Suggested management of immunocompromized kidney patients suffering from SARS
Identifieur interne : 000205 ( Pmc/Corpus ); précédent : 000204; suivant : 000206Suggested management of immunocompromized kidney patients suffering from SARS
Auteurs : Man-Chun ChiuSource :
- Pediatric Nephrology (Berlin, Germany) [ 0931-041X ] ; 2003.
Abstract
The treatment of severe acute respiratory syndrome (SARS) is still empirical and controversial. Herein we report our experience in treating approximately 40 SARS children and adolescents. Treatment of SARS kidney patients is limited. Paediatric nephrologists should be on the alert for SARS in order to care for immunocompromised patients. Precautions should be made for both staff and patients with protective measures for infection control.
Url:
DOI: 10.1007/s00467-003-1325-8
PubMed: 14663579
PubMed Central: 7087636
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Suggested management of immunocompromized kidney patients suffering from SARS</title><author><name sortKey="Chiu, Man Chun" sort="Chiu, Man Chun" uniqKey="Chiu M" first="Man-Chun" last="Chiu">Man-Chun Chiu</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">14663579</idno><idno type="pmc">7087636</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7087636</idno><idno type="RBID">PMC:7087636</idno><idno type="doi">10.1007/s00467-003-1325-8</idno><date when="2003">2003</date><idno type="wicri:Area/Pmc/Corpus">000205</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000205</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Suggested management of immunocompromized kidney patients suffering from SARS</title><author><name sortKey="Chiu, Man Chun" sort="Chiu, Man Chun" uniqKey="Chiu M" first="Man-Chun" last="Chiu">Man-Chun Chiu</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Pediatric Nephrology (Berlin, Germany)</title><idno type="ISSN">0931-041X</idno><idno type="eISSN">1432-198X</idno><imprint><date when="2003">2003</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The treatment of severe acute respiratory syndrome (SARS) is still empirical and controversial. Herein we report our experience in treating approximately 40 SARS children and adolescents. Treatment of SARS kidney patients is limited. Paediatric nephrologists should be on the alert for SARS in order to care for immunocompromised patients. Precautions should be made for both staff and patients with protective measures for infection control.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Hon" uniqKey="Hon">Hon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chiu" uniqKey="Chiu">Chiu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chiu" uniqKey="Chiu">Chiu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Peiris" uniqKey="Peiris">Peiris</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="So" uniqKey="So">So</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Leung" uniqKey="Leung">Leung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wong" uniqKey="Wong">Wong</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="editorial"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Pediatr Nephrol</journal-id><journal-id journal-id-type="iso-abbrev">Pediatr. Nephrol</journal-id><journal-title-group><journal-title>Pediatric Nephrology (Berlin, Germany)</journal-title></journal-title-group><issn pub-type="ppub">0931-041X</issn><issn pub-type="epub">1432-198X</issn><publisher><publisher-name>Springer-Verlag</publisher-name><publisher-loc>Berlin/Heidelberg</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">14663579</article-id><article-id pub-id-type="pmc">7087636</article-id><article-id pub-id-type="publisher-id">1325</article-id><article-id pub-id-type="doi">10.1007/s00467-003-1325-8</article-id><article-categories><subj-group subj-group-type="heading"><subject>Editorial Commentary</subject></subj-group></article-categories><title-group><article-title>Suggested management of immunocompromized kidney patients suffering from SARS</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Chiu</surname><given-names>Man-Chun</given-names></name><address><email>chiumc@ha.org.hk</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.415229.9</institution-id><institution-id institution-id-type="ISNI">0000000417997070</institution-id><institution>Department of Paediatrics and Adolescent Medicine,</institution><institution>Princess Margaret Hospital,</institution></institution-wrap>Lai King Hill Road, Kowloon, Hong Kong</aff></contrib-group><pub-date pub-type="epub"><day>24</day><month>10</month><year>2003</year></pub-date><pub-date pub-type="ppub"><year>2003</year></pub-date><volume>18</volume><issue>12</issue><fpage>1204</fpage><lpage>1205</lpage><history><date date-type="received"><day>6</day><month>8</month><year>2003</year></date><date date-type="rev-recd"><day>21</day><month>8</month><year>2003</year></date><date date-type="accepted"><day>22</day><month>8</month><year>2003</year></date></history><permissions><copyright-statement>© IPNA 2003</copyright-statement><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.</license-p></license></permissions><abstract id="Abs1"><p>The treatment of severe acute respiratory syndrome (SARS) is still empirical and controversial. Herein we report our experience in treating approximately 40 SARS children and adolescents. Treatment of SARS kidney patients is limited. Paediatric nephrologists should be on the alert for SARS in order to care for immunocompromised patients. Precautions should be made for both staff and patients with protective measures for infection control.