RESUMO
AbstractParacoccidioidomycosis is a systemic mycosis caused by Paracoccidioides brasiliensis. It occurs more frequently in its chronic form, which particularly affects male adults from rural areas. These patients present with pulmonary involvement and systemic symptoms. Skin and mucosal lesions are rather typical and might suggest the diagnosis. The involvement of the upper airway mucosa is common and the patients usually complain of dysphagia and dysphonia. Nonetheless, in endemic areas, physicians should maintain a high level of suspicion even when faced with some atypical symptoms. We present the case of an adult diagnosed with nasopharyngeal paracoccidioidomycosis after presenting with an unusual otolaryngologic syndrome including unilateral soft palate paralysis with velopharyngeal insufficiency and hearing loss secondary to middle ear effusion.
Assuntos
Perda Auditiva/diagnóstico , Otite Média com Derrame/diagnóstico , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/diagnóstico , Adulto , Anti-Infecciosos , Orelha Média/microbiologia , Orelha Média/patologia , Perda Auditiva/tratamento farmacológico , Perda Auditiva/microbiologia , Perda Auditiva/patologia , Humanos , Masculino , Ventilação da Orelha Média , Nasofaringe/microbiologia , Nasofaringe/patologia , Otite Média com Derrame/tratamento farmacológico , Otite Média com Derrame/microbiologia , Otite Média com Derrame/patologia , Palato Mole/microbiologia , Palato Mole/patologia , Paracoccidioides/efeitos dos fármacos , Paracoccidioides/patogenicidade , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/microbiologia , Paracoccidioidomicose/patologia , Resultado do Tratamento , Combinação Trimetoprima e SulfametoxazolRESUMO
Hearing was evaluated in 244 ears of 124 children in Angola by auditory brainstem response audiometry 3 months after bacterial meningitis. Of all ears, 81% recovered without impairment. Of all children, 74% recovered without impairment, 5% had unilateral and 11% bilateral impairment. Seizures before or during hospital stay and disease severity were the best predictors of ≥ 80 dB impairment.
Assuntos
Perda Auditiva/microbiologia , Meningites Bacterianas/complicações , Angola/epidemiologia , Criança , Pré-Escolar , Potenciais Evocados Auditivos do Tronco Encefálico , Feminino , Escala de Coma de Glasgow , Perda Auditiva/epidemiologia , Humanos , Lactente , Masculino , Meningites Bacterianas/epidemiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Convulsões/microbiologia , Resultado do TratamentoRESUMO
A 75-year-old woman presented to the Tropical Diseases Hospital, Goiania, Brazil, with a two-day history of fever and chills followed by headache and vomiting over the last 24 hours. The cerebrospinal fluid (CSF) showed 270 leukocytes/mmc (30 percent neutrophils); 20 red cells/mmc; undetectable levels of glucose and 232 mg/dL of protein. The Gram stain revealed several Gram-positive cocci, and CSF culture yielded Streptococcus bovis. A colonoscopy showed diverticula in descendent and transverse colon. After a 14-day course of penicillin G, the patient was discharged in a good state of health, with only mild hearing impairment.
Assuntos
Diverticulose Cólica/complicações , Perda Auditiva/microbiologia , Meningites Bacterianas/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus bovis , Idoso , Antibacterianos/uso terapêutico , Feminino , Perda Auditiva/tratamento farmacológico , Humanos , Meningites Bacterianas/complicações , Meningites Bacterianas/tratamento farmacológico , Penicilina G/uso terapêutico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus bovis/efeitos dos fármacos , Streptococcus bovis/patogenicidade , Resultado do TratamentoRESUMO
OBJECTIVE: To describe the clinical features and outcome of pneumococcal meningitis in Jamaican children. METHODS: All patients admitted to the Bustamante Hospital for Children, during the period 1995-1999, who had pneumococcus isolated from cerebrospinal fluid (CSF) or pleocytosis in association with a blood culture isolate of pneumococcus were selected. Demographic, clinical and laboratory data were collected. RESULTS: Twenty-five (23%) of 111 patients with pneumococcal infections satisfied criteria for meningitis. The median age was 8 months (range 0.5-60 months). There were 4 (16%) cases of sickle cell disease, 2 (50%) of whom were first diagnosed during the current illness. This represents a 53-fold increased risk of pneumoccocal meningitis in patients with Sickle-cell disease based on population prevalence rates. Oxacillin resistance occurred in 3 (12%) patients, one of whom died. Mortality rate was 12% (3) with all deaths occurring in infants < 1 year. Poor outcome occurred in 36% (9) of the patients. Of the (35%) 8 survivors who had follow-up evaluation, (38%) 3 had documented hearing loss. CONCLUSIONS: Meningitis is a common clinical syndrome of invasive pneumococcal disease, occurring in 23% of cases resulting in mortality and high morbidity among Jamaican children. Local seroepidemiological studies are urgently needed to inform national vaccine decisions. As an interim plan, policymakers should consider a risk-based strategy to vaccine prophylaxis that will ensure that high risk groups such as children with sickle cell disease are offered currently available conjugate pneumococcal vaccines.
