Intrahepatic cholestasis after thiabendazole.
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Biomedical subjects
Publications and source records attributed to W R Weir.
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Eight patients who developed tuberculosis at the site of a recent injury are described. They were all in apparent good health before and at the time of the injury. There are only two precedents of such cases in the literature, and the possible pathogenetic mechanisms are discussed.
All cases referred for computed tomography (CT) from a 48-bed infectious disease unit over a 3-year period were reviewed. Thirty patients were examined on 45 occasions with head and body cases approximately equal in number. Positive diagnoses were made in 38 examinations (84%), although this included 3 incidental findings. The most common indication for CT was exclusion of cerebral abscess presenting as meningitis (11 cases). The most common disease was tuberculosis (12 cases), although a wide spectrum of disease including four noninfective cases was encountered. CT made a direct contribution to the management of patients with meningitis, encephalitis, cerebral abscess, septicemia, hepatic abscess, tuberculosis, and lymphoma. Although CT was only utilized in a small proportion of patients admitted to this unit, the technique provided valuable information in the management of a number of problematic cases.
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A fatal case of primary amebic meningoencephalitis (PAME) in a 35-year-old Nigerian Muslim farmer is described. The disease was contracted during ritual washing before prayers, which involved the sniffing of water up his nose to clean it. The water came from a man-made pond at his farm. The clinical presentation, isolation of the ameba from the cerebrospinal fluid and nasal passages, poor response to amphotericin B, and ultimate fatal outcome prove this to be a case of PAME. On the basis of its ability to grow at 42 degrees C, morphology of the trophozoite, cyst, and flagellate forms, animal pathogenicity, and nuclear division the ameba was identified as Naegleria fowleri. Pathogenic N. fowleri were recovered from samples of water and soil from the pond. This represents the fourth proven case of PAME from northern Nigeria.
A single injection of a long-acting preparation of penicillin (Triplopen) was compared with a five-day course of crystalline and procaine penicillin in the treatment of meningococcal meningitis. The clinical response of patients treated with Triplopen was very similar to that of patients treated with crystalline penicillin and much more convenient to administer. However, four patients treated with Triplopen had a positive CSF culture 48 or 72 hours after their injection. One injection of Triplopen cannot, therefore, be recommended as an entirely safe form of treatment for meningococcal meningitis unless patients can be carefully followed.
A single injection of a long-acting oily preparation of chloramphenicol (Tifomycine) was compared with a five-day course of crystalline and procaine penicillin in the treatment of 131 adult patients with meningococcal meningitis. The clinical response to treatment was similar in the two groups of patients. Serial lumbar punctures showed a parallel fall in CSF cell count, protein and lactate and all posttreatment cultures were sterile. Single injection chloramphenicol treatment was cheaper and much easier to administer than penicillin. Long-acting chloramphenicol is thus an effective form of treatment for meningococcal meningitis and is likely to prove of particular value in the management of epidemics in areas with limited medical resources.
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Hepatitis is a well-recognised complication of Epstein-Barr virus (EBV) infection that usually resolves spontaneously. Jaundice occasionally results from the unusual complication of autoimmune haemolytic anaemia rather than hepatitis. Two adult patients are described with infectious mononucleosis-related hepatitis who also developed significant haemolysis, a situation that could have led to diagnostic delay and a deleterious outcome. Haemolysis should be considered in all patients who become jaundiced after infectious mononucleosis. The management of this potentially fatal complication is discussed.