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2.
Nervenarzt ; 90(10): 1055-1066, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31538208

RESUMO

Myasthenia gravis (MG) is an autoimmune disorder caused by antibodies against acetylcholine receptors (AChR) or other structural proteins of the neuromuscular junction. This diminishes cholinergic transmission, thus leading to exercise-induced fatigue and sometimes manifest muscle weakness, including the bulbar and ocular musculature. Whereas ocular MG is as a rule initially symptomatically treated with acetylcholine esterase inhibitors, generalized MG requires long-term immunosuppression. The thymus plays a particular role in the pathophysiology of AChR antibody-positive MG, which can also manifest as a paraneoplastic disorder in the context of a thymoma. This article reviews the basic and advanced treatment options of the different disease subtypes including plasma exchange and immunoglobulins for treatment in a myasthenic crisis. Recently, clinical approval of eculizumab, a complement inhibitor, enriched the pharmacological armamentarium for AChR antibody-positive MG patients not appropriately responding to immunosuppression alone.


Assuntos
Miastenia Gravis , Anticorpos Monoclonais Humanizados/uso terapêutico , Humanos , Imunoglobulinas/uso terapêutico , Imunossupressão , Miastenia Gravis/imunologia , Miastenia Gravis/terapia , Troca Plasmática , Timo/imunologia , Timo/patologia
3.
Acta Clin Croat ; 58(1): 173-179, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363340

RESUMO

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that usually affects children and young adults. It most commonly has a monophasic course, although relapses are reported. Clinical presentation of the disease includes encephalopathy and multifocal neurological deficits. There are no established reliable criteria for diagnosis of ADEM and sometimes it is difficult to distinguish it from first attack of multiple sclerosis, especially in adults. The diagnosis of ADEM is based on clinical, radiological and laboratory findings. In the treatment of ADEM, high doses of corticosteroids, plasmapheresis and immunoglobulins are used. We report a case of a young adult female patient with ADEM who fully recovered after prompt administration of high dose methylprednisolone and immunoglobulins.


Assuntos
Corticosteroides/uso terapêutico , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Encefalomielite Aguda Disseminada/tratamento farmacológico , Imunoglobulinas/uso terapêutico , Feminino , Humanos , Imagem por Ressonância Magnética , Metilprednisolona/uso terapêutico , Resultado do Tratamento , Adulto Jovem
4.
BMC Vet Res ; 15(1): 234, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286936

RESUMO

BACKGROUND: Enterotoxigenic Escherichia coli K88 (E. coli K88) are considered as a major cause of diarrhea and death in newly weaned piglets. Oral passive immunization with chicken egg yolk immunoglobulins (IgY) have attracted considerable attention for treatment of gastrointestinal infection due to its high specificity. In this study it was estimated the protective effect of anti-K88 fimbriae IgY against E. coli K88 adhesion to piglet intestinal mucus in vitro and to investigate the potential use of IgY for controlling E. coli-induced diarrhea in weaned piglets in vivo. RESULTS: E. coli K88 was incubated with IgY for 24 h, and the bacterial growth profiles showed that specific IgY with a concentration higher than 5 mg/mL was observed to significantly inhibit the growth of E. coli K88 compared to nonspecific yolk powder in a liquid medium. Moreover, pretreatment with 50 mg/mL of IgY was found to significantly decrease the adhesion ability of E. coli K88 to porcine jejunal and ileal mucus, further supported by the observations from our immunofluorescence microscopic analysis. In vivo, administration of IgY successfully protected piglets from diarrhea caused by E. coli K88 challenge. Additionally, IgY treatment efficiently alleviated E. coli-induced intestinal inflammation in piglets as the gene expression levels of inflammatory cytokines TNF-α, IL-22, IL-6 and IL-1ß in IgY-treated piglets remained unchanged after E. coli K88 infection. Furthermore, IgY significantly prevented E. coli K88 adhering to the jejunal and ileal mucosa of piglets with E. coli infection and significantly decreased E. coli and enterotoxin expression in colonic contents. CONCLUSION: Outcome of the study demonstrated that IgY against the fimbrial antigen K88 was able to significantly inhibit the growth of E. coli K88, block the binding of E. coli to small intestinal mucus, and protect piglets from E. coli-induced diarrhea. These results indicate that passive immunization with IgY may be useful to prevent bacterial colonization and to control enteric diseases due to E. coli infection. The study has great clinical implication to provide alternative therapy to antibiotics in E coli induced diarrhea.


