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Liang Y, Wu J, Chen G, Du Y, Yan Y, Xie S, Qian W, Chen A, Yi C, Tian M. Risk factor analysis and prediction model construction for severe adenovirus pneumonia in children. Ital J Pediatr 2024; 50:210. [PMID: 39385312 PMCID: PMC11465519 DOI: 10.1186/s13052-024-01771-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 09/22/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Severe adenovirus pneumonia in children has a high mortality rate, but research on risk prediction models is lacking. Such models are essential as they allow individualized predictions and assess whether children will likely progress to severe disease. METHODS A retrospective analysis was performed on children with adenovirus pneumonia who were hospitalized at the Children's Hospital of Nanjing Medical University from January 2017 to March 2024. The patients were grouped according to clinical factors, and the groups were compared using Ridge regression and multiple logistic regression to identify risk factors associated with severe adenovirus pneumonia. A prediction model was constructed, and its value in clinical application was evaluated. RESULTS 699 patients were included in the study, with 284 in the severe group and 415 in the general group. Through the screening of 44 variables, the final risk factors for severe adenovirus pneumonia in children as the levels of neutrophils (OR = 1.086, 95% CI: 1.054‒1.119, P < 0.001), D-dimer (OR = 1.005, 95% CI: 1.003‒1.007, P < 0.001), fibrinogen degradation products (OR = 1.341, 95% CI: 1.034‒1.738, P = 0.027), B cells (OR = 1.076, 95%CI: 1.046‒1.107, P < 0.001), and lactate dehydrogenase (OR = 1.008, 95% CI: 1.005‒1.011, P < 0.001). The value of the area under the receiver operating characteristic curve was 0.974, the 95% CI was 0.963-0.985, and the P-value of the Hosmer-Lemeshow test was 0.547 (P > 0.05), indicating that the model had strong predictive power. CONCLUSION In this study, the clinical variables of children with adenovirus pneumonia were retrospectively analyzed to identify risk factors for severe disease. A prediction model for severe disease was constructed and evaluated, showing good application value.
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Affiliation(s)
- Yaowen Liang
- The Second Hospital of Nanjing, Affiliated Hospital to Nanjing University of Chinese Medicine, Nanjing, China
| | - Jinhuan Wu
- Department of Intensive Care Unit, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Chen
- Children's Hospital of Nanjing Medical University; The Second Hospital of Nanjing, Affiliated Hospital to Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuchen Du
- The Second Hospital of Nanjing, Affiliated Hospital to Nanjing University of Chinese Medicine, Nanjing, China
| | - Yi Yan
- Department of Respiratory, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Shuqin Xie
- Department of Respiratory, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wenxian Qian
- The Second Hospital of Nanjing, Affiliated Hospital to Nanjing University of Chinese Medicine, Nanjing, China
| | - Apeng Chen
- Department of Respiratory, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Changhua Yi
- The Second Hospital of Nanjing, Affiliated Hospital to Nanjing University of Chinese Medicine, Nanjing, China.
| | - Man Tian
- Department of Respiratory, Children's Hospital of Nanjing Medical University, Nanjing, China.
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2
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Zhang W, Liu F, Liang E, Zhang L. Evolution of Treatment Modalities for Disseminated HAdV Infection in Neonates. Pediatrics 2024; 154:e2024066677. [PMID: 39238444 DOI: 10.1542/peds.2024-066677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/24/2024] [Accepted: 07/24/2024] [Indexed: 09/07/2024] Open
Abstract
Human adenovirus (HAdV) infection in newborns is a rare condition that typically affects multiple organ systems and has a high mortality rate. We report a case of neonatal HAdV-D37 infection that presented with fever and respiratory distress that was confirmed by metagenomic next-generation sequencing using blood and bronchoalveolar lavage fluid. We treated the patient with intravenous immunoglobulin, methylprednisolone, and anticoagulants, and the patient recovered. Our review of 41 cases of HAdV found that treatment with intravenous immunoglobin might have improved the outcome of HAdV-D infection. We further suggest that glucocorticoid therapy may have additional therapeutic validity in the setting of severe or disseminated disease and that monitoring coagulation function and timely anticoagulation treatment should be considered to prevent complications associated with disseminated intravascular coagulation.
