Lassa hemorrhagic shock syndrome-on-a-chip.

Lack of experimental human models hinders research on Lassa hemorrhagic fever and the development of treatment strategies. Here, we report the first chip-based model for Lassa hemorrhagic syndrome. The chip features a microvessel interfacing collagen network as a simple mimic for extracellular matrix, allowing for quantitative and real-time vascular integrity assessment. Luminal infusion of Lassa virus-like particles led to a dramatic increase in vascular permeability in a viral load-dependent manner. Using this platform, we showed that Fibrin-derived peptide FX06 can be used to suppress the vascular integrity loss. This simple chip-based model proved promising in the assessment of disease severity and provides an easy-to-use platform for future investigation of Lassa pathogenesis and drug development in a human-like setting.

Influenza A with hemorrhagic shock and encephalopathy syndrome in an adult: A case report.

INTRODUCTION: Hemorrhagic shock and encephalopathy syndrome (HSES) is a type of acute encephalopathy mainly seen in infants. It is a syndrome encompassing an onset of high fever, disturbance of consciousness, convulsion, and shock that rapidly progresses to watery diarrhea and liver and renal dysfunctions. It is extremely rare in adults, and the number of reports is limited worldwide. We report the case of an adult patient with HSES, which occurred after influenza A infection. PATIENT CONCERNS: A 52-year-old man visited his family doctor 2 days after he noticed fever and was diagnosed with influenza A using an influenza rapid diagnosis kit; he underwent treatment on an outpatient basis. He was immediately hospitalized after developing fever, abdominal pain, malaise, and shock 16 hours after the commencement of the treatment. Abrupt acute brain swelling was noted 24 hours after hospitalization. DIAGNOSES: The antibody titer to influenza A (H3N2) was 1:40. Computed tomography obtained 24 hours after treatment initiation confirmed acute cerebral edema and cerebral herniation. Electroencephalogram at that time showed a flat line. INTERVENTIONS: For the treatment of influenza A, laninamivir 150 mg was started immediately after the diagnosis by the family doctor, and 600 mg dose was given daily after hospitalization (or since 24 hours after the treatment initiation). For the management of shock, dobutamine 3 µg/kg/min and noradrenaline up to 0.2 µg/kg/min were used together with bolus infusion. OUTCOMES: The patient was declared brain dead on his 6th hospital day and he died on his 27th hospital day. CONCLUSION: Drastic courses such as that in our case with HSES can follow influenza infections even in adults.

BK viremia in critically ill surgical patients with hemorrhagic or septic shock.

BACKGROUND: Infections with polyomavirus BK virus (BKV) are a common cause of renal dysfunction after renal transplantation and may also be harmful in surgical patients with shock. The aim of the present study was to determine the frequency of BKV viremia in critically ill surgical patients with septic or hemorrhagic shock, and, if viremia is detectable, whether viremia may be associated with renal dysfunction. FINDINGS: A total of 125 plasma samples from 44 critically ill surgical patients with septic or hemorrhagic shock were tested by real-time polymerase chain reaction (PCR) for BKV DNA during their stay on the intensive care unit (ICU). BKV viremia occurred in four patients, i.e. in three of the septic and in one of the hemorrhagic shock group. There was no association between viremia and renal dysfunction. All positive samples contained a low viral load (< 500 copies/ml). CONCLUSIONS: Since BK viremia was rarely found and with low viral load only in critically ill surgical patients with shock, it is very unlikely that BK viremia results in BK nephropathy later on.

Hemorrhagic shock and encephalopathy syndrome in a child with pandemic H1N1 2009 influenza virus.

We report a case of hemorrhagic shock and encephalopathy in a child with pandemic 2009 H1N1 influenza infection. The patient succumbed within 3 days of admission.

Haemorrhagic shock and encephalopathy associated with rotavirus infection.

We report on a 21-month-old girl with a haemorrhagic shock and encephalopathy who survived. Rotavirus genomic ribonucleic acid was detected by reverse transcription polymerase chain reaction in stool, blood and cerebrospinal fluid. Serum antibody titres of the rotavirus were also high. Plasmapheresis had a stabilizing effect on the course of the disease. This case indicates that rotavirus infection may play an important role in the devastating cascade that occurs in some patients with this syndrome. The findings suggest that extensive investigation for rotavirus infection, particularly infection of the central nervous system, should be carried out in patients with haemorrhagic shock and encephalopathy.