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We assessed 160 patients who received imipenem/cilastatin/relebactam for ≥2 days. At treatment initiation, the median Charlson Comorbidity Index was 5, 45% were in the intensive care unit, and 19% required vasopressor support. The in-hospital mortality rate was 24%. These data advance our understanding of real-world indications and outcomes of imipenem/cilastatin/relebactam use.
Assuntos
Antibacterianos , Compostos Azabicíclicos , Cilastatina , Imipenem , Humanos , Masculino , Antibacterianos/farmacologia , Feminino , Imipenem/farmacologia , Pessoa de Meia-Idade , Idoso , Cilastatina/farmacologia , Cilastatina/administração & dosagem , Cilastatina/uso terapêutico , Estados Unidos , Compostos Azabicíclicos/farmacologia , Combinação Imipenem e Cilastatina/administração & dosagem , Mortalidade Hospitalar , Estudos Retrospectivos , Unidades de Terapia Intensiva , Idoso de 80 Anos ou mais , Resultado do Tratamento , AdultoRESUMO
La púrpura fulminante o purpura fulminans es un síndrome de trombosis microvascular cutánea y necrosis hemorrágica de rápida evolución. Se presenta el caso de un paciente masculino, internado por patología infecciosa y evento cardiovascular agudo, que desarrolla púrpura fulminante por déficit de proteína C, relacionado a cuadro infeccioso concomitante.
Purpura fulminans is a rapidly evolving syndrome of cutaneous microvascular thrombosis and hemorrhagic necrosis. We present the case of a male patient, hospitalized for an infectious pathology and an acute cardiovascular event, who developed purpura fulminans due to protein C deficiency, related to a concomitant infectious condition.
RESUMO
INTRODUCCIÓN: La neumonía adquirida en la comunidad es una de las enfermedades con mayor prevalencia en la comunidad pediátrica en nuestro país. De las diferentes etiologías que pueden causarlas, la neumonía ocasionada por Streptococcus pneumoniae puede ser prevenida con el uso de inmunización. Actualmente se disponen de tres tipos de vacunas antineumocócicas conjugadas autorizadas de uso pediátrico de forma sistemática. OBJETIVO: Identificar la prevalencia de neumonía bacteriana en niños bajo 5 años de edad, que requirieron hospitalización comparando la vacuna neumocócica recibida: 10 valente (PCV10) versus 13 valente (PCV13). PACIENTES Y MÉTODOS: Estudio de descriptivo, retrospectivo. Se incluyeron pacientes hospitalizados bajo 5 años de edad, con diagnóstico de neumonía bacteriana mediante codificación CIE10 en un hospital de tercer nivel de la ciudad de Quito-Ecuador, durante el año 2019. RESULTADOS: Se estudiaron 175 pacientes de los cuales 74 cumplieron con criterios clínicos de neumonía, de estos 46 recibieron PCV10 y 28 recibieron vacuna PCV13. DISCUSIÓN Y CONCLUSIONES: La prevalencia de neumonía bacteriana fue mayor en los pacientes inmunizados con PCV10 lo que sugiere una relación de menor probabilidad de neumonía con el uso de la vacuna PCV13.
BACKGROUND: Community-acquired pneumonia is one of the most prevalent diseases in the pediatric community in our country, of the different etiologies that can cause them, pneumonia caused by Streptococcus pneumoniae can be prevented with the use of immunization. Currently there are three types of authorized pneumococcal conjugate vaccines for pediatric use in a systematic way. AIM: To identify the prevalence of bacterial pneumonia in children under 5 years of age who required hospitalization by comparing the pneumococcal vaccine received: 10 valent (PCV10) versus 13 valent (PCV13). METHODS: Descriptive, retrospective study. Hospitalized patients under 5 years of age with a diagnosis of bacterial pneumonia by ICD10 coding in a third level hospital in the city of Quito - Ecuador during 2019 were included. Results: 175 patients were studied, of which 74 patients met clinical criteria for pneumonia, of these 46 received PCV10 and 28 received PCV13 vaccine. DISCUSSION AND CONCLUSIONS: The prevalence of bacterial pneumonia was higher in patients immunized with PCV10, suggesting a relationship of lower probability of pneumonia with the use of the PCV13 vaccine.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Vacinas Conjugadas/administração & dosagem , Pneumonia Bacteriana/prevenção & controle , Pneumonia Bacteriana/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae , Criança Hospitalizada/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Imunização/estatística & dados numéricos , Equador/epidemiologiaRESUMO
The term bronchoesophageal fistula is used for the abnormal communication between the esophageal lumen and the pulmonary bronchi. There are no reports of this condition in production animals, and its origin is unknown. A male Dorper sheep from the Veterinary Hospital of the Santo Amaro University, SP, Brazil, presented clinical signs of tachypnea, apathy, and coughing after eating. The animal died suddenly after a fever break. During the gross evaluation, a fistula was noticed in the middle third of the thoracic esophagus with communication to the right cranial lung lobe, forming an encapsulated area measuring 24.5 cm x 22.0 cm x 9.4 cm. Fibrous tissue delimited the pulmonary lobe and feed filled the compartment. This is a rare condition with unclear etiopathogenesis.(AU)
O termo fístula broncoesofágica denomina a comunicação anormal entre o lúmen esofágico e os brônquios pulmonares. Não há relatos dessa condição em animais de produção, e sua origem é desconhecida. Um ovino macho da raça Dorper, proveniente do Hospital Veterinário da Universidade Santo Amaro, SP, Brasil, apresentou sinais clínicos de taquipneia, apatia e tosse após a alimentação. O animal morreu repentinamente após quadro febril. Na avaliação macroscópica notou-se fístula no terço médio do esôfago torácico com comunicação para o lobo pulmonar cranial direito, formando uma área encapsulada medindo24,5 cm x 22,0 cm x 9,4 cm. Tecido fibroso delimitava o lobo pulmonar e conteúdo alimentar preenchia o compartimento. Esta é uma condição rara com etiopatogenia incerta.(AU)
Assuntos
Animais , Masculino , Ovinos , Fístula Brônquica/diagnóstico , Fístula Esofágica/diagnósticoRESUMO
