RESUMO

AIMS: Staphylococcus aureus is one of the most common pathogens in hospital environment and community. Panton-Valentine leukocidin (PVL) production is clinically associated with skin abscesses, soft tissues infections, bacteraemia and sepsis. This study aimed to investigate the effects of the presence of genes lukF/S-PV coding for PVL, in histological and haematological features during systemic infection, using a Swiss mice experimental model. METHODS AND RESULTS: Experiments were performed using 25 mice distributed into five experimental groups, intravenously inoculated with 50 µl suspensions at density 1·0 × 107  CFU per ml of strains: methicillin-susceptible (MSSA) and pvl-negative strains isolated from nasal colonization; MSSA pvl-positive strains isolated from nasal colonization; methicillin-resistant (MRSA) and pvl-positive strains isolated from peripheral blood of a patient with severe pulmonary infection; and a MRSA pvl-positive strains isolated from a peripheral blood culture of a patient with bacteraemia. Haematological analysis was performed at 24, 48, 72 and 96 h post-infection. Morphoanatomy and histopathological analyses were performed at 96 h post-infection. For all S. aureus strains tested, the capability of intravenous dissemination and survival into mice tissues was demonstrated. Inflammatory processes at different levels were related to the presence of pvl genes, and included alterations in the format, size and colour of the organs. Staphylococcus aureus pvl-positive strains were detected in greater numbers in the organs of the infected animals. CONCLUSIONS: The pvl-positive strains isolated from blood cultures were capable to induce the greatest modifications in both haematological and histopathological profiles, and seemed to aggravate the systemic infections. SIGNIFICANCE AND IMPACT OF THE STUDY: These findings are valuable in characterizing infections caused by S. aureus in humans and murine.

Assuntos

RESUMO

BACKGROUND: To describe clinical, laboratorial, radiological, and histopathological lung findings from necroscopy of aidetic children with pulmonary disease. MATERIAL AND METHODS: Fourteen children admitted at the Hospital Universitário Antônio Pedro - Universidade Federal Fluminense, Niterói, RJ, and Instituto de Puericultura e Pediatria Martagão Gesteira - Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, between 1989 and 1996, were revised in a retrospective survey. RESULTS: Eight were males (57%). The median age was 1.2 years old (from three months to nine years). Nine children (64.4%) were younger than 24 months old. The HIV transmission was vertical in 10 (71%) children. In these cases, five mothers were contaminated from heterosexual relations. Pneumonia (n=8), oral candidiasis (n=8), and diarrhea (n=5) were the most common previous conditions. The most frequent signs and symptoms on admission were fever (n=12), respiratory distress (n=10), cough (n=10), peripheral lymphadenopathy (n=11), hepatomegaly and/or splenomegaly (n=10), and malnutrition (n=9). The chest x-rays findings were condensation (n=5) and diffuse infiltrates (n=6) patterns. The microscopic lung characteristics were compatibles with pneumonia by cytomegalovirus (CMV) (n=9), bacteria (n=8), Pneumocystis carinii (n=3), Toxoplasma gondii (n=1), Hystoplasma capsulatum (n=1) and Lymphocytic interstitial pneumonia (n=1). The association between CMV and bacteria was observed in six cases. CONCLUSIONS: Age less than two years old, vertical transmission, inespecific clinical presentation of pneumonia, and infiltrates and condensation patterns at the x-rays were the predominant characteristics. Cytomegalovirus and bacteria were the most common etiologic agents, being their association frequent. Lymphocytic interstitial pneumonia and pneumonia by P. carinii were not common causes of pulmonary disease.

Assuntos

RESUMO

OBJETIVOS: Descrever os aspectos clínicos, laboratoriais, radiológicos e anatomopatológicos encontrados em tecidos pulmonares de necrópsias de crianças com Aids e acometimento pulmonar. MÉTODOS: Foram revisados, retrospectivamente, prontuários, radiografias simples de tórax e laudos de necrópsias de 14 crianças com Aids e acometimento pulmonar. RESULTADOS: Oito casos eram do sexo masculino e seis do feminino. As idades variaram de três meses a nove anos, mediana de 1,2, sendo nove deles menores de dois anos. A transmissäo foi vertical em 10 pacientes, dos quais cinco mäes tinham história de contaminaçäo por relaçäo heterossexual; três, por hemotransfusäo e em duas, ignorada. Pneumonia (n=8), candidíase oral (n=8) e diarréia (n=5) foram as doenças prévias mais referidas. Os sinais e sintomas observados à internaçäo foram febre (n=12), dispnéia (n=10), tosse (n=11), linfoadenomegalia (n=11), hepato e/ou esplenomegalia (n=10), desnutriçäo (n=9), palidez (n=8), cianose (n=5) e baqueteamento digital (n=2). Os achados radiológicos mais comuns foram infiltrados difusos (n=6) e condensaçöes (n=5). As alteraçöes histológicas pulmonares foram compatíveis com pneumonia pelo citomegalovírus (n=9), por bactérias (n=8), por Pneumocystis carinii (n=3), por Hystoplasma capsulatum (n=1), por Toxoplasma gondii (n=1) e pneumonia intersticial linfocítica (n=1). A associaçäo CMV e bactéria foi observada em seis casos. CONCLUSÖES: Houve predomínio de menores de dois anos, de transmissäo vertical, de quadro clínico inespecífico de doença pulmonar e de infiltrados e condensaçöes à radiografia. Citomegalovírus e bactérias foram os agentes mais comuns, sendo freqüente a sua associaçäo. Pneumonia Intersticial Linfocítica e Pneumonia pelo P. carinii näo foram causas freqüentes de doenças pulmonares

