RESUMO
We report a case of Group A streptococcal infection-induced toxic shock syndrome (GAS-TSS) with severe acute respiratory distress syndrome (ARDS), successfully treated with venoarterial extracorporeal membrane oxygenation (V-A ECMO). A 31-year-old woman was transferred due to high fever, continuous uterine contractions and fetal bradycardia at 31 weeks of gestation. She was in a shock status on arrival, and as fetal heart beat disappeared, we canceled the cesarean section and took priority in maternal rescue. At 21 h after the admission, pulseless ventricular tachycardia occurred, and V-A ECMO was introduced after defibrillation, which dramatically improved her respiratory and circulatory conditions. On the 3rd day, GAS was isolated from blood culture. The patient was freed from V-A ECMO on the 5th day and was discharged on the 25th day without permanent impairment. V-A ECMO should be considered as an effective therapeutic option against ARDS and circulation failure in GAS-TSS during pregnancy.
Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Complicações Infecciosas na Gravidez/terapia , Síndrome do Desconforto Respiratório/terapia , Choque Séptico/terapia , Infecções Estreptocócicas/complicações , Streptococcus pyogenes , Adulto , Bradicardia/microbiologia , Feminino , Morte Fetal , Doenças Fetais/microbiologia , Humanos , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Terceiro Trimestre da Gravidez , Síndrome do Desconforto Respiratório/microbiologia , Choque Séptico/microbiologia , Infecções Estreptocócicas/microbiologia , Resultado do TratamentoAssuntos
Flutter Atrial/microbiologia , Bloqueio Atrioventricular/microbiologia , Bradicardia/microbiologia , Doença de Lyme/complicações , Doença de Lyme/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Flutter Atrial/fisiopatologia , Flutter Atrial/cirurgia , Bloqueio Atrioventricular/fisiopatologia , Bradicardia/fisiopatologia , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Ecocardiografia , Eletrocardiografia , Teste de Esforço , Feminino , Humanos , Doença de Lyme/tratamento farmacológicoRESUMO
BACKGROUND: Tachyarrhythmia (TA) and bradyarrhythmia (BA) are cardiac rhythm disorders that result in the decline of quality of life. While patients with periodontitis are at a high risk of cardiovascular disease (CVD), little causal information between TA and BA has been provided to date. To assess the relationship, periodontal bacterial infection in patients with TA or BA was evaluated. METHODS: The subjects were patients with TA (n = 98) or BA (n = 40) who attended Tokyo Medical and Dental University hospital. Periodontal and blood examinations were performed. Periodontopathic bacterial existence in saliva was evaluated. RESULTS: We found that specific periodontopathic bacteria, Porphyromonas gingivalis and Prevotella intermedia, were highly detected in saliva from TA patients compared to BA subjects. The rates of hypertension and dyslipidemia were comparable between the two groups. CONCLUSION: Specific periodontal bacterial infection might affect TA progression.
