1/12. Influenza infection in patients before and after liver transplantation.Infection with influenza virus poses specific problems in pediatric and adult liver transplant recipients, both before and after liver transplantation. These include a higher rate of pulmonary and extrapulmonary complications, development of rejection with graft dysfunction, prolonged shedding of influenza virus, and increased drug-resistance. Hepatic decompensation may occur during influenza infection in patients with cirrhosis. Current prophylaxis includes yearly vaccination with trivalent inactivated vaccine. Appropriate diagnosis and prompt treatment of any upper respiratory infections are indicated in these patients. In this review, we describe a case of influenza viral pneumonia in an adult liver transplant recipient, review basic and clinical aspects of influenza infection in this patient population, and discuss current modes of prevention and treatment in detail.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/12. Neonatal presentation of ventricular tachycardia and a Reye-like syndrome episode associated with disturbed mitochondrial energy metabolism.BACKGROUND: hyperammonemia, hypoglycemia, hepatopathy, and ventricular tachycardia are common presenting features of carnitine-acylcarnitine translocase deficiency (Mendelian Inheritance in Man database: *212138), a mitochondrial fatty acid oxidation disorder with a lethal prognosis. These features have not been identified as the presenting features of mitochondrial cytopathy in the neonatal period. CASE PRESENTATION: We describe an atypical presentation of mitochondrial cytopathy in a 2 day-old neonate. She presented with a Reye-like syndrome episode, premature ventricular contractions and ventricular tachycardia. Initial laboratory evaluation exhibited a large amount of 3-methylglutaconic acid on urine organic acid analysis, mild orotic aciduria and a nonspecific abnormal acylcarnitine profile. The evaluation for carnitine-acylcarnitine translocase deficiency and other fatty acid oxidation disorders was negative. The patient later developed a hypertrophic cardiomyopathy and continued to be affected by recurrent Reye-like syndrome episodes triggered by infections. A muscle biopsy exhibited signs of a mitochondrial cytopathy. During the course of her disease, her Reye-like syndrome episodes have subsided; however, cardiomyopathy has persisted along with fatigue and exercise intolerance. CONCLUSIONS: This case illustrates that, in the neonatal period, hyperammonemia and ventricular tachycardia may be the presenting features of a lethal carnitine-acylcarnitine translocase deficiency or of a mitochondrial cytopathy, associated with a milder clinical course. This association broadens the spectrum of presenting phenotypes observed in patients with disturbed mitochondrial energy metabolism. Also, the presence of 3-methylglutaconic aciduria suggests mitochondrial dysfunction and mild orotic aciduria could potentially be used as a marker of mitochondrial disease.- - - - - - - - - - ranking = 2.2472179291686keywords = tract (Clic here for more details about this article) |
3/12. Acute encephalopathy in siblings. reye syndrome vs salicylate intoxication.siblings, aged 9 and 7 years, had simultaneous onset of vomiting, disorientation, ataxia, and coma. Both children had prodromal symptoms of upper respiratory tract infections, and had been treated with large doses of aspirin. Laboratory data showed evidence of hepatocellular dysfunction, with an elevated serum ammonia level in one patient; salicylate levels were 50 and 44 mg/100 ml. The child who died had autopsy evidence of cerebral edema and fatty liver. The difficulty in clinically differentiating reye syndrome from salicylate intoxication is discussed.- - - - - - - - - - ranking = 398901.07375026keywords = upper respiratory tract infection, respiratory tract infection, upper respiratory tract, respiratory tract, tract infection, tract, upper (Clic here for more details about this article) |
4/12. Reye's syndrome. A diagnosis occasionally first made at medicolegal autopsy.Reye's syndrome, a condition characterized pathologically by cerebral edema and fatty change of the liver, has been described extensively in the medical literature as a disease manifested clinically by encephalopathy and coma. This is a report of five cases of Reye's syndrome occurring as sudden, unexpected deaths outside of the hospital. In each of these cases, there is a vague history of a previous viral illness. A history of aspirin intake is inconstant. Each child either had no significant past illnesses or there was a history of repeated upper respiratory infections. The classic progression of signs and symptoms usually described for Reye's syndrome, where vomiting usually precedes encephalopathy and coma, was not present in any of the cases. Results of autopsies showed the characteristic findings for Reye's syndrome, and additional tests showed no other explanation for the deaths. This manifestation of the disease is seldom described in medical literature, but it may be encountered occasionally by the medical examiner.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
