OBJECTIVE: To investigate the clinical characteristics and treatment of pneumocystis carinii pneumonia (PCP) in children with acute lymphoblastic leukemia (ALL), in order to improve the early diagnosis and effective treatment. METHODS: Clinical data of five children with ALL developing PCP in the post-chemotherapy granulocyte deficiency phase were analyzed retrospectively. The clinical manifestations, laboratory tests, imaging findings, treatment methods and effect were summarized. RESULTS: The male-to-female ratio of the five children was 1∶4, and the median age was 5.5 (2.9-8) years old. All patients developed PCP during granulocyte deficiency phase after induction remission chemotherapy. The clinical manifestations were generally non-specific, including high fever, tachypnea, dyspnea, non-severe cough, and rare rales in two lungs (wet rales in two patients). Laboratory tests showed elevated C-reactive protein (CRP), serum procalcitonin (PCT), (1,3)-β-D-glucan (BDG), lactate dehydrogenase (LDH) and inflammatory factors including IL-2R, IL-6 and IL-8. Chest CT showed diffuse bilateral infiltrates with patchy hyperdense shadows. Pneumocystis carinii(PC) was detected in bronchoalveolar lavage fluid (BALF) or induced sputum by high-throughput sequencing in all patients. When PCP was suspected, chemotherapy was discontinued immediately, treatment of trimethoprim-sulfame thoxazole (TMP-SMX) combined with caspofungin against PC was started, and adjunctive methylprednisolone was used. Meanwhile, granulocyte-stimulating factor and gammaglobulin were given as the supportive treatment. All patients were transferred to PICU receiving mechanical ventilation due to respiratory distress during treatment. Four children were cured and one died. CONCLUSION PCP should be highly suspected in ALL children with high fever, dyspnea, increased LDH and BDG, and diffuse patchy hyperdense shadow or solid changes in lung CT. The pathogen detection of respiratory specimens should be improved as soon as possible. TMP/SMZ is the first-line drug against PCP, and the combination of Caspofungin and TMP/SMZ treatment for NH-PCP may have a better efficacy. Patients with moderate and severe NH-PCP may benefit from glucocorticoid.
Caspofungin/therapeutic use* ; Child ; Child, Preschool ; Dyspnea ; Female ; Humans ; Male ; Pneumonia, Pneumocystis/therapy* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy* ; Respiratory Sounds ; Retrospective Studies

OBJECTIVE: To analyze the clinical characteristics of predictors in pediatric acute leukemia complicated with septic shock and explore the prognostic factors. METHODS: The clinical characteristics of 70 children with acute leukemia and complicated with septic shock hospitalized in Sun Yat-sen Memorial Hospital from March 2012 to March 2021 were retrospectively analyzed. The clinical characteristics of patients in survival group and death group were analyzed and compared. Multiple logistic regression was used to test for predictors of death. RESULTS: Among the 70 children, 41 were males and 29 were females, with a median age of 7.0 (1.0-15.0) years old. 81.4% were hospital acquired infections. The pathogens were mostly Gram-negative bacteria (50/66, 75.8%) and the clinical manifestations were cold shock. Mortality rate was 34.3% (24/70). The length of hospitalization, duration of fever and antibiotic exposure longevity before the onset of septic shock were significantly different between survival group and death group. At septic shock onset, compared with the survival group, patients in the death group were younger, had lower platelet counts and higher levels of C-reactive protein and procalcitonin, and were more likely to have acute heart failure and more mechanical ventilation (all p<0.05). The results of multivariable analysis showed that mortality was independently associated with pediatric sequential organ failure assessment score (pSOFA) (odds ratio: 1.616, 95% CI: 1.160-2.251, p=0.005) and acute heart failure (odds ratio: 18.308, 95% CI: 1.939-172.911, p=0.011). In addition, the ROC curve analysis showed that pSOFA score had AUC of 0.8551 (95% CI: 0.7607-0.9495, p<0.001) predicting PICU mortality and its best predictive value was >9.5 (sensitivity 75.0%, specificity 87.0%). CONCLUSION Pediatric acute leukemia complicated with septic shock is characterized as rapid deterioration and high mortality. A pSOFA score greater than 9.5 and acute heart failure are associated with poor outcomes.
Humans ; Child ; Adolescent ; Shock, Septic/complications* ; Retrospective Studies ; ROC Curve ; Leukemia ; Heart Failure

ObjectiveThe present study was conducted to investigate the protective effect on cardiac function and potential mechanism of Compound Danshen Dripping Pills （CDDPs） on myocardial ischemia reperfusion in rats. MethodsThirty two male SD rats were underwent cardiac reperfusion following 45 minutes of left anterior descending coronary artery ligation， and randomly divided into 4 groups （n= 8 ）， rats in each group were given different doses of CDDPs （40，80，120 mg·kg^-1·d^-1 ）， or normal saline （control group） by gavage. Another 8 rats underwent similar procedure but without LAD ligation were set as sham group （were also given same volume of normal saline by gavage）. The treatment lasted for 4 weeks. Then echocardiography was conducted to evaluate the end-point cardiac function. HE and Masson’s trichrome staining were performed to observe the change of histomorphology and fibrosis. CD31/α-SMA immunofluorescence was implemented to investigate the endothelial to mesenchymal transition in cardiac microvessels. Western Blot was used to analyze the expression of α-SMA and CD31 in ventricular tissue of infarcted border zone. Data were analyzed by one-way ANOVA or Kruskal-Wallis H non-parametric test. ResultsCompared with normal saline group， treatment with different doses of CDDP could increase ejection fraction and fractional shortening significantly （P＜0.05 at least）， decrease left ventricular end-diastolic volume and the E/A ratio significantly （P＜0.05 at least）， reduce the cardiac collagen volume fraction （both P<0.05）， and suppress the expression of mesenchymal marker α-SMA in cardiac microvessels detected by immunofluorescent staining（P＜0.05 at least）， and decrease the expression of α-SMA and increase the expression of CD31 in ventricular tissue of infarcted border zone detected by Western blot. ConclusionTreatment with 40/80/120 mg·kg^-1·d^-1 doses of CDDPs for 4 weeks could improve cardiac function in rats underwent ischemia-reperfusion， this might be through reducing the occurrence of endothelial to mesenchymal transition in microvessels within heart tissue， and subsequently decreasing the cardiac fibrosis.

Humans ; Islets of Langerhans Transplantation