1
|
Rodrigues AS, Correia de Azevedo A, Nobre S, Fonseca P. Multisystemic Disease in a Child and Successful Recovery With Antiviral Treatment. Cureus 2024; 16:e53893. [PMID: 38468986 PMCID: PMC10927160 DOI: 10.7759/cureus.53893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
Cytomegalovirus (CMV), a member of the Herpesviridae family, typically causes asymptomatic infections or mild mononucleosis-like syndromes in immunocompetent individuals. However, severe manifestations are well-documented in immunocompromised populations. This case report presents a previously healthy seven-year-old girl with a rare and complex presentation of primary CMV infection leading to severe multiorgan involvement, hepatosplenomegaly, cholestasis, bicytopenia, and a prolonged disease course. The patient's condition prompted an exhaustive diagnostic investigation, ruling out other potential causes. The diagnosis was confirmed by positive CMV IgM and IgG antibodies and a significantly elevated CMV DNA viral load. Treatment with intravenous ganciclovir resulted in a remarkable recovery. The case underscores the importance of considering CMV as a potential etiology of hepatitis, even in immunocompetent children, and the challenges of diagnosing complicated CMV infections. While guidelines for treating CMV in immunocompetent individuals are lacking, this report suggests that antiviral therapy may be beneficial in severe cases. Further research is needed to establish clear treatment protocols for such instances. This report contributes to the limited body of literature on severe CMV-induced hepatitis in immunocompetent children, emphasizing the need for heightened clinical awareness and timely interventions to prevent progression to acute liver failure.
Collapse
Affiliation(s)
| | | | - Susana Nobre
- Paediatric Hepatology and Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Paula Fonseca
- Pediatrics, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT
| |
Collapse
|
2
|
Takehara T, Nishida H, Ichikawa K, Hosokawa Y, Nawano T, Takai S, Fukuhara H, Himuro M, Tsuchiya N, Watanabe M. Immune thrombocytopenia secondary to primary cytomegalovirus infection after renal transplantation treated with a thrombopoietin receptor agonist: a case report. BMC Nephrol 2023; 24:336. [PMID: 37957545 PMCID: PMC10644401 DOI: 10.1186/s12882-023-03385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is an acquired disorder characterised by a low platelet count due to immune-mediated destruction and impaired platelet production. Here we report a rare case of primary cytomegalovirus (CMV) infection followed by thrombocytopenia after renal transplantation (RT). CASE PRESENTATION A 24-year-old male patient with end-stage kidney disease secondary to hereditary focal segmental glomerulosclerosis was treated with peritoneal dialysis and received ABO-compatible living-related RT from his aunt. Nine months after the RT, the patient was diagnosed with primary CMV infection. After initiating treatment for primary CMV infection, the patient developed thrombocytopenia. After excluding other diseases or drugs that may cause thrombocytopenia, the patient was finally diagnosed with ITP, administered prednisolone (PSL), and started on Helicobacter pylori eradication therapy. Tapering the PSL dose was difficult, but thrombopoietin receptor agonists (TPO-RAs) were effective. CONCLUSIONS In this case, the patient was diagnosed with ITP, and other causes of thrombocytopenia after RT were successfully ruled out. This case report demonstrates that RT recipients can develop ITP after CMV infection, and, in such cases, TPO-RAs may be an attractive option as a second-line therapy.
Collapse
Affiliation(s)
- Tomohiro Takehara
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Hayato Nishida
- Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kazunobu Ichikawa
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Yuka Hosokawa
- Department of Internal Medicine III, Division of Hematology and Cell Therapy, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Takaaki Nawano
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Satoshi Takai
- Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Hiroki Fukuhara
- Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masahito Himuro
- Department of Internal Medicine III, Division of Hematology and Cell Therapy, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| |
Collapse
|
3
|
Ohta R, Naito Y, Nishikura N, Inoue K, Sano C. Thrombocytopenia in Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis Indicating the Presence of Cytomegalovirus Infection: A Case Report. Cureus 2023; 15:e38850. [PMID: 37303320 PMCID: PMC10256278 DOI: 10.7759/cureus.38850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Although cytomegalovirus (CMV) usually colonizes the human body without causing symptoms, CMV infections often develop in immunocompromised hosts. Immunosuppression can trigger CMV infection, and its prediction is essential; however, this is challenging without specific criteria. We present the case of an 87-year-old male patient who visited a rural community hospital with the chief complaint of persistent cough, productive of bloody sputum. Initially, the patient developed thrombocytopenia without any abnormalities of liver function; however, a positive myeloperoxidase antineutrophil cytoplasmic antibody (ANCA) test and the presence of alveolar hemorrhage and glomerulonephritis confirmed ANCA-associated vasculitis. The patient's symptoms and thrombocytopenia resolved transiently after treatment with prednisolone and rituximab. However, the recurrence of thrombocytopenia and the appearance of urinary intracytoplasmic inclusion bodies during the treatment course were investigated using an antigenemia test, which ultimately confirmed CMV viremia. Valganciclovir treatment resolved all the symptoms. This case report showed that thrombocytopenia might indicate the presence of CMV infection in ANCA-associated vasculitis and that intracytoplasmic inclusion bodies in immunosuppressed patients require investigation of CMV infection for effective treatment.