BACKGROUND: The detection of coinfections is important to initiate appropriate antimicrobial therapy. Molecular diagnostic testing identifies pathogens at a greater rate than conventional microbiology. We assessed both bacterial coinfections identified via culture or the BioFire® FilmArray® Pneumonia Panel (FA-PNEU) in patients infected with SARS-CoV-2 in the ICU and the concordance between these techniques. METHODS: This was a prospective study of patients with SARS-CoV-2 who were hospitalized for no more than 48 h and on mechanical ventilation for no longer than 24 h in 8 ICUs in Medellín, Colombia. We studied mini-bronchoalveolar lavage or endotracheal aspirate samples processed via conventional culture and the FA-PNEU. Coinfection was defined as the identification of a respiratory pathogen using the FA-PNEU or cultures. Serum samples of leukocytes, C-reactive protein, and procalcitonin were taken on the first day of intubation. We analyzed the empirical antibiotics and the changes in antibiotic management according to the results of the FA-PNEUM and cultures. RESULTS: Of 110 patients whose samples underwent both methods, FA-PNEU- and culture-positive samples comprised 24.54% versus 17.27%, respectively. Eighteen samples were positive in both techniques, 82 were negative, 1 was culture-positive with a negative FA-PNEU result, and 9 were FA-PNEU-positive with negative culture. The two bacteria most frequently detected by the FA-PNEU were Staphylococcus aureus (37.5%) and Streptococcus agalactiae (20%), and those detected by culture were Staphylococcus aureus (34.78%) and Klebsiella pneumoniae (26.08%). The overall concordance was 90.1%, and when stratified by microorganism, it was between 92.7 and 100%. The positive predictive value (PPV) was between 50 and 100% and were lower for Enterobacter cloacae and Staphylococcus aureus. The negative predictive value (NPV) was high (between 99.1 and 100%); MecA/C/MREJ had a specificity of 94.55% and an NPV of 100%. The inflammatory response tests showed no significant differences between patients whose samples were positive and negative for both techniques. Sixty-one patients (55.45%) received at least one dose of empirical antibiotics. CONCLUSIONS: The overall concordance was 90.1%, and it was between 92.7% and 100% when stratified by microorganisms. The positive predictive value was between 50 and 100%, with a very high NPV.
Assuntos
COVID-19 , Coinfecção , Pneumonia , Antibacterianos/uso terapêutico , Bactérias , COVID-19/diagnóstico , Colômbia , Hospitais , Humanos , Unidades de Terapia Intensiva , Reação em Cadeia da Polimerase Multiplex/métodos , Pneumonia/tratamento farmacológico , Estudos Prospectivos , SARS-CoV-2RESUMO
Pandoraea pnomenusa is a Gram-negative bacterium of the Pandoraea genus and is mainly associated with the colonization of structurally abnormal airways. During the COVID-19 pandemic, many microorganisms have been associated with coinfection and superinfection in SARS-CoV-2 pneumonia, but so far, no coinfection or superinfection by P. pnomenusa has been reported. We present the first case describing this association in a previously healthy patient. Clinical manifestations, treatment, and outcomes are shown.
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Respiratory problems due to tracheobronchial foreign bodies (FBs) are unusual in horses; although equines kept in pastures eventually inhale FBs, as conifer twigs of Araucaria angustifolia. A 1,5-year-old Criolle foal was presented with hemoptysis, dyspnea, restlessness and fever (40.9 ºC rectal temperature). Complete blood count showed intense neutropenia, monocytosis, thrombocytopenia and hypoproteinemia. Treatment was carried out but no clinical improvement was observed. At the post-mortem examination, marked amount of dark red liquid was observed in the thoracic cavity (hemothorax). The lung parenchyma was diffusely consolidated, predominantly in the cranioventral area, associated with mild pleural fibrin deposition. The right primary bronchus was obliterated by a Araucaria angustifolia pine branch measuring 18 cm in length, with adjacent darkened areas (lung consolidation). Microscopically, there was diffuse necrosis with severe hemorrhage in the lungs, associated with marked neutrophilic inflammatory infiltrate, numerous coccoid bacterial aggregates, and fibrinous pleuritis. Additionally, there was diffuse alveolar edema and multifocal thrombosis. Lung fragments were submitted for bacterial culture and mixed bacterial growth was observed with a predominance of Streptococcus equi subsp. zooepidemicus. Inhalation of branches is not commonly reported in horses, but it must be included in the differential diagnoses of pneumonia, and attention should be taken when allowing horses to graze in areas where the plant occurs.
Problemas respiratórios devido a corpos estranhos (CEs) traqueobrônquicos são incomuns em equinos, embora cavalos em pastagem possam eventualmente aspirar CEs, como galhos de Araucaria angustifolia. Um potro Crioulo, 1,5 anos, apresentou hemoptise, dispneia, inquietação e temperatura retal de 40,9 ºC. O hemograma revelou intensa neutropenia, monocitose, trombocitopenia e hipoproteinemia. O tratamento foi realizado, mas sem sucesso. Na cavidade torácica, foi observada grande quantidade de líquido avermelhado livre (hemotórax). Os pulmões estavam difusamente consolidados, predominantemente cranioventral e com discreta deposição de fibrina sobre a superfície pleural. O brônquio principal direito estava obliterado por um ramo de pinheiro de Araucaria angustifolia com 18 cm de comprimento. Microscopicamente, notou-se necrose de coagulação pulmonar difusa com hemorragia severa, infiltrado inflamatório neutrofílico marcado, numerosos agregados bacterianos cocoides e pleurite fibrinosa. Fragmentos de pulmão foram submetidos ao isolamento bacteriológico e abundante crescimento misto com predominância de Streptococcus equi subsp. zooepidemicus foi observado. A inalação de grimpas de pinheiro não é comumente relatada em equinos, mas deve ser incluída nos diagnósticos diferenciais de pneumonia e deve-se ter atenção ao introduzir cavalos no campo com a presença da planta.
