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5.
Int J Immunopathol Pharmacol ; 36: 3946320221131981, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36203358

RESUMO

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may present with some systemic lupus erythematosus (SLE) manifestations intermingled with Kawasaki disease features. These emerging presentations were dubbed under the umbrella term 'multisystem inflammatory syndrome in children (MIS-C)'. A one and half-year-old girl, admitted to Mansoura University Children's Hospital (MUCH) with fever, bad general condition, vomiting, widespread maculopapular, vasculitic rash, hands and feet oedema, oral ulceration, arthralgia and lymphadenopathy. Moreover, bicytopenia, positive antinuclear, anti-double-stranded DNA antibodies and low C3 qualified her as a case of juvenile SLE. Despite the child received the initial therapy of immunosuppressive medication, her general condition deteriorated with fever persistence and rash exacerbation. At that time, the skin of her hands and feet started to peel. Thus, an expanded study for other alternatives was obligatory; SARS-CoV-2 infection testing revealed positive IgG serology, and retesting for lupus autoantibodies turned negative. HRCT chest showed bilateral basal consolidation with ground-glass appearance. Furthermore, Echo exhibited coronary artery dilation with thrombus inside. This evolution raised the concern for COVID-related MIS-C syndrome. This report provides a model of COVID-19 heterogeneity with protean immune-related manifestations. This case has a unique presentation that necessities its description, in order to provide a nidus for future studies in this new entity.


Assuntos
COVID-19 , Exantema , Lúpus Eritematoso Sistêmico , Anticorpos Antivirais , Autoanticorpos , COVID-19/complicações , COVID-19/diagnóstico , Criança , DNA , Exantema/etiologia , Feminino , Febre , Humanos , Imunoglobulina G , Lactente , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
7.
PLoS One ; 17(10): e0276497, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36269747

RESUMO

Skin rash is a well-known predictive marker of the response to cetuximab (Cmab) in metastatic colorectal cancer (mCRC). However, the mechanism of skin rash development is not well understood. Following exposure to EGFR-targeted therapies, changes in IL-8 levels have been reported. The aim of this study was to evaluate the association between skin rash and inflammatory cytokine levels, including IL-8. Between 2014 and 2017, we prospectively enrolled 38 mCRC patients who underwent chemotherapy with either Cmab or bevacizumab (Bmab) at two hospitals. We performed multiplex cytokine ELISA with 20 inflammatory cytokines including E-selectin, GM-CSF, IFN-alpha, IFN-γ, IL-1 alpha, IL-1 beta, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, IP-10, MCP-1, MIP-1 alpha, MIP-1 beta, P-selectin, sICAM-1, and TNF-alpha at baseline before cycle 1, 24 h after cycle 1, before cycle 2 (= 14 d), and before cycle 3 (= 28 d). Cytokine levels were compared using ANOVA after log-transformation. IL-8 genotypes in 30 patients treated with Cmab were determined using the polymerase chain reaction restriction fragment length polymorphism technique. Depending on the RAS mutational status, 30 and eight patients were treated with Cmab and Bmab-based chemotherapy, respectively. Skin rash developed in 23 (76.6%) of the 30 patients treated with Cmab plus FOLFIRI, after cycle 1. Only the mean log-transformed serum IL-8 level in patients with skin toxicity was statistically lower (2.83 ± 0.15) than in patients who did not experience skin toxicity (3.65 ± 0.27) and received Bmab (3.10 ± 0.26) (ANOVA test, p value = 0.0341). In addition, IL-8 polymorphism did not affect IL-8 levels, skin toxicity, or tumor response in Cmab treated patients. This study suggests that the inflammatory cytokine levels might be affected by Cmab exposure and are associated with the development of skin rash in mCRC patients. Further studies are warranted to evaluate this interaction in Cmab treated patients.


Assuntos
Cetuximab , Neoplasias Colorretais , Exantema , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/uso terapêutico , Cetuximab/efeitos adversos , Quimiocina CXCL10 , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Selectina E , Receptores ErbB/efeitos dos fármacos , Receptores ErbB/metabolismo , Exantema/etiologia , Exantema/imunologia , Fator Estimulador de Colônias de Granulócitos e Macrófagos/uso terapêutico , Interleucina-10 , Interleucina-13 , Interleucina-17 , Interleucina-1alfa , Interleucina-1beta , Interleucina-4 , Interleucina-6 , Interleucina-8 , Selectina-P , Fator de Necrose Tumoral alfa/uso terapêutico
8.
Pediatrics ; 150(5)2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36305212

