RESUMO
El síndrome hemolítico urémico secundario a Streptococcus pneumoniae (SHU-Sp) es una complicación poco frecuente de las enfermedades invasoras por S. pneumoniae. Presenta una alta morbimortalidad, con requerimiento de transfusiones de glóbulos rojos y plaquetas, terapia de sustitución de la función renal de inicio precoz y más prolongada, así como mayores complicaciones a largo plazo, comparado con las formas secundarias a infección entérica por Escherichia coli productora de toxina Shiga. Presentamos el caso clínico de una preescolar de dos años, previamente sana, vacunada con tres dosis de PCV13, que desarrolló una insuficiencia renal aguda, anemia hemolítica y plaquetopenia, en el contexto de una neumonía con empiema y bacteriemia por S. pneumoniae.
Streptococcus pneumoniae associated hemolytic uremic syndrome (Sp-HUS) is an uncommon complication of invasive pneumococcal infections. Patients with Sp-HUS have a higher mortality and long term morbidity than those due to HUS from Shiga toxin-producing Escherichia coli infections (STEC-HUS). They often require more red blood cells and platelet transfusions, and early initiation of renal substitution therapy, presenting a higher rate of arterial hypertension and chronic renal disease in the long term, compared to STEC-HUS. We report a healthy 2 year-old infant, vaccinated with three doses PCV13, that developed acute renal failure, hemolytic anemia and thrombocytopenia in the course of a complicated pneumococcal pneumonia with empyema and bacteremia.
Assuntos
Humanos , Feminino , Pré-Escolar , Infecções Pneumocócicas/complicações , Síndrome Hemolítico-Urêmica/etiologia , Infecções Pneumocócicas/terapia , Infecções Pneumocócicas/diagnóstico por imagem , Streptococcus pneumoniae , Trombocitopenia , Radiografia Torácica , Insuficiência Renal , Síndrome Hemolítico-Urêmica/terapia , Síndrome Hemolítico-Urêmica/diagnóstico por imagemRESUMO
The nasal priming with nonviable Lactobacillus rhamnosus CRL1505 (NV1505) or its purified peptidoglycan (PG1505) differentially modulates the respiratory innate immune response in infant mice, improving their resistance to primary respiratory syncytial virus (RSV) infection and secondary pneumococcal pneumonia. In association with the protection against RSV-pneumococcal superinfection, it was found that NV1505 or PG1505 significantly enhance the numbers of CD11c+SiglecF+ alveolar macrophages (AMs) producing interferon (IFN)-ß. In this work, we aimed to further advance in the characterization of the beneficial effects of NV1505 and PG1505 in the context of a respiratory superinfection by evaluating whether their immunomodulatory properties are dependent on AM functions. Macrophage depletion experiments and a detailed study of their production of cytokines and antiviral factors clearly demonstrated the key role of this immune cell population in the improvement of both the reduction of pathogens loads and the protection against lung tissue damage induced by the immunobiotic CRL1505 strain. Studies at basal conditions during primary RSV or S. pneumoniae infections, as well as during secondary pneumococcal pneumonia, brought the following five notable findings regarding the immunomodulatory effects of NV1505 and PG1505: (a) AMs play a key role in the beneficial modulation of the respiratory innate immune response and protection against RSV infection, (b) AMs are necessary for improved protection against primary and secondary pneumococcal pneumonia, (c) the generation of activated/trained AMs would be essential for the enhanced protection against respiratory pathogens, (d) other immune and nonimmune cell populations in the respiratory tract may contribute to the protection against bacterial and viral infections, and (e) the immunomodulatory properties of NV1505 and PG1505 are strain-specific. These findings significantly improve our knowledge about the immunological mechanisms involved in the modulation of respiratory immunity induced by beneficial microbes.
Assuntos
Fatores Imunológicos/uso terapêutico , Macrófagos Alveolares/imunologia , Peptidoglicano/uso terapêutico , Infecções Pneumocócicas/imunologia , Infecções por Vírus Respiratório Sincicial/imunologia , Animais , Antígenos CD11/genética , Antígenos CD11/metabolismo , Células Cultivadas , Chlorocebus aethiops , Imunidade Inata , Fatores Imunológicos/farmacologia , Lacticaseibacillus rhamnosus/metabolismo , Macrófagos Alveolares/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Peptidoglicano/farmacologia , Infecções Pneumocócicas/terapia , Infecções por Vírus Respiratório Sincicial/terapia , Lectinas Semelhantes a Imunoglobulina de Ligação ao Ácido Siálico/genética , Lectinas Semelhantes a Imunoglobulina de Ligação ao Ácido Siálico/metabolismo , Células VeroRESUMO
OBJECTIVE: To describe a case series of four (4) patients with hemolytic uremic syndrome due to Streptococcus pneumoniae in a level four complexity institution in the city of Bogotá, D.C., Colombia. CASES DESCRIPTION: We describe cases of four patients who presented respiratory symptoms and fever. All four patients were in regular conditions on hospital admission, after which they required intensive care and ventilatory support. Upon admission, three cases showed evidence of pleuropulmonary complication. Penicillin-sensitive Streptococcus pneumoniae was isolated in all cases. All patients presented anemia, severe thrombocytopenia, schistocytes on peripheral blood smear, and hyperazotemia. They required blood transfusion and renal replacement therapy during their hospitalization. The patients were diagnosed with hemolytic uremic syndrome due to S. pneumoniae. Three of the four patients had a progressive recovery of the renal function and were discharged after an average of 36 days of hospital stay. The remaining patient had two amputations in the extremities due to thrombotic vascular complications and was discharged after 99 days of hospital stay, requiring hemodialysis every other day. COMMENTS: Hemolytic uremic syndrome due to Streptococcus pneumoniae is a rare but severe complication of invasive pneumococcal disease. Complicated pneumonia is the main condition associated with this entity. It is noteworthy the short period in which these cases were presented, considering the low annual incidence of the disease.