Assuntos
Animais , Masculino , Broncopneumonia/veterinária , Streptococcus equi , Corpos Estranhos/veterinária , Araucaria , Doenças dos Cavalos/sangue , Pulmão , CavalosRESUMO
Introducción: Las infecciones respiratorias agudas abarcan entre 20 y 40 % del total de todas las hospitalizaciones y 20 - 34 % de las muertes en menores de 5 años de edad, fundamentalmente a expensas de neumonía. Objetivo: Describir aspectos epidemiológicos, clínicos y microbiológicos en pacientes menores de 5 años con neumonía bacteriana. Métodos: Se realizó un estudio descriptivo y transversal de 39 pacientes con neumonía y aislamientos bacterianos en hemocultivos, líquido pleural y/o exudados nasofaringeos, ingresados en el Hospital Infantil Docente Sur Antonio María Béguez Cesar de Santiago de Cuba, desde enero de 2018 hasta diciembre de 2019. Se analizaron variables de interés, tales como edad, sexo, factores de riesgo, sintomatología y cultivos microbiológicos. Se utilizaron la frecuencia absoluta y el porcentaje como medidas de resumen. Resultados: Prevalecieron los pacientes entre 1 - 4 años de edad, el sexo femenino y los hemocultivos con estafilococos coagulasa negativo, así como neumococos, estos últimos también aislados en exudados nasofaríngeos. Los factores de riesgo más frecuentes fueron infección respiratoria aguda previa, uso anticipado de antibióticos, asistencia a círculo infantil, supresión precoz de lactancia materna, fiebre, tos, tiraje y alteraciones del murmullo vesicular. Predominaron la insuficiencia respiratoria aguda y el derrame pleural como complicaciones. Se notificó más gravedad en los lactantes y ocurrieron 2 decesos, para una letalidad de 1,47 %. Conclusiones: La conjunción de factores de riesgo detectados, la baja positividad de los cultivos, la identificación de bacterias prevalentes en hemocultivos y el descenso de la letalidad resultaron de interés en el estudio.
Introduction: Acute respiratory infections take in between 20 and 40 % of all the hospitalizations and 20 - 34% of deaths in children under 5 years, fundamentally at the expense of pneumonia. Objective: To describe epidemiologic, clinical and microbiologic aspects in patients under 5 years with bacterial pneumonia. Methods: A descriptive and cross-sectional study of 39 patients with pneumonia and bacterial isolations in hemocultures, pleural fluid and/or nasopharyngeal swabs was carried out. They were admitted to Antonio María Béguez Cesar Southern Teaching Children Hospital in Santiago de Cuba, from January, 2018 to December, 2019. Variables of interest were analyzed, such as age, sex, risk factors, symptomatology and microbiologic cultures. The absolute frequency and the percentage as summary measures were used. Results: There was a prevalence of patients among 1 - 4 years, female sex and the hemocultures with negative coagulase staphylococcu, as well as pneumococus, these last ones also isolated in nasopharingeal swabs. The most frequent risk factors were previous acute respiratory infection, premature use of antibiotics, attendance to day care center, early suppression of breastfeeding, fever, cough, tirage and changes of the vesicular breath sound. The acute respiratory failure and pleural effusion as complications prevailed. More seriousness was notified in infants and there were 2 deaths, for a letality of 1.47 %. Conclusions: The combination of detected risk factors, low positivity of the cultures, identification of bacterias prevalents in hemocultures and the decrease of letality was of interest in the study.
Assuntos
Pneumonia Bacteriana , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/epidemiologia , Atenção Secundária à Saúde , CriançaRESUMO
Resumen Bordetella bronchiseptica es un cocobacilo Gram negativo patógeno de animales que, con poca frecuencia causa infecciones en seres humanos. La mayoría de casos registrados en la literatura están asociados con pacientes que presentan algún tipo de inmunosupresión. Este reporte de caso se refiere a una paciente femenina de 67 años con antecedentes de linfoma pulmonar, que recibió quimioterapia y radioterapia 16 años atrás, fue ingresada al Servicio de Medicina Interna del Hospital Tomás Casas Casajús con un diagnóstico de neumonía bacteriana, tras descartarse infección por Covid19. Unos días después, se aisló una B. brochiseptica de una muestra de esputo y con el reporte de la prueba sensibilidad a los antibióticos, se modificó la terapia de antibióticos que originalmente se había indicado, lo que se conlleva a una mejoría en el estado físico de la paciente. Sin embargo, debido a una aparente infección nosocomial la paciente se contagió de SARS- CO2 y falleció debido a las complicaciones causadas por el Covid19.
Abstract Bordetella bronchiseptica is an animal pathogenic Gram negative coccobacillus that infrequently causes human infections. Most of the cases recorded in the literature are associated with patients with some type of immunosuppression. In this case, a 67-year- old female patient with a history of pulmonary lymphoma, who received chemotherapy and radiotherapy 16 years ago, is admitted to the Internal Medicine Service of the Tomás Casas Casajús Hospital, with a diagnosis of bacterial pneumonia, after ruling out Covid19 infection. A few days later, a B. brochiseptica is isolated from a sputum sample and with the report of the antibiotic sensitivity test, the antibiotic therapy that had originally been indicated is modified, which is reflected in an improvement in the physical state of the patient. However, due to an apparent nosocomial infection, the patient becomes infected with SARS-CO2 and dies due to complications caused by Covid19.
