zithromax and Myasthenia-Gravis

The aim of our study was to investigate the interrelations of symptoms, clinical outcomes and treatment regimens in pregnant women, diagnosed with myasthenia gravis and superimposed COVID-19 infection.. We conducted an observational retrospective study between August, 2020 and July, 2021. Five patients with preexisting MG and superimposed COVID- infection were included in our study. We investigated the duration of MG, the antibody patient status, any present comorbidities, MG baseline treatment and MG severity class prior to the COVID-19 infection, MG severity class and treatment during the COVID-infection, and last but not least, the maternal and fetal clinical outcome.. None of the participants were hospitalized as they were treated under quarantine at their homes. The most frequently reported complaints were anosmia, headache and fever, which were observed in 3 out of 5 patients. The MG severity was evaluated twice - before and after the quarantine period. Progression to a more advanced stage was found in 2 of our 5 patients. Three of the patients did not require any changes in the prescribed baseline MG treatment. In 2 patients the pyridostigmine dosage had to be increased. One patient received azithromycin and 4 patients were given LMWH (nadroparin) as specific anti-COVID measures. All patients fully recovered and gave birth to healthy newborns.. To our knowledge, this is the first study on pregnant MG patients with superimposed COVID-19 infection. Based on our observations in this study it would seem that the coexistence of MG and COVID-19 infection in pregnancy does not elicit exacerbation in neither of those conditions. Further research is needed to confirm or challenge these findings, especially with the prospects of new virus variants emerging in the future.

Topics: Azithromycin; COVID-19; Female; Heparin, Low-Molecular-Weight; Humans; Infant, Newborn; Myasthenia Gravis; Observational Studies as Topic; Pregnancy; Retrospective Studies

The COVID-19 pandemic presents two main concerns for patients with myasthenia gravis (MG); chronic immunosuppression may put them at greater risk, and some proposed treatments for COVID-19 could cause MG exacerbation.. We present three patients with generalized seropositive MG who developed COVID-19. All patients had a favorable outcome, with only one patient experiencing exacerbation. In this case, exacerbation began before COVID-19; she required ICU admission, non-invasive ventilatory support, and received hydroxychloroquine, lopinavir and ritonavir which were well tolerated. One patient received IVIG in place of scheduled plasma exchange.. Outcome was favorable in all cases despite immunosuppressive therapy, use of experimental COVID-19 medication and switching of plasma exchange for IVIG.

Topics: Adult; Aged; Azithromycin; Betacoronavirus; Coronavirus Infections; COVID-19; COVID-19 Drug Treatment; Diabetes Mellitus, Type 2; Female; Humans; Hydroxychloroquine; Hypertension; Hypothyroidism; Immunocompromised Host; Immunoglobulins, Intravenous; Immunosuppressive Agents; Lopinavir; Male; Myasthenia Gravis; Pandemics; Plasmapheresis; Pneumonia, Viral; Ritonavir; SARS-CoV-2; Treatment Outcome

The etiology of acute exacerbations of myasthenia gravis (MG) is not well understood and further characterization can lead to improved preventative measures. This study aims to characterize factors contributing to MG exacerbations.. A total of 127 MG patient charts were reviewed retrospectively (2011-2016) to obtain demographics, immunizations, pharmaceutical records, contributing factors of each MG exacerbation, emergency department (ED) visits, hospitalizations, and duration.. There were 212 exacerbations requiring 106 ED visits and 141 hospitalizations (average admission 6.5 days). Highest contributors were infections (30%) and medications that may worsen MG (19%), with 24% unattributed. Infection related exacerbations were associated with 44.3% of ED visits and 39.7% of hospitalizations. Patients prescribed beta-blockers were associated with more exacerbations (P < .01). Patients prescribed medications that may worsen MG had a higher exacerbation frequency shortly after administration.. Infections and cautioned medications are frequently factors in acute MG exacerbations needing urgent medical attention and warrant caution.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Disease Progression; Emergency Service, Hospital; Female; Fluoroquinolones; Gentamicins; Glucocorticoids; Hospitalization; Humans; Infections; Magnesium; Male; Middle Aged; Myasthenia Gravis; Prednisone; Retrospective Studies; Risk Factors; Symptom Flare Up

We report the case of a 25-year-old female patient with severe aggravation of myasthenia gravis due to azithromycin which was prescribed for an influenza syndrome. One hour after the intake of 500 mg azithromycin the patient developed weakness of the legs and respiratory distress due to respiratory muscle failure. She was hospitalized in a comatose state and required intubation and mechanical ventilation for six days. Acute worsening of myasthenia gravis was observed in this patient in 1986 after parenteral administration of erythromycin. Erythromycin causing aggravation of myasthenia gravis by interfering with neuromuscular transmission is reported in the literature. The close temporal relationship between the intake of azithromycin and severe worsening of myasthenia gravis in our patient suggests that azithromycin, a new azalid-antibiotic of the macrolid group, can exacerbate myasthenia gravis. We conclude that azithromycin should be added to the list of drugs to be used with caution in patients with myasthenia gravis.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Female; Humans; Myasthenia Gravis; Paralysis; Respiratory Insufficiency