scholarly journals OP0097 LISTERIA MONOCYTOGENES. DESCRIPTION AND ANALYSIS OF CASES IN AN IMMUNODEPRESSED POPULATION BY RHEUMATIC DISEASES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 53.2-54
Author(s):  
M. Lisbona Muñoz ◽  
P. León ◽  
G. Lopez Antequera ◽  
E. Rubio-Romero
Keyword(s):  
Listeria Monocytogenes ◽  
Rheumatic Disease ◽  
Pregnant Women ◽  
Rheumatic Diseases ◽  
Case Series ◽  
Similar Proportion ◽  
Neurological Manifestations ◽  
Biological Dmards ◽  
Parametric Data ◽  
The Impact

Background:Listeria monocytogenes is a gram-positive bacteria that cause the invasive disease listeriosis. Human clinical syndromes are infrequent, mostly appearing in immunosuppressed individuals, newborns, the elderly, pregnant women, and occasionally healthy patients.Objectives:We describe and analyze Listeria-related demographics and clinical features to determine the predisposing conditions for severe infections in an immunodepressed population by rheumatic diseases.Methods:Descriptive Observational Study. A retrospective analysis of 143 patients were performed affected by listeriosis, with positive isolation of Listeria monocytogenes from blood, treated in the H.U. Virgen del Rocío (Seville- Spain) between 2003-2019. Of them 9 were rheumatic patients. The type of clinical manifestation was analyzed, paying special attention to the characteristics associated with patients with neurological complications or unfavorable outcome (death and / or abortion in pregnant women), immunosuppression (associated with cancer or rheumatic disease) was assessed as independent variables, chronic diseases (Hypertension, Diabetes Mellitus, dyslipidemia, COPD, Renal Insufficiency and Ischemic Heart Disease) as well as other baseline characteristics of the patient. (age, sex, pregnancy) and their toxic habits (tobacco and alcohol).Results:The sample includes a similar proportion of men (70 cases) and women (73 cases), of all ages. Of the total patients, most (85%) required hospital admission, with a duration median (non-parametric data) of 11 days. 78% of the cases admitted showed a favorable evolution. However, 15.4% resulted in death and 5.6% in abortion. This percentage of abortions represented 29% of the total pregnant women admitted Of all the patients admitted, a third (33%) were immunocompromised, including patiets with cancer (79%) and rheumatic diseases (21%). Include lupus (33%), RA (22%), APs (11%), polymyalgia rheumatica (11%), panuveitis (11%) and ANCA vasculitis MPO specificity (11%). All of them required admission although the majority showed a favorable evolution, except one of the patient. which resulted in death, in which case in addition to lupus he presented with prostate cancer. Regarding the baseline treatment of these patients, 7 underwent treatment with synthetic DMARDs and three with biological DMARDs (1 Adalimumab, 1 Infliximab and 1 Rituximab) As a result of the listeria infection, most of them had fever or digestive symptoms and two of they experienced neurological manifestations (meningoencephalitis) None of these last two (with lupus and RA) had biological DMARDs.Conclusion:Listeriosis is an uncommon but potentially serious infection usually in older people, pregnant women and immunocompromised patients. In our sample, 33% of the patients were immunocompromised. Of the 9 patients. affected by listeria with rheumatic disease we find a death for meningoencephalitis. Given the impact of this infection in immunosuppressed patients should pay attention in our patients with fever and neurological manifestations.Reference:[1]Eleftherios Mylonakis et al. A Case Series and Review of 222 Cases. Medicine 2002; 81: 260-269.[2]Alcoba Lez M et al.Meningitis por Listeria monocytogenes en el adulto en España. Presentación de 10 casos y revisión de la literatura. Rev Clin Esp 2002; 202 (12): 638-643.[3]Eleftherios Mylonakis et al. Central Nervous Sistem Infection with Listeria monocytogenes. 33 Years’ Experience at a General Hospital and Review of 776 Episodes from tha Literature. Medicine 1998; 77: 313-336.Disclosure of Interests:None declared

scholarly journals Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)

2021 ◽  
Author(s):  
Biyan Nathanael Harapan ◽  
Hyeon Joo Yoo
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Case Reports ◽  
Case Series ◽  
Altered Mental Status ◽  
Neurological Complications ◽  
Neurological Symptoms ◽  
Neurological Manifestations ◽  
Fisher Syndrome ◽  
Novel Coronavirus ◽  
The Impact