Collapse
Affiliation(s)
| | - Yumi Naito
- Community Care, Unnan City Hospital, Unnan, JPN
| | | | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
| |
Collapse
|
4
|
Echcharii N, Chekhlabi N, Dini N. A Case of Cytomegalovirus Infection With Severe Thrombocytopenia in an Infant Who Was Successfully Managed With Antiviral Therapy. Cureus 2022; 14:e30640. [DOI: 10.7759/cureus.30640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
|
5
|
A case series of CMV infections in infants and its inoppurtune immuno-hematological manifestations. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
6
|
Hu H, Cheng Y, Peng Q, Chen K. Clinical Features, Treatment Courses, and Distribution of Cytomegalovirus Genotypes among Thrombocytopenia Patients Aged Younger than 12 Months. Am J Perinatol 2021; 38:1403-1411. [PMID: 32526777 DOI: 10.1055/s-0040-1713001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aims of this study were to evaluate the clinical characteristics, laboratory data, and treatment of the cytomegalovirus (CMV)-associated thrombocytopenia in infants aged younger than 12 months and to investigate the possible relationship between genotypes of glycoprotein B (gB) and glycoprotein H (gH) and CMV-associated thrombocytopenia. STUDY DESIGN Infants with positive identification of cytomegalovirus (CMV) and thrombocytopenia, being treated at Hubei Maternal and Child Health Hospital from January 2015 to June 2019 were included. Genotype of gB and gH analysis were done by nested polymerase chain reaction (nPCR) and restrictions length polymorphism. RESULTS The prevalence of CMV congenital, perinatal, and postnatal infection were 1.4% (76/5428), 29.1% (378/1301), and 41.8% (243/581), respectively. A total of 29 immunocompetent patients with CMV-associated thrombocytopenia were analyzed, including 7 (9.2%, 7/76) congenital infections, 14 (3.7%, 14/378) perinatal infections, and 8 (3.3%, 8/243) postnatal infections. Platelet count at diagnosis <20 × 109/L was the common hematologic finding of CMV-associated thrombocytopenia in perinatal infection (1/7 congenital infection vs. 10/14 perinatal infection vs. 3/8 postnatal infection, Chi-square (χ2) = 6.616, p = 0.037). Notably, significantly higher frequency of hepatobiliary symptoms was found in congenital and perinatal infections groups (4/7 congenital infection vs. 10/14 perinatal infection vs. 1/8 postnatal infection, χ2 = 7.188, p = 0.027). Intravenous immunoglobulin was prescribed for 24 (82.8%, 24/29) patients, and antiviral agents were prescribed for 9 (31.0%, 9/29) patients. The most prevalent genotypes of CMV in the study were gB1 (60.7%, 17/28) and gH2 (57.1%, 16/28). CONCLUSION There was a substantial percentage of symptomatic CMV infection in patients aged younger than 12 months. Thrombocytopenia is one of the common clinical manifestations in congenital CMV infection. The gB1 genotype had more virulence in infants with acquired CMV infection. There might be an association between gH2 genotype of CMV and CMV-associated thrombocytopenia.
