We study the journal that talks about the epidemiology and clinical manifestations of immune thrombocytopenia, which published on Hämostaseologie in Feb.2019. This article not only focuses on the age distribution of ITP but also on the symptoms of ITP. It also points out the difference between children and adult IPT patients. Hopefully, our note can help you to know about ITP deeply.
Evaluation of etiological differences in thrombocytopenia in underdeveloped c...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This case study describes a 63-year-old female who presented with severe polyarthralgia two days after receiving a Sinopharm COVID-19 vaccine. She had symmetric joint pain and swelling in her hands, wrists, knees, ankles and shoulders. Initial testing and symptoms were suggestive of reactive arthritis, but she did not respond to steroids. Synovial fluid from her knees grew gram-negative bacilli identified as E. coli, indicating septic polyarthritis. This case highlights that septic arthritis can initially present as polyarthritis and be misdiagnosed as other conditions like reactive arthritis if infection is not considered.
This document discusses cardiovascular diseases in HIV patients. It notes that cardiovascular disease is more common in HIV patients due to multiple potential factors, including traditional risk factors, HIV itself, antiretroviral therapy, and chronic inflammation. It also discusses specific cardiac complications in more detail, such as cardiomyopathy, pericardial effusion, endocarditis, pulmonary hypertension, vasculitis, and the possible association between viral infections and coronary artery disease.
Cardiovascular abnormalities are common in 25-75% of AIDS patients, caused by either direct infection from HIV or indirect effects of antiretroviral therapy. Cardiovascular diseases are among the top 4 leading causes of death in AIDS patients. HIV attacks the immune system and can cause conditions like dilated cardiomyopathy, endocarditis, myocarditis, pericarditis, pulmonary hypertension, coronary artery disease, and atherosclerosis. Risk factors for cardiovascular problems in AIDS patients include malnutrition, opportunistic infections, autoimmunity, malignancy, lifestyle factors, and certain antiretroviral drugs which can cause metabolic abnormalities. Lifestyle modifications, lipid management, immunoglobulin therapy, surgery, and addressing nutritional deficiencies
Austin Arthritis is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Arthritis.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances & happenings in all areas of Arthritis. Austin Arthritis accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Arthritis.
Austin Arthritis strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science
Immune Thrombocytopenia (ITP) is an autoimmune disorder characterized by low platelet count due to increased platelet destruction and impaired production. The bone marrow findings in ITP show increased immature megakaryocytes with scant cytoplasm and absent lobulation in the nucleus. Dysplastic megakaryocytes with separated nuclei and micromegakaryocytes are also seen. Megakaryocytes in ITP frequently show emperipolesis of lymphocytes or lymphocytes and nucleated red blood cells within the cytoplasm. These bone marrow findings are sensitive and specific for diagnosing ITP.
Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a rare systemic necrotizing vasculitis characterized by granulomatous inflammation involving the respiratory tract and necrotizing glomerulonephritis. It is associated with the presence of antineutrophil cytoplasmic antibodies (ANCA). Treatment involves inducing remission with high-dose corticosteroids combined with cyclophosphamide or rituximab to prevent organ damage and relapses. With effective treatment, remission rates are high but relapses remain common, requiring long-term management and monitoring.
A 35-year-old male patient with HIV was admitted with complaints of painful swelling in his right lower limb. Doppler imaging showed deep vein thrombosis in the right leg. The patient had no other risk factors for DVT. He was treated with anticoagulation therapy and his symptoms improved. Deep vein thrombosis is more common in HIV-infected individuals due to factors causing a hypercoagulable state induced by the virus. The report examines the case of DVT in an HIV-positive patient without other risk factors.
Evaluation of etiological differences in thrombocytopenia in underdeveloped c...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This case study describes a 63-year-old female who presented with severe polyarthralgia two days after receiving a Sinopharm COVID-19 vaccine. She had symmetric joint pain and swelling in her hands, wrists, knees, ankles and shoulders. Initial testing and symptoms were suggestive of reactive arthritis, but she did not respond to steroids. Synovial fluid from her knees grew gram-negative bacilli identified as E. coli, indicating septic polyarthritis. This case highlights that septic arthritis can initially present as polyarthritis and be misdiagnosed as other conditions like reactive arthritis if infection is not considered.
This document discusses cardiovascular diseases in HIV patients. It notes that cardiovascular disease is more common in HIV patients due to multiple potential factors, including traditional risk factors, HIV itself, antiretroviral therapy, and chronic inflammation. It also discusses specific cardiac complications in more detail, such as cardiomyopathy, pericardial effusion, endocarditis, pulmonary hypertension, vasculitis, and the possible association between viral infections and coronary artery disease.
Cardiovascular abnormalities are common in 25-75% of AIDS patients, caused by either direct infection from HIV or indirect effects of antiretroviral therapy. Cardiovascular diseases are among the top 4 leading causes of death in AIDS patients. HIV attacks the immune system and can cause conditions like dilated cardiomyopathy, endocarditis, myocarditis, pericarditis, pulmonary hypertension, coronary artery disease, and atherosclerosis. Risk factors for cardiovascular problems in AIDS patients include malnutrition, opportunistic infections, autoimmunity, malignancy, lifestyle factors, and certain antiretroviral drugs which can cause metabolic abnormalities. Lifestyle modifications, lipid management, immunoglobulin therapy, surgery, and addressing nutritional deficiencies
Austin Arthritis is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Arthritis.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances & happenings in all areas of Arthritis. Austin Arthritis accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Arthritis.
Austin Arthritis strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science
Immune Thrombocytopenia (ITP) is an autoimmune disorder characterized by low platelet count due to increased platelet destruction and impaired production. The bone marrow findings in ITP show increased immature megakaryocytes with scant cytoplasm and absent lobulation in the nucleus. Dysplastic megakaryocytes with separated nuclei and micromegakaryocytes are also seen. Megakaryocytes in ITP frequently show emperipolesis of lymphocytes or lymphocytes and nucleated red blood cells within the cytoplasm. These bone marrow findings are sensitive and specific for diagnosing ITP.
Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a rare systemic necrotizing vasculitis characterized by granulomatous inflammation involving the respiratory tract and necrotizing glomerulonephritis. It is associated with the presence of antineutrophil cytoplasmic antibodies (ANCA). Treatment involves inducing remission with high-dose corticosteroids combined with cyclophosphamide or rituximab to prevent organ damage and relapses. With effective treatment, remission rates are high but relapses remain common, requiring long-term management and monitoring.
A 35-year-old male patient with HIV was admitted with complaints of painful swelling in his right lower limb. Doppler imaging showed deep vein thrombosis in the right leg. The patient had no other risk factors for DVT. He was treated with anticoagulation therapy and his symptoms improved. Deep vein thrombosis is more common in HIV-infected individuals due to factors causing a hypercoagulable state induced by the virus. The report examines the case of DVT in an HIV-positive patient without other risk factors.
This document discusses reactive arthritis (ReA), also known as Reiter's syndrome. It defines ReA as acute nonpurulent arthritis that occurs 1-4 weeks after an infection elsewhere in the body. Common infections that can trigger ReA include gastrointestinal or genitourinary infections by bacteria like Salmonella, Shigella, Yersinia, Campylobacter, or Chlamydia. The document discusses the pathophysiology, clinical features, diagnosis, treatment, and prevention of ReA. It also briefly summarizes some other systemic diseases that can present with arthritis symptoms, such as systemic lupus erythematosus, psoriatic arthritis, inflammatory bowel disease, rheumatic fever, and
Cardiomyopathy in HIV patients has been shown to progress faster than idiopathic Dilated Cardiomyopathy in the HIV negative population. It is therefore important to recognize this condition early in this population and manage it appropriately. Studies need to be done to validate the current therapy for cardiomyopathy in this population since it is still unclear that LV dysfunction in this population responds in a similar fashion as in HIV negative patients with Dilated Cardiomyopathy
This document discusses coronary artery disease in HIV patients. It covers the relative magnitude of cardiovascular disease among HIV patients, current data on the association between HIV and coronary artery disease, known risk factors and how they may be modulated by HIV diagnosis, screening and prevention recommendations, and areas for future research. Key points include increased rates of myocardial infarction and atherosclerosis in HIV patients, traditional and HIV-specific risk factors, screening tools and their limitations, effects of antiretroviral therapy on risk, and lifestyle and medical interventions for prevention.
kidney disease in HIV-positive patients, Moh'd sharshirMoh'd sharshir
Patients with HIV are at risk for both acute kidney injury and chronic kidney disease due to various factors like medication toxicity, HIV-associated nephropathy, and immune complex kidney diseases. The risk factors for acute kidney injury in HIV patients are similar to the general population but also include factors specific to HIV like low CD4 count and co-infection with hepatitis C virus. Timely screening for chronic kidney disease is important in HIV patients to monitor for decline in kidney function and proteinuria, in order to guide management and reduce risk of end-stage renal disease.
A Case Report on Hepatitis C Induced Acute Immune Thrombocytopeniaijtsrd
Chronic hepatitis C virus HCV infection is recognized as a global health problem with 170 to 200 million people estimated to be infected worldwide. Chronic HCV is one of the most common chronic viral infections worldwide and it is a major cause of cirrhosis, end stage liver disease and hepatocellular carcinoma. While HCV induced thrombocytopenia observed among these patients, thrombocytopenia is one of the rarely observed. We present a case with HCV infection in which thrombocytopenia developed in starting phase treatment. Although there are not an adequate number of studies on this subject, it was concluded thrombocytopenia that developed because of HCV infection is a favorable option. Dr. Jay B. Patel | Gaurav Rajauria | Dr. Rajveer Singh "A Case Report on Hepatitis C Induced Acute Immune Thrombocytopenia" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd30882.pdf Paper Url :https://www.ijtsrd.com/medicine/immunology/30882/a-case-report-on-hepatitis-c-induced-acute-immune-thrombocytopenia/dr-jay-b-patel
The UC San Diego AntiViral Research Center sponsors weekly presentations on HIV, HBV, HCV, TB and other infectious diseases to provide current research, clinical practices and trends. This presentation was on renal disease in HIV/AIDS patients. It discussed the various causes of acute and chronic kidney disease seen in this population, including HIV-associated nephropathy. Treatment focuses on antiretroviral therapy to suppress HIV viral load, though options are limited in advanced renal disease. The case presentation involved a patient with multiple comorbidities where a renal biopsy showed findings consistent with HIV-associated nephropathy.
HIV-associated nephropathy (HIVAN) is a kidney disease characterized by proteinuria, kidney damage, and focal segmental glomerulosclerosis that primarily affects people with HIV. It was first reported in 1984 and is most common in African Americans. The introduction of antiretroviral therapy has decreased the incidence of end-stage renal disease due to HIVAN. HIV infection of renal epithelial cells directly contributes to HIVAN pathogenesis, and the kidneys may serve as an important viral reservoir even when viral loads are undetectable in blood. Treatment with antiretroviral therapy, ACE inhibitors, and steroids can help reduce progression of kidney disease in patients with HIVAN.
This document summarizes the types and causes of kidney disease associated with HIV infection. It discusses HIV-associated nephropathy (HIVAN) in particular, which predominantly affects black populations and involves both glomerular and tubular kidney damage. The pathogenesis of HIVAN involves direct infection of kidney cells by HIV. Treatment focuses on antiretroviral therapy and ACE inhibitors, with corticosteroids and immunosuppressants also being investigated.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
HIV-associated nephropathy (HIVAN) is a type of renal disease that predominantly affects people of African descent with HIV. It is characterized by collapsing focal segmental glomerulosclerosis and severe tubular injury. The pathogenesis involves direct infection and damage of kidney cells by HIV as well as immune complex deposition. While the disease often progresses to renal failure if left untreated, early diagnosis and treatment with antiretroviral therapy can stabilize renal function and prevent worsening of kidney disease for many patients.
