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1.
Medicine (Baltimore) ; 98(38): e17185, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567961

RESUMO

Infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus (PVL-SA) mostly present as recurrent skin abscesses and furunculosis. However, life-threatening infections (eg, necrotizing pneumonia, necrotizing fasciitis, and osteomyelitis) caused by PVL-SA have also been reported.We assessed the clinical phenotype, frequency, clinical implications (surgery, length of treatment in hospitals/intensive care units, and antibiotic treatments), and potential preventability of severe PVL-SA infections in children.Total, 75 children treated for PVL-SA infections in our in- and outpatient units from 2012 to 2017 were included in this retrospective study.Ten out of 75 children contracted severe infections (PVL-methicillin resistant S aureus n = 4) including necrotizing pneumonia (n = 4), necrotizing fasciitis (n = 2), pyomyositis (n = 2; including 1 patient who also had pneumonia), mastoiditis with cerebellitis (n = 1), preorbital cellulitis (n = 1), and recurrent deep furunculosis in an immunosuppressed patient (n = 1). Specific complications of PVL-SA infections were venous thrombosis (n = 2), sepsis (n = 5), respiratory failure (n = 5), and acute respiratory distress syndrome (n = 3). The median duration of hospital stay was 14 days (range 5-52 days). In 6 out of 10 patients a history suggestive for PVL-SA colonization in the patient or close family members before hospital admission was identified.PVL-SA causes severe to life-threatening infections requiring lengthy treatments in hospital in a substantial percentage of symptomatic PVL-SA colonized children. More than 50% of severe infections might be prevented by prompt testing for PVL-SA in individuals with a history of abscesses or furunculosis, followed by decolonization measures.


Assuntos
Toxinas Bacterianas/metabolismo , Exotoxinas/metabolismo , Leucocidinas/metabolismo , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/metabolismo , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Pneumonia Necrosante/microbiologia , Estudos Retrospectivos , Infecções dos Tecidos Moles/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/patologia , Infecções Estafilocócicas/terapia
2.
Zhonghua Er Ke Za Zhi ; 57(8): 625-630, 2019 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-31352749

