Navegando por Palavras-chave "pneumonia"

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    Analysis of invasive pneumonia-causing strains of Streptococcus pneumoniae: serotypes and antimicrobial susceptibility
    (Soc Brasil Pediatria, 2011-01-01) Yoshioka, Cristina R. M.; Martinez, Marina B.; Brandileone, Maria Cristina de Cunto [UNIFESP]; Ragazzi, Selma B.; Guerra, Maria L. L. S.; Santos, Silvia R.; Shieh, Huei H.; Gilio, Alfredo Elias; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); IAL
    Objectives: To identify the most common pneumococcal serotypes in children hospitalized with invasive pneumonia, correlate isolated serotypes with those included in conjugate vaccines, and ascertain the sensitivity of the isolated pneumococcal strains to penicillin and other antibiotics.Methods: From January 2003 to October 2008, a retrospective study of hospitalized children with a diagnosis of Streptococcus pneumoniae pneumonia was conducted at the university hospital of Universidade de São Paulo. Criteria for inclusion were: age greater than 29 days and less than 15 years, radiological and clinical diagnosis of pneumonia, and isolation of Streptococcus pneumoniae in blood cultures and/or pleural effusion.Results: the study included 107 children. the most common serotypes were 14 (36.5%), 1 (16%), 5 (14.6%), 6B (6.3%) and 3 (4.2%). the proportion of identified serotypes contained in the heptavalent, 10-valent and 13-valent conjugate vaccines was 53.1, 86.5, and 96.9%, respectively. Pneumococcal strains were sensitive to penicillin (minimum inhibitory concentration, MIC <= 2 mu g/mL) in 100 cases (93.5%) and displayed intermediate resistance (MIC = 4 mu g/mL) in 7 cases (6.5%). No strains were penicillin-resistant (MIC >= 8 mu g/mL) according to the Clinical and Laboratory Standards Institute 2008 standards. Tested isolates were highly sensitive to vancomycin, rifampicin, ceftriaxone, clindamycin, erythromycin, and chloramphenicol.Conclusions: Our results confirm a significant potential impact of conjugate vaccines, mainly 10-valent and 13-valent, on invasive pneumonia. Furthermore, susceptibility testing results show that penicillin is still the treatment of choice for invasive pneumonia in our setting.
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    Avaliação de um pacote de medidas para prevenção de pneumonia associada à ventilação mecânica em unidades de terapia intensiva de um hospital universitário
    (Universidade Federal de São Paulo (UNIFESP), 2014-08-31) Pereira, Elaine Cristina [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de Medeiros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Ventilator-associated pneumonia (VAP) is the leading cause of infection in intensive care units (ICU) is associated with high mortality rates, longer hospital stay and higher costs. Among patients using mechanical ventilation around 10-20% develop this infection. There are simple steps that when applied together appear to be favorable in reducing rates of this infection. Objective: To evaluate the impact of a protocol for prevention of VAP incidence of this infection, mortality, duration of mechanical ventilation and length of hospital stay in two ICUs. Method: Patients admitted to the ICU of Pneumology and ICU of Cardiovascular Surgery (UPOCC) of a university hospital underwent a daily protocol for prevention of VAP between January 1 to December 31, 2011 In this protocol we evaluated the suitability of elevation bedside between 30th - 45th, cuff pressure above 20 cmH2O, exchange ventilatory circuit every seven days, no condensate in the ventilatory circuit, peptic ulcer prophylaxis, prophylaxis for deep venous thrombosis and awaken daily sedation. The information collected in 2011 were compared to information collected retrospectively in 2010 when there was no application of the Protocol. For statistical analysis statistical tests such as Pearson chi-square, Student's t test, considering a significance level of 5% and a confidence interval of 95% were used. Was also used Stata 12 