This document discusses stroke in HIV infection. It begins by providing background on HIV/AIDS classifications and prevalence statistics. It then describes the CDC classification system for HIV infection and lists conditions under categories B and C. It discusses the epidemiology of stroke in HIV patients, noting rates vary from 0.5-5% in studies. Potential causes of ischemic and hemorrhagic stroke are outlined. Treatment focuses on underlying infections or disorders. While HAART reduced some complications, protease inhibitors may increase atherosclerosis risk. In conclusion, strokes in HIV patients tend to occur in severe immunosuppression and various infectious etiologies can cause ischemic or hemorrhagic strokes.
Agranulocytosis is a life-threatening disorder in any age and also in the elderly subjects who are receiving on the average a larger number of drugs than younger subjects. This disorder frequently occurs as an adverse reaction to drugs, particularly to antibiotics, antiplatelet agents, antithyroid drugs, neuroleptics or anti-epileptic agents and nonsteroidal anti-inflammatory agents. Although patients experiencing drug-induced agranulocytosis may initially be asymptomatic, the severity of the neutropenia usually translates into the onset of severe sepsis that requires intravenous broad-spectrum antibiotherapy. In this setting, hematopoietic growth factors have been shown to shorten the duration of neutropenia. Thus with appropriate management, the mortality rate of idiosyncratic drug-induced agranulocytosis is now of 5 to 10%. Today, drug-induced agranulocytosis still remains a rare event with an annual incidence from 3 to 12 cases per millions of people. However, given the increased life expectancy and subsequent longer exposure to drugs, as well as the development of new agents, physicians should be aware of this complication and its management.
Clinical Particularities of Drug-Induced Agranulocytosis or Severe Neu...dynajolly
Agranulocytosis is a life-threatening disorder in any age and also in the elderly subjects who are receiving on the average a larger number of drugs than younger subjects. This disorder frequently occurs as an adverse reaction to drugs, particularly to antibiotics, antiplatelet agents, antithyroid drugs, neuroleptics or anti-epileptic agents and nonsteroidal anti-inflammatory agents. Although patients experiencing drug-induced agranulocytosis may initially be asymptomatic, the severity of the neutropenia usually translates into the onset of severe sepsis that requires intravenous broad-spectrum
antibiotherapy. In this setting, hematopoietic growth factors have been shown to shorten the duration of neutropenia. Thus with appropriate management, the mortality rate of
idiosyncratic drug-induced agranulocytosis is now of 5 to 10%. Today, drug-induced agranulocytosis still remains a rare event with an annual incidence from 3 to 12 cases per millions of people. However, given the increased life expectancy and subsequent longer exposure to drugs, as well as the development of new agents, physicians should be aware of this complication and its management.
This document provides an overview of infective endocarditis (IE), a rare but life-threatening disease caused by bacterial infection of the heart valves or endocardium. It discusses the epidemiology, risk factors, causative pathogens, pathophysiology, and challenges in diagnosis and treatment of IE. Key points include: IE incidence ranges from 1.5 to 11.6 cases per 100,000 people globally, with mortality around 25% even with treatment; risk factors include underlying heart conditions like rheumatic heart disease as well as healthcare exposures; staphylococci and streptococci cause most cases but proportions vary globally; the vegetation develops through bacterial adhesion to damaged heart valves and formation of a protective matrix.
This document summarizes a study comparing clinical characteristics and risk factors for severe COVID-19 in 167 hospitalized patients in Anhui, China. The key findings were:
1) 17.9% of patients had severe disease. Older age, comorbidities like diabetes, lower oxygen saturation, lower lymphocyte and CD4 counts, and higher levels of CRP, LDH and IL-6 were associated with more severe disease.
2) Independent risk factors for severe disease identified through logistic regression were lower oxygen saturation and lower CD4 cell count.
3) All patients recovered and were discharged without deaths, though severe cases required treatments like mechanical ventilation, glucocorticoids and immunoglobulins
This document discusses HIV and its impact on the kidneys. It includes information from a nephrologist and clinical studies showing:
1) HIV can cause kidney disease, most notably HIV-associated nephropathy (HIVAN), which disproportionately affects African Americans.
2) Early studies from the pre-HAART era in the 1980s-1990s showed high rates of kidney disease and failure in people with HIV.
3) Later studies from the HAART era in the 2000s found lower rates of new kidney disease but higher overall prevalence, suggesting antiretroviral drugs may be improving outcomes for some but also contributing to kidney issues over the long term.
This document discusses coagulopathy and thrombosis in COVID-19 patients. It reviews a case where a clot-busting drug improved a patient's condition, suggesting blood clots play a bigger role in the disease than previously thought. Autopsies show COVID patients' lungs and other organs choked with microclots. The virus may directly infect blood vessels, impairing blood flow regulation and promoting clotting. Routine monitoring of coagulation markers and use of preventative doses of anticoagulants are recommended for COVID patients.
This document provides an overview of kidney disorders associated with HIV infection. It discusses acute kidney injury in HIV patients, which is more common than in the general population. It also reviews electrolyte disturbances, medication toxicity from antiretrovirals and other HIV drugs, and thrombotic microangiopathy associated with HIV. The document focuses in depth on HIV-associated nephropathy (HIVAN), immune complex glomerulonephritis, and hepatitis C co-infection in HIV patients. It provides details on the pathogenesis, epidemiology, clinical presentation, pathology, diagnosis and treatment of these important kidney conditions seen in individuals living with HIV.
