Cytomegalovirus Infection Presenting as Severe Sepsis, Hepatitis, and Autoimmune Hemolytic Anemia in an Immunocompetent Child in Pediatric Intensive Care Unit

Choudhary, Abhijit; Mehta, Ankit

doi:10.1097/inf.0000000000003250

Cited by 3 publications

(3 citation statements)

References 4 publications

(3 reference statements)

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“…6 In high-income countries, the frequency of CMV active infection in critically ill pediatric patients is low and published data are limited to a few case reports. [9][10][11] Conversely, 33% of African infants with severe pneumonia requiring mechanical ventilation had CMV pneumonitis. Of note, 60% of them were HIV-infected.…”

Section: Discussionmentioning

confidence: 99%

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Cytomegalovirus Active Infection in Critically Ill Children

Schwab,

Yamamoto,

Aragon

et al. 2023

Pediatric Infectious Disease Journal

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Objective: To describe the epidemiology, clinical characteristics and outcomes of children with cytomegalovirus (CMV) active infection in the pediatric intensive care unit (PICU) and to investigate risk factors for mortality. Methods: This was a retrospective cohort study of patients who had CMV DNA detected in blood samples and/or tracheal aspirates by polymerase chain reaction (PCR) during stay at 2 PICUs of a university hospital. Suspected cases without etiological confirmation and patients with laboratory-confirmed CMV infection before PICU admission were excluded. Results: Demographic, clinical and outcome data were collected from medical records. From January 1, 2012, to December 31, 2019, 4748 children were admitted to the PICUs. Thirty-five (0.74%; 95% CI 0.51%–1.02%) had laboratory-confirmed CMV active infection; 71.4% were immunocompromised and 11 (31.4%) died. Patients who died were older than those who survived (median age 65 vs. 5.5 months, respectively; P = 0.048), and they received antiviral therapy for a shorter time (median 12 vs. 23 days, respectively; P = 0.001). The main causa mortis was septic shock (82%) and in most deceased patients (73%) the last CMV PCR before death was positive. PELOD score >6 was a risk factor for death (RR 2.96; 95% CI 1.07–8.21). Viral load in blood had a poor ability for the prediction of death (area under the receiver operating characteristic curve 0.62; 95% CI 0.37–0.84). Conclusions: The incidence of CMV active infection during PICU stay was 0.74% in an upper-middle income country with a high CMV seroprevalence. PELOD score higher than 6 was a risk factor for death. No association was observed between CMV viral load and mortality.

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Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8] Nevertheless, data on the frequency and impact of CMV active infection in critically ill pediatric patients are scarce. [9][10][11] We aimed to describe the epidemiology, clinical characteristics and outcomes of children with active CMV infection in the pediatric intensive care unit (PICU) and to investigate risk factors for mortality.…”

mentioning

confidence: 99%

Cytomegalovirus Active Infection in Critically Ill Children

Schwab,

Yamamoto,

Aragon

et al. 2023

Pediatric Infectious Disease Journal

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“…The main components responsible for AIHA are autoantibodies with or without the involvement of complement C; however, several cellular immune effectors, cytokine dysregulation, and ineffective bone marrow compensation are being increasingly recognized. AIHA may be primary or may be associated with various diseases (lymphoproliferative, autoimmune and infectious diseases, immune deficiencies, solid tumors, organ transplantation, and drugs), and the immunological mechanisms cited are a combination of multiple factors ( 3 – 6 ). Although AIHA can occur at any age, it is very rare in infancy and childhood, with an estimated incidence of 0.2 per 100,000/year ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Type O blood, the MCHC, and the reticulocyte count impact the early recurrence of primary warm-antibody autoimmune hemolytic anemia in children: A retrospective cohort analysis

et al. 2022

Front. Pediatr.

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ObjectivePrimary warm-antibody autoimmune hemolytic anemia (w-AIHA) is prone to recurrence in children. In this study, we aimed to identify risk indicators for the early recurrence of primary w-AIHA and construct an effective recurrence risk assessment model.MethodsThis was a retrospective cohort study. The clinical data of patients hospitalized with primary w-AIHA in the Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, between 1 January 2018 and 30 September 2021, were collected at the initial diagnosis. Univariate and multivariate logistic regression analyses were used to determine risk indicators for the early recurrence of primary w-AIHA in children, and ROC curve and Kaplan–Meier survival analyses were used for verification. Finally, a risk assessment model for early recurrence in children with primary w-AIHA was constructed using Cox regression and visualized using a nomogram. The model was also verified internally and externally.ResultsThis study included 62 children with primary w-AIHA. Of which, 18 experienced recurrence 1 year after the initial diagnosis. The univariate and multivariate logistic regression analyses showed that type O blood and the reticulocyte count (Ret) were risk indicators for the early recurrence of pediatric primary w-AIHA (P = 0.009, 0.047, respectively). The mean corpuscular hemoglobin concentration (MCHC) is a protective factor (P = 0.040). According to the ROC curve and Kaplan–Meier survival analyses, children with primary w-AIHA whose blood type was O or had an MCHC of <313.5 pg/fL or a Ret of ≥0.161×1012/L had a higher risk of early recurrence (HR = 2.640, 4.430 and 4.450, respectively, and P = 0.040, 0.015 and 0.018, respectively). The blood types (O), MCHCs, and Rets of 56 patients were incorporated into the Cox regression model, and the recurrence risk assessment model for children with primary w-AIHA was successfully constructed and visualized using a nomogram. The calibration curves and decision-curve analysis (DCA) suggested that the risk model has clinical applicability and effectiveness.ConclusionChildren with type O blood and an MCHC value of <313.5 pg/fL or a Ret value of ≥0.161×1012/L have a higher risk of early recurrence. The risk assessment model for the early recurrence of pediatric primary w-AIHA constructed in this study has good clinical applicability and effectiveness.

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RNF20 deletion causes inflammation in model of sepsis through the NLRP3 activation

Liu

Zhai

et al. 2023

Immunopharmacology and Immunotoxicology

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Cytomegalovirus Infection Presenting as Severe Sepsis, Hepatitis, and Autoimmune Hemolytic Anemia in an Immunocompetent Child in Pediatric Intensive Care Unit

Cited by 3 publications

References 4 publications

Cytomegalovirus Active Infection in Critically Ill Children

Cytomegalovirus Active Infection in Critically Ill Children

Type O blood, the MCHC, and the reticulocyte count impact the early recurrence of primary warm-antibody autoimmune hemolytic anemia in children: A retrospective cohort analysis

RNF20 deletion causes inflammation in model of sepsis through the NLRP3 activation

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