Intravenous Immunoglobulin as a Therapeutic Option for Mycoplasma pneumoniae Encephalitis

Objective: To analyze the outcomes of a cohort of children diagnosed with Mycoplasma pneumoniae encephalitis whose treatment regimens included intravenous immunoglobulin (IVIG). Methods: A retrospective study was performed at a single center between 2011 and 2016 of children diagnosed with Mycoplasma pneumoniae encephalitis whose acute treatment regimen included IVIG. Details of therapeutic interventions and the clinical course were retrieved from medical records via an institutionally approved protocol. The modified Rankin score was used to quantify outcomes. Results: Four children met inclusion criteria, 3 of whom had prodromal symptoms of infection lasting 5 to 7 days before onset of their neurologic symptoms. One patient presented with neurologic symptoms with no clinical prodrome. The initial treatment regimen included systemic corticosteroids, antibiotics, or both. IVIG was administered for a total dose of 2 g/kg divided over 2 to 4 days to all 4 children. All children showed clinical improvement after IVIG. The 3 children with prodromal symptoms showed immediate and dramatic clinical improvement after IVIG therapy. Discussion: The immediate response to immunomodulatory therapy in the patients with prodrome suggests that the neurologic syndrome may be caused at least in part by an autoimmune process. The child who did not respond to IVIG had no prodrome, and also had normal electroencephalographic (EEG) and brain magnetic resonance imaging (MRI) findings. These cases suggest that early administration of IVIG should be considered in patients suspected of having Mycoplasma encephalitis, particularly in those who have had prodromal symptoms.

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Treatment of Mycoplasma pneumoniae-Induced Rash and Mucositis With Cyclosporine

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475419874444 ◽

2019 ◽

Vol 23 (6) ◽

pp. 608-612 ◽

Cited By ~ 2

Author(s):

Heidi Oi-Yee Li ◽

Sophia Colantonio ◽

Michele L. Ramien

Keyword(s):

Mycoplasma Pneumoniae ◽

Pediatric Patients ◽

Therapeutic Option ◽

Case Series ◽

Supportive Therapy ◽

Standards Of Care ◽

Prodromal Symptoms ◽

Potential Efficacy ◽

Effective Therapeutic Option ◽

Evidence Based Guidelines

Background Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a relatively newly recognized clinical entity that typically presents with predominant mucositis accompanied by variable cutaneous involvement 7-9 days after the onset of prodromal symptoms. There are no evidence-based guidelines for treatment, and current standards of care may include supportive therapy, antibiotics, corticosteroids, and intravenous immunoglobulin . Objective This case series aims to describe the potential efficacy of cyclosporine A (CsA) in the treatment of MIRM. Methods The present case series details our use of CsA early in the course of MIRM in 3 pediatric patients. Results Rapid clinical resolution was observed following CsA therapy. Conclusions We suggest that early initiation of CsA may be an effective therapeutic option for MIRM.

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Evaluation of Brain Magnetic Resonance Imaging (MRI) Findings of Neonates with Clinical Seizure Admitted to Yazd Shahid Sadoughi Hospital and its Effect on Diagnostic and Therapeutic Interventions of Newborns from 2015-2016

Journal of Shahid Sadoughi University of Medical Sciences ◽

10.18502/ssu.v28i9.4777 ◽

2020 ◽

Author(s):

Razieh Fallah ◽

Mohammad Javad Asadi ◽

Reza Nafisi Moghadam ◽

Mohammad Hossein Ahrar Yazdi

Keyword(s):

Magnetic Resonance Imaging ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Common Type ◽

Therapeutic Interventions ◽

Resonance Imaging ◽

Mri Findings ◽

Clinical Seizure ◽

Magnetic Resonance Imaging Mri ◽

Abnormal Brain

Introduction: In neonatal period, brain magnetic resonance imaging (MRI) is the best neuroimaging to find etiology of seizure. The aim of this study was to evaluate brain MRI findings of neonates with clinical seizure and its effect on diagnostic and therapeutic interventions of newborn. Methods: In a retrospective study, medical records and brain MRI findings of neonates with clinical seizure admitted to Neonatal Intensive Care Unit or Pediatric Ward of Shahid Sadoughi Hospital, Yazd, Iran from September 2018 and before were evaluated. The data were analyzed using SPSS version 16 software , the required indicators and tables were prepared and Fisher exact test and Chi-square test were used to determine the relationship between qualitative variables and independent t-test was used to compare the means in the two groups Results: Twenty-five girls and 38 boys were studied. The cause of seizures was found in 94% and the most common cause of congenital hypoxia was in 22 infants (35%). The most common type of seizure was tonic in 23 infants (36.5%) and the most common type of generalized seizure was in 47 infants (75%). Brain MRI was abnormal in 19 neonates (30%). Based on the MRI results, there was a change in therapeutic interventions (brain surgery) in four infants (6.3%) and in diagnostic interventions (metabolic tests) in 19 infants (30%). Abnormal brain MRI was more frequent in neonates by cesarean section (46%) than normal vaginal delivery (19%), (p= 0.01) and also neonates with partial seizure (37.5%) had an abnormal MRI than generalized seizure (21%), (p= 0.03). Mean of hospitalization days was longer in neonates with abnormal brain MRI (12.32±2.76 days) than neonates with normal MRI (8.57±2.82 days) (P = 0.02). Conclusion: Based on the results of this study, brain MRI might be useful in finding intracranial pathology that causes seizure in neonates by cesarean section to detect birth asphyxia and in newborns with partial seizure.

