Varicella and Stroke in Children

Varicella zoster virus (VZV) is the only human virus known to replicate in arteries. After the acute infection, the virus persists in a noninfectious latent form in ganglia along the neuraxis, with intermittent periods of reactivation. Both primary and secondary reactivation are associated with stroke in children. These patients, regardless of the chosen treatment, have a high risk of recurrence, particularly those with worsening arterial stenosis. There are no specific therapy protocols for varicella-associated stroke in children, and the use of steroids or antiviral drugs is still controversial. We present a series of 4 children with stroke following varicella infection, with no recurrence and stable vascular stenosis at a mean follow-up of 18 months without steroid treatment. We also analyze possible correlations between anti-protein C, protein S and protein Z autoantibodies, and post-varicella arteriopathy.

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Varicella-zoster immunoglobulin treatment in pregnant women in Denmark from 2005 to 2015: descriptive epidemiology and follow-up

Epidemiology and Infection ◽

10.1017/s0950268816001485 ◽

2016 ◽

Vol 144 (16) ◽

pp. 3426-3434 ◽

Cited By ~ 4

Author(s):

C. JESPERSEN ◽

I. G. HELMUTH ◽

T. G. KRAUSE

Keyword(s):

Pregnant Women ◽

Severe Infection ◽

Varicella Infection ◽

Varicella Zoster ◽

Additional Information ◽

Immunoglobulin Treatment ◽

Exposure During Pregnancy ◽

Selective Vaccination ◽

Seronegative Woman

SUMMARYPrimary infection with varicella-zoster virus in pregnancy poses a risk of severe infection and embryopathies. Upon exposure, seronegative women are candidates for varicella-zoster immunoglobulin (VZIG). The aim of this paper was to describe risk factors for VZIG treatment including sources of varicella exposure and to study how many women developed clinical infection and received postpartum vaccination. We identified all pregnant women who received VZIG from December 2005 to March 2015. Additional information was obtained from Danish registers and a follow-up questionnaire. A total of 104 women were included and 88 completed the questionnaire. Significantly more women had ‘other country of origin’ than Denmark. They were more often second para (57%) and had most commonly been exposed to varicella by their own child (58%). Five women developed clinical varicella infection, and only 26·5% were vaccinated after delivery. The study concludes that few women developed infection after VZIG and none developed pneumonia. General practitioners should be particularly aware of obtaining varicella anamnesis in parous women from non-temperate countries in order to perform selective vaccination prior to pregnancy. In case of varicella exposure during pregnancy in a seronegative woman, postpartum vaccination is crucial.

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Changes in Haematological Indices, Blood Viscosity and Inhibitors of Coagulation during Treatment of Endometriosis with Danazol

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648842 ◽

1994 ◽

Vol 72 (02) ◽

pp. 218-221 ◽

Cited By ~ 7

Author(s):

I Ford ◽

C Li ◽

I D Cooke ◽

F E Preston

Keyword(s):

Blood Viscosity ◽

Protein S ◽

C Protein ◽

Protein Levels ◽

Normal Limits ◽

Menopausal Women ◽

Coagulation Inhibitors ◽

Red Cell Count ◽

Pre Treatment

SummaryThe effects of treatment with danazol (600 mg daily) on haemostatic and haematological function were investigated in 18 pre-menopausal women with endometriosis. Blood samples were taken at 2 pre-treatment visits, at 6, 12 and 24 weeks on treatment, and at 6 weeks after discontinuation of the drug. Haemoglobin, red cell count, haematocrit and platelet count all rose significantly during treatment with danazol (p <0.01 vs. baseline). Plasma fibrinogen levels fell significantly (p <0.01), while whole blood viscosity increased during treatment and remained significantly elevated at follow-up. The prothrombin time shortened, but remained within normal limits, and there were no significant changes in factor VII:C, Vila, or fibrinopeptide A. No significant changes were found in platelet function. Plasma B-beta 15-42 increased significantly. Functional levels of protein C, protein S, and antithrombin III, all rose significantly, above the normal range, while C4b-binding protein levels fell. We conclude that the observed changes in coagulation inhibitors and fibrinolytic activity may be considered beneficial in the context of venous thromboembolism. The rheological effects, however, indicate a degree of caution in the use of the drug in individuals considered to be at risk from arterial cardiovascular disease.

