RESUMEN
Respiratory viruses are an important yet underestimated cause of infectious morbidity and mortality in immunocompromised children and adolescents. Here, we report the occurrence of fatal lower respiratory tract disease associated with human metapneumovirus (HMPV) infection in a 10-year-old girl with chronic graft-versus-host disease following allogeneic hematopoietic stem cell transplantation (HSCT) for secondary chronic myeloid leukemia. Symptoms occurred 8 months after HSCT while on immunosuppression with 0.2 mg/kg/day of prednisone, and presented as dry cough, bilateral pneumonitis, and progressive respiratory distress. Non-invasive and invasive microbiological investigations revealed HMPV type B as the sole pathogen. Histopathological findings showed interstitial and intra-alveolar pneumonitis with profound alveolar cell damage. The patient was treated with intravenous and oral ribavirin and polyvalent immunoglobulins, but ultimately died from respiratory failure. The case reflects the potentially fatal impact of infections by respiratory viruses in immunocompromised patients and the need for effective approaches to their prevention and treatment.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas/efectos adversos , Metapneumovirus/aislamiento & purificación , Infecciones por Paramyxoviridae/virología , Infecciones del Sistema Respiratorio/virología , Niño , Resultado Fatal , Femenino , Enfermedad Injerto contra Huésped/complicaciones , Humanos , Huésped Inmunocomprometido , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Infecciones por Paramyxoviridae/complicaciones , Infecciones por Paramyxoviridae/diagnóstico , Infecciones por Paramyxoviridae/patología , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/patología , Trasplante Homólogo/efectos adversosRESUMEN
AIM: Aim of our study was to evaluate BNP as early cardiotoxicity biomarker after completion of chemotherapy in twenty children with hematological malignancies at diagnosis (t=0) and after completion of intensive chemotherapy (t=1). METHODS: Demographic data, underlying disease, cumulative anthracyclines dose, measurement of serum BNP and evaluation of systolic function of left ventricle with ejection fraction (EF) and shortening fraction (FS) in both times . Pathological values for EF and FS were found in 4 (20%) and 1 (5%) patient at t=1, while respective values were normal at diagnosis. RESULTS: Mean BNP values at t=0 were 59.09±19.95 pg/mL and differ significantly from values at t=1 (153.22±29.14 pg/mL) (P=0.04). Mean value of EF also differed significantly (75.42±4.11% vs. 69.87±10.51%, P=0.04). No statistic difference was found regarding FS values at both (P=0.102). CONCLUSION: Present data indicate that anthracyclines related cardiotoxicity is registered in children with hematological malignancies and BNP represents a useful biomarker of myocardial dysfunction.