Neumonía bacteriana en niños en Ecuador: una mirada al impacto de las vacunas

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.

Analysis of chest imaging features of novel coronavirus pneumonia, bacterial pneumonia and viral pneumonia / 中华危重病急救医学

Objective:To investigate and summarize the chest CT imaging features of patients with novel coronavirus pneumonia (COVID-19), bacterial pneumonia and other viral pneumonia.Methods:Chest CT data of 102 patients with pulmonary infection due to different etiologies were retrospectively analyzed, including 36 patients with COVID-19 admitted to Hainan Provincial People's Hospital and the Second Affiliated Hospital of Hainan Medical University from December 2019 to March 2020, 16 patients with other viral pneumonia admitted to Hainan Provincial People's Hospital from January 2018 to February 2020, and 50 patients with bacterial pneumonia admitted to Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from April 2018 to May 2020. Two senior radiologists and two senior intensive care physicians were participated to evaluated the extent of lesions involvement and imaging features of the first chest CT after the onset of the disease.Results:Bilateral pulmonary lesions were more common in patients with COVID-19 and other viral pneumonia, and the incidence was significantly higher than that of bacterial pneumonia (91.6%, 75.0% vs. 26.0%, P < 0.05). Compared with other viral pneumonia and COVID-19, bacterial pneumonia was mainly characterized by single-lung and multi-lobed lesion (62.0% vs. 18.8%, 5.6%, P < 0.05), accompanied by pleural effusion and lymph node enlargement. The proportion of ground-glass opacity in the lung tissues of patients with COVID-19 was 97.2%, that of patients with other viral pneumonia was 56.2%, and that of patients with bacterial pneumonia was only 2.0% ( P < 0.05). The incidence rate of lung tissue consolidation (25.0%, 12.5%), air bronchial sign (13.9%, 6.2%) and pleural effusion (16.7%, 37.5%) in patients with COVID-19 and other viral pneumonia were significantly lower than those in patients with bacterial pneumonia (62.0%, 32.0%, 60.0%, all P < 0.05), paving stone sign (22.2%, 37.5%), fine mesh sign (38.9%, 31.2%), halo sign(11.1%, 25.0%), ground-glass opacity with interlobular septal thickening (30.6%, 37.5%), bilateral patchy pattern/rope shadow (80.6%, 50.0%) etc. were significantly higher than those of bacterial pneumonia (2.0%, 4.0%, 2.0%, 0%, 22.0%, all P < 0.05). The incidence of local patchy shadow in patients with COVID-19 was only 8.3%, significantly lower than that in patients with other viral pneumonia and bacterial pneumonia (8.3% vs. 68.8%, 50.0%, P < 0.05). There was no significant difference in the incidence of peripheral vascular shadow thickening in patients with COVID-19, other viral pneumonia and bacterial pneumonia (27.8%, 12.5%, 30.0%, P > 0.05). Conclusions:The probability of ground-glass opacity, paving stone and grid shadow in chest CT of patients with COVID-19 was significantly higher than those of bacterial pneumonia, and it was more common in the lower lungs and lateral dorsal segment. In other patients with viral pneumonia, ground-glass opacity was distributed in both upper and lower lungs. Bacterial pneumonia is usually characterized by single lung consolidation, distributed in lobules or large lobes and accompanied by pleural effusion.

Value of peripheral blood PCT, CRP, FIB and D-D levels for early diagnosing PTB complicated with bacterial pneumonia / 中国热带医学