RESUMO

An 11-year-old, previously healthy boy presented to the emergency center (EC) for acute respiratory distress in the setting of 5 months of recurrent and worsening rash with progressive fatigue, shortness of breath, chest pain, and cough. At the onset of his rash, he and his younger brothers were diagnosed with roseola. Although his brothers' symptoms resolved, the patient's rash recurred, prompting his primary care provider to prescribe amoxicillin. The rash subsequently worsened, so amoxicillin was stopped; a prednisone course was prescribed which alleviated the rash. Upon completion of the prednisone course, the rash returned more diffusely with associated symptoms of shortness of breath, chest pain, and cough. Because of these symptoms, his mother brought him to the EC, where his vitals were notable for tachypnea and tachycardia. His initial EC imaging workup was remarkable for an echocardiogram with a mild to moderate circumferential pericardial effusion, chest x-ray (CXR) with a large right pleural effusion, and chest computerized tomography significant for prominent and diffuse mediastinal and hilar lymphadenopathy with numerous enlarged axillary lymph nodes. Laboratory results were notable for elevated liver enzymes, inflammatory markers, d-dimer, and brain natriuretic peptide. Differential diagnosis remained broad, including infectious, oncologic, and rheumatologic etiologies. Our panel of experts reviews the evaluation, hospital course, and treatment of this patient presenting with an unusual rash and serositis.


Assuntos
Exantema , Derrame Pleural , Humanos , Masculino , Criança , Tosse , Prednisona , Exantema/etiologia , Dor no Peito/etiologia , Dispneia , Amoxicilina
9.
BMJ ; 379: e070996, 2022 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-36202423
11.
Adv Emerg Nurs J ; 44(4): 285-291, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36269810

RESUMO

The differential diagnosis of rashes in children is challenging. Pediatric rashes indicate a broad spectrum of clinical conditions and include those that are benign and self-limiting to those that may indicate a serious multisystem inflammatory response. It is essential that emergency nurse practitioners have the knowledge and skill set to accurately identify the spectrum of rashes in the pediatric population to arrive at the correct diagnosis for patient management and avoid costly and unnecessary diagnostic testing. The purpose of this article is to describe a case report of a young child with urticaria multiforme, a commonly misdiagnosed clinical condition, including the distinctive clinical features, differential diagnosis, and most current treatment recommendations. Other clinical conditions that present with skin lesions resembling urticaria multiforme conditions have also been discussed.


Assuntos
Exantema , Profissionais de Enfermagem , Dermatopatias , Urticária , Criança , Humanos , Exantema/diagnóstico , Exantema/etiologia , Urticária/diagnóstico , Urticária/patologia , Diagnóstico Diferencial
14.
PLoS Negl Trop Dis ; 16(10): e0010727, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36228027

RESUMO

BACKGROUND: In the clinical course of diseases such as arboviruses, skin rashes may appear, as is often seen in other infectious diseases. The aim of this study was to estimate the prevalence of arboviruses and other infectious causes of skin rash in a tertiary health unit in Manaus, Amazonas state, Western Brazilian Amazon. METHODOLOGY/PRINCIPAL FINDINGS: This was a cross-sectional study of patients presenting with rash who sought care at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) from February 2018 to May 2019. Individuals of either gender, aged over 18 years, were invited to participate voluntarily. Infection by Zika virus (ZIKV), dengue virus (DENV), chikungunya virus (CHIKV), Mayaro virus (MAYV), Oropouche virus (OROV) and measles was evaluated using RT-qPCR (real-time polymerase chain reaction). Immunodiagnostic tests for EBV, CMV, HIV, syphilis, rubella and measles were also performed. A total of 340 participants were included, most were female (228, 67.1%) with an average age of 36.5 years (SD ± 12.2 years). The highest prevalence was of ZIKV monoinfections (65.3%, 222/340), followed by DENV (0.9%, 3/340) and CHIKV infection (0.3%, 1/340). No cases of MAYV, OROV or rubella were found. Other causes of skin rash were detected: measles (2.9%, 10/340), parvovirus B19 (0.9% 3/340), HIV (0.3%, 1/340) and syphilis 0.6% (2/340). The co-infections identified were ZIKV+HIV (0.3%, 1/340), ZIKV+measles (0.3%, 1/340), ZIKV+parvovirus B19 (0.3%, 1/340), ZIKV+EBV (0.3%, 1/340), EBV+parvovirus B19 (0.3%, 1/340), CMV+parvovirus B19 (0.6%, 2/340), CMV+syphilis (0.3%, 1/340), ZIKV+EBV+parvovirus B19 (0.3%, 1/340) and CMV+EBV+parvovirus B19 (0.9%, 3/340). Approximately one quarter of patients had no defined cause for their skin rash (25.3%, 86/340). CONCLUSIONS: Despite the benign clinical evolution of most of the diseases diagnosed in this series of cases, syndromic surveillance of diseases such as syphilis and HIV are of utmost importance. Periodic serosurveillance might also aid in evaluating the trends of endemic diseases and eventual outbreaks.


