Limits...
Protothecal peritonitis in child after bone marrow transplantation: case report and literature review of paediatric cases.

Sykora T, Horakova J, Buzzasyova D, Sladekova M, Poczova M, Sufliarska S - New Microbes New Infect (2014)

Bottom Line: Even though no death of a paediatric patient due to this infection has been reported and the mortality rate associated with protothecosis is low, our patient died from multiorgan failure as a result of numerous post-transplant complications and a strain of cultivated alga that was highly resistant to antifungal agents.Paediatric cases were successfully treated mostly with amphotericin B and azoles.As the number of immunocompromised patients increases, it is necessary to think more about unusual pathogens such as Prototheca.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital Bratislava, Slovakia.

ABSTRACT
The case presented here illustrates a protothecal infection caused by Prototheca wickerhamii in a paediatric haematopoietic stem cell recipient followed by a review of the literature of all 13 paediatric cases published since 1980. Protothecosis is a rare disease caused by algae, not described in this setting before. Infection was proven additionally post-mortem from peritoneal dialysis fluid. Even though no death of a paediatric patient due to this infection has been reported and the mortality rate associated with protothecosis is low, our patient died from multiorgan failure as a result of numerous post-transplant complications and a strain of cultivated alga that was highly resistant to antifungal agents. Prototheca spp. show various susceptibility profiles, and there is no direct correlation between in vitro activity and clinical response. There are different treatment regimens described but there are no clear published guidelines of specific therapy of protothecosis. Paediatric cases were successfully treated mostly with amphotericin B and azoles. As the number of immunocompromised patients increases, it is necessary to think more about unusual pathogens such as Prototheca.

No MeSH data available.


Related in: MedlinePlus

Course of present case with C reactive protein changes, microbiology findings and antifungaltherapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4265046&req=5

fig01: Course of present case with C reactive protein changes, microbiology findings and antifungaltherapy.

Mentions: Day +1 after SCT he developed febrile neutropenia. Aetiology of this febrile episode waslater identified from a blood culture as Klebsiella pneumoniae and it was treatedaccording to the antibiotic sensitivity tests. In the peri-transplant period he developed a severeveno-occlusive liver disease with high bilirubin blood level, body fluid retention and ascites withthe necessity for abdominal drain insertion. Later, anuria and respiratory failure developed and thepatient was transferred to the intensive care unit for mechanical ventilation and peritonealdialysis. Bilirubin blood levels continued to rise up to 857 μmol/L(50.1 mg/dL), a molecular adsorbent recirculation system was used four times. On neutrophilengraftment day +21 the patient's condition had improved—laboratoryinflammation markers were decreased as well as fever. On day +26, the intestinal form of GVHDdeveloped with massive intestinal bleeding. Candida fabianii and multiresistantStaphylococcus epidermidis and Enterococcus faecalis wereidentified as microbial agents causing other concomitant infections (Fig.1).


Protothecal peritonitis in child after bone marrow transplantation: case report and literature review of paediatric cases.

Sykora T, Horakova J, Buzzasyova D, Sladekova M, Poczova M, Sufliarska S - New Microbes New Infect (2014)

Course of present case with C reactive protein changes, microbiology findings and antifungaltherapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4265046&req=5

fig01: Course of present case with C reactive protein changes, microbiology findings and antifungaltherapy.
Mentions: Day +1 after SCT he developed febrile neutropenia. Aetiology of this febrile episode waslater identified from a blood culture as Klebsiella pneumoniae and it was treatedaccording to the antibiotic sensitivity tests. In the peri-transplant period he developed a severeveno-occlusive liver disease with high bilirubin blood level, body fluid retention and ascites withthe necessity for abdominal drain insertion. Later, anuria and respiratory failure developed and thepatient was transferred to the intensive care unit for mechanical ventilation and peritonealdialysis. Bilirubin blood levels continued to rise up to 857 μmol/L(50.1 mg/dL), a molecular adsorbent recirculation system was used four times. On neutrophilengraftment day +21 the patient's condition had improved—laboratoryinflammation markers were decreased as well as fever. On day +26, the intestinal form of GVHDdeveloped with massive intestinal bleeding. Candida fabianii and multiresistantStaphylococcus epidermidis and Enterococcus faecalis wereidentified as microbial agents causing other concomitant infections (Fig.1).

Bottom Line: Even though no death of a paediatric patient due to this infection has been reported and the mortality rate associated with protothecosis is low, our patient died from multiorgan failure as a result of numerous post-transplant complications and a strain of cultivated alga that was highly resistant to antifungal agents.Paediatric cases were successfully treated mostly with amphotericin B and azoles.As the number of immunocompromised patients increases, it is necessary to think more about unusual pathogens such as Prototheca.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital Bratislava, Slovakia.

ABSTRACT
The case presented here illustrates a protothecal infection caused by Prototheca wickerhamii in a paediatric haematopoietic stem cell recipient followed by a review of the literature of all 13 paediatric cases published since 1980. Protothecosis is a rare disease caused by algae, not described in this setting before. Infection was proven additionally post-mortem from peritoneal dialysis fluid. Even though no death of a paediatric patient due to this infection has been reported and the mortality rate associated with protothecosis is low, our patient died from multiorgan failure as a result of numerous post-transplant complications and a strain of cultivated alga that was highly resistant to antifungal agents. Prototheca spp. show various susceptibility profiles, and there is no direct correlation between in vitro activity and clinical response. There are different treatment regimens described but there are no clear published guidelines of specific therapy of protothecosis. Paediatric cases were successfully treated mostly with amphotericin B and azoles. As the number of immunocompromised patients increases, it is necessary to think more about unusual pathogens such as Prototheca.

No MeSH data available.


Related in: MedlinePlus