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[Yersinia enterocolitica infections and thalassemia major in children]
Insights
Severe Yersinia enterocolitica infections occurred in two children with thalassemia. Prompt discontinuation of deferoxamine and oral antibiotics are recommended for febrile diarrhea in thalassemic patients to prevent sepsis.
Area of Science:
- Infectious Diseases
- Hematology
- Pediatrics
Background:
- Thalassemia is a genetic blood disorder characterized by reduced hemoglobin production.
- Patients with thalassemia often require iron chelation therapy, such as deferoxamine, and are susceptible to infections.
- Yersinia enterocolitica is a bacterial pathogen that can cause gastrointestinal illness and systemic infections.
Observation:
- Two children with homozygous thalassemia presented with severe Yersinia enterocolitica infections.
- One child had septicemia, while the other had mesenteric adenitis.
- Iron overload and deferoxamine therapy were identified as potential factors increasing Yersinia enterocolitica infectivity.
Findings:
- The patient with mesenteric adenitis was successfully treated with laparotomy and cefotaxime-netilmicin.
- The patient with septicemia required multiple antibiotic regimens, with recovery achieved using rifampicin-netilmicin after initial treatments failed.
- This highlights the challenges in treating severe Yersinia infections in this patient population.
Implications:
- Yersinia enterocolitica infection can lead to severe complications, including septicemia, in children with thalassemia.
- Discontinuation of deferoxamine therapy and prompt initiation of oral antimicrobial treatment (e.g., trimethoprim-sulfamethoxazole) are crucial for thalassemic patients with febrile diarrhea.
- Early recognition and appropriate management are vital to prevent disseminated infection and improve outcomes in pediatric thalassemia patients.
Abstract:
We report two cases of severe Yersinia enterocolitica infection in children with homozygous thalassemia. One patient had septicemia and the other had mesenteric adenitis. Two factors can enhance the infectivity of Yersinia enterocolitica in children with thalassemia: iron overload and deferoxamine therapy. Laparotomy and cefotaxime-netilmicin therapy were successful in the patient with mesenteric adenitis. In the patient with septicemia, cefotaxime-netilmicin, then doxycycline-netilmicin failed, and recovery was finally achieved under rifampicin-netilmicin. Because of the possibility of septicemic dissemination secondary to digestive Yersinia enterocolitica infection in children with thalassemia, we advocate immediate discontinuation of deferoxamine and prescription of oral antimicrobial therapy (trimethoprim-sulfamethoxazole for instance) in every thalassemic patient with febrile diarrhea.