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Resumen El Streptococcus viridans es conocido más comúnmente como agente infeccioso en las endocarditis, sin embargo, poco se conoce sobre su potencial infeccioso en otros órganos o sistemas, donde ha demostrado una elevada mortalidad. El reconocimiento del Streptococcus viridans como agente productor de abscesos en otras localizaciones como a nivel hepático o pulmonar, permitirá un diagnóstico oportuno mediante los distintos métodos de imagen, reduciendo las graves consecuencias para el paciente y los tiempos de hospitalización. Se presenta el caso de un paciente del sexo masculino de 33 años de edad sin antecedentes crónico degenerativos, que inició con sintomatología 7 meses previos a su ingreso, con fiebre intermitente, fatiga, astenia, anorexia y pérdida de peso. A la exploración física presentó dolor a la palpación media y profunda en hipocondrio derecho, en el panel de laboratorios presentó llamativa neutrofilia, en la tomografía de tórax y abdomen se mostró lesión cavernomatosa en pulmón y quistes complicados hepáticos, a los cuales se les realizó drenaje percutáneo guiado por ultrasonido, con envío de muestras a cultivo con resultado positivo para Streptococcus viridans, lo que permitió brindar el tratamiento dirigido al paciente, y que remitiera la enfermedad.
Abstract Streptococcus viridans is more commonly known as an infectious agent in endocarditis, however, little is known about its infectious potential in other organs or systems, where it has shown high mortality. The recognition of Streptococcus viridans as an abscess-producing agent in other locations, such as the liver or lungs, will allow timely diagnosis using different imaging methods, reducing serious consequences for the patient and hospitalization times. We present the case of a 33-year-old male patient with no chronic degenerative history, who started symptoms 7 months prior to admission, with intermittent fever, fatigue, asthenia, anorexia and weight loss, on physical examination he presented pain at the medium and deep palpation in the right hypochondrium, in the laboratory panel I present striking neutrophilia, in the tomography of the thorax and abdomen a cavernous lesion in the lung and complicated hepatic cysts are shown, to which percutaneous drainage guided by ultrasound is performed, with sending of cultured samples with a positive result for Streptococcus viridans. Thus, allowing treatment to be provided to the patient, thereby achieving remission of the disease.
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RESUMEN Introducción: Desde 1980 se conocen casos de síndromes neuropsiquiátricos infantiles en el mundo y su concepto ha evolucionado con cambios en las definiciones de 1995 (PITANDS: trastornos neuropsiquiátricos pediátricos autoinmunes precipitados por infección), 1998 (PANDAS: síndrome neuropsiquiátrico autoinmune pediátrico asociado con la infección por estreptococos), 2010 (PANS: síndrome pediátrico neuropsiquiátrico de inicio agudo) y 2012 (CANS: síndromes neuropsiquiátricos agudos de los niños). A pesar de que se conoce desde hace más de 20 años, aún es una enfermedad que suele pasar inadvertida para muchos profesionales de la salud. Objetivo: Sensibilizar a la comunidad médica acerca de la identificación de la enfermedad y disminuir la morbilidad asociada con un diagnóstico tardío. Caso clínico: Una niña de 6 años consultó a urgencias por trastorno de rechazo alimentario. En el tratamiento hospitalario se identificó historia clínica con criterios diagnósticos de PANS-PANDAS. Mostraba un curso clínico recurrente-remitente, tal y como describe la literatura, con pobre respuesta a los tratamientos de primera línea. Conclusiones: En todo niño en edad escolar que se presente con trastorno obsesivo compulsivo o trastornos alimentarios, con sin otros síntomas, se debe evaluar y descartar su asociación con PANS-CANS.
ABSTRACT Introduction: Since 1980, there have been known cases of childhood neuropsychiatric syndromes in the world and its concept has evolved with changes in the definitions in 1995 (PITANDs - paediatric infection-triggered autoimmune neuropsychiatric disorders), 1998 (PANDAS - paediatric autoimmune neuropsychiatric syndrome associated with streptococci infection), 2010 (PANS - paediatric acute-onset neuropsychiatric syndrome) and 2012 (CANS - childhood acute neuropsychiatric syndrome). Despite being known for more than 20 years, it is still an illness that often goes unnoticed by many health professionals. Objective: To sensitise the medical community about the identification of the disease and reduce the morbidity associated with a late diagnosis. Clinical case: A 6-year-old schoolgirl brought to the emergency department due to her refusal to eat. In the hospital treatment, a clinical history was identified with PANS-PANDAS diagnostic criteria. She exhibited a relapsing-remitting clinical course, as described in the literature, with poor response to first-line treatments. Conclusions: In all school-age child presenting with obsessive compulsive disorder or eating disorders, with other symptoms or not, a possible link to PANS-CANS should be evaluated and ruled out.
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ABSTRACT Objective: To evaluate the importance attributed to tonsillitis by guardians and their level of knowledge about the disease, correlating their management with their schooling and socioeconomic profiles. Methods: A quantitative, descriptive and observational cross-sectional study involving students aged 5 to 17 years from state-owned and private schools. A questionnaire was applied on management of tonsillitis and knowledge about rheumatic fever, addressing demographic and socioeconomic data. Results: A total of 323 students were included, predominantly females (61.3%), from state-owned schools (77.1%), with a mean age of 9.7±0.3 years. Among the guardians, 48.6% completed high school. Among the students 75.2% had at least one episode of odynophagia in the previous 12 months. Considering the previous 2 years, 89.8% reported this symptom. There was no collection of bacteriological specimens in 67.8%, and in 83% if taking into account only the last episode, despite the search for medical care in most cases (92.6%). The use of anti-inflammatory drugs was very frequent (43.0% "always" and 42.4% "sometimes"). Among the guardians, 81.7% denied being aware of the relation between rheumatic fever and inappropriate treatment of odynophagia; 85.8% said they wished they had received more information. Conclusion: Although it is quite common in schoolchildren, tonsillitis is neglected by many guardians and health professionals, and the ignorance of its relation with rheumatic fever is practically universal, which may contribute to its high prevalence.
