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2.
Wiad Lek ; 73(9 cz. 2): 1968-1972, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148842

RESUMO

OBJECTIVE: The aim: Is to increase effectiveness and assess safety of the antiviral therapy in complex treatment of patients with psoriasis with activated chronic herpes virus infection of types 1 and 2. PATIENTS AND METHODS: Matherials and methods: 120 patients and 25 practically healthy persons were examined. RESULTS: Results: It has been studied an effect of antiviral therapy on the background of basic therapy in patients with P+HSV 1,2: the percentage of HSV 1,2 DNA detection after the use of acyclovir and/or inosine pranobex was decreased in saliva from 22.0±3.43 % to 6.7±1.32 % (р<0.01) and in epithelium - from 33.3±4.23 % to 6.7±1.8 % (р<0.01); The use of antiviral therapy has showed a decrease in the expression of miR 155 molecules from 126.3 ±10.5 U/6 to 62.4±5.48 U/6 (р<0.05), an increase in the number of T-regulatory lymphocytes from 6.8±1.25% to 9.1±1.41% (p=0.0503); a decrease of IFN-α level in saliva from10.1±1.84 ng/ml to 8.2±1.27 ng/ml (р1=0.0398); in the serum IL-23 level was significantly decreased from14.9±2.11 pg/ml to 8.8±2.03 pg/ml (р<0.05) and TGF-ß synthesis was increased from 3.9±1.23 pg/ml to 9.3±2.21 pg/ml (р<0.01). CONCLUSION: Conclusions: An improved method of treatment and evaluation of its clinical and immunological effectiveness based on an integral criterion was suggested as a result of conducted antiviral therapy amid basic therapy in patients with psoriasis with activated HSV-1 and HSV-2.


Assuntos
Antivirais , Herpesvirus Humano 1 , Psoríase , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Herpesvirus Humano 2 , Humanos , Psoríase/complicações , Psoríase/tratamento farmacológico
3.
Georgian Med News ; (304-305): 56-61, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965250

RESUMO

It was found on the base on the study of clinical and immunological parameters of 47 patients with HIV-associated herpes infections (recurrent labial herpes and/or aphthous stomatitis, genital herpes and shingles) that supplement of the basic therapy (valaciclovir 1.0 g daily intake orally 2 times a day for 7-10 days) 6 subcutaneous injections of the drug "Allokin-alpha" in dose 1 mg in a day enables significantly shorten the duration of clinical manifestations of herpes infections, reduce the frequency of relapses and also the duration of the first relapse after treatment. The immunoregulatory effect alokin-alpha used in the treatment of patients with HIV co-infection herpes is installed. Thus, the combination therapy provided a further reduce of CD4+-lymphocytes number at II clinical stage of HIV infection. The concentration of interleukin-8 (IL-8) decreased at I and II stages of immunodeficiency, that statistically weighty different from the values before treatment (P<0,05-0,02). Similarly, the level of IL-10 (P<0.05) decreased. It is important that the impact of treatment on immune parameters match the clinical effect.


Assuntos
Antivirais/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Aciclovir/uso terapêutico , Humanos , Valaciclovir , Valina
4.
BMC Infect Dis ; 20(1): 605, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32807089

RESUMO

BACKGROUND: Herpetic esophagitis (EH) usually affects those who are immunocompromised and is uncommon in immunocompetent patients. In these cases, EH may occasionally present as an acute and self-limited illness. Such cases are rare and only a few have beenreported and limited published reviews exist making the benefits of antiviral therapy in immunocompetent patients unknown. CASE PRESENTATION: We report four cases of young patients who presented dysphagia, odynophagia and epigastric pain. Endoscopic findings revealed lesions in the distal esophagus and histopathological changes compatible with herpes virus infection confirmed by viral DNA in every case. After treatment, every patient showed significant improvement and tolerated oral intake after discharge. CONCLUSIONS: In this publication, we present four immunocompetent patients with EH, without relevant alterations in laboratory workup and with negative HIV status. This disease is infrequent in patients with such characteristics and there are few cases published. In order to better understand this pathology, we present the symptoms, the endoscopic alterations and the clinical evolution with treatment. In our series, 50% of patients had serology compatible with acute HVS type 1 infection, 25% had a subacute infection pattern (IgM and IgG positive antibodies) and in another 25% of patients, serology was not done. No patient presented leukocyte alterations, while all patients presented with anatomopathological findings compatible with acute herpetic esophagitis and responded to acyclovir therapy.


