Systemic evaluation of febrile thrombocytopenia

Background: Febrile patient with thrombocytopenia is commonly encountered by physicians especially during monsoon and perimonsoon period. Infections with protozoa, bacteria and viruses can cause thrombocytopenia with or without disseminated intravascular coagulation. Commonly dengue, malaria, scrub typhus and other rickettsial infections, meningococci, leptospira and certain viral infections present as fever with thrombocytopenia. Occasionally these patients can go on to develop a stormy course with multiorgan dysfunction requiring intensive care unit admission associated with high morbidity and mortality. Though thrombocytopenia is encountered in various diseases, it is for sure that potentially fatal bleeding due to thrombocytopenia is rare. The study was intended to know the underlying etiology of febrile thrombocytopenia in our community, the various presentations and relationship between platelet level and severity of disease and prognosis.Methods: This study was carried out in 218 adult patients (age above 18 years) presenting with fever having thrombocytopenia (platelet count <1,50,000/mm3) in Dept. of medicine in IIMS and R Lucknow UP.Results: Dengue was the commonest cause of fever with thrombocytopenia (58.71%) followed by P. falciparum malaria 8.71% and P. vivax malaria 6.88%. Bleeding manifestations were seen in 24.31% of patients. 58.49% of patients had patechie/purpura as the commonest bleeding manifestation followed by hematuria in 16.98 %.Conclusions: Fever with thrombocytopenia consists of occult presentations of common diseases rather than rare disease. Infection is the commonest cause of fever with thrombocytopenia. Among infections, dengue was the commonest cause. Treatment of underlying condition will lead to rapid improvement in platelet count with complete clinical recovery.

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Regulation of Serum Exosomal MicroRNAs in Mice Infected with Orientia tsutsugamushi

Microorganisms ◽

10.3390/microorganisms9010080 ◽

2020 ◽

Vol 9 (1) ◽

pp. 80

Author(s):

Le Jiang ◽

Tatyana Belinskaya ◽

Zhiwen Zhang ◽

Teik-Chye Chan ◽

Wei-Mei Ching ◽

...

Keyword(s):

Post Infection ◽

Viral Infections ◽

Scrub Typhus ◽

Late Phase ◽

Many Body ◽

Host Immune Responses ◽

Lethal Infection ◽

Exosomal Mirnas ◽

Exosomal Mirna ◽

Intercellular Communications

Exosomes are small extracellular vesicles that carry proteins, lipids, and nucleic acids. They are circulated in many body fluids and play an important role in intercellular communications. MicroRNAs (miRNAs), as major components of exosomes, are often regulated in many diseases including bacterial and viral infections. Functionally, exosome-carried miRNAs interact with various immune cells and affect their behavior. Little is known whether exosomal miRNAs are regulated during scrub typhus, a potentially lethal infection caused by intracellular bacteria, Orientiatsutsugamushi. In the present study, we utilized a scrub typhus mouse model and collected serum at various time points post infection. A custom quantitative PCR array covering 92 murine miRNAs was used to profile serum exosomal miRNAs. A total of 12 miRNAs were found to be significantly up- or down-regulated at least at one time point post infection when compared to uninfected animals. Further analysis identified multiple miRNAs in the let-7 family that were consistently down-regulated at early and late phase of infection. Functionally, serum exosomes isolated from infected mice displayed strong proinflammatory effect when incubated with bone marrow-derived macrophages. Our data revealed dynamic regulations of serum exosomal miRNA during scrub typhus infection, which could significantly influence host immune responses and disease outcome.

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SALMONELLA BREDENEY MENINGITIS

PEDIATRICS ◽

10.1542/peds.9.5.597 ◽

1952 ◽

Vol 9 (5) ◽

pp. 597-601

Author(s):

HOWARD L. KANTOR

Keyword(s):

Blood Transfusion ◽

Carrier State ◽

Careful Examination ◽

Rapid Improvement ◽

Clinical Recovery ◽

Source Of Infection ◽

The Family ◽

Salmonella Meningitis ◽

Observation Period ◽

Multiple Antibiotics

A case of Salmonella bredeney meningitis with recovery in a 19 day old infant is reported. This is the youngest patient with Salmonella meningitis known to have recovered. This is the second known case of Salmonella meningitis with recovery in a patient less than one month of age. Treatment with multiple antibiotics and chemotherapy both parenterally and intrathecally produced rapid improvement. An equally effective supportive blood transfusion may have aided this recovery. The use of chloromycetin after discontinuance of all other antibiotics was effective in producing a clinical recovery without relapse. No sequelae were noted at the end of a three month observation period. Attempts at discovering the carrier state of the infesting organism by careful examination of the family revealed no source of infection.

