Pneumonia adquirida na comunidade em adultos hospitalizados : estudo da etiologia, epidemiologia e fatores prognósticos

OBJETIVO: Determinar a etiologia, epidemiologia e os fatores prognósticos de pneumonia adquirida na comunidade (PAC) em adultos imunocompetentes hospitalizados. MÉTODOS: Durante um período de 3 anos, foram estudados, prospectivamente, 110 pacientes consecutivos com diagnóstico de PAC. RESULTADOS: Sessenta e seis (60%) pacientes eram homens, a idade média foi de 54 anos, 42 (38,2%) eram maiores de 65 anos, 81 (73,6%) apresentavam comorbidades, 70 (63%) pertenciam às classes IV e V de Fine e 24 (21,8%) pacientes foram admitidos em unidade de terapia intensiva (UTI). Um agente etiológico foi identificado em 60 (54,5%) casos, incluindo Streptococcus pneumoniae em 23 (20,9%) casos, Staphylococcus aureus em 14 (12,7%), Pseudomonas aeruginosa em 7 (6,4%), Haemophilus influenzae em 5 (4,6%) e Legionella pneumophila em 5 (4,6%) casos, como os patógenos mais freqüentemente isolados. O uso de antimicrobianos previamente à admissão hospitalar ocorreu em 33,6% dos casos e foi significativamente associado com etiologia desconhecida. Houve 15 (13,6%) óbitos e três variáveis foram estatisticamente associadas ao desfecho: idade > 65 anos, índice de Fine V e IV e internação em UTI. Alterações no tratamento empírico inicial foram realizadas em 43 (39%) casos devido à obtenção do diagnóstico etiológico. CONCLUSÕES: Em nosso estudo, S. pneumoniae foi o principal agente etiológico de PAC, seguido de S. aureus e P. aeruginosa, que apresentaram freqüência elevada em indivíduos com pneumonia grave e/ou fatores de risco conhecidos. A determinação do agente etiológico serviu para otimizar o tratamento proposto pelos consensos e estimar a prevalência local dos patógenos.

Estudo do papel da proteína multifuncional APE1/Ref-1 sobre a resposta inflamatória na meningite bacteriana

Despite advances in antibiotic therapy, bacterial meningitis (BM) remains with high mortality and morbidity rates in worldwide. One important mechanism associated to sequels during disease is the intense inflammatory response which promotes an oxidative burst and release of reactive oxygen species, consequently leading to cell death. Activation of DNA repair enzymes during oxidative stress has been demonstrated in several neurological disorders. APE1/Ref-1 is a multifunctional protein involved in DNA repair and plays a redox function on transcription factors such as NFkB and AP-1.The aim of this study was assess the role of APE1/Ref-1 on inflammatory response and the possibility of its modulation to reduce the sequels of the disease. Firstly it was performed an assay to measure cytokine in cerebrospinal fluid of patients with BM due to Streptococcus pneumoniae and Neisseriae meningitides. Further, a cellular model of inflammation was used to observe the effect of the inhibition of the endonuclease and redox activity of APE1/Ref-1 on cytokine levels. Additionally, APE1/Ref-1 expression in cortex and hippocampus of rat with MB after vitamin B6 treatment was evaluated. Altogether, results showed a similar profile of cytokines in the cerebrospinal fluid of patients from both pathogens, although IFNy showed higher expression in patients with BM caused by S. pneumoniae. On the other hand, inhibitors of APE1/Ref-1 reduced cytokine levels, mainly TNF-α. Reduction of oxidative stress markers was also observed after introduction of inhibitors in the LPS-stimulated cell. In the animal model, BM increased the expression of the protein APE1/Ref-1, while vitamin B6 promoted reduction. Thereby, this data rise important factors to be considered in pathogenesis of BM, e.g., IFNy can be used as prognostic factor during corticosteroid therapy, APE1/Ref-1 can be an important target to modulate the level of inflammation and VIII oxidative stress, and vitamin B6 seems modulates several proteins related to cell death. So, this study highlights a new understanding on the role of APE1/Ref-1 on the inflammation and the oxidative stress during inflammation condition

Complicated pneumonias with empyema and/or pneumatocele in children

To investigate the incidence, procedure type, characteristics of pleural fluid and pneumatoceles, and evolution of pneumonia complicated with empyema and/or pneumatoceles. Review of 394 pediatric pneumonia in patients at S (a) over capo Paulo State University Hospital during 2 years. We studied those with complications such as pleural effusion and pneumatocele. There were 121 (30.71%) with complications such as pleural effusion and pneumatocele; these were significantly higher in infants. One hundred and six children were needle aspirated, of these 78 underwent drainage, and 15 observation only. From the drained, seven needed thoracotomy or pleurostomy. Fluid was purulent in 50%, and pneumatoceles were seen in 33 cases (8.3%) with spontaneous involution in 28 (85%). Pleural fluid culture was negative in 51% cases; in positive cultures, Streptococcus pneumoniae was the most common agent. Complicated pneumonia incidence was higher in the second year of life and more than 70% occurred before 4 years of age. Closed thoracic drainage was effective in over 90%. Large effusions and mediastinal deviations were submitted to more aggressive procedures. Pneumatoceles predominated in the under 3s and were generally evident in the first chest X-ray. Most cases had spontaneous pneumatocele involution, and in almost half the cases were still present at drain tube removal.

