Clinical and laboratorial features of spontaneous bacterial peritonitis in southern Brazil / Características clínicas e laboratoriais da peritonite bacteriana espontânea no sul do Brasil

CONTEXT AND OBJECTIVE: Spontaneous bacterial peritonitis (SBP) is a severe complication that occurs in 8-27% of hospitalized patients with liver cirrhosis and ascites, with high mortality rates. This study aimed to identify the clinical characteristics associated with SBP. DESIGN AND SETTING: Cross-sectional study, conducted in a public university. METHODS: The study consecutively included individuals with liver cirrhosis and ascites between September 2009 and March 2012. Forty-five patients were included: mean age 53.2 ± 12.3 years, 82.2% male, 73.8% Caucasian, mean Model of End-stage Liver Disease (MELD) score of 19.5 ± 7.2, and 33.3% with SBP. The subjects were divided into two groups: SBP and controls. RESULTS: Comparison between individuals with SBP and controls showed that those with SBP had lower mean prothrombin activity time (36.1 ± 16.0% versus 47.1 ± 17.2%; P = 0.044) and lower median serum-ascites albumin gradient (SAAG) (1.2 versus 1.7, P = 0.045). There was a tendency towards higher mean MELD in the SBP group, not significant (22.2 ± 7.6 versus 17.9 ± 6.7; P = 0.067). There was a strong positive correlation between the neutrophil count in ascitic fluid and serum leukocyte count (r = 0.501; P = 0.001) and a negative correlation between the neutrophil count in ascitic fluid with prothrombin activity time (r = -0.385; P = 0.011). CONCLUSION: A few characteristics are associated with the presence of SBP, especially liver dysfunction, SAAG and peripheral leukocytosis. .

CONTEXTO E OBJETIVO: Peritonite bacteriana espontânea (PBE) é uma complicação grave que ocorre em 8-27% dos pacientes hospitalizados com cirrose hepática e ascite, e apresenta altas taxas de mortalidade. O objetivo deste estudo é identificar as características clínicas associadas à PBE. TIPO DE ESTUDO E LOCAL: Estudo transversal, conduzido em uma universidade pública. MÉTODOS: O estudo incluiu, consecutivamente, indivíduos com cirrose hepática e ascite entre setembro 2009 e março 2012. Foram incluídos 45 indivíduos com média de idade de 53,2 ± 12,3 anos, sendo 82,2% homens, 73,8% brancos, com MELD (Modelo para Doença Hepática Terminal) de 19,5 ± 7,2, e 33,3% com PBE. Os indivíduos foram divididos em dois grupos: PBE e controles. RESULTADOS: Quando se compararam os indivíduos com PBE aos controles, observou-se menor média de tempo de atividade da protrombina (TAP; 36,1 ± 16,0% versus 47,1 ± 17,2%; P = 0,044) e menor mediana de gradiente albumina soro-ascite (GASA; 1,2 versus 1,7; P = 0,045). Houve tendência do grupo com PBE de apresentar maior média de MELD, sem significância estatística (22,2 ± 7,6 versus 17,9 ± 6,7; P = 0,067). Foi observada forte correlação positiva entre neutrófilos do líquido ascítico e contagem sérica de leucócitos (r = 0,501; P = 0,001) e correlação negativa de neutrófilos do líquido ascítico com TAP (r = -0,385; P = 0,011). CONCLUSÃO: Poucas características estão associadas à presença de PBE, em especial a disfunção hepática, o GASA e a leucocitose periférica. .

Perfil microbiológico de la peritonitis bacteriana espontánea en una ciudad del sur de Brasil / Microbiological profile of spontaneous bacterial peritonitis in a Southern

Introducción: La peritonitis bacteriana espontánea (PBE) es una de las complicaciones infecciosas másfrecuentes que afectan a los pacientes con cirrosis y ascitis descompensadas, la cual presenta un alto índicede mortalidad. Objetivo: Identifi car los principales agentes causantes de la PBE en un Hospital Universitarioentre los años 2008 y 2011. Métodos: Se llevó a cabo un estudio transversal de resultados positivos decultivos de líquido ascítico. Se obtuvieron variables clínicas y de laboratorio de los registros médicos.Resultados: Se incluyeron 47 pacientes de 55,7 ± 15,5 años de edad con cultivos positivos de líquidoascítico, de los cuales 70,2% eran hombres y 53,6% presentaba cirrosis. Todos los pacientes cirróticos presentaronGASA ≥ 1,1 y conteo promedio de neutrófi los en el líquido ascítico de 3.260,8 ± 5.122,9 células. Elmicrobio encontrado más frecuentemente fue el Escherichia coli (25,5%), seguido por el Klebsiella (14,9%), elEnterococcus (8,5%) y el Streptococcus (8,5%). No se observaron diferencias signifi cativas cuando se compararonlos pacientes cirróticos con los no cirróticos respecto a la prevalencia del E. coli (19,2% vs. 33,3%;p= 0,270), Klebsiella (19,2% vs. 9,5%; p= 0,436), Enterococcus (7,7% vs. 9,5%; p= 1,000) y Streptococcus(15,4% vs. 0,0%; p= 0,117). La presencia de infección causada por dos o más microbios es más común entrelas personas sin cirrosis (11,5% vs. 38,1%; p= 0,047).Conclusión: El perfi l microbiológico de los cultivos de líquido ascítico de este hospital es similar al de otrosestudios relacionados con el PBE, con prevalencia de bacterias Gram negativas

