scholarly journals New-onset seizure in HIV-infected adult Zambians

Neurology ◽  
2016 ◽  
Vol 88 (5) ◽  
pp. 477-482 ◽  
Author(s):  
Omar K. Siddiqi ◽  
Melissa A. Elafros ◽  
Christopher M. Bositis ◽  
Igor J. Koralnik ◽  
William H. Theodore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Opportunistic Infections ◽  
Clinical Laboratory ◽  
Jc Virus ◽  
Seizure Recurrence ◽  
Onset Seizure ◽  
Karnofsky Score ◽  
Varicella Zoster ◽  
Identifiable Risk Factor ◽  
New Onset

Objective:To identify the etiology of new-onset seizure in HIV-infected Zambian adults and identify risk factors for seizure recurrence.Methods:A prospective cohort study enrolling HIV-infected adults with new-onset seizure within 2 weeks of index seizure obtained clinical, laboratory, and neuroimaging data to determine seizure etiology. Participants were followed to identify risk factors for seizure recurrence. Risk factors for mortality were examined as mortality rates were unexpectedly high.Results:Eighty-one patients with CSF for analysis were enrolled and followed for a median of 306 days (interquartile range 61–636). Most (91%) were at WHO stage III/IV and 66 (81%) had a pre-seizure Karnofsky score ≥50. Prolonged or multiple seizures occurred in 46 (57%), including 12 (15%) with status epilepticus. Seizure etiologies included CNS opportunistic infections (OI) in 21 (26%), hyponatremia in 23 (28%), and other infections in 8 (10%). OIs included Cryptococcus (17%), JC virus (7%) and 5% each for tuberculosis, cytomegalovirus, and varicella-zoster virus. No etiology could be identified in 16 (20%). Thirty (37%) patients died during follow-up and 20 (25%) had recurrent seizures with survival being the only identifiable risk factor.Conclusions:HIV-infected adults with new-onset seizure in Zambia often have advanced HIV disease with OI being the most frequent seizure etiology. Seizure recurrence is common but no risk factors for recurrence other than survival were identified. These findings suggest an urgent need for immune reconstitution in this population. Initiating treatment for seizure prophylaxis where only enzyme-inducing antiepileptic medications are available could threaten antiretroviral efficacy.

scholarly journals Risk factors of recurrent seizure, co-morbidities, and mortality in new onset seizure in elderly

Seizure ◽  
2013 ◽  
Vol 22 (7) ◽  
pp. 577-580 ◽  
Author(s):  
Kanitpong Phabphal ◽  
Alan Geater ◽  
Kitti Limapichat ◽  
Pornchai Sathirapanya ◽  
Suwanna Setthawatcharawanich
Keyword(s):  
Risk Factors ◽  
Onset Seizure ◽  
Recurrent Seizure ◽  
New Onset

scholarly journals Association between Risk Factors and New-Onse Seizures in Old Age Population

2021 ◽  
pp. 47-58
Author(s):  
Samee Jatoi ◽  
Dayo Abdullah ◽  
M. Z. Jilani ◽  
Soomro Fatima
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Heart Disease ◽  
Brain Tumor ◽  
Old Age ◽  
Cns Infection ◽  
Control Group ◽  
Onset Seizure ◽  
And Control ◽  
New Onset

Objective: To determine the association between risk factors and new-onset seizures in old age population at a tertiary care hospital, Karachi. Methods: A case control study on old age patients of > 60 years visited emergency department (ED) either with new onset seizure or without seizure were conducted at ED of Ziauddin University Hospital Karachi. 154 consecutive old age patients were distributed into two groups i.e., case group (77 old age patients of new onset seizure) and control group (77 old age patients without seizure). Risk factors including stroke, dementia, head trauma, metabolic causes, brain tumor, infection of central nervous system (CNS), depression and anxiety were evaluated. Results: Out of 154 old age patients, male was 32 (41.6%) and 40 (51.9%) and female was 45 (58.4%) and 37 (48.1%) in case and control group respectively. Type of seizure in control group was generalized tonic–clonic seizure (GTCS) in 51 (66.2%) patients and focal seizure in 26 (33.8%) patients. Comorbidities were diabetes mellitus (DM) in 76 (98.7%) and 59 (76.6%) patients, hypertension (HTN) in 72 (93.5%) and 63 (81.8%) patients and ischemic heart disease (IHD) in 39 (50.6%) and 25 (32.5%) patients. Risk factors were stroke in 23 (29.9%) and 16 (20.8%) patients, dementia in 3 (3.9%) and 0 (0.0%) patients, head trauma in 0 (0.0%) and 33 (42.9%) patients, metabolic causes in 27 (35.1%) and 27 (35.1%) patients, brain tumor in 6 (7.8%) and 0 (0.0%) patients, CNS infection in 17 (22.1%) and 1 (1.3%) patients and depression in 2 (2.6%) and 0 (0.0%) patients. Conclusion: New-onset seizures are significantly associated with age, diabetes mellitus, hypertension, ischemic heart disease, brain tumor and CNS infection.

