Aspectos gerais das septicemias e bacteriemias estafilocócicas no adulto

Gonçalves, Adrelirio J. R.; G. Neto, Francisco Duarte; Brasil, Maria Helena Silva; Santos, Vitorino Modesto dos; Henrique, Sílvio; Saldanha, Leopoldo F.; Souza Filho, Albino J.; Suzuki, Lúcia Emi

doi:10.1590/S0037-86821969000300001

Resumos

São apresentados 25 casos de infecções sistêmicas por estafilococos por pacientes adultos. Foram incluídos somente os casos em que houve concordância entre os achados bacteriológicos e clínicos. O Staphylccoceus aureus foi o mais encontrado em hemoculturas (17 casos). Dezoito casos comportaram-se verdadeiramente como septicemias caracterizadas por lesões metastáticas principalmente pulmonares, configurando os quadros clássicos de infartos pulmonares sépticos múltiplos. As principais complicações cardiovasculares foram a miocardite, endocardite, choque e o cor pulmonale agudo. As complicações neurológicas mais freqüentes foram meningite, coma e convulsões, tôdas seguidas de óbito. A porta de entrada mais freqüente foi através de infecção cutânea presente em 48% dos casos, seguida do aparelho genital feminino em conseqüência do abôrto provocado (20%). É apresentado estudo anátomo-patológico de 4 casos. Na discussão são apresentadas características biológicas do germe no sentido de facilitar o entendimento da fisiopatologia destas infecções sistêmicas assim como de esclarecer o quadro clínico exibido pelos pacientes. Breves considerações são realizadas no que concerne a patogenia e o quadro clínico nestas infecções e aspectos gerais de conduta terapêutica são assinalados.

Systemic infections by staphylococcus in 25 adult patients is reviewed. In all cases observed the germ identified bacteriologically as Staphylococcus aureus was isolated in blood culture in 17 cases. Clinical picture of septicemia with metastatic lesions mainly to the lungs and presenting the classical clinicai findings of multiple septic pulmonary infarts was observed in 18 cases. The most frequent cardiovascular complications were: myocarditis, endocarditis, shock and acute cor pulmonale. Meningitis, convulsions and coma were the outstandig neurological complications. The most frequent portal of entry was through skin infection (48% of our cases). In 20% of the cases criminal abortion was responsible for inception of the systemic infection. Pathological study in 4 cases is presented. The biological characteristics of the germ are paramount in the understanding of physiopathology of the systemic infection and in the understanding of the clinical picture as is discussed at length. The pathogenesis, clinical aspects and fundamentals of the therapeutic approach are briefly considered.

Aspectos gerais das septicemias e bacteriemias estafilocócicas no adulto^* * Trabalho do Serviço de Clinica Médica do Hospital dos Servidores do Estado.

Adrelirio J. R. Gonçalves^I; Francisco Duarte G. Neto^II; Maria Helena Silva Brasil^III; Vitorino Modesto dos Santos^IV; Sílvio Henrique^V; Leopoldo ^VI; Albino J. Souza Filho^IV; Lúcia Emi Suzuki^VI ^I

^IDo Hospital Isolamento Francisco de Castro e Médico Assistente do Serviço de Clínica Médica do H. S. E.

^IIChefe de Clínica do Serviço de Anatomia Patológica

^IIIResidente Assistente do Serviço de Anatomia Patológica

^IVEx-Residente do Serviço de Clínica Médica

^VEx-Residente Chefe do Serviço de Clínica Médica

^VIEx-Residente do Serviço de Clínica Médica. Instrutor de Ensino da Cadeira de C.M. da Faculdade da U.F.S.C

^VIIResidente-Júnior do Serviço de Clínica Médica

RESUMO

São apresentados 25 casos de infecções sistêmicas por estafilococos por pacientes adultos.

