Behavior of clinical and humoral variables on admission as predictors of death in patients with community-acquired pneumonia. Comparative study between adults and older adults. / Comportamiento de variables clínicas y humorales al ingreso, como predictores de fallecimiento en pacientes con neumonía adquirida en la comunidad. Estudio comparativo entre adultos y adultos mayores

Community-acquired pneumonia is recognized as one of the main infectious health problems worldwide. The objective was to determine the condition of predictors of death for a group of selected clinical conditions, and for laboratory variables frequently used in practice. Study with descriptive design, which included 967 patients with pneumonia hospitalized between 2016 and 2019, and whose information was obtained from clinical records. Statistical treatment included bivariate and multivariate analysis (logistic regression); it was used the ratio of crossed products (odds ratio) and its 95% confidence interval. Several manifestations were significantly more frequent in older adults: dyspnea (OR 1.5[1.07,2.1]), absence of productive cough (OR 1.7 [1.3, 2.4]), neuropsychological manifestations (OR 2 [1.4,2.8]), tachypnea (OR 1.5 [1.1,2.1]), arterial hypotension (OR 2.1 [1.2,3.6]), anemia (OR 1.6[1.2,2.2]), elevated creatinine (OR 1.6[1.2,2.3]) and hypoproteinemia (OR 3.3[1.9,5.7]); showed a significant association with death: absence of productive cough, neuropsychological manifestations, temperature below 36 degrees Celsius, blood pressure below 110/70 mmHg, respiratory rate above 20 per minute, hemoglobin below 100 g/L, erythrosedimentation greater than 20 mm/L, leukopenia less than 5 x 109/L and serum creatinine above 130 micromol/L. As conclusions certain clinical and laboratory conditions present in the patient at the time of hospital admission, of routine exploration in the comprehensive assessment of the patient, were predictors of death. Additionally, the existence of evident differences in the number of conditions with a predictive nature of death between the population with pneumonia under 60 years of age and the elderly, as well as in the frequency of these conditions in both subgroups, is verified.

La neumonía adquirida en la comunidad está reconocida como uno de los principales problemas de salud de tipo infeccioso al nivel mundial. La investigación tuvo como objetivo determinar el carácter de predictores de fallecimiento de un grupo de condiciones clínicas seleccionadas, y de variables de laboratorio de uso frecuente en la práctica. Se realizó un estudio con diseño descriptivo, que incluyó a 967 pacientes con neumonía hospitalizados entre 2016 y 2019, y cuya información se obtuvo de los expedientes clínicos. El tratamiento estadístico incluyó análisis bivariante y multivariado (regresión logística); como estadígrafo se utilizó la razón de productos cruzados (odds ratio) y su intervalo de confianza de 95%. Entre los resultados se destacan los siguientes: varias manifestaciones fueron significativamente más frecuentes en los adultos mayores: disnea (OR 1,5[1,07;2,1]), ausencia de tos productiva (OR 1,7[1,3;2,4]), manifestaciones neuropsicológicas (OR 2[1,4;2,8]), taquipnea (OR 1,5[1,1;2,1]), hipotensión arterial (OR 2,1[1,2;3,6]), anemia (OR 1,6[1,2;2,2]), creatinina elevada (OR 1,6[1,2;2,3]) e hipoproteinemia (OR 3,3[1,9;5,7]); mostraron asociación significativa con el fallecimiento: ausencia de tos productiva, manifestaciones neuropsicológicas, temperatura por debajo de 36 grados Celsius, tensión arterial inferior a 110/70 mmHg, frecuencia respiratoria por encima de 20 por minuto, hemoglobina inferior a 100 g/L, velocidad de sedimentación eritrocitaria superior a 20 mm/L, leucopenia inferior a 5 x 109/L y creatinina sérica por encima de 130 micromol/L. Se concluye que ciertas condiciones clínicas y de laboratorio presentes en el paciente al momento del ingreso hospitalario, de exploración habitual en la valoración integral del enfermo, constituyeron predictores de fallecimiento. Adicionalmente, se comprueba la existencia de evidentes diferencias en el número de condiciones con carácter predictor de muerte entre la población con neumonía menor de 60 años y los adultos mayores, así como en la frecuencia de estas condiciones en ambos subgrupos.