Esparfloxacino e as fluorquinolonas: Uma revisao de sua classificacao, atividade antibacteriana, mecanismo de acao, caracteristicas farmacocineticas, tolerabilidade e perspectivas farmaceuticas

A revision was accomplished in the literature on the quinolones, antibacterial class that presents wide action spectrum, focusing, mainly, the sparfloxacin, third generation fluorquinolone which has potente activity against Gram positive organisms, including Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA), Gram negative organisms, Legionelia spp, Mycoplasma spp, Chlamydia spp and Mycobacterium spp, including multidrug resistant organisms.

Analise citotoxica de esparfloxacino e seus produtos de degradaçao em células mononucleares humanas

Sparfloxacin, a difluorquinolone derivative, is a potent antibacterial agent active against a wide range of gram-positive and gram-negative organisms including Streptococcus pneumoniae, Staphylococcus aureus, methicillin resistant S. aureus, Legionella spp, Mycoplasma spp; Chlamydia spp. and Mycobacteria. A drawback of fluorquinolones is their photoreactivity. Sparfloxacin has been studied in terms of therapeutic activities. However, few reports about analytical methods of sparfloxacin are available in the literature. The aim of this study was to determine cytotoxic effects, using sparfloxacin reference substance (SPAX-SR), sparfloxacin tablets (SPAX-COMP) and sparfloxacin tablets submitted UV light during 36 hours (SPAX-COMP.36) solution, and two isolated products (7 and 9) of SPAX-SR submitted UV-C light, in concentrations of 31.25, 62.5, 125 and 250 μg/mL by in vitro mononuclear humane culture cells. The results, statistically analyzed by Teste de Tukey, showed SPAX, SPAX-COMP and SPAX-COMP.36 solutions could reduce the cells number in these conditions. These results could not be observed for products 7 or 9. These results can suggest that isolated product can be less cytotoxic than SPAX-SR, is method can also be used to identified products degradation of sparfloxacin in stability study. However, the low activity achieved with sparfloxacin submitted to UV-light is a source of concern and requires further investigation about its photodegradation mechanism.

Análise térmica de esparfloxacino

Sparfloxacin, a third-generation fluoroquinolone, is a potent antibacterial agent against a wide range of Gram-positive and Gram-negative organisms, for example Streptococcus pneumonias, Staphylococcus aureus (including methicillin-resistant strains), Legionella spp., Mycoplasma spp., Chlamydia spp. and Mycobacterium spp. This compound has been submitted to thermal analysis and the results are presented here. The DSC curve of sparfloxacin has an endothermic peak that indicates a melting point at 276.5 °C. The DTA curve of the sample in synthetic air shows two exothermic peaks, at 341.6 and 579.2 °C, attributed to compound decomposition. In the TG curve, the loss of mass can be seen to occur in two steps between 285.5 and 645.3 °C. The DTA curve obtained in a nitrogen atmosphere shows an exothermic peak, with decomposition of sparfloxacin at 340.0 °C; from the corresponding TG plot, the loss of mass starts at 254.4 °C.

Pneumonias

Pneumonia is an infectious disease with great morbidity and mortality worldwide. According to the current guidelines recommendations the authors reviewed the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). In this paper will be presented data about etiology, clinics and diagnostic tools. © Copyright Moreira Jr. Editora.

Impacto da eferocitose na fagocitose e atividade microbicida via recptores Scavenger em macrófagos alveolares papel de prostaglandina E2

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fatores determinantes no resultado do tratamento do empiema pleural em crianças: drenagem pleural simples ou videotoracoscopia? Ensaio clínico controlado

Pós-graduação em Bases Gerais da Cirurgia - FMB

Meningitis and pneumococcal pyomyositis in a child with intramuscular hemangiomas: an autopsy case report

Pyomyositis is the bacterial infection of skeletal muscle, usually accompanied by abscesses. The main etiologic agent is Staphylococcus aureus. There are rare cases attributed to Streptococcus pneumoniae. This paper presents an autopsy of a four year old child with multiple congenital intramuscular hemangiomas that developed pneumococcal pyomyositis associated with meningitis. The authors propose the hypothesis that patients with hemangiomas, mainly the intramuscular type, may also represent a risk group for pyomyositis. The possibility of respiratory/meningeal co-infection, might also be considered even if the clinical picture is restricted to the muscular system.

