RESUMO
Hepatitis E virus (HEV) infection causes acute liver disease, but severe infections are rare in immunocompetent patients. We describe a case of HEV infection in a previously healthy male trauma patient in France who received massive transfusions. Genotyping confirmed HEV in a transfused platelet pool and the donor.
Assuntos
Anticorpos Antivirais/sangue , Antivirais/uso terapêutico , Plaquetas/virologia , Hepatite E/diagnóstico , Transfusão de Plaquetas/efeitos adversos , Ribavirina/uso terapêutico , Adulto , Doadores de Sangue/ética , Transfusão de Sangue/métodos , Colecistite Aguda/fisiopatologia , Colecistite Aguda/cirurgia , Colecistite Aguda/terapia , Hepatite E/tratamento farmacológico , Hepatite E/etiologia , Vírus da Hepatite E/genética , Vírus da Hepatite E/imunologia , Vírus da Hepatite E/isolamento & purificação , Humanos , Masculino , Síndrome do Desconforto Respiratório/fisiopatologia , Síndrome do Desconforto Respiratório/terapia , Costelas/lesões , Choque Séptico/fisiopatologia , Choque Séptico/terapia , Baço/lesões , Esplenectomia , Ruptura Esplênica/cirurgiaRESUMO
We report a case of transfusion-associated bacteremia caused by Psychrobacter arenosus. This psychrotolerant bacterium was previously isolated in 2004 from coastal sea ice and sediments in the Sea of Japan, but not from humans. P. arenosus should be considered a psychrotolerant bacterial species that can cause transfusion-transmitted bacterial infections.
Assuntos
Bacteriemia/diagnóstico , Infecções por Moraxellaceae/diagnóstico , Psychrobacter/genética , Reação Transfusional , Anemia/terapia , Antibacterianos/administração & dosagem , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , França , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Infecções por Moraxellaceae/tratamento farmacológico , Infecções por Moraxellaceae/etiologia , Psychrobacter/efeitos dos fármacos , Psychrobacter/isolamento & purificação , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Resultado do TratamentoAssuntos
Afibrinogenemia/complicações , Fibrinogênio/administração & dosagem , Hematoma Subdural Intracraniano/prevenção & controle , Ferimentos e Lesões/prevenção & controle , Afibrinogenemia/congênito , Hematoma Subdural Intracraniano/diagnóstico por imagem , Hematoma Subdural Intracraniano/terapia , Humanos , Recém-Nascido , Masculino , Radiografia , Ferimentos e Lesões/diagnóstico por imagemRESUMO
OBJECTIVE: The aim of this study was to assess the consumption of anti-haemophilic drugs by adults and children with severe haemophilia A or B (residual activity of FVIII or FIX < or =2%) and to quantify the average direct medical costs. METHOD: A retrospective multicentre cost-of-illness study from the perspective of French national health insurance system. The costs include only the use of clotting factors. MAIN OUTCOME MEASURE: Consumption was expressed in UI/kg/year and costs in euros/kg/year. RESULTS: From January 1, 2001 to December 31, 2002, data from 81 adults and 30 children with severe haemophilia A (n = 92) or B (n = 19) and included in the "SNH" were collected and analysed. A coagulation factor inhibitor was present in 10 patients (9%). Four of them were high responders. Mean age and body weight were respectively 28 +/- 17 years and 58 +/- 24 kg. Except for one adult patient, all (99%) had outpatient treatment, 44 patients (40%) were hospitalized and treated by recombinant or/and plasma-derived FVIII or FIX or/and rFVIIa. Overall median annual consumption of anti-haemophilic drugs per patient was estimated at 1,333 UI/kg, with a median cost-of-illness of 1,156 euros/kg. Patients with severe haemophilia B consumed more than patients with severe haemophilia A, though not significantly (P = 0.096), with a median of 2,167 vs. 1,100 UI/kg/year and a median cost of 1,760 vs. 917 euros/kg/year (P = 0.13). Children consumed respectively more than adults (P = 0.008), with a median of 3,204 vs. 1,106 UI/kg/year and a median cost of 2,614 vs. 913 euros/kg/year (P = 0.012). The median cost for patients with an inhibitor was 3,291 euros/kg/year, approximately threefold higher than that of patients without an inhibitor (926 euros/kg/year) (P = 0.022). CONCLUSION: It suggests a higher consumption and cost of anti-haemophilic drugs among children when compared to adults. Haemophilia B patients did not consume significantly more than haemophilia A patients, whereas the consumption and cost for patients with or without inhibitors differed significantly.