RESUMO
BACKGROUND: This study investigated the correlation between spot-check transcutaneous hemoglobin (Hb) and simultaneously measured venous Hb in children. METHODS: Two hundred and seventeen children weighing 10-30 kg in whom complete blood count had been obtained for any reason were enrolled in this study. Demographic characteristics and vital signs were recorded. Prior to taking blood samples, transcutaneous Hb, heart rate, oxygen saturation, and perfusion index were measured using a probe connected to the subject's thumb. To determine the reliability of the transcutaneous measurement versus venous blood measurement performed via an autoanalyzer device, interclass correlation coefficient (ICC) was calculated. The correlation between the two measurements was evaluated on Bland-Altman analysis. RESULTS: A total of 59.4% of the patients were boys. The average age was 53 months (range, 6-132 months). Average bodyweight was 16 kg (range, 10-25 kg). Mean venous Hb, hematocrit, and transcutaneous Hb were 11.94 ± 1.15 g/dL, 35.8 ± 3.2%, and 12.42 ± 1.24 g/dL, respectively. The ICC for the reliability of the transcutaneous measurements versus venous blood measurements was r = 0.67 (95%CI: 0.5776-0.7526). The correlation between the two sets of measurements was good, as evaluated by the Bland-Altman analysis. CONCLUSION: There is good correlation between transcutaneous and venous blood measurements of Hb. In the future, transcutaneous measurement, as a non-invasive method, may be an alternative for the measurement of Hb in childhood.
Assuntos
Hemoglobinas/análise , Pré-Escolar , Feminino , Testes Hematológicos/métodos , Humanos , Lactente , Masculino , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
BACKGROUND: To evaluate the clinical feature and outcome of invasive fungal infections (IFI) in children with hematologic and malign diseases. PATIENTS AND METHODS: The medical records of children with hematologic and malignant diseases, who were hospitalized at our hospital between January 2010 and December 2011, were reviewed. Proven, probable, and possible IFIs were diagnosed according to the revised definitions of the European Organization for Research and Treatment of Cancer/Mycosis Study Group. The demographic, clinical, and laboratory characteristics of the patients who met the study criteria were evaluated. RESULTS: IFI was diagnosed in 67 (7.2%) febrile episodes of 56 patients, of which 10 (1.2%) were proven, 20 (2%) probable, and 37 (4%) possible IFI. Blood culture of 10 cases with proven IFI yielded yeast and the most common isolated agent was Candida parapsilosis. Seventy percent of cases with fungemia had central venous catheter (CVC). Twenty cases with probable IFI had invasive mold infection. The cases with mold infection had higher median C-reactive protein values, lower neutrophil counts, and longer duration of neutropenia compared with the cases with yeast infection. A total of 14 patients (20.9%) died. Presence of CVC, bone marrow transplantation, total parenteral nutrition, prolonged fever, and proven/probable IFI were detected more often in patients who died, compared with patients who survived. CONCLUSIONS: IFIs are important causes of death in children with hematologic and malignant diseases. Mold infections are seen more frequently in cases with prolonged and profound neutropenia, and invasive yeast infections, especially with non-albicans Candida species, in cases with CVC. Early and effective treatment considering these findings will help to decrease the mortality.
Assuntos
Fungemia/etiologia , Neoplasias Hematológicas/complicações , Micoses/etiologia , Adolescente , Antifúngicos/uso terapêutico , Criança , Pré-Escolar , Feminino , Seguimentos , Fungemia/tratamento farmacológico , Neoplasias Hematológicas/virologia , Humanos , Lactente , Masculino , Micoses/tratamento farmacológico , Resultado do TratamentoRESUMO
Pott's puffy tumor (PPT) is a rare complication of sinusitis characterized by subperiosteal abscess and osteomyelitis of the frontal bone. Early diagnosis and treatment is vital before it causes intracranial complications such as subdural empyema or brain abscess. Herein we describe the case of a 12-year-old patient who developed preseptal cellulitis and PPT, and was successfully treated with abscess drainage, sinus surgery and long-term antibiotic therapy.