OBJETIVO: Describir las características clínicas y evolución de la meningitis meningocócica en niños jamaicanos. MÉTODOS: Se escogieron todos los pacientes que ingresaron al Hospital Infantil Bustamante, durante el período de 1995-1999, y que tuvieron pneumococos aislados del líquido cefalorraquídeo (LCR) o pleocitosis asociada con un aislado de pneumococos en un cultivo de sangre. Se recogieron los datos demográficos y clínicos, así como los datos de laboratorio. RESULTADOS: Veinticinco (23%) de los pacientes con infecciones pneumocócicas correspondían a los criterios de la meningitis. La edad promedio fue de 8 meses (rango 0.5 - 60 meses). Hubo 4 (16%) casos de anemia falciforme, 2 (50%) de los cuales fueron diagnosticados primeramente durante la enfermedad corriente. Esto representa un aumento de riesgo de meningitis meningocócica 53 veces mayor en pacientes con anemia ciclémica, teniendo en cuenta las tasas de prevalencia poblacional. Se halló resistencia a la oxacilina en 3 (12%) pacientes, uno de los cuales murió. La tasa de mortalidad fue del 12% (3), correspondiendo todas las muertes a infantes < 1 año. Resultados pobres se produjeron en (9) 36% de los pacientes. De los 8 (35%) supervivientes que tuvieron evaluación de seguimiento, 3 (38%) tuvieron pérdida de la audición documentada. CONCLUSIONES: La meningitis es un síndrome clínico común de la enfermedad pneumocócica invasiva, que tiene lugar en 23 % de los casos, y que trae por consecuencia mortalidad y una alta morbilidad entre los niños jamaicanos. Se requieren con urgencia estudios seroepidemiológicos locales a fin de tener información para las decisiones nacionales sobre las vacunas. A modo de plan provisional, los encargados de trazar las políticas deben considerar una estrategia de riesgo para la profilaxis de vacuna, a fin de asegurar que los grupos de alto riesgo, tales como los niños con anemia falciforme, puedan tener a su alcance las vacunas pneumocócicas conjugadas actualmente disponibles.
Assuntos
Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Meningite Pneumocócica/mortalidade , Anemia Falciforme/complicações , Anemia Falciforme/epidemiologia , Perda Auditiva/epidemiologia , Perda Auditiva/etiologia , Perda Auditiva/microbiologia , Hospitais Pediátricos/estatística & dados numéricos , Incidência , Jamaica/epidemiologia , Meningite Pneumocócica/complicaçõesRESUMO
OBJECTIVE: To describe the clinical features and outcome of pneumococcal meningitis in Jamaican children. METHODS: All patients admitted to the Bustamante Hospital for Children, during the period 1995-1999, who had pneumococcus isolated from cerebrospinal fluid (CSF) or pleocytosis in association with a blood culture isolate of pneumococcus were selected. Demographic, clinical and laboratory data were collected. RESULTS: Twenty-five (23%) of 111 patients with pneumococcal infections satisfied criteria for meningitis. The median age was 8 months (range 0.5-60 months). There were 4 (16%) cases of sickle cell disease, 2 (50%) of whom were first diagnosed during the current illness. This represents a 53-fold increased risk of pneumoccocal meningitis in patients with Sickle-cell disease based on population prevalence rates. Oxacillin resistance occurred in 3 (12%) patients, one of whom died. Mortality rate was 12% (3) with all deaths occurring in infants < 1 year. Poor outcome occurred in 36% (9) of the patients. Of the (35%) 8 survivors who had follow-up evaluation, (38%) 3 had documented hearing loss. CONCLUSIONS: Meningitis is a common clinical syndrome of invasive pneumococcal disease, occurring in 23% of cases resulting in mortality and high morbidity among Jamaican children. Local seroepidemiological studies are urgently needed to inform national vaccine decisions. As an interim plan, policymakers should consider a risk-based strategy to vaccine prophylaxis that will ensure that high risk groups such as children with sickle cell disease are offered currently available conjugate pneumococcal vaccines.