Assuntos
Síndrome Hemolítico-Urêmica/etiologia , Síndrome Hemolítico-Urêmica/terapia , Infecções Pneumocócicas/complicações , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Amputação Cirúrgica/métodos , Transfusão de Sangue/métodos , Pré-Escolar , Síndrome Hemolítico-Urêmica/diagnóstico , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Infecções Pneumocócicas/diagnóstico por imagem , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/terapia , Pneumonia Pneumocócica/diagnóstico , Insuficiência Renal/etiologia , Insuficiência Renal/terapia , Terapia de Substituição Renal/métodos , Choque Séptico/etiologia , Trombose/cirurgia , Resultado do TratamentoRESUMO
The effect of Lactobacillus rhamnosus CRL1505 (Lr) on macrophages (Ma) and dendritic cells (DC) in the orchestration of anti-pneumococcal immunity was studied using malnutrition and pneumococcal infection mouse models. Monocytes (Mo), Ma, and DC in two groups of malnourished mice fed with balanced diet (BCD) were studied through flow cytometry; one group was nasally administered with Lr (BCD+Lr group), and the other group was not (BCD group). Well-nourished (WNC) and malnourished (MNC) mice were used as controls.Malnutrition affected the number of respiratory and splenic mononuclear phagocytes. The BCD+Lr treatment, unlike BCD, was able to increase and normalize lung Mo and Ma. The BCD+Lr mice were also able to upregulate the expression of the activation marker MHC II in lung DC and to improve this population showing a more significant effect on CD11b+ DC subpopulation. At post-infection, lung Mo values were higher in BCD+Lr mice than in BCD mice and similar to those obtained in WNC group. Although both repletion treatments showed similar values of lung Ma post-infection, the Ma activation state in BCD+Lr mice was higher than that in BCD mice. Furthermore, BCD+Lr treatment was able to normalize the number and activation of splenic Ma and DC after the challenge.Lr administration stimulates respiratory and systemic mononuclear phagocytes. Stimulation of Ma and DC populations would increase the microbicide activity and improve the adaptive immunity through its antigen-presenting capacity. Thus, Lr contributes to improved outcomes of pneumococcal infection in immunocompromised hosts.
Assuntos
Imunidade , Lacticaseibacillus rhamnosus , Desnutrição/terapia , Infecções Pneumocócicas/terapia , Probióticos/administração & dosagem , Animais , Células Dendríticas/citologia , Pulmão/imunologia , Macrófagos/citologia , Masculino , Camundongos , Infecções Pneumocócicas/imunologia , Baço/imunologiaRESUMO
ABSTRACT Objective: To describe a case series of four (4) patients with hemolytic uremic syndrome due to Streptococcus pneumoniae in a level four complexity institution in the city of Bogotá, D.C., Colombia. Cases description: We describe cases of four patients who presented respiratory symptoms and fever. All four patients were in regular conditions on hospital admission, after which they required intensive care and ventilatory support. Upon admission, three cases showed evidence of pleuropulmonary complication. Penicillin-sensitive Streptococcus pneumoniae was isolated in all cases. All patients presented anemia, severe thrombocytopenia, schistocytes on peripheral blood smear, and hyperazotemia. They required blood transfusion and renal replacement therapy during their hospitalization. The patients were diagnosed with hemolytic uremic syndrome due to S. pneumoniae. Three of the four patients had a progressive recovery of the renal function and were discharged after an average of 36 days of hospital stay. The remaining patient had two amputations in the extremities due to thrombotic vascular complications and was discharged after 99 days of hospital stay, requiring hemodialysis every other day. Comments: Hemolytic uremic syndrome due to Streptococcus pneumoniae is a rare but severe complication of invasive pneumococcal disease. Complicated pneumonia is the main condition associated with this entity. It is noteworthy the short period in which these cases were presented, considering the low annual incidence of the disease.
RESUMO Objetivo: Descrever uma série de casos de quatro pacientes com síndrome hemolítico-urêmica por pneumococo em uma instituição de referência em Bogotá, Colômbia. Descrição dos casos: Descrevemos os casos de quatro pacientes que apresentaram sintomas respiratórios e febre. Todos estavam em estado geral regular à admissão hospitalar e necessitaram de cuidados intensivos e suporte ventilatório. Na admissão, em três dos casos foi evidenciada a complicação pleuropulmonar. Isolamento de Streptococcus pneumoniae sensível à penicilina foi realizado em todos os casos. Os quatro pacientes precisaram de transfusão sanguínea e terapia de reposição renal durante a hospitalização. Nos testes laboratoriais, observou-se anemia, trombocitopenia grave, presença de esquizócitos em esfregaço de sangue periférico e hiperazotemia. Com esse quadro, o diagnóstico foi de síndrome hemolítico-urêmica associada à infecção por S. pneumoniae. Houve recuperação progressiva da função renal em três dos quatro pacientes, que tiveram alta após 36 dias de internação hospitalar, em média. Um paciente teve complicações vasculares trombóticas, resultando em duas amputações nas extremidades, e teve alta após 99 dias de internação, com necessidade de hemodiálise em dias alternados. Comentários: A síndrome hemolítico-urêmica por Streptococcus pneumoniae é uma complicação rara, mas grave, da doença invasiva pneumocócica. A pneumonia complicada é a principal condição associada a essa entidade. Destaca-se o curto período em que esses casos foram apresentados, levando em conta a baixa incidência anual de síndrome hemolítico-urêmica.
