1/277. Caterpillars: an unusual source of ingestion. PURPOSE: To describe a series of patients seen in a pediatric emergency department with adverse effects following an ingestion of a caterpillar. methods: Case series. RESULTS: Ten patients presented to the emergency department following ingestion of a caterpillar. Adverse effects ranged from drooling and refusal to drink to diffuse urticaria. Six patients were admitted and five underwent direct laryngoscopy and bronchoscopy in the operating room. None of the 10 patients had an adverse outcome. CONCLUSIONS: Previously not described, significant adverse effects can occur following ingestion of a caterpillar. In addition, although not previously reported, the caterpillar of the Hickory Tussock moth can cause adverse effects in humans. ( info) |
| We report the case of a young male who developed severe nephrotic syndrome within 2-3 weeks after being stung by 3 wasps. A percutaneous kidney biopsy specimen revealed mesangioproliferative glomerulonephritis with occasional subepithelial deposits suggestive of early membranous nephropathy. The patient was treated with oral prednisone 60 mg/day with no significant clinical response after 4 weeks, at which point he was started on oral cyclophosphamide, 100 mg/day, while the prednisone dose was tapered to 20 mg every other day over a 2-week period. Six months after initiation of cyclophosphamide, he still has severe nephrotic syndrome. We also briefly review the literature on hymenoptera sting associated nephrotic syndrome. ( info) |
| erythema chronicum migrans is characterized by an expanding erythematous band about an arthropod bite. While rare, it is an important disease to recognize because of its rapid response to even modest doses of antibiotics. This response and the association with arthropod bites suggest a microbial vector. Richettsial titers have been demonstrated in several cases but we were unable to show them in our patient, who we believe is the second reported case of erythema chronicum migrans incurred by an American without traveling abroad. ( info) |
4/277. Characterization of Epstein-Barr virus (EBV)-infected natural killer (NK) cell proliferation in patients with severe mosquito allergy; establishment of an IL-2-dependent NK-like cell line. The clinical evidence of a relationship between severe hypersensitivity to mosquito bite (HMB) and clonal expansion of EBV-infected NK cells has been accumulated. In order to clarify the mechanism of EBV-induced NK cell proliferation and its relationship with high incidence of leukaemias or lymphomas in HMB patients, we studied clonally expanded NK cells from three HMB patients and succeeded in establishing an EBV-infected NK-like cell line designated KAI3. immunoblotting and reverse transcriptase-polymerase chain reaction (RT-PCR) analyses revealed that KAI3 cells as well as infected NK cells exhibited an EBV latent infection type II, where EBV gene expression was limited to EBNA 1 and LMP1. As KAI3 was established by culture with IL-2, IL-2 responsiveness of peripheral blood NK cells from patients was examined. The results represented markedly augmented IL-2-induced IL-2R alpha expression in NK cells. This characteristic property may contribute to the persistent expansion of infected NK cells. However, KAI3 cells as well as the NK cells from patients were not protected from apoptosis induced by either an anti-Fas antibody or NK-sensitive k562 cells. Preserved sensitivity to apoptosis might explain the relatively regulated NK cell numbers in the peripheral blood of the patients. To our knowledge, KAI3 is the first reported NK-like cell line established from patients of severe chronic active EBV infection (SCAEBV) before the onset of leukaemias or lymphomas. KAI3 cells will contribute to the study of EBV persistency in the NK cell environment and its relationship with high incidence of leukaemias or lymphomas in HMB patients. ( info) |
5/277. Cutaneous nocardiosis caused by nocardia brasiliensis after an insect bite. We report the case of a primary lymphocutaneous nocardiosis occurring on the right calf of a healthy 56-year-old man after an insect bite. Analysis of the purulent exudate obtained from the nodule revealed nocardia brasiliensis. The initial therapy with trimethoprim-sulfamethoxazole had to be stopped due to a drug eruption. However, with minocycline treatment the patient recovered within 5 weeks. Superficial (sporotrichoid) infections and a history of outdoor injury should be considered suspicious for cutaneous nocardiosis. ( info) |