Assuntos
Humanos , Feminino , Idoso , Infecções por Bordetella/diagnóstico por imagem , Linfoma/complicações , Costa RicaRESUMO
Introducción: La radiografía de tórax constituye el mejor método de diagnóstico para la confirmación clínica de la neumonía, aunque existen discrepancias en relación con su causalidad. Objetivo: Describir los patrones imagenológicos según variables clínicas, epidemiológicas y microbiológicas en pacientes menores de 5 años ingresados por neumonía bacteriana. Métodos: Se realizó un estudio descriptivo, prospectivo y transversal de 84 pacientes con diagnóstico de neumonía y aislamiento bacteriano en hemocultivos y/o líquido pleural. Como variables analizadas figuraron: edad, sexo, factores de riesgo, manifestaciones clínicas, así como resultados de los estudios imagenológicos de tórax y de los cultivos microbiológicos. Como medidas de resumen se utilizaron la frecuencia absoluta y el porcentaje. Resultados: En la serie predominaron la consolidación alveolar (57,1 %), el grupo de 1-4 años y el sexo masculino, así como también el uso de tratamiento antimicrobiano previo al ingreso, la supresión precoz de lactancia materna y la presencia de fumadores en casa como principales factores de riesgo. La fiebre, la tos, la taquipnea, el tiraje, la rinorrea y los estertores húmedos resultaron ser las manifestaciones clínicas más frecuentes y prevaleció el neumococo en pacientes con patrón de condensación alveolar (64,6 %). Conclusiones: El patrón de consolidación alveolar estuvo relacionado con causa predominantemente neumocócica, con múltiples factores de riesgo y con síntomas típicos de neumonía bacteriana.
Introduction: Chest radiography is the best diagnostic method for clinical confirmation of pneumonia, although there are discrepancies in its relation to causation. Objective: To describe imaging patterns according to clinical, epidemiological, and microbiological variables, in patients under five years of age admitted for bacterial pneumonia. Methods: descriptive, prospective, and cross-sectional study of 84 patients diagnosed with pneumonia and bacterial isolation in blood cultures and / or pleural fluid. Variables of interest were operationalized, with frequency, and percentage calculations being performed. Results: alveolar consolidation (57.1 %) prevailed in preschoolers, male sex, with previous antimicrobial treatment, early suppression of breastfeeding, and smoking at home. Fever, cough, tachypnea, retraction, rhinorrhea, and wet rales were the most frequent symptoms. Pneumococcus prevailed (64.6 %) in patients with alveolar condensation pattern. Conclusions: the pattern of alveolar consolidation was consistent with pneumococcal causality predominantly; with multiple risk factors and typical clinical presentation of bacterial pneumonia.
Assuntos
Radiografia Torácica , Pré-Escolar , Pneumonia Bacteriana/diagnóstico por imagem , Atenção Secundária à Saúde , Pneumonia Bacteriana/epidemiologiaRESUMO
This study aimed to determine the frequency and distribution of infectious diseases diagnosed through necropsy examination and histopathological analysis in growing/finishing pigs along 12 years (2005-2016) in Southern Brazil. We evaluated 1906 anatomopathological exams of pigs at growing/finishing phases, of which the infectious diseases corresponded to 75.6% of the cases (1,441/1,906). Porcine circovirus type 2 (PCV2) infections were the most frequent, accounting for 51.3% of the cases (739/1,441) with a higher frequency from 2005 to 2007, characterizing an epidemic distribution, with a gradual decline after 2008. Infectious diseases affecting the respiratory system were the second major cause with 30.1% of the cases. Among these, necrotizing bronchiolitis caused by swine Influenza (15.1%, 218/1,441) and bacterial pneumonia (15%, 216/1,441) were the main conditions. Influenza was mostly diagnosed from 2010 to 2013, accounting for 43.1% (167/387) of the cases. After this period, both respiratory infectious diseases were endemic. Digestive system infectious diseases accounted for 10.5% of the diagnoses (151/1,441), with the following main conditions: Salmonella spp. enterocolitis (43.7%, 66/151), Lawsonia spp. proliferative enteropathy (41.7%, 63/151), and Brachyspira spp. colitis (14.6%, 22/151). The latter had a higher incidence from 2012 to 2014 with all cases detected in this period. Polyserositis and bacterial meningitis represented, respectively, 5.8% (84/1,441) and 2.3% (33/1,441) of the cases diagnosed, with a constant endemic character.(AU)
O objetivo deste estudo consistiu em determinar a frequência e a distribuição das doenças infecciosas diagnosticadas através de exame de necropsia e análise histopatológica em suínos nas fases de crescimento/terminação ao longo de 12 anos (2005-2016) no sul do Brasil. Foram avaliados 1906 laudos anatomopatológicos de suínos nas fases de crescimento/terminação, dos quais as doenças infecciosas corresponderam a 75,6% (1441/1906) do total. As infecções por circovírus suíno tipo 2 (PCV2) foram as mais frequentes, contabilizando 51,3% (739/1441) dos casos, com uma alta frequência de 2005 a 2007 caracterizando uma distribuição epidêmica neste período, e um declínio gradual após o ano de 2008. A segunda principal causa incluiu as doenças infecciosas que afetam o sistema respiratório (30,1% dos casos). Dentre essas, destacaram-se a influenza suína (15,1%; 218/1441) e pneumonias bacterianas (15%; 216/1441). O diagnóstico de influenza apresentou uma frequência elevada de 2010 a 2013, totalizando 43,1% (167/387) dos casos. Após este período, ambas doenças infecciosas respiratórias exibiram caráter endêmico. As doenças infecciosas do sistema digestório totalizaram 10,5% (151/1441) dos diagnósticos, com as seguintes principais condições: enterocolite por Salmonella spp. (43,7%; 66/151), enteropatia proliferativa por Lawsonia spp. (41,7%; 63/151) e colite por Brachyspira spp. (14,6%; 22/151). A colite por Brachyspira spp. apresentou uma alta incidência de 2012 a 2014 com todos os casos detectados no período. As polisserosites e meningites bacterianas representaram 5,8% (84/1441) e 2,3% (33/1441) dos casos diagnosticados, respectivamente, com um caráter endêmico constante.(AU)
Assuntos
Animais , Doenças dos Suínos/epidemiologia , Doenças Transmissíveis/patologia , Doenças Transmissíveis/epidemiologia , Infecções por Circoviridae/patologia , Infecções por Circoviridae/epidemiologia , Infecções por Orthomyxoviridae/patologia , Infecções por Orthomyxoviridae/epidemiologia , Alphainfluenzavirus , Sus scrofa , Enterocolite/epidemiologia , Pneumonia Suína MicoplasmáticaRESUMO
