Clinical observation over the dynamic of the intrauteral mixed infection in the child of early age

Abstract

Difficulty in diagnosis of the intrauterine infections (IUI) is associated with the low specificity of clinical manifestations and the multiple organ injury, prolonged persistence of the pathogen in the body, a significant prevalence of mixed infections and their frequent combination with the somatic disorders in newborns. The clinical case of mixed intrauterine infection in the child of early age is presented. The full-term boy was under the observation, he was born with severe anemic syndrome, indirect hyperbilirubinemia and hepatosplenomegaly. According to clinical observation and ultrasound of the abdomen the size of his liver and spleen increased progressively for six days after birth, it was accompanied by dynamic increase of total bilirubin due to its direct fraction, decrease of platelets count. ELISA-diagnostics of the child’s serum revealed the presence of the anti-toxoplasma and anti-cytomegalovirus antibodies. Taking into account obtained clinical and paraclinical data, the newborn child was diagnosed with intrauterine mixed infection with primary hematopoietic and liver damage (cholestatic-cytolytic variant). Anti-toxoplasma immunoglobulin was administered to child, but because of severe liver injury specific causal treatment of toxoplasmosis was postponed due to its hepatotoxicity. Later on anemic syndrome with indirect hyperbilirubinemia recurrently repeated in a child, it was dependent on transfusions but refractory to treatment. The presence of DNA of CMV and herpes virus type 6 was confirmed by PCR in the dynamic study of the five-month old child’s blood. Taking into account the obtained results of the examination, the child was diagnosed with severe congenital cytomegalovirus infection in the replication phase and comorbid congenital nonspherocytic hemolytic anemia of unknown origin with continuous crisis. The patient received anti-cytomegalovirus ganciclovir intravenously, antiherpetic valaciclovir orally. As a result of the treatment positive clinical dynamics was observed, which was accompanied by a decrease of the hepatolienal syndrome and gaining weight, but multiple red blood cell transfusions were not accompanied by significant or prolonged rise in hemoglobin levels. After the treatment twice done PCR child’s blood tests for CMV DNA were negative. Taking into account the crisis duration of the disease, splenectomy was discussed. The clinical case refers to the rare clinical diagnostic situations in medical practice when it is difficult to make a final conclusion about the etiology of the IUI. Verification of the intrauterine mixed infection was problematic in the neonatal period and during follow-up. The complexity of the diagnostic process was caused by the absence of the typical neurological symptoms. The diagnosis of mixed IUI was complicated by coexistence of the congenital nonspherocytic hemolytic anemia, the genesis of which could not be set, despite the study of enzyme activity in red blood cells, assessment of their osmotic resistance and Coombs tests. Damage of the erythroid stem hematopoiesis probably was caused by the infectious factors during the intrauteral period as well as by the hereditary pathology of the erythron.