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1.
BMC Infect Dis ; 20(1): 205, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32143599

RESUMO

BACKGROUND: The occurrence of segmental/lobar pattern pneumonia (S/L-PP) in children has recently increased. The pathogens of the disease may change for the misuse of antibiotics and the application of vaccines. Therefore, pathogens positive in hospitalized children with S/L-PP and their association with clinical characteristics may have changed. The aim of this study was to analyze the pathogens positive in hospitalized children with S/L-PP and their association with clinical characteristics. METHOD: The current study analyzed the epidemiological and clinical characteristics of pathogens positive in children with S/L-PP under 14 years old at a single hospital between 1st Jan 2014 and 31st Dec 2018 retrospectively. The pathogens were detected by microbial cultivation, indirect immunofluorescence of the kit (PNEUMOSLIDE IgM), Elisa, and/or real-time PCR in the samples of the patients. RESULTS: A total of 593 children with S/L-PP received treatment at a single hospital during the study period by inclusion criteria. Four hundred fifty-one patients were single positive for one pathogen and 83 patients were positive for at least 2 pathogens. Mycoplasma pneumoniae (M.pneumoniae) (72.34%) was the most commonly detected pathogen, followed by Streptococcus pneumoniae (S.pneumoniae) (8.77%). The prevalence of M.pneumoniae in children with S/L-PP increased with time (p < 0.05). The positive rate of M.pneumoniae increased with ages of patients (p < 0.05). M.pneumoniae was statistically associated with the extrapulmonary manifestations while S.pneumoniae was statistically associated with abnormal white blood cells (WBCs) and C reactive proteins (CRPs) (p < 0.05). CONCLUSION: M.pneumoniae was the most positive pathogen in children with S/L-PP. The positive rate of M.pneumoniae in children with S/L-PP increased with time and the ages of children. M.pneumoniae was associated with extrapulmonary manifestations while S.pneumoniae was associated with abnormal WBCs and CRPs.


Assuntos
Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/diagnóstico , Pneumonia Pneumocócica/diagnóstico , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Proteína C-Reativa/análise , Criança , Criança Hospitalizada , Pré-Escolar , Feminino , Humanos , Lactente , Leucócitos/citologia , Masculino , Pneumonia por Mycoplasma/epidemiologia , Pneumonia Pneumocócica/epidemiologia , Prevalência , Estudos Retrospectivos , Estações do Ano
2.
Artigo em Japonês | MEDLINE | ID: mdl-31856573

RESUMO

Streptococcus pneumoniae is one of the major bacterial pathogens of community-acquired pneumonia. Immunochromatographic assay tests are used to detect pneumococcal capsular antigen. In many cases, They can be read visually. The Alere™ reader (Reader), which was developed in October 2018 by Alere Medical Co., Ltd. (currently, Abbott Diagnostics Medical Co., Ltd.) for interpreting BinaxNOW™ Streptococcus pneumoniae test (BinaxNOW™), quickly displays the results of the immunochromatographic tests, objectively and accurately, as it was launched for the purpose of streamlining laboratory workflow. The performance of the reader was evaluated by using urine samples from 100 patients, who were ordered pneumococcal urine antigen test from September 2018 to February 2019 at our hospital. Of the 100 samples, 14 were visually positive and 19 were reader positive. All visually positive samples generated reader positive result. Because 1 of the 5 cases which indicated a negative visual determination and positive reader determination was a sample with strong viscosity and turbidity, it was retested after centrifugation at 3,000×g for 10 min, resulting in negative reader determination. In 2 cases, S. pneumoniae were detected in sputum gram stains and culture tests. 5 discrepant samples were all visually and reader positive after concentration by centrifugal ultrafiltration. A questionnaire about visual interpretation was conducted among 31 individuals, by using urine from day 0 to day 4 collected from the patients whose test result was visually negative, reader positive and sputum culture positive at day 0. As a result, the number of operators who determined visually positive was 0 on day 0 (0%), 16 on day 1 (51.6%), 13 on day 2 (41.9%), 2 on day 3 (6.5%), and 0 on day 4 (0%). There were individual differences in ability to interpret low level positive result visually. On the other hand, reader can remove individual differences among operators from the interpretation of BinaxNOW™ and interpret positive result earlier than visual interpretation. Therefore reader was considered to be useful tool in clinical settings.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia Pneumocócica , Streptococcus pneumoniae , Antígenos de Bactérias , Testes Diagnósticos de Rotina , Humanos , Pneumonia Pneumocócica/diagnóstico , Streptococcus pneumoniae/isolamento & purificação
4.
Eur J Clin Microbiol Infect Dis ; 38(7): 1249-1254, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30949897

