RESUMO
BACKGROUND: The lung infections by Staphylococcus aureus are strongly associated with its ability to produce enterotoxins. However, little is known about the mechanisms underlying trafficking of bone marrow (BM) neutrophils during airway inflammation induced by Staphylococcal enterotoxin B (SEB). We therefore aimed to investigate the effects of mouse airways SEB exposure on BM neutrophil counts and its adhesive properties as well as on the release of cytokines/chemokines that orchestrate BM neutrophils trafficking to lung tissue. METHODS: Male BALB/c mice were intranasally exposed to SEB (1⯵g), and at 4, 16 and 24â¯h thereafter, BM, circulating blood, bronchoalveolar lavage (BAL) fluid and lung tissue were collected. BM neutrophils adhesion, MAC-1 and LFA1-α expressions (by flow cytometry) as well as measurement of cytokine and/or chemokines levels were assayed after SEB-airway exposure. RESULTS: Prior exposure to SEB promoted a marked influx of neutrophils to BAL and lung tissue, which was accompanied by increased counts of BM immature neutrophils and blood neutrophilia. BM neutrophil expressions of LFA1-α and MAC-1 were unchanged by SEB exposure whereas a significant enhancement of adhesion properties to VCAM-1 was observed. The early phase of airway SEB exposure was accompanied by high levels of GM-CSF, G-CSF, IFN-γ, TNF-α and KC/CXCL1, while the latter phase by the equilibrated actions of SDF1-α and MIP-2. CONCLUSION: Mouse airways exposure to SEB induces BM cytokines/chemokines release and their integrated actions enhance the adhesion of BM neutrophils leading to acute lung injury.
Assuntos
Células da Medula Óssea/imunologia , Citocinas/metabolismo , Neutrófilos/imunologia , Pneumonia Estafilocócica/imunologia , Staphylococcus aureus/imunologia , Administração Intranasal , Animais , Medula Óssea/imunologia , Medula Óssea/patologia , Células da Medula Óssea/metabolismo , Líquido da Lavagem Broncoalveolar/citologia , Líquido da Lavagem Broncoalveolar/imunologia , Citocinas/imunologia , Enterotoxinas/administração & dosagem , Enterotoxinas/imunologia , Humanos , Contagem de Leucócitos , Pulmão/citologia , Pulmão/imunologia , Pulmão/patologia , Masculino , Camundongos , Infiltração de Neutrófilos/imunologia , Neutrófilos/metabolismo , Pneumonia Estafilocócica/microbiologia , Pneumonia Estafilocócica/patologia , Staphylococcus aureus/metabolismoRESUMO
PURPOSE: To investigate the efficacy and mechanisms of root tuber of Polygonum ciliinerve (Nakai) ohwi (rPC) which has been used to treat bacterial infection in traditional Chinese medicine. METHODS: With the mouse model of Staphylococcus aureus (S. aureus) pneumonia, the phenotype of rPC treated mice, including body weight, mortality, lung slices and bacterial burden were evaluated. Furthermore, inflammatory factors in bronchoalveolar lavage (BAL) were determined by ELISA and the distribution of T cells in lung was assessed by immunofluorescence assay. RESULTS: rPC treatment could dose-dependently reduce weight loss and mortality in S. aureus-infected mice. Upon 10 mg/ml rPC treatment, S. aureus-infected mice showed about 8 grams increase in body weight (P<0.001) and 50% enhancement in mortality. The integrity of lung tissue and bacterial burden were also improved by rPC treatment. Moreover, rPC was found to modulate the immune response in infection. CONCLUSION: rPC has therapeutic potential for S. aureus infections and pneumonia with immunomodulatory functions.