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Affiliation(s)
- Wenjing Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Fang Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Enlin Liang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Li Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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3
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Totapally BR, Totapalli S, Sendi P, Martinez PA. Epidemiology of Adenovirus Infection in Hospitalized Children in the United States From 1997 to 2019. Pediatr Infect Dis J 2024; 43:748-755. [PMID: 38621167 DOI: 10.1097/inf.0000000000004365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVE The study aimed to explore the prevalence, clinical features, resource utilization, temporal trends and outcomes associated with adenoviral infections in hospitalized children. METHODS A retrospective analysis using the Healthcare Cost and Utilization Project's Kids' Inpatient Database from 1997 to 2019 was performed. Children 29 days to 17 years of age with adenoviral infection were selected. Chi-square, Kruskal-Wallis tests, linear trend analysis and multivariable analysis were used for data analysis. RESULTS A total of 40,135 children under 18 years of age with adenoviral infection were discharged in the United States with an overall prevalence of 18.9 per 10,000 discharges and 6.9 children per 100,000 population. By linear trend analysis, the hospitalization rate has significantly increased with the highest prevalence in 2019. Adenoviral infection was more prevalent in Black children, in winter months, in the Midwest region, in children with government insurance and in the lowest income quartile. The majority (85%) of adenovirus-related hospitalizations occurred under 6 years of age. Mechanical ventilation, extracorporeal membrane oxygenation support, acute kidney injury and liver failure were documented in 11.9%, 0.4%, 2.7% and 0.4%, respectively. The overall case fatality rate was 1.4%, which decreased from 1997 to 2019 ( P < 0.05). By regression analysis, an increased mortality rate was associated with the need for mechanical ventilation, the presence of complex chronic conditions, immune deficiency, central nervous system infection and pneumonia/bronchiolitis. CONCLUSIONS Most human adenovirus infections occur in children under 6 years of age and cause mild illness. Human adenovirus can lead to serious illness in children with complex chronic conditions and immune deficiency conditions.
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Affiliation(s)
- Balagangadhar R Totapally
- From the Division of Critical Care Medicine, Nicklaus Children's Hospital
- Department of Pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Seevitha Totapalli
- Department of Pediatrics, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Prithvi Sendi
- From the Division of Critical Care Medicine, Nicklaus Children's Hospital
- Department of Pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Paul A Martinez
- From the Division of Critical Care Medicine, Nicklaus Children's Hospital
- Department of Pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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4
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Kranz LA, Hahn WS, Thompson WS, Hentz R, Kobrinsky NL, Galardy P, Greenmyer JR. Neonatal hemophagocytic lymphohistiocytosis: A meta-analysis of 205 cases. Pediatr Blood Cancer 2024; 71:e30894. [PMID: 38296838 DOI: 10.1002/pbc.30894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Neonatal hemophagocytic lymphohistiocytosis (nHLH), defined as HLH that presents in the first month of life, is clinically devastating. There have been few large descriptive studies of nHLH. OBJECTIVES The objective of this study was to perform a meta-analysis of published cases of nHLH. METHODS A comprehensive literature database search was performed. Cases of HLH were eligible for inclusion if clinical analysis was performed at age ≤30 days. Up to 70 variables were extracted from each case. RESULTS A total of 544 studies were assessed for eligibility, and 205 cases of nHLH from 142 articles were included. The median age of symptom onset was day of life 3 (interquartile range [IQR]: 0-11, n = 141). Median age at diagnosis was day of life 15 (IQR: 6-27, n = 87). Causes of HLH included familial HLH (48%, n = 99/205), infection (26%, n = 53/205), unknown (17%, n = 35/205), macrophage activation syndrome/rheumatologic (2.9%, n = 4/205), primary immune deficiency (2.0%, n = 5/205), inborn errors of metabolism (2.4%, n = 5/205), and malignancy (2.0%, n = 4/205). Fever was absent in 19% (n = 28/147) of all neonates and 39% (n = 15/38) of preterm neonates. Bicytopenia was absent in 26% (n = 47/183) of patients. Central nervous system (CNS) manifestations were reported in 63% of cases (n = 64/102). Liver injury (68%, n = 91/134) and/or liver failure (24%, n = 32/134) were common. Flow cytometry was performed in 22% (n = 45/205) of cases. Many patients (63%, n = 121/193) died within the period of reporting. Discernable values for HLH diagnostic criteria were reported between 30% and 83% of the time. CONCLUSIONS Evaluation of nHLH requires rapid testing for a wide range of differential diagnoses. HLH diagnostic criteria such as fever and bicytopenia may not occur as frequently in the neonatal population as in older pediatric populations. Neurologic and hepatic manifestations frequently occur in the neonatal population. Current reports of nHLH suggest a high mortality rate. Future publications containing data on nHLH should improve reporting quality by reporting all clinically relevant data.
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Affiliation(s)
- Lincoln A Kranz
- University of North Dakota School of Medicine, Grand Forks, North Dakota, USA
| | - Wyatt S Hahn
- University of North Dakota School of Medicine, Grand Forks, North Dakota, USA
| | - Whitney S Thompson
- Mayo Clinic, Neonatal and Perinatal Medicine, Clinical Genomics, Center for Individualized Medicine, Rochester, Minnesota, USA
| | - Roland Hentz
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Paul Galardy
- Pediatric Hematology and Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob R Greenmyer
- Pediatric Hematology and Oncology, Hospice and Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Sen ES, Ramanan AV. Cytokine Storm Syndrome Associated with Hemorrhagic Fever and Other Viruses. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1448:249-267. [PMID: 39117819 DOI: 10.1007/978-3-031-59815-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
A wide variety of infections can trigger cytokine storm syndromes including those caused by bacteria, viruses, fungi and parasites. The most frequent viral trigger is Epstein-.Barr virus which is covered in Chapter 16. CSS associated with COVID-19 is also discussed separately (Chapter 22). This chapter will focus on other viruses including the hemorrhagic fever viruses, influenza, parainfluenza, adenovirus, parvovirus, hepatitis viruses, measles, mumps, rubella, enterovirus, parechovirus, rotavirus, human metapneumovirus and human T-lymphotropic virus. The published literature consists of many single case reports and moderate-sized case series reporting CSS, in most circumstances meeting the 2004 diagnostic criteria for hemophagocytic lymphohistiocytosis (HLH). There is no published clinical trial evidence specifically for management of HLH associated with these viruses. In some situations, patients received supportive therapy and blood product transfusions only but in most cases, they were treated with one or more of intravenous corticosteroids, intravenous immunoglobulin and/or etoposide. These were successful in many patients although in significant numbers progression of infection to CSS was associated with mortality.