Assuntos
Arbovírus , Febre de Chikungunya , Infecções por Citomegalovirus , Dengue , Exantema , Infecções por HIV , Sarampo , Rubéola (Sarampo Alemão) , Sífilis , Infecção por Zika virus , Zika virus , Adulto , Brasil/epidemiologia , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Estudos Transversais , Dengue/diagnóstico , Dengue/epidemiologia , Exantema/epidemiologia , Exantema/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Infecção por Zika virus/complicações , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologia
16.
Am Fam Physician ; 106(4): 455-466, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36260907
17.
BMJ Glob Health ; 7(9)2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36162867

RESUMO

INTRODUCTION: As new vaccines are developed more vaccine coadministrations vaccines are being offered to make delivery more practical for health systems and patients. We compared the safety of coadministered vaccines with separate vaccination for 20 coadministrations by considering nine types of adverse events following immunisation (AEFI). METHODS: Real-life immunisation and adverse event data for this observational cohort study were extracted from the Oxford-Royal College of General Practitioners Research and Surveillance Centre for children registered in the database between 2008 and 2018. We applied the self-controlled case series method to calculate relative incidence ratios (RIR) for AEFI. These RIRs compare the RI of AEFI following coadministration with the RI following separate administration of the same vaccines. RESULTS: We assessed 3 518 047 adverse events and included 5 993 290 vaccine doses given to 958 591 children. 17% of AEFI occurred less and 11% more frequently following coadministration than would have been expected based on the RIs following separate vaccinations, while there was no significant difference for 72% of AEFI. We found amplifying interaction effects for AEFI after five coadministrations comprising three vaccines: for fever (RIR 1.93 (95% CI 1.63 to 2.29)), rash (RIR 1.49 (95% CI 1.29 to 1.74)), gastrointestinal events (RIR 1.31 (95% CI 1.14 to 1.49)) and respiratory events (RIR 1.27 (1.17-1.38)) following DTaP/IPV/Hib+MenC+ PCV; gastrointestinal events (RIR 1.65 (95% CI 1.35 to 2.02)) following DTaP/IPV/Hib+MenC+ RV; fever (RIR 1.44 (95% CI 1.09 to 1.90)) and respiratory events (RIR 1.40 (95% CI 1.25 to 1.57)) following DTaP/IPV/Hib+PCV+ RV; gastrointestinal (RIR 1.48 (95% CI 1.20 to 1.82)) and respiratory events (RIR 1.43 (95% CI 1.26 to 1.63)) following MMR+Hib/MenC+PCV; gastrointestinal events (RIR 1.68 (95% CI 1.07 to 2.64)) and general symptoms (RIR 11.83 (95% CI 1.28 to 109.01)) following MMR+MenC+PCV. Coadministration of MMR+PCV led to more fever (RIR 1.91 (95% CI 1.83 to 1.99)), neurological events (RIR 2.04 (95% CI 1.67 to 2.49)) and rash (RIR 1.06 (95% CI 1.01 to 1.11)) compared with separate administration, DTaP/IPV/Hib+MMR to more musculoskeletal events (RIR 3.56 (95% CI 1.21 to 10.50)) and MMR+MenC to more fever (RIR 1.58 (95% CI 1.37 to 1.82)). There was no indication that unscheduled coadministrations are less safe than scheduled coadministrations. CONCLUSION: Real-life RIRs of AEFI justify coadministering routine childhood vaccines according to the immunisation schedule. Further research into the severity of AEFI following coadministration is required for a complete understanding of the burden of these AEFI.


Assuntos
Exantema , Vacinação , Criança , Estudos de Coortes , Exantema/etiologia , Humanos , Imunização/efeitos adversos , Esquemas de Imunização , Vacinação/efeitos adversos
18.
Aust J Gen Pract ; 51(9): 684-686, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36045625
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