Assuntos
Antibacterianos/farmacologia , Medicamentos de Ervas Chinesas/farmacologia , Imunomodulação/efeitos dos fármacos , Pneumonia Estafilocócica/prevenção & controle , Polygonum/química , Substâncias Protetoras/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Animais , Líquido da Lavagem Broncoalveolar/química , Quimiocina CCL2/análise , Contagem de Colônia Microbiana , Ensaio de Imunoadsorção Enzimática , Imuno-Histoquímica , Interleucina-6/análise , Pulmão/efeitos dos fármacos , Pulmão/patologia , Camundongos Endogâmicos C57BL , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Estafilocócica/patologia , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/análiseRESUMO
Abstract Purpose: To investigate the efficacy and mechanisms of root tuber of Polygonum ciliinerve (Nakai) ohwi (rPC) which has been used to treat bacterial infection in traditional Chinese medicine. Methods: With the mouse model of Staphylococcus aureus (S. aureus) pneumonia, the phenotype of rPC treated mice, including body weight, mortality, lung slices and bacterial burden were evaluated. Furthermore, inflammatory factors in bronchoalveolar lavage (BAL) were determined by ELISA and the distribution of T cells in lung was assessed by immunofluorescence assay. Results: rPC treatment could dose-dependently reduce weight loss and mortality in S. aureus-infected mice. Upon 10 mg/ml rPC treatment, S. aureus-infected mice showed about 8 grams increase in body weight (P<0.001) and 50% enhancement in mortality. The integrity of lung tissue and bacterial burden were also improved by rPC treatment. Moreover, rPC was found to modulate the immune response in infection. Conclusion: rPC has therapeutic potential for S. aureus infections and pneumonia with immunomodulatory functions.
Assuntos
Animais , Pneumonia Estafilocócica/prevenção & controle , Staphylococcus aureus/efeitos dos fármacos , Medicamentos de Ervas Chinesas/farmacologia , Substâncias Protetoras/farmacologia , Polygonum/química , Imunomodulação/efeitos dos fármacos , Antibacterianos/farmacologia , Pneumonia Estafilocócica/patologia , Pneumonia Estafilocócica/tratamento farmacológico , Fatores de Tempo , Ensaio de Imunoadsorção Enzimática , Líquido da Lavagem Broncoalveolar/química , Imuno-Histoquímica , Contagem de Colônia Microbiana , Reprodutibilidade dos Testes , Interleucina-6/análise , Fator de Necrose Tumoral alfa/análise , Resultado do Tratamento , Quimiocina CCL2/análise , Pulmão/efeitos dos fármacos , Pulmão/patologia , Camundongos Endogâmicos C57BLRESUMO
We describe three cases of community-acquired necrotizing pneumonia which were caused by Panton-Valentine leucocidin-producing strains of Staphylococcus aureus (one of them methicillin sensitive). All cases were successfully treated without any sequelae for the patients due to the prompt initiation of adequate antimicrobial therapy. High suspicion toward this fatal pathogen was the key to the successful outcome of the patients.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Toxinas Bacterianas/biossíntese , Exotoxinas/biossíntese , Leucocidinas/biossíntese , Pneumonia Estafilocócica/diagnóstico , Staphylococcus aureus/metabolismo , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/patologia , Necrose/microbiologia , Necrose/patologia , Pneumonia Estafilocócica/microbiologia , Pneumonia Estafilocócica/patologia , Índice de Gravidade de DoençaRESUMO
We describe three cases of community-acquired necrotizing pneumonia which were caused by Panton-Valentine leucocidin-producing strains of Staphylococcus aureus (one of them methicillin sensitive). All cases were successfully treated without any sequelae for the patients due to the prompt initiation of adequate antimicrobial therapy. High suspicion toward this fatal pathogen was the key to the successful outcome of the patients.
