Evandro Roberto Baldacci

Colonização de orofaringe por Streptococcus pneumoniae em crianças de creches municipais de Taubaté-SP: correlação entre os principais sorotipos e a vacina pneumocócica conjugada heptavalente

OBJECTIVE: Streptococcus pneumoniae usually colonizes the oropharynx of healthy people. Oropharyngeal carriage is related to the invasion of adjacent structures and to the development of invasive disease. A descriptive cross-sectional study was performed aiming at verifying the prevalence of oropharyngeal colonization by S. pneumoniae in children attending day care centers in the city of Taubate - SP; verifying the frequency of S. pneumoniae serotypes in isolated strains; and relating the most frequent serotypes to the composition of the conjugated heptavalent pneumococcal vaccine currently in use. METHODS: from June 29 to December 15 1998, samples of oropharyngeal material were collected from 987 children, ranging from 8 to 71 months old, enrolled in day care centers in Taubate - SP. The identification of S. pneumoniae was based on the observation of the colonies that presented partial hemolysis in agar-blood and agar-blood with gentamycin plates and on the observation of inhibited growth around the optochin disc. Serotyping was performed by the Quellung reaction, using specific antiserum, provided by the Centers for Disease Control and Prevention (Atlanta, GA/USA), and the Danish nomenclature system. RESULTS: as a result, S. pneumoniae was isolated from the oropharynx in 209 out of 987 children (colonization rate of 21.2%). Twenty eight serotypes were identified. The seven most frequent serotypes were: 6A/6B (21.5%), 19F (14.8%), 18C (7.4%), 23F (7.4%), 9V (6.7%), 14 (5.2%), 10A (4.4%). Except for serotype 10A, all the other six are included in the vaccine. The only vaccine serotype which was not found was serotype 4. CONCLUSION: agreement of 63% between the oropharynx colonizer serotypes and the serotypes present in the vaccine was found.

Etiologia viral e bacteriana de casos de gastroenterite infantil: uma caracterização clínica

Numa pesquisa sobre gastroenterites infantis, feita em criancas internadas no Instituto da Crianca do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brasil, foram identificados rotavirus em 35,2% dos pacientes e bacterias patogenicas em 37,0%; em 38,9% nao foi possivel identificar rotavirus ou bacterias patogenicas; foram identificados rotavirus em associacao com bacterias patogenicas em 11,1% dos casos. Esta pesquisa compreendeu, alem do estudo etiologico, outros aspectos, como distribuicao etaria, estado nutricional, tipo e grau de desidratacao e duracao media da diarreia.Numa pesquisa sobre gastroenterites infantis, feita em criancas internadas no Instituto da Crianca do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brasil, foram identificados rotavirus em 35,2% dos pacientes e bacterias patogenicas em 37,0%; em 38,9% nao foi possivel identificar rotavirus ou bacterias patogenicas; foram identificados rotavirus em associacao com bacterias patogenicas em 11,1% dos casos. Esta pesquisa compreendeu, alem do estudo etiologico, outros aspectos, como distribuicao etaria, estado nutricional, tipo e grau de desidratacao e duracao media da diarreia.

Ocorrência de astrovírus humanos na cidade de São Paulo, Brasil

Foram detectados astrovirus humanos durante estudo longitudinal de 13 meses sobre a incidencia de virus diarreicos em 146 criancas menores de 2 anos de idade, hospitalizadas em clinica pediatrica de um hospital universitario, na cidade de Sao Paulo, SP, Brasil. Das 67 criancas internadas com diarreia aguda, 3% foram positivas para astrovirus, por ocasiao de sua admissao, pelo Ensaio Imunoenzimatico Monoclonal Amplificado (ASTROVIRUS BIOTIN-AVIDIN ELISA, CDC, USA). As 79 criancas sem diarreia, admitidas durante o mesmo periodo por outra causa (controles), foram negativas para astrovirus, por ocasiao de seu internamento. Entretanto, 4,8% do total de criancas hospitalizadas sofreram infeccoes por astrovirus durante sua permanencia no hospital. Este e o primeiro estudo sobre a ocorrencia de astrovirus humanos no Brasil, que assim participam significativamente na etiologia da gastroenterite infantil em nosso meio.

Evaluation of humoral response to heptavalent pneumococcal conjugate vaccine in HIV-infected children