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Naturally Occurring Anticoagulants and Their Association With Thromboembolism In Patients With β-Thalassemia Major

Blood ◽

10.1182/blood.v122.21.4792.4792 ◽

2013 ◽

Vol 122 (21) ◽

pp. 4792-4792

Author(s):

Sadia Sultan ◽

Syed Mohammed Irfan ◽

Rozina Zeeshan

Keyword(s):

Protein C ◽

Complete Blood Count ◽

Conflicts Of Interest ◽

Protein S ◽

Thrombotic Risk ◽

C Protein ◽

Positive Correlation ◽

The Mean ◽

And Control

Introduction Hypercoagulopathy and thromboembolic manifestations are being increasing acknowledged in transfusion dependent thalassemics; both intermedia and major. Studies in preceding decade have shown that hemostatic alterations including natural anticoagulant deficiency obligate thalassemic for thromboembolism. The aim of our study is to determine the status of natural anticoagulants and their association with thromboembolism during follow up. Method This is a prospective case-control study, during which 40 cases and 30 controls were registered between Jan 2009 to Dec 2009. Complete blood count, protein C, protein S, antithrombin, serum ferritin, liver function test; HbsAg and Anti HCV were determined. Patients were followed till 30th June 2012 for thromboembolic disease. Data was entered and analyzed using SPSS version 17. The results were expressed as mean ± SD for quantitative variables and qualitative variables are presented as frequency & percentages. Student‘t’ test was applied for the comparison of means. We also computed spearman correlation at 5% level of significance to identify relationship between the deficiency of natural anticoagulants with maternal characteristics, hematological parameters and biochemical markers. Chi- square test was applied for correlation of prothrombotic markers with hepatitis B & C. Results The mean age of patients and control was 12.30±5.5 and 13.39±4.5 years respectively. There were 21 males and 19 females in patient group. The mean protein C, protein S and antithrombin in patients and control were 58.25±22.5 versus 110.67±22.60 (P<0.001), 67.90±19.58 versus 98.70±21.54 and 89.73±18.09 versus 104.0±10.98 (P<0.001) respectively. Protein C was exceedingly deficient in 65% followed by protein S & antithrombin in 35% and 20% respectively. Protein S deficiency revealed positive correlation with protein C deficiency and hemoglobin ≤ 8 gm% was correlated with antithrombin deficiency(P<0.05). No positive correlation of prothrombotic markers were established with others parameters evaluated. Till June 2012, 7 patients were lost to follow up and 2 died owing to cardiac failure. Of the 31 patients in regular follow up none has experienced thromboembolism both clinically and radiologically. Conclusion Decremented prothrombotic markers, primarily protein C, are implicated in elevated thrombotic risk in TM patients. However we did not encounter thromboembolism in our patients during follow up. We recommend prothrombotic screening and prophylactic anticoagulation in high risk group: bed bound splenectomized, cardiopulmonary complications and post operative. Disclosures: No relevant conflicts of interest to declare.

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Use of Prothrombin Complex Concentrates for Prophylaxis and Treatment of Bleeding Episodes in Patients with Hereditary Deficiency of Prothrombin, Factor VII, Factor X, Protein C, Protein S, or Protein Z

Thrombosis Research ◽

10.1016/s0049-3848(99)00083-3 ◽

1999 ◽

Vol 95 (4) ◽

pp. S39-S50 ◽

Cited By ~ 21

Author(s):

Eckhard Lechler

Keyword(s):

Protein C ◽

Protein S ◽

Factor Vii ◽

Factor X ◽

Prothrombin Complex Concentrates ◽

X Protein ◽

Protein Z ◽

C Protein ◽

Bleeding Episodes

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Sagittal sinus thrombosis secondary to varicella infection-a case report

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20175193 ◽

2017 ◽

Vol 4 (6) ◽

pp. 1693 ◽

Cited By ~ 1

Author(s):

Gurinder Mohan ◽

Harharpreet Kaur ◽

Navjot Kaur

Keyword(s):

Sinus Thrombosis ◽

Pediatric Population ◽

Protein S ◽

Neurological Complications ◽

Endothelial Damage ◽

Varicella Infection ◽

Vascular Events ◽

Varicella Zoster ◽

Sagittal Sinus ◽

Sagittal Sinus Thrombosis

Varicella zoster virus (VZV) is known to produce a benign self-limiting exanthematous illness in the pediatric population. The neurological complications which are seen in less than 1% cases include cerebellitis and encephalitis. Stroke due to arterial vasculitis is well known but cerebral venous sinus thrombosis following varicella infection is rarely reported. We present a case of sagittal sinus thrombosis subsequent to varicella infection. The mechanisms underlying cerebral vascular events after VZV infection could be vasculitis, thrombosis due to direct endothelial damage and acquired protein S deficiency.

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NEONATAL STROKE DUE TO VARICELLA ARTERIOPATHY

Romanian Journal of Neurology ◽

10.37897/rjn.2015.4.8 ◽

2015 ◽

Vol 14 (4) ◽

pp. 235-237

Author(s):

N.S. Sampath Kumar ◽

◽

V. Umamaheswara Reddy ◽

Agrawal Amit ◽

V. Ganesh ◽

...

