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4.
J Infect Dev Ctries ; 11(8): 597-603, 2017 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31085820

RESUMO

INTRODUCTION: Sepsis is a major cause of childhood death worldwide. In developing countries, epidemiological data about sepsis is scarce. This study describes and compares the frequency of etiological agents and initial sites of infection in children with or without sepsis, identifying risk factors and assessing outcomes. METHODOLOGY: Clinical and demographic data from patients < 13 years of age with reported fever in a pediatric emergency department were collected and registered in forms. Patients were classified as with or without sepsis according to Goldstein et al.'s criteria [6]. RESULTS: Of 254 patients, 120 (47%) did and 134 (53%) did not meet the sepsis definition. Overall, the median age (IQR) was 1.7 (0.8-3.9) years, and 153 (60%) were boys. Patients with sepsis were older (2.8 [1.1-5.3] versus 1.3 [0.6-2.9] years; p < 0.001) and had sickle-cell disease more frequently (7.6% versus 0.8%; p = 0.007). By multiple logistic regression, age and sickle-cell disease were independently associated with sepsis. The most frequent initial infections were pneumonia (43.7%), diarrhea (17.3%) and cellulitis/adenitis (13.0%). The frequency of these did not differ when patients with or without sepsis were compared. Etiology was established in 57 (22.4%) patients, 32 (26.7%), and 25 (18.7%) with or without sepsis, respectively. Four (3.3%) patients died in the sepsis subgroup, whereas none died in the other subgroup. CONCLUSIONS: Children who met the 2005 international consensus definition of sepsis showed differences in age and comorbidities (sickle-cell disease) upon admission and were more likely to die.

5.
J Immunol Methods ; 433: 31-7, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26928648

RESUMO

The etiological diagnosis of infection by Streptococcus pneumoniae in children is difficult, and the use of indirect techniques is frequently warranted. We aimed to study the use of pneumococcal proteins for the serological diagnosis of pneumococcal infection in children with pneumonia. We analyzed paired serum samples from 13 Brazilian children with invasive pneumococcal pneumonia (positive control group) and 23 Finnish children with viral pharyngitis (negative control group), all aged <5years-old. Children with pharyngitis were evaluated for oropharyngeal colonization, and none of them carried S. pneumoniae. We used a multiplex bead-based assay with eight proteins: Ply, CbpA, PspA1 and 2, PcpA, PhtD, StkP and PcsB. The optimal cut-off for increase in antibody level for the diagnosis of pneumococcal infection was determined for each antigen by ROC curve analysis. The positive control group had a significantly higher rate of ≥2-fold rise in antibody levels against all pneumococcal proteins, except Ply, compared to the negative controls. The cut-off of ≥2-fold increase in antibody levels was accurate for pneumococcal infection diagnosis for all investigated antigens. However, there was a substantial increase in the accuracy of the test with a cut-off of ≥1.52-fold rise in antibody levels for PcpA. When using the investigated protein antigens for the diagnosis of pneumococcal infection, the detection of response against at least one antigen was highly sensitive (92.31%) and specific (91.30%). The use of serology with pneumococcal proteins is a promising method for the diagnosis of pneumococcal infection in children with pneumonia. The use of a ≥2-fold increase cut-off is adequate for most pneumococcal proteins.


Assuntos
Anticorpos Antibacterianos/sangue , Imunoensaio/métodos , Pneumonia Pneumocócica/diagnóstico , Antígenos de Bactérias/imunologia , Proteínas de Bactérias/imunologia , Brasil , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Microesferas , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Testes Sorológicos , Streptococcus pneumoniae/isolamento & purificação
6.
Mem Inst Oswaldo Cruz ; 109(2): 229-35, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24714967

RESUMO

During the influenza pandemic of 2009, the A(H1N1)pdm09, A/H3N2 seasonal and influenza B viruses were observed to be co-circulating with other respiratory viruses. To observe the epidemiological pattern of the influenza virus between May 2009-August 2011, 467 nasopharyngeal aspirates were collected from children less than five years of age in the city of Salvador. In addition, data on weather conditions were obtained. Indirect immunofluorescence, real-time transcription reverse polymerase chain reaction (RT-PCR), and sequencing assays were performed for influenza virus detection. Of all 467 samples, 34 (7%) specimens were positive for influenza A and of these, viral characterisation identified Flu A/H3N2 in 25/34 (74%) and A(H1N1)pdm09 in 9/34 (26%). Influenza B accounted for a small proportion (0.8%) and the other respiratory viruses for 27.2% (127/467). No deaths were registered and no pattern of seasonality or expected climatic conditions could be established. These observations are important for predicting the evolution of epidemics and in implementing future anti-pandemic measures.


Assuntos
Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vírus da Influenza A Subtipo H3N2/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/epidemiologia , Estações do Ano , Tempo (Meteorologia) , Adenoviridae/isolamento & purificação , Brasil/epidemiologia , Pré-Escolar , Processos Climáticos , Coinfecção , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Lactente , Recém-Nascido , Vírus da Influenza A Subtipo H1N1/fisiologia , Vírus da Influenza A Subtipo H3N2/fisiologia , Vírus da Influenza B/fisiologia , Influenza Humana/virologia , Líquido da Lavagem Nasal/virologia , Pandemias , Chuva/virologia , Vírus Sinciciais Respiratórios/isolamento & purificação , Respirovirus/isolamento & purificação , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência , Luz Solar , Carga Viral
7.
Mem. Inst. Oswaldo Cruz ; 109(2): 229-235, abr. 2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-705817

RESUMO

During the influenza pandemic of 2009, the A(H1N1)pdm09, A/H3N2 seasonal and influenza B viruses were observed to be co-circulating with other respiratory viruses. To observe the epidemiological pattern of the influenza virus between May 2009-August 2011, 467 nasopharyngeal aspirates were collected from children less than five years of age in the city of Salvador. In addition, data on weather conditions were obtained. Indirect immunofluorescence, real-time transcription reverse polymerase chain reaction (RT-PCR), and sequencing assays were performed for influenza virus detection. Of all 467 samples, 34 (7%) specimens were positive for influenza A and of these, viral characterisation identified Flu A/H3N2 in 25/34 (74%) and A(H1N1)pdm09 in 9/34 (26%). Influenza B accounted for a small proportion (0.8%) and the other respiratory viruses for 27.2% (127/467). No deaths were registered and no pattern of seasonality or expected climatic conditions could be established. These observations are important for predicting the evolution of epidemics and in implementing future anti-pandemic measures.


Assuntos
Pré-Escolar , Humanos , Lactente , Recém-Nascido , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , /isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/epidemiologia , Estações do Ano , Tempo (Meteorologia) , Adenoviridae/isolamento & purificação , Brasil/epidemiologia , Processos Climáticos , Coinfecção , Técnica Indireta de Fluorescência para Anticorpo , Vírus da Influenza A Subtipo H1N1/fisiologia , /fisiologia , Vírus da Influenza B/fisiologia , Influenza Humana/virologia , Líquido da Lavagem Nasal/virologia , Pandemias , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Chuva/virologia , Vírus Sinciciais Respiratórios/isolamento & purificação , Respirovirus/isolamento & purificação , Análise de Sequência , Luz Solar , Carga Viral
8.
J Bras Pneumol ; 40(1): 69-72, 2014.
Artigo em Inglês, Português | MEDLINE | ID: mdl-24626272

RESUMO

We compared bacteremic pneumococcal pneumonia (BPP) and pneumococcal empyema (PE), in terms of clinical, radiological, and laboratory findings, in under-fives. A cross-sectional nested cohort study, involving under-fives (102 with PE and 128 with BPP), was conducted at 12 centers in Argentina, Brazil, and the Dominican Republic. Among those with PE, mean age was higher; disease duration was longer; and tachypnea, dyspnea, and high leukocyte counts were more common. Among those with BPP, fever and lethargy were more common. It seems that children with PE can be distinguished from those with BPP on the basis of clinical and laboratory findings. Because both conditions are associated with high rates of morbidity and mortality, prompt diagnosis is crucial.