New-Onset Seizure Associated with Quetiapine and Olanzapine

2002 ◽  
Vol 36 (3) ◽  
pp. 437-439 ◽  
Author(s):  
Dawson W Hedges ◽  
Kreg G Jeppson
Keyword(s):  
Risk Factors ◽  
White Woman ◽  
Atypical Antipsychotics ◽  
Low Dose ◽  
Case Reports ◽  
Seizure Threshold ◽  
Onset Seizure ◽  
Case Summary ◽  
New Onset

OBJECTIVE: To report a case involving a witnessed seizure in a patient receiving concurrent olanzapine and quetiapine. CASE SUMMARY: A 27-year-old white woman was observed to have a seizure while receiving a stable dosage of olanzapine 15 mg/d, with the addition of quetiapine 100 mg in the evening 1 day before the occurrence of the seizure. There were no known risk factors for epilepsy. DISCUSSION: This case reports a new-onset seizure in the context of concurrent olanzapine and quetiapine use. Interpretation is complicated by recent discontinuation of low-dose clonazepam. CONCLUSIONS: While uncommon, seizures can occur with non-clozapine atypical antipsychotics. Caution is indicated when using these drugs with other agents that may lower the seizure threshold.

scholarly journals Zygomycetes in Human Disease

2000 ◽  
Vol 13 (2) ◽  
pp. 236-301 ◽  
Author(s):  
Julie A. Ribes ◽  
Carolyn L. Vanover-Sams ◽  
Doris J. Baker
Keyword(s):  
Risk Factors ◽  
Human Disease ◽  
Opportunistic Infections ◽  
Clinical Laboratory ◽  
Antifungal Drugs ◽  
Sufficient Evidence ◽  
Severe Malnutrition ◽  
Minor Trauma ◽  
Human Pathogens ◽  
Tissue Destruction

SUMMARY The Zygomycetes represent relatively uncommon isolates in the clinical laboratory, reflecting either environmental contaminants or, less commonly, a clinical disease called zygomycosis. There are two orders of Zygomycetes containing organisms that cause human disease, the Mucorales and the Entomophthorales. The majority of human illness is caused by the Mucorales. While disease is most commonly linked to Rhizopus spp., other organisms are also associated with human infection, including Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces, and Syncephalastrum spp. Although Mortierella spp. do cause disease in animals, there is no longer sufficient evidence to suggest that they are true human pathogens. The spores from these molds are transmitted by inhalation, via a variety of percutaneous routes, or by ingestion of spores. Human zygomycosis caused by the Mucorales generally occurs in immunocompromised hosts as opportunistic infections. Host risk factors include diabetes mellitus, neutropenia, sustained immunosuppressive therapy, chronic prednisone use, iron chelation therapy, broad-spectrum antibiotic use, severe malnutrition, and primary breakdown in the integrity of the cutaneous barrier such as trauma, surgical wounds, needle sticks, or burns. Zygomycosis occurs only rarely in immunocompetent hosts. The disease manifestations reflect the mode of transmission, with rhinocerebral and pulmonary diseases being the most common manifestations. Cutaneous, gastrointestinal, and allergic diseases are also seen. The Mucorales are associated with angioinvasive disease, often leading to thrombosis, infarction of involved tissues, and tissue destruction mediated by a number of fungal proteases, lipases, and mycotoxins. If the diagnosis is not made early, dissemination often occurs. Therapy, if it is to be effective, must be started early and requires combinations of antifungal drugs, surgical intervention, and reversal of the underlying risk factors. The Entomophthorales are closely related to the Mucorales on the basis of sexual growth by production of zygospores and by the production of coenocytic hyphae. Despite these similarities, the Entomophthorales and Mucorales have dramatically different gross morphologies, asexual reproductive characteristics, and disease manifestations. In comparison to the floccose aerial mycelium of the Mucorales, the Entomophthorales produce a compact, glabrous mycelium. The asexually produced spores of the Entomophthorales may be passively released or actively expelled into the environment. Human disease with these organisms occurs predominantly in tropical regions, with transmission occurring by implantation of spores via minor trauma such as insect bites or by inhalation of spores into the sinuses. Conidiobolus typically infects mucocutaneous sites to produce sinusitis disease, while Basidiobolus infections occur as subcutaneous mycosis of the trunk and extremities. The Entomophthorales are true pathogens, infecting primarily immunocompetent hosts. They generally do not invade blood vessels and rarely disseminate. Occasional cases of disseminated and angioinvasive disease have recently been described, primarily in immunocompromised patients, suggesting a possible emerging role for this organism as an opportunist.