</p></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>SARS</kwd><kwd>Children</kwd><kwd>Kidney</kwd><kwd> Treatment</kwd><kwd>Mortality</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© IPNA 2003</meta-value></custom-meta></custom-meta-group></article-meta></front><body><p>The treatment of severe acute respiratory syndrome (SARS) is still empirical and controversial, and little is known worldwide about the treatment for SARS kidney transplant patients. The incidence of SARS reported in children is relatively low compared with adults. We have the experience of managing approximately 40 SARS children and adolescents and share herein the knowledge that we have gained.</p><p>Coronavirus has been identified to be the virus responsible for the SARS epidemic, and by July 2003, the World Health Organization (WHO) reported altogether more than 8400 cases of SARS with an alarming mortality of 812 cases [<xref ref-type="bibr" rid="CR1">1</xref>]. In Hong Kong, we had altogether 1755 clinical SARS patients of whom 113 were below 18 years of age [<xref ref-type="bibr" rid="CR2">2</xref>]. In contrast with adults, there were no deaths seen in children and adolescents. It seems children suffered much less from the infection than adults, although some adolescents could have severe lung involvement [<xref ref-type="bibr" rid="CR3">3</xref>, <xref ref-type="bibr" rid="CR4">4</xref>, <xref ref-type="bibr" rid="CR5">5</xref>]. In our hospital, among 43 SARS children and adolescents, only 5 required PICU care including 1 adolescent girl who needed intubation; all recovered from the disease with no sequelae [<xref ref-type="bibr" rid="CR5">5</xref>].</p><p>The disease is considered to have a hyperimmune response following the initial phase of virus replication, which can lead to lung destruction [<xref ref-type="bibr" rid="CR6">6</xref>]. Treatment is still controversial. Ribavirin had been used as an antiviral agent, and steroid had been given in most of our patients to help suppress the hyperimmune response [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR8">8</xref>]. The regimen used in children is slightly different with lower dosage of steroid given [<xref ref-type="bibr" rid="CR9">9</xref>]; however, their efficacy had not been proven although anecdotal evidence suggests that corticosteroids may be beneficial. Convalescent serum had been tried in patients with some good results [<xref ref-type="bibr" rid="CR10">10</xref>].</p><p>There was only one adult kidney transplant patient afflicted with SARS. He was over 60 years old and also suffered from diabetes mellitus. He had been transplanted for some years and his clinical condition was not good even before having SARS. He was treated with pulse methylprednisolone, prednisone and ribavirin, without changing his usual immunosuppressant therapy. He died eventually (C.B. Leung, pers. commun.).</p><p>Treatment of SARS in kidney transplant is empirical. The usual immunosuppressant regimen might not need to be changed to keep the transplanted kidney from rejection; however, if additional immunosuppressants are to be used for SARS, they will probably need to be given at reduced dosages depending on the duration after kidney transplantation and current immunosuppressants for fear of overwhelming infections. Immunoglobulins may be considered for protection. With immunosuppression, fever might not be a prominent feature, and respiratory symptoms and signs need to be closely watched with frequent X-ray chest monitoring, especially in the second week when deterioration might be expected. Such patients should be isolated and those medical personnel taking care of them must be fully protected, with strict isolation measures enforced.</p><p>For SARS, mortality ran high in those with co-morbid illnesses including cardiac, pulmonary, liver diseases, diabetes mellitus and renal failure; and in the advanced age group, mortality could exceed 40% (T.K. Kong, pers. commun.). In Hong Kong, 7 of 19 adult ESRD patients on haemodialysis or peritoneal dialysis infected with SARS died (C.B. Leung et al., pers. commun.). Fortunately, there were no children on dialysis infected. Since SARS children fare much better than the aged, it is likely that those ESRD children might also have a better outcome.</p><p>Paediatric nephrologists should be on the alert for SARS, because we have to care for a group of immunocompromised patients including those transplant children. Those children presenting with fever should be isolated and investigated especially at times of a SARS outbreak. Precautions should be made for both staff and patients with protective measures for infection control. If all medical professionals are on the alert, taking vigilant measures against SARS, WHO is optimistic that, should SARS return, it will not do so with a vengeance [<xref ref-type="bibr" rid="CR11">11</xref>].</p></body><back><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><mixed-citation publication-type="other">World Health Organization. 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Update 89-What happens if SARS returns? http://www.who.int/csr/don/2003_06_26/en/</mixed-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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