Meningite bacteriana: uma revisão / Bacterial meningitis: a review

A meningite bacteriana é uma inflamação das leptomeninges que envolvem o Sistema Nervoso Central. Essa patologia, que possui diversos agentes etiológicos, apresenta-se na forma de síndrome, com quadro clínico grave. Entre as principais bactérias que causam a meningite, estão a Neisseria meningitis e Streptococcus pneumoniae. A transmissão ocorre através das vias aéreas por meio de gotículas, sendo a corrente sanguínea a principal rota para as bactérias chegarem à barreira hematoencefálica e, a partir dessa, até as meninges. Atualmente existem vários métodos de diagnóstico precisos, onde a cultura de líquido cefalorraquidiano (LCR) é o método padrão ouro. Ademais, a melhora na qualidade do tratamento com beta-lactâmicos e a maior possibilidade de prevenção, devido à elevação do número e da eficácia de vacinas, vem contribuindo para redução dos casos da doença e de sua gravidade. Porém, apesar desses avanços, ainda há um elevado número de mortalidades e sequelas causadas por essa síndrome.

Bacterial meningitis is an inflammation of the leptomeninges that surround the Central Nervous System. This pathology, which has several etiological agents, is presented as a syndrome with a severe clinical scenario. The main bacteria causing meningitis include Neisseria meningitis and Streptococcus pneumoniae. It can be transmitted by droplets through the airways, with the bacteria using the bloodstream as the main route to reach the blood-brain barrier, and from there to the meninges. There are currently several accurate diagnostic methods, with CSF culture being the gold standard. In addition, the improvement in the quality of beta-lactam treatment and the greater possibility of prevention due to the increased number and effectiveness of vaccines have contributed to reducing the number of cases and severity of the disease. Nevertheless, despite these advances, this syndrome still presents a high number of mortalities and sequelae.

Epidemiología de las meningitis bacterianas en niños en un hospital pediátrico: 2011-2016 / Epidemiology of bacterial meningitis in children at a pediatric hospital: 2011-2016

Introducción: Las meningitis bacterianas en niños son causa de importante morbimortalidad. Los principales agentes etiológicos son Neisseria meningitidis, Streptococcus pneumoniae y Haemophilus influenzae. En los últimos años, luego de la introducción sucesiva de vacunas conjugadas al calendario nacional de inmunizaciones, se ha visto un cambio en la epidemiología de estas infecciones. Objetivo: Describir las características clínicas, epidemiológicas y evolutivas de los niños hospitalizados con meningitis bacteriana confirmada microbiológicamente entre 2011 y 2016 en un hospital de tercer nivel de complejidad. Materiales y métodos: Cohorte retrospectiva. Se incluyeron niños entre 1 mes de vida y 17 años con cuadro clínico compatible con meningitis bacteriana y cultivo positivo y/o PCR en líquido cefalorraquídeo y/o hemocultivos positivos para Neisseria meningitidis, Streptococcus pneumoniae y Haemophilus influenzae b. Se registraron las características demográficas, clínicas y evolutivas hasta los 30 días del egreso. Se utilizó mediana y rango intercuartilo (RIC) para variables continuas y porcentaje para variables categóricas. Se utilizó Stata 10. Resultados: n=65. Edad: mediana de 9 meses (RIC 4-35). Varones: 58% (n=38). Se identificó Neisseria meningitidis en un 48% (n=31), Haemophilus influenzae b en un 26% (n=17) y Streptococcus pneumoniae en un 26% (n=17). El 26% (n=17) de los pacientes presentaba alguna comorbilidad. Tuvieron hemocultivos positivos el 62% (n = 40) de los pacientes y 86% (n=55) de los líquidos cefalorraquídeos. Todos los pacientes recibieron tratamiento antimicrobiano con ceftriaxona tanto como tratamiento empírico como definitivo y 92% (n=60) recibieron corticoides empíricos. La mediana de días de internación fue de 11 (RIC 8-17). El 28% (n=18) requirió cuidados intensivos, y el 8% (n=5) falleció. Durante el período de estudio se observó que la frecuencia de meningitis por Streptococcus pneumoniae disminuyó en el final del estudio (9% en 2016 vs 60% en 2011), mientras que la frecuencia de meningitis por Neisseria meningitidis en 2016 fue mayor que al inicio del período (64% en 2016 vs. 40% en 2011). La frecuencia de identificación de Haemophilus influenzae b se mantuvo estable. Conclusiones: Las meningitis bacterianas confirmadas por Neisseria meningitidis, Streptococcus pneumoniae y Haemophilus influenzae b prevalecieron en niños menores de 12 meses. En esta cohorte se observó un predominio de las infecciones por Neisseria meningitidis en los últimos años, y una disminución en la frecuencia de meningitis por Streptococcus pneumoniae en el período post introducción de la vacuna conjugada 13 valente al calendario nacional de inmunizaciones. (AU)