Assuntos
Aderência Bacteriana/efeitos dos fármacos , Diarreia/etiologia , Diarreia/prevenção & controle , Escherichia coli Enterotoxigênica/efeitos dos fármacos , Infecções por Escherichia coli/complicações , Imunoglobulinas/farmacologia , Animais , Antígenos de Bactérias/imunologia , Citocinas/genética , Diarreia/microbiologia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/patologia , Infecções por Escherichia coli/prevenção & controle , Proteínas de Escherichia coli/imunologia , Proteínas de Fímbrias/imunologia , Regulação da Expressão Gênica/efeitos dos fármacos , Regulação da Expressão Gênica/imunologia , Imunização Passiva , Imunoglobulinas/uso terapêutico , Mucosa Intestinal/metabolismo , Mucosa Intestinal/microbiologia , Ligação Proteica/efeitos dos fármacos , Suínos
5.
BMC Infect Dis ; 19(1): 625, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307420

RESUMO

BACKGROUND: Visceral disseminated varicella zoster virus (VDVZV) infection is a rare disease with a high mortality rate (55%) in immunocompromised patients, but it is not yet widely recognized in the field of nephrology. We report a case of VDVZV contracted during immunosuppressive therapy for membranous nephropathy. CASE PRESENTATION: A 36-year-old woman was diagnosed with membranous nephropathy and was being treated with immunosuppressive therapy consisting of 60 mg/day prednisolone, 150 mg/day mizoribine, and 150 mg/day cyclosporine. Nephrosis eased; therefore, the prednisolone dosage was reduced. However, 50 days after starting immunosuppressive therapy, the patient suddenly developed strong and spontaneous abdominal pain, predominantly in the epigastric area, without muscular guarding or rebound tenderness. Blood data indicated neutrophil-dominant elevated white blood cell count, reduced platelet count, elevated transaminase and lactate dehydrogenase, slightly increased C-reactive protein, and enhanced coagulability. Abdominal computed tomography revealed a mildly increased enhancement around the root of the superior mesenteric artery with no perforation, intestinal obstruction, or thrombosis. The cause of the abdominal pain was unknown, so the patient was carefully monitored and antibiotic agents and opioid analgesics administered. The following day, blisters appeared on the patient's skin, which were diagnosed as varicella. There was a marked increase in the blood concentration of VZV-DNA; therefore, the cause of the abdominal pain was diagnosed as VDVZV. Treatment with acyclovir and immunoglobulin was immediately started, and the immunosuppressive therapy dose reduced. The abdominal pain resolved rapidly, and the patient was discharged 1 week after symptom onset. DISCUSSIONS AND CONCLUSIONS: This patient was VZV-IgG positive, but developed VDVZV due to reinfection. Abdominal pain due to VDVZV precedes the skin rash, which makes it difficult to diagnose before the appearance of the rash, but measuring the VZV-DNA concentration in the blood may be effective. Saving the patient's life requires urgent administration of sufficient doses of acyclovir and reduced immunosuppressive therapy.


Assuntos
Glomerulonefrite Membranosa/diagnóstico , Herpesvirus Humano 3/isolamento & purificação , Infecção pelo Vírus da Varicela-Zoster/diagnóstico , Dor Abdominal/etiologia , Aciclovir/uso terapêutico , Adulto , Antivirais/uso terapêutico , Contagem de Células Sanguíneas , DNA Viral/sangue , Feminino , Glomerulonefrite Membranosa/complicações , Glomerulonefrite Membranosa/tratamento farmacológico , Herpesvirus Humano 3/genética , Humanos , Imunoglobulinas/uso terapêutico , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Tomografia Computadorizada por Raios X , Infecção pelo Vírus da Varicela-Zoster/complicações , Infecção pelo Vírus da Varicela-Zoster/tratamento farmacológico
6.
Medicine (Baltimore) ; 98(20): e15726, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096528

