1,721,127 research outputs found
Acute liver failure: a rare clinical presentation of visceral leishmaniasis.
No full textWe recently re-examined a case of Visceral Leishmaniasis, in a 36-year-old caucasian immune-competent men with an unusual clinical presentation. Together with symptoms and signs of a severe acute liver involvement, he presented weight loss, huge spleen enlargement, pancytopenia and increased ?-globulin serum level with a high polyclonal peak. He had no fever, but over-abundant night sweats were frequent. The patient was considered to have liver cirrhosis, and the diagnosis of visceral leishmaniosis was made with a year's delay. From this case report we may learn that, despite an unusual clinical presentation, the diagnosis of visceral leishmaniasis should not be excluded when other characteristic signs and symptoms and laboratory abnormalities are present
Recurrent thrombosis: A case report of young patient JAK2+ without myeloproliferative disease and other risk factors. The role of sport activity
No full textIn the pathogenesis of thrombotic events, especially those of unknown origin, the role of the JAK2-V617F mutation have been underestimated so far. commonly, JAK2 mutations are associated with chronic myeloproliferative neoplasms (MPNs). this paper reports the clinical events occurred to a woman positive for JAK2-V617F mutation and no MPNs, who experienced three episodes of thrombosis, without other risk factor. only a few studies have so far described cases of thrombophilia exclusively related to a JAK2 in the absence of MPN, but none of them presented a severe clinical history like that of the patient described here. it is advisable in clinical practice, to search for the JAK2 mutation in all cases of unexplained venous thrombosis. A 46-year-old Caucasian woman was first observed at our clinic in January 2018, after an episode of partial thrombosis of the transverse sigmoid of the venous central axis still under oral treatment with warfarin. After the thrombotic episode, the patient ensured self-sufficiency, but she was unable to drive, had memory disorders and sometimes slight space-time disorientation. The patient reported other episodes of thrombosis occurred in 2000 and in August 2013. the major concern of patients who have undergone numerous thrombotic events is a further recurrence or a new episode. We searched for all thrombophilic mutations and for and for all other indicative parameters of thrombotic predisposition. only one heterozygosity was found for the c677t mutation for MthFR, with homocysteine always in the normal values. Mutation of the JAK2-V617 gene was searched and found present. the anticoagulant therapy was changed by introducing apixaban 5 mg, one tablet twice a day. the general situation gradually improved and after 2 months of treatment, the patient completely recovered their autonomy, was well oriented and started driving again. this patient achieved a stable excellent clinical condition, free of thrombotic events for a two-years follow-up. it is advisable in clinical practice, to search for the JAK2 mutation in all cases of unexplained venous thrombosis, because this mutation can involve a thrombotic risk regardless of the evidence of a concomitant myeloproliferative disease
Hepatic flares in chronic hepatitis C: Spontaneous exacerbation vs hepatotropic viruses superinfection
No full textThe hepatitis C virus (HCV) causes an acute infection that is frequently asymptomatic, but a spontaneous eradication of HCV infection occurs only in one-third of patients. The remaining two-thirds develop a chronic infection that, in most cases, shows an indolent course and a slow progression to the more advanced stages of the illness. Nearly a quarter of cases with chronic hepatitis C (CHC) develop liver cirrhosis with or without hepatocellular carcinoma. The indolent course of the illness may be troubled by the occurrence of a hepatic flare, i.e., a spontaneous acute exacerbation of CHC due to changes in the immune response, immunosuppression and subsequent restoration, and is characterized by an increase in serum aminotransferase values, a frequent deterioration in liver fibrosis and necroinflammation but also a high frequency of sustained viral response to pegylated interferon plus ribavirin treatment. A substantial increase in serum aminotransferase values during the clinical course of CHC may also be a consequence of a superinfection by other hepatotropic viruses, namely hepatitis B virus (HBV), HBV plus hepatitis D virus, hepatitis E virus, cytomegalovirus, particularly in geographical areas with high endemicity levels. The etiology of a hepatic flare in patients with CHC should always be defined to optimize follow-up procedures and clinical and therapeutic decisions. © 2014 Baishideng Publishing Group Inc. All rights reserved
Treatment of HCV genotype 1 chronic hepatitis with pegylated-interferon plus ribavirin with or without boceprevir or telaprevir: a meta-analysis of randomized controlled trials on the role of response predictors
No full textAn update on the treatment options for HBV/HCV coinfection
No full textIntroduction: Despite the reciprocal inhibition exerted by HBV and HCV genomes, dual HBV/HCV infection is associated with more severe forms of liver disease and warrant effective treatment. Areas covered: A careful evaluation of disease progression to establish the predominance of one virus over another, concomitant HIV infection and comorbidities is essential to make the best therapy choices. In most virological conditions interferon (IFN)-based treatment has been replaced by a combination of different classes of second generation directly acting antivirals (DAAs), which offer better tolerability and HCV eradication in 95% of cases. Tenofovir or entecavir should be part of treatment for patients with active HBV production, for those coinfected with HIV and for those with cirrhosis. Expert opinion: DAAs have been successfully used to eradicate HCV infection in recent years, but the high cost may limit their use particularly in developing countries. Entecavir and tenofovir have been demonstrated to be effective for long-term inhibition of HBV replication. Careful monitoring of serum ALT and markers of HBV and HCV replication before and during treatment is essential for an early diagnosis and treatment of virus reactivation
