Cases Of Sickness Research Articles

Funnel‐web spider bite: a systematic review of recorded clinical cases

To investigate species-specific envenoming rates and spectrum of severity of funnel-web spider bites, and the efficacy and adverse effects of funnel-web spider antivenom. Cases were identified from a prospective study of spider bite presenting to four major hospitals and three state poisons information centres (1999-2003); museum records of spider specimens since 1926; NSW Poisons Information Centre database; MEDLINE and EMBASE search; clinical toxinology textbooks; the media; and the manufacturer's reports of antivenom use. Patient age and sex, geographical location, month, expert identification of the spider, clinical effects and management; envenoming was classified as severe, mild-moderate or minor/local effects. 198 potential funnel-web spider bites were identified: 138 were definite (spider expertly identified to species or genus), and 77 produced severe envenoming. All species-identified severe cases were attributed to one of six species restricted to NSW and southern Queensland. Rates of severe envenoming were: Hadronyche cerberea (75%), H. formidabilis (63%), Atrax robustus (17%), Hadronyche sp. 14 (17%), H. infensa (14%) and H. versuta (11%). Antivenom was used in 75 patients, including 22 children (median dose, 3 ampoules; range, 1-17), with a complete response in 97% of expertly identified cases. Three adverse reactions were reported, all in adults: two early allergic reactions (one mild and one with severe systemic effects requiring adrenaline), and one case of serum sickness. Severe funnel-web spider envenoming is confined to NSW and southern Queensland; tree-dwelling funnel webs (H. cerberea and H. formidabilis) have the highest envenoming rates. Funnel-web spider antivenom appears effective and safe; severe allergic reactions are uncommon.

Estimating the prevalence of cannabinoid use urine testing: A preliminary study in Kerman, Iran

Aims This primary study was performed to determine the prevalence rate of cannabinoid consumed in Kerman (Iran). Measurements Urine samples of 700 males, referred to a clinical lab in Kerman city were collected for detection of cannabinoid metabolites. Assessment analysis was a monophasic immunoassay rapid technique. The study was completely blind and only age and residence of samples were revealed. All stages were confirmed and supervised by the ethics committee. Results The prevalence of cannabinoid use was 0.6%. All four positive cases were urban, with ages 31, 36, 40 and 67. More than 90% of referred cases were urban with mean age of 46.8±16 while the mean age of rural cases was 54.3±17 years. Conclusions Considering the age range and possibility of the underlying disease in the study population, the prevalence of cannabinoid use was more than what was expected. Urine analysis as a method for assessing the prevalence rate requires a wide sample size and age distribution matching the age distribution of the study population. In addition, the entrance criteria should not include sick cases.

Four cases of equine grass sickness: acute, subacute, chronic and surviving chronic grass sickness

Four cases of equine grass sickness: acute, subacute, chronic and surviving chronic grass sickness

Multi-organ involvement and failure in a radiation accident: the Chinese experience of 1963

In 1963, six cases of acute radiation sickness resulting from an accidental non-uniform 60Co γ-ray irradiation of approximately 10 Ci were treated first in Hefei, Anhui province, and were then transferred to our hospital. The whole body average doses were estimated to be 2 × 102 cGy to ∼8 × 103 cGy. Two of patients died of intestinal acute radiation sickness within 2 weeks. Autopsy findings revealed findings consistent with multi-organ failure. Four cases survived, and one of them recovered from septicaemic shock. Loss of hair, systemic infection, high fever and bleeding occurred in five cases. The essential therapeutic measures were strict isolation, preventive treatment with anti-infection drugs, fresh blood transfusion and sometimes infusion of formed blood elements. Among the survivors, two cases received homologous bone marrow transfusion. The general conditions of four cases followed-up for a period of 24–40 years are apparently good, with transparent lens, normal thyroid function and normal immunol...

