缺乏的关系。结果:感染组血清降钙素原水平明显高于发热原因不详组(P0.05)。结论:血清降钙素原水平对于乳腺癌化疗后中性粒细胞减少伴感染的早期诊断具有重要意义,且不受患者的年龄、化疗方案、发热程度和粒细胞水平影响。%Objective:To explore clinical value of procalcitonin in breast cancer patients with neutropenia associated with fever after chemotherapy. Method:The clinical data of 118 hospitalized patients with breast cancer associated with fever after chemotherapy from March 2008 to September 2012 were analyzed. The patients were divided into the infected group and the fever reasons unknown group according to clinical symptoms,signs,etiology. The relationship of serum procalcitonin levels were comparative analyzed between the two groups. The relationship of serum procalcitonin levels with age,chemotherapy scheme,heating degree and agranulocytosis levels were analyzed. Result:Serum procalcitonin levels in the infected group was significantly higher than the fever reasons unknown group(P0.05). Conclusion:Serum procalcitonin levels has a great significance for early diagnosis of infection in breast cancer patients with neutropenia associated with fever after chemotherapy,and it did not infected by patients age,chemotherapy scheme, heating degree and agranulocytosis levels.

  17. Genetic variants of GADD45A, GADD45B and MAPK14 predict platinum-based chemotherapy-induced toxicities in Chinese patients with non-small cell lung cancer

    Science.gov (United States)

    Jia, Ming; Zhu, Meiling; Wang, Mengyun; Sun, Menghong; Qian, Ji; Ding, Fei; Chang, Jianhua; Wei, Qingyi

    2016-01-01

    The JNK and P38α pathways play a crucial role in tissue homeostasis, apoptosis and autophagy under genotoxic stresses, but it is unclear whether single nucleotide polymorphisms (SNPs) of genes in these pathways play a role in platinum-based chemotherapy-induced toxicities in patients with advanced non-small cell lung cancer (NSCLC). We genotyped 11 selected, independent, potentially functional SNPs of nine genes in the JNK and P38α pathways in 689 patients with advanced NSCLC treated with platinum-combination chemotherapy regimens. Associations between these SNPs and chemotherapy toxicities were tested in a discovery group of 345 patients and then validated in a replication group of 344 patients. In both discovery and validation groups as well as their pooled analysis, carriers of GADD45B rs2024144T variant allele had a significantly higher risk for severe hematologic toxicity and carriers of MAPK14 rs3804451A variant allele had a significantly higher risk for both overall toxicity and gastrointestinal toxicity. In addition, carriers of GADD45A rs581000C had a lower risk of anemia, while carriers of GADD45B rs2024144T had a significantly higher risk for leukocytopenia or agranulocytosis. The present study provides evidence that genetic variants in genes involved in the JNK and P38α pathways may predict platinum-based chemotherapy toxicity outcomes in patients with advanced NSCLC. Larger studies of other patient populations are needed to validate our findings. PMID:26993769

  18. Chest x-ray findings of opportunistic infections

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yul; Jeon, Suk Chul; Lim, Jeong Ki; Park, Jae Hyung; Kim, Chu Wan [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1983-06-15

    The chest x-ray findings of 20 cases of pulmonary opportunistic infection were analyzed according to causative agents. The results were as follows: 1. Final diagnoses of 20 cases of opportunistic infections were tuberculosis in 6 cases, pneumocystis carinii pneumonia in 5 cases, bacterial infection in 7 cases, and fungal infection in 2 cases. 2. The underlying diseases were leukemia in 6 cases, kidney transplantation in 6 cases, lymphoma in 3 cases, nephrotic syndrome in 1 case, nasopharyngeal cancer in 1 case, multiple myeloma in 1 case, agranulocytosis in 1 case, and hypogammaglobulinemia in 1 case. 3. In tuberculosis, all the 6 cases showed severe manifestations such as military tuberculosis, tuberculous pneumonia, moderately advanced tuberculosis and tuberculous pericarditis. 4. In pneumocystis carinii pneumonia, the most frequent findings were bilateral alveolar densities and peripheral field of the lung was saved in most cases. 5. In 2 cases of fungal infections bilateral multiple cavity nodules were noted. 6. In cases of bacterial infection there was more cases of gram negative infection than gram positive and 2 cases of pseudomonas revealed bilateral multiple cavitary nodules.

  19. Blue gods, blue oil, and blue people.

    Science.gov (United States)

    Fairbanks, V F

    1994-09-01

    Studies of the composition of coal tar, which began in Prussia in 1834, profoundly affected the economies of Germany, Great Britain, India, and the rest of the world, as well as medicine and surgery. Such effects include the collapse of the profits of the British indigo monopoly, the growth in economic power of Germany based on coal tar chemistry, and an economic crisis in India that led to more humane tax laws and, ultimately, the independence of India and the end of the British Empire. Additional consequences were the development of antiseptic surgery and the synthesis of a wide variety of useful drugs that have eradicated infections and alleviated pain. Many of these drugs, particularly the commonly used analgesics, sulfonamides, sulfones, and local anesthetics, are derivatives of aniline, originally called "blue oil" or "kyanol." Some of these aniline derivatives, however, have also caused aplastic anemia, agranulocytosis, and methemoglobinemia (that is, "blue people"). Exposure to aniline drugs, particularly when two or three aniline drugs are taken concurrently, seems to be the commonest cause of methemoglobinemia today. PMID:8065194

  20. Chest x-ray findings of opportunistic infections

    International Nuclear Information System (INIS)

    The chest x-ray findings of 20 cases of pulmonary opportunistic infection were analyzed according to causative agents. The results were as follows: 1. Final diagnoses of 20 cases of opportunistic infections were tuberculosis in 6 cases, pneumocystis carinii pneumonia in 5 cases, bacterial infection in 7 cases, and fungal infection in 2 cases. 2. The underlying diseases were leukemia in 6 cases, kidney transplantation in 6 cases, lymphoma in 3 cases, nephrotic syndrome in 1 case, nasopharyngeal cancer in 1 case, multiple myeloma in 1 case, agranulocytosis in 1 case, and hypogammaglobulinemia in 1 case. 3. In tuberculosis, all the 6 cases showed severe manifestations such as military tuberculosis, tuberculous pneumonia, moderately advanced tuberculosis and tuberculous pericarditis. 4. In pneumocystis carinii pneumonia, the most frequent findings were bilateral alveolar densities and peripheral field of the lung was saved in most cases. 5. In 2 cases of fungal infections bilateral multiple cavity nodules were noted. 6. In cases of bacterial infection there was more cases of gram negative infection than gram positive and 2 cases of pseudomonas revealed bilateral multiple cavitary nodules

  1. Spontaneous hematologic recovery from bone marrow aplasia after accidental tenfold overdosage with radiophosphorus

    Energy Technology Data Exchange (ETDEWEB)

    Gmuer, J.; Bischof, B.; Coninx, S.; Bucher, U.; Poretti, G.; Henrichs, K.; Kaul, A.; Roedler, H.D.; Buettner, K.; Frick, P.G.

    1983-04-01

    Two patients with polycythemia vera received intravenously an accidental tenfold overdosage of radiophosphorus therapy (60 and 50 mCi 32P, respectively). In both patients, the occurrence of hemorrhagic complications 3 wk after the 32P medication led to detection of the error and referral to our hospital. Upon admission they showed an agranulocytosis, severe thrombocytopenia, and bone marrow aplasia. In both cases, spontaneous recovery of the hematopoiesis was observed from day 40 posttreatment onward. In one patient, a slow but ultimately complete normalization of blood counts and marrow morphology took place, whereas in the other, a mild thrombocytopenia persists. Nearly 5 yr after the accidental overdosage, both patients are clinically well. Symptoms of polycythemia vera have not reappeared up to now. Attempts were made to evaluate the radiation dose absorbed by the bone marrow. In the first patient, the daily 32P excretion was determined from day 22 to day 60, whereas in the other patient a whole body count was performed on day 78 after administration. From these results, an approximate cumulative bone marrow dose of 10 Sv (1000 rem) could be calculated.

