[Resistant Streptococcus pneumoniae]. / Streptococcus pneumoniae resistente.

Streptococcus pneumoniae is a common pathogen in children that in recent years has shown a progressive rise in resistance to the usual antibiotics and also to the new third generation cephalosporins. We report a review of Streptococcus pneumoniae strains isolated at our hospital from pediatrics patients in whom we observed an increased incidence of resistance to cefotaxime significantly related with the rise in resistance to penicillin. The resistance of penicillin-resistant strains to various antibiotics was analyzed and the following results were obtained: cefotaxime, 0% susceptible, 83% intermediate and 17% resistant; erythromycin, 16,7% susceptible, 8,3& intermediate and 75% resistant; vancomycin, 100% susceptible; chloramfenicol, 16,7% susceptible and 83,3% resistant; and cotrimoxazole, 100% resistant.

[Fever of unknown origin in children (author's transl)]. / Fiebre prolongada de origen desconocido en el niño.

A study has been made of 79 children from zero to seven years of age admitted to hospital with fever of unknown origin (F.U.O.) of more than two weeks duration. Children in whom fever was not clinically observed after one week of hospitalization are not included. In 50 cases (63.2%), it was possible to establish a definitive diagnosis within the first fornight of admission. The most frequent cause of fever was that of infection, found in 51 children (64.5%), tuberculosis and urinary infections predominating with ten cases each. In another ten children neoplastic disease was diagnosed (mostly leucosis), and there was colagenosis in seven cases (8.8%). In another seven children, the etiology was not established. Mortality rate was 7.5%. Clinical history and exploration were of main importance in the orientation of the diagnoses. The findings of this study suggest that in all children presenting F.U.O., apart from hospitalization of at least one week, a very thorough anamnesis and clinical exploration are most important in establishing the diagnosis, along with a more or less aggressive approach to the problem according to the findings.

[Reye's syndrome. Clinical revision (author's transl)]. / Síndrome de Reye. Revisión de nuestra casuística.

Authors studied nine cases of Reye's syndrome, seen over a period of five years. Their ages ranged from 45 days to 3 6/12 years, eight being less than a year old. Mortality rate was 55% and two of the four surviving children presented serious neurological sequelas. In all cases liver pathology was studied by percutaneous biopsy and/or necropsy. Clinical, analitical and anatomopathological findings were similar to those usually described in this syndrome. Medical literature was revised as to etiology and pathology, noting specially the tendency of this syndrome to present in groups, its possible relationship to viral epidemics and the inconsistency of the results of certain therapeutic measures widely used until now. The possible relationship between Reye's syndrome and the usual infant vaccinations, as they found in two cases, as well as the convenience of hepatic studies in the event of postvaccinal encephalopathy is suggested.

[Early appearing neurofibromatosis (author's transl)]. / Neurofibromatosis de aparición precoz. Nuestra casuística

Six cases of neurofibromatosis in children under seven years of age with other members of the family affected are reported. Mental retardation was observed in five patients, and one had convulsive crises. Growth and bone maturation retardation, without HGH deficiency after glucagon stimulation were observed.

[Smith-Lemli-Opitz syndrome. Cardiologic considerations (author's transl)]. / Síndrome de Smith-Lemli-Opitz. Consideraciones cardiológicas

A new case of the Smith-Lemli-Opitz Syndrome is reported, associated with a type of congenital cardiopathy not described previously in this syndrome.

[Tuberculous meningitis: a disease in regression in our country?]. / Meningitis tuberculosa. Una enfermedad en regresión en nuestro medio?

OBJECTIVE: Our aim was to analyse clinical, diagnostic, therapeutical and evolutionary features in a pediatric population with tuberculous meningitis. PATIENTS AND METHODS: The medical records of thirteen children with this diagnosis admitted to Hospital Infantil Virgen del Rocío from Seville (Spain) between 1984 and 1999 were reviewed. RESULTS: The mean age was 2,35 +/- 2,3 years. The symptoms upon admission were: fever in 11 children, anorexia and vomiting in 8, disturbance of the consciousness in 7. Meningeal signs in 6, all of them older than 20 months, the remaining seven showed irritability and four of these ones hypertense fontanelles. Three patients were in the first stage of the disease, 9 in the second and 1 in the third, according to the Medical Research Council. CSF findings were indicative in all the cases. Five children had bacilloscopy positive and Mycobacterium tuberculosis was isolated in 6 patients, sometimes in CSF others in gastric juice. Mantoux skin test was positive in 11. Radiographic studies demonstrated abnormal chest findings in 8 patients (hiliar adenopathy, 1; miliary pattern, 2; and infiltrates, 5). Pathology cranial computed tomography showed in all the cases and the electroencephalogram was slowed down in the initial phases in 11. Two children died and the neurological complications were the most frequent, appearing in 9 patients. Without consequences cured 4 patients, the rest presented cognitive, visual and motor deficits, sensibility skin disturbance and late seizures. No case has been observed during the last 5 years. CONCLUSIONS: Fast diagnosis tests used for M. tuberculosis identification were useful to begin an antituberculous treatment in a high suspicion of meningeal affectation by this German patient. The early treatment will decrease complications and consequences by this disease. A decrease in the incidence looks to be in spite of the VIH infection increase nowadays.

