Summary Tissue accumulation of advanced glycation end‐products (AGEs) has been implicated in the oxidant‐induced vascular pathology of diabetes and other diseases. Because homozygous sickle cell anaemia (SCA) is a state of oxidative stress, we tested the hypothesis that circulating AGE levels are elevated in SCA. Blood was obtained from age‐ and race‐matched children classified as either non‐sickle cell controls, SCA without vaso‐occlusive crisis (SCA − VOC), or SCA with vaso‐occlusive crisis (SCA + VOC). Plasma and red blood cell (RBC) AGE levels were measured by immunoassay. RBC levels of reduced (GSH) and oxidized (GSSG) glutathione were measured by capillary electrophoresis as an indicator of endogenous antioxidant status. The results showed that plasma AGE levels and the rate of RBC AGE accumulation were significantly higher in patients with SCA compared with controls. GSH was not different between groups but was significantly inversely correlated with plasma AGEs in both controls and patients with SCA. GSSG was significantly lower and GSH/GSSG higher in SCA + VOC patients, suggesting that GSH/GSSG might be an objective indicator of acute VOC or a risk factor for VOC. We conclude that circulating AGE levels are strongly influenced by endogenous antioxidant status and may play a role in the vascular pathology of SCA.

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Infection by Baylisascaris procyonis is an uncommon but devastating cause of eosinophilic meningitis. We report the fi rst case-patient, to our knowledge, who recovered from B. procyonis eosinophilic meningitis without any recognizable neurologic defi cits. The spectrum of illness for this organism may be wider than previously recognized. E osinophilic meningitis is defi ned by >10 eosinophils/ mm 3 in the cerebrospinal fl uid (CSF) or >10% eosinophils of the total CSF leukocyte count. In the United States, the most common cause of eosinophilic meningitis is the presence of a ventriculoperitoneal shunt, but worldwide it is infection by Angiostrongylus cantonensis (1). Other infectious causes of eosinophilic meningitis include Toxocara spp., Gnathostoma spinigerum, neurocysticercosis, and Baylisascaris procyonis. The latter is an intestinal roundworm endemic to the US raccoon population (2). B. procyonis has not been described in New Orleans but is known to occur in raccoons in northern Louisiana (D. Bowman, pers. comm.) and in the nearby states of Texas, Georgia, Oklahoma (2,3), and Mississippi (C. Panuska, unpub. data).Previously, all reported human cases of B. procyonis eosinophilic meningitis have resulted in death or severe neurologic sequelae. We describe a patient with clinically apparent B. procyonis eosinophilic meningitis, who appears to have completely recovered. This patient's recovery supports the notion that a wide spectrum of clinical disease exists for this parasite and that it may be a more common human infection than previously recognized. The CaseA 4-year-old boy from New Orleans, Louisiana, who had sickle cell disease and a history of a splenectomy, was admitted to our hospital with 1 day of headache, right arm pain, and emesis. He was alert and oriented; his oral temperature was 38°C; and physical examination found only mild upper extremity tremors, dysmetria, and bilateral extensor plantar response. His blood leukocyte count was 16,000/mm 3 , with 12% eosinophils; blood cultures yielded no growth. During the next 3 days, his headache and vomiting worsened and ataxia developed. Magnetic resonance imaging of the brain, performed on day 5 of illness, demonstrated cerebellar edema (Figure). CSF analysis showed the following: 5 erythrocytes, 1,734 leukocytes/mm 3 (55% of which were eosinophils), protein 290 mg/dL, and glucose 53 mg/dL. The boy was given 1 dose of mannitol (0.25 g/kg) and a loading dose of dexamethasone (1 mg/kg), followed by 0.25 mg/kg dexamethasone every 6 hours for 2 weeks. On day 9, a parasitic infection was suspected, and albendazole (10 mg/kg every 12 hours for 5 days) was begun. The boy's history was negative for travel outside the United States, raw food consumption, household pets, developmental disability, or pica. His mother reported household rodent infestation and fecal droppings on the patient's bed; raccoons had been seen in the neighborhood, but the boy had not been directly exposed to them. Three days after corticosteroid therapy began, headache and vomiting sto...

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