N-acetylcysteine in children with acute liver failure complicating dengue viral infection

Senanayake, Manouri P; Jayamanne, M D C J P; Kankananarachchi, Imalke

doi:10.4038/cmj.v58i2.5684

Cited by 23 publications

(16 citation statements)

References 4 publications

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“…However, a universal inhibitory activity against influenza A viruses has not yet been demonstrated [241] . A successful outcome was reported following early administration of NAC to children affected with dengue hemorrhagic fever or dengue shock syndrome complicated by acute liver failure [242] . Before highly active antiretroviral therapy (HAART), NAC was tested to replenish GSH levels in HIV-infected patients since cysteine and GSH levels decrease as the HIV disease progresses [243,244] .…”

Section: Of Viral Infectionsmentioning

confidence: 99%

Inflammatory and oxidative stress in rotavirus infection

Guerrero¹,

Acosta²

2016

WJV

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Rotaviruses are the single leading cause of life-threatening diarrhea affecting children under 5 years of age. Rotavirus entry into the host cell seems to occur by sequential interactions between virion proteins and various cell surface molecules. The entry mechanisms seem to involve the contribution of cellular molecules having binding, chaperoning and oxido-reducing activities. It appears to be that the receptor usage and tropism of rotaviruses is determined by the species, cell line and rotavirus strain. Rotaviruses have evolved functions which can antagonize the host innate immune response, whereas are able to induce endoplasmic reticulum (ER) stress, oxidative stress and inflammatory signaling. A networking between ER stress, inflammation and oxidative stress is suggested, in which release of calcium from the ER increases the generation of mitochondrial reactive oxygen species (ROS) leading to toxic accumulation of ROS within ER and mitochondria. Sustained ER stress potentially stimulates inflammatory response through unfolded protein response pathways. However, the detailed characterization of the molecular mechanisms underpinning these rotavirus-induced stressful conditions is still lacking. The signaling events triggered by host recognition of virusassociated molecular patterns offers an opportunity for the development of novel therapeutic strategies aimed at interfering with rotavirus infection. The use of N-acetylcysteine, non-steroidal anti-inflammatory drugs and PPARγ agonists to inhibit rotavirus infection opens a new way for treating the rotavirus-induced diarrhea and complementing vaccines. Core tip: Rotavirus entry into the host cell requires cell surface molecules providing binding, chaperoning and oxido-reducing functions. Sialic acid/integrin α2β1, heat shock cognate protein 70 and protein disulfide isomerase (PDI) seem to perform these functions. Recently, the cell surface oxido-reduction activity based at least on PDI has been highlighted as a potential determinant of the conformational changes that are required by viral structural proteins in order to facilitate virus entry. The rotavirus-induced oxidative stress and inflammatory signaling is an attractive target for therapeutic intervention as antioxidant and anti-inflammatory treatment has Submit a

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Section: Of Viral Infectionsmentioning

confidence: 99%

Inflammatory and oxidative stress in rotavirus infection

Guerrero¹,

Acosta²

2016

WJV

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“…85 In another case series of children in Sri Lanka, 3 of 7 patients had prolonged shock and others had compensated shock. 86 All authors reported rapid clinical and biochemical recovery with early administration of NAC with no adverse events. Lee et al demonstrated that benefit of NAC is seen when administered in the early stages of hepatic encephalopathy, 87 which was supported in a recent case series from Sri Lanka.…”

Section: Treatmentmentioning

confidence: 85%

“…It was successfully used in 1 patient who had developed liver failure without hypotension . In another case series of children in Sri Lanka, 3 of 7 patients had prolonged shock and others had compensated shock . All authors reported rapid clinical and biochemical recovery with early administration of NAC with no adverse events.…”

Section: Treatmentmentioning

confidence: 96%

Liver involvement in dengue viral infections

Dissanayake

Seneviratne

2018

Reviews in Medical Virology

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Dengue fever is the commonest viral haemorrhagic fever worldwide and is a leading cause of morbidity and mortality in the tropics. Dengue viral infections are frequently associated with varying degrees of liver injury. Liver injury is more severe in dengue haemorrhagic fever or severe dengue. We review the current knowledge on liver involvement following dengue viral infections and explore the links between clinical manifestations, pathogenesis, and their impact on management.

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“…Its beneficial effect in the management of other various liver diseases, such as alcoholic hepatitis [21], acute liver failure complicating dengue viral infection [22], non-acetaminophen acute liver failure [23], or acetaminophen acute liver failure [24], is now well established.…”

Section: Discussionmentioning

confidence: 99%

Hepatomegaly and fever at the time of neutrophil recovery revealing L-asparaginase toxicity in the treatment of acute lymphoblastic leukemia

et al. 2014

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Patient: Male, 52Final Diagnosis: L-asparaginase associated steatohepatitis and pulmonary PneumocystisSymptoms: Cholestasis • hepatomegalyMedication: Corticosteroids • atovaquone • antioxidant therapyClinical Procedure: Liver biopsySpecialty: Hematology • Infectious Disease • HepatologyObjective:Challenging differential diagnosisBackground:L-asparaginase (L-aspa) is an important component of chemotherapy in acute lymphoblastic leukemia (ALL). Main adverse effects of L-aspa include allergic reactions, pancreatitis, thrombosis, and liver disturbances. L-aspa-associated steatohepatitis may be a life-threatening disorder but has very rarely been reported in the literature.Case Report:ALL was diagnosed in a 52-year-old man with a history of cardiovascular disease and obesity. Chemotherapy combining daunorubicin, vincristine, cyclophosphamide, and L-aspa was initiated. At the time of neutrophil recovery, the patient developed hepatomegaly in the context of fever and cough. On day 25, after 6 injections of L-aspa, liver function tests showed elevated alkaline phosphatase and transaminases levels. Although pulmonary Pneumocystis was concomitantly diagnosed, biological hepatic disturbances were attributed to L-aspa-associated toxicity. A liver biopsy revealed severe diffuse micro- and macrovesicular steatosis affecting more than 50% of hepatocytes. Other causes of liver dysfunction were eliminated. L-aspa and other hepatotoxic treatments were stopped, and treatment with antioxidant therapy, atovaquone, and corticosteroids was initiated. The clinical outcome was rapidly favorable.Conclusions:This case illustrates the necessity of carefully monitoring liver function test results in patients receiving L-aspa. In case of major increase of hepatic enzymes, a hepatic biopsy should rapidly be performed to exclude differential diagnosis in patients with prolonged neutropenia. L-aspa should be stopped and further administration definitively avoided. In the present case, the early administration of systemic corticosteroids as treatment of the concomitant Pneumocystis with hypoxemia could have participated to the favorable clinical evolution.

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N-acetylcysteine in children with acute liver failure complicating dengue viral infection

Abstract: A successful outcome followed early administration of NAC to children with ALF complicating severe dengue infection.

Cited by 23 publications

References 4 publications

Inflammatory and oxidative stress in rotavirus infection

Inflammatory and oxidative stress in rotavirus infection

Liver involvement in dengue viral infections

Hepatomegaly and fever at the time of neutrophil recovery revealing L-asparaginase toxicity in the treatment of acute lymphoblastic leukemia

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