Assuntos
Esofagite/diagnóstico , Herpes Simples/diagnóstico , Aciclovir/uso terapêutico , Adolescente , Antivirais/uso terapêutico , Endoscopia do Sistema Digestório , Esofagite/tratamento farmacológico , Esofagite/patologia , Esôfago/patologia , Feminino , Herpes Simples/tratamento farmacológico , Herpes Simples/virologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Simplexvirus/isolamento & purificação , Adulto Jovem
6.
PLoS One ; 15(8): e0237189, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760124

RESUMO

Herpes simplex virus 1 (HSV) is a ubiquitous human virus resident in a majority of the global population as a latent infection. Acyclovir (ACV), is the standard of care drug used to treat primary and recurrent infections, supplemented in some patients with intravenous immunoglobulin (IVIG) treatment to suppress infection and deleterious inflammatory responses. As many diverse medications have recently been shown to change composition of the gut microbiome, we used Illumina 16S rRNA gene sequencing to determine the effects of ACV and IVIG on the gut bacterial community. We found that HSV, ACV and IVIG can all independently disrupt the gut bacterial community in a sex biased manner when given to uninfected C57BL/6 mice. Treatment of HSV infected mice with ACV or IVIG alone or together revealed complex interactions between these drugs and infection that caused pronounced sex biased dysbiosis. ACV reduced Bacteroidetes levels in male but not female mice, while levels of the Anti-inflammatory Clostridia (AIC) were reduced in female but not male mice, which is significant as these taxa are associated with protection against the development of graft versus host disease (GVHD) in hematopoietic stem cell transplant (HSCT) patients. Gut barrier dysfunction is associated with GVHD in HSCT patients and ACV also decreased Akkermansia muciniphila, which is important for maintaining gut barrier functionality. Cumulatively, our data suggest that long-term prophylactic ACV treatment of HSCT patients may contribute to GVHD and also potentially impact immune reconstitution. These data have important implications for other clinical settings, including HSV eye disease and genital infections, where ACV is given long-term.


Assuntos
Aciclovir/efeitos adversos , Antivirais/efeitos adversos , Disbiose/etiologia , Herpes Simples/microbiologia , Imunoglobulinas Intravenosas/efeitos adversos , Aciclovir/uso terapêutico , Animais , Antivirais/uso terapêutico , Bacteroidetes/patogenicidade , Clostridium/patogenicidade , Disbiose/microbiologia , Feminino , Microbioma Gastrointestinal , Herpes Simples/tratamento farmacológico , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fatores Sexuais
7.
Medicine (Baltimore) ; 99(24): e20394, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541459

RESUMO

INTRODUCTION: Hyaluronic acid injections is relatively safe with little risk of complications. Although herpes reactivation after the injection of hyaluronic acid is rare, it produces quite a huge pressure and panic on patients. Quite a lot cosmetic practitioners have no awareness of preventing, diagnosing, and giving correct treatment in time due to lack of experience. PATIENT CONCERNS: A 24-year-old woman presented with erythema, crusted papules, pain and swelling on the nose after receiving the injection of hyaluronic acid. A swab of the discharge fluid was obtained for bacterial and viral culture, showing positive for herpes simplex virus. DIAGNOSIS: The patient was diagnosed as herpes reactivation after the injection of hyaluronic acid. INTERVENTIONS: The patient underwent antiviral therapy with acyclovir 400 mg, 3 times daily for seven days. OUTCOMES: After a week of antiviral treatment, the clinical signs improved. CONCLUSION: Herpes reactivation after the injection of hyaluronic acid is quite rare but needed sufficient attention of cosmetic practitioners to make the proper diagnosis, prevention and treatment.


