Doença pneumocócica invasiva em crianças e adolescentes soropositivos para HIV

Abstract

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.J Pediatr (Rio J). 2008;84(3):276-280: Pneumococcus, Streptococcus pneumoniae, children, adolescents, HIV seropositive, meningitis, pneumonia, invasive pneumococcal disease, antipneumococcal vaccine.

Avaliação de custo-efetividade da vacina pneumocócica conjugada 13-valente comparada à vacina pneumocócica polissacarídica e não vacinação no Sistema de Saúde Suplementar Brasileiro

“…Na América Latina, o S. pneumoniae é o patógeno mais comum envolvido na pneumonia adquirida na comunidade, sendo responsável por 35% dos casos (Isturiz et al, 2010). A doença pneumocócica invasiva acomete principalmente crianças menores de 5 anos, idosos e indivíduos que se encontram em alguns grupos de risco (por exemplo, infectados pelo vírus da imunodeficiência humana -HIV) (Mattei et al, 2008).…”

A THERAPEUTIC APPROACH TO MENINGOENCEPHALITIS BY Streptococcus pneumoniae IN BRAZIL

“…In a total of 100 samples, 15% resistance to penicillin, 1% resistance to cephalosporins -intermediate resistance in both cases -and no resistance to vancomycin was found. The risk factors for S. pneumoniae resistance are, mainly, the previous use of antibiotics and age inferior to one year of age 22 .A study executed byMattei et al (2008), observed that 19 children and adolescents infected with HIV and with invasive pneumococcal diseases -in which three cases were ABM -, 47.0% of the isolated S. pneumoniae strains from the CSF were not sensitive to penicillin, but all were sensitive to ceftriaxone. Of those resistant to penicillin, the most frequent serotype was 14.…”

“…Of those resistant to penicillin, the most frequent serotype was 14. The elevated resistance rate to penicillin can be explained by the fact that the HIV infected patients were submitted to frequent antimicrobial treatments32 . The resistance to penicillin was restricted to the 6B, 19F, 23F, 14 and 19A serotypes, classically known as the pediatric serotypes, responsible for the elevated number of infections in children33 .In Brazil, the greatest incidence of ABM caused by S. pneumoniae was registered in infants with less than one year of age and bacterial resistance…”