Adriana Gut Lopes Riccetto

Respiratory syncytial virus (RSV) in infants hospitalized for acute lower respiratory tract disease: incidence and associated risks

Respiratory syncytial virus (RSV) is one of the main causes of acute lower respiratory tract infections worldwide. We examined the incidence and associated risks for RSV infection in infants hospitalized in two university hospitals in the state of São Paulo. We made a prospective cohort study involving 152 infants hospitalized for acute lower respiratory tract infections (ALRTI) in two university hospitals in Campinas, São Paulo, Brazil, between April and September 2004. Clinical and epidemiological data were obtained at admission. RSV was detected by direct immunofluorescence of nasopharyngeal secretions. Factors associated with RSV infection were assessed by calculating the relative risk (RR). The incidence of RSV infection was 17.5%. Risk factors associated with infection were: gestational age less than 35 weeks (RR: 4.17; 95% confidence interval (CI) 2.21-7.87); birth weight less than or equal to 2,500 grams (RR: 2.69; 95% CI 1.34-5.37); mothers educational level less than five years of schooling (RR: 2.28; 95% CI 1.13-4.59) and pulse oximetry at admission to hospital lower than 90% (RR: 2.19; 95% CI 1.10-4.37). Low birth weight and prematurity are factors associated with respiratory disease due to RSV in infants. Low educational level of the mother and poor socioeconomic conditions also constitute risk factors. Hypoxemia in RSV infections at admission indicates potential severity and a need for early oxygen therapy.

Comparison of the effects that two different respiratory physical therapy techniques have on cardiorespiratory parameters in infants with acute viral bronchiolitis

OBJECTIVE To compare the expiratory flow increase technique (EFIT) and vibration accompanied by postural drainage (PD) in terms of their effects on the heart rate (HR), respiratory rate (RR) and SpO(2) of infants with acute viral bronchiolitis (AVB). METHODS Infants with clinical and radiological diagnosis of AVB were analyzed. The HR, RR and SpO(2) were registered at four time points: prior to the procedure; and at 10, 30 and 60 min after the procedure. The patients were divided into three groups: submitted to the EFIT; submitted to vibration/PD; and control. RESULTS We included 81 infants, 27 per group, with a mean age of 4.52 years and a mean weight of 6.56 kg. Using ANOVA, we found that the EFIT and vibration/PD groups presented no significant differences in relation to the control group in terms of the mean values for HR, RR or SpO(2) (p > 0.05). Considering only the four time points evaluated, the mean RR was significantly lower in the EFIT and vibration/PD groups than in the control group (p < 0.05). CONCLUSIONS In terms of overall improvement of cardiorespiratory parameters, neither the EFIT nor vibration/PD provided any benefit to infants with BVA. However, over time, respiratory physical therapy seems to contribute to decreasing the RR in these patients.

Genetic variability in the G protein gene of human respiratory syncytial virus isolated from the Campinas metropolitan region, Brazil.

Human respiratory syncytial virus (hRSV) is recognized as the most important viral agent of serious respiratory tract diseases in the pediatric population worldwide. A prospective study for hRSV was conducted in children ageing less than 1 year admitted in two university hospitals in Campinas, São Paulo, Brazil. The aim of the present study was to investigate the genetic variability of both A and B subgroups of hRSV isolated during an epidemic period in the Campinas metropolitan region, Brazil, by sequencing a variable region of the G protein gene. Phylogenetic trees were constructed from alignments of sequences available in the GenBank database and Brazil isolates for hRSV A and B. The data demonstrate that Brazilian isolates clusters together with A and B viruses from Kenya, New Zealand, South Africa, West Virginia, United States (CH, Rochester), and other Brazilian isolates. Phylogenetic analysis of subgroup A isolates showed that the sequences obtained on the present study falls on three clusters, namely GA2, GA5, and SAA1 that co‐circulate during the analyzed period. Subgroup B isolates detected belongs to three genotypes, GB3 (SAB3) and BA (BAIII). Different subgroup B genotypes were detected and BA isolates present in our samples showed some degree of genetic variability. This is one of the first reports on the molecular epidemiology of hRSV strains from the Campinas metropolitan region, São Paulo state, Brazil. And is also the first description of the circulation pattern of hRSV genotypes in two university hospitals, revealing interesting differences between the two subgroups of the virus. J. Med. Virol. 80:1653–1660, 2008.