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Affiliation(s)
- Ethan S Sen
- Consultant in Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - A V Ramanan
- Consultant in Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
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6
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Mammas IN, Drysdale SB, Charalampous C, Koletsi P, Papatheodoropoulou A, Koutsaftiki C, Sergentanis T, Merakou K, Kornarou H, Papaioannou G, Kramvis A, Greenough A, Theodoridou M, Spandidos DA. Navigating paediatric virology through the COVID‑19 era (Review). Int J Mol Med 2023; 52:83. [PMID: 37503745 PMCID: PMC10555476 DOI: 10.3892/ijmm.2023.5286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
The present review article presents the key messages of the 8th Workshop on Paediatric Virology organised virtually by the Institute of Paediatric Virology based on the island of Euboea in Greece. The major topics covered during the workshop were the following: i) New advances in antiviral agents and vaccines against cytomegalovirus; ii) hantavirus nephropathy in children; iii) human rhinovirus infections in children requiring paediatric intensive care; iv) complications and management of human adenovirus infections; v) challenges of post‑coronavirus disease 2019 (COVID‑19) syndrome in children and adolescents; and vi) foetal magnetic resonance imaging in viral infections involving the central nervous system. The COVID‑19 era requires a more intensive, strategic, global scientific effort in the clinic and in the laboratory, focusing on the diagnosis, management and prevention of viral infections in neonates and children.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion
- First Department of Paediatrics, School of Medicine, University of Athens, 11527 Athens
- Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece
| | - Simon B. Drysdale
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London SW17 0RE
- Department of Paediatrics, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | | | - Patra Koletsi
- Department of Paediatrics, 'Penteli' Children's Hospital, 15236 Palaia Penteli
- Paediatric Intensive Care Unit (PICU), 'Penteli' Children's Hospital, 15236 Palaia Penteli
| | | | - Chryssie Koutsaftiki
- COVID-19 Reference Centre, 'Rafina' Health Care Centre, 19009 Rafina
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Theodoros Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Kyriakoula Merakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Helen Kornarou
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens
| | - Georgia Papaioannou
- Department of Paediatric Radiology, 'Mitera' Children's Hospital, 15123 Athens, Greece
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, 2193 Johannesburg, South Africa
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, King's College London, London SE5 9RS, UK
| | - Maria Theodoridou
- First Department of Paediatrics, School of Medicine, University of Athens, 11527 Athens
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion
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Benevenuta C, Mussinatto I, Orsi C, Timeus FS. Secondary hemophagocytic lymphohistiocytosis in children (Review). Exp Ther Med 2023; 26:423. [PMID: 37602304 PMCID: PMC10433411 DOI: 10.3892/etm.2023.12122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/16/2023] [Indexed: 08/22/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening condition characterized by hyperinflammation in an uncontrolled and ineffective immune response. Despite great improvement in diagnosis and treatment, it still represents a challenge in clinical management, with poor prognosis in the absence of an aggressive therapeutic approach. The present literature review focuses on secondary HLH at pediatric age, which represents a heterogeneous group in terms of etiology and therapeutic approach. It summarizes the most recent evidence on epidemiology, pathophysiology, diagnosis, treatment and prognosis, and provides a detailed description and comparison of the major subtypes of secondary HLH. Finally, it addresses the open questions with a focus on diagnosis and new treatment insights.
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Affiliation(s)
- Chiara Benevenuta
- Department of Pediatrics, Azienda Sanitaria Locale Torino 4, Chivasso Hospital, I-10034 Turin, Italy
| | - Ilaria Mussinatto
- Department of Pediatrics, Azienda Sanitaria Locale Torino 4, Chivasso Hospital, I-10034 Turin, Italy
| | - Cecilia Orsi
- Department of Pediatrics, Azienda Sanitaria Locale Torino 4, Chivasso Hospital, I-10034 Turin, Italy
| | - Fabio S. Timeus
- Department of Pediatrics, Azienda Sanitaria Locale Torino 4, Chivasso Hospital, I-10034 Turin, Italy
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8
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Byrne BJ, Elder M, Leon-Astudillo C, Corti M. Secondary hemophagocytic lymphohistiocytosis following Zolgensma therapy: An evolving story on the innate response to systemic gene therapy. Mol Ther 2022; 30:3503-3504. [PMID: 36436512 PMCID: PMC9734075 DOI: 10.1016/j.ymthe.2022.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Barry J. Byrne
- University of Florida, Department of Pediatrics, Gainesville, FL, USA,Corresponding author: Barry J. Byrne, University of Florida, Department of Pediatrics, Gainesville, FL, USA.