  2. Antiepileptic drug hypersensitivity syndrome.

    Science.gov (United States)

    Schlienger, R G; Shear, N H

    1998-01-01

    The antiepileptic drug hypersensitivity syndrome (AHS) is an adverse drug reaction associated with the aromatic antiepileptic drugs (AEDs) phenytoin (PHT), carbamazepine (CBZ), phenobarbital (PB), and primidone. The syndrome is defined by the triad of fever, skin rash, and internal organ involvement. It can also be caused by other drugs, such as sulfonamides, dapsone, minocycline, terbinafine, azathioprine, and allopurinol. Diagnosis of AHS may be difficult because of the variety of clinical and laboratory abnormalities and manifestations and because the syndrome may mimic infectious, neoplastic, or collagen vascular disorders. The incidence is approximately 1 in 3,000 exposures. AHS starts with fever, rash, and lymphadenopathy, within the first 2-8 weeks after initiation of therapy. Internal manifestations include, among others, agranulocytosis, hepatitis, nephritis, and myostitis. AHS is associated with a relative excess of reactive oxidative metabolites of the AED. Insufficient detoxification may lead to cell death or contribute to the formation of antigen that triggers an immune reaction. Crossreactivity among PHT, CBZ, and PB is as high as 70-80%. PMID:9798755

  3. Drug hypersensitivity syndrome.

    Science.gov (United States)

    Kumari, Rashmi; Timshina, Dependra K; Thappa, Devinder Mohan

    2011-01-01

    Drug hypersensitivity syndrome (DHS) is an adverse drug reaction commonly associated with the aromatic antiepileptic drugs (AEDs), viz., phenytoin (PHT), carbamazepine (CBZ), phenobarbital (PB), lamotrigine, primidone, etc. It can also be caused by other drugs, such as sulfonamides, dapsone, minocycline, gold derivatives, cyclosporine, captopril, diltiazem, terbinafine, azathioprine and allopurinol. Diagnosis of DHS may be difficult because of the variety of clinical and laboratory abnormalities and manifestations and because the syndrome may mimic infectious, neoplastic or collagen vascular disorders. The risk for developing hypersensitivity within 60 days of the first or second prescription in new users of PHT or CBZ was estimated to be 2.3-4.5 per 10,000 and 1-4.1 per 10,000, respectively. The syndrome is defined by the fever, skin rash, lymphadenopathy and internal organ involvement within the first 2-8 weeks after initiation of therapy. Internal manifestations include, among others, agranulocytosis, hepatitis, nephritis and myositis. Insufficient detoxification may lead to cell death or contribute to the formation of antigen that triggers an immune reaction. Cross-reactivity among PHT, CBZ and PB is as high as 70%-80%. Management mainly includes immediate withdrawal of the culprit drug, symptomatic treatment and systemic steroids or immunoglobulins. PMID:21220873

  4. Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.

    Directory of Open Access Journals (Sweden)

    Claudia Gregoriano

    Full Text Available Literature regarding acute human toxicity of thiopurines is limited to a handful of case reports. Our objectives were to describe all cases of overdose with thiopurines reported to the Swiss Toxicological Information Centre between 1995-2013. A retrospective analysis was performed to determine circumstances, magnitude, management and outcome of overdose with these substances. A total of 40 cases (14 paediatric were reported (azathioprine, n = 35; 6-mercaptopurine, n = 5. Of these, 25 were with suicidal intent, 12 were accidental and 3 were iatrogenic errors. The magnitude of overdose ranged from 1.5 to 43 (median 8 times the usual dose in adults. Twelve cases (30% had attributable symptoms. The majority of these were minor and included gastrointestinal complaints and liver function test and blood count abnormalities. Symptoms were experienced by patients who took at least 1.5-times their usual daily thiopurine dose. Overdoses over two or more consecutive days, even if of modest size, were less well tolerated. One case of azathioprine and allopurinol co-ingestion over consecutive days led to agranulocytosis. Decontamination measures were undertaken in 11 cases (10 activated charcoal, 1 gastric lavage and these developed fewer symptoms than untreated patients. This study shows that acute overdoses with thiopurines have a favourable outcome in the majority of cases and provides preliminary evidence that gastrointestinal decontamination with activated charcoal may reduce symptom development after overdose of these substances if patients present to medical services soon after ingestion.

  5. Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.

    Science.gov (United States)

    Gregoriano, Claudia; Ceschi, Alessandro; Rauber-Lüthy, Christine; Kupferschmidt, Hugo; Banner, Nicholas R; Krähenbühl, Stephan; Taegtmeyer, Anne B

    2014-01-01

    Literature regarding acute human toxicity of thiopurines is limited to a handful of case reports. Our objectives were to describe all cases of overdose with thiopurines reported to the Swiss Toxicological Information Centre between 1995-2013. A retrospective analysis was performed to determine circumstances, magnitude, management and outcome of overdose with these substances. A total of 40 cases (14 paediatric) were reported (azathioprine, n = 35; 6-mercaptopurine, n = 5). Of these, 25 were with suicidal intent, 12 were accidental and 3 were iatrogenic errors. The magnitude of overdose ranged from 1.5 to 43 (median 8) times the usual dose in adults. Twelve cases (30%) had attributable symptoms. The majority of these were minor and included gastrointestinal complaints and liver function test and blood count abnormalities. Symptoms were experienced by patients who took at least 1.5-times their usual daily thiopurine dose. Overdoses over two or more consecutive days, even if of modest size, were less well tolerated. One case of azathioprine and allopurinol co-ingestion over consecutive days led to agranulocytosis. Decontamination measures were undertaken in 11 cases (10 activated charcoal, 1 gastric lavage) and these developed fewer symptoms than untreated patients. This study shows that acute overdoses with thiopurines have a favourable outcome in the majority of cases and provides preliminary evidence that gastrointestinal decontamination with activated charcoal may reduce symptom development after overdose of these substances if patients present to medical services soon after ingestion. PMID:24489721

  6. Drug hypersensitivity syndrome

    Directory of Open Access Journals (Sweden)

    Rashmi Kumari

    2011-01-01

    Full Text Available Drug hypersensitivity syndrome (DHS is an adverse drug reaction commonly associated with the aromatic antiepileptic drugs (AEDs, viz., phenytoin (PHT, carbamazepine (CBZ, phenobarbital (PB, lamotrigine, primidone, etc. It can also be caused by other drugs, such as sulfonamides, dapsone, minocycline, gold derivatives, cyclosporine, captopril, diltiazem, terbinafine, azathioprine and allopurinol. Diagnosis of DHS may be difficult because of the variety of clinical and laboratory abnormalities and manifestations and because the syndrome may mimic infectious, neoplastic or collagen vascular disorders. The risk for developing hypersensitivity within 60 days of the first or second prescription in new users of PHT or CBZ was estimated to be 2.3-4.5 per 10,000 and 1-4.1 per 10,000, respectively. The syndrome is defined by the fever, skin rash, lymphadenopathy and internal organ involvement within the first 2-8 weeks after initiation of therapy. Internal manifestations include, among others, agranulocytosis, hepatitis, nephritis and myositis. Insufficient detoxification may lead to cell death or contribute to the formation of antigen that triggers an immune reaction. Cross-reactivity among PHT, CBZ and PB is as high as 70%-80%. Management mainly includes immediate withdrawal of the culprit drug, symptomatic treatment and systemic steroids or immunoglobulins.

  7. Risks and benefits of rapid clozapine titration

    Directory of Open Access Journals (Sweden)

    Jeannie D. Lochhead

    2016-05-01

    Full Text Available Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response. This raises the question of whether, in some patients, it may be safe to use a more rapid clozapine titration. The following case illustrates the potential risks associated with the use of multiple antipsychotics and rapid clozapine titration. We present the case of a young man with schizophrenia who developed life threatening neuroleptic malignant syndrome (NMS during rapid clozapine titration and treatment with multiple antipsychotics. We were unable to find another case in the literature of NMS associated with rapid clozapine titration. This case is meant to urge clinicians to carefully evaluate the risks and benefits of rapid clozapine titration, and to encourage researchers to further evaluate the safety of rapid clozapine titration. Rapid clozapine titration has implications for decreasing health care costs associated with prolonged hospitalizations, and decreasing the emotional suffering associated with uncontrolled symptoms of psychosis. Clozapine is considered the most effective antipsychotic available thus efforts should focus on developing strategies that would allow for safest and most efficient use of clozapine to encourage its utilization for treatment resistance schizophrenia.

  8. Early diagnosis and successful treatment of disseminated toxoplasmosis after cord blood transplantation.

    Science.gov (United States)

    Kurihara, Taro; Sumi, Masahiko; Kaiume, Hiroko; Takeda, Wataru; Kirihara, Takehiko; Sato, Keijiro; Ueki, Toshimitsu; Hiroshima, Yuki; Ueno, Mayumi; Ichikawa, Naoaki; Kaneko, Yumi; Hikosaka, Kenji; Norose, Kazumi; Kobayashi, Hikaru

    2016-06-01

    A 66-year-old woman with refractory angioimmunoblastic T-cell lymphoma underwent cord blood transplantation. Prior to transplantation, a serological test for Toxoplasma gondii-specific IgG antibodies was positive. On day 96, she exhibited fever and dry cough. Chest CT showed diffuse centrilobular ground glass opacities in both lungs. The reactivation of T. gondii was identified by the presence of parasite DNA in peripheral blood and bronchoalveolar lavage fluid. Moreover, brain MRI revealed a space occupying lesion in the right occipital lobe. Therefore, disseminated toxoplasmosis was diagnosed. She received pyrimethamine and sulfadiazine from day 99. The lung and brain lesions both showed improvement but the PCR assay for T. gondii DNA in peripheral blood was positive on day 133. On day 146, she developed blurred vision and reduced visual acuity, and a tentative diagnosis of toxoplasmic retinochoroiditis was made based on ophthalmic examination results. As agranulocytosis developed on day 158, we decided to discontinue pyrimethamine and sulfadiazine and the treatment was thus switched to atovaquone. Moreover, we added spiramycin to atovaquone therapy from day 174, and her ocular condition gradually improved. In general, the prognosis of disseminated toxoplasmosis after hematopoietic stem cell transplantation (HSCT) is extremely poor. However, early diagnosis and treatment may contribute to improvement of the fundamentally dismal prognosis of disseminated toxoplasmosis after HSCT. PMID:27384853

  9. [Infection after dental intervention. Iatrogenic or general medical cause? Case report].