program to calculate the density of incidence of pneumonia, with a confidence interval of 95%. Results: In the Pulmonary ICU decreased the duration of mechanical ventilation ranged from an average of 12 days in 2010 to 9.5 days in 2011 (p = 0.024). Although this unit was a reduction in the number of reintubations which in 2010 had a mean value of 15.1 episodes in 2011 and the value was 14.9 (p = 0.001). ICU of Pneumology there was a reduction in the incidence density, which ranged from 15.4%, with a total of 19 cases in 2010 to 9.3%, with a total of 10 cases in 2011 (p = 0.193) . In UPOCC was no reduction in length of hospital stay showed that on average 45 days in 2010 and 40 days in 2011 (p = 0.014). In UPOCC was no increase in incidence density which increased from 13.6% with a total of 16 cases in 2010 to 14.5% with a total of 10 cases in 2011 (p = 0.896). The adequacy in relation to the indicators obtained a value greater than 80% in at least five of the seven indicators, with XIX better performance presented by UPOCC. The ICU of Pneumology had a worse performance than the realization of awakening diary already UPOCC was less adequate in relation to the measurement of cuff pressure. Microorganisms found in two ICUs were similar between the pre-intervention period and intervention in both ICUs. Conclusion: Although we found no statistically significant difference in ICU Pulmonology showed a lower value in the incidence density of VAP in the year in which the protocol was applied. The period of application of the Protocol statistically significant difference in ICU of pulmonology in relation to shorter mechanical ventilation, and reducing episodes of reintubation was observed. The UPOCC showed a reduction in hospital stay. We observe a good fit to the protocol in two ICUs studied. Studies with a longer period of time are needed to confirm the usefulness of prevention protocols in reducing VAP.
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    Bronquiolite obliterante com pneumonia em organização e aspergiloma em paciente com linfoma-leucemia de células T
    (Sociedade Brasileira de Pneumologia e Tisiologia, 2000-02-01) Jhayya, Teresa S. [UNIFESP]; Perez, Domingo B. [UNIFESP]; Llarges, Celia Mallart [UNIFESP]; Ferreira, Rimarcs Gomes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    There are few reports in the medical literature about association between bronchiolitis obliterans with organizing pneumonia (BOOP) and aspergilloma. This report shows the presence of both BOOP and pulmonary aspergilloma in a patient with adult T cell leukemia-lymphoma. It is suggested that these findings represent a random association rather than the expression of a nosologic unity.
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    Coccidioidomycosis in armadillo hunters from the state of Ceara, Brazil
    (Fundaco Oswaldo Cruz, 2012-09-01) Brillhante, Raimunda Sâmia Nogueira; Moreira Filho, Renato Evando; Rocha, Marcos Fábio Gadelha; Castelo-Branco, Debora de Souza Collares Maia; Fechine, Maria Auxiliadora Bezerra; Lima, Rita Amanda Chaves de; Picanco, Yuri Vieira Cunha; Cordeiro, Rossana de Aguiar; Camargo, Zoilo Pires de [UNIFESP]; Queiroz, Jose Ajax Nogueira; Araujo, Roberto Wagner Bezerra de; Mesquita, Jaco Ricarte Lima de; Sidrim, Jose Julio Costa; Univ Fed Ceara; Hosp Sao Jose Doencas Infecciosas; Universidade Federal de São Paulo (UNIFESP)
    Coccidioidomycosis is a systemic mycosis with a variable clinical presentation. Misdiagnosis of coccidioidomycosis as bacterial pneumopathy leads to inappropriate prescription of antibiotics and delayed diagnosis. This report describes an outbreak among armadillo hunters in northeastern Brazil in which an initial diagnosis of bacterial pneumonia was later confirmed as coccidioidomycosis caused by Coccidioides posadasii. Thus, this mycosis should be considered as an alternative diagnosis in patients reporting symptoms of pneumonia, even if these symptoms are only presented for a short period, who are from areas considered endemic for this disease.