Assuntos
Drenagem/métodos , Tumor de Pott/diagnóstico , Criança , Diagnóstico Diferencial , Seio Frontal/diagnóstico por imagem , Seio Frontal/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Tumor de Pott/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Leukocytoclastic vasculitis (LCV), a disease characterized by inflammation of the small vessels, presents with palpable purpura, especially in the lower extremities. Its etiology is known to include drugs, infection, collagen tissue disease, and malignancy, but LCV caused by anti-tuberculosis drugs is very rarely seen. This report describes the case of a 12-year-old girl who developed LCV with rifampicin and ethambutol while undergoing anti-tuberculosis treatment due to extensive pulmonary involvement.
Assuntos
Antituberculosos/efeitos adversos , Vasculite Leucocitoclástica Cutânea/induzido quimicamente , Biópsia , Criança , Feminino , Humanos , Pele/patologia , Tuberculose Pulmonar/tratamento farmacológico , Vasculite Leucocitoclástica Cutânea/diagnósticoRESUMO
Sodium-2-mercaptoethanesulfonate (Mesna) is a mucolytic substance that is also used for chemically assisted tissue dissection in otological surgery. We investigated the effects of Mesna as a chemical agent on the closing time of perforation of the eardrum in an experimental animal model. We performed simple myringotomy with a knife on 44 tympanic membranes of 22 rats. Four rats were excluded from the study because of serosity in their ears. Rats were divided into two study groups and a control group. These groups were the Mesna-administered group (Group A) (8 rats, 15 tympanic membranes), the saline-administered group (Group B) (8 rats, 14 tympanic membranes) and the control (native) group (6 rats, 11 tympanic membranes) (Group C). We applied Mesna locally for 20 min following myringotomy. Examination was made with an otoendoscope on days 1, 2, 3, 5, and 7, and patency rates were recorded. According to our results, we found that the closing time of the tympanic membrane was significantly longer in the Mesna group than in the saline administrated and native group. After myringotomy procedure, the application of a single dose of Mesna may contribute to the recovery duration of middle-ear pathologies by delaying the closing time of tympanic membrane perforation. However, Mesna cannot be an alternative method for the application of ventilation tubes.
Assuntos
Expectorantes/farmacologia , Mesna/farmacologia , Ventilação da Orelha Média/métodos , Membrana Timpânica/cirurgia , Cicatrização/efeitos dos fármacos , Administração Tópica , Animais , Expectorantes/administração & dosagem , Mesna/administração & dosagem , Ratos , Fatores de Tempo , Membrana Timpânica/efeitos dos fármacosRESUMO
Acute suppurative parotitis is a rare disease in childhood. Its incidence is higher in premature newborns. Parotid swelling and pus drainage from Stenson's duct is pathognomonic, and Staphylococcus aureus is the causative agent in most cases. Here, a 33-day-old patient with acute suppurative parotitis is presented.
Assuntos
Parotidite/diagnóstico , Infecções Estafilocócicas/complicações , Supuração/microbiologia , Doença Aguda , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Cefotaxima/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido , Glândula Parótida/microbiologia , Glândula Parótida/patologia , Parotidite/tratamento farmacológico , Parotidite/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Supuração/tratamento farmacológico , Teicoplanina , Resultado do Tratamento , UltrassonografiaRESUMO
Listeria species may cause life-threatening events including meningitis and invasive infection in newborns, pregnant women, older and immunodeficient people. The most common Listeria species that causes infection is L. monocytogenes. It is known that Listeria innocua has no pathogenicity. A 9-month-old baby had ventriculoperitoneal shunt and was treated with adrenocorticotropic hormone because of infantile spasms. He was brought to hospital with fever and vomiting. Upon physical examination, the patient seemed uncomfortable and had a temperature of 38.6°C. Laboratory results were as follows: hemoglobin, 6.7 g/dL; leukocyte count, 5420/mm(3) ; platelet count, 169,000/mm(3) ; and C-reactive protein, 100 mg/L (normal <5 mg/L). On analysis of cerebrospinal fluid (CSF), leukocyte count was 480/mm(3) , protein was 46 mg/dL and CSF glucose was 35 mg/dL. L. innocua was isolated in CSF culture. We describe this unusual case of ventriculoperitoneal shunt infection with L. innocua.