RESUMO

Objective: To compare the characteristics of Mycoplasma pneumoniae necrotizing pneumonia (MPNP) and bacterial necrotizing pneumonia (BNP), and explore the biomarkers for differentiation of MPNP from BNP. Methods: A retrospective, observational study of 52 necrotizing pneumonia (NP) cases who were hospitalized in our hospital from January 2008 to December 2017 was conducted. According to the pathogen causing NP, patients were divided into two groups, BNP and MPNP, and the clinical manifestations, laboratory data, imaging findings, hospital course and prognosis between these groups were analyzed. Results: This study enrolled 19 boys and 33 girls, and the median ages of patients were 4.4 (0.1-13.8) years old. Of the totally of 52 NP patients, 19 were in the BNP group (9 boys and 10 girls), 33 were in the MPNP group (10 boys and 23 girls). The mean age of MPNP patients was much older than that of BNP patients (5.2 (2.3-13.2) years vs. 1.8 (0.1-13.8) years, Z=-0.128, P<0.01). The number of patients with tachypnea and pleural effusion septation were significantly higher in BNP patients than those in MPNP patients (15 cases vs. 4 cases, χ(2)=23.222, P<0.01; 14 cases vs. 1 case, χ(2)=29.326, P<0.01), which more needed to oxygentherapy (18 cases vs. 12 cases, χ(2)=16.833, P<0.01) and undergo chest drainage (9 cases vs. 4 cases, χ(2)=5.829, P=0.022); while the number of patients required bronchoalveolar lavage was higher in MPNP patients than that in BNP patients (5 cases vs. 32 cases, χ(2)=29.326, P<0.01). The values of white blood cell (WBC) (23.2 (5.2-67.1)×10(9)/L vs. 9.7 (6.3-18.7)×10(9)/L, Z=-4.855, P<0.01), procalcitonin (PCT) (3.69 (0.23-90.15) mg/L vs. 0.28 (0.02-1.44) mg/L, Z=-3.207, P=0.001), C reactive protein (CRP) (160 (94-220) mg/L vs. 90 (5-134) mg/L, Z=-4.337, P<0.01), interleukin (IL)-10 (11.7 (4.2-401.5) ng/L vs. 4.8 (2.0-23.4) ng/L, Z=-2.278, P=0.023), pleural fluid cell count (5 200 (120-50 000)×10(6)/L vs. 790 (68-6 920)×10(6)/L, Z=-3.125, P=0.002), pleural fluid lactic dehydrogenase (LDH) (3 990 (589-29 382) U/L vs. 2 211 (673-3 993) U/L, Z=-2.488, P=0.013) in BNP group were significantly higher than those in MPNP group; while the values of pleural fluid glucose(0.43 (0.03-18.00) mmol/L vs. 5.95 (4.27-7.87) mmol/L, Z=-2.795, P=0.005), serum tumor necrosis factor (TNF)-α (2.3 (1.0-2.8) ng/L vs. 2.6 (1.3-109.2) ng/L, Z=-2.113, P=0.035) and interferon (IFN)-γ (4.8 (2.6-7.7) ng/L vs. 11.9 (2.9-154.6) ng/L, Z=-2.455, P=0.014) were lower in BNP group than those in MPNP group. Meanwhile, the mean time from the onset of symptoms to the discovery of necrotic lesions was longer in MPNP group than that in BNP group ((20.6±6.4) days vs. (14.6±6.2) days, t=3.029, P=0.004). After treatments, all patients were discharged without death, WBC and PCT recovered more quickly in MPNP group than those in BNP group (12 (0-24) days vs. 0 (0-23) days, Z=-4.484, P<0.01; 10 (5-15) days vs. 0 (0-23) days, Z=-3.244, P=0.001). As to prognosis, 34 cases were followed up, and the results showed that patients recovered without surgical intervention, and chest lesions were resolved within 3.0 (1.0-8.0) months, and the time to necrosis disappearance was similar in the BNP group and MPNP greup (3.0 (1.0-8.0) months vs. 3.0 (1.0-8.0) months, Z=-0.128, P=0.001). In receiver operator characteristic curve analysis, the cut-off values for the age, WBC, CRP, PCT, pleural fluid cell count and pleural fluid glucose were set at 2.4 years of age, 17.2×10(9)/L, 157 mg/L, 1.505 mg/L, 2 630×10(6)/L and 3.73 mmol/L, respectively. Conclusions: NP is found to be severe and prolonged, yet, reversible through proper therapy, such as rational antibiotics application. The age, WBC, CRP, PCT, pleural fluid cell count and pleural fluid glucose could be used as biomarkers to differentiate MPNP from BNP in children.


Assuntos
Mycoplasma pneumoniae , Necrose/patologia , Pneumonia por Mycoplasma/diagnóstico , Pneumonia Necrosante/diagnóstico , Adolescente , Antibacterianos/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pneumonia por Mycoplasma/microbiologia , Pneumonia Necrosante/microbiologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
3.
Niger Postgrad Med J ; 26(1): 65-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860202

RESUMO

Necrotising pneumonia (NP) is a rare complication of bacterial pneumonia which is associated with severe morbidity and mortality. Pneumonia of polymicrobial aetiology predicts worse pathology with fulminating clinical course. Reports of necrotising pneumonia from multiple bacterial infections are scanty in published literature. We report a case of a toddler with NP in whom Klebsiella pneumonia and Staphylococcus aureus, two pathogens which are well documented in its aetiopathogenesis, were isolated concurrently from his sputum and blood. Severe pneumonia, which shows slow response to recommended antibiotics treatment, should raise the suspicion of NP and possibly one of the polymicrobial origins. Even in resource-constrained settings, prompt institution of antibiotics and supportive care can result in resolution of pulmonary lesions.