[Infectious mononucleosis: study on hospitalized children]. / Mononucleosis infecciosa: estudio en niños hospitalizados.

OBJECTIVES: To analyze the patients diagnosed of infectious mononucleosis (IM) in our institution, in order to study the symptoms and clinical evolution. MATERIAL AND METHOD: We retrospectively analyse 37 hospitalized children aged between 3 months and 14 years. Diagnosed of IM by production of immunoglobulin M (IgM) to viral capsid antigen (VCA). RESULT: In our series of 37 children, 14 were less than 4 years old. Among clinical data, lymphadenopathy (86%), fever (81%) and pharyngotonsillitis (70%) were the more striking. We found jaundice only in three of the older children. Upper airways obstruction was common, and specially severe in young children. Three patients developed pneumonia during the disease course. Only ten patients produced heterophile antibodies. Two children showed dual antibody rises to Epstein-Barr virus and cytomegalovirus. Corticotherapy was used in 7 children. The complications are presented in 68% of patients. CONCLUSIONS: Clinical aspects of IM were similar to those in the young adult, and complications occur more frequently. We found lack of heterophile antibodies, more frequent in youngest.

[Hypochondroplasia: an effected family presentation (author's transl)]. / Hipocondroplasia. Presentación de una familia con varios miembros afectados

A family suffering from hypochondroplasia in which father, mother and offspring are affected and in whose family tree various probably affected members are found on both sides, according to a pattern of autosomic dominant heritage is presented. The difficulty of diagnosis is discussed, not only in the first years of life but also later on, and in mild or moderate forms, which may in part explain the few cases reported in the literature.

[Neonatal meningitis by "flavobacterium meningoseptium" (author's transl)]. / Meningitis neonatal por "flavobacterium meningosepticum". Aportación de un caso.

We informed a case of neonatal meningitis caused by "Flavobacterium meningosepticum", the first to be described in our country, taking into consideration its ethioepidemiology and therapy.

[Favism (study of 8 families)]. / Favismo (Estudio de ocho familias).

This paper presents ten cases of total glucose-6-phosphate dehydrogenase (G-6-PD) deficiency in individuals with hemolytic crisis after exposure to products of the fava been ("Vicia faba"). Three other cases of total G-6-PD deficiency and eleven partial deficit cases of the enzyme, without associated hemolysis were detected in a total of forty individuals belonging to eight families of the province of Seville examinated for G-6-PD levels. Important differences were noted in the G-6-PD enzyme dosage taken during the crisis and six and twelve months after. This fact was interpreted as a secondary effect to the elimination of the enzymopenic cells because of hemolysis. Data suggests the existence of a relatively stable form of G-6-PD that could explain the dissociation between the incidence of deficit in G-6-PD level in the general population and the reduced casuist of favism reported in our literature.

[Melitococcal hepatic encephalopathy]. / Encéphalopathie hépatique mélitococcique.

A 5 year old child with brucellosis is described who developed severe liver disease with neuropsychiatric signs and electroencephalographic changes.

[Di Giorge's syndrome with congenital heart disease (author's transl)]. / Síndrome de Di Giorge Estudio cardiológico en tres casos.

Authors describe three cases of Di Giorge's syndrome (thymic and parathyroid aplasia) proved through anatomical study postmorten, associated with cardiac malformations (Tetralogy of Fallot with pulmonary atresia, persistent truncus arteriosus and large patent ductus arteriosus). Clinical characteristics of the stated syndrome are analized with special reference to congenital heart diseases that are included in it.

[Visceral leishmaniasis in childhood (author's transl)]. / El Kala-azar en la infancia. Estudio en la provincia de Sevilla.

Authors present six cases of kala-azar in children under six years of age observed in the province of Seville, during a three year period. Ethiologic, clinical, evolutive and therapeutic aspects of this illness are analized. Two of the patients presented jaundice, in which a liver-spleen scan was performed and nothing else but the hepato-splenomegaly was found, as it was described in a previous case. Importance of visualizing leishmanias by bone marrow puncture for a true diagnosis is remarked.

[Hypoglycorrhachia in mumps meningitis (author's transl)]. / Hipoglucorraquia en meningitis urlianas.

Eighty cases of mumps meningitis are studied in children between the ages of one to seven years. The parotids were affected before, after and during the meningitis in all cases. In fifteen cases, when admitted to the hospital, levels of glucose were found in the C.S.F. equal or lower than 40 mg/100 ml. In three of them the hypoglycorrhachia persisted for a long time, as reported by other authors. The possible causes of low C.S.F. glucose values in meningitis are analized, not explanation for this phenomenon in viral meningitis is found.