RESUMO

RATIONALE: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most frequent autoimmune encephalitis in children, and its presentation is various. The disease can be triggered by various infections. PATIENT CONCERNS: Case 1 was a 7-year-old female with the presentation of seizure, repeated fever, language disorder, and decreased muscle strength of the right limbs; Case 2 was a 7-year-old male with the manifestation of repeated emesis, headache, involuntary movement, altered personality, seizures, and cognitive impairment; Case 3 was a 2-year-old female with repeated fever, emesis, seizures, coma, and decreased muscle strength of limbs. Anti-NMDAR antibody was identified in cerebrospinal fluid (CSF) in the 3 cases, confirming the diagnosis of anti-NMDAR encephalitis. Pathogenic examinations revealed positive serum Epstein-Barr virus (EBV)-nuclear antigen and EBV-capsid antigen (CA)-IgG antibodies in the 3 cases, as well as positive EBV-early antigen (EA)-IgG antibody in CSF. Case 1 also had positive EBV-CA-IgA antibody; Case 3 also had positive EBV-CA-IgA and EBV-CA-IgG antibodies. DIAGNOSES: Anti-NMDAR antibody and EBV-EA-IgG antibody in CSF were tested positive in the 3 cases. Thus, they were diagnosed as anti-NMDAR encephalitis associated with reactivated EBV infection. INTERVENTIONS: All of the 3 cases received immunoglobulin, corticosteroid, and ganciclovir treatment. Cases 2 and 3 also received antiepileptic drugs due to repeated seizures. In addition, Case 3 also received assistant respiration, plasma exchange, and rituximab. OUTCOMES: The 3 cases were substantially recovered after treatment. Repeat CSF analysis showed decreased titer of the anti-NMDAR antibody. LESSONS: Reactivated EBV infection may trigger anti-NMDAR encephalitis in children, which has not been reported previously. Related possible virology tests should be completed while diagnosing the disease.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/tratamento farmacológico , Encefalite Antirreceptor de N-Metil-D-Aspartato/virologia , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Convulsões/tratamento farmacológico , Corticosteroides/uso terapêutico , Encefalite Antirreceptor de N-Metil-D-Aspartato/líquido cefalorraquidiano , Anticonvulsivantes/uso terapêutico , Autoanticorpos/líquido cefalorraquidiano , Proteínas do Capsídeo/imunologia , Criança , Pré-Escolar , Infecções por Vírus Epstein-Barr/líquido cefalorraquidiano , Infecções por Vírus Epstein-Barr/complicações , Antígenos Nucleares do Vírus Epstein-Barr/imunologia , Feminino , Ganciclovir/uso terapêutico , Humanos , Imunoglobulinas/uso terapêutico , Masculino , Convulsões/líquido cefalorraquidiano , Convulsões/etiologia , Resultado do Tratamento
7.
BMC Infect Dis ; 19(1): 451, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31113404

RESUMO

BACKGROUND: The emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) with high case fatality has been reported from many countries. Understanding of clinical disease and sequel of SPHS needs larger studies with adequate numbers. The purpose of this study was to describe the characteristics and sequel by different therapeutic approaches for SPHS in Leptospirosis in Sri Lanka. METHODS: This study was conducted at Teaching Hospital-Karapitiya (THK), Galle, Sri Lanka from June 2015 to December 2017. THK is the main tertiary care center for the Southern Province. All confirmed-cases of leptospirosis who presented during this period and were admitted to five medical units of THK were included in this study. SPHS was defined as a patient presenting; haemoptysis, arterial hypoxemia (Acute Lung Injury Score < 2.5), haemoglobin drop (10% from the previous value), or diffused alveolar shadows in the chest radiograph, without alternative explanation other than leptospirosis. RESULTS: Of the 128 MAT confirmed cases of leptospirosis, 111 (86.7%) had acute kidney injury (AKI) whilst SPHS was seen in 80 (62.5%). Patients typically developed SPHS within the first week of illness, mostly on days 4 and 5. The case fatality rate of this study sample was 28.1% (n = 36), while for patients with SPHS, it was 41.5%. Most of the deaths (n = 19) were within the first 3 days of admission (on the same day 8, and within next 48 h 11). Among SPHS patients, 59 received therapeutic plasma exchange (TPE). The survival rate was higher (n = 35, 74.5%) when the TPE was performed within the first 48 h of detecting SPHS compared to patients in whom the procedure was done after 48 h (n = 5, 54.5%). Of the 19 leptosprosis patients with SPHS who did not receive TPE, 17 died (89.5%). However, the group of patients who received TPE was primarily the patients survived beyond day 3. CONCLUSIONS: We observed that during the study period, SPHS was common and the mortality rate was higher in the study area. The treatment modalities tested need further evaluation and confirmation.


