Clinical-epidemiological evaluation of respiratory syncytial virus infection in children attended in a public hospital in midwestern Brazil.

UNLABELLED: Respiratory syncytial virus (RSV) is responsible for annual respiratory infection outbreaks in infants and young children worldwide, frequently causing bronchiolitis and pneumonia. We evaluated clinical and epidemiological features of acute respiratory infections (ARIs) caused by respiratory syncytial virus (RSV) in children less than five years old. Nasopharyngeal aspirate samples from children with ARI symptoms, attended at the 'Hospital das Clínicas'--Federal University of Uberlândia, MG, Brazil, were collected and tested for RSV by the immunofluorescence assay (IFA). Patients' clinical and epidemiological data were also obtained. From April 2000 to June 2003, 317 nasopharyngeal samples were collected from children less than 54 months old. Seventy-six samples (24.0%) were positive for RSV, with 53% (40/76) obtained from male patients. Hospitalization occurred in 50% (38/76) of the cases, with an average period of 10.6 days, in most cases (87%, 33/38) occurring in children less than 12 months of age. Although an association between this age group and the presentation of more severe clinical symptoms was observed, such as bronchiolitis in 51% (27/53) of the patients and pneumonia in 19% (10/53), no patients died. RSV was found from February to August, with the highest incidence in May. CONCLUSIONS: RSV is an important agent that causes ARIs; the clinical manifestations varied from mild to severe and patients frequently required hospitalization; RSV mostly affected children less than one year old.

Clinical-epidemiological evaluation of respiratory syncytial virus infection in children attended in a public hospital in midwestern Brazil

Respiratory syncytial virus (RSV) is responsible for annual respiratory infection outbreaks in infants and young children worldwide, frequently causing bronchiolitis and pneumonia. We evaluated clinical and epidemiological features of acute respiratory infections (ARIs) caused by respiratory syncytial virus (RSV) in children less than five years old. Nasopharyngeal aspirate samples from children with ARI symptoms, attended at the 'Hospital das Clínicas' - Federal University of Uberlândia, MG, Brazil, were collected and tested for RSV by the immunofluorescence assay (IFA). Patients' clinical and epidemiological data were also obtained. From April 2000 to June 2003, 317 nasopharyngeal samples were collected from children less than 54 months old. Seventy-six samples (24.0 percent) were positive for RSV, with 53 percent (40/76) obtained from male patients. Hospitalization occurred in 50 percent (38/76) of the cases, with an average period of 10.6 days, in most cases (87 percent, 33/38) occurring in children less than 12 months of age. Although an association between this age group and the presentation of more severe clinical symptoms was observed, such as bronchiolitis in 51 percent (27/53) of the patients and pneumonia in 19 percent (10/53), no patients died. RSV was found from February to August, with the highest incidence in May. Conclusions: RSV is an important agent that causes ARIs; the clinical manifestations varied from mild to severe and patients frequently required hospitalization; RSV mostly affected children less than one year old.

[Prevalence of serotypes and antimicrobial resistance of invasive strains of Streptococcus pneumoniae]. / Prevalência de sorotipos e resistência antimicrobiana de cepas invasivas do Streptococcus pneumoniae.

