[Bacterial meningitis in pediatrics. Study of 166 cases]. / Meningitis bacteriana en la edad pediátrica. Estudio de 166 casos.

OBJECTIVE: The purpose of this study was to evaluate the clinical and epidemiological characteristics of meningitis in our environment. PATIENTS AND METHODS: A retrospective study of 166 cases of meningitis diagnosed in our hospital during a 10 year period (1986-1995) was performed. The patients were between 1 month and 14 years of age. RESULTS: Sixty-six percent of the patients were male and 34% female. Eleven cases were younger than 2 months (6.6%), 122 cases (73.5%) were between 3 months and 5 years of age and 33 cases (19.9%) were older than 5 years. The most frequent symptoms and signs were fever (96%), vomiting (60%), impairment of consciousness (24%) and meningeal signs (49%). CSF cultures were positive in 52% and blood cultures in 32%. The pathogen isolated was N. meningitidis in 53 cases (32%), H. influenzae in 38 (23%), S. pneumoniae in 9 patients (5%) and others in 3 children (2%). Meningitis due to H. influenzae increased each year. No microorganism was isolated in blood and CSF in 63 cases (38%). Meningitis in children between 3 months and 5 years of age was due to N. meningitidis in 40 children (33%) and H. influenzae in 36 (29%). The mortality rate was 3%. The most frequent complications were sepsis (36%) and seizures (16%). CONCLUSIONS: The most frequently isolated agent in our study was N. meningitis. Meningitis due to H. influenzae is increasing such that H. influenzae and N. meningitis currently show similar frequency in children between 3 months and 5 years of age.

[Pulmonary tuberculosis in children: its age-dependent aspects]. / Tuberculosis pulmonar en el niño: características según la edad.

OBJECTIVE: The aim of this study was to investigate the clinical and radiological particularities of pulmonary tuberculosis depending on the age of the child. PATIENTS AND METHODS: The medical records of all children with pulmonary tuberculosis diagnosed between 1985 to 1996 were reviewed. They were divided into three age groups according to age: < 3 years, 3-5 year and 6-15 years. RESULTS: Of the 173 children identified, 51.4% were male. Forty percent were < 3 years if age, 33.1% between 3 and 5 years and 26.1% between 6 and 15 years old. The frequency of diagnosis derived from a case contact investigation was higher in children < 3 years of age (38.6%) and children aged 3-5 years (52.6%) than in children between 6-15 years old (21.7%, p < 0.05 for both). In the other cases, diagnosis was the result of investigation of an ill child, investigation of a child after pulmonary tuberculosis was diagnosed in a sibling and routine tuberculin skin test reactivity. An adult source of tuberculosis was identified in 68.6% of the children < 3 years old, 59.6% of children aged 3-5, but only in 37% of the children aged 6-15 years (p < 0.05 for both). The case contact was a family member in 92.7% of the children < 6 years of age and in 66.7% of children aged 6-15 years (p < 0.01). Culture of Mycobacterium tuberculosis was positive in 47.1% of children < 3 years old and 43.9% of children aged 6-15 years, but only in 27.5% of children aged 3.5 years (p < 0.05). Pulmonary parenchymal disease was more frequently found in children < 3 years (67.5%) than in children aged 6-15 years (39.4%, p < 0.05). CONCLUSIONS: Investigation of an adult source is essential when a child is diagnosed of pulmonary tuberculosis. Pulmonary tuberculosis is more intense and the source of adult contact is more frequently found in children < 3 years old.

[Encephalitis due to measles]. / Encefalitis por sarampión.

OBJECTIVE: We present seven cases of acute encephalitis following measles, which were diagnosed during the epidemic that occurred in Spain in 1986. PATIENTS AND METHODS: We studied seven patients diagnosed of encephalitis due to measles. The diagnosis of measles was a made by the presence of a characteristic morbiliform rash and the detection of specific IgM antibodies. The diagnosis of encephalitis was based on the symptoms and the routine examinations of blood, CSF, EEG, CT, ophthalmic exploration and the study of the audiovisual evoked potentials. RESULTS: The patients were between 5 and 9 years of age. None of them had been previously vaccinated for measles. The symptoms of encephalitis occurred 1 to 12 days after the appearance of the rash and the most frequent symptoms were drowsiness and vomiting. All of the patients had EEG abnormalities that returned to normal 1 to 18 months after the diagnosis. One patient presented CT abnormalities. CSF examination revealed an increase of the cell count in one case. The ophthalmic exploration was normal except in one of the patients which had optic neuritis. There were no abnormalities in the audiovisual evoked potentials. All of the cases showed good evolution. Five years later, all of the patients have had a normal development. CONCLUSIONS: The correct vaccination of measles can eradicate this disease.

