RESUMO
During a 3-year study at the neonatal intensive care unit, University Hospital of the West Indies, the incidence of group B streptococcal (GBS) septicaemia was 13.6/1,000 admissions and 1.4/1,000 live births. GBS accounted for 35% of blood culture isolates and was the most frequent cause of septicaemia. Underlying disease or other possible predisposing factors were identified in 16 of 25 neonates with GBS septicaemia. Comparison of early onset and late onset disease indicated an increased incidence of prematurity, prolonged rupture of membranes, and respiratory distress in the former and a predominance of meningitis associated cases in the latter. Mortality was 50% for early onset cases, 29% for late onset cases and 36% overall. Antimicrobial therapy and preventive measures which may be appropriate for a developing country are discussed.
Assuntos
Países em Desenvolvimento , Sepse/epidemiologia , Infecções Estreptocócicas/epidemiologia , Humanos , Lactente , Recém-Nascido , Jamaica , Prognóstico , Estudos Prospectivos , Sepse/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificaçãoRESUMO
During a 5-month period, 513 stool samples submitted to the enteric laboratory at the University Hospital of the West Indies were examined for Cryptosporidium. Oocysts were detected in 4.9% of all stools, 7.3% of diarrhoeal stools, 19.5% of stools from malnourished children and 23.7% of stools from malnourished children with diarrhoea. Cryptosporidium was the sole pathogen detected in all 25 positive stools, and was the second most frequent enteric isolate. All cases of cryptosporidiosis occurred in children less than 2.5 years of age. All 15 malnourished children were admitted to hospital where they presented with dehydration (87%), vomiting (93%), fever (100%) and diarrhoea which lasted an average of 15.3 days. Two of these children died. In contrast, dehydration (20%), vomiting (40%) and fever (50%) were less common and diarrhoea less protracted in well-nourished children, four of whom were admitted to hospital. This preliminary report suggests that cryptosporidial gastroenteritis presents with increased frequency and severity in malnourished compared with well-nourished Jamaican children.
Assuntos
Criptosporidiose/etiologia , Países em Desenvolvimento , Distúrbios Nutricionais/complicações , Pré-Escolar , Criptosporidiose/epidemiologia , Diarreia Infantil/microbiologia , Fezes/microbiologia , Feminino , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Jamaica , Masculino , PrognósticoRESUMO
A randomized, controlled, trial of a topical antibiotic preparation (neomycin, bacitracin, and polymyxin B) was performed in 30 patients with homozygous sickle cell (SS) disease and chronic leg ulceration. Over a period of 8 weeks, the reduction in ulcer size was significantly (P less than 0.05) greater in the treatment group than in the control group. The results suggest that these topical antibiotics may contribute to the therapy of chronic leg ulceration associated with sickle cell disease.
Assuntos
Anemia Falciforme/complicações , Bacitracina/uso terapêutico , Úlcera da Perna/tratamento farmacológico , Neomicina/uso terapêutico , Polimixina B/uso terapêutico , Polimixinas/uso terapêutico , Administração Tópica , Adolescente , Adulto , Bacitracina/administração & dosagem , Ensaios Clínicos como Assunto , Combinação de Medicamentos , Feminino , Humanos , Úlcera da Perna/complicações , Masculino , Pessoa de Meia-Idade , Neomicina/administração & dosagem , Polimixina B/administração & dosagem , Distribuição AleatóriaAssuntos
Infecções por Enterobacteriaceae/epidemiologia , Enterobacteriaceae/efeitos dos fármacos , Sulfametoxazol/farmacologia , Trimetoprima/farmacologia , Combinação de Medicamentos/farmacologia , Resistência Microbiana a Medicamentos , Humanos , Jamaica , Combinação Trimetoprima e SulfametoxazolRESUMO
During 1982-83 there was a substantial increase in the number of S. ohio infections at the University Hospital of the West Indies, which coincided with the appearance of strains resistant to chloramphenicol, cotrimoxazole, ampicillin, neomycin and carbenicillin. Multiresistant strains of S. ohio accounted for 19.3% of all salmonella isolates during this period and all of 40 strains tested were able to transfer resistance determinants to E. coli K12 J 53-2. S. ohio was cultured from stool (60), blood (5), wounds and abscesses (4) and postmortem material (2). Eighty-six per cent of S. ohio infections occurred in children of 3 years old or less. There was a high incidence of gastroenteritis in malnourished children, a 14% incidence of localizing infections and a 7% incidence of septicaemia. Two infants with severe gastroenteritis and bronchopneumonia died. There were a number of unusual infections including two cases of septicaemia in children receiving chloramphenicol for Haemophilus influenzae meningitis, a scrotal abscess secondary to extravasation of urine and infected scabies in a child with marasmic kwashiorkor.
Assuntos
Infecções por Salmonella/epidemiologia , Adolescente , Adulto , Antibacterianos/farmacologia , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Gastroenterite/epidemiologia , Gastroenterite/microbiologia , Humanos , Lactente , Pessoa de Meia-Idade , Osteomielite/epidemiologia , Osteomielite/microbiologia , Salmonella/efeitos dos fármacos , Salmonella/isolamento & purificação , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/microbiologia , Sepse/epidemiologia , Sepse/microbiologia , Dermatopatias Infecciosas/epidemiologia , Dermatopatias Infecciosas/microbiologia , Índias OcidentaisRESUMO
A total of 222 cases of septicaemia was recorded at the University Hospital of the West Indies between June 1982 and June 1983. This gave an overall incidence of 16.1 per 1000 admissions. The 233 bacterial strains isolated comprised 100 Gram-positive and 133 Gram-negative organisms with Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus aureus being the most frequent. Highest rates of septicaemia were recorded in patients less than 1 year and over 50 years of age. Septicaemia caused by Gram-positive organisms was predominantly a disease of children whereas that caused by Gram-negative organisms arose more often in neonates and in patients over 50 years of age. A predisposing factor was noted in 104 patients of whom 42 had neoplastic disease. The most frequently identified initial sites of infection were the respiratory tract, the gastro-intestinal tract and the meninges. Most blood stream infections were community-acquired, three quarters of all septicaemic patients being admitted to the departments of medicine or paediatrics. There were 11 cases of polymicrobial septicaemia caused predominantly by Gram-negative organisms in patients with underlying disease. Appropriate antimicrobial drugs were administered to 57% of septicaemic patients whereas 17% received superfluous antimicrobial therapy. In those patients who received inappropriate antimicrobial therapy there was a marked increase in mortality. Forty of 61 deaths were attributed to septicaemia. Mortality from septicaemia caused by Gram-negative organisms was 21% compared with 13% for that caused by Gram-positive organisms. The organisms associated with the highest case fatality rates were Escherichia coli, 53%; Enterobacter sp., 27%; and beta-haemolytic streptococci 24%. There were no deaths from septicaemia caused by Haemophilus influenzae, Salmonella sp. or Serratia sp. The highest mortality rates were associated with neoplastic disease, diabetes, polymicrobial septicaemia, urinary tract infections and old age.