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Humans , Male , Female , Child, Preschool , Child , Adolescent , Students , Tonsillitis/epidemiology , Schools , Brazil/epidemiology , Cross-Sectional StudiesABSTRACT
Group B Streptococcus (GBS) is a major cause of severe perinatal infection, stillbirth, premature delivery, and neonatal infectious diseases. Ascending infection after vaginal colonization is the main route of prenatal GBS transmission. The pathogenic mechanism of GBS from asymptomatic colonization to invasive infection mainly relates to virulence factors, the regulation of two-component systems and immune escape. This paper reviews progress in pathogenic mechanism of perinatal GBS infection in recent years, aiming to provide a theoretical basis for the development of vaccines and new treatment approaches against GBS.
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La enfermedad por neumococo se defino como cualquier infección causada por la bacteria Streptococcus pneumoniae; esta se denomina invasiva cuando el aislamiento de este microorganismo se confirma en sitios corporales que son normalmente estériles, tales como la sangre y el líquido cefalorraquídeo, y no invasiva cuando la infección se produce en sitio corporales que normalmente no son estériles. La enfermedad renal crónica y la diabetes mellitus son factores de riesgo importantes para el desarrollo de enfermedad neumocócica debido a su estado de inmunosupresión, por lo que la vacunación antineumocócica es una medida preventiva fundamental en los pacientes que padecen estas condiciones.
Pneumococcal disease is defined as any infection caused by the bacteria Streptococcus pneumoniae; it is called invasive when the isolation of this microorganism is confirmed in sites of the body that are normally sterile, such as blood and cerebrospinal fluid, and non-invasive when the infection occurs in sites of the body that are normally non-sterile. Chronic kidney disease and diabetes mellitus are important risk factors for the development of pneumococcal disease due to their status of immunosuppression;therefore, anti-pneumococcal vaccination is a fundamental preventive measure in patients who suffer from these conditions.
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Introducción: el estreptococo del grupo B (EGB) es una causa frecuente de sepsis neonatal. La enfermedad precoz disminuyó su incidencia por la profilaxis antibiótica, a diferencia de la sepsis tardía, que aumentó su incidencia en los últimos años. Objetivo: conocer la incidencia de la sepsis tardía en el período 2016-2017 en el Centro Hospitalario Pereira Rossell (CHPR). El secundario, describir las características epidemiológicas y clínicas de sepsis tardía por EGB en niños ingresados a la Unidad de Cuidados Intensivos de Niños (UCIN) del CHPR en el período 2007-2017. Resultados: la incidencia calculada de sepsis tardía por EGB fue de 0,53 casos/1000 recién nacidos (RN) vivos. Entre los años 2007 y 2017 ingresaron cinco niños por sepsis tardía por EGB a la UCIN del CHPR. La presentación clínica más frecuentes fue fiebre sin foco y meningitis. Se obtuvieron tres aislamientos en sangre de EBG y tres en líquido cefalorraquídeo (dos en cultivo y otro por detección de ADN). Ninguno falleció. Los casos con meningitis presentaron alteraciones en la tomografía de cráneo. Un niño fue pretérmino. Conclusiones: la sepsis tardía se vincula a importante morbimortalidad en pediatría. No se ha establecido cuáles son los principales factores de riesgo asociados a una enfermedad grave ni las políticas para disminuir su incidencia.
Background: group B streptococcus (GBS) is a common cause of neonatal sepsis. Early disease decreased its incidence due to antibiotic prophylaxis. Late sepsis increased its incidence in recent years. Objectives: to know the incidence of late onset EGB sepsis in the period 2016-2017 at the Pereira Rossell Hospital Center (CHPR), and secondly, to describe the epidemiological characteristics and the clinical presentation of late onset sepsis due to GBS in children admitted to the Children's Intensive Care Unit (UCIN) of the CHPR in the period 2007-2017. Results: the calculated incidence of late sepsis due to GBS was 0.53 cases/1000 live newborns. Between 2007-2017, 5 children were admitted due to GBS late sepsis at the UCIN. The most frequent clinical presentation was fever without focus and meningitis. 3 isolates were obtained in EBG blood cultures and 3 in cerebrospinal fluid (2 in culture and another by DNA detection). None of them died. Cases with meningitis showed abnormalities in the brain tomography. 1 of the 5 was preterm. Conclusions: late sepsis is associated with significant morbidity and mortality in pediatric patients. The main risk factors associated with serious disease and the policies needed to reduce its incidence have not been established.
