Pathogen screening and prognostic factors in children with severe ARDS of pulmonary origin

Phung, Thuy Thi Bich; Suzuki, Tadaki; Phan, Phuc Huu; Kawachi, Shoji; Furuya, Hiroyuki; Thu, Huong Nguyen; Kageyama, Tsutomu; Tuan, Ta Anh; Đao, Nam Huu; Nunoi, Hiroyuki; Tran, Dien Minh; Le, Hai Thanh; Nakajima, N.

doi:10.1002/ppul.23694

Cited by 20 publications

(18 citation statements)

References 39 publications

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“…It is characterized by inflammatory obstruction of the small airways and hyperinflation of the lungs and typically presents along with breathing problems and wheezing. RSV is the primary causative agent of bronchiolitis worldwide, causing between 70 or 80 percent of ARIs during the high season [18][19][20]. RSV was the only virus associated with bronchiolitis in this study.…”

Section: Discussionmentioning

confidence: 53%

Clinical and Pathogenic Characteristics of Lower Respiratory Tract Infection Treated at the Vietnam National Children’s Hospital

Pham

Nguyen

Tran

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Lower respiratory tract infections are commonly caused by viruses and cause significant morbidity and mortality among children. Early identification of the pathological agent causing these infections is essential to avoid unnecessary antibiotic use and improve patient management. Multiplex PCR techniques were recently developed to detect multiple viral pathogens using a single PCR reaction. In this study, we identify viral pathogens in children with respiratory infections. We collected 194 nasopharyngeal aspirates from infants (2-24 months old) with lower respiratory tract infections treated at the Vietnam National Children's Hospital between November 2014 and June 2015 and assessed the presence of 16 virus types and subtypes by multiplex PCR using the xTAG Respiratory Viral Panel (RVP) assay. Overall, 73.7% of the samples were positive for at least one virus, and 24.2% corresponded to infections with multiple viruses. e most common viruses were respiratory syncytial virus and enterovirus/ rhinovirus. ese viruses were more frequent among younger patients (2-5 months old) and caused symptoms similar to those of bronchiolitis and pneumonia. e most common clinical manifestation caused by respiratory tract infection was bronchiolitis. Elevated neutrophils levels were associated with adenovirus infection. Our results showed that the xTAG Respiratory Viral Panel (RVP) can effectively detect multiple viruses causing respiratory infections in children and that the nasopharyngeal aspirates are a good sample choice to detect respiratory viruses in children. Applying this approach in the clinical setting would improve patient management and allow early diagnosis, thus avoiding the unnecessary use of antibiotics.

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Section: Discussionmentioning

confidence: 53%

Clinical and Pathogenic Characteristics of Lower Respiratory Tract Infection Treated at the Vietnam National Children’s Hospital

Pham

Nguyen

Tran

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…Fungal infections are hardly ever the first pathogens Fig. 3 CT scan of the lung on day 12 after admission thought of, but fungal coinfections were described in children suffering ARDS due to viral infection [2]. Risk factors for fungal infections in ICU-patients are numerous, including immunosuppressive drugs and the differentiation of contamination or infection in nonhematological patients is challenging.…”

Section: Discussionmentioning

confidence: 99%

“…Polimicrobial infections are seen regularly in immunocompromised critically ill patients. Fungal coinfections were described in children [2] and adults suffering ARDS [3,4] due to viral infections. Pneumocystis jiroveci is often found in immunocompromised patients [5], as is the reactivation of Cytomegalovirus [6].…”