| | - Melissa Elder
- University of Florida, Department of Pediatrics, Gainesville, FL, USA
| | | | - Manuela Corti
- University of Florida, Department of Pediatrics, Gainesville, FL, USA
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9
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Keramari S, Fidani L, Poutoglidis A, Chatzis S, Tsetsos N, Kaiafa G. Adenoviral Infections in Neonates: A Case-Based Literature Review. Cureus 2022; 14:e29082. [PMID: 36249608 PMCID: PMC9555808 DOI: 10.7759/cureus.29082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
Adenoviral infections in neonates are associated with high rates of mortality due to the lack of humoral immunity. A comprehensive search of published literature in PubMed, Google Scholar, and Science Direct electronic databases was conducted for case reports published between the years 1990 and 2021. The aim of our study is to investigate the risk factors, clinical manifestations, treatment, and outcomes of adenoviral infections in neonates. In our study, 36 cases were included. The most common type of infection was disseminated one (14/36, 38.8%), followed by adenoviral pneumonia (13/36, 36.1%). Cidofovir was administered in seven cases (19.4%), and death was reported in six of them. One preterm low birthweight neonate with disseminated adenoviral infection was treated with a combination of cidofovir, intravenous immune globulin, and haploidentical virus-specific T lymphocytes (VSTs) and survived. In this review, we found a statistically significant difference in the outcome based on the type of adenoviral infection (p=0.001). Disseminated infection and pneumonia are associated with the worst prognosis. In addition, mortality was observed to be higher in neonates with disseminated disease in contrast to neonates with localized infection (p=0.002). However, the antiviral treatment had no statistically significant effect on the mortality rate (p=0.137). There is a necessity for further investigation and randomized studies to validate the results of the present study.
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10
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Galletta F, Cucinotta U, Marseglia L, Cacciola A, Gallizzi R, Cuzzocrea S, Messina S, Toscano A, Gitto E. Hemophagocytic lymphohistiocytosis following gene replacement therapy in a child with type 1 spinal muscular atrophy. J Clin Pharm Ther 2022; 47:1478-1481. [PMID: 35924856 DOI: 10.1111/jcpt.13733] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 12/31/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Onasemnogene abeparvovec (OA) is the first gene replacement therapy for the treatment of paediatric patients with bi-allelic mutations in the SMN1 gene. Efficacy and safety of OA have been assessed in several studies with promising results, despite rare side effects have been described. CASE SUMMARY A 3-year-old child with spinal muscular atrophy was treated with OA and subsequently developed fever, widespread erythematous skin lesions and hepatosplenomegaly. Laboratory tests were suggestive for Hemophagocytic lymphohistiocytosis (HLH). WHAT IS NEW AND CONCLUSION To our knowledge, this is the first case of HLH following gene replacement therapy with OA, described in literature.
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Affiliation(s)
- Francesca Galletta
- Neonatal and Pediatric Intensive Care Unit, University of Messina, Messina, Italy, Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Ugo Cucinotta
- Neonatal and Pediatric Intensive Care Unit, University of Messina, Messina, Italy, Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Lucia Marseglia
- Neonatal and Pediatric Intensive Care Unit, University of Messina, Messina, Italy, Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Annalisa Cacciola
- Neonatal and Pediatric Intensive Care Unit, University of Messina, Messina, Italy, Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Romina Gallizzi
- Pediatric Unit, Department of Medical of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Sonia Messina
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Toscano
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Eloisa Gitto
- Neonatal and Pediatric Intensive Care Unit, University of Messina, Messina, Italy, Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
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11
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Obermeier PE, Heim A, Biere B, Hage E, Alchikh M, Conrad T, Schweiger B, Rath BA. Linking digital surveillance and in-depth virology to study clinical patterns of viral respiratory infections in vulnerable patient populations. iScience 2022; 25:104276. [PMID: 35573195 PMCID: PMC9092969 DOI: 10.1016/j.isci.2022.104276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/09/2022] [Accepted: 04/17/2022] [Indexed: 11/29/2022] Open
Abstract
To improve the identification and management of viral respiratory infections, we established a clinical and virologic surveillance program for pediatric patients fulfilling pre-defined case criteria of influenza-like illness and viral respiratory infections. The program resulted in a cohort comprising 6,073 patients (56% male, median age 1.6 years, range 0–18.8 years), where every patient was assessed with a validated disease severity score at the point-of-care using the ViVI ScoreApp. We used machine learning and agnostic feature selection to identify characteristic clinical patterns. We tested all patients for human adenoviruses, 571 (9%) were positive. Adenovirus infections were particularly common and mild in children ≥1 month of age but rare and potentially severe in neonates: with lower airway involvement, disseminated disease, and a 50% mortality rate (n = 2/4). In one fatal case, we discovered a novel virus: HAdV-80. Standardized surveillance leveraging digital technology helps to identify characteristic clinical patterns, risk factors, and emerging pathogens. We used mobile health technology to enable clinical pattern recognition The ViVI ScoreApp provided precision data for cross-cohort meta-analysis Neonates with adenovirus infection are at risk of severe or fatal disease outcomes In one neonate with disseminated disease, we found a new adenovirus: HAdV-D80