experienced by patients with decompensated cirrhosis and ascites, has a high mortality rate. Objective:Our objective was to identify the main agents causing SBP at a University Hospital between 2008 and 2011.Methods: A cross-sectional study of positive results from ascitic fl uid cultures was carried out. Clinical andlaboratory variables were extracted from the medical records.Results: 47 patients with positive ascitic fl uid cultures were included. Average age was 55.7 years ± 15.5years, 70.2% were men, and 53.6% of patients presented cirrhosis. All cirrhotic patients presented GASA≥ 1.1 and mean neutrophil count in the ascitic fl uid of 3,260.8 ± 5,122.9 cells. The most frequent germsfound were Escherichia coli (25.5%), Klebsiella (14.9%), Enterococcus (8.5%) and Streptococcus (8.5%). Nosignifi cant differences were observed between cirrhotic and non-cirrhotic patients regarding the prevalenceof E.coli (19.2% vs. 33.3%; P=0.270), Klebsiella (19.2% vs. 9.5%; P=0,436), Enterococcus (7.7% vs. 9.5%;P=1.000) or Streptococcus (15.4% vs. 0.0%; P=0.117). The presence of infection by two or more germs wasmore common among individuals without cirrhosis (11.5% vs. 38.1%; P=0.047).Conclusion: The microbiological profi le of ascitic fl uid cultures showed a prevalence of gram-negativebacteria similar to other studies related to spontaneous bacterial peritonitis

Exacerbações infecciosas da doença pulmonar obstrutiva crônica / Infectious exacerbations of chronic obstructive pulmonary disease

Objetivo: Descrever as manifestações clínicas, laboratoriais e os patógenos bacterianos presentes nas exacerbações da DPOC em pacientes internados em um hospital geral. Métodos: Estudo de delineamento transversal, quantitativo e observacional, realizado durante um ano, no qual foi preenchida uma ficha mediante informações do paciente internado com exacerbação de DPOC, com relação ao quadro clínico, história da doença, uso de antimicrobianos, exames laboratoriais e de imagem. Foi realizada coleta de escarro e cultura quantitativa, com ponto de corte para infecção de 106 UFC/ml. Resultados: Foram avaliados 47 pacientes, sendo 24 (52,2%) do gênero masculino, com média de idade de 67,1 anos. Encontrou-se a associação de tosse, dispneia e mudança da expectoração em 38 (80,9%) participantes. Evidenciou-se leucocitose em 26 (55,3%) casos. Houve crescimento de Pseudomonas aeruginosa em 5 (10,6%) culturas de escarro. Obteve-se 44 (93,6%) das culturas sem critérios para infecção e 3 (6,4%) com critérios microbiológicos de infecção bacteriana. O índice de concordância Kappa entre uso de antimicrobianos e a presença ou não de infecção microbiologicamente confirmada foi de 0,006 (p<0,05). Conclusão: O agente microbiano predominantemente isolado foi Pseudomonas aeruginosa. Presença de leucocitose não apresentou associação com quadro de infecção bacteriana evidenciada por crescimento de patógenos em cultura. Ocorreu fraca concordância entre o uso de antimicrobiano e a presença ou ausência de infecção microbiologicamente diagnosticada.

Autoantibody profile in individuals with chronic hepatitis C

Introduction Autoantibodies are often produced during infection with chronic hepatitis C virus (HCV), but it remains controversial whether they influence the biochemical profile and histological features of this disease. Therefore, this current study sought to describe these autoantibodies and evaluate their impact on the clinical and histological presentation of hepatitis C. Methods This cross-sectional analytical study assessed patients with HCV (RNA+) from October 2011 to July 2012. Results This study included 66 patients, with a mean age of 53.2±10.5 years. Of these patients, 60.6% were male, and 54.3% presented with genotype 1. Non-organ-specific autoantibodies (NOSA) were detected in 24% of the patients; of these, 7.6% were anti-mitochondrial antibodies (AMA+), 26.7% were anti-smooth muscle antibodies (SMA+) and 6.8% were liver kidney microsomal type 1 antibodies (LKM1+). With respect to the thyroid autoantibodies, 7.4% were anti-peroxidase (ATPO+) antibodies, and none were anti-thyroglobulin (ATG+) antibodies. Regarding celiac disease autoantibodies, 5.8% were endomysial antibodies (EMA+), and no transglutaminase (TTG+) antibodies were detected. Cryoglobulins were found in 2.1% of patients. When NOSA+ individuals were compared to patients without the presence of NOSAs, they exhibited higher median alkaline phosphatase (0.7 vs. 0.6 xULN; p=0.041), lower median platelet counts (141,500.0 vs. 180,500.0/mm 3 ; p=0.036), lower mean prothrombin activity (72.6±11.5% vs. 82.2±16.0%; p=0.012) and an increased prevalence of significant fibrosis (E≥2) (45.5% vs. 18.2%; p=0.012). There was also a tendency for a greater proportion of NOSA+ cases to have marked periportal activity (APP≥3) (44.5% vs. 15.6%; p=0.087). Conclusions In addition to the high prevalence of autoantibodies associated with HCV infection, it was observed that NOSA ...