This study aimed to determine the frequency and distribution of infectious diseases diagnosed through necropsy examination and histopathological analysis in growing/finishing pigs along 12 years (2005-2016) in Southern Brazil. We evaluated 1906 anatomopathological exams of pigs at growing/finishing phases, of which the infectious diseases corresponded to 75.6% of the cases (1,441/1,906). Porcine circovirus type 2 (PCV2) infections were the most frequent, accounting for 51.3% of the cases (739/1,441) with a higher frequency from 2005 to 2007, characterizing an epidemic distribution, with a gradual decline after 2008. Infectious diseases affecting the respiratory system were the second major cause with 30.1% of the cases. Among these, necrotizing bronchiolitis caused by swine Influenza (15.1%, 218/1,441) and bacterial pneumonia (15%, 216/1,441) were the main conditions. Influenza was mostly diagnosed from 2010 to 2013, accounting for 43.1% (167/387) of the cases. After this period, both respiratory infectious diseases were endemic. Digestive system infectious diseases accounted for 10.5% of the diagnoses (151/1,441), with the following main conditions: Salmonella spp. enterocolitis (43.7%, 66/151), Lawsonia spp. proliferative enteropathy (41.7%, 63/151), and Brachyspira spp. colitis (14.6%, 22/151). The latter had a higher incidence from 2012 to 2014 with all cases detected in this period. Polyserositis and bacterial meningitis represented, respectively, 5.8% (84/1,441) and 2.3% (33/1,441) of the cases diagnosed, with a constant endemic character.(AU)
O objetivo deste estudo consistiu em determinar a frequência e a distribuição das doenças infecciosas diagnosticadas através de exame de necropsia e análise histopatológica em suínos nas fases de crescimento/terminação ao longo de 12 anos (2005-2016) no sul do Brasil. Foram avaliados 1906 laudos anatomopatológicos de suínos nas fases de crescimento/terminação, dos quais as doenças infecciosas corresponderam a 75,6% (1441/1906) do total. As infecções por circovírus suíno tipo 2 (PCV2) foram as mais frequentes, contabilizando 51,3% (739/1441) dos casos, com uma alta frequência de 2005 a 2007 caracterizando uma distribuição epidêmica neste período, e um declínio gradual após o ano de 2008. A segunda principal causa incluiu as doenças infecciosas que afetam o sistema respiratório (30,1% dos casos). Dentre essas, destacaram-se a influenza suína (15,1%; 218/1441) e pneumonias bacterianas (15%; 216/1441). O diagnóstico de influenza apresentou uma frequência elevada de 2010 a 2013, totalizando 43,1% (167/387) dos casos. Após este período, ambas doenças infecciosas respiratórias exibiram caráter endêmico. As doenças infecciosas do sistema digestório totalizaram 10,5% (151/1441) dos diagnósticos, com as seguintes principais condições: enterocolite por Salmonella spp. (43,7%; 66/151), enteropatia proliferativa por Lawsonia spp. (41,7%; 63/151) e colite por Brachyspira spp. (14,6%; 22/151). A colite por Brachyspira spp. apresentou uma alta incidência de 2012 a 2014 com todos os casos detectados no período. As polisserosites e meningites bacterianas representaram 5,8% (84/1441) e 2,3% (33/1441) dos casos diagnosticados, respectivamente, com um caráter endêmico constante.(AU)
Assuntos
Animais , Doenças dos Suínos/epidemiologia , Doenças Transmissíveis/patologia , Doenças Transmissíveis/epidemiologia , Circovirus , Infecções por Circoviridae/patologia , Infecções por Circoviridae/epidemiologia , Infecções por Orthomyxoviridae/patologia , Infecções por Orthomyxoviridae/epidemiologia , Alphainfluenzavirus , Sus scrofa , Enterocolite/epidemiologia , Pneumonia Suína MicoplasmáticaRESUMO
ABSTRACT Objective: To highlight the pathogenicity of Streptococcus anginosus, which is rare in pediatric patients, but can cause severe infections that are known to have a better outcome when treated early with interventional procedures and prolonged antibiotic therapy. Case description: The patient is a 6-year-old boy with global developmental delay, examined in the emergency room due to fever and respiratory distress. The physical examination and diagnostic workout revealed complicated pneumonia with empyema of the left hemithorax; he started antibiotic therapy and underwent thoracic drainage. Pleural fluid cultures grew Streptococcus anginosus. On day 11, the child had a clinical deterioration with recurrence of fever, hypoxia, and respiratory distress. At this point, considering the causative agent, he was submitted to video-assisted thoracoscopic decortication, with good progress thereafter. Comments: Streptococcus anginosus is a commensal bacterium of the human oral cavity capable of causing severe systemic infections. Although reports of complicated thoracic infections with this agent are rare in the pediatric population, they have been increasing in adults. Streptococcus anginosus has a high capacity to form abscess and empyema, requiring different therapeutic approaches when compared to complicated pneumonia caused by other agents.
RESUMO Objetivo: Alertar para a patogenicidade do Streptococcus anginosus que, apesar de raro em pediatria, pode causar infeções graves que necessitam de tratamento invasivo e antibioterapia de longo curso para obter um melhor prognóstico. Descrição do caso: Criança de seis anos, com atraso do desenvolvimento psicomotor, avaliado no serviço de urgência por febre e dificuldade respiratória. O exame físico, juntamente com os exames complementares, revelou uma pneumonia complicada com empiema no hemitórax esquerdo, tendo iniciado antibioterapia e sido submetido à drenagem do líquido pleural. Foi identificado Streptococcus anginosus nesse líquido. No 11º dia de doença, a criança agravou o seu estado clínico, com recidiva da febre, hipoxemia e dificuldade respiratória. Considerando-se o microrganismo identificado, o paciente foi submetido à decorticação pulmonar por videotoracoscopia, com boa evolução clínica posterior. Comentários: Streptococcus anginosus é uma bactéria comensal da cavidade oral humana, que pode causar infecções sistêmicas graves. Apesar de serem raros os casos descritos em pediatria, têm sido cada vez mais descritas infecções torácicas complicadas em adultos. Esse microrganismo também tem a capacidade de formar abcessos e empiemas, que precisam de intervenções terapêuticas diferentes, quando comparados a pneumonias complicadas causadas por outros agentes.
