Pari Nanavaty is a rambunctious 5-year-old who moves gleefully from loving hugs to fanciful play. Her playful exuberance is a far cry from the day last winter when she became sick with a powerful bacterial infection that nearly ended her young life.
Her parents, Rajiv and Urvi Nanavaty of Chesapeake, vividly recall the day last winter when their instincts drove them to the emergency center at CHKD in hopes of an explanation for her frightening symptoms.
“We thought Pari had something like the flu at first,” her mother said. “But I got really worried when she seemed to get even sicker in a short time. Her skin became bluish, and she was having a really hard time breathing.”
Urvi called her husband at his office in Suffolk where he is a neurologist. He trusted her instincts when Urvi said this was really scaring her. So he hurried home to examine his daughter. “I wanted to make sure we could have time to get her to CHKD if she was seriously sick,” Rajiv recalls. One look and he knew that was exactly what they should do.
At CHKD’s Emergency Center, an X-ray revealed pneumonia in both of Pari’s lungs, and antibiotics were started. She was admitted to the hospital, but through the night and into the next day, her condition grew worse. She was moved to the pediatric intensive care unit where pediatric critical care specialist Thomas Cholis and the specially trained PICU staff could administer care as other specialists worked to identify the bug that was affecting her and plan her treatment.
Pari spiraled into septic shock. With her kidneys shutting down and her lungs barely functioning, her body swelled with edema.
“She became almost unrecognizable,” said Urvi, who was beset with fear. “I wanted to know if I would get my baby back,” she recalls. “I felt helpless.”
Infectious disease specialist Randall Fisher described Pari’s onset of the rare toxic shock syndrome. “She had really bad pneumonia in both lungs, which could have more than one explanation,” he said. “Then there was diarrhea and a reddish rash on her body. These findings suggested the possibility of toxic shock syndrome. With bacteria circulating in her blood and failure of her lungs and kidneys, she was in grave danger.”
Her father says that being a doctor made it harder for him to be objective about the potential outcome of his daughter’s frightful experience. “Perhaps we know too much and therefore worry the most,” Rajiv said later.
One of the diseases suspected in such severe cases is hemolytic uremic syndrome (HUS), a devastating disease that causes kidney failure and destroys red blood cells. Pari’s father was aware of the possibilities of HUS and worried even more. But tests revealed that her red blood cells were not being ruptured.
Dr. Fisher zeroed in on the devastating bacterial infection called group-A Streptococcus. He explains that group-A strep infections in the throat are common, but when the infection appears in the blood, as in Pari’s case, it is much worse. Toxic shock syndrome can result, though rarely. Each year there are only about 300 cases diagnosed in the U.S. Toxic shock is such a devastating disease that about 35 percent of patients don’t survive.
“We knew we had to clear this infection with antibiotics as quickly as possible,” Dr. Fisher recalls.
He decided that a one-two punch of antibiotics was the best course – one antibiotic to rapidly kill the bacteria and another to suppress the production of the toxin that leads to toxic shock syndrome.
To give her lungs a chance to heal, Pari was intubated and maintained on a ventilator. Because of severe kidney failure, her body was unable to get rid of toxins and water. Pediatric nephrologist Reem Raafat started Pari on daily kidney dialysis to remove all the waste and excess water from her sick body. This procedure enabled her physicians to provide her with better nutrition and to hasten her recovery.
A week in intensive care with massive doses of two antibiotics, routine dialysis and myriad support systems brought improvement, and Pari was moved to a room for another week to recuperate. Two days before she was well enough to return home, Dr. Raafat said she would not need further dialysis – a major milestone that triggered a day of celebration for her relieved family. Follow-up visits to CHKD in the months since her illness have brought good news: Her kidneys are fully recovered now.
The Nanavatys have a large extended family and were comforted with the visits from grandparents and in-laws during Pari’s hospitalization. “My husband’s parents were visiting in India for a wedding when Pari got sick,” Urvi said, “but they came back quickly to be with her. My father-in-law worried that it would be his last chance to see her.”
“We were very appreciative of the way everybody took such good care of all our family at CHKD,” Rajiv said. “I found that we were in extremely competent hands. Everybody was wonderful and very expert.”
Today, Pari is the picture of health. She attends kindergarten at Western Branch Elementary School with her big sister, Foram, 7. She is a creative child, her mother says, and full of life. “She has her own way of creating a delightful environment around herself,” she explains as Pari twirls around the room.
The Nanavatys never miss a chance to express their gratitude for CHKD, so they appeared as a family on the Telethon last summer. “We like to tell everybody how fortunate we are to have Children’s Hospital in our community,” Rajiv said.
“We can never repay the wonderful people at CHKD for all their help in bringing Pari back to us,” Urvi added. “Surely they saved her life.”
Drs. Cholis, Fisher and Raafat practice with Children’s Specialty Group PLLC at CHKD.
This story was featured in the first quarter 2009 issue of KidStuff, a publication of Children's Hospital of The King's Daughters. Click to read more patients' stories.