Keyword(s):

Laboratory Data ◽

Cerebral Haemorrhage ◽

Arterial Disease ◽

Varicella Infection ◽

Varicella Zoster ◽

Neurologic Sequelae ◽

The Common ◽

Peripheral Arterial ◽

Varicella Zoster Infection

Varicella zoster is one of the common infective etiological factors known to produce arteriopathy of cerebral vasculature. Varicella zoster infection spreads transaxonally first to the adventitia and later transmurally to intima. Primary infection or reactivation of varicella zoster, both are associated with involvement of cerebral vessels of large as well as of small calibre varicella zoster associated arteriopathy was reported up to 12 months after the infection. Recurrence of strokes are seen post varicella infection. Hence the identification of varicella zoster as an etiological agent of ischemic stroke in neonatal age group patients is necessary and requires follow-up. Other neurologic sequelae following varicella infection are aneurysm formation leading to subarachnoid and cerebral haemorrhage, carotid dissection and rarely peripheral arterial disease. Due to lack of adequate epidemiological, neuroimaging and laboratory data, guidelines for treatment of varicella ateriopathy are not clear.

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Anti-Ige (Omalizumab) Improved Trombotic Emboli by Elevating Activated Protein C, Protein S, and Antithrombin III in a Case of Prothrombin G20210A Mutation: Long Term Follow-Up

Journal of Genetic Disorders & Genetic Reports ◽

10.4172/2327-5790.1000129 ◽

2016 ◽

Vol 05 (01) ◽

Author(s):

Arzu Didem Yalcin ◽

Betul Celik

Keyword(s):

Protein C ◽

Antithrombin Iii ◽

Activated Protein C ◽

Protein S ◽

Prothrombin G20210a ◽

C Protein ◽

G20210a Mutation ◽

Long Term Follow Up

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Laboratory Identification of Familial Thrombophilia: Do the Pitfalls Exceed the Benefits? A Reassessment of ABO-Blood Group, Gender,Age, and other Laboratory Parameters on the Potential Influence on a Diagnosis of Protein C, Protein S, and Antithromb

Laboratory Hematology ◽

10.1532/lh96.05029 ◽

2005 ◽

Vol 11 (3) ◽

pp. 174-184 ◽

Cited By ~ 11

Author(s):

EMMANUEL J. FAVALORO ◽

SOMA SOLTANI ◽

JANE MCDONALD ◽

ELLA GREZCHNIK ◽

LEANNE EASTON

Keyword(s):

Blood Group ◽

Protein C ◽

Protein S ◽

Abo Blood Group ◽

Potential Influence ◽

C Protein ◽

Laboratory Parameters

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Reduced Flow-Mediated Dilatation Is Not Related to COVID-19 Severity Three Months after Hospitalization for SARS-CoV-2 Infection

Journal of Clinical Medicine ◽

10.3390/jcm10061318 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1318

Author(s):

Marianne Riou ◽

Walid Oulehri ◽

Cedric Momas ◽

Olivier Rouyer ◽

Fabienne Lebourg ◽

...

Keyword(s):

Vascular Endothelium ◽

Matched Control ◽

Acute Infection ◽

Critical Role ◽

Lung Damage ◽

Vascular Effect ◽

Flow Mediated Dilatation ◽

Artery Flow

The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly worldwide, with more than two million deaths. Evidence indicates the critical role of the vascular endothelium in its pathophysiology but, like potential changes in functional vasodilation, the vascular effect of SARS-CoV-2 at a given distance from the acute infection is largely unknown. We assessed brachial artery flow-mediated dilatation (FMD) in 27 COVID-19 patients needing conventional or intensive care unit hospitalization, three months after SARS-CoV-2 infection diagnosis and in nine age- and sex- matched control subjects. Interestingly, the FMD was lower in COVID-19 patients as compared to controls (8.2 (7.2–8.9) vs. 10.3 (9.1–11.7)); p = 0.002, and half of the hospitalized COVID-19 survivors presented with a reduced FMD < 8% at three months of COVID-19 onset. Impaired FMD was not associated with severe or critical SARS-CoV-2 infection, reflected by ICU hospitalization, total hospitalization duration, or severity of lung damage. In conclusion, reduced FMD is often observed even three months after hospitalization for SARS-CoV-2 infection, but such alteration predominantly appears to not be related to COVID-19 severity. Longer and larger follow-up studies will help to clarify the potential prognosis value of FMD among COVID-19 patients, as well as to further determine the mechanisms involved.

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