Subject(s)
Arachnid Vectors , Ehrlichiosis/diagnosis , Granulocytes/microbiology , Ticks/microbiology , Aged , Animals , Bites and Stings/complications , Female , Humans , MassachusettsABSTRACT
Babesiosis is a tick-borne protozoal disease with infrequent clinical complications. We report three cases of noncardiogenic pulmonary edema in patients from Nantucket Island, MA, with a history of Lyme disease and review the clinical presentation of babesiosis and its treatment. Respiratory complications in our patients, as well as in the four previously reported cases in the literature, occurred a few days after initiation of medical therapy. We hypothesize that the pathophysiology of the pulmonary edema is multifactorial, due to decreased deformability of the infected erythrocytes, increased cytoadherence of red blood cells in capillaries and venules, and a possible role of excessive production of certain cytokines, such as tumor necrosis factor and interleukin-1.
Subject(s)
Babesiosis/complications , Lyme Disease/complications , Pulmonary Edema/etiology , Respiratory Insufficiency/etiology , Acute Disease , Adhesiveness , Adult , Aged , Babesiosis/drug therapy , Babesiosis/epidemiology , Cardiac Catheterization , Clindamycin/therapeutic use , Combined Modality Therapy , Erythrocyte Deformability , Erythrocytes , Female , Humans , Incidence , Interleukin-1/blood , Male , Pulmonary Edema/blood , Pulmonary Edema/diagnosis , Pulmonary Edema/physiopathology , Quinine/therapeutic use , Respiration, Artificial , Respiratory Insufficiency/blood , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/physiopathology , Tumor Necrosis Factor-alpha/analysisABSTRACT
A 27-year-old woman who acquired cutaneous leishmaniasis in Central America was inadvertently treated with 10 times the intended daily dose of the pentavalent antimonial compound sodium stibogluconate (Pentostam): 8500 mg (143 mg/kg) instead of 850 mg. The patient felt "wiped out" during the 4-h infusion of the drug. After the mistake in dosing was discovered, she was vigorously hydrated and carefully monitored in an intensive care unit for greater than 48 h. Her vital signs were stable, and no arrhythmias were noted. Her alanine aminotransferase level rose briefly to 2.4 times the upper limit of normal, and her white blood cell count briefly fell 43% to a low of 3700/microliter. Her skin lesions subsequently healed without further therapy. Although sodium stibogluconate has been associated with a variety of side effects, in this case, a single high dose of the drug was tolerated without serious toxicity.
Subject(s)
Antimony Sodium Gluconate/poisoning , Leishmaniasis, Cutaneous/drug therapy , Adult , Animals , Antimony Sodium Gluconate/administration & dosage , Antimony Sodium Gluconate/therapeutic use , Drug Overdose/therapy , Female , Fluid Therapy , Humans , Infusions, Intravenous , Leishmania braziliensis/isolation & purificationABSTRACT
Noninvasive screening of the lower extremities for deep vein thrombosis was performed bilaterally on 1,118 patients. Impedance plethysmography alone was used in 868. Venography in 135 revealed an accuracy of 88%, with a false-negative rate of 5.3% and a false-positive rate of 18.6%. A combined ultrasonic Doppler and modified impedance technic was used in 250 patients. Venography in forty revealed an accuracy of 95%, with a false-positive rate of 10% and no undetected thrombi. The combined technic, emphasizing the more accurate modality in three anatomic areas, has proven sensitive, specific, and reliable as a screening test for deep venous thrombosis.
