Neurological manifestations of West Nile virus
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
After a typical incubation period of 3–8 days, but potentially as long as 28 days after infection, systemic symptoms can develop. West Nile fever develops in about 20% of patients characterized as non-specific “flu-like” symptoms consisting of fever, headache, malaise, anorexia, abdominal pain, sore throat, back pain, and/or diarrhea [24,25,27]. In one series of patients, it was noted that the most commonly reported symptoms were fever (100%), generalized fatigue (74%), nausea/vomiting (44%), headache (48%), and back/limb pain (35%) [28]. A maculopapular rash occurs in ~25%–50% of patients.24 This is morbilliform, nonpruritic, and predominantly involves the torso and proximal extremities, sparing the palms and soles. For unclear reasons, the rash tends to be seen more frequently in both younger patients as well as in those without neuroinvasive disease [12,29,30].
Human immunodeficiency virus (HIV)
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
The most common mode of HIV infection is sexual transmission through the genital mucosa (14), with initial infection of a small number of T lymphocytes, macrophages, and dendritic cells located in the lamina propria. Initial replication occurs in the regional lymph nodes, followed by migration of infected T lymphocytes or virions into the bloodstream, where secondary amplification in the gastrointestinal tract, spleen, and bone marrow results in massive infection of susceptible cells (15). The period of peak viremia, which occurs in the first 6 weeks, results in a symptomatic illness in 40% to 90% of patients, termed acute HIV infection. The most common symptoms include fever, fatigue, pharyngitis, lymphadenopathy, and myalgias. A maculopapular rash involving the trunk also occurs in 40% to 80% of patients (16). Oral or genital ulcers can also occur. Given the nonspecific mononucleosis like symptoms of acute HIV infection, the diagnosis is often missed. A high index of suspicion is required to make the diagnosis, because commonly used screening tests for HIV antibody are negative for the first 4 weeks following infection. Detection of the p24 antigen or HIV RNA by PCR in the absence of HIV antibodies would confirm the diagnosis. This has important public health implications as the patient is unaware of being infected with HIV and yet is highly infectious because of the very high viral load.
Rubella Virus Infections
Sunit K. Singh, Daniel Růžek in Neuroviral Infections, 2013
Rubella is usually a mild disease in children, but may be more severe in adults, who may experience a prodrome with malaise and low-grade fever. Lymphadenopathy usually develops before the rash and may persist for 10-14 days after the rash has disappeared. The cervical, postauricular, and suboccipital lymph nodes are most frequently affected. The characteristic maculopapular rash appears after an incubation period of approximately 14 days (range 12-23 days) (Figures 17.3 and 17.4). A discrete rash appears first on the face and spreads quickly to the trunk and limbs. The rash may persist for 1-3 days or may be fleeting; lesions may coalesce. Cough, sore throat, conjunctivitis, and headache may also occur in adults. Occasionally, rubella presents with a more severe fever and constitutional symptoms similar to measles. Virus is excreted from about 7 days before the onset of rash and for 7-10 days thereafter, but patients are only infectious for about 10 days. Joint symptoms may occur, as described below (see Complications and Pathogenesis).
Spotted fever diagnosis: Experience from a South Indian center
Published in Pathogens and Global Health, 2021
Elangovan D, Perumalla S, Gunasekaran K, Rose W, Verghese V p, Abhilash K Pp, Prakash Jaj, Dumler Js
Among these 48 spotted fever (SF) cases, 41 (84%) were children. Male (n = 28) to female (n = 21) ratio among these was 4:3. Rash appeared by the fifth day after fever onset in 45 (92%) of the 48 cases. Maculopapular rash was observed in 34 (70.8%) patients; while six (12.5%) had macular rash, purpuric or petechial rash (severe rash) was seen in 8 patients (16.7%). Rash on palms and soles was observed in 35 (71.4%), pedal edema in 19 (39.6%) and hepatomegaly in one (2.1%) case. Among the 48 patients, 43 received doxycycline and 5 received azithromycin, and all demonstrated defervescence of fever within 72 hours of initiation of therapy. Rickettsia-specific therapy (doxycycline or azithromycin) was initiated in 44 (90%) of the 48 patients before samples were sent for spotted fever diagnostic assays. None of our spotted fever cases had eschar and there were no fatalities.
Squamous cell carcinoma of the lung: improving the detection and management of immune-related adverse events
Published in Expert Review of Anticancer Therapy, 2022
Lara Kujtan, Rama Krishna Kancha, Beth Gustafson, Lindsey Douglass, Christopher RH Ward, Blake Buzard, Janakiraman Subramanian
Dermatologic toxicity is the most common IRAE associated with checkpoint inhibitors. Rashes are more common (5% ≥G3) with combination anti-CTLA4 and anti-PD-1 therapies compared to single agent anti-PD1 therapy (10%, <1% G3) with an average onset of 3–4 weeks [38,41,42]. Patients typically present with a pruritic maculopapular rash on the trunk or extremities. For mild rashes covering <10% of the body surface area (BSA), continuation of the ICI and treatment with moderate potency topical steroids and oral antihistamines is appropriate. These patients need to be counseled to avoid skin irritants and sun exposure [37]. GABA agonists may also be considered for pruritus, which may present in conjunction with rash or without obvious skin lesions [38,43]. ICIs should be held for grade 2 moderate to severe rash covering 10–30% of the BSA or when rash significantly affects quality of life. Initiate class one high-potency topical corticosteroids (such as clobetasol or betamethasone) and consult dermatology for possible skin biopsy to rule out bullous pemphigoid, Stevens-Johnson syndrome, or toxic epidermal necrolysis. Systemic steroids may be considered for grade 2 dermatologic toxicities, and initiated for grade 3 toxicities [38]. For grade 3 or 4 skin toxicity with skin sloughing, blisters, or severe rash unmanageable with prior interventions consult dermatology and consider high dose intravenous corticosteroids with consideration for permanent ICI discontinuation [37]. Grade ≥2 dermatologic toxicities may recur after a steroid taper. Dermatologist consultation and or steroid-sparing agents, such as dupilumab for eczema and rituximab for pemphigus, may be considered for these patients [44,45].
Secondary hemophagocytic lymphohistiocytosis in pediatric patients: a single center experience and factors that influenced patient prognosis
Published in Pediatric Hematology and Oncology, 2019
Melahat Melek Oguz, Gurses Sahin, Esma Altinel Acoglu, Emine Polat, Husniye Yucel, Fatma Zehra Oztek Celebi, Hilal Unsal, Meltem Akcaboy, Eyup Sari, Saliha Senel
In three of the patients, HLH was triggered by drugs. One male patient was receiving vancomycin due to enterococci detection in his urine culture. On day 18 of admission, a maculopapular rash appeared and fever reoccurred. In the peripheral blood, we detected a 5-fold increase in the total number of eosinophils, and he was diagnosed with DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) due to vancomycin. Clinical and laboratory features of the patient fulfilled the criteria for the diagnosis of HLH. Anti-epileptic drugs such as carbamazepine and levatiracetam resulted in DRESS-associated HLH in two other patients (Table 3).