Levamisole Exposure and Hematologic Indices in Cocaine Users
Levamisole Exposure and Hematologic Indices in Cocaine Users
复制标题
DOI：
10.1111/j.1553-2712.2011.01202.x
复制
发表时间：
2011-11-01
影响因子：
4.4
通讯作者：
Babu, Kavita M.
中科院分区：
文献类型：
--
作者：
Chai, Peter R.;Bastan, William;Babu, Kavita M.
目的：左旋咪唑是一种抗蠕虫药物，在美国缉获的可卡因中发现了近70%的含量。零星病例文献描述了与使用可卡因继发的左旋咪唑暴露相关的危及生命的粒细胞缺乏症。作者比较了确认接触左旋咪唑和不接触左旋咪唑的可卡因吸毒者的血液学指标的分布。方法：回顾2009年9月至2009年12月期间在寿命医院系统中接受全面毒理学测试的所有患者的记录(n=799)。在这些患者中，有95名患者符合纳入条件(可卡因阳性，同时进行全血细胞计数)。将患者分为左旋咪唑阳性组(n=47)和阴性组(n=48)。主要结果指标为白细胞总数(WBC)、中性粒细胞绝对数(ANC)和淋巴细胞绝对数(ALC)；次要结果指标包括中性粒细胞、淋巴细胞、嗜酸性粒细胞、单核细胞和嗜碱性粒细胞的百分比，以及确定的共同摄取物。结果：两组人的年龄、性别和种族构成相似。两组患者的WBC总数、ANC和ALC无显著差异。中性粒细胞、嗜酸性粒细胞、嗜碱性粒细胞或单核细胞的相对比例在两组之间没有显著差异。左旋咪唑阳性组有1例中性粒细胞减少，而阴性组有3例中性粒细胞减少。此外，对描述左旋咪唑引起的粒细胞缺乏症(n=33)的病例报告进行了文献综述。在这些病例中，52%的患者以口咽部主诉为主诉；在另外27%的病例中，患者以软组织感染或紫癜为主诉。结论：在所有可卡因使用者中，中性粒细胞减少症的总发生率为4.2%，在左旋咪唑阳性组中为2.1%。据报道，有数量惊人的左旋咪唑相关性中性粒细胞减少症患者出现口咽部不适、脉管炎或发热。提供了一种在急诊科环境下识别左旋咪唑毒性的临床算法。需要进一步的研究来确定左旋咪唑相关性中性粒细胞减少症所需的情况。
Objectives: Levamisole is an antihelminthic agent found in nearly 70% of seized U.S. cocaine. Sporadic case literature describes a life-threatening agranulocytosis associated with levamisole exposure secondary to cocaine use. The authors compared the distribution of hematologic indices in a population of cocaine users with and without a confirmed exposure to levamisole. Methods: The records of all patients in the Lifespan hospital system who underwent comprehensive toxicologic testing between September 2009 and December 2009 (n = 799) were reviewed. Of these, 95 patients were eligible for inclusion (cocaine-positive with a simultaneous complete blood count). Patients were grouped into levamisole-positive (n = 47) and -negative (n = 48) groups. The primary outcome measures were total white blood cell count (WBC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC); secondary outcome measures included percent neutrophils, lymphocytes, eosinophils, monocytes, and basophils, as well as identified co-ingestants. Results: Both groups had a similar makeup of age, sex, and race. The total WBC count, ANC, and ALC were not significantly different between the two groups. There was no significant difference in relative proportion of neutrophils, eosinophils, basophils, or monocytes between the groups. There was one neutropenic patient in the levamisole-positive group, while three patients were neutropenic in the negative group. Additionally, a literature review of case reports describing levamisole-induced agranulocytosis (n = 33) was conducted. In 52% of these cases, patients presented with an oropharyngeal chief complaint; in an additional 27%, patients presented with soft tissue infections or purpura. Conclusions: The overall incidence of neutropenia was 4.2% in all cocaine users and 2.1% in the levamisole-positive group. A striking number of the reported patients with levamisole-associated neutropenia have presented to care with oropharyngeal complaints, vasculitis, or fever. A clinical algorithm for identifying levamisole toxicity in the emergency department setting is provided. Further research is necessary to determine the circumstances required for levamisole-associated neutropenia.