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    A comparison of moxifloxacin and amoxicillin in the treatment of community-acquired pneumonia in Latin America: results of a multicenter clinical trial
    (Ediciones Doyma S/l, 2003-09-01) Jardim, José Roberto [UNIFESP]; Rico, G.; la Roza, C. de; Obispo, E.; Urueta, J.; Wolff, M.; Miravitlles, M.; Grp Estudio Latinoamer CAP 5; Universidade Federal de São Paulo (UNIFESP); Ctr Med Nacl La Raza; Hosp Clin Barcelona; Hosp Gen Tijuana; INER; Fdn Arriaran
    Since community-acquired pneumonia (CAP) is a common disease with a high morbidity rate, it is important to obtain information concerning its etiology and susceptibility to antibiotics across different geographic areas. This study presents data obtained in 5 Latin American counties in the course of an international clinical trial that evaluated the efficacy and safety of treatment with either moxifloxacin or amoxicillin administered for 10 days to patients suspected of having CAP caused by a pneumococcal infection. Details are given of the pathogens identified, the patterns of sensitivity to antibiotics observed, and the clinical and microbiological results obtained.A total of 84 patients were studied, of whom 70 (83.3%) were evaluated at the end of the trial to determine the efficacy and safety of the treatment received. Gram-positive bacteria were found in samples from 29 patients (80.5%). the pathogen was Streptococcus pneumoniae in 28 of those cases (77.7%). Gram-negative bacteria were found in 7 patients (19.4%), the most common being Haemophilus influenzae in 3 patients (8.3%). the presence of atypical microorganisms was detected in 18 of the 70 patients (25%), mainly Mycobacterium pneumoniae (n = 11), and in 6 cases (8.5%) the infection was mixed. Ten strains of S. pneumoniae (35.7%) were shown to be susceptible to penicillin, 2 (7.1%) were highly resistant, and 16 (57.1%) showed moderate resistance. the clinical success rate at the final visit after treatment was 94.1% for moxifloxacin and 91.7% for amoxicillin. the results of this trial demonstrate a high prevalence of S. pneamoniae with reduced susceptibility to penicillin in patients with CAP in Latin America. It also revealed a high incidence of atypical pathogens and mixed infection in 8.6% of patients. This information should be taken into account when establishing protocols for empirical treatment of CAP in Latin America.
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    Doença pneumocócica invasiva em crianças e adolescentes soropositivos para HIV
    (Sociedade Brasileira de Pediatria, 2008-06-01) Mattei, Sonia M.; Falleiros-carvalho, Luiza Helena [UNIFESP]; Cavalcante, Nilton J. F.; UNITAU Faculdade de Medicina de Taubaté; Universidade Federal de São Paulo (UNIFESP); Faculdade de Medicina de Marília; Universidade Metropolitana de Santos; Universidade de São Paulo (USP); Instituto de Infectologia Emilio Ribas Programa de Pós-Graduação em Infectologia em Saúde Pública; Secretaria da Saúde de São Paulo Controle de Doenças
    OBJECTIVE: Invasive pneumococcal disease (IPD) primarily affects children less than 5 years old, the elderly and certain at-risk groups; especially people infected by the human immunodeficiency virus (HIV). The objective of this study was to analyze invasive pneumococcal diseases (IPD) in children and adolescents infected by the human immunodeficiency virus (HIV), with relation to morbidity, the case fatality ratio, pneumococcus serotypes, susceptibility to penicillin and ceftriaxone and to the proportion of susceptible and resistant Streptococcus pneumoniae (Sp) included in the 7-valent pneumococcal conjugate vaccine that has already been licensed. METHODS: A total of 19 cases of IPD were identified among HIV seropositive patients aged from 1 month to 20 years and hospitalized between 1993 and 2000. Data were recorded on standardized charts containing information on age, clinical diagnosis and progression, serotypes and the susceptibility to penicillin and ceftriaxone of the Sp strains identified in cultures. When the minimum inhibitory concentration was < 0.1 mcg/mL, Sp were defined as susceptible to penicillin (SpSPn), and all other strains were defined as not susceptible (SpNSPn). RESULTS: Of the 19 HIV seropositive cases with IPD, 16 (84%) had pneumonia and three (16%), had meningitis; 13 (68%) cases were children less than 2 years old and 16 (84%) were less than 5 years old. The case fatality ratio was 10%. Seven (54%) of the 13 cases less than 2 years old were SpNSPn and 10 (77%) were caused by serotypes covered by the 7-valent pneumococcal conjugate vaccine. From the 10 isolated serotypes the most frequent were 14, 6B and 23F, all them susceptible to ceftriaxone. From the three patients with meningitis, two were caused by SpNSPn. CONCLUSION: In this study most of the IPD occurred in children less than 2 years old; 77% of the strains and 86% of the serotypes of SpNSPn were covered by the 7-valent pneumococcal conjugate vaccine.