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Ethylenediaminetetraacetic Acid‑Dependent Pseudothrombocytopenia in Patient Previously Treated as Dengue Fever

Berkala Kedokteran ◽

10.20527/jbk.v17i1.10250 ◽

2021 ◽

Vol 17 (1) ◽

pp. 65

Author(s):

Hendra Wana Nur’amin ◽

Muhammad Darwin Prenggono ◽

Wivina Riza Devi

Keyword(s):

Bone Marrow ◽

Platelet Count ◽

Dengue Fever ◽

Complete Blood Count ◽

Ethylenediaminetetraacetic Acid ◽

Bone Marrow Aspiration ◽

Normal Platelet ◽

Low Platelet Count ◽

Bleeding Manifestation ◽

Secondary Hospital

Abstract: One of the most widely used anticoagulants for a complete blood count is ethylenediaminetetraacetic acid (EDTA). Pseudothrombocytopenia (PTCP) may be caused by EDTA, this condition may lead to inappropriate diagnosis and treatment. We report a 25-year-old female with unspecific headache and joint pain with very low platelet count since 1 month before hospital admission. She was diagnosed with Dengue fever infection and got some platelet transfusion from the previous secondary hospital. She was carried out for a blood test with another anticoagulant (sodium citrate) and bone marrow aspiration. The results showed that she had normal platelet count and bone marrow cellularity. When a patient was identified with thrombocytopenia without any bleeding manifestation, hematology disease, and family history, PTCP should be taken into consideration to prevent unnecessary intervention. Keywords: platelet, pseudothrombocytopenia, ethylenediaminetetraacetic acid, Dengue fever

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Thrombocytopenia in children: a clinico-etiological profile in an urban tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20185195 ◽

2018 ◽

Vol 6 (1) ◽

pp. 131

Author(s):

Subramanian V. ◽

Santosh Kumar K.

Keyword(s):

Platelet Count ◽

Viral Infections ◽

Tertiary Care ◽

Care Hospital ◽

Drug Induced ◽

Medical College ◽

Clinical Complications ◽

Paediatric Department ◽

The Relationship ◽

Haematological Finding

Background: Thrombocytopenia is a common haematological finding that we come across while managing a sick child. Etiological profile and presentation of thrombocytopenia varies among children. The objective of this study was to study the clinical and laboratory profile of children with thrombocytopenia, associated clinical complications and assess the relationship between platelet levels and severity of disease.Methods: The study was carried out in 644 children between 1 month and 12 years, admitted in Paediatric Department of Raja Rajeshwari medical college and hospital, Bangalore between August 2012 to August 2014.Results: The commonest causes of thrombocytopenia in our study were of infectious aetiology (86.6%). Among Infections Viral infections were the major cause in more than 78% of cases. Other causes included haematological problems, drug induced thrombocytopenia and connective tissue disorders. Bleeding manifestations were present in 33.07% of patients and the commonest bleeds were skin and mucous membranes. Bleeding manifestations were seen most commonly in children with a platelet count less than 50000/µl.Conclusions: Viral Infections were the commonest cause for thrombocytopenia in Children. Platelet count was neither predictive of bleeding manifestations nor predictive of need for platelet transfusion.

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The Value of Neutrophil/monocyte Ratio in Early Diagnosis of Children Mycoplasma Pneumoniae Pneumonia

10.21203/rs.3.rs-64768/v1 ◽

2020 ◽

Author(s):

Shasha Yao ◽

Yao Xie ◽

Fei Chen ◽

Xiao Chen ◽

Miao Zhang ◽

...

Keyword(s):

