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Case Report: Severe ARDS in a Pediatric Hematopoietic Stem-Cell Transplantation Recipient Caused by Disseminated Toxoplasmosis
Toxoplasma gondii infection is a severe complication of hematopoietic stem-cell transplantation (HSCT) recipients that can remain unnoticed without a high clinical suspicion. We present the case of a 6-year-old patient with acute lymphoblastic leukemia and HSCT recipient who was admitted to the Pedi...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826680/ https://www.ncbi.nlm.nih.gov/pubmed/35155320 http://dx.doi.org/10.3389/fped.2021.810718 |
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author | de la Mata Navazo, Sara Slöcker Barrio, María García-Morín, Marina Beléndez, Cristina Escobar Fernández, Laura Rincón-López, Elena María Aguilera Alonso, David Guinea, Jesús Marín, Mercedes Butragueño-Laiseca, Laura López-Herce Cid, Jesús |
author_facet | de la Mata Navazo, Sara Slöcker Barrio, María García-Morín, Marina Beléndez, Cristina Escobar Fernández, Laura Rincón-López, Elena María Aguilera Alonso, David Guinea, Jesús Marín, Mercedes Butragueño-Laiseca, Laura López-Herce Cid, Jesús |
author_sort | de la Mata Navazo, Sara |
collection | PubMed |
description | Toxoplasma gondii infection is a severe complication of hematopoietic stem-cell transplantation (HSCT) recipients that can remain unnoticed without a high clinical suspicion. We present the case of a 6-year-old patient with acute lymphoblastic leukemia and HSCT recipient who was admitted to the Pediatric Intensive Care Unit (PICU) on post-transplantation day +39 with fever, hypotension, severe respiratory distress and appearance of a lumbar subcutaneous node. She developed severe Acute Respiratory Distress Syndrome (ARDS) and underwent endotracheal intubation and early mechanical ventilation. Subsequently, she required prone ventilation, inhaled nitric oxide therapy and high-frequency oscillatory ventilation (HFOV). An etiologic study was performed, being blood, urine, bronchoalveolar lavage and biopsy of the subcutaneous node positive for Toxoplasma gondii by Polymerase Chain Reaction (PCR). Diagnosis of disseminated toxoplasmosis was established and treatment with pyrimethamine, sulfadiazine and folinic acid started. The patient showed clinical improvement, allowing weaning of mechanical ventilation and transfer to the hospitalization ward after 40 days in the PICU. It is important to consider toxoplasmosis infection in immunocompromised patients with sepsis and, in cases of severe respiratory distress, early mechanical ventilation should be started using the open lung approach. In Toxoplasma IgG positive patients, close monitoring and appropriate anti-infectious prophylaxis is needed after HSCT. |
format | Online Article Text |
id | pubmed-8826680 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-88266802022-02-10 Case Report: Severe ARDS in a Pediatric Hematopoietic Stem-Cell Transplantation Recipient Caused by Disseminated Toxoplasmosis de la Mata Navazo, Sara Slöcker Barrio, María García-Morín, Marina Beléndez, Cristina Escobar Fernández, Laura Rincón-López, Elena María Aguilera Alonso, David Guinea, Jesús Marín, Mercedes Butragueño-Laiseca, Laura López-Herce Cid, Jesús Front Pediatr Pediatrics Toxoplasma gondii infection is a severe complication of hematopoietic stem-cell transplantation (HSCT) recipients that can remain unnoticed without a high clinical suspicion. We present the case of a 6-year-old patient with acute lymphoblastic leukemia and HSCT recipient who was admitted to the Pediatric Intensive Care Unit (PICU) on post-transplantation day +39 with fever, hypotension, severe respiratory distress and appearance of a lumbar subcutaneous node. She developed severe Acute Respiratory Distress Syndrome (ARDS) and underwent endotracheal intubation and early mechanical ventilation. Subsequently, she required prone ventilation, inhaled nitric oxide therapy and high-frequency oscillatory ventilation (HFOV). An etiologic study was performed, being blood, urine, bronchoalveolar lavage and biopsy of the subcutaneous node positive for Toxoplasma gondii by Polymerase Chain Reaction (PCR). Diagnosis of disseminated toxoplasmosis was established and treatment with pyrimethamine, sulfadiazine and folinic acid started. The patient showed clinical improvement, allowing weaning of mechanical ventilation and transfer to the hospitalization ward after 40 days in the PICU. It is important to consider toxoplasmosis infection in immunocompromised patients with sepsis and, in cases of severe respiratory distress, early mechanical ventilation should be started using the open lung approach. In Toxoplasma IgG positive patients, close monitoring and appropriate anti-infectious prophylaxis is needed after HSCT. Frontiers Media S.A. 2022-01-26 /pmc/articles/PMC8826680/ /pubmed/35155320 http://dx.doi.org/10.3389/fped.2021.810718 Text en Copyright © 2022 de la Mata Navazo, Slöcker Barrio, García-Morín, Beléndez, Escobar Fernández, Rincón-López, Aguilera Alonso, Guinea, Marín, Butragueño-Laiseca and López-Herce Cid. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pediatrics de la Mata Navazo, Sara Slöcker Barrio, María García-Morín, Marina Beléndez, Cristina Escobar Fernández, Laura Rincón-López, Elena María Aguilera Alonso, David Guinea, Jesús Marín, Mercedes Butragueño-Laiseca, Laura López-Herce Cid, Jesús Case Report: Severe ARDS in a Pediatric Hematopoietic Stem-Cell Transplantation Recipient Caused by Disseminated Toxoplasmosis |
title | Case Report: Severe ARDS in a Pediatric Hematopoietic Stem-Cell Transplantation Recipient Caused by Disseminated Toxoplasmosis |
title_full | Case Report: Severe ARDS in a Pediatric Hematopoietic Stem-Cell Transplantation Recipient Caused by Disseminated Toxoplasmosis |
title_fullStr | Case Report: Severe ARDS in a Pediatric Hematopoietic Stem-Cell Transplantation Recipient Caused by Disseminated Toxoplasmosis |
title_full_unstemmed | Case Report: Severe ARDS in a Pediatric Hematopoietic Stem-Cell Transplantation Recipient Caused by Disseminated Toxoplasmosis |
title_short | Case Report: Severe ARDS in a Pediatric Hematopoietic Stem-Cell Transplantation Recipient Caused by Disseminated Toxoplasmosis |
title_sort | case report: severe ards in a pediatric hematopoietic stem-cell transplantation recipient caused by disseminated toxoplasmosis |
topic | Pediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826680/ https://www.ncbi.nlm.nih.gov/pubmed/35155320 http://dx.doi.org/10.3389/fped.2021.810718 |
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