RESUMO

Culture of expectorated sputum in the microbiological diagnosis of community-acquired pneumonia (CAP) is considered valid only if high-quality (HQ) samples are obtained, but evidence regarding pneumococcal etiology specifically is lacking. We studied 323 radiologically confirmed CAP cases in patients aged ≥ 65 years. Sputum samples were assessed for quality microscopically and cultured. Two quality criteria sets were applied to delineate HQ from low-quality (LQ) sputa: leukocytes/epithelial cells ratio > 5 and ≤ 2.5 epithelial cells/400× magnification field (HQ1), or leukocytes/epithelial cells ratio > 1 (HQ2). A sputum sample was obtained and the quality assessed in 224 cases; 47% were HQ1 and 76% HQ2. Encapsulated pneumococci (EPnc) were cultured in 25 (24%), 14 (12%), 35 (21%), and 4 (7%) of the HQ1-, LQ1-, HQ2-, and LQ2-samples, respectively. If another pneumococcal test (blood culture, urine antigen, or ≥ twofold increase in CbpA or PsaA antibodies) was positive, EPnc were cultured at similar proportions in HQ1- and LQ1-sputa; if the other test was negative, EPnc were cultured less often in LQ1- than HQ1-sputa. EPnc were found less often in LQ2- than in HQ2-sputa. Our results suggest similar specificity in LQ- and HQ-sputum cultures. All sputum samples add value to the pneumococcal CAP-diagnosis in the elderly.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Pneumonia Pneumocócica/diagnóstico , Escarro/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Contagem de Colônia Microbiana , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Masculino , Pneumonia Pneumocócica/microbiologia , Sensibilidade e Especificidade , Sorotipagem , Streptococcus pneumoniae/crescimento & desenvolvimento
5.
Am J Emerg Med ; 37(5): 1006.e5-1006.e7, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30777376

RESUMO

BACKGROUND: Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge. CASE REPORT: An otherwise healthy 75-year-old male was brought to the emergency department in a state of general deterioration, confusion, and shock. Bedside ultrasound showed a significant pericardial effusion. His condition quickly deteriorated and the resuscitation included emergent bedside pericardiocentesis. The drainage was purulent and later cultures grew out Streptococcus pneumoniae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Purulent pericarditis is extremely rare but should be considered in the patient with a fulminant infectious process (particularly pneumonia) and signs of pericardial effusion. Treatment should include appropriate antibiotics and early drainage.


Assuntos
Pericardite/diagnóstico , Pneumonia Pneumocócica/diagnóstico , Sepse/diagnóstico , Idoso , Reanimação Cardiopulmonar , Drenagem , Evolução Fatal , Humanos , Masculino , Pericardiocentese , Pericardite/etiologia , Pericardite/terapia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/etiologia , Infecções Pneumocócicas/terapia , Pneumonia Pneumocócica/complicações , Pneumonia Pneumocócica/terapia , Sistemas Automatizados de Assistência Junto ao Leito , Sepse/terapia , Tomografia Computadorizada por Raios X , Ultrassonografia
6.
BMC Geriatr ; 19(1): 3, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616612

