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1.
Medicina (B.Aires) ; 81(1): 37-46, mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1287239

ABSTRACT

Resumen La neumonía adquirida en la comunidad (NAC) representa un importante problema sanitario y ~20% de los pacientes requiere hospitalización. El objetivo principal del trabajo fue determinar las características clínico-imagenológicas de los episodios de NAC que requirieron internación. Los objetivos secundarios fueron determinar el rédito diagnóstico de los estudios microbiológicos e identificar las complicaciones. Realizamos un estudio analítico retrospectivo en un hospital de tercer nivel durante el período 2017-2019, en adultos admitidos por NAC, excluyendo embarazadas. Identificamos 340 episodios en 321 pacientes, la mediana de edad fue 75 años (rango intercuartil 57-85). Los factores de riesgo más frecuentes fueron inmunocompromiso (30%), enfermedad neurológica (22%) y enfermedad renal crónica (17%). Según tres scores pronósticos de gravedad, CURB65, qSOFA y PSI/PORT, 216 (63.5%), 290 (85.3%) y 130 (38%) episodios fueron identificados como de bajo riesgo, respectivamente. Del total de los episodios, 49 (14.4%) requirieron internación en unidad de cuidados intensivos, 39 (11.5%) ventilación mecánica y se registraron 30 (8.8%) muertes durante la hospitalización. Los patrones de imagen más frecuentes fueron consolidativo en 134 (39.4%), intersticio-alveolar en 98 (28.8%) y mixto entre ambos patrones en 67 (19.7%) episodios. Identificamos el agente causal en 79 (23.2%) episodios. Los microorganismos aislados más frecuentemente fueron influenza en 37 (10.9%) y Streptococcus pneumoniae en 11 (3.2%). La mayoría de los episodios afectaron pacientes ancianos y el principal patrón radiológico fue el consolidativo. El agente causal se pudo identificar en uno de cada cuatro episodios y el método con mayor rédito diagnóstico fue el test para influenza.


Abstract Community-acquired pneumonia (CAP) represents a major health issue and ~20% of the patients require in-hospital attention. The main objective of the study was to determine clinical-imaging features of CAP episodes requiring hospitalization. The secondary objectives were to determine the diagnostic yield of microbiological analyses and the medical complications. A retrospective analytical study was conducted on adults admitted due to CAP in a third-level hospital in the period 2017-2019. Pregnant women were excluded. A total of 340 CAP episodes were identified in 321 patients; the median age was 75 years old (interquartile range 57-85). The most frequent risk factors were immunocompromise 102 (30%), neurological disease 75 (22%), and chronic kidney disease 58 (17%). According to three prognostic scores, CURB65, qSOFA and PSI/PORT, 216 (63.5%), 290 (83.5%) and 130 (38%) patients were identified as low risk, respectively. A total of 49 (14.4%) episodes required admission at the critical care unit and 39 (11.5%) required mechanical ventilation; 30 patients (8.8%) died during hospitalization. The radiologic patterns most frequently found were consolidation in 134 (39.4%), interstitial-alveolar pattern in 98 (28.8%), and the combination of both patterns in 67 (19.7%) episodes. Identification of the causal agent was achieved in 79 (23.2%) episodes. The most frequently isolated microorganisms were influenza virus in 37 (10.9%) episodes and Streptococcus pneumoniae in 11 (3.2%). Most of the hospitalized CAP patients were elderly with consolidative radiological patterns. The causal agent could be identified in less than a quarter of the patients, with the influenza test being the method with the highest diagnostic yield.


Subject(s)
Humans , Female , Adult , Aged , Pneumonia/epidemiology , Pneumonia/diagnostic imaging , Pneumonia, Pneumococcal , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Community-Acquired Infections/epidemiology , Streptococcus pneumoniae , Retrospective Studies , Hospitalization
2.
Rev. cuba. invest. bioméd ; 40(1): e930, ene.-mar. 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289453

ABSTRACT

Introducción: Las enfermedades infecciosas del tracto respiratorio se encuentran entre las primeras causas de entidades respiratorias en edades extremas de la vida. Objetivo: Describir las bases inmunológicas de la enfermedad y el nuevo candidato vacunal conjugado antineumocócico PCV7-TT desarrollado en Cuba. Métodos: Se realizó una búsqueda en las bases de datos Medline, Pubmed, SciELO, LILACS, Cochrane Library y Web of Science, de documentos publicados entre mayo del 2018 y marzo del 2020. Se seleccionaron los 64 artículos de mayor relevancia y novedad. Resultados: Streptococcus pneumoniae es el agente etiológico de la enfermedad neumocócica; se le atribuye alrededor de un millón de defunciones anuales, principalmente en países en vías de desarrollo. Es un coco Gram-positivo, anaerobio facultativo y encapsulado que se encuentra dividido en 48 serogrupos y 97 serotipos tipificados. Presenta varios factores de virulencia que garantizan su mecanismo de patogenicidad; uno de los más importantes es el polisacárido capsular que constituye la diana de las vacunas antineumocócicas conjugadas y no conjugadas existentes. En el presente artículo se consideró la proteína de superficie C del neumococo como un posible candidato en la investigación y desarrollo de vacunas preventivas. Asimismo, las vesículas extracelulares podría ser un posible candidato para adyuvante vacunal con fines preventivos y terapéuticos. Conclusiones: El neumococo es un problema de salud a nivel global y el uso de vacunas conjugadas antineumocócicas constituye la herramienta más eficaz para su prevención. El candidato vacunal PCV7-TT desarrollado en Cuba es seguro, bien tolerado, inmunogénico y no inferior a las vacunas actualmente registradas(AU)