Assuntos
Toxinas Bacterianas/biossíntese , Exotoxinas/biossíntese , Leucocidinas/biossíntese , Pneumonia Estafilocócica/diagnóstico , Staphylococcus aureus/metabolismo , Adolescente , Adulto , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/patologia , Feminino , Humanos , Masculino , Necrose/microbiologia , Necrose/patologia , Pneumonia Estafilocócica/microbiologia , Pneumonia Estafilocócica/patologia , Índice de Gravidade de DoençaRESUMO
El Staphylococcus aureus afecta frecuentemente al ser humano. Dentro de las manifestaciones clínicas, la neumonía necrotizante se asocia a una alta mortalidad. Nuestro objetivo es describir la evolución de las infecciones graves por Staphylococcus aureus en tres unidades de terapia intensiva pediátricas y analizar los casos de neumonía necrotizante en el período del 01-2011 al 03-2013. Se analizaron 43 pacientes; 76,7% presentaron infección adquirida en la comunidad, y en 31 fue por Staphylococcus aureus resistente a la meticilina adquirido en la comunidad. El principal motivo de ingreso fue la claudicación respiratoria. Se documentó bacteriemia en el 55,8% de los casos. El 86% de los ingresos requirieron asistencia respiratoria mecánica y 27 pacientes desarrollaron shock séptico. La estadía en la unidad de terapia intensiva fue de 13 (5-25) días, y la mortalidad, del 14%. La neumonía necrotizante estuvo presente en el 51% de los casos. Conclusión. Se identificó una alta proporción de infección adquirida en la comunidad. La neumonía necrotizante se asociócon una peor evolución.
Staphylococcus aureus frequently affects human beings. Among clinical manifestations, necrotizing pneumonia is associated with a high mortality rate. Our objective is to describe the progress of severe Staphylococcus aureus infections in three intensive care units and analyze cases of necrotizing pneumonia in the period ranging from January 2011 to March 2013. Forty- three patients were studied, 76.7% had a community-acquired infection, and 31 had community-acquired methicillin-resistant Staphylococcus aureus. The main reason for admission was respiratory failure. Bacteremia was confirmed in 55.8% of cases. Mechanical ventilation was required in 86% of admitted patients, while 27 patients developed septic shock. The length of stay in the intensive care unit was 13 (5-25) days, and the mortality rate was 14%. Necrotizing pneumonia was observed in 51% of cases. Conclusion. A high rate of community-acquired infection was identified. Necrotizing pneumonia was associated with a worse clinical course.
Assuntos
Humanos , Criança , Pneumonia Estafilocócica/patologia , Índice de Gravidade de Doença , Unidades de Terapia Intensiva Pediátrica , Estudos Prospectivos , Estudos Retrospectivos , Hospitalização , NecroseRESUMO
Staphylococcus aureus frequently affects human beings. Among clinical manifestations, necrotizing pneumonia is associated with a high mortality rate. Our objective is to describe the progress of severe Staphylococcus aureus infections in three intensive care units and analyze cases ofnecrotizing pneumonia in the period ranging from January 2011 to March 2013. Forty-three patients were studied, 76.7% had a community-acquired infection, and 31 had community-acquired methicillin-resistant Staphylococcus aureus. The main reason for admission was respiratory failure. Bacteremia was confirmed in 55.8% of cases. Mechanical ventilation was required in 86% of admitted patients, while 27 patients developed septic shock. The length of stay in the intensive care unit was 13 (5-25) days, and the mortality rate was 14%. Necrotizing pneumonia was observed in 51% of cases. Conclusion. A high rate of community-acquired infection was identified. Necrotizing pneumonia was associated with a worse clinical course.
Assuntos
Pneumonia Estafilocócica/patologia , Criança , Hospitalização , Humanos , Unidades de Terapia Intensiva Pediátrica , Necrose , Estudos Prospectivos , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To assess the incidence of necrotizing pneumonia (NP) in children submitted to thoracoscopy, comparing patients with and without NP in terms of the presentation and clinical evolution. METHODS: A retrospective study of children with pleural empyema submitted to thoracoscopy. Thoracoscopy was performed in patients not previously submitted to thoracic drainage and in whom there was evidence of loculated effusion or pneumothorax, as well as in those previously submitted to thoracic drainage and in whom there was persistent pneumothorax or fever with purulent discharge. On the basis of the thoracoscopy findings, patients were distributed into two groups: those with NP (NP group) and those without (no-NP group). RESULTS: The study sample comprised 52 patients. Of the 24 patients with NP, 19 (79%) had undergone thoracic drainage prior to thoracoscopy, 11 (46%) presented with pneumothorax, and 16 (67%) developed bronchopleural fistula. In the NP group, the median drainage time and the median length of hospital stay were 18 and 19 days, respectively. Of the 28 patients without NP, 10 (36%) had undergone thoracic drainage prior to thoracoscopy, 9 (32%) presented pneumothorax, and 5 (18%) developed bronchopleural fistula. In the no-NP group, the median drainage time and the median length of hospital stay were 6 and 10 days, respectively. CONCLUSIONS: Pneumothorax should raise the suspicion of NP. Early thoracoscopy can be a valuable treatment option for NP in children because it hastens recovery in comparison with the medical treatment alone and avoids extensive late thoracotomy lung resections.