Complicações em crianças internadas com pneumonia: fatores socioeconômicos e nutricionais

BACKGROUND: To study the relationship between socioeconomic factors, nutritional status, evolution and complications in children with pneumonia. METHODS: A prospective, descriptive study on 85 children hospitalized with pneumonia from April 1999 to November 2000. RESULTS: Complications occurred in 31.8% children; of these, 26.6% - respiratory insufficiency, 44% -pleural effusion, 22% -atelectasis. A significant relationship was observed between complications and the female sex (p=0.03; Odds Ratio=2.99 Confidence Interval 95%=1.16 -7.72) but this was not the case with age (p=0.98), maternal age (p=0.24), maternal educational level (p=0.62) and per capita income (p=0.07). No relationship was found between nutritional status and complication evolution, as well as with the other parameters (z score for the Waterlow classification, weight/age, height/age, weight/height and body mass index -p>0.05). CONCLUSIONS: Risk for complications was 2.99 times higher in the female group; no significant difference was found between the other parameters and complication evolution in children hospitalized with pneumonia.

Variant isolates of human metapneumovirus subgroup B genotype 1 in Campinas, Brazil

BACKGROUND Human metapneumovirus (HMPV) is a paramyxovirus associated with respiratory illness. The genotypes of HMPV isolates in Brazil have not been well characterized. OBJECTIVES To investigate the presence of HMPV in clinical samples collected from pediatric patients of two university hospitals in the region of Campinas (São Paulo, Brazil) and to genotype them by partial sequencing of the HMPV F gene. STUDY DESIGN Nasopharyngeal aspirates were collected from children hospitalized between April and September, 2004 because of acute respiratory infections (ARI). RESULTS We identified HMPV in 8 of 142 (5.6%) clinical samples. We determined through phylogenetic analysis that HMPV isolates in Campinas during the study were clustered within subgroup B genotype 1. Two of the isolates analyzed showed significant differences from previously isolated B1 viruses, when compared to HMPV isolated in South Africa and Canada, and clustered in a separate branch within this genotype. CONCLUSIONS In 2004 in our geographic region all HMPV isolates from pediatric patients were in the B1 HMPV genetic group, with two variant isolates.

Endocarditis by Kocuria rosea in an immunocompetent child.

Kocuria rosea belongs to genus Kocuria (Micrococcaceae family, suborder Micrococcineae, order Actinomycetales) that includes about 11 species of bacteria. Usually, Kocuria sp are commensal organisms that colonize oropharynx, skin and mucous membrane; Kocuria sp infections have been described in the last decade commonly affecting immunocompromised patients, using intravenous catheter or peritoneal dialysis. These patients had mainly bacteremia/recurrent sepsis. We hereby describe the case of a 10-year-old girl, immunocompetent, who had endocarditis/sepsis by K. rosea which was identified in five different blood cultures by Vitek 2 ID-GPC card (BioMérieux, France). Negative HIV serology, blood count within normal range of leukocytes/neutrophils and lymphocytes, normal fractions of the complement, normal level of immunoglobulins for the age; lymphocyte immunophenotyping was also within the expected values. Thymus image was normal at chest MRI. No catheters were required. Identification of K. rosea was essential to this case, allowing the differentiation of coagulase-negative staphylococci and use of an effective antibiotic treatment. Careful laboratory analysis of Gram-positive blood-born infections may reveal more cases of Kocuria sp infections in immunocompetent patients, which may collaborate for a better understanding, prevention and early treatment of these infections in pediatrics.

Sala de emergência em pediatria: casuística de um hospital universitário

AbStRAct Objective : Describe the clinical course of pediatric patients treated at a pediatric emergency room in a university hospital. Methods : This retrospective descriptive study was conducted between January 1 st and December 31 st , 2004. Data retrieved were: demographical and clinical characacteristics, diagnostic hy-potheses, need of tracheal intubation, deaths, transfers and need of hospitalization of children between zero and 14 years old. Patients were divided in four groups: no deaths; deaths 24 hours; transfers to other hospitals after initial care. Results : 203 children were treated: 59.1% boys; mean age of 3.4 years; 65% previously healthy. The most common diag-nosis was respiratory failure (31.1%). Of the 22 deaths, 3.5% took place during the first 24 hours and 7.4% after this; 172 children (84.7%) were discharged after a mean hospital length of stay of 19.2 days. Nine children (4.4%) were transferred to other hospitals. Among the 203 children, 50 children (24.6%) were intubated after admission and 86 children (42.4%) had to be admitted to a pediatric intensive care unit.