RESUMO

BACKGROUND: Procalcitonin (PCT) is a useful marker for pneumonia. However, its clinical usefulness in elderly patients has not been studied extensively. This study aimed to assess the relationship between PCT and prognosis and pneumonia severity in elderly patients with pneumonia acquired outside the hospital. METHODS: Data considered relevant to pneumonia severity and prognosis were retrospectively obtained from clinical charts of all patients with pneumonia who were admitted to our hospital from 2010 to 2017. The primary outcome was 30-day mortality in elderly patients (aged ≥75 years), and the relationship between PCT levels and pneumonia severity, as determined by the pneumonia severity index (PSI) was also examined. RESULTS: Data were collected from 667 patients, of which 436 were elderly patients. Multivariate and receiver operating characteristic curve analysis revealed that albumin, body mass index, and PSI class rather than PCT are important factors related to 30-day mortality in elderly patients. PCT was also not an independent prognostic factor in younger patients. PCT levels significantly differed by pneumonia severity (mild, moderate, and severe) in both younger (p < 0.001) and elderly (p < 0.0001) patients, with levels increasing as severity increased. In contrast, C-reactive protein (CRP) levels and white blood cell counts did not significantly differ by pneumonia severity in younger and elderly patients. A subgroup analysis focused on Streptococcus pneumoniae pneumonia revealed that PCT levels differed by severity in elderly patients (p = 0.03), with levels increasing as severity increased. CONCLUSION: PCT was not an independent predictor of 30-day mortality in both of elderly and younger patients. PCT levels, but not CRP levels, significantly increased with increasing pneumonia severity in younger and elderly patients, although the degree of increase tended to be lower in elderly patients compared to younger patients for the same severity. PCT levels also significantly increased with increasing pneumonia severity in elderly patients with Streptococcus pneumoniae pneumonia.


Assuntos
Hospitalização/tendências , Pneumonia Pneumocócica/sangue , Pneumonia Pneumocócica/mortalidade , Pró-Calcitonina/sangue , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Pneumonia Pneumocócica/diagnóstico , Prognóstico , Estudos Retrospectivos
7.
Expert Rev Anti Infect Ther ; 17(2): 107-115, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30618315

RESUMO

INTRODUCTION: Community-acquired pneumonia (CAP) continues to be a leading cause of hospitalization and mortality worldwide. Streptococcus pneumoniae and Legionella pneumophila remain the major etiological agents and are responsible for a significant proportion of CAP mortality. Among diagnostic tests for CAP, urine antigen detection of S. pneumoniae and L. pneumophila is widely accepted due to the simplicity of collection and the rapidity of the test results. Areas covered: This comprehensive review outlines the urinary antigen tests available, discusses their sensitivity and specificity, and assesses the usefulness of their results as the basis for targeted therapy. Expert commentary: There have been advances in urine antigen detection tests for patients with CAP. New methodologies show greater sensitivity, detect S. pneumoniae and L. pneumophila in a single test, and also detect pneumococcal serotypes. In addition, urine antigen detection tests have shown a high specificity, which means that a positive result practically indicates the causative pathogen of CAP. Therefore, a positive result can lead to a targeted therapy that is likely to improve patient outcomes and reduce the risk of resistance and adverse events. However, well-designed studies are needed to evaluate the usefulness of urine antigen detection tests with regard to clinical outcomes.


Assuntos
Antígenos de Bactérias/urina , Infecções Comunitárias Adquiridas/diagnóstico , Pneumonia Bacteriana/diagnóstico , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Infecções Comunitárias Adquiridas/microbiologia , Farmacorresistência Bacteriana , Hospitalização , Humanos , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Doença dos Legionários/microbiologia , Pneumonia Bacteriana/microbiologia , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/microbiologia , Sensibilidade e Especificidade , Streptococcus pneumoniae/isolamento & purificação
9.
Paediatr Int Child Health ; 39(3): 224-226, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-29790830

RESUMO

Empyema necessitans is a rare complication of acute bacterial pneumonia, especially in children. It is a complication of empyema characterised by the extension of pus from the pleural cavity into the thoracic wall to form a mass of purulent fluid in the adjacent soft tissue. An inflammatory chest wall mass following pneumonia caused by Streptococcus pneumonia in a six-month-old infant is reported. The case emphasises that children presenting with persistent fever and a painful chest wall mass following pneumonia should be investigated immediately as there might be an urgent need for surgery.


Assuntos
Empiema Pleural/complicações , Empiema Pleural/diagnóstico , Pneumonia Pneumocócica/complicações , Pneumonia Pneumocócica/diagnóstico , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/patologia , Parede Torácica/patologia , Feminino , Humanos , Lactente , Streptococcus pneumoniae/isolamento & purificação
10.
Diagn Microbiol Infect Dis ; 94(1): 60-65, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30583882

