Acquired Immunodeficiency from Maternal Chemotherapy and Severe Primary <i>Pneumocystis</i> Infection in an Infant

Lim, Adeline; Mattke, Adrian; Clark, Julia; Pinzón-Charry, Alberto; Alphonso, Nelson; Kapur, Nitin

doi:10.1155/2020/5740304

Cited by 3 publications

(3 citation statements)

References 32 publications

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“…Immunocompromised pediatric patients are at especially high risk of hospital death and are very susceptible to opportunistic infections [ 12 ] (survival rates of 33.3 and 57.5% for immunocompromised and nonimmunocompromised infants). However, some pediatric case reports of VV-ECMO used to treat Pneumocystis pneumonia reported that patients with hematological diseases and iatrogenic immunosuppression experienced good outcomes [ 13 – 15 ]. Also, the use of ECMO to treat Pneumocystis pneumonia was associated with better patient survival than that of patients with other conditions recorded in both the ELSO and Stockholm registries (51 and 89% survival, respectively [ 16 ]).…”

Section: Discussionmentioning

confidence: 99%

Use of Extracorporeal Membrane Oxygenation in Pneumocystis Pneumonia of an Infant with AIDS

Cane

Boislambert²,

Sgro³

et al. 2020

Case Reports in Pediatrics

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Pneumocystis pneumonia is a common complication of cellular immunosuppression and may trigger severe pulmonary complications. Rapid onset of acquired immunodeficiency syndrome is possible in infants infected with human immunodeficiency virus (HIV). We report here the case of a 13-week-old girl who was previously healthy presenting with altered immunity and refractory acute respiratory distress syndrome (ARDS) initially attributed to bacterial pneumonia. Venovenous extracorporeal membrane oxygenation (VV-ECMO) was initiated because her condition was poor. An HIV infection was later fortuitously diagnosed after accidental exposure of a nurse to the child’s urine. The mother had congenitally transmitted HIV to the child after late (undetected) infection during pregnancy. The lung lesions were finally attributed to Pneumocystis pneumonia. We prescribed combined antiretroviral, antibiotic, and steroid therapy aimed at preventing immune reconstitution inflammatory syndrome. VV-ECMO weaning progressed over 30 days to the time of decannulation, rapidly followed by extubation and hospital discharge. The case highlights the fact that rare curable causes of refractory pediatric ARDS should always be investigated early. VV-ECMO should not be excluded as an ARDS treatment for immunocompromised children.

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Section: Discussionmentioning

confidence: 99%

Use of Extracorporeal Membrane Oxygenation in Pneumocystis Pneumonia of an Infant with AIDS

Cane

Boislambert²,

Sgro³

et al. 2020

Case Reports in Pediatrics

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“…Clinical data were systematically collected and analyzed using descriptive statistics, encompassing baseline characteristics, days of mechanical ventilation prior to ECMO, pre-ECMO blood gas metrics, oxygenation indices, mechanical ventilation settings before and during ECMO, duration on ECMO, post-ECMO mechanical ventilation time, total hospital stay, and outcomes. Characteristics of the reported cases are presented in Table 1 [13][14][15][16] .…”

Section: Literature Reviewmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in the treatment of critical Pneumocystis jirovecii pneumonia in a child with Langerhans cell histiocytosis: a case report and literature review