Assuntos
Humanos , Masculino , Lactente , Pré-Escolar , Adolescente , Infecções Pneumocócicas/complicações , Streptococcus pneumoniae/isolamento & purificação , Síndrome Hemolítico-Urêmica/etiologia , Síndrome Hemolítico-Urêmica/terapia , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/terapia , Infecções Pneumocócicas/diagnóstico por imagem , Pneumonia Pneumocócica/diagnóstico , Choque Séptico/etiologia , Trombose/cirurgia , Transfusão de Sangue/métodos , Resultado do Tratamento , Terapia de Substituição Renal/métodos , Insuficiência Renal/etiologia , Insuficiência Renal/terapia , Síndrome Hemolítico-Urêmica/diagnóstico , Amputação Cirúrgica/métodos , Tempo de Internação/estatística & dados numéricosRESUMO
We report an uncommon case of septic arthritis of the ankle from a Streptococcus pneumoniae infection and provide an update of the literature reported since 2002. A 58-year-old female presented to the hospital with right ankle pain and an inability to bear weight. She reported a history of productive cough, vomiting, diarrhea, and subjective fevers 4 days earlier. Streptococcus pneumonia was identified in her ankle aspirate, and she was treated urgently with operative incision and debridement, followed by postoperative intravenous antibiotics. At her 7-week follow-up, she demonstrated complete resolution of symptoms and near-complete recovery of range of motion. This case demonstrates the importance of early identification, as the majority of patients recover fully with prompt treatment. The literature review included 44 cases of pneumococcal septic arthritis and found that the knee was the most commonly affected joint, followed by the shoulder and ankle. Blood cultures were positive for S. pneumoniae in 27 of 38 adults (71%) and 4 of 6 children (67%). Comorbid conditions were present in 32 of 38 adults (84%) and 4 of 7 children (57%), the most frequent of which were alcoholism and osteoarthritis in adults and malignancy or immunosuppression in children. Additionally, roughly half of included adults had an extra-articular focus of pneumococcal disease, most frequently pneumonia. Operative treatment was undertaken in 32 of 38 adults (84%) and all 7 children. Of adults with data available, 24 of 33 (73%) recovered with complete joint function, compared with 5 of 7 children (71%).
Assuntos
Artrite Infecciosa/terapia , Infecções Pneumocócicas/diagnóstico , Antibacterianos/uso terapêutico , Artrite Infecciosa/microbiologia , Tosse/microbiologia , Desbridamento , Diarreia/microbiologia , Feminino , Febre/microbiologia , Humanos , Pessoa de Meia-Idade , Infecções Pneumocócicas/terapia , Streptococcus pneumoniaeRESUMO
Streptococcus pneumoniae is able to activate coagulation and induce platelet aggregation, both of which are typical responses to systemic inflammation. The interactions between inflammation and coagulation and between soluble adhesion molecules and endothelial cells are important in the pathogenesis of an unbalanced haemostatic system. Therefore, an exaggerated and/or insufficiently controlled haemostatic activity may appreciably contribute to the severity of the disease. The aim of the present study was to evaluate the effect of the oral administration of Lactobacillus casei CRL 431 on platelet and endothelial activation mechanisms in a respiratory pneumococcal infection model in mice. S. pneumoniae induced an increase in platelet counts and enhanced the expression of P-selectin in control group, with higher endothelial activation in lung shown by the increase in von Willebrand factor (vWF) and vascular cell adhesion molecule 1 (VCAM-1) expression. Also, infection induced a decrease in CXCR-4 leukocytes, increased expression in annexinV and cell death at the pulmonary level and decreased antithrombin levels in bronchoalveolar lavage. In contrast, L. casei mice restored platelet counts, favoured faster P-selectin expression, lower vWF levels and VCAM-1 expression than control group. Also, L. casei induced higher levels of annexinV expression and lower cell death in the lung. Moreover, it was able to modulate antithrombin levels within the normal range, which would indicate lower coagulation activation and a protective effect locally exerted by L. casei. In this work, the ability of L. casei to favourably modulate platelet and endothelial functionality during a pulmonary infection with S. pneumoniae was demonstrated. Our findings offer a promising perspective for the use of this probiotic strain in the prevention of thrombotic complications associated with pneumococcal pneumonia, especially in at-risk patients. In addition, the use of L. casei would provide novel alternatives for the prevention and treatment of thrombosis associated with various diseases.
Assuntos
Plaquetas/fisiologia , Células Endoteliais/fisiologia , Lacticaseibacillus casei/crescimento & desenvolvimento , Infecções Pneumocócicas/terapia , Probióticos/administração & dosagem , Infecções Respiratórias/terapia , Animais , Análise Química do Sangue , Modelos Animais de Doenças , Camundongos , Contagem de Plaquetas , Infecções Pneumocócicas/patologia , Infecções Respiratórias/patologia , Resultado do TratamentoRESUMO
RESUMO Objetivo: Relatar um caso raro de uma criança com meningite associada a pericardite na doença pneumocócica invasiva. Descrição do caso: Este relato descreve uma evolução clínica desfavorável de um lactente feminino de 6 meses de idade, previamente hígido, que apresentou inicialmente sintomas respiratórios e febre. A radiografia de tórax revelou um aumento da área cardíaca sem alterações radiográficas nos pulmões. Após a identificação do derrame pericárdico, o paciente apresentou convulsões e entrou em coma. Pneumonia foi descartada durante a investigação clínica. Contudo, foi identificado Streptococcus pneumoniae nas culturas de líquor e sangue. O exame neurológico inicial foi compatível com morte encefálica, posteriormente confirmada pelo protocolo. Comentários: A pericardite purulenta tornou-se uma complicação rara da doença pneumocócica invasiva desde o advento da terapia antibiótica. Pacientes com pneumonia extensa são primariamente predispostos e, mesmo com tratamento adequado e precoce, estão sujeitos a altas taxas de mortalidade. A associação de meningite pneumocócica e pericardite é incomum e, portanto, de difícil diagnóstico. Por isso, uma alta suspeição diagnóstica é necessária para instituir o tratamento precoce e aumentar a sobrevida.