Assuntos
Humanos , Masculino , Criança , Infecções Estreptocócicas/complicações , Empiema Pleural/microbiologia , Pneumonia Bacteriana/microbiologia , Streptococcus anginosus , Infecções Estreptocócicas/terapia , Infecções Estreptocócicas/diagnóstico por imagem , Drenagem , Empiema Pleural/terapia , Empiema Pleural/diagnóstico por imagem , Pneumonia Bacteriana/terapia , Pneumonia Bacteriana/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida , Transtornos do Neurodesenvolvimento/complicações , Antibacterianos/uso terapêuticoRESUMO
Abstract Case Description: A 52-year-old female patient was admitted to our clinic with complaints of cough, sputum, fever and fatigue. The patient has been receiving immunosuppressive therapy for thrombocytopenic purpura for 5 years. Clinical Finding: Inspiratory crackles were heard on both hemithorax. Oxygen saturation measured with the pulse oximeter was 97%. Chest X-ray showed diffuse reticular opacities that were more prominent in the upper zones of both lungs. WBC counts were 17,600 mm3 and Platelet counts were 29,000 mm3. Thorax CT showed that there were many thin-walled cavities and millimetric nodules accompanied by ground-glass infiltrates in the upper and middle lobes. Gram staining of bronchial fluid, taken by bronchoscopy, revealed Gram-negative bacilli and intense polymorphonuclear leukocytes. The bacteria were defined as Delftia acidovorans by BD Phoenix automated system. Treatment and outcomes: The patient was hospitalized with suspicion of opportunistic pulmonary infections and cavitary lung disease. After the empirical treatment of intravenous piperacillin-tazobactam and oral clarithromycin, her clinical and radiological findings significantly regressed, and she was discharged with outpatient follow-up. Clinical Relevance: This is the first example of cavitary pneumonia due to Delftia acidovorans in an immunocompromised patient. We would like to emphasize that Delftia pneumonia should be considered in the differential diagnosis of pulmonary cavitary involvement in such patients.
Resumen Descripción del caso: Una mujer de 52 años llegó a la clínica con tos, esputo, fiebre y fatiga. El paciente estuvo recibiendo terapia inmunosupresora durante 5 años para el tratamiento de la púrpura trombocitopénica. Hallazgo clínico: se escucharon crepitaciones inspiratorias en ambos hemitórax. La saturación de oxígeno fue del 97%. La radiografía de tórax mostró opacidades reticulares difusas que eran más prominentes en las zonas superiores de ambos pulmones. Los recuentos de leucocitos fueron de 17,600 mm3 y los recuentos de plaquetas fueron de 29,000 mm3. La TC de tórax mostró muchas cavidades de pared delgada y nódulos milimétricos acompañados de infiltrados vitrales en los lóbulos superior y medio. La tinción de Gram del líquido bronquial reveló bacilos gramnegativos y leucocitos polimorfonucleares. Las bacterias fueron identificadas como Delftia acidovorans. Tratamiento y resultados: La paciente fue hospitalizado con una sospecha de infección oportunista pulmonar y enfermedad pulmonar cavitaria. Después del tratamiento empírico de piperacilina-tazobactam intravenosa y claritromicina oral, los síntomas y signos retrocedieron significativamente, y fue dada de alta con seguimiento ambulatorio. Relevancia clínica: este es el primer registro de neumonía cavitaria causado por Delftia acidovorans en una paciente inmunocomprometida. Enfatizamos que la neumonía por Delftia debe considerarse en el diagnóstico diferencial de la afectación de la cavidad pulmonar en tales pacientes.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Bactérias Gram-Negativas/diagnóstico , Pneumonia Bacteriana/diagnóstico , Delftia acidovorans/isolamento & purificação , Antibacterianos/administração & dosagem , Tomografia Computadorizada por Raios X , Hospedeiro Imunocomprometido , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Claritromicina/administração & dosagem , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/tratamento farmacológico , Combinação Piperacilina e Tazobactam/administração & dosagem , Pulmão/microbiologia , Pulmão/diagnóstico por imagemRESUMO
BACKGROUND: Community-acquired bacterial pneumonia (CABP) is an acute, lower respiratory bacterial infection. Despite advances in medical care, CABP remains associated with considerable morbidity, mortality, and healthcare costs; early empiric treatment is recommended by the Infectious Diseases Society of America and by the American Thoracic Society. Omadacycline is an oral and intravenous (IV) once-daily aminomethylcycline antibiotic that is approved in the United States for the treatment of adult patients with CABP. OBJECTIVE: To estimate the budget impact of introducing omadacycline as a treatment option among patients with suspected or documented CABP from a US hospital perspective. METHODS: A budget impact model was developed in Microsoft Excel® 2010. Population, clinical, and cost inputs were based on the available literature, clinical trial data, and real-world evidence databases. Emergency departments and observation units were assumed to be hospital-owned as part of the analyses. Sensitivity analyses assessed the impact of key parameters on the model results, and scenario analyses were explored to analyze the budget impact of reducing length of hospital stay and avoiding hospitalization. RESULTS: The introduction of omadacycline as a treatment resulted in a total budget increase of $20,643 over 3 years. This increase was mainly attributed to treatment acquisition costs. In a scenario where the length of hospital stay was reduced by 1 day (under the assumption that an antibiotic with IV and oral formulations can facilitate earlier discharge from inpatient care), the 3-year total budget decreased to $2384; reducing the hospital stay by 2 days resulted in 3-year cost-savings of $15,875. Shifting inpatient care to the outpatient setting with omadacycline resulted in 3-year cumulative cost-savings of $112,843. CONCLUSION: This is the first omadacycline budget impact model developed for adult patients with suspected or documented CABP. The model projected a modest budget increase with the introduction of omadacycline, mainly due to treatment acquisition costs.
