Nhiễm phế cầu xâm nhập ở trẻ em

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Streptococcus pneumoniae)
Liset Olarte, MD, MSc,*† Mary Anne Jackson, MD*†
*Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO
†University of Missouri–Kansas City School of Medicine, Kansas City, MO
EDUCATION GAP:
invasive pneumococcal disease-
-xin (pneumococcal
conjugate vaccines -
-
(OBJECTIVES)
1.
.
2.
3.
KEY POINTS:
1.
nasopharyngeal
*
2.
bacterial otitis media
3.
- 30%

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- Invasive pneumococcal disease
-
-invasive disease)
4.
- liên
5. susceptibilities)
–
Pneumococcal
pneumonia
-10.6 -
-
-
national
immunization programs cao.

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MICROBIOLOGY)
-
lancet-shaped diplococci
“lancet-shaped diplococci”
.
(genetic materi
Streptococcus mitis.
,
xin.
-
t

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psonin immune
system
.
a
(<1%).
( mean age)

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- x
Mean vs Median:
The mean “average“
together and dividing by the number of items in the set: 10 + 10 + 20 + 40 + 70
/ 5 = 30. The median is found by ordering the set from lowest to highest and
finding the exact middle. The median is just the middle number: 20.
thanh nonvaccine.
theo (Seasonality)
-
-

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Impact of PCVs).
(6B,9V,14,19F v
(antibiotic-resistant IPD)
p.
(penicillin-
nonsusceptible IPD)
-
19A
19A -
19A (multidrug-resistant
(MDR))
-MDR 19A.
(giving and getting)
-

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19A.
(Clinical Syndromes)
wide range of
-
-
-
(mastoiditis), viêm xoang (sinusitis).
(primaryimmunodeficiencies)
(immunocompromisingconditions).
* Note :

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Immunodeficiencies:a condition in which a body is unable to produce enough
antibodies to fight bacteria and viruses, often resulting in infection and disease
Immunocompromising :at more risk from disease because of something, such
as a health condition or medical treatment, that prevents the body's immune
system from working as well as it should:
Some fungal diseases have proved to be highly pathogenic in
immunocompromised patients, such as those with AIDS.
Good hygiene is particularly important if anyone in the house is older,
immunocompromised, or a newborn.
Nh
Bacteremia)
vi khu n-huy t n
(occult bacteremia) -
-
1.5 % nhân -
DIC
(disseminatedintravascular coagulation
(multiorgan failure).
What is bacteremia and how is it associated with sepsis?
Updated: Oct 07, 2020

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Bacteremia is defined as the presence of viable bacteria within the liquid
component of blood (blood infection). It may be primary (without an
identifiable focus of infection) or, more often, secondary (with an intravascular
or extravascular focus of infection). Although sepsis is associated with bacterial
infection, bacteremia is not a necessary ingredient in the activation of the
inflammatory response that results in sepsis. In fact, septic shock is associated
with culture-positive bacteremia in only 30-50% of cases. [3, 4, 5]
“ ”
Pneumonia)
S pneumoniae remains the leading cause of bacterial community-acquired
pneumonia in young children, and it is the
second most common bacterial pathogen in older children
after Mycoplasma pneumoniae. (23) S pneumoniae remains
the most common etiology of bacterial parapneumonic empyema in the United
States.
Mycoplasma pneumoniae
(bacterial parapneumonic empyema)
-
arapneumonic effusion
empyema necrotizing pneumonia
rò ph qu n-màng ph i
Meningitis)

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bulging fontanelle
thi u sót th n kinh c c b (focal neurological deficit)
t l t vong ca b nh
(Case fatality rate - CFR)
kinh (neurologic sequela -2013, m t thính giác giác quan
(Sensorineural hearing loss:SNHL)
Dr Ayla Al Kabbani◉ and Dr Daniel J Bell◉ et al.
The epidemiological term, the case fatality rate (CFR) (also known as case
fatality ratio, fatality rate or lethality rate) is a proportion from the number of
individuals who having been diagnosed with a disease, that shows how many
die from that disease in a given time period. Following from this, the
numerator is the number who have died from the disease in a specified
time period, and the denominator is the overall number who have
been diagnosed with that disease.
Other Clinical Syndromes)
Austrian syndrome.

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không
immunochromatographic membrane test) t
tụ (latex agglutination test - LAT)
PCR (
(Multiplex
PCR meningitis/encephalitis panels)
false-positive results)
Antimicrobial Susceptibility)
-
-

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-lactamases.
trimethoprim-sulfamethoxazole, macrolides, tetracyclines,
lincosamides (clindamycin), fluoroquinolones
Vi n Chu Lâm sàng và Xét nghi m(Clinical and
LaboratoryStandards Institute-CLSI)
- (revised)
-
(Minimuminhibitory concentration -MIC) -
)
19A sau khi PCV13
35B -
CDC Active Bacterial Core Surveillance
m
2010-2017 : penicillin, 89.4% 96%;cefotaxime, 91.4% 97.9%;
erythromycin, 73.8% 70.7%; trimethoprim-sulfamethoxazole, 77.6%
82%; levofloxacin, 99.7% 99.9%.