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is responsible for the outbreak of coronavirus disease 19 (COVID-19) and was first identified in Wuhan, China in December 2019. It is evident that the COVID-19 pandemic has become a challenging world issue. Although most COVID-19 patients primarily develop respiratory symptoms, an increasing number of neurological symptoms and manifestations associated with COVID-19 have been observed. In this narrative review, we elaborate on proposed neurotropic mechanisms and various neurological symptoms, manifestations, and complications of COVID-19 reported in the present literature. For this purpose, a review of all current published literature (studies, case reports, case series, reviews, editorials, and other articles) was conducted and neurological sequelae of COVID-19 were summarized. Essential and common neurological symptoms including gustatory and olfactory dysfunctions, myalgia, headache, altered mental status, confusion, delirium, and dizziness are presented separately in sections. Moreover, neurological manifestations and complications that are of great concern such as stroke, cerebral (sinus) venous thrombosis, seizures, meningoencephalitis, Guillain–Barré syndrome, Miller Fisher syndrome, acute myelitis, and posterior reversible encephalopathy syndrome (PRES) are also addressed systematically. Future studies that examine the impact of neurological symptoms and manifestations on the course of the disease are needed to further clarify and assess the link between neurological complications and the clinical outcome of patients with COVID-19. To limit long-term consequences, it is crucial that healthcare professionals can early detect possible neurological symptoms and are well versed in the increasingly common neurological manifestations and complications of COVID-19.

Comorbidities of rheumatic disease

2013 ◽  
Author(s):  
Tuulikki Sokka ◽  
Kari Puolakka ◽  
Carl Turesson
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Health Professionals ◽  
Physical Inactivity ◽  
Organ Damage ◽  
Inflammatory Rheumatic Diseases ◽  
Rheumatology Clinic ◽  
Cholesterol Levels ◽  
Lifestyle Choices ◽  
The Impact

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. In this chapter, we discuss the impact of comorbidities to the patient. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.

scholarly journals Outcomes of COVID-19 in a cohort of pediatric patients with rheumatic diseases

2021 ◽  
Author(s):  
Diana Sofia Villacis-Nunez ◽  
Christina A. Rostad ◽  
Kelly Rouster-Stevens ◽  
Arezou Khosroshahi ◽  
Shanmuganathan Chandrakasan ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Pediatric Patients ◽  
Univariate Analysis ◽  
Case Series ◽  
Hospitalized Patients ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Severe Immunosuppression ◽  
Dose Corticosteroid

Abstract Background There are few reports of COVID-19 in pediatric patients with rheumatic diseases. This study describes the clinical presentation and outcomes of COVID-19 in this population. Methods We analyzed a single-center case series of pediatric patients with rheumatic diseases and laboratory-confirmed COVID-19. Demographic, baseline and COVID-19 associated clinical features were compared between ambulatory and hospitalized patients using univariate analysis. Results Forty cases were identified: 32 (80%) in the ambulatory group and 8 (20%) hospitalized. Older age (median age 18 years vs 16 years; p = 0.01) and African American race (OR 8.42; 95% CI [1.20-101.69]; p = 0.01) predominated in hospitalized patients. Systemic lupus erythematosus (OR 6.77; 95% CI [1.01–56.71]; p = 0.02), medium/high-dose corticosteroid use (OR 10.62; 95% CI [1.46–99.57]; p = 0.008), mycophenolate use (OR 11.91; 95% CI [1.64-149.35]; p = 0.005), and severe immunosuppression (OR 16.83; 95% CI [1.74-861.43]; p = 0.004) were associated with increased odds of hospitalization. Patients with fever (OR 11.91; 95% CI [1.64-149.35]; p = 0.004), dyspnea (OR 16.51; CI [1.10-998.37]; p = 0.02), and myalgias (OR 13.40; 95% CI [1.43-194.56)]; p = 0.009) were more commonly encountered in the hospitalized group. Rheumatic disease flares were almost exclusive to hospitalized patients (OR 42.13; 95% CI [3.40-2463.87]; p < 0.001).. All patients recovered. Conclusions Medium/high-dose corticosteroid use, mycophenolate use, and severe immunosuppression were risk factors for hospitalization. Fever, dyspnea and myalgias were high-risk symptoms. The type of rheumatic disease, as well as disease flare could be contributing factors to the need for hospitalization.

