Now showing 1 - 10 of 24
  • Publication
    Journal Article
    The epidemiology of melioidosis in Australia and Papua New Guinea.
    (2000-02-05) ;
    Fisher DA
    ;
    Howard DM
    ;
    ;
    Selvanayagam S
    ;
    Snelling PL
    ;
    ;
    Mayo MJ
    Melioidosis was first described in Australia in an outbreak in sheep in 1949 in north Queensland (22 degrees S). Human melioidosis was first described from Townsville (19 degrees S) in 1950. Melioidosis is hyperendemic in the Top End of the Northern Territory (NT) and as in parts of northeastern Thailand it is the commonest cause of fatal community-acquired septicemic pneumonia. In the 9 years since 1989 the prospective NT melioidosis study at Royal Darwin Hospital (12 degrees S) has documented 206 culture confirmed cases of melioidosis, with an average annual incidence of 16.5/100,000. Melioidosis is also seen in the north of Western Australia and north Queensland, including the Torres Strait Islands, but is uncommon in adjacent Papua New Guinea. Serological studies suggest that infection is rare in the Port Moresby region, but there is emerging evidence of melioidosis from Western Province. The NT study has documented inoculating events in 52 (25%) of cases, with an incubation period of 1-21 days (mean 9 days); 84% of cases had acute disease from presumed recent acquisition and 13% had chronic disease (sick, > 2 months). In 4% there was evidence of possible reactivation from a latent focus; 28 of 153 (18%) males had prostatic abscesses. The overall mortality was 21% (43 cases), with a mortality rate in septicemic cases (95) of 39% and in non-septicemic cases (103) of 4%. Pneumonia was the commonest presentation in both groups and, in addition, eight patients (two deaths) presented with melioidosis encephalomyelitis. Melioidosis clusters in temperate Australia are attributed to animals imported from the north. Molecular typing of Burkholderia pseudomallei isolates from temperate southwest Western Australia showed clonality over 25 years. In this outbreak and in studies from the NT, some soil isolates are molecularly identical to epidemiologically related animal and human isolates. Molecular typing has implicated the water supply in two clonal outbreaks in remote aboriginal communities in northern Australia. Further prospective collaborative studies are required to evaluate whether there are truly regional differences in clinical features of melioidosis and to better understand how B. pseudomallei is acquired from the environment.
      1277
  • Publication
    Case Reports
    West nile virus (Kunjin subtype) disease in the northern territory of Australia--a case of encephalitis and review of all reported cases.
    (2011-11)
    Gray TJ
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    ; ;
    Whelan PI
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    Jackson J
    ;
    Smith DW
    ;
    West Nile virus Kunjin subtype (WNV/KUNV) is enzootic across the tropical north of Australia, with epizootic spread into other jurisdictions. The clinical spectrum of illness in humans is poorly described. We report a clinical case of WNV/KUNV encephalitis and performed a retrospective chart audit of all cases of WNV/KUNV notified in the Northern Territory from 1992 to 2010. Thirteen cases of WNV/KUNV disease were identified; case notes were available for 10 of these presentations. Six of these patients had confirmed infection and presented with neuroinvasive illness, whereas the other four suspect cases comprised three cases with arthralgia, myalgia, and/or rash and one case with fever alone. On the available evidence, WNV/KUNV is of lower virulence compared with the New York 1999 strain. Difficulties in serological diagnosis, especially when paired acute and convalescent sera are not available, may adversely impact the accuracy of the epidemiological and clinical understanding of this virus.
      1341
  • Publication
    Journal Article
    Neurosyphilis: Still prevalent and overlooked in an at risk population.