    Science.gov (United States)

    Gander, Thomas; Bingoel, Alperen Sabri; Mascolo, Luana; Grätz, Klaus W; Lübbers, Heinz-Theo

    2013-01-01

    Whenever a dentist is dealing with abscess formation in the oral and maxillofacial region, it is mostly from dental origins. However, sometimes uncommon (co-)factors are present and responsible for major complications. Many general conditions or medications can significantly influence the course of an inflammation. It might spread faster and wider and also be resistant to "correct" therapy. This case report should raise awareness about general conditions supporting inflammation and demonstrate the importance of interdisciplinary treatment in these situations. A 76-year-old patient was referred to the maxillofacial surgery clinic after extraction of two teeth resulted in therapy-resistant painful swelling. Her dentist already had initiated "standard" therapy including Ponstan® (mefenamic acid) and Clamoxyl® (amoxicillin) without success. Initial blood testing came back with severe agranulocytosis. Immediately all potentially myelosuppressing drugs were stopped while myelosupporting drugs were prescribed. Under close interdisciplinary treatment conditions, healing was then uneventful without the necessity of surgical intervention. The challenge in inflammation treatment is to identify patients with uncommonly severe, fast-progressing, or therapy-resistant disease as early as possible. Further examination including blood workup for several medical parameters is indispensable in those patients. PMID:23426587

  10. Expansion of polyclonal B-cell precursors in bone marrow from children treated for acute lymphoblastic leukemia.

    Science.gov (United States)

    Duval, M; Fenneteau, O; Cave, H; Gobillot, C; Rohrlich, P; Guidal, C; Lescoeur, B; Legac, S; Schlegel, N; Sterkers, G; Vilmer, E

    1997-06-01

    In a series of 12 patients (mean age: 3 years at diagnosis) receiving chemotherapy for acute lymphoblastic leukemia, bone marrow examinations performed during hematopoietic recovery following treatment-induced agranulocytosis or completion of maintenance treatment showed at least 15% of non malignant immature cells which were sometimes hardly distinguishable from leukemic cells. No comparable data was observed in patients treated with G-CSF. The cytological features of these cells as well as their immunophenotyping were defined. Results showed that the majority of cells expressed HLA-DR, CD19, CD10 and cytoplasmic IgM but not the CD34 markers. This predominant and homogeneous pre-B cell population which likely represents the expansion of a minor population detectable in normal bone marrow is phenotypically indistinguishable from leukemic cells. The pattern of IgH gene rearrangements studied by PCR amplification of the CDRIII region showed that these cells were polyclonal. Except in one patient, minimal residual disease was not detected using probes specific for IgH or TCR gene rearrangement of the malignant clone. In children during the hematopoietic recovery after chemotherapy, immature marrow cells in great numbers, even with an highly homogeneous immunophenotype identical to the malignant clone's, are not sufficient for the diagnosis of relapse.

  11. Proteomic profile of aminoglutethimide-induced apoptosis in HL-60 cells: Role of myeloperoxidase and arylamine free radicals.

    Science.gov (United States)

    Khan, Saifur R; Baghdasarian, Argishti; Nagar, Prarthna H; Fahlman, Richard; Jurasz, Paul; Michail, Karim; Aljuhani, Naif; Siraki, Arno G

    2015-09-01

    In this study, the cellular effects resulting from the metabolism of aminoglutethimide by myeloperoxidase were investigated. Human promyelocytic leukemia (HL-60) cells were treated with aminoglutethimide (AG), an arylamine drug that has a risk of adverse drug reactions, including drug-induced agranulocytosis. HL-60 cells contain abundant amounts of myeloperoxidase (MPO), a hemoprotein, which catalyzes one-electron oxidation of arylamines using H2O2 as a cofactor. Previous studies have shown that arylamine metabolism by MPO results in protein radical formation. The purpose of this study was to determine if pathways associated with a toxic response could be determined from conditions that produced protein radicals. Conditions for AG-induced protein radical formation (with minimal cytotoxicity) were optimized, and these conditions were used to carry out proteomic studies. We identified 43 proteins that were changed significantly upon AG treatment among which 18 were up-regulated and 25 were down-regulated. The quantitative proteomic data showed that AG peroxidative metabolism led to the down-regulation of critical anti-apoptotic proteins responsible for inhibiting the release of pro-apoptotic factors from the mitochondria as well as cytoskeletal proteins such as nuclear lamina. This overall pro-apoptotic response was confirmed with flow cytometry which demonstrated apoptosis to be the main mode of cell death, and this was attenuated by MPO inhibition. This response correlated with the intensity of AG-induced protein radical formation in HL-60 cells, which may play a role in cell death signaling mechanisms.

  12. Discovery and SAR of 6-alkyl-2,4-diaminopyrimidines as histamine H₄ receptor antagonists.

    Science.gov (United States)

    Savall, Brad M; Chavez, Frank; Tays, Kevin; Dunford, Paul J; Cowden, Jeffery M; Hack, Michael D; Wolin, Ronald L; Thurmond, Robin L; Edwards, James P

    2014-03-27

    This report discloses the discovery and SAR of a series of 6-alkyl-2-aminopyrimidine derived histamine H4 antagonists that led to the development of JNJ 39758979, which has been studied in phase II clinical trials in asthma and atopic dermatitis. Building on our SAR studies of saturated derivatives from the indole carboxamide series, typified by JNJ 7777120, and incorporating knowledge from the tricyclic pyrimidines led us to the 6-alkyl-2,4-diaminopyrimidine series. A focused medicinal chemistry effort delivered several 6-alkyl-2,4-diaminopyrimidines that behaved as antagonists at both the human and rodent H4 receptor. Further optimization led to a panel of antagonists that were profiled in animal models of inflammatory disease. On the basis of the preclinical profile and efficacy in several animal models, JNJ 39758979 was selected as a clinical candidate; however, further development was halted during phase II because of the observation of drug-induced agranulocytosis (DIAG) in two subjects. PMID:24495018

  13. Molecularly targeted therapy for Kaposi's sarcoma in a kidney transplant patient: case report, "what worked and what did not"

    Directory of Open Access Journals (Sweden)

    Correa-Rotter Ricardo

    2007-03-01

    Full Text Available Abstract Background Imatinib is a tyrosine-kinase inhibitor; for which there is limited information regarding its effects on AIDS Kaposi's sarcoma and none in patients with transplant-associated Kaposi's sarcoma. Sirolimus, an immunosuppressive drug used for kidney transplant, exhibits antiangiogenic activity related to impaired production of VEGF (vascular endothelial growth factor, clinical benefit has been reported in Kaposi's sarcoma associated with renal graft. Case Presentation Here we report a case of an 80 year old male, who developed Kaposi's Sarcoma nine months after receiving a living non-related donor kidney transplant at age 74. Three years after treatment with different chemotherapeutic agents for progressive cutaneous Kaposi's Sarcoma with no visceral involvement, he was prescribed Imatinib (200 mg/day for two weeks followed by 400 mg/day after four weeks of treatment he developed anasarca, further progression of KS and agranulocytosis. Imatinib was discontinued and there was significant clinical recovery. One year later his immunosuppressive therapy was changed to Sirolimus and regression of the Kaposi's sarcoma occurred. Conclusion The lack of benefit and severe toxicity associated with the use of Imatinib in this patient should alert clinicians of potentially adverse consequence of its use in patients with transplant associated Kaposi's sarcoma. On the other hand the positive response seen in this patient to Sirolimus even after a long evolution of Kaposi's sarcoma, multiple chemotherapy regimens and extensive cutaneous disease further suggest it therapeutical utility for transplant associated Kaposi's sarcoma.