Comorbidities of rheumatic disease

2015 ◽  
Author(s):  
Tuulikki Sokka ◽  
Kari Puolakka ◽  
Carl Turesson
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Health Professionals ◽  
Physical Inactivity ◽  
Organ Damage ◽  
Inflammatory Rheumatic Diseases ◽  
Rheumatology Clinic ◽  
Cholesterol Levels ◽  
Lifestyle Choices ◽  
The Impact

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. In this chapter, we discuss the impact of comorbidities to the patient. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.

Comorbidities of rheumatic disease

2013 ◽  
pp. 243-250
Author(s):  
Tuulikki Sokka ◽  
Kari Puolakka ◽  
Carl Turesson
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Health Professionals ◽  
Organ Damage ◽  
Inflammatory Rheumatic Diseases ◽  
Rheumatology Clinic ◽  
Cholesterol Levels ◽  
Lifestyle Choices ◽  
The Impact ◽  
Index Disease

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. The concept of ‘multimorbidity’ is being used increasingly, shifting the focus from the index disease to two or more chronic diseases that exist in the same individual. In this chapter, we discuss the impact of multi/comorbidities. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.

scholarly journals COVID-19 in pregnancy: What do we really know?

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 362
Author(s):  
Jerome Bouaziz ◽  
Marc Even ◽  
Frederique Isnard-Bogillot ◽  
Eli Vesale ◽  
Mariam Nikpayam ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Pregnant Women ◽  
Current Knowledge ◽  
Case Reports ◽  
Case Series ◽  
Adverse Outcomes ◽  
Health Concern ◽  
Case Control Studies ◽  
Increased Risk ◽  
The Impact

Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to escalate worldwide and has become a pressing global health concern. This article comprehensively reviews the current knowledge on the impact of COVID-19 over pregnant women and neonates, as well as current recommendations for their management. We also analyse previous evidences from viral respiratory diseases such as SARS, Middle East respiratory syndrome, and influenza that may help to guide clinical practice during the current pandemic. We collected 23 case reports, case series, and case-control studies (18 from China) comprising 174 pregnant women with COVID-19. The majority of mothers showed a clinical presentation of the disease similar to that of non-infected adults. Preliminary evidences point towards a potentially increased risk of pregnancy adverse outcomes in women with COVID-19, with preterm delivery the most frequently observed (16.7%) followed by fetal distress (9.77%). The most commonly reported adverse neonatal outcomes included respiratory symptoms (7.95%) and low birth weight (6.81%). A few studies reported other maternal comorbidities that can influence these outcomes. Mothers with other comorbidities may be at higher risk of infection. Mother-to-child transmission of SARS-CoV-2 appears unlikely, with no study observing intrauterine transmission, and a few cases of neonatal infection reported a few hours after birth. Although the WHO and other health authorities have published interim recommendations for care and management of pregnant women and infants during COVID-19 pandemic, many questions remain open. Pregnant women should be considered in prevention and control efforts, including the development of drugs and vaccines against SARS-CoV-2. Further research is needed to confirm the exact impact of COVID-19 infection during pregnancy. To fully quantify this impact, we urgently need to integrate the current knowledge about viral characteristics, epidemiology, disease immunopathology, and potential therapeutic strategies with data from the clinical practice.

scholarly journals A Case Series of Third-Trimester Raltegravir Initiation: Impact on Maternal HIV-1 Viral Load and Obstetrical Outcomes

2015 ◽  
Vol 26 (3) ◽  
pp. 145-150 ◽  
Author(s):  
I Boucoiran ◽  
K Tulloch ◽  
N Pick ◽  
F Kakkar ◽  
J van Schalkwyk ◽  
...  
Keyword(s):  
Viral Load ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Case Series ◽  
Perinatal Transmission ◽  
University Hospital ◽  
Perinatal Hiv ◽  
The Impact ◽  
Hiv 1 ◽  
In Pregnancy

