A carregar...
Publicação
Doença estreptocócica invasiva em cuidados intensivos pediátricos
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 457.06 KB | Adobe PDF |
Orientador(es)
Resumo(s)
Introdução: A incidência da doença invasiva a Streptococcus do grupo A (DSI) aumentou na Europa e América do Norte a partir das últimas décadas do século passado, tanto em adultos como crianças, com elevada morbilidade e mortalidade associadas. Objetivo: Avaliar a incidência e características clínicas da DSI em crianças hospitalizadas em Unidade de Cuidados Intensivos (UCI). Métodos: Estudo descritivo de casos ocorridos entre 1 de janeiro de 2007 e 31 de dezembro de 2016 na UCI Pediátricos do Hospital de Santa Maria (HSM). Foram analisados dados demográficos, antecedentes pessoais, achados clínicos e laboratoriais, intervenções terapêuticas e evolução dos doentes durante o internamento. Resultados: Foram incluídos 18 casos de DSI em 17 doentes (um doente apresentou dois episódios temporalmente distintos), sendo as entidades clínicas mais comuns a pneumonia (11 casos) e a Síndrome de Choque Tóxico Estreptocócico (STSS) (9). A mediana de idades foi de 2,5 anos, não se tendo verificado significativa prevalência de género. Em seis casos foram identificados fatores de risco/infeções concomitantes. Todos os doentes foram medicados com associação de um β-lactâmico e clindamicina e em 9 foi administrada imunoglobulina endovenosa. Dois casos foram alvo de intervenção cirúrgica. Sete doentes tiveram falência de dois ou mais órgãos, tendo sido instituído suporte inotrópico em 7, ventilação invasiva em 4, substituição renal em 1; um doente necessitou de suporte de oxigenação por membrana extracorporal (ECMO). Não se registaram óbitos. Conclusões: O presente estudo é ilustrativo da potencial gravidade da DSI, com necessidade de diagnóstico e intervenção precoces e medidas avançadas de suporte de órgão, que contribuíram para a ausência de mortalidade. É necessária a criação de um registo nacional para avaliar a atual epidemiologia da doença. A ausência de sequenciação do gene emm não permitiu inferir acerca das estirpes bacterianas envolvidas.
Introduction: The incidence of invasive group A streptococcal (GAS) disease has increased in Europe and North America in the late 20th century, both in adults and children, with high morbidity and mortality. Aim: To evaluate the incidence and clinical characteristics of invasive GAS disease in hospitalized children in an intensive care unit (ICU). Methods: Descriptive study of invasive GAS cases admitted to Hospital de Santa Maria’s paediatric ICU between January 1st, 2007 and December 31st, 2016. We reviewed demographic features, clinical and laboratorial records, treatment and patient course during the hospital admission. Results: Eighteen cases of SID were included, in 17 different patients (one with two temporarily distinct episodes), and the most common clinical presentations were pneumoniae (11 cases) and streptococcal toxic shock syndrome (STSS) (9). The median age was 2,5 years, with no significant gender prevalence. Six cases had risk factors/concomitant infections. All patients were treated with the combination of one β- lactam agent and clindamycin, nine received intravenous immunoglobulin and two had surgery. Seven patients had multiorgan dysfunction. Inotropic support was used in 7 cases, mechanical ventilation in 4, renal replacement therapy in one; one patient required extracorporeal membrane oxygenation. All patients survived. Conclusions: As shown in this study, the severity of invasive GAS disease demands early diagnosis and intervention and the availability of multi-organ support that allows for improved survival. The creation of national database for this illness is required to evaluate its current epidemiology. The absence of emm typing precluded the determination of the bacterial strains envolved.
Introduction: The incidence of invasive group A streptococcal (GAS) disease has increased in Europe and North America in the late 20th century, both in adults and children, with high morbidity and mortality. Aim: To evaluate the incidence and clinical characteristics of invasive GAS disease in hospitalized children in an intensive care unit (ICU). Methods: Descriptive study of invasive GAS cases admitted to Hospital de Santa Maria’s paediatric ICU between January 1st, 2007 and December 31st, 2016. We reviewed demographic features, clinical and laboratorial records, treatment and patient course during the hospital admission. Results: Eighteen cases of SID were included, in 17 different patients (one with two temporarily distinct episodes), and the most common clinical presentations were pneumoniae (11 cases) and streptococcal toxic shock syndrome (STSS) (9). The median age was 2,5 years, with no significant gender prevalence. Six cases had risk factors/concomitant infections. All patients were treated with the combination of one β- lactam agent and clindamycin, nine received intravenous immunoglobulin and two had surgery. Seven patients had multiorgan dysfunction. Inotropic support was used in 7 cases, mechanical ventilation in 4, renal replacement therapy in one; one patient required extracorporeal membrane oxygenation. All patients survived. Conclusions: As shown in this study, the severity of invasive GAS disease demands early diagnosis and intervention and the availability of multi-organ support that allows for improved survival. The creation of national database for this illness is required to evaluate its current epidemiology. The absence of emm typing precluded the determination of the bacterial strains envolved.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Pediatria Cuidados intensivos Doença invasiva Streptococcus grupo A