Cell-Free DNA Sequencing, Pathogen Detection, and the Journey to Value
| Autor: | Catherine S. Forster, John M. Morrison, Sonya C. Tang Girdwood |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Urinalysis Pediatrics Gastroenterology 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Internal medicine medicine Humans Blood culture 030212 general & internal medicine medicine.diagnostic_test business.industry Septic shock General Medicine Sequence Analysis DNA medicine.disease Rash Leukocyte esterase Shock (circulatory) Pediatrics Perinatology and Child Health Vancomycin Kawasaki disease medicine.symptom business Cell-Free Nucleic Acids medicine.drug |
| Zdroj: | Hospital pediatrics. 10(9) |
| ISSN: | 2154-1671 |
| Popis: | A previously healthy 9-month-old girl presented to the emergency department for fever, rash, and decreased urine output for 3 days. She was in compensated shock: temperature of 39.6°C, heart rate of 168 beats per minute, and blood pressure of 130/63. Her examination was notable for a diffuse blanching rash. Laboratory studies showed an elevated procalcitonin of 21.74 ng/mL, normal white blood cell count of 7.90 K/µL, and elevated creatinine of 0.36 mg/dL. Urinalysis demonstrated large blood, negative nitrites, trace leukocyte esterase, and 30 to 49 white blood cells per high-power field. Renal ultrasound was consistent with pyelonephritis. Because of concern for septic shock, she was given 60 mL/kg of normal saline and ceftriaxone and transferred to the PICU. In the PICU, vancomycin was added on the first day of admission because of worsening clinical status. She required vasopressor support with epinephrine for 2 days. Her initial microbiologic evaluation was unrevealing: urine culture grew 1000 to 9000 colony-forming units of normal flora, blood culture was negative, and respiratory pathogen panel result was positive for rhinovirus. Abdominal ultrasound on hospital day 1 showed developing left perinephric abscesses. Her rash worsened, and she developed lip peeling and conjunctivitis on day 2, concerning for Kawasaki disease or a toxin-mediated process, typically caused by Staphylococcus aureus or Streptococcus pyogenes. Because it is unusual for either pathogen to cause pyelonephritis in infants, and because the patient had persistent fevers, a blood sample was sent for sequencing of microbial cell-free DNA (cfDNA) on day 3. On day 7, testing resulted with evidence of S aureus in the blood. She was switched from vancomycin and ceftriaxone to ceftaroline for methicillin-sensitive … |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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