Section: Introductionmentioning

confidence: 99%

A case report of fatal disseminated fungal sepsis in a patient with ARDS and extracorporeal membrane oxygenation

et al. 2020

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Background: With the following report we want to present an unusual case of a patient suffering from acute respiratory distress syndrome with early discovery of bacterial pathogens in bronchoalveolar liquid samples that developed a fatal undiscovered disseminated fungal infection. Case presentation: A 67-year-old man was admitted to our university hospital with dyspnea. Progressive respiratory failure developed leading to admission to the intensive care unit, intubation and prone positioning was necessary. To ensure adequate oxygenation and lung protective ventilation veno-venous extracorporeal membrane oxygenation was established. Despite maximal therapy and adequate antiinfective therapy of all discovered pathogens the condition of the patient declined further and he deceased. Postmortem autopsy revealed Mucor and Aspergillus mycelium in multiple organs such as lung, heart and pancreas as the underlying cause of his deterioration and death. Conclusion: Routine screening re-evaluation of every infection is essential for adequate initiation and discontinuation of every antiinfective therapy. In cases with unexplained deterioration and unsuccessful sampling the possibility for diagnostic biopsies should be considered.

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“…In addition, the serum levels of INF-γ and IL-6 also decreased after the administration of rTM. We previously reported that serum level of INF-γ on the intubation day was one of the possible prognostic factors affecting a fatal outcome in a child with severe ARDS of pulmonary origin [ 19 ]. On the basis of the previous results, poor outcome might be predicted in the present case.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous pneumonia-induced severe ARDS complicated with DIC in a female child: a case of successful treatment

et al. 2018

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BackgroundTuberculous (TB) pneumonia can induce acute respiratory distress syndrome (ARDS). Although TB pneumonia is one of the causes of disease and death among children worldwide, the literature on TB pneumonia-induced ARDS is limited. We report herein on the successful treatment of a two-year-old female child with TB pneumonia-induced severe ARDS complicated with disseminated intravascular coagulation (DIC).Case presentationA two-year-old Vietnamese female child with sustained fever and cough for 20 days was transferred to our hospital. She had severe dyspnea and a chest X-ray showed bilateral infiltration without findings of heart failure. After tracheal intubation, her oxygenation index (OI) and PaO2/FiO2 (PF) ratio were 29 and 60 mmHg, respectively. Mycobacterium tuberculosis was detected by real-time polymerase chain reaction (rPCR) assay of tracheal lavage fluid. She was diagnosed as having severe ARDS that developed from TB pneumonia. Anti-tuberculous therapy and cardiopulmonary support were started. However, her respiratory condition deteriorated despite treatment with high-frequency oscillating ventilation (HFO), vasopressor support, and 1 g/kg of immunoglobulin. On the third day after admission, her International Society on Thrombosis and Hemostasis DIC score had increased to 5. Recombinant human soluble thrombomodulin (rTM) was administered to treat the DIC. After the administration of rTM was completed, OI gradually decreased, after which the mechanical ventilation mode was changed from HFO to synchronized intermittent mandatory ventilation. The DIC score also gradually decreased. Plasma levels of soluble receptor for advanced glycan end products (sRAGE) and high mobility group box 1 (HMGB-1), which are reported to be associated with ARDS severity, also decreased. In addition, inflammatory biomarkers, including interferon-gamma (IFN-γ) and interleukin-6 (IL-6), decreased after the administration of rTM. Although severe ARDS (P/F ratio ≦ 100 mmHg) continued for 19 days, the patient’s OI and P/F ratio improved gradually, and she was extubated on the 27th day after admission. The severe ARDS with DIC was successfully treated, and she was discharged from hospital on day 33 post-admission.ConclusionsWe successfully treated a female child suffering from TB pneumonia-induced severe ARDS complicated with DIC using multimodal interventions. (338/350).

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Pathogen screening and prognostic factors in children with severe ARDS of pulmonary origin

Cited by 20 publications

References 39 publications

Clinical and Pathogenic Characteristics of Lower Respiratory Tract Infection Treated at the Vietnam National Children’s Hospital

Clinical and Pathogenic Characteristics of Lower Respiratory Tract Infection Treated at the Vietnam National Children’s Hospital

A case report of fatal disseminated fungal sepsis in a patient with ARDS and extracorporeal membrane oxygenation

Tuberculous pneumonia-induced severe ARDS complicated with DIC in a female child: a case of successful treatment

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