1/6. Delayed life-threatening reaction to anthrax vaccine.BACKGROUND: anthrax is an acute infectious disease caused by the spore-forming bacterium bacillus anthracis. Due to the current world threat of unpredictable biological terrorism, the Department of Defense has mandated the systematic vaccination of all US military personnel against this warfare agent. Many may experience al mild flu-like illness and soreness at the injection site, but systemic reactions are rare. CASE REPORT: We report a delayed and potentially serious life-threatening adverse reaction to anthrax vaccine. A previously healthy 34-year-old male was transported to the emergency department with dyspnea, diaphoresis, pallor, and urticarial wheals on his face, arms, and torso after the administration of the third dose of anthrax vaccine. All symptoms resolved after pharmacological intervention and the patient was discharged. Pharmaco-epidemiological data indicate that 30% of anthrax vaccine recipients experience mild local reactions. With large numbers of military personnel being vaccinated, emergency physicians may encounter more vaccine-related adverse reactions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Prolonged urinary retention after collagen periurethral injections: a sequela of humoral immunity.BACKGROUND: Approximately 3% of candidates for collagen periurethral injections are ineligible because of an immediate hypersensitivity reaction to skin testing. After a negative skin test, physicians believe patients should be free of any adverse clinical events from hypersensitivity reactions. We present a patient who developed prolonged urinary retention from a delayed hypersensitivity reaction after negative skin testing. CASE: After a negative skin test, a 51-year-old woman underwent collagen periurethral injections for recurrent genuine stress incontinence associated with a fixed bladder neck. After reporting complete resolution of symptoms, she developed complete urinary retention associated with a delayed hypersensitivity reaction at both the skin test and injection sites. Her retention resolved after a year of intermittent catheterization and antibiotics for persistent urinary tract infection. CONCLUSION: Delayed hypersensitivity reactions may be associated with an adverse clinical event in up to 2.5% of patients despite a negative skin test. After skin testing, physicians should counsel their patients accordingly.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/6. Delayed hypersensitivity reaction to subcutaneous heparin.Two women developed well-demarcated eczematous and erythematous plaques localized to the injection sites of subcutaneous preservative-free heparin 72-96 h after heparin administration. The plaques resolved within a week of discontinuing the therapy. Neither epicutaneous testing with preservative-free heparin nor in vitro proliferation assays to heparin and two low molecular weight glycosaminoglycans could elicit a response in either patient. In contrast, both patients developed localized eczematous plaques 48-96 h after re-challenge with intradermal and/or subcutaneous heparin. Delayed hypersensitivity reactions to subcutaneous heparin are uncommon and have not been reported in the Australasian medical literature. Given the frequency with which heparin preparations are used, it is important for physicians and surgeons to be aware of this potential adverse reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. The late asthmatic response.Since LARs are associated with increases in airways reactivity, their significance may go well beyond the increase in symptoms due just to the allergen exposure. This is especially true since the increase in non-specific airways reactivity can last for weeks after a single exposure to allergen. Every effort should be made to search for possible allergic triggers in patients suspected to have LARs. Careful attention to historical information and skin test reactivity are critical in this evaluation. In situations where this approach is not revealing and where serious concerns remain about potential environmental triggers, a bronchial challenge to the suspected antigen can be considered. Since the nonspecific airways reactivity in patients with LAR may possibly be due to inflammation in the airways, the potential risk of transient induction of airways inflammation must be carefully weighed against the value of information that can be obtained from this procedure. Bronchial challenge should be performed only in an inpatient setting by experienced personnel under the supervision of a physician. A full explanation of the potential risks and benefits of this type of evaluation must be given to the patient and family. Treatment is primarily directed at allergen avoidance with use of a prophylactic drug, such as cromolyn sodium, when allergen avoidance is not possible.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Spread of tuberculosis within a family.A man aged 22 was admitted to hospital with active pulmonary tuberculosis. Routine contact examination and close follow-up of his family detected fourteen members who had been infected. Thorough follow-up of all close contacts of patients with infectious tuberculosis is vital to the control of tuberculosis. Efficient contact procedure depends on close liaison between chest clinic, health visitor, and district community physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Treatment site reactions to Zyderm collagen Implantation.Two cases of treatment site granulomatous reaction to Zyderm collagen Implant that occurred in spite of a negative skin test are reported. A delayed hypersensitivity reaction to ZCI is suggested by the clinical time course and the histologic findings of hypersensitivity granulomas. Humoral immunity is also implicated in the reaction since elevated anti-Zyderm serum antibodies and plasma cell infiltrates are present. Resolution of the clinical signs and symptoms occurred over several months with no treatment. The physician using ZCI should be aware of this rare adverse reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |