ABSTRACT
Durante la pandemia por COVID-19 se observaron diversas reacciones adversas a fármacos. Esto pudo haber estado relacionado con una mayor susceptibilidad inmunológica de los pacientes con SARS-CoV-2 a presentar este tipo de cuadros, así como también con la exposición a múltiples medicamentos utilizados en su tratamiento. Comunicamos el caso de un paciente con una infección respiratoria grave por COVID-19, que presentó 2 reacciones adversas graves a fármacos en un período corto de tiempo. (AU)
During the COVID-19 pandemic, various adverse drug reactions were observed. This could have been related to a greater immunological susceptibility of patients with SARS-CoV-2 to present this type of symptoms, as well as exposure to multiple drugs used in their treatment. We report the case of a patient with a severe respiratory infection due to COVID-19, who presented 2 serious adverse drug reactions associated with paracetamol in a short period of time. (AU)
Subject(s)
Humans , Male , Adult , Stevens-Johnson Syndrome/diagnosis , Drug-Related Side Effects and Adverse Reactions/diagnosis , Exanthema/diagnosis , Acute Generalized Exanthematous Pustulosis/diagnosis , COVID-19/complications , COVID-19 Drug Treatment/adverse effects , Patient Care Team , gamma-Globulins/administration & dosage , Methylprednisolone/administration & dosage , Incidence , Risk Factors , Stevens-Johnson Syndrome/drug therapy , Treatment Outcome , Cyclosporine/adverse effects , Drug-Related Side Effects and Adverse Reactions/drug therapy , Exanthema/drug therapy , Acute Generalized Exanthematous Pustulosis/drug therapy , Acetaminophen/adverse effectsABSTRACT
Abstract Objectives: present a case of Inborn errors of immunity (IEI) as a potential diagnosis in pediatric patients with recurrent infections. Description: male patient, 13 years old, since he was eight months old had recurrent diarrhea, sinusitis, otitis, abscesses and urinary tract infections. At the age of ten, he presented mastoiditis progressing to meningitis, he was admitted to a tertiary hospital, where an immunological evaluation was performed, which led to the diagnosis of Predominantly Antibody Deficiency (PAD), with suspected X-linked Agammaglobulinemia (XLA). Treatment was initiated with administration of intravenous gamma globulin 400 mg/kg every four weeks, with a significant improvement of the condition. Discussion: usually, the diagnosis of XLA tends to be made in the first three years of life. However, in this report, although the first manifestations started at eight months of age, there was a delay of ten years before starting the treatment. In fact, the diagnosis of children and adults with IEI can be delayed if healthcare professionals are unable to find the true cause of recurrent infections. Therefore, the relevance of considering such pathologies in the presence of risk signs is highlighted, as early diagnosis being essential in treating and preventing morbidities.
Resumo Objetivos: apresentar um caso de Erro Inato da Imunidade (EII) como diagnóstico em potencial de pacientes pediátricos com infecções de repetição. Descrição: paciente masculino, 13 anos, desde os oito meses de idade apresentou quadros repetidos de diarreias, sinusites, otites, abscessos e infecções do trato urinário; destacando-se a otite, sinusite e diarreia pela maior recorrência. Aos dez anos, quando apresentou mastoidite evoluindo para meningite, foi internado em um hospital terciário, onde foi realizada avaliação imunológica, a qual levou ao diagnóstico de Deficiência Predominantemente de Anticorpos (DPAs), tendo como suspeita a agamaglobulinemia ligada ao cromossomo X (ALX). Foi iniciado tratamento com administração de gamaglobulina endovenosa 400 mg/kg a cada quatro semanas, ocorrendo melhora significativa do quadro. Discussão: normalmente, o diagnóstico da ALX tende a ser feito nos primeiros três anos de vida. Neste relato, entretanto, embora as primeiras manifestações tenham iniciado aos oito meses de idade, ocorreu um atraso de dez anos até o início do tratamento. De fato, o diagnóstico de crianças e adultos com EII pode ser retardado se os profissionais de saúde não conseguirem encontrar a causa das infecções recorrentes. Destaca-se, portanto, a relevância de se considerar tais patologias na vigência de sinais de riscos, pois o diagnóstico precoce é fundamental para tratar e prevenir morbidades.
Subject(s)
Humans , Male , Adolescent , gamma-Globulins/administration & dosage , Agammaglobulinemia/diagnosis , Primary Immunodeficiency Diseases/complications , BrazilABSTRACT
Since the wild poliovirus no longer circulates, the number of cases of acute flaccid paralysis decreased. However, cases related to non-polio enteroviruses and neurotrope viruses continue to occur. We present a nine-year-old patient with meningitis and myelitis with motor involvement in the lower limbs and neurogenic bladder associated with enterovirus, with complete resolution of the neurological symptoms following the administration of hyperimmune gammaglobulin.
Desde la eliminación de la circulación del virus polio salvaje, disminuyeron los casos de parálisis fláccida aguda. Sin embargo, continúan ocurriendo casos asociados a otros enterovirus no polio y virus neurotropos. Se presenta el caso de una paciente de 9 años con diagnóstico de meningitis y mielitis con compromiso motor en los miembros inferiores y vejiga neurogénica asociado a enterovirus, con resolución completa del cuadro neurológico posterior a la administración de gammaglobulina hiperinmune.
Subject(s)
Enterovirus Infections/diagnosis , Meningitis, Viral/virology , Myelitis/virology , Paralysis/virology , Child , Enterovirus Infections/drug therapy , Enterovirus Infections/pathology , Female , Humans , Meningitis, Viral/drug therapy , Myelitis/drug therapy , Paralysis/drug therapy , Urinary Bladder, Neurogenic/drug therapy , Urinary Bladder, Neurogenic/virology , gamma-Globulins/administration & dosageABSTRACT
PURPOSE:: To determine if the combination of lidocaine with epinephrine or gamma globulin would decrease the rate or reduce the amount of local absorption of lidocaine through the airway. METHODS:: Twenty adult male cats were randomly and evenly distributed into four groups: 1) Group LG: lidocaine administered with gamma globulin; 2) Group LS: lidocaine administered with physiological saline); 3) Group LE: lidocaine administered with epinephrine; 4) Group C: control group. Invasive blood pressure, heart rate, and concentration of lidocaine were recorded before and after administration. RESULTS:: The peak of plasma concentrations appeared difference (Group LG: 1.39 ± 0.23 mg/L; Group LS: 1.47 ± 0.29 mg/L and Group LE: 0.99 ± 0.08 mg/L). Compared to Group C, there were significant differences in the average heart rate of Groups LG, LS, and LE (P < 0.05). The average systolic blood pressures were significantly different when each group was compared to Group C (P < 0.05). The biological half-life, AUC0-120, peak time, and half-life of absorption among the three groups have not presented statistically significant differences (P > 0.05). CONCLUSION:: Administering lidocaine in combination with gamma globulin through airway causes significant decrease the rate and reduce the amount of local absorption of lidocaine in cats.
Subject(s)
Adrenergic beta-Agonists/pharmacokinetics , Anesthetics, Local/pharmacokinetics , Epinephrine/pharmacokinetics , Lidocaine/pharmacokinetics , Respiratory Tract Absorption/drug effects , gamma-Globulins/pharmacokinetics , Adrenergic beta-Agonists/administration & dosage , Anesthetics, Local/administration & dosage , Anesthetics, Local/blood , Animals , Blood Pressure/drug effects , Bronchoscopy/methods , Cats , Drug Combinations , Epinephrine/administration & dosage , Heart Rate/drug effects , Lidocaine/administration & dosage , Lidocaine/blood , Male , Random Allocation , Reference Values , Reproducibility of Results , Time Factors , Trachea/drug effects , gamma-Globulins/administration & dosageABSTRACT
Abstract Purpose: To determine if the combination of lidocaine with epinephrine or gamma globulin would decrease the rate or reduce the amount of local absorption of lidocaine through the airway. Methods: Twenty adult male cats were randomly and evenly distributed into four groups: 1) Group LG: lidocaine administered with gamma globulin; 2) Group LS: lidocaine administered with physiological saline); 3) Group LE: lidocaine administered with epinephrine; 4) Group C: control group. Invasive blood pressure, heart rate, and concentration of lidocaine were recorded before and after administration. Results: The peak of plasma concentrations appeared difference (Group LG: 1.39 ± 0.23 mg/L; Group LS: 1.47 ± 0.29 mg/L and Group LE: 0.99 ± 0.08 mg/L). Compared to Group C, there were significant differences in the average heart rate of Groups LG, LS, and LE (P < 0.05). The average systolic blood pressures were significantly different when each group was compared to Group C (P < 0.05). The biological half-life, AUC0-120, peak time, and half-life of absorption among the three groups have not presented statistically significant differences (P > 0.05). Conclusion: Administering lidocaine in combination with gamma globulin through airway causes significant decrease the rate and reduce the amount of local absorption of lidocaine in cats.
Subject(s)
Animals , Male , Cats , gamma-Globulins/pharmacokinetics , Epinephrine/pharmacokinetics , Adrenergic beta-Agonists/pharmacokinetics , Respiratory Tract Absorption/drug effects , Anesthetics, Local/pharmacokinetics , Lidocaine/pharmacokinetics , Reference Values , Time Factors , Trachea/drug effects , Blood Pressure/drug effects , Bronchoscopy/methods , gamma-Globulins/administration & dosage , Epinephrine/administration & dosage , Random Allocation , Reproducibility of Results , Adrenergic beta-Agonists/administration & dosage , Drug Combinations , Heart Rate/drug effects , Anesthetics, Local/administration & dosage , Anesthetics, Local/blood , Lidocaine/administration & dosage , Lidocaine/bloodABSTRACT
X-linked agammaglobulinemia (XLA) is characterized by absent or severely reduced B cells, low or undetectable immunoglobulin levels and clinically by extracellular bacterial infections which mainly compromise the respiratory tract as well as recurrent diarrheas. The mainstay of treatment is gammaglobulin replacement therapy, which allows most patients to reach adulthood with high quality of life. We analyzed the clinical features of 14 patients over 18 years of age with XLA diagnosis that received treatment in our unit from the year 2003, the date the first patient was derived, until 2015. The average age at which patients were referred was 20.4 years old; age at the last consult was 25.5. The average follow-up time was 59.8 months. Previously to being diagnosed all patients had suffered infections, most frequently respiratory. After diagnosis all were started on intravenous gammaglobulin replacement treatment and in spite of infections being reduced in severity and frequency, there were cases of severe disease with long term sequelae. At the beginning of our follow-up 35.7% presented impaired respiratory function with only one case being severe. In no cases during this period did the respiratory function worsen, nor were there severe clinical complications. Three patients were switched to subcutaneous immunoglobulin treatment with good tolerance. The number of XLA cases is increasing, as most reach the second decade of life without serious complications and remain free of severe infectious disease and further impairment of their respiratory functions with the treatment.