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Affiliation(s)
- Patrick E. Obermeier
- Vienna Vaccine Safety Initiative, Pediatric Infectious Diseases, Berlin, Germany
- Charité University Medical Center, Department of Pediatrics, Berlin, Germany
- UMR Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France
| | - Albert Heim
- National Reference Laboratory for Adenoviruses, Hannover Medical School, Hannover, Germany
| | - Barbara Biere
- National Reference Centre for Influenza, Robert Koch-Institute, Berlin, Germany
| | - Elias Hage
- National Reference Laboratory for Adenoviruses, Hannover Medical School, Hannover, Germany
| | - Maren Alchikh
- Vienna Vaccine Safety Initiative, Pediatric Infectious Diseases, Berlin, Germany
- Charité University Medical Center, Department of Pediatrics, Berlin, Germany
- UMR Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France
| | - Tim Conrad
- Department of Mathematics and Computer Science, Freie Universität Berlin, Berlin, Germany
| | - Brunhilde Schweiger
- National Reference Centre for Influenza, Robert Koch-Institute, Berlin, Germany
| | - Barbara A. Rath
- Vienna Vaccine Safety Initiative, Pediatric Infectious Diseases, Berlin, Germany
- Charité University Medical Center, Department of Pediatrics, Berlin, Germany
- UMR Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France
- Corresponding author
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12
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Rajbanshi A, Giri P, Laha S, Poddar S. Epidemiology, clinical presentation, and respiratory sequelae of severe adenoviral pneumonia in children admitted in a tertiary care pediatric intensive care unit from Eastern India: A single-center observational study. JOURNAL OF PEDIATRIC CRITICAL CARE 2022. [DOI: 10.4103/jpcc.jpcc_84_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Balakumar N, Sendi P, Totapally BR. Epidemiology and Outcomes of Neonatal Hemophagocytic Lymphohistiocytosis. Front Pediatr 2022; 10:848004. [PMID: 35558361 PMCID: PMC9090447 DOI: 10.3389/fped.2022.848004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Neonatal hemophagocytic lymphohistiocytosis (HLH) is a rare entity. The objective of the study was to describe the prevalence, clinical characteristics, interventions and outcomes of neonates diagnosed with HLH in the United States. METHODS A retrospective analysis of 2009, 2012, and 2016 Kids' Inpatient Database was performed. Neonates discharged/died with a diagnosis of HLH were identified and analyzed. RESULTS Among 11,130,055 discharges, 76 neonates had a diagnosis of HLH. Fifty-two percent (95% CI: 38.6-63.6) were males and 54% (95% CI: 39.7-68.5) were white. Herpes simplex infection was present in 16% (95% CI: 9.2-28.1). 24.4% (95% CI: 14.5-37.9) received chemotherapy, 11.5% (95% CI: 5.2-23.6) IVIG and 3.6% (95% CI: 0.8-14.4) allogenic hemopoietic stem cell transplantation. Organ dysfunction was commonly seen and severe sepsis was documented in 26.6% (95% CI: 16.4-39.9). Median LOS was 16 (IQR 7-54) days. The mortality was 42% (95% CI: 30.8-55). CONCLUSIONS HLH is a rare diagnosis and carries a high mortality in neonates. Herpes simplex virus is the most common infection associated with neonatal HLH. HLH should be considered in the differential diagnosis in neonates presenting with multi-organ dysfunction or sepsis.
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Affiliation(s)
- Niveditha Balakumar
- Division of Critical Care Medicine, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX, United States
| | - Prithvi Sendi
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, FL, United States.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Balagangadhar R Totapally
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, FL, United States.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
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14
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Li Y, Wang D, Zhang J, Huang P, Du H, Xu J, Chen H, Yan Y, Chen H, Lu X, Liu D. Human Adenovirus Type 7 Infections in Hubei, China During 2018-2019: Epidemic Features and Genetic Characterization of the Detected Viruses. Front Cell Infect Microbiol 2021; 11:684606. [PMID: 34490137 PMCID: PMC8417316 DOI: 10.3389/fcimb.2021.684606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Human adenoviruses (HAdVs) type 7 can cause severe respiratory disease. During the period between December 2018 and August 2019, HAdV-7 infection was identified in 129 patients in Wuhan Children's Hospital, Hubei Province, China. Samples were collected from hospitalized children and metagenomic sequencing was applied to detect the HAdV infections. Hemophagocytic lymphohistiocystosis (HLH) related to HAdV infections was observed in some patients clinically and patients were divided into two groups based on this to test the differences among clinical indicators. Genome variation, in silico restriction endonuclease analysis (REA), and phylogenetic analyses were carried out to show the genome characterization of HAdV-7 in this study. It was found that many indicators, such as all blood routine indicators, in patients of the HLH group showed significant levels. In this study, REA revealed that HAdV-7 might belong to genome 7d and genome variation analysis displayed the stable genome of HAdV. HAdV-7 is an ongoing threat to the public, and global surveillance should be established.
