ГЕМОФАГОЦИТАРНЫЙ СИНДРОМ У РЕБЕНКА С СЕПСИСОМ, ВЫЗВАННЫМ SERRATIA PROTEAMACULANS

A clinical case of development of secondary hemophagocytic syndrome is presented on the background of sepsis caused by Serratia proteamaculans, in a child of monthly age, culminating in recovery. Hemophagocytic syndrome in the child developed on the 32nd day of life and was accompanied by fever, hepatosplenomegaly, anemia, thrombocytopenia, elevated blood levels of triglycerides and ferritin. Blood culture was positive for Serratia proteamaculans. Isolate of Serratia proteamaculans was resistant to aminopenicillins (including protected ones), 1–4 generations of cephalosporins and aminoglycosides but sensitive to ciprofloxacin and moderately sensitive to imipenem and meropenem. The duration of fever in the child was seven days, thrombocytopenia, hyperfertritinemia and hypertriglyceridemia – 28 days. The normalization of the indices of ferritin, triglycerides and platelets coincided with the reduction of bacteremia and high values of the C-reactive protein. The duration of bacteremia was three weeks: the isolation of Serratia proteamaculans from the blood occurred three times. Elevated levels of C-reactive protein in the blood were noted for 30 days. Reduced hemoglobin and red blood cells counts were noted for eight weeks. Positive dynamics of the hemophagocytic syndrome occurred as a result of measures aimed at treating sepsis – antibiotic therapy with imipenem in combination with ciprofloxacin, appointed by the decision of the medical commission on the basis of the sensitivity of Serratia proteamaculans to antibiotics, intravenous immunoglobulin, and infusion therapy. Glucocorticosteroids and cytotoxic agents (etoposide, cyclosporin A) have not been used in this case.Представлен клинический случай развития вторичного гемафагоцитарного синдрома на фоне сепсиса, вызванного Serratia proteamaculans, у ребенка месячного возраста, завершившийся выздоровлением. Гемафагоцитарный синдром у ребенка развился на 32-й день жизни и сопровождался лихорадкой, гепатолиенальным синдромом, анемией, тромбоцитопенией, повышением в крови уровня триглицеридов и ферритина. Из крови ребенка была выделена Serratia proteamaculans, кото- рая оказалась устойчивой к аминопенициллинам (в том числе защищенным), цефалоспоринам 1–4 поколений, аминогликозидам и чувствительной к ципрофлоксацину и умеренно чувствительна к имипенему и меропенему. Продолжительность лихорадки у ребенка составила 7 дней, тромбоцитопении, гиперферферритенемии и ги- пертриглицеридемии – 28 дней. При этом нормализация показателей ферритина, триглицеридов и тромбоцитов совпала с купированием бактериемии и высоких значений С-реактивного белка крови. Продолжительность бактериемии составила 3 недели: выделение Serratia proteamaculans из крови происходило трехкратно. Повышенный уровень С-реактивного белка в крови отмечался в течение 30 дней. Сниженные показатели гемо- глобина и эритроцитов отмечались в течение 8 недель. Положительная динамика гемафагоцитарного синдрома произошла в результате проведения только комплекса мероприятий, направленных на терапию сепсиса – антибактериальной терапии имипенемом в сочетании с ципрофлоксацином, назначенной решением врачебной комиссии на основании результатов чувствительности Serratia proteamaculans к антибиотикам, внутривенного введения иммуноглобулина, инфузионной терапии. Глюкокортикостероиды и цитостатики (этопозид, циклоспорин А) в данном случае не использовались