RESUMO
CASE DESCRIPTION: A 52-year-old female patient was admitted to our clinic with complaints of cough, sputum, fever and fatigue. The patient has been receiving immunosuppressive therapy for thrombocytopenic purpura for 5 years. CLINICAL FINDING: Inspiratory crackles were heard on both hemithorax. Oxygen saturation measured with the pulse oximeter was 97%. Chest X-ray showed diffuse reticular opacities that were more prominent in the upper zones of both lungs. WBC counts were 17,600 mm3 and Platelet counts were 29,000 mm3. Thorax CT showed that there were many thin-walled cavities and millimetric nodules accompanied by ground-glass infiltrates in the upper and middle lobes. Gram staining of bronchial fluid, taken by bronchoscopy, revealed Gram-negative bacilli and intense polymorphonuclear leukocytes. The bacteria were defined as Delftia acidovorans by BD Phoenix automated system. TREATMENT AND OUTCOMES: The patient was hospitalized with suspicion of opportunistic pulmonary infections and cavitary lung disease. After the empirical treatment of intravenous piperacillin-tazobactam and oral clarithromycin, her clinical and radiological findings significantly regressed, and she was discharged with outpatient follow-up. CLINICAL RELEVANCE: This is the first example of cavitary pneumonia due to Delftia acidovorans in an immunocompromised patient. We would like to emphasize that Delftia pneumonia should be considered in the differential diagnosis of pulmonary cavitary involvement in such patients.
DESCRIPCIÓN DEL CASO: Una mujer de 52 años llegó a la clínica con tos, esputo, fiebre y fatiga. El paciente estuvo recibiendo terapia inmunosupresora durante 5 años para el tratamiento de la púrpura trombocitopénica. HALLAZGO CLÍNICO: se escucharon crepitaciones inspiratorias en ambos hemitórax. La saturación de oxígeno fue del 97%. La radiografía de tórax mostró opacidades reticulares difusas que eran más prominentes en las zonas superiores de ambos pulmones. Los recuentos de leucocitos fueron de 17,600 mm3 y los recuentos de plaquetas fueron de 29,000 mm3. La TC de tórax mostró muchas cavidades de pared delgada y nódulos milimétricos acompañados de infiltrados vitrales en los lóbulos superior y medio. La tinción de Gram del líquido bronquial reveló bacilos gramnegativos y leucocitos polimorfonucleares. Las bacterias fueron identificadas como Delftia acidovorans. TRATAMIENTO Y RESULTADOS: La paciente fue hospitalizado con una sospecha de infección oportunista pulmonar y enfermedad pulmonar cavitaria. Después del tratamiento empírico de piperacilina-tazobactam intravenosa y claritromicina oral, los síntomas y signos retrocedieron significativamente, y fue dada de alta con seguimiento ambulatorio. RELEVANCIA CLÍNICA: este es el primer registro de neumonía cavitaria causado por Delftia acidovorans en una paciente inmunocomprometida. Enfatizamos que la neumonía por Delftia debe considerarse en el diagnóstico diferencial de la afectación de la cavidad pulmonar en tales pacientes.
Assuntos
Antibacterianos/administração & dosagem , Delftia acidovorans/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Pneumonia Bacteriana/diagnóstico , Claritromicina/administração & dosagem , Feminino , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Hospedeiro Imunocomprometido , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pessoa de Meia-Idade , Combinação Piperacilina e Tazobactam/administração & dosagem , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Tomografia Computadorizada por Raios XRESUMO
Introducción: en la edad pediátrica, los niños menores de 5 años son los que tienen la más alta tasa de mortalidad, y la neumonía constituye la causa más frecuente de muerte en este grupo de edad. Objetivo: caracterizar los aspectos clínicos epidemiológicos de los pacientes con neumonía grave adquirida en la comunidad en una Unidad de Cuidados Intensivos Pediátricos. Métodos: estudio descriptivo y transversal en pacientes con neumonía grave adquirida en la comunidad durante el periodo comprendido entre el 1ro septiembre de 2016 al 28 de febrero de 2017, a fin de caracterizarles según algunas variables, tales como: sexo, edad, signos y síntomas, complicaciones, microorganismos aislados y antimicrobianos utilizados. Resultados: de un total de 30 pacientes, el grupo de edad más afectado fue de 1 a 4 años (50 por ciento). La fiebre, la polipnea y el tiraje resultaron elementos clínicos de alto valor predictivo de neumonía. La insuficiencia respiratoria aguda fue la complicación observada en el 100 por ciento de los pacientes. Se obtuvo aislamiento microbiológico en 7 pacientes, lo cual representó 23,3 por ciento, todos en hemocultivo. Los microorganismos aislados fueron: Estafilococo coagulasa negativo, Estafilococo piógeno y Streptococcus pneumoniae. Conclusiones: la morbilidad por neumonía grave es mayor en niños menores de 5 años y del sexo masculino. La insuficiencia respiratoria resulta la complicación más observada. La etiología se plantea por el cuadro clínico y resultado de los hemocultivos(AU)
Introduction: in the pediatric age, children under 5 years old are those with the highest mortality rate, and pneumonia is the most frequent cause of death in this age group. Objective: to characterize the clinical epidemiological aspects of patients with severe pneumonia acquired in the community in a Pediatric Intensive Care Unit. Methods: descriptive and transversal study in patients with severe pneumonia acquired in the community during the period from September 1, 2016 to February 28, 2017, in order to characterize them according to some variables, such as: sex, age, signs and symptoms, complications, isolated microorganisms and antimicrobials used. Results: out of a total of 30 patients, the most affected age group was 1 to 4 years (50 percent). Fever, polypnea and retraction were clinical elements with a high predictive value of pneumonia. Acute respiratory failure was the complication observed in 100 percent of patients. Microbiological isolation was obtained all in blood culture in 7 patients, which represented 23.3 percent,. The isolated microorganisms were: negative Staphylococcus coagulase, Staphylococcus pyogen and Streptococcus pneumoniae. Conclusions: Morbidity due to severe pneumonia is higher in male children under 5 years old. Respiratory failure is the most observed complication. The etiology is posed by the clinical manifestations and the results of blood cultures(AU)