Assuntos
Hemorragia/etiologia , Leptospirose/complicações , Pneumopatias/etiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Adulto , Feminino , Hemorragia/mortalidade , Hemorragia/terapia , Hospitais de Ensino/estatística & dados numéricos , Humanos , Imunoglobulinas/uso terapêutico , Leptospirose/mortalidade , Leptospirose/terapia , Pneumopatias/mortalidade , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Mortalidade , Troca Plasmática , Sri Lanka/epidemiologia , Síndrome
8.
BMJ Case Rep ; 12(5)2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31061198

RESUMO

Epistaxis may be attributed to many causes during the winter including dry mucous membranes from low indoor humidity from heating. However, epistaxis may also be due to thrombocytopaenia. Immune thrombocytopaenia purpura (ITP) is an autoimmune disorder causing thrombocytopaenia. Viral infections sometimes lead to ITP. Vaccines, predominantly the measles-mumps-rubella vaccine, have been associated with the development of ITP. There are several published case reports regarding influenza vaccine induced ITP. However, an association between ITP and influenza vaccination has not been firmly proven yet. We report the case of an adult with three episodes of epistaxis, each within 1 week of receiving a yearly influenza trivalent inactivated vaccine, the last episode being more severe and also featuring gross haematuria.


Assuntos
Epistaxe/induzido quimicamente , Hematúria/induzido quimicamente , Vacinas contra Influenza/efeitos adversos , Trombocitopenia/induzido quimicamente , Vacinação/efeitos adversos , Idoso , Anti-Inflamatórios/uso terapêutico , Dexametasona/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Imunoglobulinas/uso terapêutico , Influenza Humana/prevenção & controle , Masculino , Transfusão de Plaquetas , Prednisona/uso terapêutico , Resultado do Tratamento
10.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015248

RESUMO

Chikungunya (CHIK) viral fever is a self-limiting illness that presents with severe debilitating arthralgia, myalgia, fever and rash. Neurological complications are rare. We present a case of a 36-year-old woman who presented with acute onset progressive difficulty swallowing and left arm weakness. She was diagnosed with CHIK viral fever 4 weeks prior to admission. After investigations, she was diagnosed with a pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. In hospital, she required ventilator support. Her condition improved after five sessions of intravenous immunoglobulin with almost complete resolution within 6 months of symptom onset. With frequent CHIK outbreaks, the neurological complications are increasingly seen in the emergency department. The knowledge of these associations will result in early diagnosis and treatment.


Assuntos
Febre de Chikungunya/virologia , Síndrome de Guillain-Barré/diagnóstico , Imunoglobulinas/uso terapêutico , Adulto , Febre de Chikungunya/complicações , Vírus Chikungunya/isolamento & purificação , Diagnóstico Diferencial , Diagnóstico Precoce , Eletromiografia/métodos , Feminino , Síndrome de Guillain-Barré/tratamento farmacológico , Síndrome de Guillain-Barré/fisiopatologia , Síndrome de Guillain-Barré/terapia , Humanos , Imunoglobulinas/administração & dosagem , Fatores Imunológicos/uso terapêutico , Resultado do Tratamento , Ventiladores Mecânicos/efeitos adversos
11.
J Med Case Rep ; 13(1): 49, 2019 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-30825875

