ABSTRACT
El siguiente reporte de caso describe la presentación del síndrome inflamatorio multisistémico asociado a la infección por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2 por sus siglas en inglés) en niños, que inicialmente se comparó con el síndrome mucocutáneo linfonodular, mejor conocido como enfermedad de Kawasaki clásica. Sin embargo, existen marcadas diferencias entre ambos síndromes, como se observará en el desarrollo del caso clínico, el cual cursa con un importante compromiso pulmonar, desarrollando un síndrome de distress respiratorio agudo pediátrico y posteriormente secuelas cardiovasculares que determinan el desenlace desfavorable. En este caso, la paciente desarrolló las manifestaciones de gravedad al sexto día de enfermedad y se inició cuidados intensivos oportunos con soporte aminérgico, ventilación con maniobras de protección alveolar e inicio temprano de inmunoglobulinas, lo que permitió el destete progresivo de todas las medidas instauradas. Así como se obtuvieron aciertos en el manejo intensivo, otros aspectos de la terapéutica se van dejando de lado con el mayor conocimiento de esta entidad y su reconocimiento temprano
The following case report describes the presentation of the multisystemic inflammatory syndrome associated with infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children, which was initially compared with lymphonodular mucocutaneous syndrome, better known as classic Kawasaki disease. However, there are marked differences between both syndromes, as will be observed in the development of the clinical case, which presents with significant pulmonary involvement, developing a pediatric acute respiratory distress syndrome and later cardiovascular sequelae that determine the unfavorable outcome. In this case, the patient developed the manifestations of severity on the sixth day of the disease and timely intensive care with aminergic support, ventilation with alveolar protection maneuvers and early initiation of immunoglobulins was started, which allowed progressive weaning of all the measures established. As well as successes were obtained in the intensive management, other aspects of the therapy are being put aside with the greater knowledge of this entity and its early recognition
Subject(s)
Child , Child , Coronavirus Infections , BetacoronavirusABSTRACT
BACKGROUND: S pneumoniae is the most common cause of community-acquired pneumonia. AIM: To evaluate the clinical characteristics, antibiotic resistance, management and prognostic factors in pneumococcal pneumonia. METHODS: Prospective evaluation in 46 adults (age +/- sd: 68 +/- 17 years) hospitalized with pneumococcal pneumonia confirmed by sputum, blood or pleural fluid cultures. Clinical and radiographic variables, risk factors for antibiotic resistance, and hospital mortality rate were recorded. RESULTS: Heart disease (39%), COPD/asthma (25%), and diabetes mellitus (18%) were the most frequent underlying diseases. None of the patients had previously received pneumococcal vaccine. Only 17% of the patients had the classic triad of chills, fever and productive cough. At admission, interestingly, 17% presented with congestive heart failure. Resistance of pneumococci to penicillin, cefotaxime or erythromycin was 15%, 6% and 11%, respectively. Antibiotic use prior to admission was significantly associated with antibiotic resistance (OR = 6; CI 95% = 1.1-32; p < 0.05). Fifty per cent of the patients were admitted to intermediate or intensive care units, 15% were mechanically ventilated, 20% developed septic shock, 20% developed acute renal failure and 13% died in the hospital. Clinical factors significantly associated with higher mortality were systolic hypotension (< or = 90 mmHg), ICU admission and BUN > 30 mg per dL. CONCLUSIONS: Our data suggest that pneumococcal pneumonia is still a severe infection with high mortality; hence, efforts should be made at prevention using pneumococcal immunization.