ABSTRACT Objective: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. Case description: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. Comments: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.
Assuntos
Humanos , Masculino , Feminino , Streptococcus pneumoniae/isolamento & purificação , Derrame Pericárdico/diagnóstico por imagem , Pericardite/diagnóstico , Pericardite/fisiopatologia , Pericardite/microbiologia , Pericardite/terapia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/fisiopatologia , Infecções Pneumocócicas/terapia , Ecocardiografia/métodos , Radiografia Torácica/métodos , Líquido Cefalorraquidiano/microbiologia , Evolução Fatal , Hemocultura/métodos , Meningite/diagnóstico , Meningite/fisiopatologia , Meningite/microbiologia , Meningite/terapia , Antibacterianos/administração & dosagem , Antibacterianos/classificação , Exame Neurológico/métodosRESUMO
OBJECTIVE: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. CASE DESCRIPTION: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. COMMENTS: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.
OBJETIVO: Relatar um caso raro de uma criança com meningite associada a pericardite na doença pneumocócica invasiva. DESCRIÇÃO DO CASO: Este relato descreve uma evolução clínica desfavorável de um lactente feminino de 6 meses de idade, previamente hígido, que apresentou inicialmente sintomas respiratórios e febre. A radiografia de tórax revelou um aumento da área cardíaca sem alterações radiográficas nos pulmões. Após a identificação do derrame pericárdico, o paciente apresentou convulsões e entrou em coma. Pneumonia foi descartada durante a investigação clínica. Contudo, foi identificado Streptococcus pneumoniae nas culturas de líquor e sangue. O exame neurológico inicial foi compatível com morte encefálica, posteriormente confirmada pelo protocolo. COMENTÁRIOS: A pericardite purulenta tornou-se uma complicação rara da doença pneumocócica invasiva desde o advento da terapia antibiótica. Pacientes com pneumonia extensa são primariamente predispostos e, mesmo com tratamento adequado e precoce, estão sujeitos a altas taxas de mortalidade. A associação de meningite pneumocócica e pericardite é incomum e, portanto, de difícil diagnóstico. Por isso, uma alta suspeição diagnóstica é necessária para instituir o tratamento precoce e aumentar a sobrevida.
Assuntos
Antibacterianos , Meningite , Pericardite , Infecções Pneumocócicas , Streptococcus pneumoniae/isolamento & purificação , Antibacterianos/administração & dosagem , Antibacterianos/classificação , Hemocultura/métodos , Líquido Cefalorraquidiano/microbiologia , Ecocardiografia/métodos , Evolução Fatal , Feminino , Humanos , Lactente , Meningite/diagnóstico , Meningite/microbiologia , Meningite/fisiopatologia , Meningite/terapia , Exame Neurológico/métodos , Derrame Pericárdico/diagnóstico por imagem , Pericardite/diagnóstico , Pericardite/microbiologia , Pericardite/fisiopatologia , Pericardite/terapia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/fisiopatologia , Infecções Pneumocócicas/terapia , Radiografia Torácica/métodosRESUMO
La enfermedad neumocócica invasiva (ENI) es causa de morbimortalidad prevenible en pediatría. Con la introducción de vacunas antineumocócicas conjugadas disminuyó la prevalencia de ENI en 61,9% en los menores de 2 años, y se produjo un cambio en la distribución de serotipos y un aumento de ENI por serotipos no vaccinales. En este contexto, es relevante la vigilancia epidemiológica de los serotipos emergentes causantes de ENI en la población. Se presentará el caso de una lactante de 11 meses con diagnóstico de meningitis causada por neumococo serotipo 38, su evolución y consecuencias clínicas, y se realiza un análisis de la situación epidemiológica actual.
In pediatrics,invasive pneumococcal disease is a preventable cause ofmorbidity andmortality.The introduction of conjugated pneumococcal vaccines has reduced the prevalence of invasive pneumococcal disease by 61.9% in the under two's and has brought about a change in the distribution of serotypes and a rise in invasive pneumococcal disease caused by non-vaccine serotypes.This being the case,itis very importanttomonitorthe epidemiology ofthe emerging serotypes causing the disease in the population.We presentthe case of an 11 month old infant diagnosed with meningitis caused by serotype 38, describing his clinical course andclinical consequences; andweperforman analysis ofthepresent epidemiologica lsituation
Assuntos
Humanos , Feminino , Lactente , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/terapia , Streptococcus pneumoniae/isolamento & purificação , Sorotipagem , SorogrupoRESUMO
OBJECTIVE: To compare the efficacy of 3 treatment options in patients with chronic blepharitis. METHODOLOGY: An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs. RESULTS: A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P<.05), Group 3 showed no clinical improvement for itching (P=.16), dry eye (P=.29), eyelashes falling (P=.16), and erythema at the eyelid margin (P=.29). CONCLUSIONS: Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone.