Assuntos
Antibacterianos/uso terapêutico , Klebsiella pneumoniae/isolamento & purificação , Pneumonia Bacteriana/diagnóstico , Pneumonia Necrosante/diagnóstico , Staphylococcus aureus/isolamento & purificação , Pré-Escolar , Humanos , Nigéria , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Pneumonia Necrosante/tratamento farmacológico , Pneumonia Necrosante/microbiologia , Escarro/microbiologia
4.
Vet Microbiol ; 229: 72-80, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30642601

RESUMO

Staphylococcus aureus is one of the most important pathogens causing rabbit necrotizing pneumonia and brings huge economic losses to rabbit production. This study investigated the preventive effect of a phage on rabbit necrotizing pneumonia caused by S. aureus. S. aureus S6 was isolated from the lungs of rabbits suffering necrotizing pneumonia and identified. A novel phage named VB-SavM-JYL01 was isolated by using S. aureus S6 as a host and showed a broader host range than the phages GH15 and K. The genome of VB-SavM-JYL01 lacked bacterial virulence-, antibiotic resistance- and lysogenesis-related genes. A single intranasal administration of VB-SavM-JYL01 (3 × 109 PFU) could effectively improve the survival rate at 48 h to 90% (9/10) compared with the survival rate of 10% and 80% observed with the PBS or linezolid treatment, respectively. The bacterial count in the lungs of rabbits treated with the phage VB-SavM-JYL01 was 4.18 × 104 CFU/g at 24 h, which was significantly decreased compared to that of rabbits treated with PBS (7.38 × 107 CFU/g) or linezolid (3.12 × 105 CFU/g). The phage treatment significantly alleviated lung tissue damage. The levels of total proteins, Panton-Valentine leukocidin (PVL), alpha-toxin (Hla) and cytokines in the lungs of the rabbits treated with the phage were significantly lower than those of the rabbits treated with PBS and similar to those of the rabbits treated with linezolid. These data demonstrate the potential utility of phage as an alternative for preventing rabbit necrotizing pneumonia caused by S. aureus.


Assuntos
Pneumonia Necrosante/veterinária , Pneumonia Estafilocócica/veterinária , Coelhos/microbiologia , Fagos de Staphylococcus , Staphylococcus aureus/virologia , Animais , Feminino , Pneumonia Necrosante/microbiologia , Pneumonia Necrosante/prevenção & controle , Pneumonia Estafilocócica/prevenção & controle
6.
Intern Med ; 58(5): 685-691, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30333405

RESUMO

A 66-year-old man was transferred to our hospital for pneumonia that was resistant to sulbactam/ampicillin and levofloxacin therapy. Chest computed tomography showed the rapidly progressive formation of multiple cavities. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated, and the patient was diagnosed with necrotizing pneumonia caused by community-acquired MRSA (CA-MRSA). The MRSA strain had type IV staphylococcus cassette chromosome mec and genes encoding Panton-Valentine leucocidin (PVL). CA-MRSA necrotizing pneumonia with the PVL gene is rare; only three cases have been previously reported in Japan. We administered anti-MRSA antibiotics and the patient achieved complete clinical and radiological improvement.


Assuntos
Toxinas Bacterianas/genética , Exotoxinas/genética , Leucocidinas/genética , Staphylococcus aureus Resistente à Meticilina/genética , Pneumonia Necrosante/diagnóstico por imagem , Pneumonia Estafilocócica/diagnóstico por imagem , Idoso , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico por imagem , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Humanos , Masculino , Resistência a Meticilina , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Necrosante/tratamento farmacológico , Pneumonia Necrosante/microbiologia , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Estafilocócica/microbiologia , Radiografia , Tomografia Computadorizada por Raios X
8.
Rev Inst Med Trop Sao Paulo ; 60: e74, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30462797

RESUMO

Rhodococcus equi is a facultative aerobic, intracellular, non-motile, non-spore-forming, Gram-positive, weakly acid-fast coccobacillus belonging to the group of nocardioform actinomycetes. R. equi infections are rare opportunistic illnesses in patients with Acquired Immunodeficiency Syndrome (AIDS), associated with a high mortality rate. The most common clinical presentation of R. equi infections is a chronic cavitary pneumonia. Due to its acid-fastness, R. equi can be mistaken for others acid-fast organisms, as Mycobacterium tuberculosis. In turn, R. equi is also a gram-positive pleomorphic bacteria and can be mistaken for diphtheroids or Micrococcus organisms, being accidentally disregarded as oral contaminants in sputum cultures. Therefore, in Brazil, a highly prevalent tuberculosis (TB) country, pulmonary infections caused by R. equi may mimic pulmonary TB and represent a diagnostic challenge. Here, we report on a case of chronic cavitary pneumonia by R. equi in a Human Immunodeficiency Virus (HIV)-infected patient, focusing on diagnostic aspects.