Introdução: o estreptococo do grupo B (SGB) é uma causa frequente de sepse neonatal. A doença precoce diminuiu sua incidência devido à profilaxia antibiótica, ao contrário da sepse tardia, que aumentou sua incidência nos últimos anos. Objetivo: conhecer a incidência de sepse tardia no período 2016-2017 no Centro Hospitalar Pereira Rossell (CHPR) e descrever as características epidemiológicas e clínicas da sepse tardia por SGB em crianças internadas na Unidade de Terapia Intensiva Infantil (UTIN) do CHPR no período de 2007-2017. Resultados: a incidência calculada de sepse tardia por SGB foi de 0,53 casos/1000 recém-nascidos vivos (RNs). Entre 2007-2017, 5 crianças foram internadas na UTIN do CHPR por sepse tardia devido a GBS. A apresentação clínica mais frequente foi febre sem causa e meningite. 3 isolados de EBG foram obtidos no sangue e 3 no líquido cefalorraquidiano (2 em cultura e outro por detecção de DNA). Nenhum dos pacientes morreu. Os casos com meningite apresentaram alterações na tomografia de crânio. Uma criança era pré-termo. Conclusões: a sepse tardia está associada a significativa morbimortalidade em pediatria. Os principais fatores de risco associados a uma doença grave e as políticas para reduzir sua incidência ainda não foram estabelecidas.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Streptococcal Infections/epidemiology , Neonatal Sepsis/etiology , Streptococcal Infections/complications , Streptococcal Infections/diagnosis , Uruguay/epidemiology , Catastrophic Illness , Epidemiology, Descriptive , Incidence , Retrospective StudiesABSTRACT
ABSTRACT Purpose: The aims of this study were to characterize alpha-hemolytic streptococci among isolates from cases of infectious endophthalmitis and keratitis and to determine their distributions. Methods: The sample included 27 and 35 nonduplicated isolates of alpha-hemolytic streptococci recovered from patients with infectious endophthalmitis (2002-2013) and keratitis (2008-2013), respectively. Isolates were identified by the optochin susceptibility and bile solubility tests, using a biochemical identification system. The minimum inhibitory concentration was determined by the broth microdilution method. Molecular identification was performed by analyses of three constitutive genes and the complementary multilocus sequence. The molecular epidemiology of Streptococcus pneumoniae was investigated using multilocus sequence typing, and the presence of the capsular polysaccharide-encoding gene was assessed using conventional polymerase chain reaction. Outcomes were evaluated using the patients' medical records. Results: Phenotypic tests differentiated S. pneumoniae from other alpha-hemolytic streptococci, consistent with later molecular identifications. Streptococcus oralis was significantly prevalent among the endophthalmitis isolates, as was S. pneumoniae in the keratitis isolates. High levels of susceptibility to antibiotics were observed, including vancomycin, cephalosporins, and fluoroquinolones. High genetic variability was detected among the 19 S. pneumoniae strains, with 15 predicted to be encapsulated. The medical records of patients with infectious endophthalmitis were reviewed (n=15/27; 56%), and final visual acuity was assessed in 12 cases (44%). Many patients progressed to a final visual acuity state of "no light perception" (6/12; 50%), "light perception" (3/12; 25%), or "hand motion" (1/12; 8%). The medical records of patients with infectious keratitis were also reviewed (n=24/35; 69%), and final visual acuity was assessed in 18 cases (51%). Similarly, most patients progressed to a final visual acuity state of "no light perception" (6/18; 33%), "light perception" (1/18; 6%), or "hand motion" (6/18; 33%). Overall, the majority of patients progressed to a final visual acuity state of "no light perception" (12/30), "light perception" (4/30), or "hand motion" (7/30). Conclusions: The distribution of alpha-hemolytic streptococci in ocular infections suggested the presence of a species-specific tissue tropism. The prognoses of patients with ocular streptococcal infections were highly unfavorable, and antibiotic resistance did not contribute to the unfavorable clinical progressions and poor outcomes.
RESUMO Objetivo: O objetivo deste estudo foi caracterizar os estreptococos alfa-hemolíticos isolados de endoftalmite infecciosa e ceratite e determinar sua distribuição. Métodos: A amostra incluiu 27 e 35 isolados não-duplicados de estreptococos alfa-hemolíticos recuperados de pacientes com endoftalmite infecciosa (2002-2013) e ceratite (2008-2013), respectivamente. Os isolados foram identificados pelos testes de suscetibilidade à optoquina e bile solubilidade, utilizando um sistema de identificação bioquímica. A concentração inibitória mínima foi determinada pelo método de microdiluição em caldo. A identificação molecular foi realizada pela análise de três genes constitutivos e análise complementar de sequências multilocus. A epidemiologia molecular do Streptococcus pneumoniae foi investigada por tipagem de sequência multilocus, e a presença do gene codificador do polissacarídeo capsular foi avaliada por reação em cadeia da polymerase convencional. Os resultados foram avaliados utilizando os prontuários médicos dos pacientes. Resultados: Os testes fenotípicos diferenciaram S. pneumoniae dos outros estreptococos alpha-hemolíticos, consistentes com identificações moleculares posteriores. S. oralis foi significativamente prevalente entre os isolados de endoftalmite, assim como S. pneumoniae nos isolados de ceratite. Foram observados altos níveis de suscetibilidade a antibióticos, incluindo vancomicina, cefalosporinas e fluoroquinolonas. Alta variabilidade genética foi detectada entre as 19 cepas de S. pneumoniae, com 15 previstas para serem encapsuladas. Os prontuários médicos dos pacientes com endoftalmite infecciosa foram revisados (n=15/27; 56%), e a acuidade visual final foi avaliada em 12 casos (44%). Muitos pacientes evoluiram para um estado final de acuidade visual de "sem percepção luminosa" (6/12; 50%), "percepção luminosa" (3/12; 25%) ou "movimentos de mãos" (1/12; 8%). Também foram revisados os prontuários médicos dos pacientes com ceratite infecciosa (n=24/35; 69%), e a acuidade visual final foi avaliada em 18 casos (51%). Da mesma foram, a maioria dos pacientes evoluiu para um estado final de acuidade visual de "sem percepção luminosa" (6/18; 33%), "percepção luminosa" (1/18; 6%) ou "movimentos de mãos" (6/18; 33%). No geral, a maioria dos pacientes evoluiu para um estado final de acuidade visual de "sem percepção luminosa" (12/30), "percepção luminosa" (4/30) ou "movimentos de mãos" (7/30). Conclusões: A distribuição de estreptococos alfa-hemolíticos nas infecções oculares sugeriu a presença de um tropismo de tecido específico da espécie. Os prognósticos dos pacientes com infeções oculares por estreptococos foram altamente desfavoráveis e a resistência a antibióticos contribuiu não para as progressões clínicas desfavoráveis e os maus resultados.