Introduction: Infectious diseases of the respiratory tract are among the leading causes of respiratory conditions in patients at extreme ages. Objective: Describe the immunological bases of the disease and the new conjugate pneumococcal vaccine candidate PCV7-TT developed in Cuba. Methods: A search was conducted in the databases Medline, Pubmed, SciELO, LILACS, Cochrane Library and Web of Science for documents published from May 2018 to March 2020. The 64 most relevant and novel papers were selected. Results: Streptococcus pneumoniae is the causative agent of pneumococcal disease, a condition causing about one million deaths a year worldwide, mainly in developing countries. It is a Gram-positive facultative anaerobic encapsulated coccus divided into 48 serogroups and 97 typified serotypes. Several virulence factors ensure its pathogenicity mechanism. One of the most important of these is the capsular polysaccharide constituting the target of the existing conjugate and non-conjugate pneumococcal vaccines. The study considered pneumococcal surface protein C as a possible candidate for the research and development of preventive vaccines. On the other hand, extracellular vesicles could be a possible vaccine adjuvant candidate for preventive and therapeutic use. Conclusions: Pneumococcus is a global health problem, and the use of conjugate pneumococcal vaccines is the most effective tool for its prevention. The vaccine candidate PCV7-TT developed in Cuba is safe, well-tolerated, immunogenic and not inferior to the vaccines so far registered(AU)


Subject(s)
Humans , Polysaccharides , Streptococcus pneumoniae , Communicable Diseases , Pneumococcal Vaccines , Virulence Factors , Extracellular Vesicles , Membrane Proteins
3.
Article in Chinese | WPRIM | ID: wpr-879878

ABSTRACT

OBJECTIVE@#To analyze the clinical data of children with invasive pneumococcal disease (IPD) or noninvasive pneumococcal disease (NIPD), and to provide a reference for clinical diagnosis and treatment.@*METHODS@#A retrospective analysis was performed on the medical data and the drug susceptibility test results of isolated strains of 518 children who were hospitalized due to @*RESULTS@#The children with IPD had a median age of 2.2 years, and the children aged ≤5 years accounted for 80.0%. For the children with IPD, the main type of infection was meningitis which was observed in 19 children (54.3%), and the most common underlying disease was hematological malignancy in 8 children (22.9%); 14 children (40.0%) were admitted to the pediatric intensive care unit (PICU), 18 children (51.4%) experienced complications, and 8 children (22.9%) died. For the children with NIPD, the median age was 1.2 years; the main type of infection was pneumonia in 429 children (88.8%), and the most common underlying disease was congenital heart disease in 60 children (12.4%); 60 children (12.4%) were admitted to the PICU, 102 children (21.1%) experienced complications, and 11 children (2.3%) died. The IPD group had significantly higher incidence rate of complications, PICU admission rate, and mortality rate than the NIPD group (@*CONCLUSIONS@#SP infection is common in children under 5 years of age, and the children with underlying diseases including hematological malignancy are at high risk for IPD. Although the complication rate, PICU admission rate, and mortality rate of NIPD children are lower than those of IPD children, they still cannot be ignored. Penicillin may be used as an empirical treatment for children with NIPD, but not for those with IPD.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Humans , Incidence , Infant , Intensive Care Units, Pediatric , Pneumococcal Infections/drug therapy , Pneumococcal Vaccines , Retrospective Studies , Streptococcus pneumoniae
4.
Arq. bras. oftalmol ; 83(6): 463-472, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1153079

ABSTRACT

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/epidemiology
5.
Arch. argent. pediatr ; 118(3): e305-e308, jun. 2020. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1116994

ABSTRACT

El síndrome urémico hemolítico asociado a Streptococcus pneumoniae (SUH-Sp) se define como anemia hemolítica microangiopática, plaquetopenia y lesión renal aguda, en un paciente con infección invasiva por Streptococcus pneumoniae (Sp). Varón de 2 años, con neumonía con derrame pleural por Sp aislado en hemocultivos y líquido pleural. A las 72 h, presentó palidez, decaimiento, quejido respiratorio y oliguria. En el análisis de laboratorio se encontró anemia, plaquetopenia, aumento de la urea, la creatinina y la lactato deshidrogenasa en sangre; coombs directa +; esquistocitos en frotis; fibrinógeno; coagulograma normal; dímero D aumentado. Orina con proteinuria y hematuria. En Terapia Intensiva requirió asistencia respiratoria mecánica y transfusión con glóbulos rojos lavados; se recuperó progresivamente. El Instituto Malbrán informó serotipo 38 de Sp. Es el primer paciente comunicado con este serotipo


