11/136. Unusual viral infections (progressive multifocal leukoencephalopathy and cytomegalovirus disease) after high-dose chemotherapy with autologous blood stem cell rescue and peritransplantation rituximab.Efforts to reduce relapse of non-Hodgkin lymphoma after autologous transplantation have included ex vivo stem cell selection and/or peritransplantation immunotherapy. The late infectious and immunologic consequences of these maneuvers are not well understood, although an increase in early cytomegaloviral disease after CD34( ) stem cell selection and an alteration in immunoglobulin and T-cell recovery after peritransplantation rituximab has been noted. We report the first 2 cases of progressive multifocal leukoencephalopathy caused by JC papovavirus after autologous peripheral blood stem cell transplantation and a case each of cytomegalovirus retinitis and pneumonitis. All 4 patients experienced significant impairment of CD4 T-cell recovery, placing them at risk for these unusual viral infections. The clustering of cases is concerning because all occurred shortly after the introduction of peritransplantation rituximab into treatment protocols (4 of 62 immunotherapy recipients compared with 0 of 276 without; z = 3.595; P <.001), although a direct association with this CD20 B-cell-directed therapy remains speculative.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
12/136. Impaired response to interferon-alpha/beta and lethal viral disease in human STAT1 deficiency.The receptors for interferon-alpha/beta (IFN-alpha/beta) and IFN-gamma activate components of the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway, leading to the formation of at least two transcription factor complexes. STAT1 interacts with STAT2 and p48/IRF-9 to form the transcription factor IFN-stimulated gene factor 3 (ISGF3). STAT1 dimers form gamma-activated factor (GAF). ISGF3 is induced mainly by IFN-alpha/beta, and GAF by IFN-gamma, although both factors can be activated by both types of IFN. Individuals with mutations in either chain of the IFN-gamma receptor (IFN-gammaR) are susceptible to infection with mycobacteria. A heterozygous STAT1 mutation that impairs GAF but not ISGF3 activation has been found in other individuals with mycobacterial disease. No individuals with deleterious mutations in the IFN-alpha/beta signaling pathway have been described. We report here two unrelated infants homozygous with respect to mutated STAT1 alleles. Neither IFN-alpha/beta nor IFN-gamma activated STAT1-containing transcription factors. Like individuals with IFN-gammaR deficiency, both infants suffered from mycobacterial disease, but unlike individuals with IFN-gammaR deficiency, both died of viral disease. Viral multiplication was not inhibited by recombinant IFN-alpha/beta in cell lines from the two individuals. Inherited impairment of the STAT1-dependent response to human IFN-alpha/beta thus results in susceptibility to viral disease.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
13/136. Infections in the heart transplant recipient.The overall incidence of infection after transplantation has decreased with improved immunosuppressive agents, increased knowledge and use of prophylaxis, and better detection and treatment of infection. Nevertheless, infection continues to be a major cause of morbidity and mortality in heart transplant recipients. The knowledgeable nurse in any setting who cares for a transplant recipient must be aware of the lifelong susceptibility to common and opportunistic infections. The transplant recipient and his or her family must also be aware of the risks of early opportunistic infection. Infection is a lifelong concern for all persons on immunosuppressant medications, and the individual must learn appropriate precautions to reduce this risk. hand washing and avoidance of infected individuals are the most important self-care actions that the transplant patient should adopt. Recipients must also learn to monitor for subtle signs of infection. The nurse is responsible for teaching self-care to patients and family members. Ultimately, a team effort by the patient, family, nurses, and physicians can reduce the risk of infection in this vulnerable population.- - - - - - - - - - ranking = 1.4keywords = infection (Clic here for more details about this article) |
14/136. Transient elevation of platelet count in patients with chronic idiopathic thrombocytopenic purpura: association with infection.platelet count occasionally increases after infection in patients with chronic idiopathic thrombocytopenic purpura (ITP). We report 5 such patients. Three of them were males. Between November 1992 and December 2001, increased platelet counts were observed 9 times in 5 patients with chronic ITP. Corticosteroids were administered during 7 episodes; splenectomy was performed to treat 3 episodes. Antibiotics were administered in the course of 6 episodes to treat complicating infection. Platelet counts showing 1.4- to 24-fold increases have been observed. Median duration from the onset of infection until peak platelet count was 14 days. However, platelet count finally decreased to the initial level in all episodes. These findings suggest that infection is associated with the elevation of platelet count in some patients with chronic ITP, although this phenomenon is transient.- - - - - - - - - - ranking = 1.6keywords = infection (Clic here for more details about this article) |
15/136. Early-onset acute transverse myelitis following hepatitis b vaccination and respiratory infection: case report.Acute transverse myelitis is an acute inflammatory process of the spinal cord and it is a rare clinical syndrome in childhood. In this paper, we report a case of 3 years-old boy who developed acute onset tetraparesia following a viral respiratory infecction and hepatitis b vaccination. magnetic resonance imaging of the spinal cord disclosed signal-intensity abnormalities from C4 to C3. A diagnosis of acute transverse myelitis was made and the patient was treated with IV methylprednisolone and IV immunoglobulin. The child had a fair outcome despite of the very acute course of the disease and the presence of a cervical sensory level which usually harbor a poor prognosis.- - - - - - - - - - ranking = 0.8keywords = infection (Clic here for more details about this article) |
