RESUMEN
BACKGROUND: Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization. METHODS: We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0-2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization). RESULTS: Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94-194). Two patients died during follow-up (3% [95% CI, 1%-11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%-94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed). CONCLUSIONS: In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.
Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Trombosis Intracraneal , Trombocitopenia , Trombosis , Vacunas , Trombosis de la Vena , Adulto , COVID-19/prevención & control , Vacunas contra la COVID-19/efectos adversos , Hemorragia Cerebral , Femenino , Humanos , Trombosis Intracraneal/diagnóstico , Masculino , Factores de Riesgo , SARS-CoV-2Asunto(s)
Intoxicación por Arsénico/diagnóstico , Arsénico/análisis , Diarrea/etiología , Agua Dulce/química , Vómitos/etiología , Adulto , Intoxicación por Arsénico/complicaciones , Intoxicación por Arsénico/tratamiento farmacológico , Terapia por Quelación , Diagnóstico Diferencial , Alucinaciones/etiología , Hepatitis/etiología , Humanos , Hipotensión/etiología , Masculino , Northern Territory , Pancitopenia/etiología , Trastornos de la Sensación/etiología , Succímero/efectos adversos , Succímero/uso terapéutico , Contaminantes Químicos del Agua/efectos adversos , Contaminantes Químicos del Agua/análisisRESUMEN
Murray Valley encephalitis virus (MVEV) is a mosquito-borne virus endemic to Australia and New Guinea. Encephalitis due to MVEV is potentially devastating, and no therapeutic interventions of proven value exist. Prevention relies largely on personal protective measures against mosquito bites. We present a case of MVEV encephalitis with a favourable outcome following intensive care management and prolonged rehabilitation, and the epidemiological features of a further 21 cases notified to the health department of Australia's Northern Territory. As cases occur in travellers, and epidemics occur sporadically in south-eastern Australia, clinicians across Australia and further abroad should be familiar with the disease and its diagnosis and management.