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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE

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Gazzetta Medica Italiana Archivio per le Scienze Mediche 1999 August;158(4):127-32

language: English

Transfusional tox­o­plas­mo­sis, car­di­o­vas­cu­lar dis­or­ders, di­a­bete mel­lit­us and tha­lid­o­mide

Barbosa Vosgerau J. C.

Centro Municipal de Especialidades, Secretariat of Health ­from Ponta Grossa


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Chronic tox­o­plas­mo­sis may af­fect any or­gan but its on­set is ­very ­slow ­over the ­years. It is re­port­ed a pa­tient ­that had ir­ri­ta­bil­ity, se­vere ­joints/­bone, ­skin le­sions ­with se­vere prur­it­us dur­ing the ­first ­month af­ter ­blood trans­fu­sion, pro­gres­sive­ly se­vere lym­phed­e­ma, se­vere ­heart fail­ure, an­a­sar­ca, brad­y­car­dia, tach­y­car­dia, ex­tra­sys­toles, atri­o­ven­tric­u­lar ­block, aor­ta cal­cifi­ca­tion, hy­per­ten­sion, tox­o­plas­mic sep­tic ­shock, di­a­betes mel­lit­us, chron­ic al­ka­line phos­pha­tase in­crease, ­acute trans­ami­nas­es el­e­va­tion, uri­nary in­fec­tion ­with uri­nary in­con­ti­nence, ­acute re­nal fail­ure, chron­ic ane­mia, hy­per­cho­les­ter­o­le­mia, hy­per­trig­ly­cer­i­de­mia, hy­po­cho­les­ter­o­le­mia, eo­sin­o­phil­ia, bas­o­phil­ia, leu­ko­cy­to­sis, neu­tro­pe­nia, neu­tro­fil­ia, un­re­spon­sives to usu­sal meas­ures. These clin­i­cal/la­bor­a­to­ry dis­or­ders re­mit­ted or had a ­marked im­prove­ment ­with rox­ith­rom­y­cin 900 mg/day, dap­sone, py­ri­meth­a­mine, but the re­sponse ­were ­more con­spic­u­ous ­with tha­lid­o­mide 6.5 g/day was add­ed to the med­i­ca­tion. It is pos­tu­lat­ed ­that ­these dis­or­ders are re­lat­ed to IFN-γ, TNF-α e and IFN-α ­host in­tox­i­ca­tion trig­gered by toxoplasma. It was con­clud­ed: 1. for a ef­fi­cient treat­ment is nec­es­sary not on­ly to ­kill the par­a­sites (­with the spe­cif­ic ­anti-tox­o­plas­mo­sis med­i­cines in a trip­let ­scheme) but main­ly to re­duce the pos­sible cy­to­kines in­tox­i­ca­tion trig­gered in the ­host by toxoplasma, ­with tha­lid­o­mide in a ­dose de­pen­tent man­ner. 2. Thalidomide has a crit­i­cal ­role in the treat­ment of tox­o­plas­mo­sis-re­lat­ed ­heart, liv­er, kid­ney fail­ure.

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