Prevalence and clinical aspects of respiratory syncytial virus A and B groups in children seen at Hospital de Clínicas of Uberlândia, MG, Brazil.

Respiratory syncytial virus (RSV) is well recognized as the most important pathogen causing acute respiratory disease in infants and young children, mainly in the form of bronchiolitis and pneumonia. Two major antigenic groups, A and B, have been identified; however, there is disagreement about the severity of the diseases caused by these two types. This study investigated a possible association between RSV groups and severity of disease. Reverse transcription-polymerase chain reaction was used to characterize 128 RSV nasopharyngeal specimens from children less than five years old experiencing acute respiratory disease. A total of 82 of 128 samples (64.1%) could be typed, and, of these, 78% were group A, and 22% were group B. Severity was measured by clinical evaluation associated with demographic factors: for RSV A-infected patients, 53.1% were hospitalized, whereas for RSV B patients, 27.8% were hospitalized (p = 0.07). Around 35.0% of the patients presented risk factors for severity (e.g., prematurity). For those without risk factors, the hospitalization occurred in 47.6% of patients infected with RSV A and in 18.2% infected with RSV B. There was a trend for RSV B infections to be milder than those of RSV A. Even though RSV A-infected patients, including cases without underlying condition and prematurity, were more likely to require hospitalization than those infected by RSV B, the disease severity could not to be attributed to the RSV groups.

Measles vaccination: influence of age on its efficacy.

The authors compare the serologic efficacy and the clinical protection afforded by three different measles vaccination schemes in adequately nourished children in São Paulo city, Brazil. Two hundred forty two children were divided into three groups. Group A, comprising 117 children who had received the vaccine before 12 months of age and a second dose at 12 months of age or more. Group B, comprising 46 children who had received only one dose, before 12 months of age. Group C, comprising 79 children who had received only one dose, at 12 months of age or more. The geometric mean titer of antibodies in Group A was 790.1; in Group B, 251.1; and in Group C, 550.3. There was no statistically significant difference between Groups A and C. The exposure to the measles virus was probably similar in all groups, and the children in Group A and C had similar chances of acquiring the disease after vaccination whereas in Group B the chances were higher when compared to the other two groups. The results obtained in this study favor the use, in developing countries, of a vaccination program against measles that includes an early first dose at eight months of age and revaccination after 12 months of age.

Respiratory viruses in children younger than five years old with acute respiratory disease from 2001 to 2004 in Uberlândia, MG, Brazil.

The main viruses involved in acute respiratory diseases among children are: respiratory syncytial virus (RSV), influenzavirus (FLU), parainfluenzavirus (PIV), adenovirus (AdV), human rhinovirus (HRV), and the human metapneumovirus (hMPV). The purpose of the present study was to identify respiratory viruses that affected children younger than five years old in Uberlândia, Midwestern Brazil. Nasopharyngeal aspirates from 379 children attended at Hospital de Clínicas (HC/UFU), from 2001 to 2004, with acute respiratory disease, were collected and tested by immunofluorescence assay (IFA) to detect RSV, FLU A and B, PIV 1, 2, and 3 and AdV, and RT-PCR to detect HRV. RSV was detected in 26.4% (100/379) of samples, FLU A and B in 9.5% (36/379), PIV 1, 2 and 3 in 6.3% (24/379) and AdV in 3.7% (14/379). HRV were detected in 29.6% (112/379) of the negative and indeterminate samples tested by IFI. RSV, particularly among children less than six months of life, and HRV cases showed highest incidence. Negative samples by both IFA and RT-PCR might reflect the presence of other pathogens, such as hMPV, coronavirus, and bacteria. Laboratorial diagnosis constituted an essential instrument to determine the incidence of the most common viruses in respiratory infections among children in this region.

[Penicillin-resistant pneumococcus: practical implications] / Pneumococo resistente à penicilina: implicações práticas.

