Levamisole

左旋咪唑
  • 文章类型: Journal Article
    目的:本研究的目的是报告2例掺杂左旋咪唑的可卡因诱导的粘膜类天疱疮。
    方法:本研究对病例报告和文献进行综述。
    结果:两名患者表现为双侧严重化脓性结膜炎,角膜溃疡,和快速渐进式缩短。两名患者都是活跃的可卡因使用者。完整的血液分析显示,抗中性粒细胞胞浆抗体免疫荧光阳性,具有混合的核周抗中性粒细胞胞浆抗体和胞浆染色的抗中性粒细胞胞浆抗体模式。结膜组织的直接免疫荧光检查显示,成分3和免疫球蛋白在基底膜上呈线性沉积。诊断为左旋咪唑掺杂可卡因诱导的粘膜类天疱疮。在案例1中,通过使用质谱法调查患者借记卡上的可卡因残留物,证实了这种怀疑,里面有左旋咪唑的痕迹.在这两种情况下,积极的免疫抑制疗法联合全身性糖皮质激素和利妥昔单抗能够控制疾病.然而,当这些疗法开始时,两名患者均发生了严重的角膜损伤,需要进行角膜移植.
    结论:鉴于可卡因滥用的增加,重要的是,眼科医生要意识到它与严重的非典型瘢痕性结膜炎的关联。据我们所知,我们提出的第一个案例证明左旋咪唑和眼瘢痕性类天疱疮之间的因果关系。
    OBJECTIVE: The aim of this study was to report 2 cases of levamisole-adulterated cocaine-induced mucous membrane pemphigoid.
    METHODS: This study is a review of case reports and literature.
    RESULTS: Two patients presented with bilateral severe purulent conjunctivitis, corneal ulceration, and rapidly progressive forniceal shortening. Both patients were active cocaine users. A complete blood analysis showed a positive antineutrophil cytoplasmic antibody immunofluorescence with a mixed perinuclear antineutrophil cytoplasmic antibody and cytoplasmic-staining antineutrophil cytoplasmic antibody pattern. Direct immunofluorescence examination of conjunctival tissue showed linear deposition of component 3 and immunoglobulins at the basal membrane. A diagnosis of levamisole-adulterated cocaine-induced mucous membrane pemphigoid was made. In case 1, this suspicion was confirmed by investigating remnants of cocaine on the patient\'s debit card using mass spectrometry, which contained traces of levamisole. In both cases, aggressive immunosuppressive therapy combining systemic corticosteroids and rituximab was able to control the disease. However, by the time these therapies were initiated, significant corneal injury had occurred requiring corneal grafts in both patients.
    CONCLUSIONS: Given the rising abuse of cocaine, it is important that ophthalmologists are made aware of its association with severe atypical cicatricial conjunctivitis. To the best of our knowledge, we present the first case proving the causal relationship between levamisole and ocular cicatricial pemphigoid.
