RESUMEN
The first case of COVID-19 was detected in Dec 2019, in China. The disease shortly evolved into a pandemic and imposed an unparalleled health and social burden on mankind. Severe forms of COVID-19 mainly affect adults, especially the elderly and those with comorbidities. We report a severe case of COVID-19 in a previously healthy 12-year-old female who was admitted to the emergency room on May 26, 2020, with fever, abdominal pain, vomiting, and diarrhea. During the hospital stay, she tested positive for SARS-CoV-2 and developed multiple organ failure and catastrophic thrombotic events resulting in bilateral amputation of legs and fingers. She was discharged from the hospital for outpatient follow-up after 107 days. By the time this report was written, the patient was undergoing prosthesis prescription and training and regaining her independence to walk.
O primeiro caso de covid-19 foi detectado em dezembro de 2019, na China. A doença rapidamente evoluiu para uma pandemia e trouxe um fardo social e de saúde sem paralelo para a humanidade. As formas graves de covid-19 afetam principalmente adultos, especialmente idosos com comorbidades. Relatamos um caso grave de covid-19 em uma paciente de 12 anos de idade, previamente saudável, que deu entrada no pronto-socorro em 26/05/2020 com febre, dores abdominais, vômitos e diarreia. Durante a investigação, apresentou teste positivo para SARS-CoV-2 e evoluiu com falência múltipla de órgãos e eventos trombóticos catastróficos, resultando em amputação bilateral de pernas e quirodáctilos. Ela recebeu alta hospitalar para acompanhamento ambulatorial após 107 dias. No momento da redação deste relato, a paciente estava sendo submetida a protetização e recuperando marcha independente.
RESUMEN
OBJECTIVE: This study sought to evaluate infections related to health care caused by coagulase-negative Staphylococci in a neonatal intensive care unit by assessing antimicrobial susceptibility profiles and potentially effective antibiotic regimens. METHODS: This was a retrospective descriptive study performed on a case series of healthcare-associated infections, and the antimicrobial susceptibility profiles were evaluated. Newborns from other hospitals who were admitted to a neonatal intensive care unit in Rio de Janeiro between January 1, 2010, and June 30, 2012, were studied. RESULTS: In total, 765 patients were admitted, totaling 3,051 patient-days, and the incidence density of general infection was 18.9 per 1,000 patient-days. The rate of central venous catheter use was 71.6%, and the positive culture rate for all sites and all infections related to health care were 68.4%. Coagulase-negative Staphylococci were identified in 11 (19.2%) of 57 health care-related infections, and infections with extended-spectrum beta-lactamase producing Klebsiella pneumoniae and Candida sp. constituted 5 cases each. Of the 11 cases of coagulase-negative Staphylococci, 10 (90.9%) were primary bloodstream infections. The sensitivity of the coagulase-negative Staphylococci isolates to vancomycin, clindamycin, ciprofloxacin, oxacillin and gentamycin was 100%, 81.8%, 72.7%, 27.2% and 22.2%, respectively. There were no deaths directly attributed to coagulase-negative Staphylococci infection. CONCLUSION: Coagulase-negative Staphylococci was the main agent identified in healthcare-associated infections, with low rates of infections related to central venous catheter. In hospitals with a high oxacillin resistance profile, similar to those included in this study, vancomycin may be used as an initial therapy, although clindamycin represents a viable alternative.
Asunto(s)
Antibacterianos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Unidades de Cuidado Intensivo Neonatal , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Antibacterianos/farmacología , Coagulasa , Femenino , Humanos , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Estudios Retrospectivos , Staphylococcus/efectos de los fármacos , Staphylococcus/enzimologíaRESUMEN
With the aim of measuring the prevalence of anti-parvovirus B19 IgG antibodies during pregnancy up to 24 weeks of gestation and detecting cases of nonimmune hydrops fetalis, 249 sera from pregnant women attending a reference hospital in Rio de Janeiro city, from June 2003 to November 2004 were collected. They were followed-up until the end of pregnancy, with 17 cases of fetal hydrops detected. Four cases were caused by parvovirus B19 and two of them occurred in pregnant women living in the western zone of the city, during February 2005. Anti-parvovirus B19 IgG antibodies were found in 172 (71.6%) pregnant women (CI 95% 65.5%-77.7%); this antibody prevalence is similar to results found for others Brazilian cities. The only variable associated with previous acquisition of IgG antibodies to parvovirus B19 was number of pregnancies greater than one (p= 0.02, CI 95% 0.36-0.94).