Introduction: In children, bacterial meningitis is an important cause of morbidity and mortality. The main etiological agents are Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Over the last years, the successive introduction of conjugated vaccines in the national immunization calendar has led to a change in the epidemiology of these infections. Objective: To describe the clinical and epidemiological features and outcome of children admitted because of microbiologically confirmed meningitis seen between 2011 and 2016 at a tertiary care hospital. Material and methods: A retrospective cohort study was conducted. Children between 1 month of life and 17 years of age with clinical features compatible with bacterial meningitis and positive cultures and/or PCR in cerebrospinal fluid (CSF) and/or positive blood cultures for Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae b were included. Demographic, clinical, and outcome features were recorded until 30 days after discharge. Median and interquartile range (IQR) were calculated for continuous variables and percentages for categorical variables. The Stata 10 program was used. Results: n=65. Age: median was 9 months (IQR 4-35). Boys: 58% (n=38). Neisseria meningitidis was identified in 48% (n=31), Haemophilus influenzae b in 26% (n=17), and Streptococcus pneumoniae in 26% (n=17). Overall, 26% (n=17) of the patients presented with comorbidities. Positive blood cultures were found in 62% (n = 40) and positive CSF cultures in 86% (n=55) of the patients. All patients received antimicrobial treatment with ceftriaxone both empirically and as final treatment and corticosteroids were empirically started in 92% (n=60). Median hospital stay was 11 days (IQR 8-17). Overall, 28% (n=18) required intensive care and 8% (n=5) of the patients died. The incidence of meningitis due to Streptococcus pneumoniae was observed to diminish at the end of the study period (9% in 2016 vs 60% in 2011), while the incidence of meningitis due to Neisseria meningitidis in 2016 was higher than at the end of the study period (64% in 2016 vs. 40% in 2011). The frequency of identification of Haemophilus influenzae b remained stable. Conclusions: Confirmed bacterial infections due to Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae b were prevalent in infants younger than 12 months of age in this cohort of patients. Infections due to Neisseria meningitidis predominated over the last years and the incidence of meningitis due to Streptococcus pneumoniae diminished after the introduction of the 13 valent conjugated vaccine was introduced in the national immunization calendar.(AU)

The virulence of Streptococcus pneumoniae partially depends on dprA

Abstract Streptococcus pneumoniae is one of the most frequent opportunistic pathogens worldwide. DNA processing protein A (DprA) is an important factor involved in bacterial uptake and DNA integration into bacterial genome, but its role in S. pneumoniae virulence remains unclear. The aim of this study was to characterize the effects of the pneumococcal dprA gene on the pathogenesis of S. pneumoniae. To construct a dprA-deficient pneumococcal strain, the dprA gene of the S. pneumoniae strain D39 was inactivated. The virulence of this dprA-deficient strain, designated ΔD39, was compared with that of the wild-type strain by evaluating their respective capabilities to adhere to human pulmonary epithelial cells (PEC-A549) and by analyzing their choline-binding protein expression levels. In addition, the expression profiles of genes associated with virulence and host survival assays were also conducted with the mutant and the wild-type strain. Our results indicate that the capability of ΔD39 to adhere to the PEC-A549 airway cells was significantly lower (p < 0.01) compared with D39. Additionally, the 100-KD choline-binding protein was not detected in ΔD39. The addition of competence-stimulating peptide (CSP) lead to a significantly reduction of psaA mRNA expression in the dprA-deficient mutant and an increased level of psaA transcripts in the wild-type strain (p < 0.01). The median survival time of mice intraperitoneally infected with ΔD39 was significantly higher (p < 0.01) than that of mice infected with D39. The results of this study suggest that DprA has a significant effect on virulence characteristics of S. pneumoniae by influencing the expression of choline-binding protein and PsaA.

Meningite aguda bacteriana na população infantojuvenil: principais agentes e métodos para diagnóstico - uma revisão da literatura / Acute bacterial meningitis in children and young population: main agents and methods for diagnosis - a literature review

A meningite bacteriana é uma afecção de grande significância devido a sua relação com alta mortalidade e morbidade na população neonatal a jovem. Devido a este fato é importante o conhecimento sobre esta doença e os seus principais agentes etiológicos. Com o objetivo de relatar os principais métodos de diagnóstico, assim como os principais agentes etiológicos envolvidos na fisiopatologia da meningite bacteriana em população jovem foi realizada uma busca por artigos publicados nos últimos 5 anos nas bases de dados Pubmed, Scielo, Bireme e Lilacs. A literatura atual aponta como microrganismos predominantes na incidência dessa doença a N. meningitidis S. pneumoniae, sendo as mais recorrentes na população de faixa etária entre 29 dias e 17 anos. Os fatores relacionados ao prognóstico estão intimamente relacionados com a distinção da classificação do agente etiológico em bacteriano ou viral, importante para a determinação da terapia adequada.

Bacterial meningitis is a highly significant disease due to its relationship with high mortality and morbidity in neonatal and young population. Due to this is important to know about this disease and its main etiological agents. In purpose to report the main diagnostic methods, as well as the main etiological agents involved in the pathophysiology of bacterial meningitis was conducted a search for articles published in the last five years in Pubmed, Scielo, Bireme and Lilacs. The current literature indicates N. meningitidis S. pneumoniae the most predominant microorganisms in the incidence of this disease between population aged between 29 days and 17 years. Factors related to prognosis are closely related to the classification distinction of the etiologic agent in bacterial or viral, important to determine the ap- propriate therapy.

Are Pneumococci resistant to microlides?

Background: Streptococcus pneumoniae is the most common cause of acute community - acquired pneumonia and accounts for 30-40% of lower respiratory tract infections. It accounts also for about 50% of hospital-acquired pneumonia. Macrolides remain the primary antibiotic of choice for physicians treating such infections. Macrolide resistance in Strept. pneumoniae is primarily due to two mechanisms; target site modification [encoded by the erm [B] gene] and efflux pump expulsion [encoded by the mef gene]

Objectives: The aim of this study was to identify the incidence of Strept. pneumoniae among acute and chronic otitis media cases; to perform the antimicrobial sensitivity tests for such isolates, to determine the percentage of Strept. pneumoniae resistant to erythromycin, clarithromycin and azithromycin, to assess the antibiotic susceptibility profile of macrolide-resistant Strept. pneumoniae and lastly to detect the frequency of common macrolide resistant genes [The mefE and ermB genes] among erythromycin resistant Strept. pneumoniae by PCR technique

Methodology: 317 patients suffering from acute or chronic otitis media, attended to pediatric and ENT- Outpatient Clinics at Al- Azhar University Hospital of Assiut, were isolated and tested for Strept. pneumoniae and for antibiotics sensitivity pattern. Resistant strains for erythromycin, clarithromycin and azithromycin were assayed for MIC using E test. PCR for erm[B] and mef[E] resistant determinant genes by multiplex PCR was applied

Results: 78 [24.6%] isolates of Strept. pneumoniae were isolated. Of them 66 and 12 isolates from acute and chronic otitis media respectively. Cefoperazone was the most sensitive drug, followed by Cefotaxime, Azithromycin and Amoxacillin-clavulanate. Tetracyclin was the most resistant drug followed by Clindamycin and Apramycin. The E- test confirmed the results of disc diffusion test. By PCR, 10 [41.7%] isolates have both erm B and mef E genes, while 8 [33.3%] isolates have mef E gene only and 2 [8.3%] isolates showed erm B gene only

Conclusion: There is a high prevalence of erythromycin resistant Strept. pneumoniae. So macrolides cannot be recommended for the treatment of pneumococcal infections without susceptibility testing. Results point to the importance of detection of erm B and mef E genes for epidemiological aspects and to track possible presence of macrolide resistance

The Association between Asthma and Invasive Pneumococcal Disease: A Nationwide Study in Korea

The purpose of this study was to investigate the association between asthma and invasive pneumococcal disease (IPD) in Korea. A retrospective population-based cohort study was conducted using the Korean Health Insurance Review and Assessment database 2010-2011. The subjects included 935,106 (2010) and 952,295 (2011), of whom 398 (2010) and 428 (2011) patients with IPD were identified. There was significant difference in the prevalence of IPD in patients with and without asthma (0.07% vs. 0.02% in 2010 and 0.08% vs. 0.01% in 2011; P<0.001). After adjusting for age and gender, patients with asthma showed over a three-fold increased risk of IPD compared with patients without asthma (adjusted odds ratio [aOR] 3.90, 95% confidence interval [CI] 3.02-5.03 in 2010 / aOR, 5.44; 95% CI, 4.10-7.22 in 2011; P<0.001). These findings were also significant in children (aOR, 2.08; 95% CI, 1.25-3.45 in 2010; P=0.005 / aOR, 3.26; 95% CI, 1.74-6.11 in 2011; P<0.001). Although diabetes mellitus was also significantly associated with IPD, relatively low ORs compared with those of asthma were noted (aOR, 1.85; 95% CI, 1.35-2.54 in 2010 / aOR, 2.40; 95% CI, 1.78-3.24 in 2011; P<0.001). Both children and adults with asthma are at increased risk of developing IPD.

Colonização Nasofaringeana por streptococcus pneumoniae: estudo lngitudinal em crianças menores de cinco anos de idade / Colonization nasopharyngeal by Streptococcus pneumoniae: longitudinal study in children under Five years old

Streptococcus pneumoniae é um dos agentes etiológicos mais importantes em infecções adquiridas na comunidade. Este patógeno coloniza o trato respiratório de indivíduos saudáveis, apresentando maior prevalência entre 1 e 2 anos de idade (aproximadamente 50%) e depois diminui com a idade adulta (aproximadamente 10%). A alta incidência das doenças pneumocócicas e a crescente resistência aos antimicrobianos, favoreceu a introdução das vacinas conjugadas (ano de 2000). Após a introdução das vacinas conjugadas foi observado à queda na incidência da doença pneumocócica e diminuição da prevalência de colonização por sorotipos vacinais. Em contrapartida vem sendo notado o aumento de casos de doença sorotipos não vacinais. Por isso a importância de verificar a dinâmica da colonização nasofaringeana por pneumococos em crianças < 5 anos de idade antes da introdução da vacina. Foram selecionadas radomicamente 203 crianças residentes da comunidade de Pau da Lima, Salvador, Bahia, das quais foi colhido a amostra nasofaringeana em quatro períodos durante um ano com intervalo de três a quatro meses entre cada coleta. No período de janeiro de 2008 a janeiro de 2009 foram colhidos um total de 721 swabs, sendo 398 positivos para pneumococos (56%)...

Streptococcus pneumoniae is one of the most important etiologic agents in community-acquired infections. This pathogen colonizes the respiratory tract of healthy individuals shortly after birth, with higher prevalence of between 1 and 2 years of age (approximately 50%) and then decreases with age reaching adult rates below 10%. The high incidence and increasing antimicrobial resistance, favored the introduction of conjugate vaccines in 2000. After the introduction of conjugate vaccines a decreasing incidence of pneumococcal disease and carriage rates by vaccine serotypes was observed. In contrast we observe an increase in number of cases of disease and carriage by non-vaccine serotypes. Thus, this study aims to determine the dynamics of nasopharyngeal colonization by pneumococci in children <5 years of age after introduced the conjugate vaccine. A total of 203 children were random selected at the community of Pau da Lima in Salvador, Bahia, of whom the nasopharyngeal swab was collected in four periods with interval of 3 to 4 months between each collection. A total of 721 swabs were collected from January 2008 to January 2009, with 398 positive for pneumococci (56%)...

Caracterización de la meningoencefalitis en el Hospital Militar Central Dr. Luis Díaz Soto, 2004-2008 / Characterization of meningoencephalitis at Dr. Luis Díaz Soto Central Military Hospital, 2004-2008

Introducción: las meningoencefalitis son un grupo de enfermedades en las que básicamente ocurre una reacción inflamatoria de las envolturas que recubren el cerebro, las que pueden ocasionar graves secuelas y afectan al 25-50 porciento de los sobrevivientes. Objetivo: determinar las características epidemiológicas y microbiológicas, así como las complicaciones de las meningoencefalitis, en el Hospital Militar Central Dr. Luis Díaz Soto. Métodos: se realizó un estudio retrospectivo de corte transversal, en el que se utilizaron 100 pacientes con meningoencefalitis confirmada por cuadro clínico, estudio citoquímico del líquido cefalorraquídeo y la identificación del agente etiológico. Se realizó un test de Chi cuadrado para conocer el comportamiento entre las variables demogróficas y el tipo de meningoencefalitis. Resultados: se obtuvo el 72 porciento de meningoencefalitis viral y el 28 porciento de meningoencefalitis bacteriana con predominio del sexo masculino. Los síntomas y signos más frecuentes fueron: la fiebre (83 porciento), la cefalea (77 porciento), los vómitos (65 porciento) y los signos meníngeos (78 porciento). Acompañaron la meningoencefalitis bacteriana el aumento de la celularidad (> 500 mm³ en el 57,14 porciento) y las proteínas (> 0,45 g/L en el 78,57 porciento); el edema cerebral como complicación, el Streptococcus pneumoniae como agente etiológico más frecuente aislado (42,86 porciento) y el 50 porciento de casos sin identificación del microorganismo. Se evidencia un predominio de la etiología viral y la prevalencia del sexo masculino en los dos tipos de meningoencefalitis, así como una coincidencia en la sintomatología, los principales gérmenes aislados y las complicaciones más frecuentes reportadas

Introduction: Meningoencephalitides are a group of diseases basically characterized by an inflammatory reaction of the membranes covering the brain. Serious sequelae may affect 25-50 percent of survivors. Objective: Determine the epidemiological and microbiological characteristics and the complications caused by meningoencephalitis at Dr. Luis Díaz Soto Central Military Hospital. Methods: A retrospective cross-sectional study was conducted with 100 patients with meningoencephalitis confirmed by clinical status, cerebrospinal fluid cytochemical examination and identification of the etiological agent. A chi-square test was applied to determine the relationship between demographic variables and the type of meningoencephalitis. Results: 72 percent of meningoencephalitis cases were viral and 28 percent were bacterial, with a predominance of the male sex. The most frequent signs and symptoms were fever (83 percent), headache (77 percent), vomiting (65 percent) and meningeal signs (78 percent). Bacterial meningoencephalitis was accompanied by increased cellularity (> 500 mm3 in 57,14 percent) and proteins (> 0,45 g/L in 78.57 percent); cerebral edema as a complication, Streptococcus pneumoniae as the most frequent etiological agent isolated (42,86percent) and 50 percent of cases with no microorganism identified. A predominance of the viral etiology and the male sex was observed in the two types of meningoencephalitis, as well as similar symptoms, main isolated germs and most frequent complications

Caracterização de cepas de streptococcus pneumoniae causadoras de doença invasiva na cidade de Salvador, Bahia / Characterization of strains of Streptococcus pneumoniae causing invasive disease in the city of Salvador, Bahia

A doença pneumocócica invasiva (DPI) continua sendo uma das principais causas de morbidade e mortalidade no mundo, mesmo com a disponibilidade atual de terapias antimicrobianas e vacinas conjugadas. O objetivo desse estudo foi caracterizar o perfil fenotípico e genotípico das cepas invasivas de Streptococcus pneumoniae isoladas de diferentes sítos de infecção que circulam em hospitais públicos e privados da cidade de Salvador-Brasil no período de janeiro de 2008 a julho de 2011. Os isolados de S. pneumoniae de doença invasiva foram identificados por métodos microbiológicos clássicos e submetidos à determinação capsular através da técnica de Multiplex-PCR. A sensibilidade aos antimicrobianos foi determinada pela técnica de microdiluição em caldo. A caracterização genotípica foi realizada por PFGE e MLST. No período do estudo foram identificados 75 casos de DPI com cultura positiva, sendo 82,7% provenientes de hemocultura, 9,3% de líquido pleural e 8,0% de líquor. As crianças representaram 37,9% e os idosos 24,0% da população em estudo. Os sorotipos mais prevalentes foram o 14 (14,7%), 19F (13,3%), 6B (10,7%), 23F (9,3%), 3 (9,3%) e 19A (6,7%). Um total de 57,3% dos sorotipos identificados estão representados na vacina PCV10. Não-susceptibilidade à penicilina (CIM ≥ 4μg/mL) foi observada em 5,3% dos isolados. Para o SMX-TMP, tetraciclina e eritromicina, os índices de não-susceptibilidade foram de 55%, 15% e 11%, respectivamente. A tipagem por PFGE classificou 61,3% dos isolados de DPI como não-clonais e 29 (38,7%) em 10 perfis clonais. Quando comparados aos isolados de meningite isolados no Hospital Couto Maia, 22,7% apresentaram perfis semelhantes, que foram distribuídos em seis grupos clonais (quatro grupos clonais com isolados não-susceptíveis à penicilina e dois sensíveis). Foram encontrados 22 STs diferentes entre as 26 amostras caracterizadas por MLST. Quando comparado aos clones já caracterizados pelo PMEN, verificou-se que na cidade de Salvador circulam clones já identificados em outros países, a exemplo dos clones: Colombia23F-26 (SLV 338), Portugal19F-21 (ST 177), Spain9V-3 (SLV 156) e Netherlands3-31 (ST 180). Os isolados de pneumococos deste estudo apresentam maior taxa de resistência, incluindo resistência a múltiplas drogas quando comparados aos dos casos de meningite identificados em casos de meningite, com exceção da penicilina. Embora os clones mais frequentemente associados aos casos de meningite pneumocócia em Salvador tenham sido identificados nesta casuistica, os isolados de pneumococos provenientes de outras formas de doença invasiva apresentaram uma maior diversidade fenotípica e genotípica, ressaltando a importância do monitoramento contínuo das cepas invasivas nas diferentes manifestações da doença pneumocócica no tempo das vacinas conjugadas.

Non invasive real-time monitoring of bacterial infection & therapeutic effect of anti-microbials in five mouse models.

