RESUMEN
INTRODUCTION: Human papillomavirus (HPV) vaccination has been anecdotally connected to the development of dysautonomia, chronic fatigue, complex regional pain syndrome and postural tachycardia syndrome. OBJECTIVES: To critically evaluate a potential connection between HPV vaccination and the above-noted conditions. METHODS: We reviewed the literature containing the biology of the virus, pathophysiology of infection, epidemiology of associated cancers, indications of HPV vaccination, safety surveillance data and published reports linking HPV vaccination to autonomic disorders. RESULTS: At this time, the American Autonomic Society finds that there are no data to support a causal relationship between HPV vaccination and CRPS, chronic fatigue, and postural tachycardia syndrome to other forms of dysautonomia. CONCLUSION: Certain conditions are prevalent in the same populations that are vaccinated with the HPV vaccine (peri-pubertal males and females). This association, however, is an insufficient proof of causality.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/epidemiología , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Sociedades Médicas/tendencias , Enfermedades del Sistema Nervioso Autónomo/inducido químicamente , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Síndrome de Fatiga Crónica/inducido químicamente , Síndrome de Fatiga Crónica/diagnóstico , Síndrome de Fatiga Crónica/epidemiología , Humanos , Vacunas contra Papillomavirus/efectos adversos , Síndrome de Taquicardia Postural Ortostática/inducido químicamente , Síndrome de Taquicardia Postural Ortostática/diagnóstico , Síndrome de Taquicardia Postural Ortostática/epidemiología , Disautonomías Primarias/inducido químicamente , Disautonomías Primarias/diagnóstico , Disautonomías Primarias/epidemiología , Estados Unidos/epidemiologíaRESUMEN
Stimulant medication may mimic the tachycardia of postural orthostatic tachycardia syndrome. Two case histories illustrate how missing the clinical distinction between a primary dysautonomia and a medication effect may have avoidable adverse consequences.
Asunto(s)
Fentermina/efectos adversos , Síndrome de Taquicardia Postural Ortostática/diagnóstico , Adulto , Estimulantes del Sistema Nervioso Central/efectos adversos , Estimulantes del Sistema Nervioso Central/farmacología , Errores Diagnósticos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Proteínas de Transporte de Noradrenalina a través de la Membrana Plasmática/antagonistas & inhibidores , Obesidad , Síndrome de Taquicardia Postural Ortostática/inducido químicamente , Pruebas de Mesa InclinadaAsunto(s)
Inhibidores de Captación Adrenérgica/efectos adversos , Clorhidrato de Atomoxetina/efectos adversos , Síndrome de Taquicardia Postural Ortostática/inducido químicamente , Síndrome de Taquicardia Postural Ortostática/diagnóstico , Adolescente , Inhibidores de Captación Adrenérgica/sangre , Clorhidrato de Atomoxetina/sangre , Frecuencia Cardíaca/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Síndrome de Taquicardia Postural Ortostática/sangreRESUMEN
Postural orthostatic tachycardia syndrome (POTS) is a common condition of orthostatic intolerance in response to changes in position. We report a case of a middle-aged woman presenting with a new onset of POTS likely due to chemotherapy for treatment of breast cancer. She was started on a trial of a beta blocker, which was effective in controlling her symptoms and heart rate. The objective of this report was to encourage clinicians to consider POTS as a differential diagnosis, while managing patients with symptoms of orthostatic intolerance.
Asunto(s)
Neoplasias de la Mama , Síndrome de Taquicardia Postural Ortostática , Neoplasias de la Mama/tratamiento farmacológico , Femenino , Frecuencia Cardíaca , Humanos , Persona de Mediana Edad , Síndrome de Taquicardia Postural Ortostática/inducido químicamente , Síndrome de Taquicardia Postural Ortostática/diagnóstico , Síndrome de Taquicardia Postural Ortostática/tratamiento farmacológicoRESUMEN
OBJECTIVE: The antimalarial agent mefloquine has been reported to cause a number of possible side effects. Here we describe a case demonstrating a previously unreported complication, the postural orthostatic tachycardia syndrome (POTS). CASE HISTORY: A 44-year-old woman presented with symptoms of severe orthostatic intolerance (palpitations and dizziness) in combination with postural tachycardia (but no fall in blood pressure) following the use of mefloquine prophylaxis. Investigations revealed evidence of autonomic dysfunction (with loss of ECG R-R interval variation) consistent with POTS. Her symptoms responded well to beta-blockade with propranolol. CONCLUSION: The possibility of POTS should be considered in patients presenting with symptoms of palpitations, dizziness, presyncope or other features suggestive of autonomic dysfunction following the use of mefloquine.
Asunto(s)
Antimaláricos/efectos adversos , Arritmias Cardíacas/inducido químicamente , Mareo/inducido químicamente , Mefloquina/efectos adversos , Síndrome de Taquicardia Postural Ortostática/inducido químicamente , Adulto , Femenino , HumanosRESUMEN
We describe a young woman who developed POTS with positive serum anti-NMDA receptor antibodies and no evidence of encephalitis after vaccination with HPV vaccine, Cervarix. Her symptoms improved significantly with immunomodulatory therapy and re-occurred after immunomodulatory therapy was stopped, suggesting an autoimmune etiology of POTS after vaccination.