Assuntos
Antibacterianos/uso terapêutico , Blefarite/terapia , Irrigação Terapêutica , Administração Oftálmica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Antibacterianos/administração & dosagem , Blefarite/tratamento farmacológico , Blefarite/microbiologia , Blefarite/parasitologia , Doença Crônica , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Pestanas , Feminino , Géis , Preparações para Cabelo , Humanos , Masculino , Metronidazol/administração & dosagem , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Infestações por Ácaros/tratamento farmacológico , Infestações por Ácaros/terapia , Ácaros , Neomicina/administração & dosagem , Neomicina/uso terapêutico , Pomadas , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/terapia , Polimixinas/administração & dosagem , Polimixinas/uso terapêutico , Índice de Gravidade de Doença , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/terapia , Resultado do Tratamento , Adulto JovemRESUMO
Estudiamos 537 niños internados en el Hospital Dr. Notti, entre 1993 y 2011, con enfermedad invasiva neumocócica. La mediana de edad fue 19 meses (R = 0-192 m); 34,82% fueron < 1 año y 23,46%, t 60 meses. Predominaron neumonía con y sin derrame (48,04%) y meningitis (29,05%), con una letalidad de 6,14%. El 56,86% de los serotipos identificados fueron 14, 5 y 1. Mostraron sensibilidad a la penicilina el 99,74% de cepas no meníngeas y a la ceftriaxona, el 98,08% de cepas meníngeas. Los factores de riesgo en neumonía con derrame se asociaron a la edad t 60 meses, RR 1,47 (1,06-2,04), p 0,02, serotipos 5, RR 2,57 (1,71-3,87), p 0,0001 y 1 RR 1,86 (1,17-2,96), p 0,014 y en las meningitis, principalmente a < 1 año, RR 2,35 (1,87-3,06), p 0,0000 y serotipo 18C, RR 2,19 (1,3-3,7), p 0,024. Conclusión. El Streptococcus pneumoniae representó un problema importante en menores de un año, en quienes predominó la meningitis y causó más de la mitad de las muertes, y en mayores de 60 meses, en los que prevalecieron neumonías con derrame. La mayoría fueron sensibles a la penicilina y a la ceftriaxona.
Five hundred and thirty-seven children admitted to Hospital Dr. Notti and diagnosed with invasive pneumococcal disease between 1993 and 2011 were studied. Their median age was 19 months (range= 0-192 months); 34.82% were <1 year old and 23.46%, ≥60 months old. Pneumonia with or without effusion (48.04%) and meningitis (29.05%) were the most predominant conditions, with a case fatality rate of 6.14%. Identified serotypes corresponded to 14, 5 and 1 in 56.86% of cases. Sensitivity to penicillin was observed in 99.74% of non-meningeal strains, while sensitivity to ceftriaxone was found in 98.08% of meningeal strains. Risk factors in pneumonia with effusion were associated to age ≥60 months old, RR: 1.47 (1.06-2.04), p= 0.02, to serotype 5, RR: 2.57 (1.71-3.87), p= 0.0001, and to serotype 1, RR: 1.86 (1.17-2.96), p= 0.014; in the case of meningitis, risk factors were mainly associated to age <1 year old, RR: 2.35 (1.87-3.06), p= 0.0000, and to serotype 18C, RR: 2.19 (1.3-3.7), p= 0.024. Conclusion. Streptococcus pneumonia was a major problem in infants younger than one year old, who predominantly developed meningitis which caused half of deaths, and in children older than 60 months old, who had a prevalence of pneumonia with effusion. Most cases were sensitive to penicillin and ceftriaxone
Assuntos
Humanos , Lactente , Pré-Escolar , Infecções Pneumocócicas/terapia , Argentina , Fatores de Tempo , Vigilância da População , Estudos Retrospectivos , Hospitais PediátricosRESUMO
INTRODUCTION: Streptococcus pneumoniae infection in adults is related to pneumonia, meningitis and bacteremia. Its care costs in adults are not well documented in Colombia and it has a greater impact in people over 45 years old. OBJECTIVES: The aims of this study were to analyze the associated costs of pneumonia, bacteremia and meningitis in invasive S. pneumoniae infection in Colombia among hospitalized adults and to estimate outpatient costs for community-acquired pneumonia. Additionally, we wanted to serve as a starting point for future economic evaluations. MATERIALS AND METHODS: We performed a direct cost study associated with S. pneumoniae outpatient community-acquired pneumonia, bacteremia and meningitis costs confirmed by cultures. A cohort of hospitalized adults treated between January 2010 and June 2011 in three third level hospitals in Bogotá was analyzed. We evaluated 107 records and 60 bills charged to the payer. The data were classified according to care and treatment costs. We performed an estimate of direct costs for community-acquired pneumonia for outpatient cases through Delphi methodology using expert clinicians. RESULTS: The average direct costs associated with pneumococcal disease were US$ 6,283, US$ 3,886, and US$ 4,768 for pneumonia, meningitis and bacteremia, respectively (exchange rate 1 US$ = Col$ 1,938.34; average variation between 2010 and 2011). Pneumonia cases were 70% men and 30% women; the distribution for meningitis was the same for both genders (50%); and for bacteremia we had 67% men and 33% women. Outpatient cost of community-acquired pneumonia was estimated at US$ 82.2 ( Col $ 159,280 ) in adults. For special cases, direct cost increased to US$ 142 ( Col $ 274,427). CONCLUSIONS: The management of S. pneumoniae infection in people over 45 years old represents a high cost due to the use of drugs and hospitalization, which has a direct impact on health resources. Prevention and early treatment for pneumonia can reduce the cost and the burden of the disease.
