Letter: Treatment of diffuse schistosomal polyposis of the colon with niridazole (Ambilhar).
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Biomedical subjects
Publications and source records attributed to S Bassily.
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Percutaneous needle biopsy of the kidney on eight nephrotic patients with Schistosoma mansoni and chronic Salmonella paratyphi A infection showed diffuse proliferative glomerular change in all biopsies. Capillary basement membrane was normal. Diffuse granular deposits were detected in the glomerular mesangial cells by direct staining with fluorescein labelled anti-IgG anti-IgM. No fluorescence was obtained with rabbit anti-Salmonella paratyphi A. After treatment with ampicillin and niridazole, a reduction of cellular proliferation and mesangial matrix expansion was observed. Simultaneously following treatment there occurred a dramatic clinical improvement with cessation of proteinuria and a return of plasma protein levels and serum complement (C3) to normal values.
Twelve patients with proven Salmonella typhi or Salmonella paratyphi A bacteriuria and recurrent bacteremia associated with schistosomiasis were treated for four weeks with amoxicillin (250 mg four times daily). Seven of the 12 patients were seriously ill and febrile before treatment. They showed a dramatic response, and, within three to six days of initiation of amoxicillin therapy, they were afebrile and much improved clinically. Amoxicillin was rapidly and highly concentrated in the urine of all patients; peak levels of 115-2,700 mug/ml were obtained within 2-4 hr of the first dose. Concentration of the drug in serum was also rapid and in all but two patients exceeded the minimal inhibitory concentration of the organism within 4 hr of the first dose. Within one week after treatment started, all urine and blood specimens obtained from the patients became negative for Salmonella and remained so throughout the four-week follow-up period, during which the patients were hospitalized.
Thirteen patients with concomitant chronic salmonellosis and schistosomiasis and with the nephrotic syndrome were studied. Of the seven patients' sera examined, all had markedly low complement C3 and near normal C4 levels. This indirectly suggests an active role of Salmonella endotoxin in the etiology of the nephrosis.
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