[Chemoprophylaxis of tuberculosis: compliance to treatment in the pediatric population]. / Quimioprofilaxis tuberculosa: grado de cumplimiento en la población pediátrica.

We have reviewed the success of tuberculosis chemoprophylaxis in 369 children. These children ranged from 4 months to 14 years of age and had been prescribed chemoprophylaxis with Isoniazide at 10 mg/kg/day. Out of these, 258 (69.91%) finished the prophylaxis and 111 (30.08%) did not. Taking into account the reason for the consultation, of those who sought assistance due to contact with a patient with tuberculosis, 70.33% performed the treatment and 29.60% did not. For those in which the reason was a positive Mantoux, the data were 68.1% and 30.8%, respectively. No statistically significant differences were found between the two groups. We feel that the relatively high rate of noncompliance in our patients is a matter of concern. At the present time, chemoprophylaxis with Isoniazide is the best method available for the prevention of tuberculosis. We emphasize the need for its proper performance. We report several measures, such as the determination of Isoniazide metabolites in urine, which may be beneficial for better control and follow-up of these patients.

[Bronchoscopy in pulmonary tuberculosis in children]. / Broncoscopia en la tuberculosis pulmonar del niño.

We retrospectively analyzed thirty-seven cases of infantile pulmonary tuberculosis that had been subjected to bronchoscopy. Although this exploration produced evidence of bronchial wall irritation, the macroscopic findings, as well as the histological ones, were frequently insufficient to make the diagnosis of tuberculosis. The bacteriological study of bronchial exudates of these patients was more efficient since we encountered BAAR in 34.2% of the samples.

[Contacts of children with tuberculous patients]. / Contactos infantiles de enfermos tuberculosos.

One hundred and nine adults recently diagnosed of active pulmonary tuberculosis (all of them with smear positive sputum) were selected. Their household contacts under fifteen years of age were studied. 73.1 por 100 of the children were tuberculin-positive, and 33.1 por 100 of these "reactors" had developed a pulmonary tuberculosis themselves. The bacillary density in the sputum of the source case was correlated to percentage of infected and ill children among his contacts. Neonatal vaccination with BCG showed a protective effect against the illness in children under eight years of age.

[IgG2 deficiency associated with recurrent pneumonia and asthma (review of an IgG subclass)]. / Déficit de IgG2 asociado a neumonías de repetición y asma. (Revisión de subclases de IgG).

Very low levels of IgG2 were detected in a 7 1/2 years old girl affected by recurrent pneumonias and atopic related disease. A similar clinical picture was present in two siblings (of 9 and 4 years old), although their of IgG subclass deficiencies is made, with special emphasis on IgG2 and their relationship with recurrent sinopulmonary infections, atopy and other immunodeficiencies.

[Pulmonary tuberculosis in infants: apropos of 149 cases]. / Tuberculosis pulmonar en la infancia: a propósito de 149 casos.

One hundred and forty-nine cases of childhood pulmonary tuberculosis were analysed being a 77.6% of the 192 cases of tuberculosis diagnosed at the Pediatric Infectious Diseases Department of "La Paz" Hospital, in a ten year period. The children were aged 3 months to 14 years; 65% of them were less than 6 years of age. The source case was found in 67.1% of the children. The primary means of diagnosis was contact screening (38.1%), followed by a 27.5% that presented with non-specific symptoms, while 18.1% of the cases presented with respiratory symptoms. Gastric aspirates yield the organism in 25.8% of cases. Radiologically the following was found: 38.9% mixed patterns, 32.2% nodal patterns, 23.4% parenchymal patterns, 1.34 miliary tuberculosis, 1.34% caverns and 2.68% pleural effusions. Right lung location was more frequent in parenchymatous forms (68%), as well as in nodal forms (61.5%). The duration of the course of therapy changed along this ten years period: from twelve months initially to ten months posteriorly, subsequently becoming a six month course of treatment. All cases experienced full recovery.

[Short term treatment of infantile pulmonary tuberculosis]. / Tratamiento de corta duración de la tuberculosis pulmonar infantil.

Due to the scarcity of published articles on short-course chemotherapeutic regimens for pediatric pulmonary tuberculosis, the following study has been carried out: Twenty-five children diagnosed of pulmonary tuberculosis were administered a short course therapeutic regimen consisting of three tuberculostatics for the first two month (isoniazid, rifampicin and pyrazinamide) and only two (isoniazid and rifampicin) for the following four months. The results were compared with those obtained from a control group of twenty-five children receiving the "classical" therapy: two drugs (isoniazid and rifampicin) for a nine month period. The statistical analysis did not demonstrate any significant difference related to evolution, duration and complications of the disease, between both groups. Therefore, this short course therapeutic regimen could be accepted for pediatric pulmonary tuberculosis.