Assuntos
Preenchedores Dérmicos/efeitos adversos , Herpes Simples/induzido quimicamente , Ácido Hialurônico/efeitos adversos , Nariz/virologia , Simplexvirus/isolamento & purificação , Aciclovir/administração & dosagem , Aciclovir/uso terapêutico , Administração Oral , Adulto , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Preenchedores Dérmicos/administração & dosagem , Feminino , Herpes Simples/patologia , Herpes Simples/prevenção & controle , Humanos , Ácido Hialurônico/administração & dosagem , Nariz/patologia , Resultado do Tratamento , Adulto Jovem
8.
BMC Infect Dis ; 20(1): 435, 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571239

RESUMO

BACKGROUND: The aseptic meningitis caused by varicella zoster virus (VZV) reactivation was less described in the literature, most of which were detected by means of polymerase chain reaction. The authors presented 4 adult immunocompetent patients with acute aseptic meningitis with VZV infection diagnosed by next-generation sequencing (NGS). CASE PRESENTATION: Four patients were admitted to the hospital with headache and fever between March 2018 and August 2019. The median ages were 37 years (range 22-52 years). The median symptoms onset to clinic time was 3.5 days (range 3-6 days). Two patients had signs of meningeal irritation. Rash occurred after the meningitis symptoms in 1 patient (time from meningitis symptoms to rash, 2 days). No other sign or symptom was reported. The brain Magnetic resonance imaging and electroencephalography were normal in all patients. Cerebrospinal fluid (CSF) samples were obtained at a median of 4 days (range 3-7 days) from the meningitis symptoms onset. Opening pressure of lumbar puncture after admission were high in these cases (median 256 mm H2O; range 165-400 mm H2O). White blood cell counts and protein levels were significantly elevated in CSF samples (median 317 × 10^6/L, range 147-478 × 10^6/L; median 1.41 g/L, range 0.57-1.79 g/L). The cytology of CSF demonstrated a lymphocytic pleocytosis, and most multinuclear cells. The culture of CSF was negative for all 4 cases, while T-cell spot test was positive for 2 cases, who were administrated with anti-tuberculosis treatment for suspicious tuberculous meningitis. NGS of CSF (the Vision Medical Research Institute) detected specific sequences of VZV in the 4 cases within 72 h after admission. The inappropriate treatment were stopped while acyclovir were continued intravenously for 10-14 days. All patients recovered completely. CONCLUSIONS: VZV is an infectious agent that causes aseptic meningitis in immunocompetent adults and could not be accompanied by skin manifestations. The NGS of CSF is a rapid detection for the identification and differentiation of meningitis in patients, which is of great importance for providing the rapid and accurate diagnosis and the targeted antimicrobial therapy for central nervous system infection.


Assuntos
Líquido Cefalorraquidiano/virologia , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Meningite Asséptica/etiologia , Meningite Viral/etiologia , Infecção pelo Vírus da Varicela-Zoster/complicações , Aciclovir/uso terapêutico , Adulto , Antivirais/uso terapêutico , Líquido Cefalorraquidiano/citologia , Exantema/etiologia , Exantema/virologia , Herpesvirus Humano 3/genética , Humanos , Imagem por Ressonância Magnética , Masculino , Meningite Asséptica/diagnóstico , Meningite Asséptica/tratamento farmacológico , Meningite Viral/diagnóstico por imagem , Pessoa de Meia-Idade , Infecção pelo Vírus da Varicela-Zoster/diagnóstico por imagem , Infecção pelo Vírus da Varicela-Zoster/tratamento farmacológico , Adulto Jovem
9.
Rinsho Shinkeigaku ; 60(7): 461-465, 2020 Jul 31.
Artigo em Japonês | MEDLINE | ID: mdl-32536661