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    Incidência de pneumonia associada à ventilação mecânica em pacientes submetidos à aspiração endotraqueal pelos sistemas aberto e fechado: estudo prospectivo - dados preliminares
    (Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2001-01-01) Zeitoun, Sandra Salloum [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; Diccini, Solange [UNIFESP]; Juliano, Yara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital do Sepaco
    This a randomized clinical trial in which 20 patients were prospectively evaluated for the incidence of ventilator-associated pneumonia (VAP), of whom 12 received endotracheal suctioning by an open-suction method and 8 by a closed-suction method. Differences in the incidence of VAP was not significantly different (p = 0.4) between closed and open suctioning. Differences in Acute Physiology and Chronic Health Evaluation II, duration of entubation, and the use of steroids were all not significant. All patients in the study used H2 antagonist and a nasogastric tube. Proceeding with the study will involve a sample increase with a possible change in the results.
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    Intravenous azithromycin plus ceftriaxone followed by oral azithromycin for the treatment of inpatients with Community-Acquired Pneumonia: An open-label, non-comparative multicenter trial
    (Contexto, 2008-06-01) Rubio, Fernando Gongora [UNIFESP]; Cunha, Clovis A.; Lundgren, Fernando L. C.; Lima, Maria P. J. S.; Teixeira, Paulo J. Z.; Oliveira, Julio C. A.; Golin, Valdir; Mattos, Waldo L. L. D.; Maehlmann, Herbert K.; Moreira, Edson D.; Jardim, José Roberto [UNIFESP]; Silva, Rodney L. F.; Silva, Patricia H. B.; Hosp Base FUNFARME; Nossa Senhora Gracas Hosp; Otavia Freitas Gen Hosp; Catholic Univ; Irmandade Santa Casa Miseriocordia Porto Alegre; Univ Fed Juiz de Fora; Irmandade Santa Casa Miseriocordia; Nossa Senhora Conceicao Hosp; Gen Hosp Itapecerica Serra OSS Seconci; Gen Hosp Roberto Santos; Universidade Federal de São Paulo (UNIFESP); Univ Fed Parana; Sanatorinhos Hosp OSS Acao Comunitaria
    Community-Acquired Pneumonia (CAP) is a major public health problem. in Brazil it has been estimated that 2,000,000 people are affected by CAP every year. of those, 780,000 are admitted to hospital, and 30,000 have death as the outcome. This is an open-label, non-comparative study with the purpose of evaluating efficacy, safety, and tolerability levels of IV azithromycin (IVA) and IV ceftriaxone (IVC), followed by oral azithromycin (OA) for the treatment of inpatients with mild to severe CAP. Eighty-six patients ( mean age 56.6 +/- 19.8) were administered IVA (500mg/day) and IVC (1g/day) for 2 to 5 days, followed by AO (500mg/day) to complete a total of 10 days. At the end of treatment (EOT) and after 30 days (End of Study - EOS) the medication was evaluated clinically, microbiologically and for tolerability levels. Out of the total 86-patient population, 62 (72.1%) completed the study. At the end of treatment, 95.2% (CI(95): 88.9% - 