Sepsis due to Streptococcus pneumoniae associated with secondary hemophagocytic lymphohistiocytosis in a splenectomized patient for spherocytosis

Bîrluțiu, Victoria; Bîrluţiu, Rareş Mircea

doi:10.1097/md.0000000000007520

Cited by 10 publications

(10 citation statements)

References 47 publications

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“…[ 20,48 ] Consequently, the sensitivity and specificity of pH would need to be evaluated clinically, especially compared to inflammation from aseptic loosening (which is also interesting but would be treated differently). [ 13,49 ] Moreover, the threshold and required resolution would depend upon the application, for example in early screening versus confirmation or monitoring.…”

Section: Resultsmentioning

confidence: 99%

“…[ 11 ] The current standard of care involves arthrocentesis when an infection is suspected, where the joint is aspirated using a syringe to collect synovial fluid from the joint capsule and analyzed for white blood cell count and differential, crystals, Gram stain, and culture. [ 12,13 ] In addition, the synovial fluid contains infection biomarkers such as glucose, [ 14 ] low pH/high lactate concentrations, [ 15 ] C‐reactive protein, [ 16,17 ] interleukins, [ 18 ] interferon‐γ, [ 10 ] α defensin, [ 16 ] and cathelicidin [ 19 ] which can be useful for the diagnosis of infection.…”

Section: Introductionmentioning

confidence: 99%

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Synovial Fluid pH Sensor for Early Detection of Prosthetic Hip Infections

Wijayaratna

Kiridena

Adams

et al. 2021

Adv Funct Materials

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An implantable sensor developed to measure synovial fluid pH for noninvasive early detection and monitoring of hip infections using standard‐of‐care plain radiography is described. The sensor is made of a pH responsive polyacrylic acid‐based hydrogel, which expands at high pH and contracts at low pH. A radiodense tantalum bead and a tungsten wire are embedded in the two ends of the hydrogel to monitor the change in length of the hydrogel sensor in response to pH via plain radiography. The effective acid dissociation constant (pKa) of the hydrogel‐based pH sensor is 5.6 with a sensitivity of 3 mm/pH unit between pH 4 and 8. The sensor shows a linear response and reversibility in the physiologically relevant pH range of pH 6.5 and 7.5 in both buffer and bovine synovial fluid solutions with a 30‐minute time constant. The sensor is attached to an explanted prosthetic hip, and the pH response is determined from the X‐ray images by measuring the length between the tantalum bead and the radiopaque wire. Therefore, the developed sensor will enable noninvasive detection and studying of implant hip infection using plain radiography.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Synovial Fluid pH Sensor for Early Detection of Prosthetic Hip Infections

Wijayaratna

Kiridena

Adams

et al. 2021

Adv Funct Materials

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“…In Japan, the incidence of childhood HLH caused by bacterial infection accounts for about 6% of all IAHS cases [ 3 ], including Streptococcus pneumonia , Mycobacterium tuberculosis , Leptospira, Brucella, and group B hemolytic streptococcus, Streptococcus suis , Haemophilus influenzae , Klebsiella pneumonia , Staphylococcus aureus , Mycobacterium bovis , Salmonella typhimurium , Mycoplasma pneumonia , Q fever, Jungle typhus, etc. [ 4 – 9 ]. There is no report of S. intermedius brain abscess-induced HLH mentioned in literature before.…”

Section: Discussionmentioning

confidence: 99%

The first case of Streptococcus intermedius brain abscess with hemophagocytic histiocytosis

