Characterization of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis Among Patients Admitted to Kenyatta National Hospital: A Retrospective Cross-Sectional Study

Irungu, Kenneth; Nyamu, David G; Opanga, Sylvia

doi:10.1007/s40801-017-0105-x

Cited by 17 publications

(27 citation statements)

References 19 publications

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“…Furthermore, their median TTO of symptoms was 8 days with a range of 1-28 days, matching other studies. 18,25 This is consistent with the latency period for the T-lymphocyte-mediated type IV hypersensitivity reaction notable for causing SJS and TEN. 62 The prevalence of SJS and TEN in our database review was 284 cases within 14 years, which represents an average frequency of 20 cases per year.…”

Section: Discussionsupporting

confidence: 79%

“…This is in accordance with previous studies documenting HIV infection as a major risk for SJS and TEN. 12,17,18 By contrast, only 7% of patients in the European multicenter studies had SJS/TEN and HIV comorbidity. 9,64 The very high prevalence of HIV infection in Nigeria could explain the high proportion of patients on antiretroviral drugs in our study.…”

Section: Discussionmentioning

confidence: 98%

“…[12][13][14][15] Previous studies describing the epidemiology of SJS and TEN in low-and middle-income countries (LMICs) were hospital based and involved a small number of patients. [16][17][18][19] Consequently, only a narrow range of the potential culpable drugs and drug classes were captured in the studies. 16,17,19 The rarity of SJS and TEN limits the practicability of large population studies to estimate the incidence; therefore, hospital-databased incidence assumptions would have accuracy limitations.…”

Section: Introductionmentioning

confidence: 99%

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Severe cutaneous adverse drug reactions manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national pharmacovigilance center in Nigeria: a database review from 2004 to 2017

Oshikoya

Ogunyinka

Ogar

et al. 2020

Therapeutic Advances in Drug Safety

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Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCARs). There is scant literature on the characteristics and causes of these conditions among the Nigerian population. Here, we describe the epidemiology, associated morbidity and mortality, and culpable drugs in SJS and TEN cases using the National Pharmacovigilance (NPC) database in Nigeria. Methods: A retrospective review of the NPC database was done to analyze SJS and TEN cases reported over a period of 14 years. Annual reports, age and sex of patients, type of reporter, suspects and concomitant drugs, time to onset (TTO) of the reactions, and outcome of SJS and TEN were evaluated. Results: The NPC received a total of 24,015 adverse drug reaction (ADR) reports. SJS and TEN accounted for 284 (0.1%) of the total reports, of which 254 (89.4%) were SJS and the remainder were TEN. Females ( n = 184, 64.8%) and individuals aged 19–40 years ( n = 181, 63.7%) were the most affected by SJS and TEN. Antiretrovirals, followed by antibiotics, were the most common drug classes reported to cause SJS and TEN, with nevirapine ( n = 174, 40.7%) and co-trimoxazole ( n = 143, 33.5%) being the most widely implicated drugs. Among patients with reported outcomes, 73 (28.7%) SJS and 3 (10.0%) TEN cases recovered without sequelae, at the time of reporting. Severity of the SCAR was reported for only 171 (69.0%) cases, of which 12 (4.7%) and 8 (26.7%) resulted in death (Grade 5) among SJS and TEN cases, respectively. Conclusions: Antiretroviral and antibiotics were the commonly reported offending group of drugs for SJS and TEN cases. Nevirapine and co-trimoxazole were the commonly reported suspect drugs. SJS and TEN were reported most frequently in females and in patients aged 19–40 years, indicating that drug surveillance and counseling in these groups of patients may be beneficial.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Severe cutaneous adverse drug reactions manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national pharmacovigilance center in Nigeria: a database review from 2004 to 2017

Oshikoya

Ogunyinka

Ogar

et al. 2020

Therapeutic Advances in Drug Safety

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“…We retrieved 109 articles examining SJS/TEN in HIV+ individuals, of which five retrospective studies [37][38][39][40][41] and a prospective study were eligible [36]. No meta-analysis was retrieved on the burden of SJS/TEN in HIV+ individuals on HAART or without in SSA.…”