Background & objectives: In vivo imaging system has contributed significantly to the understanding of bacterial infection and efficacy of drugs in animal model. We report five rapid, reproducible, and non invasive murine pulmonary infection, skin and soft tissue infection, sepsis, and meningitis models using Xenogen bioluminescent strains and specialized in vivo imaging system (IVIS). Methods: The progression of bacterial infection in different target organs was evaluated by the photon intensity and target organ bacterial counts. Genetically engineered bioluminescent bacterial strains viz. Staphylococcus aureus Xen 8.1, 29 and 31; Streptococcus pneumoniae Xen 9 and 10 and Pseudomonas aeruginosa Xen-5 were used to induce different target organs infection and were validated with commercially available antibiotics. Results: The lower limit of detection of colony forming unit (cfu) was 1.7-log10 whereas the lower limit of detection of relative light unit (RLU) was 4.2-log10. Recovery of live bacteria from different target organs showed that the bioluminescent signal correlated to the live bacterial count. Interpretation & conclusions: This study demonstrated the real time monitoring and non-invasive analysis of progression of infection and pharmacological efficacy of drugs. These models may be useful for pre-clinical discovery of new antibiotics.

Estudo da colonização na asofaringeana por Streptococcus pneumoniae em crianças com suspeita clínica de pneumonia / Naasofaringeana study of colonization by Streptococcus pneumoniae in children with clinical suspicion of pneumonia

Streptococcus pneumoniae constitui um dos mais importantes patógenos bacterianos do trato respiratório, podendo causar infecções invasivas e não invasivas, levando a altas taxas de morbi-mortalidade, particularmente em crianças menores de cinco anos de idade. A bactéria ganha acesso ao hospedeiro através da colonização da nasofaringe, que representa um importante reservatório para a transmissão deste patógeno na comunidade, contribuindo para a disseminação horizontal de S. pneumoniae entre os indivíduos de uma população. No presente estudo, procuramos caracterizar o perfil de colonização nasofaringeana por S. pneumoniae em pacientes menores de cinco anos de idade com suspeita clínica de pneumonia, atendidos na Unidade de Saúde de São Marcos, Bairro de Pau da Lima, Salvador, no ano de 2009. Um total de 205 swabs foram coletados entre as crianças consideradas elegíveis para o estudo. Os isolados de S. pneumoniae foram identificados através de métodos microbiológicos clássicos e a determinação do sorogrupo/sorotipo foi realizada empregando-se a técnica de Multiplex-PCR. A sensibilidade a sete antimicrobianos foi testada através da técnica de microdiluição em caldo, sendo que os isolados com CIM para penicilina ≥ 0,125 μg/mL foram considerados não-susceptíveis. A técnica de PFGE foi realizada para 26 isolados correspondentes aos sorotipos mais frequentes e associados a não-sensibilidade à penicilina (sorotipos 14, 19F e 23F). Um total de 72 (35,1%) crianças foram diagnosticadas com pneumonia, sendo 39 (54,2%) menores de dois anos de idade. A taxa de colonização geral foi de 50,2%, não havendo diferença entre essas taxas quando se considerou o grupo de crianças confirmadas e suspeitas para pneumonia. Crianças na faixa etária de 36 a 47 meses formaram o grupo com maior risco de ter pneumonia bacteriana (OR: 3.17 [1.29-7.88]). Entre os sorotipos encontrados, o sorogrupo 6 (6A/6B) (17,3%) foi predominante, seguido dos sorotipos 14 (15,4%), 19F (10,6%), sorogrupo 15 (15B/15C) (9,6%), 23F (6,7%) e o sorotipo 19A (6,7%). Os demais sorotipos e sorogrupos compreenderam 33,7%. O padrão de sorotipos foi semelhante aqueles encontrados nos casos de meningite pneumocócica na cidade de Salvador. Um total de 41 isolados (39,8%) apresentaram CIM ≥ 0,125 μg/mL para penicilina e a resistência a SMX-TMP foi identificada em 69,2% dois isolados. A tipagem por PFGE identificou 11 padrões eletroforéticos, sendo que a maioria dos isolados do sorotipo 14 estavam relacionados a clones amplamente disseminados entre os casos de doença pneumocócica (“A” e “GK”). Um total de 50,5% dos isolados foram de sorotipos inclusos na vacina decavalente (PCV10) e considerando os isolados não-susceptíveis à penicilina, esta representatividade foi de 90,2%. O estudo ressalta a importância de um contínuo monitoramento do perfil de sorotipos na colonização nasofaringeana por S. pneumoniae, no período pós-vacina e da necessidade de busca.