OBJECTIVE: To describe the impact of initiating raltegravir (RAL)-containing combination antiretroviral therapy (cART) regimens on HIV viral load (VL) in pregnant women who have high or suboptimal VL suppression late in pregnancy.METHODS: HIV-infected pregnant women who started RAL-containing cART after 28 weeks’ gestation from 2007 to 2013 were identified in two university hospital centres.RESULTS AND DISCUSSION: Eleven HIV-infected women started RAL at a median gestational age of 35.7 weeks (range 31.1 to 38.0 weeks). Indications for RAL initiation were late presentation in pregnancy (n=4) and suboptimal VL suppression secondary to poor adherence or viral resistance (n=7). Mean VL at the time of RAL initiation was 73,959 copies/mL (range <40 to 523,975 copies/mL). Patients received RAL for a median of 20 days (range one to 71 days). The mean decline in VL from the time of RAL initiation to delivery was 1.93 log, excluding one patient who received only one RAL dose and one patient with undetectable VL at the time of RAL initiation. After eight days on RAL, 50% of the women achieved a VL <1000 copies/mL (the threshold for recommended Caesarean section to reduce the risk for perinatal transmission). There were no cases of perinatal HIV transmission.CONCLUSION: The present study provides preliminary data to support the use of RAL-containing cART to expedite HIV-1 VL reduction in women who have a high VL or suboptimal VL suppression late in pregnancy, and to decrease the risk of HIV perinatal transmission while avoiding Caesarean section. Further assessment of RAL safety during pregnancy is warranted.

scholarly journals Uncharted waters: mesenchymal stem cell treatment for pediatric refractory rheumatic diseases; a single center case series

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Stephen C. Wong ◽  
Leah C. Medrano ◽  
Alice D. Hoftman ◽  
Olcay Y. Jones ◽  
Deborah K. McCurdy
Keyword(s):  
Stem Cells ◽  
Clinical Trials ◽  
Adverse Events ◽  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Tertiary Care ◽  
Case Series ◽  
Janus Kinase ◽  
Adjunctive Treatment ◽  
Infusion Therapy

Abstract Background With the advent of innovative therapies including biologics and Janus kinase inhibitors, children with rheumatic diseases are more likely to have improved outcomes. Despite these advances, some children do not respond, or they, or their parents fear adverse events and seek other alternatives. Increasingly, private companies are offering mesenchymal stem cells (MSC) as an alternative, which are described as natural therapies for rheumatic diseases, often insinuating them as a cure. MSC have immunomodulatory properties, and transplantation of these stem cells have been used to successfully treat immunologic conditions like graft-versus-host disease. Lately, MSC research in adult lupus has been encouraging, but the clinical trials are still underway and in most, MSC therapy is not a standalone treatment. This retrospective case series will highlight three cases of pediatric refractory autoimmune disease whose parents sought out and received MSC therapy as a self-decision without first seeking medical advice from our specialty. The three families felt that their children were improved and in two believed that their child was cured. MSC have the potential of beneficial immunomodulation and may be a powerful tool in the therapy of rheumatic disease, but well controlled clinical trials are necessary and should be designed and monitored by experts in childhood rheumatic disease. Case presentation Three children with three different rheumatic diseases; systemic lupus erythematosus, mixed connective tissue disease and juvenile idiopathic arthritis were under the care of pediatric rheumatology at a large, tertiary-care, teaching institution. Multiple non-biologic and biologic disease-modifying anti-rheumatic drugs failed to significantly decrease disease activity, and as a result, the families chose to undergo MSC therapy. After transplantation, all children improved per patient and parent report and tapered off conventional immunosuppressive drugs. No serious adverse events occurred in these three patients. Conclusion The three cases presented in this report reflect comparable beneficial outcomes and minimal risks published in adult studies. These were not controlled studies, however, and benefit was reported rather than documented. These cases suggest that MSC transplantation may prove a promising adjunctive treatment option; however, further research, development of standardized infusion therapy protocols, and well-designed monitored clinical trials are essential.

scholarly journals Uncharted waters: Mesenchymal stem cell Treatment for Pediatric Refractory Rheumatic Diseases; A Single Center Case Series

2021 ◽  
Author(s):  
Stephen Chee-Yung Wong ◽  
Leah C Medrano ◽  
Alice D Hoftman ◽  
Olcay Y Jones ◽  
Deborah K McCurdy
Keyword(s):  
Stem Cells ◽  
Clinical Trials ◽  
Mesenchymal Stem Cells ◽  
Stem Cell ◽  
Mesenchymal Stem Cell ◽  
Adverse Events ◽  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Case Series ◽  
Janus Kinase