RESUMO

BACKGROUND: For patients with complicated generator pocket infection, expert consensuses universally advocate complete device and leads removal followed by delayed replacement on the contralateral side. We cured our patient by partial generator removal and reimplantation of sterilized pulse generator on the ipsilateral side. We also performed a literature review about incomplete removal therapy for the management of cardiac implantable electronic device infection. CASE PRESENTATION: An 86-year-old Chinese Han man was diagnosed as having third-degree atrioventricular block and received a permanent double-chamber pacemaker in his left prepectoral area 15 years ago. Nine years later, the entire system was removed because of confirmed infection, and a new device was reimplanted in the contralateral area. He developed skin necrosis around the pacemaker pocket after 1 year, and his generator was renewed without leads extraction at another medical center. He was subsequently admitted several times for surgical tissue debridement at another institution due to extended skin necrosis. At the time of the new admission, he had severe infection, heart failure, and hypoalbuminemia. He was diagnosed as having complicated pacemaker pocket infection. Our preferred treatment strategy was for complete removal of both the generator and transvenous pacing leads, and we intended to implant an epicardial pacemaker in our patient if necessary. However, he rejected the treatment strategy and firmly refused to replace his generator. We had to attempt a novel pacemaker-preserving strategy considering our patient's severe comorbidities. Finally, we cured him by partial generator removal and reimplantation of the sterilized pulse generator on the ipsilateral side. There was no sign of wound dehiscence or infection during a 6-month follow-up. CONCLUSIONS: We would posit that partial removal of infected generators combined with conservative treatment may be a proper treatment of complicated generator pocket infection, especially for those who are susceptible to cardiac complications. Reimplantation of a sterilized pulse generator on the ipsilateral side may be an option if patients reject a new device and contralateral vascular condition is not really suitable. Opting for such treatment should be at the consideration of the primary care physician based on the condition of the patient.


Assuntos
Anti-Infecciosos/uso terapêutico , Tratamento Conservador , Remoção de Dispositivo/métodos , Necrose/diagnóstico , Marca-Passo Artificial/microbiologia , Infecções Relacionadas à Prótese/diagnóstico , Retalhos Cirúrgicos/patologia , Idoso de 80 Anos ou mais , Terapia Combinada , Humanos , Imunoglobulinas/uso terapêutico , Masculino , Necrose/terapia , Infecções Relacionadas à Prótese/terapia , Reimplante/métodos , Albumina Sérica Humana/uso terapêutico , Retalhos Cirúrgicos/microbiologia , Resultado do Tratamento
12.
Pol Merkur Lekarski ; 46(273): 130-133, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30912522

RESUMO

Glucocorticosteroids (GCS) were used for decades to modulate immune system. Numerous studies were performed to evaluate their effects on cell mediated response and humoral immunity. AIM: The aim of study was to evaluate the potential associations between chronic use of GCS and immunological tests. PATIENTS AND METHODS: A cohort of patients (n=15) from Department of Dermatology of University Hospital of Cracow, Poland with cutaneous lupus erythematous were identified on individual record review. Flow cytometry was performed to determine the counts of circulating subsets of lymphocytes. Additionally, using nephelometry, serum concentrations of immunoglobulins (i.e. IgA, IgM, IgG) were assessed. RESULTS: A cohort of patients (n=15) from Department of Dermatology of University Hospital of Cracow, Poland with cutaneous lupus erythematous were identified on individual record review. Flow cytometry was performed to determine the counts of circulating subsets of lymphocytes. Additionally, using nephelometry, serum concentrations of immunoglobulins (i.e. IgA, IgM, IgG) were assessed. CONCLUSIONS: A cohort of patients (n=15) from Department of Dermatology of University Hospital of Cracow, Poland with cutaneous lupus erythematous were identified on individual record review. Flow cytometry was performed to determine the counts of circulating subsets of lymphocytes. Additionally, using nephelometry, serum concentrations of immunoglobulins (i.e. IgA, IgM, IgG) were assessed.