Streptococcus pneumoniae associated hemolytic uremic syndrome (Sp-HUS) is defined as microangiopathic hemolytic anemia, thrombocytopenia and acute renal injury, in a patient with Streptococcus pneumoniae (Sp) invasive infection. A 2-year-old boy was admitted with pneumonia and empyema. Sp was isolated from blood and pleural fluid cultures. After 72 h, the patient showed paleness, asthenia, respiratory whining and oliguria. Laboratory showed anemia, low platelets, increased blood urea, creatirnina, lactate dehdrogenase, direct Coombs +, schistocytes, fibrinogen, normal coagulogram and increased D-dimer. Proteinuria and hematuria were detected in urine. Mechanical ventilatory assistance and transfusions of washed red blood cells were required. The patient recovered progressively. Sp serotype 38 was isolated in the National Reference Laboratory "Malbran". This is the first report associated to this serotype


Subject(s)
Humans , Male , Child, Preschool , Hemolytic-Uremic Syndrome , Pneumonia , Respiratory Insufficiency , Streptococcus pneumoniae , Renal Insufficiency , Anemia, Hemolytic
6.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 18(1)abr. 2020. ilus, tab
Article in Spanish | LILACS, BDNPAR | ID: biblio-1291903

ABSTRACT

Streptococcus pneumoniae sigue siendo una de las causas más importantes de morbilidad y mortalidad en niños y adultos alrededor del mundo. El objetivo del estudio fue describir la frecuencia de aislamiento de S. pneumoniae en enfermedad invasiva, distribución de serotipos y sensibilidad antimicrobiana en Paraguay (2010-2018). Se estudiaron 793 cepas de S. pneumoniae aisladas de pacientes de todas las edades con enfermedad invasiva en Paraguay, provenientes de los diferentes centros centinelas y colaboradores en el marco de la vigilancia de meningitis y neumonías, durante el periodo 2010-2018. La frecuencia general según diagnóstico resultó 74.9% de neumonías (n=594), 18.4% de meningitis (n=146) y 6.7% de sepsis (n=53). El serotipo 14 fue más frecuente con 174 aislamientos (22.0%), seguido del serotipo 19A con 84 aislamientos (10.6%), el serotipo 3 con 66 aislamientos (8.3%) y el 6A con 37 aislamientos (4.7%). En meningitis se registró una frecuencia general de resistencia a penicilina del 32,2% y de ceftriaxona del 1,4%. En los casos de no meningitis la resistencia a penicilina fue del 0,8% y ceftriaxona del 0,3%. Los resultados de serotipos y sensibilidad antimicrobiana proporcionarán información necesaria para la implementación de estrategias de prevención y tratamiento de la enfermedad neumocócica en nuestro país, por lo que es necesaria una vigilancia continua para evaluar la carga de enfermedad, los serotipos circulantes y el aumento de la resistencia a los antibióticos


Streptococcus pneumoniae remains one of the most important causes of morbidity and mortality in children and adults worldwide. The objective of the study was to describe the frequency of isolation of S. pneumoniae in invasive disease, serotype distribution and antimicrobial susceptibility in Paraguay (2010-2018). We studied 793 strains of S. pneumoniae isolated from patients of all ages with invasive disease in Paraguay, from different sentinel centers and collaborators in the framework of meningitis and pneumonia surveillance during the period 2010-2018. The general frequency according to diagnosis was 74.9% of pneumonia (n = 594), 18.4% of meningitis (n = 146) and 6.7% of sepsis (n = 53). Serotype 14 was more frequent with 174 isolates (22.0%), followed by serotype 19A with 84 isolates (10.6%), serotype 3 with 66 isolates (8.3%) and 6A with 37 isolates (4.70%). In meningitis, there was a general frequency of penicillin resistance of 32.2% and ceftriaxone of 1.4%. In cases of non-meningitis, penicillin resistance was 0.8% and ceftriaxone 0.3%. The results of serotypes and antimicrobial sensitivity will provide necessary information for the implementation of prevention strategies and treatment of pneumococcal disease in our country, therefore it is necessary to continue monitoring in order to assess the burden of the disease, circulating serotypes and increased antibiotic resistance


Subject(s)
Humans , Male , Female , Pneumonia, Pneumococcal , Streptococcus pneumoniae , Meningitis, Pneumococcal
7.
Arch. argent. pediatr ; 118(2): e208-e210, abr. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1100488

ABSTRACT

La glomerulonefritis aguda desencadenada por Streptococcus pneumoniae es una patología de baja prevalencia. Existen diversos reportes que comunican distintas cepas nefritogénicas; sin embargo, la 6C ha sido escasamente señalada como tal.Se presenta el caso de un paciente de 4 años, quien ingresó a Terapia Intensiva con pleuroneumonía por Streptococcus pneumoniae serotipo 6C y desarrolló, de modo concomitante, edemas, hipertensión arterial, hematuria, proteinuria, disminución del filtrado glomerular y del nivel de complemento C3. Se diagnosticó glomerulonefritis aguda. Su evolución fue satisfactoria en un breve plazo. Esta patología, por lo general, es de curso transitorio y benigno; sin embargo, en ocasiones, puede complicar la evolución de un paciente críticamente enfermo, por lo cual se hace necesario tenerla entre los diagnósticos diferenciales para considerar.