Assuntos

RESUMO

OBJECTIVE: To present a case of acute appendicitis in a premature infant. METHODS: Retrospective review of the literature using Medline and Lilacs databases, as well as the necropsy report. CLINICAL REPORT: A white male preterm infant born at 34 weeks of gestation weighing 1,750g to a primiparous mother. The Apgar score was 4 and 8 at 1st and 5th minutes, respectively. The physical exam was normal until the 9th day of life when the child developed clinical features suggestive of acute abdomen, possibly due to necrotizing enterocolitis with perforation. He was submitted to exploratory laparotomy, which leaded to the diagnostic of acute appendicitis. CONCLUSION: Acute appendicitis must be discarded on the differential diagnostic when there is a suspicion of necrotizing enterocolitis with perforation, and risk factors are not present.

RESUMO

PURPOSE: To report the result of patients treated with IV methylprednisolone divided into three groups and compare their follow-up during the last 12 years. METHODS: Seventy children with active rheumatic carditis (76 episodes) in heart failure Class III and IV (NYHA) were studied. The diagnosis was based on modified Jones' criteria. After ruling out infections and strongyloidiasis, treatment with IV methylprednisolone bolus was started three times a week until the laboratory tests became negative. Patients were divided into 3 groups, according to the time of hospital admittance: Groups 1, 2 and 3, comprising of 40, 18 and 12 children, respectively. RESULTS: Eighteen children in Group 1 (45%) were in their 1st attack: 2 series of pulsetherapy were used in 10 (25%), 3 in 9 (23%) and 4 in 21 (52%). In Group 2, 14 cases (77%) were in their 1st attack: 2 series were used in 7 (39%), 4 in 9 (50%) and 5 in 2 (11%). The echocardiogram showed a flail mitral valve in 12 (66%) of these patients (1 death occurred after mitral valvoplasty). In Group 3, 6 patients needed 5 or more series of pulsetherapy and a flail mitral valve was present in 5 (41%). One child underwent mitral valve replacement while still in the active phase, after 8 series of pulsetherapy, and another died. The number of patients who needed 5 or more series was significantly higher in Group 3. CONCLUSION: There were variations in the presentation and evolution of the cases during these 12 year. The established pulsetherapy protocol continues to be useful to treat severe cases.

Assuntos

RESUMO

PURPOSE: To evaluate the severity of cardiac complications of neonatal asphyxia in relation to the length and degree of hypoxia. METHODS: Ninety babies with an Apgar score < or = 6 were examined in the intensive care unit at our institution during seven years. Arterial blood for measuring pH, glucose, LDH and MB fraction of CK, together with serial electrocardiogram (ECG), echocardiogram and chest X rays was obtained. The fatal cases were studied with macro and microscopic examination. RESULTS: From a total of 90 cases, 73 were premature: 30 (41%) appropriate for gestation age (AGA) and 43 (59%) small for gestation age (SGA). Twenty one (23%) cases had arterial pH < 7.2. The most common clinical conditions were: pneumonia 28 (31%), anemia 24 (26%) and jaundice 12 (13%). The main cardiological findings were: systolic murmur in 46 (50%), signs of heart hypertrophy in 18 (20%) and heart failure in 8 (9%). On ECG the main findings were ST and T abnormalities. The echocardiogram showed a patent ductus arteriosus (PDA) in 20 (22%), tricuspid regurgitation in 6 (7%), pulmonary hypertension in 6 (7%), dyskinesia and ventricular dilatation in 4 (5%). Necropsy was performed in 23 cases and macro and microscopy obtained in 14; the most frequent findings were: myocite necrosis in 8 (54%), congestion, vacuolization and loss of striae in 4 (29%). CONCLUSION: In the majority of cases, patients had a benign course, even those presenting with severe acidemia. Many abnormal EKGs and echocardiograms became normal after a few weeks. Among those who had a fatal outcome, the severity of histological lesions was observed in babies who had suffered asphyxia for more prolonged periods.