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Affiliation(s)
- Ying Li
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Decheng Wang
- CAS Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, China.,National Virus Resource Center, Chinese Academy of Sciences, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Wuhan, China.,Wuhan Institute of Virology, University of Chinese Academy of Sciences, Beijing, China
| | - Jingjing Zhang
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peiqi Huang
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Du
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiali Xu
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hebin Chen
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Yan
- CAS Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, China.,National Virus Resource Center, Chinese Academy of Sciences, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Wuhan, China.,Wuhan Institute of Virology, University of Chinese Academy of Sciences, Beijing, China
| | - Hongwei Chen
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoxia Lu
- Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Liu
- CAS Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, China.,National Virus Resource Center, Chinese Academy of Sciences, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Wuhan, China.,Wuhan Institute of Virology, University of Chinese Academy of Sciences, Beijing, China
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15
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Demey B, Brault C, Maizel J, Francois C. From Upper Respiratory Symptoms to Hemophagocytic Lymphohistiocytosis: Case Report of a Human Adenovirus Infection in Haploidentical Hematopoietic Stem Cell Transplant Recipient. Pathogens 2021; 10:pathogens10030340. [PMID: 33804012 PMCID: PMC8001405 DOI: 10.3390/pathogens10030340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/03/2021] [Accepted: 03/13/2021] [Indexed: 11/23/2022] Open
Abstract
Human adenovirus infection is rare in adult population, except for in immunocompromised individuals. Recipients of allogenic haploidentical hematopoietic stem cell transplantation are reported at high risk for human adenovirus, which is often lethal when it evolves into the disseminated form. Despite existent guidelines, prevention, early diagnosis, and therapeutics remain challenging. Here, we report the case of a fatal evolution of human adenovirus respiratory infection and discuss the actual recommendations to prevent recurrence of this major issue.
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Affiliation(s)
- Baptiste Demey
- Department of Virology, Amiens University Medical Center, 80000 Amiens, France;
- AGIR Research Unit, EA 4294, Jules Verne University of Picardie, 80000 Amiens, France
- Correspondence:
| | - Clément Brault
- Intensive Care Department, Amiens University Medical Center, 80000 Amiens, France; (C.B.); (J.M.)
| | - Julien Maizel
- Intensive Care Department, Amiens University Medical Center, 80000 Amiens, France; (C.B.); (J.M.)
| | - Catherine Francois
- Department of Virology, Amiens University Medical Center, 80000 Amiens, France;
- AGIR Research Unit, EA 4294, Jules Verne University of Picardie, 80000 Amiens, France
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16
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Zhang HY, Xiao M, Yan F, Zhang MR, Zhang Y. Risk Factors for the Development of Hemophagocytic Lymphohistiocytosis in Children With Severe Adenovirus Pneumonia: A Single-Center Retrospective Study. Front Pediatr 2021; 9:654002. [PMID: 34660470 PMCID: PMC8517263 DOI: 10.3389/fped.2021.654002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate and analyze the relevant risk factors for hemophagocytic lymphohistiocytosis (HLH) in children with severe adenovirus pneumonia (SAP). Methods: A retrospective study of children with SAP was performed in 30 cases developing HLH and 94 cases not developing HLH from December 2018 to August 2019. The binary logistic regression analysis was used to identify risk factors that were significantly associated with the development of HLH after the univariate analysis, and the receiver operating characteristic (ROC) curve was performed to find out the cut-off value for the significant relevant factors. Results: Two factors were associated with the development of HLH, which were the length of fever (OR = 1.331, 95%CI: 1.002-1.769) and triglycerides (TG) (OR = 17.345, 95%CI: 1.358-221.538). The cut-off value of the length of fever was 12.5 days, and the cut-off value of TG was 3.02 mmol/L. Conclusion: Children with SAP who had a duration of fever over 12.5 days and the TG level over 3.02 mmol/L are more likely to develop HLH.
