Abstract
Background: Hospital-acquired infection, often with Staphylococcus aureus, is an important complication in intestinal transplant.
Clinical case: A 2-year-old girl underwent small bowel transplantation owing to a small bowel volvulus. On the first postoperative day, lymphocyte phenotypes, serum immunoglobulins and chemotactic and phagocytic activity of neutrophils were assessed in peripheral blood. A decrease in the ingestion phase of phagocytosis by neutrophils was identified, in comparison with the results of 20 healthy children. On the second day, the patient had low fever and, on the third, abdominal pain. In view of this, she underwent a laparotomy that revealed purulent ascites due to Staphylococcus aureus. Specific treatment resulted in rapid regression of the infectious condition and good evolution of the patient.
Conclusions: A decrease in the ingestion stage of phagocytosis by neutrophils preceded staphylococcal purulent ascites clinical manifestations, and immunologic assessment contributed to early diagnosis and treatment of the infection. We believe evaluation of neutrophilic activity is important in patients undergoing intestinal transplantation in order for possible hospital-acquired infections to be early diagnosed.
References
Primeggia J, Matsumoto CS, Fishbein TM, Karacki PS, Fredette TM, Timpone JG. Infection among adult small bowel and multivisceral transplant recipients in the 30-day postoperative period. Transpl Infect Dis. 2013;15(5):441-448. DOI: http://dx.doi.org/10.1111/tid.12107
Naspitz CK, Solé D, Carneiro-Sampaio MMS, Gonzalez CH. Níveis séricos de IgG, IgM, IgA em crianças brasileiras normais. J Pediatr. 1982;52(3):121-126.
De-Moraes-Pinto MI, Ono E, Santos-Valente EC, Almeida LC, De-Andrade PR, Saraiva-Dinelli MI, et al. Lymphocyte subsets in human immunodeficiency virus-unexposed Brazilian individuals from birth to adulthood. Mem Inst Oswaldo Cruz. 2014;109(8):989-998. DOI: http://dx.doi.org/10.1590/0074-0276140182
Forte WC, Guardian VC, Mantovani PA, Dionigi PC, Menezes MC. Evaluation of phagocytes in atopic dermatitis. Allergol Immunopathol (Madr). 2009;37(6):302-308. DOI: http://dx.doi.org/10.1016/j.aller.2009.06.003
Mosca T, Menezes MC, Silva AV, Stirbulov R, Forte WC. Chemotactic and phagocytic activity of blood neutrophils in allergic asthma. Immunol Invest. 2015;44(5):509-520. DOI: http://dx.doi.org/10.3109/08820139.2015.1041606
Menezes MC, Malafronte P, Souza JF, Sens YA, Forte WC. Evaluation of neutrophilic activity in patients submitted to kidney transplantation. Ren Fail. 2010;32(4):464-468. DOI: http://dx.doi.org/10.3109/08860221003664272
Neves-Forte WC. Imunologia do básico ao aplicado. Tercera edición. Brasil: Atheneu; 2015.
Angele MK, Faist E. Clinical review: Immunodepression in the surgical patient and increased susceptibility to infection. Crit Care. 2002;6(4):298-305. DOI: http://dx.doi.org/10.1186/cc1514
Simitsopoulou M, Walsh TJ, Kyrpitzi D, Petraitis V, Kontoyiannis DP, Perlin DS, Roilides E. Methylprednisolone impairs conidial phagocytosis but does not attenuate hyphal damage by neutrophils against exserohilum rostratum. Med Mycol. 2015;53:189-193. DOI: http://dx.doi.org/10.1093/mmy/myu034
Simon D, Vassina E, Yousefi S, Kozlowski E, Braathen LR, Simon HU. Reduced dermal infiltration of cytokine-expressing inflammatory cells in atopic dermatitis after short-term topical tacrolimus treatment. J Allergy Clin Immunol. 2004;114(4):887-895. DOI: http://dx.doi.org/10.1016/j.jaci.2004.05.066

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