Assuntos
Infecções Bacterianas , Listeria , Complicações Pós-Operatórias , Derivação Ventriculoperitoneal , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapiaRESUMO
One of the most important causes of mortality in thalassemic patients is infectious disease. Thalassemic patients develop severe invasive infection caused by microorganisms that are rare in healthy individuals. We describe the case of a 13-year-old splenectomized boy who presented with septic shock and who died 36 h after admission, despite broad-spectrum antibiotics and aggressive supportive care. Serratia marcescens was isolated from cultures of blood and tracheal aspirate. It is known that rare microorganisms will cause severe community-acquired infection in splenectomized patients with thalassemia major.
Assuntos
Sepse/microbiologia , Infecções por Serratia/complicações , Serratia marcescens , Talassemia beta/complicações , Adolescente , Evolução Fatal , Humanos , MasculinoRESUMO
BACKGROUND: The aim of this study was to investigate the efficacy and safety of colistin therapy in pediatric patients with severe nosocomial infections in pediatric intensive care unit. METHODS: The medical records of patients treated with colistin at a 200-bed university children hospital were reviewed. RESULT: Thirty-one patients (male/female = 22/9; median age, 3 years; range, 3 months-17 years) received forty-one courses of colistin. The average dose of colistin was 4.9 ± 0.5 mg/kg/day and average treatment duration was 19.8 ± 10.3 days. Three patients who received concomitant nephrotoxic agent with colistin developed nephrotoxicity. Colistin treatment was well tolerated in other patients, and neurotoxicity was not seen in any patient. Favourable outcome was achieved in 28 (68.3%) episodes. Twelve patients died during the colistin therapy. Six of these patients died because of primary underlying disease. The infection-related mortality rate was found 14.6% in this study. CONCLUSION: In our study, colistin therapy was found to be acceptable treatment option for the severe pediatric nosocomial infections caused by multi-drug resistant bacteria. However, the use of concomitant nephrotoxic drugs with colistin must be avoided and renal function test should be closely monitored.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Colistina/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/epidemiologia , Adolescente , Antibacterianos/efeitos adversos , Criança , Pré-Escolar , Colistina/efeitos adversos , Feminino , Hospitais Universitários , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Resultado do TratamentoRESUMO
BACKGROUND: Gastroesophageal reflux (GER) is a common clinical pathology detected in childhood. Bile acids (BAs) are present in reflux and cause various pathologies in the esophagus, the larynx, and the lungs. OBJECTIVE: We aimed to show if aminoguanidine (AG) contributes to the biochemical and histopathologic treatment of experimental aspiration pneumonitis induced by BAs. METHODS: Twenty-eight female Sprague Dawley rats were used. There were 4 groups in the study: (1) group aspirated with 0.9% saline (n = 7), (2) group aspirated with 0.9% saline and treated with AG (n = 7), (3) group aspirated with a solution of 10 mg/kg taurocholic acid and 5 mg/kg taurochenodeoxycholate (n = 7), and (4) group aspirated with BA and treated with AG (n = 7). The saline and BA solutions were administered as 1 mL/kg intratracheally. The AG was administered intraperitoneally twice a day at a 150 mg/kg dose for 7 days. The different histopathologic and biochemical parameters were analyzed. RESULTS: Clara cell protein 16 and malondialdehyde levels were found to be significantly higher in the BA group than in the group where saline was administered; however, they were significantly lower in the BA + AG group than in the BA group. The total superoxide dismutase activity decreased significantly in the BA group compared with the group where saline was administered. A significant increase in superoxide dismutase activity was observed in the BA + AG group when compared with the group where only BA was administered. When the group where BA was administered solely was compared with the group where saline was administered, peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar histiocytes, interstitial fibrosis, and granuloma were significantly higher in the BA group than in the saline group. When the BA + AG group was compared with the BA group, peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar histiocytes, interstitial fibrosis, and granuloma were found to be significantly lower. CONCLUSIONS: Oxidant stress increases and antioxidant capacity decreases in pneumonitis induced by BAs. AG administration as an antioxidant helps in recovery, both biochemically and histopathologically. Consequently, AG seems to be an alternative that should be considered in a conservative approach to treating aspiration pneumonitis.