Aberrant expression of calcitonin gene-related peptide and its correlation with prognosis in severe childhood pneumonia

OBJECTIVES: The purpose of this study was to evaluate the relationship between the serum levels of calcitonin gene-related peptide (CGRP) and the prognosis of pediatric patients with severe pneumonia. METHODS: Children diagnosed with severe pneumonia (n=76) were stratified into the survival (n=58) and non-survival groups (n=18) according to their 28-day survival status and into the non-risk (n=51), risk (n=17) and high-risk (n=8) categories based on the pediatric critical illness score (PCIS). Demographic data and laboratory results were collected. Serum CGRP levels were determined by enzyme-linked immunosorbent assay (ELISA). A receiver operating characteristic (ROC) curve was generated to determine the cutoff score for high CGRP levels. RESULTS: Serum CGRP levels were significantly higher in the survival group than in the non-survival group and were significantly higher in the non-risk group than in the risk and high-risk groups. The ROC curve for the prognostic potential of CGRP yielded a significant area under the curve (AUC) value with considerable sensitivity and specificity. CONCLUSION: Our findings show that CGRP downregulation might be a diagnostic marker that predicts the prognosis and survival of children with severe pneumonia.

Utilidad de la proteína C reactiva sérica en el diagnóstico y tratamiento del adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad / Immunocompetent adults hospitalized for a community-acquired pneumonia: Serum C-reactive protein as a prognostic marker

Background: C-reactive protein (CRP) is used to monitor patients' response during treatment of infectious diseases. Morbidity and mortality associated with community-acquired pneumonia (CAP) is high, particularly in hospitalized patients. Better risk prediction during hospitalization could improve management and ultimately reduce mortality rates. Aim: To evaluate CRP measured at admission and the third day of hospitalization as a predictor for adverse events in CAP. Material and Methods: A prospective cohort study of adult patients hospitalized with CAP at an academic hospital. Major adverse outcomes were admission to ICU, mechanical ventilation, prolonged hospital length of stay, hospital complications and 30-day mortality. Predictive associations between CRP (as absolute levels and relative decline at third day) and adverse events were analyzed. Results: Eight hundred and twenty-three patients were assessed, 19% were admitted to ICU and 10.6% required mechanical ventilation. The average hospital stay was 8.8 ± 8.2 days, 42% had nosocomial complications and 8.1% died within 30 days. Ninety eight percent of patients had elevated serum CRP on admission to the hospital (18.1 ± 14.1 mg/dL). C-reactive protein measured at admission was associated with the risk of bacterial pneumonia, bacteremic pneumonia, septic shock and use of mechanical ventilation. Lack of CRP decline within three days of hospitalization was associated with high risk of complications, septic shock, mechanical ventilation and prolonged hospital stay. Conclusions: CRP responses at third day of hospital admission was a valuable predictor of adverse events in hospitalized CAP adult patients.

Proteína 3 contendo um domínio NACHT, porção C-terminal rica em repetições de leucina e de domínio pirina e LL-37: valor prognóstico de novos biomarcadores em pneumonia adquirida na comunidade / NACHT, LRR, and PYD domains-containing Protein 3 and LL-37: prognostic value of new biomarkers in community-acquired pneumonia

RESUMO Objetivo Este estudo teve como objetivo determinar os níveis séricos de proteína 3 contendo um domínio NACHT, porção C-terminal rica em repetições de leucina e de domínio pirina (NLRP3) e catelicidina LL-37, bem como investigar sua importância prognóstica em pneumonia adquirida na comunidade (PAC). Métodos Este estudo prospectivo incluiu 76 pacientes com PAC. Foram obtidos dados demográficos e características clínicas. Os níveis séricos de NLRP3 e LL-37 foram determinados por meio do teste ELISA. A correlação entre NLRP3 e LL-37 foi estimada por intermédio da análise de Spearman. A associação entre NLRP3 e LL-37 com 30 dias de taxa de sobrevida e de mortalidade foi avaliada pela curva de Kaplan-Meier e análise de regressão logística. Resultados Os níveis séricos de NLRP3 estavam elevados, enquanto os níveis de LL-37 apresentaram redução significativa em pacientes com PAC grave. Observou-se correlação significativa entre os níveis séricos de NLRP3 e LL-37 em pacientes com PAC. Pacientes com níveis elevados de NLRP3 e níveis reduzidos de LL-37 exibiram maior taxa de sobrevida em 30 dias e de mortalidade quando comparados com aqueles com níveis inferiores de NLRP3 e LL-37. Conclusões Pacientes com PAC grave tendem a apresentar níveis séricos elevados de NLRP3 e níveis reduzidos de LL-37, o que pode ser utilizado como um potencial biomarcador prognóstico.

ABSTRACT Objective This study aimed to determine the serum levels of NACHT, Leucine-rich repeat (LRR), and Pyrin (PYD) domains-containing Protein 3 (NLRP3) and cathelicidin LL-37, and investigate their prognostic significance in community-acquired pneumonia (CAP). Methods The sample of this prospective study was composed of 76 consecutive patients with CAP. Demographic data and clinical characteristics were collected. Serum levels of NLRP3 and LL-37 were determined by ELISA. Spearman's analysis was used to evaluate the correlation between NLRP3 and LL-37. Association of NLRP3 and LL-37 with 30-day survival and mortality rates was assessed using the Kaplan-Meier curve and logistic regression analysis. Results Serum NLRP3 significantly increased whereas serum LL-37 significantly decreased in patients with severe CAP. Significant correlation was observed between serum NLRP3 and LL-37 in CAP patients. Patients with higher levels of NLRP3 and lower levels of LL-37 showed lower 30-day survival rate and higher mortality compared with those with lower NLRP3 and higher LL-37 levels. Conclusion Severe CAP patients tend to present higher serum NLRP3 and lower serum LL-37, which might serve as potential biomarkers for CAP prognosis.

Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia? / Os níveis de pró-peptídeo natriurético cerebral N-terminal determinam o prognóstico de pneumonia adquirida na comunidade?

ABSTRACT Objective: Pneumonia is a leading cause of mortality worldwide, especially in the elderly. The use of clinical risk scores to determine prognosis is complex and therefore leads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiac biomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognostic role of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear. The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patients with CAP, as well as its correlation with clinical risk scores. Methods: Consecutive inpatients with CAP were enrolled in the study. At hospital admission, venous blood samples were collected for the evaluation of NT-proBNP levels. The Pneumonia Severity Index (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ≥ 65 years (CURB-65) score were calculated. The primary outcome of interest was all-cause mortality within the first 30 days after hospital admission, and a secondary outcome was ICU admission. Results: The NT-proBNP level was one of the best predictors of 30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p < 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001), whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006). The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL. Conclusions: The NT-proBNP level appears to be a good predictor of ICU admission and 30-day mortality among inpatients with CAP, with a predictive value for mortality comparable to that of the PSI and better than that of the CURB-65 score.