100%) reported cure or clinical improvement; at the end of the study, that figure was 88.9% (CI(95): 74.1% - 91.7%). Out of the 86 patients enrolled in the study, 15 were microbiologically evaluable for bacteriological response. of those, 6 reported pathogen eradication at the end of therapy (40%), and 8 reported presumed eradication (53.3%). At end of study evaluation, 9 patients showed pathogen eradication (50%), and 7 showed presumed eradication (38.89%). Therefore, negative cultures were obtained from 93.3% of the patients at EOT, and from 88.9% at the end of the study. One patient (6.67% of patient population) reported presumed microbiological resistance. At study end, 2 patients (11.11%) still reported undetermined culture. Uncontrollable vomiting and worsening pneumonia condition were reported by 2.3% of patients.Discussion and Conclusion Treatment based on the administration of IV azithromycin associated to ceftriaxone and followed by oral azithromycin proved to be efficacious and well-tolerated in the treatment of Brazilian inpatients with CAP.
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    The Metabolic Sensor GPR43 Receptor Plays a Role in the Control of Klebsiella Pneumoniae Infection in the Lung
    (Frontiers Media Sa, 2018) Galvao, Izabela; Tavares, Luciana P.; Correa, Renan O.; Fachi, Jose Luis; Rocha, Vitor Melo; Rungue, Marcela; Garcia, Cristiana C.; Cassali, Geovanni; Ferreira, Caroline M. [UNIFESP]; Martins, Flaviano S.; Oliveira, Sergio C.; Mackay, Charles R.; Teixeira, Mauro M.; Vinolo, Marco Aurelio R.; Vieira, Angelica T.
    Pneumonia is one of the leading causes of death and mortality worldwide. The inflammatory responses that follow respiratory infections are protective leading to pathogen clearance but can also be deleterious if unregulated. The microbiota is known to be an important protective barrier against infections, mediating both direct inhibitory effects against the potential pathogen and also regulating the immune responses contributing to a proper clearance of the pathogen and return to homeostasis. GPR43 is one receptor for acetate, a microbiota metabolite shown to induce and to regulate important immune functions. Here, we addressed the role of GPR43 signaling during pulmonary bacterial infections. We have shown for the first time that the absence of GPR43 leads to increased susceptibility to Klebsiella pneumoniae infection, which was associated to both uncontrolled proliferation of bacteria and to increased inflammatory response. Mechanistically, we showed that GPR43 expression especially in neutrophils and alveolar macrophages is important for bacterial phagocytosis and killing. In addition, treatment with the GPR43 ligand, acetate, is protective during bacterial lung infection. This was associated to reduction in the number of bacteria in the airways and to the control of the inflammatory responses. Altogether, GPR43 plays an important role in the "gut-lung axis" as a sensor of the host gut microbiota activity through acetate binding promoting a proper immune response in the lungs.