OBJECTIVE: To review epidemiological, laboratorial and clinical aspects of the penicillin-resistant pneumococcus, and to consider the impact of the rapidly increasing drug-resistance on the management of the main infections caused by these pathogens. METHODS: Bibliographic review covering the last ten years, using both Medline system and direct research. RESULTS AND CONCLUSIONS: The Streptococcus pneumoniae is an important agent in acute otitis media, pneumonia and meningitis in children. The clinical evaluation of the pneumococcal infections depends on the age and health condition of the patient, site and severity of the infection and the adequacy of the treatment. Penicillin was uniformly effective against pneumococcus until three decades ago, when the first reports of clinical resistance were published. Since then, there has been a rapidly increasing in the level and rates of resistance to penicillin, which parallels to others beta lactams and antimicrobials. This paper includes a suscint review of the genetic and phenotypic mechanisms of the resistance to penicillin, the available bacteriologic tests for determination of in vitro susceptibility to antimicrobials and finally the importance of the pneumococcus in acute otitis media, pneumonia/bacteremia and meningitis. There has been new empirical therapeutic regimens recommended for meningitis, according to the community rates and levels of resistance to beta lactams and to the presence of certain underlying conditions among the patients, such as immunedepressant diseases and frequent antibiotic consumption. The rapidly increasing prevalence of drug-resistant strains emphasizes the importance of judicious antibiotic use and the development of a conjugate vaccine, effective to prevent invasive infections and to reduce the rate of carriage of the pneumococcus, even among infants.

Neurocysticercosis in Brazilian children: report of 10 cases.

In a 6-year period, ten cases of neurocysticercosis were diagnosed in children with ages ranging from 4 to 13 years, in a Brazilian teaching hospital. Most of the children presented epilepsy and/or raised intracranial pressure, but meningoencephalitis and psychotic reactions were also observed. The cerebrospinal fluid (CSF) cell count ranged from 1 to 52 cells per mm3, with pleocytosis in 6 cases, mostly by lymphocytes and eosinophils. Antibodies to Cysticercus cellulosae were detected in the CSF in all cases. A cranial radiograph was abnormal in 5 out of 6 cases, and a computed tomographic (CT) scan in 4 out of 8 cases. Stool examination was positive for ova and/or proglottids of Taenia sp in 4 out of the 10 cases. Seven patients were treated with either praziquantel or albendazole plus dexamethasone; there were no important side effects, and surgical treatment was required in no case. Neurocysticercosis must be included in the differential diagnosis of seizures, raised intracranial pressure, meningitis and psychotic reactions in children living in or having travelled to the tropics. The diagnosis can be suspected by the presence of eosinophils in the CSF, and confirmed by imaging methods such as CT scans and by immunological tests in the CSF.

Prevalence and clinical aspects of respiratory syncytial virus A and B groups in children seen at Hospital de Clínicas of Uberlândia, MG, Brazil

Respiratory syncytial virus (RSV) is well recognized as the most important pathogen causing acute respiratory disease in infants and young children, mainly in the form of bronchiolitis and pneumonia. Two major antigenic groups, A and B, have been identified; however, there is disagreement about the severity of the diseases caused by these two types. This study investigated a possible association between RSV groups and severity of disease. Reverse transcription-polymerase chain reaction was used to characterize 128 RSV nasopharyngeal specimens from children less than five years old experiencing acute respiratory disease. A total of 82 of 128 samples (64.1 percent) could be typed, and, of these, 78 percent were group A, and 22 percent were group B. Severity was measured by clinical evaluation associated with demographic factors: for RSV A-infected patients, 53.1 percent were hospitalized, whereas for RSV B patients, 27.8 percent were hospitalized (p = 0.07). Around 35.0 percent of the patients presented risk factors for severity (e.g., prematurity). For those without risk factors, the hospitalization occurred in 47.6 percent of patients infected with RSV A and in 18.2 percent infected with RSV B. There was a trend for RSV B infections to be milder than those of RSV A. Even though RSV A-infected patients, including cases without underlying condition and prematurity, were more likely to require hospitalization than those infected by RSV B, the disease severity could not to be attributed to the RSV groups.