Clustering of equine grass sickness cases in the United Kingdom: a study considering the effect of position-dependent reporting on the space–time K-function

Equine grass sickness (EGS) is a largely fatal, pasture-associated dysautonomia. Although the aetiology of this disease is unknown, there is increasing evidence that Clostridium botulinum type C plays an important role in this condition. The disease is widespread in the United Kingdom, with the highest incidence believed to occur in Scotland. EGS also shows strong seasonal variation (most cases are reported between April and July). Data from histologically confirmed cases of EGS from England and Wales in 1999 and 2000 were collected from UK veterinary diagnostic centres. The data did not represent a complete census of cases, and the proportion of all cases reported to the centres would have varied in space and, independently, in time. We consider the variable reporting of this condition and the appropriateness of the space-time K-function when exploring the spatial-temporal properties of a 'thinned' point process. We conclude that such position-dependent under-reporting of EGS does not invalidate the Monte Carlo test for space-time interaction, and find strong evidence for space time clustering of EGS cases (P < 0.001). This may be attributed to contagious or other spatially and temporally localized processes such as local climate and/or pasture management practices.

Paralysis and Blindness during a Balloon Ascent to High Altitude

An account of the classic balloon ascent to over 29,000 ft (8840 m) by J. Glaisher and H. T. Coxwell on September 5, 1862, appeared in The Lancet and is reproduced here. Glaisher reported paralysis of his arms and legs and sudden loss of sight. Coxwell also lost the use of his hands and could only open the valve of the balloon to initiate its descent by seizing the cord with his teeth. These symptoms are unusual for acute hypoxia, and in a recent article Michael J. Doherty suggested that they may have been caused by decompression sickness. However, this seems unlikely based on many reported cases of subatmospheric decompression sickness.

Efficacy and safety of induction therapy with rabbit antithymocyte globulins in liver transplantation for hepatitis C

Background Hepatitis C virus (HCV)-related end-stage liver disease (ESLD) is the leading cause for orthotopic liver transplantation (OLT). However, in recent years, the long-term results of OLT in this setting are worsening, possibly due to the powerful immunosuppressants in use. The aim of our study was to assess the safety and efficacy of induction therapy using rabbit antithymocyte globulin antibodies (RATG). Methods Over an 18-month period from January 2000 to June 2001, 16 patients underwent OLT for HCV-related ESLD and survived more than 1 month posttransplantation. They received induction therapy based on RATG (Thymoglobulins, Sangstat, France) at 1 mg/kg per day for 3 consecutive days, and it was then adjusted to maintain a CD2 count below 50/mm 3. Overall, RATG was given for a median of 5 days for a total dose of 406 ± 45 mg. Steroids were started pretransplant and tacrolimus on day 1. The primary end-points were patient and graft survivals at 6 months posttransplantation, incidence of rejection, infectious complications (bacterial, viral, and fungal) and recurrence of HCV infection based on biochemical, virological, and histologic criteria. Results The survival rates were 100% for patients and 93.7% for grafts. The acute rejection rate was 37.5%. The median time to acute rejection was 15.5 days. There was only one serum sickness case. Cytomegalovirus infections occurred in 25% of patients. The rate of de novo diabetes that required insulin therapy was at 50%. The rate of HCV recurrence was 56.25%. In addition, HCV RNA serum concentrations increased significantly posttransplantation (>1 log). In conclusion, RATG induction therapy is safe and efficient in HCV-positive liver recipients.

Doctors, patients and influenza-like illness: clinicians or patients at risk?

Background: Healthcare providers can transmit influenza and influenza-like illness (ILI) to patients and vice versa. However, the magnitude of this problem in the healthcare system as a whole is unknown. Using population-based administrative health data, we tested the hypothesis of a temporal association of ILI diagnosis among clinicians and their patients. Methods: Healthcare providers under study included physicians (85%) and a variety of other medical professionals (such as chiropractors, dentists and optometrists). Cases of ILI were defined as having an ICD-9 code of influenza (487), pneumonia (480–486) or bronchitis (466 and 490) in a province-wide healthcare-provider billing system. Rates of ILI among persons who saw a sick (case) and non-sick (control) doctor were calculated and compared. Results: The rate of ILI was lower among providers than among patients for every year of the study. The mean number of exposures to patients diagnosed with ILI was higher among case providers than among control providers ( P=0.044). However, exposure to case providers did not significantly increase the risk of ILI diagnosis among patients (OR=1.11; 95% confidence intervals 0.85–1.36). Interpretation: Our findings are consistent with the hypothesis of patient-to-provider transmission. However, we may have underestimated the association and magnitude of this effect. Our results do not support the hypothesis that infectious doctors transmit disease to their patients, although this may be partly accounted for by the lower rates of ILI among the provider population in general.

Reanalyzing the 1900-1920 sleeping sickness epidemic in Uganda.