@#Abstract: Objective　To investigate the early diagnostic value of peripheral blood procalcitonin (PCT), C-reactive protein (CRP), fibrinogen (FIB) and D-dimer (D-D) levels in patients with pulmonary tuberculosis (PTB) complicated with bacterial pneumonia. Methods　A total of 102 patients who admitted to Department of Tuberculosis of Affiliated Nantong Hospital of Shanghai University from Jan 2021 to May 2022 were enrolled in this study and divided into a group (52 cases) with pulmonary tuberculosis (PTB) patients and a group (50 cases) with PTB patients complicated with bacterial pneumonia. The levels of PCT, CRP, FIB and D-D in the peripheral blood were measured, the differences and correlations in all indicators were compared among two groups. The sensitivity and specificity of these indicators in the early diagnosis of PTB complicated with bacterial pneumonia were analyzed by receiver operating characteristic (ROC) curve. Results　The levels of PCT, CRP, FIB and D-D in the peripheral blood from the PTB complicated with bacterial pneumonia group were 0.06 (0.04, 0.16) ng/mL, 38.00 (3.88, 96.10) mg/L, 4.51 (3.02, 6.07) g/L, and 0.59 (0.34, 1.88) mg/L, respectively, which were significantly higher than corresponding 0.04 (0.03, 0.04) ng/mL, 3.20 (0.84, 7.22) mg/L, 2.96 (2.48, 3.77) g/L, and 0.27 (0.17, 0.36) mg/L in the PTB group (Z=-4.784, -5.233, -3.853, -4.199, all P<0.001). Furthermore, the levels of CRP and FIB in the PTB complicated by bacterial pneumonia group were highly positively correlated (r=0.855, P<0.001). The area under the ROC curve (AUC) of PCT, CRP, FIB and D-D for early diagnosis of PTB complicated with bacterial pneumonia were 0.757, 0.794, 0.747 and 0.764, respectively. In addition, the AUC obtained by simultaneous measurement of PCT, CRP, FIB and D-D was as high as 0.916, and the sensitivity and specificity of diagnosing PTB complicated with bacterial pneumonia were increased to 85.7% and 96.9%, respectively, which were higher than those of individual indicators. Conclusions　Levels of peripheral blood PCT, CRP, FIB, and D-D all show varying degrees of increase in patients with PTB complicated with bacterial pneumonia, and detecting the levels of all four markers, rather than any single marker, can assist in early monitoring whether the tuberculosis patients are complicated with bacterial pneumonia.

Aspectos epidemiológicos, clínicos y microbiológicos en pacientes menores de 5 años con neumonía bacteriana / Epidemiological, clinical and microbiologic aspects in patients under 5 years with bacterial pneumonia

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.

Neumonía por Bordetella bronchiseptica en paciente con antecedente de linfoma pulmonar / Bordetella bronchiseptica pneumonia in a patient with a history of pulmonary lymphoma

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.

Cupping treatment combined with antibiotics for bacterial pneumonia in children: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy of cupping treatment combined with antibiotics and antibiotics alone for bacterial pneumonia in children.@*METHODS@#A total of 72 children with bacterial pneumonia were randomly divided into an observation group (36 cases, 1 case dropped off) and a control group (36 cases). The children in the control group were treated with intravenous drip of cefodizine sodium [80 mg/(kg•d)] for 7 days. Based on the treatment of the control group, the children in the observation group were treated with cupping treatment on the bladder meridian of the back on the first day and the fourth day of antibiotic treatment; each cupping treatment was given for 5-10 min; the treatment of observation group was given for 7 days. The days for complete fever reduction, TCM syndrome scores and Canadian acute respiratory illness flu scale (CARIFS) scores before and after treatment were observed, and the clinical efficacy was evaluated.@*RESULTS@#The days for complete fever reduction in the observation group were shorter than that in the control group (@*CONCLUSION@#Cupping treatment combined with antibiotics has similar efficacy with antibiotics alone for bacterial pneumonia in children, but shows better effect in shortening the duration of fever and improving pulmonary symptoms.

Advances of Lefamulin: a new pleuromutilin antibiotic / 药学学报

Lefamulin (BC-3781) is a semi-synthetic pleuromutilin antibiotic, approved for the treatment of community-acquired bacterial pneumonia (CABP) by Food and Drug Administration (USA) in August 2019, with the commodity name of Xenleta. It is the first pleuromutilin antibiotics used for systemic treatment of bacterial infections in human. Lefamulin binds to the peptidyl transferase center of the 50S ribosomal subunit to prevent peptide transfer, thus inhibits protein synthesis. Lefamulin displays expanded activity against gram-positive organisms, and also shows high activity against atypical microorganism like Mycoplasma pneumoniae. This review discusses the mechanism, bacterial spectrum of activity, preclinical and clinical data of Lefamulin.

Patrones imagenológicos en pacientes menores de 5 años con diagnóstico de neumonía bacteriana / Imaging patterns in patients under 5 years with diagnosis of bacterial pneumonia

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.

Infectious diseases dynamics in growing/finishing pigs in Southern Brazil (2005-2016) / Dinâmica de ocorrência das doenças infecciosas em suínos nas fases de crescimento e terminação no sul do Brasil (2005-2016)

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)

Complicated pneumonia with empyema caused by streptococcus anginosus in a child / Complicated pneumonia with empyema caused by streptococcus anginosus in a child

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.

