Andrea Maciel de Oliveira Rossoni

Acute bacterial meningitis caused by Streptococcus pneumoniae resistant to the antimicrobian agents and their serotypes

The main objectives of this study are to evaluate the resistance rates of Streptococcus pneumonia to penicillin G, ceftriaxone and vancomycin in patients with meningitis; to analyze possible risk factors to the antimicrobian resistance; to describe the serotypes detected and to suggest an initial empirical treatment for meningitis. The sensitiveness and serotypes of all isolated S. pneumoniae of patients with acute bacterial meningitis received by the Paraná State Central Laboratory from April 2001 to august 2002 have been evaluated. One hundred S. pneumoniae have been isolated, of which 15% were resistant to penicillin, 1% to cephalosporin and 0% to vancomycin. The serotypes most found were 14 (19%), 3 and 23F (10% each). When only the resistant serotypes were analyzed, the most prevalent was the 14 with 44%. The risk factors found in relation to the S. pneumoniae resistance were: age under one year old (p=0.01) and previous use of antibiotic (p=0.046). The resistance rates found, which were moderate to penicillin, low to cephalosporin and neutral to vancomycin, suggest the isolated use of a 3rd generation cephalosporin as an initial empirical therapy for the treatment of acute bacterial meningitis with a communitarian background.

Interferon-gamma release assay versus tuberculin skin test for latent tuberculosis infection among HIV patients in Brazil

SETTING Patients HIV+ attending in a reference clinic, Southern Brazil. OBJECTIVE To compare the interferon-gamma-release assay (IGRA - QuantiFERON(®) TB Gold In-Tube) with the tuberculin skin test (TST - PPD-Rt 23) for latent tuberculosis infection (LTBI) in patients with HIV. DESIGN Cohort study. Patients were simultaneously submitted to the TST and blood collection for the IGRA. RESULTS A total of 140 subjects were included. Nine (6.4%) were IGRA+/TST+, 12 (8.6%) were IGRA+/TST-, 4 (3%) were IGRA-/TST+, and 115 (82%) IGRA-/TST-. There was poor agreement between tests (kappa=0.2), and no correlation between these results and CD4+ T lymphocyte counts. During follow-up, one patient with negative results on both tests died from sepsis, and another with discordant results (IGRA+/TST-) exhibited TST seroconversion. Compared to the TST, IGRA showed a sensitivity and specificity of 69% and 90%, respectively. The IGRA detected 8% more positive results than the TST. All patients were followed up for 2 years. CONCLUSION The higher accuracy of the IGRA would result in LTBI treatments being administered to patients who would have otherwise been overlooked, decreasing the number of active tuberculosis cases. The long-term survival of HIV carriers requires further evaluation.

Laboratorial atopy markers in children with human immunodeficiency virus

Changes in immune system functions are one of the most important consequences of human immunodeficiency virus (HIV) infection. Studies have reported a higher prevalence of disease mediated by immunological hypersensitivity mechanisms in HIV-positive patients. This study aims to observe how immunological changes in HIV-infected children interfere in atopy determinants. Fifty-seven HIV-positive children were studied between June 2004-August 2005 to evaluate the possible modifications in atopy diagnosis from prick test environmental allergen reactivity. Patients were subjected to two evaluations: on both occasions, atopic and non-atopic groups were correlated with immunological (CD4+ and CD8+ lymphocyte concentrations and serum levels of IgA, IgM, IgG and IgE) and viral parameters (HIV viral load). The percent atopy was 20.05 in the first and 29.82 in the second evaluation and atopy was diagnosed in patients without immunosuppression or with moderate immunosuppression. Six patients changed from a negative to a positive atopy profile. One patient with a decreased CD4+ T lymphocyte concentration failed to demonstrate prick test positivity between evaluations. Multivariate analysis showed that the variables associated with atopy diagnosis included a personal history of allergic diseases as well as elevated IgE for age and elevated IgE levels. Atopy development in HIV-infected children seems to be modulated by genetic and environmental factors as well as immunological condition.

Acute bacterial meningitis in HIV, patients in southern Brazil: Curitiba, Paraná, Brazil.

Acute communitarian bacterial meningitis and AIDS are prevalent infectious disease in Brazil. The objective of this study was to evaluate the frequency of acute communitarian bacterial meningitis in AIDS patients, the clinical and cerebrospinal fluid (CSF) characteristics. It was reviewed the Health Department data from city of Curitiba, Southern Brazil, from 1996 to 2002. During this period, 32 patients with AIDS fulfilled criteria for acute bacterial meningitis, representing 0.84% of the AIDS cases and 1.85% of the cases of bacterial meningitis. S. pneumoniae was the most frequent bacteria isolated. The number of white blood cells and the percentage of neutrophils were higher and CSF glucose was lower in the group with no HIV co-infection (p 0.12; 0.008; 0.04 respectively). Bacteria not so common causing meningitis can occur among HIV infected patients. The high mortality rate among pneumococcus meningitis patients makes pneumococcus vaccination important.

