Deafness associated with Lassa fever

Article Abstract:

Research has shown that many viruses, including mumps, rubeola (measles), varicella-zoster (a herpes virus), cytomegalovirus, and influenza B, can cause pathologies of the inner ear, such as deafness and vertigo, and of the facial nerve (paralysis of the face). Studies have isolated antibodies against various of these viruses in the blood of patients who experience sudden hearing loss. Similar correlations have been made at autopsy, when the temporal bones of deceased patients with a history of sudden hearing loss have been found to contain a pattern of damage that is congruent with viral damage. Lassa fever is an endemic virus-induced fever that was first identified in northeastern Nigeria, and the disease presents a model system to examine the pattern of virus-induced hearing loss. An article in the October 24, 1990 issue of The Journal of the American Medical Association discusses the patterns of hearing loss in patients and exposed relatives and hospital workers during the present epidemic in West Africa. This study demonstrates that the level of hearing loss seen following a bout of Lassa fever is greater than that known for any other virus. In 12 clinical staff members who were immunologically positive for Lassa fever antibodies, 8 were found to have hearing loss. The authors associate a high incidence of West African hearing loss with Lassa fever. The disease is often treated with ribavirin, an antiviral agent, which appears to be effective against some manifestations of the disease, but is unable to prevent damage to the ear. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Deafness, Lassa fever, editorial

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Diclofenac-associated hepatotoxicity

Article Abstract:

A nonsteroidal anti-inflammatory drug (NSAID), newly released in the US, may be associated with toxic effects on the liver (hepatotoxicity). Case reports of seven patients who took the drug, diclofenac (Voltaren), are presented. All developed hepatitis within a few months of starting treatment. Their symptoms and illness course are described. The patients took the medication because of pain from arthritis or fibrositis (pain in muscles and joints). When diclofenac was discontinued, the liver abnormalities disappeared, with one exception: one patient died of fulminant (massive) hepatitis. Results from European studies (where the drug has been used since 1974) and this report indicate that women, people in their mid-50s, and patients with osteoarthritis are particularly vulnerable to hepatitis from diclofenac use. The use of other drugs, such as steroids, with diclofenac may increase a patient's vulnerability. This is the first report of this complication of the drug in the US since it was approved by the Food and Drug Administration. Careful patient monitoring is recommended if diclofenac is used. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Liver, Diclofenac, Hepatitis, Voltaren (Medication)

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Guidelines for the diagnosis of rheumatic fever: Jones criteria, 1992 update

Article Abstract:

The American Heart Association has updated the Jones criteria used to diagnose acute rheumatic fever. The diagnosis should only be made in patients who have had a documented case of streptococcal pharyngitis (strep throat) and have two major symptoms of rheumatic fever or one major and two minor symptoms. Strep throat is best diagnosed using tests that can detect antibodies in the blood to the bacterium, or culturing throat swabs. Major symptoms of rheumatic fever include a heart murmur indicating an inflammation of the heart valves, arthritis in the major joints, involuntary movement of the trunk and extremities, a distinctive rash and nodules under the skin around certain joints. Minor symptoms include joint pain and fever, an elevated erythrocyte sedimentation rate and a prolonged PR interval on the ECG. Individuals with a history of rheumatic fever may not meet the Jones criteria for acute rheumatic fever. Nevertheless, they are at great risk of recurrent rheumatic fever, and should be monitored accordingly.

Streptococcal infections, Rheumatic fever

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