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Souha S Kanj - One of the best experts on this subject based on the ideXlab platform.
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disseminated herpes simplex virus and varicella zoster virus co infection in a patient with Idiopathic Thrombocytopenic Purpura
Journal of Infection and Public Health, 2019Co-Authors: Christina Bergqvist, Dany Nassar, Saeed El Zein, Souha S KanjAbstract:Abstract Concomitant disseminated herpes simplex virus (HSV) and varicella zoster virus (VZV) infection is a rare event. We describe a case of disseminated HSV and VZV infection in an 80-year-old patient many years after splenectomy for Idiopathic Thrombocytopenic Purpura (ITP). This is the first case of disseminated HSV-1 and VZV infection with molecular evidence of the simultaneous presence of both viruses in two different body sites (the skin and cerebrospinal fluid). This adds to the three reports of patients developing cutaneous disseminated herpes zoster multiple years after splenectomy for ITP.
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Disseminated herpes simplex virus and varicella zoster virus co-infection in a patient with Idiopathic Thrombocytopenic Purpura
Elsevier, 2019Co-Authors: Christina Bergqvist, Dany Nassar, Saeed El Zein, Yasmin Abi Aad, Souha S KanjAbstract:Concomitant disseminated herpes simplex virus (HSV) and varicella zoster virus (VZV) infection is a rare event. We describe a case of disseminated HSV and VZV infection in an 80-year-old patient many years after splenectomy for Idiopathic Thrombocytopenic Purpura (ITP). This is the first case of disseminated HSV-1 and VZV infection with molecular evidence of the simultaneous presence of both viruses in two different body sites (the skin and cerebrospinal fluid). This adds to the three reports of patients developing cutaneous disseminated herpes zoster multiple years after splenectomy for ITP. Keywords: Disseminated herpes simplex virus, Disseminated varicella zoster virus, Idiopathic Thrombocytopenic Purpura, Splenectom
Leah Adix - One of the best experts on this subject based on the ideXlab platform.
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grading of hemorrhage in children with Idiopathic Thrombocytopenic Purpura
The Journal of Pediatrics, 2002Co-Authors: George R Buchanan, Leah AdixAbstract:Abstract Objective: To develop an instrument to allow semiquantitative assessment of hemorrhage in children with Idiopathic Thrombocytopenic Purpura (ITP). Study design: Bleeding severity was graded on a scale of 0 to 4 in 4 different sites (overall, oral, epistaxis, and skin) on the basis of history during the previous 24 hours and physical examination. Results: Children with ITP (n = 54) were assessed on 109 different occasions by multiple observers, including 81 measurements by one of the authors. Grade of bleeding correlated inversely with platelet count. Grade 3 or 4 hemorrhage was infrequently encountered except involving the skin, where assessment was difficult. Grade 4 mucosal or internal hemorrhage was noted in 7 patients; none had life-threatening or fatal bleeding. Interrater agreement in grading of overall and mouth bleeding and epistaxis was acceptable. Conclusions: We conclude that scoring of hemorrhage is possible in children with ITP and that the grade of hemorrhage may represent a clinically meaningful end point in future studies. (J Pediatr 2002;141:683-8)
George R Buchanan - One of the best experts on this subject based on the ideXlab platform.
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grading of hemorrhage in children with Idiopathic Thrombocytopenic Purpura
The Journal of Pediatrics, 2002Co-Authors: George R Buchanan, Leah AdixAbstract:Abstract Objective: To develop an instrument to allow semiquantitative assessment of hemorrhage in children with Idiopathic Thrombocytopenic Purpura (ITP). Study design: Bleeding severity was graded on a scale of 0 to 4 in 4 different sites (overall, oral, epistaxis, and skin) on the basis of history during the previous 24 hours and physical examination. Results: Children with ITP (n = 54) were assessed on 109 different occasions by multiple observers, including 81 measurements by one of the authors. Grade of bleeding correlated inversely with platelet count. Grade 3 or 4 hemorrhage was infrequently encountered except involving the skin, where assessment was difficult. Grade 4 mucosal or internal hemorrhage was noted in 7 patients; none had life-threatening or fatal bleeding. Interrater agreement in grading of overall and mouth bleeding and epistaxis was acceptable. Conclusions: We conclude that scoring of hemorrhage is possible in children with ITP and that the grade of hemorrhage may represent a clinically meaningful end point in future studies. (J Pediatr 2002;141:683-8)
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Idiopathic Thrombocytopenic Purpura diagnosed during the second decade of life