Клинический случай течения норвежской чесотки у пациента с ВИЧ-инфекцией

Norwegian scabies is a rare variant of scabies, which has clinical differences from the classical variant, which can cause diagnostic errors. Risk factors for developing the disease are various immunodeficiency states (HIV infection, malignant neoplasms, leprosy). A clinical case of the development of Norwegian scabies in a 22-year-old patient with HIV-infection stage 4B, with a level of CD4-lymphocytes in the blood of 8 cells/µl, is presented. The patient was hospitalized with complaints of weakness, skin rashes, itching and fever up to 40°C. On examination, there was dryness of the skin with erythematous areas on the arms, legs, and torso, as well as massive dirty-gray crusts on the skin of the scalp, torso, palms, elbows, dorsal surface of the feet. Purulent crusts were visualized on the elbows (Ardy’s symptom).Treatment of scabies was carried out by treating the skin with a solution of benzyl benzoate. Against the background of the therapy, there was a positive trend in the form of the disappearance of skin itching, unpleasant odor, and complete disappearance of crusts on the 7th day of treatment.Норвежская чесотка – редко встречающийся вариант чесотки, имеющий клинические отличия от классического представляющий поэтому диагностические сложности. Факторами риска развития норвежской чесотки являются различные иммунодефицитные состояния (ВИЧ-инфекция, злокачественные новообразования, лепра). Представлен клинический случай развития норвежской чесотки у пациента 22 лет с ВИЧ-инфекцией со стадией 4В, с уровнем CD4-лимфоцитов в крови 8 клеток/мкл. Пациент госпитализирован с жалобами на слабость, кожные высыпания, зуд и повышение температуры тела до 40°С. При осмотре отмечались сухость кожных покровов с эритематозными участками на руках, ногах, туловище, а также массивные корки грязно-серого цвета на коже волосистой части головы, туловища, ладоней, локтей, тыльной поверхности стоп. На локтях визуализировались гнойные корочки (симптом Арди).Лечение чесотки проводилось обработкой пораженных участков кожи раствором бензилбензоата. На фоне проводимой терапии отмечалась положительная динамика в виде исчезновения кожного зуда, неприятного запаха, полного отпадения корочек на 7-й день лечения

Comparative Assessment of Cytokine Pattern in Early and Late Onset of Neonatal Sepsis

Neonatal sepsis is a significant health issue associated with high mortality. Immune responses associated with neonatal sepsis, such as proinflammatory cytokine production, are believed to play a central role in the pathogenesis of this disease. In the present study, serum levels of the proinflammatory cytokines TNF-α, IL1-β, and IL-6 and the anti-inflammatory cytokines IL-4 and IL-10 were evaluated for 25 subjects with neonatal sepsis. We observed that subjects with late onset of sepsis (LOS), as well as those with early onset of sepsis (EOS), had a substantial increase in serum TNF-α. In contrast to EOS, subjects with LOS demonstrated a significant increase in serum levels IL-6 and IL-10. Additionally, we observed a significant difference in cytokine profiles between acute and postacute cases of neonatal sepsis. For instance, the level of proinflammatory cytokines, such as TNF-α and IL-6, was elevated in the acute phase, whereas the production of anti-inflammatory cytokines, such as IL-10, became substantially upregulated during the postacute phase. Additionally, no correlation was observed between cytokine levels and CRP levels or lymphocyte counts. Thus, in contrast to CRP levels and lymphocyte counts, examination of the cytokine profile can provide valuable information when determining the most effective therapy for treating neonatal sepsis. This information may be useful to physicians when determining if anti-inflammatory or immune stimulatory therapy is warranted

HEMOPHAGOSYTIC SYNDROME IN A CHILD WITH SEPSIS CAUSED BY SERRATIA PROTEAMACULANS

A clinical case of development of secondary hemophagocytic syndrome is presented on the background of sepsis caused by Serratia proteamaculans, in a child of monthly age, culminating in recovery. Hemophagocytic syndrome in the child developed on the 32nd day of life and was accompanied by fever, hepatosplenomegaly, anemia, thrombocytopenia, elevated blood levels of triglycerides and ferritin. Blood culture was positive for Serratia proteamaculans. Isolate of Serratia proteamaculans was resistant to aminopenicillins (including protected ones), 1–4 generations of cephalosporins and aminoglycosides but sensitive to ciprofloxacin and moderately sensitive to imipenem and meropenem. The duration of fever in the child was seven days, thrombocytopenia, hyperfertritinemia and hypertriglyceridemia – 28 days. The normalization of the indices of ferritin, triglycerides and platelets coincided with the reduction of bacteremia and high values of the C-reactive protein. The duration of bacteremia was three weeks: the isolation of Serratia proteamaculans from the blood occurred three times. Elevated levels of C-reactive protein in the blood were noted for 30 days. Reduced hemoglobin and red blood cells counts were noted for eight weeks. Positive dynamics of the hemophagocytic syndrome occurred as a result of measures aimed at treating sepsis – antibiotic therapy with imipenem in combination with ciprofloxacin, appointed by the decision of the medical commission on the basis of the sensitivity of Serratia proteamaculans to antibiotics, intravenous immunoglobulin, and infusion therapy. Glucocorticosteroids and cytotoxic agents (etoposide, cyclosporin A) have not been used in this case

