1/2. plesiomonas shigelloides overgrowth in the small intestine.An 83-year-old male presented with chronic diarrhea and protein malnutrition associated with plesiomonas shigelloides overgrowth in the small intestine. This overgrowth was related to achlorhydria and small-bowel diverticula. Tests for heat-labile and heat-stable enterotoxin were negative on the P. shigelloides isolated from both the small bowel aspirate (3 x 10(8) bacteria per ml) and the patient's stool. The patient responded satisfactorily to tetracycline, to which this unusual isolate was susceptible in vitro. The ability to correctly identify and determine the antimicrobial susceptibility of P. shigelloides in the setting of small-bowel overgrowth will help determine appropriate therapy.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/2. Reversible hepatotoxicity associated with hepatic vitamin a accumulation in a protein-deficient patient.A 62-yr-old white male presented with edema, protein malnutrition, and abnormal liver function. He had ingested from 40,000-50,000 IU of vitamin a per day for 7 yr. Examination of liver tissue by light and electron microscopy revealed findings characteristic of an excessive accumulation of vitamin a. liver tissue contained massive amounts of vitamin a (19,000 IU/g); however, both the serum concentration of vitamin a and retinol-binding protein were below normal, and serum RBP was not saturated. On a normal diet the patient was able to mobilize hepatic vitamin a, as indicated 71 days later by a repeat biopsy of the liver, which then contained 9000 IU of vitamin a/g. During this time his nutrition improved, serum vitamin a rose, and serum RBP became transiently saturated. The amount of vitamin a ingested by this patient was less than that usually producing recognizable hepatotoxicity, and he had no extra hepatic manifestations of vitamin toxicity, consistent with a low serum vitamin a concentration and a low vitamin a to retinol-binding protein ratio. At presentation he was apparently unable to normally mobilize vitamin a from his liver, which may have been due to an accompanying protein deficiency.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |