RESUMO
Introducción: El derrame pleural paraneumónico resulta la complicación más frecuente de la neumonía bacteriana, de manejo complejo y muchas veces quirúrgico. No existen publicaciones en Cuba provenientes de ensayos clínicos controlados y aleatorizados ni del uso de la estreptoquinasa recombinante (Heberkinasa®) en el derrame pleural. Objetivo: Evaluar la eficacia y la seguridad de la Heberkinasa® en el tratamiento del derrame pleural paraneumónico complicado complejo y el empiema en niños. Métodos: Ensayo clínico fase III, abierto, aleatorizado (2:1), en grupos paralelos y controlado. Se concluyó la inclusión prevista de 48 niños (1-18 años de edad), que cumplieron los criterios de selección. Los progenitores otorgaron el consentimiento informado. Los pacientes se distribuyeron en dos grupos: I- experimental: terapia estándar y administración intrapleural diaria de 200 000 UI de Heberkinasa® durante 3-5 días y II-control: tratamiento estándar. Las variables principales: necesidad de cirugía y la estadía hospitalaria. Se evaluaron los eventos adversos. Resultados: Ningún paciente del grupo I-experimental requirió cirugía, a diferencia del grupo II-control en el que 37,5 por ciento necesitó cirugía video-toracoscópica, con diferencia altamente significativa. Se redujo la estadía hospitalaria (en cuatro días), las complicaciones intratorácicas y las infecciones asociadas a la asistencia sanitaria en el grupo que recibió Heberkinasa®. No se presentaron eventos adversos graves atribuibles al producto. Conclusiones: La Heberkinasa® en el derrame pleural paraneumónico complicado complejo y empiema resultó eficaz y segura para la evacuación del foco séptico, con reducción de la necesidad de tratamiento quirúrgico, de la estadía hospitalaria y de las complicaciones, sin eventos adversos relacionados con su administración(AU)
Introduction: Paraneumonic pleural effusion is the most frequent complication of bacterial pneumonia, with complex and often surgical management. There are no publications in Cuba from randomized controlled clinical trials or the use of recombinant streptokinase (Heberkinase®) in pleural effusion. Objective: To evaluate the efficacy and safety of Heberkinase® in the treatment of complex complicated parapneumonic pleural effusion and empyema in children. Methods: Phase III, open-label, randomized (2:1), parallel-group, controlled clinical trial. The planned inclusion of 48 children (1-18 years of age), who met the selection criteria, was completed. Parents gave informed consent. The patients were divided into two groups: I-experimental: standard therapy and daily intrapleural administration of 200,000 IU of Heberkinase® for 3-5 days; and II-control: standard treatment. The main variables: need for surgery and hospital stay. Adverse events were evaluated. Results: No patient in group I-experimental required surgery, unlike group II-control in which 37.5 percent required video-assisted thoracoscopic surgery, with a highly significant difference. Hospital stay (to 4 days), intrathoracic complications and infections associated to healthcare in the group that received Heberkinase® was reduced. No serious adverse events attributable to the product occurred. Conclusions: Heberkinase® in complex complicated parapneumonic pleural effusion and empyema was effective and safe for the draining of the septic focus, with reduction of the need for surgical treatment, hospital stay and complications, with no adverse events related to its administration(AU)
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Derrame Pleural/complicações , Pneumonia/complicações , Estreptoquinase/uso terapêutico , Resultado do Tratamento , Empiema Pleural/tratamento farmacológico , Pneumonia Bacteriana/etiologia , Unidades de Terapia Intensiva Pediátrica , Ensaio Clínico Controlado Aleatório , Ensaio Clínico Fase IIIRESUMO
BACKGROUND: Melioidosis is an infectious disease caused by Burkholderia pseudomallei. In Mexico, the disease is rarely diagnosed in humans and there is no evidence of simultaneous environmental isolation of the pathogen. Here, we describe clinical profiles of fatal cases of melioidosis in two children, in a region without history of that disease. CASE PRESENTATION: About 48 h before onset of symptoms, patients swam in a natural body of water, and thereafter they rapidly developed fatal septicemic illness. Upon necropsy, samples from liver, spleen, lung, cerebrospinal fluid, and bronchial aspirate tissues contained Burkholderia pseudomallei. Environmental samples collected from the locations where the children swam also contained B. pseudomallei. All the clinical and environmental strains showed the same BOX-PCR pattern, suggesting that infection originated from the area where the patients were swimming. CONCLUSIONS: The identification of B. pseudomallei confirmed that melioidosis disease exists in Sonora, Mexico. The presence of B. pseudomallei in the environment may suggest endemicity of the pathogen in the region. This study highlights the importance of strengthening laboratory capacity to prevent and control future melioidosis cases.