Subject(s)
Humans , Endophthalmitis , Endophthalmitis/drug therapy , Endophthalmitis/epidemiology , Keratitis , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology , Streptococcus pneumoniae , Microbial Sensitivity Tests , Keratitis/drug therapy , Keratitis/epidemiologyABSTRACT
Introducción: La gingivoestomatitis estreptocócica es una inflamación aguda de las encías y mucosa bucal. Es una infección específica por estreptococo, poco frecuente. Objetivo: Valorar la correspondencia entre el diagnóstico presuntivo de la gingivoestomatitis estreptocócica, el diagnóstico etiológico y la evolución clínica de los pacientes tratados. Métodos: Se realizó un estudio descriptivo en el período comprendido de septiembre del año 2018 a abril del 2019, en el Hospital Militar "Manuel Fajardo". La población de estudio estuvo constituida por 13 pacientes de 15 a 24 años que acudieron a los servicios de urgencias estomatológicas, quienes fueron diagnosticados con gingivoestomatitis estreptocócica. Las variables estudiadas fueron, edad, sexo, características clínicas, síntomas, correspondencia entre el diagnóstico presuntivo, el etiológico y evolución de la enfermedad. Resultados: El 61,5 por ciento de los pacientes fueron del sexo masculino y la media de edad fue de 18,5 años, el sangramiento estuvo presente en la totalidad de los pacientes, el 92,3 por ciento presento úlceras, en el 76,9 por ciento la enfermedad estaba generalizada, entre los síntomas predominaron el dolor y la fiebre. El diagnóstico etiológico del estreptococo beta hemolítico fue del 84,6 por ciento. La evolución de la enfermedad con el tratamiento recibido fue satisfactoria en el 76,9 por ciento de los pacientes. Conclusiones: Se observó alta correspondencia entre el diagnóstico presuntivo realizado en la consulta de urgencias y el diagnóstico etiológico de la gingivoestomatitis estreptocócica. La mayoría de los pacientes tuvo una evolución satisfactoria con el tratamiento(AU)
Introduction: Streptococcal gingivostomatitis is an acute inflammation of the gums and oral mucosa. It is a specific streptococcus infection with low frequency. Objective: To assess the correspondence between the presumptive diagnosis of streptococcal gingivostomatitis, the etiological diagnosis and the clinical evolution of the treated patients. Methods: A descriptive study was carried out in the period from September 2018 to April 2019, at the Hospital Militar "Manuel Fajardo Rivero". The study population consisted of 13 patients aged 15 to 24 who attended the stomatological emergency services who were diagnosed with streptococcal gingivostomatitis. The variables studied were, age, sex, clinical characteristics, symptoms, correspondence between presumptive diagnosis, etiological and disease evolution. Results: 61.5 percent of the patients were male and the average age was 18.5 years, bleeding was present in all patients, 92.3 percent had ulcers, in 76.9 percent the disease was widespread, pain and fever predominated among the symptoms. The etiological diagnosis of beta hemolytic streptococcus was 84.6 percent. The evolution of the disease with the treatment received was satisfactory in 76.9 percent of the patients. Conclusions: High correspondence was observed between the presumptive diagnosis made in the emergency department and the etiological diagnosis of streptococcal gingivostomatitis. The majority of the patients had a satisfactory evolution with the treatment(AU)
Subject(s)
Humans , Adolescent , Adult , Clinical Evolution , Gingiva , Hemorrhage , Infections , International Cooperation , Methods , Mouth Mucosa , Epidemiology, DescriptiveABSTRACT
Objetivo: Describir el uso irracional de antibióticos en base a criterios de McIsaac (criterios de Centor modificados por McIsaac), en una unidad de salud de primer nivel de atención. Métodos: Se realizó un estudio descriptivo transversal con los registros de pacientes de 3 a 19 años atendidos en el servicio de emergencia (246), con los diagnósticos de faringitis aguda, amigdalitis aguda, e infecciones respiratorias superiores agudas de múltiples sitios y sin especificar. Se estableció como prescripción inadecuada si el facultativo indicó antibióticos con un puntaje menor o igual a 1 sobre 5 puntos o si no prescribió antibióticos con puntaje mayor o 4 sobre 5 puntos. Resultados: Se estimó 24,29% de uso inadecuado de antibióticos de los registros de emergencia. Se prescribió antibióticos en 160 pacientes, de los cuales se encontró que, amoxicilina fue el más utilizado (61,87%); seguido de benzilpenicilina benzatina (28,12%) y en tercer lugar macrólidos (8,12%). Conclusión: En la unidad de primer nivel analizada se encontró que el uso inadecuado de antibióticos es superior a la prevalecía estimada de faringoamigdalitis estreptocócica para el grupo de edad estudiado. Por esto, es imperativo que se tomen las medidas necesarias a nivel institucional y comunitario para lograr su reducción y evitar las complicaciones que se derivan de esta.
Objetivo: Descrever o uso irracional de antibióticos com base nos critérios de McIsaac (critérios de Centor modificados por McIsaac), em uma unidade de saúde de primeiro nível de atenção. Métodos: Foi realizado um estudo descritivo transversal com os prontuários de pacientes de 3 a 19 anos atendidos no serviço de emergência (246), com diagnóstico de faringite aguda, amigdalite aguda, e infecções respiratórias superiores agudas de múltiplos locais e sem especificação. Estabeleceu-se como uma prescrição inadequada se o médico indicou antibióticos com um escore menor ou igual a 1 de 5 pontos ou se ele não prescreveu antibióticos com um escore maior ou igual a 4 de 5 pontos. Resultados: O uso inadequado de antibióticos foi estimado em 24,29% dos prontuários de emergência. Antibióticos foram prescritos em 160 pacientes, dos quais constatou-se que a amoxicilina foi a mais utilizada (61,87%); em segundo, a penicilina benzatina (28,12%); e, em terceiro lugar, os macrolídeos (8,12%). Conclusão: Na unidade de primeiro nível analisada foi encontrado que o uso de antibióticos é superior à prevalência de faringite estreptocócica estimada para a faixa etária estudada. Então, é imperativo que a nível institucional e comunitário sejam tomadas as medidas necessárias para sua redução e evitar as complicações resultantes.