Platelet Count ◽

Early Diagnosis ◽

Blood Cell ◽

Mycoplasma Pneumoniae ◽

Viral Infections ◽

Clinical Symptoms ◽

Monocyte Count ◽

Neutrophil Lymphocyte Ratio ◽

Imaging Characteristics ◽

Mycoplasma Pneumoniae Pneumonia

Abstract Background:To investigate the value of blood cell analysis in early diagnosis of mycoplasma pneumoniae pneumonia (MP). Methods:The clinical parameters, including patient characteristics, clinical symptoms, imaging characteristics and laboratory examination data of the patients hospitalized in the Department of Pediatrics, Nanjing Jiangning Hospital from January 2018 to March 2020 due to community-acquired pneumonia were collected for retrospective analysis. The data were analyzed by SPSS 22.0 software for statistical analysis. P<0.05 was considered statistically significant.Results:The levels of white blood cell count (WBC), absolute neutrophil count (NEU), absolute monocyte count (MON), platelet count (PLT), neutrophil/lymphocyte ratio(NLR), mean platelet volume/platelet count (MPV/PLT) and neutrophil/monocyte ratio (NMR) in children with bacterial pneumonia (BP)were significantly higher than those of children withMP and children withviral pneumonia (VP), the NMR level in children withMP was higher than that of children with VP,the NMR levelsin the three groups of children were significantly different (P<0.05).Combined with the NMR level, the children’s age andpulmonary consolidation information,the AUC areas of MP, BP and VP had high accuracy fordifferential diagnosis of MP. Conclusion:As a comprehensive indicator of neutrophils and monocytes, NMR may differentiate pneumonia caused by mycoplasma pneumoniae, bacterial and viral infections, which provides new direction for early differential diagnosis of pneumonia.

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Scrub Typhus and Other Rickettsial Infections

Indian Journal of Critical Care Medicine ◽

10.5005/jp-journals-10071-23841 ◽

2021 ◽

Vol 25 (S2) ◽

pp. S138-S143

Author(s):

Karthik Gunasekaran ◽

George M. Varghese ◽

Deepti Bal

Keyword(s):

Scrub Typhus ◽

Rickettsial Infections

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The Causes and Long-Term Consequences of Viral Encephalitis

Frontiers in Cellular Neuroscience ◽

10.3389/fncel.2021.755875 ◽

2021 ◽

Vol 15 ◽

Author(s):

Karen Bohmwald ◽

Catalina A. Andrade ◽

Nicolás M. S. Gálvez ◽

Valentina P. Mora ◽

José T. Muñoz ◽

...

Keyword(s):

Viral Encephalitis ◽

Viral Infections ◽

Immune Cell ◽

Clinical Symptoms ◽

Brain Inflammation ◽

High Morbidity ◽

Stiff Neck ◽

The Impact ◽

The Brain

Reports regarding brain inflammation, known as encephalitis, have shown an increasing frequency during the past years. Encephalitis is a relevant concern to public health due to its high morbidity and mortality. Infectious or autoimmune diseases are the most common cause of encephalitis. The clinical symptoms of this pathology can vary depending on the brain zone affected, with mild ones such as fever, headache, confusion, and stiff neck, or severe ones, such as seizures, weakness, hallucinations, and coma, among others. Encephalitis can affect individuals of all ages, but it is frequently observed in pediatric and elderly populations, and the most common causes are viral infections. Several viral agents have been described to induce encephalitis, such as arboviruses, rhabdoviruses, enteroviruses, herpesviruses, retroviruses, orthomyxoviruses, orthopneumovirus, and coronaviruses, among others. Once a neurotropic virus reaches the brain parenchyma, the resident cells such as neurons, astrocytes, and microglia, can be infected, promoting the secretion of pro-inflammatory molecules and the subsequent immune cell infiltration that leads to brain damage. After resolving the viral infection, the local immune response can remain active, contributing to long-term neuropsychiatric disorders, neurocognitive impairment, and degenerative diseases. In this article, we will discuss how viruses can reach the brain, the impact of viral encephalitis on brain function, and we will focus especially on the neurocognitive sequelae reported even after viral clearance.

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1583. The Utility of the Immunodeficiency Scoring Index (ISI) to Predict Outcomes of Coronavirus (HCoV) Infections in Hematopietic Cell Transplant (HCT) Recipients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1411 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S495-S495

Author(s):

Fareed Khawaja ◽

Terri Lynn Shigle ◽

Shashank S Ghantoji ◽

Marjorie Batista ◽

Ella Ariza-Heredia ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Tract ◽

Viral Infections ◽

Fatal Outcome ◽

High Morbidity ◽

Cell Transplant ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections ◽

Overall Mortality

Abstract Background Respiratory viral infections in HCT recipients are associated with high morbidity and mortality, especially after progression from upper respiratory tract infection (URI) to lower respiratory tract infections (LRI). Data on risk factors (RF) for LRI and mortality is lacking for HCoV infections after HCT. We aimed to validate our ISI in HCoV infections. Methods All adult HCT recipients with HCoV infection from 2015 to 2017 were evaluated. An ISI based on RF was used to classify patients as low (0–2), moderate (3–6), or high (7 or higher) risk for progression to LRI or death. We defined LRI as HCoV detected in nasal wash and/or bronchoalveolar lavage and new lung infiltrates on diagnostic imaging. Clinical parameters were collected and ISI were calculated for comparison. Results A total of 144 adult HCT recipients with 166 episodes of HCoV infections were analyzed. The most common HCoV serotype for LRI and URI was 229E (42.4%) and OC43 (37.6%), respectively, and most patients were infected between November and March each year (Figures 1 and 2). When compared with URI, patients with LRI were more likely in the pre-engraftment period, had multiple respiratory viruses infections, had nosocomially acquired HCoV, required hospitalization, ICU transfer, and mechanical ventilation (all, P < 0.05). Overall mortality rate was 4% at Day 30 from diagnosis and all patients who died had LRI with an 18% mortality. Among those who died, 33% had nosocomial infection, 67% were co-infected with another respiratory virus and 67% required mechanical ventilation. Using an ISI cut off of <4, the negative predictive value (NPV) for progression to LRI was 86% with a specificity of 76%. Conclusion HCT recipients with HCoV LRI were more likely to have a fatal outcome. The NPV of the ISI for progression to LRI was high and could be used as a prognostic tool for future studies and for therapeutic clinical trials. Disclosures All authors: No reported disclosures.