Foram incluídos somente os casos em que houve concordância entre os achados bacteriológicos e clínicos. O Staphylccoceus aureus foi o mais encontrado em hemoculturas (17 casos). Dezoito casos comportaram-se verdadeiramente como septicemias caracterizadas por lesões metastáticas principalmente pulmonares, configurando os quadros clássicos de infartos pulmonares sépticos múltiplos.

As principais complicações cardiovasculares foram a miocardite, endocardite, choque e o cor pulmonale agudo.

As complicações neurológicas mais freqüentes foram meningite, coma e convulsões, tôdas seguidas de óbito.

A porta de entrada mais freqüente foi através de infecção cutânea presente em 48% dos casos, seguida do aparelho genital feminino em conseqüência do abôrto provocado (20%).

É apresentado estudo anátomo-patológico de 4 casos.

Na discussão são apresentadas características biológicas do germe no sentido de facilitar o entendimento da fisiopatologia destas infecções sistêmicas assim como de esclarecer o quadro clínico exibido pelos pacientes.

Breves considerações são realizadas no que concerne a patogenia e o quadro clínico nestas infecções e aspectos gerais de conduta terapêutica são assinalados.

SUMMARY

Systemic infections by staphylococcus in 25 adult patients is reviewed.

In all cases observed the germ identified bacteriologically as Staphylococcus aureus was isolated in blood culture in 17 cases. Clinical picture of septicemia with metastatic lesions mainly to the lungs and presenting the classical clinical findings of multiple septic pulmonary infarts was observed in 18 cases.

The most frequent cardiovascular complications were: myocarditis, endocarditis, shock and acute cor pulmonale. Meningitis, convulsions and coma were the outstandig neurological complications.

The most frequent portal of entry was through skin infection (48% of our cases). In 20% of the cases criminal abortion was responsible for inception of the systemic infection.

Pathological study in 4 cases is presented.

The biological characteristics of the germ are paramount in the understanding of physiopathology of the systemic infection and in the understanding of the clinical picture as is discussed at length.

The pathogenesis, clinical aspects and fundamentals of the therapeutic approach are briefly considered.

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Full text available only in PDF format.