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    New susceptibility breakpoints in antimicrobial resistance rates of invasive pneumococcal strains
    (Soc Brasil Pediatria, 2009-09-01) Wolkers, Paula Carolina Bejo; Mantese, Orlando Cesar [UNIFESP]; Paula, Alan de; Almeida, Vivieni Vieira Prado; Aguiar, Paula Augusta Dias Fogaca de; Alvares, Jackelline Rodrigues [UNIFESP]; Almeida, Samanta Cristine Grassi [UNIFESP]; Brandileone, Maria Cristina de Cunto [UNIFESP]; Universidade Federal de Uberlândia (UFU); Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); IAL
    Objective: To evaluate the impact of new penicillin susceptibility breakpoints on resistance rates of pneumococcal strains collected from children with pneumonia.Methods: Pneumococcal strains collected from patients admitted with pneumonia were isolated at the clinical analysis lab of Hospital de Clinicas de Uberlandia, Uberlandia, Brazil, and sent to Instituto Adolfo Lutz, São Paulo, Brazil, for further identification, serotyping and determination of antimicrobial susceptibility.Results: From April 1999 to December 2008, 330 strains of pneumococcus were sent to Instituto Adolfo Lutz; of these, 195 (59%) were collected from patients with pneumonia. One hundred strains collected from patients <= 12 years old were analyzed. the patients' age ranged from 1 to 12.6 years old (with mean age of 2.4 and median of 1.7 years). Forty-seven patients were male. the strains were isolated from blood (42%) and pleural fluid (58%). There were 35 oxacillin-resistant strains: according to the criteria defined by the Clinical and Laboratory Standards Institute (CLSI) in 2007 [minimum inhibitory concentration (MIC) <= 0.06 mu g/mL for susceptibility (S), 0.12 to 1 mu g/mL for intermediate resistance (IR), and <= 2 mu g/mL for full resistance (FR)], 22 strains had IR and 11 strains had FR. According to the current breakpoints defined by the CLSI in 2008 (<= 2 mu g/mL for S, 4 mu g/mL for IR and >= 8 mu g/mL for FR), only one strain had IR to penicillin. There was resistance to co-trimoxazole (80%), tetracycline (21%), erythromycin (13%), clindamycin (13%), and ceftriaxone (one strain simultaneously resistant to penicillin).Conclusions: When the new breakpoints for in vitro susceptibility were applied, penicillin resistance rates dropped 97%, from 33 to 1%.
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    Níveis plasmáticos de vitamina A em crianças carentes com pneumonia na fase aguda e após recuperação
    (Sociedade Brasileira de Pediatria, 2005-04-01) Silva, Rosangela da; Lopes Jr., Emílio; Sarni, Roseli Oselka Saccardo [UNIFESP]; Taddei, Jose Augusto de Aguiar Carrazedo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Faculdade de Medicina do ABC Departamento de Saúde Materno Infantil; Universidade de Santo Amaro
    OBJECTIVE: The aim of this study was to examine the plasma retinol of children in the acute phase of pneumonia and after recovery and to investigate the association between plasma levels of retinol after recovery with socioeconomic variables, nutritional status and severity of pneumonia. METHODS: A prospective cohort study which included 40 low-income hospitalized children with pneumonia, aged 6 months to 5 years. We evaluated: plasma retinol level during the acute phase and after recovery, years of schooling of the head of the family, per capita income, birth weight, nutritional status, hemoglobin levels and severity of pneumonia. RESULTS: Mean plasma retinol levels were significantly higher after recovery than during the acute phase of infection (1.4±0.6 vs. 1.7±0.6 µmol/l, p = 0.03). The frequency of inadequate plasma retinol levels (< 1.05 µmol/l) was 32.5 and 17.5% for the acute phase and after recovery, respectively. There were no statistically significant associations between plasma retinol deficiency and the clinical and epidemiological variables studied. More severe pneumonia was observed in 30/40 (75%) of the patients. There was no statistically significant association between plasma retinol inadequacy after recovery and severity of pneumonia (4/30 - 13.3% vs. 3/10 - 30.0%, p = 0.34). CONCLUSION: Serum retinol levels were significantly higher after recovery than during the acute phase of pneumonia. There was no statistically significant association between the deficiency of serum retinol and the clinical and epidemiological variables studied.