Assuntos
Síndrome de Imunodeficiência Adquirida/microbiologia , Infecções por Actinomycetales/microbiologia , Pneumonia Necrosante/microbiologia , Rhodococcus equi , Síndrome de Imunodeficiência Adquirida/diagnóstico , Infecções por Actinomycetales/diagnóstico , Doença Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Necrosante/diagnóstico
9.
Microbiol Spectr ; 6(5)2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30291703

RESUMO

Fulminant staphylococcal infection indicates an explosive, intense, and severe infection occurring in a patient whose previous condition and antecedent would never have caused any anticipation of life-threatening development. This includes necrotizing pneumonia, necrotizing fasciitis, and to some extent toxic shock syndrome and infective endocarditis. In the three former diseases, toxin production plays a major role whereas in the latter (fulminant presentation of infective endocarditis), association with any particular toxinic profile has never been demonstrated. This article reviews the clinical, pathophysiological, and therapeutic aspects of these diseases.


Assuntos
Infecções Estafilocócicas/fisiopatologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus/patogenicidade , Bacteriemia , Endocardite/microbiologia , Fasciite Necrosante/microbiologia , Humanos , Pneumonia Necrosante/microbiologia , Choque Séptico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos
10.
PLoS Pathog ; 14(9): e1007308, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30248149

RESUMO

Gram-positive bacteria, including Staphylococcus aureus are endemic in the U.S., which cause life-threatening necrotizing pneumonia. Neutrophils are known to be critical for clearance of S. aureus infection from the lungs and extrapulmonary organs. Therefore, we investigated whether the NLRP6 inflammasome regulates neutrophil-dependent host immunity during pulmonary S. aureus infection. Unlike their wild-type (WT) counterparts, NLRP6 knockout (KO) mice were protected against pulmonary S. aureus infection as evidenced by their higher survival rate and lower bacterial burden in the lungs and extrapulmonary organs. In addition, NLRP6 KO mice displayed increased neutrophil recruitment following infection, and when neutrophils were depleted the protective effect was lost. Furthermore, neutrophils from the KO mice demonstrated enhanced intracellular bacterial killing and increased NADPH oxidase-dependent ROS production. Intriguingly, we found higher NK cell-mediated IFN-γ production in KO mouse lungs, and treatment with IFN-γ was found to enhance the bactericidal ability of WT and KO neutrophils. The NLRP6 KO mice also displayed decreased pyroptosis and necroptosis in the lungs following infection. Blocking of pyroptosis and necroptosis in WT mice resulted in increased survival, reduced bacterial burden in the lungs, and attenuated cytokine production. Taken together, these novel findings show that NLRP6 serves as a negative regulator of neutrophil-mediated host defense during Gram-positive bacterial infection in the lungs through regulating both neutrophil influx and function. These results also suggest that blocking NLRP6 to augment neutrophil-associated bacterial clearance should be considered as a potential therapeutic intervention strategy for treatment of S. aureus pneumonia.


Assuntos
Infiltração de Neutrófilos/imunologia , Pneumonia Estafilocócica/imunologia , Receptores de Superfície Celular/imunologia , Animais , Linfócitos T CD4-Positivos/imunologia , Feminino , Interações Hospedeiro-Patógeno/imunologia , Humanos , Inflamassomos/imunologia , Interferon gama/biossíntese , Células Matadoras Naturais/imunologia , Pulmão/imunologia , Pulmão/microbiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Pneumonia Necrosante/imunologia , Pneumonia Necrosante/microbiologia , Pneumonia Estafilocócica/microbiologia , Piroptose/imunologia , Espécies Reativas de Oxigênio/metabolismo , Receptores de Superfície Celular/deficiência , Receptores de Superfície Celular/genética , Staphylococcus aureus/imunologia , Regulação para Cima
11.
J Vet Diagn Invest ; 30(5): 728-732, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30027827