Acute glomerulonephritis caused by Streptococcuspneumoniaeis a low prevalence pathology. There are several reports communicating different nephritogenic serotypes, however, 6C has been scarcely indicated as such. It is presented the case of a 4-year-old patient who entered Intensive Therapy Unit with pleuropneumonia due to Streptococcuspneumoniae serotype 6C and concomitantly developed edemas, arterial hypertension, hematuria, proteinuria, decreased glomerular filtration rate and C3 complement level. Acute glomerulonephritis was diagnosed. His evolution was satisfactory in a short time. This pathology is usually of a transitory and benign course; however, sometimes it can potentially complicate the evolution of a critically ill patient, so it is necessary to have it among the differential diagnoses to consider.


Subject(s)
Humans , Male , Child, Preschool , Pleuropneumonia/diagnosis , Glomerulonephritis , Pleuropneumonia/drug therapy , Streptococcus pneumoniae , Diagnosis, Differential
9.
Chinese Journal of Epidemiology ; (12): 1945-1979, 2020.
Article in Chinese | WPRIM | ID: wpr-877520

ABSTRACT

Pneumococcal disease is a serious global public health problem and a leading cause of morbidity and mortality of children and adults in China. Antibiotics are commonly used to treat pneumococcal disease. However, antibiotic resistance to Streptococcus pneumoniae has become a severe problem around the world due to widespread antibiotic use. Immunoprophylaxis of pneumococcal disease with pneumococcal vaccines is therefore of great importance. In this article, we review the etiology, clinical presentation, epidemiology, and disease burden of pneumococcal disease and the vaccinology of pneumococcal vaccines. Our review is based on the Expert Consensus on Immunoprophylaxis of Pneumococcal Disease (2017 version), the Pneumococcal Vaccines WHO Position Paper (2019), and recent national and international scientific advances. This consensus article aims to provide public health and vaccination staff with appropriate evidence for pneumococcal vaccine use and to improve professional capacity for pneumococcal disease prevention and control.


Subject(s)
Adult , Child , China/epidemiology , Consensus , Humans , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines/therapeutic use , Streptococcus pneumoniae/immunology , Vaccines, Conjugate/administration & dosage
10.
Article in Chinese | WPRIM | ID: wpr-877507

ABSTRACT

Pneumococcal disease is a serious global public health problem and a leading cause of morbidity and mortality of children and adults in China. Antibiotics are commonly used to treat pneumococcal disease. However, antibiotic resistance to


Subject(s)
Adult , Child , China , Consensus , Humans , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines , Streptococcus pneumoniae , Vaccines, Conjugate
11.
Article in Korean | WPRIM | ID: wpr-811288

ABSTRACT

An increase in the number of patients with infectious diseases in Korea, can be attributed to various factors, such as the prevalence of new infectious diseases of the 21st century, the re-emergence of past infectious diseases, an increase in the number of elderly individuals, patients with chronic diseases, immune deficiency, and globalization. In this context, vaccination becomes vital for the adult population. Although, the guidelines for adult immunization are currently being updated, the rate of adult vaccination remains lower than that of infant vaccination. At present, the major challenges for increasing the rate of adult immunization include negative views on the need for some immunizations and a lack of understanding of group immunity among the youth. Consequently, a successful immunization program will be required to direct efforts towards educating patients and spreading awareness. Based on the current guidelines and practical applications, varicella zoster; Japanese encephalitis; tetanus, diphtheria, and pertussis; pneumococcus; measles, mumps, and rubella; and hepatitis A vaccines could effectively be considered for adult vaccination.


Subject(s)
Adolescent , Adult , Aged , Chickenpox , Chronic Disease , Communicable Diseases , Diphtheria , Encephalitis, Japanese , Hepatitis A Vaccines , Herpes Zoster , Humans , Immunization Programs , Immunization , Infant , Internationality , Korea , Measles , Mumps , Pneumococcal Vaccines , Prevalence , Rubella , Streptococcus pneumoniae , Tetanus , Vaccination , Whooping Cough
12.
Article in English | WPRIM | ID: wpr-811069