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    Nosocomial infection in a pediatric intensive care unit in a developing country
    (Brazilian Society of Infectious Diseases, 2003-12-01) Abramczyk, Marcelo Luiz [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Carvalho, Eduardo S. [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: Determine the rate and outcome of nosocomial infection (NI) in pediatric intensive care unit patients in a developing country. DESIGN: Prospective cohort study using the Centers for Disease Control and Prevention definitions to diagnose nosocomial infection and NNISS (National Nosocomial Infection Surveillance System) methodology. SETTING: São Paulo Hospital - Universidade Federal de São Paulo (UNIFESP) - Brazil, a 700-bed teaching hospital with an 8-bed pediatric intensive care unit. PARTICIPANTS: All 515 children consecutively admitted to the pediatric intensive care unit from April 1996 to October 1997. RESULTS: The NI incidence was 18.3% and the mean infection rate per 1,000 patient days was 46.1; the ventilator-associated pneumonia rate was 18.7 per 1,000 ventilator days; the central line-associated bloodstream infection rate was 10.2 per 1,000 central line days; and the urinary tract catheter-associated infection rate was 1.8 per 1,000 catheter days. Pneumonia was the most common NI (31.6%), followed by bloodstream infections (17.3%), and surgical site infection (17.3%). Gram-negative bacterias were the most common pathogens identified in the NIs (54.8%), followed by Gram-positive bacterias (23.8%), and yeasts. CONCLUSION: Pneumonia was the most common type of NI. A high incidence of ventilator-associated pneumonia and central line-associated bloodstream infections was found, whereas the urinary tract catheter-associated infection rate was low. Gram-negative bacterias were the most common etiologic agents identified in the unit, and yeasts were frequently found. Pediatric patients have characteristics of their own, with major differences when compared to the adult population.
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    Pneumonia adquirida na comunidade em pacientes tratados ambulatorialmente: aspectos epidemiológicos, clínicos e radiológicos das pneumonias atípicas e não atípicas
    (Sociedade Brasileira de Pneumologia e Tisiologia, 2000-02-01) Rocha, Rosali Teixeira [UNIFESP]; Vital, Anna Cristina [UNIFESP]; Silva, Clystenes Odyr Soares [UNIFESP]; Pereira, Carlos Alberto de Castro [UNIFESP]; Nakatani, Jorge [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Aim: To evaluated the etiologic percentage of the atypical pneumoniae in outpatients and to identify the epidemiologic, clinical and radiographic features that permit to distinguish between atypical and non-atypical pneumonia. Methods: All patients underwent clinical and radiographic evaluation. Serum and sputum samples were obtained to serological tests including Legionella sp, Chlamydia sp, M. pneumoniae, Influenza A and Influenza B virus, and Gram stain, respectively. These procedures were performed on the first and 21 days after inclusion. Three independent observers reviewed chest X-rays. Results: During 22 months, 129 patients were evaluated. The final population under study comprised 69 patients (46 men ¾ 23 women) with a mean age of 37 years. The etiologic diagnosis was defined in 34 (50%) of the patients. Etiologic agents included Chlamydia sp, 11 (16%) isolated cases; M. pneumoniae 7 (10%) cases. Influenza A was the third more frequent agent in 4 (6%) patients, and Legionella sp in 4 (6%). Mixed infections were observed with association of Chlamydia sp and M. pneumoniae in 5 (7.3%) cases, Chlamydia sp and Influenza B one (1.5%) case, and another of M. pneumoniae and Influenza A. The atypical pneumonia and non-atypical pneumonia groups were compared to respiratory symptoms and signs. There were no differences between them. The three independent observers' radiographic evaluation showed disagreement among them as to the type of pneumonia. Radiographic diagnoses of individual observers were compared to the clinical diagnoses, and no significant association was obtained for any observer. Conclusion: Pneumonia caused by atypical agents occurs in 50% of the outpatients with community acquired pneumonia. It is not possible to distinguish atypical pneumonia from non-atypical pneumonia. The clinical and radiographic presentations are similar in both groups.