Sepsis is a clinical syndrome resulting from a dysregulated inflammatory response to infection. It occurs on a continuum from systemic inflammatory response syndrome (SIRS) to sepsis to septic shock and multiple organ dysfunction syndrome (MODS). Sepsis affects over 750,000 Americans annually and is a leading cause of death, with high mortality rates the more severe the presentation becomes. Early recognition and treatment, including antibiotics within 1-3 hours, fluids, and vasopressors if needed, are critical to improving outcomes.
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia caused by increased platelet destruction and impaired platelet production. It commonly presents as purpura and bruising in children and has two clinical forms - an acute self-limiting form in children and a chronic form in adults. Treatment involves corticosteroids, IVIG, thrombopoietin receptor agonists, rituximab or splenectomy depending on severity and response to initial therapies.
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by increased platelet destruction and decreased platelet production. It most commonly presents as purpura and bruising. ITP is diagnosed through identifying isolated thrombocytopenia after excluding other potential causes. Treatment involves corticosteroids, IVIG, thrombopoietin receptor agonists, or splenectomy depending on the severity and chronicity of the condition. ITP has both acute and chronic forms, with acute often resolving spontaneously in children and chronic typically persisting for over 6 months in adults.
- Idiopathic thrombocytopenic purpura (ITP) is an autoimmune bleeding disorder characterized by low platelet count. It has an annual incidence of 100 cases per million people per year, about half occurring in children.
- The etiology is unknown but involves autoantibodies against platelets that cause their premature destruction. Most children experience resolution within 6 months regardless of treatment, while ITP is usually chronic in adults.
- Treatment is based on platelet count, bleeding severity, and lifestyle. Options include observation, corticosteroids, IVIG, and anti-D immunoglobulin. For refractory cases, splenectomy, rituximab or thrombopoietin
This document discusses reactive arthritis (ReA), also known as Reiter's syndrome. It defines ReA as acute nonpurulent arthritis that occurs 1-4 weeks after an infection elsewhere in the body. Common infections that can trigger ReA include gastrointestinal or genitourinary infections by bacteria like Salmonella, Shigella, Yersinia, Campylobacter, or Chlamydia. The document discusses the pathophysiology, clinical features, diagnosis, treatment, and prevention of ReA. It also briefly summarizes some other systemic diseases that can present with arthritis symptoms, such as systemic lupus erythematosus, psoriatic arthritis, inflammatory bowel disease, rheumatic fever, and
Cardiomyopathy in HIV patients has been shown to progress faster than idiopathic Dilated Cardiomyopathy in the HIV negative population. It is therefore important to recognize this condition early in this population and manage it appropriately. Studies need to be done to validate the current therapy for cardiomyopathy in this population since it is still unclear that LV dysfunction in this population responds in a similar fashion as in HIV negative patients with Dilated Cardiomyopathy
This document discusses coronary artery disease in HIV patients. It covers the relative magnitude of cardiovascular disease among HIV patients, current data on the association between HIV and coronary artery disease, known risk factors and how they may be modulated by HIV diagnosis, screening and prevention recommendations, and areas for future research. Key points include increased rates of myocardial infarction and atherosclerosis in HIV patients, traditional and HIV-specific risk factors, screening tools and their limitations, effects of antiretroviral therapy on risk, and lifestyle and medical interventions for prevention.
kidney disease in HIV-positive patients, Moh'd sharshirMoh'd sharshir
Patients with HIV are at risk for both acute kidney injury and chronic kidney disease due to various factors like medication toxicity, HIV-associated nephropathy, and immune complex kidney diseases. The risk factors for acute kidney injury in HIV patients are similar to the general population but also include factors specific to HIV like low CD4 count and co-infection with hepatitis C virus. Timely screening for chronic kidney disease is important in HIV patients to monitor for decline in kidney function and proteinuria, in order to guide management and reduce risk of end-stage renal disease.
A Case Report on Hepatitis C Induced Acute Immune Thrombocytopeniaijtsrd
Chronic hepatitis C virus HCV infection is recognized as a global health problem with 170 to 200 million people estimated to be infected worldwide. Chronic HCV is one of the most common chronic viral infections worldwide and it is a major cause of cirrhosis, end stage liver disease and hepatocellular carcinoma. While HCV induced thrombocytopenia observed among these patients, thrombocytopenia is one of the rarely observed. We present a case with HCV infection in which thrombocytopenia developed in starting phase treatment. Although there are not an adequate number of studies on this subject, it was concluded thrombocytopenia that developed because of HCV infection is a favorable option. Dr. Jay B. Patel | Gaurav Rajauria | Dr. Rajveer Singh "A Case Report on Hepatitis C Induced Acute Immune Thrombocytopenia" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd30882.pdf Paper Url :https://www.ijtsrd.com/medicine/immunology/30882/a-case-report-on-hepatitis-c-induced-acute-immune-thrombocytopenia/dr-jay-b-patel
The UC San Diego AntiViral Research Center sponsors weekly presentations on HIV, HBV, HCV, TB and other infectious diseases to provide current research, clinical practices and trends. This presentation was on renal disease in HIV/AIDS patients. It discussed the various causes of acute and chronic kidney disease seen in this population, including HIV-associated nephropathy. Treatment focuses on antiretroviral therapy to suppress HIV viral load, though options are limited in advanced renal disease. The case presentation involved a patient with multiple comorbidities where a renal biopsy showed findings consistent with HIV-associated nephropathy.
HIV-associated nephropathy (HIVAN) is a kidney disease characterized by proteinuria, kidney damage, and focal segmental glomerulosclerosis that primarily affects people with HIV. It was first reported in 1984 and is most common in African Americans. The introduction of antiretroviral therapy has decreased the incidence of end-stage renal disease due to HIVAN. HIV infection of renal epithelial cells directly contributes to HIVAN pathogenesis, and the kidneys may serve as an important viral reservoir even when viral loads are undetectable in blood. Treatment with antiretroviral therapy, ACE inhibitors, and steroids can help reduce progression of kidney disease in patients with HIVAN.