In vivo characterization of streptococcus pneumoniae genes involved in the pathogenesis of meningitis by differential fluorescence induction

To further understand the pathogenesis of pneumococcal meningitis, and provide some target candidates for the development of drugs. This study was performed at the Department of Laboratory Medicine, Key Laboratory of Diagnostic Medicine [Ministry of Education], Chongqing Medical University, Chongqing, China from March 2006 to December 2007. A promoter-trap library of Streptococcus pneumoniae TIGR4, reported by green fluorescent protein was constructed, and used to infect BALB/c mice [n=15] intranasally, to set up a meningitis model. The control group [n=5] were inoculated with sterile phosphate buffered saline. The bacteria containing the promoter fusions induced only in meningitis brain tissue, not in vitro were screened by differential fluorescence induction. The obtained bacteria were prepared to re-infect the mice and re-screened, as above. The sorted bacteria were spread on trypticase soy agar with 5% sheep blood agar plates containing chloramphenicol [2.5 micro g/ml], and were used for DNA cloning, sequencing, and bioinformatics analysis. A total of 52 genes were obtained. Bioinformatics analysis revealed that these in vivo induced genes were involved in functions such as, adherence, energy metabolism, nutrient substance transport, transcription regulation, DNA metabolism, as well as, cell wall synthesis. In addition, there were some genes encoding for some hypothetical proteins with unknown, or putative functions. Pneumococcal genes involved in meningitis identified in this study are potential targets to understand the pathogenesis of pneumococcal meningitis

Pneumonias comunitárias em adultos: como eu trato. Temas de Atualização e Revisão em Clínica Médica / Community pneumonias in adults: how I treat? Themes of Updating and Revision in Medical Clinic

Pneumonia comunitária é um problema comum na prática de clínica médica. O diagnóstico deve ser pensado em casos febris e(ou) com sinais e sintomas respiratórios, nos quais a radiografia torácica é fundamental nesta caracterização. Uma vez estabelecido o diagnóstico, devemos estratificar o paciente por grupos de risco para uma evolução desfavorável, aplicando critérios já bem estudados (CURB-65 e PSI) para definir hospitalização e a intensidade de cuidados médicos necessários. A avaliação clínico-epidemiológica ajuda na seleção da antibioticoterapia mais eficaz. Parâmetros de acompanhamento pragmáticos da resposta terapêutica, incluindo período pós-alta, são fornecidos.

Community acquired pneumonia is a fairly common problem in general practice. Clinical suspicion should arise in febrile cases, with or whitout respiratory symptoms, in which a chest radiograph is pivotal in the diagnosis. Once the diagnosis has been clinched, the patient should be risk stratified by groups, using well stablished criteria (CURB-65, PSI) to define hospital admission and level of medical care. Clinical epidemiologic analysis assists in the definition of the proper antimicrobial agent. Pragmatic therapeutic parameters of clinical response are provided (including post-dischargel).

Childhood pneumonia-organisms and their pattern of sensitivity

To isolate causative organisms of pneumonia in children between 2 months to 5 years and to determine the sensitivity pattern of these organisms. It was an observational study in children presented with fever,cough or difficulty in breathing in outpatient department or emergency room of pediatrics department of Abbasi Shaheed Hospital, Karachi. The study was carried out in the department of Paediatric, Karachi Medical and Dental College and Abbasi Shaheed Hospital over a period of ten months [17 -01-08 to 15-11- 08]. Children between 2 months to 5 years, who present at outpatients department or in emergency room with complaint of fever, cough or/and difficulty in breathing were included in study. 100 cases of pneumonia fulfill WHO criteria who visited out patients and in emergency room during this period were enrolled in the study. The diagnosis is made by observing respiratory rate more than 50 per minute if the child was 2 months to 12 months and 40 per minute or more if the child was 12 months to 5 years of age. A nasopharyngeal swab was taken from each child for culture and sensitivity pattern. The idea behind choosing this site is that, obtaining nasopharyngeal swab is very simple, safe and without the risk of any serious complications. Majority of pneumonia cases are occurring under two years of age [85%] and maximum number of pneumonia cases are occurring under 1 year [54%]. Sex distribution of pneumonia cases of the study showing that out of 100 cases of pneumonia 60 were males and 40 were females. A male to female ratio of 3:2. Two most common pathogens i.e. S.pneumoniae [60%] and H.influenzae[25%] are mainly responsible for childhood pneumonia and these organisms are well covered with the first line antibiotics recommended by WHO ARI programme for out patient treatment of pneumonia i.e. co-trimoxazole, amoxycillin and ampicillin Streptoccocus pneumonia is sensitive to amoxicillin 98%,co-trimoxazole 80% and ampicilln 98% while sensitivity of H. influenza with amoxicillin, co-trimoxazole and ampicilin is 91%, 91% and 100% respectively. The organisms isolated in this study and their sensitivity pattern shows that two most common pathogens of pneumonia are S.pneumoniae and H.influenzae and these organisms are well covered with the first line antibiotics recommended by WHO ARI programme for out patient treatment of pneumonia i.e. co-trimoxazole, amoxicillin and ampicillin