Epidemiology of acute and chronic hepatitis B and delta over the last 5 decades in Italy
No full textThe spread of hepatitis B virus (HBV) infection has gradually decreased in Italy in the last 5 decades as shown by the steady reduction in the incidence rates of acute hepatitis B, from 10/100000 inhabitants in 1984 to 0.85/100000 in 2012, and by the reduced prevalence of hepatitis B surface antigen (HBsAg)-positive cases among chronic hepatitis patients with different etiologies, from 60% in 1975 to about 10% in 2001. The prevalence of HBsAg chronic carriers in the general population also decreased from nearly 3% in the 1980s to 1% in 2010. Linked to HBV by its characteristics of defective virus, the hepatitis delta virus (HDV) has shown a similar epidemiological impact on the Italian population over time. The incidence of acute HDV infection decreased from 3.2/100000 inhabitants in 1987 to 0.8/100000 in 2010 and the prevalence of HDV infection in HBsAg chronic carriers decreased from 24% in 1990 to 8.5% in 2006. Before the beneficial effects of HBV mass vaccination introduced in 1991, the decreased endemicity of HBV and HDV infection in Italy paralleled the improvement in screening blood donations, the higher standard of living and impressive reduction in the birth rate associated with a marked reduction in the family size. A further contribution to the decline in HBV and HDV infections most probably came from the media campaigns to prevent the spread of human immunodeficiency virus infection by focusing the attention of the general population on the same routes of transmission of viral infections such as unsafe sexual intercourse and parenteral exposures of different kinds. © 2014 Baishideng Publishing Group Inc. All rights reserved
Clinical presentation of covid-19: Case series and review of the literature
No full textCOVID-19 infection has a broad spectrum of severity ranging from an asymptomatic form to a severe acute respiratory syndrome that requires mechanical ventilation. Starting with the description of our case series, we evaluated the clinical presentation and evolution of COVID-19. This article is addressed particularly to physicians caring for patients with COVID-19 in their clinical practice. The intent is to identify the subjects in whom the infection is most likely to evolve and the best methods of management in the early phase of infection to determine which patients should be hospitalized and which could be monitored at home. Asymptomatic patients should be followed to evaluate the appearance of symptoms. Patients with mild symptoms lasting more than a week, and without evidence of pneumonia, can be managed at home. Patients with evidence of pulmonary involvement, especially in patients over 60 years of age, and/or with a comorbidity, and/or with the presence of severe extrapulmonary manifestations, should be admitted to a hospital for careful clinical-laboratory monitoring
Rituximab-based treatment, HCV replication, and hepatic flares
No full textRituximab, a chimeric mouse-human monoclonal antibody directed to the CD20 antigen expressed on pre-B lymphocytes and mature lymphocytes, causes a profound B-cell depletion. Due to its peculiar characteristics, this drug has been used to treat oncohaematological diseases, B cell-related autoimmune diseases, rheumatoid arthritis, and, more recently, HCV-associated mixed cryoglobulinaemic vasculitis. Rituximab-based treatment, however, may induce an increased replication of several viruses such as hepatitis B virus, cytomegalovirus, varicella-zoster virus, echovirus, and parvovirus B19. Recent data suggest that rituximab-based chemotherapy induces an increase in HCV expression in hepatic cells, which may become a target for a cell-mediated immune reaction after the withdrawal of treatment and the restoration of the immune control. Only a few small studies have investigated the occurrence of HCV reactivation and an associated hepatic flare in patients with oncohaematological diseases receiving R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). These studies suggest that the hepatic flares are frequently asymptomatic, but life-threatening liver failure occurs in nearly 10 of cases. © 2012 Evangelista Sagnelli et al
Clinical applications of antibody avidity and immunoglobulin M testing in acute HCV infection
No full textAcute hepatitis C is often asymptomatic, frequently remains undiagnosed and frequently evolves to chronic hepatitis. Early, short-term interferon treatment is efficacious in acute hepatitis C, and so underscores the importance of an early diagnosis and the need to distinguish acute infection from acute exacerbation of chronic HCV infection. The gold standard for the diagnosis of acute hepatitis C is demonstration of conversion to anti-HCV positivity, HCV RNA positivity or both, events that frequently occur before the patient comes to medical attention. Several laboratory approaches to assist with early diagnosis of acute hepatitis C have been developed. Our studies, reviewed here, show that testing for antibody avidity and anti-HCV immunoglobulin M allow diagnosis in up to 90% of cases of acute hepatitis C. ©2012 International Medical Press
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