Objective: To describe the irrational use of antibiotics based on McIsaac criteria (Centor criteria modified by McIsaac), in a primary care facility. Methods: A cross-sectional descriptive study was conducted with the medical record of patients from 3 to 19 years old, treated in the emergency department (246), with the diagnoses of acute pharyngitis, acute tonsillitis, and acute upper respiratory infections from multiple sites and not specified. It was established as an inappropriate prescription if the physician indicated antibiotics with a score less than or equal to 1 out of 5 points or if he did not prescribe antibiotics with a score greater than or equal to 4 out of 5 points. Results: Inadequate use of antibiotics was found in 24.29% of emergency records. Antibiotics were prescribed in 160 patients, of which, amoxicillin was the most used (61.87%); followed by benzathine penicillin (28.12%) and in third place macrolides (8.12%). Conclusion: In the first level unit analyzed, it was found that the inappropriate use of antibiotics is superior to the estimated prevalence of streptococcal pharyngitis for the age group studied. Therefore, it is imperative that the necessary measures are taken at the institutional and community level to achieve its reduction and avoid the complications that result from it.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Streptococcal Infections , Pharyngeal Diseases , Pharyngitis , Tonsillitis , Drug Utilization , Inappropriate PrescribingABSTRACT
PURPOSE: In Kawasaki disease (KD) patients, coronary artery complications, incomplete and refractory types occur more frequently in patients with streptococcal or other bacterial/viral infections. Recently, we observed a higher incidence of coronary lesions in KD patients with high anti-streptolysin O (ASO) titer. Therefore, we hypothesized that KD patients diagnosed with concurrent streptococcal infection have poor prognoses, with respect to treatment response and development of coronary artery lesions. METHODS: A retrospective review was performed in 723 patients with KD who were admitted to 2 major hospitals between June 2010 and September 2017. RESULTS: Among 723 patients with KD, 11 initially showed an elevated ASO titer (>320 IU/mL) or elevated follow-up ASO titer after treatment. Of these patients, 5 showed no response to the first intravenous immunoglobulin treatment, 3 had abnormalities of the coronary arteries. This is a significantly higher proportion of patients with a high ASO titer (n=3, 27.3%) than those with a normal ASO titer (n=53 [7.4%], P=0.047). A severe clinical course was seen in 81.8% of patients in the high ASO group versus 14.5% of patients in the normal ASO group. CONCLUSION: It is not certain whether acute streptococcal infection may cause KD, but this study revealed that KD with high ASO titers showed higher rates of severe clinical course. It may be helpful to analyze concurrent streptococcal infection in patients with a severe clinical course.
Subject(s)
Humans , Antistreptolysin , Coronary Disease , Coronary Vessels , Follow-Up Studies , Immunoglobulins , Incidence , Mucocutaneous Lymph Node Syndrome , Prognosis , Retrospective Studies , Streptococcal InfectionsABSTRACT
Objective@#To analyze the clinical characteristics of streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes (S. pyogenes) in the third trimester to improve clinical awareness of this disease.@*Methods@#A retrospective study was conducted to analyze the clinical data of two patients with STSS caused by S. pyogenes in Jinan Maternal and Child Health Care Hospital and nine reported cases of healthy pregnant women infected with S. pyogenes at 28-42 gestational weeks with detailed data retrieved from Chinese National Knowledge Infrastructure and PubMed database from January 1997 to December 2018.@*Results@#The two cases admitted to our hospital were both multiparas, with onset in winter and no specific symptoms in early stage. Disseminated intravascular coagulation (DIC) was developed in both cases on admission. In one case, the fetal heart rate was reduced and disappeared soon after admission. The other patient was diagnosed as stillbirth on admission. Both patients died and blood culture revealed infection of group A streptococcus. Nine previous cases were reported in one Chinese and five English articles. No high-risk pregnancy or premature rupture of membranes was reported in these 11 cases. Among the 11 cases, ten were positive for S. pyogenes indicated by blood or tissue culture and one was positive for streptococcal toxin. Ten cases had high fever and three presented with respiratory symptoms in early stage. Abdominal pain and watery diarrhea were common symptoms and all patients developed multiple organ dysfunction and DIC. Cases occurred in winter or spring were more common. Nine women died within 36 h after the onset of fulminant symptoms. Only two survived and hospitalized for 90 d and 25 d, respectively, after emergent cesarean section indicated by reduced fetal heart rate. Unfortunately, both neonates died after birth. For the babies, there were seven intrauterine fetal deaths, one stillbirth and three live births, but only one survived (whose mother developed respiratory cardiac arrest 90 min after delivery).@*Conclusions@#STSS caused by S. pyogenes in pregnant women exacerbates rapidly with a high mortality. Early identification of clinical manifestations and rapid progress of the disease are crucial for early diagnosis and treatment, which may help improve maternal and fetal outcomes.
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Objective To analyze the clinical characteristics of streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes (S.pyogenes) in the third trimester to improve clinical awareness of this disease.Methods A retrospective study was conducted to analyze the clinical data of two patients with STSS caused by S.pyogenes in Jinan Maternal and Child Health Care Hospital and nine reported cases of healthy pregnant women infected with S.pyogenes at 28-42 gestational weeks with detailed data retrieved from Chinese National Knowledge Infrastructure and PubMed database from January 1997 to December 2018.Results The two cases admitted to our hospital were both multiparas,with onset in winter and no specific symptoms in early stage.Disseminated intravascular coagulation (DIC) was developed in both cases on admission.In one case,the fetal heart rate was reduced and disappeared soon after admission.The other patient was diagnosed as stillbirth on admission.Both patients died and blood culture revealed infection of group A streptococcus.Nine previous cases were reported in one Chinese and five English articles.No high-risk pregnancy or premature rupture of membranes was reported in these 11 cases.Among the 11 cases,ten were positive for S.pyogenes indicated by blood or tissue culture and one was positive for streptococcal toxin.Ten cases had high fever and three presented with respiratory symptoms in early stage.Abdominal pain and watery diarrhea were common symptoms and all patients developed multiple organ dysfunction and DIC.Cases occurred in winter or spring were more common.Nine women died within 36 h after the onset of fulminant symptoms.Only two survived and hospitalized for 90 d and 25 d,respectively,after emergent cesarean section indicated by reduced fetal heart rate.Unfortunately,both neonates died after birth.For the babies,there were seven intrauterine fetal deaths,one stillbirth and three live births,but only one survived (whose mother developed respiratory cardiac arrest 90 min after delivery).Conclusions STSS caused by S.pyogenes in pregnant women exacerbates rapidly with a high mortality.Early identification of clinical manifestations and rapid progress of the disease are crucial for early diagnosis and treatment,which may help improve maternal and fetal outcomes.
