RESUMEN
Although chickenpox can cause severe morbidity and mortality in pediatric renal transplant recipients, published reports describing treatment of these patients are few, especially in the cyclosporine era. Sixty-nine episodes of chickenpox occurring in 66 patients were diagnosed in our transplant population between January 1984 and May 1996. Immunosuppression consisted of prednisone and azathioprine (30 cases); prednisone, azathioprine, and cyclosporine (38 cases); or prednisone alone (1 case). Azathioprine was temporarily discontinued in 66 of 68 cases. Cyclosporine was continued at the preexisting dose in 36 of 38 cases. Acyclovir was administered parenterally in 62 of 69 cases. Sixty-five of 66 patients survived. Cyclosporine use did not increase the incidence of severe disease (p > 0.1). Acute allograft rejection occurred in three patients and responded to prednisone. Chickenpox in children with renal transplants can be successfully treated with intravenous acyclovir and temporary withdrawal of azathioprine. Allograft rejection is uncommon with this approach. Patients receiving cyclosporine do not appear to experience increased morbidity or mortality with chickenpox.
Asunto(s)
Varicela/tratamiento farmacológico , Trasplante de Riñón , Aciclovir/administración & dosificación , Administración Oral , Adolescente , Azatioprina/administración & dosificación , Varicela/mortalidad , Niño , Ciclosporina/administración & dosificación , Quimioterapia Combinada , Rechazo de Injerto/epidemiología , Humanos , Terapia de Inmunosupresión , Incidencia , Inyecciones Intravenosas , Prednisona/administración & dosificación , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
A 3,200 gm 12-day-old male infant with complex urologic problems underwent charcoal hemoperfusion for severe accidental chloramphenicol intoxication. Immediately prior to CH, with a serum chloramphenicol level of 98 micrograms/ml, the child was in profound shock, ashen-gray, hypothermic, and acidotic. Chloramphenicol levels indicated virtually complete removal of this drug by the CH column. Three hours of CH treatment resulted in a reduction of the chloramphenicol level to 13.5 micrograms/ml and complete reversal of the described clinical syndrome. No serious complications of CH were encountered. We conclude that chloramphenicol poisoning is treatable by CH and that this therapeutic modality may be safely carried out in infants and small children.