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  • 文章类型: Journal Article
    左旋咪唑是一种具有免疫调节特性的抗蠕虫药物,可添加到可卡因中以增加其效力和重量。左旋咪唑掺杂的可卡因(LAC)可能会引起抗中性粒细胞胞浆抗体(ANCA)相关的全身性小血管炎(AAV)。我们旨在表征LAC诱导的AAV中发展为肺肾综合征(PRS)的人的表型,并总结其治疗和结果。搜索了Pubmed和WebofScience(直到2022年9月)。包括描述成人(年龄≥18岁)同时存在弥漫性肺泡出血和肾小球肾炎并确认或怀疑LAC暴露的报告。报告,人口统计,临床和血清学特征,提取治疗和结果特征。在确认的280条记录中,八个符合纳入标准,包括八个独特的案例。年龄在22-58岁之间,50%是女性。只有一半的病例发生皮肤受累。其他相关血管炎的发现和血清学是异质的。所有患者都接受了类固醇的免疫抑制,通常添加环磷酰胺和利妥昔单抗。我们得出的结论是,LAC诱导的AAV可能会发生PRS。由于临床和血清学表现重叠,因此将LAC诱导的AAV与原发性AAV区分开具有挑战性。对于患有PRS的人来说,询问可卡因的使用是必要的,以指导诊断,并适当地建议可卡因戒烟与免疫抑制作为治疗。
    Levamisole is an anti-helminthic drug with immunomodulatory properties that is added to cocaine to increase its potency and weight. Levamisole-adulterated cocaine (LAC) may cause an antineutrophil cytoplasmic antibody (ANCA)-associated systemic small vessel vasculitis (AAV). We aimed to characterize the phenotype of persons developing pulmonary-renal syndrome (PRS) in LAC-induced AAV and summarize its treatment and outcomes. Pubmed and Web of Science were searched (until September 2022). Reports that described co-existing diffuse alveolar hemorrhage and glomerulonephritis in an adult (age ≥ 18) with confirmed or suspected LAC exposure were included. Reports, demographics, clinical and serologic features, treatment and outcome characteristics were extracted. Of the 280 records identified, eight met the inclusion criteria, including eight unique cases. Persons were aged 22-58 years, and 50% were women. Cutaneous involvement occurred in only half of the cases. Other associated vasculitis findings and serologies were heterogeneous. All patients received immunosuppression with steroids, with cyclophosphamide and rituximab commonly added. We concluded that PRS could occur from LAC-induced AAV. Distinguishing LAC-induced AAV from primary AAV is challenging as clinical and serologic presentations overlap. Asking about cocaine use is requisite in persons presenting with PRS to guide diagnosis and appropriately counsel on cocaine cessation in conjunction with immunosuppression as treatment.
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  • 文章类型: Review
    一名72岁的女性,有长期使用可卡因的历史,在被狗咬伤9个月后出现面部大面积溃疡和鼻窦结构缺失。活检为传染性阴性,血管,或肿瘤病理。尽管戒除了可卡因,但患者仍失去了15个月的随访,并以明显更大的病变返回。额外的炎症和感染性检查为阴性。静脉给予类固醇类药物临床改善。因此,由于可卡因/左旋咪唑,她被诊断为坏疽性脓皮病和可卡因引起的中线破坏性病变。坏疽性脓皮病是一种罕见的皮肤病,通常累及眼睛和眼附件。诊断涉及临床检查,对类固醇的反应,排除传染性或自身免疫性疾病,并确定潜在的触发因素,包括可卡因/左旋咪唑。本报告重点介绍了一种罕见的眶周脓皮病,引起与伴随可卡因引起的中线破坏性病变相关的瘢痕性外翻,并回顾了临床表现的重要方面。诊断,以及坏疽性脓皮病和可卡因/左旋咪唑自身免疫现象的管理。
    A 72-year-old woman with a history of chronic cocaine use presented 9 months after a dog bite with a large facial ulceration and absent sinonasal structures. Biopsies were negative for infectious, vasculitic, or neoplastic pathologies. The patient was lost to follow up for 15 months and returned with a significantly larger lesion despite abstinence from cocaine. Additional inflammatory and infectious workup was negative. Intravenous steroids were administered with clinical improvement. Therefore, she was diagnosed with pyoderma gangrenosum and cocaine-induced midline destructive lesion due to cocaine/levamisole. Pyoderma gangrenosum is a rare dermatologic condition that uncommonly involves the eye and ocular adnexa. Diagnosis involves clinical examination, response to steroids, exclusion of infectious or autoimmune conditions, and identifying potential triggers including cocaine/levamisole. This report highlights a rare presentation of periorbital pyoderma gangrenosum causing cicatricial ectropion associated with concomitant cocaine-induced midline destructive lesion and reviews important aspects of clinical manifestations, diagnosis, and management of pyoderma gangrenosum and cocaine/levamisole autoimmune phenomenon.
