RESUMEN
Pneumonia comunitária é um problema comum na prática de clínica médica. O diagnóstico deve ser pensado em casos febris e(ou) com sinais e sintomas respiratórios, nos quais a radiografia torácica é fundamental nesta caracterização. Uma vez estabelecido o diagnóstico, devemos estratificar o paciente por grupos de risco para uma evolução desfavorável, aplicando critérios já bem estudados (CURB-65 e PSI) para definir hospitalização e a intensidade de cuidados médicos necessários. A avaliação clínico-epidemiológica ajuda na seleção da antibioticoterapia mais eficaz. Parâmetros de acompanhamento pragmáticos da resposta terapêutica, incluindo período pós-alta, são fornecidos.
Community acquired pneumonia is a fairly common problem in general practice. Clinical suspicion should arise in febrile cases, with or whitout respiratory symptoms, in which a chest radiograph is pivotal in the diagnosis. Once the diagnosis has been clinched, the patient should be risk stratified by groups, using well stablished criteria (CURB-65, PSI) to define hospital admission and level of medical care. Clinical epidemiologic analysis assists in the definition of the proper antimicrobial agent. Pragmatic therapeutic parameters of clinical response are provided (including post-dischargel).
Asunto(s)
Masculino , Femenino , Adulto , Neumonía Bacteriana/etiología , Neumonía Bacteriana/fisiopatología , Neumonía Bacteriana/terapia , Neumonía Bacteriana/transmisión , Antiinfecciosos , Infecciones Comunitarias Adquiridas , Tratamiento de Urgencia , Macrólidos/uso terapéutico , Protocolos Clínicos/normas , Streptococcus pneumoniae/patogenicidad , beta-Lactamasas/uso terapéuticoRESUMEN
Panton-Valentine leukocidin-producing Staphylococcus aureus is an emerging pathogen world-wide, causing necrotizing lung infections in otherwise healthy individuals. We describe 2 episodes of patient-to-patient transmission of Panton-Valentine leukocidin-producing S. aureus, resulting in acute, life-threatening pulmonary complications in patients with cystic fibrosis. Appropriate infection control measures may be warranted to prevent similar episodes.
Asunto(s)
Toxinas Bacterianas/biosíntesis , Fibrosis Quística/complicaciones , Transmisión de Enfermedad Infecciosa , Exotoxinas/biosíntesis , Leucocidinas/biosíntesis , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/transmisión , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/transmisión , Antibacterianos/uso terapéutico , Preescolar , Trazado de Contacto , Fibrosis Quística/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Resistencia a la Meticilina , Medición de Riesgo , Índice de Severidad de la Enfermedad , Hermanos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/aislamiento & purificación , Resultado del TratamientoRESUMEN
En las últimas décadas ha sido reportado en varios países un aumento en el número de hospitalizaciones por neumonía bacteriana y también por complicaciones supurativas en niños. Se ha señalado al Streptococcus pneumoniae como el principal agente causal y también se ha advertido un aumento en la resistencia de éste a penicilina; sin embargo, no se ha logrado establecer una relación de causalidad. Se postula que el fenómeno de resistencia no tiene incidencia en la mayor frecuencia de complicaciones observadas y que éstas si podrían tener relación con el serotipo de S. pneumoniae (principalmente serotipos 1, 3 y 14). La neumonía necrotizante o excavada es considerada una complicación grave de la neumonía bacteriana, se asocia a fiebre prolongada, más días de hospitalización y mayor frecuencia de complicaciones (insuficiencia respiratoria, síndrome séptico). En su diagnóstico la radiografía de tórax ha demostrado ser menos sensible que la tomografía. La disminución de la impregnación del medio de contraste del parénquima pulmonar observada por hipoperfusión pueden ir posteriormente a la necrosis. El mecanismo de la necrosis está relacionado con la oclusión trombótica de los capilares alveolares. A pesar que la necrosis y la formación de cavidades pueden comprometer extensas zonas de lóbulos del pulmón, la indicación de resección quirúrgica en niños es excepcional y el seguimiento radiológico muestra resolución completa.