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Objective To study the clinical manifestations and antibiotic sensitivity features of early-and late-onset invasive infections caused by group B Streptococcus (GBS). Methods A total of 96 infants with invasive GBS infections were enrolled prospectively from seven tertiary hospitals of GBS Infection Research Cooperative Group in southwest Fujian, such as Xiamen Maternal and Child Care Hospital, etc., from January 2016 to June 2018. According to the onset time of infection after birth, they were divided into early-onset GBS disease (GBS-EOD) group (<7 d, n=67) and the late-onset GBS disease (GBS-LOD) group (7-89 d, n=29). Clinical manifestations, disease spectrum, complications and outcomes of the two groups were compared. Drug sensitivity test was carried out using disk diffusion test. Chi-square or Fisher's exact test, two independent sample t-test or Mann-Whitney U tests were used for statistical analysis. Results (1) The average ages at onset in GBS-EOD and GBS-LOD groups were (15.8±6.7) h (0.5-142.0 h) and (25.0±8.1) d (9-89 d), respectively. The incidence of tachypnea, pallor, fever and convulsion were noted in 68.7% (46/67) vs 44.8% (13/29), 52.2% (35/67) vs 17.2% (5/29), 23.9% (16/67) vs 65.5% (19/29) and 7.5% (5/67) vs 48.3% (14/29) of GBS-EOD and GBS-LOD groups with χ2 values of 6.282, 10.199, 15.146 and 21.237 (all P<0.05). The main clinical manifestations of GBS-EOD were tachypnea and pallor, while most of the patients in the GBS-LOD group developed fever and convulsions. (2) The incidence of pneumonia, sepsis, meningitis, sepsis complicated by septic joints, pneumonia complicated by sepsis, sepsis complicated by meningitis and pneumonia complicated by sepsis and meningitis were noted in 43.3% (29/67) vs 20.7% (6/29), 9.0% (6/67) vs 17.2% (5/29), 0.0% (0/67) vs 3.4% (1/29), 0.0% (0/67) vs 6.9% (2/29), 31.3% (21/67) vs 13.8% (4/29), 6.0% (4/67) vs 31.0% (9/29) and 10.4% (7/67) vs 6.9% (2/29) of GBS-EOD and GBS-LOD groups. There was a statistically significant difference in the disease spectrum between the two groups (Fisher's exact test, all P<0.001). Compared with the GBS-LOD group, the GBS-EOD group had a higher incidence of pneumonia [85.1% (57/67) vs 41.4% (12/29), χ2=19.116, P<0.001] and a lower incidence of meningitis [16.4% (11/67) vs 41.4% (12/29), χ2=6.922, P=0.009]. Complications such as acute respiratory distress syndrome (ARDS), pulmonary hemorrhage, shock and persistent pulmonary hypertension of the newborn (PPHN) occurred much more in the GBS-EOD group than the GBS-LOD group [28.4% (19/67) vs 6.9% (2/29), 13.4% (9/67) vs 0.0% (0/29), 11.9% (8/67) vs 10.3% (3/29), 4.5% (3/67) vs 0.0% (0/29), χ2=13.683, P<0.001]. (3) Among the 96 patients, 23 (24.0%) had meningitis and 73 (76.0%) developed pneumonia and sepsis. Meningitis resulted in a higher fatality rate [17.4% (4/23) vs 4.1% (3/73), χ2=4.564, P=0.035] and longer average hospital stay [(37.2±12.6) vs (14.1±5.3) d, t=7.831, P<0.001] than pneumonia and sepsis. Seven out of the 19 meningitis survivors developed intracranial complications. (4) The overall fatality rate in this study was 7.3% (7/96) and no significant difference was found between GBS-EOD and GBS-LOD group [7.5% (5/67) vs 6.9% (2/29), χ2=0.010, P=0.982]. Among the 67 GBS-EOD infants, 58 (86.6%) occurred within 24 h and five of them died, but no death was reported in the other nine cases occurred after 24 h. (5) Totally 96 strains of GBS were isolated with 100% sensitivity to penicillin, ampicillin, cefazolin and meropenem, and 97% to vancomycin. Around 79.3%-91.0% of GBS isolates were resistant to clindamycin and erythromycin. Conclusions Clinial features vary greatly in GBS-LOD and GBS-EOD cases. Infants with meningitis have poor prognosis. The drug resistance rate of GBS to erythromycin and clindamycin are relatively high.
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Objective To discuss the controversial role of breast milk in late-onset group B Streptococcus (GBS) infections.Methods This study reported a case of recurrent late-onset GBS sepsis with the suspicion of breast milk transmission in an extremely preterm infant born at 22+6 weeks who was treated at the University of Hong Kong-Shenzhen Hospital in September 2016.Literatures about late-onset GBS cases associated with contaminated breast milk were reviewed to investigate whether GBS could be transmitted through breast milk.Results (1) Case report:A breast-fed extremely preterm infant born at 22+6 gestational weeks suffered from GBS sepsis along with meningitis for the first time on 100 d.The mother was negative for rectovaginal GBS screening.Breast milk wasn't tested as no signs of mastitis were found.The neonate recovered from the first GBS sepsis after 14 days of antibiotic treatment,then returned to breastfeeding.On 126 d,GBS sepsis reoccurred in this baby.Fresh breast milk culture yielded GBS which was identical with the GBS strains isolated from the neonatal blood in antimicrobial susceptibility.After recovery from the second episode,the baby was partially breastfed again without further relapses of late-onset GBS sepsis.(2) Literature review:64 cases of late-onset GBS infections that transmitted via breast milk were retrieved from PubMed,while no Chinese cases had been reported.Clinical data of the 65 cases (including this case) were reviewed and the results revealed that contaminated breast milk was associated with late-onset GBS infections.The reported relapse rate of GBS infections transmitted via breast milk was 25％ for two episodes and 7％ for three episodes.Conclusions GBS contaminated breast milk could potentially cause late-onset GBS sepsis in infants and further studies are required to identify the underlying mechanisms.