OBJECTIVE: To determine the prevalence of serotypes and antimicrobial susceptibility of invasive strains of Streptococcus pneumoniae and to discuss the implications of these findings for vaccine formulation. METHODS: Strains of Streptococcus pneumoniae obtained from normally sterile fluids from patients admitted with invasive diseases were isolated and identified at the Hospital de Clínicas, Universidade Federal de Uberlândia, state of Minas Gerais, and forwarded to Instituto Adolfo Lutz, state of São Paulo, for further identification, serotyping and determination of antimicrobial susceptibility. RESULTS: From April 1999 to March 2003, 148 invasive strains of Streptococcus pneumoniae were obtained. The age of patients ranged from 1 day to 88.83 years (mean: 21.33+/-25.82 years; median: 4.42 years). Eighty-four (56.7%) patients were male. The most common diagnoses were pneumonia (91 cases; 61.4%), meningitis (32 cases; 21.6%) and occult bacteremia (15 cases; 10.1%). Strains were isolated mostly from blood (76 occasions; 51.3%), pleural fluid (39 occasions; 26.3%) and cerebrospinal fluid (30 occasions; 20.2%). There were 23 different serotypes, and the most common were 14, 3, 1, 5, 6A, 6B and 18C. Among 30 (20.2%) oxacillin-resistant strains, 23 (15.5%) were confirmed as resistant to penicillin (12.8% intermediate resistance and 2.7% full resistance). Oxacillin-resistant strains were restricted to serotypes 14, 23F, 19A and 6B. Resistance to penicillin varied with age, being more common in children under two years of age (p = 0.0008). We observed decreased sensibility to sulfamethoxazole-trimethoprim (92 isolates; 63.4%), to erythromycin (12 isolates; 8.3%), to clindamycin (12 isolates; 8.7%), to ofloxacin (one strain; 0.8%) and to cefotaxime (three strains; 2%; also resistant to penicillin). All isolates were susceptible to chloramphenicol, rifampin and vancomycin. CONCLUSIONS: The decreased susceptibility to penicillin, detected in 15.5% of the strains was predominant in children under two years of age. There were 23 different Streptococcus pneumoniae serotypes. The 23-valent polysaccharide vaccine covers 82.6% of the serotypes and 90.2% of the invasive strains isolated in this population. In addition, 46.7% of the serotypes and 63.6% of the strains isolated from children until five years of age are covered in the currently available 7-valent conjugated vaccine (PN CRM7).

Prevalência de sorotipos e resistência antimicrobiana de cepas invasivas do Streptococcus pneumoniae / Prevalence of serotypes and antimicrobial resistance of invasive strains of Streptococcus pneumoniae

OBJETIVO: Avaliar o perfil de sorotipos e a susceptibilidade aos antimicrobianos de cepas de Streptococcus pneumoniae obtidas em espécimes clínicos de pacientes com doença invasiva, bem como suas implicações na formulaçäo de vacinas pneumocócicas. MÉTODOS: Cepas de pneumococo isoladas no Laboratório de Análises Clínicas do Hospital de Clínicas da Universidade Federal de Uberlândia a partir de amostras clínicas de pacientes com doença invasiva foram identificadas e enviadas ao Instituto Adolfo Lutz em São Paulo para confirmaçäo da identificaçäo, sorotipagem e determinaçäo da susceptibilidade aos antimicrobianos. RESULTADOS: De abril de 1999 a março de 2003, foram isoladas 148 cepas invasivas de pneumococo, sendo 84 (56,7 por cento) provenientes de pacientes do sexo masculino. A idade variou de um dia a 88,83 anos, com média de 21,33+25,82 anos e mediana de 4,42 anos. Os diagnósticos clínicos mais comuns foram pneumonia (91 casos; 61,4 por cento), meningite (32 casos; 21,6 por cento) e bacteremia sem foco evidente (15 casos; 10,1 por cento). As principais fontes de recuperaçäo foram sangue (76 amostras; 51,3 por cento), líquido pleural (39; 26,3 por cento) e liquor (30; 20,2 por cento). No total, foram identificados 23 diferentes sorotipos entre 143 amostras testadas, sendo os mais comuns os seguintes: 14, 3, 1, 5, 6A, 6B e 18C. Dentre 30 (20,2 por cento) cepas oxacilina-resistentes, 23 (15,5 por cento) confirmaram a resistência à penicilina (12,8 por cento com nível intermediário e 2,7 por cento, com nível pleno), que esteve restrita aos sorotipos 14, 23F, 19A e 6B, predominando em indivíduos com até dois anos de idade (p = 0,0008). Foi detectada susceptibilidade diminuída ao cotrimoxazol (63,4 por cento), à eritromicina (8,3 por cento), à clindamicina (8,7 por cento) e à ofloxacina (0,8 por cento). A resistência à cefotaxima foi detectada em três das 30 cepas testadas (2 por cento das 148), todas elas com resistência confirmada à penicilina. Näo foi observada resistência a cloranfenicol, rifampicina ou vancomicina. CONCLUSÕES: A resistência à penicilina foi detectada em 15,5 por cento das cepas e predominou em crianças abaixo de dois anos de idade. Foram identificados 23 diferentes sorotipos de Streptococcus pneumoniae em pacientes internados com doença invasiva, e a maioria dos sorotipos (82,6 por cento) e das cepas (90,2 por cento) está incluída na vacina polissacarídica 23-valente

