A RARE CASE OF NOSOCOMAL INFECTION WITH CORONA VIRUS OC43 IN RHIZOMELIC CHONDRODYSPLASIA

Rhizomelic chondrodysplasia punctata type 1 is an inherited disease with extremely rare presentation. It affects 1 in 100,000 individuals [2]. Rhizomelic chondrodysplasia punctata is associated with significantly delayed development and severe mental retardation. Most children with this condition do not achieve developmental milestones and has growth retardation. RCDP is an autosomal-recessive disease caused by mutations in the PEX7 gene. In this article I presented a a rare case of patient with Rhizomelic chondrodysplasia punctata type 1 admitted with pneumonia then he has been infected by nosocomal infection with corona virus and RSV that necessitate shifting him to PICU. At the end due to the severity of respiratory problems of individuals with Rhizomelic chondrodysplasia it becomes the corona virus more dangerous and aggressive then we needs to special caution and high rate of care from both therapeutic and preventive standpoints. Chest x-ray showed : Bilateral peribronchial wall thickening related to small airway disease , associated with irregular opacity seen at the right lung lower zone, possibly due to early pneumonia. The cardiomediastinal silhouette is unremarkable . No pleural effusion or pneumithorax ,No interval change. Then he had been shifted to the ward as case of pneumonia, He was on IV fluid maintenance ,hypertonic solution q6hr , cefuroxime , acetaminophen drops PRN , salbutamol q6hr PRN. After that he had been investigated by nasopharyngeal aspirate specimen and Chest x-ray. coronavirus OC43 and RSV was detected on nasopharyngeal aspirate specimen . Chest x-ray showed: interval worsening of lung base aeration, more on the left side . the rest of the finding appear unchanged. rhizomelic chondrodysplasia punctata.

If mother and father both are carriers, the chances of getting affected for a child is 25% in each pregnancy; therefore, it is of utmost importance that the reproductive partner of a carrier be offered testing. A negative does not eliminate the possibility of inheritance of the gene mutation by the child. Rhizomelic chondrodysplasia punctata is associated with significantly delayed development and severe mental retardation. Most children with this condition do not achieve developmental milestones and has growth retardation. These children may also have seizure episodes. It is generally associated with recurrent respiratory infections and breathing problems which may be life threatening. Because of their severe health problems, most children with this do not survive long. It is rare for affected child to live past age 10. The milder form of this disease is characterized milder degrees of rhizomelia along with growth and mental retardation. Distinctive facial features such as prominent forehead, widely set eyes, sunken appearance of face, small nose. Additionally, almost all affected individuals present with cataract. The cataracts are apparent at birth (congenital) or develop in early infancy like in our patient.

ISSN: 2320-5407
Int. J. Adv. Res. 6(1), 1396-1401 1397 Case Report:-This is a 10 months old boy, presented to ED due to of cough and excessive secretion for 2 days .He is a known case of Rhizomelic type chondrodysplasia punctata type 1 ,History of Left kidney grade 1 hydronephrosis, Left inguinal hernia , moderate ASD and small PDA , Bilateral congenital cataract status post Bilateral lens aspiration and anterior vitrectomy, Gastroesophageal reflux disease on ranitidine, On Gastrostomy feeding tube since birth .He was in his usual state of health until 2 days before He presented to ED with cough that awakes him from sleeping associated with excessive secretion , Shortness of breath and posttussive vomiting twice a day ,He had histort of contact with sick person. He had history of previous admission in PICU 3 month ago intubated and connected to mechanical ventilation due to viral bronchiolitis for 1 month.
No history of fever, Upper respiratory tract infection symptoms, cyanosis or apnea , or change bowel habit , No history of abnormal urinary symptom ,No history of abnormal movement ,No history of skin rash.
Past History: Antenatal and Birth history: Uneventful pregnancy , product of NSVD, admission to ICU due to chondrodysplasia for investigation put on nasal cannula ,stay for 2 month +12 day Immunization: received only birth vaccine Developmental History : developmental milestones of 1 month old , gross motor: turns head side to side. Speech: cries , social : calms when comfortable . Family History : + consanguinity , father he is soldier ,healthy , mother she is house wife ,healthy , 3 sibling 1 st one girl ,5 years old healthy has rhizomelic type chondrodysplasia punctata type 1, 2 nd one girl 3 years old healthy , The patient is the 3ed one, No hx of chronic disease , hereditary or genetic run in family . 1398 Chest x-ray showed : Bilateral peribronchial wall thickening related to small airway disease , associated with irregular opacity seen at the right lung lower zone, possibly due to early pneumonia. The cardiomediastinal silhouette is unremarkable . No pleural effusion or pneumithorax ,No interval change.
Then he had been shifted to the ward as case of pneumonia, He was on IV fluid maintenance ,hypertonic solution q6hr , cefuroxime , acetaminophen drops PRN , salbutamol q6hr PRN. After that he had been investigated by nasopharyngeal aspirate specimen and Chest x-ray. coronavirus OC43 and RSV was detected on nasopharyngeal aspirate specimen .
1399 Chest x-ray showed: interval worsening of lung base aeration, more on the left side . the rest of the finding appear unchanged.
Patient showed signs of Respiratory distress with multiple desating down to 40s. He had one episode of apnea observed at night, relived with stimulation, face mask and in some occasion with suctioning. That necessitate shifting him to PICU .He required 2L OXYGEN through Nasal cannula and salbutamol. patient was on clindamycin and ceftrixone.

Discussion:-
Human coronaviruses are known causes of the common cold. Subtype OC43 (HCoV-OC43) is the more prevalent human coronavirus in several parts of the world. Recent studies have suggested these viruses can cause severe lower respiratory tract illnesses in children , but Due to the severity of respiratory problems of individuals with Rhizomelic chondrodysplasia punctata might indicate the bad prognosis and a major cause of morbidity and mortality when he infected with this virus. Because of that they are needs to special caution and high rate of care from both therapeutic and preventive standpoints. And when worsening the patent condition like in our patient we shifted him to PICU to received a proper care.

Conclusion:-
Due to the severity of respiratory problems individuals with RCDP require the influenza vaccine and RSV monoclonal antibody. There has been no systematic study for oral plasmalogen supplementation to determine clinical benefits.
RCDP is a rare presentation in paediatric age group. There is no cure for RCDP. Unfortunately, most children do not survive after age of 10. Diagnosis was done mainly on the basis of clinical examination and investigations such as X-rays. We concluded that, Management of RCDP is symptomatic and supportive and may include physiotherapy and orthopedic procedures (in later stages) to improve function. The child may also undergo cataract surgery to improve vision.