The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society
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Methadone maintenance treatment (MMT) is commonly used for chronic pain control and for substitution in heroin addicts undergoing rehabilitation. Methadone is known to prolong QT interval and sometimes cause torsade de pointes (TdP) and ventricular fibrillation (VF). ⋯ To our knowledge, worsening of methadone-induced TdP by amiodarone has not been reported before. We describe here a case of methadone-induced TdP that deteriorated into ventricular fibrillation upon treatment with intravenous (IV) amiodarone and resolved after discontinuation of amiodarone and treatment with IV magnesium, potassium, and lidocaine.
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This epidemiological review analyzed cases of Naegleria fowleri primary amebic meningoencephalitis (PAM) and Balamuthia mandrillaris granulomatous amebic encephalitis (GAE) for behavioral and demographic risk factors for pathogen exposures and potential transmission by organ transplantation. The Centers for Disease Control and Prevention (CDC) Naegleria Workgroup Registry provided 121 cases of laboratory-confirmed PAM over the period, 1937-2007. The CDC and the California Encephalitis Project provided 28 cases of GAE over the period, 1994-2010. ⋯ Risk factors for GAE included male gender, exposures in southern-tier US states, Hispanic ethnicity in California, occupational or recreational contacts with soil, and recent organ transplantation. Fatal free-living amebic infections of the brain are increasing today due to more frequent environmental, recreational, and occupational exposures; organ transplantation; and unanticipated clusters of PAM due to N. fowleri inoculations following nasal sinus irrigation using neti pots filled with municipal tap water. Potential organ donors dying from meningoencephalitis of unexplained causes should be screened for free-living amebic infections of the brain capable of hematogenous dissemination in organ recipients.