Sleeping sickness has long been a major public health problem in Uganda. From 1900 to 1920, more than 250,000 people died in an epidemic that affected the southern part of the country, particularly the Busoga region. The epidemic has traditionally been ascribed to Trypanosoma brucei gambiense, a parasite now confined to central and western Africa. The Busoga region still reports sleeping sickness, although it is caused by T.b. rhodesiense, commonly believed to have spread to Uganda from Zambia in the 1940s. Our analysis of clinical data recorded in the early 1900s shows that the clinical course of sleeping sickness cases during the 1900-1920 epidemic in Uganda was markedly different from T.b. gambiense cases, but similar to T.b. rhodesiense. These findings suggest that T.b. rhodesiense was present in Uganda and contributed to the epidemic. The historic context is reassessed in the light of these data.

Cyclines et acné : attention aux effets indésirables ! Aspects récents de la littérature

Purpose. – Cyclines are broad-spectrum antibiotics often used in acne. Side effects might occur precociously or more insidiously during long term treatment such in acne. The aim of this study is to review all adverse effects recently reported in this indication. Current knowledge and key points. – A literature review from 1997 to 2001 has been conducted. Seventy-six articles reporting 250 cases have been found. Data analysis indicated that minocycline is the most widely incriminated molecule. Seventy-two cases revealed autoimmune disorders : lupus like syndrome associated or not with autoimmune hepatitis, 5 cases developed vasculitis. These reactions occurred in long term treatment (several weeks to several months). Fifteen cases of hypersensitivity syndromes and 3 cases of serum sickness like illness have been reported. These reactions occurred within the first weeks of exposure. Twenty-four cases of pseudotumor cerebri and 123 cases of abnormal pigmentations (skin, nails, mouth, bones or organs) have also been found. Eight cases presented other diseases. Future prospects and projects. – Adverse effects of cyclines might be serious and sometimes unknown. Long term treatment by tetracyclines must be researched in patients presenting such symptoms. Moreover, several adverse drug reactions might be avoided by an optimal use of the drug (oesophageal ulcerations, photosensitivity) or by shorter periods of treatment (autoimmune disorders, pigmentations); only DRESS are drug adverse reactions unpredictable and sometimes severe.

Rabbit antithymocyte globulin as induction immunotherapy in pediatric heart transplantation.

There is little published data on the use of antithymocyte globulins in children. This retrospective study describes the use of Thymoglobulin (Imtix, SangStat, Lyon, France) in pediatric cardiac transplantation over a 13-year period in a single center that adjusted the dose of Thymoglobulin according to platelet count monitoring and examines the short-term hematological effects as well as longer-term outcomes. Data for all children who received a heart transplant at the Hôpital Cardiologique at Lyon from 1984 to 2001 and who were given Thymoglobulin as part of their immunosuppressive protocol were extracted. The dose of Thymoglobulin given depended on baseline platelet count and was 2, 1.5, or 1 mg/kg per day over 5 days for the following platelet count groups: greater than 150,000/mm (normal group), 100 to 150,000/mm (mild thrombocytopenia group), and 50 to 100,000/mm (moderate thrombocytopenia group). Thirty children of median age 14.2 years were given a median cumulative dose of Thymoglobulin of 8 mg/kg per patient; the moderate thrombocytopenia subgroup was given significantly less (6.4 mg/kg) ( P=0.032). Immediate tolerability of Thymoglobulin was good, with no cases of first-dose syndrome, anaphylaxis, or serum sickness. The platelet count decreased at the start of therapy, but recovered after discontinuation, and did not give rise to clinical concern. Patients were followed up for a median of 6.3 years (7 days-15.5 years); actuarial survival was 90%, 86%, and 74.5%, respectively, at 1, 5, and 10 years. In the first year, 50% of patients suffered an episode of rejection. The overall incidence of infection in the month following transplantation was 40%. One lymphoma occurred at 5 months. The use of Thymoglobulin in pediatric heart-transplant patients as part of an immunosuppressive protocol, with dose adjustment according to platelet levels, has been shown to be effective in terms of rejection rate and patient survival and safe in terms of the incidence of infections and malignancy.