5/12. Reye's syndrome-like illness in a patient receiving amiodarone.A 16-yr-old boy who was receiving amiodarone for ventricular arrhythmias developed a Reye's syndrome-like illness several days after an upper respiratory infection. Liver biopsy revealed microvesicular fat and spotty hepatocellular necrosis, typical of Reye's syndrome. Recovery was complete. This case report suggests that medications other than aspirin may predispose to Reye's syndrome, and that children receiving amiodarone should receive prophylaxis against influenza B and chicken pox.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
6/12. Reye's syndrome associated with respiratory syncytial virus infection.An upper respiratory tract infection in a 22-month-old boy was followed by rapid loss of consciousness, hypoglycaemia, uraemia, and death. Necropsy examination showed fatty change of liver and kidneys, severe cerebral oedema, bronchiolitis, and endocardial fibroelastosis affecting the left ventricle. Immunofluorescence staining showed infection with respiratory syncytial virus (RSV). The clinical and pathological findings were those of Reye's syndrome, not previously reported accompanying RSV infection.- - - - - - - - - - ranking = 398901.07375026keywords = upper respiratory tract infection, respiratory tract infection, upper respiratory tract, respiratory tract, tract infection, tract, upper (Clic here for more details about this article) |
7/12. Isolation of influenza virus from liver and muscle biopsy specimens from a surviving case of Reye's syndrome.Influenza virus (A/ohio/7/76) was demonstrated by haemagglutination and by direct electron microscopy in chick embryo fluids inoculated with liver, muscle, cerebrospinal fluid, and nasotracheal secretions obtained from a boy with Reye's syndrome, 8 days after the onset of the upper-respiratory-tract symptoms and at the height of neurological and hepatic involvement. This finding accords with the hypothesis that Reye's syndrome may be an epiphenomenon of influenza-virus infection. It is postulated that the pathogenesis of Reye's syndrome may be related to the other influenzal eipiphenomena including influenzal pneumonia in previously healthy persons and influenza-associated myopathy, both of which, like Reye's syndrome, become clinically evident about 7 days after the first clinical signs of influenza.- - - - - - - - - - ranking = 3.2472179291686keywords = tract, upper (Clic here for more details about this article) |
8/12. Simulated Reye's syndrome and salicylate therapy.A 4-year-old girl with juvenile rheumatoid arthritis developed fever, protracted vomiting, disturbance of consciousness and decorticate posture following the administration of salicylate. There were elevated levels of transaminases in serum, hyperammonemia and a fatty liver. However, the fatty droplets were different electronmicroscopically from that of Reye's syndrome. This observation emphasizes the importance of electronmicroscopic observation of the liver in the differential diagnosis between Reye's syndrome and aspirin-induced encephalopathy, because the clinico-pathological findings of intoxication are so similar.- - - - - - - - - - ranking = 2.2472179291686keywords = tract (Clic here for more details about this article) |
9/12. Decreased serum carnitine in valproate induced reye syndrome.A 3-year-old girl developed acute liver disease after treatment with valproate for 6 months. She developed the typical features of reye syndrome. serum free carnitine was decreased as well as 3-keto-valproic acid, the main metabolite of beta-oxidation of valproate. The serum valproate concentration was at the upper limit of the therapeutic range. The possible importance of carnitine in the pathogenesis of valproate induced liver disease is discussed.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
10/12. Reye's syndrome in the adult: case report and review of the literature.A 22-year-old male presented with a brief history of progressive encephalopathy. One week previously, he had developed an upper respiratory infection that resolved spontaneously and was followed by intractable vomiting. He had taken salicylates for several days during the viral syndrome. The diagnosis of Reye's syndrome was confirmed by hepatic histology. Aggressive conservative management was followed by complete metabolic and neurological recovery. There are fewer than 10 reported cases of Reye's syndrome in adults but this disease may be more common than is generally suspected. The diagnosis should be considered in patients presenting with emesis and obtundation, who have recently had a viral illness and exhibit elevated blood ammonia and transaminases with normal cerebrospinal fluid. Confirmation is achieved by liver biopsy. Therapy is directed toward aggressive reduction of increased intracranial pressure.- - - - - - - - - - ranking = 3.2472179291686keywords = tract, upper (Clic here for more details about this article) |
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