Assuntos
Empiema , Pneumonia Pneumocócica , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Empiema/diagnóstico , Empiema/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva Pediátrica , Masculino , Readmissão do Paciente , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/epidemiologia , Medição de Risco
9.
Braz. j. infect. dis ; 17(5): 573-578, Sept.-Oct. 2013. tab
Artigo em Inglês | LILACS | ID: lil-689883

RESUMO

Methicillin-resistant Staphylococcus aureus has emerged as a pathogen associated with community-acquired infections worldwide. We report the spectrum of community-acquired S. aureus infections and compare the patients infected with methicillin-susceptible or methicillin-resistant strains among patients aged <20 years. Overall, 90 cases of community acquired S. aureus were detected in an 11-year period. Clinical and microbiological data were registered. Fifty-nine (66%) patients were male and the median age was two years. The majority (87%) of the patients were hospitalized and chronic underlying illnesses were detected in 27 (30%) cases. Overall, 34 (37.8%) patients had skin/soft tissue infections and 56 (62.2%) patients had deep-seated infection. Four (5.1%) patients were transferred to the intensive care unit and two (2.6%) died. Complications were detected in 17 (18.9%) cases, such as pleural effusion (41.2%), osteomyelitis (23.5%), and sepsis (17.6%). Six (6.7%) methicillin-resistant strains were detected. Patients infected with methicillin-susceptible or methicillin-resistant strains had similar baseline characteristics and treatment outcomes. Approximately 93% of the cases received systemic antibiotics, out of which 59 (65.5%) used oxacillin or cefalotin. Both methicillin-susceptible and methicillin-resistant S. aureus strains resulted in morbidity and death among children in this setting where methicillin-resistant strains are infrequent.


Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Antibacterianos/uso terapêutico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Antibacterianos/farmacologia , Brasil/epidemiologia , Estudos de Coortes , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Testes de Sensibilidade Microbiana , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Estudos Retrospectivos , Índice de Gravidade de Doença , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação
10.
Braz J Infect Dis ; 17(5): 573-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24055391

RESUMO

Methicillin-resistant Staphylococcus aureus has emerged as a pathogen associated with community-acquired infections worldwide. We report the spectrum of community-acquired S. aureus infections and compare the patients infected with methicillin-susceptible or methicillin-resistant strains among patients aged <20 years. Overall, 90 cases of community-acquired S. aureus were detected in an 11-year period. Clinical and microbiological data were registered. Fifty-nine (66%) patients were male and the median age was two years. The majority (87%) of the patients were hospitalized and chronic underlying illnesses were detected in 27 (30%) cases. Overall, 34 (37.8%) patients had skin/soft tissue infections and 56 (62.2%) patients had deep-seated infection. Four (5.1%) patients were transferred to the intensive care unit and two (2.6%) died. Complications were detected in 17 (18.9%) cases, such as pleural effusion (41.2%), osteomyelitis (23.5%), and sepsis (17.6%). Six (6.7%) methicillin-resistant strains were detected. Patients infected with methicillin-susceptible or methicillin-resistant strains had similar baseline characteristics and treatment outcomes. Approximately 93% of the cases received systemic antibiotics, out of which 59 (65.5%) used oxacillin or cefalotin. Both methicillin-susceptible and methicillin-resistant S. aureus strains resulted in morbidity and death among children in this setting where methicillin-resistant strains are infrequent.


Assuntos
Antibacterianos/uso terapêutico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Antibacterianos/farmacologia , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Lactente , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Índice de Gravidade de Doença , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação
11.
Pediatr Pulmonol ; 48(5): 464-9, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22888091

RESUMO

This study assessed the inter-observer agreement in the interpretation of several radiographic features in the chest radiographs (CXR) of 803 children aged 2-59 months with non-severe acute lower respiratory tract infection (ALRI). Inclusion criteria comprised: report of respiratory complaints, detection of lower respiratory findings, and presence of pulmonary infiltrate on the CXR taken on admission and read by the pediatrician on duty. Data on demographic and clinical findings on admission were collected from children included in a clinical trial on the use of amoxicillin (ClinicalTrials.gov Identifier NCT01200706). CXR was later read by two independent pediatric radiologists blinded to clinical information and pneumonia was finally diagnosed if there was agreement on the presence of pulmonary infiltrate or pleural effusion. The kappa index (κ) of agreement was calculated. The radiologists agreed that 774 (96.4%) and 3 (0.4%) CXR were appropriate or inappropriate for reading, respectively, and that 222 (28.7%) and 459 (59.3%) CXR presented or did not present pneumonia. In intent to treat analysis, that is, considering the 803 enrolled patients, κ for the presence of pneumonia was 0.725 (95% CI: 0.675-0.775). The overall agreement was 78.7% (normal CXR [n = 385, 60.9%], pneumonia [n = 222, 35.1%], other radiological diagnosis [n = 22, 3.5%], inappropriate for reading [n = 3, 0.5%]). The most frequent radiological findings were alveolar infiltrate (33.2%) and consolidation (32.9%) by radiologist 1 and consolidation (28.3%) and alveolar infiltrate (19.3%) by radiologist 2. Concordance for consolidation was 86.7% (k = 0.683, 95%CI: 0.631-0.741). Agreement was good between two pediatric radiologists when diagnosis of pneumonia among children with non-severe ALRI was compared.