RESUMO
Brucellosis is a worldwide zoonotic infection with a diverse clinical presentation. Pericardial and pleural involvement is rare in brucellosis. There is no presentation with pleural and pericardial effusion in childhood brusellosis. In endemic countries Brucellosis must thought as an unknown etiology of pericardial and pleural effusion.
Assuntos
Brucelose/complicações , Pneumopatias/complicações , Derrame Pericárdico/etiologia , Derrame Pleural/etiologia , Antibacterianos/uso terapêutico , Brucella/isolamento & purificação , Brucelose/diagnóstico , Brucelose/tratamento farmacológico , Feminino , Humanos , Pneumopatias/diagnóstico , Pneumopatias/tratamento farmacológico , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/tratamento farmacológico , Pleura/diagnóstico por imagem , Pleura/microbiologia , Derrame Pleural/diagnóstico , Derrame Pleural/tratamento farmacológico , Radiografia Torácica , Ultrassonografia , Adulto JovemRESUMO
PURPOSE: Tularemia is an infection caused by Francisella tularensis. Its diagnosis and treatment may be difficult in many cases. The aim of this study was to evaluate treatment modalities for pediatric tularemia patients who do not respond to medical treatment. METHODS: A single-center, retrospective study was performed. A total of 19 children with oropharyngeal tularemia were included. RESULTS: Before diagnosis, the duration of symptoms in patients was 32.15±17.8 days. The most common lymph node localization was the cervical chain. All patients received medical treatment (e.g., streptomycin, gentamicin, ciprofloxacin, and doxycycline). Patients who had been given streptomycin, gentamicin, or doxycycline as initial therapy for 10-14 days showed no response to treatment, and recovery was only achieved after administration of oral ciprofloxacin. Response to treatment was delayed in 5 patients who had been given ciprofloxacin as initial therapy. Surgical incision and drainage were performed in 9 patients (47.5%) who were unresponsive to medical treatment and were experiencing abcess formation and suppuration. Five patients (26.3%) underwent total mass excision, and 2 patients (10.5%) underwent fine-needle aspiration to reach a conclusive differential diagnosis and inform treatment. CONCLUSION: The causes of treatment failure in tularemia include delay in effective treatment and the development of suppurating lymph nodes.
RESUMO
HSV 1 encephalitis is the most common cause of sporadic and focal viral encephalitis. Opercular syndrome is characterized by swallowing and speech difficulties which are associated with deterioration of voluntary control of face, pharynx, tongue and chewing muscles. It can be developed in patients with Herpes simplex encephalitis (HSE). Here, a twelve-year-old boy who was diagnosed with HSE and Opercular syndrome, is presented. The patient recovered without sequela as a result of 30 days of intravenous and 10 days of oral acyclovir treatment. It might be important as well, to personalize and elongate the treatment in terms of prognosis.
