scholarly journals Dengue-triggered Hemophagocytic lymphohistiocytosis in an adolescent with autoimmune thyroiditis

2020 ◽  
Vol 3 (3) ◽  
pp. 71-73
Author(s):  
Muthukani Sankaranarayanan ◽  
◽  
Suganya Velayutham ◽  
N Vani ◽  
K Usharani ◽  
...  
Keyword(s):  
Autoimmune Thyroiditis ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Dengue Infection ◽  
Elevated Serum ◽  
Thyroid Peroxidase ◽  
Severe Anemia ◽  
Intermittent Fever ◽  
Timely Initiation ◽  
Moderate Anemia ◽  
Ns1 Antigen

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a life threatening hyperinflammatory hematological syndrome characterized by cytokine storm and the diagnosis can be missed as it mimics sepsis or multi-organ dysfunction syndrome. Case Report: A 15-year old adolescent girl presented with six-day history of high grade intermittent fever with easy fatigability and dyspnea on exertion. She was found to have severe anemia elsewhere (Hemoglobin- 4 g/dl, normal 11-16.5 g/dl) and referred to our hospital due to persistent fever, tiredness and recurrent vomiting. On examination she was pale and febrile. Her blood investigations revealed moderate anemia, leukopenia and markedly elevated liver transaminases with coagulopathy. Dengue NS1 antigen and IgM antibodies were positive suggestive of acute dengue infection. Further workup revealed markedly elevated serum ferritin (37973 ng/ml, normal 10-120 ng/ml) and lactate dehydrogenase levels (5311 U/L, normal 180-360 U/L). Plasma fibrinogen level was low (164 mg/dl, normal 200-400 mg/dl). Bone marrow biopsy done on day 3 revealed hemophagocytosis. Serum TSH was mildly elevated (6.5 mU/L, normal 3.5-5 mU/L) and anti-thyroid peroxidase (TPO) antibodies (68 IU/ml, normal <5.6 IU/ml) were also significantly elevated. Diagnosis of Hemophagocytic lymphohistiocytosis (HLH) secondary to dengue infection and autoimmune thyroiditis was made. She was treated with dexamethasone 10 mg/m2 /day from day 3 of admission along with supportive treatment. She rapidly improved and her laboratory parameters returned back to normal at 1 week of follow up. Conclusion: Dengue fever with unexplained severe anemia in the absence of bleeding should be evaluated for HLH as timely initiation of treatment will be life saving

scholarly journals Expression of Cytokines and Cytokine Receptors-Genes in Patients with Different Forms of Thyroid Pathology in Ukrainian Population

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Iryna Kamyshna ◽  
Aleksandr Kamyshnyi
Keyword(s):  
Autoimmune Thyroiditis ◽  
Interleukin 6 ◽  
Interleukin 1 ◽  
White Blood Cells ◽  
Elevated Serum ◽  
Interleukin 10 ◽  
Thyroid Peroxidase ◽  
Thyroid Peroxidase Antibodies ◽  
Interleukin 6 Receptor ◽  
Peripheral White Blood Cells

Abstract Multiple susceptibility genes can be involved in the development of Hashimoto’s thyroiditis. Some of these genes are implicated in other autoimmune diseases, while others are specific to thyroid autoimmune response. 153 patients with thyroid pathology were enrolled in the study (152 women and 1 man, the average age was 46,02±14,3). They were divided into 3 groups: 16 patients with postoperative hypothyroidism; 65 patients with hypothyroidism resulting from autoimmune thyroiditis, and 72 patients with both AIT and elevated serum an anti-thyroglobulin and anti-thyroid peroxidase antibodies. We used a pathway-specific real-time Polymerase chain reaction array to identify and verify cytokines and receptor pathway-associated gene expression in peripheral white blood cells in randomly selected 12 individuals from each group. In the patients with postoperative hypothyroidism and those with hypothyroidism resulting from autoimmune thyroiditis, the expression of Chemokine (C-X3-C motif) receptor 1, Chemokine (C-X-C motif) receptor 4, Interleukin 6, and Interleukin 6 receptor significantly decreased, while the expression of IL6ST and IL10RA increased. In contrast, mRNA levels of Chemokine (C-X3-C motif) receptor 1, Chemokine (C-X-C motif) receptor 4, Interleukin 6, and Interleukin 6 receptor increased in the autoimmune thyroiditis patients with elevated serum anti-thyroglobulin and anti-thyroid peroxidase antibodies, while the expression of Interleukin 6 signal transducer and Interleukin 10 receptor, alpha decreased in this group of patients. The patients with hypothyroidism resulting from autoimmune thyroiditis and patients with elevated serum anti-thyroglobulin and anti-thyroid peroxidase antibodies had significantly lowered expression of Interleukin 10, while the expression of Interleukin 1, beta and Interleukin 1 receptor, type I was elevated. autoimmune thyroiditis and hypothyroidism affect the mRNA-level expression of cytokines and cytokine receptor genes in a gene-specific manner, and these changes to gene expression can be among the triggers of autoimmune inflammation progression in the thyroid gland. Transcriptional activity of cytokines, inducer, and receptor genes in the peripheral white blood cells can be used as an important minimally invasive prognostic marker of the autoimmune thyroid disease severity.

