RESUMO
BACKGROUND: Rh antibodies produced by patients receiving Rh-matched RBC units may be associated with inheritance of altered RH alleles or a result of altered Rh epitopes on donor red blood cells (RBC). On this background, our aim was to evaluate unexpected Rh antibodies in Brazilian patients receiving regular transfusions and determine the clinical significance of the alloantibody produced. MATERIAL AND METHODS: We investigated seven patients (5 with sickle cell disease, 1 with myelodysplastic syndrome and 1 with ß-thalassaemia) with unexplained Rh antibodies. All patients had complete serological and molecular analyses. A lookback at the donor units transfused to these patients was performed and donors suspected of having Rh variants were recruited for further analysis. Laboratory and clinical findings were used to evaluate the clinical significance of the alloantibodies produced. RESULTS: The unexpected Rh antibodies found in the patients were not linked to the expression of partial Rh phenotypes according to serological and molecular analyses. Anti-D was found in two patients, anti-C was found in one patient, anti-c was found in one patient and anti-e was found in three patients carrying conventional D, C, c and e antigens respectively. Serological and molecular analyses of donors' samples revealed that six donors whose RBC were transfused to these patients carried partial Rh antigens. Only one anti-e in a patient with ß-thalassaemia was autoreactive and could not be explained by RH diversity in his donors. Three of the seven Rh antibodies were associated with laboratory and clinical evidence of a delayed haemolytic transfusion reaction or decreased survival of transfused RBC at first detection. DISCUSSION: Our study provides evidence that patients exposed to RBC units from donors with Rh variants may develop antibodies and some of these may be of clinical significance.
Assuntos
Anemia Falciforme , Antígenos de Grupos Sanguíneos , Anemia Falciforme/terapia , Epitopos , Eritrócitos , Humanos , IsoanticorposRESUMO
Multiorganic failure is a rare manifestation of hantavirus infection but it should be included among differential diagnoses of multiorganic failure in the pediatric age. Currently, there is no effective therapy for this infection. A high suspicion index and early referral to a pediatric intensive care unit with extracorporeal membrane oxygenation may lead to a favourable impact in the outcome. We report a fatal case of hantavirus infection in a 9-year-old girl with a severe disease refractory to hemodynamic supportive measures, and characterized by purpura fulminans, cerebral infarcts, cardiopulmonary failure, and acute renal failure. Commentaries and review about these infrequent clinical manifestations are made.
Assuntos
Infarto Cerebral/virologia , Infecções por Hantavirus/complicações , Insuficiência de Múltiplos Órgãos/virologia , Púrpura Fulminante/virologia , Criança , Evolução Fatal , Feminino , HumanosRESUMO
El fallo multiorgánico es raro en la infección por hantavirus y debería ser incluido dentro de los diagnósticos diferenciales de disfunción ultiorgánica en la edad pediátrica. Actualmente, no existe terapia eficaz para esta infección. Un alto índice de sospecha y la derivación temprana a una unidad de cuidados intensivos con disponibilidad de oxigenación con membrana extracorpórea pueden mejorar el pronóstico. Con motivo de un caso fatal de una niña de 9 años infectada por hantavirus, que exhibió una enfermedad caracterizada por púrpura fulminante, infartos cerebrales, fallo cardiopulmonar e insuficiencia renal aguda, refractaria a todas las medidas de apoyo, decidimos comentar el cuadro clínico y hacer una revisión del tema.
