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一名β地中海贫血患者在无症状COVID-19感染后发生播散性spp.心内膜炎。

Disseminated spp. Endocarditis in a Beta-Thalassemia Patient after Asymptomatic COVID-19 Infection.

作者信息

Cinteza Eliza, Nicolescu Alin, Ciomartan Tatiana, Gavriliu Liana-Cătălina, Voicu Cristiana, Carabas Adelina, Popescu Monica, Margarint Irina

机构信息

Department of Pediatrics, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Department of Pediatric Cardiology, "Marie Curie" Emergency Children's Hospital, 041451 Bucharest, Romania.

出版信息

Diagnostics (Basel). 2022 Mar 8;12(3):657. doi: 10.3390/diagnostics12030657.

Abstract

spp. is a group of fungi belonging to the order. Cases of fungal endocarditis are sporadic, but more frequent in immunocompromised patients. COVID-19 (SARS-CoV-2 Infection Disease 2019) infections, prematurity, deferoxamine treatment, iron overload, neutropenia, diabetes, and malignant hemopathies proved to be risk factors for mucormycosis. We present the case of a 7-year-old boy who was treated every three weeks with blood transfusion for major beta-thalassemia, receiving deferoxamine for secondary hemochromatosis. After two weeks with nonspecific respiratory and digestive symptoms, he was admitted for fever, followed by lower limb ischemia and neurological signs. Echocardiography revealed massive endocarditis affecting the mitral and tricuspid valves with embolization phenomena in the brain, lungs, kidney, spleen, and lower limbs. As a particular finding, IgG antibodies for COVID-19 were positive. Emergency cardiac surgery was performed. The mitral valve necessitated replacement with CarboMedics prosthesis. Unfortunately, the patient did not survive. spp. was confirmed via the PCR analysis of vegetations. endocarditis in the context of a systemic infection presented as an opportunistic infection affecting a child who had several risk factors. Mucormycosis is challenging to treat, with high mortality. Prophylactic treatment in beta-thalassemia patients with iron-chelator deprivation drugs, such as deferiprone, may help in preventing these particular fungal infections.

摘要

spp.是属于该目的一组真菌。真菌性心内膜炎病例较为散发性,但在免疫功能低下患者中更为常见。事实证明,2019冠状病毒病(新冠病毒感染疾病2019)感染、早产、去铁胺治疗、铁过载、中性粒细胞减少、糖尿病和恶性血液病是毛霉菌病的危险因素。我们报告了一名7岁男孩的病例,他因重型β地中海贫血每三周接受一次输血治疗,并因继发性血色素沉着症接受去铁胺治疗。在出现非特异性呼吸道和消化道症状两周后,他因发热入院,随后出现下肢缺血和神经症状。超声心动图显示大量心内膜炎累及二尖瓣和三尖瓣,并伴有脑、肺、肾、脾和下肢的栓塞现象。特别值得一提的是,新冠病毒IgG抗体呈阳性。进行了急诊心脏手术。二尖瓣需要用CarboMedics人工瓣膜置换。不幸的是,患者未能存活。通过对赘生物的PCR分析确诊为spp.。全身性感染背景下的心内膜炎表现为机会性感染,影响了一名有多种危险因素的儿童。毛霉菌病治疗具有挑战性,死亡率很高。对β地中海贫血患者使用铁螯合剂剥夺药物(如去铁酮)进行预防性治疗,可能有助于预防这些特殊的真菌感染。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c24f/8946993/37fba5a9c3a9/diagnostics-12-00657-g001.jpg

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