A 13-year-old girl with a history of relapsed acute lymphoblastic leukemia (ALL) underwent an UCT 6 months ago. She is engrafted without evidence of GVHD and is no longer receiving immunosuppression. She presents to the emergency department with a fever of 40.1°C and tachypnea. Her saturations are 88% while breathing room air so she is placed on low flow oxygen via nasal cannula. On examination, she is in obvious distress with increased work of breathing and decreased breath sounds in the left lower lung base with rhonchi. A chest radiograph is obtained which shows a large opacity in the left lower lung field with air-bronchograms and trace pleural effusion. Question: What vaccine-preventable infection should be considered? Answer:\nStreptococcus pneumoniae.
An 8-year-old boy, with a history of relapsed acute myeloid leukemia (AML) after an UCT, is admitted to the hospital to begin preparation for a second HCT, using a second UCB graft that will be infused in 7 days. On the third day of his myeloablative preparative chemotherapy, 4 days prior to infusion of his second transplant, he develops a temperature of 39.8°C. On examination, he is hypotensive (blood pressure is 64/32 mmHg) and tachycardic at 150 beats/min. His lungs are clear to auscultation. Blood cultures are obtained from his central line, and he is started on broad-spectrum empiric antibacterial antibiotics. He receives multiple fluid boluses and his hemodynamic status improves. Question: What is the likely underlying etiology of his hemodynamic change? Answer: Gram-positive infection of his central venous catheter.