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Tocilizumab Improves the Prognosis of COVID-19 in Patients with High IL-6

Journal of Clinical Medicine ◽

10.3390/jcm10081583 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1583

Author(s):

Robert Flisiak ◽

Jerzy Jaroszewicz ◽

Magdalena Rogalska ◽

Tadeusz Łapiński ◽

Aleksandra Berkan-Kawińska ◽

...

Keyword(s):

Monoclonal Antibody ◽

Mechanical Ventilation ◽

Confidence Interval ◽

Clinical Improvement ◽

Interleukin 6 ◽

Death Rate ◽

Treatment Effectiveness ◽

Therapeutic Option ◽

Oxygen Supplementation ◽

End Points

Despite direct viral effect, the pathogenesis of coronavirus disease 2019 (COVID-19) includes an overproduction of cytokines including interleukin 6 (IL-6). Therefore, tocilizumab (TOC), a monoclonal antibody against IL-6 receptors, was considered as a possible therapeutic option. Patients were selected from the SARSTer database, containing 2332 individuals with COVID-19. Current study included 825 adult patients with moderate to severe course. Analysis was performed in 170 patients treated with TOC and 655 with an alternative medication. The end-points of treatment effectiveness were death rate, need for mechanical ventilation, and clinical improvement. Patients treated with TOC were balanced compared to non-TOC regarding gender, age, BMI, and prevalence of coexisting conditions. Significant effect of TOC on death was demonstrated in patients with baseline IL-6 > 100 pg/mL (hazard ratio [HR]: 0.21, 95% confidence interval [CI]: 0.08–0.57). The best effectiveness of TOC was achieved in patients with a combination of baseline IL-6 > 100 pg/mL and either SpO2 ≤ 90% (HR: 0.07) or requiring oxygen supplementation (HR: 0.18). Tocilizumab administration in COVID-19 reduces mortality and speeds up clinical improvement in patients with a baseline concentration of IL-6 > 100 pg/mL, particularly if they need oxygen supplementation owing to the lower value of SpO2 ≤ 90%.

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Epilepsy in Propionic Acidemia: Case Series of 14 Saudi Patients

Journal of Child Neurology ◽

10.1177/0883073818786157 ◽

2018 ◽

Vol 33 (11) ◽

pp. 713-717 ◽

Cited By ~ 1

Author(s):

Afnan AlGhamdi ◽

Muhammad Talal Alrifai ◽

Abdullah I. Al Hammad ◽

Fuad Al Mutairi ◽

Abdulrahman Alswaid ◽

...

Keyword(s):

Autosomal Recessive ◽

Case Series ◽

Brain Magnetic Resonance Imaging ◽

Propionic Acidemia ◽

Resonance Imaging ◽

Mri Findings ◽

Epileptiform Discharges ◽

Magnetic Resonance Imaging Mri ◽

Autosomal Recessive Manner ◽

Delayed Myelination

Propionic acidemia is an inborn error of metabolism that is inherited in an autosomal recessive manner. It is characterized by a deficient propionyl-CoA carboxylase due to mutations in either of its beta or alpha subunits. In the literature, there is a clear association between propionic acidemia and epilepsy. In this cohort, we retrospectively reviewed the data of 14 propionic acidemia patients in Saudi Arabia and compared the findings to those of former studies. Six of the 14 (43%) patients developed epileptic seizure, mainly focal seizures. All patients were responsive to conventional antiepileptic drugs as their seizures are controlled. The predominant electroencephalographic (EEG) findings were diffuse slowing in 43% and multifocal epileptiform discharges in 14% of the patients. In 1 patient, burst suppression pattern was detected, a pattern never before reported in patients with propionic acidemia. Brain magnetic resonance imaging (MRI) findings mainly consisted of signal changes of the basal ganglia (36%), generalized brain atrophy (43%), and delayed myelination (43%).The most common genotype in our series is the homozygous missense mutation in the PCCA gene (c.425G>A; p. Gly142Asp). However, there is no clear genotype–seizure correlation. We conclude that seizure is not an uncommon finding in patients with propionic acidemia and not difficult to control. Additional studies are needed to further elaborate on genotype–seizure correlation.

