Characteristics of Postpartum Japanese Mothers Who Were Nonrespondents to the Japan Environment and Children’s Study

Case ReportA 6-month-old girl was admitted to the intensive care unit of a tertiary pediatric hospital for shortness of breath and respiratory distress for three days following one month of cough.A er ve days antibiotics therapy (amoxicillin sulbactam for three days followed by meropenem for two days), chest CT scan showed severe pneumonia with local consolidation.A er beroptic bronchoscopy and alveolar lavage, she was intubated for ventilation and transported by ambulance to our hospital because of persistent cyanosis.e girl was gravida 2 para 2 and vaginal delivered spontaneously at full gestation age to a gravida 2 para 2 mother with Apgar score of 10 at rst minute and birth weight 4000 g.Her non-consanguineous parents and elder brother were healthy.ere was no family history of tuberculosis.She was vaccinated at birth for BCG and hepatitis B and no other vaccinations were given because of recurrent infections with oral herpes, bronchitis and pneumonia a er one month old.Physical examination revealed le sub-axillary lymphadenitis (Figure 1) and bilateral pulmonary rales, no rash and no hepatosplenomegaly were observed and failure to thrive (6000g at admission).Peripheral blood routine test showed: white blood cell counts 9.7 × 10 9 /L, lymphocytes di erential 8%, hemoglobin and platelet were normal.C-reactive protein, procalcitonin, serum electrolytes, biochemical enzymes of organs, liver and renal function and coagulation function were normal.Chest radiographs showed bilateral in ltration pneumonia.Abdominal sonography was normal.Super cial sonography showed le sub-axillary lymph node enlargement and liquefaction.High-throughput sequencing on Bronchoalveolar Lavage Fluid (BALF) identi ed 697 sequences of Mycobacteruim tuberculosis complex and 95146 sequences of Pneumocystis jiroveci, respectively.