Diagnostic value of lymphocyte subset classification for active pulmonary tuberculosis in renal transplant recipients / 器官移植

Objective To evaluate the clinical value of lymphocyte subset classification in the diagnosis of active pulmonary tuberculosis in renal transplant recipients. Methods Clinical data of 52 recipients undergoing renal transplantation were retrospectively analyzed. According to the results of imaging and etiological examination, 52 recipients were divided into the stable group(n=19), tuberculosis group (n=9), bacteria group (n=12) and fungi group (n=12), respectively. The renal function of recipients was compared, and the proportion and absolute value of lymphocyte subset were analyzed and compared among four groups. The diagnostic value of lymphocyte subset classification for active pulmonary tuberculosis after renal transplantation was evaluated. Results Compared with the stable group, the levels of blood urea nitrogen and serum creatinine in the tuberculosis group, bacteria group and fungi group were significantly increased (all P < 0.05). The proportion of CD3+, CD8+, CD4+, natural killer (NK) cells and CD19+ lymphocyte subsets were not significantly different (all P>0.05). And the absolute values of CD3+, CD8+, CD4+, NK cells and CD19+ lymphocyte subsets were significantly decreased (all P < 0.05). The proportion of CD8+ lymphocyte subset in the tuberculosis group and fungi group was significantly higher than that in the bacteria group (both P < 0.05). The optimal cut-off value of CD8+ lymphocyte subset ratio in the differential diagnosis of active pulmonary tuberculosis and bacterial pneumonia was 33.27%, and the sensitivity and specificity were 0.889 and 0.833, respectively. The area under the curve (AUC) was 0.880. Conclusions The classification of lymphocyte subset can provide auxiliary diagnostic basis for differential diagnosis and individualized treatment of active pulmonary tuberculosis and bacterial pneumonia in renal transplant recipients.

Delftia acidovorans pneumonia with lung cavities formation / Neumonia con formación de cavidades pulmonares causada por Delftia acidovorans

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.

Caracterización de pacientes con neumonía grave adquirida en la comunidad / Characterization of patients with severe pneumonia acquired in the community

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)

Neumonía adquirida en la comunidad: una revisión narrativa / Community-acquired pneumonia: a review of the Literature

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.

Absceso pulmonar primario en pediatría. Reporte de casos y revisión de la literatura

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.

Síndrome de Austrian: reporte de caso / Austrian syndrome: report of one case

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.

Clinical analysis and treatment of antibiotic-associated diarrhea in senile patients with severe bacterial pneumonia / 实用医学杂志

Objective To explore the clinical manifestations ,risk factors and treatment of antibiotic asso-ciated diarrhea(AAD)in senile patients with severe bacterial pneumonia. Methods Retrospective analysis was made on senile patients of bacterial pneumonia combined with antibiotic associated diarrhea. Results There were 114 patients out of 572 cases had AAD. The incidence of AAD in these senile patients was 19.93%. There were 62.28% patients more than 80 years old. The incidence AAD was 37.3% with third generation cephalosporin treat-ment,28.6% penicillin with enzyme inhibitor treatment and 19.2% with carbopenems treatment. Conclusions The high risk factors of AAD in senile patients with bacterial pneumonia include patient′s age,and time, APACHE Ⅱ,category,combination therapyof antibacterial,and invasive operations. We should pay more atten-tion to AAD and related high risk factors when using these antibiotics in clinics. Rational selection and use of anti-bacterial are important measures to stop senile patients from ADD. Pharmaceutical care could help to optimize the treatment plan and reduce its adverse reaction of antibacterial in senile patients.

Clinical value of the combination of procalcitonin and hypersensitive C-reactive protein detection for the assessment of bacterial pneumonia / 中国基层医药

Objective To explore the clinical value of the combination of procalcitonin (PCT) and hypersensitive C-reactive protein (hs-CRP) detection for the assessment of bacterial pneumonia.Methods Fifty bacterial pneumonia patients were randomly selected and included into the observation group,another fifty healthy subjects were selected as the control group in the same period.The levels of hs-CRP and PCT in the two groups were detected,and the detection results were comparatively analyzed.Results The PCT level [(3.13 ± 0.43) μg/L] and hs-CRP level[(55.37 ± 9.64)mg/L] in the observation group before treatment were significantly higher than those in the control group [PCT level (0.04 ± 0.01)μg/L,hs-CRP level (6.46 ± 0.89)mg/L],and the differences were statistically significant (t =50.7993,36.3980,all P ＜0.05).There were no significant differences in the PCT and hs -CRP levels between the two groups after treatment (t =0.5000,0.9444,all P ＞ 0.05).The PCT level (3.11 ±0.85) μg/L and hs-CRP level (20.31 ± 3.96) mg/L in the patients with CURB-65 score of 4-5 were significantly higher than those in patients with CURB-65 score of 0-1 and 2-3 [PCT level (1.19 ± 0.42) μg/L and hs-CRP level (1.86 ± 0.53) mg/L in patients with CURB-65 score of 0-1,PCT level (1.82 ± 0.54) μg/L and hs-CRP level (9.85 ± 1.21)mg/L in patients with CURB-65 score of 2-3],and the differences were statistically significant (t =8.3565,5.0788,20.8283,10.9947,all P ＜ 0.05).Conclusion The levels of serum PCT and hs-CRP are significantly increased in the patients with bacterial pneumonia,but the levels are decreased significantly after treatment.The combination of hs-CRP and PCT detection has significant value for the assessment of bacterial pneumonia,which is helpful to evaluate the condition of the disease,and has great clinical significance.