Subject(s)
Agammaglobulinemia/complications , Agammaglobulinemia/drug therapy , Disease Progression , Genetic Diseases, X-Linked/complications , Genetic Diseases, X-Linked/drug therapy , Immunoglobulins, Intravenous/administration & dosage , gamma-Globulins/administration & dosage , Administration, Cutaneous , Administration, Intravenous , Adult , Follow-Up Studies , Humans , Male , Quality of Life , Respiratory Tract Infections/etiology , Retrospective Studies , Young AdultABSTRACT
La agammaglobulinemia ligada al cromosoma X (XLA) se caracteriza por la ausencia o reducción significativa de linfocitos B, niveles bajos o indetectables de inmunoglobulinas y, clínicamente, por infecciones principalmente respiratorias por bacterias capsuladas extracelulares y diarrea recurrente. El tratamiento de reemplazo con gammaglobulina ha permitido a la mayor parte de los enfermos llegar a adultos con una buena calidad de vida. Analizamos las características clínicas de 14 pacientes mayores de 18 años con diagnóstico de XLA asistidos en nuestra Unidad desde 2003, fecha en que fue derivado el primer paciente, hasta 2015. La edad promedio en el momento de la derivación fue de 20.4 años, en el momento de la última consulta de 25.5. El tiempo promedio de seguimiento fue de 59.8 meses. Previo al diagnóstico todos habían presentado infecciones, las más frecuentes fueron las respiratorias. Posteriormente al diagnóstico todos iniciaron tratamiento de reemplazo con gammaglobulina endovenosa, y a pesar de que las infecciones disminuyeron en frecuencia y gravedad, en este período se presentaron enfermedades con secuelas graves. Al comenzar el seguimiento en nuestra Unidad, 35.7% presentaban deterioro de la función respiratoria, solo grave en un paciente. Durante el seguimiento ninguno presentó deterioro de la función respiratoria ni complicaciones clínicas importantes. Tres pasaron a gammaglobulina subcutánea con buena tolerancia. El número de adultos con XLA es cada vez mayor, la mayoría llegan a la segunda década de la vida sin complicaciones graves y bajo tratamiento se mantienen libres de enfermedades infecciosas graves y de progresión de sus secuelas pulmonares.
X-linked agammaglobulinemia (XLA) is characterized by absent or severely reduced B cells, low or undetectable immunoglobulin levels and clinically by extracellular bacterial infections which mainly compromise the respiratory tract as well as recurrent diarrheas. The mainstay of treatment is gammaglobulin replacement therapy, which allows most patients to reach adulthood with high quality of life. We analyzed the clinical features of 14 patients over 18 years of age with XLA diagnosis that received treatment in our unit from the year 2003, the date the first patient was derived, until 2015. The average age at which patients were referred was 20.4 years old; age at the last consult was 25.5. The average follow-up time was 59.8 months. Previously to being diagnosed all patients had suffered infections, most frequently respiratory. After diagnosis all were started on intravenous gammaglobulin replacement treatment and in spite of infections being reduced in severity and frequency, there were cases of severe disease with long term sequelae. At the beginning of our follow-up 35.7% presented impaired respiratory function with only one case being severe. In no cases during this period did the respiratory function worsen, nor were there severe clinical complications. Three patients were switched to subcutaneous immunoglobulin treatment with good tolerance. The number of XLA cases is increasing, as most reach the second decade of life without serious complications and remain free of severe infectious disease and further impairment of their respiratory functions with the treatment.
Subject(s)
Humans , Male , Adult , Young Adult , Immunoglobulins, Intravenous/administration & dosage , Disease Progression , Agammaglobulinemia/complications , Agammaglobulinemia/drug therapy , Genetic Diseases, X-Linked/complications , Genetic Diseases, X-Linked/drug therapy , Quality of Life , Respiratory Tract Infections/etiology , Administration, Cutaneous , gamma-Globulins/administration & dosage , Retrospective Studies , Follow-Up Studies , Administration, IntravenousABSTRACT
The protective effect of human gamma globulins on Mycobacterium tuberculosis infection was evaluated in a mouse model of intratracheal infection. Animals receiving human gamma globulins intranasally, 2h before intratracheal challenge showed a significant decrease in lung bacilli load compared to non-treated animals in different time intervals of up to 2 months after challenge. The same effect was obtained when M. tuberculosis was pre-incubated with the gamma globulin before challenge. The protective effect of the gamma-globulin formulation was abolished after pre-incubation with M. tuberculosis. These results suggest a potential role of specific antibodies in the defence against mycobacterial infections.
