1/11. Influenza virus-induced encephalopathy: clinicopathologic study of an autopsied case.BACKGROUND: Rapid progressive encephalopathy with a high fever, consciousness loss and recurrent convulsions has been occasionally reported in children during influenza pandemics in japan since 1995. We examined a 2-year old girl with hemorrhagic shock and encephalopathy syndrome associated with acute influenza a virus infection (A/Nagasaki/76/98; H3N2), to answer several questions for which no histologic or virologic data exist. methods: A clinicopathologic study using immunohistochemical staining and viral genome detection by reverse transcriptase polymerase chain reaction (RT-PCR) was performed with this autopsied case. RESULTS: The virus antigen was positive in CD8 T lymphocytes from the lung and spleen. The virus infected a very limited part of the brain, especially Purkinje cells in the cerebellum and many neurons in the pons, without inducing an overt immunologic reaction from the host. The RT-PCR used for detecting the hemagglutinin gene demonstrated positive bands in all frozen tissues and cerebrospinal fluid taken at autopsy and not in samples obtained on admission. CONCLUSIONS: The pathologic change induced by the direct viral invasion cannot be responsible for all of the symptoms, especially for the rapid and severe clinical course of the disease within 24-48 h after the initial respiratory symptoms. Together with the rapid production of several inflammatory cytokines, the breakdown of the blood-brain barrier may induce severe brain edema and can be a major pathologic change for the disease. Any therapeutic strategy to control this multistep progression of the disease could be effective.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
2/11. Clinical manifestations of influenza a myocarditis during the influenza epidemic of winter 1998-1999.OBJECTIVES: The clinical features of myocarditis that developed during the influenza epidemic of winter 1998-1999 were investigated to emphasize the need for medical attention to this disease. methods: Nine patients were treated under diagnoses of acute myocarditis during the winter of 1998-1999. Five (two males and three females, mean age 52 /- 18 years) were examined with myocarditis associated with influenza A. The diagnosis of influenza A myocarditis was based on electrocardiographic and echocardiographic abnormalities, increased creatine kinase levels and at least a four-fold increase in influenza a virus titers using paired sera. RESULTS: All patients had preceding flu-like symptoms and fever. Cardiac involvement developed between 4 and 7 days after the onset of influenza symptoms. dyspnea progressively worsened in three patients, one went into shock and one had persistent fever, cough and mild dyspnea without apparent cardiac symptoms. Three patients had ST elevation associated with Q waves and one had complete left bundle branch block. The creatine kinase levels were abnormally increased and global wall motion of the left ventricle on echocardiography was decreased in all patients. Two patients had diagnoses of fulminant myocarditis. One patient died of pneumonia following cerebral infarction, but the left ventricular dysfunction normalized in the remaining four patients. CONCLUSIONS: Cardiac involvement occurred between 4 and 7 days after the onset of influenza symptoms, and worsening dyspnea was the most common symptom. electrocardiography, echocardiography and creatine kinase levels should be checked to determine the potential for cardiac involvement when patients present with suspected influenza associated with worsening dyspnea or prolonged weakness. Increasing the awareness of influenza myocarditis may help in the earlier identification and treatment of this disease during influenza epidemics.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
3/11. A case of influenza subtype A virus-induced fulminant myocarditis: an experience of percutaneous cardio-pulmonary support (PCPS) treatment and immunohistochemical analysis.A 64-year-old man was admitted to the emergency center of Furukawa City Hospital because of common cold-like symptoms and hypotension. He was diagnosed as fulminant myocarditis with cardiogenic shock and arrhythmia elicited by influenza virus subtype A. Cardiac angiography, echocardiography and biopsy also showed myocarditis, and serum antibody titer to influenza virus subtype A was increased to 4-fold in paired serums. Treatments of both percutaneous cardio-pulmonary support (PCPS) and intra-aortic balloon pumping (IABP) were carried out to sustain the general circulation. PCPS treatment was discontinued on the 25th day of the admission, but IABP was continued. Finally, he died of multiple organ failure. The autopsy revealed myocardial necrosis with a slight fibrosis and a small amount of lymphocytic infiltration into the ventricular wall, which were compatible with restrictive myocarditis. Moreover, immunohistochemical analysis also showed the presence of viral antigens in cardiac myocytes. This case clearly showed that PCPS and IABP can be beneficial to sustain the general circulation in fulminant myocarditis, but cardiac pumping function failed completely to recover from myocardial damage.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
4/11. Recurrent fulminant viral myocarditis with a short clinical course.A 75-year-old man recovered from an episode of acute influenza. A myocarditis with a normalized level of serum cardiac troponin t, but less than 2 weeks after recovery, he rapidly fell into cardiogenic shock and died of fulminant myocarditis. The autopsied heart showed marked inflammatory cell infiltration that mainly consisted of mononuclear cells positive for CD8, suggesting that the second bout of myocarditis was caused by viral re-infection.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
5/11. influenza b virus infection associated with non-bacterial septic shock-like illness.We report the details of four children aged between 6 months and 5.5 years who had underlying chronic disease and who developed life-threatening illness in association with influenza virus B infection. Influenza has received relatively little attention, yet its morbidity and mortality in children can be considerable. This report emphasises the need to vaccinate the population groups at high risk, such as children with cardiovascular disorders, chronic bronchopulmonary, metabolic and renal disease and chronic neurological disorders.- - - - - - - - - - ranking = 5.6872397289954keywords = shock, septic shock (Clic here for more details about this article) |
