amoxicillin-potassium-clavulanate-combination and Wounds-and-Injuries

Acute porphyria is historically known as "the little imitator" in reference to its reputation as a notoriously difficult diagnosis. Variegate porphyria is one of the four acute porphyrias, and can present with both blistering cutaneous lesions and acute neurovisceral attacks involving abdominal pain, neuropsychiatric features, neuropathy, hyponatremia, and a vast array of other nonspecific clinical features.. A 40-year-old man presented to the Emergency Department (ED) as a major trauma call, having been found in an "acutely confused state" surrounded by broken glass. Primary survey revealed: hypertension, tachycardia, abdominal pain, severe agitation, and confusion with an encephalopathy consistent with acute delirium, a Glasgow Coma Scale score of 13, and head-to-toe "burn-like" abrasions. Computed tomography was unremarkable, and blood tests demonstrated hyponatremia, acute kidney injury, and a neutrophilic leukocytosis. The next of kin eventually revealed a past medical history of variegate porphyria. The patient was experiencing an acute attack and received supportive management prior to transfer to intensive care, subsequently making a full recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the importance of recognizing acute medical conditions in patients thought to be suffering from major trauma. Acute porphyria should be considered in any patient with abdominal pain in combination with neuropsychiatric features, motor neuropathy, or hyponatremia. Patients often present to the ED without any medical history, and accurate diagnosis can be essential in the acute setting to minimize morbidity and mortality. The label of the major trauma call must be taken with great caution, and a broad differential diagnosis must be maintained throughout a diligent and thorough primary survey.

Topics: Abdominal Pain; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Diagnosis, Differential; Emergency Service, Hospital; Humans; Male; Porphyria, Variegate; Rhabdomyolysis; Vomiting; Wounds and Injuries

The paper describes features of myiasis in a cohort of 163 dogs in an animal shelter, monitored over 3.5 years (4 fly activity seasons). Seven dogs (4 males, 3 females) were presented with myiasis; two dogs were presented twice with infestation in different areas of their body. The overall incidence rate (IR) of myiasis was 5.8 cases per 10(3) animal-months at risk, or else 0.0058 case per animal-month at risk. Six cases occurred from May to July and three from August to October, giving IRs of 7.7 per 10(3) animal-months and 3.9 per 10(3) animal-months, respectively, and an IR ratio of 1.97 (P=0.35). Five cases occurred in males and four in females, giving IRs of 7.8 per 10(3) animal months and 4.3 per 10(3) animal-months, respectively, and an incidence rate ratio of 1.78 (P=0.41). Three cases were diagnosed as cutaneous myiasis of the thigh, 2 cases as myiasis of the ear canal, 2 as myiasis of the prepuce, 1 as myiasis of the toes and 1 case as myiasis of the vagina. Median time from entrance into the shelter to infestation was 5 months; it was 1m in three dogs which were injured at entrance of animal into the shelter, but longer (5-15m) in the other four dogs. Larvae were identified as 2nd or 3rd stage instars of Wohlfahrtia magnifica. Signs characteristic of local inflammation, in the affected area of the body, were recorded. Treatment included mechanical removal of larvae, cleansing of the area, administration of injectable moxidectin and a broad-spectrum antimicrobial agent. Complete recovery was achieved within 1.5 months, bar that of preputial infestations which required 2.5 months.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Clindamycin; Cohort Studies; Diptera; Dogs; Female; Greece; Insecticides; Larva; Macrolides; Male; Myiasis; Risk Factors; Wounds and Injuries