ABSTRACT
BACKGROUND: Influenza is an important cause of morbidity and mortality in immunocompromised hosts. Recommendations exists for vaccination each year, yet disease can still occur. OBJECTIVES: To describe the course of fulminant influenza infection in a patient with HCV. STUDY DESIGN: Case study in which correlation was made between immunoglobulin response to influenza vaccination to the disease and its unique clinical course caused by influenza virus. RESULTS: Influenza A/Jerusalem 17/98 (H(1)N(1)) was isolated from the throat of a chronic hepatitis C carrier who, presented with shortness of breath, and subsequent massive bilateral pneumonia. The patient was previously immunized IM with inactive influenza vaccine. He developed protective levels of humoral antibodies (1:80 hemagglutination inhibition (HI) antibodies) against the three strains of the vaccine that evidently did not prevent respiratory infection. The development of massive bilateral pneumonia and continued presence of influenza virus in the respiratory tract may have been due to his underlying medical condition and possible lack of mucosal secretory IgA (SIgA) antibodies. CONCLUSION: We have presented a case of prolonged influenza infection post vaccination. This case emphasizes the importance of an improved vaccine that would stimulate a better immunologic response, especially in immunocompromised patients.
Subject(s)
Antibodies, Viral/immunology , Carrier State , Hepatitis C, Chronic/complications , Influenza A virus/immunology , Influenza Vaccines , Influenza, Human/complications , Influenza, Human/prevention & control , Antibodies, Viral/blood , Hemagglutination Inhibition Tests , Hepatitis C, Chronic/virology , Humans , Immunocompromised Host , Influenza Vaccines/administration & dosage , Influenza, Human/virology , Injections, Intramuscular , Male , Middle Aged , VaccinationABSTRACT
Hypocalcemia associated with labor and lactation is a rare condition reported previously in patients with hypovitaminosis D. We here describe a case of a young woman in whom symptomatic severe hypocalcemia appeared after her second delivery, early in lactation. At the end of lactation the condition worsened. We review all previously reported cases and suggest a possible physiologic explanation for the association between pregnancy, lactation and the appearance of symptomatic hypocalcemia.
Subject(s)
Hypocalcemia/etiology , Hypoparathyroidism/etiology , Lactation , Puerperal Disorders , Adult , Calcium/administration & dosage , Calcium/therapeutic use , Dietary Supplements , Female , Humans , Vitamin D/administration & dosage , Vitamin D/therapeutic use , Vitamin D Deficiency/complicationsABSTRACT
PURPOSE: To determine the causes of pleural effusions in patients with heart failure, and the association of the characteristics of these statistics with the use of diuretics. SUBJECTS AND METHODS: Eighty-one patients with a definite diagnosis of heart failure who underwent thoracentesis were evaluated. Fluids were classified as transudates or exudates using Light's criteria. RESULTS: Forty-one effusions (in 34 patients) were transudates, and 54 (in 47 patients) were exudates. A specific cause was found for 32 of the exudates (27 patients); except for heart failure, no obvious cause was found for the remaining 22 fluids (20 patients). Exudates with a specific cause for an exudate were more likely to have at least two of Light's criteria (18 of 27 [67%]) than did exudates without a known cause (2 of 21 [10%]). Intravenous diuretic therapy in the 24 hours before thoracentesis was significantly more common among patients with exudates without a specific cause. CONCLUSIONS: Patients with heart failure may have exudative pleural effusions without an obvious cause except heart failure.
Subject(s)
Heart Failure/complications , Pleural Effusion/etiology , Aged , Diuretics/administration & dosage , Exudates and Transudates/chemistry , Female , Heart Failure/drug therapy , Humans , Male , Pleural Effusion/diagnosis , Pleural Effusion/mortality , Retrospective Studies , Risk Factors , Statistics, Nonparametric , Survival AnalysisABSTRACT
Warfarin induced skin necrosis occurs in 0.01-0.1% of warfarin treated patients. The usual presentation is that of painful lesions developing in obese women after the initiation of warfarin treatment. The lesions usually evolve into full thickness skin necrosis within a few days. Although the exact mechanism is not totally clear, low levels of Protein C or S, either functional or inherited, are associated with many of the cases. We report the case of a 17-year-old patient treated with warfarin because of iliofemoral deep vein thrombosis post abortion. The patient developed several huge haemorrhagic blisters on the affected leg. The condition rapidly developed into full thickness skin and fat necrosis. The necrotic lesions were excised and eventually covered with skin graft. The combination of the patient tendency towards hyper-coagulation and the local factors is discussed.
