Changes in lipid profile observed in children over the course of infectious disease

A young infant with transient severe hypertriglyceridemia temporarily associated with meropenem administration: A case report and review of the literature

BACKGROUND

Slight changes in the lipid profile can be observed over the acute phase of infectious diseases. Moreover, some anti-infective drugs can modify serum lipid concentrations, although antibiotics do not seem to have a relevant, direct, or acute effect on the lipid profile.

METHODS

A 75-day-old breastfed Caucasian female, born at term after a regular pregnancy, was hospitalized for osteomyelitis. She was immediately treated with intravenous meropenem and vancomycin. Therapy was effective, but after 22 days of treatment, her blood was found to be viscous with a purple shade.

RESULTS

A fasting blood sample showed serum triglycerides of 966 mg/dL, total cholesterol of 258 mg/dL, and high-density lipoprotein cholesterol of 15 mg/dL. Secondary causes of hyperlipidemia and primary hereditary disorders were ruled out. Thereafter, the possibility that antibiotics may have had a role in the hypertriglyceridemia was considered, and meropenem was discontinued. After 72 hours of meropenem discontinuation, a sharp modification of lipid variables was observed, and further testing showed a complete normalization of the lipid profile.

CONCLUSION

In this child with osteomyelitis, the increase in serum triglycerides appeared suddenly after 3 weeks of meropenem treatment and resolved quickly after meropenem discontinuation, thus highlighting the possible association between meropenem and lipid profile alterations. Monitoring the lipid profile should be considered in cases of long-term treatment with meropenem, and further studies on meropenem safety should include evaluation of the lipid profile.

Nonfasting low-density lipoprotein testing: utility for cholesterol screening in pediatric primary care

This prospective study assessed the clinical application of a nonfasting low-density lipoprotein cholesterol measure in a pediatric primary care population. A homogenous direct low-density lipoprotein cholesterol assay was tested in healthy children, aged 4 to 12 years, at risk for hyperlipidemia, as defined by American Academy of Pediatrics, and including patients with incomplete family histories. This nonfasting homogeneous assay was comparable to modified beta quantification, the gold standard reference method of measuring low-density lipoprotein cholesterol, and the current recommended screening method, total cholesterol. Results from the study suggest that this nonfasting assay can provide more direct low-density lipoprotein cholesterol measurements for healthy children, with improved clinical utility and greater overall patient convenience in testing for important cholesterol abnormalities.

Should children with infection be tested for lipid, lipoprotein and apolipoprotein?

The lipid profile is known to alter in patients with infection, but there has not been a study of the apolipoprotein levels in serum of otherwise healthy children during infection. Lipids, lipoproteins, apolipoproteins A-1 and B and lipoprotein (a) were evaluated prospectively in 31 consecutive children, aged 4-15 years, who were admitted to the hospital with bacterial pharyngitis. The degree of dyslipidemia associated with bacterial pharyngitis was assessed using each child as his/her own control and by comparison with 79 healthy children who had not had an infection during the past 3 months. Serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A-1 and apolipoprotein B levels were significantly decreased during the symptomatic phase of the disease, whereas the serum triglyceride level was slightly elevated. Serum lipoprotein (a) concentration did not change significantly. In conclusion, it is suggested that serum lipids, lipoproteins and apolipoproteins should not be assessed during infection because of the possible transient changes of these parameters during infection or inflammation.

Changes in plasmatic biochemical parameters during experimental murine paracoccidioidomycosis

Determinations of plasma cholesterol, HDL-cholesterol, triglycerides, total proteins, bilirubin, aspartate transaminases (AST), glucose, iron and total iron binding capacity were evaluated after 15 and 90 days of intraperitoneal infection with 5 x 10(6) virulent yeasts of Paracoccidioides brasiliensis Pb 18 isolate in resistant (A/J) and susceptible (B10.A) mice. Significant differences between control and infected groups were seen: an increase of triglycerides and total proteins for both strains, a decrease of glucose and HDL-cholesterol in B10.A mice and of iron in both strains, while AST, bilirubin and TIBC increased only in B10.A mice. While glucose, AST, bilirubin and TIBC were strongly modified in susceptible mice, no differences were seen in the resistant infected group, thus confirming the usefulness of biochemical parameters as an index of infection severity, as well as of recovery.

Transient hypertriglyceridemia of infancy

A premature boy who had suffered from IRDS, bronchopulmonary dysplasia and retinopathy of prematurity developed massive hypertriglyceridemia (48.1 mmol/L) together with moderate hypercholesterolemia (12.6 mmol/L) at 5 months of age. Lipoprotein electrophoresis revealed a marked elevation of the level of the very low density lipoprotein fraction. There was a moderate decrease in the activity of a lipolytic enzyme, lipoprotein lipase (LPL). The child had neither liver or renal disorder nor any inflammatory disease. The hyperlipidemia disappeared spontaneously at the age of 3 years. The cause of the decreased LPL activity could not be established. A partial genetic deficiency in lipoprotein lipase appears the most likely explanation, since no signs of secondary lowering of LPL activity could be found.

Anticholesterol antibodies and plaque formation

Immunization of rabbits with a protein-free formulation consisting of liposomes containing 71% cholesterol and lipid A induced cholesterol antibodies in rabbits fed a diet containing 0.5% and 1.0% cholesterol. Elevation in plasma cholesterol levels was significantly less in immunized than in nonimmunized rabbits. Immunization also resulted in a marked decrease in the risk of developing atherosclerosis as determined by analysis of aortic atherosclerosis by quantitative histological examination and fatty streaks by automated morphometric probability-of-occurrence mapping.