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616.13/.14-002.7:616.33-053.2 (1) |
Pathology of the circulatory system, blood vessels. Cardiovascular complaints (975) |
Pathology of the digestive system. Complaints of the alimentary canal (1732) |
SM ISO690:2012 REVENCO, Ninel, EREMCIUC, Rodica, GAIDARJI, Olga, FOCA, Silvia-Gabriela, BOTNARU, Victor, GUDUMAC, Eva, CRIVCEANSCHI, Eugenia, MARIN, Ala, TIRON, Ludmila, PETROVICI, Virgil. Interrelațiile dintre granulomatoza cu poliangeită, portajul stafilococului auriu și infecțiile acute – caz clinic. In: Buletin de Perinatologie, 2019, nr. 2(83), pp. 112-116. ISSN 1810-5289. |
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Buletin de Perinatologie | ||||||
Numărul 2(83) / 2019 / ISSN 1810-5289 | ||||||
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CZU: 616.13/.14-002.7:616.33-053.2 | ||||||
Pag. 112-116 | ||||||
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Background: Granulomatosis with polyangiitis (GPA) is a chronic vasculitis involving small- to medium-sized arteries. It is characterized by granulomatous infl ammation of the upper and lower respiratory tracts; necrotizing, pauci-immune glomerulonephritis; and vasculitis that frequently involves other organs. Staphylococcus aureus is thought to play a crucial role in onset and fl ares of GPA. Method and materials: We report a clinical case of a patient with granulomatosis with polyangiitis complicated with infective endocarditis due to Staph. aureus. Results: At the onset of the disease patient complaint on persistent fever, anorexia, nausea and vomiting. Laboratory assays revealed increased acute phase reactants. X-ray revealed signs of sinusitis and pulmonary infection. Septic workup revealed repeated positive blood cultures for staph. aureus. In spite to adequate antibiotic treatment child’s condition gradually worsened. Nasal crusting and epistaxis was reported by patient. An repeated X-ray of the chest showed multiple nodules and cavities in the lungs. She was suspected to have GPA. Lung biopsy was taken and the diagnosis of GPA was confi rmed. Imunnosupresive therapy was started with no expected clinical improvement. In the meanwhile patient developed a new murmur. On heart ultrasound vegetations were revealed. Th e diagnosis of infective endocarditis was made. Th e patient was treated with a 4 weeks regimen of vancomycin. Her condition markedly improved. Aft er the treatment of active infection, an alternative regimen of GPA treatment was chosen. No relapse of lung disease was reported in 3 months follow-up. Conclusions: Th e case reported above highlights the importance of high index of suspicion of GPA in patients with staph. aureus infections who do not respond to conventional therapy. Nasal crusts biopsy can aid diff erential diagnosis and promote early diagnosis |
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Cuvinte-cheie granulomatosis with polyangiitis, Staph. aureus, carrier, Infective endocarditis, children |
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<?xml version='1.0' encoding='utf-8'?> <oai_dc:dc xmlns:dc='http://purl.org/dc/elements/1.1/' xmlns:oai_dc='http://www.openarchives.org/OAI/2.0/oai_dc/' xmlns:xsi='http://www.w3.org/2001/XMLSchema-instance' xsi:schemaLocation='http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd'> <dc:creator>Revenco, N.E.</dc:creator> <dc:creator>Eremciuc, R.V.</dc:creator> <dc:creator>Gaidarji, O.</dc:creator> <dc:creator>Foca, S.</dc:creator> <dc:creator>Botnaru, V.I.</dc:creator> <dc:creator>Gudumac, E.M.</dc:creator> <dc:creator>Crivceanschi, E.</dc:creator> <dc:creator>Marin, A.</dc:creator> <dc:creator>Tiron, L.</dc:creator> <dc:creator>Petrovici, V.G.