RESUMO
The authors compared pre-treatment and post-treatment characteristics of 206 prospectively enrolled patients with Kawasaki disease (KD) responsive to intravenous immunoglobulin (IVIG) with those of 23 (10% of total) IVIG non-responders. Demographic characteristics were similar in both groups. Compared to IVIG responders, non-responders had a longer total duration of fever and a higher incidence of coronary artery lesions. Prior to IVIG, non-responders had higher neutrophil differential and C-reactive protein, and lower cholesterol. 24 hours after the IVIG infusion, a total leucocyte count >13.1×10(9)/l, neutrophil differential >51% and total protein <72 g/l showed reasonable sensitivity (91%, 91% and 64%, respectively) and specificity (89%, 76% and 78%, respectively) as independent characteristics of non-response to IVIG. Laboratory parameters before and shortly after IVIG may reflect the severity of inflammation in KD patients and assist in informing further management.
Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/terapia , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Pré-Escolar , Colesterol/sangue , Doença das Coronárias/etiologia , Feminino , Febre/etiologia , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Lactente , Contagem de Leucócitos , Masculino , Síndrome de Linfonodos Mucocutâneos/sangue , Síndrome de Linfonodos Mucocutâneos/complicações , Neutrófilos/patologia , Estudos Prospectivos , Fatores de Risco , Falha de TratamentoRESUMO
BACKGROUND: M. pneumoniae pneumonia (MP) has been reported in 10-40% of community-acquired pneumonia cases. We aimed to evaluate the difference of clinical features in children with MP, according to their age and chest radiographic patterns. METHODS: The diagnosis of MP was made by examinations at both admission and discharge and by two serologic tests: the indirect microparticle agglutinin assay (>or=1:40) and the cold agglutinins titer (>or=1:32). A total of 191 children with MP were grouped by age:
Assuntos
Pneumonia por Mycoplasma/diagnóstico , Adolescente , Fatores Etários , Testes de Aglutinação , Anticorpos Antibacterianos/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Mycoplasma pneumoniae/imunologia , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/patologiaRESUMO
PURPOSE: The pathophysiology of hypogammaglobulinemia in nephrotic syndrome (NS) remains unknown. We evaluated the differences in the distribution of anti-bacterial antibodies and anti-viral antibodies, and those of immune antibodies and natural antibodies in steroid-sensitive NS. MATERIALS AND METHODS: We examined the antibody status of 18 children who had routine vaccinations. The levels of immnunoglobulin G (IgG), the IgG subclasses, and the antibodies induced by vaccinations such as diphtheria-pertussis-tetanus and measles-mumpsrubella were analyzed in children with steroid-sensitive NS. RESULTS: There was a positive correlation between the albumin and IgG values (r = 0.6, p < 0.01), and the four IgG subclasses were all evenly depressed in the nephrotic children during the acute stage of the disease. The antibodies induced by bacterial antigens were depressed and the seropositivity of anti-viral antibodies tended to be lower than those of age-matched control children during the acute stage. The depressed immune antibody status recovered rapidly in the remission stage of NS, despite corticosteroid treatment. CONCLUSIONS: IgG levels correlated positively with albumin levels, and all antibodies, including immune and natural antibodies, were depressed in the acute stage of NS. Our results suggest that hypogammaglobulinaemia in NS may be associated with intravascular homeostasis of oncotic pressure.