The Journal of Pediatrics, 2002Co-Authors: Eric J Lowe, George R BuchananAbstract:Abstract Objective: To retrospectively review our institutional experience of adolescents with Idiopathic Thrombocytopenic Purpura (ITP). Study design: Medical record review of all patients diagnosed with ITP between the ages of 10 and 18 years seen at our center from January 1976 to March 2000. Results: Data were collected from 126 patients. Of the evaluable 110 cases, 63 (57%) satisfied the criteria for chronic ITP, 30 (27%) for acute ITP, and 17 (15%) were uncertain. Sex distribution and mean ages were similar in all 3 groups. Platelet count at presentation was higher in patients with chronic ITP. Splenectomy was performed in 24 patients, with 17 (77%) of 22 having normal platelet counts at last follow-up. Outcome for the nonsplenectomized patients with chronic ITP included normalization of platelet count (n = 4), minimal or no bleeding without treatment (n = 29), treatment for ongoing symptoms (n = 5), and unknown (n = 1). Two patients died, 1 from intracranial hemorrhage and 1 from Escherichia coli sepsis and pulmonary hemorrhage. Conclusions: Patients 10 to 18 years of age with ITP are more likely than younger children to have chronic disease. Many patients with ITP recover without drug therapy or need for splenectomy. ITP in adolescents shares features of both childhood and adult ITP. (J Pediatr 2002;141:253-8)
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newly diagnosed Idiopathic Thrombocytopenic Purpura in childhood an observational study
The Lancet, 2001Co-Authors: Thomas Kuhne, Paul Imbach, Paula Boltonmaggs, Willi Berchtold, Victor S Blanchette, George R BuchananAbstract:Summary Background Diagnosis and management of Idiopathic Thrombocytopenic Purpura (ITP) have been based primarily on expert opinion and practice guidelines rather than on evidence. We have used a registry to prospectively survey the presenting features and the diagnostic evaluation and management practices used for children with ITP worldwide. Methods We used the Intercontinental Childhood ITP Registry which had been widely advertised. 209 physicians from 136 institutions in 38 countries participated by submitting data for each of their newly diagnosed patients. Data from 2031 children with ITP was registered between June, 1997, and May, 2000, and we analysed 6-month follow-up data from 1496 children. Findings There was a peak in occurrence of childhood ITP during spring and a nadir in the autumn. Mean initial platelet count was 15·4×10 9 /L (SD 19·7). 1447 (73%) of 1976 children were admitted to hospital. Initial management consisted of no drug treatment in 612 (31%), intravenous immunoglobulin in 576 (29%), corticosteroids in 651 (33%), or both in 137 (7%) patients. Intracranial haemorrhage was reported in two patients. Interpretation The variable approaches to management of childhood ITP demonstrate the need for prospective clinical trials, which should be feasible within such a study group.
Christina Bergqvist - One of the best experts on this subject based on the ideXlab platform.
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disseminated herpes simplex virus and varicella zoster virus co infection in a patient with Idiopathic Thrombocytopenic Purpura
Journal of Infection and Public Health, 2019Co-Authors: Christina Bergqvist, Dany Nassar, Saeed El Zein, Souha S KanjAbstract:Abstract Concomitant disseminated herpes simplex virus (HSV) and varicella zoster virus (VZV) infection is a rare event. We describe a case of disseminated HSV and VZV infection in an 80-year-old patient many years after splenectomy for Idiopathic Thrombocytopenic Purpura (ITP). This is the first case of disseminated HSV-1 and VZV infection with molecular evidence of the simultaneous presence of both viruses in two different body sites (the skin and cerebrospinal fluid). This adds to the three reports of patients developing cutaneous disseminated herpes zoster multiple years after splenectomy for ITP.
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Disseminated herpes simplex virus and varicella zoster virus co-infection in a patient with Idiopathic Thrombocytopenic Purpura
Elsevier, 2019Co-Authors: Christina Bergqvist, Dany Nassar, Saeed El Zein, Yasmin Abi Aad, Souha S KanjAbstract:Concomitant disseminated herpes simplex virus (HSV) and varicella zoster virus (VZV) infection is a rare event. We describe a case of disseminated HSV and VZV infection in an 80-year-old patient many years after splenectomy for Idiopathic Thrombocytopenic Purpura (ITP). This is the first case of disseminated HSV-1 and VZV infection with molecular evidence of the simultaneous presence of both viruses in two different body sites (the skin and cerebrospinal fluid). This adds to the three reports of patients developing cutaneous disseminated herpes zoster multiple years after splenectomy for ITP. Keywords: Disseminated herpes simplex virus, Disseminated varicella zoster virus, Idiopathic Thrombocytopenic Purpura, Splenectom
John G Kelton - One of the best experts on this subject based on the ideXlab platform.