RESUMO Objetivo: A pneumonia é uma das principais causas de mortalidade no mundo, especialmente em idosos. O uso de escores de risco clínico para determinar o prognóstico é complexo e, portanto, leva a erros na prática clínica. A pneumonia pode causar aumento nos níveis de biomarcadores cardíacos, como o N-terminal pro-brain natriuretic peptide (NT-proBNP, pró-peptídeo natriurético cerebral N-terminal). O papel prognóstico do nível de NT-proBNP na pneumonia adquirida na comunidade (PAC) continua incerto. O objetivo deste estudo foi avaliar o papel prognóstico do nível de NT-proBNP em pacientes com PAC, bem como sua correlação com escores de risco clínico. Métodos: Pacientes consecutivos internados com PAC foram incluídos no estudo. Na internação hospitalar, foram coletadas amostras de sangue venoso para avaliação dos níveis de NT-proBNP. Foram calculados o Pneumonia Severity Index (PSI, Índice de Gravidade de Pneumonia) e o escore Confusão mental, Ureia, frequência Respiratória, Blood pressure (pressão arterial) e idade ≥ 65 anos (CURB-65). O desfecho primário de interesse foi mortalidade por todas as causas nos primeiros 30 dias após a admissão hospitalar, e um desfecho secundário foi admissão na UTI. Resultados: O nível de NT-proBNP foi um dos melhores preditores de mortalidade em 30 dias, com uma área sob a curva (ASC) de 0,735 (IC95%: 0,642-0,828; p < 0,001), assim como o PSI, que teve uma ASC de 0,739 (IC95%: 0,634-0,843; p < 0,001), enquanto CURB-65 teve uma ASC de apenas 0,659 (IC95%: 0,556-0,763; p = 0,006). O nível de corte do NT-proBNP que mostrou ser o melhor preditor de admissão na UTI e de mortalidade em 30 dias foi de 1.434,5 pg/ml. Conclusões: O nível de NT-proBNP parece ser um bom preditor de admissão na UTI e de mortalidade em 30 dias entre pacientes internados com PAC, com um valor preditivo para mortalidade comparável ao do PSI e superior ao do CURB-65.

Valor prognóstico da procalcitonina em pacientes com infecções do trato respiratório inferior no ambiente hospitalar / Prognostic value of procalcitonin in hospitalized patients with lower respiratory tract infections

RESUMO Infecções do trato respiratório inferior são condições frequentes e potencialmente letais, consistindo nas principais causas de prescrição inadequada de antibióticos. A caracterização de sua gravidade e a predição prognóstica dos pacientes acometidos auxiliam na condução, permitindo maior acerto nas decisões sobre a necessidade e o local de internação, assim como a duração do tratamento. A incorporação de biomarcadores às estratégias classicamente utilizadas representa estratégia promissora, com destaque para a procalcitonina. O objetivo deste artigo foi apresentar uma revisão narrativa sobre a potencial utilidade e as limitações do uso da procalcitonina como um marcador prognóstico em pacientes hospitalizados portadores de infecções do trato respiratório inferior. Os estudos publicados sobre o tema são heterogêneos, no que tange à variedade de técnicas de mensuração da procalcitonina, seus valores de corte, os contextos clínicos e a gravidade dos pacientes incluídos. Os dados obtidos indicam valor moderado da procalcitonina para predizer o prognóstico de pacientes com infecções do trato respiratório inferior, não superior a metodologias classicamente utilizadas, e com utilidade que se faz notar apenas quando interpretados junto a outros dados clínicos e laboratoriais. De modo geral, o comportamento da procalcitonina, ao longo dos primeiros dias de tratamento, fornece mais informações prognósticas do que sua mensuração em um momento isolado, mas faltam informações sobre a custo-efetividade dessa medida em pacientes em terapia intensiva. Estudos que avaliaram o papel prognóstico da procalcitonina inicial em pacientes com pneumonia adquirida na comunidade apresentam resultados mais consistentes e com maior potencial de aplicabilidade prática, mas com utilidade limitada a valores negativos para a seleção de pacientes com baixo risco de evolução desfavorável.

ABSTRACT Lower respiratory tract infections are common and potentially lethal conditions and are a major cause of inadequate antibiotic prescriptions. Characterization of disease severity and prognostic prediction in affected patients can aid disease management and can increase accuracy in determining the need for and place of hospitalization. The inclusion of biomarkers, particularly procalcitonin, in the decision taken process is a promising strategy. This study aims to present a narrative review of the potential applications and limitations of procalcitonin as a prognostic marker in hospitalized patients with lower respiratory tract infections. The studies on this topic are heterogeneous with respect to procalcitonin measurement techniques, cutoff values, clinical settings, and disease severity. The results show that procalcitonin delivers moderate performance for prognostic prediction in patients with lower respiratory tract infections; its predictive performance was not higher than that of classical methods, and knowledge of procalcitonin levels is most useful when interpreted together with other clinical and laboratory results. Overall, repeated measurement of the procalcitonin levels during the first days of treatment provides more prognostic information than a single measurement; however, information on the cost-effectiveness of this procedure in intensive care patients is lacking. The results of studies that evaluated the prognostic value of initial procalcitonin levels in patients with community-acquired pneumonia are more consistent and have greater potential for practical application; in this case, low procalcitonin levels identify those patients with a low risk of adverse outcomes.

