Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Immuno-suppressed Child

Immuno-suppressed Child

Pdf Summary

The presentation by Jennifer A Muszynski, MD, MPH, FCCM at Nationwide Children’s Hospital and The Ohio State University College of Medicine focuses on the complexities and care involved in treating immunosuppressed children, addressing specifically those who have undergone solid organ and stem cell transplants.<br /><br />To facilitate understanding, the presentation is divided into several key modules. Initially, it provides an overview of the different types of immune deficiencies: congenital, acquired (e.g., HIV/AIDS, critical illness-induced), and exogenous (e.g., from autoimmune diseases, cancer treatments, or transplantations).<br /><br />A section is dedicated to the mechanisms and side effects of various immunosuppressive drugs. It includes anti-proliferative drugs like Cyclophosphamide, anti-metabolites like Azathioprine, cytotoxic drugs such as Actinomycin, and monoclonal antibodies like Rituximab.<br /><br />An additional focus is on CAR-T cell therapy, which involves genetically modifying patients’ T cells to target tumor cells. The associated complications such as cytokine release syndrome and neurotoxicity are also discussed, with treatment protocols including Tocilizumab and synthetic steroids.<br /><br />The presentation extensively covers infections that immunosuppressed children face. It provides insight into bacterial, viral (e.g., CMV, HSV, Adenovirus, JCV, VZV), and fungal infections (e.g., Candida, Aspergillus) and examines the associated risks and symptoms.<br /><br />Specific complications related to hematopoietic stem cell transplantation (HSCT) are examined, such as Graft-versus-Host Disease (GVHD), sinusoidal obstruction syndrome, and transplant-associated thrombotic microangiopathy. Treatments, including high-dose corticosteroids and Eculizumab, are highlighted.<br /><br />For solid organ transplantation, risks of infections and rejections (acute, hyperacute, chronic) are detailed. The presentation touches on strategies for monitoring and managing these risks, emphasizing the importance of a multidisciplinary approach.<br /><br />Finally, the discussion underscores the need for specialized prophylaxis, treatment for opportunistic infections, and careful immunosuppressive management to optimize outcomes for these vulnerable pediatric patients. <br /><br />In conclusion, understanding the diverse aspects of immune suppression and transplant management is crucial for improving the care of immunosuppressed children.

Keywords

immunosuppressed children

solid organ transplants

stem cell transplants

immune deficiencies

immunosuppressive drugs

CAR-T cell therapy

infections

hematopoietic stem cell transplantation

Graft-versus-Host Disease

prophylaxis

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