Farmer Health Beliefs About an Occupational Illness that Affects Farmworkers: The Case of Green Tobacco Sickness

Latino migrant and seasonal farmworkers, like all agricultural workers, experience high rates of occupational illness and injury. Interventions to reduce occupational injury among farmworkers must attend to the health beliefs of agricultural employers as well as employees, as employers control many aspects of the work environment. Occupational safety programs for Latino migrant and seasonal farmworkers must also be conceptually based in health behavior change and health disparities theories. We examine health beliefs of tobacco farmers about green tobacco sickness (GTS) to show the importance of delineating employer beliefs in agricultural safety. GTS is a highly prevalent occupational illness among tobacco workers that results from nicotine poisoning through dermal absorption of nicotine during cultivation and harvesting. We use qualitative methods structured by the Explanatory Models of Illness approach to identify farmer beliefs about the etiology, onset, pathophysiology, course, and treatment of GTS. Data were collected through semi-structured in-depth interviews with 15 North Carolina tobacco farmers. A computer-assisted, systematic qualitative analysis framework was applied to the interview transcripts. While tobacco farmers were generally knowledgeable about GTS, their explanatory models for this occupational illness often mis-identified its causes (heat and bending rather than nicotine) and minimized its seriousness. These models included methods of prevention that are not proven (e.g., use of anti-nausea drugs) or are more harmful than GTS (smoking cigarettes). The need for medical treatment was also discounted. Addressing each of these beliefs is important in any program to prevent GTS among farmworkers. Documenting and understanding the beliefs and knowledge of agricultural employers is an important undertaking in our efforts to reduce occupational injury and illness among farmworkers.

Biomarkers of exposure to cyanogens in horses with grass sickness

To test the hypothesis that equine grass sickness may be associated with the ingestion of cyanogenic glycosides from white clover (Trifolium repens), the concentrations of whole blood cyanide, and plasma...

Evaluation of three ancillary treatments in the management of equine grass sickness

Brotizolam, acetylcysteine and aloe vera gel were evaluated as ancillary treatments for 29 cases of equine grass sickness. None of the treatments had any significant beneficial effect on the survival...

Long-term survival of equine surgical colic cases. Part 1: patterns of mortality and morbidity.

Postoperative complications and mortality can occur many weeks or months after colic surgery. We are interested in the long-term outcome of these cases. This study documents patterns of mortality and morbidity among 341 horses that recovered from colic surgery March 1998-August 2000. The progress of each horse was rigorously followed by periodic telephone and postal questionnaires. Event time data were recorded for each animal and a total of 321 horse years of survival, together with death from all causes, colic-related death and various postoperative complications. Postoperative survival (of all horses excluding grass sickness cases) was triphasic over the first 600 days and there was marked mortality in the first 10 days postoperatively. The probability of survival postoperatively decreased to 0.87 by 10 days, 0.82 by 100 days and declined slowly to 0.75 at 600 days. Horses suffering from epiploic foramen entrapment had a significantly reduced probability of postoperative survival (RR = 2.1, P = 0.033). The causes of death for 104 horses that died postoperatively and the prevalence of postoperative complications are recorded for the study population. Postoperative colic was the most prevalent complication with 100 horses (29%) suffering one or more episodes. However, only 16 horses (4.6%) suffered 3 or more episodes. The incidence of postoperative colic was 0.55 episodes/horse year at risk. This study provides data that will inform the prognosis for postoperative colic cases and identifies epiploic foramen entrapment as carrying a worse prognosis for survival than other strangulating lesions.

Genetic characterization of Trypanosoma brucei gambiense and clinical evolution of human African trypanosomiasis in Côte d'Ivoire.

Human African trypanosomiasis is a parasitic infection caused by protozoa belonging to Trypanosoma brucei subspecies. The clinical evolution of this disease is complex and might be because of the parasite itself, as genetic diversity has been observed in T. brucei ssp. We investigated the relationship between the genetic diversity of trypanosomes and the diversity of clinical patterns in Côte d'Ivoire. We studied clinical sleeping sickness cases, and genetically analysed the trypanosomes isolated from these patients. An important genetic monomorphism among stocks isolated in Côte d'Ivoire was observed by using various markers: isoenzymes electrophoresis, random amplified polymorphism DNA and PCR of microsatellite sequences. At the same time, the diversity of clinical patterns and evolutions was confirmed by clinical analysis. The existence of an individual susceptibility to disease (human trypanotolerance) should be taken into account even if our genetic conclusions might be distorted because the isolation success rates were particularly poor. In fact, we observed that the isolation success rate varied significantly depending both on the focus of origin (P=0.0002) and on the ethnic group (P=0.0317) of the patient. Further investigations are required in order to study a possible selective impact of the use of the kit for in vitro isolation of trypanosomes as an isolation technique.

