Aerococcus viridans como agente etiológico de endocardite em valva nativa / Aerococcus viridans as etiological agent in native valve endocarditis

Aerococcus viridans é um patógeno humano incomum e endocardite por este agente na literatura é rara. Relata-se o caso de paciente feminina, 56 anos,hospitalizada devido a quadro de picos febris que, após investigação, foi diagnosticada através dos critérios clínicos de Duke, com endocardite em valva nativa. Foi evidenciado através das hemoculturas o crescimento de A. viridans, sendo o primeiro casoreportado no Brasil. Há relatos desse agente também em infecções urinárias, bacteremia, meningite e artrite séptica. No presente caso, a paciente teve melhorresposta clínica após o início da ampicilina, confirmando alguns artigos que orientam o tratamento com penicilinas.

Aerococcus viridans is an uncommon human pathogen and reports of endocarditis caused by this agent arerare in the literature. This clinical case study describes a 56 year-old female patient admitted to hospital forspiking fevers. After investigation, this was diagnosed as native valve endocarditis, based on the Duke clinicalcriteria and confirmed through the growth of A. viridans in blood cultures, making this the first reported case in Brazil. There are also reports of thisagent in urinary tract infections, bacteremia, meningitis and septic arthritis. In this case, the patient had a better clinical response after starting on ampicillin, confirmed by some articles that recommend treatment withpenicillins.

Serum C-reactive protein concentrations in early abdominal and pulmonary sepsis.

OBJECTIVES: To evaluate the C-reactive protein serum levels in patients with pulmonary and abdominal sepsis during the first five days of sepsis progression. METHODS: The present investigation was a retrospective cohort study conducted at the university hospital with 345 patients who were admitted to the intensive care unit and diagnosed with sepsis of pulmonary or abdominal origin. Serum C-reactive protein concentrations were measured by the turbidimetric immunoassay. For analysis of C-reactive protein, day 1 was defined as the day on which the patient was clinically diagnosed with sepsis. RESULTS: Thirty-four patients with sepsis (9.8%), 114 patients with severe sepsis (33.0%), and 197 patients with septic shock (57.2%) were evaluated. The age of the patients was 56.4 ± 19.8 years. The serum C-reactive protein concentrations were higher on the day of sepsis diagnosis in the group with abdominal infection compared with the group with pulmonary sepsis (17.8 ± 10.1 mg/dL versus 14.9 ± 11.1 mg/dL, p=0.025) and remained significantly higher during the first five days of sepsis progression. CONCLUSION: The serum C-reactive protein concentrations were significantly higher in the patients with abdominal sepsis compared with the patients with pulmonary sepsis during the first five days of sepsis progression.

Dosagens séricas de proteína C-reativa na fase inicial da sepse abdominal e pulmonar / Serum C-reactive protein concentrations in early abdominal and pulmonary sepsis

OBJETIVO: Avaliar os níveis séricos de proteína C-reativa em pacientes com sepse pulmonar e abdominal nos primeiros 5 dias de progressão da sepse. MÉTODOS: Estudo de coorte retrospectivo em hospital universitário. Foram selecionados 345 pacientes admitidos em unidade de terapia intensiva e diagnosticados com sepse de origem pulmonar ou abdominal. A dosagem sérica de proteína C-reativa foi realizada por imunoensaio turbidimétrico. Para análises da proteína C-reativa, o dia 1 foi definido como o do diagnóstico clínico da sepse. RESULTADOS: Foram avaliados 34 pacientes com sepse (9,8%), 114 com sepse grave (33,0%) e 197 com choque séptico (57,2%). A idade dos pacientes foram 56,4±19,8 anos. Concentrações séricas de proteína C-reativa foram mais elevadas no dia do diagnóstico de sepse no grupo com infecção de origem abdominal em comparação ao grupo com sepse pulmonar (17,8±10,1 mg/dL versus 14,9±11,1 mg/dL; p=0,025) e mantiveram-se significativamente mais elevadas nos primeiros 5 dias de evolução da sepse. CONCLUSÃO: As concentrações séricas de proteína C-reativa foram significativamente mais elevadas nos pacientes com sepse de origem abdominal do que em pacientes com sepse de origem pulmonar nos 5 primeiros dias de evolução da sepse.

OBJECTIVES: To evaluate the C-reactive protein serum levels in patients with pulmonary and abdominal sepsis during the first five days of sepsis progression. METHODS: The present investigation was a retrospective cohort study conducted at the university hospital with 345 patients who were admitted to the intensive care unit and diagnosed with sepsis of pulmonary or abdominal origin. Serum C-reactive protein concentrations were measured by the turbidimetric immunoassay. For analysis of C-reactive protein, day 1 was defined as the day on which the patient was clinically diagnosed with sepsis. RESULTS: Thirty-four patients with sepsis (9.8%), 114 patients with severe sepsis (33.0%), and 197 patients with septic shock (57.2%) were evaluated. The age of the patients was 56.4±19.8 years. The serum C-reactive protein concentrations were higher on the day of sepsis diagnosis in the group with abdominal infection compared with the group with pulmonary sepsis (17.8±10.1 mg/dL versus 14.9±11.1 mg/dL, p=0.025) and remained significantly higher during the first five days of sepsis progression. CONCLUSION: The serum C-reactive protein concentrations were significantly higher in the patients with abdominal sepsis compared with the patients with pulmonary sepsis during the first five days of sepsis progression.