RESUMO
The first fatal case caused by the new genome type 7i is described in an 8-month-old boy requiring long-term respiratory support who developed Reye's syndrome, acute respiratory distress, and bronchiolitis obliterans with fatal evolution. Adenovirus was detected in nasopharyngeal secretions and was persistently positive during hospitalization. IgM and IgG adenovirus antibody titers measured in serum by enzyme-linked immunoassay (EIA) were 1:32 and 1:800, respectively. Serum interleukins (IL) and interferons (IFN) measured by EIA were as follows: IL-2, 110 pg/ml; IL-6, 300 pg/ml; IL-8, 7,000 pg/ml; TNF-alpha, 35 pg/ml, IL-1 and IL-4 undetectable, IFN-alpha 2,200 pg/ml, and IFN-gamma 700 pg/ml. Virologic studies showed that adenovirus isolated belonged to subgenus B, and digestion of viral DNA with Bam HI, Sma I, Bgl II, and Hind III identified the isolate as belonging to genome type 7i. Autopsy showed bronchiolitis obliterans with diffuse alveolar damage and perivenular fatty degeneration with polymorphonuclear infiltrates in the periportal spaces. The difficulty in obtaining adequate oxygenation with minimization of iatrogenic oxygen injury is discussed.
Assuntos
Infecções por Adenoviridae/virologia , Adenoviridae/genética , Adenoviridae/isolamento & purificação , DNA Viral/isolamento & purificação , Adenoviridae/classificação , Infecções por Adenoviridae/genética , Evolução Fatal , Genoma Viral , Humanos , Lactente , MasculinoRESUMO
To explore the pathogenic mechanisms involved in adenovirus infection, we evaluated total levels of immunoglobulins, antiadenovirus antibodies, adenovirus-specific circulating immune complexes, and cytokines in serum samples obtained from 38 hospitalized children with adenovirus infection. According to their clinical findings and outcome, the infections were classified as follows: (1) moderate (group I, n = 10), (2) severe (group II, n = 12), and (3) fatal (group III, n = 16). About 60% of the children had elevated IgM levels. IgG-containing adenovirus-specific circulating immune complexes were initially detected in 7 of 16 group III patients, 4 of whom had low serum levels of the third component of complement. A decrease in initial antiadenovirus IgG antibodies was observed in 3 of 10 patients in group III. Serum interleukin-6 was not detected in group I (none of 10), but was present in group II (7 of 12, p = 0.016) and group III (13 of 16, p < 0.001). Interleukin-8 was detected in all groups; values in fatal cases were significantly higher than in surviving children. Tumor necrosis factor alpha was not observed in group I (none of 10) and was uncommon in group II (2 of 12) but was frequently detected in group III (9 of 15, p = 0.01). Interleukin-1 and interleukin-4 were rarely detected in serum samples. Increased concentrations of interleukin-6, interleukin-8, and tumor necrosis factor alpha were associated with hypoperfusion, febrile peaks, tonic-clonic seizures, and septic shock. In 5 of 10 patients in groups II and III, autoantibodies specific for smooth muscle were found. Our findings indicate that high serum values for interleukin-6, interleukin-8, and tumor necrosis factor alpha are associated with severity of adenovirus infection.
Assuntos
Infecções por Adenovirus Humanos/imunologia , Adenovírus Humanos/imunologia , Anticorpos Antivirais/sangue , Interleucinas/sangue , Infecções Respiratórias/imunologia , Fator de Necrose Tumoral alfa/análise , Infecções por Adenovirus Humanos/mortalidade , Autoanticorpos/sangue , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Recém-Nascido , Masculino , Prognóstico , Estudos Prospectivos , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidadeRESUMO
Se buscó analizar la incidencia de las hiponatremias en la unidad de cuidados intensivos del Hospital de Niños "Ricardo Gutiérrez" en el período comprendido entre junio y setiembre de 1991. Las hiponatremias (valor del sodio igual o menor a 130 meq/litro) se presentaron en 13 pacientes (20 por ciento) de los 64 ingresos en dicho período. Se dividió a los pacientes en dos grupos: hiponatremia aguda (cuando el ritmo de descenso fue mayor de 0,5 mmol/l/hora) y crónica (cuando fue menor de dicho valor). En base a este factor fundamental y a la fisiopatología productora y perpetuadora de la hiponatremia se decidió su tratamiento
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Adolescente , Hiponatremia/diagnóstico , Unidades de Terapia Intensiva/estatística & dados numéricos , Hiponatremia/classificação , Hiponatremia/terapia , Estudos RetrospectivosRESUMO
Se buscó analizar la incidencia de las hiponatremias en la unidad de cuidados intensivos del Hospital de Niños "Ricardo Gutiérrez" en el período comprendido entre junio y setiembre de 1991. Las hiponatremias (valor del sodio igual o menor a 130 meq/litro) se presentaron en 13 pacientes (20 por ciento) de los 64 ingresos en dicho período. Se dividió a los pacientes en dos grupos: hiponatremia aguda (cuando el ritmo de descenso fue mayor de 0,5 mmol/l/hora) y crónica (cuando fue menor de dicho valor). En base a este factor fundamental y a la fisiopatología productora y perpetuadora de la hiponatremia se decidió su tratamiento (AU)