Assuntos
Melioidose/complicações , Pneumonia Bacteriana/etiologia , Adolescente , Burkholderia pseudomallei/isolamento & purificação , Criança , Evolução Fatal , Feminino , Humanos , Masculino , Melioidose/diagnóstico , Melioidose/patologia , Melioidose/fisiopatologia , México , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/patologia , Pneumonia Bacteriana/fisiopatologia , Sepse/microbiologia , NataçãoRESUMO
RESUMEN Rhodococcus equi es un microorganismo emergente asociado a infecciones oportunistas en individuos inmunocomprometidos, especialmente en pacientes con infección por virus de inmunodeficiencia humana. Se desarrolló una búsqueda en la Biblioteca Virtual de Infomed, fueron revisados 215 trabajos científicos sin limitación de año y país, seleccionándose 55. El rhodococcus es un patógeno intracelular capaz de crecer y persistir dentro de los macrófagos que expresan en su superficie el receptor Mac-1 (CD11b/CC18), y posteriormente destruirlos. La manifestación clínica más frecuente es la neumonía de comienzo insidioso y en su evolución natural tiende a la cavitación. El diagnóstico se realiza mediante su identificación en cultivo de muestras de tejido afectado. Los hemocultivos son positivos en el 50% de los inmunodeprimidos En el diagnóstico radiográfico, los hallazgos más comunes referidos en la literatura científica son el compromiso lobar y la cavitación. La particular evolución que experimentan los pacientes con síndrome de inmunodeficiencia adquirida y neumonía por R. equi, obliga a implementar esquemas terapéuticos basados en antimicrobianos con actividad bactericida intracelular, administrados inicialmente por vía intravenosa y durante un tiempo prolongado e incluso la cirugía. La infección por R. equi es una complicación infrecuente en pacientes con síndrome de inmunodeficiencia adquirida, pero con una elevada tasa de letalidad, por lo que debe ser sospechado en pacientes que presenten una infección respiratoria de curso inhabitual. El diagnóstico precoz, el tratamiento antimicrobiano combinado y prolongado y el inicio de la Terapia Antiretroviral de Gran Actividad en forma temprana pueden mejorar la evolución y el pronóstico de estos pacientes.
ABSTRACT Rhodococcus equi is an emergent microorganism associated to opportunistic infections in immune-compromised individuals, especially in patients infected with the human immunodeficiency virus. A search was carried out in the Virtual Library of Infomed; 215 scientific works were reviewed without limits of publication years and countries. From them, 55 were chosen. Rhodococcus equi is an intracellular pathogen that is able to grow and live inside the macrophages expressing the Mac-1 (CD11b/CC18) receptor in the surface and destroying them later. The most common clinical manifestation is insidious beginning pneumonia, tending to cavitation in its natural evolution. The diagnosis is made through identification in culture of affected tissues samples. Blood cultures are positive in 50 % of the immune-depressed people. At the radiographic diagnosis, the most common findings referred to in the scientific literature are lobar compromise and cavitation. The particular evolution of the patients with acquired immune-deficiency syndrome and pneumonia due to Rhodococcus equi forces the implementation of therapeutic schemes based on antimicrobials with intracellular bactericide activity, administered firstly intravenously and during a long time, and even to perform the surgery. Rhodococcus equi infection is an infrequent complication in patients with acquired immunodeficiency syndrome, but having a high lethality rate, therefore it should be suspected in patients presenting a respiratory infection of unusual curse. The precocious diagnosis, combined and prolonged antimicrobial treatment and early beginning of the highly active antiretroviral therapy could improve the evolution and prognosis of these patients.