Abstract Background:With the advent of innovative therapies including biologics and Janus kinase inhibitors, children with rheumatic diseases are more likely to have improved outcomes. Yet, despite these advances, some children do not respond, or they, or their parents fear adverse events and seek other alternatives. Increasingly, there are private companies that offer mesenchymal stem cells (MSC) as an alternative and describe it as a more natural therapy for rheumatic diseases, often insinuating that there will be a cure. Mesenchymal stem cells have immunomodulatory properties, and transplantation of these stem cells have been used to successfully treat immunologic conditions like graft-versus-host disease. More recently, MSC research in adults with lupus has been encouraging, but the clinical trials are still underway and in most, mesenchymal stem cell therapy is not a standalone treatment. This retrospective case series will highlight three cases of children with refractory autoimmune disease whose parents sought out and received MSC therapy as a self-decision without first seeking medical advice from our specialty. In our cases, the three families felt that their children were improved and in two believed that their child was cured. Mesenchymal stem cells have the potential of beneficial immunomodulation and may be a powerful tool in the therapy of rheumatic disease, but well controlled clinical trials are necessary and should be designed and monitored by experts in childhood rheumatic disease. Case Presentation:Three children with three different rheumatic diseases; systemic lupus erythematosus, mixed connective tissue disease and juvenile idiopathic arthritis were under the care of pediatric rheumatology at a large, tertiary-care, teaching institution. Multiple non-biologic and biologic disease-modifying anti-rheumatic drugs failed to significantly decrease disease activity, and as a result, the families chose to undergo MSC therapy. After transplantation, all children improved per patient and parent report and tapered off conventional immunosuppressive drugs. No serious adverse events occurred in these three patients. Conclusion:The three cases presented in this study reflect comparable beneficial outcomes and minimal risks published in adult studies. These were not controlled studies, however, and benefit was reported rather than documented. These cases suggest that MSC transplantation may prove a promising adjunctive treatment option; however, further research, development of standardized infusion therapy protocols, and well-designed and monitored clinical trials are essential.

scholarly journals Epidemiological characteristics and outcomes of SARS-CoV-2 infection in patients with rheumatic diseases: first report from the Argentine SAR-COVID registry

2021 ◽  
pp. 7-15
Author(s):  
Carolina A. Isnardi ◽  
Gimena Gómez ◽  
Rosana Quintana ◽  
Karen Roberts ◽  
Guillermo Berbotto ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Latin American ◽  
Rheumatic Diseases ◽  
Clinical Characteristics ◽  
Wide Distribution ◽  
National Registry ◽  
Immunomodulatory Treatment ◽  
First Report ◽  
Epidemiological Characteristics ◽  
The Impact

In order to assess the impact of SARS-CoV-2 infection in patients with rheumatic diseases, the Argentine Society of Rheumatology has developed the National Registry of Patients with Rheumatic Diseases and COVID-19 (SAR-COVID). The aim of this study was to evaluate the sociodemographic and clinical characteristics of patients with rheumatic diseases and SARS-CoV-2 infection included in the SAR-COVID registry and to describe the complications and outcomes of COVID-19 in this population. Methods: SAR-COVID is a national, multicenter and observational registry, in which patients ≥18 years of age, with a diagnosis of a rheumatic disease who had SARS-CoV-2 infection are consecutively included. Sociodemographic data, comorbidities, underlying rheumatic disease and treatment, clinical characteristics, complications, laboratory and treatment of the SARS-CoV-2 infection were recorded. Results: a total of 525 patients were included, with a mean age of 51.3 years (SD 15.2). The most frequent rheumatic diseases were rheumatoid arthritis (40.4%), systemic lupus erythematous (14.9%) and spondyloarthritis (8.2%). At the time of the infection, 72.9% were receiving immunosuppressive or immunomodulatory treatment and 36.9% glucocorticoids. Most of the patients were diagnosed using RT-PCR (95%), at outpatient consultation (39.4%), at the emergency room (32.2%) or during hospitalization (14.7%). Symptoms were present in 96% of the patients, the most frequent being fever (56.2%), cough (46.7%) and headache (39.2%). During infection, 35.1% were hospitalized, 11.6% were admitted to the ICU and 6.9% died due to COVID-19. Most of them (75.1%) recovered completely. Conclusions: in this first report of the SAR-COVID registry we found a wide distribution of rheumatic diseases. Most of the patients had a good evolution of the infection, however 7% died as a result of it, comparable to other Latin American registries with similar populations.

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