Neumonía estafilocócica complicada en un paciente pediátrico: a propósito de un caso clínico / Stafilocócica pneumony complicated in a pediatric patient: on the purpose of a clinical case

La neumonía es definida por la Organización Mundial de Salud (OMS) como una infección respiratoria aguda que afecta a los alvéolos pulmonares, dificultando la respiración y absorción de oxígeno afectando a la población infantil. Por eso se propuso analizar la neumonía estafilocócica complicada con enfoque clínico, radiológico y tratamiento en el paciente pediátrico para establecer elementos que ayuden a la elaboración de protocolos de diagnóstico y tratamiento. Se realizó un estudio de tipo documental, observacional y analítico mediante la entrevista directa con el paciente y familiares y el análisis clínico de los signos y síntomas presentados por el paciente. Mediante la valoración clínico, radiológico y oportuno tratamiento en el paciente pediátrico con neumonía estafilocócica complicada, se logró establecer elementos que podrán ayudar a la elaboración de un protocolo de diagnóstico y tratamiento de dicha patología(AU)

Pneumonia is defined by the World Health Organization (WHO) as an acute respiratory infection that affects the pulmonary alveoli, making it difficult to breathe and absorb oxygen, affecting the child population. Therefore, it was proposed to analyze complicated staphylococcal pneumonia with a clinical, radiological and treatment approach in the pediatric patient to establish elements that help to develop diagnostic and treatment protocols. A documentary, observational and analytical study was conducted through a direct interview with the patient and family members and the clinical analysis of the signs and symptoms presented by the patient. By means of the clinical, radiological evaluation and timely treatment in the pediatric patient with complicated staphylococcal pneumonia, it was possible to establish elements that may help to elaborate a protocol for the diagnosis and treatment of said pathology(AU)

Success stories about severe pneumonia caused by Panton-Valentine leucocidin-producing Staphylococcus aureus

We describe three cases of community-acquired necrotizing pneumonia which were caused by Panton-Valentine leucocidin-producing strains of Staphylococcus aureus (one of them methicillin sensitive). All cases were successfully treated without any sequelae for the patients due to the prompt initiation of adequate antimicrobial therapy. High suspicion toward this fatal pathogen was the key to the successful outcome of the patients.

The Difference in Clinical Presentations between Healthcare-Associated and Community-Acquired Pneumonia in University-Affiliated Hospital in Korea

PURPOSE: Healthcare-associated pneumonia (HCAP) has been proposed as a new category of pneumonia. However, epidemiological studies for HCAP in South Korea are limited. This study aimed to reveal the differences between HCAP and community-acquired pneumonia (CAP), especially in elderly patients, in university-affiliated hospital in South Korea. MATERIALS AND METHODS: We conducted a retrospective observational study of patients with HCAP and CAP (older than 60 years old) who were hospitalized between January 2007 and December 2008. We compared the baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics, and clinical outcomes. RESULTS: A total of 210 patients were evaluated, including 35 patients with HCAP (17%) and 175 with CAP (83%). The most common causative organism was Streptococcus pneumoniae in CAP (33.3%), whereas, Staphylococcus aureus was most common pathogen in HCAP (40.0%). Initial inappropriate antibiotics (6.3% vs. 22.9%; p < 0.005) and initial treatment failure (15.4% vs. 31.4%; p = 0.018) were more frequent in HCAP than CAP. However, mortality (11.4% vs. 5.7%; p = 0.369) was not different between the two groups. CONCLUSION: The present study provides additional evidence that HCAP should be distinguished from CAP, even in elderly patients, in South Korea. Physicians should consider S. aureus and MDR pathogens in selecting initial empirical antibiotics of HCAP in South Korea.

Post operative penicillin-non-susceptible Streptococcus pneumoniae meningitis and septic shock in a child.

The authors describe a one-year-old girl with a fronto-ethmoidal encephalomeningocele who developed wound infection, purulent meningitis and septic shock 5 hours after operation. The patient was treated with intravenous ceftazidime and vancomycin empirically. The cerebrospinal fluid (CSF) and eye discharge grew Streptococcus pneumoniae (S. pneumoniae). The minimal inhibitory concentration (MIC) by E-test of penicillin and cefotaxime were 1.0 and 0.38 ug/ml respectively so the antibiotics were switched to cefotaxime 300 mg/kg/day. She recovered completely after appropriate treatment. Penicillin-non-susceptible S. pneumoniae should be considered as one of the causes of post-operative serious infection of the face and neck in the era of increasing prevalence of penicillin-resistant S. pneumoniae.

Right-sided diaphragmatic hernia masquerading as staphylococcal pneumonia.