Redução transitória nos níveis séricos de retinol em crianças com pneumonia e resposta de fase aguda / Transient decreased retinol serum levels in children with pneumonia and acute phase response

OBJETIVO: Comparar os níveis séricos de retinol em crianças pré-escolares durante um episódio de pneumonia e 45 dias após a resolução da infecção. MÉTODOS: O estudo foi conduzido com crianças pré-escolares sem infecção (grupo controle, n = 9) ou com pneumonia (n = 12), após a hospitalização (fase 1) e 45 dias após a alta (fase 2). A avaliação nutricional incluiu antropometria, questionário alimentar e exames laboratoriais, incluindo os níveis urinários e séricos de retinol. Aplicou-se o teste pareado de Student ou de Mann-Whitney. RESULTADOS: Não houve diferença na ingestão alimentar. Documentaram-se menores valores de hemoglobina sanguínea e dos níveis séricos de sódio e albumina durante a fase 1, além de maiores valores da proteína C reativa. Não houve mudança no retinol urinário, enquanto os níveis séricos aumentaram após a recuperação da pneumonia. CONCLUSÕES: Durante a pneumonia, as crianças apresentam redução transitória nos níveis séricos de vitamina A, um epifenômeno da resposta de fase aguda.

OBJECTIVE: To compare serum retinol levels in preschool children during an episode of pneumonia and 45 days after the resolution of the infection. METHODS: The study was conducted with preschool children without any infection (control group, n = 9) or children hospitalized for pneumonia (n = 12), who were evaluated soon after hospitalization (phase 1) and 45 days later (phase 2). Nutritional assessment included anthropometric measurements, a food questionnaire, and laboratory blood routine examination, including urinary and serum retinol levels. Paired Student t or Mann-Whitney tests were used as required. RESULTS: Food intake was similar between groups. Blood hemoglobin and serum sodium and albumin decreased during phase 1, while there were higher C-reactive protein serum values. Urinary retinol levels remained unchanged whereas serum retinol increased significantly after pneumonia recovery. CONCLUSIONS: During the course of pneumonia, children had transient decrease in serum levels of vitamin A, an epiphenomenon of the acute phase response.

The association between plasma D-dimer levels and community-acquired pneumonia

BACKGROUND: Plasma D-dimer levels are directly related to the intra- and extra-vascular coagulation that occurs in acute and chronic lung damage in patients with community-acquired pneumonia (CAP). OBJECTIVES: This study examines the relationship between the severity of community-acquired pneumonia and D-dimer levels. In addition, the study examines the correlations among community-acquired pneumonia, the radiological extent of the disease and mortality. METHODS: The Pneumonia Severity Index was used to classify patients into five groups. Patients were treated at home or in the hospital according to the guidelines for community-acquired pneumonia. Blood samples were taken from the antecubital vein with an injector and placed into citrated tubes. After they were centrifuged, the samples were evaluated with the quantitative latex method. RESULTS: The study included 60 patients who had been diagnosed with community-acquired pneumonia (mean age 62.5 ± 11.7) and 24 healthy controls (mean age 59.63 ± 6.63). The average plasma D-dimer levels were 337.3 ± 195.1ng/mL in the outpatient treatment group, 691.0 ± 180.5 in the inpatient treatment group, 1363.2 ± 331.5 ng/mLin the intensive care treatment group and 161.3 ± 38.1ng/mL in the control group (p<0.001). The mean D-dimer plasma level was 776.1 ± 473.5ng/mL in patients with an accompanying disease and 494.2 ± 280.1 ng/mL in patients without an accompanying disease (p<0.05). CONCLUSIONS: Plasma D-dimer levels were increased even in community-acquired pneumonia patients who did not have an accompanying disease that would normally cause such an increase.

C-reactive protein levels and decrease of albumin levels in hospitalized elderly patients with community-acquired pneumonia.