  14. Vasculitis por Propiltiouracilo: reporte de un caso

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    Donato A. Salas-Segura

    2002-06-01

    Full Text Available Se reporta el caso clínico de una paciente femenina de 43 años que presentó dos complicaciones secundarias al uso de propiltiouracilo: vasculitis y agranulocitosis.La vasculitis asociada con el tratamiento antitiroideo es una entidad clínica bien documentada, pero rara, y de un mecanismo patogénico no claro aún. Hay pocos casos reportados de asociación entre la ingesta de propiltiouracilo, la aparición de anticuerpos anticitoplasmáticos antineutrófilos y vasculitis ANCA positiva. Este es probablemente uno de ellos.We report a case of 43-year-old woman who developed two complications associated with the use of propylthiouracil: vasculitis and agranulocytosis. Vasculitis associated with antithyroid therapy is a rare well-documented clinical entity with a pathogenic mechanism not clear yet. There a few published reports of an association between treatment with propylthiouracil, and the occurrence of ANCA positivity and ANCA-associated vasculitis. This is probably one more.

  15. Graves' Disease Pharmacotherapy in Women of Reproductive Age.

    Science.gov (United States)

    Prunty, Jeremy J; Heise, Crystal D; Chaffin, David G

    2016-01-01

    Graves' disease is an autoimmune disorder in which inappropriate stimulation of the thyroid gland results in unregulated secretion of thyroid hormones resulting in hyperthyroidism. Graves' disease is the most common cause of autoimmune hyperthyroidism during pregnancy. Treatment options for Graves' disease include thioamide therapy, partial or total thyroidectomy, and radioactive iodine. In this article, we review guideline recommendations for Graves' disease treatment in women of reproductive age including the recent guideline from the American College of Obstetricians and Gynecologists. Controversy regarding appropriate thioamide therapy before, during, and after pregnancy is reviewed. Surgical and radioactive iodine therapy considerations in this patient population are also reviewed. In patients who may find themselves pregnant during therapy or develop Graves' disease during their pregnancy, consideration should be given to the most appropriate treatment course for the mother and fetus. Thioamide therapy should be used with either propylthiouracil or methimazole at appropriate doses that target the upper range of normal to slightly hyperthyroid to avoid creating hypothyroidism in the fetus. Consideration should also be given to the adverse effects of thioamide, such as agranulocytosis and hepatotoxicity, with appropriate patient consultation regarding signs and symptoms. Individuals who wish to breastfeed their infants while taking thioamide should receive the lowest effective dose. Surgery should be reserved for extreme cases and limited to the second trimester, if possible. Radioactive iodine therapy may be used in nonpregnant individuals, with limited harm to future fertility. Radioactive iodine therapy should be withheld in pregnant women and those who are actively breastfeeding. Clinicians should keep abreast of developments in clinical trials and evidence-based recommendations regarding Graves' disease in reproductive-age women for any changes in evidence

  16. A study of toxicity and differential gene expression in murine liver following exposure to anti-malarial drugs: amodiaquine and sulphadoxine-pyrimethamine

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    Rath Srikanta

    2011-05-01

    Full Text Available Abstract Background Amodiaquine (AQ along with sulphadoxine-pyrimethamine (SP offers effective and cheaper treatment against chloroquine-resistant falciparum malaria in many parts of sub-Saharan Africa. Considering the previous history of hepatitis, agranulocytosis and neutrocytopenia associated with AQ monotherapy, it becomes imperative to study the toxicity of co-administration of AQ and SP. In this study, toxicity and resulting global differential gene expression was analyzed following exposure to these drugs in experimental Swiss mice. Methods The conventional markers of toxicity in serum, oxidative stress parameters in tissue homogenates, histology of liver and alterations in global transcriptomic expression were evaluated to study the toxic effects of AQ and SP in isolation and in combination. Results The combination therapy of AQ and SP results in more pronounced hepatotoxicity as revealed by elevated level of serum ALT, AST with respect to their individual drug exposure regimen. Furthermore, alterations in the activity of major antioxidant enzymes (glutathione peroxidase, superoxide dismutase, catalase, glutathione reductase, indicating the development of oxidative stress, was more significant in AQ+SP combination therapy. cDNA microarray results too showed considerably more perturbed gene expression following combination therapy of AQ and SP as compared to their individual drug treatment. Moreover, a set of genes were identified whose expression pattern can be further investigated for identifying a good biomarker for potential anti-malarial hepatotoxicity. Conclusion These observations clearly indicate AQ+SP combination therapy is hepatotoxic in experimental Swiss mice. Microarray results provide a considerable number of potential biomarkers of anti-malarial drug toxicity. These findings hence will be useful for future drug toxicity studies, albeit implications of this study in clinical conditions need to be monitored with cautions.

  17. Rare and very rare adverse effects of clozapine

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    De Fazio P

    2015-08-01

    Full Text Available Pasquale De Fazio,1 Raffaele Gaetano,1 Mariarita Caroleo,1 Gregorio Cerminara,1 Francesca Maida,2 Antonio Bruno,3 Maria Rosaria Muscatello,3 Maria Jose Jaén Moreno,4 Emilio Russo,2 Cristina Segura-García1 1Department of Health Sciences, School of Specialization in Psychiatry, 2Department of Health Sciences, School of Specialization in Pharmacology, University “Magna Graecia”, Catanzaro, 3Department of Neurosciences, School of Specialization in Psychiatry, University of Messina, Messina, Italy; 4Department of Social Health Sciences, Radiology and Physical Medicine, University of Cordoba, Cordoba, Spain Abstract: Clozapine (CLZ is the drug of choice for the treatment of resistant schizophrenia; however, its suitable use is limited by the complex adverse effects’ profile. The best-described adverse effects in the literature are represented by agranulocytosis, myocarditis, sedation, weight gain, hypotension, and drooling; nevertheless, there are other known adverse effects that psychiatrists should readily recognize and manage. This review covers the “rare” and “very rare” known adverse effects of CLZ, which have been accurately described in literature. An extensive search on the basis of predefined criteria was made using CLZ and its combination with adverse effects as keywords in electronic databases. Data show the association between the use of CLZ and uncommon adverse effects, including ischemic colitis, paralytic ileus, hematemesis, gastroesophageal reflux disease, priapism, urinary incontinence, pityriasis rosea, intertriginous erythema, pulmonary thromboembolism, pseudo-pheochromocytoma, periorbital edema, and parotitis, which are influenced by other variables including age, early diagnosis, and previous/current pharmacological therapies. Some of these adverse effects, although unpredictable, are often manageable if promptly recognized and treated. Others are serious and potentially life-threatening. However, an adequate

  18. Exploring an animal model of amodiaquine-induced liver injury in rats and mice.

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    Liu, Feng; Cai, Ping; Metushi, Imir; Li, Jinze; Nakayawa, Tetsuya; Vega, Libia; Uetrecht, Jack

    2016-09-01

    Amodiaquine (AQ) is associated with a relatively high incidence of idiosyncratic drug-induced liver injury (IDILI) and agranulocytosis. A previous study reported that a combination of high dose AQ and glutathione (GSH) depletion led to liver injury. However, the characteristics of this toxicity were very different from AQ-induced liver injury in humans. We developed a model of AQ-induced liver injury with characteristics similar to the injury in humans by treating mice with lower doses of AQ for several weeks. In this study we found that not only did GSH depletion not increase AQ covalent binding to hepatic proteins at this lower dose, but also it paradoxically prevented the liver injury. We extended the model to rats and found AQ treatment led to a mild delayed onset liver injury that resolved despite continued treatment with AQ. Immunohistochemistry indicated the presence of Kupffer cell activation, apoptosis and hepatocyte proliferation in the liver. There was also an increase in serum IL-2, IL-5, IL-9, IL-12, MCP-1 and TGFβ, but a decrease in leptin. Coincident with the elevated serum ALT, the number of liver CD4(+) T-cells, IL-17 secreting cells and TH17/Treg cells increased at Week 3 and decreased during continued treatment. Increases in NK1.1+ cells and activated M2 macrophages were also observed during liver injury. These results suggest that the outcome of the liver injury was determined by the balance between effector and regulatory cells. Co-treatment with cyclosporin prevented AQ-induced liver injury, which supports an immune mechanism. Retinoic acid (RA), which has been reported to enhance natural killer (NK) cell activity, exacerbated AQ-induced liver injury. These results suggest that AQ-induced IDILI is immune mediated and the subsequent adaptation appears to represent immune tolerance. PMID:27416278

  19. Binding of levomepromazine and cyamemazine to human recombinant dopamine receptor subtypes

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    Lalit K. Srivastava

    2009-09-01

    Full Text Available Background and Objectives: Clozapine (CLOZ and levomepromazine (LMP improve treatment-resistant schizophrenia. The superior efficacy of CLOZ compared with other antipsychotic agents has been attributed to an effect on D1-like and D4 receptors. We examined the binding of LMP, CLOZ and cyamemazine (CMZ, a neuroleptic analog of LMP, to human recombinant dopamine (rDA receptor subtypes. Methods: Binding studies were performed on frozen membrane suspensions of human rDA receptor subtypes expressed in Sf9 cells. Results: (i LMP has a high affinity (Ki, nM for rD2 receptor subtypes (rD2L 8.6; rD2S 4.3; rD3 8.3; rD4.2 7.9; (ii LMP and CLOZ have comparable affinities for the rD1 receptor (54.3 vs 34.6; (iii CMZ has high affinities for rD2-like and rD1-like receptors (rD2L 4.6; rD2S 3.3; rD3 6.2; rD4.2 8.5; rD1 3.9; rD5 10.7; (iv CMZ is 9 times more potent than CLOZ at the rD1 receptor and 5 times more potent than CLOZ at the rD4.2 receptor; (v CMZ has high affinities for rD1 and rD5 receptor subtypes compared with LMP and CLOZ. Conclusions: If D1 and D4 receptors are important sites for the unique action of CLOZ, the present study points to a need for clinical trials comparing CMZ with CLOZ in schizophrenia and in particular, treatment-resistant schizophrenia, especially given the risk for agranulocytosis with CLOZ.