RESUMO

Three Florida pumas ( Puma concolor coryi) that had spent time in captivity prior to being released in the wild were found exhibiting respiratory signs and reluctance to move. All 3 pumas died shortly after immobilization, despite supportive veterinary care. Significant autopsy findings included necrotizing interstitial pneumonia, with pulmonary edema and hyaline membranes, and suppurative myocarditis. Organisms morphologically consistent with Bartonella henselae were identified in intravascular histiocytes in the lung of one of the pumas on histopathology and confirmed via transmission electron microscopy. B. henselae was detected in fresh lung tissue and confirmed by PCR and sequence analysis (16S-23S spacer region, pap31, and rpoB genes) from one of the affected pumas. In all affected pumas, B. henselae was detected by PCR in formalin-fixed, paraffin-embedded lung tissue, and positively staining organisms were identified in sections of lung by immunohistochemistry for B. henselae. In situ hybridization detected B. henselae DNA in lung tissue from 2 of 3 affected pumas. Our case series suggests that B. henselae can be associated with a fatal disease syndrome in Florida pumas. The cause of susceptibility to fatal disease associated with B. henselae infection in these pumas remains unknown.


Assuntos
Infecções por Bartonella/veterinária , Bartonella henselae/isolamento & purificação , Doenças Pulmonares Intersticiais/veterinária , Miocardite/veterinária , Puma , Animais , Infecções por Bartonella/microbiologia , Infecções por Bartonella/fisiopatologia , Florida , Doenças Pulmonares Intersticiais/microbiologia , Doenças Pulmonares Intersticiais/fisiopatologia , Miocardite/microbiologia , Miocardite/fisiopatologia , Pneumonia Necrosante/microbiologia , Pneumonia Necrosante/fisiopatologia , Pneumonia Necrosante/veterinária , Supuração/microbiologia , Supuração/fisiopatologia , Supuração/veterinária
12.
Int J Tuberc Lung Dis ; 22(6): 614-616, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29566781

RESUMO

SETTING: Tertiary care hospital, Western Cape, South Africa. DESIGN: Retrospective descriptive study of a case series of necrotising pneumonia (NP) in children associated with Mycobacterium tuberculosis presenting over a 4-year period in a country with high human immunodeficiency virus (HIV) and tuberculosis (TB) prevalence. OBJECTIVE: To describe the clinical and radiological features of, and treatment regimens and outcomes in, children with NP. RESULTS: Of 32 children (median age 16.5 months, interquartile range 10-33), 8 (25%) (median age 49 months) had NP associated with M. tuberculosis, 6 of whom were HIV-infected. Chest computed tomography (CT) was diagnostic in all cases: no radiological signs were suggestive of TB. There was no difference in the clinical picture, chest radiography or CT scan between M. tuberculosis-associated and bacterial NP. M. tuberculosis was cultured in 75% of cases; pleural fluid acid-fast bacilli was positive in an additional two cases. Surgery was required in 46% of the M. tuberculosis cases. At follow-up, 50% of these cases had complete radiological resolution similar to bacterial NP. CONCLUSION: This series highlights the fact that M. tuberculosis not only causes acute pneumonia in children, it also results in numerous complications. M. tuberculosis should be considered as a cause of NP in all children, especially HIV-infected children, living in high TB prevalence regions.


Assuntos
Infecções por HIV/epidemiologia , Mycobacterium tuberculosis/isolamento & purificação , Pneumonia Necrosante/diagnóstico , Tuberculose Pulmonar/diagnóstico , Pré-Escolar , Seguimentos , Humanos , Lactente , Pneumonia Necrosante/microbiologia , Pneumonia Necrosante/terapia , Prevalência , Estudos Retrospectivos , África do Sul/epidemiologia , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/terapia
13.
BMC Pulm Med ; 17(1): 103, 2017 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-28728546

RESUMO

BACKGROUND: To describe the experience of combination therapy with extracorporeal membrane oxygenation(ECMO), high-frequency oscillatory ventilation(HFOV) and prone positioning in treating severe respiratory failure caused by community acquired methicillin resistant Staphylococcus aureus(CA-MRSA). CASE PRESENTATION: A 30-year-old female presented with fever and dyspnea for 3 days. She was diagnosed CA-MRSA pneumonia complicated by severe respiratory failure, pneumothorax and neutropenia. Venovenous ECMO was applied within 8 h of the pneumothorax diagnosis. For amelioration of ventilator-induced lung injury, HFOV and prone positioning were combined with ECMO. The patient's condition improved considerably. ECMO was weaned on day 19, and she was discharged on day 48 with good lung recovery. CONCLUSIONS: To the best of our knowledge, this was the first case in which ECMO was combined with HFOV and prone positioning to treat severe necrotic CA-MRSA pneumonia complicated with pneumothorax. This combination therapy may provide safe respiratory support, may minimize the risk of barotrauma, and provide better drainage of secretions in patients with necrotizing pneumonia.