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Pneumonia/complicações , Insuficiência Respiratória/etiologia , Infecções Estafilocócicas/complicações , Pneumonia Bacteriana/mortalidade , Epidemiologia Descritiva , Estudos TransversaisRESUMO
Introducción: el absceso pulmonar es una patología infrecuente en la edad pediátrica, y de etiología diversa. El tratamiento es médico - quirúrgico. Objetivo: revisar la presentación clínica, la bacteriología, las imágenes y la evolución de abscesos pulmonares en la edad pediátrica. Material y Métodos: estudio observacional, descriptivo, realizado de enero de 2010 a setiembre de 2016. Se incluyeron todos los pacientes menores de 16 años, con diagnóstico de absceso pulmonar verificado por tomografía. Se recabaron datos clínicos, hematológicos, bacteriológicos, el tratamiento y la evolución. Resultados: se incluyeron 10 pacientes, con un promedio de edad de 6 años, más frecuente el sexo masculino. Un 80% se desarrolló como complicación de neumonía adquirida en la comunidad (NAC) y el 100% fue primario. El diagnóstico se confirmó por TAC de tórax. El germen aislado fue Staphylococcus aureus en 30%. El pulmón más afectado fue el derecho. Todos curaron con tratamiento médico solamente, utilizándose cefalosporina de tercera generación, unida a un antibiótico antiestafilocócico por más de 4 semanas. No se registraron óbitos ni reingresos. Conclusión: los abscesos pulmonares son poco frecuentes. Pueden presentarse como complicación de NAC o septicemia. Responden bien al tratamiento médico prolongado y pueden presentarse en población pediátrica sin patologías de base.
Introduction: Pulmonary abscess is an infrequent pathology in the pediatric age with a diverse etiology. The treatment is medical - surgical. Objective: To review the clinical presentation, bacteriology, images and outcomes of pulmonary abscesses in pediatric patients. Materials and Methods: This was an observational, descriptive study, carried out from January 2010 to September 2016. All patients under 16 years of age, with a diagnosis of pulmonary abscess verified by computerized axial tomography (CT), were included. We collected the relevant clinical, hematological, bacteriological, treatment and outcome information for each case. Results: 10 patients were included. They had an average age of 6 years, more frequently male. 80% developed as a complication of community-acquired pneumonia (CAP) and 100% were primary. The diagnosis was confirmed by chest CT. Staphylococcus aureus was isolated in 30% of cases. The right lung was the most frequently affected. All cases were cured with medical treatment only, using a third-generation cephalosporin, combined with an anti- staphylococcal antibiotic, with a treatment course of over 4 weeks. There were no deaths or readmissions. Conclusions: Pulmonary abscesses are rare. They can present as a complication of CAP or septicemia. They respond well to prolonged medical treatment and can occur in pediatric population without underlying pathologies.
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La neumonía adquirida en la comunidad (NAC) continúa siendo una de las principales causas de mortalidad en Colombia, pues es responsable de 13 de cada 100.000 muertes. Su principal agente etiológico es el Streptococcus pneumoniae, seguido por Haemophilus influenzae y Staphylococcus aureus. Se han identificado algunos factores de riesgo como comorbilidades y factores de exposición epidemiológica, los cuales incrementan la posibilidad de contraer una infección por microrganismos específicos. Su diagnóstico debe basarse tanto en la clínica como en hallazgos paraclínicos e imagenológicos. Herramientas como las escalas CURB-65 y PSI asociadas al criterio clínico permiten calcular el riesgo de mortalidad y el área de atención del paciente según su clasificación. En esta revisión se consideran los diferentes elementos para una adecuada evaluación y manejo del paciente que cursa con NAC, el uso de algunos biomarcadores, situaciones especiales para apreciar, como la neumonía severa, y estrategias para una adecuada prevención.
Community acquired pneumonia (CAP) is one of the first mortality causes in Colombia it accounts for 13 of every 100,000 deaths per year. Its principal etiologic agent is still Streptococcus pneumoniae, followed by Haemophilus influenzae and Staphylococcus aureus. Several risk factors have been described for CAP and specific pathoghens, such as coomorbidities and exposition factors. Diagnosis is made by clinical findings associated to laboratory workup and radiological evidence. CURB-65 and PSI are the most known and used tools that, in association with clinical evaluation, calculate the mortality risk and evaluate the setting of management. This literature review aims to consider crucial aspects for the correct assessment of CAP patients, biomarkers used in CAP, particular situations such as severe CAP as well as prevention strategies.
Assuntos
Humanos , Pneumonia , Índice de Gravidade de Doença , Biomarcadores , Pneumonia BacterianaRESUMO
Austrian syndrome is a triad characterized by pneumonia, meningitis and endocarditis, as a result of a Streptococcus pneumoniae bacteremia. We report a previously healthy 49 year-old male, who consulted at the emergency care unit with a history of one week of pleuritic pain, fever leading to an altered level of consciousness and seizures. A diagnosis of community-acquired pneumonia and meningitis was reached, isolating Streptococcus pneumoniae in the cerebrospinal fluid and blood cultures. Antibiotic treatment was started but the patient had an unsatisfactory response. During hospitalization a new heart murmur was found in the physical examination. An echocardiography was performed and a massive aortic valve insufficiency was found along with vegetations and a perforation of the same valve. The valve was replaced by a prosthetic one and the patient responded satisfactorily to the surgical and antibiotic treatment, without complications.