RESUMO

OBJECTIVES: Austrian syndrome comprises the triad of pneumonia, meningitis, and endocarditis secondary to Streptococcus pneumonia. We present what we believe to be the first reported case of Austrian syndrome with quadruple heart valve involvement and review the literature detailing cases of quadruple valve infective endocarditis. CASE PRESENTATION AND RESULTS: A case is presented of a patient with radiographic evidence of a left lower lobe pneumonia. Sequential transthoracic followed by transesophageal echocardiogram done to evaluate the presence of a cardiac murmur revealed the presence of quadruple valve vegetations. Multiple blood cultures were persistently negative. The patient went on to develop seizures secondary to proven meningitis. Microbiological diagnosis was eventually established through positive Streptococcus pneumoniae antigen (Alere BinaxNOW®) from cerebrospinal fluid, establishing a presumptive clinical diagnosis of Austrian syndrome. A computerized PubMed search for reports of quadruple valve infective endocarditis and their references was collated. A total of 22 patients were found, including our patient. The median age of presentation was 47.5 years. Five patients had a history of intravenous drug abuse, another 5 had underlying congenital heart disease, and 1 had both. Two patients (9.1%) had 2 microorganisms isolated. Staphylococcus aureus and Streptococcus viridans (3 cases, 13.6% each) were the most commonly implicated microorganism. Heart failure was the commonest complication, afflicting 11 patients (50.0%). Ten patients (45.5%) underwent surgery. Overall case fatality rate was 50.0%. Cardiac surgery was of statistical significance in predicting survival (P = 0.009). CONCLUSION: Quadruple valve endocarditis is associated with a high mortality rate, and cardiac surgery may be protective.


Assuntos
Endocardite/diagnóstico , Endocardite/patologia , Meningite Pneumocócica/diagnóstico , Meningite Pneumocócica/patologia , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/patologia , Streptococcus pneumoniae/isolamento & purificação , Ecocardiografia , Endocardite/complicações , Valvas Cardíacas/patologia , Humanos , Masculino , Meningite Pneumocócica/complicações , Pessoa de Meia-Idade , Pneumonia Pneumocócica/complicações
11.
J Microbiol Immunol Infect ; 52(4): 571-577, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28918242

RESUMO

BACKGROUND: Most cases of complicated pneumonia in children are caused by pneumococcal infections. Thomsen-Friedenreich antigen (TA) is present on erythrocytes, platelets and glomeruli, and it can be activated during pneumococcal infection. The aim of this study was to investigate the predictive value of TA activation for pneumococcal infection and association with the severity of complicated pneumonia. MATERIALS AND METHODS: Patients with lobar pneumonia were routinely tested for TA at the Department of Pediatrics, Mackay Memorial Hospital from January 2010 to December 2015. We retrospectively reviewed and analyzed their charts and data including age, sex, etiology of infection, chest tube insertion or video-assisted thoracoscopic surgery, length of hospital stay, TA activation, white blood cell count and level of C reactive protein. RESULTS: A total of 142 children with lobar pneumonia were enrolled, including 35 with empyema, 31 with effusion, 11 with necrotizing pneumonia and four with lung abscess. Streptococcus pneumoniae was the most commonly identified pathogen. Twenty-two patients (15.4%) had activated TA, all of whom were infected with S. pneumoniae. TA activation had 100% specificity and 100% positive predictive value for pneumococcal infection. In the multivariate analysis in lobar pneumonia, TA activation (OR, 15.8; 95% CI, 3.0-83.5; p = 0.001), duration of fever before admission (OR, 1.2; 95% CI, 1.1-1.5; p = 0.013) and initial CRP level (OR, 1.1; 95% CI, 1.0-1.1; p = 0.004) were independent predictors of empyema. CONCLUSIONS: TA activation is a specific marker for pneumococcal pneumonia and might indicate higher risk for complicated pneumonia.


Assuntos
Antígenos Glicosídicos Associados a Tumores/sangue , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/imunologia , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/imunologia , Streptococcus pneumoniae/imunologia , Adolescente , Proteína C-Reativa , Criança , Pré-Escolar , Empiema , Feminino , Febre , Humanos , Testes Imunológicos/métodos , Lactente , Contagem de Leucócitos , Modelos Logísticos , Pulmão/diagnóstico por imagem , Masculino , Pediatria , Infecções Pneumocócicas/epidemiologia , Pneumonia Pneumocócica/complicações , Pneumonia Pneumocócica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Streptococcus pneumoniae/patogenicidade , Taiwan , Toracostomia
12.
Mol Biol Rep ; 46(1): 1013-1021, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30569391