    (2020-10-07)
    Ramachandran PS
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    ; ;
    Singleton S
    ;
    Lowe M
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    ; ;
    BACKGROUND: Neurosyphilis (NS) presents with a variety of clinical syndromes that can be attributed to other aetiologies due to difficulties in its diagnosis. We reviewed all cases of NS from the "Top End" of the Australian Northern Territory over a ten-year period to assess incidence, clinical and laboratory manifestations. METHODS: Patient data (2007-2016) were extracted from hospital records, centralised laboratory data and Northern Territory Centre for Disease Control records. Clinical records of patients with clinically suspected NS were reviewed. A diagnosis of NS was made based on the 2014 US CDC criteria. Results were also recategorized based on the 2018 US CDC criteria. RESULTS: The population of the "Top End" is 185,570, of whom 26.2% are Indigenous. A positive TPPA was recorded in 3126 individuals. A total of 75 (2.4%) of TPPA positive patients had a lumbar puncture (LP), of whom 25 (35%) were diagnosed with NS (9 definite, 16 probable). Dementia was the most common manifestation (58.3%), followed by epilepsy (16.7%), psychosis (12.5%), tabes dorsalis (12.5%) and meningovascular syphilis (8.3%). 63% of probable NS cases were not treated appropriately due to a negative CSF VDRL. Despite increased specificity of the 2018 US CDC criteria, 70% of patient in the probable NS group were not treated appropriately. The overall annual incidence [95%CI] of NS was 2.47[1.28-4.31] per 100 000py in the Indigenous population and 0.95[0.50-1.62] in the non-Indigenous population (rate ratio = 2.60 [1.19-5.70];p = 0.017). CONCLUSION: Neurosyphilis is frequently reported in the NT, particularly in Indigenous populations. Disturbingly, 60% of probable neurosyphilis patients based on the 2014 criteria, and 70% based on the 2018 criteria with were not treated appropriately. It is critical that clinicians should be aware of the diagnosis of NS and treat patients appropriately.
      1008
  • Publication
    Journal Article
    Endemic melioidosis in tropical northern Australia: a 10-year prospective study and review of the literature.
    (2000-10) ;
    Fisher DA
    ;
    Howard DM
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    ;
    Lo D
    ;
    Selva-Nayagam S
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    ;
    Huffam SE
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    Snelling PL
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    Marks PJ
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    Stephens DP
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    Lum GD
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    Jacups SP
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    In a prospective study of melioidosis in northern Australia, 252 cases were found over 10 years. Of these, 46% were bacteremic, and 49 (19%) patients died. Despite administration of ceftazidime or carbapenems, mortality was 86% (43 of 50 patients) among those with septic shock. Pneumonia accounted for 127 presentations (50%) and genitourinary infections for 37 (15%), with 35 men (18%) having prostatic abscesses. Other presentations included skin abscesses (32 patients; 13%), osteomyelitis and/or septic arthritis (9; 4%), soft tissue abscesses (10; 4%), and encephalomyelitis (10; 4%). Risk factors included diabetes (37%), excessive alcohol intake (39%), chronic lung disease (27%), chronic renal disease (10%), and consumption of kava (8%). Only 1 death occurred among the 51 patients (20%) with no risk factors (relative risk, 0.08; 95% confidence interval, 0.01-0.58). Intensive therapy with ceftazidime or carbapenems, followed by at least 3 months of eradication therapy with trimethoprim-sulfamethoxazole, was associated with decreased mortality. Strategies are needed to decrease the high mortality with melioidosis septic shock. Preliminary data on granulocyte colony-stimulating factor therapy are very encouraging.
      1322
  • Publication
    Comparative Study
    Substantia nigra degeneration in motor neurone disease: a quantitative study.
    (1992-10) ;
    Blumbergs, P C
    There is increasing evidence of degeneration of nerve cells other than motor neurones in sporadic motor neurone disease (MND). Sporadic MND is occasionally associated with Parkinsonism. The aim of this study was to determine whether neuronal loss occurs in the substantia nigra of MND patients. Case records and pathological material from 14 patients with MND were reviewed. No patient had Parkinsonism documented. Sections of substantia nigra from the patients and 14 age/sex matched controls were analysed by neuronal and macrophage quantitation. The mean number of pigmented neurones at one standard level of substantia nigra was 863 in cases and 1094 in controls (p < 0.02); on average 21% (95% CI, 7-35%) fewer in the cases. The mean number of macrophages containing neuromelanin in cases was 106 and in controls 45 (p < 0.02). The results indicate that patients with MND have degeneration of the substantia nigra. Thus MND should be considered as a type of multiple system atrophy in which the motor neurone bears the brunt of the disease. The implication of this to the relationship between classical MND and MND with Parkinsonism-Dementia of the Western Pacific is discussed.