This document summarizes the types and causes of kidney disease associated with HIV infection. It discusses HIV-associated nephropathy (HIVAN) in particular, which predominantly affects black populations and involves both glomerular and tubular kidney damage. The pathogenesis of HIVAN involves direct infection of kidney cells by HIV. Treatment focuses on antiretroviral therapy and ACE inhibitors, with corticosteroids and immunosuppressants also being investigated.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
HIV-associated nephropathy (HIVAN) is a type of renal disease that predominantly affects people of African descent with HIV. It is characterized by collapsing focal segmental glomerulosclerosis and severe tubular injury. The pathogenesis involves direct infection and damage of kidney cells by HIV as well as immune complex deposition. While the disease often progresses to renal failure if left untreated, early diagnosis and treatment with antiretroviral therapy can stabilize renal function and prevent worsening of kidney disease for many patients.
This document discusses stroke in HIV infection. It begins by providing background on HIV/AIDS classifications and prevalence statistics. It then describes the CDC classification system for HIV infection and lists conditions under categories B and C. It discusses the epidemiology of stroke in HIV patients, noting rates vary from 0.5-5% in studies. Potential causes of ischemic and hemorrhagic stroke are outlined. Treatment focuses on underlying infections or disorders. While HAART reduced some complications, protease inhibitors may increase atherosclerosis risk. In conclusion, strokes in HIV patients tend to occur in severe immunosuppression and various infectious etiologies can cause ischemic or hemorrhagic strokes.
Agranulocytosis is a life-threatening disorder in any age and also in the elderly subjects who are receiving on the average a larger number of drugs than younger subjects. This disorder frequently occurs as an adverse reaction to drugs, particularly to antibiotics, antiplatelet agents, antithyroid drugs, neuroleptics or anti-epileptic agents and nonsteroidal anti-inflammatory agents. Although patients experiencing drug-induced agranulocytosis may initially be asymptomatic, the severity of the neutropenia usually translates into the onset of severe sepsis that requires intravenous broad-spectrum antibiotherapy. In this setting, hematopoietic growth factors have been shown to shorten the duration of neutropenia. Thus with appropriate management, the mortality rate of idiosyncratic drug-induced agranulocytosis is now of 5 to 10%. Today, drug-induced agranulocytosis still remains a rare event with an annual incidence from 3 to 12 cases per millions of people. However, given the increased life expectancy and subsequent longer exposure to drugs, as well as the development of new agents, physicians should be aware of this complication and its management.
Clinical Particularities of Drug-Induced Agranulocytosis or Severe Neu...dynajolly
Agranulocytosis is a life-threatening disorder in any age and also in the elderly subjects who are receiving on the average a larger number of drugs than younger subjects. This disorder frequently occurs as an adverse reaction to drugs, particularly to antibiotics, antiplatelet agents, antithyroid drugs, neuroleptics or anti-epileptic agents and nonsteroidal anti-inflammatory agents. Although patients experiencing drug-induced agranulocytosis may initially be asymptomatic, the severity of the neutropenia usually translates into the onset of severe sepsis that requires intravenous broad-spectrum
antibiotherapy. In this setting, hematopoietic growth factors have been shown to shorten the duration of neutropenia. Thus with appropriate management, the mortality rate of
idiosyncratic drug-induced agranulocytosis is now of 5 to 10%. Today, drug-induced agranulocytosis still remains a rare event with an annual incidence from 3 to 12 cases per millions of people. However, given the increased life expectancy and subsequent longer exposure to drugs, as well as the development of new agents, physicians should be aware of this complication and its management.
This document provides an overview of infective endocarditis (IE), a rare but life-threatening disease caused by bacterial infection of the heart valves or endocardium. It discusses the epidemiology, risk factors, causative pathogens, pathophysiology, and challenges in diagnosis and treatment of IE. Key points include: IE incidence ranges from 1.5 to 11.6 cases per 100,000 people globally, with mortality around 25% even with treatment; risk factors include underlying heart conditions like rheumatic heart disease as well as healthcare exposures; staphylococci and streptococci cause most cases but proportions vary globally; the vegetation develops through bacterial adhesion to damaged heart valves and formation of a protective matrix.
This document summarizes a study comparing clinical characteristics and risk factors for severe COVID-19 in 167 hospitalized patients in Anhui, China. The key findings were:
1) 17.9% of patients had severe disease. Older age, comorbidities like diabetes, lower oxygen saturation, lower lymphocyte and CD4 counts, and higher levels of CRP, LDH and IL-6 were associated with more severe disease.
2) Independent risk factors for severe disease identified through logistic regression were lower oxygen saturation and lower CD4 cell count.
3) All patients recovered and were discharged without deaths, though severe cases required treatments like mechanical ventilation, glucocorticoids and immunoglobulins
This document discusses HIV and its impact on the kidneys. It includes information from a nephrologist and clinical studies showing:
1) HIV can cause kidney disease, most notably HIV-associated nephropathy (HIVAN), which disproportionately affects African Americans.
2) Early studies from the pre-HAART era in the 1980s-1990s showed high rates of kidney disease and failure in people with HIV.
3) Later studies from the HAART era in the 2000s found lower rates of new kidney disease but higher overall prevalence, suggesting antiretroviral drugs may be improving outcomes for some but also contributing to kidney issues over the long term.
This document discusses coagulopathy and thrombosis in COVID-19 patients. It reviews a case where a clot-busting drug improved a patient's condition, suggesting blood clots play a bigger role in the disease than previously thought. Autopsies show COVID patients' lungs and other organs choked with microclots. The virus may directly infect blood vessels, impairing blood flow regulation and promoting clotting. Routine monitoring of coagulation markers and use of preventative doses of anticoagulants are recommended for COVID patients.
