Febrile neutropenia following parvovirus B19 infection and cross anti-kell reaction to E. coli in pregnancy / Infeção por parvovírus B19 causando neutropenia febril e reação cruzada anti-Kell com E. coli na gravidez

Abstract Parvovirus B19 has tropism for red line blood cells, causing immune hydrops during pregnancy. A positive anti-Kell Coombs reaction usually happens during pregnancy when there is production of antibodies that target Kell antigens, but cross reactions to other antigens may occur. A 24-year-old Gypsy primigravida, 0 Rhesus positive, presented with persistent isolated hyperthermia for 2 weeks and a positive indirect Coombs test result with anti-Kell antibodies at routine tests. She had a 19-week live fetus. The blood tests revealed bicytopenia with iron deficiency anemia, leucopoenia with neutropenia, and elevated C-reactive protein. She was medicated with imipenem, and had a slow clinical recovery. Blood, urine and sputum samples were taken to perform cultures and to exclude other systemic infections. Escherichia coli was isolated in the urine, which most probably caused a transient cross anti-Kell reaction. Haemophilus influenza in the sputum and seroconversion to parvovirus B19 was confirmed, causing unusual deficits in the white cells, culminating in febrile neutropenia. Despite the patient's lack of compliance to the medical care, both maternal and fetal/neonatal outcomes were good. This a rare case report of 2 rare phenomena, a cross anti-Kell reaction to E. coli and parvovirus B19 infection with tropism for white cells causing febrile neutropenia, both events occurring simultaneously during pregnancy.

Resumo O parvovírus B19 tem tropismo para as células sanguíneas da linha vermelha, causando hidropsia imune durante a gravidez. O teste Coombs anti-Kell positivo ocorre durante a gravidez quando há produção de anticorpos contra os antígenos de Kell, mas pode haver reações cruzadas para outros antígenos. Uma grávida primigesta de etnia cigana, de 24 anos, 0 Rhesus positivo, recorreu ao hospital às 19 semanas de gestação por hipertermia isolada persistente por 2 semanas e umteste Coombs indireto positivo por anticorpos anti-Kell em testes de rotina da gravidez. O estudo analítico revelou bicitopenia com anemia ferropênica, leucopenia com neutropenia, e elevação da proteína C-reativa. A paciente foi medicada com imipenem, e teve uma recuperação clínica lenta. Foram colhidas amostras de sangue, urina e expectoração para culturas bacterianas. Na urina, foi isolada Escherichia coli, o que provavelmente causou a reação anti-Kell cruzada transitória. Na expectoração, foi isolada Haemophilus influenza, e foi confirmada seroconversão para o parvovírus B19, que causou um déficit incomum na linhagem sanguínea branca, culminando com neutropenia febril. Apesar da má adesão aos cuidados médicos, os desfechos materno e fetal/neonatal foram bons. Este é um caso de 2 fenômenos raros, uma reação cruzada anti-Kell à infecção por E. coli, e parvovírus B19 comtropismo para células brancas causando neutropenia febril, ambos ocorrendo simultaneamente durante a gravidez.

The effects of prenatal infection on the lung development of rat pups / 国际儿科学杂志

Objective To explore the effects of prenatal infection on the development of lungs by dynamic observation of morphology and numbers of inflammatory cells in lungs of rat pups exposed to antenatal inflammation.Methods Pregnant Wistar rats were randomly divided into experimental group and control group.Pregnant rats of both groups were intraperitoneal injected with either lipopolysaccharide (LPS) 2.5mg/kg or the same volume of normal saline on embryonic day 19 and 20, respectively, and were allowed to term deliver.Onday1, 3, 7, 14, 21and28 (D1, D3, D7, D14, D21 andD28), eight pups of each group were killed by 10％ chloral hydrate (1ml/kg) and lungs were collected.The numbers of myeloperoxidase (MPO) and CD68 as markers of both neutrophils and macrophages were counted.Morphometric assessments were performed by measuring the mean numbers of alveolar, the mean ratio of alveolar surface area to per tissue and the mean thickness of alveolar septum.Results With the increasing of postnatal days, the mean numbers of alveolar and the mean ratio of alveolar surface area to per tissue in both groups increased.The mean thickness of alveolar septum got thinner and the numbers of inflammatory cells decreased.On D1, D3, D7 and D14, the mean alveolar numbers of the experimental group (88, 89, 102 and 127 /mm2) were significantly less than those of the control group (105, 109, 123, 156/mm2), P =0.024, 0.009, 0.013, 0.004, respectively.On D1, D3 and D7, the mean ratios of alveolar surface area to per tissue were significantly larger (0.552,0.603 and0.533) than those of control group (0.478, 0.485 and 0.404), P=0.003, 0.001, 0.000, respectively.On D1 and D3, the alveolar septum thickness was significantly thinner (12.30 and 10.75 μm) thanthatin control group (17.13 and 16.13 μm), P=0.000, 0.000, respectively.On D1, D3, D7 and D14, the mean numbers of neutrophils of the experimental group (681, 582, 393 and 379/mm2) were significantly more than those of control group (164, 211, 145 and 179 /mm2), P =0.000, 0.000, 0.000,0.003, respectively.On D1, D3 and D7, the mean numbers of macrophages (613, 578 and 337 /mm2)were significantly more than those of control group (170, 182 and 127, /mm2) , P=0.000, 0.000, 0.000,respectively.Conclusion Prenatal infection results in larger and fewer alveolars and more inflammatory cells in lungs of rat pups.With the increasing of postnatal days, the alveolar morphology was similar to the controis.