Assuntos
Empiema Pleural/cirurgia , Pneumonia Estafilocócica , Toracoscopia , Pré-Escolar , Métodos Epidemiológicos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pneumonia Estafilocócica/epidemiologia , Pneumonia Estafilocócica/patologia , Pneumonia Estafilocócica/terapia , Pneumotórax/patologia , Fatores de TempoRESUMO
OBJETIVO: Analisar a incidência de pneumonia necrosante (PN) em crianças submetidas a toracoscopia e comparar pacientes com e sem PN em relação às diferentes apresentações e evolução clínica. MÉTODOS: Estudo retrospectivo de crianças portadoras de empiema e submetidas a toracoscopia. A toracoscopia foi realizada em pacientes não submetidos a drenagem torácica prévia e evidência de derrame septado ou pneumotórax, assim como naqueles submetidos previamente a drenagem torácica e pneumotórax persistente ou febre e secreção purulenta. Baseado na presença de PN durante a toracoscopia, os pacientes foram divididos em dois grupos: com PN e sem PN. RESULTADOS: Participaram do estudo 52 pacientes. Dos 24 pacientes com PN, 19 (79 por cento) foram submetidos a drenagem torácica anterior à toracoscopia, 11 (46 por cento) apresentaram pneumotórax, e 16 (67 por cento) evoluíram com fístula broncopleural. Neste grupo, as medianas do tempo de drenagem e de hospitalização foram, respectivamente, 18 e 19 dias. Dos 28 pacientes sem PN, 10 (36 por cento) foram submetidos a drenagem torácica anterior à toracoscopia, 9 (32 por cento) apresentaram pneumotórax, e 5 (18 por cento) evoluíram com fístula broncopleural. Neste grupo, as medianas do tempo médio de drenagem e de hospitalização foram, respectivamente, 6 e 10 dias. CONCLUSÕES: A PN deve ser suspeitada na presença de pneumotórax. A toracoscopia precoce pode ser uma opção terapêutica de grande valor na PN da infância, pois acelera a recuperação quando comparada ao tratamento médico isolado e evita ressecções pulmonares extensas da toracotomia tardia.
OBJECTIVE: To assess the incidence of necrotizing pneumonia (NP) in children submitted to thoracoscopy, comparing patients with and without NP in terms of the presentation and clinical evolution. METHODS: A retrospective study of children with pleural empyema submitted to thoracoscopy. Thoracoscopy was performed in patients not previously submitted to thoracic drainage and in whom there was evidence of loculated effusion or pneumothorax, as well as in those previously submitted to thoracic drainage and in whom there was persistent pneumothorax or fever with purulent discharge. On the basis of the thoracoscopy findings, patients were distributed into two groups: those with NP (NP group) and those without (no-NP group). RESULTS: The study sample comprised 52 patients. Of the 24 patients with NP, 19 (79 percent) had undergone thoracic drainage prior to thoracoscopy, 11 (46 percent) presented with pneumothorax, and 16 (67 percent) developed bronchopleural fistula. In the NP group, the median drainage time and the median length of hospital stay were 18 and 19 days, respectively. Of the 28 patients without NP, 10 (36 percent) had undergone thoracic drainage prior to thoracoscopy, 9 (32 percent) presented pneumothorax, and 5 (18 percent) developed bronchopleural fistula. In the no-NP group, the median drainage time and the median length of hospital stay were 6 and 10 days, respectively. CONCLUSIONS: Pneumothorax should raise the suspicion of NP. Early thoracoscopy can be a valuable treatment option for NP in children because it hastens recovery in comparison with the medical treatment alone and avoids extensive late thoracotomy lung resections.