This document provides an overview of kidney disorders associated with HIV infection. It discusses acute kidney injury in HIV patients, which is more common than in the general population. It also reviews electrolyte disturbances, medication toxicity from antiretrovirals and other HIV drugs, and thrombotic microangiopathy associated with HIV. The document focuses in depth on HIV-associated nephropathy (HIVAN), immune complex glomerulonephritis, and hepatitis C co-infection in HIV patients. It provides details on the pathogenesis, epidemiology, clinical presentation, pathology, diagnosis and treatment of these important kidney conditions seen in individuals living with HIV.
Sepsis is a clinical syndrome resulting from a dysregulated inflammatory response to infection. It occurs on a continuum from systemic inflammatory response syndrome (SIRS) to sepsis to septic shock and multiple organ dysfunction syndrome (MODS). Sepsis affects over 750,000 Americans annually and is a leading cause of death, with high mortality rates the more severe the presentation becomes. Early recognition and treatment, including antibiotics within 1-3 hours, fluids, and vasopressors if needed, are critical to improving outcomes.
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia caused by increased platelet destruction and impaired platelet production. It commonly presents as purpura and bruising in children and has two clinical forms - an acute self-limiting form in children and a chronic form in adults. Treatment involves corticosteroids, IVIG, thrombopoietin receptor agonists, rituximab or splenectomy depending on severity and response to initial therapies.
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by increased platelet destruction and decreased platelet production. It most commonly presents as purpura and bruising. ITP is diagnosed through identifying isolated thrombocytopenia after excluding other potential causes. Treatment involves corticosteroids, IVIG, thrombopoietin receptor agonists, or splenectomy depending on the severity and chronicity of the condition. ITP has both acute and chronic forms, with acute often resolving spontaneously in children and chronic typically persisting for over 6 months in adults.
- Idiopathic thrombocytopenic purpura (ITP) is an autoimmune bleeding disorder characterized by low platelet count. It has an annual incidence of 100 cases per million people per year, about half occurring in children.
- The etiology is unknown but involves autoantibodies against platelets that cause their premature destruction. Most children experience resolution within 6 months regardless of treatment, while ITP is usually chronic in adults.
- Treatment is based on platelet count, bleeding severity, and lifestyle. Options include observation, corticosteroids, IVIG, and anti-D immunoglobulin. For refractory cases, splenectomy, rituximab or thrombopoietin
This document presents a case study of a 10-year-old girl who presented with petechiae and was diagnosed with idiopathic thrombocytopenic purpura (ITP). Her clinical examination and lab tests confirmed the diagnosis of ITP. She was monitored as an outpatient without treatment. Over the next few years, her platelet count remained low and she received various treatments including IVIG and corticosteroids. Her condition was managed long-term with intermittent corticosteroid therapy and consideration of splenectomy. The document also provides background information on ITP including epidemiology, pathophysiology, diagnosis, treatment guidelines, and outcomes.
Dr. Renesha Islam and Dr. Farzana AlamMou presented two cases of pediatric patients with bleeding and low platelet counts. The first case was a 5-year-old boy, Yasin, with petechiae and bleeding who had a platelet count of 35,000/cmm. The second case was a 13-year-old girl, Asma, with ecchymosis and menorrhagia who had a platelet count of 20,000/cmm. The doctors then discussed immune thrombocytopenia, including its history, pathophysiology involving autoantibodies and impaired platelet production, classification as acute or chronic, and clinical manifestations ranging from no symptoms to severe bleeding.
1. A 3-year-old child presented with bruising, petechiae on the legs, and a platelet count of 15,000/uL. The provisional diagnosis is idiopathic thrombocytopenic purpura (ITP). Differentials include leukemia, aplastic anemia, and lymphoma.
2. ITP is an autoimmune disorder where antibodies destroy platelets, causing a low platelet count. It typically presents acutely following a viral infection. Treatment involves initial measures like IVIG or steroids to rapidly raise platelet counts.
3. For chronic ITP that persists over 1 year, treatment involves IVIG, steroids, and potentially splenectomy for resistant cases to
This document summarizes the case of a 10-year-old girl diagnosed with idiopathic thrombocytopenic purpura (ITP) who presented with petechiae. Her initial workup showed a platelet count of 10,600. Over the next few years, she was treated with various therapies including IVIG and corticosteroids, but her platelet counts remained low. She eventually underwent splenectomy, which increased her platelet count but she remained dependent on treatment. The document provides an overview of ITP including epidemiology, pathogenesis, diagnosis and management guidelines.
1. Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder where antibodies develop against platelets, causing them to be destroyed by the spleen. This leads to low platelet counts and bruising.
2. ITP most often presents as a sudden onset of bruises and bleeding in otherwise healthy young children following a viral infection. Physical exams are typically normal aside from bruising.
3. Treatment is usually not needed for mild cases and 70-80% of children see spontaneous remission within 6 months. Options when treatment is needed include IVIG, IV anti-D, corticosteroids, and splenectomy in severe cases.
The document describes a case of a 23-year-old male presenting with tender bilateral tonsillar and cervical lymphadenopathy for 5 days, along with a low-grade fever of 100.2°F and sore throat with trouble swallowing for 1 day. On exam, the patient has enlarged tonsils with whitish exudate. The best next step in management is to obtain a rapid strep test to determine if the patient has streptococcal pharyngitis.
This document summarizes recent advances in the treatment of immune thrombocytopenia (ITP). It discusses definitions and classifications of ITP, pathophysiology, clinical presentation, diagnostic workup, and treatment recommendations. For initial treatment, corticosteroids, IVIG, and anti-D are recommended. For persistent or chronic ITP, thrombopoietin receptor agonists, rituximab, and splenectomy may be considered. The goals of treatment are to prevent bleeding while minimizing toxicity and optimizing quality of life.