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current options for the treatment of Idiopathic Thrombocytopenic Purpura
Seminars in Hematology, 2007Co-Authors: Donald M Arnold, John G KeltonAbstract:Idiopathic Thrombocytopenic Purpura (ITP) is an autoimmune disease characterized by low platelets and bleeding. Platelet autoantibodies result in accelerated platelet destruction by the reticuloendothelial cells in the spleen and liver, overwhelming the compensatory capability of the bone marrow to increase platelet production. The goal of treatment for patients with ITP is to raise the platelet count to high enough levels to prevent bleeding using the least toxic therapy, recognizing the generally benign nature of the illness. Corticosteroids, intravenous immune globulin, and splenectomy remain mainstays of treatment; however, newer therapies including rituximab and the thrombopoietin receptor agonists are remodeling conventional treatment algorithms. Immune suppressant medications and cytotoxic drugs continue to be used in patients with severe and chronic refractory ITP with some success; however, estimates of the effect of these and other treatments are limited by the lack of randomized trials using clinical end points. In this article, treatments for ITP are reviewed with a focus on their mechanism of action and the best available evidence from clinical studies. A move towards early aggressive therapy may alter the natural history of this self-perpetuating illness.
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systematic review efficacy and safety of rituximab for adults with Idiopathic Thrombocytopenic Purpura
Annals of Internal Medicine, 2007Co-Authors: Donald M Arnold, Francesco Dentali, Mark Crowther, Ralph M Meyer, Richard J Cook, Christopher Sigouin, Graeme Fraser, Wendy Lim, John G KeltonAbstract:Rituximab, a monoclonal anti-CD20 antibody, is increasingly being used to treat Idiopathic Thrombocytopenic Purpura (ITP). However, the efficacy of ritixumab against ITP and its safety are uncertai...
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a retrospective 11 year analysis of obstetric patients with Idiopathic Thrombocytopenic Purpura
Blood, 2003Co-Authors: Kathryn E Webert, Christopher Sigouin, Nancy M Heddle, Richa Mittal, John G KeltonAbstract:Numerous studies have examined the outcomes of infants born to mothers with Idiopathic Thrombocytopenic Purpura (ITP). Fewer studies have discussed the morbidity of obstetric patients with ITP. We describe a retrospective study of 92 women with ITP during 119 pregnancies over an 11-year period. Most women had thrombocytopenia during pregnancy. At delivery, women in 98 pregnancies (89%) had platelet counts lower than 150 × 109/L; most had mild to moderate thrombocytopenia. For many, the pregnancy was uneventful; however, women had moderate to severe bleeding in 25 pregnancies (21.5%). Women in 37 pregnancies (31.1%) required treatment to increase platelet counts. During delivery, 44 women (37.3%) received epidural analgesia without complications, with most having a platelet count between 50 and 149 × 109/L. Most deliveries (82.4%) were vaginal. Bleeding was uncommon at delivery. Infant platelet counts at birth ranged from 12 to 436 × 109/L; 25.2% of infants had platelet counts lower than 150 × 109/L, and 9% had platelet counts lower than 50 × 109/L. Eighteen infants (14.6%) required treatment for hemostatic impairment. Two fetal deaths occurred. One was caused by hemorrhage. ITP in pregnancy carries a low risk, but mothers and infants may require therapy to raise their platelet counts. (Blood. 2003;102:4306-4311)
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Idiopathic Thrombocytopenic Purpura complicating pregnancy
Blood Reviews, 2002Co-Authors: John G KeltonAbstract:Idiopathic Thrombocytopenic Purpura (ITP) is a condition that often develops in young women, and, consequently, physicians will frequently manage pregnant patients with this disorder. The lack of prospective trials investigating ITP in pregnancy has meant that physicians frequently rely on personal experience and anecdotal evidence to manage these patients. However, recent, large, prospective and retrospective studies have clarified several important aspects of ITP in pregnancy. First, ITP should be distinguished from incidental thrombocytopenia of pregnancy, a high frequency and benign, mild drop in the platelet count that occurs late in pregnancy. Second, although the platelet count often drops in pregnant ITP patients, serious morbidity or mortality is distinctly uncommon for the mothers. The overall frequency of thrombocytopenia in the infant is quite low, and about 5% of infants will have a birth platelet count less than 20 x 10(9)/L and about 1% will have significant bleeding complications.
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management of Idiopathic Thrombocytopenic Purpura in pregnancy
Seminars in Hematology, 2000Co-Authors: Karamjit K Gill, John G KeltonAbstract:Idiopathic Thrombocytopenic Purpura (ITP) is a relatively common autoimmune disorder among women of child-bearing age. It has a frequency of approximately one to two per 1,000 live births, accounting for about 3% of all cases of maternal thrombocytopenia at delivery. ITP in pregnancy necessitates the management of two patients, the mother and her baby; hence, the close collaboration of a multidisciplinary group composed of a hematologist, obstetrician, and pediatrician is essential. Our understanding of thrombocytopenia in pregnancy has evolved considerably over the last decade, yet the optimal diagnostic and treatment strategies for ITP in pregnancy continues to create controversy. In reviewing the recent literature, there is resurgence in the trend towards treating these patients in a more conservative fashion. This review will summarize the current approach to the diagnosis of ITP in pregnancy, as well as explore the pertinent and controversial issues of investigation and management.