  20. Electroanalysis of trimethoprim on metalloporphyrin incorporated glassy carbon electrode.

    Science.gov (United States)

    Rajith, Leena; Kumar, Krishnapillai Girish

    2010-09-01

    Trimethoprim (TMP) is a bacteriostatic antibiotic mainly used in the prophylaxis and treatment of urinary tract infections. It belongs to the class of chemotherapeutic agents known as dihydrofolate reductase inhibitors. Its use is associated with idiosyncratic reactions, including liver toxicity and agranulocytosis. In order to determine TMP electrochemically, a metalloporphyrin modified glassy carbon electrode was prepared by coating [5,10,15,20- tetrakis(4-methoxyphenyl) porphyrinato]Mn (III)chloride (TMOPPMn(III)Cl) solution on the surface of the electrode. The electrochemical behaviour of TMP in Phosphate buffer solution (PBS) on TMOPPMn(III)Cl modified glassy carbon electrode (TMOPPMn(III)Cl/GCE) was explored using differential pulse voltammetry (DPV). The voltammograms showed enhanced oxidation response at the TMOPPMn (III)Cl/GCE with respect to the bare GCE for TMP, attributable to the electrocatalytic activity of TMOPPMn(III)Cl. Electrochemical parameters of the oxidation of TMP on the modified electrode were analyzed. The electro-oxidation of TMP was found to be irreversible, pH dependent and adsorption controlled on the modified electrode. It is found that the oxidation peak current is proportional to the concentration of TMP over the range 6 × 10⁻⁸ - 1 × 10⁻⁶ M with a very low detection limit of 3 × 10⁻⁹ M at 2 min open circuit accumulation. The repeatability expressed as relative standard deviation (RSD) for n = 9 was 3.2% and the operational stability was found to be 20 days. Another striking feature is that equimolar concentration of sulfamethoxazole did not interfere in the determination of TMP. Applicability to assay the drug in urine and tablet samples has also been studied.

  1. Experience of Nursing During the Treatment of Aplastic Anemia Patients to Prevent Infection%再生障碍性贫血患者治疗期间预防感染的护理体会

    Institute of Scientific and Technical Information of China (English)

    王芳

    2014-01-01

    目的浅析再生障碍性贫血患者治疗期间预防感染的护理体会。方法我院对60例再障患者予以有效的预防感染和护理。结果60例患者中,基本治愈13例,好转38例,无变化9例,总有效率85%。结论再障患者住院期间如发生粒细胞减少或缺乏,应及时采取隔离措施。同时,要做好相应基础及心理护理,并予以升白细胞类及抗感染药物治疗,以使患者快速、安全地渡过感染期,避免致命感染,促进疾病及早康复。%Objective Nursing experience of regeneration in the treatment of aplastic anemia patients during infection prevention. Methods Our hospital to prevent infection and ef ective nursing care of 60 cases of aplastic anemia patients. Results The 60 patients, 13 patients were cured, 38 cases improved, no change in 9 cases, the total ef iciency of 85%. Conclusion During such as the occurrence of neutropenia or agranulocytosis in aplastic anemia patients, should take timely measures. At the same time, to do a good job in the basic nursing and psychological nursing, and to increase white blood cell and anti infection therapy, to enable the patients quickly, safely through the period of infection, avoid fatal infection disease, promote early rehabilitation.

  2. Effect of different methods of haematopoietic stem cell transplantation for the treatment of severe aplastic anemia%不同的造血干细胞移植方式对重型再生障碍性贫血治疗效果的影响

    Institute of Scientific and Technical Information of China (English)

    戚永磊; 许多荣; 王顺清; 邹外一; 李娟

    2012-01-01

    transplantation (Allo-PBSCT) , allogeneic bone marrow transplantation (Allo-BMT) and Allo-PBSCT plus Allo-BMT for the treatment of severe aplastic anemia (SAA). Methods; Thirty^seven patients with SAA received HLA-matched sibling donor stem cell transplantation ( n = 11, Allo-PBSCT group, n =14, Allo-BMT group, n = 12, Allo-PBSCT plus BMT group). The mean time of reconsitution of neutrophils (Neu) and platelets (Pit) , short tandem repeats (STR) in detecting the engratment, the incidence of infection with agranulocytosis , and graft versus host diseases (GvHD)were observed.The three-year incidence of graft failure(GF),mortality and disease -tree survival(DFS) after transplantation were also investigated.Results; The mean time of reconsitution of Neu was (13. 5 ± 2. 3) days.(21. 2 ±3. 5) days and (14. 7 ±2. 4) days in Allo-PBSCT group, Allo-PBSCT plus BMT group and Allo-BMT group respectively.Significant differences were observed between the front two groups and the latter group(P<0.05).The mean time of reconsitution of Pit was (24 ±4) days.(22±5) days and (23 ±5)days respectively in Allo-PBSCT group, Allo-PBSCT plus BMT group and Allo-BMT group respectively No statistical difference among the three groups.Full donor chimerism was confirmed in all 37 patients at post-tranplant day28. The incidence of infection with agranulocytosis of Allo -PBSCT group and Allo-PBSCT plus BMT group was 9% and 17% respectively and were lower obviously than that in Allo -BMT group which was 57% and there were statistical differences between the front two groups and the latter group( P < 0. 05 ).The incidence of GvHD of Allo -PBSCT group was 36% and no GvHD happened in Allo-BMT group and Allo-PBSCT plus BMT group and the statistical differences between the front group and the latter groups was positive respectively(P <0. 05). The three-year incidence of GF, mortality and DFS in PBSCT group was 36. 3%, 9. 0% and 63. 6% respectively.All patients in Allo-PBSCT plus BMT group and Allo-BMT group

  3. [Occupational diseases caused by exposure to sensitizing metals].

    Science.gov (United States)

    Kusaka, Y

    1993-03-01

    Diseases caused by occupational exposure to sensitizing metals including platinum (Pt), rhodium (Rh), nickel (Ni), chromium (Cr), cobalt (Co), gold (Au), mercury (Hg), zirconium (Zr) and beryllium (Be) are reviewed. Allergic reactions induced by the metals are described according to the classification by Coombs and Gell. Metals with unproven sensitizing potential are not discussed if reports on these are either very rare or devoid of convincing evidence for allergic involvement. The sensitizing metals are haptens which are not themselves able to act as antigens. There is evidence that combination of the metals with circulating or tissue protein gives rise to new antigens. An alternative hypothesis is that these metals interfere with the antigen recognition step of the immune response. Immunomodulatory effects or immunotoxicity of the metals may be also involved in metal-induced hypersensitivity. Occupational exposure to Pt, Rh, Ni, Cr, and Co causes allergic asthma via type I allergic reaction in which serum from affected individuals shows specific IgE antibodies against mental-human serum albumin conjugates. Some rheumatoid arthritis patients treated with gold salt therapy develop glomerulonephritis, thrombocytopenia, or agranulocytosis, which arise from type II and/or type III allergic reactions. Occupational exposure to mercury causes glomerulonephritis in which involvement of type III reaction is suggested. Type IV hypersensitivity reaction of the skin also takes place following exposure to the metals: allergic contact dermatitis is evoked by exposure to Ni, Cr, Co, Rh, and Hg; cutaneous granuloma is formed by contact with Zr and Be. Be is also a sensitizer of the lungs, resulting in granulomatous disease. Diagnosis of metal-induced allergic diseases is made on the basis of allergological tests with metal antigens including skin tests, radioallergosorbent test for specific antibody, lymphocyte transformation test, macrophage migration inhibition test, and

  4. Clozapine reinitiation following a "red result" secondary to chemotherapy

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    Munshi T

    2013-08-01

    mg. The decision to reinitiate clozapine following a red result is not to be taken lightly, but needs to be considered in terms of the risks versus benefits. More literature surrounding this issue would be of great benefit to clinicians, patients, and their families.Keywords: clozapine agranulocytosis, clozapine discontinuation, red result, clozapine rechallenge, R-CHOP chemotherapy

  5. Sulfadoxine-pyrimethamine-based combinations for malaria: a randomised blinded trial to compare efficacy, safety and selection of resistance in Malawi.