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’
nhân nhi 2015-2016.
-
,85.8%)
-
sinh.
crobial Treatment)
AAFP (American Academy of Family Physicians
gây viêm tai
S pneumoniae, Haemophilus influenzae, Moraxella
catarrhalis.Am -
-
-
clavulanate (amoxicil
purulent conjunctivitis)
-
- H influenzae M catarrhalis.
penicillin ,
ceftriaxone

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-
-
.
(community-acquiredpneumonia-ACP)
(Pediatric Infectious Diseases Society
the Infectious Diseases Society of America -IDSA)
-
Cefpodoxime, cefuroxime, cefprozil, levofloxacin, linezolid
t
nh nhân b m màng ph i (empyema)do ph c u khu n có th yêu c u
d m ng c (thoracostomy tube drainage) c tiêu s i
huy t và / ho c ph u thu t n i soi l ng ng c có h tr video (video-assisted
thoracoscopic surgery)
-

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-
au -
-
(proinflammatory mediators
-
PREVENTION)
Active Immunization)
Có hai lo i v c xin ng a ph c u: v c xin polysaccharide và v c xin liên h p.
Pneumococcal Polysaccharide Vaccine
c u khu n 23-valent (PPSV23) (Pneumovax23VR;
Merck & Co, Whitehouse Station, NJ) là lo i v c xin polysaccharide duy nh t
hi n có.
2, 8, 9N,10A, 11A, 12F, 15B, 17F, 20, 22F,
33F. Kháng nguyên PPSV23 có kh n d ch y u, chúng t
thu c vào t dài h n.

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mi n d ch niêm m c (Mucosal immunity)
protection/ herdimmunity
Pneumococcal Conjugate Vaccines)
PCV : 10-valent PCV(SynflorixVR ;
GlaxoSmithKline Inc, London, England) PCV13. 10-valent PCV
(www.cdc.gov/pneumococcal/global.html).
-
-
-
–2017),t l bao ph PCV qu c gia c a Hoa K i
v i l ch tiêm 4 li u v n m c x p x i v i tr t n 35 tháng tu i,
(40) nh n m nh r ng v c i thi n.
Catch-up immunization
-

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“catch-up vaccination”
The practice of giving a vaccine to people who did not receive it at the
recommended age. Catch-up vaccines may be given to a person who has not
been previously vaccinated, who has missed a scheduled vaccine dose, or who
has not completed a vaccine series. They may also be given to some people,
such as those with a weakened immune system, who might be at high risk of
certain types of infection, such as human papillomavirus (HPV) infection.
Thông tin v v c xin Menactra (Mỹ)
V c xin c ng h p Menactra xu t x t i M c s n xu t theo công ngh m i
c a hãng v u th gi i Sanofi Pasteur (Pháp), có kh
phòng ng a b nh các b nh viêm màng não, nhi m khu n huy t và viêm ph i do
vi khu n não mô c u tuýp A, C, Y, W-135 gây ra.(https://vnvc.vn/menactra-
vac-xin-nao-mo-cau-nhom-acy-va-w-135-polysaccharide-cong-hop-giai-doc-
bach-hau/
t k kho ng
th c ho c sau khi nh n PCV13.

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u h tphân nhóm huy t thanh
cho nh u tiêu chu nt
PneumoRecs VaxAdvisor
www.cdc.gov/vaccines/vpd/
pneumo/hcp/pneumoapp.html
Kháng sinh dự phòng(Antibiotic Prophylaxis)
Kháng sinh d c khuy m v i nh ng
b nh nhân b nhi m ph c u xâm nh p (invasive pneumococcal infections)
Kháng sinh d c ch nh cho nh ng b nh nhân không
có lách v m t gi i ph u ho c ch tình tr ng mi n d ch c a h .
Kháng sinh d phòng làm gi i tr hoàn
toàn.
Thu enicillin V (125 mg 2 l n /ngày cho tr <3 tu i và 250
mg 2 l n/ngày cho tr >=3 tu i). Nh ng thu c thay th cho nh ng b nh nhân d
ng v i penicillin là erythromycin và azithromycin. Tr không có lách th phát
sau b nh t bào hình li m nên ti p t c d phòng kháng sinh ít nh n khi
5 tu i.
H u h t nh ng b nh nhân này, d phòng có th an toàn lúc 5 tu i tr khi
tr ph i tr i qua ph u thu t c t lách(splenectomy) ho c b IPD. Th i gian t
cho kháng sinh d phòng nh ng b nh nhân không có lách th phát sau nh ng
nguyên nhân khác thì v nh.
Nh n ghép t bào t o máu b t bào ghép ch ng l i ch m n tính (chronic
graft-versus-host disease) có t l cao b i nh n ghép t bào t o
máu. D c khuy n cáo cho nh ng b nh nhân này.