AIM: To obtain: (1) the correlation between initial CRP level on admission with the decrease of albumin level during hospitalization, (2) the mean difference in initial CRP level between the groups of patients with and without decrease of albumin level during hospitalization, and (3) the risk difference of decreasing albumin level in patients with high CRP levels on the admission compared to whom with low CRP level on the admission, in hospitalized elderly patients with CAP. METHODS: A prospective cohort study were conducted on 23 hospitalized elderly patients with CAP. Subjects with diseases and conditions that could interfere with CRP and albumin level besides pneumonia infection were excluded. The patient's CRP level was measured upon the initiation of the study, while the patient's albumin level was measured on the first and fifth day of hospitalization to observe changes that took place during 5 days of hospitalization. Pearson's correlation test, independent t-test, and chi-square test were used to answer the objectives of the study. RESULTS: We found that there were negative correlation between the initial CRP level and the percentage of albumin level decrease during 5 days of hospitalization (r=-0.442, p= 0.035) and significance difference in the mean initial CRP level between patients with and without decreasing albumin level (mean difference 99.69 mg/L, 95%CI 13.25 to 186.13 mg/L; P 0.026). The risk difference of decreasing albumin level during hospitalization between patients with high and low initial CRP levels did not attained statistical significance (RR 2.12. 95%CI 0.26 to 29.07; p=0.621). CONCLUSION: In hospitalized elderly patients with community-acquired pneumonia with high initial CRP levels tend to experience a decrease in albumin level during hospitalization.

Níveis plasmáticos de vitamina A em crianças carentes com pneumonia na fase aguda e após recuperação / Plasma vitamin A levels in deprived children with pneumonia during the acute phase and after recovery

OBJETIVO: Comparar os níveis plasmáticos de retinol em crianças de baixo nível socioeconômico com pneumonia, antes e depois da resolução do processo infeccioso; investigar a associação entre os níveis plasmáticos de retinol, após a resolução da infecção, com algumas variáveis socioeconômicas, a condição nutricional e a gravidade da pneumonia. MÉTODOS: Estudo de coorte prospectivo desenvolvido com 40 crianças, hospitalizadas por pneumonia, na faixa etária de 6 meses a 5 anos. Foram avaliados o nível plasmático de retinol na fase aguda e após a resolução da infecção, a escolaridade do chefe da família, a renda per capita, o peso ao nascer, a condição nutricional, os níveis de hemoglobina e a gravidade da pneumonia. RESULTADOS: O valor médio de retinol plasmático após a resolução do processo infeccioso foi maior em relação à fase aguda da infecção (1,4±0,6 versus 1,7±0,6 æmol/l, p = 0,03). A freqüência de níveis inadequados de retinol (< 1,05 æmol/l) foi de 32,5 e 17,5 por cento na fase aguda e na resolução do processo infeccioso, respectivamente. Não se verificou relação estatisticamente significante entre a deficiência retinol e as variáveis clínico-epidemiológicas estudadas. A pneumonia mais grave foi observada em 30/40 (75 por cento) dos pacientes. Não houve diferença estatisticamente significante entre a inadequação dos níveis plasmáticos de retinol, após a resolução do processo infeccioso, com a gravidade da pneumonia (4/30 - 13,3 por cento versus 3/10 - 30,0 por cento, p = 0,34). CONCLUSAO: Os níveis plasmáticos de retinol foram mais altos após a resolução do processo infeccioso em relação à fase aguda, não havendo associação com as variáveis clínico-epidemiológicas estudadas.

Immune response in patient's with pneumonia

A total sample 178 infected/with pneumonia was investigated. These patient's were classified in to two groups; group [A] called typical pneumonia [110 patient] and group [B] called atypical pneumonia [68] The classification of these groups was depend ent on chest X-ray and hematological tests. There was an increase in the percentage of neutrophil and X - ray showed lobar pneumonia pattern in group [A], while there was an increase in percentages of lymphocytes and X-ray showed broncho pneumonia pattern in group [B]. the result showed a significant increase [P<0.01] in the stimulation of lymphocytes and ability of phagocytic cells to engulf in group [B] in comparesion with group [A]

Blood zinc levels in children hospitalized with severe pneumonia: a case control study.