Bacteriology of sore throat infections in Kano, Nigeria

A study was conducted over a 1-year period [1st August, 2002-31st July, 2003] during which throat swabs were taken aseptically from 294 patients [aged between 0-70 years] diagnosed for sore throat infection [from the Aminu Kano Teaching Hospital and Murtala Mohammed Specialist Hospital]. The different bacterial pathogens associated with sore throat infection, their seasonal variation, and possible association with gender and age, were determined. Also their susceptibility was determined towards antibiotics. Confirmation of bacterial sore throat infection was carried out in 115 [39.12%] patients of the 294 patients examined. Five different types of bacterial pathogens were isolated from the throats of the subjects viz. Streptococcus pneumoniae, 51 [44.35%], Streptococcus pyogenes, 21 [18.26%] Staphylococcus aureus 3 [26.95%], Klebsiella pneumoniae 8 [6.96%] and Eschericfiia coli 4 [3.48%]. Streptococcus pneumoniae was the most frequently isolated organism. The months of October and November had the highest number of cases. The results also showed a significant difference in infection rate between two sexes, with females having 74 [64.35%] and males 41 [35.65%] at p >/= 0.05. Infection was also most prevalent among age group 21-30 years [35.65%] in both hospitals. The infection rate decreased with increasing age. Results of Antibiotic sensitivity test indicate that Augmentin has the widest spectrum of activity against bacterial etiological agents of sore throat in Kano, followed by Erythromycin, Gentamycin and Chloramphenicol

Streptococcus pneumoniae as a cause of early onset neonatal sepsis: first report from Kuwait

Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis. We present a case of S. pneumoniae bacteremia that developed on the second day of life in a neonate born at 38 weeks of gestation to a mother who had prolonged rupture of the membranes [19 hours]. The isolate was penicillin sensitive. The child responded to a 14 day course of antibiotics. S. pneumoniae was isolated from the vagina of the mother by a swab culture collected prior to delivery, and isolates from the mother and the baby had the same sensitivity patterns. This case expands the spectrum of organisms responsible for early onset neonatal sepsis in Kuwait. To our knowledge, such an incident was not previously reported from Kuwait

Vacunas para la prevención de enfermedades por streptococcus pneumoniae (S. pn) / Vaccines for the prevention of diseases by streptococcus pneumoniae (S. pn)

Las infecciones causadas por S.pn. son un importante problema de salud pública en la infancia en todo el mundo. Es la principal causa de infecciones respiratorias altas (otitis media, sinusitis), bajas (neumonía), bacteremia oculta y meningitis agudas. Adicionalmente, el problema de la creciente resistencia a antimicrobianos ha puesto una variable más al complejo escenario clínico. El estudio de la epidemiología de las infecciones por streptococcus pneumoniae resulta particularmente importante para conocer el real impacto de medidas de prevención a través de medidas sociales, uso de terapia antimicrobiana empírica y prevención a través de vacunas. En estos aspectos resultan particularmente importantes dos iniciativas en desarrollo: la vigilancia latinoamericana de los serotipos mas prevalentes en la región (Sistema Regional de Vigilancia para Vacunas, SIREVA)(8,9) y los estudios locales del Centro para Desarrollo de Vacunas (CVD-Chile) dirigido por la Dra. Rosanna Lagos Z. (1,2,3).

Complicaciones respiratorias asociadas a neumonía bacteriana / Respiratory complications associated to bacterial pneumonia

En las últimas décadas ha sido reportado en varios países un aumento en el número de hospitalizaciones por neumonía bacteriana y también por complicaciones supurativas en niños. Se ha señalado al Streptococcus pneumoniae como el principal agente causal y también se ha advertido un aumento en la resistencia de éste a penicilina; sin embargo, no se ha logrado establecer una relación de causalidad. Se postula que el fenómeno de resistencia no tiene incidencia en la mayor frecuencia de complicaciones observadas y que éstas si podrían tener relación con el serotipo de S. pneumoniae (principalmente serotipos 1, 3 y 14). La neumonía necrotizante o excavada es considerada una complicación grave de la neumonía bacteriana, se asocia a fiebre prolongada, más días de hospitalización y mayor frecuencia de complicaciones (insuficiencia respiratoria, síndrome séptico). En su diagnóstico la radiografía de tórax ha demostrado ser menos sensible que la tomografía. La disminución de la impregnación del medio de contraste del parénquima pulmonar observada por hipoperfusión pueden ir posteriormente a la necrosis. El mecanismo de la necrosis está relacionado con la oclusión trombótica de los capilares alveolares. A pesar que la necrosis y la formación de cavidades pueden comprometer extensas zonas de lóbulos del pulmón, la indicación de resección quirúrgica en niños es excepcional y el seguimiento radiológico muestra resolución completa.