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    Program to Diagnose Probability of Aspiration Pneumonia in Patients with Ischemic Stroke
    (Fundação Otorrinolaringologia, 2014-09-01) Pinto, Gisele; Zétola, Viviane; Lange, Marcos; Gomes, Guilherme; Nunes, Maria Cristina; Hirata, Gisela; Lagos-guimarães, Hellen Nataly; Universidade Federal do Paraná Department of Internal Medicine; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Paraná Department of Gastroenterology and Endoscopy; Universidade Tuiuti do Paraná Department of Communication Disorders
    Introduction Stroke is a major cause of death and disability worldwide, with a strong economic and social impact. Approximately 40% of patients show motor, language, and swallowing disorders after stroke. Objective To evaluate the use of software to infer the probability of pneumonia in patients with ischemic stroke. Methods Prospective and cross-sectional study conducted in a university hospital from March 2010 to August 2012. After confirmation of ischemic stroke by computed axial tomography, a clinical and flexible endoscopic evaluation of swallowing was performed within 72 hours of onset of symptoms. All patients received speech therapy poststroke, and the data were subsequently analyzed by the software. The patients were given medical treatment and speech therapy for 3 months. Results The study examined 52 patients with a mean age of 62.05 ± 13.88 years, with 23 (44.2%) women. Of the 52 patients, only 3 (5.7%) had a probability of pneumonia between 80 and 100% as identified by the software. Of all patients, 32 (61.7%) had pneumonia probability between 0 and 19%, 5 (9.5%) between 20 and 49%, 3 (5.8%) between 50 and 79%, and 12 (23.0%) between 80 and 100%. Conclusion The computer program indicates the probability of patient having aspiration pneumonia after ischemic stroke.
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    A prospective, randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction system
    (Blackwell Publishing Ltd, 2003-07-01) Zeitoun, Sandra Salloum [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; Diccini, Solange [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The objective of this study was to verify the incidence of nosocomial pneumonia in intubated and extended mechanically ventilated patients having endotracheal suctioning by an open vs. closed suction method aiming to decrease nosocomial pneumonia.Twenty-four (51.1%) patients received open-tracheal suction and 23 (48.9%) received closed-tracheal suction. The inclusion criteria were: surgical and medical patients older than 13 years, undergoing mechanical ventilation for more than 48 hours. Additional data were gathered using the Acute Physiology and Chronic Health Evaluation II, and details on smoking, alcoholism, diabetes mellitus, renal failure, previous lung disease, and previous use of antibiotics, steroids, H-2 antagonists and antacids.Among the 24 patients having open-tracheal suction, 11 developed nosocomial pneumonia while of the 23 patients undergoing closed-tracheal suction, seven developed infection (P = 0.278). Risk factors for nosocomial pneumonia were not significantly different between the two groups. In the final logistical regression model the following variables remained: groups (open and closed) [odds ratio (OR) = 0.014; confidence interval (CI) = 0.001-0.416; P = 0.014] and use of prior antibiotics (OR = 2.297; CI = 1.244-4.242; P = 0.008).Use of a closed suction system did not decrease the incidence of nosocomial pneumonia when compared with the open system. The exogenous risk factors were the most important for acquiring this infection.
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    Surgery for aspiration: Analysis of laryngotracheal separation in 23 children
    (Springer, 2006-10-01) Manrique, Dayse; Parenti Settanni, Flavio Aurelio; Brasil, Osíris de Oliveira Camponês do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The aim of this study was to analyze the efficacy of laryngotracheal separation (LTS) in eliminating aspiration in children by comparing pre- and postoperative conditions. This prospective study used an internal control group. Children with neurologic impairment and a diagnosis of chronic aspiration were subjected to LTS at the Associacao de Assistencia a Crianca Deficiente (AACD). Twenty-three children had undergone LTS with the modified Lindeman technique. All of them gained complete control of aspiration. Frequency of hospitalization, number of respiratory infections, and level of secretion were statistically reduced. After surgery only 21.7% of the children were capable of oral intake exclusively. LTS is an effective and safe technique that can be used in children resulting in aspiration control in 100% of the patients and without repercussions in the respiratory secretion and pulmonary infections.