Assuntos
Infecções Respiratórias/diagnóstico por imagem , Pré-Escolar , Infecções Comunitárias Adquiridas , Feminino , Humanos , Lactente , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Radiografia , Reprodutibilidade dos Testes
12.
Expert Rev Vaccines ; 8(6): 695-8, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19485750

RESUMO

The impact of the heptavalent pneumococcal conjugate vaccine (PCV7) on the natural history of otitis media (OM) has been studied recently. In a high-risk population, PCV7 significantly reduced the risk of recurrent, bilateral or multiple tympanic membrane perforation, as well as the risk of chronic suppurative OM at 9 months of age. PCV7 did not reduce the time to the development of OM nor the burden of OM. Major challenges are the polymicrobial etiology of OM (Streptococcus pneumoniae and Haemophilus influenzae) in high-risk populations and the serotype replacement among pneumococcal strains. A vaccine including nontypable H. influenzae and 11 pneumococcal serotypes has been identified as a more efficacious option for preventing OM. In the near future, the development and evaluation of a vaccine containing pneumococcal protein, such as pneumococcal surface protein A, which is a structurally variable and serologically cross-reactive surface protein important to the pneumococcal virulence, will be a potential tool against OM.

13.
Pediatr Pulmonol ; 44(3): 249-52, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19205052

RESUMO

To assess if chest radiographic findings present on admission are associated with severity of childhood community-acquired pneumonia (CAP), a total of 161 children hospitalized with pulmonary infiltrate were enrolled in the study; 48 (30%) patients were excluded because of presence of bilateral chest radiographic alterations (33; 20%) and presence of underlying diseases (15; 9%). According to WHO and BTS criteria, severe CAP was present in 57 (50%) and in 96 (85%) cases, respectively; 29 (26%) were aged less than 1 year. The median age (months) was 22 (mean 24 +/- 14, range 2-58). Overall, radiographic finding was right-sided in 77 (68%) cases and the upper lobe was compromised in 36 (32%) cases. By analyzing data stratified to age, the frequency of upper lobe involvement was significantly higher among severe cases (WHO criteria) only for those patients aged > or =1 year (13/35 [37%] vs. 7/45 [16%], P = 0.03, OR [95% CI] 3.2 [1.1-9.2]). The specificity and positive predictive value of upper lobe involvement for severity among the latter group of patients were 84% (95% CI 70-93%) and 65% (95% CI 41-84%), respectively. No association was found by using the BTS criteria. The admission chest radiography was useful to predict severity of children aged > or =1 year hospitalized with CAP.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Índice de Gravidade de Doença , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Estudos Prospectivos , Radiografia
15.
Arq Neuropsiquiatr ; 61(2B): 353-8, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12894266