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Affiliation(s)
- Hua-Yong Zhang
- Department of Cardiology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Xiao
- Department of Rheumatology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Yan
- Department of Critical Care Medicine, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mao-Rong Zhang
- Department of Respiratory Department, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Zhang
- Department of Cardiology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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17
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Otto WR, Behrens EM, Teachey DT, Lamson DM, Barrett DM, Bassiri H, Lambert MP, Mount S, Petrosa WL, Romberg N, Sullivan KE, Topjian AA, Fisher BT, Kajon AE. Human Adenovirus 7-Associated Hemophagocytic Lymphohistiocytosis-Like Illness: Clinical and Virological Characteristics in a Cluster of Five Pediatric Cases. Clin Infect Dis 2020; 73:e1532-e1538. [PMID: 32866230 DOI: 10.1093/cid/ciaa1277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/26/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition of immune dysregulation. Children often suffer from primary genetic forms of HLH, which can be triggered by infection. Others suffer from secondary HLH as a complication of infection, malignancy, or rheumatologic disease. Identifying the exact cause of HLH is crucial, as definitive treatment for primary disease is hematopoietic stem cell transplant. Adenoviruses have been associated with HLH but molecular epidemiology data are lacking. METHODS We describe the clinical and virologic characteristics of 5 children admitted with adenovirus infection during 2018-2019 who developed HLH or HLH-like illness. Detailed virologic studies, including virus isolation and comprehensive molecular typing were performed. RESULTS All patients recovered; clinical management varied but included immunomodulating and antiviral therapies. A genetic predisposition for HLH was not identified in any patient. Adenovirus isolates were recovered from 4/5 cases; all were identified as genomic variant 7d. Adenovirus type 7 DNA was detected in the fifth case. Phylogenetic analysis of genome sequences identified two clusters - one related to strains implicated in 2016-2017 outbreaks in Pennsylvania and New Jersey, the other related to a 2009 Chinese strain. CONCLUSIONS It can be challenging to determine whether HLH is the result of an infectious pathogen alone or genetic predisposition triggered by an infection. We describe 5 children from the same center presenting with an HLH-like illness after onset of adenovirus type 7 infection. None of the patients were found to have a genetic predisposition to HLH. These findings suggest that adenovirus 7 infection alone can result in HLH.
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Affiliation(s)
- William R Otto
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA.,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Edward M Behrens
- Immune Dysregulation Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Rheumatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David T Teachey
- Immune Dysregulation Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daryl M Lamson
- Wadsworth Center, New York State Department of Health (NYSDOH), Albany, New York, USA
| | - David M Barrett
- Immune Dysregulation Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hamid Bassiri
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA.,Immune Dysregulation Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michelle P Lambert
- Immune Dysregulation Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Hematology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Suzanne Mount
- Infectious Disease Diagnostics Laboratory, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Whitney L Petrosa
- Immune Dysregulation Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Neil Romberg
- Immune Dysregulation Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathleen E Sullivan
- Immune Dysregulation Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexis A Topjian
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brian T Fisher
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA.,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Immune Dysregulation Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adriana E Kajon
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico
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18
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Zhang FZ, Cai YQ, Tang LF. Adenovirus-associated hemophagocytic syndrome in a young child. World J Pediatr 2020; 16:215-216. [PMID: 31502024 DOI: 10.1007/s12519-019-00300-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/29/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Fei-Zhou Zhang
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou, 310051, China
| | - Yu-Qing Cai
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou, 310051, China
| | - Lan-Fang Tang
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou, 310051, China.
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19
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Alcamo AM, Wolf MS, Alessi LJ, Chong HJ, Green M, Williams JV, Simon DW. Successful Use of Cidofovir in an Immunocompetent Child With Severe Adenoviral Sepsis. Pediatrics 2020; 145:peds.2019-1632. [PMID: 31826930 PMCID: PMC6939840 DOI: 10.1542/peds.2019-1632] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 01/22/2023] Open
Abstract
Adenovirus infection is common in childhood and is generally associated with self-limited disease. Cidofovir, a viral DNA polymerase inhibitor, is used to treat adenovirus infection in select populations but is not often recommended for immunocompetent patients because of limited antiviral activity and nephrotoxicity. Here, we report a case of fulminant adenovirus infection associated with lymphopenia and multiple organ failure requiring extracorporeal membrane oxygenation support in a previously healthy child. After 1 week of supportive therapy, the patient had persistent organ failure and continued to have adenoviremia of >560 000 copies per mL. Weekly doses of cidofovir with concurrent probenecid for renal protection was initiated. Adenovirus blood load declined after the first cidofovir dose, becoming undetectable after 3 doses. The patient was successfully decannulated from extracorporeal membrane oxygenation, extubated, and eventually discharged at his functional baseline without need for ongoing respiratory support. Lymphopenia improved after viremia resolved, and a subsequent immunologic workup revealed no evidence of primary immunodeficiency. The viral isolate was genotyped as adenovirus type 7. This case reveals the successful use of cidofovir for management of severe adenovirus infection in a previously healthy child. To date, there are no universally accepted recommendations for the use of cidofovir in this population. Further study is warranted to determine the potential role of cidofovir in treating severe adenovirus infections in immunocompetent children.
