Tormenta de Citocinas

  • 文章类型: Journal Article
    灾难性抗磷脂综合征(CAPS)是一种罕见的危及生命的临床疾病,代表了抗磷脂综合征(APS)最严重的临床表现。它于1992年首次在一组表现出多器官受累和APS微血管病变特征的患者中进行了描述。CAPS的大多数当前知识来自于对2000年创建的“CAPS注册表”中收集的所有病例的分析,以对这种情况进行研究。大多数病例是由导致多器官血栓形成和细胞因子风暴的血栓形成前情况触发的。对“CAPS注册”中的病例的分析表明,抗凝三联疗法,糖皮质激素,血浆置换和/或静脉免疫球蛋白与CAPS的更好预后相关。知识的提高使死亡率从第一个系列中报告的50%下降到最近出版物中的25-30%。
    The catastrophic antiphospholipid syndrome (CAPS) is a rare life-threatening clinical condition that represents the most severe clinical presentation of the antiphospholipid syndrome (APS). It was first described in 1992 in a group of patients that presented with multiorgan involvement and microangiopathic features of APS. Most of the current knowledge of CAPS comes from the analysis of all cases collected at the \"CAPS Registry\" that was created in 2000 to perform studies on this condition. Most cases are triggered by a prothrombotic situation that leads to a multiorgan thrombosis and a cytokine storm. The analysis of cases included in the \"CAPS Registry\" has shown that the triple therapy with anticoagulation, glucocorticoids, and plasma exchange and/or intravenous immunoglobulins is associated to a better prognosis of CAPS. The improvement of the knowledge allowed a decrease from the 50% mortality rate reported in the first series to 25-30% in the most recent publications.
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  • 文章类型: Case Reports
    UNASSIGNED: Dengue fever is a mosquito-borne infectious disease endemic in over 100 countries around the world. Among the complications that dengue can cause the Hemophagocytic Lymphohistiocytosis is one of great concern for its severity and complex diagnosis.
    UNASSIGNED: Hereby we document a case of this disease expressed on a previously healthy 6-year-old female patient whose dengue infection was so severe that needed intensive care management with vasoactive drugs and diuretics. After a short period of wellness began newly with fever, pancytopenia, hepatitis, and inflammatory response symptoms.
    UNASSIGNED: A Dengue associated Hemophagocytic Lymphohistiocytosis syndrome was suspected and treated with intravenous corticosteroids on a 3-day scheme at no signs of malignancy with excellent response. The health care professionals must know about this not novel entity in order to reach an efficient diagnosis and treatment mostly, but not only, those in tropical and sub-tropical regions of the word were dengue virus is endemic.
    UNASSIGNED: La fiebre por dengue es una enfermedad infecciosa transmitida por mosquitos, endémica en más de 100 países alrededor del mundo. La Linfohistiocitosis Hemofagocítica, dentro de las complicaciones que puede ocasionar el dengue, es una de las más preocupantes por su complejidad diagnostica y gravedad.
    UNASSIGNED: Femenino de 6 años de edad, previamente sana, cuya infección por dengue fue tan grave que requirió manejo en cuidados intensivos. Después de un breve período de bienestar recrudeció la fiebre, además de pancitopenia, hepatitis y síntomas de respuesta inflamatoria.
    UNASSIGNED: Se sospechó síndrome de Linfohistiocitosis Hemofagocítica asociada a Dengue y se trató con corticoides intravenosos en un esquema de 3 días con excelente respuesta. Los profesionales de la salud deben conocer esta entidad no novedosa para poder llegar a un diagnóstico y tratamiento eficaz en su mayoría, pero no solo, en las regiones tropicales y subtropicales del mundo donde el virus del dengue es endémico.
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  • 文章类型: Journal Article
    SARS-CoV-2是一种新的RNA病毒,可导致2019年冠状病毒病(COVID-19),世界卫生组织(WHO)宣布为流行病。它会引发非典型肺炎,可发展为多器官衰竭。COVID-19可导致免疫系统失调,引发炎症反应,模拟噬血细胞淋巴组织细胞增生症.一些研究表明,抗IL-6受体抗体,比如托珠单抗,在SARS-CoV-2相关的严重急性呼吸道感染的治疗中起着重要作用。然而,抗IL-1受体抗体的作用,比如anakinra,在COVID-19的治疗中尚未确定。我们提出了一个51岁的男子诊断为严重的呼吸道感染与SARS-CoV-2相关的抗病毒和抗IL-6治疗难治的病例报告。抗IL-1(anakinra)治疗后,具有良好的临床结局和分析性改善。
    SARS-CoV-2 is a new RNA virus which causes coronavirus disease 2019 (COVID-19), declared a pandemic by the World Health Organization (WHO). It triggers an atypical pneumonia that can progress to multiorgan failure. COVID-19 can cause dysregulation of the immune system, triggering an inflammatory response, and simulate haemophagocytic lymphohistiocytosis. Several studies have proposed that anti-IL-6 receptor antibodies, such as tocilizumab, play an important role in the treatment of severe acute respiratory infection associated with SARS-CoV-2. However, the role of anti-IL-1 receptor antibodies, such as anakinra, in the treatment of COVID-19 has not been established. We present a case report of a 51-year-old man diagnosed with severe respiratory infection associated with SARS-CoV-2 that was refractory to antiviral and anti-IL-6 treatment, with a favourable clinical outcome and analytical improvement after treatment with anti-IL-1 (anakinra).
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