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Manifestações osteoarticulares no contexto de doença pneumocócica invasiva atípica : a propósito de dois casos clínicos
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Resumo(s)
O Streptococcus pneumoniae é um diploco Gram-positivo que coloniza a nasofaringe e é frequentemente responsável por pneumonia, sinusite, otite e meningite, sendo uma importante causa de morbimortalidade em todo o mundo, sobretudo em crianças e idosos. A infeção osteoarticular por S. pneumoniae é uma manifestação pouco frequente, mas não rara, de infeção pneumocócica no adulto. Além da virulência da bactéria, a patogénese da doença e a sua expressão clínica, evolução e gravidade dependem de fatores do hospedeiro, nomeadamente de patologias associadas que podem comprometer a resposta imunitária do organismo à infeção.
Apresentam-se dois casos de doença pneumocócica invasiva com expressão osteoarticular em doentes com fatores de risco para infeção pneumocócica e sem imunização prévia. O primeiro caso refere-se a um homem de 46 anos com história de alcoolismo abusivo no passado e bacteriémia por S. pneumoniae e espondilodiscite cervical. O diagnóstico de doença pneumocócica invasiva conduziu ao diagnóstico inaugural de infeção pelo vírus da imunodeficiência humana. O segundo caso diz respeito a um homem idoso, de 84 anos, com diabetes mellitus e alcoolismo no passado. O doente apresentava bacteriémia e oligoartrite pneumocócicas e meningite. O S. pneumonie era sensível, em ambos os casos, à penicilina e os doentes foram tratados com beta-lactâmicos.
Apesar do S. pneumoniae ser o terceiro microorganismo mais frequente de artrite sética, a literatura acerca deste tema é limitada. Pretende-se com a apresentação destes casos divulgar uma expressão clínica pouco frequente de infeção pneumocócica e, com os dados da revisão da literatura, caracterizar a epidemiologia e as manifestações clínicas desta entidade, identificar fatores específicos que predispõem à infeção osteoarticular e determinam o prognóstico da doença, bem como avaliar o impacto da vacinação antipneumocócica.
Streptococcus pneumoniae is a Gram-positive diplococcus that colonizes the nasopharynx and is often responsible for pneumonia, sinusitis, otitis and meningitis, being an important cause of morbidity and mortality worldwide, especially in children and in the elderly. Osteoarticular infection by S. pneumoniae is an uncommon, but not rare, manifestation of pneumococcal infection in adults. In addition to bacterial virulence, disease’s pathogenesis and clinical expression, course and severity depend on host factors, particularly on associated diseases that may compromise the host immune response to infection. This article presents two cases of invasive pneumococcal disease with osteoarticular expression in patients with risk factors for pneumococcal infection and without prior immunization. The first case refers to a 46-year-old man with history of severe alcohol abuse in the past and S. pneumoniae bacteremia and cervical spondylodiscitis. The diagnosis of invasive pneumococcal disease led to the inaugural diagnosis of human immunodeficiency virus infection. The second case concerns an 84-year-old male patient with diabetes mellitus and alcohol abuse in the past. The patient presented with pneumococcal bacteremia, oligoarthritis and meningitis. S. pneumonie was, in both cases, penicillin sensitive and the patients were treated with beta-lactam antibiotics. Although S. pneumoniae is the third most frequent microorganism of septic arthritis, the literature on this topic is limited. The aim of this presentation is to disclose an uncommon clinical expression of pneumococcal infection and, with the literature review data, to characterize the epidemiology and clinical manifestations of this entity, to identify specific factors that predispose to osteoarticular infection and that determine the prognosis of the disease as well as assess the impact of pneumococcal vaccination.
Streptococcus pneumoniae is a Gram-positive diplococcus that colonizes the nasopharynx and is often responsible for pneumonia, sinusitis, otitis and meningitis, being an important cause of morbidity and mortality worldwide, especially in children and in the elderly. Osteoarticular infection by S. pneumoniae is an uncommon, but not rare, manifestation of pneumococcal infection in adults. In addition to bacterial virulence, disease’s pathogenesis and clinical expression, course and severity depend on host factors, particularly on associated diseases that may compromise the host immune response to infection. This article presents two cases of invasive pneumococcal disease with osteoarticular expression in patients with risk factors for pneumococcal infection and without prior immunization. The first case refers to a 46-year-old man with history of severe alcohol abuse in the past and S. pneumoniae bacteremia and cervical spondylodiscitis. The diagnosis of invasive pneumococcal disease led to the inaugural diagnosis of human immunodeficiency virus infection. The second case concerns an 84-year-old male patient with diabetes mellitus and alcohol abuse in the past. The patient presented with pneumococcal bacteremia, oligoarthritis and meningitis. S. pneumonie was, in both cases, penicillin sensitive and the patients were treated with beta-lactam antibiotics. Although S. pneumoniae is the third most frequent microorganism of septic arthritis, the literature on this topic is limited. The aim of this presentation is to disclose an uncommon clinical expression of pneumococcal infection and, with the literature review data, to characterize the epidemiology and clinical manifestations of this entity, to identify specific factors that predispose to osteoarticular infection and that determine the prognosis of the disease as well as assess the impact of pneumococcal vaccination.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Streptococcus pneumoniae Doença pneumocócica invasiva Artrite séptica Osteomielite vertebral Espondilodiscite Vacina antipneumocócica