Collapse
Affiliation(s)
- Hongbo Hu
- Department of Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Ying Cheng
- Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Qiaoying Peng
- Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Kun Chen
- Department of Laboratory, Wuhan Ninth Hospital, Wuhan, China
| |
Collapse
|
7
|
de Melo Silva J, Pinheiro-Silva R, Costa de Oliveira R, de Castro Alves CE, Barbosa AN, Pontes GS. Prevalence and Recurrence Rates of Cytomegalovirus Infection Among Patients With Hematological Diseases in the Western Brazilian Amazon: A Cross-Sectional Study. Front Public Health 2021; 9:692226. [PMID: 34692617 PMCID: PMC8529106 DOI: 10.3389/fpubh.2021.692226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Cytomegalovirus (CMV) is a worldwide distributed pathogen that may cause serious complications in patients with hematological diseases. This study aimed to serologically characterize CMV infection in patients suffering from hematological diseases in Amazonas state, Brazil. Serum samples from 323 patients were tested for the presence of anti-CMV IgM or IgG antibodies using an enzyme-linked immunosorbent assay. Positive samples for IgM were submitted to the IgG avidity test to differentiate primary infection from recurrent infection. An epidemiological questionnaire was administered to collect the sociodemographic information of the study population. The overall prevalence of CMV infection verified in this study was 91.3%. The highest rates were found in patients suffering from platelet disorders (94.5%), anemia (93.3%), or leukemia (91%). The study population was predominantly composed of individuals with low socioeconomic status. Blood transfusions were more common in patients with anemia or leukemia, but this variable was not correlated with the seropositivity for CMV infection. Measurement of IgG avidity in patients positive for anti-CMV IgM demonstrated a recurrent infection rate of 5.2% (17/323). Over 80% of recurrent infections occurred in patients with acute lymphocytic leukemia (ALL) or anemia. Our findings indicated that CMV infection is highly prevalent in patients from the western Brazilian Amazon who have hematological diseases. The prevalence observed progressively rose with increasing age, whereas anemia or ALL figured as risk factors for the recurrence of CMV infection.
Collapse
Affiliation(s)
- Jean de Melo Silva
- Programa de Pós-graduação em Ciências Hematológicas, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Renato Pinheiro-Silva
- Programa de Pós-graduação em Ciências Hematológicas, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Regiane Costa de Oliveira
- Programa de Pós-graduação em Ciências Hematológicas, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | | | - Gemilson Soares Pontes
- Programa de Pós-graduação em Ciências Hematológicas, Universidade do Estado do Amazonas, Manaus, Brazil.,Programa de Pós-graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas, Manaus, Brazil.,Laboratório de Virologia e Imunologia, Instituto Nacional de Pesquisa da Amazônia, Manaus, Brazil
| |
Collapse
|
8
|
Abbasi F, Kaydani GA, Tahannezhad Z, Nakhaie M, Asnafi AA, Moradi M. Prevalence of Cytomegalovirus (CMV) and Epstein-Barr Virus (EBV) Subclinical Infection in Patients with Acute Immune Thrombocytopenic Purpura (ITP). Int J Hematol Oncol Stem Cell Res 2021; 15:139-144. [PMID: 35082994 PMCID: PMC8748239 DOI: 10.18502/ijhoscr.v15i3.6843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Immune thrombocytopenic purpura (ITP) defined as a bleeding disorder in which the number and production of platelets reduced by the immune system; however, the destruction of peripheral blood platelets also occurs. Although its exact etiology and pathogenesis not already know, several studies have shown that Epstein-Barr virus (EBV) and cytomegalovirus (CMV) known as possible causative agents of ITP. This investigation aims to evaluate the presence of CMV and EBV in two groups of case and control by polymerase chain reaction (PCR). Materials and Methods: we considered the presence of CMV and EBV in 48 acute ITP patients and 48 healthy people. Study participants were recruited from Ahvaz Shafa Hospital between 2017 and 2018 and the presence of two viruses was investigated by (PCR). Results: Out of 48 acute ITP patients, the CMV DNA was detected from the blood of 12 (25%) patients and the EBV DNA from the blood of 2 (4.2%) other patients. In addition, only one patient was (2.1%) co-infected with CMV and EBV. In contrast, in 48 healthy subjects, 3 (6.6%) had CMV and none of the control group was infected with EBV. Conclusion: Due to the presence of both EBV and CMV in the acute ITP patients in Ahvaz, they can be considered as factors in the progression of this disease. Therefore, consideration of the methods of elimination and treatment of these two viruses in these patients may be used as a treatment strategy in ITP patients in the future.