BIBLIOGRAFIA

1) BARNES, B. A. ; BEHRINGER, G. E.. ; WHEELOCK, F. C. ; WILKINS, E. W. - Postcperative sepsis: trends and factors influencing sepsis over a 20-year period revicwed in 20.000 cases. Ann. Surg. - 154: 585, 1961.
2) BIER, O. - XVIII - Germes piogênicos - Estafilococo Bacteriologia e Imonologia, 12ª edição, pg. 1347 Ed. Melhoramentos, São Paulo, 1964.
3) BORDEN, C. W. - Fundamental and therapeutic concepts in hypovolemic and bacteremic shoch. Med. Clin. North Am. 46: 395. 1962.
4) CLUFF, L. E. ; REYNOLDS, R. J. - Management of staphylococcal infection. Amer. J. Med. - 39: 812, 1965.
5) DE ARAGAO. R. M; DE CASTRO, H.; ROSEMBERG, J. A. - Estudos sôbre o estafilococo penicilino resistente. O Hospital, 66 : 473, 1964.
6) DOWLING, H. F. - Present status of therapy with combinations of antibiotics. Amer .J. Med. - 39: 796, 1965.
7) EKSTEDT, R. D. ; NUNGESTER, W. J. - Coagulase in reversing antibacterial activity of normal human serum of Micrococcus pyogenes. Proc. Soc. Exp. Bicl. and Med. - 89: 90, 1955.
8) EKSTEDT, R. D. ; YOTIS, W. W. - Studies on staphylococci. II - effect of coagulase on the virulence of coagulase negative strains. J. Bact. - 80: 496, 1960.
9) FRÉOUR, P. ; KANE, P. A. ; GERMOUTY, J. - Le staphyloccque dans la pathologie pleuro-pulmonaire de 1'adulte. Le Poumon et le Coeur - 9: 977, 1964.
10) HALL, W. H. - The specífic diagnosis and treatment of pneumonias. Med. Clin. North America, 43: 191, 1959.
11) HAY, D. R. -. Pulmonary manifestations of staphylococcal pyaemia. Thorax - 15: 82, 1960.
12) HASSAL, J. E. ; ROUNTREE, P. M. - Staphylococcal septicaemia. Lan23) cet - I: 213, 1959.
13) JENSEN, K. ; LASSEN, H. C. A. - Fulminating Staphylococcal infections treated with Fucidin and Penicillin or Semisynthetic Penicillin. Ann. Intern. Med. 60: 790, 1964.
14) KAPRAL, F. A.; LI, I. W. - Virulence and coagulases of Staphylococcus aureus. Proc. Soc. Exp. Biol. and Med. - 104: 151, 1960.
15) KATZ, S. - Infectious disease emergencies. Med. Clin. North America - 46: 473, 1962.
16) KIRBY, W. M. M. PENY, D. M. and BAUER, A. W. - Treatment of staphylococcal septicemia with vancomycin. New Engl. J. of Med. 262: 49-55 1960.
17) KOENIG, M. G. ; MELLY, M. A. ROGERS, D. E. - Factors relating to the virulence of staphilococci. II -observations on four mouse pathogenic strains. J. Exp. Med. - 116: 589, 1962.
18) KOENIG, M. G. ; MELLY, M. A. ; ROGERS, D. E. - Factors relating to the virulence of staphylococci. J. Exp. Med. - 116: 601, 1962.
19) KOENIG, M. G. - The treatment of staphiloccccal infections. Med. Clin. North America - 47: 1231, 1963.
20) KUMAR, S. ; LINDORFER, R. K. - The caracterizafion of staphylococcal toxins. I - The electrophoretical migration of the alfa hemolytic, dermonecrotic, lethal and leucocidal activities of crude tcxins. J. Exp. Med. -115: 1095, 1962.
21) KUMAR, S. et al - The characterization of staphylococcal toxins. II- the 'isolation and characterization of a homogeneous staphylococcal protein possessing alfa hemolytic, dermonecrotic, lethal and leucocidal activities. J. Exp. Med. - 115: 1107, 1962.
22) LI, I. W. ; KAPRAL, F. A. - Virulence and coagulases of staphylococcus aureus. II - survival of certain coagulase negative mutants in the organs of intravenously infected rabbits. J. Infeet. Dis. - 111: 204, 1962.
