HEMOPHAGOSYTIC SYNDROME IN A CHILD WITH SEPSIS CAUSED BY SERRATIA PROTEAMACULANS

Abstract

A clinical case of development of secondary hemophagocytic syndrome is presented on the background of sepsis caused by Serratia proteamaculans, in a child of monthly age, culminating in recovery. Hemophagocytic syndrome in the child developed on the 32nd day of life and was accompanied by fever, hepatosplenomegaly, anemia, thrombocytopenia, elevated blood levels of triglycerides and ferritin. Blood culture was positive for Serratia proteamaculans. Isolate of Serratia proteamaculans was resistant to aminopenicillins (including protected ones), 1–4 generations of cephalosporins and aminoglycosides but sensitive to ciprofloxacin and moderately sensitive to imipenem and meropenem. The duration of fever in the child was seven days, thrombocytopenia, hyperfertritinemia and hypertriglyceridemia – 28 days. The normalization of the indices of ferritin, triglycerides and platelets coincided with the reduction of bacteremia and high values of the C-reactive protein. The duration of bacteremia was three weeks: the isolation of Serratia proteamaculans from the blood occurred three times. Elevated levels of C-reactive protein in the blood were noted for 30 days. Reduced hemoglobin and red blood cells counts were noted for eight weeks. Positive dynamics of the hemophagocytic syndrome occurred as a result of measures aimed at treating sepsis – antibiotic therapy with imipenem in combination with ciprofloxacin, appointed by the decision of the medical commission on the basis of the sensitivity of Serratia proteamaculans to antibiotics, intravenous immunoglobulin, and infusion therapy. Glucocorticosteroids and cytotoxic agents (etoposide, cyclosporin A) have not been used in this case.

Keywords

• сепсис
• serratia proteamaculans
• гемофагоцитарный синдром