Collapse
Affiliation(s)
- Farshad Abbasi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gholam Abbas Kaydani
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Laboratory Sciences, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zari Tahannezhad
- Department of Laboratory Sciences, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Nakhaie
- Department of Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Amin Asnafi
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Moradi
- Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
9
|
Thi LAP, Panchangam SC, Do HT, Nguyen VH. Prospects and challenges of photocatalysis for degradation and mineralization of antiviral drugs. NANOSTRUCTURED PHOTOCATALYSTS 2021. [PMCID: PMC8237458 DOI: 10.1016/b978-0-12-823007-7.00012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Among the outbreak of influenza and other pandemics such as SARS-CoV-2 recently over the globe, antiviral drugs were significantly concerned with controlling the disease and these pandemics. They have been developed for seven decades around more than 90 drugs categorized licensed to treat nine human infectious diseases. Based on their functional group, antiviral compounds will mitigate infectivity and symptoms and reduce the illness period by arresting the viral replication cycle at different stages. Antiviral drugs have been developed complexly and met many biothreat challenges due to their high biosafety level requirement. In recent years, the spreading of novel virus strains that are a threat to human life, the development in researching and manufacturing new types of antiviral drugs increases and the use by patients and clinicians have increased. Antiviral compounds have been reported only partly removed during wastewater treatment. They were available in wastewater treatment plant effluents and found in surface water from rivers and streams, underground water, and even in drinking water. Photocatalytic degradation of antiviral drugs was exploding to clear the environmental waters from the antiviral drugs. The principle of photocatalysis is based on the excitation of the catalyst material by irradiation of light. The catalyst produces free radicals under the action of photons, which will destroy the pollutants adsorbed on its surface. The photocatalytic degradation mechanism of antiviral drugs can be understood through decomposing in a heterogeneous photocatalytic system and which species are involved in the active decomposition of the drug and then photocatalytically degrading into intermediates or mineralization products. The intermediates and the reaction pathway of antiviral compound photocatalytic degradation are complicated. However, some of the degradation processes are complete, and inorganic compounds (CO2 and H2O) are their final products.
Collapse
|
10
|
Shragai T, Lebel E, Deshet D, Varon D, Avivi I, Kirgner I, Sarid N. Characteristics and outcomes of adults with cytomegalovirus‐associated thrombocytopenia: a case series and literature review. Br J Haematol 2020; 191:863-867. [DOI: 10.1111/bjh.17017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Tamir Shragai
- Department of Hematology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Eyal Lebel
- Department of Hematology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Dana Deshet
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Hematology Edith Wolfson Medical Center Holon Israel
| | - David Varon
- Department of Hematology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Irit Avivi
- Department of Hematology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ilya Kirgner
- Department of Hematology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Nadav Sarid
- Department of Hematology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| |
Collapse
|
11
|
Zhang Y, Zeng X, Jiao Y, Li Z, Liu Q, Ye J, Yang M. Mechanisms involved in the development of thrombocytopenia in patients with COVID-19. Thromb Res 2020; 193:110-115. [PMID: 32535232 PMCID: PMC7274097 DOI: 10.1016/j.thromres.2020.06.008] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023]
Abstract
Corona Virus Disease 2019 (COVID-19) is caused by the novel coronavirus SARS-CoV-2. Emerging genetic and clinical evidence suggests similarities between COVID-19 patients and those with severe acute respiratory syndrome and Middle East respiratory syndrome. Hematological changes such as lymphopenia and thrombocytopenia are not rare in COVID-19 patients, and a smaller population of these patients had leukopenia. Thrombocytopenia was detected in 5–41.7% of the patients with COVID-19. Analyzing the dynamic decrease in platelet counts may be useful in the prognosis of patients with COVID-19. However, the mechanisms underlying the development of thrombocytopenia remain to be elucidated. This review summarizes the hematological changes in patients infected with SARS-CoV-2 and possible underlying mechanisms of thrombocytopenia development. Early diagnosis and treatment of COVID-19 patients can reduce mortality. There is no laboratory test index to predict disease progression and prognosis. Progressive decline in platelets may be a prognostic factor for COVID-19 patients. Monitoring platelet count may be an effective index for COVID-19 progression.
Collapse
Affiliation(s)
- Yujiao Zhang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xiaoyuan Zeng
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yingying Jiao
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zongpeng Li
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jieyu Ye
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Mo Yang
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China.
| |
Collapse
|
12
|
Nannou C, Ofrydopoulou A, Evgenidou E, Heath D, Heath E, Lambropoulou D. Antiviral drugs in aquatic environment and wastewater treatment plants: A review on occurrence, fate, removal and ecotoxicity. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 699:134322. [PMID: 31678880 DOI: 10.1016/j.scitotenv.2019.134322] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 05/23/2023]
Abstract
The environmental release of antiviral drugs is of considerable concern due to potential ecosystem alterations and the development of antiviral resistance. As a result, interest on their occurrence and fate in natural and engineered systems has grown substantially in recent years. The main scope of this review is to fill the void of information on the knowledge on the worldwide occurrence of antiviral drugs in wastewaters and natural waters and correlate their levels with their environmental fate. According to the conducted literature survey, few monitoring data exists for several European countries, such as Germany, France, and the UK. Lesser data are available for Asia, where approximately 80% of the studies focus on Japan. Several articles study the occurrence of mostly antiretroantivirals in sub-Saharan African countries, while there is a lack of data for other developing regions of the world, including the rest of Africa, South America, and the biggest part of Asia. An importantly smaller number of studies exists for North America, while no studies exist for Oceania. The against innfluenza drug oseltamivir along with its active carboxy metabolite is found to be the most studied antiviral drug. The distribution of antiviral drugs across all geographic regions varies from low ng L-1 to high μg L-1 levels, in some cases, even in surface waters. This overarching review reveals that monitoring of antiviral drugs is necessary, and some of those compounds may require toxicological attention, in the light of either spatial and temporal high concentration or potential antiviral resistance. Based on the information provided herein, the need for a better understanding of the water quality hazards posed by antiviral drugs existence in wastewater outputs and freshwater ecosystems is demosntrated. Finally, the future challenges concerning the occurrence, fate, and potential ecotoxicological risk to organisms posed by antiviral drug residues are discussed.
