acyclovir and Lethargy

Topics: Acyclovir; Dyskinesias; Encephalitis, Herpes Simplex; Herpes Simplex; Humans; Infant; Lethargy

To describe a term newborn with acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem involvement including seizures associated to ischemic lesions in the brain.. Coronavirus disease 2019 (COVID-19) is predominantly a respiratory infection, but it may affect many other systems. Most pediatric COVID-19 cases range from asymptomatic to mild-moderate disease. There are no specific clinical signs described for neonatal COVID-19 infections. In children, severe central nervous system compromise has been rarely reported.. We describe a 17-day-old newborn who acquired a SARS-CoV-2 infection in a family meeting that was admitted for fever, seizures and lethargy and in whom consumption coagulopathy, ischemic lesions in the brain and cardiac involvement were documented.. SARS-CoV-2 neonatal infection can be associated with multi-organic involvement. In our patient, significant central nervous system compromise associated to ischemic lesions and laboratory findings of consumption coagulopathy were found.. Although neonatal SARS-CoV-2 infections are infrequent, they can be associated with multi-organic involvement. Neonatologists and pediatricians should be aware of this unusual way of presentation of COVID-19 in newborn infants.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Brain; Brain Ischemia; Ceftriaxone; COVID-19; COVID-19 Drug Treatment; Fever; Frontal Lobe; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lethargy; Magnetic Resonance Imaging; Male; Nasopharynx; SARS-CoV-2; Seizures

The work-up and initial management of a critically ill neonate is challenging and anxiety provoking for the Emergency Physician. While sepsis and critical congenital heart disease represent a large proportion of neonates presenting to the Emergency Department (ED) in shock, there are several additional etiologies to consider. Underlying metabolic, endocrinologic, gastrointestinal, neurologic, and traumatic disorders must be considered in a critically ill infant. Several potential etiologies will present with nonspecific and overlapping signs and symptoms, and the diagnosis often is not evident at the time of ED assessment.. We present the case of a neonate in shock, with a variety of nonspecific signs and symptoms who was ultimately diagnosed with tachycardia-induced cardiomyopathy secondary to a resolved dysrhythmia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the diagnostic and therapeutic approach to the critically ill neonate in the ED, and expands the differential diagnosis beyond sepsis and critical congenital heart disease. Knowledge of the potential life-threatening etiologies of shock in this population allows the Emergency Physician to appropriately test for, and empirically treat, several potential etiologies simultaneously. Additionally, we discuss the diagnosis and management of supraventricular tachycardia and Wolff-Parkinson-White syndrome in the neonatal and pediatric population, which is essential knowledge for an Emergency Physician.

Topics: Acidosis; Acyclovir; Adenosine; Ampicillin; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Antiviral Agents; Cardiomyopathies; Cefotaxime; Electrocardiography; Emergency Service, Hospital; Feeding Behavior; Fluid Therapy; Glucose; Humans; Hypoglycemia; Hypotension; Hypoxia; Infant, Newborn; Lethargy; Male; Propanolamines; Propranolol; Shock; Tachycardia; Tachycardia, Supraventricular; Vomiting; Wolff-Parkinson-White Syndrome

Topics: Acyclovir; Diagnosis, Differential; Dyspnea; Electrocardiography; Encephalitis, Varicella Zoster; Female; Humans; Immunosuppressive Agents; Infusions, Intravenous; Lethargy; Lupus Erythematosus, Systemic; Middle Aged; Pleural Effusion; Prednisone; Pulmonary Disease, Chronic Obstructive; Tachycardia

Herpes simplex encephalitis (HSE) can cause high mortality and morbidity in children. Since local data of HSE in children are rare, we performed a retrospective study to evaluate the prognostic factors and outcome of HSE in Taiwan.. Children were enrolled into this study if they were diagnosed as having encephalitis and also had positive polymerase chain reaction for herpes simplex virus (HSV) from cerebrospinal fluid, and/or positive immunoglobulin M or at least four-fold elevation of immunoglobulin G against HSV type 1 or type 2 from serum during the period from December 1, 1984 to January 31, 2003.. Forty patients were enrolled in this study. Twenty six patients (65%) had good outcome and 14 (35%) had poor outcome. No mortality or recurrence was found. Three-fifths of the patients were between 1 year and 6 years of age. Fever (75%) was the most common finding at admission, followed by seizures (63%), lethargy (60%), and altered consciousness (48%). Seizure and lethargy at the time of admission were more common in the poor outcome group (71% vs 58% and 64% vs 58%). Abnormal computed tomography/magnetic resonance imaging findings were found in 63% of patients in whom the examinations were performed. Abnormal electroencephalogram (EEG) findings were noted in 79% of tested patients. Acyclovir was used to treat 29 patients (73%). Abnormal neuroimaging or EEG findings were more prevalent in patients with poor outcome (75% vs 55% and 92% vs 71%), as well as delayed (>/=3 days) initiation of acyclovir therapy (92% vs 71%). There was no significant difference between the poor and good outcome groups in gender, age distribution, and clinical presentation.. As we cannot predict the outcome of patients with HSE in the early beginning of illness and delay of treatment may cause disaster, early diagnosis and prompt acyclovir initiation are important requirements for successful management.

Topics: Acyclovir; Adolescent; Antiviral Agents; Child; Child, Preschool; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Fever; Humans; Infant; Lethargy; Male; Retrospective Studies; Seizures; Taiwan; Treatment Outcome; Unconsciousness