6/277. serum sickness-like syndrome due to mosquito bite. Local inflammatory reactions at the site of a mosquito bite are frequent. Immediate systemic reactions have occasionally been reported. The first case of a patient with relapsing episodes of a serum sickness-like syndrome following mosquito bites is reported herein. A 62-year-old patient came to the emergency room complaining of sudden malaise, chills, fever, headache, cervical lymph node enlargement, arthromyalgia, generalized purpura and leukopenia 6 h after a mosquito bite. He had experienced multiple similar episodes in the last 20 years, also following mosquito bites. Infectious and autoimmune diseases were ruled out. Serum IgE was 9,102 kU/l. Prick test of whole-body culex pipiens extract was positive. Specific IgE to aedes communis was 2.25 kU/l. SDS-PAGE immunoblotting of the patient's serum with whole-body C. pipiens extract revealed 43 and 17 kDa IgG-binding proteins and 22 and 17 kDa IgE-binding proteins, neither of which were found with control sera. skin biopsy was consistent with leukocytoclastic vasculitis. The presence of both mosquito-specific IgE and IgG in the patient's serum suggest a possible cooperative immune response leading to clinical manifestations of serum sickness. ( info) |
7/277. Centipede inflicted postmortem injury. We here report the first case of postmortem injury caused by a centipede. An old man was found dead in his bedroom. The death was estimated to be due to intracranial hemorrhage and to have occurred two days before the police inspection. A centipede about 12 cm long emerged from a subcutaneous cavity on the victim's forearm. Obviously, the centipede had dug the cavity on the intact skin. A police inspector was bitten by the centipede, so he stepped on the centipede on the floor. The exudate from the insect was identified to be derived from the victim's blood. ( info) |
8/277. Fire ant attacks on residents in health care facilities: a report of two cases. BACKGROUND: Imported fire ants now infest more than 310 million acres in the united states and puerto rico. Colonies have been found in arizona, california, new mexico, and virginia. Available reports suggest that each year, fire ants sting more than 50% of persons in endemic areas, resulting in a variety of medical consequences. OBJECTIVE: To describe fire ant attacks among patients in health care facilities. DESIGN: Case series and literature review. SETTING: Two nursing homes in mississippi. patients: Two nursing home residents. MEASUREMENTS: Clinical records to describe clinical sequelae of multiple stings. RESULTS: With the 2 incidents reported here, the total number of reported indoor fire ant attacks on humans since 1989 is 10. Six of the persons attacked, including the 2 nursing home residents described here (who died after the stings), had preexisting neurologic impairment. Eight of the 10 attacks have been reported in the past 4 years. CONCLUSIONS: The presence of fire ants in occupied dwellings indicates the presence of active fire ant colonies in the immediate proximity. Efforts to eradicate these insects should be undertaken immediately, especially if immobile persons are present. These persons should be considered at risk for fire ant attacks as long as the ants are present. ( info) |
9/277. hypertension and abdominal pain: uncommon presentation after exposure to a pine caterpillar. The pine caterpillar Thaumatopoea wilkinsoni is found in pine woods all over israel. Contact with its hair usually results in local reactions. Systemic reactions after contact with caterpillar hairs are known in other caterpillar species, but have been described only once after contact with T. wilkinsoni. We describe a group of adolescents who were exposed to T. wilkinsoni while camping in a pine wood. Three of them were referred to an emergency department. They had severe pruritus, pain and edema at the contact sites, with papular and urticarial rashes. Two of the patients had abdominal pain and one patient had hypertension for several hours. The hypertension resolved spontaneously. CONCLUSION: skin eruptions are the most common manifestations of T. wilkinsoni contact, however, although systemic manifestations are rare, abdominal pain and hypertension may occur. ( info) |
10/277. An unusual site of chigger bite in a patient with scrub typhus. A 70-year-old female farmer was admitted to the hospital because of fever, headache, and diarrhea for 7 days. hypotension, right-sided pleural effusion with respiratory distress and leukocytosis were noted. She was initially treated as systemic bacterial infection by i.v. administration of ampicillin/sulbactam and amikacin. Because fever persisted in spite of aggressive treatment, a repeat thorough physical examination was done. An eschar was found over the left-sided labium majus and an enlarged lymph node was noted over the left inguinal region. Under the impression of scrub typhus, minocycline was administered. The patient's clinical condition improved dramatically within 3 days. The diagnosis was later confirmed by a serologic test for rickettsia tsutsugamushi. ( info) |