Collapse
Affiliation(s)
- Christina Nannou
- Department of Chemistry, Aristotle University of Thessaloniki. GR 54124, Thessaloniki, Greece
| | - Anna Ofrydopoulou
- Department of Chemistry, Aristotle University of Thessaloniki. GR 54124, Thessaloniki, Greece
| | - Eleni Evgenidou
- Department of Chemistry, Aristotle University of Thessaloniki. GR 54124, Thessaloniki, Greece
| | - David Heath
- Department of Environmental Sciences, Jožef Stefan Institute, Jamova cesta 39, 1000 Ljubljana, Slovenia
| | - Ester Heath
- Department of Environmental Sciences, Jožef Stefan Institute, Jamova cesta 39, 1000 Ljubljana, Slovenia; Jožef Stefan International Postgraduate School, Jamova cesta 39, 1000 Ljubljana, Slovenia
| | - Dimitra Lambropoulou
- Department of Chemistry, Aristotle University of Thessaloniki. GR 54124, Thessaloniki, Greece.
| |
Collapse
|
13
|
Uemura S, Mori T, Nino N, Sakakibara N, Takafuji S, Myojin S, Takami Y, Morioka I, Nishimura N, Kugo M, Iijima K. An infant with refractory cytomegalovirus-induced thrombocytopenia. Clin Case Rep 2020; 8:75-78. [PMID: 31998491 PMCID: PMC6982504 DOI: 10.1002/ccr3.2581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/22/2019] [Accepted: 10/17/2019] [Indexed: 11/18/2022] Open
Abstract
The present case underscores the importance of considering the association of severe thrombocytopenia or immune thrombocytopenia with cytomegalovirus (CMV) infection because CMV-induced thrombocytopenia occasionally requires antiviral therapy.
Collapse
Affiliation(s)
- Suguru Uemura
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Takeshi Mori
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Nanako Nino
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Nana Sakakibara
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Satoru Takafuji
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Shota Myojin
- Department of PediatricsJapanese Red Cross Society Himeji HospitalHimejiJapan
| | - Yuichi Takami
- Department of PediatricsJapanese Red Cross Society Himeji HospitalHimejiJapan
| | - Ichiro Morioka
- Department of Pediatrics and Child HealthNihon University School of MedicineItabashi‐kuJapan
| | - Noriyuki Nishimura
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Masaaki Kugo
- Department of PediatricsJapanese Red Cross Society Himeji HospitalHimejiJapan
| | - Kazumoto Iijima
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| |
Collapse
|
14
|
A case of neonatal cytomegalovirus infection with severe thrombocytopenia that was successfully managed with empiric antiviral therapy. IDCases 2019; 19:e00675. [PMID: 32226764 PMCID: PMC7093750 DOI: 10.1016/j.idcr.2019.e00675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 11/22/2022] Open
Abstract
Antiviral therapy against cytomegalovirus (CMV) infection is indicated for symptomatic infection in the fetus and premature neonates. In mature neonates, the benefit of antiviral therapy for severe CMV infection remains controversial. Additionally, when diagnosing symptomatic CMV disease occurring during the early neonatal period, it is difficult to differentiate between congenital and acquired infections. We herein report a neonatal case of CMV infection complicated with severe thrombocytopenia that was successfully managed with antiviral treatment. A 21-day-old male infant presented with low-grade fever and erythema on his extremities. During outpatient follow-up, he developed petechiae and thrombocytopenia (platelet count 17,000/μL). Subsequent serological examination and molecular detection of CMV confirmed the diagnosis of CMV infection. In consideration of the severe thrombocytopenia, antiviral therapy with valganciclovir 32 mg/kg/day was initiated. The platelet counts increased with decreasing CMV loads. After excluding congenital CMV infection, we discontinued antiviral therapy without relapse of the disease. The present case suggests that neonatal cases of severe symptomatic CMV infection may require antiviral therapy while excluding the possibility of congenital infection.
Collapse
|