ABSTRACT

PURPOSE: Different characteristics of airway microbiome in asthmatics may lead to differential immune responses, which in turn cause eosinophilic or neutrophilic airway inflammation. However, the relationships among these factors have yet to be fully elucidated.METHODS: Microbes in induced sputum samples were subjected to sequence analysis of 16S rRNA. Airway inflammatory phenotypes were defined as neutrophils (>60%) and eosinophils (>3%), and inflammation endotypes were defined by levels of T helper (Th) 1 (interferon-γ), Th2 (interleukin [IL]-5 and IL-13), Th-17 (IL-17), and innate Th2 (IL-25, IL-33, and thymic stromal lymphopoietin) cytokines, inflammasomes (IL-1β), epithelial activation markers (granulocyte-macrophage colony-stimulating factor and IL-8), and Inflammation (IL-6 and tumor necrosis factor-α) cytokines in sputum supernatants was assessed by enzyme-linked immunosorbent assay.RESULTS: The numbers of operational taxonomic units were significantly higher in the mixed (n = 21) and neutrophilic (n = 23) inflammation groups than in the paucigranulocytic inflammation group (n = 19; p < 0.05). At the species level, Granulicatella adiacens, Streptococcus parasanguinis, Streptococcus pneumoniae, Veillonella rogosae, Haemophilus parainfluenzae, and Neisseria perflava levels were significantly higher in the eosinophilic inflammation group (n = 20), whereas JYGU_s levels were significantly higher in the neutrophilic inflammation group compared to the other subtypes (P < 0.05). Additionally, IL-5 and IL-13 concentrations were correlated with the percentage of eosinophils (P < 0.05) and IL-13 levels were positively correlated with the read counts of Porphyromonas pasteri and V. rogosae (P < 0.05). IL-1β concentrations were correlated with the percentage of neutrophils (P < 0.05). had a tendency to be positively correlated with the read count of JYGU_s (P = 0.095), and was negatively correlated with that of S. pneumoniae (P < 0.05).CONCLUSIONS: Difference of microbial patterns in airways may induce distinctive endotypes of asthma, which is responsible for the neutrophilic or eosinophilic inflammation in asthma.


Subject(s)
Asthma , Colony-Stimulating Factors , Cytokines , Enzyme-Linked Immunosorbent Assay , Eosinophils , Haemophilus parainfluenzae , Inflammasomes , Inflammation , Interleukin-13 , Interleukin-33 , Interleukin-5 , Microbiota , Necrosis , Neisseria , Neutrophils , Phenotype , Pneumonia , Porphyromonas , Sequence Analysis , Sputum , Streptococcus , Streptococcus pneumoniae , Veillonella
13.
Article in English | LILACS | ID: biblio-1057206

ABSTRACT

ABSTRACT Objective: To describe a case series of four (4) patients with hemolytic uremic syndrome due to Streptococcus pneumoniae in a level four complexity institution in the city of Bogotá, D.C., Colombia. Cases description: We describe cases of four patients who presented respiratory symptoms and fever. All four patients were in regular conditions on hospital admission, after which they required intensive care and ventilatory support. Upon admission, three cases showed evidence of pleuropulmonary complication. Penicillin-sensitive Streptococcus pneumoniae was isolated in all cases. All patients presented anemia, severe thrombocytopenia, schistocytes on peripheral blood smear, and hyperazotemia. They required blood transfusion and renal replacement therapy during their hospitalization. The patients were diagnosed with hemolytic uremic syndrome due to S. pneumoniae. Three of the four patients had a progressive recovery of the renal function and were discharged after an average of 36 days of hospital stay. The remaining patient had two amputations in the extremities due to thrombotic vascular complications and was discharged after 99 days of hospital stay, requiring hemodialysis every other day. Comments: Hemolytic uremic syndrome due to Streptococcus pneumoniae is a rare but severe complication of invasive pneumococcal disease. Complicated pneumonia is the main condition associated with this entity. It is noteworthy the short period in which these cases were presented, considering the low annual incidence of the disease.


RESUMO Objetivo: Descrever uma série de casos de quatro pacientes com síndrome hemolítico-urêmica por pneumococo em uma instituição de referência em Bogotá, Colômbia. Descrição dos casos: Descrevemos os casos de quatro pacientes que apresentaram sintomas respiratórios e febre. Todos estavam em estado geral regular à admissão hospitalar e necessitaram de cuidados intensivos e suporte ventilatório. Na admissão, em três dos casos foi evidenciada a complicação pleuropulmonar. Isolamento de Streptococcus pneumoniae sensível à penicilina foi realizado em todos os casos. Os quatro pacientes precisaram de transfusão sanguínea e terapia de reposição renal durante a hospitalização. Nos testes laboratoriais, observou-se anemia, trombocitopenia grave, presença de esquizócitos em esfregaço de sangue periférico e hiperazotemia. Com esse quadro, o diagnóstico foi de síndrome hemolítico-urêmica associada à infecção por S. pneumoniae. Houve recuperação progressiva da função renal em três dos quatro pacientes, que tiveram alta após 36 dias de internação hospitalar, em média. Um paciente teve complicações vasculares trombóticas, resultando em duas amputações nas extremidades, e teve alta após 99 dias de internação, com necessidade de hemodiálise em dias alternados. Comentários: A síndrome hemolítico-urêmica por Streptococcus pneumoniae é uma complicação rara, mas grave, da doença invasiva pneumocócica. A pneumonia complicada é a principal condição associada a essa entidade. Destaca-se o curto período em que esses casos foram apresentados, levando em conta a baixa incidência anual de síndrome hemolítico-urêmica.