Assuntos
Oxigenação por Membrana Extracorpórea , Ventilação de Alta Frequência , Pneumonia Necrosante/terapia , Pneumotórax/terapia , Decúbito Ventral , Insuficiência Respiratória/terapia , Adulto , Terapia Combinada , Feminino , Humanos , Staphylococcus aureus Resistente à Meticilina , Pneumonia Necrosante/complicações , Pneumonia Necrosante/microbiologia , Pneumotórax/microbiologia , Insuficiência Respiratória/microbiologia
14.
Rev Argent Microbiol ; 49(2): 139-141, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28325626

RESUMO

The aim of this report is to describe a rare case of necrotizing pneumonia due to group B Streptococcus serotype III in a relatively young male adult (48 years old) suffering from diabetes. The organism was isolated from his pleural fluid and was only resistant to tetracycline. The patient first received ceftazidime (2g/8h i.v.)+clindamycin (300mg/8h) for 18 days and then he was discharged home and orally treated with amoxicillin clavulanic acid (1g/12h) for 23 days with an uneventful evolution. As in the cases of invasive infection by Streptococcus pyogenes, clindamycin could prevent streptococcal toxic shock syndrome.


Assuntos
Complicações do Diabetes , Pneumonia Necrosante , Infecções Estreptocócicas , Clindamicina , Diabetes Mellitus , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Necrosante/complicações , Pneumonia Necrosante/diagnóstico , Pneumonia Necrosante/microbiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes
15.
Pediatr Ann ; 46(2): e65-e68, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28192581

RESUMO

Necrotizing pneumonia refers to the development of necrosis, liquefication, and cavitation of the lung parenchyma from an infectious pathogen. Nearly 4% of all community-acquired pneumonias are necrotizing, although studies retrospectively evaluating the incidence have found it to be increasing during the past 20 years. Common presenting symptoms include fever, tachypnea, and cough, and most of those afflicted also develop complications such as parapneumonic effusions, empyemas, or bronchopleural fistulae. When compared to age-matched controls with parapneumonic effusions or severe pneumonias without a necrotizing component, those with necrotizing pneumonia have been shown to have more elevated white blood cell counts and inflammatory markers that take longer to normalize, a longer duration of symptoms despite initiation of therapy, and a longer hospital stay. Despite the high incidence of complications during the acute phase of illness, the overall prognosis of necrotizing pneumonia has been shown to be promising, with nearly all children surviving the illness. [Pediatr Ann. 2017;46(2):e65-e68.].


Assuntos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Necrosante/microbiologia , Infecções Estafilocócicas/microbiologia , Antibacterianos/uso terapêutico , Lavagem Broncoalveolar , Feminino , Humanos , Recém-Nascido , Testes de Sensibilidade Microbiana , Pneumonia Necrosante/diagnóstico , Pneumonia Necrosante/tratamento farmacológico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Tomografia Computadorizada por Raios X , Vancomicina/uso terapêutico
16.
Artigo em Inglês | MEDLINE | ID: mdl-28137816