RESUMO

Streptococcus pneumoniae is the most important pathogen causing community-acquired pneumonia (CAP). The current diagnostic microbial standard detects S. pneumoniae in less than 30% of CAP cases. A quantitative polymerase chain reaction (PCR) targeting autolysin (lytA) is able to increase the rate of detection. The aim of this study is validation of this quantitative PCR in vitro using different available strains and in vivo using clinical samples (oropharyngeal swabs). The PCR autolysin (lytA) was validated by testing the intra- and inter-run variability. Also, the in vitro specificity and sensitivity, including the lower limit of detection was determined. In addition, a pilot-study was performed using samples from patients (n = 28) with pneumococcal pneumonia and patients (n = 28) with a pneumonia without detection of S. pneumoniae with the current diagnostic microbial standard, but with detection of either a viral and or another bacterial pathogen to validate this test further. The intra- and inter-run variability were relatively low (SD's ranging from 0.08 to 0.96 cycle thresholds). The lower limit of detection turned out to be 1-10 DNA copies/reaction. In-vitro sensitivity and specificity of the tested specimens (8 strains carrying lytA and 6 strains negative for lytA) were both 100%. In patients with pneumococcal and non-pneumococcal pneumonia a cut-off value of 6.000 copies/mL would lead to a sensitivity of 57.1% and a specificity of 85.7%. We were able to develop a quantitative PCR targeting lytA with good in-vitro test characteristics.


Assuntos
Boca/microbiologia , Faringe/microbiologia , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/microbiologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Curva ROC , Reprodutibilidade dos Testes , Adulto Jovem
13.
Rev Med Chil ; 146(7): 839-845, 2018 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-30534882

RESUMO

BACKGROUND: Bacteremic pneumococcal pneumonia (BPP) is a preventable disease with high morbimortality. AIM: To evaluate clinical aspects and mortality on BPP patients admitted to a Chilean regional hospital. PATIENTS AND METHODS: We looked for adult patients with Streptococcus pneumoniae isolated from blood cultures between 2010 and 2014 years and reviewed clinical records of those who were admitted with pneumonia. RESULTS: We identified 70 BPP patients: 58% were men, mean age was 56 years, 30% were > 65 years, 70% with basic public health insurance, 26% were alcoholics, 86% had comorbidities. Only two patients were vaccinated against S. pneumoniae. CURB-65 severity index for community acquired pneumonia was > 3 in 37% of patients. Twenty-four patients were admitted to ICU, twenty required mechanical ventilation and twenty-four died (34%). Mortality was associated with an age over 65 years, presence of comorbidities and complications of pneumonia. A total of 22 serotypes of S. pneumoniae were identified, five of them (1,3,7F,14 y 9V) were present in 57% of cases. CONCLUSIONS: Elevated mortality of our BNN patients was associated with comorbidities and possibly with socio economic factors, which conditioned a late access to medical care.


Assuntos
Bacteriemia/mortalidade , Pneumonia Pneumocócica/mortalidade , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Ceftriaxona/uso terapêutico , Chile/epidemiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/tratamento farmacológico , Pneumonia Pneumocócica/microbiologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores Socioeconômicos , Streptococcus pneumoniae/isolamento & purificação
14.
BMC Emerg Med ; 18(1): 29, 2018 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-30180803

RESUMO

BACKGROUND: Smuggling of illegal drugs by hiding them inside one's own body, also called body packing, is a worldwide phenomenon. Cocaine is the most frequently transported drug. Body packing is a potentially lethal practice. The most serious complications of body packing are gastrointestinal obstruction or perforation and drug toxicity due to packet leakage or rupture. CASE PRESENTATION: A 30-year-old confirmed body packer was brought to our emergency department from jail because of agitation and mydriasis. He presented with a high respiratory rate of 40/min but normal oxygen saturation on ambient air, a heart rate of 116 bpm, a blood pressure of 116/68 mmHg and a temperature of 38.0° Celsius. Blood tests were suggestive of infection, urine analysis was positive for cocaine. Abdominal and thoracic computed tomography scans showed pulmonary infiltrates as a possible focus of infection; signs of bowel obstruction or perforation were absent. Given his clinical presentation, we suspected severe infection rather than massive cocaine intoxication to be the main problem. We therefore withheld immediate surgical decontamination. Instead, we started broad-spectrum antibiotic treatment with piperacillin/tazobactam plus clarithromycin for suspected severe community-acquired pneumonia or abdominal sepsis and treated the patient with intravenous midazolam for symptomatic cocaine intoxication. After detection of urinary pneumococcal antigen, the antibacterial regimen was changed to ceftriaxone and vancomycin for pneumococcal pneumonia. In addition, we found human immunodeficiency virus (HIV) type 1 infection as underlying disease. The patient recovered from his acute illness and was discharged after 7 days of treatment with ceftriaxone plus vancomycin. Antiretroviral therapy was started in an outpatient setting. CONCLUSIONS: With this case report, we emphasize the need to look for alternative diagnoses to intoxication and gastrointestinal obstruction in acutely ill body packers with atypical presentation. Special risks, such as underlying HIV infection and potential antimicrobial resistance according to the individual's geographical origin, should be taken into account while treating these patients.