Subject(s)
Humans , Male , Infant , Child, Preschool , Adolescent , Pneumococcal Infections/complications , Streptococcus pneumoniae/isolation & purification , Hemolytic-Uremic Syndrome/etiology , Hemolytic-Uremic Syndrome/therapy , Pneumococcal Infections/microbiology , Pneumococcal Infections/therapy , Pneumococcal Infections/diagnostic imaging , Pneumonia, Pneumococcal/diagnosis , Shock, Septic/etiology , Thrombosis/surgery , Blood Transfusion/methods , Treatment Outcome , Renal Replacement Therapy/methods , Renal Insufficiency/etiology , Renal Insufficiency/therapy , Hemolytic-Uremic Syndrome/diagnosis , Amputation/methods , Length of Stay/statistics & numerical data
14.
Article in English | WPRIM | ID: wpr-762453

ABSTRACT

As 16S ribosomal RNA (rRNA)-targeted sequencing can detect DNA from non-viable bacteria, it can be used to identify pathogens from clinical samples even in patients pretreated with antibiotics. We compared the results of 16S rRNA-targeted sequencing and culture for identifying bacterial species in normally sterile body fluid (NSBF): cerebrospinal, pericardial, peritoneal and pleural fluids. Over a 10-year period, a total of 312 NSBF samples were evaluated simultaneously using 16S rRNA-targeted sequencing and culture. Results were concordant in 287/312 (92.0%) samples, including 277 (88.8%) negative and 10 (3.2%) positive samples. Of the 16 sequencing-positive, culture-negative samples, eight showed clinically relevant isolates that included Fusobacterium nucleatum subsp. nucleatum, Streptococcus pneumoniae, and Staphylococcus spp. All these samples were obtained from the patients pretreated with antibiotics. The diagnostic yield of 16S rRNA-targeted sequencing combined with culture was 11.2%, while that of culture alone was 6.1%. 16S rRNA-targeted sequencing in conjunction with culture could be useful for identifying bacteria in NSBF samples, especially when patients have been pretreated with antibiotics and when anaerobic infection is suspected.


Subject(s)
Anti-Bacterial Agents , Bacteria , Body Fluids , DNA , Fusobacterium nucleatum , Humans , RNA, Ribosomal, 16S , Staphylococcus , Streptococcus pneumoniae
15.
Arch. argent. pediatr ; 117(4): 373-376, ago. 2019. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1054939

ABSTRACT

La meningitis bacteriana recurrente es un fenómeno muy poco frecuente en los niños. Las fracturas de la base del cráneo y los implantes cocleares son factores predisponentes importantes, y el agente aislado con mayor frecuencia es el Streptococcus pneumoniae. La implementación de la vacuna neumocócica conjugada de 13 serotipos (VNC13) redujo la incidencia de enfermedades neumocócicas invasivas. La incidencia de enfermedades neumocócicas intercurrentes en pacientes vacunados suele estar relacionada con afecciones predisponentes preexistentes. En este artículo, presentamos un caso de meningitis neumocócica recurrente en una paciente con un implante coclear que sufrió un traumatismo craneoencefálico luego de haber recibido la vacunación completa con la VNC13. La paciente tuvo tres episodios de meningitis en el transcurso de un año. Se detectó la presencia de S. pneumoniae en el cultivo de líquido cefalorraquídeo (LCR) en el primer y tercer episodios, y mediante la prueba de reacción en cadena de la polimerasa (PCR, por su sigla en inglés) en el segundo episodio. Se realizó una intervención neuroquirúrgica luego del tercer episodio de meningitis, y la paciente no tuvo problemas de recurrencias durante los siguientes dos años. Hasta donde sabemos, en la bibliografía no se han descrito casos de meningitis de serotipo 1 por S. pneumoniae luego de la inmunización completa con PCV13.


Recurrent bacterial meningitis is a very rare phenomenon in children. Skull base fractures and cochlear implant are the important predisposing factors and, Streptococcus pneumoniae is the most frequently isolated agent. Implementation of 13-valent conjugated pneumococcal vaccine (PCV13) has reduced the occurence of invasive pneumococcal diseases. Vaccination breakthrough is typically related to underlying predisposing conditions. Herein, we reported recurrent pneumococcal meningitis in a patient with a cochlear implant who experienced a head trauma after being fully vaccinated with PCV13. The patient experienced three meningitis episodes within one year. S.pneumoniae was determined on CSF culture in the first and third episodes and detected by PCR at the second episode. Neurosurgical intervention was performed after the third meningitis episode, and the patient had no recurrence problems for the following two years. To our knowledge, breakthrough S.pneumoniae serotype 1 meningitis after full PCV13 immunization has not been reported elsewhere in the literature.


Subject(s)
Humans , Female , Child, Preschool , Streptococcus pneumoniae , Meningitis, Pneumococcal , Cochlear Implantation , Pneumococcal Vaccines , Brain Injuries, Traumatic
16.
Infectio ; 23(2): 183-188, Apr.-June 2019. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-989950

