RESUMO
Objective To measure the rate of the A2063G mutation in the Mycoplasma pneumoniae ( M. pneumoniae) 23S rRNA domain V in children with pneumonia and to determine the correlation between radiographic findings and the presence of the A2063G mutation. Methods Patients who were hospitalized with a confirmed diagnosis of M. pneumoniae pneumonia were enrolled in this study. M. pneumoniae strains were collected for genotype analysis. Chest radiography was performed on all children prior to and following macrolide treatment. Clinical and imaging data were obtained. Results Of 211 patients, 195 (92.42%) harboured M. pneumoniae with the A2063G mutation. No significant differences were identified in inflammation score, chest radiography inflammation absorption grade before and after macrolide treatment, or pulmonary complications (atelectasis, hydrothorax, or pleuritis) prior to macrolide treatment when children were stratified based on the presence or absence of the A2063G mutation. Conclusions A high proportion of children with pneumonia harboured strains of M. pneumoniae with the A2063G mutation in the 23S rRNA domain V. However, no obvious chest radiographic features of M. pneumoniae pneumonia were associated with the A2063G variant.
Assuntos
Hidrotórax/diagnóstico por imagem , Mutação , Mycoplasma pneumoniae/genética , Pleurisia/diagnóstico por imagem , Pneumonia por Mycoplasma/diagnóstico por imagem , Atelectasia Pulmonar/diagnóstico por imagem , RNA Ribossômico 23S/genética , Antibacterianos/farmacologia , Criança , Pré-Escolar , Farmacorresistência Bacteriana/genética , Feminino , Humanos , Hidrotórax/tratamento farmacológico , Hidrotórax/etiologia , Hidrotórax/microbiologia , Macrolídeos/farmacologia , Masculino , Mycoplasma pneumoniae/efeitos dos fármacos , Mycoplasma pneumoniae/crescimento & desenvolvimento , Mycoplasma pneumoniae/isolamento & purificação , Pleurisia/tratamento farmacológico , Pleurisia/etiologia , Pleurisia/microbiologia , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/microbiologia , Atelectasia Pulmonar/tratamento farmacológico , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/microbiologia , RadiografiaRESUMO
BACKGROUND AND STUDY AIMS: Spontaneous bacterial empyema (SBEM) is an underestimated condition in patients with ascites and hepatic hydrothorax with a high mortality. This study aimed to find whether spontaneous bacterial peritonitis (SBP) is a prerequisite for SBEM. PATIENTS AND METHODS: 3000 HCV-related cirrhotic patients with ascites and hydrothorax were screened for the presence of SBP (ascitic fluid neutrophils >250/mm3) and SBEM (positive pleural fluid culture and neutrophils >250/mm3 or negative pleural fluid culture and neutrophils >500/mm3 with no evidence of pneumonia/parapneumonic effusion on chest radiograph or CT). RESULTS: The prevalence of SBEM in cirrhotic patients was 1.2% (36/3000) unlike SBP (1.6%; 48/3000). SBEM was detected in 51.4% of the patients with hepatic hydrothorax (36/70). A total of 70 patients had concomitant ascites and hydrothorax, namely SBP (n=17), SBEM (n=5), and dual SBP and SBEM (n=31), whereas 17 patients had sterile concomitant ascites and hydrothorax. Age, sex, liver function, kidney function tests, complete blood count, INR, MELD, MELD-Na, blood chemistry, and culture/sensitivity for ascitic and pleural fluid were statistically not different (p>0.05) between SBP and dual SBP and SBEM patients. Escherichia coli and Klebsiella pneumoniae were detected in the culture. From univariate analysis, no predictors of dual SBP and SBEM were detected. CONCLUSION: SBEM is a part of SBP in cirrhotic patients with ascites and hydrothorax.
Assuntos
Ascite/etiologia , Empiema/epidemiologia , Hidrotórax/etiologia , Cirrose Hepática/complicações , Peritonite/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Ascite/microbiologia , Cefotaxima/uso terapêutico , Egito/epidemiologia , Empiema/tratamento farmacológico , Empiema/microbiologia , Escherichia coli , Infecções por Escherichia coli/complicações , Feminino , Humanos , Hidrotórax/microbiologia , Infecções por Klebsiella/complicações , Klebsiella pneumoniae , Masculino , Pessoa de Meia-Idade , Peritonite/tratamento farmacológico , Peritonite/microbiologia , PrevalênciaRESUMO
In patients with cirrhosis of the liver, ascites is a common symptom, some of these patients will also present hydrothorax. Under rare circumstances patients with liver cirrhosis develop hydrothorax without showing any signs of ascites. This study presents one such case and shows autopsy findings consistent with hepatic hydrothorax without ascites. Furthermore, we present CT imaging which shows the possible cause of death in the case of severe hydrothorax.
Assuntos
Hidrotórax/patologia , Cirrose Hepática/patologia , Tamponamento Cardíaco/etiologia , Escherichia coli/isolamento & purificação , Feminino , Patologia Legal , Humanos , Hidrotórax/etiologia , Hidrotórax/microbiologia , Cirrose Hepática/complicações , Pessoa de Meia-Idade , Choque/etiologia , Tomografia Computadorizada por Raios XRESUMO
Over the past decade, an increasing number of opportunistic fungal infections have been reported in immunocompromised subjects. Microascus spp. and their anamorphs Scopulariopsis spp. have been recovered from a wide geographical range. We report a case of Scopulariopsis brumptii in a 27-year-old man with AIDS presenting with breathlessness, pericardial effusion and hydrothorax in Chennai, southern India, in February 2007. Because of respiratory arrest, the patient was intubated. However, the patient developed obstructive shock and died due to cardiac dysfunctions. This report underlines the need for a direct, intensive approach to investigations in immunocompromised patients, especially those with AIDS.