Assuntos
Transporte Intracorporal de Contrabando , Cocaína/sangue , Infecções por HIV/complicações , Pneumonia Pneumocócica/complicações , Adulto , Antibacterianos/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Infecções por HIV/diagnóstico , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/tratamento farmacológico
15.
PLoS One ; 13(7): e0200620, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30028834

RESUMO

BACKGROUND: The pneumococcal urinary antigen test (UAT) has been known to improve sensitivity and specificity for the diagnosis of pneumococcal pneumonia. Associations of UAT results with prognosis in community acquired pneumonia (CAP) are not known. We hypothesized that positive UAT is associated with a good prognosis, and incorporation of UAT into CRB65 would improve its prognostic performance. METHODS: In this registry-based retrospective study, we analyzed CAP patients over a 10-year period beginning in April 2008. Patients who had UAT results were included in multivariable extended Cox-regression analyses to determine the association between UAT positivity and 30-day mortality. UAT results were incorporated for patients with a CRB65 score of 1 by subtracting 1 from the scoring system if the test was positive. The performance of the modified scoring systems was assessed with area under the receiver operating characteristic (AUROC) curves. RESULTS: Among 5145 CAP patients, total 2280 patients had UAT results and were included in analyses. A positive UAT result was associated with a good prognosis after a week of hospitalization (aHR, 0.14; p = 0.007). After modification of CRB65 using UAT results, positive and negative predictive values for 30-day mortality were increased from 7.7 to 8.3 (p<0.001) and 98.9 to 99.1 (p = 0.010). The AUROC increased from 0.73 to 0.75 (p<0.001). CONCLUSIONS: Positive results on UAT could be considered as a good prognostic factor in CAP. UAT could be used as a useful tool in deciding whether to refer patients to the hospital, especially in moderate CAP with a CRB score of 1.


Assuntos
Antígenos de Bactérias/urina , Infecções Comunitárias Adquiridas/mortalidade , Pneumonia Pneumocócica/mortalidade , Streptococcus pneumoniae/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/microbiologia , Pneumonia Pneumocócica/urina , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Curva ROC , República da Coreia/epidemiologia , Estudos Retrospectivos , Streptococcus pneumoniae/imunologia , Taxa de Sobrevida
16.
BMC Res Notes ; 11(1): 399, 2018 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-29925417

RESUMO

OBJECTIVES: High-dose penicillin therapy is effective in approximately 90% of pneumococcal pneumonia cases diagnosed based on urinary pneumococcal antigen tests or Gram staining at admission. The efficacy of high-dose penicillin therapy for pneumococcal pneumonia diagnosed based on an initial comprehensive assessment comprising a syndromic approach, Gram staining of sputum and urinary pneumococcal antigen testing was investigated. RESULTS: Seventy adult patients diagnosed with pneumococcal pneumonia based on an initial comprehensive assessment and treated with high-dose penicillin G at admission were included. The median patient age was 76.5 years, and 37.1% of the patients were women. The urinary pneumococcal antigen test was positive in 67.1% of all patients, and Gram staining of sputum showed that gram-positive cocci were dominant in 58.6% of the patients. The primary outcome was treatment success based on vital signs until day 6. Treatment with high-dose penicillin G was effective in 87.1% of the patients (95% CI 79.1-95.2%), and the proportion of patients who received other antibiotics because of treatment failure with penicillin G was only 5.7%. The efficacy of high-dose penicillin G treatment for pneumococcal pneumonia diagnosed based on a comprehensive assessment at admission may be comparable to that in previous reports.