RISK FACTORS IN THE DEVELOPMENT OF LIVER ABSCESSES AND DIAGNOSTIC STRATEGY IN THEIR SUSPECTED PRESENCE

2016 ◽  
Vol 2 (1) ◽  
pp. 31
Author(s):  
Josiah Iju WILSON ◽  
Vladimir Egorovich MEDVEDEV
Keyword(s):  
Risk Factors ◽  
Clinical Laboratory ◽  
Inflammatory Diseases ◽  
Bacterial Overgrowth ◽  
Diagnostic Strategy ◽  
Hydrogen Breath Test ◽  
Severe Condition ◽  
Liver Ultrasound ◽  
Liver Abscesses ◽  
History Of

Introduction: The main risk aetiological factors of liver abscesses and development of precision liver ultrasound recommendations to detect signs of possible abscess formation were studied.Material and methods: 248 patients of both sexes aged 4-81 years with liver abscesses were analyzed. Medical history, physical examination, clinical laboratory tests, hydrogen breath test with, ultrasound examination, if necessary - computed tomography and fine needle diagnostic biopsy under ultrasound guidance were carried out..Results and discussion: It was established that liver abscesses are aetiologically heterogeneous, in which the largest in the group was pylephlebitic (64.1%), posttraumatic (14.5%), cholangiogenic (12.5%) and contact abscesses (1.2 %). In connection with the effacement or nonspecific clinical picture, often severe condition of the patient, the prevalence of symptoms in some cases of other diseases, liver abscesses may not be promptly diagnosed.Conclusion: The presence of clinical and laboratory signs of suppurate inflammatory processes, risk factors such as the presence of bacterial overgrowth syndrome, inflammatory diseases of the intestines, history of the use of proton pump inhibitors, diseases in association with cholestasis, surgery, history of trauma, abscesses of other locations, it is recommended that precision liver ultrasound should be carried out to detect possible echo signs of liver abscesses.

scholarly journals Epidemiology, Risk Factors, and Outcomes of Opportunistic Infections after Kidney Allograft Transplantation in the Era of Modern Immunosuppression: A Monocentric Cohort Study

2019 ◽  
Vol 8 (5) ◽  
pp. 594 ◽  
Author(s):  
Philippe Attias ◽  
Giovanna Melica ◽  
David Boutboul ◽  
Nathalie De Castro ◽  
Vincent Audard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factor ◽  
Opportunistic Infections ◽  
Control Group ◽  
Kidney Allograft ◽  
Extended Criteria Donor ◽  
Allograft Transplantation ◽  
Kidney Recipients ◽  
Independent Risk Factors ◽  
Kidney Transplantations

Epidemiology of opportunistic infections (OI) after kidney allograft transplantation in the modern era of immunosuppression and the use of OI prevention strategies are poorly described. We retrospectively analyzed a single-center cohort on kidney allograft adult recipients transplanted between January 2008 and December 2013. The control group included all kidney recipients transplanted in the same period, but with no OI. We analyzed 538 kidney transplantations (538 patients). The proportion of OI was 15% (80 and 72 patients). OI occurred 12.8 (6.0–31.2) months after transplantation. Viruses were the leading cause (n = 54, (10%)), followed by fungal (n = 15 (3%)), parasitic (n = 6 (1%)), and bacterial (n = 5 (0.9%)) infections. Independent risk factors for OI were extended criteria donor (2.53 (1.48–4.31), p = 0.0007) and BK viremia (6.38 (3.62–11.23), p < 0.0001). High blood lymphocyte count at the time of transplantation was an independent protective factor (0.60 (0.38–0.94), p = 0.026). OI was an independent risk factor for allograft loss (2.53 (1.29–4.95), p = 0.007) but not for patient survival. Post-kidney transplantation OIs were mostly viral and occurred beyond one year after transplantation. Pre-transplantation lymphopenia and extended criteria donor are independent risk factors for OI, unlike induction therapy, hence the need to adjust immunosuppressive regimens to such transplant candidates.

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