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Characteristic Brain Magnetic Resonance Imaging (MRI) Findings in Neonates With Tuberous Sclerosis Complex

Journal of Child Neurology ◽

10.1177/08830738060210042301 ◽

2006 ◽

Vol 21 (4) ◽

pp. 280-285 ◽

Cited By ~ 10

Author(s):

Gemma Arca ◽

Esperanza Pacheco ◽

Israel Alfonso ◽

Michael S. Duchowny ◽

Steven J. Melnick

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Tuberous Sclerosis ◽

Tuberous Sclerosis Complex ◽

Brain Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Mri Findings ◽

Magnetic Resonance Imaging Mri

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Superficial siderosis: Case report and literature review

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1304219k ◽

2013 ◽

Vol 141 (3-4) ◽

pp. 219-222

Author(s):

Nikola Kresojevic ◽

Igor Petrovic ◽

Natasa DragasevicMiskovic ◽

Vladimir Kostic

Keyword(s):

Spinal Cord ◽

Hearing Loss ◽

Mr Imaging ◽

Brain Mri ◽

Therapeutic Interventions ◽

Superficial Siderosis ◽

Mri Findings ◽

Hand Tremor ◽

Hemosiderin Deposition ◽

Clinical Triad

Introduction. Superficial siderosis (SS) is caused by chronic subarachnoid bleeding and is characterized by free iron and hemosiderin deposition along the pial and subpial structures of central nervous system. SS leads to progressive and irreversible CNS damage. The most common causes of chronic subarachnoidal bleeding are tumors, head and spinal cord trauma, arteriovenous malformations and aneurysms. SS is characterized by clinical triad: sensorineural hearing loss, cerebellar ataxia and piramydal signs. Brain MR imaging is the investigation of choice for the diagnosis of SS. Typical findings include hypointensities seen on T2?weighted MR imaging around the brain, cerebellum, brain stem, spinal cord, VIII cranial nerve and atrophy of cerebellum and medulla. Case Outline. A 71-year?old female patient noticed hand tremor in the middle of the third decade of life, and later slowly progressive bilateral hearing loss. At the age of 64 she developed un? steady gate, hand clumsiness and dysarthria, to became incapable of independent walking and standing five years later. Clinical course and brain MRI findings were typical for SS, but additional investigation did not reveal the couse of subarahnoidal bleeding. Conclusion. SS represents a rare and under?recognized condition that must be considered in all patients with cerebellar syndrome of unknown cause. Early diagnosis of SS in some cases with identified cause of chronic bleeding allowes therapeutic interventions that may prevent further progression of the disease.

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The characteristics of prodromal symptoms in the development of the psychotic disorder

European Psychiatry ◽

10.1016/s0924-9338(11)73128-5 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1423-1423

Author(s):

J.S. Kostic ◽

L. Milosavljevic ◽

M. Stankovic

Keyword(s):

Early Detection ◽

Sleep Disorder ◽

Attention Deficit ◽

Clinical Picture ◽

Attention Deficit Disorder ◽

Psychotic Disorders ◽

Social Withdrawal ◽

Therapeutic Interventions ◽

Prodromal Stage ◽

Prodromal Symptoms

ObjectivesIn most cases, prodromal changes in behavior, lasting from several days to several years, often precede psychotic disorders and indicate the beginning of psychosis. Prodromal symptoms are nonspecific, making an accurate detection difficult. It is typical that the earlier stadium of the appearance of the disorder, the more insidious the prodromal stage is.MethodRetrospectively, authors analyzed periods of nonspecific symptoms in ten patients, aged 16 to 20 years, who developed a clinical picture of psychosis.ResultsThe most frequent prodromal symptoms in our research were anxiety, irritability and sleep disorder, which were followed by the attention deficit disorder, a sense of confusion and difficulty in dealing with the environment, accompanied by social withdrawal.ConclusionAuthors pay attention to the cognition and early detection of prodromal symptoms, which gives the opportunity for earlier therapeutic interventions in the course of the disorder and the possibility for a better outcome and prognosis of the disorder.

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THALLIUM POISONING

PEDIATRICS ◽

10.1542/peds.22.6.1170 ◽

1958 ◽

Vol 22 (6) ◽

pp. 1170-1182

Author(s):

Philip H. Chamberlain ◽

William B. Stavinoha ◽

Helen Davis ◽

William T. Kniker ◽

Theodore C. Panos

Keyword(s):

Urinary Excretion ◽

Clinical Improvement ◽

Clinical Picture ◽

Urine Volume ◽

Acute Onset ◽

Neurologic Symptoms ◽

Thallium Poisoning ◽

High Degree

Fourteen children with thallium poisoning are described. Alopecia and neurologic symptoms dominate the clinical picture. In the absence of alopecia, the diagnosis depends upon a high degree of suspicion in regard to any child presenting bizarre neurologic complaints with acute onset. The best means of confirming a diagnosis of thallotoxicosis is by finding thallium in the urine. Dithizon appeared to be beneficial treatment in five of six severely ill patients. Further cautious trials of this drug are indicated. On the basis of the few patients studied, it appears that increased urinary excretion of thallium is not correlated with urine volume, clinical improvement or the use of dithizon.

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