23) LOURIA, D. B. ; KAMINSKI, T. and BUCHMAN, J. - Vancomycin in severe staphylococcal. infecticns. Arch. Intern. Med. 107: 225-240. 1961.
24) MARTIN, W. J. ; MC HENRY M; C; - Bacteremia due to Gram-negative bacilli. Resume oí experiences in 303 cases. Lancet - 84: 385, 1964.
25) MARTIN, W. J. ; WELLMAN, W. E, - Clinically useful antimicrobial agents. Pcstgraduate Medicine. 42: 350, 1967.
26) MERRIL, S. L.; DA VIS, A.; SMOLENS, B. and FINEGOLD, S. M. - Cephalothin in serious bacterial infection. Ann. Intern. Med. 64: 1-12, 1966.
27) MORSE, S. I. - Isolation and properties of a surface antigen of staphylococcus aureus. J. Exp. Med. - 115: 295, 1962.
28) MORTIMER JR., E. A. - HospiUi starhilococcal infections. Med. Clin. North America - 47: 1247, 1963.
29) RAMMELKAMP JR. C. H. - Staphylococcal disease. Cecil-Loeb Textbook of Medicine, pg. 190 Edited by Beeson and Mc Dermott, W. B. Saunders Co. Phiiadelphia and London, 1963.
30) RIBEIRO, T. M.; BARBOSA, T. J. - Estafilococcia pleuropulmonar. Pediatria Moderna, Dezembro de 1967.
31) ROBBINS, S. L. - Staphylococcal infections. Textbock of Pathology pg. 243. Edited by W. B. Saunders Co. Phiiadelphia and London, 1963.
32) RODMAN W. ; HAMBURGER, M. - Fifteen years' experience with staphyloccccus septicemia ina large city hosoital. Amer. J. Med.. - 22: 437, 1957.
33) ROGERS, D. E. - The phagocytosis of staphycocci Recent Progress in Microbiology VIII - University of Toronto Press, pg. 575.
34) ROGERS, D. E. ; TOMPSETT, R. - The survival of staphylococci within human leucocytes. J. Exp. Med. - 95: 209, 1952.
35) ROGERS, D. E. - Current problem of staphylccoccal infections. Ann. Intern. Med. - 45: 748, 1956.
36) ROGERS, D. E. ; MELLY, M. A. - The dinamics and immunology of the fagocytosis of staphylccocci. Transactions of the Assoc. of Amer. Physicians - 74: 216, 1961.
37) ROGERS, D. E. - Staphylococci and man J. A. M. A. - 181: 38, 1962.
38) SABATH, L. D. ; STEINHAUER, B. W. and. FINLAND, M. Combined, action of penicillín G with methicillin or oxacillin against Staphylococcus aureus. New Engl. J. of Med. 268: 284-286, 1963.
39) SCHIRGER, A. ; MARTIN, W. J., ; NICHOLS, D. E. - Micrococcal bacteremia without endocarditis. Clinicai data and therapeutic considerations in 109 cases. Ann. Intern. Med. -47: 39, 1957.
40) SERRA, A.; VIEIRA, R. R.; ATTIÉ, F. -Septicemia estafilocócica pós-abôrto Jornal Brasileiro de Medicina, 4: 109, 1961.
41) SMITH, J. M. - Staphylococcal infections. The yeav Book Pub., inc. Ist Ed., Chicago, 1958.
42) SPINK, W. W. Staphylococcal infections and the problem of antibioticresistent staphylocccci. Arch. Intern. Med. - 94: 167, 1954.
43) THAL, A. P. ; EGNER, W. - The mechanism of shock produced by means of staphylococcal toxin. A. M. A. Arch. Path. - 61: 488, 1956.
44) WEINSTEIN, L. ; KLAINER, A. S. -Management of emergencies. Septic shock. Pathogenesis and treatment. New Engl. J. of Med. - 274: 950, 1966.
45) WILSON, L. M. - Etiology of bacterial endocarditis before and since the introduction of antibiotics. Ann. Intern. Med. 58: 946, 1963.
46) WISE, R. I. - The staphylococcus approach to therapy. Med. Clin. North America - 49: 1403, 1965.
47) WOODLEY, D. W. and WENDELL, H. H. - The treatment of severe staphylococcal infections with vancomycin. Ann. Intern. Med. 55: 235, 1961.