      1192
  • Publication
    Journal Article
    Neurological melioidosis.
    (2000-02-05) ;
    Fisher DA
    ;
    Howard DM
    ;
    Neurological abnormalities have long been recognised in animals with melioidosis, including laboratory rodents and sheep in the first Australian outbreak in 1949. Autopsies in animals have shown microabscesses and lymphocytic infiltration to be present on occasion in the same animal, but Burkholderia pseudomallei is usually able to be grown from central nervous system (CNS) tissue. In humans CNS melioidosis is unusual, but both macroscopic brain abscesses and encephalitis occur. There has been a recently recognised syndrome of meningoencephalitis with varying involvement of brainstem, cerebellum and spinal cord. The prospective melioidosis study at Royal Darwin Hospital has documented 12 cases of CNS melioidosis over 9 years out of a total of 232 cases of melioidosis (5%). Prominent features on presentation were unilateral limb weakness (6), predominant cerebellar signs (2), mixed cerebellar and brainstem features with peripheral weakness (2) and flaccid paraparesis (2). Eight patients had unilateral VIIth nerve palsy and six bulbar palsy, with five requiring prolonged ventilation. Brain CT scans are usually normal initially, but MRI shows dramatic changes. Three patients died and only three made a full recovery. In two patients with predominant mononuclear CSF pleocytosis, B. pseudomallei was cultured from CSF and autopsy in one of these showed necrotising encephalitis with microabscesses. Although it has been postulated that a neurotropic exotoxin may account for melioidosis encephalomyelitis, the recent findings and comparison with the animal data suggest that direct organism spread within the CNS may be primarily responsible. Preliminary molecular typing of isolates shows no evidence of a specific strain of B. pseudomallei responsible for CNS melioidosis end further studies are required to determine if the apparent higher rate of CNS disease in Australia is due to true regional differences or is from increased ascertainment.
      1195
  • Publication
    Case Reports
    Murray Valley Encephalitis Virus: An Ongoing Cause of Encephalitis in Australia's North.
    (2018-05-11)
    Floridis J
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    McGuinness SL
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    ; ; ;
    Murray Valley encephalitis virus (MVEV) is a mosquito-borne virus endemic to Australia and New Guinea. Encephalitis due to MVEV is potentially devastating, and no therapeutic interventions of proven value exist. Prevention relies largely on personal protective measures against mosquito bites. We present a case of MVEV encephalitis with a favourable outcome following intensive care management and prolonged rehabilitation, and the epidemiological features of a further 21 cases notified to the health department of Australia's Northern Territory. As cases occur in travellers, and epidemics occur sporadically in south-eastern Australia, clinicians across Australia and further abroad should be familiar with the disease and its diagnosis and management.
      614
  • Publication
    Case Reports
    Locally acquired hepatitis E in the Northern Territory of Australia.
    (1995-03-20)
    Heath TC
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    ; ;
    Bowden FJ
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    Fisher DA
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    Demediuk BH
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    Locarnini SA
    ;
    Anderson DA
      1160
  • Publication
    Journal Article
    The stroke gap.
    (2017-05-01)
    Ramachandran, Prashanth
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      1059
  • Publication
    Journal Article
    Management of cerebral venous thrombosis due to adenoviral COVID-19 vaccination.