Subject(s)
Immunologic Factors/administration & dosage , Mycobacterium tuberculosis/drug effects , Tuberculosis, Pulmonary/prevention & control , gamma-Globulins/administration & dosage , Administration, Intranasal , Animals , Colony Count, Microbial , Immunologic Factors/immunology , Male , Mice , Mice, Inbred BALB C , Mycobacterium tuberculosis/immunology , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Pulmonary/microbiology , gamma-Globulins/immunologyABSTRACT
La enfermedad de Kawasaki es un proceso vasculítico multisistémico cuya etiología es poco conocida. La presentación clínica es florida y su evolución está condicionada al inicio temprano de la terapia específica con gammaglobulinas, de allí la importancia de un diagnóstico precoz. Habitualmente estos casos cursan con dilatación del lecho arterial coronario siendo excepcional la aparición de alteraciones a nivel de arterias de mayor calibre, menos común aneurismas a nivel cerebral, que confiere un peor pronóstico para estos pacientes. Presentamos el caso de lactante de 3 meses de edad con aneurisma de ambas arterias coronarias, arteria subclavia izquierda, cerebral media derecha y ambas Iliacas, y obstrucción de las mismas.
Kawasaki disease, a multisystem vasculitis of unknown etiology can present in various ways. It is crucial to make an early diagnosis, and consequently give gamma globulin in order to abort its insidious evolution and not infrequently fatal outcome. Aneurysms and obstruction of the coronary arteries are the most characteristic presentations. Other large vessels may be involved, with the cerebral circulation being affected least often but having the worst prognosis. We present a clinical case of a 3 month old breast fed infant with aneurysms and obstructions in both coronary arteries, the left subclavian, right middle cerebral, and both iliac arteries.
Subject(s)
Humans , Female , Infant , Aneurysm/physiopathology , Fever/diagnosis , T-Lymphocytes/immunology , Mucocutaneous Lymph Node Syndrome/pathology , Mucocutaneous Lymph Node Syndrome/therapy , gamma-Globulins/administration & dosage , Nervous System Diseases/etiology , Enzyme-Linked Immunosorbent Assay/methods , Polymerase Chain Reaction/methods , VenezuelaABSTRACT
The present study was aimed at the preparation and performance evaluation of Intacglobin-loaded liposomes for selective drug presentation to the lungs. Egg phosphatidylcholine- and cholesterol-based liposomes (1:1 and 1:0.25 mol/mol) were prepared by a dehydration-rehydration procedure. A tissue distribution study after single intranasal administration of 0.5 microCi 125I-Intacglobin-loaded liposomes was conducted in Balb/c mice. The efficiencies of drug entrapment (30%) and the average diameters did not differ significantly between the two liposome formulations. However, liposomes composed of an increased cholesterol amount showed a lower in vitro drug release rate. The airway penetration efficiency of the liposomal formulation was determined by the cumulative percentage of the dose reaching the lungs (AUC) and its sojourn time therein, and were 1.7- and 2.2-times higher compared with the plain 125I- Intacglobin solution-based formulation, respectively. A significantly greater (p<0.001) drug localization index after 24 h was found at the lungs in comparison with the other tissues (p<0.01), although similar values were detected between groups following administration of either liposomes or control solutions, despite the formulations attributes. In conclusion, it is suggested that longer Intacglobin exposure at the pulmonary region is observed after administration of the liposomal formulation. The results open future perspectives in assessing local passive immunization for the treatment of respiratory infectious diseases.
Subject(s)
gamma-Globulins/administration & dosage , gamma-Globulins/pharmacokinetics , Administration, Intranasal , Animals , Bronchi/drug effects , Bronchi/metabolism , Drug Carriers , Humans , Iodine Radioisotopes , Liposomes , Male , Mice , Mice, Inbred BALB C , Tissue Distribution , Trachea/drug effects , Trachea/metabolismABSTRACT
The effect of the administration of a commercial preparation of human gamma globulins has been evaluated in a mouse model of intranasal infection with BCG. First, we demonstrated the passage of specific antibodies to saliva and lung lavage following the intranasal or intraperitoneal administration to mice of human gamma globulins. This treatment of mice inhibited BCG colonization of the lungs (p < 0.01). A similar inhibitory effect was observed after infection of mice with gamma globulin opsonized BCG organisms (p < 0.01). These results are relevant for the development of new strategies for the control and treatment of tuberculosis.
