In 1999 the decision was taken to start a transmural consultation service for HIV-seropositive drug users at the Consultation Office for Alcohol and Drugs [Dutch acronym: CAD] in Heerlen, the Netherlands. This consultation service was run by an AIDS consultant from Maastricht University Hospital together with the addiction physician from the CAD. In the period 1 November 1998-30 April 2002 29 HIV-seropositive drug users made use of this consultation service. Highly active antiretroviral therapy was prescribed to 23 patients during an average of 21 months (range: 4-51). Eighteen patients responded well to this therapy (viral load < 50 copies/ml) after 12-24 weeks of treatment and thereafter during 21 months. Direct observed therapy (DOT) was applied to 16 patients. Therapeutic failure due to poor compliance was observed in 3 patients. Two of them had initially been successfully treated with medication whilst under supervision but the treatment failed when they became responsible for taking their own medication. It seems that involving the Consultation Office for Alcohol and Drugs in the treatment and DOT has a favourable effect on the treatment of HIV-positive drug users.
A 38-year-old subcutaneous injecting heroin addict had subacute blurred vision, dysarthria and dysphagia. The next day she could not swallow or speak and developed weakness of all limbs and respiratory failure. Electromyography showed abnormalities compatible with a presynaptic neuromuscular transmission deficit, which supported the diagnosis of botulism. The point of entry was probably a skin abscess due to injections. Treatment with antitoxin and antibiotics resulted in a favourable recovery. Wound botulism is caused by local production of toxin by Clostridium botulinum after wound infection. Although it is a rare variant of botulism, it is increasingly being reported in drug users who inject subcutaneously.
Four patients with anaphylaxis attributed to the intake of the centrally acting muscle relaxant tolperisone hydrochloride (Mydocalm) were observed at the Emergency Department of the Geneva University Hospital between November 2001 and March 2003. All patients were middle-aged women who took tolperisone for chronic muscular pain. All reactions occurred within an hour after oral intake of this drug frequently prescribed in Switzerland. The severity of anaphylaxis ranged from urticarial reactions to shock with arterial hypotension. Prick-to-prick skin testing performed in one patient with a tablet of tolperisone diluted in water was negative. Its globally restricted commercialisation may explain the lack of reports on such adverse effects in the MedLine database. Anaphylactic reactions to this drug, however, are mentioned in other sources such as the Swiss Drug Compendium and the WHO drug reaction database. Together, these findings suggest that anaphylaxis to tolperisone is not uncommon and should be known to physicians in countries where this drug is available.
To determine the prevalence of HIV infection and gain insights into the risk behaviour among injecting drug users (IDU) in Heerlen and Maastricht, the Netherlands.Descriptive inventory.In 1994, 1996 and 1998/1999 a questionnaire on risk behaviour was obtained from 866 IDUs in Heerlen and Maastricht, and 858 saliva and serum samples were also obtained for testing on HIV antibodies.In the total region of Heerlen and Maastricht, no significant change in HIV prevalence was found (1994: 10%, 1996: 12%, 1998/1999: 14%). However, in Heerlen the HIV prevalence was demonstrated to have increased significantly (1994: 11%, 1996: 16%, 1998/1999: 22%), whereas in Maastricht HIV prevalence was constant (1998/1999: 5%). The percentage of participants that injected drugs in the six months preceding the survey decreased from 80% in 1994 to 63% in 1998/1999. Injection-related risk behaviour slightly decreased: in 1998/1999 14% of the participants had borrowed used syringes or needles in the last 6 months. Additionally, inconsistent condom use with steady and casual sexual partners was reported. Of the participants, 86-89% did not always use condoms with steady partners and 49% with casual partners.In view of the increasing HIV prevalence among IDUs in Heerlen, the persistent injecting and sexual risk behaviour and the large number of IDUs who have sexual contact with non-users in Heerlen and Maastricht, there is a substantial risk of HIV transmission both within the IDU community and to the general population.
Acetaminophen (paracetamol) is a widely prescribed analgesic-antipyretic drug. Adverse allergic reactions to this drug are rare. We report a case of anaphylactic shock due to acetaminophen. Results of skin prick tests and intradermal tests were negative. Oral rechallenge resulted in generalized urticaria associated with an increased plasma level of histamine. Acetaminophen should be added to the list of causes of anaphylaxis.
Summary Background The preservative methylisothiazolinone ( MI ) is used in combination with methylchloroisothiazolinone ( MCI ), but the MCI/MI mixture has been identified as highly allergenic. MI is considered to be less allergenic, and since the mid‐2000s has been widely used alone, but is now clearly identified as a contact allergen. The F rench V igilance N etwork for D ermatology and A llergy of the S tudy and R esearch G roup on C ontact D ermatitis ( REVIDAL‐GERDA ) added MI to its baseline patch testing series in 2010. Objective To evaluate the change in the proportion of MI ‐positive tests in F rance between 2010 and 2012. Patients/materials/methods We conducted a nationwide, multicentre, retrospective study of all MI ‐tested patients between 2010 and 2012. Results Sixteen centres participated in the study (7874 patients were tested). Patch tests were performed mainly at a concentration of MI 200 ppm aq. We observed a significant increase in the proportion of MI ‐positive tests in 2012 and 2011 as compared with 2010 (5.6%, 3.3%, and 1.5%, respectively; p < 0.001). Conclusions We report a significant increase in the number of MI ‐positive tests. MI is confirmed to be a rapidly emerging allergen, as also observed in other E uropean countries.