Impacto da eferocitose na atividade microbicida via receptores “scavenger” em macrófagos alveolares: papel de prostaglandina E2

Segundo a Organização Mundial da Saúde, em países de baixa renda as infecções do trato respiratório ocupam o primeiro lugar dentre as causas de morte, sendo responsável por 11,2% das mesmas. Dentre estas, a causada por Streptococcus pneumoniae é uma das responsáveis pelo maior número de mortes em crianças ou adultos acometidos por doenças pulmonares crônicas. No pulmão os macrófagos alveolares (MAs) através de receptores expressos na superfície celular, como receptores “scavenger”, possuem um papel crítico na fagocitose e atividade microbicida de diferentes bactérias Gram-positivas. Em indivíduos acometidos por doenças pulmonares crônicas há um grande acúmulo de células apoptóticas (ACs) e estes podem ser mais susceptíveis a infecções pulmonares bacterianas como por S. pneumoniae. A presença destas ACs poderia contribuir para o aumento desta susceptibilidade através da supressão da resposta imune. Portanto, neste trabalho avaliamos se o efeito supressor mediado por ACs pode interferir na modulação das atividades microbicidas de MAs contra S. pneumoniae via receptores “scavenger”. A partir dos resultados encontrados, pode-se sugerir que 1) a eferocitose por MAs possui efeito imunossupressor na atividade microbicida contra S. pneumoniae; 2) a atividade supressora mediada pela fagocitose de ACs por MAs foi inibida na presença de bloqueadores de SR-A, sugerindo que os SR-B I/II são menos sensíveis a efeito supressor decorrente da eferocitose; 3) a PGE2, oriunda da eferocitose, liga-se ao receptor EP2 e suprime a atividade microbicida de MAs; 4) as produções de IL-1α, TNF-α e NO estão aumentadas na presença de ACs, sugerindo que a eferocitose por MAs promove um descontrole na ativação de MAs mediante a infecção por S. pneumoniae

Eferocitose na presença de PAMP estimula ativação de macrófagos de perfil misto M1/M2

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Multirresistência microbiana e opções terapêuticas disponíveis

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the universal immunisation of infants in Brazil

Background Cost-effectiveness studies have been increasingly part of decision processes for incorporating new vaccines into the Brazilian National Immunisation Program. This study aimed to evaluate the cost-effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) in the universal childhood immunisation programme in Brazil. Methods A decision-tree analytical model based on the ProVac Initiative pneumococcus model was used, following 25 successive cohorts from birth until 5 years of age. Two strategies were compared: (1) status quo and (2) universal childhood immunisation programme with PCV10. Epidemiological and cost estimates for pneumococcal disease were based on National Health Information Systems and literature. A 'top-down' costing approach was employed. Costs are reported in 2004 Brazilian reals. Costs and benefits were discounted at 3%. Results 25 years after implementing the PCV10 immunisation programme, 10 226 deaths, 360 657 disability-adjusted life years (DALYs), 433 808 hospitalisations and 5 117 109 outpatient visits would be avoided. The cost of the immunisation programme would be R$10 674 478 765, and the expected savings on direct medical costs and family costs would be R$1 036 958 639 and R$209 919 404, respectively. This resulted in an incremental cost-effectiveness ratio of R$778 145/death avoided and R$22 066/DALY avoided from the society perspective. Conclusion The PCV10 universal infant immunisation programme is a cost-effective intervention (1-3 GDP per capita/DALY avoided). Owing to the uncertain burden of disease data, as well as unclear long-term vaccine effects, surveillance systems to monitor the long-term effects of this programme will be essential.

Cross-reactivity of antipneumococcal surface protein C (PspC) antibodies with different strains and evaluation of inhibition of human complement factor H and secretory IgA binding via PspC

Pneumococcal surface protein C (PspC) is an important candidate for a cost-effective vaccine with broad coverage against pneumococcal diseases. Previous studies have shown that Streptococcus pneumoniae is able to bind to both human factor H (FH), an inhibitor of complement alternative pathway, and human secretory IgA (sIgA) via PspC. PspC was classified into 11 groups based on variations of the gene. In this work, we used three PspC fragments from different groups (PspC3, PspC5, and PspC8) to immunize mice for the production of antibodies. Immunization with PspC3 induced antibodies that recognized the majority of the clinical isolates as analyzed by Western blotting of whole-cell extracts and flow cytometry of intact bacteria, while anti-PspC5 antibodies showed cross-reactivity with the paralogue pneumococcal surface protein A (PspA), and anti-PspC8 antibodies reacted only with the PspC8-expressing strain. Most of the isolates tested showed strong binding to FH and weaker interaction with sIgA. Preincubation with anti-PspC3 and anti-PspC5 IgG led to some inhibition of binding of FH, and preincubation with anti-PspC3 partially inhibited sIgA binding in Western blotting. The analysis of intact bacteria through flow cytometry showed only a small decrease in FH binding after incubation of strain D39 with anti-PspC3 IgG, and one clinical isolate showed inhibition of sIgA binding by anti-PspC3 IgG. We conclude that although anti-PspC3 antibodies were able to recognize PspC variants from the majority of the strains tested, partial inhibition of FH and sIgA binding through anti-PspC3 antibodies in vitro could be observed for only a restricted number of isolates.