Subject(s)
Mycobacterium bovis , Tuberculosis/prevention & control , gamma-Globulins/therapeutic use , Administration, Intranasal , Animals , Disease Models, Animal , Enzyme-Linked Immunosorbent Assay/methods , Humans , Infusions, Parenteral , Lung/immunology , Lung/microbiology , Male , Mice , Mice, Inbred BALB C , Mycobacterium bovis/isolation & purification , Phagocytosis , Saliva/immunology , Tuberculosis/immunology , gamma-Globulins/administration & dosage , gamma-Globulins/pharmacokineticsSubject(s)
Immunoglobulins, Intravenous/administration & dosage , Mucocutaneous Lymph Node Syndrome/drug therapy , gamma-Globulins/administration & dosage , Dose-Response Relationship, Drug , Drug Administration Schedule , Early Diagnosis , Humans , Japan , Mucocutaneous Lymph Node Syndrome/diagnosis , Severity of Illness IndexABSTRACT
Common variable immunodeficiency (CVID) is an immunological disorder characterized by defective antibody production, recurrent infections, most notably of the respiratory tract, autoimmune phenomena and cancer. Some CVID patients may also present disturbances of the cellular immune response such as a decrease in the number and proportion of different lymphocyte populations, diminished lymphoproliferative response to mitogens and antigens, altered production of cytokines, and deficient expression of cell-surface molecules. Most Brazilian CVID patients included in this study show a decrease in T and B lymphocyte counts in the peripheral blood. Furthermore, their lymphocytes are more susceptible to apoptosis following activation than normal individuals, and they have a decrease in the expression of activation molecules like CD25, CD69, CD40L and CD70. Moreover, they show a decreased synthesis of IL-4 and IL-5 in comparison with normal individuals. The increase in susceptibility to apoptosis following activation, may also be responsible for the decrease in the expression of activation molecules and CD40L, decrease in Th2 cytokines synthesis, and in the number of T and B circulating cells. In this study we discuss some of these immunological disturbances correlating them to the patients' clinical features and comparing our patients' findings to the literature.
Subject(s)
B-Lymphocytes/immunology , Common Variable Immunodeficiency , Common Variable Immunodeficiency/immunology , T-Lymphocytes/immunology , Common Variable Immunodeficiency/complications , Common Variable Immunodeficiency/therapy , Humans , IgA Deficiency/genetics , IgA Deficiency/immunology , Lymphocyte Activation/genetics , Opportunistic Infections/immunology , Opportunistic Infections/microbiology , gamma-Globulins/administration & dosageSubject(s)
Rh Isoimmunization/prevention & control , Rh-Hr Blood-Group System , Adult , Cohort Studies , Female , Fetomaternal Transfusion , Gestational Age , Humans , Immunoglobulins/administration & dosage , Infant, Newborn , Isoantibodies , Parity , Pregnancy , Rh Isoimmunization/immunology , Rh-Hr Blood-Group System/immunology , Rho(D) Immune Globulin , Risk Factors , gamma-Globulins/administration & dosageSubject(s)
Adult , Female , Humans , Infant, Newborn , Pregnancy , Rh Isoimmunization/prevention & control , Rh-Hr Blood-Group System , Cohort Studies , Fetomaternal Transfusion , Gestational Age , Immunoglobulins/administration & dosage , Isoantibodies , Parity , Rh Isoimmunization/immunology , Rh-Hr Blood-Group System/immunology , Risk Factors , gamma-Globulins/administration & dosageABSTRACT
OBJECTIVE: The aim of this multicenter prospective and randomized study was to determine the effect of adding corticosteroids to intravenous gamma globulin (i.v.GG) therapy on serum cytokine levels, as well as to see its effect on the clinical course in children in the acute phase of Kawasaki disease (KD). STUDY DESIGN: Patients with KD (n=32) were randomized to receive either i.v.GG alone (G group) or i.v.GG plus corticosteroids (G+S group). The clinical course and cytokine responses between groups were compared. RESULTS: The pretreatment serum levels of interleukin (IL)-2, IL-6, IL-8, and IL-10 were significantly higher in patients with KD than in healthy controls. Although i.v.GG alone failed to reduce cytokine concentrations within 24 hours of i.v.GG administration, corticosteroids plus i.v.GG reduced IL-2, IL-6, IL-8, and IL-10 levels. The levels of IL-2, IL-6, IL-8, and IL-10 within 24 hours after initiating i.v.GG therapy were significantly lower in the G+S group than in the G group. The duration of fever was shorter, and the C-reactive protein concentration decreased more quickly in the G+S group than in the G group. CONCLUSIONS: These findings suggest that corticosteroids rapidly ameliorate symptoms by reducing cytokine levels in children with KD.