RESUMO

In January 2008, a 59-year-old man with a history of diabetes mellitus was admitted to our hospital with herpes simplex virus (HSV) encephalitis of his right temporal lobe, which was diagnosed by PCR testing of his cerebrospinal fluid (CSF). He was treated with intravenous acyclovir for three weeks and made a full recovery. On discharge, his CSF was negative for HSV on PCR testing. Seven years later, in March 2015, the man was readmitted to our hospital with fever, disorientation, and nominal dysphasia. Diffusion-weighted MRI of his head revealed a high-intensity area in his left temporal lobe. Testing of his CSF revealed a moderately increased monocyte count and HSV on PCR testing, so he was diagnosed with recurrent HSV encephalitis. He was treated with intravenous acyclovir for three weeks. On discharge, his CSF was negative for HSV on PCR testing, but he had mild residual amnesia. There have been few reports of HSV encephalitis with viral reactivation recurring after a long remission period in adults. This case illustrates the need for prolonged follow up of individuals with HSV encephalitis in order to detect recurrences.


Assuntos
Aciclovir/uso terapêutico , Encefalite por Herpes Simples/diagnóstico , Encefalite por Herpes Simples/tratamento farmacológico , Idoso , Líquido Cefalorraquidiano/virologia , Encefalite por Herpes Simples/virologia , Humanos , Masculino , Reação em Cadeia da Polimerase , Recidiva , Simplexvirus/isolamento & purificação , Fatores de Tempo , Resultado do Tratamento
11.
Neurology ; 95(10): 445-449, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32586897

RESUMO

Here, we report a case of COVID-19-related acute necrotizing encephalopathy where SARS-CoV-2 RNA was found in CSF 19 days after symptom onset after testing negative twice. Although monocytes and protein levels in CSF were only marginally increased, and our patient never experienced a hyperinflammatory state, her neurologic function deteriorated into coma. MRI of the brain showed pathologic signal symmetrically in central thalami, subinsular regions, medial temporal lobes, and brain stem. Extremely high concentrations of the neuronal injury markers neurofilament light and tau, as well as an astrocytic activation marker, glial fibrillary acidic protein, were measured in CSF. Neuronal rescue proteins and other pathways were elevated in the in-depth proteomics analysis. The patient received IV immunoglobulins and plasma exchange. Her neurologic status improved, and she was extubated 4 weeks after symptom onset. This case report highlights the neurotropism of SARS-CoV-2 in selected patients and emphasizes the importance of repeated lumbar punctures and CSF analyses in patients with suspected COVID-19 and neurologic symptoms.


Assuntos
Encéfalo/diagnóstico por imagem , Infecções por Coronavirus/líquido cefalorraquidiano , Leucoencefalite Hemorrágica Aguda/líquido cefalorraquidiano , Pneumonia Viral/líquido cefalorraquidiano , RNA Viral/líquido cefalorraquidiano , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Proteína Glial Fibrilar Ácida/líquido cefalorraquidiano , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Interleucina-6/líquido cefalorraquidiano , Leucoencefalite Hemorrágica Aguda/diagnóstico por imagem , Leucoencefalite Hemorrágica Aguda/fisiopatologia , Leucoencefalite Hemorrágica Aguda/terapia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Proteínas de Neurofilamentos/líquido cefalorraquidiano , Pandemias , Troca Plasmática , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Reação em Cadeia da Polimerase em Tempo Real , Tomografia Computadorizada por Raios X , Tropismo Viral , Proteínas tau/líquido cefalorraquidiano
12.
J Recept Signal Transduct Res ; 40(6): 605-612, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32476594