Assuntos
Humanos , Infecções por HIV/complicações , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/tratamento farmacológico , Antirretrovirais/uso terapêutico , Infecções por Actinomycetales/diagnóstico , Rhodococcus equi/patogenicidade , Pneumonia Bacteriana/etiologiaAssuntos
Ectima/etiologia , Neoplasias do Mediastino/diagnóstico por imagem , Doenças Nasais/etiologia , Infecções Oportunistas/etiologia , Pneumonia Bacteriana/diagnóstico por imagem , Infecções por Pseudomonas/diagnóstico por imagem , Sarcoma Sinovial/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Colite Ulcerativa/complicações , Colite Ulcerativa/tratamento farmacológico , Ectima/patologia , Evolução Fatal , Gangrena , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Masculino , Neoplasias do Mediastino/complicações , Mesalamina/efeitos adversos , Mesalamina/uso terapêutico , Necrose , Doenças Nasais/microbiologia , Doenças Nasais/patologia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologia , Pneumonia Bacteriana/etiologia , Infecções por Pseudomonas/etiologia , Infecções por Pseudomonas/patologia , Sarcoma Sinovial/complicações , Choque Séptico/etiologiaRESUMO
Patients with infantile spasms, an intractable epileptic disorder, often are treated with adrenocorticotropic hormone. Legionella pneumophila is a rare cause of pneumonia in children. We describe 2 infants with Legionella pneumonia whose infection occurred within 1 month after starting adrenocorticotropic hormone.
Assuntos
Hormônio Adrenocorticotrópico/efeitos adversos , Hormônios/efeitos adversos , Legionella pneumophila , Doença dos Legionários/diagnóstico , Doença dos Legionários/etiologia , Pneumonia Bacteriana/diagnóstico , Feminino , Humanos , Lactente , Doença dos Legionários/terapia , Masculino , Pneumonia Bacteriana/etiologia , Pneumonia Bacteriana/terapia , Espasmos Infantis/tratamento farmacológicoRESUMO
The aim of this study was to determine the effect of ingestion of pasteurized and subsequently frozen-thawed pooled colostrum (≥50 mg Ig/mL) with different bacterial counts and immunoglobulin concentration (IgC) on the occurrence of diarrhea and pneumonia in 306 neonatal Holstein calves in a hot environment. Calves were assigned to be fed colostrum with total bacterial counts (TBC) lower or greater than 100 000 colony-forming units (cfu)/mL, total coliform counts (TCC) greater or lower than 10 000 cfu/mL, and IgC lower or higher than 85 mg Ig/mL. Calves fed colostrum with TBC ≥100 000 cfu/mL were more likely (risk ratio 1.34, confidence interval 1.05-1.71; P < 0.05) to present pneumonia than calves receiving colostrum with lower TBC (incidence 53.2 vs. 39.8%). Calves fed colostrum with high TCC had increased chances of suffering pneumonia (51.4 vs. 42.1%; P < 0.05) than calves fed colostrum with lower TCC. Calves fed colostrum with ≥85 mg Ig/mL tended to present higher daily weight gain (505 ± 113 vs. 484 ± 126 g; P = 0.09). TBC and TCC in colostrum did not influence the incidence rate of diarrhea. It was concluded that under the conditions of the present study, heavy contamination of on-farm pasteurized frozen-thawed colostrum is seemingly unavoidable and this contamination poses a threat for pneumonia, but not for diarrhea.
Assuntos
Ração Animal/microbiologia , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/etiologia , Bovinos/crescimento & desenvolvimento , Bovinos/imunologia , Colostro , Diarreia/epidemiologia , Diarreia/veterinária , Dieta/veterinária , Exposição Ambiental/efeitos adversos , Contaminação de Alimentos , Temperatura Alta/efeitos adversos , Imunoglobulina G , Pneumonia Bacteriana/veterinária , Animais , Animais Recém-Nascidos , Carga Bacteriana , Colostro/imunologia , Colostro/microbiologia , Diarreia/etiologia , Feminino , Congelamento , Incidência , Masculino , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/etiologia , Aumento de PesoRESUMO
Se reporta un caso de bacteriemia recurrente por Bordetella bronchiseptica en un paciente inmunocomprometido con antecedentes de trasplante alogénico de medula ósea por síndrome mielodisplásico, quien ingresó al hospital por síndrome febril. Bordetella bronchiseptica es un agente patógeno veterinario poco común en humanos que afecta principalmente a pacientes inmunocomprometidos y es causa poco frecuente de bacteriemia.