Subject(s)
Acute-Phase Reaction/drug therapy , Acute-Phase Reaction/etiology , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Cytokines/blood , Cytokines/drug effects , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/drug therapy , Prednisolone/administration & dosage , Prednisolone/therapeutic use , gamma-Globulins/administration & dosage , gamma-Globulins/therapeutic use , Acute-Phase Reaction/blood , Child , Child, Preschool , Drug Therapy, Combination , Female , Humans , Infant , Infusions, Intravenous , Male , Mucocutaneous Lymph Node Syndrome/blood , Outcome Assessment, Health Care , Prospective Studies , Severity of Illness Index , Time FactorsABSTRACT
La enfermedad de Kawasaki (EK) es una importante causa de enfermedad cardiovascular adquirida en niños. La terapia con gammaglobulina endovenosa (IVGG) administrada precozmente disminuiría la incidencia y severidad del compromiso coronario (CC). Objetivo: describir el compromiso cardiovascular (CCV) en nuestro medio mediante un estudio retrospectivo de 60 pacientes que presentaron EK entre enero de 1987 y mayo de 1999. 23 pacientes (38 por ciento) manifestaron CCV. De estos 20 por ciento (n:12) evidenciaron compromiso coronario (5 dilataciones y 7 aneurismas), pericarditis 15 por ciento, miocarditis 11,6 por ciento, alteración valvular 1,6 por ciento, arritmias 3,3 por ciento y un paciente con infarto agudo al miocardio. No hubo fallecidos. 43/60 (71,6 por ciento) se trataron con IVGG, en promedio a los 7,6 días, de estos 25,5 por ciento (n:11) desarrollaron CC, y en 75 por ciento de estos pacientes CC regresó espontáneamente. Conclusiones: se observó un alto porcentaje de CC, pese al tratamiento con IVGG con una evolución relativamente benigna. Se observó como factores de riesgo para el desarrollo de CC la trombocitosis > 700,000/mm al cubo, y CC fue más severo en el sexo masculino. Faltan estudios prospectivos a largo plazo para determinar la real implicancia de la EK en la edad adulta
Subject(s)
Humans , Male , Female , Child, Preschool , Heart Diseases/etiology , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/drug therapy , Aneurysm/etiology , Arrhythmias, Cardiac/etiology , gamma-Globulins/administration & dosage , gamma-Globulins/pharmacology , Heart Diseases/epidemiology , Heart Diseases/prevention & control , Incidence , Myocarditis/etiology , Pericarditis/etiology , Risk FactorsABSTRACT
Se presenta una serie de 5 casos con infecciones invasivas por S. pyogenes observados durante 1999, con el objetivo de ilustrar la diversidad clínica de estas infecciones. Todos los pacientes presentaron bacteremia y tenían condiciones mórbidas asociadas. Tres pacientes presentaron shock, dos de ellos de tipo tóxico y el mismo número de pacientes presentó manifestaciones cutáneas. Dos pacientes tuvieron alteraciones de coagulación. Todos los casos tenían leucocitosis (valor promedio 16800 por mm3) y aumento de la proteína C reactiva (300 mg/L en promedio). Los valores de desviación a izquierda y eritrosedimentación presentaron una amplia variación en sus resultados, observando pacientes con cifras normales. Cuatro pacientes recibieron tratamiento quirúrgico y 3 pacientes gamaglobulina endovenosa. Tres pacientes fallecieron (dos de ellos a las 72 horas). Los pacientes que sobrevivieron tuvieron una hospitalización prolongada que superó el mes de duración. Todos los aislamientos bacterianos portaban el gen que codifica por el superantígeno SpeA