{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:30:14Z","timestamp":1784194214996,"version":"3.55.0"},"reference-count":17,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T00:00:00Z","timestamp":1655769600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>Nocardia<\/jats:italic> infections are rare opportunistic infections in SOT recipients, with few reported pediatric cases. Pediatric patients with single ventricle congenital heart defects requiring HT may be more susceptible to opportunistic infections due to a decreased T\u2010cell repertoire from early thymectomy and potential immunodeficiencies related to their congenital heart disease. Other risk factors in SOT recipients include the use of immunosuppressive medications and the development of persistent lymphopenia, delayed count recovery and\/or lymphocyte dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We report the case of a patient with hypoplastic left heart syndrome who underwent neonatal congenital heart surgery (with thymectomy) prior to palliative surgery and 2 HTs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After developing respiratory and neurological symptoms, the patient was found to be positive for <jats:italic>Nocardia farcinica<\/jats:italic> by BAL culture and cerebrospinal fluid PCR. Immune cell phenotyping demonstrated an attenuated T and B\u2010cell repertoire. Despite antibiotic and immunoglobulin therapy, his symptoms worsened and he was subsequently discharged with hospice care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Pediatric patients with a history of congenital heart defects who undergo neonatal thymectomy prior to heart transplantation and a long\u2010term history of immunosuppression should undergo routine immune system profiling to evaluate for T\u2010 and B\u2010cell deficiency as risk factors for opportunistic infection. Such patients could benefit from long\u2010term therapy with TMP\/SMX for optimal antimicrobial prophylaxis, with desensitization as needed for allergies. Disseminated nocardiosis should be considered when evaluating acutely ill SOT recipients, especially those with persistent lymphopenia and known or suspected secondary immunodeficiencies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14344","type":"journal-article","created":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T11:42:20Z","timestamp":1655811740000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Fatal nocardiosis infection in a pediatric patient with an immunodeficiency after heart <scp>re\u2010transplantation<\/scp>"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7661-6010","authenticated-orcid":false,"given":"Daniel H.","family":"Mai","sequence":"first","affiliation":[{"name":"Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3372-5094","authenticated-orcid":false,"given":"Jennifer","family":"Sedler","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1922-9131","authenticated-orcid":false,"given":"Kenneth","family":"Weinberg","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7761-5853","authenticated-orcid":false,"given":"Daniel","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9725-3279","authenticated-orcid":false,"given":"Alan","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2639-7053","authenticated-orcid":false,"given":"Roshni","family":"Mathew","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0576-0856","authenticated-orcid":false,"given":"Sharon","family":"Chen","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Lee","sequence":"additional","affiliation":[{"name":"Lucile Salter Packard Children's Hospital at Stanford  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4980-2234","authenticated-orcid":false,"given":"John C.","family":"Dykes","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0818-3150","authenticated-orcid":false,"given":"Seth A.","family":"Hollander","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,21]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13509"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1086\/514340"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw241"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.774780"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.02.028"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI39269"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.2741\/3896"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.130.5.2401"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2010.237172"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-02-139154"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.7.2.213"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-197711000-00015"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/14653249.2012.715243"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.20921"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3062.2000.020306.x"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13587"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2710.210620"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.14344","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/petr.14344","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.14344","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T10:04:54Z","timestamp":1724839494000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.14344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,21]]},"references-count":17,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1111\/petr.14344"],"URL":"https:\/\/doi.org\/10.1111\/petr.14344","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,21]]},"assertion":[{"value":"2022-03-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14344"}}