Assuntos
Corticosteroides , Imunoglobulinas , Lúpus Eritematoso Sistêmico , Subpopulações de Linfócitos , Corticosteroides/uso terapêutico , Estudos de Coortes , Humanos , Imunoglobulinas/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/imunologia , Subpopulações de Linfócitos/efeitos dos fármacos , Polônia
13.
Autoimmun Rev ; 18(5): 535-541, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30844552

RESUMO

BACKGROUND: Consensus guidelines are not available for the use of immunoglobulin replacement therapy (IGRT) in patients developing iatrogenic secondary antibody deficiency following B-cell targeted therapy (BCTT) in autoimmune rheumatic disease. OBJECTIVES: To evaluate the role of IGRT to manage hypogammaglobulinemia following BCTT in autoimmune rheumatic disease (AIRD). METHODS: Using an agreed search string we performed a systematic literature search on Medline with Pubmed as vendor. We limited the search to English language papers with abstracts published over the last 10 years. Abstracts were screened for original data regarding hypogammaglobulinemia following BCTT and the use of IGRT for hypogammaglobulinemia following BCTT. We also searched current recommendations from national/international organisations including British Society for Rheumatology, UK Department of Health, American College of Rheumatology, and American Academy of Asthma, Allergy and Immunology. RESULTS: 222 abstracts were identified. Eight papers had original relevant data that met our search criteria. These studies were largely retrospective cohort studies with small patient numbers receiving IGRT. The literature highlights the induction of a sustained antibody deficiency, risk factors for hypogammaglobulinemia after BCTT including low baseline serum IgG levels, how to monitor patients for the development of hypogammaglobulinemia and the limited evidence available on intervention thresholds for commencing IGRT. CONCLUSION: The benefit of BCTT needs to be balanced against the risk of inducing a sustained secondary antibody deficiency. Consensus guidelines would be useful to enable appropriate assessment prior to and following BCTT in preventing and diagnosing hypogammaglobulinemia. Definitions for symptomatic hypogammaglobulinemia, intervention thresholds and treatment targets for IGRT, and its cost-effectiveness are required.


Assuntos
Antirreumáticos/efeitos adversos , Linfócitos B/imunologia , Imunoglobulinas/uso terapêutico , Síndromes de Imunodeficiência/induzido quimicamente , Síndromes de Imunodeficiência/terapia , Doenças Reumáticas/tratamento farmacológico , Agamaglobulinemia/induzido quimicamente , Agamaglobulinemia/terapia , Doenças Autoimunes/tratamento farmacológico , Humanos , Imunização Passiva/métodos , Estudos Retrospectivos , Rituximab/efeitos adversos
15.
Medicine (Baltimore) ; 98(5): e14260, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702583

RESUMO

RATIONALE: The coexistence of Ramsay Hunt syndrome (RHS) and varicella-zoster virus (VZV) encephalitis is rare. A patient who developed RHS after being infected with VZV, along with a pontine lesion, is reported in the present study. PATIENT CONCERNS: A 41-year-old male patient presented with his mouth askew for 7 days, and dizziness, accompanied by hearing loss for 3 days. DIAGNOSES: The patient was initially diagnosed with RHS. Brainstem encephalitis was confirmed by lumbar puncture and cerebrospinal fluid. Brain magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) revealed how VZV entered the intracranial space along the vestibulocochlear nerve and facial nerve in the acute period. INTERVENTIONS: Intravenous acyclovir, IV, immunoglobulins (IVIg) and methylprednisolone were administered. OUTCOMES: The herpes was cleared up and left facial nerve palsy was improved, but hearing loss in the left ear did not improve. LESSONS: An MRI was necessary for some VZV infections limited to the cranial nerve, although there was no evidence of brain stem injury. DWI provided evidence, showing how VZV entered the brain in the early stage. This allowed the doctor to judge the necessity of a lumbar puncture.


