Azithromycin Prophylaxis in an Adolescent With PANDAS.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) is a type of pediatric obsessive-compulsive disorder with an acute symptom onset and periodic recurrence that is triggered by streptococcal infection. Due in part to the multifaceted assessment involved in the diagnosis of PANDAS and lack of consensus on the best treatment, management of these cases is complex. A background and case of PANDAS exacerbation in an adolescent patient, who presented with visuomotor impairment and was treated with azithromycin (Zithromax, Pfizer, New York, NY) prophylaxis to prevent further clinical deterioration, is described here.

Diabetic ketoacidosis depletes plasma tryptophan.

Diabetic ketoacidosis (DKA) is a severe metabolic disturbance of insulin-dependent diabetes mellitus (IDDM) which has a significant effect on amino acid metabolism. Amino acids serve as precursors for various neurotransmitters which are involved in affective disorders, and patients with IDDM are known to have an increased prevalence of affective disorders. We monitored the plasma concentrations of 23 amino acids in six adolescents prior to treatment of DKA and at 6, 24 and 120 hours after initiation of treatment. The well-known increase in the concentrations of the glucogenic amino acids and the decrease in the branched-chain amino acids were observed in response to treatment of DKA. Low levels of tryptophan were found prior to treatment of DKA. Treatment increased the plasma tryptophan levels, but the mean concentration remained low throughout the sampling period. Only the glutamate-derived amino acids (glutamate, proline and glutamine) from the Krebs cycle pool were significantly affected by treatment. Glutamine declined initially, but recovered as the plasma pH normalized. Our results indicate that DKA causes a depletion of plasma tryptophan. This depletion may predispose some patients with IDDM to have affective disorders secondary to a neurotransmitter imbalance.

Use of a Biocompetitive Agent to Control Preharvest Aflatoxin in Drought Stressed Peanuts.

A three-year study was conducted to evaluate the use of a nonaflatoxin-producing strain of Aspergillus parasiticus (NRRL 13539) as a biocompetitive agent for the control of preharvest aflatoxin contamination of peanuts. The agent was added to the soil of the environmental control plot facility at the National Peanut Research Laboratory and tested by subjecting peanuts to optimal conditions for the development of aflatoxin contamination. Edible peanuts from the treated soil contained aflatoxin concentrations of 11, 1, and 40 ppb for crop years 1987, 1988, and 1989, respectively, compared to untreated peanuts with 531, 96, and 241 ppb, respectively. In addition, treatment in 1989 with low and high inoculum levels of a UV-induced mutant from the NRRL 13539 strain resulted in aflatoxin concentrations of 29 and 17 ppb, respectively, in edible peanuts. Soil populations of the biocompetitive agents were not higher than populations of wild strains of A. flavus/parasiticus in untreated soil subjected to late-season drought stress. This is an important ecological consideration relative to the utilization of this biocontrol system.