RESUMO

The protective efficacy of tedizolid phosphate, a novel oxazolidinone that potently inhibits bacterial protein synthesis, was compared to those of linezolid, vancomycin, and saline in a rabbit model of Staphylococcus aureus necrotizing pneumonia. Tedizolid phosphate was administered to rabbits at 6 mg/kg of body weight intravenously twice daily, which yielded values of the 24-h area under the concentration-time curve approximating those found in humans. The overall survival rate was 83% for rabbits treated with 6 mg/kg tedizolid phosphate twice daily and 83% for those treated with 50 mg/kg linezolid thrice daily (P = 0.66 by the log-rank test versus the results obtained with tedizolid phosphate). These survival rates were significantly greater than the survival rates of 17% for rabbits treated with 30 mg/kg vancomycin twice daily (P = 0.003) and 17% for rabbits treated with saline (P = 0.002). The bacterial count in the lungs of rabbits treated with tedizolid phosphate was significantly decreased compared to that in the lungs of rabbits treated with saline, although it was not significantly different from that in the lungs of rabbits treated with vancomycin or linezolid. The in vivo bacterial production of alpha-toxin and Panton-Valentine leukocidin, two key S. aureus-secreted toxins that play critical roles in the pathogenesis of necrotizing pneumonia, in the lungs of rabbits treated with tedizolid phosphate and linezolid was significantly inhibited compared to that in the lungs of rabbits treated with vancomycin or saline. Taken together, these results indicate that tedizolid phosphate is superior to vancomycin for the treatment of S. aureus necrotizing pneumonia because it inhibits the bacterial production of lung-damaging toxins at the site of infection.


Assuntos
Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Organofosfatos/uso terapêutico , Oxazóis/uso terapêutico , Pneumonia Necrosante/tratamento farmacológico , Pneumonia Estafilocócica/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Animais , Linezolida/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/metabolismo , Testes de Sensibilidade Microbiana , Pneumonia Necrosante/microbiologia , Pneumonia Estafilocócica/microbiologia , Coelhos , Staphylococcus aureus/metabolismo , Vancomicina/uso terapêutico
17.
Artigo em Inglês | MEDLINE | ID: mdl-28115346

RESUMO

The role broad-spectrum antibiotics play in the spread of antimicrobial resistance, coupled with their effect on the healthy microbiome, has led to advances in pathogen-specific approaches for the prevention or treatment of serious bacterial infections. One approach in clinical testing is passive immunization with a monoclonal antibody (MAb) targeting alpha toxin for the prevention or treatment of Staphylococcus aureus pneumonia. Passive immunization with the human anti-alpha toxin MAb, MEDI4893*, has been shown to improve disease outcome in murine S. aureus pneumonia models. The species specificity of some S. aureus toxins necessitates testing anti-S. aureus therapeutics in alternate species. We developed a necrotizing pneumonia model in ferrets and utilized an existing rabbit pneumonia model to characterize MEDI4893* protective activity in species other than mice. MEDI4893* prophylaxis reduced disease severity in ferret and rabbit pneumonia models against both community-associated methicillin-resistant S. aureus (MRSA) and hospital-associated MRSA strains. In addition, adjunctive treatment of MEDI4893* with either vancomycin or linezolid provided enhanced protection in rabbits relative to the antibiotics alone. These results confirm that MEDI4893 is a promising candidate for immunotherapy against S. aureus pneumonia.


Assuntos
Antibacterianos/uso terapêutico , Pneumonia Necrosante/tratamento farmacológico , Staphylococcus aureus/fisiologia , Animais , Antibacterianos/farmacologia , Anticorpos Monoclonais/imunologia , Furões , Proteínas Hemolisinas/metabolismo , Staphylococcus aureus Resistente à Meticilina/fisiologia , Pneumonia Necrosante/microbiologia , Pneumonia Estafilocócica , Coelhos , Staphylococcus aureus/efeitos dos fármacos
18.
Pediatr Pulmonol ; 52(2): 247-254, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27392317

