Large artery ischaemic stroke in severe acute respiratory syndrome (SARS)

Umapathi, Thirugnanam; Kor, Ai Ching; Venketasubramanian, Narayanaswamy; Lim, Charles; Pang, Boon Chuan; Yeo, Tseng Tsai; Lee, Cheng Chuan; Lim, Poh Lian; Kuperan, Ponnudurai; Chuah, Khoon Leong; Tan, Puay Hoon; Tai, D. Y. H.; Ang, Sze Peng Brenda

doi:10.1007/s00415-004-0519-8

Cited by 253 publications

(275 citation statements)

References 17 publications

Supporting

Mentioning

254

Contrasting

Unclassified

Order By: Relevance

“…There was evidence of pulmonary embolism in four out of eight postmortem cases [130]. In addition, there were five cases of large artery ischaemic stroke of which three cases had been given IVIg [131].…”

Section: Ivig (Intravenous γ -Globulin) and Pentaglobulinmentioning

confidence: 99%

SARS: clinical presentation, transmission, pathogenesis and treatment options

2006

View full text Add to dashboard Cite

SARS (severe acute respiratory syndrome) appeared as the first emerging infectious disease of this century. It is fortunate that the culprit virus can be grown without much difficulty from a commonly used cell line, allowing an unlimited supply of isolates for further molecular studies and leading to the development of sensitive diagnostic assays. How the virus has successfully jumped the species barrier is still a mystery. The superspreading events that occurred within hospital, hotel and high-density housing estate opens a new chapter in the mechanisms and routes of virus transmission. The old practice of quarantine proved to be still useful in controlling the global outbreak. Despite all the available sophisticated tests, alertness with early recognition by healthcare workers and prompt isolation of suspected cases is still the most important step for containing the spread of the infection. Although the rapidly evolving outbreak did not allow the conducting of systematic clinical trails to evaluate treatment options, the accumulated experience on managing SARS patients will improve the clinical outcome should SARS return. Although SARS led to more than 700 deaths worldwide, the lessons learnt have prepared healthcare systems worldwide to face future emerging and re-emerging infections.

show abstract

Section: Ivig (Intravenous γ -Globulin) and Pentaglobulinmentioning

confidence: 99%

SARS: clinical presentation, transmission, pathogenesis and treatment options

2006

View full text Add to dashboard Cite

show abstract

“…Comment: The data suggest that evaluation of antibody titers may provide useful information about IVIG, which may be used for immunomodulation when a new influenza virus emerges in the human population. However, it is important to watch for thromboembolic complications, because when SARS patients were treated with IVIG in 2003, there were reports of thromboembolic disease despite the use of prophylactic lowmolecular-weight heparin, which was likely related to increased blood viscosity (Lew et al, 2003;Chong et al, 2004;Umapathi et al, 2004).…”

Section: Intravenous Immunoglobulin (Ivig) Preparationsmentioning

confidence: 99%

Adjunctive therapies and immunomodulatory agents in the management of severe influenza

2013

View full text Add to dashboard Cite

In addition to neuraminidase inhibitors and other drugs that directly target viral replication, a number of adjunctive and immunomodulatory therapies are currently under evaluation for the treatment of influenza. These novel treatments, which focus either on pathophysiological aspects of influenza virus infection or the neutralization of virus with antibodies, are the subject of this review. Cytokine dysregulation has been observed in patients with severe influenza, such as avian influenza A (H5N1) and pandemic 2009 influenza A (H1N1pdm09) virus infections, but the role of immunomodulatory therapy is unclear, due to lack of data from randomized controlled trials (RCTs). Convalescent plasma appears to be useful as an adjunctive therapy for the treatment of H5N1 and H1N1pdm09 infections. Until lately, data interpretation was limited to case reports and studies of non-randomized design, but a recent RCT found that patients with severe influenza A (H1N1pdm09) who were treated with hyperimmune immunoglobulin from persons who had survived the same disease had a lower peak viral load and lower mortality than controls, providing treatment was begun within 5 days of symptom onset. The efficacy of agents with potential immunomodulating effects, including intravenous immunoglobulin, N-acetylcysteine, acute use of statins, macrolides, peroxisome proliferator-activated receptors agonists, celecoxib and mesalazine, and the role of plasmapheresis and hemoperfusion as rescue therapy, deserve more investigation and where feasible, studies by RCTs. Prospective observational studies have shown that systemic corticosteroids increase morbidity (e.g., secondary infections) and mortality in H1N1pdm09 influenza. This article forms part of a symposium in Antiviral Research on "Treatment of influenza: targeting the virus or the host."

show abstract

“…73 as pulmonary embolism and ischemic stroke, despite use of prophylactic low-molecular-weight heparin. [56][57][58] Thus, it is important to monitor for the complications of IV Ig, especially vascular thrombotic events.…”

Section: Igmentioning

confidence: 99%

Clinical Management of Pandemic 2009 Influenza A(H1N1) Infection

Hui

Lee

Chan

2010

Chest

101

View full text Add to dashboard Cite

Antiviral therapy and vaccination are important strategies for controlling pandemic 2009 influenza A(H1N1) but efficacy depends on the timing of administration and is often limited by supply shortage. Patients with dyspnea, tachypnea, evidence of hypoxemia, and pulmonary infiltrates on chest radiograph should be hospitalized. Patients with severe illness or underlying medical conditions that increase the risk of more severe disease should be treated with oseltamivir or zanamivir as soon as possible, without waiting for the results of laboratory tests. Lung-protective ventilation strategy with a low tidal volume and adequate pressure, in addition to a conservative fluid management approach, is recommended when treating adult patients with ARDS. Extracorporeal membrane oxygenation has emerged as an important rescue therapy for critically ill patients. Use of systemic steroids was associated with delayed viral clearance in severe acute respiratory syndrome and H3N2 infection. Low-dose corticosteroids may be considered in the treatment of refractory septic shock. Passive immunotherapy in the form of convalescent plasma or hyperimmune globulin may be explored as rescue therapy. More data are needed to explore the potential role of IV gamma globulin and other drugs with immunomodulating properties, such as statins, gemfibrozil, and N-acetyl-cysteine. Health-care workers must apply strict standard and droplet precautions when dealing with suspected and confirmed case and upgrade to airborne precautions when performing aerosol-generating procedures. Nonpharmacologic measures, such as early case isolation, household quarantine, school/workplace closure, good community hygiene, and restrictions on travel are useful measures in controlling an influenza pandemic at its early phase.

show abstract

Large artery ischaemic stroke in severe acute respiratory syndrome (SARS)

Cited by 253 publications

References 17 publications

SARS: clinical presentation, transmission, pathogenesis and treatment options

SARS: clinical presentation, transmission, pathogenesis and treatment options

Adjunctive therapies and immunomodulatory agents in the management of severe influenza

Clinical Management of Pandemic 2009 Influenza A(H1N1) Infection

Contact Info

Product

Resources

About