Serum TNF-α,IL-1β and IL-6 expression levels and significance of children with severe pneumococcal infection / 国际检验医学杂志

Objective To explore serum tumor necrosis factor-α(TNF-α),interleukin 1β(IL-1β),interleu-kin 6(IL-6)expression levels and clinical significance of children with severe pneumococcal infection.Methods 37 cases of children with severe Streptococcus pneumococcal infection(severe infection group)and 36 cases with normal Streptococcus pneumoniae infection(normal infection group)treated in our hospital from January 2016 to January 2017 were enrolled as the study objects,and 37 cases of healthy children were enrolled as the control group in the same period.The levels of immunoglobulin IgA,IgM,IgG and the levels of TNF-,IL-1 and IL-6 in the serum of all children were detected.Results CD3+,CD4+,CD4+/CD8+,IgA and IgG levels in the severe infection group,the normal infection group were significantly lower than those of the control group (P<0.05).Serum TNF-α,IL-1β and IL-6 levels in the severe infection group were significantly higher than those in the normal infection group,and the normal infection group were higher than the control group(P<0.05).Serum TNF-α,IL-1β and IL-6 levels in acute period of the severe infection group were significantly higher than those in recovery period of the same group and same period of the normal infection group,and the acute period were higher than in recovery period of the same group(P<0.05).IL-1β level in recovery period of the severe infection group were significantly higher than that in recovery period of the normal infection group and the control group(P<0.05).Conclusion Children with severe pneumococcal infection have im-mune dysfunction,and serum TNF-α,IL-1β,IL-6 levels significantly increased.These data suggest that the three can be used as a reference marker for assessing the severity of severe pneumococcal infections.

Caracterización de pacientes fallecidos por enfermedad neumocóccica invasiva en la poblacion infantil de Bogotá, Colombia / Characterization of patients who died of invasive pneumococcal disease in the child population of Bogota, Colombia

Introducción: El Streptococcus pneumoniae (S. pneumoniae), también denominado neumococo, es una de las principales bacterias asociadas a mortalidad en menores de 2 años, con una incidencia de morbimortalidad variable de acuerdo a la demografía y exposición a factores protectores o de riesgo. Objetivo: Caracterizar los pacientes fallecidos por enfermedad neumocóccica invasiva (ENI) entre el 2008-2014 en la población infantil de 8 instituciones de salud en Bogotá, Colombia. Pacientes y método: Estudio observacional descriptivo tipo serie de casos, en pacientes fallecidos por ENI, mayores de 28 días hasta los 18 años, en 8 instituciones de tercer nivel de atención en Bogotá, Colombia. Periodo del estudio del 1 de enero de 2008 al 15 de enero de 2014. Tamaño de la muestra: 239 pacientes. Resultados: Se revisaron 239 casos registrados de ENI, presentando una mortalidad del 7,5% (n = 18). La edad promedio de los pacientes que fallecieron fue de 43,7 meses, con un rango de edad entre 2 y 176 meses (14 años); el 66% de los casos era de sexo masculino. Se identificaron serotipos en 8 pacientes, encontrando: 6A, 6B, 10A, 14, 18C, 23B, 23F, 35B. La presentación clínica más frecuente de los casos de mortalidad fue meningitis con el 33% (6 casos), seguida por bacteriemia sin foco en el 28% (5 casos) y neumonía con el 27% (5 casos). Se presentaron situaciones clínicas combinadas como neumonía y meningitis en el 11% (2 casos). Dos de los pacientes tenían factores de riesgo para ENI claramente documentados (asplenia y enfermedad respiratoria crónica). Conclusiones: La mortalidad por ENI es especialmente alta en los menores de 2 años y en pacientes de sexo masculino, especialmente cuando presenta foco meníngeo (44%). La serotipificación no fue posible en todos los pacientes fallecidos, ya que no se envió la cepa aislada al Instituto Nacional de Salud. Se requiere una vigilancia continua y sistemática para evaluar el impacto de la vacunación y las posibles modificaciones en el patrón de presentación de la enfermedad.

Introduction: Streptococcus pneumoniae (S. pneumoniae), also known as pneumococcus, is one of the main bacteria associated with mortality in children under 2 years of age, with a morbidity and mortality incidence that varies according to demographics and exposure to risk, or protective factors. Objective: To describe the child mortality due to invasive pneumococcal disease (IPD) between 2008 -2014 (6 years), in 8 Medical Centres in Bogotá, Colombia. Patients and method: Descriptive observational case series of patients who died of IPD, aged 28 days to 18 years, in 8 tertiary care institutions in Bogota, Colombia. The study period was from 1 January 2008 to 15 January 2014. Sample size: 239 patients. Results: A total of 239 registered cases of IPD were reviewed, showing a mortality of 8% (n 18). The mean age of patients that died was 43.7 months, with an age range from 2 to 176 months (14 years), with 66% of the cases being male. Serotypes were identified in 8 patients, finding: 6A, 6B, 10A, 14, 18C, 23B, 23F, and 35B. The most common clinical presentation of the cases was meningitis with mortality of 33% (6 cases), followed by bacteraemia without focus in 28% (5 cases), and pneumonia with 27% (5 cases). Combined clinical situations were presented, such as pneumonia and meningitis in 11% (2 cases). Two of the patients had clearly documented risk factors for IPD (asplenia and chronic respiratory disease). Conclusions: IPD mortality is particularly high in children under 2 years in male patients, especially when presented with a meningeal focus (44%). Serotyping was not possible in all patients who died, since no strain isolated was sent to the National Institute of Health. Continuous and systematic vigilance is required to evaluate the impact of vaccination and possible changes in the pattern of presentation of disease.