et al. 2022

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Background Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening immune syndrome associated with an excessive systemic inflammatory response. Viral infection caused HLH is the most common secondary HLH, but there are relatively few reports of HLH caused by bacterial infection. The present study is the first case of HLH caused by Streptococcus intermedia meningitis. Case presentation The patient is an 11-year-old and 9-month-old boy. The main symptoms are fever, headache, and vomiting. The imaging finding of the brain is cerebritis and brain abscess. The cerebrospinal fluid (CSF) routine test showed increased nucleated cells, but the smear and culture of CSF were negative. The metagenomics next-generation sequencing (mNGS) of CSF detected Streptococcus intermedius, and the body temperature of the children returned to normal after antibiotic treatment according to etiology. One week later, the child developed fever again, with Kawasaki disease-like manifestations. After high-dose immunoglobulin therapy, the body temperature returned to normal again. The routine blood test showed a progressive decrease in leukocytes and platelets, and bone marrow biopsy detected histiocytes phagocytosed blood cells. Then infection-associated hemophagocytic syndrome (IAHS) was diagnosed, high-dose methylprednisolone and sequential therapy were given and the patient’s recovery was encouraging. Conclusions Our case shows that HLH can also be secondary to Streptococcus intermediate infection, and early bone marrow biopsy is the golden standard for HLH diagnosis. mNGS can improve the detection sensitivity for pathogens when traditional pathogenic tests are negative. Conventional chemotherapy regimens may not be required for IAHS when high-dose glucocorticoids and immunoglobulin therapy are effective.

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“…Several studies have reported bacterial infection-associated HLH [7], including Mycoplasma pneumoniae [8,9], Listeria monocytogenes [10], Leptospira [11], Brucella [12], group B streptococcus [13], and Coxiella burnetii [14]. Secondary HLH caused by S. pneumococcus has been previously described in adults after splenectomy or with primary immunodeficiency [15,16]. However, there are very few cases of secondary HLH complicated with IPD in previously healthy children.…”

Section: Discussionmentioning

confidence: 99%

Hemophagocytic lymphohistiocytosis complicating invasive pneumococcal disease: a pediatric case report

et al. 2020

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Background: Hemophagocytic lymphohistiocytosis (HLH) is an infrequent but life-threatening disease due to excessive immune activation. Secondary HLH can be triggered by infections, autoimmune diseases, and malignant diseases. Streptococcus pneumoniae is a pathogenic bacterium responsible for invasive pneumococcal disease (IPD) such as meningitis and bacteremia. Although the pneumococcal conjugate vaccine (PCV) has led to reductions in IPD incidence, cases of IPD caused by serotypes not included in PCV are increasing. There are few reports of secondary HLH caused by IPD in previously healthy children. We herein report a rare case of a previously healthy boy with secondary HLH complicating IPD of serotype 23A, which is not included in the pneumococcal 13-valent conjugate vaccine (PCV-13). Case presentation: An 11-month-old boy who had received three doses of PCV-13 was hospitalized with prolonged fever, bilateral otitis media, neutropenia and elevated C-reactive protein (CRP) levels. Blood culture on admission revealed S. pneumoniae, leading to a diagnosis of IPD. HLH was diagnosed based on a prolonged fever, neutropenia, anemia, hepatosplenomegaly, hemophagocytosis in the bone marrow, and elevated serum levels of triglycerides, ferritin, and soluble interleukin-2 receptor. He received broad-spectrum antibiotics and intravenous immunoglobulins for IPD and high-dose steroid pulse therapy and cyclosporine A for HLH; thereafter, his fever resolved, and laboratory findings improved. The serotype of the isolated S. pneumoniae was 23A, which is not included in PCV-13. Conclusions: It is important to consider secondary HLH as a complication of IPD cases with febrile cytopenia or hepatosplenomegaly, and appropriate treatment for HLH should be started without delay.

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Sepsis due to Streptococcus pneumoniae associated with secondary hemophagocytic lymphohistiocytosis in a splenectomized patient for spherocytosis

Cited by 10 publications

References 47 publications

Synovial Fluid pH Sensor for Early Detection of Prosthetic Hip Infections

Synovial Fluid pH Sensor for Early Detection of Prosthetic Hip Infections

The first case of Streptococcus intermedius brain abscess with hemophagocytic histiocytosis

Hemophagocytic lymphohistiocytosis complicating invasive pneumococcal disease: a pediatric case report

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