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    David J Bell

    Full Text Available BACKGROUND: In Malawi, there has been a return of Plasmodium falciparum sensitivity to chloroquine (CQ since sulfadoxine-pyrimethamine (SP replaced CQ as first line treatment for uncomplicated malaria. When used for prophylaxis, Amodiaquine (AQ was associated with agranulocytosis but is considered safe for treatment and is increasingly being used in Africa. Here we compare the efficacy, safety and selection of resistance using SP or CQ+SP or artesunate (ART+SP or AQ+SP for the treatment of uncomplicated falciparum malaria. METHODOLOGY AND FINDINGS: 455 children aged 1-5 years were recruited into a double-blinded randomised trial comparing SP to the three combination therapies. Using intention to treat analysis with missing outcomes treated as successes, and without adjustment to distinguish recrudescence from new infections, the day 28 adequate clinical and parasitological response (ACPR rate for SP was 25%, inferior to each of the three combination therapies (p<0.001. AQ+SP had an ACPR rate of 97%, higher than CQ+SP (81% and ART+SP (70%, p<0.001. Nineteen children developed a neutropenia of

  6. 急性淋巴细胞白血病患儿诱导缓解期合并可逆性后部白质脑病临床特征%Reversible posterior leukoencephalopathy syndrome in children with acute lymphocytic leukaemia after remission induction chemotherapy

    Institute of Scientific and Technical Information of China (English)

    林巍; 谢静; 郑胡镛; 程华; 张元元; 张瑞东

    2014-01-01

    Objective To investigate the etiology,clinical manifestations,imaging characteristics and treatment of reversible posterior leukoencephalopathy syndrome in children with acute lymphocytic leukaemia after remission induction chemotherapy.Methods Analysize the clinico-radiological features、central nervous system symptoms and associated symptoms、treatment and prognosis of reversible posterior leukoencephalopathy syndrome in children with acute lymphocytic leukaemia receiving induction chemotherapy in hematology center of Beijing children′s hospita from June 201 1 to March 2012.Results Eight children (3 males and 5 females)with a mean age of 5 years were identified.Presenting symptoms included seizures (8/8 ),disturbance of consciousness (3/8 ),and visual disturbance (2/8 ).High blood pressure,agranulocytosis,and coagulation disorders,electrolyte disturbance were existed,and they all used granulocyte colony-stimulating factor.All children had typical radiological features of reversible posterior leukoencephalopathy syndrome.Six cases of children with head magnetic resonance imaging results suggest that vasogenic edema,the prognosis is good.Two cases of cytotoxic edema,in one case of recurrence,the prognosis is bad.Conclusion reversible posterior leukoencephalopathy syndrome is an underappreciated complication in cancer children receiving remission induction chemotherapy.Head magnetic resonance imaging is an important means of diagnosis and assessment of reversible posterior leukoencephalopathy syndrome prognosis. During chemotherapy require close monitoring of blood pressure,electrolyte,blood coagulation,actively is needed.%目的:探讨急性淋巴细胞白血病(acute lymphoblastic leukemiu,ALL)患儿,在诱导缓解化疗期间发生可逆性后部白质性脑病综合征(reversible posterior leukoencephalopathy sysdrome,RPLS)的病因、临床表现、影像学特征及治疗。方法2011年6月至2012年3月,北京儿童医院血液病中

  7. 急性白血病患者侵袭性真菌病的临床研究与分析%The clinical study and analysis of acute leukemia patients with invasive fungal disease

    Institute of Scientific and Technical Information of China (English)

    李志敏; 夏瑞祥

    2015-01-01

    Objective To learn the risk factors and clinical features of acute leukemia patients with invasive fungal disease to pro-vide guidance for the diagnosis and treatment of invasive fungal disease. Methods The clinical data of 1 272 cases of acute leukemia pa-tients were studied retrospectively, and the risk factors associated with invasive fungal disease and its clinical features were statistically ana-lysed. Results The number of invasive fungal disease which occurred in 1 272 cases of acute leukemia patients was 124, the infection rate was 9. 75% and the site of infection was mainly in the lung and blood. The number of days in hospital, agranulocytosis duration and joint use time of broad-spectrum antibiotics were independent risk factors of invasive fungal infection. The main pathogen was Candida albicans, most of which was sensitive to amphotericin B and voriconazole. Conclusion Patients associated with acute leukemia are susceptible to invasive fungal disease. Candida albicans is the main pathogen, and during the treatment of primary disease, shortening the length of hospital stay, time to neutrophil recovery and strengthening support for treatment and rational use of broad-spectrum antibiotics can effectively reduce the in-cidence of invasive fungal disease.%目的:分析急性白血病( AL)患者侵袭性真菌病( IFD)的相关危险因素和临床特点,为IFD的诊断和治疗提供指导。方法对1272例AL患者进行回顾性研究,统计分析IFD的相关危险因素及临床特点。结果 1272例AL患者中发生IFD 124例,感染率为9.75%,感染部位以肺部和血液为主;住院天数、粒细胞缺乏持续时间和广谱抗菌药物联合使用时间是侵袭性真菌感染的独立危险因素;病原菌以白色念珠菌为主,多对两性霉素B和伏立康唑敏感。结论 AL患者是IFD的易感人群,以白色念珠菌感染为主,在治疗原发病的同时,缩短住院天数、粒细胞恢复时间,加强支

  8. Tratamento de suporte e quelação de ferro em pacientes com síndromes mielodisplásicas Supportive care, tranfusion and chelation therapy for patients with myelodysplastic syndromes

    Directory of Open Access Journals (Sweden)

    Elizabeth X. Souto

    2006-09-01

    survival to develop clinically relevant iron overload. Chelation therapy presents with some limitations in particular the long time required for deferoxamine infusion and the difficulties of patients to comply with treatment and to acquire an infusion pump. The clinical use of deferiprone, an oral chelator, is not indicated for MDS patients because of the risk of neutropenia and agranulocytosis. Deferasirox is a new oral chelator currently under clinical development that will probably be, in the future, an adequate option for MDS patients with iron overload. Additional studies in MDS patients are necessary to establish better diagnostic and chelation therapy criteria.

  9. Clozapine and Fever: A Case of Continued Therapy With Clozapine.

    Science.gov (United States)

    Bruno, Valentina; Valiente-Gómez, Alicia; Alcoverro, Oscar

    2015-01-01

    Clozapine is a major atypical antipsychotic drug used in treatment-resistant schizophrenia (Patel and Allin. Ther Adv Psychopharmacol 2011;1:25-29). It interferes with dopamine binding to D1, D2, D3, and D5 receptors but has high affinity to D4. It also has an anticholinergic effect and antagonizes α-adrenergic, histaminergic, and serotoninergic receptors (Oerther and Ahlenius. J Pharmacol Exp Ther 2000;292:731-736). Clozapine has proved effective in treating positive and negative symptoms in patients with refractory schizophrenia, thus accounting for its frequent use. Despite its effectiveness, this drug is not without its adverse effects. The most well known is agranulocytosis. There are, however, many others, such as myocarditis, aspiration pneumonia, ileus, fever, hyperglycemia, hyperlipidemia, hypertriglycemia, tachycardia, and weight gain, among others (Bruijnzeel et al. Asian J Psychiatr 2014;11:3-7). Fever induced by clozapine is a common phenomenon (Lowe et al. Ann Pharmacother 2007;41:1700-1704), which usually occurs in the first 4 weeks of treatment, and its prevalence oscillates from 0.5% and 55%, depending on the study (Jeong et al. Schizophr Res 2002;56:191-193; Young et al. Schizophr Bull 1998;24:381-390). The fever lasts for 2.5 days on average, and unless the treatment is discontinued, it generally abates between day 8 and 16 of treatment (Kohen et al. Ann Pharmacother 2009;43:143-146). There are several different theories about the physiopathological mechanism; it could be a variation of malignant neuroleptic syndrome, an infection secondary to neutropenia, and allergic reaction or the emergence of the immunomodulating effect of clozapine. Some case reports in the bibliography have shown that patients in treatment with clozapine can develop a mild leukocytosis, but the presence of other concurrent symptoms, which indicate infection, is not common (Tham and Dickson. J Clin Psychiatry 2002;63:880-884). The theory of an allergic reaction is

  10. Misdiagnosis Analysis of 31 Cases of Atypical Hyperthyroidism%非典型甲状腺功能亢进症31例误诊分析

    Institute of Scientific and Technical Information of China (English)