Presence of in vitro electrical activity in the ileum of horses with enteric nervous system pathology: equine dysautonomia (grass sickness)

Equine dysautonomia (grass sickness) is a frequently fatal disease of horses characterised by intestinal stasis. Interstitial cells of Cajal (ICC) are the pacemakers and mediators of neurotransmission in the gastrointestinal tract. Impaired ICC-mediated control of motility has been implicated in intestinal disorders in laboratory mammals, humans and in equine grass sickness. The aim of this study was to compare the in vitro electrical properties of ileum from grass sickness cases with horses free from gastrointestinal disease. Intracellular microelectrode recordings were made from smooth muscle cells in cross-sectional preparations of equine ileum, superfused in vitro. Samples were taken from six horses with grass sickness and from eight horses free from gastrointestinal disease, all euthanised on humane grounds. Ileal tissues were processed for haematoxylin and eosin histology, and c-Kit immunohistochemistry. Membrane potential oscillations were recorded in the ileal preparations from four of the six horses with grass sickness and from all of the normal horses. A waxing and waning pattern of the membrane potential oscillation activity was noted in some cells. In comparison to the normal horses, the membrane potential oscillations in grass sickness horses had a significantly reduced frequency ( P=0.0001) and increased duration ( P=0.0002). Immunohistochemistry revealed the presence but reduction of ICC in grass sickness. Histological assessment of the same tissues used for analysis of the ICC showed the depletion and pathology of the enteric neurons in grass sickness. Therefore, the majority of ileal preparations from grass sickness-affected horses exhibited prominent membrane potential oscillation activity suggesting that, although the neural elements are damaged severely, the ICC-mediated pacemaker function remains intact.

The origins of a new Trypanosoma brucei rhodesiense sleeping sickness outbreak in eastern Uganda

Sleeping sickness, caused by two trypanosome subspecies, Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense, is a parasitic disease transmitted by the tsetse fly in sub-Saharan Africa. We report on a recent outbreak of T b rhodesiense sleeping sickness outside the established south-east Ugandan focus, in Soroti District where the disease had previously been absent. Soroti District has been the subject of large-scale livestock restocking activities and, because domestic cattle are important reservoirs of T b rhodesiense, we investigated the role of cattle in the origins of the outbreak. We identified the origins of cattle entering the outbreak area in the 4 years preceding the outbreak. A matched case-control study was conducted to assess whether the distance of villages from the main market involved with restocking was a risk factor for sleeping sickness. We investigated the spatial clustering of sleeping sickness cases at the start of the outbreak. Over 50% (1510 of 2796) of cattle traded at the market were reported to have originated from endemic sleeping sickness areas. The case-control study revealed that distance to the cattle market was a highly significant risk factor for sleeping sickness (p<0.001) and that there was a significant clustering of cases (27 of 28) close to the market at the start of the outbreak (p<0.001). As the outbreak progressed, the average distance of cases moved away from the cattle market (0.014 km per day, 95% CI 0.008-0.020 km per day, p<0.001). The results are consistent with the disease being introduced by cattle infected with T b rhodesiense imported to the market from the endemic sleeping sickness focus. The subsequent spread of the disease away from the market suggests that sleeping sickness is becoming established in this new focus. Public health measures directed at controlling the infection in the animal reservoir should be considered to prevent the spread of sleeping sickness.

The resurgence of trypanosomosis in Botswana.

No sleeping sickness or nagana cases have been reported in Botswana since 1985. In view of several confirmed clinical cases of nagana and reports of heavy bovine mortality, a parasitological survey was conducted to determine the prevalence of trypanosome infection in cattle in Maun and Shakawe areas of Ngamiland district. Wet blood films, buffy coat and Giemsa-stained thick and thin blood smears were used to detect trypanosomes in animals. Overall,trypanosome infection rate was 15.98%, with 5.94% and 27.29% in Maun and Shakawe respectively. The urgent need to combat trypanosomosis in Ngamiland, particularly in the Shakawe area, is highlighted, and a 3-phase integrated tsetse control strategy for this disease problem is discussed.

Bupropion-Induced Erythema Multiforme

Bupropion-Induced Erythema Multiforme