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Drug rash, eosinophilia, and systemic symptoms ( DRESS) syndrome is a severe systemic hypersensitivity reaction that usually occurs within 6 weeks of exposure to the offending drug. Diagnosis is usually straightforward in patients with pyrexia, skin rash, hepatitis, and eosinophilia with a preceding history of exposure to agents often associated with DRESS syndrome, such as aromatic anticonvulsants and sulfa drugs, but diagnosis of DRESS may still be a challenge. We report a 4-year-old child with probable DRESS syndrome complicated by multiple hematologic complications that developed 1 month after exposure to fluoxetine, a drug not known to be associated with such severe reactions. [ABSTRACT FROM AUTHOR]

Background: Human parvovirus B19 (B19) virus is a newly recognized agent for transfusion transmitted diseases. Beta-thalassemia major patients receive a hypertransfusion regimen, hence, are prone to acquire B19 infection; moreover, B19 escapes viral inactivation methods and donor units are not tested for B19, but there are just a couple of studies globally and none from the Asian continent. Hence, a study was designed to find the frequency of B19 infection and its transmission in multitransfused thalassemia patients. Materials and Methods: Ninety multitransfused beta-thalassemia major (thalassemia) patients, 32 controls (age, sex matched) without any history of transfusion were enrolled. Besides the donor units were tested in B19 un-infected patients. B19 specific IgG and IgM antibodies in the sera were analyzed by ELISA (in-house), using B19 VPI and VP2 recombinant and purified antigens; additionally HBsAg and anti-HIV and anti- HCV antibodies were tested for coexisting infections. Results: Seventy-three (81%) thalassemia patients tested positive for anti-B19 IgG antibodies as compared to seven (21%) in the controls group (P < 0.01), while anti-B19 IgM antibodies were detected in 37 (41.1%) compared to two (6.2%) in the controls (P < 0.01). Mean age of the thalassemia patient was eight years (range 2 - 18 years) and B19 infection was highest in the six-to-ten year range. Seropositivity increased with the number of transfusions. Two of the four HBsAg positive and five of the seven anti-HCV IgM antibody-positive patients also had anti-B19 IgM. After a six-month follow-up, four (25%) of the 16 seronegative patients seroconverted and anti-B19 IgM antibodies were detected in their donor units. Conclusions: Most of multitransfused thalassemics were B19 seropositive or had anti-B19 IgM; in the remaining uninfected group, B19 got transmitted through infected / IgM-positive donor units. [ABSTRACT FROM AUTHOR]

Backgound and Objectives: Parvovirus B19 (B19) being a non-enveloped DNA virus is hence thermo-stable to the current methods of viral inactivation. Therefore transfusion of blood or its component from a viremic donor to non-immune recipients may result in transfusion-transmitted B19 infection with occasional sinister complications. The serologically naïve blood donor population in our country has not been studied. Hence a study was designed to find the sero-status of B19 virus in normal voluntary blood donor population (relatives of recipients) as an indirect measure of the susceptibility to B19 in north Indians together with seroepidemiology of B19. Methods: An in-house anti-B19 IgG ELISA was standardized using cloned, baculovirus expressed, and purified VP1/VP2 capsid proteins as antigen. Anti-B19 IgG antibodies in sera (diluted 1:400) of 1000 healthy voluntary blood donors (18-60 years; mean 30.5 years) were analyzed and their epidemiologic data were documented. Results: A total of 399 (39.9%) donors were seropositive for B19 virus. Seroprevalence was higher in males than females (44% vs 27%) and it increased with increasing age (P<0.01). Socioeconomically, B19 IgG antibody positivities were 61.8%, 61.1%, and 44.4% in low, medium, and high income groups respectively with unskilled laborers having higher seroprevalence in low (48.5%) and middle (58.7%) income group (P<0.05). Housing conditions revealed B19 seroprevalence as 42.6% in donors living in small houses compared to 20.4% in larger houses (P<0.01) but no difference with religion. Conclusions: Seroprevalence to B19 in normal voluntary blood donors was low leaving a large proportion of north Indians susceptible to B19 infection. [ABSTRACT FROM AUTHOR]

Circulating immune complexes (ClC) were estimated in 78 patients of leukaemias and lymphomas by Clq deviation ELISA and PEG assay. In all leukaemias a significant elevation in ClC was seen at the time of first presentation. While in ALL a decrease occurred on therapy as partial or complete remission was achieved, no such fall was seen in AML or CML-BC when treated. ClC levels were much higher in non-Hodgkins lymphoma than in Hodgkins disease and showed a direct correlation with B symptoms and activity of the disease. The ClC levels were highest in null-ALL followed by those in common ALL and T-ALL. The mean duration of remission in patients of ALL without elevation in ClC was much longer than in those with ClC. [ABSTRACT FROM AUTHOR]

Leptospirosis is a zoonosis prevalent worldwide and is endemic in many parts of India. In early leptospiremic as well as late immune phase of the disease kidney, liver, heart, and lungs are commonly involved. Neurological manifestations are rare but may occur during immune phase in the form of aseptic meningitis, meningoencephalitis, seizures, myelitis, polyradiculoneuritis, and myalgia. In this report, we describe a rare case of leptospirosis with combined involvement of nerve, muscle, and myoneural junction in generalized fashion along with pulmonary, renal, and hepatic dysfunction. [ABSTRACT FROM AUTHOR]

A 5-year-old male, drowsy, jaundiced child presented with fulminant hepatitis and had HAV and HEV infection. He had hepatic encephalopathy grade 1, fever, pallor, hypotension, crepitations in his right lung base and hepatosplenomegaly with dyspnoea. He had highly raised liver enzymes and hypoalbuminemia (2.8 g/dl) but anemia (hemoglobin of 7.7 g/dl and 5.7 g/dl 2 days later), reticulocytopenia and severe thrombocytopenia (44 × 109/l) were unexplained. Parvovirus B19-specific IgM antibodies and B19 DNA were found in the serum of the child. Chest X-ray showed pleural effusion and bronchopneumonia, while blood culture isolated coagulase-negative staphylococci (BACTEC 9120) and he had low oxygen saturation. Hence, he was treated with IV amoxicillin+ clavulinic acid and oxygen inhalation. He had seizures and cardiac arrest but was revived. On the third day his condition worsened and the child died despite intensive care. Hence it is concluded that his anemia and thrombocytopenia were B19 induced and this might have aggravated or caused fulminant hepatitis. [ABSTRACT FROM PUBLISHER]

Presents a letter to the editor about human parvovirus published in the January 1, 2005 issue of the "British Journal of Haematology."