III ICD-9-CM Codes for Commonly Administered Pediatric Vaccines/Toxoids and Immune Globulins

Abstract Background After an animal-associated injury (AAI) in rabies-endemic regions, post-exposure prophylaxis (PEP) is needed to prevent infection.1,3 PEP consist of rabies vaccinations (RV) and in some cases also additional rabies immune globulins (RIG). Not always PEP medication, and RIG in particular, is accessible. Along with an increased number of exposure notifications among Dutch travelers, this might lead to treatment delay, and thus to increased health risks. Until now, research mainly focused on factors associated with exposition, but none on which factors are associated with PEP delay. This study aimed to identify which general sample characteristics are associated with PEP delay while being abroad. Methods A quantitative retrospective observational study was conducted. The study population consisted of insured Dutch international travelers who actively contacted their medical assistance company (2015-2019) because of an animal-associated injury (AAI) (N = 691). The association between general sample characteristics and delay of different PEP treatments was studied using survival analysis. Results Travelers without PrEP had an increased hazard, and therefore a shorter delay, for receiving their first RV as compared to travelers with PrEP (HR:1.11, 95%CI:1.01-1.22). The travelers needing both RV and RIG had a decreased hazard, and therefore a longer delay, as compared to travelers only needing RV (HR:0.81, 95%CI:0.67-0.96). General sample characteristic associated with RIG administration delay was travel destination. Travelers to Central and South America, East Mediterranean and Europe had a decreased hazard, and therefore a longer delay, for receiving RIG treatments relative to travelers to South East Asia (HR:0.31, 95%CI:0.13-0.70; HR:0.34, 95%CI:0.19-0.61; HR:0.46, 95%CI:0.24-0.89; HR:0.48, 95%CI:0.12-0.81 respectively). Conclusions Our results suggest that the advice for PrEP should be given based travel destination, as these was found to be the main factor for PEP delay, among travelers going to rabies endemic countries.

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A Case of Acute Motor Sensory Axonal Neuropathy: A Variant of Guillain-Barré Syndrome, with Possible Syndrome of Irreversible Lithium-Effectuated Neurotoxicity

Case Reports in Medicine ◽

10.1155/2020/4683507 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

David Y. Liu ◽

Jessica R. Hollenbach ◽

Jason A. Gregorin ◽

Jonathan H. Wynbrandt

Keyword(s):

Prolonged Mechanical Ventilation ◽

Axonal Neuropathy ◽

Guillain Barre Syndrome ◽

Respiratory Compromise ◽

Term Care ◽

Fluid Analysis ◽

Guillain Barré Syndrome ◽

Immune Globulins ◽

Prolonged Recovery ◽

Guillain Barré

Acute Motor Sensory Axonal Neuropathy (AMSAN) is a rare and severe variant of Guillain-Barré syndrome (GBS) that has a prolonged recovery course. GBS is often suspected due to ascending muscle weakness, sensation difficulties, respiratory compromise, and antecedent diarrhea. The diagnosis of GBS is supported by cerebrospinal fluid analysis showing albuminocytologic dissociation. Electromyogram and nerve conduction study confirm the diagnosis and allow for further classification by variant. Treatment involves either IV immune globulins or plasmapheresis, and patients typically recover. However, depending on the variant and severity, patients may ultimately require prolonged mechanical ventilation with tracheostomy. In these cases, they may continue to have persistent muscle and sensation abnormalities requiring long-term care. We present a unique case of a 38-year-old female patient with decade-long use of lithium for bipolar disorder that presented with acute lithium toxicity. Though she was ultimately diagnosed with AMSAN, the Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) may have also contributed to her persistent neurological sequelae.

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