Aspectos epidemiologicos, clinicos e laboratoriais da infecção pelo virus sincicial respiratorio em crianças menores de um ano, internadas com doeça respiratoria aguda
Adriana Gut Lopes Riccetto
TESE
Português
(Broch.)
T/UNICAMP R358a
[Epidemiological, clinical and laboratorial aspects of respiratory syncytial virus infection in hospitalized infants]
Campinas, SP : [s.n.], 2006.
81p. : il.
Orientadores: Emilio Carlos Elias Baracat, Clarice Weis Arns
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Resumo: Infecções respiratórias agudas são a causa mais comum de internação hospitalar em pediatria.O Vírus Sincicial Respiratório (VSR) é o principal agente destas infecções, com apresentação clínica de bronquiolite ou pneumonia. Os casos graves ocorrem principalmente em pacientes prematuros, com...
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Resumo: Infecções respiratórias agudas são a causa mais comum de internação hospitalar em pediatria.O Vírus Sincicial Respiratório (VSR) é o principal agente destas infecções, com apresentação clínica de bronquiolite ou pneumonia. Os casos graves ocorrem principalmente em pacientes prematuros, com pneumopatias crônicas, cardiopatias e imunodeficiências. Uma proporção de pacientes internados necessita de ventilação pulmonar mecânica invasiva (VPMI). O acompanhamento após a fase aguda mostra frequentemente obstrução respiratória recorrente. Objetivos: Descrever as características epidemiológicas e clínicas de lactentes menores de 12 meses, hospitalizados com doença respiratória aguda baixa, determinando fatores associados à ventilação mecânica e à infecção pelo VSR, e as características evolutivas tardias desta população. Casuística e métodos: Estudo de corte prospectivo, realizado de 01 de abril a 30 de setembro de 2004, em dois hospitais universitários da região de Campinas, São Paulo, Brasil. Foram avaliados 152 lactentes de 0 a 12 meses internados com diagnóstico inicial de doença respiratória aguda baixa. Realizou-se avaliação clínica e pesquisa do VSR, por imunofluorescência direta (EFD), em secreção nasofaríngea Os pacientes foram divididos em dois grupos, de acordo com a necessidade de VPMI e presença do VSR, comparando-se os fatores prognósticos. Seis a 12 meses após a internação hospitalar, os pacientes com IFD positiva para VSR e os submetidos à VPMI foram convocados e avaliados quanto à presença de sibilância recorrente. A associação entre fatores de risco e desfecho estudado foi analisada por Risco Relativo (RR) e intervalos de confiança (IC95%). Para comparação de proporções foi utilizado o teste Qui-quadrado e teste Exato de Fischer. Para comparação das medidas contínuas entre dois grupos foi aplicado o teste de Mann-Whitney. O nível de significância adotado para os testes estatísticos foi de 5%. Resultados. A pesquisa de VSR foi realizada em 149 lactentes, com positividade de 17,4% (26 pacientes) Vinte e um pacientes (13,8%) foram submetidos à VPMI e os fatores significativamente associados ã VPMI foram: idade menor de 3 meses (RR=2,35, IC95%: 1,06-5,22) e tempo de aleitamento materno menor que um mês (RR=3,15, IC95%: 1,35-7,35). Na comparação dos grupos com e sem a presença de VSR os fatores associados à infecção foram: idade gestacional abaixo de 35 semanas (RR=4,17, IC95%:2,21-7,87), peso ao nascer menor de 2500g (RR=2,69, IC95%: 1,34-5,37) e escolaridade materna menor que 5 anos (RR=2,28, IC 95%: 1,13-4,59). Na evolução clínica em seguimento ambulatorial, 26 de 41 convocados compareceram (63,4%), destes 19,2% eram não sibilantes, 57,7% eram sibilantes intermitentes e 23,1% sibilantes persistentes. Na comparação entre os grupos não sibilantes e sibilantes intermitentes, ocorreu diferença significativa na variável hospitalização após a alta, ocorrendo apenas no segundo grupo de pacientes. Na comparação entre os grupos não sibilantes e sibilantes persistentes leves/moderados, não ocorreram diferenças significativas nas variáveis analisadas. Conclusões: A incidência do VSR foi de 17,5% entre os lactentes internados com doença respiratória aguda baixa. Os fatores associados à VPM1 foram: idade menor que 3 meses e tempo de aleitamento materno menor que 1 mês Os fatores associados à aquisição do VSR foram idade gestacional abaixo de 35 semanas, peso ao nascer menor de 2500g e escolaridade materna menor que 5 anos. Na evolução clínica tardia, os lactentes com pesquisa positiva para VSR e os lactentes submetidos à VPMI apresentaram-se como sibilantes intermitentes, sem necessidade de corticoterapia inalatória e com maior número de hospitalizações após a alta
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Abstract: In pediatrics, acute respiratory infections are the most common cause of hospitalization. The Respiratory Syncytial Virus (RSV) is the main agent responsible for these infections that are clinically manifested as bronchiolitis or pneumonia Severe cases occur mostly in premature patients...