We report a case of recurrent bacteraemia caused by Bordetella bronchiseptica in an immunocompromised patient with a history of allogenic bone marrow transplantation for myelodysplastic syndrome, who was admitted to hospital with febrile syndrome. Bordetella bronchiseptica is an uncommon human pathogen which mainly affects immunocompromised patients, being a rare cause of bacteraemia.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Bordetella/microbiologia , Infecções Oportunistas/microbiologia , Transplante de Medula Óssea , Bordetella bronchiseptica/isolamento & purificação , Bacteriemia/microbiologia , Recidiva , Síndromes Mielodisplásicas/terapia , Infecções por Bordetella/etiologia , Infecções Oportunistas/etiologia , Hospedeiro Imunocomprometido , Bordetella bronchiseptica/efeitos dos fármacos , Bacteriemia/etiologia , Pneumonia Bacteriana/etiologia , Pneumonia Bacteriana/microbiologia , Farmacorresistência Bacteriana Múltipla , Aloenxertos , Gastroenterite/etiologia , Gastroenterite/microbiologia , Doença Enxerto-Hospedeiro/tratamento farmacológico , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêuticoRESUMO
A northern Gulf of Mexico (GoM) cetacean unusual mortality event (UME) involving primarily bottlenose dolphins (Tursiops truncatus) in Louisiana, Mississippi, and Alabama began in February 2010 and continued into 2014. Overlapping in time and space with this UME was the Deepwater Horizon (DWH) oil spill, which was proposed as a contributing cause of adrenal disease, lung disease, and poor health in live dolphins examined during 2011 in Barataria Bay, Louisiana. To assess potential contributing factors and causes of deaths for stranded UME dolphins from June 2010 through December 2012, lung and adrenal gland tissues were histologically evaluated from 46 fresh dead non-perinatal carcasses that stranded in Louisiana (including 22 from Barataria Bay), Mississippi, and Alabama. UME dolphins were tested for evidence of biotoxicosis, morbillivirus infection, and brucellosis. Results were compared to up to 106 fresh dead stranded dolphins from outside the UME area or prior to the DWH spill. UME dolphins were more likely to have primary bacterial pneumonia (22% compared to 2% in non-UME dolphins, P = .003) and thin adrenal cortices (33% compared to 7% in non-UME dolphins, P = .003). In 70% of UME dolphins with primary bacterial pneumonia, the condition either caused or contributed significantly to death. Brucellosis and morbillivirus infections were detected in 7% and 11% of UME dolphins, respectively, and biotoxin levels were low or below the detection limit, indicating that these were not primary causes of the current UME. The rare, life-threatening, and chronic adrenal gland and lung diseases identified in stranded UME dolphins are consistent with exposure to petroleum compounds as seen in other mammals. Exposure of dolphins to elevated petroleum compounds present in coastal GoM waters during and after the DWH oil spill is proposed as a cause of adrenal and lung disease and as a contributor to increased dolphin deaths.
Assuntos
Doenças das Glândulas Suprarrenais/mortalidade , Glândulas Suprarrenais/patologia , Golfinho Nariz-de-Garrafa , Brucelose/mortalidade , Pulmão/patologia , Poluição por Petróleo/efeitos adversos , Pneumonia Bacteriana/mortalidade , Doenças das Glândulas Suprarrenais/etiologia , Doenças das Glândulas Suprarrenais/patologia , Animais , Golfinho Nariz-de-Garrafa/microbiologia , Golfinho Nariz-de-Garrafa/virologia , Brucelose/etiologia , Brucelose/microbiologia , Brucelose/patologia , Feminino , Golfo do México , Louisiana , Masculino , Infecções por Morbillivirus/etiologia , Infecções por Morbillivirus/mortalidade , Infecções por Morbillivirus/patologia , Infecções por Morbillivirus/virologia , Mortalidade , Pneumonia Bacteriana/etiologia , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/patologiaRESUMO
We report a case of recurrent bacteraemia caused by Bordetella bronchiseptica in an immunocompromised patient with a history of allogenic bone marrow transplantation for myelodysplastic syndrome, who was admitted to hospital with febrile syndrome. Bordetella bronchiseptica is an uncommon human pathogen which mainly affects immunocompromised patients, being a rare cause of bacteraemia.