Table 1.
Clinical, laboratories and treatment of case 1, female, 8 years old, with septicemia
| Time | First hospitalization (Oct 1st, 2022 – Dec 13th, 2022) | Second hospitalization | Third hospitalization | ||||
|---|---|---|---|---|---|---|---|
| Oct 1st | Oct 6th | Oct 14th | Nov 1st | Dec 1st | Jan 9th—16th, 2023 | Jan 27th – Feb 17th, 2023 | |
| Clinical | |||||||
| Temperature | 39 – 400 C | 390 C | 380 C | 38.20 C | No fever | 36.90C | No fever |
| Glasgow Come Scale | 15 | 15 | 15 | 15 | 15 | 15 | 15 |
| Pulse (times/min) | 100 | 150 | 130 | - | 86 | ||
| Blood pressure (mmHg) | 90/60 | 100/50 | - | - | 100/60 | ||
| Breathing (times/min) | 20 | 50 | 35 | 25 | |||
| Rale in the lungs | (-) | ( +) | ( +) | (-) | (-) | (-) | |
| SpO2 | 0.98 | 0.85 | 0.98 | 0.98 | |||
| Skin | Blister rash, scattered | Cloudy blisters, whole body | Blisters scab | Blisters scab | Blisters scab | Normal | |
| Other issues | Left shoulder ulcer 1 cm, yellow discharge | Right hand swelling | Swelling of right forearm and back of hand | Cellulitis, fluid leakage in the right hand | Pus-inflamed distal third of the right lower leg | Right heel abscess leaking pus | Right heel abscess without pus leakage |
| Swelling of the right hand and ankle joints on both sides | Bleeding at the site of infusion | Many small abscesses on both sides of the knee and left elbow | |||||
| Severe edematous extremities | |||||||
| Abdominal distended | |||||||
| Liver, spleen (below costal margin) | Spleen 2 cm | Enlarged liver and spleen | Normal | Normal | Normal | Normal | |
| Laboratorya | |||||||
| Red blood cells (T/L) | 4.63 | 3.67 | 3.39 | 3.92 | 4.59 | 5.13 | 5.82 |
| Hb (g/L) | 113 | 92 | 87 | 98 | 109 | 119 | 135 |
| Hct | 0.34 | 0.28 | 0.27 | 0.3 | 0.33 | ||
| White blood cells (G/L) | 19.8 | 5.7 | 5.9 | 11.5 | 6.2 | 5.5 | 5.5 |
| Neutrophil (%) | 83.6 | 75.5 | 68.1 | 75.9 | 49.6 | 34.4 | 42.3 |
| Platelet (G/L) | 232 | 12 | 167 | 534 | 336 | 287 | 257 |
| CD4 + T cells | 346 | ||||||
| CRP (mg/L) | 228.3 | 208.4 | 121.6 | 79 | 23.5 | 12.6 | |
| AST/ALT (U/L) | 114/259 | 106/193 | 184/170 | 30/9 | 33/16 | 15/32 | |
| Albumin/protein | - | 25/56 | 29 | 42/85 | |||
| Creatinine(mmol/L) | 38 | 37 | 23 | 27 | 35 | 34 | 44 |
| Na/K (mmo/L) | 132/3.4 | 135/3.0 | 131/3.8 | 139/3.6 | 134/3.6 | 137/3.9 | 137/4.2 |
| PT% | 0.75 | 0.76 | 0.73 | ||||
| APTT (s) | 35 | 31.4 | |||||
| Fibrinogen (g/L) | 5.15 | 4.98 | |||||
| D-Dimer (ng/ml) | 16015 | 16739 | 5241 | ||||
| Blood culture | ( +)b | (-) | (-) | (-) | |||
| Wound culture | (-) | (-) | (-) | ||||
| Urine test (protein; red cells) | 0.3 g/L; 200 | 1.0 g/L; 80 | (-) | (-) | |||
| X-Ray | Pneumonia | Pneumonia | Pneumonia | Osteitis of right wristc | Osteitis of right calcaneal | Multiple tunnel-like bone resorption in the right heel | |
| CT/MRI | Pneumonia, stable tuberculosis and osteomyelitis of the right handd | Left tibial osteomyelitis | |||||
| Diagnosis | Sepsis, complications of osteomyelitis due to C. Violaceum | Osteitis of calcaneal | Osteitis of calcaneal | ||||
| Treatment | - The combination of ceftazidime (02–04/10) and linezolid (01 – 11/10) | - Dredge the inflammation | - Inflammatory pulp curettage, ciprofloxacin + ceftriaxon | ||||
| - The combination of meropenem and ciprofloxacin (04 /10– 01/12) | Outpatient, oral moxifloxacin for 2 weeks | Outpatient, oral ciprofloxacin for 3 weeks | |||||
| Oral combination of levofloxacin and co-trimoxazole (01—13/12) | |||||||
| HFNC Flow, platelet transfusion: 150 ml (06/10) and 250 ml (07/10), Human albumin: 20 g (05, 06 and 07/10), red blood cell transfusion: 250 ml (05, 12 and 17/10) | |||||||
| The right hand: drainage (01/11) and curettage inflammation (12/11) | |||||||
| December 13th: discharged from hospital, oral levofloxacin for 28 days, follow-up every month | |||||||
aOther tests: including HIV test, influenza A, B, Covid -19, nasopharyngeal culture, and blister fluid culture,.doppler echocardiogram, cerebrospinal fluid analysis and brain CT scan. All results were negative
bBlood culture results after 3 days identified C. violaceum, sensitive to levofloxacin, ciprofloxacin, imipenem and resistant to Ceftazidime
cX-ray taken on November 18th
dMRI results: Lung scan on October 17th, metacarpal scan on October 19th