ABSTRACT

Resumen Introducción: El cultivo de la sangre es el método más utilizado en la búsqueda de infecciones del paciente pediátrico porque orienta la terapia antimicrobiana. Objetivo: Determinar la incidencia de hemocultivos positivos y su caracterización microbiológica en pacientes de cuidado intensivo pediátrico del Hospital de San José, Bogotá-Colombia. Materiales y métodos: Descripción de hemocultivos positivos en pacientes pediátricos de la unidad desde abril de 2012 a 2017. Se determinó la incidencia de hemocultivos positivos y se describió la población estudiada y los gérmenes aislados incluido su perfl de antibiograma. Resultados: Ingresaron 1773 pacientes a la UCIP, 241 pacientes (13,6%) fueron hemocultivados, de los cuales 80 (33,2%) fueron positivos, pero 50% de estos fueron catalogados como contaminaciones. La mediana de edad fue de 21 meses, con 64% de sexo masculino. El 57% fue ventilado y 45% tuvieron un catéter central. La mortalidad fue de 15,4%. La patología más frecuentemente fue respiratoria (75%). De los gérmenes no contaminantes el más frecuente aislado fue Staphylococcus aureus (30%), seguido de Klebsiella pneumoniae (17,5%) y Streptococcus pneumoniae (17,5%). El germen contaminante más frecuente fue Staphylococcus epidermidis (47,5%). Conclusión: La frecuencia de hemocultivos positivos es baja y es frecuente que se aíslen gérmenes contaminantes. El patrón fue similar a lo reportado por la red GREBO.


Abstract Introduction. Blood culture is the method most used in the search for pediatric infections because it guides the antimicrobial therapy. Objective. To determine the incidence of positive blood cultures and their microbiological characterization in patients of the pediatric intensive care service of San José Hospital, Bogotá-Colombia. Materials and methods: Description of positive blood cultures in pediatric patients of the unit from April 2012 to 2017. The incidence of positive blood cultures was determined and the population studied and the isolated germs were described, including their antibiogram profle. Results: 1773 patients were admitted to the PICU, 241 patients (13.6%) were blood cultures, of which 80 (33.2%) were positive, but 50% of these were classifed as contaminations. The median age was 21 months, with 64% male. 57% were ventilated and 45% had a central catheter. Mortality was 15.4%. The most frequent pathology was respiratory (75%). Of the non-polluting organisms, the most frequent isolate was Staphylococcus aureus (30%), followed by Klebsiella pneumoniae (17.5%) and Streptococcus pneumoniae (17.5%). The most frequent contaminant was Staphylococcus epidermidis (47.5%). Conclusion: The frequency of positive blood cultures is low and polluting organisms are often isolated. The pattern was similar to that reported by the GREBO network.


Subject(s)
Humans , Male , Infant , Staphylococcus epidermidis , Critical Care , Blood Culture , Staphylococcus aureus , Streptococcus pneumoniae , Bacterial Infections , Microbial Sensitivity Tests , Klebsiella pneumoniae , Microbiological Phenomena , Anti-Infective Agents
17.
Arch. argent. pediatr ; 117(2): 155-157, abr. 2019. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1001173

ABSTRACT

El Streptococcus pneumoniae es la causa más frecuente de una neumonía complicada. La neumonía neumocócica necrosante (NNN) constituye una complicación rara y relacionada con el serotipo. Los serotipos 1, 3, 14, 15, 19A y 33 fueron los más frecuentemente informados en los niños con NNN antes de la inmunización. A pesar de la práctica extendida de la vacunación, el S. pneumoniae sigue siendo la causa de las enfermedades invasivas. Aquí se informa el caso de un niño que había recibido el esquema completo con la vacuna neumocócica conjugada de 13 serotipos (VCN13) diagnosticado con NNN del serotipo 3. La progresión de la enfermedad invasiva por S. pneumoniae debe considerarse a pesar de la inmunización completa.


Streptococcus pneumoniae is the most common cause of complicated pneumonia. Pneumococcal necrotizing pneumonia (PNP) is a rare and serotype related complication. Serotypes 1, 3, 14, 15, 19A and 33 were the most reported serotypes in children with PNP before immunization. Despite widespread vaccination, S. pneumoniae is still cause of invasive diseases. We reported a child, fully immunized with 13-valent conjugated pneumococcal vaccine (PCV13) who was diagnosed PNP due to serotype 3. Breakthrough invasive infection caused by S. pneumoniae must be considered in mind despite fully vaccination.


Subject(s)
Humans , Male , Infant , Streptococcus pneumoniae , Child , Immunization , Pneumonia, Necrotizing
18.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 126-129, Jan.-Mar. 2019. graf
Article in Portuguese | LILACS | ID: biblio-985129

ABSTRACT

RESUMO Objetivo: Relatar um caso raro de uma criança com meningite associada a pericardite na doença pneumocócica invasiva. Descrição do caso: Este relato descreve uma evolução clínica desfavorável de um lactente feminino de 6 meses de idade, previamente hígido, que apresentou inicialmente sintomas respiratórios e febre. A radiografia de tórax revelou um aumento da área cardíaca sem alterações radiográficas nos pulmões. Após a identificação do derrame pericárdico, o paciente apresentou convulsões e entrou em coma. Pneumonia foi descartada durante a investigação clínica. Contudo, foi identificado Streptococcus pneumoniae nas culturas de líquor e sangue. O exame neurológico inicial foi compatível com morte encefálica, posteriormente confirmada pelo protocolo. Comentários: A pericardite purulenta tornou-se uma complicação rara da doença pneumocócica invasiva desde o advento da terapia antibiótica. Pacientes com pneumonia extensa são primariamente predispostos e, mesmo com tratamento adequado e precoce, estão sujeitos a altas taxas de mortalidade. A associação de meningite pneumocócica e pericardite é incomum e, portanto, de difícil diagnóstico. Por isso, uma alta suspeição diagnóstica é necessária para instituir o tratamento precoce e aumentar a sobrevida.


