ABSTRACT
OBJECTIVE: To analyze the clinical and laboratory characteristics of vertebral osteomyelitis in community-acquired bacterial meningitis patients. METHODS: All episodes of vertebral osteomyelitis in a cohort study of adult patients with community-acquired bacterial meningitis in the Netherlands were analyzed. Subsequently, a systematic review of published cases was performed. RESULTS: Between March 2006 and August 2018, 10 of 1974 (0.5%) meningitis patients were diagnosed with vertebral osteomyelitis. The median age was 70 years (interquartile range (IQR) 54-74 years); six (60%) were male and four (40%) were female. The median time between diagnosis of bacterial meningitis and vertebral osteomyelitis was 6 days (IQR 1-13 days). The most common presenting symptoms were back or neck pain, occurring in seven patients (70%); one patient presented with neurological deficits due to cauda equina compression. Streptococcus pneumoniae was the causative pathogen in five patients and Staphylococcus aureus in three. The literature review identified 32 additional cases, showing a similar distribution by age, sex, and pathogen. Seven (18%) of 40 patients from the series presented here and those reported in the literature died. CONCLUSIONS: Concomitant vertebral osteomyelitis is rare in community-acquired bacterial meningitis patients. Persisting back pain is a clue to the diagnosis and should prompt magnetic resonance imaging of the spine, because prolonged antibiotic treatment or surgical treatment may be indicated.
Subject(s)
Meningitis, Bacterial , Osteomyelitis , Staphylococcal Infections , Adult , Aged , Cohort Studies , Female , Humans , Male , Meningitis, Bacterial/complications , Meningitis, Bacterial/diagnosis , Middle Aged , Osteomyelitis/diagnosis , SpineABSTRACT
Community-acquired bacterial meningitis remains a disease with high impact. The epidemiology of this disease changed substantiality to large-scale introduction of conjugated vaccines. Streptococcus pneumoniae and Neisseria meningitidis are the main causative pathogens outside the neonatal age. Clinical presentation of patients with bacterial meningitis varies depending on age and underlying condition. A delay in diagnosis and antimicrobial therapy has been associated with increased risk of adverse clinical outcome. Empirical antibiotic treatment should be based on common bacterial species that cause the disease according to the patient's age group or clinical setting and on local antibiotic susceptibility patterns of the predominant pathogens.
Subject(s)
Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/epidemiology , Anti-Bacterial Agents/therapeutic use , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , HumansABSTRACT
OBJETIVO: Analisar o perfil das internações hospitalares por doenças respiratórias em crianças e adolescentes na cidade de São Paulo (SP). MÉTODOS: Estudo ecológico de séries temporais. Foram obtidas informações sobre internações hospitalares por doenças respiratórias (Código Internacional de Doenças, 10ª Revisão: J00-J99) em hospitais conveniados ao Sistema Único de Saúde, localizados na cidade de São Paulo, entre 2000 e 2004. Foram descritas as principais características de distribuição temporal, por faixa etária e por causa de morbidade respiratória na infância e na adolescência. RESULTADOS: As pneumonias e broncopneumonias (51 por cento), a asma (18 por cento) e as doenças agudas e crônicas das vias aéreas superiores (10 por cento) responderam pela maior parte das internações. As crianças até cinco anos são as mais internadas, independentemente da causa específica. Entre os adolescentes, observou-se que as principais causas de internações foram as doenças respiratórias que afetam o interstício pulmonar (0,1 por cento) e as afecções necróticas e supurativas das vias aéreas inferiores (0,2 por cento). Na faixa etária de seis a dez anos, predominam as internações por doenças agudas e crônicas das vias aéreas superiores (10 por cento). Houve tendência de aumento das internações por doenças respiratórias ao longo do período analisado, além da constatação de que o pico de morbidade se dá no começo do outono. CONCLUSÕES: As internações por doenças respiratórias de crianças e adolescentes apresentam padrão de distribuição dependente da faixa etária e da sazonalidade. Quanto menor a faixa etária maior o número de internações.
OBJECTIVE:To analyze the profile of children and adolescents' hospital admissions due to respiratory diseases in São Paulo (SP), Brazil. METHODS: This is an ecological time series study. Data was obtained on hospital admissions for respiratory diseases (International Classification of Diseases, 10th Revision: J00-J99) in hospitals under the Brazilian Unified Health System located in São Paulo between 2000 and 2004. Main characteristics of the temporal distribution of respiratory morbidity in childhood and adolescence by age and cause are described. RESULTS: Pneumonia and bronchopneumonia (51 percent), asthma (18 percent) and acute and chronical diseases from upper airways (10 percent) accounted for most of the admissions. Children up to five years are most frequently hospitalized, regardless of the specific cause. Among adolescents, the main causes of hospitalization were respiratory diseases that affects mainly the interstitial lung (0.1 percent) and the necrotic and suppurative diseases of lower airways (0.2 percent). From the age of six to ten years, admissions for acute and chronic diseases from upper airways (10 percent) were predominant. The peak of morbidity occurs in early autumn. There was a trend towards increasing hospital admissions for respiratory illnesses during the analyzed period. CONCLUSIONS: The distribution of hospital admissions for respiratory diseases in children and adolescents is dependent on age and season. The younger the age the greater the number of hospital admissions.