Assuntos
Encefalite por Varicela Zoster/complicações , Herpes Zoster da Orelha Externa/etiologia , Ponte/patologia , Aciclovir/uso terapêutico , Adulto , Paralisia Facial/etiologia , Herpes Zoster da Orelha Externa/tratamento farmacológico , Humanos , Imunoglobulinas/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico
16.
Pneumologie ; 73(2): 94-107, 2019 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-30759496

RESUMO

Clinical manifestations of primary immunodeficiency are heterogeneous, and early diagnosis is challenging. Leading symptoms are recurrent upper and lower respiratory tract infections. Response to antibiotic therapy is often reduced. Beside infectious complications autoimmunity, autoinflammation and malignant diseases occur frequently. About 50 % of all PID patients are diagnosed after childhood, and the main group are patients with primary antibody deficiencies. Treatment of choice is the immunoglobulin substitution and the prophylactic or therapeutic use of antibiotics. In patients presenting with immunodysregulation, immunosuppression is additionally indicated. Especially due to recurrent lower airway infection and/or interstitial lung diseases PID patients have a decreased live expectancy. Hence, both early diagnosis and sufficient therapy are mandatory.


Assuntos
Imunoglobulinas/uso terapêutico , Síndromes de Imunodeficiência/tratamento farmacológico , Infecção , Inflamação/imunologia , Autoimunidade , Criança , Humanos , Síndromes de Imunodeficiência/imunologia , Infecção/imunologia , Neoplasias , Pneumologia , Infecções Respiratórias/etiologia
17.
J Microbiol Biotechnol ; 29(2): 311-320, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30609885

RESUMO

Fusobacterium nucleatum is a morbific agent in periodontitis and halitosis. Egg yolk antibody (IgY) was obtained from egg yolks from chickens stimulated with F. nucleatum. This study was to assess the effectiveness of IgY on periodontitis and halitosis caused by F. nucleatum in vitro and in vivo. The growth of F. nucleatum was inhibited (p <0. 05) by different concentrations of IgY in vitro and the results of a Halimeter show volatile sulfur compounds (VSCs) were reduced to 904 ± 57 ppb at a concentration 40 mg/ml of IgY. The changes of fatty acids of F. nucleatum were determined using GC-MS. The scores for odor index of rat saliva were decreased. The major constituent of volatile organic compounds (VOCs) including short-chain acids decreased 46.2% in 10 mg/ml IgY, ammonia decreased 70% in 40 mg/ml IgY, while aldehydes and olefine ketones were almost unchanged. The ELISA assay revealed that IL-6 and TNF-α were decreased after 4 weeks' IgY treatment. Morphometric (X-ray) and histological analyses (HE) showed that IgY reduced alveolar bone loss and collagen fibers became orderly in rat models. As a result, IgY may have the potential to treat periodontitis and halitosis.


Assuntos
Halitose/tratamento farmacológico , Imunoglobulinas/uso terapêutico , Periodontite/tratamento farmacológico , Perda do Osso Alveolar/tratamento farmacológico , Perda do Osso Alveolar/microbiologia , Perda do Osso Alveolar/patologia , Amônia/análise , Animais , Galinhas , Modelos Animais de Doenças , Feminino , Fusobacterium nucleatum/efeitos dos fármacos , Fusobacterium nucleatum/crescimento & desenvolvimento , Fusobacterium nucleatum/imunologia , Halitose/microbiologia , Imunoglobulinas/imunologia , Imunoglobulinas/farmacologia , Interleucina-6/sangue , Periodontite/microbiologia , Ratos Sprague-Dawley , Compostos de Enxofre/análise , Fator de Necrose Tumoral alfa/sangue , Compostos Orgânicos Voláteis/análise
18.
Can J Neurol Sci ; 46(1): 38-43, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30688201