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  • 文章类型: Journal Article
    背景:免疫治疗已成为治疗疣的关键治疗工具。疣的免疫治疗目前仅限于顽固性病变。少数方案似乎非常有效。此外,缺乏基于证据的研究。
    目标:此外,在大多数情况下,其安全性和有效性尚未进行双盲评估,对照临床试验,这使得许多列出的治疗方法的可重复性难以分析,并且可能的安慰剂效应难以排除。
    方法:分析和讨论不同类型的全身免疫疗法。本报告中提到了疣的不同类型的免疫疗法。
    结果:紫锥菊治疗中常用的全身免疫治疗方法,蜂胶,口服类维生素A,甘草酸,左旋咪唑,西咪替丁,和硫酸锌都被报道为不同类型疣的有效治疗方式。
    结论:免疫治疗已成为疣最重要的治疗方法之一。这种治疗不仅需要顽固性或多发性病变,但在大多数治疗病例中也是如此。
    BACKGROUND: Immunotherapy has emerged as a critical therapeutic tool for the treatment of warts. Immunotherapy for warts is currently restricted to recalcitrant lesions. A small number of regimens appear to be extremely effective. Furthermore, there is a scarcity of evidence-based research.
    OBJECTIVE: Furthermore, in the majority of cases, their safety and effectiveness have not been evaluated in double-blind, controlled clinical trials, making the reproducibility of many of the listed treatments difficult to analyze and a possible placebo effect difficult to rule out.
    METHODS: Analyzing and discussing different types of systemic immunotherapy. The different types of immunotherapy for warts are mentioned in this report.
    RESULTS: Systemic immunotherapeutic modalities commonly used in the treatment Echinacea, propolis, oral retinoids, glycyrrhizinic acid, levamisole, cimetidine, and zinc sulfate have all been reported as effective treatment modalities for different types of warts.
    CONCLUSIONS: Immunotherapy has emerged as one of the most important therapeutic modalities for warts. Such treatment is required not only for recalcitrant or multiple lesions, but also in the majority of treated cases.
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  • 文章类型: Journal Article
    自杀是一个主要的公共卫生问题,尝试和自杀的风险随着年龄的增长而增加。我们介绍了一对老年夫妇的案例,他们决定使用左旋咪唑掺假的可卡因通过自我中毒一起自杀。选择双重自杀,选择的方法(自我中毒),自行服用的药物(可卡因),给药途径(摄入)是法医病理学实践中很少遇到的事件,尤其不是组合。在这篇文章中,我们将回顾有关这些自杀方法的频率和特征的文献。还提供了左旋咪唑的作用和作用机理的概述,强调在可卡因死亡的常规毒理学分析中包括该物质及其代谢物的重要性。
    Suicide is a major public health issue and the risk of attempting and committing suicide increases with age. We present the case of an elderly couple who decided to commit suicide together by self-poisoning using levamisole-adulterated cocaine. The choice of committing a double suicide, the method selected (self-poisoning), the drug self-administered (cocaine), and the route of administration (ingestion) are events rarely encountered in the forensic pathology practice, especially not in combination. In this article, we will review the literature regarding the frequency and features of these methods of suicide. An overview of the effects and mechanism of action of levamisole is also provided, highlighting the importance of including this substance and its metabolites in the routine toxicological analyses for cocaine deaths.