Adult Vaccination

Adult vaccination should no longer be considered a luxury for developed countries. Instead, we must view how lifelong immunisation can have an important public health role in reducing vaccine preventable diseases and their sequelae. In Singapore, we do not have an “official” adult immunisation schedule and many of the references and recommendations that I will discuss come from the United States where such recommendations have been in existence for many years. Travel vaccinations are being considered in a separate article in this series. The “routine” adult vaccinations are against: Influenza, pneumococcal infection, tetanus, diphtheria, pertussis, varicella zoster, human papilloma virus, measles, mumps, and rubella.

Impacto Económico de la Vacuna contra el Neumococo en Pacientes Oncológicos / Economic impact of neumococcal vaccine on oncological patients

Objetivos: Evaluar económicamente la vacuna contra S pneumoniae en pacientes oncológicos para Colombia. Métodos: Dado que la efectividad de la vacuna en este tipo de pacientes no está comprobada, se calculó el costo de los primeros seis años de un programa de vacunación para pacientes oncológicos y se estimó el costo de oportunidad con alternativas de detección temprana de cáncer. Resultados: Un programa de vacunación de pacientes oncológicos contra S pneumoniae costaría en sus primeros seis años cerca de treinta y un mil millones de pesos constantes de 2006. Con estos recursos se podrían realizar aproximadamente 170 000 colonoscopias o pruebas de detección temprana de VPH, 500 000 mamografías o más de 3 800 000 citologías. Conclusiones: Dada la escasez de recursos, es preferible económicamente destinar estas cifras a adelantar programas cuya efectividad esté comprobada, ya sea para detección temprana de cáncer o para vacunación de niños sanos.

Objective: An economic evaluation of an anti-S pneumoniae vaccine for oncological patients in Colombia. Methods: As there is no evidence of vaccine effectiveness for this kind of patient, the cost of a vaccination programme for oncological patients was calculated during its first six years and the opportunity cost was estimated for early cancer detection alternatives. Results: An anti-S. pneumoniae vaccination programme for oncological patients would cost around $31 000 000 000 (Colombian pesos in 2006, i.e. nearly US$12 400 000) during its first years. Alternative programs could be developed with this amount, such as 170 000 colonoscopies or early HPV detection, 500 000 mammographies, or more than 3 800 000 cytologies. Conclusions: Given the scarcity of resources, it would be better (from an economic point of view) to devote this amount to programmes whose effectiveness has been proven, such as early cancer detection or vaccinating healthy children.

Overwhelming Pneumococcal Infection Due to Congenital Hyposplenism or Asplenia in Adults / General Medicine

We recently encountered a case of fatal pneumococcal infection in a previously healthy 19-year-old female. She had no history of splenectomy, but on autopsy she was found to have hyposplenism. It has been widely reported that life-threatening pneumococcal infection can occur after splenectomy, though cases of hyposplenic or asplenic adults, without a history of splenectomy, are very rare. We report this case and review the literature dealing with 6 similar cases.

Study on the effect of products of neuraminidase gene(nan A) in the infection of Streptococcus pneumoniae in chinchillas / 中华传染病杂志

To explore the effect of products of nan A gene on the changes of cell surface carbohydrates of the chinchilla eustachian tube after infection with Streptococcus pneumoniae. Methods Using lectin histochemical techique to compare the changes of the cell surface carbohydrates in the chinchilla eustachian tube after infection with S.pneumoniae D39 or ?NA1 mutant. Results The labeling pattern revealed that the staining with Limax flavus agglutinin (LFA) and Sambucus nigra agglutinin (SNA) was decreased in epithelium of the eustachian tube in the D39 cohort compared to the uninfected control, which indicated that the normal terminal sialic acid residue were removed. Concurrently, the increased staining with wheat germ agglutinin (WGA), succinylated wheat germ agglutinin (Succ WGA), Bandeiraea simplicfolia lectin II (BSL II), peanut agglutinin (PNA) and Erythrina cristagalli lectin (ECL) was observed in the lumen surface of eustachian tube subsequent to intranasal inoculation with D39. However, the ?NA1 neuraminidase deficient mutant did not show any significant changes in the lectin labeling patterns as compared with those of the control cohort. Conclusions The products of the nan A gene play an important role in the changes of cell surface carbohydrates and thus may be responsible for the colonization in the chinchilla eustachian tube after infection with Streptococcus pneumoniae.