ABSTRACT Objective: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. Case description: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. Comments: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.


Subject(s)
Humans , Male , Female , Streptococcus pneumoniae/isolation & purification , Pericardial Effusion/diagnostic imaging , Pericarditis/diagnosis , Pericarditis/physiopathology , Pericarditis/microbiology , Pericarditis/therapy , Pneumococcal Infections/diagnosis , Pneumococcal Infections/physiopathology , Pneumococcal Infections/therapy , Echocardiography/methods , Radiography, Thoracic/methods , Cerebrospinal Fluid/microbiology , Fatal Outcome , Blood Culture/methods , Meningitis/diagnosis , Meningitis/physiopathology , Meningitis/microbiology , Meningitis/therapy , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/classification , Neurologic Examination/methods
19.
Article in Chinese | WPRIM | ID: wpr-775130

ABSTRACT

OBJECTIVE@#To study the clinical characteristics, drug sensitivity of isolated strains, and risk factors of drug resistance in children with invasive pneumococcal disease (IPD).@*METHODS@#The clinical characteristics and drug sensitivity of the isolated strains of 246 hospitalized children with IPD in nine grade A tertiary children's hospitals from January 2016 to June 2018 were analyzed.@*RESULTS@#Of the 246 children with IPD, there were 122 males and 124 females. Their ages ranged from 1 day to 14 years, and among them, 68 (27.6%) patients were less than 1 year old, 54 (22.0%) patients were 1 to 2 years old, 97 (39.4%) patients were 2 to 5 years old, and 27 (11.0%) patients were 5 to 14 years old. Pneumonia with sepsis was the most common infection type (58.5%, 144/246), followed by bloodstream infection without focus (19.9%, 49/246) and meningitis (15.0%, 37/246). Forty-nine (19.9%) patients had underlying diseases, and 160 (65.0%) had various risk factors for drug resistance. The isolated Streptococcus pneumoniae strains were 100% sensitive to vancomycin, linezolid, moxifloxacin, and levofloxacin, 90% sensitive to ertapenem, ofloxacin, and ceftriaxone, but had a low sensitivity to erythromycin (4.2%), clindamycin (7.9%), and tetracycline (6.3%).@*CONCLUSIONS@#IPD is more common in children under 5 years old, especially in those under 2 years old. Some children with IPD have underlying diseases, and most of the patients have various risk factors for drug resistance. Pneumonia with sepsis is the most common infection type. The isolated Streptococcus pneumoniae strains are highly sensitive to vancomycin, linezolid, moxifloxacin, levofloxacin, ertapenem, and ceftriaxone in children with IPD.


Subject(s)
Anti-Bacterial Agents , Ceftriaxone , Child , Child, Preschool , Drug Resistance , Female , Humans , Infant , Male , Microbial Sensitivity Tests , Pneumococcal Infections , Streptococcus pneumoniae
20.
Article in Chinese | WPRIM | ID: wpr-774113

ABSTRACT

OBJECTIVE@#To study the features of pathogens in children with lower respiratory tract infection.@*METHODS@#A total of 108 children who were hospitalized due to lower respiratory tract infection and underwent fiber bronchoscopy between January 2017 and June 2018 were enrolled. Bronchoalveolar lavage fluid samples were collected. Multiple quantitative real-time PCR was performed to detect pathogens.@*RESULTS@#Of the108 children, 85 (78.7%) were found to have pathogens, among whom 52 (48.1%) had single pathogen infection and 33 (30.6%) had multiple pathogen infections. Mycoplasma pneumoniae was detected in 38 children (35.2%), and was the most common pathogen. The children aged 36 - <72 months had the highest detection rate of Mycoplasma pneumoniae. Both Streptococcus pneumoniae and Haemophilus influenzae were detected in 29 children (26.9%) and Streptococcus pneumoniae was mainly detected in children aged <24 months. Each of Acinetobacter baumannii, Candida albicans and Klebsiella pneumoniae was detected in 3 children. Among the 31 children with bronchopneumonia, 9 were found to have Haemophilus influenza, with the highest detection rate of 29%. Among the 34 children with lobar pneumonia, 22 were found to have Mycoplasma pneumoniae, with the highest detection rate of 65%. Among the 22 children with bronchial foreign bodies and bronchopneumonia, 10 were found to have Streptococcus pneumoniae, with the highest detection rate of 45%.@*CONCLUSIONS@#In children with lower respiratory tract infection, Mycoplasma pneumoniae is the most common pathogen, followed by Streptococcus pneumoniae and Haemophilus influenzae. There are differences in the detection rates of pathogens between children with different ages and different types of lower respiratory tract infection.


Subject(s)
Bronchoalveolar Lavage Fluid , Child , Child, Preschool , Haemophilus influenzae , Humans , Infant , Mycoplasma pneumoniae , Respiratory Tract Infections , Streptococcus pneumoniae
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