Section: Sjs/tenmentioning

confidence: 99%

Epilepsy management in pregnant HIV+ women in sub-Saharan Africa, clinical aspects to consider: a scoping review

Menon

Beňová

Mabeya

2020

BMC Med

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Background Since the introduction of highly active antiretroviral therapy (HAART), acquired immune deficiency syndrome (AIDS) related mortality has markedly declined. As HAART is becoming increasingly available, the infection with human immunodeficiency virus (HIV+) in sub-Saharan Africa (SSA) is becoming a chronic condition. While pregnancy in HIV+ women in SSA has always been considered a challenging event for the mother and the fetus, for pregnant HIV+ women also diagnosed with epilepsy (WWE), there are additional risks as HIV increases the odds of developing seizures due to the vulnerability of the central nervous system to other infections, immune dysfunction, and overall metabolic disturbances. In light of a growing proportion of HIV+ WWE on HAART and an increasing number of pregnant women accessing mother-to-child transmission of HIV programs through provision of HAART in SSA, there is a need to develop contextualized and evidenced-based clinical strategies for the management of epilepsy in this population. In this study, we conduct a literature scoping review to identify issues that warrant consideration for clinical management. Result Twenty-three articles were retained after screening, which covered six overarching clinical aspects: status epilepticus (SE), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), dyslipidemia, congenital malformation (CM), chronic kidney disease (CKD), and neurological development. No studies for our population of interest were identified, highlighting the need for a cautionary approach to be employed when extrapolating findings. Conclusion High risks of CM and drug interactions with first-line antiepileptic drugs (AEDs) warrant measures to increase the accessibility and choices of safer second-line AEDs. To ensure evidence-based management of epilepsy within this population, the potential high prevalence of SE, CKD, dyslipidemia, and SJS/TEN and the cumulative effect of drug-drug interactions should be considered. Further understanding of the intersections between pregnancy and drug-drug interactions in SSA is needed to ensure evidenced-based management of epilepsy in pregnant HIV+ WWE. To prevent SE, the barriers for AED treatment adherence in pregnant HIV+ women should be explored. Our review underscores the need to conduct cohort studies of HIV+ WWE in reproductive age over time and across pregnancies to capture the cumulative effect of HAART and AED to inform clinical management.

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“…Necrolysis (TEN) This syndrome is the most severe skin manifestation of DHR. Both reactions (SJS and TEN) are thought to represent a spectrum of a single reaction [37]. The percentage of skin involvement defines the difference between SJS (less than 10%) and TEN (more than 30%).…”

Section: Stevens-johnson Syndrome (Sjs) and Toxic Epidermalmentioning

confidence: 99%

A Practical Approach to Demystifying Drug Allergy in the Intensive Care Unit. A Review Article

Al-Sanouri¹,

Maslamani²,

Sanouri³

2018

OJIM

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Drug hypersensitivity reaction (DHR) is defined as an immunologically mediated response to a pharmacology agent. Some reactions require prior sensitization and some do not. The interactions between different drugs and the immune system occur by different mechanisms leading to variable clinical features. Some reactions are simple and do not alter patient quality of life. Some are life threatening and require immediate recognition and appropriate therapy. Confirming the diagnosis of DHR is often challenging. The environment in the Intensive care units (ICU) is considered high risk place for DHR development as it offers most of the risk factors. In this review, we offer a delicate combined approach that allows an accurate diagnosis of most of the DHRs encountered in the ICU.

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Characterization of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis Among Patients Admitted to Kenyatta National Hospital: A Retrospective Cross-Sectional Study

Cited by 17 publications

References 19 publications

Severe cutaneous adverse drug reactions manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national pharmacovigilance center in Nigeria: a database review from 2004 to 2017

Severe cutaneous adverse drug reactions manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national pharmacovigilance center in Nigeria: a database review from 2004 to 2017

Epilepsy management in pregnant HIV+ women in sub-Saharan Africa, clinical aspects to consider: a scoping review

A Practical Approach to Demystifying Drug Allergy in the Intensive Care Unit. A Review Article

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