Assuntos
Aciclovir/administração & dosagem , Antivirais/administração & dosagem , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/patologia , Disartria/diagnóstico , Disartria/patologia , Encefalite por Herpes Simples/complicações , Encefalite por Herpes Simples/tratamento farmacológico , Paralisia Facial/diagnóstico , Paralisia Facial/patologia , Criança , Cabeça/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
The serogroup epidemiology of invasive meningococcal disease (IMD), which varies considerably by geographic region and immunization schedule, changes continuously. Meningococcal carriage data are crucial for assessing IMD epidemiology and designing f potential vaccination strategies. Meningococcal seroepidemiology in Turkey differs from that in other countries: serogroups W and B are the predominant strains for IMD during childhood, whereas no serogroup C cases were identified over the last 10 y and no adolescent peak for IMD was found. There is a lack of data on meningococcal carriage that represents the whole population. The aims of this multicenter study (12 cities in Turkey) were to evaluate the prevalence of Neisseria meningitidis carriage, the serogroup distribution and the related risk factors (educational status, living in a dormitory or student house, being a household contact with Hajj pilgrims, smoking, completion of military service, attending bars/clubs) in 1518 adolescents and young adults aged 10-24 y. The presence of N. meningitidis DNA was tested, and a serogroup analysis was performed using polymerase chain reaction. The overall meningococcal carriage rate was 6.3% (n = 96) in the study population. A serogroup distribution of the 96 N. meningitidis strains isolated from the nasopharyngeal specimens revealed serogroup A in 5 specimens (5.2%), serogroup B in 9 specimens (9.4%), serogroup W in 64 specimens (66.6%), and serogroup Y in 4 specimens (4.2%); 14 were classified as non-grouped (14.4%). No serogroup C cases were detected. The nasopharyngeal meningococcal carriage rate was 5% in the 10-14 age group, 6.4% in the 15-17 age-group, and 4.7% in the 18-20 age group; the highest carriage rate was found in the 21-24 age group (9.1%), which was significantly higher than those of the other age groups (p < 0.05). The highest carriage rate was found in 17-year-old adolescents (11%). The carriage rate was higher among the participants who had had close contact with Hajj/Umrah pilgrims (p < 0.01) or a history of upper respiratory tract infections over the past 3 months (p < 0.05). The nasopharyngeal carriage rate was 6.3% among adolescents and young adults in Turkey and was similar to the recent rates observed in the same age groups in other countries. The most prevalent serogroup was W, and no serogroup C cases were found. In conclusion, the present study found that meningococcal carriage reaches its peak level by age 17, the highest carriage rate was found in 21 - to 24 - year-olds and the majority of the carriage cases were due to serogroup W. Adolescents and young adult carriers seem to be a potential reservoir for the disease, and further immunization strategies, including adolescent immunization, may play a role in the control of IMD.
Assuntos
Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis/isolamento & purificação , Sorogrupo , Adolescente , Portador Sadio/imunologia , Criança , DNA Bacteriano , Humanos , Masculino , Infecções Meningocócicas/imunologia , Infecções Meningocócicas/microbiologia , Nasofaringe/microbiologia , Neisseria meningitidis/classificação , Neisseria meningitidis/genética , Neisseria meningitidis/imunologia , Reação em Cadeia da Polimerase , Prevalência , Fatores de Risco , Estudos Soroepidemiológicos , Turquia/epidemiologia , Vacinação , Adulto JovemRESUMO
Panton-Valentine leukocidin (PVL) is an exotoxin that is produced by many strains of Staphylococcus aureus, and an important virulence factor. A PVL-positive S. aureus infection leads to rapid and severe infections of soft tissue and necrotizing pneumonia in healthy adolescents, and has a high mortality. This case report included a 12-year-old male patient who admitted for fever, respiratory distress and hip pain and was identified with necrotizing pneumonia with septic pulmonary embolism, psoas abscess, cellulitis and osteomyelitis. The PVL positive methicillin-sensitive S. aureus (MSSA) was isolated in the patient blood culture.
La leucocidina de Panton-Valentine (LPV) es una exotoxina producida por muchas cepas de Staphylococcus aureus, y un importante factor de virulencia. Una infección por S. aureus positivo para LPV deriva en infecciones rápidas y graves de partes blandas y neumonía necrosante en adolescentes sanos, y la tasa de mortalidad es elevada. Presentamos el caso de un paciente de 12 años hospitalizado por fiebre, dificultad respiratoria y coxalgia en el que se identificó neumonía necrosante con embolia pulmonar séptic absceso del psoas, celulitis y osteomielitis. En el hemocultivo del paciente se aisló S. aureus sensible a la meticilina (SASM) positivo para LPV.