Assuntos
Pré-Escolar , Feminino , Humanos , Masculino , Empiema Pleural/cirurgia , Pneumonia Estafilocócica , Toracoscopia , Métodos Epidemiológicos , Tempo de Internação/estatística & dados numéricos , Pneumonia Estafilocócica/epidemiologia , Pneumonia Estafilocócica/patologia , Pneumonia Estafilocócica/terapia , Pneumotórax/patologia , Fatores de TempoRESUMO
The aim of this study was to describe a case of necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus. The sample was isolated from a blood culture collected less than 48 hours after hospital admission. The patient had been healthy until the infectious process started. The isolate had the mecA gene with "staphylococcal cassette chromosome mec" (SCCmec) type IVa. The possibility that Staphylococcus aureus harboring this genetic determinant might be present in our setting should be considered in situations of severe pneumonia within the community.
Assuntos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Estafilocócica/microbiologia , Adolescente , Proteínas de Bactérias/genética , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Staphylococcus aureus Resistente à Meticilina/genética , Necrose , Proteínas de Ligação às Penicilinas , Pneumonia Estafilocócica/patologiaRESUMO
O objetivo desse estudo foi descrever um caso de pneumonia necrotizante por Staphylococcus aureus resistente a meticilina. A amostra foi isolada em hemocultura coletada menos de 48 horas da admissão hospitalar. A paciente era previamente hígida quando do início do processo infeccioso. O isolado possuía o gene mecA, com "staphylococcal cassette chromosome mec" tipo IVa". A presença de Staphylococcus aureus carreando esse determinante genético em nosso meio deve ser considerada em pneumonias comunitárias graves.
The aim of this study was to describe a case of necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus. The sample was isolated from a blood culture collected less than 48 hours after hospital admission. The patient had been healthy until the infectious process started. The isolate had the mecA gene with "staphylococcal cassette chromosome mec" (SCCmec) type IVa. The possibility that Staphylococcus aureus harboring this genetic determinant might be present in our setting should be considered in situations of severe pneumonia within the community.
Assuntos
Adolescente , Feminino , Humanos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Estafilocócica/microbiologia , Proteínas de Bactérias/genética , Infecções Comunitárias Adquiridas/microbiologia , Staphylococcus aureus Resistente à Meticilina/genética , Necrose , Pneumonia Estafilocócica/patologiaAssuntos
Pessoa de Meia-Idade , Humanos , Feminino , Dor no Peito/diagnóstico , Próteses Valvulares Cardíacas/efeitos adversos , Evolução Fatal , Insuficiência da Valva Mitral/patologia , Insuficiência da Valva Mitral , Valva Mitral , Estenose da Valva Mitral , Estenose da Valva Mitral/patologia , Manifestações Neurológicas , Pneumonia Estafilocócica/patologia , Pneumonia EstafilocócicaAssuntos
Pessoa de Meia-Idade , Humanos , Feminino , Dor no Peito/diagnóstico , Próteses Valvulares Cardíacas/efeitos adversos , Manifestações Neurológicas , Insuficiência da Valva Mitral/patologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/patologia , Estenose da Valva Mitral/diagnóstico por imagem , Pneumonia Estafilocócica/patologia , Pneumonia Estafilocócica/diagnóstico por imagem , Valva Mitral , Evolução FatalRESUMO
We have seen 10 newborn babies who developed respiratory distress and whose chest radiographs showed a miliary nodular pattern of disease. Of these infants only 3 had blood cultures that were positive for staphylococcus aureus. Of the remaining 7, 2 had conjunctivitis from which Staphylococcus aureus was cultured, 4 had negative cultures and 1 did not have a blood culture done. All patients were diagnosed as having bacterial pneumonia and appeared to respond favourably to antibiotic therapy. The pulmonary abnormalities resolved. The children were clinically well in less than 3 weeks. The author suggests that the miliary pattern is one of the radiological patterns of neonatal pneumonia possibly produced by hematogenous bacterial dissemination.