16/136. Cytophagic histiocytic panniculitis with atypical lymphocytes in peripheral blood.A 26-year-old female patient developed high fever, hepatosplenomegaly and subcutaneous nodules. Atypical lymphocytes were present in the peripheral blood. skin biopsy revealed lobular panniculitis. bone marrow examination showed prominent phagocytosis by benign histiocytes. The diagnosis of cytophagic histiocytic panniculitis was made, and the disease has been well controlled with oral prednisolone. This is the first report of cytophagic histiocytic panniculitis with atypical lymphocytes in the peripheral blood, which are frequently seen in virus-associated hemophagocytic syndrome. This observation suggests that underlying viral infection may be one factor in the development of cytophagic histiocytic panniculitis.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
17/136. Fatal virus-associated hemophagocytic syndrome in a young adult producing nontraumatic splenic rupture.A 24-year-old man with no previous medical history was admitted to a local hospital with pancytopenia after a recent "viral illness." During his hospitalization, he developed sudden abdominal distension and hypotension. Surgical exploration of his abdomen revealed a ruptured spleen. The spleen was removed, but the patient did not survive the operation. We investigated this unexpected and unexplained hospital death for any traumatic or iatrogenic injury. The cause of death after review of the clinical history, autopsy, and microscopic sections was virus-associated hemophagocytic syndrome (VAHS). VAHS consists of a generalized histiocytic proliferation and marked hemophagocytosis associated with a systemic viral infection. Clinically it presents as pancytopenia and organomegaly. This recently described entity is often confused with malignant histiocytosis. This is the first case report of VAHS producing nontraumatic splenic rupture, thus adding to the differential diagnosis of spontaneous splenic rupture and sudden natural death.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
18/136. Diplacusis, hearing threshold and otoacoustic emissions in an episode of sudden, unilateral cochlear hearing loss.Limited data are available on the relationship between diplacusis and otoacoustic emissions and sudden hearing threshold changes, and the detail of the mechanism underlying diplacusis is not well understood. Data are presented here from an intensively studied single episode of sudden, non-conductive, mild hearing loss with associated binaural diplacusis, probably due to a viral infection. Treatment with steroids was administered for 1 week. This paper examines the relationships between the hearing loss, diplacusis and otoacoustic emissions during recovery on a day-by-day basis. The hearing thresholds were elevated by up to 20 dB at 4kHz and upwards, and there was an interaural pitch difference up to 12% at 4 and 8 kHz. There was also a frequency-specific change in transient evoked otoacoustic emission (TEOAE) and distortion-product otoacoustic emission (DPOAE) level. DPOAE level was reduced by up to 20 dB. with the greatest change seen when a stimulus with a wide stimulus frequency ratio was used. Frequency shifts in the 2f2-fi DPOAE fine structure corresponded to changes in the diplacusis. Complete recovery to previous levels was observed for TEOAE, DPOAE and hearing threshold. The diplacusis recovered to within normal limits after 4 weeks. The frequency shift seen in the DPOAE fine structure did not quite resolve, suggesting a very slight permanent change. The time-courses of TEOAE. diplacusis and hearing threshold were significantly different: most notably, the hearing threshold was stable over a period when the diplacusis deteriorated. This suggests that the cochlear mechanisms involved in diplacusis, hearing threshold and OAE may not be identical.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
19/136. Infections in patients with Shwachman-diamond syndrome.Shwachman-diamond syndrome (OMIM 260400) is a multisystemic disorder characterized by pancreatic insufficiency, bone marrow dysfunction, skeletal abnormalities and immune dysfunction. Prompted by the case of a 13-year-old girl with Shwachman-diamond syndrome who presented with pneumonia attributable to pseudomonas aeruginosa, we review infectious complications of this disease. pneumonia, recurrent otitis media and skin infections/abscesses constitute the majority of infections among these children.- - - - - - - - - - ranking = 0.4keywords = infection (Clic here for more details about this article) |
20/136. Reye's syndrome. A diagnosis occasionally first made at medicolegal autopsy.Reye's syndrome, a condition characterized pathologically by cerebral edema and fatty change of the liver, has been described extensively in the medical literature as a disease manifested clinically by encephalopathy and coma. This is a report of five cases of Reye's syndrome occurring as sudden, unexpected deaths outside of the hospital. In each of these cases, there is a vague history of a previous viral illness. A history of aspirin intake is inconstant. Each child either had no significant past illnesses or there was a history of repeated upper respiratory infections. The classic progression of signs and symptoms usually described for Reye's syndrome, where vomiting usually precedes encephalopathy and coma, was not present in any of the cases. Results of autopsies showed the characteristic findings for Reye's syndrome, and additional tests showed no other explanation for the deaths. This manifestation of the disease is seldom described in medical literature, but it may be encountered occasionally by the medical examiner.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
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