scholarly journals A clinical and biochemical study of dengue fever in Kosi region of Bihar, India

2017 ◽  
Vol 4 (4) ◽  
pp. 964
Author(s):  
Rakesh Kumar ◽  
Shanker Suman ◽  
Rajiv Ranjan
Keyword(s):  
Dengue Fever ◽  
Biochemical Study ◽  
Dengue Infection ◽  
Elevated Serum ◽  
Severe Thrombocytopenia ◽  
Medical College ◽  
Orbital Pain ◽  
Ns1 Antigen ◽  
Morbilliform Rash ◽  
Conjunctival Redness

Background: Dengue is a debilitating arthropod-borne viral (arboviral) disease in humans. To improve diagnostics for patients with dengue so that they can receive effective treatments at earliest. In addition, a better understanding of clinical and biochemical study of dengue cases, effective measures can be aimed for the prevention and control of dengue epidemics.Methods: A retrospective clinical and laboratory study was undertaken among admitted patients in the Department of Physiology at Katihar Medical College and Hospital, Katihar, Kosi region of Bihar, India. Forty-two (42) patients admitted over a period of two years, with laboratory results for NS1 antigen and or /IgM positive, for dengue fever, were taken in the study. Clinical features, haematological and biochemical parameters were noted.Results: Out of the 42 patients, 38 patients were male (90.4%) and 4 patients were female (9.6%). Pyrexia was the major symptom (100%) followed by splitting headache (90.40%), myalgia (76.19%), conjunctival redness (50.00%), skin rash (42.80%), abdominal pain (30.95%), hepatosplenomegaly (28.57) ascites (26.19%) and retro orbital pain (19.04%). Severe thrombocytopenia (69.51%), leukopenia (20.19%) and elevated serum SGOT and SGPT (88.54%) were observed.Conclusions: Dengue infection is increasing proportional to increased urbanization and compromised sanitation measures. Fever associated with headache, retro orbital pain, erythematous morbilliform rash, conjunctival redness and itching in palms and soles along with thrombocytopenia, leukopenia, elevated SGPT should prompt a clinician on the possibility of dengue infection.

SERUM THYROTROPHIN AND THE RESPONSE TO THYROTROPHIN RELEASING HORMONE IN SYMPTOMLESS AUTOIMMUNE THYROIDITIS AND IN BORDERLINE AND OVERT HYPOTHYROIDISM

1974 ◽  
Vol 75 (2) ◽  
pp. 274-285 ◽  
Author(s):  
A. Gordin ◽  
P. Saarinen ◽  
R. Pelkonen ◽  
B.-A. Lamberg
Keyword(s):  
Autoimmune Thyroiditis ◽  
Elevated Serum ◽  
Mean Value ◽  
Primary Hypothyroidism ◽  
Overt Hypothyroidism ◽  
Thyrotrophin Releasing Hormone ◽  
Releasing Hormone ◽  
The Mean ◽  
The Individual ◽  
Serum Tsh

ABSTRACT Serum thyrotrophin (TSH) was determined by the double-antibody radioimmunoassay in 58 patients with primary hypothyroidism and was found to be elevated in all but 2 patients, one of whom had overt and one clinically borderline hypothyroidism. Six (29%) out of 21 subjects with symptomless autoimmune thyroiditis (SAT) had an elevated serum TSH level. There was little correlation between the severity of the disease and the serum TSH values in individual cases. However, the mean serum TSH value in overt hypothyroidism (93.4 μU/ml) was significantly higher than the mean value both in clinically borderline hypothyroidism (34.4 μU/ml) and in SAT (8.8 μU/ml). The response to the thyrotrophin-releasing hormone (TRH) was increased in all 39 patients with overt or borderline hypothyroidism and in 9 (43 %) of the 21 subjects with SAT. The individual TRH response in these two groups showed a marked overlap, but the mean response was significantly higher in overt (149.5 μU/ml) or clinically borderline hypothyroidism (99.9 μU/ml) than in SAT (35.3 μU/ml). Thus a normal basal TSH level in connection with a normal response to TRH excludes primary hypothyroidism, but nevertheless not all patients with elevated TSH values or increased responses to TRH are clinically hypothyroid.