Assuntos
Feminino , Criança , Infarto Cerebral , Infecções por Hantavirus/complicações , Infecções por Hantavirus/terapia , Insuficiência de Múltiplos Órgãos , Vasculite por IgA/complicações , Vasculite por IgA/diagnóstico , Vasculite por IgA/terapiaRESUMO
El fallo multiorgánico es raro en la infección por hantavirus y debería ser incluido dentro de los diagnósticos diferenciales de disfunción ultiorgánica en la edad pediátrica. Actualmente, no existe terapia eficaz para esta infección. Un alto índice de sospecha y la derivación temprana a una unidad de cuidados intensivos con disponibilidad de oxigenación con membrana extracorpórea pueden mejorar el pronóstico. Con motivo de un caso fatal de una niña de 9 años infectada por hantavirus, que exhibió una enfermedad caracterizada por púrpura fulminante, infartos cerebrales, fallo cardiopulmonar e insuficiencia renal aguda, refractaria a todas las medidas de apoyo, decidimos comentar el cuadro clínico y hacer una revisión del tema.(AU)
Assuntos
Feminino , Criança , Vasculite por IgA/complicações , Vasculite por IgA/diagnóstico , Vasculite por IgA/terapia , Infecções por Hantavirus/complicações , Infecções por Hantavirus/terapia , Insuficiência de Múltiplos Órgãos , Infarto CerebralRESUMO
INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) isolates are increasingly frequent causes of skin and soft-tissue infections or invasive infections in many communities. Local data are scarce. OBJECTIVE: To determine the frequency, clinical features and outcome of infections caused by MRSA. MATERIAL AND METHODS: Prospective and multicentric study of surveillance for community-acquired S. aureus infections in children from Argentina. Infections meeting the definition of community-acquired were identified. Demographic and clinical data were collected. Antibiotic susceptibilities were determined in the clinical microbiology laboratory with the methodology of the NCCLS. RESULTS: From November 2006 to November 2007, 840 S. aureus infections were diagnosed, 447 of them were community-acquired. One hundred and thirty-five children with underlying disease or previous hospital admission were excluded. Two hundred and eighty one (62%) infections were community-acquired MRSA (CA-MRSA). The median age of children was 36 months (r:1-201), 60% were male. Among the CA-MRSA isolates, 62% were obtained from children with skin and soft-tissue infections, and 38% from children with invasive infections. Of them, osteomyelitis, arthritis, empyema and pneumonia were prevalent. Eigthteen percent of children had bacteremia and 11% sepsis. The rate of clindamycin resistance of CA-MRSA isolates was 10% and 1% for trimethoprim-sulfamethoxazole. Only 31% of children had appropriate treatment at admission. The median time of treatment delayed was 72 h. The median time of parenteral treatment was 6 days (r:1-70). In 72% of patients surgical treatment was required. Three children died (1%). CONCLUSIONS: CA-MRSA isolates account for a high percentage and number of infections in children of Argentina. Community surveillance of CA-MRSA infections is critical to determine the appropriate empiric antibiotic treatment for either local or invasive infections. Clindamycin resistance was under 15% in the strains tested. Clindamycin should be use when CA-MRSA infection is suspected in children.
Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Adolescente , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/terapia , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapiaRESUMO
En los últimos años se ha informacion diversas partes del mundo la aparición deinfecciones extrahospitalarias causadas por S.aureus resistentes a la meticilina (SAMRC). Losdatos de nuestro país son muy escasos y de informesindividuales.Objetivo. Determinar la frecuencia, las característicasclínicas y la evolución final de las infeccionescausadas por SAMRC.Material y métodos. Estudio prospectivo y multicéntricode vigilancia de las infecciones extrahospitalariaspor S. aureus en niños de la Argentina. Seincluyeron niños con alguna infección clínica y microbiológicamentedocumentada por S. aureus. Lasensibilidad a los antibióticos de las cepas aisladasse investigó según normas NCCLS.Resultados. Entre 11/2006 y 11/2007 se diagnosticaron840 infecciones por S. aureus. De ellas, 582(69 por ciento) fueron comunitarias. Se excluyeron 135 niñoscon enfermedad de base o internación previa enhospitales. Para el análisis se incluyeron 447 infecciones,de las cuales 281 (62 por ciento) fueron causadas porSAMRC. La mediana de edad fue de 36 meses (r: 1-201). Un 60 por ciento fueron varones. Prevalecieron lasinfecciones de piel y partes blandas (62 por ciento). Las infeccionesosteoarticulares, el empiema pleural y laneumonía fueron las formas invasivas más frecuentes.El 18 por ciento presentó bacteriemia y el 11 por ciento sepsis. El10 por ciento de las cepas fue resistente a clindamicina y el1 por ciento a trimetoprima-sulfametoxazol. Sólo el 31 por ciento tuvoun tratamiento concordante al ingreso. La medianade retraso en el tratamiento adecuado fue de 72 h. Lamediana del tratamiento parenteral fue de 6 días (r:1-70). El 72 por ciento requirió tratamiento quirúrgico, principalmentedrenaje de colecciones purulentas (87 por ciento).Fallecieron 3 niños (1 por ciento).Conclusiones. La tasa de infecciones causadas porSAMRC es alta en niños de nuestro país. Esto constituyeun alerta epidemiológico, particularmentepara los pediatras.
