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Archive for October, 2010

The hazards of honey: infantile botulism

27 Oct, 10 | by Emma

Smith and colleagues present a fine piece of detective work around a 2 month old infant with an initially puzzling neurological presentation. They unearth valuable learning points:

  • Young infants are particularly vulnerable due to the susceptibility of their gut to colonisation due to immature intestinal flora and lack of clostridium-inhibiting bile acids. This is in contrast to botulism in adults, which follows the ingestion of preformed toxin.
  • Symptoms present insidiously and are classically described as constipation, cranial nerve palsies and progressive generalised weakness.
  • Stool samples for clostridium botulinum PCR confirm the diagnosis easily and should be sent early as a basic investigation
  • Food sourcing is possible and in this case eliciting the honey-soother history proved invaluable. Such questions ought to be part of routine questioning of carers in such cases
  • Labelling of honey has been a requirement since 1996 in the UK but clearly this is not always enough to prevent administration of honey to infants under the age of one year.

Rakesh Biswas
Deputy Editor

The hazards of honey: infantile botulism

Fulminant hepatic failure in a patient with advanced extragonadal germ cell tumour

13 Oct, 10 | by Emma

This is a heartening report which reflects what a diligent team of clinicians can achieve in terms of patient management. It is about a 36 year old man who noticed swelling in his right lower limb and eventually he was found to have not only a deep vein thrombosis to explain the right limb swelling but also a large intrabdominal tumor that was responsible for his deep vein thrombosis.

This was just the beginning of the ordeal for this man as soon after in three weeks he went on to develop severe hepatitis and altered sensorium due to liver failure.

Undaunted the clinical team went on to administer chemotherapy to the man along with ongoing investigations such as liver biopsy for his liver failure.

The patient recovered from all these formidable challenges and yet again was found to have endocarditis which was managed commendably by the multidisciplinary team with valve replacement.

This case also reiterates the potentially life-saving importance of using chemotherapy in patients with potentially-curable, chemotherapy-responsive tumours, even when the patient is critically ill, and the value of a multi-disciplinary team in a specialist cancer centre in achieving a cure for such patients. This particular case involved the input of medical oncologists, intensive care specialists, hepatologists, neurologists, cardiothoracic surgeons and a rehabilitation team, each of which provided essential input in their specialist area.

Altogether a triumph of modern medicine which needs to be documented and celebrated more often.

Rakesh Biswas
Deputy Editor

Fulminant hepatic failure in a patient with advanced extragonadal germ cell tumour

Malabsorption of antimycobacterial drugs as a cause of treatment failure in tuberculosis

6 Oct, 10 | by Emma

The case raises very interesting questions:

I wonder how commonly is this problem noticed in the developing world where treatment failure with antitubercular therapy ATT is not uncommon?
Why does ATT get selectively malabsorbed even without any other signs of malabsorption?

Malabsorption of antimycobacterial drugs as a cause of treatment failure in tuberculosis

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