RESUMO

Recently, a pathogen has been identified as a novel coronavirus (SARS-CoV-2) and found to trigger novel pneumonia (COVID-19) in human beings and some other mammals. The uncontrolled release of cytokines is seen from the primary stages of symptoms to last acute respiratory distress syndrome (ARDS). Thus, it is necessary to find out safe and effective drugs against this deadly coronavirus as soon as possible. Here, we downloaded the three-dimensional model of NSP10/NSP16 methyltransferase (PDB-ID: 6w6l) and main protease (PDB-ID: 6lu7) of COVID-19. Using these molecular models, we performed virtual screening with our anti-viral, inti-infectious, and anti-protease compounds, which are attractive therapeutics to prevent infection of the COVID-19. We found that top screened compound binds with protein molecules with good dock score with the help of hydrophobic interactions and hydrogen bonding. We observed that protease complexed with Cyclocytidine hydrochloride (anti-viral and anti-cancer), Trifluridine (anti-viral), Adonitol, and Meropenem (anti-bacterial), and Penciclovir (anti-viral) bound with a good docking score ranging from -6.8 to -5.1 (Kcal/mol). Further, NSP10/NSP16 methyltransferase complexed with Telbivudine, Oxytetracycline dihydrate (anti-viral), Methylgallate (anti-malarial), 2-deoxyglucose and Daphnetin (anti-cancer) from the docking score of -7.0 to -5.7 (Kcal/mol). In conclusion, the selected compounds may be used as a novel therapeutic agent to combat this deadly pandemic disease, SARS-CoV-2 infection, but needs further experimental research.HighlightsNSP10/NSP16 methyltransferase and main protease complex of SARS CoV-2 bind with selected drugs.NSP10/NSP16 methyltransferase and protease interacted with drugs by hydrophobic interactions.Compounds show good DG binging free energy with protein complexes.Ligands were found to follow the Lipinski rule of five.


Assuntos
Antivirais/química , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Proteínas não Estruturais Virais/química , Proteínas Virais Reguladoras e Acessórias/química , Aciclovir/análogos & derivados , Aciclovir/química , Aciclovir/uso terapêutico , Ancitabina/química , Ancitabina/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/patogenicidade , Infecções por Coronavirus/virologia , Avaliação Pré-Clínica de Medicamentos , Humanos , Meropeném/química , Meropeném/uso terapêutico , Modelos Moleculares , Simulação de Acoplamento Molecular , Pandemias , Pneumonia Viral/virologia , Conformação Proteica/efeitos dos fármacos , Ribitol/química , Ribitol/uso terapêutico , Trifluridina/química , Trifluridina/uso terapêutico , Interface Usuário-Computador , Proteínas não Estruturais Virais/antagonistas & inibidores , Proteínas não Estruturais Virais/ultraestrutura , Proteínas Virais Reguladoras e Acessórias/antagonistas & inibidores , Proteínas Virais Reguladoras e Acessórias/ultraestrutura
14.
BMC Infect Dis ; 20(1): 232, 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32188404