Assuntos
Infecções por Bacteroidaceae/diagnóstico , Bradicardia/diagnóstico , Periodontite/diagnóstico , Taquicardia/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Infecções por Bacteroidaceae/epidemiologia , Bradicardia/epidemiologia , Bradicardia/microbiologia , Feminino , Humanos , Masculino , Periodontite/epidemiologia , Porphyromonas gingivalis/isolamento & purificação , Taquicardia/epidemiologia , Taquicardia/microbiologiaAssuntos
Bradicardia/microbiologia , Ehrlichiose/complicações , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Pertussis persists in the United States despite high immunization rates. This report characterizes the presentation and acute course of critical pertussis by quantifying demographic data, laboratory findings, clinical complications, and critical care therapies among children requiring admission to the PICU. DESIGN: Prospective cohort study. SETTING: Eight PICUs comprising the Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network and 17 additional PICUs across the United States. PATIENTS: Eligible patients had laboratory confirmation of pertussis infection, were younger than 18 years old, and died in the PICU or were admitted to the PICU for at least 24 hours between June 2008 and August 2011. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 127 patients were identified. Median age was 49 days, and 105 (83%) patients were less than 3 months old. Fifty-five (43%) patients required mechanical ventilation and 12 patients (9.4%) died during initial hospitalization. Pulmonary hypertension was found in 16 patients (12.5%) and was present in 75% of patients who died, compared with 6% of survivors (p < 0.001). Median WBC was significantly higher in those requiring mechanical ventilation (p < 0.001), those with pulmonary hypertension (p < 0.001), and nonsurvivors (p < 0.001). Age, sex, and immunization status did not differ between survivors and nonsurvivors. Fourteen patients received leukoreduction therapy (exchange transfusion [12], leukopheresis [1], or both [1]). Survival benefit was not apparent. CONCLUSIONS: Pulmonary hypertension may be associated with mortality in pertussis critical illness. Elevated WBC is associated with the need for mechanical ventilation, pulmonary hypertension, and mortality risk. Research is indicated to elucidate how pulmonary hypertension, immune responsiveness, and elevated WBC contribute to morbidity and mortality and whether leukoreduction might be efficacious.
Assuntos
Hipertensão Pulmonar/microbiologia , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Coqueluche/complicações , Coqueluche/mortalidade , Bradicardia/microbiologia , Transfusão Total , Feminino , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/mortalidade , Lactente , Leucaférese , Contagem de Leucócitos , Masculino , Pneumonia/microbiologia , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Respiração Artificial , Taxa de Sobrevida , Estados Unidos/epidemiologia , Coqueluche/sangue , Coqueluche/terapiaRESUMO
OBJECTIVES: To describe children with pertussis who require intensive care. DESIGN, SETTING AND PATIENTS: An audit in Auckland, New Zealand, of pertussis admissions to the national paediatric intensive care unit (PICU) from 1991 to 2003. RESULTS: 72 children, 97% of whom were <12 months old. The annual number of cases increased with time (p = 0.04). Forty patients (56%) were coughing for less than 8 days before admission. Apnoea or paroxysmal cough was present in 33 (83%) of these children. Thirty five (49%) received assisted ventilation. Four died. 19% were readmitted to PICU. Those readmitted presented with more atypical disease and had a shorter first admission but longer total PICU admission (9 vs 5 days, p = 0.009). Of the 58 children from Auckland, nine either died (three) or had subsequent respiratory or neurodevelopmental problems (six). There was an increased risk (relative risk, 95% CI) of death or disability associated with having a co-morbidity (RR = 5.56, 1.50 to 8.15), an elevated lymphocyte count (RR = 5.75, 1.54 to 13.65), presenting with seizures/encephalopathy (4.87, 1.18 to 8.34) or shock (6.50, 1.89 to 8.94), having a PIM score of 1% or more (RR = 6.20, 1.22 to 21.72), any abnormal neurological signs (RR = 9.65, 3.32 to 15.23) or being readmitted to PICU (RR = 4.63, 1.44 to 8.82). CONCLUSIONS: Apnoea and paroxysmal cough are key symptoms of pertussis in those with shorter cough duration. Death or disability are frequent. Clinical factors define children at increased risk of these poor outcomes. Early discharge from PICU is associated with an increased risk of readmission and poor outcome.
Assuntos
Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Coqueluche/complicações , Coqueluche/terapia , Antibacterianos/uso terapêutico , Apneia/complicações , Apneia/microbiologia , Bradicardia/complicações , Bradicardia/microbiologia , Criança , Pré-Escolar , Cianose/complicações , Cianose/microbiologia , Síndrome Hemolítico-Urêmica/complicações , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/microbiologia , Lactente , Leucocitose/complicações , Linfocitose/complicações , Masculino , Auditoria Médica , Nova Zelândia/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Convulsões/complicações , Choque/complicações , Coqueluche/diagnóstico , Coqueluche/mortalidadeRESUMO
A case of pyrexia from abroad presenting to the emergency department is discussed. The causes of such pyrexia are outlined and the investigations are described. We stress that vaccination is not foolproof from acquiring an infection from abroad.
