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Doença invasiva por Haemophilus Influenzae na criança: estudo multicêntrico nacional 2010-2014
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Advisor(s)
Abstract(s)
Introdução: Uma parceria Sociedade de Infecciologia Pediátrica / Instituto Nacional de Saúde Dr. Ricardo Jorge propôs-se
avaliar a epidemiologia, fatores de risco, clínica, serotipos e suscetibilidade aos antibióticos da doença invasiva a Haemphilus influenzae nas crianças, em Portugal.
Métodos: Estudo prospetivo descritivo multicêntrico, entre 1 de janeiro de 2010 e 30 de junho de 2014 (54 meses). Cada
estirpe foi enviada ao Instituto Nacional de Saúde Dr. Ricardo Jorge acompanhada de inquérito clínico. Foi pesquisada produção
de β-lactamase, resistência antibiótica, cápsula e serotipo.
Resultados: Foram analisadas 38 estirpes (18 hospitais) isoladas em hemocultura (34), liquor (três) e líquido articular (uma). A
incidência global foi 0,45/100000. Identificaram-se 25 (65,7%) Haemophilus influenzae não-capsulados, nove (23,7%) serotipo
b (seis falências vacinais), duas (5,3%) serotipo a e duas (5,3%) serotipo f. As idades variaram entre 1 mês e 15 anos (lactentes
44,7%; 5 anos ou mais 26,3%); 23,7% tinham patologia prévia. As apresentações clínicas foram pneumonia (13), meningite
(cinco), bacteriemia (cinco), infeção respiratória alta (quatro), bronquiolite (três) sépsis sem foco (três), artrite (duas), celulite
periorbitária (uma), celulite (uma), epiglotite (uma). A meningite foi manifestação de 33,3% das infeções por serotipo b e de 4%
das devidas a Haemophilus influenzae não-capsulados (p < 0,05). As infeções respiratórias altas bacteriémicas predominaram
acima dos 5 anos (30% vs 3,6%; p < 0,05). Registaram-se sequelas neurológicas num caso (2,6%) e um óbito (2,6%). Verificou-se
produção de β-lactamase em 7,9% e resistência à cefuroxima em 18,4%. Sem resistências a amoxicilina / clavulanato, cefotaxima,
rifampicina.
Discussão: A doença invasiva por Haemophilus influenzae atingiu diferentes grupos etários, predominando nos lactentes. As
estirpes mais prevalentes foram de Haemophilus influenzae não-capsulados, causando maioritariamente bacteriemia e manifestações
respiratórias. O serotipo b manteve-se em circulação sendo responsável por dois casos / ano.
Introduction: A partnership between the Society for Paediatric Infectious Diseases and the National Institute of Health aimed to assess invasive Haemophilus influenzae disease in Portuguese children, with regard to clinical presentation, risk factors, epidemiology, serotypes and antibiotic susceptibility. Methods: In this prospective multicentre study from 1 January 2010 to 30 June 2014 (54 months), H. influenzae strains were sent to the National Institute of Health with a clinical report. β-lactamase production was determined with nitrocefin, antibiotic resistance was assessed by microdilution assay and serotyping was performed by polymerase chain reaction. Results: Thirty-eight strains, from 18 hospitals, were isolated in blood (34), cerebrospinal fluid (three) and synovial fluid (one). The overall incidence was 0.45/100 000. We identified 25 (65.7%) cases of non-encapsulated Haemophilus influenzae, nine (23.7%) serotype b (six vaccine failures), two (5.3%) serotype a, and two (5.3%) serotype f. The children’s ages ranged from 1 month to 15 years (44.7% infants, 26.3% aged ≥5 years); 23.7% had previous disease. The clinical presentations were pneumonia (13), meningitis (five), occult bactaeremia (five), upper respiratory infection (four), bronchiolitis (three) sepsis (three), arthritis (two), periorbital cellulitis (one), cellulitis (one), and epiglottitis (one). Serotype b was more often associated with meningitis than non- -encapsulated H. influenza (33.3% vs 4%, p<0.05). Upper respiratory infections predominated over the age of five (30% vs 3.6%; p<0.05). One child had neurological sequelae (2.6%) and one died (2.6%). β-lactamase producers accounted for 7.9% of strains and 18.4% were resistant to cefuroxime. There was no resistance to amoxicillin/ clavulanate, cefotaxime or rifampicin.
Introduction: A partnership between the Society for Paediatric Infectious Diseases and the National Institute of Health aimed to assess invasive Haemophilus influenzae disease in Portuguese children, with regard to clinical presentation, risk factors, epidemiology, serotypes and antibiotic susceptibility. Methods: In this prospective multicentre study from 1 January 2010 to 30 June 2014 (54 months), H. influenzae strains were sent to the National Institute of Health with a clinical report. β-lactamase production was determined with nitrocefin, antibiotic resistance was assessed by microdilution assay and serotyping was performed by polymerase chain reaction. Results: Thirty-eight strains, from 18 hospitals, were isolated in blood (34), cerebrospinal fluid (three) and synovial fluid (one). The overall incidence was 0.45/100 000. We identified 25 (65.7%) cases of non-encapsulated Haemophilus influenzae, nine (23.7%) serotype b (six vaccine failures), two (5.3%) serotype a, and two (5.3%) serotype f. The children’s ages ranged from 1 month to 15 years (44.7% infants, 26.3% aged ≥5 years); 23.7% had previous disease. The clinical presentations were pneumonia (13), meningitis (five), occult bactaeremia (five), upper respiratory infection (four), bronchiolitis (three) sepsis (three), arthritis (two), periorbital cellulitis (one), cellulitis (one), and epiglottitis (one). Serotype b was more often associated with meningitis than non- -encapsulated H. influenza (33.3% vs 4%, p<0.05). Upper respiratory infections predominated over the age of five (30% vs 3.6%; p<0.05). One child had neurological sequelae (2.6%) and one died (2.6%). β-lactamase producers accounted for 7.9% of strains and 18.4% were resistant to cefuroxime. There was no resistance to amoxicillin/ clavulanate, cefotaxime or rifampicin.
Description
Keywords
Haemophilus Influenzae Tipo B Infeções por Haemophilus Haemophilus influenzae/isolamento & purificação Criança Infecções Respiratórias Saúde Pública Portugal
Pedagogical Context
Citation
Acta Pediatr Port. 2016;47((1):21-9
Publisher
Sociedade Portuguesa de Pediatria