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Affiliation(s)
- Alicia M. Alcamo
- Departments of Critical Care Medicine and,Contributed equally as co-first authors
| | - Michael S. Wolf
- Departments of Critical Care Medicine and,Contributed equally as co-first authors
| | | | - Hey J. Chong
- Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Green
- Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John V. Williams
- Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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20
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Hauch H, Skrzypek S, Woessmann W, Lehmberg K, Ehl S, Speckmann C, Schneck E, Koerholz D, Jux C, Neuhäuser C. Tuberculosis-Associated HLH in an 8-Month-Old Infant: A Case Report and Review. Front Pediatr 2020; 8:556155. [PMID: 33194891 PMCID: PMC7661936 DOI: 10.3389/fped.2020.556155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare immunological disease, which can be mistaken for sepsis easily. Among the infectious causes that may trigger secondary HLH, tuberculosis (TBC), a rather rare pathogen nowadays, is typical. To our knowledge, this is the first case report of an infant suffering from TBC-associated HLH-induced acute respiratory failure who was treated successfully using extracorporeal membrane oxygenation. An 8-month-old boy with fever (over the last 8 wk) and pancytopenia was transferred to our institution with acute respiratory failure and for extracorporeal membrane oxygenation therapy. Bone marrow biopsy revealed hemophagocytosis. Immunological work-up for familial HLH was negative. In a desperate search for the cause of secondary HLH, an interferon-gamma release assay for TBC returned positive. However, microscopy for acid-fast bacteria as well as polymerase chain reaction for TBC were initially negative. Despite this, the child was treated with tuberculostatic therapy. TBC was finally confirmed. The child remained on extracorporeal membrane oxygenation for 28 d. Further work-up showed typical lesions of disseminated TBC. The mother was identified as the source of TBC. The boy presents with mild sequelae (fine motor skills). In infants with suspected septicemia, TBC should be considered as differential diagnosis even if the results are initially negative.
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Affiliation(s)
- Holger Hauch
- Department of Pediatric Hematology and Oncology, University Children's Hospital of Giessen, Giessen, Germany
| | - Susanne Skrzypek
- Department of Pediatric Cardiology and Intensive Care, University Children's Hospital Giessen, Giessen, Germany
| | - Wilhelm Woessmann
- Division of Pediatric Stem Cell Transplantation, University Children's Hospital Hamburg, UKE, Hamburg, Germany
| | - Kai Lehmberg
- Division of Pediatric Stem Cell Transplantation, University Children's Hospital Hamburg, UKE, Hamburg, Germany
| | - Stephan Ehl
- Center for Chronic Immunodeficiency, Institute for Immunodeficiency, Medical Center-University of Freiburg, Freiburg, Germany.,Center of Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Carsten Speckmann
- Center for Chronic Immunodeficiency, Institute for Immunodeficiency, Medical Center-University of Freiburg, Freiburg, Germany.,Center of Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology and Intensive Care Medicine, University Children's Hospital Giessen, Giessen, Germany
| | - Dieter Koerholz
- Department of Pediatric Hematology and Oncology, University Children's Hospital of Giessen, Giessen, Germany
| | - Christian Jux
- Department of Pediatric Cardiology and Intensive Care, University Children's Hospital Giessen, Giessen, Germany
| | - Christoph Neuhäuser
- Department of Pediatric Cardiology and Intensive Care, University Children's Hospital Giessen, Giessen, Germany
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21
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Oguz MM, Sahin G, Altinel Acoglu E, Polat E, Yucel H, Oztek Celebi FZ, Unsal H, Akcaboy M, Sari E, Senel S. Secondary hemophagocytic lymphohistiocytosis in pediatric patients: a single center experience and factors that influenced patient prognosis. Pediatr Hematol Oncol 2019; 36:1-16. [PMID: 30821552 DOI: 10.1080/08880018.2019.1572253] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome of excessive immune activation. Secondary HLH syndrome develops as a complication of infection, drugs, rheumatologic conditions, or malignancy. The main objectives of this work were to identify the etiology of secondary HLH and prognostic factors associated with mortality. Patients diagnosed with secondary HLH, between January 2011 and December 2016, were retrospectively included in this study. We analyzed clinical and laboratory findings as well as prognostic factors from 24 pediatric patients diagnosed with secondary HLH. The mean age of patients at the time of diagnosis was 79.9 ± 68.7 months (range: 2-202) and 54.2% of the patients were male. The most frequent HLH-2004 criterion was fever (100%). Underlying triggers of HLH were as follows: 13 (54.1%) infections, juvenile idiopathic arthritis in 5 patients (20.8%), drugs in 3 patients (12.5%), malignancies in 2 (0.8%), Kawasaki disease in 1 (0.4%) patient, and 1 (0.4%) with unknown triggers. The median time of diagnosis was 3 days (1-67 days). Overall, the mortality rate was 20.8%. In our logistic regression model, factors associated with mortality were decreased albumin levels (OR1 = 2.3[1.48-3.43]) and etoposide usage (OR2 = 1.22 [1.14-1.89]). The patient's 30-day survival was inferior among patients whose albumin level was 2 g/dL or less compared to those over 2 g/dL. Increased awareness of the underlying condition is critical in HLH patients. Our study emphasizes the prognostic significance of albumin level.
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Affiliation(s)
- Melahat Melek Oguz
- a Department of Pediatrics , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Gurses Sahin
- b Department of Pediatric Hematology and Oncology , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Esma Altinel Acoglu
- a Department of Pediatrics , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Emine Polat
- a Department of Pediatrics , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Husniye Yucel
- a Department of Pediatrics , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Fatma Zehra Oztek Celebi
- a Department of Pediatrics , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Hilal Unsal
- a Department of Pediatrics , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Meltem Akcaboy
- a Department of Pediatrics , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Eyup Sari
- a Department of Pediatrics , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Saliha Senel
- a Department of Pediatrics , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
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