</dc:creator> <dc:date>2019-05-06</dc:date> <dc:description xml:lang='en'><p>Background: Granulomatosis with polyangiitis (GPA) is a chronic vasculitis involving small- to medium-sized arteries. It is characterized by granulomatous infl ammation of the upper and lower respiratory tracts; necrotizing, pauci-immune glomerulonephritis; and vasculitis that frequently involves other organs. Staphylococcus aureus is thought to play a crucial role in onset and fl ares of GPA. Method and materials: We report a clinical case of a patient with granulomatosis with polyangiitis complicated with infective endocarditis due to Staph. aureus. Results: At the onset of the disease patient complaint on persistent fever, anorexia, nausea and vomiting. Laboratory assays revealed increased acute phase reactants. X-ray revealed signs of sinusitis and pulmonary infection. Septic workup revealed repeated positive blood cultures for staph. aureus. In spite to adequate antibiotic treatment child’s condition gradually worsened. Nasal crusting and epistaxis was reported by patient. An repeated X-ray of the chest showed multiple nodules and cavities in the lungs. She was suspected to have GPA. Lung biopsy was taken and the diagnosis of GPA was confi rmed. Imunnosupresive therapy was started with no expected clinical improvement. In the meanwhile patient developed a new murmur. On heart ultrasound vegetations were revealed. Th e diagnosis of infective endocarditis was made. Th e patient was treated with a 4 weeks regimen of vancomycin. Her condition markedly improved. Aft er the treatment of active infection, an alternative regimen of GPA treatment was chosen. No relapse of lung disease was reported in 3 months follow-up. Conclusions: Th e case reported above highlights the importance of high index of suspicion of GPA in patients with staph. aureus infections who do not respond to conventional therapy. Nasal crusts biopsy can aid diff erential diagnosis and promote early diagnosis</p></dc:description> <dc:description xml:lang='ru'><p>Введение: Гранулёматоз с полиангеитом (ГПА) является хронической формой васкулита с поражением мелких и средних сосудов. Это заболевание характеризуется гранулёматозным воспалением верхних и нижних дыхательных путей, малоимунным гломерулонефритом и васкулитом, который может поражать различные органы. Методы и материалы: Мы докладываем случай пациентки с гранулёматозом Вегенера (ГПА), осложненный стафилококковым инфекционным эндокардитом. Результаты: 10-летняя девочка поступила в больницу с жалобами на повышенную температуру, анорексию, тошноту и рвоту. Лабораторные данные указывали на повышение белков острой фазы. Рентгенологическое исследование указывали на принаки синусита и лёгочной инфекции. В гемокультуре – присутствовал золотистый стафилококк. Несмотря на лечение в соответствии с антибиограммой, состояние ребенка ухудшалось. Появились носовые кровотечения и корки. На повторном рентгене лёгких – множественные очаги и полости. На основании этих данных был заподозрен гранулёматоз с полиагиитом. После биопсии легкого диагноз был подтвержден и была инициирована иммуносупрессивная терапия, без ожидаемого эффекта. Также, у пациентки появился сердечный шум. На эхо-сердца выявилось присутствие вегетаций на трёхстворчатом клапане. Был поставлен диагноз инфекционного эндокардит и начат 4-х недельный курс ванкомицина. Клиническое состояние ребенка улучшилось. После завершения антибиотерапии была начата альтернативная схема лечения ГПА с положительной динамикой. Выводы: Данный клинический случай подчёркивает важность дифференциального диагноза с ГПА у пациентов с стафилококковыми инфекциями, которые не отвечают на конвенциональную терапию. Биопсия назальных корок может поспособствовать ранней диагностике.</p></dc:description> <dc:source>Buletin de Perinatologie 83 (2) 112-116</dc:source> <dc:subject>granulomatosis with polyangiitis</dc:subject> <dc:subject>Staph. aureus</dc:subject> <dc:subject>carrier</dc:subject> <dc:subject>Infective endocarditis</dc:subject> <dc:subject>children</dc:subject> <dc:title>Interrelațiile dintre granulomatoza cu poliangeită, portajul stafilococului auriu și infecțiile acute – caz clinic</dc:title> <dc:type>info:eu-repo/semantics/article</dc:type> </oai_dc:dc>