*

Trabalho do Serviço de Clinica Médica do Hospital dos Servidores do Estado.

Datas de Publicação

Publicação nesta coleção
02 Ago 2013
Data do Fascículo
Jun 1969

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1) BARNES, B. A. ; BEHRINGER, G. E.. ; WHEELOCK, F. C. ; WILKINS, E. W. - Postcperative sepsis: trends and factors influencing sepsis over a 20-year period revicwed in 20.000 cases. Ann. Surg. - 154: 585, 1961.

[2] 2) BIER, O. - XVIII - Germes piogênicos - Estafilococo Bacteriologia e Imonologia, 12ª edição, pg. 1347 Ed. Melhoramentos, São Paulo, 1964.

[3] 3) BORDEN, C. W. - Fundamental and therapeutic concepts in hypovolemic and bacteremic shoch. Med. Clin. North Am. 46: 395. 1962.

[4] 4) CLUFF, L. E. ; REYNOLDS, R. J. - Management of staphylococcal infection. Amer. J. Med. - 39: 812, 1965.

[5] 5) DE ARAGAO. R. M; DE CASTRO, H.; ROSEMBERG, J. A. - Estudos sôbre o estafilococo penicilino resistente. O Hospital, 66 : 473, 1964.

[6] 6) DOWLING, H. F. - Present status of therapy with combinations of antibiotics. Amer .J. Med. - 39: 796, 1965.

[7] 7) EKSTEDT, R. D. ; NUNGESTER, W. J. - Coagulase in reversing antibacterial activity of normal human serum of Micrococcus pyogenes. Proc. Soc. Exp. Bicl. and Med. - 89: 90, 1955.

[8] 8) EKSTEDT, R. D. ; YOTIS, W. W. - Studies on staphylococci. II - effect of coagulase on the virulence of coagulase negative strains. J. Bact. - 80: 496, 1960.

[9] 9) FRÉOUR, P. ; KANE, P. A. ; GERMOUTY, J. - Le staphyloccque dans la pathologie pleuro-pulmonaire de 1'adulte. Le Poumon et le Coeur - 9: 977, 1964.

[10] 10) HALL, W. H. - The specífic diagnosis and treatment of pneumonias. Med. Clin. North America, 43: 191, 1959.

[11] 11) HAY, D. R. -. Pulmonary manifestations of staphylococcal pyaemia. Thorax - 15: 82, 1960.

[12] 12) HASSAL, J. E. ; ROUNTREE, P. M. - Staphylococcal septicaemia. Lan23) cet - I: 213, 1959.

[13] 13) JENSEN, K. ; LASSEN, H. C. A. - Fulminating Staphylococcal infections treated with Fucidin and Penicillin or Semisynthetic Penicillin. Ann. Intern. Med. 60: 790, 1964.

[14] 14) KAPRAL, F. A.; LI, I. W. - Virulence and coagulases of Staphylococcus aureus. Proc. Soc. Exp. Biol. and Med. - 104: 151, 1960.

[15] 15) KATZ, S. - Infectious disease emergencies. Med. Clin. North America - 46: 473, 1962.

[16] 16) KIRBY, W. M. M. PENY, D. M. and BAUER, A. W. - Treatment of staphylococcal septicemia with vancomycin. New Engl. J. of Med. 262: 49-55 1960.

[17] 17) KOENIG, M. G. ; MELLY, M. A. ROGERS, D. E. - Factors relating to the virulence of staphilococci. II -observations on four mouse pathogenic strains. J. Exp. Med. - 116: 589, 1962.

[18] 18) KOENIG, M. G. ; MELLY, M. A. ; ROGERS, D. E. - Factors relating to the virulence of staphylococci. J. Exp. Med. - 116: 601, 1962.

[19] 19) KOENIG, M. G. - The treatment of staphiloccccal infections. Med. Clin. North America - 47: 1231, 1963.

[20] 20) KUMAR, S. ; LINDORFER, R. K. - The caracterizafion of staphylococcal toxins. I - The electrophoretical migration of the alfa hemolytic, dermonecrotic, lethal and leucocidal activities of crude tcxins. J. Exp. Med. -115: 1095, 1962.

[21] 21) KUMAR, S. et al - The characterization of staphylococcal toxins. II- the 'isolation and characterization of a homogeneous staphylococcal protein possessing alfa hemolytic, dermonecrotic, lethal and leucocidal activities. J. Exp. Med. - 115: 1107, 1962.

[22] 22) LI, I. W. ; KAPRAL, F. A. - Virulence and coagulases of staphylococcus aureus. II - survival of certain coagulase negative mutants in the organs of intravenously infected rabbits. J. Infeet. Dis. - 111: 204, 1962.

[23] 23) LOURIA, D. B. ; KAMINSKI, T. and BUCHMAN, J. - Vancomycin in severe staphylococcal. infecticns. Arch. Intern. Med. 107: 225-240. 1961.

[24] 24) MARTIN, W. J. ; MC HENRY M; C; - Bacteremia due to Gram-negative bacilli. Resume oí experiences in 303 cases. Lancet - 84: 385, 1964.

[25] 25) MARTIN, W. J. ; WELLMAN, W. E, - Clinically useful antimicrobial agents. Pcstgraduate Medicine. 42: 350, 1967.

