Application value of metagenomic next-generation sequencing for pathogen detection in childhood agranulocytosis with fever / 中国当代儿科杂志

OBJECTIVES@#To study the application value of metagenomic next-generation sequencing (mNGS) for pathogen detection in childhood agranulocytosis with fever.@*METHODS@#A retrospective analysis was performed on the mNGS results of pathogen detection of 116 children with agranulocytosis with fever who were treated from January 2020 to December 2021. Among these children, 38 children with negative mNGS results were enrolled as the negative group, and 78 children with positive results were divided into a bacteria group (n=22), a fungal group (n=23), and a viral group (n=31). Clinical data were compared between groups.@*RESULTS@#For the 116 children with agranulocytosis and fever, the median age was 8 years at diagnosis, the median turnaround time of mNGS results was 2 days, and the positive rate of mNGS testing was 67.2% (78/116). Compared with the negative group, the bacterial group had a higher procalcitonin level (P<0.05), the fungal group had higher level of C-reactive protein and positive rate of (1,3)-β-D glucan test/galactomannan test (P<0.05), and the fungal group had a longer duration of fever (P<0.05). Among the 22 positive microbial culture specimens, 9 (41%) were consistent with the mNGS results. Among the 17 positive blood culture specimens, 8 (47%) were consistent with the mNGS results. Treatment was adjusted for 28 children (36%) with the mNGS results, among whom 26 were cured and discharged.@*CONCLUSIONS@#The mNGS technique has a shorter turnaround time and a higher sensitivity for pathogen detection and can provide evidence for the pathogenic diagnosis of children with agranulocytosis and fever.

Prognostic Usefulness of Eosinopenia in the Pediatric Intensive Care Unit

Eosinopenia, a biomarker for infection, has recently been shown to be a predictor of adult mortality in the intensive care unit (ICU). Our study assessed the usefulness of eosinopenia as a mortality and an infection biomarker in the pediatric ICU (PICU). We compared the PICU mortality scores, eosinophil count and percentage at ICU admission between children who survived and those who did not survive and between children with infection and those without infection. A total of 150 patients were evaluated. The initial eosinophil count and percentage were significantly lower in the group that did not survive when compared to those that did survive (P < 0.001; P < 0.001). However, there was no significant difference in the eosinophil count and percentage seen in patients with and without infection. Eosinopenia, defined as an eosinophil count < 15 cells/microL and an eosinophil percentage < 0.25%, (hazard ratio [HR]: 2.96; P = 0.008) along with a Pediatric Index of Mortality (PIM) 2 (HR: 1.03; P = 0.004) were both determined to be independent predictors of mortality in the PICU. The presence of eosinopenia at the ICU admission can be a useful biomarker for mortality in children, but is not useful as a biomarker for infection.

Agranulocyosis in beta thalassemia major patients treated with oral iron chelating agent [deferiprone]

Deferiprone is an oral chelating agent that has been recently shown to reduce cardiac siderosis, but is also known to be associated with serious side effects like agranulocytosis which can be fatal. This report is a single centre experience of 5 cases with severe agranulocytosis in amongst 144 patients [3.47%] of thalassemia major on combined chelation therapy with subcutaneous desferrioxamine and oral deferiprone which is much higher than the previous reports

Agranulocitose e tonsilite associadas ao uso de metimazol

O tratamento do hipertireoidismo com drogas antitireoidianas pode provocar, em 0,2 a 0,3 por cento dos casos, um importante efeito colateral: a agranulocitose. As complicações infecciosas decorrentes desta condição afetam principalmente a orofaringe, sendo a tonsilite uma de suas manifestações. No presente trabalho, é relatado o caso de uma paciente do sexo feminino, com 33 anos, apresentando odinofagia e febre resistentes à vários antibióticos. A paciente era portadora de hipertireoidismo e estava em uso de metimazol há dois meses. Com o diagnóstico de angina agranulocítica, foi suspensa a droga e iniciado tratamento com ciprofloxacina, sintomáticos e estimulador de colônias granulocíticas, além de fluconazol. A paciente evoluiu satisfatoriamente, recebendo alta dez dias após o início do tratamento. Quinze dias depois, uma tireoidectomia total foi realizada. O objetivo deste relato é ressaltar a importância de se conhecer os efeitos colaterais dos medicamentos, advertir os pacientes sobre os mesmos e alertar os médicos quanto à necessidade de se avaliar o paciente como um todo, investigando sobre outras doenças existentes e medicamentos em uso.

Agranulocitose induzida pelo uso de dapsona em paciente com hanseníase tuberculóide / Agranulocytosis induced by use of dapsone in pacient with tuberculoid leprosy

Relato de caso de paciente do sexo feminino, sob tratamento para hanseníase tuberculóide, em uso de 100mg/dia de dapsona, que desenvolveu agranulocitose e septicemia. Discutem-se os mecanismos envolvidos, as causas possíveis e o quadro clínico. Sugere-se cautela durante o uso dessa droga, principalmente nas primeiras 12 semanas de tratamento.

Tratamiento de las complicaciones bucales en pacientes oncohematológicos, durante la granulocitopenia producida por la quimioterapia. Parte I / Treatment of oral complications in oncohematologic patients during granulocytopenia produced by chemotherapy. Part I

Al observar clínicamente las diferentes lesiones que se presentan en los pacientes sometidos a tratamientos con quimioterápicos por diferentes tipos de patologías sistémicas, que no sólo traen inconvenientes dolorosos sino también infecciosos, se realizaron distintos tipos de tratamientos locales y/o sistémicos. Para el presente trabajo se tomaron en cuenta todos aquellos pacientes que presentaban granulocitopenia en un período determinado, durante el cual permanecieron internados por distintas manifestaciones clínicas. Como se puede observar en las conclusiones del presente trabajo, se llegó a demostrar que la prevención en la salud bucal de los pacientes que serán sometidos a este tipo de tratamiento es fundamental para disminuir las posibilidades de lesiones "oportunistas". Pero ante la aparición de éstas, el tratarlas adecuadamente ayuda al bienestar del enfermo y minimiza los riesgos para el estado general

Agranulocytosis and aplastic anemia among Ramathibodi Hospital patients.

A one-year prospective prevalence study on aplastic anemia and agranulocytosis was performed in Ramathibodi Medical School. A total of 91,581 complete blood counts were screened for potential cases of aplastic anemia and agranulocytosis according to defined criteria. Nineteen cases of aplastic anemia and five cases of agranulocytosis were found. The prevalence of the two conditions was discussed.