Metabolic disorders in acute infectious diarrhea in children

The purpose of the study: estimate the frequency of registration of different types of acid-base state disorders in children with acute infectious diarrhea; to determine the clinical features of acute intestinal infections that occur with metabolic acidosis (MA) and without it to choose the tactics of effective correction.Мaterials and methods: retrospective cohort study was conducted of 246 patients hospitalized in a hospital with clinic of acute infectious diarrhea.Results of the study: laboratory-confirmed acidosis, were recorded in 40.7% (95% CI 34.6–46.8), 100/246 children, incl. With a pH below 7.25 in 9.3% (95% CI 5–7–12.9), 23/246. The condition of alkalosis revealed in 4.9% (95% CI 2.2–7.6) of 12/246 examined. Hyperchloremic acidosis had a place in 81% (95% CI 73.3–88.7), 81/100 patients, with a high anionic deficiency in 19% (95% CI 11.3–26.7), 19/100, P <0.001. Decompensated MA with pH <7.25 was recorded in 6.2% (95% CI 0.9–11.5), 5/81 examined with hyperchloremic acidosis and in 94.7% (95% CI 84.6–104, 8), 18/19 – with keto- and lactate-acidosis. Subcompensated MA was more often detected with rotavirus infection, RVI (50.6% (95% CI (39.4–61.8), 39/77), p <0.001. Metabolic disorders with RVI were more likely to correspond to acidosis with a high anion gap (52, 6% (95% CI 30.1–75.1) 10/19, p=0.02.) Bacterial diarrheas were more often observed in children without disturbances of the KHS (22.4% (95% CI 15.3–29, 5), 30/134), p=0.014. In assessing the characteristics of different types of MA we identified that the presence of tachypnea increases the probability of detecting acidosis with a high anion gap of 3.5 times (OR 3.5 CI 1.3–9.3).Conclusion: Our studies didn’t reveal pathognomonic clinical symptoms of various variants of metabolic acidosis

Occult bacteremia as a manifestation of invasive pneumococcal infection

Objective. To describe a case of occult bacteremia caused by Streptococcus pneumoniae.Results. A 1 year and 1 month old child was diagnosed with pneumococcal infection without a focus of infection. After examination of the child, the doctors excluded foci of infection characteristics of pneumococcal infection, and the discharge of St. pneumoniae from the blood enabled to diagnose occult bacteremia. Despite bacteremia and signs of systemic inflammatory response, the absence of severe clinical manifestations and signs of multiple organ failure gave grounds to exclude sepsis.Conclusion. This case demonstrates that bacteriological blood test in children with fever and without a focus of infection with pronounced inflammatory changes in the blood has important diagnostic value and helps to prescribe effective specific antibacterial therapy

Etiological structure and features of clinical manifestations of neonatal infections in children born by cesarean section

The etiological structure and clinical manifestations of neonatal infections in 194 newborns hospitalized in an infectious hospital werestudied. 44 children were born by cesarean section (CS), 150 children – by vaginal delivery (VD). Children born by cesarean section were significantly more often hospitalized for mixed infections of the respiratory, gastrointestinal tract and pyoinflammatory skin diseases (CS-20.5% and VD-3.3%, p<0.01). In children born by the operative route, infectious diarrhea (CS-66% and VD-39%, p<0.01), bronchiolitis (CS-20.8% and VD-6. 25%, р<0. 05), pyodermia caused by S. aureus (CS-23% and VD-15.9%, р<0.05), severe acute respiratory viral infections (CS-20.8% and VD-6.25%, р<0.05) were diagnosed more often than in children born by the vaginal delivery. The revealed features of the course of neonatal infections in children born by cesarean section dictate the need for in-depth studies on this topic