Assuntos
Tratamento de Emergência/métodos , Febre de Causa Desconhecida/microbiologia , Febre Paratifoide/diagnóstico , Salmonella paratyphi A , Viagem , Adulto , Anorexia/microbiologia , Antibacterianos/uso terapêutico , Bradicardia/microbiologia , Ceftriaxona/uso terapêutico , Controle de Doenças Transmissíveis , Busca de Comunicante , Notificação de Doenças , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Testes de Sensibilidade Microbiana , Paquistão , Febre Paratifoide/complicações , Febre Paratifoide/tratamento farmacológico , Febre Paratifoide/epidemiologia , Fatores de Risco , Vacinação , Vômito/microbiologiaRESUMO
OBJECTIVES: to evaluate the diagnostic value of clinical symptoms and signs in enteric fever and to propose a clinical diagnostic criterion. DESIGN: Prospective observational study. SETTING: Kathmandu Medical College, Teaching Hospital, Kathmandu, Nepal. MATERIALS AND METHODS: febrile patients with clinical diagnosis of enteric fever were included in the study with the aim of confirming diagnosis with blood culture, or bone marrow culture and evaluating the diagnostic accuracy of various clinical signs and symptoms. RESULTS: 64% of the clinically diagnosed cases had blood/ bone marrow culture positive. The diagnostic accuracy of the various symptoms and signs excluding fever was between 42%-75.5%. Majority of the symptom and sign did not have very high diagnostic accuracy. Hence a diagnostic criterion was proposed and clinical features with diagnostic accuracy more than 50% were taken into consideration. Major criteria included fever with diagnostic accuracy of 64%, headache with accuracy of 75.5% and relative bradycardia with an accuracy of 66%. Minor criteria included vomiting, diarrhoea, Splenomegaly, chills and abdominal pain /discomfort with diagnostic accuracy of 57%, 55%, 55%, 53% and 51% respectively. Finally after combination of various major and minor criteria a final diagnostic criterion was proposed having an accuracy of 66% and including both major and minor clinical symptom and sign. CONCLUSION: clinical diagnosis of enteric fever will be very helpful in a country like ours. Though none of the clinical symptoms and sign have very high diagnostic accuracy a diagnostic criteria may be helpful. Criteria including both major and minor signs and symptoms would be the most appropriate diagnostic tool as it includes the important abdominal symptoms and signs of enteric fever.
Assuntos
Anamnese/métodos , Exame Físico/métodos , Febre Tifoide/diagnóstico , Dor Abdominal/microbiologia , Adulto , Técnicas Bacteriológicas , Sangue/microbiologia , Exame de Medula Óssea , Bradicardia/microbiologia , Países em Desenvolvimento , Diarreia/microbiologia , Doenças Endêmicas/prevenção & controle , Doenças Endêmicas/estatística & dados numéricos , Feminino , Febre/microbiologia , Cefaleia/microbiologia , Hospitais de Ensino , Humanos , Masculino , Anamnese/normas , Nepal/epidemiologia , Exame Físico/normas , Prevalência , Estudos Prospectivos , Sensibilidade e Especificidade , Esplenomegalia/microbiologia , Febre Tifoide/sangue , Febre Tifoide/complicações , Febre Tifoide/epidemiologia , Febre Tifoide/microbiologiaRESUMO
A one year study (August 1998-July 1999) of bacteremia in febrile children was carried out in the Medical Unit (III), Yangon Children's Hospital (YCH), Myanmar, to determine: (1) the bacteria responsible for fever of five days or more in children; (2) the antibiotic sensitivity pattern of these bacteria. Children aged one month to 12 years who had fever for five days or more and who did not receive antibiotics within the first 48 hours irrespective of the diagnosis were included in this study. A total of 120 patients fulfilled the criteria. Bacteria could be isolated from 65 cases (54.2%). The commonest organism isolated was Salmonella typhi (43.1%). Others included Escherichia coli (12.3%), Staphylococcus aureus (7.7%), Pseudomonas aeruginosa (7.7%); Streptococcus, Shigella, Diplococcus, Klebsiella and Acinetobacter were also isolated. The Salmonella typhi were resistant to conventional antibiotics (ampicillin, amoxicillin, chloramphenicol, and co-trimoxazole); however, they were sensitive to amikacin, netilmicin, nalidixic acid, and cephalothin. A cluster of enteric fever cases from Mingalartaungnyunt township was noticed and was reported to the Directorate of Health. Changes in the incidence and etiology of bacteremia in hospitals are well documented. Sentinel surveys of bacteremia in major hospitals should be carried out in order to detect the changing patterns of bacteremia and antibiotic sensitivity; such surveys will be of great help in establishing local antibiotic policies.