A 9-month-old infant who was diagnosed to have right-sided diaphragmatic hernia with no other associated anomalies, is being reported here. He had presented with cough for one month and respiratory difficulty for one-week duration and history of bilious vomiting two days prior to admission. His chest X-ray showed multiple lucent shadows in the right lower zone in A-P and lateral views, with not very well defined diaphragm on the same side. A diagnosis of staphylococcal pneumonia was considered but with clinical and radiological picture, a right-sided diaphragmatic hernia was strongly suspected which was confirmed by doing fluoroscopy and CT-scan of the chest. He underwent a successful correction of the defect. So radiological finding of pleural effusion with displacement of mediastinum to the left and the presence of bowel gas high in the right upper quadrant should alert the possibility of a right-sided Bochdalek hernia.

Pneumonia estafilocócica: Aspectos clínicos e radiológicos / Staphylococcal pneumonia: clinical and radiologic aspects

Os autores que pela primeira vez descreveram a pneumonia estafilocócica como entidade clínica autônoma foram Chickering & Park, ao apresentarem, em 1919, uma série de 153 casos ocorridos em adultos, como complicação de epidemia de influenza (1). Dese então, a incidência de pneumonia estafilocócica vem aumentando, principalmente depois de iniciada a era dos antimicrobianos. Atualmente, a pneumonia estafilocócica é, dentre as pneumonias bacterianas, a de maior importância, não somente pela prevalência variável mas também pela gravidade de sua evolução

Tratamento cirúrgico de pneumonia necrosante: análise de quatro casos / Surgical treatment of necrotizing pneumonia: analysis of four cases

A pneumonia necrosante é uma patologia grave que surge como complicaçäo rara de pneumonia lobar. Quatro crianças na faixa etária entre dez e 28 meses foram hospitalizadas com pneumonia bacteriana aguda, evoluindo com toxemia, derrame pleural e insuficiência respiratória, respondendo insatisfatoriamente a antibioticoterapia e drenagem pleural. Todos os pacientes foram submetidos a tratamento cirúrgico para descorticaçäo pulmonar e ressecçäo de tecido pulmonar necrosado. Complicaçöes como fístulas broncopleurais ocorreram em dois pacientes, havendo óbito em um dos casos. Os autores concluem que a ressecçäo pulmonar de emergência é indicada quando a necrose pulmonar é diagnosticada em pacientes septicêmicos ou com fístula broncopleural de alto débito, visando a melhora do prognóstico dessas crianças, mesmo de que o índice de morbimortalidade nesses casos é alta

Neumonias adquiridas en la comunidad en pacientes de riesgo / Adquired neumonias in higs risk patients

Analizamos 101 casos de neumonia adquirida en la comunidad, en pacientes con patologia de riesgo atendidos en el CMQBB los ultimos 10 anos. Se deseaba conocer el aporte de los procedimientos de busqueda etiologica, correlacionar los patrones radiograficos pulmonares con los microbiologicos,analizar las patologias subyacentes y catalogar la evolucion del cuadro. Constatamos el agente etiologico en 76 pacientes, resultando positivas 40/60 muestras de espectoracion, 15/24 hemocultivos, 10/16 muestras de liquido pleural, 8/9 aspirados bronquiales, 4/4 aspirados broncofibroscopicos y 2/2 muestras quirurgicas. Se identifico mas frecuentemente el neumococo, los gram negativos y el estafilococo en 28, 23 y 15 pacientes respectivamente. La correlacion clinico-radiologica como hipotesis inicial de diagnostico histologico fue valida en 59 casos. De los 50 pacientes con neumopatias cronicas, 28 tenian EPOC, la insuficiencia respiratoria estuvo asociada en 35 pacientes. evolucionaron favorablemente 74 pacientes, 16 presentaron complicaciones, estableciendose insuficiencia respiratoria y cavitacion pulmonar en 8 casos cada una. Fallecieron 11 pacientes constatandose septicemia aislada o asociada en 7 de ellos. En conclusion, el diagnostico etiologico precoz, tratamiento especifico y la atencion eficaz de las patologias de riesgoasociadas determinan menor morbimortalidad por neumonia

Estudio evaluativo de las neumopatías supuradas en el servicio de pediatría del Hospital General Base Goyeneche 1974-1983 / Evaluative study in suppurated lung disease in the child health service of the Base General Hospital Goyeneche (1974-1983)

Se presentaron los datos correspondientes a 109 casos de Neumopatías Supuradas, recogidos en el Servicio de Pediatría del Hospital General Base Goyeneche, entre el 01 de junio de 1974 y 01 de junio de 1983. De 114 historias clínicas revisados minuciosamente se relacionaron 109 que reunían los criterios 2 mayores y como mínimo 1 criterio mayor y otro menor de Highman y Camphell. De estos fueron aceptados 86 historias con un criterio mayor y otro menor; 22 historias tuvieron 2 criterios mayores y una presentó 3 criterios mayores. Se valoran los síntomas, signos, hallazgos de laboratorio, bacteriológico y datos radiológicos referentes al momento del ingreso y evolución posterior, así como algunos datos anatomopatológicos. Finalmente, se analizó el tratamiento administrativo, la respuesta conseguida y las complicaciones más frecuentes y se compararon los resultados obtenidos con otros similares mostrados en la literatura