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Objective To investigate the clinical characteristics,prenatal risk factors and antibiotic resistance of neonatal early-onset blood stream infection caused by group B Streptococcus (GBS) and to provide evidence for the management of GBS infection.Methods From January 1,2001 to May 31,2017,55 neonates diagnosed with GBS-associated early-onset blood stream infection in the International Peace Maternity & Child Health Hospital were enrolled.They were divided into two groups:GBS early-onset sepsis (GBS EOS) group (n=40) and bacteremia group (n=15).Clinical data were retrospectively analyzed and compared between the two groups with two independent-samples t test and Chi-square test.Results The incidence of neonatal GBS-associated early-onset blood stream infection was 0.31％o (55/179 738).Those neonates with bacteremia had no clinical manifestations.However,in the GBS EOS group,the main manifestations were respiratory abnormalities [respiratory distress (35％,14/40) and apnea (10％,4/40)],jaundice (40％,16/40) and poor perfusion [low blood pressure,etc.32％(13/40)],and the main abnormal results of blood routine test were increased C-reaction protein [＞10 mg/L,100％ (40/40)] and elevated white blood cell count [＞25 × 109/L,78％ (31/40)].Compared with GBS EOS group,bacteremia group had a lower rate of vaginal delivery [1/15 vs 52％ (21/40),x2=9.549,P-0.002] and higher rates of maternal fever [15/15 vs 55％ (22/40),x2=10.034,P=0.002],chorioamnionitis [15/15 vs 68％ (27/40),x2=6.384,P=0.012] and empirical administration of antibiotics to infants [15/15 vs 70％ (28/40),x2=5.759,P=0.016].All tested GBS strains were susceptible to penicillin,ampicillin and vancomycin,but resistant to clindamycin (42％,22/53) and erythromycin (46％,24/52).Conclusions GBS is one of the predominant pathogens causing neonatal early-onset blood stream infection.Respiratory distress,apnea,jaundice and poor perfusion are the main manifestations.Penicillin and ampicillin are the treatment choice for neonatal early-onset GBS infection.Active and appropriate intrapartum management of pregnancies with high risk of intrauterine GBS infection as well as prophylactic prescription of antibiotics to infants may help to prevent or alleviate the symptoms of neonatal early-onset blood stream infection.
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Group B Streptococcus (GBS) is an important pathogen which may result in miscarriage, intrauterine infection and puerperal infection. Neonatal GBS infection may lead to septicemia, pneumonia and meningitis. GBS can be divided into a variety of serotypes according to the antigenic structure of capsular polysaccharide, and different serotypes of GBS vary in ethnicity, geographical distribution, pathogen virulence and pathogenic species. The distribution and identification of GBS serotypes, and their relationships with genotypes, drug resistance, virulence factors and vaccine preparation of GBS were reviewed.
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ABSTRACT Arthritis has been reported as an acute pattern, generally evanescent with oligoarthritis, mostly affecting knees and ankles in childhood systemic polyarteritis nodosa. However, chronic polyarthritis with morning stiffness mimicking juvenile idiopathic arthritis has not been reported. We describe the case of a 4-year old girl who had additive and chronic polyarthritis with edema, tenderness, pain on motion and morning stiffness for 2 months. After 45 days, she also presented painful subcutaneous nodules and erythematous-violaceous lesions in the extensor region of upper and lower limbs. She was admitted to university hospital due to high fever, malaise, myalgia, anorexia, loss of weight (1kg), painful skin lesions and severe functional disability. She was bedridden by chronic polyarthritis with limitation on motion. Systolic and diastolic blood pressures were greater than 95th percentile for height. Urine protein/creatinine ratio was 0.39g/day, and immunological tests were negative. Anti-streptolysin O was 1,687UI/mL. Skin biopsy revealed necrotizing vasculitis in medium- and small-sized vessels compatible with polyarteritis nodosa. Therefore, we had the diagnosis of systemic polyarteritis nodosa. Prednisone 2mg/kg/day was administered with complete resolution of skin lesions and arthritis, and improvement of proteinuria (0.26g/day) after 15 days. The diagnosis of childhood systemic polyarteritis nodosa should be considered for patients with chronic polyarthritis associated to cutaneous vasculitis triggered by streptococcal infection.
RESUMO Na poliarterite nodosa sistêmica pediátrica, a artrite caracteriza-se pelo padrão agudo, geralmente evanescente, com oligoartrite, e afeta principalmente joelhos e tornozelos. No entanto, a poliartrite crônica com rigidez matinal e simulando artrite idiopática juvenil ainda não foi relatada. Descrevemos o caso de uma menina de 4 anos que apresentou poliartrite crônica aditiva com edema, dor à palpação e movimento, e rigidez matinal por 2 meses. Após 45 dias, também apresentou nódulos subcutâneos dolorosos e lesões eritêmato-violáceas na região extensora dos membros superiores e inferiores. Foi internada no hospital universitário por conta de febre alta, mal-estar, mialgia, anorexia, perda de peso (1kg), lesões de pele muito dolorosas e incapacidade funcional grave. Estava restrita ao leito devido à poliartrite crônica com limitação do movimento. Pressões sistólica e diastólica foram maiores que percentil 95 para altura. Relação proteína/creatinina urinária estava 0,39g/dia, e os testes imunológicos foram negativos. Antiestreptolisina O era 1.687UI/mL. A biópsia de pele revelou vasculite necrosante de vasos de pequeno e médio calibre, compatível com poliarterite nodosa. Portanto, foi realizado o diagnóstico de poliarterite nodosa sistêmica. Foi administrada prednisona 2mg/kg/dia com resolução completa das lesões de pele e da artrite, além de melhora da proteinúria (0,26g/dia) após 15 dias. O diagnóstico de poliarterite nodosa sistêmica pediátrica deve ser considerado em pacientes com poliartrite crônica associado a lesões cutâneas vasculíticas, sendo a infecção estreptocócica um importante fator desencadeante.