Asunto(s)
Humanos , Niño , Enfermedades Respiratorias/complicaciones , Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/transmisión , Absceso Pulmonar/microbiología , Infecciones Comunitarias Adquiridas , Chile/epidemiología , Necrosis/microbiología , Neumonía Bacteriana/epidemiología , Neumonía Bacteriana , Radiografía Torácica , Staphylococcus aureus/patogenicidad , Streptococcus pneumoniae/patogenicidad , Streptococcus pyogenes/patogenicidad , Tomografía Computarizada por Rayos XRESUMEN
The distributions of the incubation periods for infectious and neoplastic diseases originating from point-source exposures, and for genetic diseases, follow a lognormal distribution (Sartwell's model). Conversely, incubation periods in propagated outbreaks and diseases with strong environmental components do not follow a lognormal distribution. In this study Sartwell's model was applied to the age at onset and age at death of foals with Rhodococcus equi pneumonia. The age at onset of clinical signs and age at death were compiled for 107 foals that had been diagnosed with R. equi pneumonia at breeding farms in Argentina and Japan. For each outcome (disease and death), these data followed a lognormal distribution. A group of 115 foals with colic from the University of California were used as a comparison group. The age at onset of clinical signs for these foals did not follow a lognormal distribution. These results were consistent with the hypothesis that foals are infected with R. equi during the 1st several days of life, similar to a point-source exposure.
Asunto(s)
Infecciones por Actinomycetales/veterinaria , Enfermedades de los Caballos/mortalidad , Enfermedades de los Caballos/transmisión , Transmisión Vertical de Enfermedad Infecciosa/veterinaria , Modelos Estadísticos , Neumonía Bacteriana/veterinaria , Rhodococcus equi , Infecciones por Actinomycetales/mortalidad , Infecciones por Actinomycetales/transmisión , Animales , Animales Recién Nacidos , Argentina/epidemiología , California/epidemiología , Femenino , Caballos , Japón/epidemiología , Neumonía Bacteriana/mortalidad , Neumonía Bacteriana/transmisión , EmbarazoRESUMEN
Q fever is a worldwide zoonosis but is not often a common cause of fever among travellers returning from the tropics. We report a case of acute Q fever, revealed by a pneumonia and acquired by a traveller in French Guyana. The chest radiography showed alveolar opacities and pleural effusion. Biological abnormalities were elevated liver enzyme levels and thrombocytopenia. The patient improved or the third day of antibiotic treatment. She mentioned that 3 other people she lived with during her trip had been diagnosed with Q fever. A common source outbreak was then suspected. They all stayed in the same farm in French Guyana. Animal exposure occurred there, in particular with a goat and a dog (both were parturient). The disease was probably transmitted by airborne dust to our patient, as no other vectors of transmission were found. Since the clinical presentation of Q fever is not specific, in order for the physician to diagnose it, he must have an awareness of the disease. Our case emphasised that looking for risk factors of Coxiella burnetii exposures is particularly important. Amongst them, the most important seems to be contact with farm animals. The clinician should thus try to trace such a possible contact when treating a case of traveler's Q fever.