Comparação entre as soluções orais de manitol a 10% e bifosfato de sódio no preparo mecânico do cólon

BACKGROUND: To compare the use of sodium biphosphate and 10% mannitol solutions for mechanical bowel preparation in terms of cleansing quality, tolerability, disorder in water and electrolyte balance, and plasma osmolality. METHOD: Sixty patients who had been referred for colonoscopy were analyzed in a randomized, double-blind, prospective study. The quality of bowel cleansing was analyzed by the examiner using Becks classification. Ingestion tolerability was established by investigating taste, whether the patient felt any discomfort or not, the development of adverse effects and the amount of solution ingested. The following measurements were made before and after ingestion of the oral bowel preparation solution: sodium, potassium, calcium, magnesium, phosphorus, urea, creatinine, glucose, hematocrit, hemoglobin and plasma osmolality. RESULTS: Both solutions resulted in bowel preparations that were classified as good or superior in over 80% of the patients. The use of sodium biphosphate resulted in less discomfort and better tolerance, although it was not superior to mannitol in terms of taste or the presence of adverse effects. Sodium biphosphate led to an increase, and mannitol to a decrease, in osmolality, reflecting the changes in plasma sodium in both groups. The former also resulted in a significant measurement change in serum phosphorus, calcium, magnesium and potassium levels, without any clinical repercussions. CONCLUSION: Both types of bowel preparation resulted in adequate cleansing. Sodium biphosphate, although better tolerated, leads to more alterations in water and electrolyte balance.

Esquemas de tratamento da tuberculose na infância e eventos adversos relacionados

The World Health Organization (WHO) recommends an initial treatment regimen for tuberculosis in children that is comparable to that for adults, with directly monitored multiple-drug therapy for 6 months. Early initiation of treatment in younger children is essential due to the possibility of rapid dissemination of the disease, severe sequelae, and death. Children and adolescents usually tolerate antituberculosis drugs very well. This article aims to review the main therapeutic regimens, dosages, and adverse effects associated with first-line drugs used in treatment regimens for tuberculosis in children and to provide some practical recommendations for the follow-up of children and adolescents undergoing treatment. The article reviews current guidelines from the WHO and the Brazilian Ministry of Health as well as currently used therapeutic regimens and their main adverse effects. The reviewed literature states that at recommended doses, antituberculosis drugs are well tolerated by the pediatric population, and severe adverse effects are rare and mostly temporary. The frequency of toxic effects may be related to disease severity. Isoniazid is the most extensively studied drug and the most commonly used in children because it is also used in the treatment of latent tuberculosis. Liver toxicity is the primary described adverse effect. In most cases, when treatment is started adequately on time, it proceeds without severe adverse effects that require the therapy to be suspended. A high degree of suspicion is required to establish the diagnosis and consequently the adequate treatment, aiming for a long-term change in the course of the disease in children. Palavras-chave:1 Physician, Master’s Candidate in the Graduate Program in Child and Adolescent Health of the Sector of Health Sciences of the Federal University of Paraná (UFPR), Curitiba, Brazil. 2 Physician of the Service of Pediatric Infectology of the Clinics Hospital Complex of the Federal University of Paraná (CHC-UFPR), Curitiba, Brazil. 3 Professor of the Department of Medicine State University of Ponta Grossa, Brazil. 4 Professor of Department of Pediatrics of the Federal University of Paraná (UFPR), Curitiba, Brazil. 5 Professor of the Department of Clinical Medicine of the Federal University of Paraná (UFPR), Curitiba, Brazil.

Diagnóstico da tuberculose em crianças: qual o papel do hemograma e das provas de atividades inflamatórias?

It is known that childhood tuberculosis (TB) is a global public health problem, although the diagnosis and treatment of TB are neglected. Few cases are confirmed by laboratory tests because TB is paucibacillary in childhood. Therefore, clinical, epidemiological, radiological, and laboratory criteria are used for diagnostic confirmation. This study reviews the literature to determine the role of hemogram and tests of inflammatory markers in diagnosis. Few studies have addressed this subject and the most common findings in the hemogram are anemia of chronic disease (normochromic and normocytic) with a non-specific leukogram and platelet disorders. The most important factor in the clinical suspicion of TB may be the absence of leukocytosis, which is common in acute febrile respiratory illnesses. The levels of inflammatory markers are usually high, but some studies question the value of ESR for the diagnosis of TB. Future studies will help confirm the usefulness of other laboratory parameters in the screening and diagnosis of TB in children. Palavras-chave:

Aderência ao seguimento no cuidado ao recém-nascido exposto à sífilis e características associadas à interrupção do acompanhamento

Introduction All newborns exposed to syphilis in pregnancy must have outpatient follow-up. The interruption of this follow-up especially threatens those children who were not treated at birth. Objective To describe the clinical, epidemiological, and sociodemographic characteristics of pregnant women with syphilis and their newborns, and to investigate the factors associated with the discontinuation of the follow-up. Methods This is an observational, descriptive, analytical, and retrospective study of medical records of 254 children exposed to syphilis, who were assisted at the Congenital Infectious Clinic of the university hospital of the Universidade Federal do Paraná, between 2000 and 2010. The newborns were classified by reference according to their follow-up. Data were analyzed by means of the binary logistic regression model in order to identify the factors associated to drop out. Results The factors associated to the interruption of the follow-up were maternal age over 30 years, mothers with 3 or more children, and the absence of cross-infections by HIV and/or viral hepatitis. Conclusion Such findings demonstrate the need to identify these families and implement strategies to promote the establishment of bonds. A greater rigor to indicate the treatment of the disease at birth is recommended, as most of them do not properly follow up.