The Chief Medical Officer (CMO) of the hospital, Nitish Mokashi, said, "15 to 18 children were the victims of adverse reaction, the reaction is called pyrogenic reaction
and can occur upon administration of any drug".
In this outbreak, once-daily dosing may have resulted in the delivery of large enough volumes or amounts of gentamicin with sufficient endotoxin over 1 hour to stimulate a pyrogenic reaction
even if the endotoxin concentration was below the USP limit of 68 EU/mL or 1.
After many reuses endotoxin can accumulate, and when it reaches the threshold of the body tolerance (5 EU/ml/kg of body weight), an endotoxin or pyrogenic reaction
ensues (fever spike, chills, myalgia, hypotension, nausea, and vomiting).
8 EU/mL) would have been sufficient to evoke a pyrogenic reaction
in an average 4 lbs.
Gram-negative bacteria express one of six types of endotoxin or lipopolysaccharide (LPS), which can potentially induce life threatening pyrogenic reactions
depending on the detailed molecular structure of LPS isoforms.
TLR2, TLR7, TLR8, TLR9) which, upon binding of their specific ligands, trigger or influence pyrogenic reactions
This can cause pyrogenic reactions
characterized by fever, chills, and/or hypotension (Bommer, Becker, & Urbaschek, 1996).
Water which is delivered to the OL-HDF machine has been shown to be safe with studies reviewed by Canaud et al (2006) reporting no incidence of pyrogenic reactions
from the administration of large amounts of infusion fluids.
Contamination of epoetin alfa with Serratia liquefaciens at an outpatient dialysis center resulted in 10 bloodstream infections and 6 pyrogenic reactions
in a single month, reported Dr.
The pyrogenic reactions
of course were due to the bacterial toxins crossing through the dialysing membrane secondary to the relative poor water treatment in those days.
were also seen quite often due to the lack of water treatment.
and gram-negative bacteremia in patients in a hemodialysis center.