[PAGID] CGD patient

[Nacho Gonzalez]

Why not add levofloxacin? It has a blood brain barrier penetration and
antiTB efficacy may be considered as first line therapy. Furthermore, 4
antiTB drugs is a standard regimen in tuberculous meningitis

Luis Ignacio Gonzalez Granado. Immunodeficiencies and Pediatric infectious
diseases division. Hospital 12 octubre. Madrid.

2009/8/19 <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

>>

>>

>

>

>

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