cefoxitin and Thrombocytopenia

The idiopathic Tn-syndrome, formerly called 'permanent mixed-field polyagglutinability', is a rare hematological disorder characterized by the expression of the Tn-antigen on all blood cell lineages. The immunodominant epitope of the Tn-antigen is terminal alpha-N-acetylgalactosamine, O-glycosidically linked to protein. Normally this residue is 3'-substituted by 5-galactose thereby forming the core 1 structure known as the Thomsen-Friedenreich (TF) antigen (Galbeta1 ==> 3GalNAcalpha1 ==> Thr/Ser). The cause of the exposure of the Tn-antigen appears to be due to the silencing of the gene expression of beta1,3galactosyltransferase, since treatment of deficient Tn(+) lymphocyte T clones with 5'azacytidine or Na butyrate leads to reexpression of enzyme activity and the sialylated TF-antigen. The Tn-syndrome is acquired and permanent and affects both sexes at any age. Its origin is unknown. Pluripotent stem cells are affected since all lineages are involved but each one to a variable extent. Therefore, normal cells co-exist with Tn-transformed cells. Clinically, patients suffering from the Tn-syndrome appear healthy. Laboratory findings usually reveal moderate thrombocyto- and leukopenia and some signs of hemolytic anemia not warranting any treatment.

Topics: Anemia, Hemolytic; Antibodies, Monoclonal; Antigens, Neoplasm; Antigens, Tumor-Associated, Carbohydrate; Azacitidine; Blood Cells; Erythrocyte Membrane; Galactosyltransferases; Hematologic Diseases; Humans; Lectins; Leukopenia; Molecular Structure; Syndrome; Thrombocytopenia

The optimal therapeutic regimen and duration of treatment for Mycobacterium abscessus lung disease is not well established.. To assess the efficacy of a standardized combination antibiotic therapy for the treatment of M. abscessus lung disease.. Sixty-five patients (11 males, 55 females, median age 55 yr) with M. abscessus lung disease were treated with clarithromycin, ciprofloxacin, and doxycycline, together with an initial regimen of amikacin and cefoxitin for the first 4 weeks of hospitalization.. Treatment response rates were 83% for symptoms and 74% for high-resolution computed tomography. Sputum conversion and maintenance of negative sputum cultures for more than 12 months was achieved in 38 (58%) patients. These rates were significantly lower in patients whose isolates were resistant to clarithromycin (17%, 2/12) compared with those whose isolates were susceptible or intermediate to clarithromycin (64%, 21/33; P = 0.007). Neutropenia and thrombocytopenia associated with cefoxitin developed in 33 (51%) and 4 (6%) patients, respectively. Drug-induced hepatotoxicity occurred in 10 (15%) patients. Because of these adverse reactions, cefoxitin was discontinued in 39 (60%) patients after treatment for a median of 22 days.. Standardized combination antibiotic therapy was moderately effective in treating M. abscessus lung disease. However, frequent adverse reactions and the potential for long-duration hospitalization are important problems that remain to be solved.

Topics: Adult; Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Cefoxitin; Chemical and Drug Induced Liver Injury; Ciprofloxacin; Clarithromycin; Doxycycline; Drug Therapy, Combination; Female; Humans; Liver; Lung; Lung Diseases; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Neutropenia; Nontuberculous Mycobacteria; Retrospective Studies; Sputum; Thrombocytopenia; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adult; Ampicillin; Anemia, Hemolytic; Cefoxitin; Female; Furosemide; Humans; Pregnancy; Pregnancy Complications; Pyelonephritis; Respiration Disorders; Thrombocytopenia