Assuntos
Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Febre/microbiologia , Hospitais Pediátricos/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Distribuição por Idade , Bacteriemia/sangue , Bacteriemia/complicações , Técnicas Bacteriológicas , Bradicardia/microbiologia , Criança , Pré-Escolar , Análise por Conglomerados , Farmacorresistência Bacteriana , Feminino , Hepatomegalia/microbiologia , Humanos , Incidência , Lactente , Pneumopatias/microbiologia , Masculino , Testes de Sensibilidade Microbiana , Mianmar/epidemiologia , Avaliação das Necessidades , Características de Residência/estatística & dados numéricos , Vigilância de Evento Sentinela , Distribuição por Sexo , Esplenomegalia/microbiologiaRESUMO
Typhoid fever, a systemic infectious disease caused by Salmonella typhi, is classically characterized by fever, paradoxical bradycardia, abdominal pain, and a rose colored rash. This was a retrospective review of 21 confirmed cases over a 5-year period. Mean age was 32.6 years (range 2-60 years), and Mexico (7/21) and El Salvador (3/21) represented the most common countries of origin. Recent travel to an endemic area was noted in 14 patients. The most common complaints were fever (15/21), headache (10/21), abdominal pain (9/21), and diarrhea (6/21). Average duration of symptoms before presentation to the Emergency Department (ED) was 7.9 days. High fever associated with bradycardia was noted in 12 patients. Leukopenia was present in 7 patients. Blood culture was the most sensitive confirmatory test while the Widal test was positive in 7 out of 11 cases. Fever of unknown origin (12/21), followed by presumed typhoid fever (3/21) were the most common ED diagnoses. It is important to recognize that patients with typhoid fever may present to EDs in the US and this disease should be included in the differential diagnosis of febrile patients from Latin America or those with a history of recent travel to endemic countries.
Assuntos
Dor Abdominal/microbiologia , Bradicardia/microbiologia , Diarreia/microbiologia , Tratamento de Emergência/métodos , Exantema/microbiologia , Febre/microbiologia , Cefaleia/microbiologia , Hispânico ou Latino , Leucopenia/microbiologia , Febre Tifoide/complicações , Febre Tifoide/diagnóstico , Adolescente , Adulto , Distribuição por Idade , Testes de Aglutinação , Criança , Pré-Escolar , Emigração e Imigração , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , América Latina/etnologia , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Febre Tifoide/tratamento farmacológico , Febre Tifoide/etnologiaRESUMO
In clinical practice, the occurrence of arrhythmias in a critical ill patient is often assumed to be due to underlying infection or sepsis. This relationship has been suggested by both case reports and textbooks of Internal Medicine. Two scenarios are deemed possible: The occurrence of "preexisting" arrhythmias in susceptible patients (those with an arrhythmogenic substrate, e.g. a myocardial infarction scar) and the occurrence of arrhythmias mediated in some way through the infection/sepsis in otherwise unsusceptible patients. The present overview portrays the scarcity of data and shows that neither scenario is supported by firm data. While sinus tachycardia is among the spectrum of expected abnormalities during infection or sepsis, bradycardia may be observed in selected cases. This seems to occur relatively frequently in patients with fungemia.