Asunto(s)
Neumonía Bacteriana/diagnóstico , Fiebre Q/diagnóstico , Adulto , Animales , Animales Domésticos , Perros , Femenino , Francia , Guyana Francesa , Cabras , Humanos , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/transmisión , Fiebre Q/tratamiento farmacológico , Fiebre Q/transmisión , Viaje , ZoonosisRESUMEN
OBJECTIVE: To evaluate efficacy and safety of cefepime in severe pneumonia of hospitalized patients. DESIGN AND PATIENTS: A prospective, multicenter, open trial was performed with 148 patients (62 patients with nosocomial pneumonia; 34 with community-acquired pneumonia and 52 undefined forms). Cefepime was intravenously administered (1,000 to 2,000 mg every 12 hours), and doses were adjusted for renal function. The efficacy endpoint was clinical response at 48 hours after completion of therapy. RESULTS: The mean age was 56.4 +/- 20.31 years. The most common bacterias isolated from patients with nosocomial pneumonia were: 5 (8.06%) Pseudomonas aeruginosa; 7 (11.29%) Pseudomonas sp.; 6 (9.68%) Klebsiella sp.; 3 (4.84%) E. coli; 2 (3.23%) Acinetobacter baumannii; 3 (4.84%) Staphylococcus aureus; 3 (4.84%) Streptococcus pneumoniae; 5 (8.06%) others. The most common isolates from patients with community-acquired pneumonia were: 2 (5.88%) Streptococcus pneumoniae; 1 (2.94%) S. aureus; 2 (5.88%) P. aeruginosa and 2 (5.88%) K. pneumoniae. Clinical efficacy was demonstrated in 137/148 (92.56%) of the cases since improvement was obtained in 20.27% and healing in 72.29%. Failure of the treatment was observed in 10 patients (6.75%) and one patient the evaluation was not possible. Adverse events were reported for 5/148 patients (3.38%). CONCLUSION: Our data suggest that cefepime was safe and effective for treatment of severe pneumonia in hospitalized patients.
Asunto(s)
Cefalosporinas/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Neumonía Bacteriana/tratamiento farmacológico , Cefepima , Infección Hospitalaria/etiología , Infección Hospitalaria/transmisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/etiología , Neumonía Bacteriana/transmisión , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Objetivo. Avaliar a eficácia e a segurança do cefepima no tratamento de pneumonia grave em pacientes hospitalizados. Casuística e Métodos. Realizamos um estudo perspectivo, multicêntrico, nao comparativo envolvendo 148 pacientes (62 com pneumonia hospitalar, 34 com pneumonia comunitária e 52 formas indefinidas). A cefepina foi administrada por via intravenosa (1.000 a 2.000mg cada 12 horas), sendo que as doses também foram ajustadas para a funçao renal. A resposta clínica foi avaliada 48 horas após o término da terapêutica com cefepina. Resultados. A média de idade foi de 56,4 + 20,31 anos. As bactérias mais comuns isoladas nos pacientes com pneumonia hospitalar foram: 5 Pseudomonas aeruginosa (8,06 por cento); 7 Pseudomonas sp. (11.29 por cento); 6 Klebsiella sp. (9,68 por cento); 3 E. coli (4,84 por cento); 2 Acinetobacter baumannii (3,23 por cento); 3 Staphylococcus aureus (4,84 por cento); 3 Streptococcus pneumoniae (4,84 por cento); 5 outras (8,06 por cento). Os mais comuns isolados nos pacientes com pneumonia adquirida na comunidade foram: 2 Streptococcus pneumoniae (5,88 por cento); 1 S. aureus (2,94 por cento); 2 P. aureginosa (5,88 por cento) e 2 K. pneumoniae (5,88 por cento). A eficácia clínica foi observada em 137/148 dos casos (92,56 por cento) sendo que a resoluçao parcial foi obtida em 20,27 por cento e cura em 72,29 por cento. Falha de tratamento foi encontrado em 10 pacientes (6,75 por cento) e um caso foi avaliado. Eventos adversos foram observados em 5/148 pacientes (3,38 por cento). Conclusao. Nosso estudo sugere que o cefepina é seguro e efetivo no tratamento de pneumonia grave em pacientes hospitalizados.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Cefalosporinas/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Neumonía Bacteriana/tratamiento farmacológico , Cefalosporinas/administración & dosificación , Cefalosporinas/efectos adversos , Infección Hospitalaria/etiología , Infección Hospitalaria/transmisión , Estudios Prospectivos , Resultado del Tratamiento , Neumonía Bacteriana/etiología , Neumonía Bacteriana/transmisiónRESUMEN
São apresentadas as pneumonias mais comuns adquiridas na comunidade, com discussão dos aspectos diagnósticos, condutas terapêuticas e preventivas