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Idiopathic thrombocytopenic purpura (ITP) is an immune-mediated disorder characterized by low platelet counts. It most commonly presents as bruising or bleeding in otherwise healthy children. While severe bleeding is rare, treatment may be required to raise platelet counts to prevent bleeding. For children with no or minor symptoms, the guidelines recommend initial observation over corticosteroids or IVIG due to low risk and lack of evidence for benefit of active treatment. Hospitalization is typically not required if prompt hematology follow-up can be provided.
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3. Introduction
• Immune thrombocytopenia (ITP)
Characterization: isolated thrombocytopenia, affecting individuals of all
ages, races and either sex
Cause:
Autoimmune destruction of platelets
→ Antibodies against platelet glycoproteins
→ Opsonization and destruction of platelets, inhibition of platelet
production
Anti-platelet antibodies are detected in approximately 60% of patients
‒ Mostly against glycoprotein IIb/ IIIa
5. Introduction
• Immune thrombocytopenia (ITP)
Primary or secondary associated with an underlying infectious,
autoimmune or neoplastic condition
Bleeding symptoms are the predominant clinical manifestation
In children, particularly in the first decade of life
‒ Less likely to present with significant bleeding or to be associated
with an underlying disorder
‒ More likely to remit spontaneously
6.
7. Epidemiology of Acute and Chronic ITP
• We searched the MEDLINE database from 1970 to 2018 using MeSH
terms describing ITP along with MeSH subheadings and keywords for
study design
• Only publications in English were included
8. Incidence of Acute ITP
• Incidence rates: ranging from 1.1 to 5.8 per 100,000 person years among
children
9. Incidence of Acute ITP
• Incidence rates: ranging from 1.6 to 3.9 per 100,000 person years among
adult
10. Incidence of Acute ITP
• Heterogeneous in their design, inclusion criteria and outcomes
→ Precluded the generation of pooled analyses and may also account for
the wide variation in estimates
• Schoonen and colleagues:
General Practice Research Database covering over 3.4 million
persons in the United Kingdom
Overall ITP incidence rate of 3.9 over 100,000 patient-years
Higher rate in women(4.4) than men(3.4)
Bimodal distribution among males: <18 years of age and 75-85 years
old
11. Incidence of Acute ITP
• Another analysis of incidence of ITP:
<18 years: 4.2 per 100,000 person years
2-5 years: boys(9.7) > girls (4.7)
13-17 years: lower (2.4), similar rates in boys and girls
12. Incidence of Acute ITP
• Moulis et al:
Insurance database covering the entire population of France
Overall incidence rate of 2.9 per 100,000 patientyears
Peaks in childhood (age 1–5 years) and the elderly (>60 years)
Overall rates were higher in women but peaks of incidence were noted
for younger boys (0–5 years) and older men (>75 years)
Seasonal variation with a peak in January and a nadir in summer in
almost all age groups (except infants that demonstrated a peak in
spring)
− Viral infections, supported by a history of a flu-like illness preceding
ITP diagnosis in up to two-thirds of children
13. Prevalence of Chronic ITP in Adults and Children
• Chronic ITP:
Definition: thrombocytopenia that persists for more than 12 months
from initial presentation
• International Working Group:
Persistent ITP, ITP lasting between 3 to 12 months given the
significant chance of spontaneous remission during this period
14. Prevalence of Chronic ITP in Adults and Children
• The point prevalence of chronic ITP in the United States was estimated as
9.5 to 11.2 per 100,000 persons
Based on analysis of insurance claims data from individual states
• Prevalence was higher in adults(12.1) than children(8.1)
15. Prevalence of Chronic ITP in Adults and Children
• Bennett et al:
18-year period prevalence of chronic ITP in the United Kingdom was
50.29 per 100,000 adults
Prevalence increasing with age
Childhood ITP:
‒ The majority remits spontaneously, often within 6 months
‒ 20 to 30% of children go onto develop chronic ITP
‒ Risk factors for developing chronic ITP:
1. Older age
2. Less severe thrombocytopenia at the initial diagnosis
3. Insidious onset of symptoms
4. Lack of platelet count recovery at 4 weeks
5. Lack of preceding infection or vaccination as a trigger
16. Prevalence of Chronic ITP in Adults and Children
• TIKI trial:
Randomized children with acute ITP to observation or immunoglobulin
therapy
No statistically significant reduction in progression to chronic ITP
among children who received immunoglobulin
• Spontaneous remission is relatively uncommon in adults with ITP
• The majority (66.7%) of adults with acute ITP develop chronic ITP
• Disease control at 6 months:
Rituximab or Eltrombopag + high-dose Dexamethasone > Corticosteroids
alone
17. 20% of ITP cases
Associated with an underlying disorder
SLE, HIV infection, HCV, Helicobacter pylori, malignancies, primary
immunodeficiency
Increases with age
Group % of secondary ITP Most common underlying cause
children 2.4% primary immunodeficiency, SLE
adults 18% malignant lymphoid disorders
Secondary ITP
20. Thrombocytopenia and bleeding symptoms
Diagnosis of ITP: platelet count <100,000/uL
Concern for bleeding is greatest: platelet <20k ~ 30k/uL
2/3 had manifestations
Typical: petechiae, bruising, epistaxis, gum bleeding, hemorrhagic
blisters
Uncommon: ICH, GI bleeding, GU bleeding, menstrual bleeding
Clinical Manifestations
21. Predictors of severe bleeding
Platelet count < 10k/uL ~ 20k/uL
Not universally reliable
Advanced age
Previous minor bleeding
Acute ITP > chronic ITP
*Age group Odds ratio of risk of major bleeding
> 60 years 28.9
40~60 years 2.8
< 40 years 1
*Cortelazzo et al
$diagnosis time Bleeding rates (PPY)
Newly 2.67
Chronic 0.73
$Altomare et al
Clinical Manifestations
23. Early study: platelet count of 7,000 to 8,000/μL is required to maintain
vascular haemostasis.