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  • 文章类型: Case Reports
    与使用可卡因/左旋咪唑相关的坏疽性脓皮病是与其消费相关的罕见疾病。哥伦比亚经常使用可卡因,该物质被左旋咪唑污染,一种驱虫药,增加精神药物的作用并增强其副作用。我们介绍了三例溃疡性病变患者的临床病例,其中诊断为使用左旋咪唑污染的可卡因继发的坏疽性脓皮病。这引起了卫生人员的注意,以调查坏疽性脓皮病中物质的滥用,并证明中断消费是管理的基础。
    Pyoderma gangrenosum associated to the use of cocaine/levamisole is a rare condition associated to their consumption. Cocaine use is frequent in Colombia, and the substance is contaminated with levamisole, an anthelmintic that increases the psychotropic effects and enhances its side effects. We present three clinical cases of patients with ulcerated lesions, in which the diagnosis was pyoderma gangrenosum secondary to the use of cocaine contaminated with levamisole. This called the attention of the health staff to investigate the abuse of substances in gangrenous pyoderma and also evidence that the interruption of consumption was the basis of management.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    发现于1960年代,常见的抗蠕虫左旋咪唑已广泛用于兽医应用。此后,其用途迅速扩展,包括各种急性和慢性疾病的人类医学治疗。由于严重不良反应的报告,美国食品和药物管理局于2000年撤回了左旋咪唑用于人类的批准;然而,美国以外的医疗选择和世界范围内的非法选择允许左旋咪唑继续获得。这种化合物在体内迅速代谢,至少有2种已知的活性代谢物。左旋咪唑具有广泛的免疫调节作用,包括对免疫反应的刺激和抑制作用。通常在治疗浓度下耐受性良好,尽管已经报道了各种与自身免疫相关的不良反应,包括粒细胞缺乏症,白细胞减少症,紫癜,可见坏死的皮肤组织。左旋咪唑免疫系统受损的个体更容易受到感染,包括COVID-19。自2000年初以来,左旋咪唑经常被用作非法街头毒品的掺假剂,尤其是可卡因,芬太尼,和海洛因。尽管它的流行程度随着时间和地理而变化,在高达79%的街头可卡因供应中检测到左旋咪唑,其含量按重量计高达74%。它在非法药物市场的存在也引起了人们对儿童和新生儿接触的可能性的关注,尽管这只有有限的轶事证据支持。左旋咪唑目前不包括在常规药物测试小组中,尽管在一系列的死前和死后标本选项中存在多种验证性测试技术。由于它在非法药物市场上的存在各不相同,医学界和法医界都需要了解左旋咪唑及其对毒理学研究的潜在影响.
    Discovered in the 1960s, the common anthelminthic levamisole has seen widespread use in veterinary applications. Its use rapidly expanded thereafter to include human medical treatments for a variety of acute and chronic disorders. Because of reports of severe adverse effects, the US Food and Drug Administration withdrew levamisole\'s approval for human use in 2000; however, medical options outside the United States and illicit options worldwide allow continued accessibility to levamisole. The compound is rapidly metabolized in the body, with at least 2 known active metabolites. Levamisole has a broad range of immunomodulatory effects, including both stimulatory and inhibitory effects on immune responses. It is generally well tolerated at therapeutic concentrations, although a variety of autoimmune-related adverse effects have been reported, including agranulocytosis, leukopenia, purpura, and visible necrotized skin tissue. Individuals with levamisole-compromised immune systems are more susceptible to infections, including COVID-19. Since the early 2000\'s, levamisole has been frequently used as an adulterating agent in illicit street drugs, especially cocaine, fentanyl, and heroin. Although its prevalence has varied over time and geographically, levamisole has been detected in up to 79% of the street supply of cocaine at levels up to 74% by weight. Its presence in illicit drug markets also raises concern over the potential for exposure of children and neonates, although this is supported by only limited anecdotal evidence. Levamisole is not currently included in routine drug testing panels, although a variety of confirmatory testing techniques exist across a range of antemortem and postmortem specimen options. Because of its varying presence in illicit drug markets, both the medical and forensic communities need to be aware of levamisole and its potential impact on toxicological investigations.
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  • 文章类型: Case Reports
    Pyoderma gangrenosum is often associated with a systemic disease. Cocaine-induced pyoderma gangrenosum, most probably caused by levamisole, has been described recently and typically presents as multiple, large cribriform ulcers. Peri-nuclear antineutrophil cytoplasmic antibody is the most common serological finding. A strong counseling for cocaine cessation, combined with wound care and immunosuppressive therapy, is the mainstay of treatment. We present two cases of cocaine-induced pyoderma gangrenosum and correlate their findings with the typical clinical, histological and serological presentation.
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  • 文章类型: Journal Article
    BACKGROUND: Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients.
    METHODS: A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out.
    RESULTS: Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion.
    CONCLUSIONS: As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.
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