The Systemic Toxic Responses of Patients to Treatment With Streptokinase Streptodornase (Sk-Sd) 12

Abstract

This paper reports the results of investigations concerning possible toxicities associated with the therapeutic use of streptococcal concentrates containing streptokinase (SK) and streptodornase (SD).Up to the present time the most obvious clinical side effect has been a pyrogenic reaction with associated symptoms of malaise, headache, arthralgia and occasionally nausea (1, 2). This reaction has been observed to begin about four to six hours after the local instillation of solutions of SK-SD; to reach its peak in 24 hours and to subside in the ensuing 24-48 hours. The febrile response occurs in 60-75%o of the treated cases, with a suggestive higher frequency in patients with massive hemorrhage (hemothorax) than in those who have local suppurative disease of infectious origin. In patients receiving repeated injections the occurrence of the reaction has been unpredictable; sometimes appearing after the first injection and not subsequent ones and, on other occasions, after one or another of the later injections, but absent at the first treatment. Furthermore, the cause of the reaction has not yet been clearly determined but may be referable primarily either to the foreign materials of the solutions of SK-SD or to the breakdown products of their enzymatic action.The present study was undertaken to determine whether untoward effects, inapparent to general clinical examination but that might be brought out by detailed laboratory examination, followed the use of SK-SD.In addition to the routine need for such a study when a new agent is used therapeutically, there is a special need in the instance of SK-SD since 1This study was supported through a contract with disease is known to be associated with the presence of streptococci and their metabolic products within the body. It is useful, then, to look for laboratory changes that might indicate alterations suggestive of the specific toxicities of streptococcal products. MATERIALS AND METHODSTwenty-eight patients were studied, who received a total of 90 local instillations of SK-SD for a variety of suppurative and hemorrhagic diseases. Observations were made on the days before treatment; immediately prior to treatment; every one to three hours in the 12 hours after treatment; and then twice daily until control levels were obtained. In 10 patients, additional observations for possible delayed effects were made from 21 to 112 days after the last treatment.Urinalysis was performed on each voided specimen on the day of treatment and thereafter until control observations were duplicated. The first 15 patients studied had complete routine analyses on each voided specimen, but the last 13 patients had each specimen routinely analyzed only during the first 12 hours after treatment, unless some change was observed during this period. Since we wished to determine the time relationship between the appearance of formed elements in the urine and clinical and peripheral blood changes, the urine was not pooled for the usual Addis counts during the first 24 to 48 hours following treatment...

The Intravenous Infusion of the Streptococcal Fibrinolytic Principle (Streptokinase) Into Patients 1

“…The WBC count returned to the range of the pre-infusion range within the ensuing 24 hours. These results are in accord with the findings of patients receiving SK-SD in extravascular areas for the eradication of hemorrhagic clots and puirulent exudation (11).…”

“…The changes are similar to, but less marked than, those observed in patients receiving local injections of SK-SD, who had a pyrogenic response to the treatment (11). The abnormalities appeared a few hours after the infusion was begun.…”

Posttraumatic Empyema

“…Intrapleural administration of these agents has no systemic absorption and does not cause coagulation defects [69]. Common systemic side effects associated with intrapleural administration of streptokinase include fever up to 40 °C and pleural pain [70]. The fever represents a delayed-type hypersensitivity reaction, probably from the presence of contaminating streptococcal proteins [71].…”

Flow resistance of individual neutrophils in coronary artery disease: decreased pore transit times in acute myocardial infarction.

“…Design-Neutrophil flow resistance was measured in 93 subjects in five groups: (group 1) 28 patients within 12 hours after the onset of myocardial infarction, before reperfusion therapy; (group 2) 18 with unstable angina; (group 3) 13 with stable angina; (group 4) 13 age matched patients without coronary disease, and (group 5) 21 healthy volunteers. Main parameters-Single neutrophil transit times through 8 pm oligopore filters determined with a modified cell transit analyser.…”

“…(Heart 1997;77: [18][19][20][21][22][23] Keywords: coronary artery disease; myocardial infarction; reperfusion; leucocytes.…”