RESUMO

BACKGROUND: Subcutaneous immunoglobulin (SCIg) treatment has been shown to control symptoms and improve overall satisfaction in patients with neurological disorders. However, a large injection volume can be overwhelming and a barrier to successful SCIg treatment. We established a nurse-led individualized approach program to facilitate a smooth and successful treatment transition from intravenous immunoglobulin (IVIg) to SCIg. The program involved a lead nurse to provide two or more individual educational sessions on SCIg administration, establish a written transition plan, and liaise care with physicians. OBJECTIVES: We aimed to evaluate the impact of our program to a successful transition defined as SCIg retention or adherence without a need to restart IVIg by six or twelve months. METHODS: We reviewed medical charts of all patients with immune-mediated neuromuscular disorders who were in our program during January 2010 to Dec 2016. RESULTS: Nineteen patients were identified. Mean IVIg treatment duration was 31.5 months (range 4-98) before the transition. Mean steady state SCIg dosage was 26.2 g/week (SD 10.3). All patients were initially able to switch to SCIg, with a retention rate of 17/19 (89.5%) at six months and 15/19 (78.9%) at twelve months. Two patients reverted back to IVIg treatment due to worsening of their symptoms at two and three months, while two required supplemental IVIg infusions. There were no major adverse events reported during the twelve-month period, but one minor cutaneous adverse event (redness around the injection site). CONCLUSIONS: Successful treatment transition may be achieved with the nurse led individualized approach program.


Assuntos
Imunoglobulinas/administração & dosagem , Doenças Neuromusculares/terapia , Medicina de Precisão/métodos , Resultado do Tratamento , Adulto , Idoso , Feminino , Humanos , Imunoglobulinas/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico , Injeções Subcutâneas , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Fatores de Tempo
19.
Echocardiography ; 36(3): 609-612, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30677173

RESUMO

Myocarditis is a common cause for acute heart failure in the pediatric population. Various imaging modalities have evolved over the past 3 decades in order to noninvasively image the myocardium in this patient population. These include standard 2-dimensional echocardiographic imaging, tissue Doppler imaging, and magnetic resonance imaging of the heart. More recently, myocardial speckle tracking also known as strain imaging has been utilized to assess regional wall motion abnormalities with increasing accuracy. We report a case of acute myocarditis in a teenage female in whom progression of myocardial strain findings correlated with the rapidly evolving clinical course of the patient.


Assuntos
Coração/diagnóstico por imagem , Coração/fisiopatologia , Miocardite/complicações , Miocardite/fisiopatologia , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Doença Aguda , Adolescente , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Cardiotônicos/uso terapêutico , Progressão da Doença , Ecocardiografia , Epinefrina/uso terapêutico , Feminino , Humanos , Imunoglobulinas/uso terapêutico , Imagem por Ressonância Magnética , Milrinona/uso terapêutico , Miocardite/terapia , Marca-Passo Artificial , Disfunção Ventricular Esquerda/terapia
20.
Am J Emerg Med ; 37(1): 176.e1-176.e2, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30291036

RESUMO

Small bowel obstruction is common in emergency departments. However, the exact cause of intestinal pseudo-obstruction (IPO) is often misdiagnosed. IPO is considered a severe manifestation of systemic lupus erythematosus (SLE). However, IPO is rare as the initial manifestation of SLE. This paper reports a female patient who presented with IPO as the initial manifestation and was ultimately diagnosed with SLE. The 31-year-old female was definitively diagnosed with SLE after IPO symptoms for 1 month. She then presented multiple organ dysfunction syndrome (MODS) leading to a poor prognosis. Patients with unexplained SBO symptoms should be aware of systemic diseases. Early diagnosis and prompt medical treatment are crucial to avoid unnecessary surgery and obtain satisfactory outcomes.


Assuntos
Pseudo-Obstrução Intestinal/diagnóstico por imagem , Pseudo-Obstrução Intestinal/etiologia , Intestino Delgado/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/complicações , Adulto , Combinação Imipenem e Cilastatina/uso terapêutico , Diagnóstico Tardio , Serviço Hospitalar de Emergência , Feminino , Humanos , Imunoglobulinas/uso terapêutico , Imunossupressores/uso terapêutico , Pseudo-Obstrução Intestinal/tratamento farmacológico , Metilprednisolona/uso terapêutico , Insuficiência de Múltiplos Órgãos/complicações , Prognóstico , Radiografia Abdominal , Tomografia Computadorizada por Raios X
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