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Abstract: In pediatrics, acute respiratory infections are the most common cause of hospitalization. The Respiratory Syncytial Virus (RSV) is the main agent responsible for these infections that are clinically manifested as bronchiolitis or pneumonia Severe cases occur mostly in premature patients who have chronic pneumopathies, cardiopathies and immunodeficiencies. Some of the hospitalized patients require invasive mechanical ventilation (IMV) Follow up after the acute phase often demonstrates recurring respiratory obstruction. Objectives: to describe the epidemiological and clinical characteristics of infants under the age of 12 months hospitalized with acute lower respiratory tract infections, determine factors related to mechanical ventilation and RSV as well as delayed evolutional characteristics of this population. Methods and Cases: This was a prospective cohort study conducted from 2001 April to 2001 September at two university hospitals in the region of Campinas, Sao Paulo. An evaluation was performed of 152 infants aged 0 to 12 months, hospitalized with an initial diagnosis of acute lower respiratory tract diseases Direct Immunofluorescence Assay (DFA) was used to perform a clinical research and assess RSV in the nasopharyngeal secretion. The patients were divided into two groups according to the need for IMV as well as the presence of RSV and their prognostic factors were compared. Six to twelve months after hospitalization, patients with DFA positive for RSV as well as patients who were subjected to IMV were recalled and checked for the presence of recurrent wheezing. The relation between risk factors and outcome was analyzed by applying Relative Risk (RR) and Confidence Intervals (CI 95%). The chi-square test and the Fisher Exact test were
used for comparing proportions. Continuous measures were compared using the Mann Whitney test. The significance level adopted for statistical tests was 5%. Results: RSV research was conducted on 149 infants, revealing 17.4% positivity (26
patients). Twenty-one patients (13 8%) were subjected to IMV' and factors significantly associated were age below three months (RR=2.35, IC 95%: 1.06-5.22) and breastfeeding period less than one month (RR=3.15; IC95%: 1.35-7.35). When both groups were compared with and without the presence of RSV, the factors associated with infection were: gestational age less than 35 weeks (RR=4 17, IC95%: 2.21-7.87), birth weight less than 2,500g (RR=2.69, 1C95%: 1.34 -5.37) and maternal education less than five years (RR=2 28, IC 95%: 1 13-4.59). Only 26 (63.4%) out of 41 patients reported for follow up of clinical evolution. Of these, 19.2% were non-sibilants, 57.7% were intermittent sibilants and 23.1% were persistent sibilants When the non-sibilant groups were compared with the intermittent sibilants, a significant difference was observed in relation to the variable - hospitalization after discharge, which only occurred in the second group. No significant difference was observed regarding the variables analyzed when non-sibilant groups were compared with moderate/mild persistent sibilants. Conclusions: The incidence of RSV was 17.5% in infants hospitalized with acute lower respiratory tract infections. Factors associated with IMV were age below three months and breastfeeding period less than one month Factors associated with acquisition of RSV were: gestational age less than 35 weeks, birth weight below 2,500 gm; maternal education level less than five years. Delayed clinical evolution revealed that infants who were positive for RSV and infants subjected to IMV demonstrated intermittent wheezing with no need for inhalation corticotherapy and also a higher number of hospitalizations after discharge Ver menos
used for comparing proportions. Continuous measures were compared using the Mann Whitney test. The significance level adopted for statistical tests was 5%. Results: RSV research was conducted on 149 infants, revealing 17.4% positivity (26
patients). Twenty-one patients (13 8%) were subjected to IMV' and factors significantly associated were age below three months (RR=2.35, IC 95%: 1.06-5.22) and breastfeeding period less than one month (RR=3.15; IC95%: 1.35-7.35). When both groups were compared with and without the presence of RSV, the factors associated with infection were: gestational age less than 35 weeks (RR=4 17, IC95%: 2.21-7.87), birth weight less than 2,500g (RR=2.69, 1C95%: 1.34 -5.37) and maternal education less than five years (RR=2 28, IC 95%: 1 13-4.59). Only 26 (63.4%) out of 41 patients reported for follow up of clinical evolution. Of these, 19.2% were non-sibilants, 57.7% were intermittent sibilants and 23.1% were persistent sibilants When the non-sibilant groups were compared with the intermittent sibilants, a significant difference was observed in relation to the variable - hospitalization after discharge, which only occurred in the second group. No significant difference was observed regarding the variables analyzed when non-sibilant groups were compared with moderate/mild persistent sibilants. Conclusions: The incidence of RSV was 17.5% in infants hospitalized with acute lower respiratory tract infections. Factors associated with IMV were age below three months and breastfeeding period less than one month Factors associated with acquisition of RSV were: gestational age less than 35 weeks, birth weight below 2,500 gm; maternal education level less than five years. Delayed clinical evolution revealed that infants who were positive for RSV and infants subjected to IMV demonstrated intermittent wheezing with no need for inhalation corticotherapy and also a higher number of hospitalizations after discharge Ver menos
Baracat, Emílio Carlos Elias, 1959-
Orientador
Arns, Clarice Weis, 1956-
Coorientador
Ribeiro, José Dirceu, 1952-
Avaliador
Tresoldi, Antônia Teresinha, 1951-
Avaliador
Arruda Neto, Eurico de
Avaliador
Vieira, Sandra Elisabete
Avaliador
Aspectos epidemiologicos, clinicos e laboratoriais da infecção pelo virus sincicial respiratorio em crianças menores de um ano, internadas com doeça respiratoria aguda
Adriana Gut Lopes Riccetto
Aspectos epidemiologicos, clinicos e laboratoriais da infecção pelo virus sincicial respiratorio em crianças menores de um ano, internadas com doeça respiratoria aguda
Adriana Gut Lopes Riccetto
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