Sepsis with Staphylococcus aureus in child with selective IgA deficiency and SARS-CoV-2 infection - case presentation

Abstract

Sepsis is one of the most severe pediatric infectious diseases that can progress to serious complications or even death without specialized treatment. It often evolves as a complication of a viral illness or against the background of a depressed host immune terrain. SARS-CoV-2 infection is a self-limiting viral infection in children, which is rarely complicated, especially in immunocompromised or co-morbid individuals. In this paper we present a clinical case of a 1 year and 2 months old child admitted to the Pediatric Infectious Diseases Clinical Department IX of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” with the diagnosis of SARS-CoV-2 infection. The positive diagnosis was established on epidemiological data (parents with SARS-CoV-2 infection), suggestive clinical picture (fever, inappetence, vomiting) and confirmed by RT-PCR. 72 hours after admission, with favorable clinical evolution, the child presented again fever and chills. Laboratory investigations show leukocytosis with neutrophilia, inflammatory syndrome present and, in nasal exudate and blood culture, staphylococcus aureus MSSA is isolated. Also, immunogram shows low IgA level, the rest of the laboratory tests are within normal limits. Antibiotic treatment was instituted, symptomatic hydroelectrolytic and acid-base rebalancing infusions with favorable evolution. The case presented shows that although SARS-CoV-2 infection is often a mild condition in children, it can evolve severely, especially in immunosuppressed individuals with comorbidities. The presented child was not known to have selective IgA immunodeficiency, which probably in combination with COVID-19 induced immunosuppression, favored the development of sepsis.