Assuntos
Bacteriemia/economia , Bacteriemia/terapia , Hospitalização , Meningite Pneumocócica/economia , Meningite Pneumocócica/terapia , Infecções Pneumocócicas/economia , Infecções Pneumocócicas/terapia , Pneumonia Pneumocócica/economia , Pneumonia Pneumocócica/terapia , Streptococcus pneumoniae , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colômbia , Infecções Comunitárias Adquiridas/economia , Infecções Comunitárias Adquiridas/terapia , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Five hundred and thirty-seven children admitted to Hospital Dr. Notti and diagnosed with invasive pneumococcal disease between 1993 and 2011 were studied. Their median age was 19 months (range= 0-192 months); 34.82% were <1 year old and 23.46%, >60 months old. Pneumonia with or without effusion (48.04%) and meningitis (29.05%) were the most predominant conditions, with a case fatality rate of 6.14%. Identified serotypes corresponded to 14, 5 and 1 in56.86% of cases. Sensitivity to penicillin was observed in99.74% of non-meningeal strains, while sensitivity to ceftriaxone was found in 98.08% ofmeningeal strains. Risk factors inpneumonia with effusionwere associated to age >60 months old, RR: 1.47 (1.06-2.04), p= 0.02, to serotype 5, RR: 2.57 (1.71-3.87), p= 0.0001, and to serotype 1, RR: 1.86 (1.17-2.96), p= 0.014; in the case of meningitis, risk factors were mainly associated to age <1 year old, RR: 2.35 (1.87-3.06), p= 0.0000, and to serotype 18C, RR: 2.19 (1.3-3.7), p= 0.024. Conclusion. Streptococcus pneumonia was a major problem in infants younger than one year old, who predominantly developed meningitis which caused half of deaths, and in children older than 60 months old, who had a prevalence of pneumonia with effusion. Most cases were sensitive to penicillin and ceftriaxone.
Assuntos
Infecções Pneumocócicas/terapia , Adolescente , Argentina , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Vigilância da População , Estudos Retrospectivos , Fatores de TempoRESUMO
Introducción. Las infecciones por Streptococcus pneumoniae en adultos se relacionan con neumonía, meningitis y bacteriemia. El costo de la atención en personas adultas no está bien documentado en Colombia, pero puede ser significativo. Objetivo. Analizar los costos asociados con la neumonía adquirida en comunidad, meningitis y bacteriemia por S. pneumoniae en adultos hospitalizados en Colombia y estimar el costo de la atención ambulatoria de esta neumonía. Servir de base para futuras evaluaciones económicas. Materiales y métodos. Se realizó un estudio de costos directos asociados a neumonía adquirida en comunidad, meningitis y bacteriemia por S. pneumoniae confirmado por cultivos. Se tomó una muestra de conveniencia de adultos hospitalizados entre enero de 2010 y junio de 2011 en tres hospitales de tercer nivel de Bogotá. Se analizaron 107 registros y se obtuvieron 60 facturas cobradas al pagador. La información se clasificó por costos de atención y tratamiento. Para los casos ambulatorios de neumonía, el estimativo de costos se hizo utilizando metodología Delphi con expertos clínicos. Resultados. El promedio de los costos directos totales asociados con neumonía fue de Col$ 12´178.949, Col$ 7´533.187 para meningitis y Col$ 9´242.806 para bacteriemia. La neumonía se presentó en 70 % de los hombres y 30 % de las mujeres; la meningitis se distribuyó igual en ambos sexos (50 %) y la bacteriemia se presentó en 67 % de los hombres y 33 % de las mujeres. El costo por adulto de la atención ambulatoria de la neumonía adquirida en la comunidad se estimó en Col$ 106.174. Para casos especiales se incrementó a Col$ 164.695. Conclusión. La enfermedad neumocócica en adultos, especialmente mayores de 45 años, representa un alto costo por el empleo de medicamentos y la estancia hospitalaria, que causan un impacto en los recursos del sistema. La prevención y el tratamiento temprano de las neumonías pueden disminuir costos y reducir la carga de enfermedad.
Introduction: Streptococcus pneumoniae infection in adults is related to pneumonia, meningitis and bacteremia. Its care costs in adults are not well documented in Colombia and it has a greater impact in people over 45 years old. Objectives: The aims of this study were to analyze the associated costs of pneumonia, bacteremia and meningitis in invasive S. pneumoniae infection in Colombia among hospitalized adults and to estimate outpatient costs for community-acquired pneumonia. Additionally, we wanted to serve as a starting point for future economic evaluations. Materials and methods: We performed a direct cost study associated with S. pneumoniae outpatient community-acquired pneumonia, bacteremia and meningitis costs confirmed by cultures. A cohort of hospitalized adults treated between January 2010 and June 2011 in three third level hospitals in Bogotá was analyzed. We evaluated 107 records and 60 bills charged to the payer. The data were classified according to care and treatment costs. We performed an estimate of direct costs for community-acquired pneumonia for outpatient cases through Delphi methodology using expert clinicians. Results: The average direct costs associated with pneumococcal disease were US$ 6,283, US$ 3,886, and US$ 4,768 for pneumonia, meningitis and bacteremia, respectively (exchange rate 1 US$ = Col$ 1,938.34; average variation between 2010 and 2011). Pneumonia cases were 70% men and 30% women; the distribution for meningitis was the same for both genders (50%); and for bacteremia we had 67% men and 33% women. O utpatient cost of community-acquired pneumonia was estimated at US$ 82.2 ( Col $ 159,280 ) in adults. For special cases, direct cost increased to US$ 142 ( Col $ 274,427). Conclusions: The management of S. pneumoniae infection in people over 45 years old represents a high cost due to the use of drugs and hospitalization, which has a direct impact on health resources. Prevention and early treatment for pneumonia can reduce the cost and the burden of the disease.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Bacteriemia/economia , Bacteriemia/terapia , Hospitalização , Meningite Pneumocócica/economia , Meningite Pneumocócica/terapia , Infecções Pneumocócicas/economia , Infecções Pneumocócicas/terapia , Pneumonia Pneumocócica/economia , Pneumonia Pneumocócica/terapia , Streptococcus pneumoniae , Colômbia , Efeitos Psicossociais da Doença , Infecções Comunitárias Adquiridas/economia , Infecções Comunitárias Adquiridas/terapiaRESUMO
