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Abstract(s)
Background: As neoplasias hematológicas (NH) são um fator de risco conhecido para doença pneumocócica invasiva (DPI). A DPI define-se como a invasão pelo Streptococcus pneumoniae de um local anatómico previamente estéril. As intercorrências infecciosas associam-se a elevada morbilidade e mortalidade, sendo responsáveis pela interrupção do tratamento das NH. Objetivo: Rever as características da DPI em doentes com NH, avaliando principalmente o risco de DPI, o impacto da vacinação e a relevância das resistências aos antibióticos. Metodologia: Revisão narrativa com pesquisa realizada através do PubMed e do Google Académico. Resultados: A incidência de DPI na população com NH é superior à da população em geral, aumentando ao longo do tempo e durante tratamentos imunossupressores. O mieloma múltiplo (MM) é a NH com maior risco. Há uma maior incidência de serotipos resistentes aos antibióticos, com destaque para os serotipos 19. A resposta serológica à vacinação é inferior e desvanece rapidamente. Verificou-se uma diminuição no risco de DPI nos doentes com NH vacinados. A resposta imunitária à vacina parece ser superior na fase precoce das NH, porém o seu tratamento desencadeia um regresso do sistema imunitário a um estado naive. Após a introdução das vacinas conjugadas nos planos nacionais de vacinação (PNV) infantil, verificou-se uma diminuição da incidência de DPI nesta população. A profilaxia antibiótica poderá ter importância em fases de maior suscetibilidade ao pneumococo. Limitações: A literatura existente é escassa e apresenta falta de evidência. Conclusão: A vacinação nos doentes com NH diminui o risco de DPI. Não existem estudos que comparem diferentes estratégias de vacinação nesta população. Possivelmente, estes indivíduos devem ser vacinados numa fase precoce da doença, ponderando-se um reforço posterior ao tratamento. A levofloxacina e o cotrimoxazol parecem ser os antibióticos indicados para profilaxia contra a DPI. Atualmente, a abordagem da DPI nestes doentes tem pouco suporte na evidência.
Background: Hematologic malignancies (HM) are a known risk factor for invasive pneumococcal disease (IPD). IPD is defined as the invasion of a previously sterile anatomical site by Streptococcus pneumoniae. Infectious diseases are a cause of morbidity and mortality and are responsible for treatment interruption of HM. Aim: To review the characteristics of IPD in patients with HM focusing on three themes: the risk of IPD, the impact of vaccination, and the relevance of antibiotic resistance in this population. Methodology: Narrative literature review with the search conducted using PubMed and Google Scholar. Results: The incidence of IPD in the HM population is higher than in the general population and increases over time and during immunosuppressive treatments. Multiple myeloma (MM) is the HM with the highest risk. There is a higher incidence of antibiotic-resistant serotypes, most notably serotypes 19. Serologic response to vaccination is lower and fades rapidly. A decreased risk of IPD has been shown in vaccinated HM patients. The immune response to vaccination appears to be better in the early phase of HM, but the treatment causes the immune system to return to a naive stage. After the introduction of conjugated vaccines into the national childhood vaccination plans, the incidence of IPD has decreased in this population. Antibiotic prophylaxis may be of importance in stages of increased susceptibility to pneumococcal infection. Limitations: The existing literature is sparse and lacks evidence. Conclusion: Vaccination decreases the risk of IPD on patients with HM. There are no studies comparing vaccination strategies. Possibly, they should be vaccinated at an early stage of the disease and a booster should be considered after treatment. Levofloxacin and co-trimoxazole seem to be the most suitable antibiotics for prophylaxis against IPD. Currently, the approach to IPD in these patients has little support in the evidence.
Background: Hematologic malignancies (HM) are a known risk factor for invasive pneumococcal disease (IPD). IPD is defined as the invasion of a previously sterile anatomical site by Streptococcus pneumoniae. Infectious diseases are a cause of morbidity and mortality and are responsible for treatment interruption of HM. Aim: To review the characteristics of IPD in patients with HM focusing on three themes: the risk of IPD, the impact of vaccination, and the relevance of antibiotic resistance in this population. Methodology: Narrative literature review with the search conducted using PubMed and Google Scholar. Results: The incidence of IPD in the HM population is higher than in the general population and increases over time and during immunosuppressive treatments. Multiple myeloma (MM) is the HM with the highest risk. There is a higher incidence of antibiotic-resistant serotypes, most notably serotypes 19. Serologic response to vaccination is lower and fades rapidly. A decreased risk of IPD has been shown in vaccinated HM patients. The immune response to vaccination appears to be better in the early phase of HM, but the treatment causes the immune system to return to a naive stage. After the introduction of conjugated vaccines into the national childhood vaccination plans, the incidence of IPD has decreased in this population. Antibiotic prophylaxis may be of importance in stages of increased susceptibility to pneumococcal infection. Limitations: The existing literature is sparse and lacks evidence. Conclusion: Vaccination decreases the risk of IPD on patients with HM. There are no studies comparing vaccination strategies. Possibly, they should be vaccinated at an early stage of the disease and a booster should be considered after treatment. Levofloxacin and co-trimoxazole seem to be the most suitable antibiotics for prophylaxis against IPD. Currently, the approach to IPD in these patients has little support in the evidence.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Keywords
Streptococcus pneumoniae Imunossupressão Vacinação pneumocócica Profilaxia antibiótica Resistência antibiótica Microbiologia