Serum Thyroid Peroxidase Antibody Level and Incident Hypertension in Iranian Men: A Suggestion for the Role of Thyroid Autoimmunity

2020 ◽  
Vol 20 (10) ◽  
pp. 1711-1718
Author(s):  
Maryam Tohidi ◽  
Aidin Baghbani-Oskouei ◽  
Atieh Amouzegar ◽  
Ladan Mehran ◽  
Fereidoun Azizi ◽  
...  
Keyword(s):  
Total Population ◽  
Thyroid Autoimmunity ◽  
Elevated Serum ◽  
Thyroid Peroxidase ◽  
Incident Hypertension ◽  
Natural Logarithm ◽  
Hazard Ratios ◽  
Thyroid Peroxidase Antibody ◽  
Unit Increase

Background: Dysfunction of the thyroid gland has profound effects on the cardiovascular system. Objective: We aimed to explore the relation of serum thyroid peroxidase antibody (TPO-Ab), as a marker of thyroid autoimmunity with incident hypertension among a euthyroid population. Methods: A total of 3681 participants (1647 men) entered the study. Multivariate Cox proportional hazard models were conducted to estimate the association between TPO-Ab and incident hypertension. Results: The mean age (standard deviation) of the participants was 37.5 (12.8) years. During a median follow-up of 12.2 years, 511 men and 519 women developed hypertension. The multivariable hazard ratios (HRs) and related 95% confidence intervals (CIs) of 1-unit increase in natural logarithm (ln) of TPO-Ab for incident hypertension were 1.09 (1.00-1.19), 1.03 (0.97-1.10), and 1.05 (1.00-1.11) for men, women, and total population, respectively. Moreover, considering the TPO-Ab status as a categorical variable (i.e. TPO-Ab positive or TPO-Ab negative), the multivariate-adjusted HRs (95% CIs) of TPO-Ab positivity for incident hypertension, were 1.33 (0.95-1.85), 1.12 (0.86-1.45) and 1.19 (0.97- 1.46) for men, women, and total population, respectively. Conclusion: Elevated serum TPO-Ab level can contribute to the development of hypertension among euthyroid men during a long follow-up; suggesting a role for thyroid autoimmunity.

scholarly journals Dengue Virus Induces the Expression and Release of Endocan from Endothelial Cells by an NS1–TLR4-Dependent Mechanism

2021 ◽  
Vol 9 (6) ◽  
pp. 1305
Author(s):  
Carlos Alonso Domínguez-Alemán ◽  
Luis Alberto Sánchez-Vargas ◽  
Karina Guadalupe Hernández-Flores ◽  
Andrea Isabel Torres-Zugaide ◽  
Arturo Reyes-Sandoval ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Mrna Expression ◽  
Cell Lines ◽  
Cell Activation ◽  
Dengue Infection ◽  
Elevated Serum ◽  
Fold Increase ◽  
Endothelial Cell Activation ◽  
Stimulation Of

A common hallmark of dengue infections is the dysfunction of the vascular endothelium induced by different biological mechanisms. In this paper, we studied the role of recombinant NS1 proteins representing the four dengue serotypes, and their role in promoting the expression and release of endocan, which is a highly specific biomarker of endothelial cell activation. We evaluated mRNA expression and the levels of endocan protein in vitro following the stimulation of HUVEC and HMEC-1 cell lines with recombinant NS1 proteins. NS1 proteins increase endocan mRNA expression 48 h post-activation in both endothelial cell lines. Endocan mRNA expression levels were higher in HUVEC and HMEC-1 cells stimulated with NS1 proteins than in non-stimulated cells (p < 0.05). A two-fold to three-fold increase in endocan protein release was observed after the stimulation of HUVECs or HMEC-1 cells with NS1 proteins compared with that in non-stimulated cells (p < 0.05). The blockade of Toll-like receptor 4 (TLR-4) signaling on HMEC-1 cells with an antagonistic antibody prevented NS1-dependent endocan production. Dengue-infected patients showed elevated serum endocan levels (≥30 ng/mL) during early dengue infection. High endocan serum levels were associated with laboratory abnormalities, such as lymphopenia and thrombocytopenia, and are associated with the presence of NS1 in the serum.

scholarly journals FALSE-NEGATIVE DENGUE CASES IN RORAIMA, BRAZIL: AN APPROACH REGARDING THE HIGH NUMBER OF NEGATIVE RESULTS BY NS1 AG KITS

2014 ◽  
Vol 56 (5) ◽  
pp. 447-450 ◽  
Author(s):  
Pablo O. A. Acosta ◽  
Fabiana Granja ◽  
Cátia A. Meneses ◽  
Ismael A. S. Nascimento ◽  
Débora D. Sousa ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Secondary Infection ◽  
Dengue Infection ◽  
False Negative ◽  
Laboratory Data ◽  
Detection Methods ◽  
Lower Sensitivity ◽  
Care Providers ◽  
Qrt Pcr ◽  
Ns1 Antigen