Objetivos: Relatar um caso clínico raro de celulite periorbitária pneumocócica em idade pediátrica. Descrição: Criança do sexo masculino, 18 meses de idade, recorreu à Urgência Pediátrica (UP) por febre, tosse não produtiva e vómitos, com exame físico sem alterações. As hipóteses diagnósticas colocadas foram: síndrome febril virusal, pneumonia ou infecção urinária. Realizou-se estudo analítico, análise sumária de urina e radiografia do tórax que não revelaram alterações. Teve alta com hemocultura e urocultura em curso. Recorreu, 24 horas depois, por manutenção da febre e vómitos. À admissão, constatou-se irritabilidade e sinais inflamatórios periorbitários à direita. Perante o diagnóstico de celulite periorbitária, foi iniciado cefuroxime endovenoso e decidido o internamento. Ao terceiro dia de internamento, a antibioterapia foi alterada para ceftriaxone, por agravamento clínico, tendo-se verificado apirexia 36 horas após essa alteração. Na primeira hemocultura colhida, foi identificado um Streptococcus pneumoniae, resistente à penicilina e cefuroxime. A evolução clínica foi favorável, com alta para o Hospital de Dia, para cumprimento terapêutico. Conclusões: A literatura alerta para a existência dessa entidade cada vez mais rara em Pediatria após a introdução da vacinação antipneumocócica. No entanto, o diagnóstico de presunção é importante, visto que essa condição é raramente identificada à admissão.
Objectives: To report a rare clinical case of a pneumococcal periorbital cellulitis in pediatric age. Description: A male child with 18 months presented to the Pediatric Emergency Department (PE) with fever, nonproductive cough and vomiting. Physical examination was unremarkable. The diagnostic hypotheses were: viral febrile syndrome, pneumonia or urinary tract infection. An analytical study, urine analysis and chest x-rays were performed and no changes were detected. The patient was discharged with urine and blood culture in progress. Twenty-four hours later, the patient presented again to the PE due to fever and vomiting maintenance. On admission, the child presented with periorbital inflammatory signals at the right side and irritability. Periorbital cellulitis was diagnosed and antibiotic treatment was initiated with intravenous cefuroxime. Patient hospitalization was decided. In the third day of hospitalization, antibiotic therapy was changed to ceftriaxone, due to clinical worsening. Apyrexia was found 36 hours after this change. In the first blood culture, it was identified a Streptococcus pneumoniae resistant to penicillin and cefuroxime. The clinical outcome was favorable, with discharge to Day Hospital, to comply therapy. Conclusions: The literature points to the existence of this entity increasingly rare in the pediatric patients after the introduction of pneumococcal vaccination. However, the presumptive diagnosis is important, since this condition is rarely identified at admission.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Antibioticoprofilaxia , Bacteriemia/terapia , Celulite Orbitária , Infecções Pneumocócicas/terapiaRESUMO
El estreptococcus pneumoniae se encuentra entre los mayores patógenos causantes de infecciones invasoras y no invasoras en los dos extremos de la vida: en niños menores de 5 años y en personas mayores de 65 años de edad. Las principales manifestaciones asociadas a infecciones neumocócicas son: neumonía, bacteriemia febril, septicemia, otitis media y meningitis. Esta bacteria es uno de los principales agentes involucrados en la mortalidad infantil, con un estimado de 1000000 de muertes globales por año, en niños menores de 5 años de edad, la mayoría provenientes de países en vías de desarrollo, por lo que es considerada como un serio problema para la salud pública alrededor del mundo. En el 2000 se introdujo al mercado de los Estados Unidos de Norte América, la primera vacuna neumocócica conjugada, que a diferencia de la ya disponible vacuna neumocócica polisacárida, es capaz de proporcionar una respuesta inmune efectiva para la protección de niños menores de 2 años. La eficacia reportada para la vacuna conjugada heptavalente en los ensayos clínicos iniciales fue de un 97.4 por ciento contra la enfermedad neumocócica invasora producida por los serotipos incluidos en la vacuna, 4, 9V, 14, 19F, 23F, 18C y 6B. En la actualidad diferentes entidades regulatorias, incluyendo la Agencia Europea de Medicamentos, EMEA, han autorizado la comercialización de la vacuna conjugada 10-valente, en la que, además de los serotipos descritos para la vacuna 7-valente, se incluyen los serotipos 1, 5 y 7F; de estos diez serotipos, ocho se encuentran conjugados con la proteína transportadora D, un elemento que se encuentra en la porción externa del Haemophilus influenzae. La otra nueva vacuna conjugada que está en fase de análisis por diferentes entidades regulatorias, incluyendo la Administración de Alimentos y Drogas de los Estados Unidos...