A case control study was conducted in a referral and teaching hospital in North India on children aged 2 months to 5 years, to compare blood zinc levels in 50 cases of severe pneumonia and 50 age,sex and nutritional status matched controls. Mean blood Zinc levels in cases and controls was 376.1 ug/dL + 225.73 and 538.52 microg/dL +/- 228.0 respectively ( P value 0.0003). In logistic regression model severe pneumonia was associated with lower blood zinc level, use of biomass fuel and isolation of H. Influenzae from nasopharyngeal swab. Cotrimoxazole resistant S. pneumoniae were isolated from 95% of cases and 41.2 % of controls (P = 0. 0004). Therefore, the role of zinc in treatment of severe pneumonia should be investigated.

Perfil laboratorial de neumonia en niños hospitalizados / Profile laboratory of neumoniae in children hospitalized

En los países en vías de desarrollo, el manejo correcto de los casos de neumonías en niños, adquiridas en comunidad, usualmente incluye la elección de un antibiótico de manera empirica debido a la poca disponibilidad de medios de identificación oportuna del agente causal. Conocer el comportamiento de algunas de las pruebas de laboratorio-clínico destinados a medir la reacción inflamatoria que ocurre en niños afectados de neumonía relacionándolas con los resultados de una prueba de detección rápida de agente causal basada en la co-aglutinación (phadebact), en una muestra de orina. Estudio de tipo observacional descriptivo mediante revisión de registros médicos del Servicio de Pediatría del Hospital Militar "Cap (Av) (f) Guillermo Hernández Jacobsen", seleccionándose aquellos que pertenecieran a niños < 12 años de edad, excluyendo a los recién nacidos, y que hubiesen sido ingreados con diagnóstico de bronconeumonía o neumonía entre enero 1996 y diciembre de 2000. Se exigió exámenes de laboratorio hemático: contaje y recuento de leucocitos, velocidad de sedimentación globular, proteína C reactiva, además de una prueba de coaglutinación (phadebact) en orina. Se utilizaron tablas de referencia que indican los puntos de corte para valores normales de cada una de las pruebas hematicas según edades pediátricas (10). El phadebact fue tomado en cuenta si era reportado como positivo para determinar germen. Como se trata de un estudio descriptivo y observacional, no se formula hipotesis. Se encontró que el contaje leucocitario, la velocidad de sedimentación globular y la proteína C reactiva son pruebas de laboratorio hemático de muy impredecible sensibilidad, pudiendo estar elevadas, normales o bajas en pacientitos que tenían un resultado positivo en el phadebact. Aun cuando el porcentaje de identificación del agente causal fue elevado, solo fue de un 47,1 por ciento de las 113 muestras procesadas. Se pudieron identificar casos con S. Neumonía, H. Influenzae y S. Beta hemolítico del grupo B. El restante 52,5 por ciento que no demostró agente alguno, puede considerarse que pudieran ser de etiología viral o estar albergando un S. Aureus. Se concluye que ante la necesidad de dar precozmente un antibiótico adecuado con el objeto de reducir la mortalidad por esta afección, tomando en cuanta que ni aun el hemocultivo resulta inequivocamente útil para tomar aquella decisión, surge la necesidad de implementarse un programa de atención simplificada

Lípidos y lipoproteínas en niños con neumonía / Lipids and lipoproteins in children with pneumonic

