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登革热重症合并吉兰-巴雷综合征及多器官功能衰竭的综合治疗方法

Integrated Approach to Severe Dengue Complicated by Guillain-Barré Syndrome and Multi-organ Failure.

作者信息

Mahashabde Madhulika L, Kumar Lokesh

机构信息

General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND.

出版信息

Cureus. 2024 Jul 6;16(7):e63939. doi: 10.7759/cureus.63939. eCollection 2024 Jul.

Abstract

This report details the case of a female patient who was admitted with severe dengue, which was further complicated by bilateral pneumonia and multiple organ involvement. The patient also developed quadriparesis, a neurological complication, and had a recent history of vaccination with the COVISHIELD COVID-19 vaccine. A nerve conduction study later determined the condition to be acute motor axonal neuropathy, a variant of Guillain-Barré syndrome (GBS). While neurological complications, such as GBS, are rare in dengue cases, they can significantly affect patient outcomes. Treatment with intravenous immunoglobulin (IVIG) has proven to be an effective disease-modifying therapy for GBS. IVIG therapy is recognized for its anti-inflammatory and immunomodulatory effects, making it beneficial in certain autoimmune conditions, including those involving the nervous system. However, its use in severe infections or sepsis remains controversial. In this case, IVIG therapy was administered alongside broad-spectrum antibiotics. The patient's favorable response to IVIG therapy and subsequent clinical improvement highlight the importance of early recognition and targeted intervention for neurological complications in dengue cases.

摘要

本报告详细介绍了一名女性患者的病例,该患者因严重登革热入院,随后并发双侧肺炎和多器官受累。患者还出现了四肢瘫,这是一种神经并发症,并且近期接种了COVISHIELD新冠疫苗。后来的神经传导研究确定该病症为急性运动轴索性神经病,这是格林-巴利综合征(GBS)的一种变体。虽然像GBS这样的神经并发症在登革热病例中很少见,但它们会显著影响患者的预后。静脉注射免疫球蛋白(IVIG)治疗已被证明是一种治疗GBS的有效疾病改善疗法。IVIG疗法因其抗炎和免疫调节作用而得到认可,使其在某些自身免疫性疾病中有益,包括那些涉及神经系统的疾病。然而,其在严重感染或脓毒症中的使用仍存在争议。在该病例中,IVIG疗法与广谱抗生素同时使用。患者对IVIG疗法的良好反应及随后的临床改善突出了对登革热病例神经并发症进行早期识别和针对性干预的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/692f/11300180/6afa960b6a8b/cureus-0016-00000063939-i01.jpg

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