[26] 26) MERRIL, S. L.; DA VIS, A.; SMOLENS, B. and FINEGOLD, S. M. - Cephalothin in serious bacterial infection. Ann. Intern. Med. 64: 1-12, 1966.

[27] 27) MORSE, S. I. - Isolation and properties of a surface antigen of staphylococcus aureus. J. Exp. Med. - 115: 295, 1962.

[28] 28) MORTIMER JR., E. A. - HospiUi starhilococcal infections. Med. Clin. North America - 47: 1247, 1963.

[29] 29) RAMMELKAMP JR. C. H. - Staphylococcal disease. Cecil-Loeb Textbook of Medicine, pg. 190 Edited by Beeson and Mc Dermott, W. B. Saunders Co. Phiiadelphia and London, 1963.

[30] 30) RIBEIRO, T. M.; BARBOSA, T. J. - Estafilococcia pleuropulmonar. Pediatria Moderna, Dezembro de 1967.

[31] 31) ROBBINS, S. L. - Staphylococcal infections. Textbock of Pathology pg. 243. Edited by W. B. Saunders Co. Phiiadelphia and London, 1963.

[32] 32) RODMAN W. ; HAMBURGER, M. - Fifteen years' experience with staphyloccccus septicemia ina large city hosoital. Amer. J. Med.. - 22: 437, 1957.

[33] 33) ROGERS, D. E. - The phagocytosis of staphycocci Recent Progress in Microbiology VIII - University of Toronto Press, pg. 575.

[34] 34) ROGERS, D. E. ; TOMPSETT, R. - The survival of staphylococci within human leucocytes. J. Exp. Med. - 95: 209, 1952.

[35] 35) ROGERS, D. E. - Current problem of staphylccoccal infections. Ann. Intern. Med. - 45: 748, 1956.

[36] 36) ROGERS, D. E. ; MELLY, M. A. - The dinamics and immunology of the fagocytosis of staphylccocci. Transactions of the Assoc. of Amer. Physicians - 74: 216, 1961.

[37] 37) ROGERS, D. E. - Staphylococci and man J. A. M. A. - 181: 38, 1962.

[38] 38) SABATH, L. D. ; STEINHAUER, B. W. and. FINLAND, M. Combined, action of penicillín G with methicillin or oxacillin against Staphylococcus aureus. New Engl. J. of Med. 268: 284-286, 1963.

[39] 39) SCHIRGER, A. ; MARTIN, W. J., ; NICHOLS, D. E. - Micrococcal bacteremia without endocarditis. Clinicai data and therapeutic considerations in 109 cases. Ann. Intern. Med. -47: 39, 1957.

[40] 40) SERRA, A.; VIEIRA, R. R.; ATTIÉ, F. -Septicemia estafilocócica pós-abôrto Jornal Brasileiro de Medicina, 4: 109, 1961.

[41] 41) SMITH, J. M. - Staphylococcal infections. The yeav Book Pub., inc. Ist Ed., Chicago, 1958.

[42] 42) SPINK, W. W. Staphylococcal infections and the problem of antibioticresistent staphylocccci. Arch. Intern. Med. - 94: 167, 1954.

[43] 43) THAL, A. P. ; EGNER, W. - The mechanism of shock produced by means of staphylococcal toxin. A. M. A. Arch. Path. - 61: 488, 1956.

[44] 44) WEINSTEIN, L. ; KLAINER, A. S. -Management of emergencies. Septic shock. Pathogenesis and treatment. New Engl. J. of Med. - 274: 950, 1966.

[45] 45) WILSON, L. M. - Etiology of bacterial endocarditis before and since the introduction of antibiotics. Ann. Intern. Med. 58: 946, 1963.

[46] 46) WISE, R. I. - The staphylococcus approach to therapy. Med. Clin. North America - 49: 1403, 1965.

[47] 47) WOODLEY, D. W. and WENDELL, H. H. - The treatment of severe staphylococcal infections with vancomycin. Ann. Intern. Med. 55: 235, 1961.