A carregar...
Publicação
Pneumonia a Pneumocystis jirovecii com internamento na Unidade de Cuidados Intensivos Pediátricos
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 745.87 KB | Adobe PDF |
Orientador(es)
Resumo(s)
Introdução: A Pneumonia é uma entidade nosológica comum em idade pediátrica, sendo a principal causa individual de mortalidade infantil em todo o mundo. São vários os agentes causais, no entanto, agentes atípicos como o Pneumocystis jirovecii, assumem maior relevância na criança imunocomprometida.
Métodos: Estudo observacional retrospetivo com base na consulta dos processos clínicos das crianças imunocomprometidas internadas na Unidade de Cuidados Intensivos Pediátricos do Hospital Santa Maria por pneumonia a Pneumocystis jirovecii, com confirmação microbiológica, entre 01/01/2008 e 31/05/2021.
Resultados: Incluídos 12 doentes com mediana de idades de 6,2 anos (4 meses – 11 anos), 7 do sexo masculino. A patologia de base mais frequente foi a oncológica em 8 doentes, 7 dos quais com neoplasia hematológica sob quimioterapia; apenas 2 estavam sob profilaxia da infeção a P. jirovecii. A febre e a dificuldade respiratória com hipoxemia foram os sinais mais frequentes e todos os doentes foram admitidos por insuficiência respiratória, 4 já sob suporte ventilatório. P. jirovecii foi isolado por qPCR na maioria dos doentes (10/12), e em 9 doentes foi identificada coinfeção com outros agentes. A terapêutica dirigida ao P. jirovecii foi cotrimoxazol em 11/12 e num doente optou-se por atovaquona. Onze doentes necessitaram de suporte ventilatório (invasivo em 8 e não invasivo em 6), 1 com oxigenação por membrana extracorporal, e 3 de suporte inotrópico/vasopressor. Registaram-se 5 óbitos.
Conclusões: Este estudo é ilustrativo da gravidade e mortalidade associadas à infeção por P. jirovecii em crianças imunocomprometidas. Revela-se crucial não apenas o elevado grau de suspeição clínica nestes doentes, como também o cumprimento de profilaxia adequada. A pesquisa sérica de (1-3)-β-D-glucan como teste de triagem em apresentações sugestivas, poderá vir a integrar a prática clínica. O cotrimoxazol mantém-se o fármaco de primeira linha na profilaxia e tratamento da infeção a P. jirovecii.
Introduction: Pneumonia is a common pediatric infection and worldwide it is the major cause of death in children. Although several agents may cause pneumonia, atypical ones, such as Pneumocystis jirovecii, are more relevant in immunocompromised children. Methods: Retrospective study based on a review of the records of immunocompromised patients admitted to Hospital de Santa Maria’s pediatric intensive care unit with Pneumocystis jirovecii pneumonia, microbiologically confirmed, between January 2008 and May 2021. Results: Twelve patients were included with median age of 6,2 years (4mo – 11y), 7 males. The most frequent underlying illness was cancer, in 8 patients (7 of which with hematological malignancies under chemotherapy); only 2 were under P. jirovecii prophylaxis. Fever and respiratory distress were the most frequent signs, all patients were admitted for respiratory failure, 4 of which under respiratory support. P. jirovecii was identified through qPCR in most cases (10/12), and 9 had co-infection with other agents. Directed treatment was trimethoprim-sulfamethoxazole (cotrimoxazole) in 11/12; one patient was given atovaquone. Eleven children required organ support, including invasive (8/12) and noninvasive (6/12) mechanical ventilation, extracorporeal membrane oxygenation (1), vasopressors/inotropes (3/12). Five patients died. Conclusions: This study illustrates the potential severity and high mortality rate of P. jirovecii in immunocompromised children. It is crucial to keep a high index of suspicion and to ensure that adequate prophylaxis is given to all patients at risk. Serum (1-3)-β-D-glucan may become a valuable triage test in suggestive cases. Cotrimoxazole remains the first line drug as prophylaxis and treatment of P. jirovecii infection.
Introduction: Pneumonia is a common pediatric infection and worldwide it is the major cause of death in children. Although several agents may cause pneumonia, atypical ones, such as Pneumocystis jirovecii, are more relevant in immunocompromised children. Methods: Retrospective study based on a review of the records of immunocompromised patients admitted to Hospital de Santa Maria’s pediatric intensive care unit with Pneumocystis jirovecii pneumonia, microbiologically confirmed, between January 2008 and May 2021. Results: Twelve patients were included with median age of 6,2 years (4mo – 11y), 7 males. The most frequent underlying illness was cancer, in 8 patients (7 of which with hematological malignancies under chemotherapy); only 2 were under P. jirovecii prophylaxis. Fever and respiratory distress were the most frequent signs, all patients were admitted for respiratory failure, 4 of which under respiratory support. P. jirovecii was identified through qPCR in most cases (10/12), and 9 had co-infection with other agents. Directed treatment was trimethoprim-sulfamethoxazole (cotrimoxazole) in 11/12; one patient was given atovaquone. Eleven children required organ support, including invasive (8/12) and noninvasive (6/12) mechanical ventilation, extracorporeal membrane oxygenation (1), vasopressors/inotropes (3/12). Five patients died. Conclusions: This study illustrates the potential severity and high mortality rate of P. jirovecii in immunocompromised children. It is crucial to keep a high index of suspicion and to ensure that adequate prophylaxis is given to all patients at risk. Serum (1-3)-β-D-glucan may become a valuable triage test in suggestive cases. Cotrimoxazole remains the first line drug as prophylaxis and treatment of P. jirovecii infection.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Imunocomprometido Pneumocystis jirovecii Cuidados intensivos Profilaxia Pediatria