ABSTRACT
BACKGROUND: Since the introduction of Haemophilus influenzae type b vaccines, invasive disease due to Haemophilus influenzae serotype a (Hia) has been reported with increasing frequency. METHODS: This study is based on hospital-based surveillance for Hia meningitis over a 5-year period. RESULTS: Thirty-five patients with H. influenzae meningitis were hospitalized and 12 were serotype a. Hia was detected in blood and cerebrospinal fluid by culture or reverse transcription polymerase chain reaction. Patients' median age was 10 months, 7 (58%) boys and 5 (41%) girls. Ten (83%) children had received at least 1 vaccine dose against Haemophilus influenzae type b. All patients were treated with ceftriaxone for a median period of 11 days. The main complications described were empyema in 5 (41%) and seizures in 3 (25%) patients. Two (16.6%) patients died due to cerebral damage and shock. CONCLUSIONS: Invasive disease due to Hia affecting young children accounts for considerable morbidity and mortality.
Subject(s)
Haemophilus Vaccines/adverse effects , Haemophilus influenzae , Meningitis, Haemophilus/microbiology , Anti-Bacterial Agents/pharmacology , Brazil , Child , Child, Preschool , Female , Haemophilus influenzae/classification , Haemophilus influenzae/drug effects , Haemophilus influenzae/isolation & purification , Humans , Infant , Male , Microbial Sensitivity Tests , SerotypingABSTRACT
This study aims to characterize the acute neurological manifestations caused by DENV, ZIKV, and YFV during hospitalization; identify the risk factors associated with persistent neurological complications after discharge; and evaluate the time to resolution during clinical follow-up. A prospective study evaluated 505 children, between March 2014 and July 2019, hospitalized with neurological manifestations and that doctors suspected infection of the central nervous system (CNS). Viral infection of collected cerebrospinal fluid (CSF) was confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR). Patients were clinically followed up after hospital discharge. Analysis of predictive factors and survival curves was performed. This study identified clinical symptoms and changes in the CSF laboratory, electroencephalogram (EEG), and CNS image as predictors of complications in children with confirmed infection in the CNS by DENV, ZIKV, or YFV. No statistical difference was found (p value 0.574) in the time to the resolution of complications in children after hospital discharge between the three types of flaviviruses. Children with YFV, detected in CSF samples, had a 53% higher risk of developing neurological complications. Performing etiological diagnosis by RT-PCR of CSF samples of children with neurological manifestations, especially during Flavivirus outbreaks, is an essential tool for improving the prognosis and clinical follow-up of these patients.
Subject(s)
Central Nervous System Infections/complications , Central Nervous System Infections/virology , Flavivirus Infections/complications , Nervous System Diseases/epidemiology , Nervous System Diseases/virology , Child , Female , Humans , Incidence , Male , Risk FactorsABSTRACT
We evaluated neurologic complications following noncongenital Zika virus infection in 11 children who presented with central nervous system signs. Zika virus RNA was detected by real-time reverse transcription-polymerase chain reaction in cerebrospinal fluid. Approximately one-quarter of patients required antiepileptic medication in follow-up, and 2 children progressed to learning difficulties or developmental delay.
Subject(s)
Developmental Disabilities/virology , Learning Disabilities/virology , Nervous System Diseases/virology , Zika Virus Infection/complications , Anticonvulsants/therapeutic use , Brazil , Child , Child, Preschool , Developmental Disabilities/diagnosis , Electroencephalography , Female , Hospitalization , Humans , Infant , Learning Disabilities/diagnosis , Male , Nervous System Diseases/diagnosis , Prospective Studies , Real-Time Polymerase Chain Reaction , Zika Virus/isolation & purification , Zika Virus Infection/diagnosis , Zika Virus Infection/psychologyABSTRACT
A 7-year-old boy that presented an encephalomyeloradiculitis and no classic symptoms of arboviruses. Zika virus (ZIKV) was confirmed by molecular analyses of cerebrospinal fluid and 1 year later by plaque reduction neutralization test. This case demonstrates that ZIKV can be associated with diffuse nervous system infection in children.
Subject(s)
Myelitis/virology , Radiculopathy/virology , Zika Virus Infection/complications , Child , Humans , MaleABSTRACT
A falta de adesäo ao tratamento, ou seja, a dificuldade do paciente em usar a medicaçäo, seguir a dieta ou modificar seu estilo de vida, de acordo com a orientaçäo médica, é um problema sempre presente na prática médica. Estima-se que apenas um terço dos pacientes tem adesäo adequada ao tratamento. Esse fenômeno implica näo só na falência da medidas profiláticas e curativas, como no desgaste da relaçäo médico-paciente. Objetivos: avaliar os fatores relacionados à adesäo ao tratamento e suas principais conseqüências. Método: foi feita revisäo bibliográfica na base de dados MEDLINE e LILACS, utilizando-se as palavras-chave adherence, compliance e treatment. Resultados: há muitas variáveis que podem influenciar a adesäo, näo havendo consenso quanto a significância de cada uma delas. Existem três grandes grupos de fatores implicados: os atribuídos ao paciente, à relaçäo médico-paciente e ao esquema terapêutico. Säo descritas como conseqüências da näo adesäo ao tratamento a näo obtençäo dos benefícios esperados, o aumento do gasto financeiro para o paciente e para o sistema de saúde e a deterioraçäo da relaçäo médico-paciente. Conclusäo: o conhecimento dos fatores que influenciam na adesäo ao tratamento pode ser decisivo no sucesso do mesmo, seja ele preventivo, seja terapêutico.