OBJETIVO: A doenca pneumococica invasiva e importante causa de morbi-mortalidade em criancas infectadas pelo HIV. O objetivo do estudo foi avaliar quantitativamente a resposta com anticorpos aos sete sorotipos pneumococicos da vacina em um grupo de criancas infectadas pelo HIV. METODOS: Estudo realizado com 40 criancas infectadas pelo HIV, com idade entre 2 e 9 anos, em seguimento em ambulatorio especializado no municipio de Sao Paulo, em 2002-2003. A dosagem de anticorpos IgG contra os polissacarideos da capsula pneumococica foi realizada por meio de ensaio imunoenzimatico (ELISA). Os anticorpos foram dosados imediatamente antes e um mes apos a aplicacao da segunda dose da vacina. Utilizaram-se dois criterios para avaliar a resposta a vacina: titulos de anticorpos >1,3 µg/mL na sorologia pos-imunizacao e aumento >4 vezes nos titulos da sorologia pos em relacao a pre-imunizacao. RESULTADOS: Para o primeiro criterio (>1,3 µg/mL), 26 (65%) criancas obtiveram resposta sorologica a vacina, 12 (30%) delas apresentaram titulos de IgG pos-imunizacao em niveis de pelo menos 1,3 µg/mL para todos os sorotipos. Para o segundo criterio (incremento >4 vezes nos titulos para quatro sorotipos ou mais), obteve-se resposta sorologica para 15 (37,5%) criancas. CONCLUSOES: A resposta a vacina foi considerada satisfatoria, com aumento estatisticamente significante dos titulos geometricos medios pos-vacinais em relacao aos pre-vacinais para todos os sorotipos estudados.OBJECTIVE Invasive pneumococcal disease is a major cause of death in HIV-infected children. The objective of the study was to assess the quantitative antibody response to the seven pneumococcal serotypes of heptavalent pneumococcal conjugate vaccine in a group of HIV-infected children. METHODS Study comprising 40 HIV-infected children aged between 2 and 9 years followed up in a specialized outpatient clinic in São Paulo, Brazil, between 2002 and 2003. Enzyme immunoassay (ELISA) was used to measure IgG antibody titers against pneumococcus capsule. Antibodies were measured immediately before and 1 month after the second dose of the vaccine. Two response criteria were used: IgG titers >or=1.3 microg/mL in the post-immunization serology and an increase of at least 4or=-fold in post- compared to pre-immunization serology. RESULTS For the first criterion (>or=1.3 microg/mL), 26 (65%) children had serological response to the vaccine, 12 (30%) showed post-immunization IgG titers of at least 1.3 microg/mL for all seven serotypes studied. For the second criterion studied (>or=4-fold increase in post- compared to pre-immunization titers for four serotypes or more), serological response was seen in 15 (37.5%) children. CONCLUSIONS Overall response to the heptavalent pneumococcal conjugate vaccine was adequate, showing a statistically significant increase in the post-immunization geometric mean titers for the seven serotypes studied.

Parinaud syndrome caused by Bartonella henselae: case report

The authors report a case of Parinaud syndrome (conjunctivitis with pre-auricular satellite adenitis) caused by Bartonella henselae, the etiologic agent of Cat Scratch Disease. The etiologic assessment of this case was performed by serum indirect immunofluorescence reaction and allowed for a better therapeutics and follow up, avoiding ineffective antibiotics and surgical interventions.

Aerobic bacteria, Chlamydia trachomatis, Pneumocystis carinii and Cytomegalovirus as agents of severe peneumonia in small infants

The authors studied 58 infants hospitalized for pneumonia in a semi-intensive care unit. Age ranged from 1 complete to 6 incomplete months. The infants were sent from another hospital in 20 cases and from home in a further 38. Pulmonary involvement, which was alveolar in 46 cases and interstitial in 12, was bilateral in 31 children. The investigation was carried out prospectively on the etiological agents associated with respiratory infection to look for evidence of aerobic bacteria (blood cultures), Chlamydia trachomatis and Cytomegalovirus (serology), and Pneumocystis carinii (direct microscopy of tracheal aspirated material). The following infectious agents were diagnosed in 21 children (36.2%): Aerobic bacteria (8), Chlamydia trachomatis (5), Pneumocystis carinii (3), Cytomegalovirus (3), Cytomegalovirus and Chlamydia trachomatis (1), Aerobic bacteria and Cytomegalovirus (1). Seven cases of infection by Chlamydia trachomatis and/or Cytomegalovirus were diagnosed out of the 12 cases with pulmonary interstitial involvement.

Avaliação da resposta humoral à vacina pneumocócica 7-valente em crianças com Aids

