RESUMO
Levamisole has been increasingly used as an adulterant of cocaine in recent years, emerging as a public health challenge worldwide. Levamisole-associated toxicity manifests clinically as a systemic vasculitis, consisting of cutaneous, hematological, and renal lesions, among others. Purpura retiform, cutaneous necrosis, intravascular thrombosis, neutropenia, and less commonly crescentic nephritis have been described in association with anti-neutrophil cytoplasmic antibodies (ANCAs) and other autoantibodies. Here we report the case of a 49-year-old male who was a chronic cocaine user, and who presented spontaneous weight loss, arthralgia, and 3 weeks before admission purpuric skin lesions in the earlobes and in the anterior thighs. His laboratory tests on admission showed serum creatinine of 4.56 mg/dL, white blood count 3,800/μL, hemoglobin 7.3 g/dL, urinalysis with 51 white blood cells/μL and 960 red blood cells/μL, and urine protein-to-creatinine ratio 1.20. Serum ANCA testing was positive (>1:320), as well as serum anti-myeloperoxidase and anti-proteinase 3 antibodies. Urine toxicology screen was positive for cocaine and levamisole, with 62.8% of cocaine, 32.2% of levamisole, and 5% of an unidentified substance. Skin and renal biopsies were diagnostic for leukocytoclastic vasculitis and pauci-immune crescentic glomerulonephritis, respectively. The patient showed a good clinical response to cocaine abstinence, and use of corticosteroids and intravenous cyclophosphamide. Last serum creatinine was 1.97 mg/dL, white blood cell count 7,420/μL, and hemoglobin level 10.8 g/dL. In levamisole-induced systemic vasculitis, the early institution of cocaine abstinence, concomitant with the use of immunosuppressive drugs in severe cases, may prevent permanent end organ damage and associate with better clinical outcomes.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Púrpura/induzido quimicamente , Levamisol/efeitos adversos , Cocaína/efeitos adversos , Vasculite Sistêmica/induzido quimicamente , Glomerulonefrite/induzido quimicamente , Púrpura/patologia , Vasculite Sistêmica/patologia , Glomerulonefrite/patologiaRESUMO
ABSTRACT With the objective of examining the frequency of bacterial agents involved in the clinical and subclinical inflammatory processes of the mammary glands of buffalos and to study the sensitivity profile of the isolated agents 128 lactating buffalos (a total of 512 mammary quarters) were examined. The California Mastitis Test was the method used for the diagnosis of frequency of subclinical cases and physical examination of the udder and a screened mug test for identification of the clinical cases. Samples of milk were collected from the quarters that showed a reaction to CMT (scores 1+, 2+, 3+) and from those with clinical mastitis. All samples were previously microbiologically tested for the identification of the agents involved together with the sensitivity tests and antimicrobials. The results indicated that the bacteria isolated and associated in the clinical and subclinical cases of the disease were mainly Staphylococcus coagulase negative.The in vitrosensitivity tests showed greater efficacy for gentamicin antibiotics (97.98%), florfenicol (93.94%) and enrophloxine (90.90%). Gentamicin showed 100% efficacy in the treatment of the clinical cases and was considered the best treatment for the control of the disease in the herd in this study.
RESUMO Com o objetivo de estudar a freqüência de agentes bacterianos envolvidos nos processos inflamatórios clínicos e subclínicos da glândula mamária de búfalas e realizar o perfil de sensibilidade dos agentes isolados, foram estudadas 128 búfalas em lactação, totalizando 512 quartos mamários. Realizou-se o California Mastitis Test para diagnóstico da freqüência de casos subclínicos e o exame físico da glândula mamária e teste da caneca telada para identificar os casos clínicos. As amostras de leite foram colhidas dos quartos que apresentaram reação ao C.M.T. (escores 1+, 2+, 3+) e daqueles com mastite clínica, sendo posteriormente realizados os exames microbiológicos para a identificação dos agentes envolvidos, além dos testes de sensibilidade a antimicrobianos. Observaram-se bactérias isoladas e associações destas em casos clínicos e subclínicos da doença, destacando-se o Staphylococcus coagulase negativa como o mais freqüente. Os testes de sensibilidade in vitro demonstraram maior eficácia para os antibióticos gentamicina (97,98%), florfenicol (93,94%) e enrofloxacina (90,90%). A gentamicina apresentou 100% de eficácia no tratamento dos casos clínicos, sendo considerada uma boa opção para o controle da doença no rebanho estudado.
RESUMO
RESUMO A mastite, inflamação da glândula mamária, é uma das principais doenças da bovinocultura de leite tendo como principal agente infeccioso bactérias do gênero Staphylococcus spp. que comumente apresentam resistência aos antibióticos utilizados no tratamento da mastite. Desta forma, objetivouse com este estudo traçar o perfil de sensibilidade antimicrobiana de 59 cepas de estafilococos coagulase positivo, isolados de amostras de leite de vaca com mastite. Os testes de sensibilidade antimicrobiana foram realizados através da técnica de difusão com discos para 13 antibióticos, verificando-se que os mais eficazes foram a vancomicina com 100% de sensibilidade e a norfloxacina com 96%. O menos eficaz foi a penicilina com 20% de sensibilidade. Em alguns municípios estudados as cepas de estafilococos apresentaram resistência múltipla para 6 a 9 antibióticos simultaneamente. Conclui-se que a análise da sensibilidade antimicrobiana in vitro deve ser considerada pelos proprietários antes da tomada de decisões para a escolha do tratamento adequado para reduzir perdas na produção de leite e em programas de controle da doença em questão.
ABSTRACT Mastitis, inflammation of the mammary gland, is one of the main diseases of milk cattle, having as the main infectious agent the Staphylococcus spp. bacteria, which commonly presents resistance to the antibiotics used in the treatment of mastitis. For this reason, this study was aimed at drawing the profile of anti-microbial sensibility of 59 strains of coagulase-positive staphylococcus, isolated from samples of cow milk with mastitis. The tests of anti-microbial sensibility were accomplished through a diffusion technique with disks for 13 antibiotics, it being verified that the most effective were vancomycin with 100% of susceptibility and norfloxacin with 96%. The least effective was penicillin with 20% of susceptibility. In some of the studied coutries the staphylococcus strains presented multiple resistance to from 6 to 9 antibiotics simultaneously. The conclusion is that the analysis of the anti-microbial susceptibility in vitro should be considered by the proprietors before taking decisions about the choice of the appropriate treatment in order to reduce losses in the production of milk and in control programs of the disease in question.