Assuntos
Antibacterianos/farmacologia , Penicilina G/farmacologia , Pneumonia Pneumocócica/tratamento farmacológico , Streptococcus pneumoniae/imunologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Penicilina G/administração & dosagem , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/microbiologia , Pneumonia Pneumocócica/urina
17.
J Immunol Methods ; 460: 72-78, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29935210

RESUMO

The aim of this study was to compare the results of serological assays using pneumococcal proteins or polysaccharides for the detection of pneumococcal infection in childhood pneumonia. Serological assays measured IgG against eight pneumococcal proteins (Ply,CbpA,PspA1,PspA2,PcpA,PhtD,StkP-C,PcsB-N), C-polysaccharide [in the whole study population, n = 183], or 19 pneumococcal capsular polysaccharides (1,2,4,5,6B,7F,8,9 V,10A,11A,12F,14,15B,17F,18C,19F,20,23F,33F) [only in a subgroup of patients, n = 53] in paired serum samples of children aged <5 years-old hospitalized with clinical and radiological diagnosis of community-acquired pneumonia. We also performed an inhibition of binding test with the anti-capsular polysaccharide assay in order to confirm the specificity of the antibody responses detected. Invasive pneumococcal pneumonia was investigated by blood culture and PCR (ply-primer). Among 183 children, the anti-protein assay detected antibody response in 77/183(42.1%) patients and the anti-C-polysaccharide assay in 28/183(15.3%) patients. In a subgroup of 53 children, the anti-protein assay detected response in 32/53(60.4%) patients, the anti-C-polysaccharide assay in 11/53(20.8%) patients, and the anti-capsular polysaccharide in 25/53(47.2%) patients. Simultaneous antibody responses against ≥2 different capsular polysaccharides were detected in 11/53(20.8%) patients and this finding could not be explained by cross-reactivity between different serotypes. Among 13 patients with invasive pneumococcal pneumonia, the sensitivity of the anti-protein assay was 92.3%(12/13), of the anti-C-polysaccharide assay 30.8%(4/13), and of the anti-capsular polysaccharide assay 46.2%(6/13). The serological assay using pneumococcal proteins is more sensitive for the detection of pneumococcal infection in children with pneumonia than the assay using pneumococcal polysaccharides. Future studies on childhood pneumonia aetiology should consider applying serological assays using pneumococcal proteins.


Assuntos
Anticorpos Antibacterianos , Proteínas de Bactérias/química , Infecções Comunitárias Adquiridas , Pneumonia Pneumocócica , Polissacarídeos Bacterianos/química , Streptococcus pneumoniae , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/imunologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Lactente , Masculino , Pneumonia Pneumocócica/sangue , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/imunologia , Estudos Prospectivos , Sensibilidade e Especificidade , Streptococcus pneumoniae/imunologia , Streptococcus pneumoniae/metabolismo
18.
S Afr Med J ; 108(5): 386-388, 2018 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-29843850

RESUMO

A 34-year-old HIV-positive man with a history of chronic substance abuse was admitted with dual infection of Streptococcus pneumoniae and Listeria monocytogenes. Combined bacteraemia with S. pneumoniae and L. monocytogenes is very rare. To the best of our knowledge, this is the first such case documented at our institution and in South Africa. Ampicillin should be added to antibiotic regimens to improve patient outcome if L. monocytogenes infection is suspected. Co-infections that occur with L. monocytogenes may have conflicting antibiotic treatment options. This case report emphasises the need for a good relationship between the local microbiology pathologist and physician to select appropriate antibiotic treatment before definitive results are available.