Streptococcus pneumoniae is one of the major pathogens causing invasive and non invasive infections in children younger than 5 years as well as in the elderly. Primary clinical syndromesassociated with pneumococcal infections are pneumonia, bacteremia, acute otitis media andmeningitis. This microorganism contributes importantly to morbidity and mortality among children under 5years of age, it is estimated that 1,000, 000 deaths occurs per year in that age range alone, mostly from developing countries, thus becoming a serious public health problem around the globe. In year 2000 the first heptavalent conjugated pneumococcal vaccine was licensed in the United States of America, it differed from the already available polysaccharide pneumococcal vaccine,by its ability to provide an effective immune response for the protection of children under the age of 2. The efficacy of the heptavalent conjugated vaccine reported in initial clinical trials was 97,4% against invasive pneumococcal disease related to vaccine serotypes (4, 9V, 14, 19F, 23F, 18C and 6B). Different health authorities worldwide, including the European Medicines Agency(EMEA) had approved the introduction of a 10-valent formulation which includes all 7 PCV7 serotypes plus serotypes 1, 5 and 7F; 8 serotypes are conjugated with protein D as a novel carrier, an element found in the outer core of the non-typeable Haemophilus influenzae. Another new conjugated vaccine is being assessed by several regulatory entities such as the Food and Drug Administration (FDA) and EMEA and in Chile is already approved. This 13-valent formulation includes the 10 serotypes contained in the 10-valent vaccine plus serotypes 3, 6A and 19A, all conjugated to the carrier protein CRM197. These new formulations pretend to enhance vaccine coverage against S. pneumoniae including the frequent serotypes in developing countries (1 and 5) and emerging serotypes such as serotypes 3, 6A, 17F and 9A after a decade of PCV7 immunization.
Assuntos
Humanos , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/fisiopatologia , Infecções Pneumocócicas/prevenção & controle , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/terapia , Vacinas , Vacinas ConjugadasRESUMO
The high incidence of overwhelming postsplenectomy infection caused by Streptococcus pneumoniae can be reduced by splenic autotransplantation. In this study the effect of splenectomy and splenic autotransplantation on the immune response to S. pneumoniae infection was investigated. Balb/c mice were divided into three groups: splenectomized (SP), splenectomized and autotransplanted (AT), and sham operated control (CT). Five days post-infection the serum antibody levels were measured and the number of S. pneumoniae CFU, neutrophil accumulation and IL-17 production in the liver and lungs were investigated. SP mice showed greater number of bacteria in both organs and lower serum levels of S. pneumoniae-specific IgM, IgG1 and IgG2a antibodies. IL-17 production and neutrophil recruitment to the liver and lungs were lower in SP mice, in comparison with both the CT and the AT groups. Levels of S. pneumoniae-specific IgM, CFU counts, neutrophil accumulation and IL-17 production did not differ significantly between the CT and AT groups. These results suggest that splenic autotransplantation restores the capacity of splenectomized mice to fight S. pneumoniae infection.
Assuntos
Fígado/imunologia , Pulmão/imunologia , Infecções Pneumocócicas/imunologia , Streptococcus pneumoniae/imunologia , Animais , Anticorpos Antibacterianos/sangue , Movimento Celular , Contagem de Colônia Microbiana , Imunidade , Interleucina-17/imunologia , Interleucina-17/metabolismo , Fígado/metabolismo , Fígado/microbiologia , Fígado/patologia , Pulmão/metabolismo , Pulmão/microbiologia , Pulmão/patologia , Camundongos , Camundongos Endogâmicos BALB C , Neutrófilos/patologia , Infecções Pneumocócicas/sangue , Infecções Pneumocócicas/cirurgia , Infecções Pneumocócicas/terapia , Esplenectomia/efeitos adversos , Streptococcus pneumoniae/crescimento & desenvolvimento , Streptococcus pneumoniae/patogenicidade , Transplante Autólogo , VirulênciaRESUMO
Background: Purulent pericarditis has become a rare clinical entity since the onset of antimicrobial therapy and has a poor outcome in the majority of cases. Case-report: A healthy 3 month-old patient admitted with dyspnea, pallor and anorexia, developing cardiogenic shock due to cardiac tamponade. Chest X-ray showed cardiomegaly. He required mechanical ventilation, volume resuscitation and vasoactive drugs. Echocardiogram showed a large pericardial effusion, CT sean ruled out lung and mediastinal infection. Pericardial drainage was performed and Vancomycin plus Ceftriaxone were initiated, with a positive blood culture for Penicillin-sensitive Streptococcus pneumoniae. The evolution was favourable after surgical drainage and controlling the infection. No extraperdicardial infection was found. He received 3 weeks of antibiotic therapy. Immunological studies were normal. Conclusion: Primary purulent pericarditis is uncommon, so early detection and treatment of this life-threatening condition may lead to a good outcome.
Hoy en día la pericarditis purulenta (PP) es una patología poco frecuente, pero de pronóstico grave. Comunicamos el caso clínico de un paciente de 3 meses, sano previamente. Consultó por palidez, rechazo alimentario y dificultad respiratoria de pocas horas de evolución. La radiografía de tórax demostró cardiomegalia. Evolucionó hacia shock cardiogénico por taponamiento cardíaco. Recibió inicialmente expansores de volumen y drogas vasoactivas. Antibioterapia con vancomicina y ceftriaxona. Ecocar-diograma objetivó derrame pericárdico extenso, complementado con TAC que descartó foco infeccioso endotoráxico. Se realizó pericardiocentesis y luego ventana pericárdica. Se aisló en hemocultivo Streptococcus pneumoniae, sensible a penicilina. Luego de drenaje quirúrgico y control de infección presentó evolución favorable. No se encontró sitio infeccioso extrapericárdico. Completó tres semanas de tratamiento antibiótico. Estudio inmunológico fue normal. La PP es observada raramente en individuos sanos. La presentación en este caso fue de horas, por un agente inhabitual y de extrema gravedad. Un diagnóstico precoz, en conjunto con un tratamiento médico-quirúrgico es fundamental, como la mejor forma de evitar secuelas.