Several studies have identified extremely low platelet counts
(<10,000/μL or <20,000/μL) as predictors of severe bleeding.
Association between Platelet Counts and Bleeding
24. In a large follow-up study of ITP patients treated with romiplostim, 61%
of severe bleeding events occurred at a platelet count <20,000/μL
Page et al noted that while platelet count correlates with bleeding,
overall, this relationship disappeared at platelet counts <30,000/μL.
In the ICIS registry, a platelet count <20,000/μL had a sensitivity of 88%
but a specificity of only 21% in predicting severe bleeding.
Association between Platelet Counts and Bleeding
25. Middelburg RA, Hematology 2016
Panzer S, Eur J Clin Invest 2007
Increased platelet activation, measured as increased expression of
platelet P-selectin, is associated with lower bleeding risk in ITP.
Tantawy AA, Pediatr Hematol Oncol 2010
Elevated levels of microparticles (a by-product of platelet activation) are
associated with less bleeding in ITP.
Association between Platelet Counts and Bleeding
26. The cause of fatigue in ITP is unclear, but has been attributed to the
pro-inflammatory effects of immune dysregulation in ITP.
Health related quality of life (HRQOL) is impaired in chronic ITP.
An early study using the short form-36 in 73 adults with ITP found that
HRQOL was significantly worse than the general population.
Fatigue and Quality of Life
27. Impairments in HRQOL have also been demonstrated in children with
ITP using the Kids’ ITP Tool (KIT).
In adults with ITP, treatment with splenectomy or rituximab improved
HRQOL scores.
In randomized, placebo-controlled trials, romiplostim therapy
significantly improved HRQOL in both adults and children.
Fatigue and poor HRQOL are not yet generally accepted indications for
treatment in ITP.
Fatigue and Quality of Life
28.
29. Chronic ITP is associated with a modestly increased risk of
thromboembolism.
Venous thromboembolism among patients with ITP of 0.40 to 0.53
per 100 patient years,
Incidence rate of arterial thromboembolism in ITP ranged from 1.0 to
2.8 per 100 patient-years
Splenectomy further increases the risk of venous thromboembolism.
Thromboembolic Risk
30. In a Danish population-based cohort, mortality rates at 5, 10 and 20
years were 22, 34 and 49%.
Causes of death including cardiovascular causes, infection, bleeding
and haematological cancer.
The risk of infections may be associated with splenectomy or
immunosuppressive medications.
Mortality
31. Common acquired bleeding disorder with peaks of incidence in
childhood and in the elderly (>60 years).
Many patients are asymptomatic.
Bleeding is the most common presenting feature and can occur as
minor bleeding or more severe bleeding.
Conclusion
32. Lower platelet counts, advanced age and prior hemorrhage are
associated with increased risk of severe bleeding.
ITP is also associated with a slightly increased risk of venous and
arterial thrombosis.
Recent studies have identified fatigue and reduced quality of life
associated with ITP.
ITP is also associated with a higher mortality rate than the general
population
Conclusion
connective tissue disorders (2.5%), myelodysplastic syndromes (2.3%), primary immune deficiencies (1.7%), HIV infection (0.9%), sarcoidosis (0.6%), antiphospholipid syndrome (0.3%) and hepatitis C infection (0.2%). 2
Epidemiology of Acute and Chronic ITP
poorly characterized because of the low frequency of severe bleeding events
PPY: per patient-year
72 Rosthøj S, Rajantie J, Treutiger I, Zeller B, Tedgård U, Henter JI;
NOPHO ITP Working Group. Duration and morbidity of chronic
immune thrombocytopenic purpura in children: five-year follow-
up of a Nordic cohort. Acta Paediatr 2012;101(07):
761–766
75 Page LK, Psaila B, Provan D, et al. The immune thrombocytopenic purpura (ITP) bleeding score: assessment of bleeding in patients
with ITP. Br J Haematol 2007;138(02):245–248
59 Neunert CE, Buchanan GR, Imbach P, et al; Intercontinental Childhood ITP Study Group Registry II Participants. Severe
hemorrhage in children with newly diagnosed immune thrombocytopenic purpura. Blood 2008;112(10):4003–4008
77 Middelburg RA, Carbaat-Ham JC, HesamH, RagusiMA, Zwaginga
JJ. Platelet function in adult ITP patients can be either increased
or decreased, compared to healthy controls, and is associated
with bleeding risk. Hematology 2016;21(09):549–551
78 Panzer S, Rieger M, Vormittag R, Eichelberger B, Dunkler D,
Pabinger I. Platelet function to estimate the bleeding risk in
autoimmune thrombocytopenia. Eur J Clin Invest 2007;37(10):
814–819
80 Tantawy AA, Matter RM, Hamed AA, Shams El Din El Telbany
MA. Platelet microparticles in immune thrombocytopenic purpura
in pediatrics. Pediatr Hematol Oncol 2010;27(04):
283–296
Venous throboembolism: which is nearly twice as high as the general population.
Arterial : 1.5 times that of the general population
Cause of death …… occurred at a higher frequency than in the general population, whereas death from solid cancers or other causes occurred at a similar rate.
higher rate of haematological malignancy may reflect the association between ITP and underlying lymphoproliferative disorders or the association between certain immunosuppressive therapies and the development of haematologic cancers.
Minor bleeding, such as petechiae, purpura and epistaxis
Severe bleeding: events such as intracranial, gastrointestinal or genitourinary bleeding
Thrombosis: which can be compounded by therapies such as splenectomy and TPO receptor agonists
ITP is also associated with a higher mortality rate than the general population, largely driven by bleeding, infections, cardiovascular events and a higher rate of haematologic cancers.