    (2022-06-10)
    Scutelnic, Adrian
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    Krzywicka, Katarzyna
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    Mbroh, Joshua
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    van de Munckhof, Anita
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    Sánchez van Kammen, Mayte
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    Aguiar de Sousa, Diana
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    Lindgren, Erik
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    Jood, Katarina
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    Günther, Albrecht
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    Hiltunen, Sini
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    Putaala, Jukka
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    Ferro, José M
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    Coutinho, Jonathan M
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    Arnold, Marcel
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    Poli, Sven
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    Heldner, Mirjam R
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    Tiede, Andreas
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    Maier, Frank
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    Kern, Rolf
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    Bartsch, Thorsten
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    Althaus, Katharina
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    Ciccone, Alfonso
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    Wiedmann, Markus
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    Skjelland, Mona
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    Medina, Antonio
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    Cuadrado-Godia, Elisa
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    Cox, Thomas
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    Aujayeb, Avinash
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    Raposo, Nicolas
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    Garambois, Katia
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    Payen, Jean-Francois
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    Vuillier, Fabrice
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    Franchineau, Guillaume
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    Timsit, Serge
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    Bougon, David
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    Dubois, Marie-Cécile
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    Tawa, Audrey
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    Tracol, Clement
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    De Maistre, Emmanuel
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    Bonneville, Fabrice
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    Vayne, Caroline
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    Mengel, Annerose
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    Michalski, Dominik
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    Pelz, Johann
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    Wittstock, Matthias
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    Bode, Felix
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    Zimmermann, Julian
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    Schouten, Judith
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    Buture, Alina
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    Murphy, Sean
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    Palma, Vincenzo
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    Negro, Alberto
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    Gutschalk, Alexander
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    Nagel, Simon
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    Schoenenberger, Silvia
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    Frisullo, Giovanni
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    Zanferrari, Carla
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    Grillo, Francesco
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    Giammello, Fabrizio
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    Martin, Mar Morin
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    ; ;
    Garcia Esperon, Carlos
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    Chew, Beng Lim Alvin
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    Kleinig, Timothy J
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    Soriano, Cristina
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    Zimatore, Domenico S
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    Petruzzellis, Marco
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    Elkady, Ahmed
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    Miranda, Miguel S
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    Fernandes, João
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    Hellström Vogel, Åslög
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    Johansson, Elias
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    Philip, Anemon Puthuppallil
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    Coutts, Shelagh B
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    Bal, Simerpreet
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    Buck, Brian
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    Legault, Catherine
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    Blacquiere, Dylan
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    Katzberg, Hans D
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    Field, Thalia S
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    Dizonno, Vanessa
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    Gattringer, Thomas
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    Jacobi, Christian
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    Devroye, Annemie
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    Lemmens, Robin
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    Kristoffersen, Espen Saxhaug
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    Bandettini di Poggio, Monica
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    Ghiasian, Masoud
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    Karapanayiotides, Theodoros
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    Chatterton, Sophie
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    Wronski, Miriam
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    Ng, Karl
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    Kahnis, Robert
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    Geeraerts, Thomas
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    Reiner, Peggy
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    Cordonnier, Charlotte
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    Middeldorp, Saskia
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    Levi, Marcel
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    van Gorp, Eric C M
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    van de Beek, Diederik
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    Brodard, Justine
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    Kremer Hovinga, Johanna A
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    Kruip, Marieke J H A
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    Tatlisumak, Turgut
    OBJECTIVE: Cerebral venous thrombosis caused by vaccine-induced immune thrombotic thrombocytopenia (VITT-CVT) is a rare adverse effect of adenovirus-based SARS-CoV-2 vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality. METHODS: We used data from an international prospective registry of patients with CVT after adenovirus-based SARS-CoV-2 vaccination. We analyzed possible, probable or definite VITT-CVT cases included until 18 January 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis. RESULTS: 99 VITT-CVT patients from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11/24 (46%), and 28/37 (76%) of patients diagnosed in March, April, and from May onwards, respectively, were treated in-line with VITT recommendations (p<0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 (32%) vs 29/55 (52%), adjusted OR 0.43 (95%CI 0.16-1.19)). However, patients who received immunomodulation had lower mortality (19/65 (29%) vs 24/34 (70%), adjusted OR 0.19 (95%CI 0.06-0.58)). Treatment with non-heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 (33%) vs 13/35 (37%), adjusted OR 0.70 (95%CI 0.24-2.04)). Mortality was also not significantly influenced by platelet transfusion (17/27 (63%) vs 26/72 (36%), adjusted OR 2.19 (95%CI 0.74-6.54)). CONCLUSIONS: In VITT-CVT patients, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT-CVT. This article is protected by copyright. All rights reserved.
      3205