RESUMO

The incidence of pediatric community acquired complicated pneumonia (PCACP) is increasing. Questions addressed: Are different types of PCACP one disease? How do different treatment protocols affect the outcome? METHODS: Retrospective analysis of medical records of PCACP hospitalizations in the three major hospitals in Jerusalem in the years 2001-2010 for demographics, clinical presentation, management, and outcome. RESULTS: Of the 144 children (51% aged 1-4 years), 91% of Jewish origin; 40% had para-pneumonic effusion (PPE), 40% empyema (EMP), and 20% necrotizing pneumonia (NP). Bacterial origin was identified in 42% (empyema 79%, P = 0.009), most common S. pneumoniae (32%), group A streptococcus (9%). Patients with EMP, compared to PPE and NP, were less likely to receive prior antibiotic treatment (35% vs. 57% and 59%, respectively, P = 0.04). Mean hospitalization was longer in patients with NP followed by EMP and PPE (16.4 ± 10.6, 15.2 ± 7.9, and 12.7 ± 4.7 days, respectively), use of fibrinolysis was not associated with the outcome. All children had recovered to discharge regardless of antibiotic therapy or fibrinolysis. ANSWER: NP is a more severe disease with prolonged morbidity and hospitalization in spite of prior antibiotic treatment. All types had favorable outcome regardless of treatment-protocol. Complicated pneumonia has an ethnic predominance. Pediatr Pulmonol. 2017;52:247-254. © 2016 Wiley Periodicals, Inc.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia Necrosante/tratamento farmacológico , Pneumonia Pneumocócica/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Empiema Pleural/etiologia , Feminino , Hospitalização , Humanos , Incidência , Lactente , Israel , Masculino , Derrame Pleural/etiologia , Pneumonia/complicações , Pneumonia/tratamento farmacológico , Pneumonia/epidemiologia , Pneumonia/microbiologia , Pneumonia Necrosante/complicações , Pneumonia Necrosante/epidemiologia , Pneumonia Necrosante/microbiologia , Pneumonia Pneumocócica/complicações , Pneumonia Pneumocócica/epidemiologia , Pneumonia Pneumocócica/microbiologia , Estudos Retrospectivos , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pneumoniae , Streptococcus pyogenes , Taxa de Sobrevida
20.
Rev. chil. cir ; 68(5): 379-383, oct. 2016. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-797349

RESUMO

Introducción: Las neumonías necrosantes (NN) con empiema son una enfermedad grave y un desafío multidisciplinario. El objetivo de este estudio es realizar una caracterización epidemiológica y, en forma secundaria, analizar su tratamiento y evolución. Presentación de casos: Se realizó un estudio retrospectivo de una serie de casos consecutivos con NN con empiema que se presentaron en el Hospital Padre Hurtado. Siete (77,8%) eran de sexo masculino. La mediana de edad fue de 53 (rango 21-73) años. El 44% presentaban comorbilidades (diabetes, HTA o enfermedades neurológicas). El 44% presentaban abuso de drogas y 3 estaban en un estado de desnutrición severa. Manejo y evolución: La mediana de tiempo de hospitalización fue de 41 (rango 16-129) días. En 4 pacientes el germen aislado fue un Enterococcus faecalis. Complicaciones torácicas ocurrieron en el 33,3% de los pacientes. Un paciente requirió una lobectomía, un paciente una fenestración y otro paciente falleció. Discusión: Las NN con empiemas son raras. Sin embargo, frente a la asociación de diabetes, desnutrición y abuso de drogas continuaremos viendo estos casos de difícil manejo con elevada morbimortalidad.


Introduction: Necrotizing pneumonia complicated with empyema is a life-threatening condition that challenges multidisciplinary teams. The aim of this study is to perform an epidemiological characterization of these patients, and secondly, analyse their treatment and outcomes. Case presentation: A retrospective analysis of a series of consecutive patients experiencing necrotizing pneumonia with empyema who presented at Hospital Padre Hurtado. Seven (77.8%) were male. The median age was 53 (range 21-73) years. 44% presented with comorbidities (diabetes, high blood pressure, and neurological diseases). 44% presented drug abuse consumption and three (33.3%) were in a state of severe malnutrition. Management and outcome: The median time of hospitalization was 41 (range 16-129) days. Thoracotomies were performed in eight (83.2%) of the patients. In four patients, the isolated bacteria's were Enterococcus faecalis. Thoracic complications occurred in three (33.3%) patients. One patient required a lobectomy, one patient a fenestration and one (11.1%) patient died. Discussion: Necrotizing pneumonias complicated with empyema are rare, however, if there is an association with drug abuse, diabetes and malnutrition, we will continue to see such challenging cases with high morbidity and mortality.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Empiema Pleural/complicações , Pneumonia Necrosante/complicações , Bactérias/isolamento & purificação , Estudos Retrospectivos , Empiema Pleural/cirurgia , Empiema Pleural/microbiologia , Empiema Pleural/diagnóstico por imagem , Pneumonia Necrosante/cirurgia , Pneumonia Necrosante/microbiologia , Pneumonia Necrosante/diagnóstico por imagem , Tempo de Internação
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