Serum samples from 150 NS1-negative (Platelia ELISA) patients presumptively diagnosed with dengue were analyzed by the TaqMan probed real-time reverse transcription PCR (TaqMan qRT-PCR) method. The qRT-PCR positive samples were tested for serotype by semi-nested RT-PCR and a qualitative immunochromatographic assay for IgG and IgM. Molecular detection methods showed 33 (22%) positive samples out of 150 NS1-antigen negative samples. Of these, 72% were collected up to day 2 after the onset of symptoms, when diagnostic sensitivity of NS1-antigen test assays is significantly enhanced. Most of the cases were not characterized as secondary infection. Twenty-eight samples were successfully serotyped, 75% of which for DENV-4, 14% for DENV-2, 7% for DENV-3 and 4% for DENV-1. These findings reaffirm the hyperendemic situation of the state of Roraima and suggest a lower sensitivity of the NS1 test, mainly when DENV-4 is the predominant serotype. Health care providers should therefore be aware of samples tested negative by NS1 antigen assays, especially when clinical symptoms and other laboratory data results show evidence of dengue infection.

scholarly journals Angioedema in a Patient with Autoimmune Thyroiditis – A Case Report

2020 ◽  
Vol 47 (2) ◽  
pp. 34-37
Author(s):  
S. Dermendzhiev ◽  
A. Dzhambov ◽  
T. Dermendzhiev
Keyword(s):  
Autoimmune Thyroiditis ◽  
Hashimoto’S Thyroiditis ◽  
Immunoglobulin E ◽  
Thyroid Autoimmunity ◽  
Hormonal Control ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Normal Range ◽  
History Of ◽  
One Year

AbstractWe present a case of a 29-year-old Bulgarian woman with autoimmune thyroiditis and recurrent angioedema. The patient presented with a one-year-long history of recurrent angioedema and Hashimoto’s thyroiditis. Physical examination showed oedema surrounded by erythema on the forearms, and erythematous, itchy plaques spreading over her face, neck, chest, abdomen, and extremities. Blood tests showed elevated total immunoglobulin E (IgE). The patient had been diagnosed with Hashimoto’s thyroiditis and hypothyroidism. She had been taking levothyroxine 50 μg/d, resulting in a good hormonal control; however, her anti-thyroid peroxidase (anti-TPO) antibodies were high. She was started on methylprednisolone and antihistamines. In three weeks, we observed a good therapeutic response to the treatment and the lesions remitted. IgE dropped within normal range. Levels of anti-TPO antibodies were persistently high. In conclusion, patients with angioedema should be tested for thyroid autoimmunity. Further delve into the pathogenesis of angioedema in them is warranted in order to explore the possibility of an underlying atopy in those not responding to the standard treatment with levothyroxine.

scholarly journals Can serum ferritin levels predict the severity of dengue early?: an observational study

2019 ◽  
Vol 7 (3) ◽  
pp. 876
Author(s):  
Velammal Petchiappan ◽  
Thaha Mohammed Hussain ◽  
Saravanan Thangavelu
Keyword(s):  
Platelet Count ◽  
Clinical Practice ◽  
Observational Study ◽  
Hospital Stay ◽  
Serum Ferritin ◽  
Early Recognition ◽  
Dengue Infection ◽  
Elevated Serum ◽  
Severe Dengue ◽  
Elderly Subjects

Background: Dengue infection is a major public health threat; early recognition is crucial to improve the survival in severe dengue. Although there are various biomarkers to predict the severity of dengue, they are not routinely used in clinical practice for prognostication. We analyzed whether serum ferritin can be used to predict the severity at an earlier stage.Methods: A hospital based prospective observational study was done involving 119 dengue cases diagnosed by positive NS1 antigen or dengue specific serology (capture ELISA). Serum ferritin was measured in all at the time of diagnosis. Clinical and platelet count monitoring was done daily; classified as severe and non-severe according to 2009 WHO criteria.Results: Out of 119, 5 developed severe dengue; patients with severe dengue had significantly lower median platelet count (p<0.0001); higher ferritin levels (p=0.03) and hospital stay (p<0.0001) than non-severe group. Age had a significant negative co-relation with platelet count (r= -0.427; p<0.0001); positive correlation with ferritin levels (r=0.16; p=0.08) and hospital stay (r= 0.26; p=0.004) indicating that elderly subjects are at risk of severe disease. Serum ferritin levels negatively correlated with the platelet count (r= -0.51 p<0.001). High ferritin levels in severe cases are noted from day 4 of clinical illness.Conclusions: Elevated serum ferritin levels can be used as a potential early prognostic marker to predict the severity of dengue infection in clinical practice.

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