Assuntos
Ampicilina/administração & dosagem , Ceftriaxona/administração & dosagem , Soropositividade para HIV/sangue , Listeria monocytogenes/isolamento & purificação , Listeriose , Pneumonia Pneumocócica , Streptococcus pneumoniae/isolamento & purificação , Adulto , Anemia/diagnóstico , Anemia/terapia , Antibacterianos/administração & dosagem , Transfusão de Sangue/métodos , Contagem de Linfócito CD4/métodos , Coinfecção/diagnóstico , Coinfecção/imunologia , Coinfecção/fisiopatologia , Coinfecção/terapia , Evolução Fatal , HIV/imunologia , Humanos , Listeriose/diagnóstico , Listeriose/imunologia , Listeriose/fisiopatologia , Listeriose/terapia , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/imunologia , Pneumonia Pneumocócica/fisiopatologia , Pneumonia Pneumocócica/terapia , Respiração Artificial/métodos
19.
Eur J Clin Microbiol Infect Dis ; 37(7): 1289-1295, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29651615

RESUMO

The Sofia Pneumococcal FIA® test is a recently introduced immunofluorescent assay automatically read aimed to detect Streptococcus pneumoniae antigen in urine. The aim of this study was to evaluate the usefulness of SofiaFIA® urinary antigen test (UAT) in comparison with classical immunochromatographic BinaxNOW® test for the diagnosis of pneumococcal pneumonia (PP). Observational study was conducted in the Hospital Universitari Vall d'Hebron from December 2015 to August 2016. Consecutive adult patients diagnosed of pneumonia and admitted to the emergency department in whom UAT was requested were prospectively enrolled. Paired pneumococcal UAT was performed (BinaxNOW® and SofiaFIA®) in urine samples. To assess the performance of both tests, patients were categorized into proven PP (isolation of S. pneumoniae in sterile fluid) or probable PP (isolation of S. pneumoniae in respiratory secretion). Sensitivity, specificity, and concordance were calculated. A total of 219 patients with pneumonia were enrolled, of whom 14% had a proven or probable PP, 22% a non-pneumococcal etiology, and 64% an unidentified pathogen. Concordance between tests was good (κ = 0.81). Sensitivity of SofiaFIA® and BinaxNOW® UAT was 78.6 and 50% for proven PP (p = 0.124), and 74.2 and 58% for proven/probable PP (p = 0.063). Specificity for both tests was 83.3 and 85.5% for proven and proven/probable PP. In patients without an identified pathogen, SofiaFIA® test was positive in 33 (23.6%) cases and BinaxNOW® in 25 (17.8%), so Sofia Pneumococcal FIA® detected 32.6% more cases than BinaxNOW® (p = 0.001). Sofia Pneumococcal FIA® test showed an improved sensitivity over visual reading of BinaxNOW® test without a noticeable loss of specificity.


Assuntos
Antígenos de Bactérias/urina , Cromatografia de Afinidade/métodos , Imunofluorescência/métodos , Pneumonia Pneumocócica/diagnóstico , Polissacarídeos Bacterianos/urina , Idoso , Antígenos de Bactérias/imunologia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Masculino , Pneumonia Pneumocócica/microbiologia , Polissacarídeos Bacterianos/imunologia , Estudos Prospectivos , Sensibilidade e Especificidade , Streptococcus pneumoniae/imunologia
20.
Chest ; 153(4): e71-e73, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29626971

RESUMO

We retrospectively report four cases from two hospitals of nonpneumococcal pleural empyema with a likely false-positive result on the pneumococcal antigen test BinaxNOW (PATB) (Alere) performed in pleural fluid samples in patients with aspiration pneumonia risk factors. To determine whether the positive reaction was due to cross-reactivity, we separately tested the isolates from the pleural fluid samples, along with collection and reference strains. All patients had polymicrobial aerobic and anaerobic positive cultures, including Parvimonas micra in every case. In all cases, 16S rDNA polymerase chain reaction sequencing yielded Fusobacterium nucleatum. Samples for culture and specific polymerase chain reaction were negative for Streptococcus pneumoniae. We found that the false-positive PATB finding was likely due to P micra, a previously unknown cross-reactivity. In case of aspiration pneumonia risk factors, a positive PATB result must be interpreted with caution because there can be a false positivity due to anaerobic infection or co-infection.


Assuntos
Empiema Pleural/imunologia , Adolescente , Adulto , Antígenos de Bactérias/metabolismo , Criança , Reações Cruzadas , Reações Falso-Positivas , Feminino , Infecções por Fusobacterium/imunologia , Fusobacterium nucleatum/imunologia , Infecções por Bactérias Gram-Positivas/imunologia , Humanos , Imunoensaio/normas , Lactente , Masculino , Pneumonia Aspirativa/imunologia , Pneumonia Pneumocócica/diagnóstico , Streptococcus pneumoniae/imunologia
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