Proinflammatory cytokine profile in children with neonatal sepsis

Research objective. Evaluation of inflammatory activity of the blood of newborns with various forms of bacterial infectious diseases with the determination of the diagnostic significance of various inflammatory markers.Materials and methods. The study includes 50 newborns with various forms of infectious diseases: 31 newborns with neonatal sepsis (group 1) and 19 newborns with localized variants of bacterial infection. The severity of inflammatory activity was assessed by the level of C-reactive protein, the number of peripheral blood leukocytes, the level of cytokines-tumor necrosis factor-α (TNF-α), interleukins IL-2, IL-6, IL-8, IL-10, interferon-ɣ (IFN-ɣ), granulocyte-macrophage colony-stimulating factor (GM-CSF).Results. In the group of children with neonatal sepsis, the first 2 days of the disease occur against the background of an increase in the concentration of TNF-α, IL-6, IL-8 and IFN-ɣ in the blood, the indices of which differed significantly (p <0.05) from the control group. Significant markers of inflammation were high concentrations in the blood of the C-reactive protein (RR-3.7, CI 1.7-8.1), IL-6 (RR-2.0, CI 1.4–3.0), and IL -8 (RR-1.5, CI 1.1–2.2). In the group of children with localized forms of bacterial infection, the first 2 days of the disease were accompanied by an increase in the concentration in the blood of TNF-α, IL-6 and IFN-ɣ (p <0.05). Moreover, the degree of increase of IL-6 was less pronounced than in the 1st group (p=0.007), and the median IL-8 did not differ from the control group (p=0,7).Conclusion. The immune response for neonatal sepsis and localized forms of bacterial infection is characterized by an increase in the level of proinflammatory cytokines in the blood. Reliable markers of inflammation in sepsis are IL-6, IL-8 and C-reactive protein, the values of which were significantly high in the group of children with neonatal sepsis

Frequency of colonization with “hypervirulent” Klebsiella pneumoniae strains of newborns and infants with community-acquired and nosocomial klebsiella infection

Currently, there is a trend towards the increase in invasive forms of infection (liver abscess, meningitis, endophthalmitis, etc.) caused by “hypervirulent” strains of Klebsiella pneumoniae (hvKP) in adults. We have studied the frequency of hvKP release in newborns and infants with various forms of community-acquired and nosocomial klebsiella infection. Strains of Klebsiella possessing the rmp A gene, which is associated with hypermucoid phenotype, were considered “hypervirulent. Klebsiella strains with the “hypermucoid phenotype”-associated rmpA gene were considered “hypervirulent”. The gene was detected by polymerase chain reaction. The authors studied a total of 85 strains. The rmpA gene was found in 20 (23%) Kl. pneumoniae strains, including 14 (33.3%) intestinal strains, 3 (25%) urine strains, 3 (15.7%) pharyngeal mucosa strains. The Klebsiella strains isolated from blood (n=5), endotracheal tube (n=6), cerebrospinal fluid (n=1) did not contain the gene. hvKP were significantly more often isolated in children with community-acquired infection (32%) than in children with nosocomial infection (11.4%; OR 3.647; 95% CI 1.100—12.096). Out of 20 children infected with hvKP, 12 (60%) patients were asymptomatic carriers, 3 (15%) children had symptoms of a urinary tract infection, and 5 (25%) children had symptoms of an intestinal infection. Infected children have both a potential risk of endogenous dissemination of the pathogen, and they are an epidemiologically dangerous to others

Monozygous twins with Epstein-Barr infection in the nasopharynx

The article describes a clinical case of monozygotic twins with hypertrophy of the organs of the lymphopharyngeal ring. The examination revealed IgG to the Epstein-Barr virus capsid antigen in both patients. One twin had Epstein-Barr virus DNA in the sample from the oropharynx. It was this child who had complaints typical of patients with adenoid vegetation, and he required surgical treatment (endoscopic shaver adenotomy and radio wave bilateral tonsillotomy). At the time of the initial examination and in the absence of complaints the second twin revealed no DNA of Epstein-Barr virus in the oropharynx. This patient was diagnosed with adenoids of 1-2 degree. Due to the complaints of the second twin that appeared during the following year of observation, with previously negative results on active Epstein-Barr virus markers served as the reason for a repeated specific laboratory examination. Epstein-Barr virus DNA was found in a sample from this child’s oropharynx. This case using the twin control method by partner enabled us to demonstrate the significance of Epstein-Barr virus in the pathogenesis and clinic manifestations of chronic diseases of the lympho-pharyngeal ring organs in children