[PAGID] CGD patient

[grumach at usp.br]

Dear Donald,

Thanks for your comment. My first hypothesis is BCG meningitis but  
should I leave without antifungal drugs? Dexamethasone was used for  
one week just after the seizures. Should i introduce it again with  
ethambutol?

Anete S Grumach

Citando "Vinh, Donald (NIH/NIAID) [F]" <vinhd at niaid.nih.gov>:


> 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

>