OBJETIVO: A doenca pneumococica invasiva e importante causa de morbi-mortalidade em criancas infectadas pelo HIV. O objetivo do estudo foi avaliar quantitativamente a resposta com anticorpos aos sete sorotipos pneumococicos da vacina em um grupo de criancas infectadas pelo HIV. METODOS: Estudo realizado com 40 criancas infectadas pelo HIV, com idade entre 2 e 9 anos, em seguimento em ambulatorio especializado no municipio de Sao Paulo, em 2002-2003. A dosagem de anticorpos IgG contra os polissacarideos da capsula pneumococica foi realizada por meio de ensaio imunoenzimatico (ELISA). Os anticorpos foram dosados imediatamente antes e um mes apos a aplicacao da segunda dose da vacina. Utilizaram-se dois criterios para avaliar a resposta a vacina: titulos de anticorpos >1,3 µg/mL na sorologia pos-imunizacao e aumento >4 vezes nos titulos da sorologia pos em relacao a pre-imunizacao. RESULTADOS: Para o primeiro criterio (>1,3 µg/mL), 26 (65%) criancas obtiveram resposta sorologica a vacina, 12 (30%) delas apresentaram titulos de IgG pos-imunizacao em niveis de pelo menos 1,3 µg/mL para todos os sorotipos. Para o segundo criterio (incremento >4 vezes nos titulos para quatro sorotipos ou mais), obteve-se resposta sorologica para 15 (37,5%) criancas. CONCLUSOES: A resposta a vacina foi considerada satisfatoria, com aumento estatisticamente significante dos titulos geometricos medios pos-vacinais em relacao aos pre-vacinais para todos os sorotipos estudados.OBJECTIVE Invasive pneumococcal disease is a major cause of death in HIV-infected children. The objective of the study was to assess the quantitative antibody response to the seven pneumococcal serotypes of heptavalent pneumococcal conjugate vaccine in a group of HIV-infected children. METHODS Study comprising 40 HIV-infected children aged between 2 and 9 years followed up in a specialized outpatient clinic in São Paulo, Brazil, between 2002 and 2003. Enzyme immunoassay (ELISA) was used to measure IgG antibody titers against pneumococcus capsule. Antibodies were measured immediately before and 1 month after the second dose of the vaccine. Two response criteria were used: IgG titers >or=1.3 microg/mL in the post-immunization serology and an increase of at least 4or=-fold in post- compared to pre-immunization serology. RESULTS For the first criterion (>or=1.3 microg/mL), 26 (65%) children had serological response to the vaccine, 12 (30%) showed post-immunization IgG titers of at least 1.3 microg/mL for all seven serotypes studied. For the second criterion studied (>or=4-fold increase in post- compared to pre-immunization titers for four serotypes or more), serological response was seen in 15 (37.5%) children. CONCLUSIONS Overall response to the heptavalent pneumococcal conjugate vaccine was adequate, showing a statistically significant increase in the post-immunization geometric mean titers for the seven serotypes studied.

Reliability of information on varicella history in preschool children.

OBJECTIVE To verify how reliable is the information provided by parents about the history of varicella in their children. METHODS 204 parents of previously healthy children attending two municipal day-care centers of São Paulo city were interviewed between August 2003 and September 2005. A standardized form was filled out with information regarding age, sex, history of varicella and other diseases, drug use and antecedent of immunization, After medical history, physical examination and checking of immunization records, 5 ml of blood were collected for ELISA (in house) varicella test. Exclusion criteria were: age less than 1 year or more than 60 months, previous immunization against chickenpox, presence of co-morbidities or recent use of immunosuppressive drugs. Data were filed in a data bank using the Excel 2003 Microsoft Office Program and stored in a PC computer. The exact Fisher test was employed to calculate sensibility, specificity, positive and negative predictive values of history of varicella informed by childrens parents. RESULTS The age of the children varied from 12 to 54 months (median, 26 months; 49 (24%) children had positive history of varicella, 155 (76%) a negative or doubtful history. The predictive positive and negative values of the information were 90% and 93%, respectively (p = 0.0001). CONCLUSIONS The degree of reliability of information about history of varicella informed by parents of children attending day care centers was high and useful to establish recommendations on varicella blocking immunization in day-care centers.

Treatment of pediatric outpatients with complicated urinary tract infections

In an open and prospective study involving outpatient children with complicated urinary tract infections (UTI), we evaluated the therapeutic efficacy of ceftriaxone administered intramuscularly, once-daily--50 to 70 mg/kg, during 8 to 10 days. Initially, the selected patients exhibited at least two of the following clinical criteria: age below 6 months, any degree of toxicity, fever, strong suspicion or proved abnormalities of their urinary tracts and lumbar pain in children older than 4 years. Significant bacteriuria was demonstrated by urine culture in 40 patients (21 boys, 19 girls), whose ages ranged from 15 days to 6 years 9 months (median 3 months). The radiological studies revealed vesicoureteral reflux in 6 patients, urethral posterior valve in 1, and neurogenic bladder in 4. The main causative agents were Escherichia coli isolated in 30 patients, Klebsiella (4) and Proteus (4). The treatment was found to be effective in 38 patients (95%). There was failure of treatment in 1 patient and a symptomatic reinfection in another one. It was concluded that children with complicated UTI could be treated alternatively by once daily ceftriaxone.

Torcicolo paroxístico benigno da infância: diagnóstico e evolução clínica de seis pacientes

Benign paroxysmal torticollis of infancy is an episodic disorder that occurs suddenly and spontaneously in the first months of life. The patients head tilts to one side for hours or days, and sometimes it can be associated with other symptoms like vomiting, sweating, pallor, irritability, headache and unstable gait. We report six patients with benign paroxysmal torticollis of infancy, whose symptoms began within the first six months of life and disappeared by five years of age. It is important that the physician be able to recognize this benign disorder to provide appropriate prognosis and not do unnecessary exams which would only cause expenses and anxiety for the child and their parents.