HEMOPHAGOSYTIC SYNDROME IN A CHILD WITH SEPSIS CAUSED BY SERRATIA PROTEAMACULANS
https://doi.org/10.22625/2072-6732-2019-11-1-98-103
Abstract
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.
About the Authors
Kh. S. Khaertynov
Kazan State Medical University.
Russian Federation
Russian Federation
V. A. Anokhin
Kazan State Medical University.
Russian Federation
Russian Federation
S. A. Lubin
City Children’s Clinical Hospital № 1.
Russian Federation
Russian Federation
A. Kh. Khaertynova
Kazan State Medical University.
Russian Federation
Russian Federation
References
1. Shah, B.A. Neonatal sepsis: an old problem with new insights / B.A. Shah, J.F. Padbury // Virulence. – 2014. –Vol. 5, N1. – P. 170-178.
2. Cuenca, A.G. Role of Innate Immunity in Neonatal Infection / A.G. Cuenca, J.L. Wynn, L.L. Moldawer // Am J Perinatol. – 2013. – Vol.30, N2. – P. 105-112.
3. Hotchkiss, R.S. The pathophysiology and treatment of sepsis / R.S. Hotchkiss, I.E. Karl // The New England journal of medicine. – 2003. – Vol.348, N2. – P. 138-150.
4. Rosado, F.G.N. Hemophagocytic Lymphohistiocytosis. An update on diagnosis and pathogenesis / F.G.N. Rosado, A.S. Kim // Am J ClinPathol. – 2013. – Vol.139. – P. 713-727.
5. Castillo, L. Secondary hemophagocytic lymphohistiocytosis and severe sepsis/systemic inflammatory response syndrome/ multiorgan dysfunction syndrome/macrophage activation syndrome share common intermediate phenotypes on a spectrum of inflammation / L. Castillo, J. Carcillo // Pediatr Crit Care Med. – 2009. – Vol.10, N.3. – P. 387-392.
6. Henter, J.I.: HLH2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis / J.I. Henter, A. Horne, M. Arico, et al // Pediatr Blood Cancer. – 2007. – Vol.48, N2. – P.124 –131.
7. Esteban Y.M. An Overview of Hemophagocytic Lymphohistiocytosis / Y.M. Esteban, J.L.O. de Jong, M.S. Tesher // Pediatric Annals. – 2017. – Vol.46, N.8. – P. 309-313.
8. Henter J.I. Diagnostic guidelines for hemophagocytic lymphohistiocytosis. The FHL Study Group of the Histiocyte Society / J.I. Henter, G. Elinder, A. Ost // Semin Oncol. – 1991. – Vol.18, N.1. – P. 29-33.
9. Suzuki N. Characteristics of hemophagocytic lymphohistiocytosis in neonates: a nationwide survey in Japan / N. Suzuki, A. Morimoto, S. Ohga, et al. // J Pediatr. – 2009. – Vol.155, N.2. – P. 235-238.
10. Freeman H.R. Review of haemophagocytic lymphohistiocytosis / H.R. Freeman, A.V. Ramanan // Arch Dis Child. – 2011. – Vol.96, N.7. – P. 688-693.
11. Machowicz R. Similar but not the same: Differential diagnosis of HLH and sepsis / R. Machowicz, G. Janka, W. Wiktor- Jedrzejczak //Critical Reviews in Oncology/Hematology. –2017. – Vol.114. – P. 1–12.
12. Larroche C. Spontaneous resolution of hemophagocytic syndrome associated with acute parvovirus B19 infection and concomitant Epstein-Barr virus reactivation in an otherwise healthy adult / C. Larroche, C. Scieux, P. Honderlick, et al.// Eur J ClinMicrobiol Infect Dis. –2002. – Vol.21, N.10. – P. 739-742.
13. Arico M. Hemophagocytic lymphohistiocytosis: report of 122 children from the International Registry. FHL Study Group of the Histiocyte Society / M. Arico, G. Janka, A. Fischer, et al. // Leukemia. – 1996. – Vol.10, N2. – P.197-203.
14. Janka G.E. Familial hemophagocytic lymphohistiocytosis / G.E. Janka // Eur J Pediatr. – 1983. – Vol.140, N.3. – P.221-230
15. Larroche C. Pathogenesis of hemophagocytic syndrome (HPS) / C. Larroche, L. Mouthon // Autoimmun Rev. – 2004. – Vol.3, N.2. – P. 69-75.
16. Voskoboinik I. Perforin-mediated target-cell death and immune homeostasis / I. Voskoboinik, M.J. Smyth, J.A. Trapani // Nat Rev Immunol Cell Biol. – 2006. – Vol.6, N.12. – P. 940-952
17. Felmet K.A. Prolonged lymphopenia, lymphoid depletion, and hypoprolactinemia in children with nosocomial sepsis and multiple organ failure / K.A. Felmet, M.W. Hall, R.S. Clark, et al.. // J Immunol. – 2005. – Vol.174, N.6. – P. 3765–3772. 18. Hotchkiss R.S. Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction / R.S. Hotchkiss, P.E. Swanson, B.D. Freeman, et al. // Crit Care Med. – 1999. –Vol.27, N.7. – P.1230–1251.
18. Toti P. Spleen depletion in neonatal sepsis and chorioamnionitis / P. Toti, C. De Felice, R. Occhini, et al. //Am J Clin- Pathol. – 2004. – Vol.122, N.5. – P. 765–771.
19. Schaer D.J. Hemophagocytic macrophages constitute a major compartement of hemeoxygenase expression in sepsis / D.J. Schaer, C.A. Schaer, G. Schoedon, et al. // Eur J Hematol. – 2006. – Vol.77, N.5. – P. 432-36.
Review
For citations:
Khaertynov Kh.S., Anokhin V.A., Lubin S.A., Khaertynova A.Kh. HEMOPHAGOSYTIC SYNDROME IN A CHILD WITH SEPSIS CAUSED BY SERRATIA PROTEAMACULANS. Journal Infectology. 2019;11(1):98-103. (In Russ.) https://doi.org/10.22625/2072-6732-2019-11-1-98-103
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