The role of maternal screening in diagnosing congenital cytomegalovirus infections in highly immune populations.

BACKGROUND: Congenital cytomegalovirus (CMV) infection is the most important infectious cause of central nervous system disease and hearing loss in children. AIMS: In this study, we aimed to investigate the role of maternal screening in early diagnosis of congenital infection in highly immune populations. METHODS: A total of 163 women were included in the study; 103 of the subjects were pregnant and were at full term. The other 60 women were not pregnant, and all were healthy. RESULTS: CMV IgG seropositivity among the pregnant and control groups was found to be 98.1% (101/103) and 98.3% (59/60), respectively, and high IgG avidity was found in all women who had IgG positivity. We did not find any primary CMV infection in the two groups. The recurrent infection rate was found to be 5.82% in the pregnant group and 3.33% in the control group. There were no significant differences between the pregnant and control women in terms of CMV excretion in urine samples (4.85 vs. 3.33%, respectively; P = 1.000) or CMV-DNA presence in serum samples (1.94 vs. 0.0%, respectively; P = 0.532). The presence of symptomatic infection was not observed in any of the 104 babies born from the 103 pregnancies. CONCLUSIONS: According to our results, a maternal screening-based approach would be useful for only a very small group that is at risk of primary infection. Considering the cost of the scan, a routine maternal-based screening program is unadvisable in developing societies, but it is necessary for studies of different cohort groups and infectious diseases.

Stevens-Johnson Syndrome triggered by a combination of clobazam, lamotrigine and valproic acid in a 7-year-old child.

Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are diseases within the spectrum of severe cutaneous adverse reactions affecting skin and mucous membranes. Antiepileptic drugs (AEDs) are used in combination, leading to potential pharmacokinetic or pharmacodynamic interactions, causing more adverse effects than might occur when the AED is taken as monotherapy. Here, we report a rare case of SJS triggered by a combination of clobazam, lamotrigine and valproic acid in a 7-year-old boy. Because of inadequate seizure control, lorazepam was replaced with clobazam. Four weeks after the addition of clobazam, the patient developed SJS with a generalized rash, fever, with liver and kidney involvement, and eosinophilia one week after the initiation of treatment. All antiepileptic drugs were discontinued, and intravenous methylprednisolone, prophylactic systemic antibiotics, intravenous fluid supplement, antipyretic, special wound care, and supportive medical care for SJS were administered. He was discharged in a stable condition on the 18th day. Our case suggests that a drug-drug interaction between valproate, lamotrigine and clobazam contributed to the development of SJS. When the clobazam was added to valproic acid and lamotrigine co-medication, the lamotrigine dose should have been decreased.

La syndrome de Stevens-Johnson (SJS) et la nécrolyse épidermique toxique sont des maladies dans le spectre de réactions cutanées graves affectant la peau et les muqueuses. Les médicaments antiépileptiques sont utilisés en combinaison, et ceci peut provoquer des effets indésirables. Ici, nous rapportons un cas rare de SJS déclenché par une combinaison de clobazam, la lamotrigine et l'acide valproïque chez un garçon de 7 ans. En raison de l' insuffisante maîtrise des crises, le lorazépam a été utilisé avec le clobazam. Quatre semaines après l'ajout de clobazam, le patient a développé SJS avec une éruption cutanée généralisée, de la fièvre. Il y avait la participation de la foie et les reins, et une éosinophilie, une semaine après le début du traitement. Tous les médicaments antiépileptiques ont été abandonnées, et la méthylprednisolone intraveineuse, des antibiotiques systémiques prophylactiques, supplément de liquide par voie intraveineuse, antipyrétique, les soins des plaies spécial, et de soutien pour les soins médicaux ont été administrés. Il a été libéré dans un état stable la 18ème journée. Notre cas suggère qu'une interaction médicamenteuse entre le valproate, la lamotrigine et clobazam ait contribué au développement de SJS. Lorsque le clobazam a été ajouté à l'acide valproïque et la lamotrigine, la dose de lamotrigine aurait dû être diminué.