Zou,

Zhao,

Chen

et al. 2024

Preprint

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Background: Children with Langerhans cell histiocytosis (LCH) are particularly susceptible to infections such as Pneumocystis jirovecii pneumonia (PJP) due to the immunosuppressive effects of chemotherapy, which can progress to acute respiratory distress syndrome (ARDS) and respiratory failure. The use of Extracorporeal Membrane Oxygenation (ECMO) to manage hypoxemia secondary to PJP in LCH presents unique challenges, including the prevention of catheter-related bloodstream infections associated with arterial and venous access. This study explores a case wherein ECMO was crucial in treating severe PJP-induced respiratory failure in a pediatric patient with LCH. Case Presentation: A 3-year-old female with a history of LCH, undergoing long-term chemotherapy and corticosteroid treatment, was admitted with fever, dyspnea, and lethargy. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid confirmed Pneumocystis jirovecii (PJ). Despite aggressive management with invasive high-frequency ventilation, inhaled nitric oxide, and prone positioning, the patient’s oxygenation remained critically low, with severe hypercapnia and resultant severe respiratory acidosis, necessitating vasopressor support for hemodynamic stability and veno-arterial (V-A) ECMO intervention. Early initiation of V-A ECMO facilitated ultraprotective lung ventilation and circulatory support, effectively preventing hemodynamic collapse. The patient was successfully decannulated after 13 days of ECMO support. Conclusion: While PJP is a rare and extremely serious opportunistic infection, the V-A ECMO support in this pediatric case effectively managed severe PJP without ECMO-related complications, underscoring the efficacy and safety of V-A ECMO in treating severe PJP pneumonia in pediatric patients.

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“…Pneumocystis jirovecii, a fungus formerly known as Pneumocystic carinii, can cause a lung infection mainly associated with pneumonia in patients with acquired immunodeficiency syndrome (AIDS) [1], patients who are immunocompromised but not infected with human immunodeficiency virus (HIV) (e.g., individuals who underwent solid organ transplantation [2], patients with acute leukaemia and other haematological malignancy [3], and those treated with immunosuppressive agents including steroids [4]), as well as malnourished persons [5,6], infants [7,8], and young children [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Molecular Analysis of Dihydropteroate Synthase Gene Mutations in Pneumocystis jirovecii Isolates among Bulgarian Patients with Pneumocystis Pneumonia

Tsvetkova,

Harizanov,

Rainova

et al. 2023

IJMS

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Pneumocystis jirovecii pneumonia (PCP) is a significant cause of morbidity and mortality in immunocompromised people. The widespread use of trimethoprim-sulfamethoxazole (TMP-SMZ) for the treatment and prophylaxis of opportunistic infections (including PCP) has led to an increased selection of TMP-SMZ-resistant microorganisms. Sulfa/sulfone resistance has been demonstrated to result from specific point mutations in the DHPS gene. This study aims to investigate the presence of DHPS gene mutations among P. jirovecii isolates from Bulgarian patients with PCP. A total of 326 patients were examined via real-time PCR targeting the P. jirovecii mitochondrial large subunit rRNA gene and further at the DHPS locus. P. jirovecii DNA was detected in 50 (15.34%) specimens. A 370 bp DHPS locus fragment was successfully amplified in 21 samples from 19 PCP-positive patients, which was then purified, sequenced, and used for phylogenetic analysis. Based on the sequencing analysis, all (n = 21) P. jirovecii isolates showed DHPS genotype 1 (the wild type, with the nucleotide sequence ACA CGG CCT at codons 55, 56, and 57, respectively). In conclusion, infections caused by P. jirovecii mutants potentially resistant to sulfonamides are still rare events in Bulgaria. DHPS genotype 1 at codons 55 and 57 is the predominant P. jirovecii strain in the country.

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Acquired Immunodeficiency from Maternal Chemotherapy and Severe Primary Pneumocystis Infection in an Infant

Cited by 3 publications

References 32 publications

Use of Extracorporeal Membrane Oxygenation in Pneumocystis Pneumonia of an Infant with AIDS

Use of Extracorporeal Membrane Oxygenation in Pneumocystis Pneumonia of an Infant with AIDS

Extracorporeal Membrane Oxygenation in the treatment of critical Pneumocystis jirovecii pneumonia in a child with Langerhans cell histiocytosis: a case report and literature review

Molecular Analysis of Dihydropteroate Synthase Gene Mutations in Pneumocystis jirovecii Isolates among Bulgarian Patients with Pneumocystis Pneumonia

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