RESUMO

OBJECTIVES: To describe the clinical and CSF findings among patients with presumptive neuroschistosomiasis (NS) and to suggest a classification for the CSF diagnosis of presumptive NS. METHOD: The charts of all patients whose CSF exam was performed at the CSF Lab, Jos Silveira Foundation, Salvador, Brazil, from 1988 to 2002 were reviewed. Those with clinically suspected NS whose indirect fluorescent antibody test (IFA) and or hemagglutination-inhibiting antibodies test (HAI) were positive to S. mansoni were identified. RESULTS: Of 377 patients, 67.9% were males; the median age was 36 years (mean 37 + 16 yrs, range 3-82 yrs). The most frequent complaints were paraparesis (59.9%), urinary retention (36.2%), lower limb pain (22.8%). WBC of CSF (count/mm ) was > 4 in 66.0% (mean 83 + 124, median 40, range 4.3-1,100), protein (mg/dl) was > 40 in 84.6% (mean 185 + 519, median 81, range 41-6,800) and eosinophils were present in 46.9%. IFA and HAI were positive in 75.3%. WBC > 4 and presence of eosinophils were associated with IFA and HAI positive (67.3% versus 51.4%, p 0.014; 49.1% versus 23.0%, p 0.0001, respectively) and protein > 40 was not (85.4% versus 77.0%, p 0.09). Presence of WBC > 4, protein > 40 and eosinophils was associated with IFA and HAI positive (71.6% versus 38.2%, p 0.0003) but presence of eosinophils and any other combination of WBC and protein were not. CONCLUSION: NS should be considered as a possible diagnosis in patients who had had contact with schistosome-infected water and present with spinal cord compromising. Presence of IFA and HAI positive to S. mansoni, WBC > 4, protein > 40 and presence of eosinophils in the CSF may be considered as a criterium of highly probable presumptive diagnosis.


Assuntos
Neuroesquistossomose/líquido cefalorraquidiano , Esquistossomose mansoni/líquido cefalorraquidiano , Doenças da Medula Espinal/líquido cefalorraquidiano , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Testes de Inibição da Hemaglutinação , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neuroesquistossomose/diagnóstico , Valor Preditivo dos Testes , Esquistossomose mansoni/diagnóstico , Sensibilidade e Especificidade , Doenças da Medula Espinal/diagnóstico
16.
Arq. neuropsiquiatr ; 61(2B): 353-358, Jun. 2003. tab
Artigo em Inglês | LILACS | ID: lil-342775

RESUMO

OBJECTIVES: To describe the clinical and CSF findings among patients with presumptive neuroschistosomiasis (NS) and to suggest a classification for the CSF diagnosis of presumptive NS. METHOD: The charts of all patients whose CSF exam was performed at the CSF Lab, José Silveira Foundation, Salvador, Brazil, from 1988 to 2002 were reviewed. Those with clinically suspected NS whose indirect fluorescent antibody test (IFA) and or hemagglutination-inhibiting antibodies test (HAI) were positive to S. mansoni were identified. RESULTS: Of 377 patients, 67.9 percent were males; the median age was 36 years (mean 37 + 16 yrs, range 3-82 yrs). The most frequent complaints were paraparesis (59.9 percent), urinary retention (36.2 percent), lower limb pain (22.8 percent). WBC of CSF (count/mm ) was > 4 in 66.0 percent (mean 83 + 124, median 40, range 4.3-1,100), protein (mg/dl) was > 40 in 84.6 percent (mean 185 + 519, median 81, range 41-6,800) and eosinophils were present in 46.9 percent. IFA and HAI were positive in 75.3 percent. WBC > 4 and presence of eosinophils were associated with IFA and HAI positive (67.3 percent versus 51.4 percent, p 0.014; 49.1 percent versus 23.0 percent, p 0.0001, respectively) and protein > 40 was not (85.4 percent versus 77.0 percent, p 0.09). Presence of WBC > 4, protein > 40 and eosinophils was associated with IFA and HAI positive (71.6 percent versus 38.2 percent, p 0.0003) but presence of eosinophils and any other combination of WBC and protein were not. CONCLUSION: NS should be considered as a possible diagnosis in patients who had had contact with schistosome-infected water and present with spinal cord compromising. Presence of IFA and HAI positive to S. mansoni, WBC > 4, protein > 40 and presence of eosinophils in the CSF may be considered as a criterium of highly probable presumptive diagnosis


Assuntos
Adolescente , Adulto , Idoso , Animais , Criança , Pré-Escolar , Feminino , Humanos , Pessoa de Meia-Idade , Neuroesquistossomose , Esquistossomose mansoni , Doenças da Medula Espinal , Idoso de 80 Anos ou mais , Líquido Cefalorraquidiano , Eosinófilos , Técnica Indireta de Fluorescência para Anticorpo , Testes de Inibição da Hemaglutinação , Contagem de Leucócitos , Neuroesquistossomose , Valor Preditivo dos Testes , Esquistossomose mansoni , Sensibilidade e Especificidade , Doenças da Medula Espinal
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