6/11. cardiac tamponade and septic shock caused by viral infection in a previously healthy woman.A previously healthy woman was admitted to hospital after 'flu-like' symptoms for 5 days followed by acute intense abdominal and lower back pain. On admission she was found to be in severe shock and was transferred to the ICU. echocardiography revealed cardiac tamponade, and pericardiocentesis was performed immediately. Thereafter her cardiovascular state improved, but she developed hypotension with low systemic vascular resistance and required vasoactive treatment for 4 days. Nine days after admission the patient was transferred to the ward, after which she recovered rapidly and completely. The cause of her illness was extensively screened. No underlying disease was found, and all bacterial cultures remained negative. Acute virus infection was confirmed by diagnostic elevations of antibody titers to Influenza A and adenovirus. Adenovirus was also isolated from her bronchoalveolar lavage fluid.- - - - - - - - - - ranking = 6.6872397289954keywords = shock, septic shock (Clic here for more details about this article) |
7/11. Systemic capillary leak syndrome presenting as recurrent shock.OBJECTIVE: To report a case of systemic capillary leak syndrome (SCLS) in a child. DESIGN: Case report. SETTING: Pediatric intensive care unit. PATIENT: A 6-yr-old girl was admitted twice to the pediatric intensive care unit, at a 10-month interval, in severe shock with important edema. RESULTS: The patient presented with acute symptoms of abdominal pain, vomiting, and syncope in the hour preceding the shock. During both episodes necessary management included aggressive intravenous fluid rehydration, mechanical ventilation, and use of inotropes/vasopressors. Suspicion of a lower limb fasciitis necessitated surgical exploration, but pathology reports were negative on both occasions revealing only subcutaneous tissue edema. The patient recovered within 24 hrs on both episodes. Investigation ruled out cardiogenic shock and septic shock due to bacterial etiology. On the first episode, a nasopharyngeal aspirate was positive for influenza A (H3N2) by both viral immunofluorescence and culture. The presumed diagnosis was toxic shock syndrome associated with influenza virus. On the second episode, all bacterial and virology cultures remained negative. Hypovolemic shock was suspected, but there was no history of dehydration, bleeding, or gastrointestinal losses (persistent vomiting or diarrhea). Noninfectious causes of hypovolemic shock with edema were ruled out, leading us to believe that she suffered from SCLS. CONCLUSIONS: Although well described in the adult literature, there have been few reports of SCLS in pediatric patients. SCLS should be considered in the differential diagnosis of recurrent hypovolemic shock without identifiable cause. The only therapeutic intervention is to obtain vascular access when initial manifestations occur and give aggressive fluid reanimation.- - - - - - - - - - ranking = 18.646050571982keywords = toxic shock syndrome, shock syndrome, shock, toxic shock, septic shock (Clic here for more details about this article) |
8/11. Postinfluenza toxic shock syndrome.Postinfluenza toxic shock syndrome is a recently described entity that results from a respiratory tract infection with toxin-producing staphylococcus aureus following an episode of influenza or influenzalike illness. This report describes a 19-year-old man who developed an influenza B respiratory infection complicated by staphylococcal pneumonia and toxic shock syndrome. The patient improved rapidly with specific antibiotic therapy, emphasizing the importance of considering this otherwise highly lethal syndrome in any individual who becomes critically ill after an initial influenzalike illness.- - - - - - - - - - ranking = 43.3454438384keywords = toxic shock syndrome, shock syndrome, shock, toxic shock (Clic here for more details about this article) |
9/11. Toxic shock syndrome. A newly recognized complication of influenza and influenzalike illness.Nine cases of severe hypotension or death compatible with toxic shock syndrome (TSS) as a complication of influenza and influenzalike illness were identified in minnesota with onsets between Jan 2, 1986, and Feb 23, 1986, in which five of the patients died. During this time, an influenza outbreak was occurring in the state. Cultures of respiratory secretions were performed in eight patients; staphylococcus aureus was isolated from all of them. Seven S aureus isolates were available for determination of exotoxin production; five isolates produced toxic shock syndrome toxin-1, one produced enterotoxin B, and one produced both. Acute influenza B infection was confirmed in three of four patients for whom throat cultures or acute and convalescent serum samples were available. Two patients fulfilled the Centers for Disease Control-confirmed case definition for TSS. Four additional patients fulfilled the CDC criteria for a probable case of TSS, and TSS was a likely diagnosis in the remaining three patients. The initial presentation was suggestive of nonsuppurative tracheitis or viral pneumonia in eight patients. In the remaining patient, the initial clinical presentation was compatible with staphylococcal pneumonia. This report demonstrates that TSS can occur as a complication of influenza and influenzalike illness.- - - - - - - - - - ranking = 19.810649173489keywords = toxic shock syndrome, shock syndrome, shock, toxic shock (Clic here for more details about this article) |
10/11. Toxic shock syndrome complicating influenza A in a child: case report and review.Despite extensive literature on toxic shock syndrome, reports of its manifestations in children remain relatively uncommon. Similarly, toxic shock syndrome in association with influenza B or influenza-like illness has been reported in 12 patients, but it has been reported to occur following influenza A in only two patients to date. We report a third case of toxic shock syndrome in a child with influenza A and review the association between epidemic influenza and toxic shock syndrome ("the Thucydides syndrome").- - - - - - - - - - ranking = 38.966089385938keywords = toxic shock syndrome, shock syndrome, shock, toxic shock (Clic here for more details about this article) |
| | Next -> |