    李中珂; 徐波

    2011-01-01

    Objective To analyze the cause of misdiagnosis of hyperthyroidism, and to propose preventive measures.Methods The clinical data of 31 misdiagnosed cases of hyperthyroidism admitted in our hospital during January 2000 and October 2008 were retrospectively analyzed.Results The initial symptoms included chronic diarrhea complaints, fatigue and weight loss (9 cases), periodic limb flaccid paralysis(7 cases), palpitations and chest tightness (5 cases), tension and irritability (3 cases), mental disorder(2 cases), anorexia and abdominal distension(2 cases), fever and fatigue (1 case), jaundice and tired of greasy food (1 case) and insomnia( 1 case).In the group, 9 cases were earlier misdiagnosed as chronic colitis, 7 cases as hypokalemic periodic paralysis, 3 cases as neurosis, myocarditis and menopause syndrome respectively, 2 cases as coronary heart disease and mental illness respectively, and 1 case as jaundice hepatitis and agranulocytosis respectively.The misdiagnosis average time was (6.7 ± 1.2) months.All patients were diagnosed by thyroid function, thyroid ultrasound and other tests.After anti-thyroid drugs and symptomatic treatment, all the patients were cured.Conclusion Hyperthyroidism has complex and diverse clinical manifestations, and it is easily misdiagnosed when the primary symptoms and main performance appears as a systematic symptom, so more attention should be paid to thyroid function tests to avoid misdiagnosis.%目的 分析甲状腺功能亢进症(甲亢)的误诊原因并提出防范措施.方法 对我院2000年1月~2008年10月收治并误诊的31例甲亢的临床资料进行回顾性分析.结果 本组初诊时诉首发症状为慢性腹泻、乏力、消瘦9例,周期性四肢软瘫7例,心悸、胸闷5例,紧张、烦躁3例,精神异常2例,食欲缺乏、腹胀2例,发热、乏力1例,黄疸、厌油1例,失眠1例.本组早期误诊为慢性结肠炎9例,低血钾性周期性麻痹7例,神经症、心肌炎、更年期综合征各3

  11. 老年恶性血液病患者化疗后急性心力衰竭的危险因素%Risk factors of acute heart failure in elderly patients with hematologic malignancies after chemotherapy

    Institute of Scientific and Technical Information of China (English)

    李皓亮; 袁义燕

    2013-01-01

    Objective:Study of risk factors in elderly patients with malignant hematological diseases occur in acute heart failure after chemotherapy.Methods:From 2012 March to 2013 March in our hospital in patients with hematologic malignancies therapy in 230 cases, a retrospective analysis of 230 cases with sex , fluid balance weight , hemoglobin , septic shock and sepsis , total course of chemotherapy , renal failure, respiratory failure, neutropenia, and heart disease index.Results:gender, total course of chemotherapy, renal insufficiency and respiratory failure in the two groups, the difference was not statistically significant (P >0.05); agranulocytosis and heart disease between the two groups, significant differences were statistically significant (P <0.05); liquid balance weight,hemoglobin values and infection shock and sepsis in two groups , significant differences were statistically significant (P <0.001).Conclusion:the risk of aged malignant hematonosis patients with acute heart failure after chemotherapy in the complicated factors , early diagnosis , intervention therapy is crucial to the early .%目的:研究观察老年恶性血液病患者在化疗后发生急性心力衰竭的危险因素。方法:选取2012年3月~2013年3月期间在我院住院治疗的恶性血液病患者230例,回顾性分析本组230例患者的性别、液体平衡量、血红蛋白值、感染性休克/脓毒血症、化疗总疗程、肾功能不全、呼吸衰竭、粒细胞缺乏、以及心脏病史等指标。结果:性别、化疗总疗程、肾功能不全以及呼吸衰竭2组比较,差异均无统计学意义(P均>0.05);粒细胞缺乏以及心脏病史2组比较,差异显著均有统计学意义(P均<0.05);液体平衡量、血红蛋白值以及感染性休克/脓毒血症2组比较,差异显著均有统计学意义(P均<0.001)。结论:老年恶性血液病患者在化疗后发生急性心力衰竭的危险因素复杂多样,

  12. Pathogenic features and risk factors of invasive fungal infection in patients with hematopathy%血液病合并侵袭性真菌感染病原学及危险因素

    Institute of Scientific and Technical Information of China (English)

    王凡; 韩志海; 孟激光; 李泳群; 陈韦; 赵春亭

    2015-01-01

    Objective To investigate the status of invasive fungal infection(IFI)associated with hematopathy,and evaluate drug resistance and risk factors of fungal infection.Methods 1 246 cases of infection occurred in patients in a hospital from 2006 to 2010 were analyzed retrospectively,pathogenic features and risk factors of IFI were ana-lyzed.Results There were 281 cases of fungal infection,and 162 fungal isolates were isolated,the main infection site was respiratory tract(134 isolates,82.72%).Four major Candida were Candida albicans ,Candida tropicalis , Candida glabrata ,and Candida krusei ;in 2006-2009,the main fungi were Candida albicans ,while in 2010,the majority were non-Candida albicans .The resistant rates of four isolated Candida to fluconazole and itraconazole were 5.15% and 4.41 % respectively,6 isolated Candida krusei strains were all resistant to both fluconazole and itraconazole,voriconazole-resistant strain was not found.The independent risk factors for fungal infection were dia-betes and duration time of agranulocytosis>14 days.Conclusion The proportion of infection caused by non-Candi-da albicans increased obviously,fluconazole-and itraconazole-resistant non-Candida albicans strains have emerged, comprehensive measures should be adopted to prevent IFI actively and treat patients early.%目的:了解血液病合并侵袭性真菌感染(IFI)的现状,分析真菌耐药情况及感染的危险因素。方法回顾性分析2006—2010年某院血液病科合并感染的患者1246例次,对 IFI 患者病原学特点及危险因素进行分析。结果真菌感染281例次,分离真菌162株,感染部位以呼吸道(134株,占82.72%)为主。4种主要酵母菌为白假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌和克柔假丝酵母菌;2006—2009年均以白假丝酵母菌为主,2010年非白假丝酵母菌超过白假丝酵母菌。4种主要酵母菌对氟康唑和伊曲康唑的总耐药率分别为5.15%和4

  13. Clozapine and Fever: A Case of Continued Therapy With Clozapine.

    Science.gov (United States)

    Bruno, Valentina; Valiente-Gómez, Alicia; Alcoverro, Oscar

    2015-01-01

    Clozapine is a major atypical antipsychotic drug used in treatment-resistant schizophrenia (Patel and Allin. Ther Adv Psychopharmacol 2011;1:25-29). It interferes with dopamine binding to D1, D2, D3, and D5 receptors but has high affinity to D4. It also has an anticholinergic effect and antagonizes α-adrenergic, histaminergic, and serotoninergic receptors (Oerther and Ahlenius. J Pharmacol Exp Ther 2000;292:731-736). Clozapine has proved effective in treating positive and negative symptoms in patients with refractory schizophrenia, thus accounting for its frequent use. Despite its effectiveness, this drug is not without its adverse effects. The most well known is agranulocytosis. There are, however, many others, such as myocarditis, aspiration pneumonia, ileus, fever, hyperglycemia, hyperlipidemia, hypertriglycemia, tachycardia, and weight gain, among others (Bruijnzeel et al. Asian J Psychiatr 2014;11:3-7). Fever induced by clozapine is a common phenomenon (Lowe et al. Ann Pharmacother 2007;41:1700-1704), which usually occurs in the first 4 weeks of treatment, and its prevalence oscillates from 0.5% and 55%, depending on the study (Jeong et al. Schizophr Res 2002;56:191-193; Young et al. Schizophr Bull 1998;24:381-390). The fever lasts for 2.5 days on average, and unless the treatment is discontinued, it generally abates between day 8 and 16 of treatment (Kohen et al. Ann Pharmacother 2009;43:143-146). There are several different theories about the physiopathological mechanism; it could be a variation of malignant neuroleptic syndrome, an infection secondary to neutropenia, and allergic reaction or the emergence of the immunomodulating effect of clozapine. Some case reports in the bibliography have shown that patients in treatment with clozapine can develop a mild leukocytosis, but the presence of other concurrent symptoms, which indicate infection, is not common (Tham and Dickson. J Clin Psychiatry 2002;63:880-884). The theory of an allergic reaction is

  14. Relato do uso de clozapina em 56 pacientes atendidos pelo Programa de Atenção à Esquizofrenia Refratária da Secretaria da Saúde e do Meio Ambiente do Estado do Rio Grande do Sul El relato del uso de clozapina en 56 pacientes atendidos por el Programa de Atención a la Esquizofrenia Refractaria de la Secretaria de Salud y Medio Ambiente del Estado de Rio Grande do Sul Clozapine use report in 56 patients seen by Clerkship of Health and Environment of the State of Rio Grande do Sul's Program of Attention to the Refractory Schizophrenia

    Directory of Open Access Journals (Sweden)

    Clarissa Severino Gama

    2004-04-01

    treating 30-61% of the psychotic symptoms with minimal adverse effects. METHODS: Clinical experience of 56 patients with refractory schizophrenia under treatment at the Psychiatry Service of the Hospital de Clínicas de Porto Alegre, included in the program to supply clozapine free of charge, promoted by the Department of Health and the Environment of the State of Rio Grande do Sul. RESULTS: The mean score for the Brief Psychiatric Rating Scale (BPRS was initially 77.9 (SD=16.1 and, at the end, 41.1 (SD=16.2. Two patients left the program and one was excluded because he developed agranulocytosis. There were 4 hospitalizations. DISCUSSION: Despite its well-established efficacy and applicability, clozapine is not free from adverse effects: postural hypotension, tachycardia, cloudy vision, dry eyes, hypersalivation, constipation and sedation frequently occur. Hematological alterations occur in 0.05-2.8%. CONCLUSIONS: There was a significant and lasting improvement of the symptoms in the patients enrolled. Diseases with a longer evolution had worse responses, probably related to neurochemical and neurophysiological damage. The importance of early treatment and the need for State intervention, offering psychosocial and financial support to optimize the treatment of this population should be highlighted.