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Beyond Cytomegalovirus and Epstein-Barr Virus: a Review of Viruses Composing the Blood Virome of Solid Organ Transplant and Hematopoietic Stem Cell Transplant Recipients

Clinical Microbiology Reviews ◽

10.1128/cmr.00027-20 ◽

2020 ◽

Vol 33 (4) ◽

Cited By ~ 1

Author(s):

Marie-Céline Zanella ◽

Samuel Cordey ◽

Laurent Kaiser

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell ◽

Clinical Significance ◽

Viral Infections ◽

Solid Organ Transplantation ◽

High Morbidity ◽

Solid Organ ◽

Cell Transplant ◽

Transplant Recipients ◽

Hematopoietic Stem

SUMMARY Viral primary infections and reactivations are common complications in patients after solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) and are associated with high morbidity and mortality. Among these patients, viral infections are frequently associated with viremia. Beyond the usual well-known viruses that are part of the routine clinical management of transplant recipients, numerous other viral signatures or genomes can be identified in the blood of these patients. The identification of novel viral species and variants by metagenomic next-generation sequencing has opened up a new field of investigation and new paradigms. Thus, there is a need to thoroughly describe the state of knowledge in this field with a review of all viral infections that should be scrutinized in high-risk populations. Here, we review the eukaryotic DNA and RNA viruses identified in blood, plasma, or serum samples of pediatric and adult SOT/HSCT recipients and the prevalence of their detection, with a particular focus on recently identified viruses and those for which their potential association with disease remains to be investigated, such as members of the Polyomaviridae, Anelloviridae, Flaviviridae, and Astroviridae families. Current knowledge of the clinical significance of these viral infections with associated viremia among transplant recipients is also discussed. To ensure a comprehensive description in these two populations, individuals described as healthy (mostly blood donors) are considered for comparative purposes. The list of viruses that should be on the clinicians’ radar is certainly incomplete and will expand, but the challenge is to identify those of possible clinical significance.

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Antiviral Effects of Hydroxychloroquine and Type I Interferon on In Vitro Fatal Feline Coronavirus Infection

Viruses ◽

10.3390/v12050576 ◽

2020 ◽

Vol 12 (5) ◽

pp. 576 ◽

Cited By ~ 4

Author(s):

Tomomi Takano ◽

Kumi Satoh ◽

Tomoyoshi Doki ◽

Taishi Tanabe ◽

Tsutomu Hohdatsu

Keyword(s):

Viral Infections ◽

Viral Disease ◽

High Morbidity ◽

Type I ◽

Feline Infectious Peritonitis ◽

Antiviral Effects ◽

Immune Mediated ◽

Coronavirus Infection ◽

Feline Coronavirus

Feline infectious peritonitis (FIP) is a viral disease with a high morbidity and mortality by the FIP virus (FIPV, virulent feline coronavirus). Several antiviral drugs for FIP have been identified, but many of these are expensive and not available in veterinary medicine. Hydroxychloroquine (HCQ) is a drug approved by several countries to treat malaria and immune-mediated diseases in humans, and its antiviral effects on other viral infections (e.g., SARS-CoV-2, dengue virus) have been confirmed. We investigated whether HCQ in association with interferon-ω (IFN-ω) is effective for FIPV in vitro. A total of 100 μM of HCQ significantly inhibited the replication of types I and II FIPV. Interestingly, the combination of 100 μM of HCQ and 104 U/mL of recombinant feline IFN-ω (rfIFN-ω, veterinary registered drug) increased its antiviral activity against type I FIPV infection. Our study suggested that HCQ and rfIFN-ω are applicable for treatment of FIP. Further clinical studies are needed to verify the combination of HCQ and rIFN-ω will be effective and safe treatment for cats with FIP.

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