Perfil etiológico das meningites bacterianas em crianças / Etiological profile of bacterial meningitis in children

Objetivo: analisar o perfil etiologico e alguns aspectos epidemiologicos das crianças com meningite bacteriana, internadas em um hospital publico universitario. Metodos: foram seguidas, prospectivamente, as crianças internadas com meningite bacteriana, diagnosticada segundo os criterios clinicos e laboratoriais habituais. Foram excluidos os casos de meningite pos-trauma, de meningite na vigencia de derivação liquorica, ou de defeitos congenitos do tubo neural, e de meningite tuberculosa.Resultados: foram analisadas 415 crianças internadas com diagnostico de meningite bacteriana, no Hospital de Clinicas da Universidade Federal de Uberlandia, no periodo de 01/01/1987 a 31/01/2001. O agente etiologico foi identificado em 315 pacientes (75,9 por cento), sendo de modo definitivo em 289 (69,3 por cento) e presuntivo, por intermedio da bacterioscopia, em outros 26 (6,6 por cento). Os agentes mais comumente identificados foram o Haemophilus influenzae b (54,2 por cento), o meningococo (20,6 por cento) e o pneumococo (18,1 por cento dos 315 pacientes). O tratamento antimicrobiano previo, detectado em 47,2 por cento dos casos, causou uma diminuicao significante no rendimento das culturas de sangue (de 50,8 por cento para 38,7 por cento) e de liquor (71,7 por cento para 57,6 por cento). Houve um predominio do acometimento de crianças com idade ate 48 meses pelo Haemophilus influenzae b, particularmente em relacao ao meningococo. A letalidade geral foi de 10,1 por cento, com diferença significante entre a letalidade do pneumococo, de 17,5 por cento, e a domeningococo, de 4,6 por cento. Conclusões: as crianças afetadas por Haemophilus influenzae b e por...

[Etiological profile of bacterial meningitis in children]. / Perfil etiológico das meningites bacterianas em crianças.

OBJECTIVE: To determine the etiologic profile and analyze some epidemiological aspects of children with bacterial meningitis admitted to a public teaching hospital. METHODS: A prospective study was conducted on children with clinical and laboratory diagnosis of bacterial meningitis, admitted to Hospital das Clínicas da Universidade Federal de Uberlândia, from January 1987 to January 2001. Patients with meningitis associated with trauma, intracranial devices or malformations of the neural tube, and tuberculosis, were not included in the study. RESULTS: From a total of 415 children with bacterial meningitis, the etiologic agent was detected in 315 (75.9%): Haemophilus influenzae b in 54.2%, meningococci in 20.6%, pneumococci in 18.1% and other agents, in 6.9%. Previous antibiotic treatment, observed in 47.2% of the cases, led to a significant decrease in positive blood cultures (from 50.8% to 38.7%) and in cerebrospinal fluid cultures (from 71.7% to 57.6%). Among children younger than 48 months Haemophilus influenzae b was predominant, particularly when compared to meningococci. The overall mortality was 10.1%, with a significant difference between the rates of pneumococcal (17.5%) and meningococcal meningitis (4.6%). CONCLUSIONS: Children affected by Haemophilus influenzae b and by pneumococci were younger than those with meningitis caused by meningococci. The blood and/or cerebrospinal fluid culture remains an important laboratory tool for etiologic diagnosis, despite the negative impact caused by antibiotic previous treatment. The agents most commonly detected were Haemophilus influenzae b, meningococci and pneumococci. Bacterial meningitis continues to present an important mortality among children, particularly when caused by pneumococci.