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Humans , Female , Child, Preschool , Polyarteritis Nodosa/complications , Polyarteritis Nodosa/pathology , Arthritis/etiology , Arthritis/pathology , Polyarteritis Nodosa/drug therapy , Arthritis/drug therapy , Skin/pathology , Subcutaneous Tissue/pathology , Erythema/pathologyABSTRACT
Objective To discuss the epidemiological situation of Streptococcus pyogens infection and drug sensitivity results in children in Meilong area in Shanghai,China,and provided scientific pathogen information for clinic infection control and treatment.Methods This was a retrospective study.The group A Streptococcus pyogens strains which were isolated from a total of 1 069 throat swab samples of pediatrics patients between May 2014 and April 2015,the strains were used the method of molecular biology for emm type and MLST and PFGE,part of the strains were used the Kirby-Bauer method for drug sensitivity test.To analyze the infection characteristics,epidemic tendency and drug sensitivity of GAS in different seasons and different age groups.Results A total of 274 S.pyogens strains were detected,the positive rate was 25.63％,the main types of emm were emm1(38.83％)and emm12(52.75％),the others were 8.42％.The main types of MLST were ST-28,ST-36,ST-49.emm types were closely related with MLST and PFGE clust.Among them,emm1/ST28,emm12/ST36,emm75/ST49 were related to each other,the same emm types were mostly the same cluster of PFGE.During this study,the patients were 3-13 years old,and the high infection age were 6-11 years old.The prevalent infection time were May 2014 and June 2014 and between Novemer 2014 to January 2015 and April 2015.The sensitivity rate of beta-lactamase drugs such as penicillin and ampicillin and levofloxacin,vancomycin and linezolid were 100％,the resistance rate of clindamycin and erythromycin and tetracycline were more than 95％.Conclusion The most popular genotype of GAS was emm12,the main age of infected patients were 6-11 years old,and the epidemic season were winter-spring and early summer in Meilong area,Shanghai,China,and beta-lactamase drugs were the first choice for GAS infection.
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Background: Erythema Nodosum (EN) is an acute nodular erythematous cutaneous eruption. It is presumed to be a hypersensitivity reaction and it may be idiopathic, or occur in association with diverse diseases and medications. Aim: To identify the main etiologies of EN among patients admitted to a medicine service of a clinical hospital. Material and Methods: Analysis of medical records of patients discharged with the diagnosis of EN during a ten years period. Patients were considered to have secondary EN when an underlying condition was found, and to have idiopathic EN when no such condition was found. Results: One hundred twenty nine patients were identified, but 91, aged 38 ± 14 years (86% females) had available clinical information. The etiology was idiopathic in 32% and secondary in 68% of patients. The leading etiologies were post-Streptococcal in 32%, followed by sarcoidosis in 11%, primary tuberculosis in 7%, Mycoplasma infection in 3%, Bartonella infection in 3%, Behçet’s syndrome in 2%, inflammatory bowel disease in 2%, drugs in 1% and other etiologies in 8%. Secondary cases of EN had higher levels of C Reactive Protein and leucocytes than idiopathic cases. Conclusions: The distribution of causes in our study population were similar to those reported in the literature (With smaller proportion of idiopathic), as was the man/woman (1/6) ratio, and the preponderance of cases in winter and spring. Infectious diseases were the leading causes of EN in this group of patients, and a reasonable initial approach in the hospital should include a diligent medical history and physical examination, complete blood count, ESR, titles ASO, PPD tuberculin skin test, chest X-ray or CT scan and, where deemed appropriate, specific autoimmune and infectious serology.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Erythema Nodosum/etiology , Retrospective Studies , Erythema Nodosum/diagnosis , HospitalizationABSTRACT
ObjectiveTo study the effects of group BStreptococcus (GBS) colonization in late pregnancies on neonatal GBS infection.MethodsA total of 17 019 pregnant women who received antenatal care and delivered in Xiamen Maternal and Child Care Hospital from June 1, 2014 to May 31, 2015 were enrolled in this study. Secretions from the lower third of the vagina in the pregnant women at 35-37 weeks of gestation or having premature baby(regardless of gestational age) were obtained to test GBS by standard bacterial culture, and 1 472 cases underwent GBS DNA test by real-time fluorescent quantitative-polymerase chain reaction (PCR) meanwhile. The pregnant women colonized with GBS (GBS culture and/or PCR DNA test positive) were given intrapartum antibiotic prophylaxis (IAP) during parturition or rupture of fetal membranes. Detection rate of the two methods was compared, and the effects of GBS colonization and IAP on neonatal GBS infection were analyzed to identify the risk factors of neonatal early-onset GBS disease (GBS-EOD). Two independent samplest-test,Chi-square test and Logistic regression analysis were used for statistical analysis. ResultsThe detection rate of GBS culture and PCR DNA test was 14.43% (2 456/17 019) and 14.13%(288/1 472), respectively. The total colonization rate was 14.52%(2 472/17 019). Based on the culture results as golden criteria, the sensitivity, specificity, positive predictive value and negative predictive value of PCR assay were 95.05%, 98.74%, 92.31% and 99.21%, respectively. There were 17 332 deliveries from the 17 019 pregnant women, of which 31 cases had GBS-EOD. The incidence of neonatal GBS-EOD in maternal GBS colonization [1.05%(26/2 472)] was 31 times higher than in pregnant women without GBS colonization [0.34‰(5/14 547)]. Among the 31 infants with GBS-EOD, 24 had pneumonia, five had sepsis, and two had meningitis. The case fatality rate was 6.45%(2/31). Logistic regression analysis found that chorioamnionitis was an independent risk factor of neonatal GBS-EOD (OR=40.425, 95%CI: 7.514-379.782,P=0.000). Compared with the non-IAP group,IAP group had a lower incidence of GBS-EOD among the pregnant women colonized with GBS [0.94%(23/2 443) vs 10.34%(3/29),χ2=24.350,P<0.01].ConclusionsGBS colonization in late pregnant women has adverse effects. Therefore, routine maternal rectovaginal culture of GBS may be necessary and IAP should be applied in those with GBS colonization.