RESUMO

BACKGROUND: The most common infection in patients positive for anti-interferon-gamma autoantibodies (anti-IFN-γ AAbs) is disseminated nontuberculous mycobacterial (dNTM) infection. Here, we report a rare case of triple infection caused by Cryptococcus, varicella-zoster virus (VZV), and nontuberculous mycobacterium in a patient with anti-IFN-γ AAbs. CASE PRESENTATION: A 53-year-old Thai man presented with a progressively enlarging right cervical mass with low-grade fever and significant weight loss for 4 months. He also developed a lesion at his left index finger. A biopsy of that lesion showed granulomatous inflammation with yeast-like organisms morphologically consistent with cryptococcosis. Serum cryptococcal antigen was positive. Histopathology of a right cervical lymph node revealed chronic granulomatous lymphadenitis, and the lymph node culture grew Mycobacterium abscessus. One month later, he complained of vision loss in his left eye and subsequently developed a group of painful vesicles at the right popliteal area of S1 dermatome. Lumbar puncture was performed and his cerebrospinal fluid was positive for VZV DNA. His blood test for anti-HIV antibody was negative. Anti-IFN-γ AAbs was positive, but test for anti-granulocyte-macrophage colony-stimulating factor autoantibodies (anti-GM-CSF AAbs) was negative. He was treated with amphotericin B plus fluconazole for cryptococcosis; a combination of amikacin, imipenem, azithromycin, and levofloxacin for dNTM infection; and, intravenous acyclovir for disseminated VZV infection. After treatment, our patient's fever and cervical lymphadenopathy were subsided, and his vision and visual acuity were both improved. CONCLUSIONS: This is the first case of triple infection with cryptococcosis, VZV, and dNTM in a patient who tested positive for anti-IFN-γ AAbs and negative for anti-GM-CSF AAbs. This case will increase awareness and heighten suspicion of these infections in patients with the described presentations and clinical characteristics, and this will accelerate diagnosis and treatment.


Assuntos
Criptococose/tratamento farmacológico , Síndromes de Imunodeficiência/complicações , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Aciclovir/uso terapêutico , Anfotericina B/uso terapêutico , Autoanticorpos , Coinfecção , Criptococose/microbiologia , Fluconazol/uso terapêutico , Herpesvirus Humano 3/imunologia , Humanos , Interferon gama/imunologia , Linfadenopatia , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium abscessus , Infecção pelo Vírus da Varicela-Zoster/tratamento farmacológico
15.
Medicine (Baltimore) ; 99(12): e19500, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195950

RESUMO

BACKGROUND: Lesions of herpes labialis are caused by the herpes simplex virus type 1 and cause pain and aesthetic compromise. It is characterized by the formation of small vesicles that coalesce and rupture forming extremely painful ulcers, that evolve to crusts, dry desquamations until their complete remission. Currently the treatment of these lesions is done with acyclovir. Although it diminishes the symptomatology, it causes viral resistance and does not prevent the recurrence of the lesions. It is known that antimicrobial photodynamic therapy (aPDT) has numerous advantages, among them: the reduction of the time of remission, and does not cause resistance. This protocol will determine the effectiveness of PDT in lesions of herpes labialis. MATERIALS AND METHODS: A total of 30 patients with herpes labialis in the prodromal stage of vesicles, ulcers, and crusts will be selected to participate in the study and randomized into 2 groups: G1 control and G2 experimental. After signing Research Ethics Committee and TA, patients in group G1 will undergo the standard gold treatment for herpes labialis with acyclovir and simulated PDT treatment. Patients in the experimental G2 group will be treated simulating the gold standard treatment of herpes labialis (placebo) and PDT. In all patients, saliva samples will be collected for analysis of cytokines, and will be performed exfoliative cytology in the lesions. The pain will be assessed through a pain scale and a questionnaire of quality of life related to oral health (OHIP-14) will be given to them. Patients will continue to be followed up after 7 days, 1 month, 3 months, and 6 months; if there is a recurrence of the lesion, they will contact the researchers.Clinical registration: clinicaltrials.gov - NCT04037475. Registered on July 2019.


Assuntos
Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Herpes Labial/terapia , Fotoquimioterapia/métodos , Aciclovir/efeitos adversos , Adulto , Antivirais/efeitos adversos , Feminino , Herpes Labial/patologia , Herpes Labial/virologia , Herpesvirus Humano 1/isolamento & purificação , Herpesvirus Humano 1/efeitos da radiação , Humanos , Masculino , Dor/etiologia , Estudos Prospectivos , Qualidade de Vida , Recidiva , Úlcera/patologia , Escala Visual Analógica , Adulto Jovem
16.
Stroke ; 51(5): 1596-1599, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32212896