Assuntos

RESUMO

PURPOSE: To describe the cardiac findings in children with AIDS, the follow-up with treatment and the correlation between clinical and pathological features. METHODS: We studied prospectively 25 children with clinical-laboratorial diagnosis of AIDS, ages between 3 months and 11 years, even those without cardiac symptoms. We classified the signs of AIDS following that of CDC-Atlanta 1994. Eight children died and it was done necropsy in six with macro and microscopic examinations. RESULTS: Fifteen cases had already complications of AIDS and were classified as C2 and C3, 5 as B2, 3 B1 and 2 as A1. Beside the symptoms related to the disease and infections we found signs of congestive heart failure III and IV (NYHA) in 5 children, pericardial effusion in 5, (one of them had cardiac tamponade). In the electrocardiogram (EKG), 8 children had repolarization abnormalities. In 1st echocardiogram (ECHO) we found some features of dilated myocardiopathy in 8 (6 were asymptomatic) 5 of those had pericardial effusion, one child had huge amount of pericardial liquid and also increased measures of intraventricular septum and posterior wall of left ventricle by ECHO and confirmed by necropsy examination. All cases of diagnosis of myocardiopathy received treatment with captopril and 4 also received furosemide and digoxina. Even under oral treatment three of them had deterioration of heart failure but after combined anti-retroviral drugs they showed better cardiac functions. From the six necropsied cases, two had increased heart weight without myocarditis, one had toxoplasma pancarditis and other one had fibrocalcic vasculopathy. CONCLUSION: We found several assymptomatic cases already with decreased ventricular function. Some worsened of heart failure even under apropriate treatment and showed better cardiac index after combined anti-retroviral drugs.

Assuntos

RESUMO

The authors report and discuss the case of an infant bearer of Epidermolysis Bullosa who was affected by acquired Cytomegalovirus infection.

RESUMO

Foram estudadas vinte grávidas hansenianas do ponto de vista clínico [oito lepromatosas (L), sete borderline, quatro tuberculóide (T) e uma indeterminada (I)] e avaliados seus recém-nascidos. Três pacientes apresentaram os primeiros sintomas da doença durante uma das gestaçöes e outra no puerpério. Uma paciente teve a doença durante 16 anos e outra recebeu tratamento durante 14. O exame bacterioscópico foi positivo em 13 e negativo em sete. O teste de Mitsuda foi negativo em 16, positivo em duas, e em outras duas näo foi realizado. O esquema terapêutico em 14 pacientes foi poliquimioterapia (diaminodifenilsufona, rifampicina e clofazimina), a monoterapia (diaminodifenilsufona) foi realizada em três e nenhuma delas mostrou resistência a droga. Outras três só iniciaram o tratamento após o parto. Os estados reacionais foram tratados com corticosteróide e ácido acetilsalicítico. O uso de drogas foi realizado de modo irregular em nove pacientes e em oito regularmente. Em dez pacientes, observaram-se surtos reacionais: oito durante a gestaçäo, uma no puerpério e outra na lactaçäo. Oito apresentaram quadro de eritema nodoso leproso e duas reaçäo reversa, sendo que uma delas desenvolveu neurite ulnar no 2§ mês de gestaçäo. Uma paciente mostrou sorologia positiva para sífilis sem manifestaçöes clínicas da doença. Outra apresentou baciloscopia positiva durante a lactaçäo. Um recém-nato apresentou quadro de dermatite esfoliativa nas primeiras horas de vida e sua mäe tinha recebido diaminodifenilsufona durante a gravidez. Entre os 20 recém-natos, cinco tinham peso inferior a 2.500g e quatro eram prematuros. Nós concluímos que os estados reacionais das pacientes, o baixo peso e a prematuridade dos recém-natos ocorreram nas grávidas do grupo de lepromatosas e borderline

Assuntos

RESUMO

UNLABELLED: We followed 20 cases of pregnant women with leprosy: eight lepromatous (L), seven "borderline", four turbeculoid and only one indeterminate (I) and their newborns. Three patients showed the first symptoms during pregnancy and another one in postpartum. One patient was sick during sixteen years and another one was treated during fourteen years. The bacterioscopic examination was positive in thirteen and negative in seven patients. The Mitsuda test was negative in sixteen, positive in two and in two others was not performed. The treatment in fourteen patients was polychimiotherapy (diamino diphenylsulfone, rifampicin and clofazimine). Three patients received dapsone monotherapy. Three women started the treatment postpartum. Reactions states were treated with corticosteroids and acetylsalicylic acid. The therapy was Irregular in nine and Regular in eight cases. Ten patients showed reactions: eight during pregnancy, one in puerperium and one in the lactation period. Eight showed erythema nodosum leprosum and two reversal reaction. One patient showed false positive biologic test for syphilis and another one had positive bacterioscopic examination in the lactation period. One patient showed false positive biologic test for syphilis and another had positive bacterioscopic examination in the lactation period. One newborn showed exfoliative dermatitis in the first hours of life and his mother had used sulfone during pregnancy. Among the twenty babies five had less than 2,500g in weight and four were premature. CONCLUSION: The reaction states of patients and low birth weight of premature babies occurred in lepromatous and "borderline" cases.

Assuntos