  15. 儿童期急性白血病合并水痘的特点及其高危预后因素的临床分析%Clinical features of chickenpox and high risk factors of prognosis in childhood cases with acute lymphocytic leukemia

    Institute of Scientific and Technical Information of China (English)

    曾慧慧; 程澄; 陈志海; 李兴旺

    2015-01-01

    were compared. Results There were 5 (31.25%) childhood patients with ALL had varicella virus exposure. Except one patient’s temperature was normal, the other 13 (81.25%) cases patients had higher fever and fever duration lasted for (7.38 ± 3.32) days, which signiifcantly longer than ordinary chickenpox patients (t=5.575, P<0.05). Skin rash scabby time were (10.92 ± 2.50) days, which signiifcantly longer than normal patients (t=4.928, P<0.05). All the patients (16 cases) had bone marrow suppression including agranulocytosis 10 (62.5%) cases and thrombocytopenia 7 (43.75%) cases. Patients with abnormal liver function were 8 (50.00%) cases, Skin infections in ALL patients were less than in ordinary patients. After antiviral treatment and active support treatment just like immunoglobulin, 11 patients cured, 4 cases were critically illed and discharged without and one case were died. The features of critically illed or dead cases were taking intravenous chemotherapy, onseting chickenpox during chemotherapy or just finish chemotherapy within a weeks. Granulocyte deficiency and granulocyte deficiency lasted for longer time than mild cases (10.08 ± 2.77 days). Conclusions Longer duration of symptoms as high fever or rash and higher complication ratio of bone marrow suppression manifestated granulocytopenia were the features of chickenpox in childhood cases with ALL. Good prognosis were achieved in childhood ALL patients when proper antiviral treatment and support treatment were implemented. Taking intravenous chemotherapy, onseting chickenpox during chemotherapy or just ifnish chemotherapy within a weeks and persistent granulocyte deifciency were associated with adverse clinical prognosis in childhood cases with ALL.

  16. 22O例医院感染病例分析%Analysis of 220 cases of nosocomial infections

    Institute of Scientific and Technical Information of China (English)

    翟红岩; 李小宝; 白玉红; 蒋静; 艾建红; 左大鹏

    2011-01-01

    infection were nosocomial infection pneumonia 43.82%, infectious fever 11.98%, sepsis 10.49%, urinary tract infection 7.87%, upper respiratory tract infection and oral infection 7.87%, respectively. The top 5 pathogens causing nosocomial infections in turn were Pseudomonas aeruginosa , Acinetobacter baumannii , Streptococcus viridans , Staphylococcus aureus, Candida albicans and E. coli; with the constituent ratios 14.54%, 10.57%, 8.81%, 7.49% and 6.61%, respectively. CONCLUSION The patients of blood and cancer receiving and treatment objects are mainly in our hospital, presenting the characteristic of bone marrow transplantation, Therefore, Laminar flow unit, blood ward and intensive care unit are the departments with higher incidences of nosocomial infection. Hospital acquired pneumonia, infectious fever and sepsis listed in the top three diseases. To strengthen the management of the patients with infections and actively take effective measures to prevent nosocomial infection is very important,especially when the patients occurred agranulocytosis.

  17. Epidemiology and antimicrobial resistance of clinical isolates about hospital infection from patients with hematological diseases%2005-2011年血液系统疾病院内感染流行病学及耐药性变迁

    Institute of Scientific and Technical Information of China (English)

    邓琦; 李青; 林雪梅; 李玉明

    2012-01-01

    Objective To investigate the epidemiology and antibiotic resistance of isolates from hospitalized patients with hematological disease from 2005 to 2011. Methods A total of 1453 bacterial strains were isolated from patients with hematological disease from January 2005 to December 2011. Antimicrobial susceptibility testing was performed by micro-dilution method. Results ①The majority of the bacterial strains were respiratory passage examples (57.5%). The pertage of blood examples in our division(13.60%) was higher than of whole hospital (6.26%), with lower positive rate of bacterial culture (52.37%) than of whole hospital (60.24%). Chemotherapy-induced agranulocytosis was the main reason for hospital infection. 578(39.8%)bacterial strains were gram positive, and 875(60.2%)gram negative bacillus. Staphylococcus epidermidis strains and glucose nonfermenters had a tendency of ascensus. ②Methicillin resistant staphylococcus aureus (MRSA) accounted for 72.8% antibiotic resistance. Detection rates of ESBLs in Escherichia coli and Kleb-siella pneumoniae were 18.9% and 10.4%, respectively. ③No obvious changes of antimicrobial resistances of Staphylococcus and Enterococcus were observed during these years. The Enterobacteriaceae strains showed lowest resistance rates to Carbopenems, next to Cefoperazone/sulbactam and Piperacillin/tazobactam. But the resistance rates of Escherichia coli to Cefepime and Ceftazidime were gradually increasing during the past years. Pseudomonas aeruginosa and Acinetobacter baumannii of glucose nonfermenters showed lowest resistance rates to Cefoperazone/sulbactam, but the resistance rate of Pseudomonas aeruginosa to Carbopenems increased. Conclusions Escherichia coli was the highest in quantity of gram negative bacillus and glucose nonfermenters had a tendencv of ascensus. The resistance rates of Escherichia coli to Cefepime and Ceftazidime, Pseudomones aeruginosa to Carbopenems were gradually increasing in the past years.%目的 分析2005

  18. A clinical analysis on invasive pulmonary aspergillosis in patients with hepatic failure%肝衰竭患者合并侵袭性肺曲霉菌病临床分析

    Institute of Scientific and Technical Information of China (English)

    邓西龙; 陈志敏; 黄煌; 潘越峻; 李粤平

    2012-01-01

    Objective To explore the risk factors,clinical characteristics,and proguosis ofinvasive pulmonary aspergillosis ( IPA ) in patients with hepatic failure.Methods The clinical data of 15 patients with hepatic failure complicated with IPA were analyzed retrospectively.Results All the patients had an underlying disorder that was chronic hepatitis B,but had no granulocytopenia or agranulocytosis.The MELD score was ( 37.13 ± 11.03 )46.7% ( 7/15 ) of the patients had history of hormone uses ; 60% ( 9/15 ) had history of broad-spectrum antibiotic uses ( single or mulitple ) 60% ( 9/15 )of patients received previous blood purification.33.3% ( 5/15 )had a reduction in CD4+ T cells or ratio imbalance.Clinical manifestations lacked of obvious specificity.Roentgenographic examination of the lungs showed changes in all the patients; GM test was positive in 73.3% ( 11/15 )of the patients.20% ( 3/15 )of the patients improved after treatment; 80% ( 12/15 ) did not repond to therapies; and 40% ( 6/15 ) were dead within 7 days after diagnosis.Conclusions Patients with hepatic failure have multiple risk factors of invasive pulmonary aspergillosis.IPA is one of the reasons for deterioration in patients with hepatic failure.Early CT examination combined with GM tests can increase the early diagnostic rate.Early effective antifungal therapy can improve the prognosis of the disease.%目的 了解肝衰竭患者合并侵袭性肺曲霉菌病的危险因素、临床特征和预后,提高对肝衰竭合并侵袭性肺曲霉菌病的认识.方法 对15例肝衰竭合并侵袭性肺曲霉菌病患者的临床资料,包括基础疾病、住院时间、ICU住院时间、激素和抗生素使用情况、临床表现、诊断分层、治疗情况以及预后等进行回顾性分析.结果 全部患者存在慢性乙型肝炎基础疾病,均无粒细胞减少或缺乏.患者MELD评分(37.13±11.03)分.其中46.7%( 7/15)的患者有激素使用史;60%( 9/15)