An Atypical Case of Hemolytic Uremic Syndrome Caused by Shiga Toxin Produced by Aeromonas spp.

Hemolytic uremic syndrome (HUS), traditionally recognized in pediatric populations, is characterized by renal insufficiency, hemolytic anemia, and thrombocytopenia, often linked to Shiga-like toxin (SLT) exposure. While typically associated with enteric pathogens like Escherichia coli (E. coli) and Shigella, Aeromonas spp. has also been identified as potential SLT producers, posing a new challenge. This study presents an exceptional case of HUS in a 77-year-old female, implicating Aeromonas hydrophila as the causative agent. The patient's clinical trajectory, marked by acute kidney injury post-consumption of raw oysters, underscores the unorthodox manifestation of HUS in adults. Diagnostic confirmation via stool antigen testing and blood culture revealed the presence of SLT and Aeromonas hydrophila, respectively. This case underscores the evolving landscape of HUS etiology, stressing the importance of heightened clinical awareness to expedite therapeutic intervention and mitigate long-term renal complications.

Itraconazole oral solution for the treatment of tinea capitis using the pulse regimen.

A 7-year-old boy with Trichophyton tonsurans tinea capitis was cured following the administration of itraconazole oral solution. He had difficulty swallowing tablets or capsules, so the availability of the oral solution was particularly advantageous. The itraconazole was given once daily in a fasting state at a dosage of 3 mg/kg/day as a pulse lasting 1 week. The first two pulses were separated by 2 weeks and the second and third pulse by 3 weeks. The decision whether or not to administer the third pulse was guided by the presence of clinical symptoms and signs of tinea capitis just prior to the scheduled administration. The availability of the oral solution will enable more young children to be considered for treatment of tinea capitis with itraconazole than was possible when only tablets or capsules were available.

Rheumatic fever in children.

Rheumatic fever (RF) and rheumatic heart disease (RHD) are major public health problems in developing countries. A prospective study carried out in a large general hospital showed that carditis was the predominant feature in first attack and also the recurrence of RF but that recurrence was associated with more severe manifestations. Echocardiography picked up cases of subclinical carditis. Presence of congestive cardiac failure in association with carditis always led to chronic RHD. Recurrence occurred only when patient defaulted penicillin prophylaxis. The overall recurrence rate was 0.026 per patient.