Clinical characteristics of 130 bacterial pneumonia children and the changes of the levels of serum WBC, CRP and PCT / 中国基层医药

Objective To observe the clinical characteristics of bacterial pneumonia children,and the changes of the serum levels of white blood cells(WBC),C-reactive protein(CRP) and procalcitonin(PCT) before and after anti-bacterial therapy,and to explore the predictive value in early diagnosis and therapy.Methods 130 bacterial pneumonia children were enrolled prospectively as pneumonia group.The clinical data were collected and the serum CRP,PCT and WBC were detected before anti-bacterial therapy (within 24h after admission) and after anti-bacterial therapy (the seventh day after admission).34 healthy children were enrolled as control group.The general clinical characteristics of the children in the pneumonia group were observed.The levels of serum CRP,PCT and WBC between the pneumonia group and the control group were compared.The levels of serum CRP,PCT and WBC before and after anti-bacterial therapy in the bacterial pneumonia children were compared.The clinical value of PCT,CRP and WBC in early predicting bacterial pneumonia was identified.Results Compared with the control group,the sex and age of the bacterial pneumonia children demonstrated no statistically significant differences (t =1.012,P =0.395;x2 =0.003,P =0.959).The mean course of the disease before admission was (5.34 ± 1.27) d,with mean temperature of (38.27 ± 0.96) ℃,and hospital days of (8.92 ± 3.93) d.35 cases were cured,and 95 cases were improved,with no death.The serum levels of CRP,PCT and WBC in pneumonia children on admission were (12.24 ±6.35) mg/L,(0.18 ± 0.15) ng/mL and (14.25 ± 7.59) 109/L,respectively,which were higher than those of the control group,the differences were statistically significant (t =4.650,5.867,2.548,all P ＜ 0.05).The serum levels of CRP,PCT and WBC in pneumonia children before anti-bacterial therapy were higher than after bacterial therapy,showed statistically significant differences(t =8.165,7.232,5.112,all P ＜ 0.05).The area under the curve (AUC)of the PCT,CRP and WBC in early predicting bacterial pneumonia were 0.928,0.834 and 0.718 respectively by the relative operating characteristic (ROC) curve analysis (P ＜ 0.05).The sensitivity and specificity of PCT in predicting bacterial pneumonia were higher than CRP and WBC.Conclusion The statistics efficacy of PCT in early predicting children bacterial infection was obviously higher than CRP and PCT.The combined detection of CRP,PCT and WBC was benefit to improve the diagnostic sensitivity and specificity of children with bacterial pneumonia.

Clinical analysis and treatment of antibiotic-associated diarrhea in senile patients with severe bacterial pneumonia / 实用医学杂志

Objective To explore the clinical manifestations ,risk factors and treatment of antibiotic asso-ciated diarrhea(AAD)in senile patients with severe bacterial pneumonia. Methods Retrospective analysis was made on senile patients of bacterial pneumonia combined with antibiotic associated diarrhea. Results There were 114 patients out of 572 cases had AAD. The incidence of AAD in these senile patients was 19.93%. There were 62.28% patients more than 80 years old. The incidence AAD was 37.3% with third generation cephalosporin treat-ment,28.6% penicillin with enzyme inhibitor treatment and 19.2% with carbopenems treatment. Conclusions The high risk factors of AAD in senile patients with bacterial pneumonia include patient′s age,and time, APACHE Ⅱ,category,combination therapyof antibacterial,and invasive operations. We should pay more atten-tion to AAD and related high risk factors when using these antibiotics in clinics. Rational selection and use of anti-bacterial are important measures to stop senile patients from ADD. Pharmaceutical care could help to optimize the treatment plan and reduce its adverse reaction of antibacterial in senile patients.