RESUMO

Background and Purpose- Focal cerebral arteriopathy is monophasic inflammatory stenosis of the distal internal carotid artery or the proximal segment of the middle cerebral artery. It is one of the most common causes of acute arterial ischemic stroke in young children but is a less familiar entity for adult neurologists. Methods- We retrospectively reviewed stroke service radiology records at a tertiary referral center from January 2013 to December 2014. Focal cerebral arteriopathy was defined as nonprogressive unifocal and unilateral stenosis/irregularity of the distal internal carotid artery or its proximal branches. Only patients aged 16 to 55 years with stroke were included. Results- There were 5 cases of focal cerebral arteriopathy: 2 males and 3 females. Three cases were from the cohort of 123 acute presentations of young stroke, and 2 cases were outpatient referrals. The mean age (range) was 43 (32-55) years. The majority presented with recurrent transient ischemic attacks/minor strokes within a single vascular territory over days to weeks. All cases had characteristic radiological features. Interval imaging demonstrated resolution in 1 case and improvement in 3 cases. Functional outcome was excellent with discharge modified Rankin Scale score ranging from 0 to 1. Recurrence occurred in 1 case. Conclusions- Focal cerebral arteriopathy is a rare cause of arterial ischemic stroke in young adults. Follow-up intracranial imaging is essential to differentiate from progressive arteriopathies. Evidence-based treatment warrants further investigation. Prognosis is favorable.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Doenças Arteriais Cerebrais/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Aciclovir/uso terapêutico , Adulto , Anticorpos Antivirais/imunologia , Antivirais/uso terapêutico , Aspirina/uso terapêutico , Estenose das Carótidas/complicações , Estenose das Carótidas/tratamento farmacológico , Estenose das Carótidas/imunologia , Angiografia Cerebral , Doenças Arteriais Cerebrais/complicações , Doenças Arteriais Cerebrais/tratamento farmacológico , Doenças Arteriais Cerebrais/imunologia , Angiografia por Tomografia Computadorizada , Terapia Antiplaquetária Dupla , Feminino , Glucocorticoides/uso terapêutico , Herpesvirus Humano 3/imunologia , Humanos , Imunoglobulina G , Imunoglobulina M , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Recidiva , Estudos Retrospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia
19.
J Pediatr ; 219: 126-132.e2, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32037154

RESUMO

OBJECTIVE: To describe the epidemiology of and risk factors associated with acute kidney injury (AKI) during acyclovir treatment in neonates and infants. STUDY DESIGN: We conducted a multicenter (n = 4), retrospective cohort study of all hospitalized infants age <60 days treated with intravenous acyclovir (≥1 dose) for suspected or confirmed neonatal herpes simplex virus disease from January 2011 to December 2015. Infants with serum creatinine measured both before acyclovir (baseline) and during treatment were included. We classified AKI based on changes in creatinine according to published neonatal AKI criteria and performed Cox regression analysis to evaluate risk factors for AKI during acyclovir treatment. RESULTS: We included 1017 infants. The majority received short courses of acyclovir (median, 5 doses). Fifty-seven infants (5.6%) developed AKI during acyclovir treatment, with an incidence rate of AKI at 11.6 per 1000 acyclovir days. Cox regression analysis identified having confirmed herpes simplex virus disease (OR, 4.35; P = .002), receipt of ≥2 concomitant nephrotoxic medications (OR, 3.07; P = .004), receipt of mechanical ventilation (OR, 5.97; P = .001), and admission to an intensive care unit (OR, 6.02; P = .006) as risk factors for AKI during acyclovir treatment. CONCLUSIONS: Among our cohort of infants exposed to acyclovir, the rate of AKI was low. Sicker infants and those exposed to additional nephrotoxic medications seem to be at greater risk for acyclovir-induced toxicity and warrant closer monitoring.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/epidemiologia , Aciclovir/efeitos adversos , Herpes Simples/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Aciclovir/administração & dosagem , Aciclovir/uso terapêutico , Administração Intravenosa , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco
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