Kenya, 1982- 20 cases of aflatoxicosis described and 12 deaths. Aflatoxin was detectable at 3.2-12mg/kg in food samples. Symptoms include hepatomegaly, abdominal discomfort, anorexia, malaise, jaundice and oedema of legs, face and trunk.
Patient diagnosed with Stage C Chronic Lymphocytic Leukaemia, treated in the MRC CLL4 study, with prednisolone for 4 weeks followed by oral chlorambucil for 7 days. Patient developed severe pneumonia due to pseudomonas and staphylococcus. Following treatment with broad spectrum antibiotics and 1 week of Abelcet, patient was readmitted with headache, disorientation and fever. CT brain scans showed 3 ring enhancing lesions, aspirated material showed neutrophils but grew aspergillus. Patient now improved on Abelcet (4 mg/kg) and oral itrconazole suspension 200mg b.d.
Thanks to Richard Chasty, Consultant Haematologist, North Staffordsire Hospital, UK.