Respiratory syncytial virus, infants and intensive therapy.

The aims of this study were to determine the presence of respiratory syncytial virus (RSV) and to assess the clinical features of the disease in infants with acute low respiratory tract infection hospitalized at pediatric intensive care units (PICU) of two university teaching hospitals in São Paulo State, Brazil. Nasopharyngeal secretions were tested for the RSV by the polymerase chain reaction. Positive and negative groups for the virus were compared in terms of evolution under intensive care (mechanical pulmonary ventilation, medications, invasive procedures, complications and case fatality). Statistical analysis was performed using the Mann Whitney and Fishers exact tests. A total of 21 infants were assessed, 8 (38.1%) of whom were positive for RSV. The majority of patients were previously healthy while 85.7% required mechanical pulmonary ventilation, 20/21 patients presented with at least one complication, and the fatality rate was 14.3%. RSV positive and negative groups did not differ for the variables studied. Patients involved in this study were critically ill and needed multiple PICU resources, independently of the presence of RSV. Further studies involving larger cohorts are needed to assess the magnitude of the impact of RSV on the clinical evolution of infants admitted to the PICU in our settings.

Prognostic factors for mechanical ventilation in infants with acute lower respiratory disease

OBJECTIVE: Acute lower respiratory tract infections are the most common cause of hospital admission in pediatrics. A number of admitted patients need invasive mechanical pulmonary ventilation (IMPV). This study aimed to evaluate prognostic factors for IMPV in infants admitted due to acute lower respiratory infection. METHODS: A prospective cohort study was conducted from April to September, 2004, in two university hospitals of the Campinas metropolitan area, Sao Paulo, Brazil. One hundred, fifty-two infants were enrolled. Epidemiological and clinical data were recorded at admission and follow-up. Two groups were analyzed, according to the need of IMPV, with a comparison of prognostic factors. Association between risk factors and the outcome were studied and assessed by Relative Risk (RR), with confidence intervals of (95%CI). RESULTS: Twenty-one patients (13.81%) needed IMPV. Factors significantly associated with IMPV on admission were: age 10 days (RR=13.69, 95%CI:4.92-38.09), oxygen therapy > 10 days (RR=13.57, 95%CI:5.41-34.03), antibiotic usage (RR=3.03, 95%CI:1.34-6.89) and readmission (RR=5.23, 95%CI:2.12-12.91) were observed. CONCLUSION: The associations between need of IMPV and early age, reduced breast feeding and cyanosis demonstrate diminished physiological reserves in the young infant with lower respiratory infection. These patients require prolonged and intensive hospital support and readmission.

Respiratory syncytial virus in Brazilian infants – Ten years, two cohorts

Abstract Background Each year, a considerable amount of children will experience at least one episode of acute viral bronchiolitis (AVB) during their first year of life. About 10% of them will be hospitalized, with significant physical and economic burdens. Objectives To compare two cohorts of infants with AVB, from same region, in a ten-year interval, regarding epidemiologic factors and viral etiology. Study design Cohorts: 142 (2004) and 172 (2014) infants at ages zero to 12 months; clinical diagnosis of AVB; medical care in hospital and genetic screening of nasopharyngeal secretion for respiratory viruses. Results The comparative analysis showed a difference in the percentage of respiratory syncytial virus (RSV) positive patients [2004 (33.1%); 2014 (70.3%)] (p<0.01). No differences were noted regarding gender, breastfeeding, tobacco exposure, crowding and maternal education. There was a difference as to the month of incidence (seasonality) of AVB (higher in April 2014). There was a higher age at attendance in the first cohort, and lower birth weight and gestational age ratios in the second cohort (p<0.05). There were no differences in hospitalization time, need of mechanical ventilation and number of deaths, however a difference regarding co-morbidities was noted (higher in 2004) (p<0.001). Conclusion None of the analyzed variables had an impact on severity features. Virology and immunology must be considered in this kind of situation, by studying genetic variants and the maturation of the immune system in AVB by RSV or other viruses.