RESUMO
BACKGROUND Despite the preponderance of evidence of immune-driven pathophysiology of disease in herpes simplex virus-1 (HSV-1) encephalitis, current treatment paradigms do not officially recommend adjunctive immunomodulatory therapy in addition to acyclovir. This may in part explain the poor long-term outcomes in patients with severe HSV encephalitis. This report is of a 21-year-old man presenting with a 4-day history of nausea, headache, and fever and a diagnosis of HSV-1 encephalitis. CASE REPORT We describe the case of a young male with clinically and radiographically severe HSV-1 encephalitis diagnosed by PCR of cerebrospinal fluid (CSF), who demonstrated immediate improvement upon treatment with intravenous immunoglobulin (IVIG, 0.5 g/kg daily ×3 days) in addition to acyclovir and dexamethasone therapy. Acyclovir therapy was extended beyond 21 days due to persistently positive HSV-1 CSF PCR. He developed N-methyl-D-aspartate (NMDA) receptor antibodies at 6 weeks, but his long-term outcome far exceeded expectations. While some of his neurological deficits appear to be permanent, he is living a normal life. CONCLUSIONS Overwhelming evidence demonstrates that brain injury due to HSV encephalitis is driven by immune reactions stimulated by HSV rather than HSV itself. Nevertheless, use of immunomodulatory therapy such as glucocorticoids and IVIG are left to the discretion of individual clinicians rather than being recommended in treatment guidelines, which instead recommend acyclovir therapy. The present case highlights the potential role of immunomodulatory therapy with IVIG in HSV encephalitis and the importance of early diagnosis and treatment.
Assuntos
Encefalite por Herpes Simples , Humanos , Masculino , Adulto Jovem , Adulto , Encefalite por Herpes Simples/diagnóstico , Encefalite por Herpes Simples/tratamento farmacológico , Imunoglobulinas Intravenosas/uso terapêutico , Antivirais/uso terapêutico , Glucocorticoides/uso terapêutico , Aciclovir/uso terapêuticoRESUMO
The California Dental Association founded the California Dental Association Foundation in 2001 as its philanthropic affiliate, with the express mission to "improve the oral health of all Californians by supporting the dental profession in its efforts to meet community needs". This mission is evident as the CDA Foundation celebrates its 10th anniversary of identifying and addressing barriers to care through innovative programs, scholarships, and grant-making.
Assuntos
Assistência Odontológica para Crianças/economia , Fundações , Acessibilidade aos Serviços de Saúde , Sociedades Odontológicas , California , Criança , Pré-Escolar , Letramento em Saúde , Humanos , Lactente , Área Carente de Assistência Médica , Assistência PerinatalRESUMO
ACT This consensus statement supports implementation of caries management by risk assessment in clinical practice by using the following principles: modification of the oral flora, patient education, remineralization, and minimal operative intervention. The statement includes a list of supporters.
Assuntos
Cárie Dentária/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Cárie Dentária/microbiologia , Cárie Dentária/prevenção & controle , Suscetibilidade à Cárie Dentária , Restauração Dentária Permanente/métodos , Humanos , Lactente , Boca/microbiologia , Educação de Pacientes como Assunto , Participação do Paciente , Medição de Risco , Remineralização DentáriaRESUMO
Caries is the most prevalent disease of children and is epidemic in some populations. A risk-based approach to managing caries targets those in greatest jeopardy for contracting the disease, as well as provides evidence-based decisions to treat current disease and control it in the future. This paper outlines key concepts necessary to effectively manage and reduce caries based on the most current science to date. Subsequent articles will outline a roadmap to success in curing dental caries.