Existen evidencias de que las infecciones interfieren en el metabolismo de los lípidos y la dislipidemia se asocia con cambios inmunológicos. Con el objetivo de investigar la relación del perfil lípidico de pacientes pediátricos durante la fase aguda y la convalecencia de procesos neumónicos, se realizó un estudio en 34 niños con diagnóstico de neumonía, hospitalizados en el Hospital "Dr. Elías Toro", entre marzo y octubre de 1997. Se determinaron colesterol y triglicéridos por método enzimático y lipoproteínas por electroforesis. Los valores de colesterol al egreso fueron significativamente mayores que al ingreso. Los triglicéridos aumentaron de manera no significativa. Las fracciones de lipoproteínas fueron diferentes respecto a los valores de referencia. La fracción alfa al egreso disminuyó, la fracción pre-ß no mostró cambios. La fracción ß al egreso fue significativamente mayor que al ingreso. Se encontró una fracción no reportada en niños sanos, con baja movilidad electroforética denominada lipoproteína de infección neumónica (LIN), que al egreso disminuyó significativamente. Adicionalmente las fracciones pre-ß y ß mostraron cambios en su composición al egreso. Se observaron de manera consistente cambios en los lípidos y las lipoproteínas posiblemente relacionados con la infección neumónica

Blood culture and respiratory syncytial virus identification in acute lower respiratory tract infection.

Even though the incidence of pneumonia in developed and developing countries is similar, the mortality is five times higher in developing countries. This study aimed to determine the prevalence of bacteremia in children with acute lower respiratory tract infection (LRTI) and relative contribution of respiratory syncytial virus (RSV). One hundred and one children under five years of age who attended a primary care level clinic with diagnosis of acute LRTI, were enrolled. Diagnosis and management of pneumonia were done according to the WHO guidelines. Two blood cultures were drawn at the time of admission. A nasopharyngeal sample was taken for detection of RSV by indirect immunofluorescence. Blood cultures were positive for pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus) in three patients. The detection for RSV was positive in 24 patients (23.7%). The clinical and radiographic presentations were not significantly different between patients with and without RSV (p > 0.05). RSV is a common cause of LRTI in children younger than five years old. Blood cultures are not commonly positive in outpatients with acute LRTI. The practice of obtaining blood cultures in primary and secondary care clinics is not useful to guide the treatment of patients with community-acquired pneumonia.

Sorotipos de pneumococos isolados de criancas com pneumonia: implicacao com a imunizacao especifica anti-pneumococica / Streptococcus pneumoniaie serotypes in children with pneumonia: vaccine especific for pneumococcal disease

Os autores identificaram q22 cepas de pneumococos isolados de 124 criancas internadas com pneumonia aguda durante um periodo de 15 anos. Estas pertenciam a 19 sorotipos (16 sorogrupos). A vacina anti-pneumococica com 23 antigenos permitiria potencial cobertura a 89,3 por cento dos casos de pneumonia, observando-se apenas os sorotipos envolvidos. Porem, e constatada eficacia reduzida desta vacina em criancas menores de dois anos, faixa etaria que abrange a maior parte dos casos estudados (mediana=1 ano). Outras vacinas anti-pneumococicas que contem um maximo de antigenos pertencentes a oito sorogrupos tem sido testadas. Nesta circunstancias os dados coletados no presente estudo sugerem a inclusao dos sorogrupos 1, 4, 5, 6, 7, 14, 19 e 23 que abrangem 89,3 por cento das cepas analisadas. O estudo constata variacao regional da frequencia dos sorogrupos de pneumococo implicados com patologias pediatricas.

Frequency and significance of electrolyte abnormalities in pneumonia.

To determine the frequency of electrolyte disturbance in pneumonia, we studied 264 hospitalized children with pneumonia for serum sodium and potassium concentration, and plasma osmolality (Posm) on the day of admission. Urine osmalality (Uosm) and urine spot sodium concentration were measured in those who had a serum sodium less than or equal to 130 mEq/L. Hyponatremia was found in 27%, hypernatremia in 3.7%. Hypokalemia (serum potassium less than or equal to 3.5 mEq/L) in 19 and 2% had hyperkalemia (serum potassium greater than or equal to 6.5 mEq/L). Of all the hyponatremia, 68% were secondary to syndrome of inappropriate ADH secretion (SIADH) as suggested by a concomitant lowering of Posm less than or equal to 280 mosm/kg and increased urinary osmolality and sodium excretion. Hyponatremia was associated with 60% longer hospital stay, two fold increase in complications and the 3.5 times higher mortality compared to that of normonatremia. The above variables were affected further, if hypokalemia coexisted with hyponatremia.