Inês Ferreira

HOSPITALIZATION FOR PERTUSSIS – A TEN YEARS CASUISTIC FROM A LEVEL III HOSPITAL

Background: Whooping cough remains a concern in pediatric age. Adolescents and adults are recognized as a source of disease transmission, particularly for infants without complete primary immunization. The objectives of this study were to characterize clinically and epidemiologicaly hospitalized pediatric cases of pertussis. Material and methods: Retrospective, observational study of pediatric patients hospitalized at a level III Portuguese hospital with Bordetella pertussis infection confirmed by PCR DNA assay, between January 2005 and December 2014. Results: Forty-three patients were admitted with an median duration of eight days. We observed a higher number of admissions in 2008 and 2012, with majority of cases in the summer. The median age was 2,5 months old (minimum 12 days; maximum 16 years), of which 86.0% (n=37) infants without complete primary vaccination. All patients had cough and 48.8% (n=21) had an identified epidemiological contact of pertussis. All were treated with macrolides, with a mean interval between onset of symptoms and treatment of eight days (minimum 2; maximum 60 days). Viral coinfection occurred in 21.6% (n=14). Ten patients were admitted to intensive care unit and two deceased. Conclusions: Like other studies, there was a incidence peak in 2012. Infants were the most vulnerable age group to infection by Bordetella pertussis, with the highest number of hospitalizations. There is a need for additional prevention strategies to improve prevention in this age group.

BRONCHOPLEURAL FISTULA IN COMMUNITY-ACQUIRED PNEUMONIA

A fistula broncopleural, embora rara em idade pediatrica, e uma das possiveis complicacoes da pneumonia adquirida na comunidade. Crianca do sexo masculino com dois anos de idade, previamente saudavel, com vacinacao anti-pneumococica completa, internado no quinto dia de doenca com pneumonia adquirida na comunidade, complicada com empiema. Colocado dreno toracico em D7 e realizada terapeutica fibrinolitica intra-pleural. Em D10 foi removido o dreno por suspeita de fistula broncopleural. A tomografia computadorizada de torax foi compativel com pneumonia necrotizante complicada com fistula broncopleural. Submetido a tratamento conservador com antibioterapia de largo espetro durante seis semanas, com evolucao favoravel. Atualmente, com dois anos de seguimento tem-se mantido assintomatico. Os autores salientam que, mesmo em criancas previamente saudaveis, a pneumonia adquirida na comunidade pode complicar com pneumonia necrotizante e fistula broncopleural.