[PAGID] CGD patient

[Vinh, Donald (NIH/NIAID) [F]]

If you believe this is BCG meningitis, then the pyrazinamide will not be useful since M. bovis/BCG produces pyraziminidase and is intrinsically resistant to pyrazinamide. Ethambutol has decent blood brain barrier penetration. Streptomycin does not. If there is paradoxical worsening on treatment, you may consider concomitant dexamethasone. 

Donald C. Vinh, MD
Infectious Disease specialist & Medical Microbiologist
Visiting Post-doctoral Fellow, LCID
NIH / NIAID
9000 Rockville Pike
Bldg 10CRC, Rm B3-4141
Bethesda, MD     USA
20892
Ph: 301-496-2473
Fax: 301-480-4507
e-mail: vinhd at niaid.nih.gov

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From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] On Behalf Of grumach at usp.br [grumach at usp.br]
Sent: Tuesday, August 18, 2009 9:10 PM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] CGD patient

Dear


I have just diagnosed CGD in a 3 month old male. He had prolonged
fever with unknown origin and BCG vaccination was not looking well. He
developed seizures and liquor showed about 600 cells, predominantly
lymphomono, high protein and low sugar. No positivity was obtained in
the cultures (for BCG still going on).
He received drugs for all possibilities: Amphotericin, Isoniazide,
Pirazinamide, ryphampicin, co-trimoxazole and antibiotics. The fever
and seizures disapeared after the 3rd day. BCG lesion is still present
(same aspect). The cerebrospinal fluid (after 30 days) presents 73
cells, lymphomono, high protein, low glucose and a previous positive
ADA.
I would suggest to change pirazinamide for ethambutol.
Do you have any suggestion?

Thanks a lot

Best regards

Anete S Grumach, MD, PhD
Outpatient group of Primary Immunodeficiencies,
Dept of Dermatology, University of São Paulo
Dept of Immunization, Adverse Events, Secretary of Health, São Paulo