Assuntos
Toxinas Bacterianas/análise , Exotoxinas/análise , Leucocidinas/análise , Infecções Estafilocócicas/diagnóstico , Criança , Infecções Comunitárias Adquiridas , Humanos , Masculino , Staphylococcus aureusRESUMO
Successful vaccination policies for protection from invasive pneumococcal diseases (IPD) dependent on determination of the exact serotype distribution in each country. We aimed to identify serotypes of pneumococcal strains causing IPD in children in Turkey and emphasize the change in the serotypes before and after vaccination with 7-valent pneumococcal conjugate vaccine (PCV-7) was included and PCV-13 was newly changed in Turkish National Immunization Program. Streptococcus pneumoniae strains were isolated at 22 different hospitals of Turkey, which provide healthcare services to approximately 65% of the Turkish population. Of the 335 diagnosed cases with S. pneumoniae over the whole period of 2008-2014, the most common vaccine serotypes were 19F (15.8%), 6B (5.9%), 14 (5.9%), and 3 (5.9%). During the first 5 y of age, which is the target population for vaccination, the potential serotype coverage ranged from 57.5 % to 36.8%, from 65.0% to 44.7%, and from 77.4% to 60.5% for PCV-7, PCV-10, and PCV-13 in 2008-2014, respectively. The ratio of non-vaccine serotypes was 27.2% in 2008-2010 whereas was 37.6% in 2011-2014 (p=0.045). S. penumoniae serotypes was less non-susceptible to penicillin as compared to our previous results (33.7 vs 16.5 %, p=0.001). The reduction of those serotype coverage in years may be attributed to increasing vaccinated children in Turkey and the increasing non-vaccine serotype may be explained by serotype replacement. Our ongoing IPD surveillance is a significant source of information for the decision-making processes on pneumococcal vaccination.
Assuntos
Vacina Pneumocócica Conjugada Heptavalente/imunologia , Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/classificação , Vacinas Conjugadas/imunologia , Antibacterianos/farmacologia , Pré-Escolar , Feminino , Hospitais , Humanos , Programas de Imunização , Masculino , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/prevenção & controle , Estudos Prospectivos , Sorogrupo , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação , Turquia/epidemiologia , VacinaçãoRESUMO
Currently, tuberculosis remains a major public health problem worldwide. Peritoneal tuberculosis occurs in approximately 1% of all of tuberculosis cases and is rarely observed in children. Diagnosis and treatment delays caused by mimicking many other intra-abdominal diseases can lead to increases in morbidity and mortality. Here, we present a case of a four-year-old child with tuberculosis peritonitis who was diagnosed by laparoscopic biopsy and histopathological examination and recovered with antituberculosis therapy. Peritoneal tuberculosis should be considered in younger patients and adults with fever, abdominal pain and weight loss in endemic areas.
Assuntos
Peritonite Tuberculosa/diagnóstico , Antituberculosos/uso terapêutico , Ascite/diagnóstico , Biópsia , Pré-Escolar , Feminino , Humanos , Laparoscopia , Peritonite Tuberculosa/tratamento farmacológicoRESUMO
Staphylococcus aureus is a common cause of musculoskeletal infections. Panton-Valentine leukocidin (PVL) is an exotoxin produced by S. aureus and is an important virulence factor. PVL-positive S. aureus infections have been associated with soft tissue infections and necrotizing pneumonia. In this case report, the clinical course of a 13-year-old boy who was admitted with right hip pain and fever, diagnosed with a gluteal abscess and incidentally discovered multiple cavitary pulmonary lesions, and had a methicillin susceptible and PVL-producing S. aureus (MSSA) extracted from the abscess culture is presented. The related literature is also reviewed.
Assuntos
Abscesso/microbiologia , Antibacterianos/uso terapêutico , Toxinas Bacterianas/análise , Exotoxinas/análise , Leucocidinas/análise , Infecções dos Tecidos Moles/microbiologia , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Adolescente , Humanos , Pulmão/microbiologia , Masculino , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Tomografia Computadorizada por Raios X , Fatores de VirulênciaRESUMO
Presenting with severe thrombocytopenia and pancytopenia is rare in children with brucellosis, and at the beginning it can be misdiagnosed as a hematological or a viral hemorrhagic disease. The follow-ups of 52 patients diagnosed with brucellosis from January, 2008, to December, 2013, in our clinic have shown the following results. Eleven out of these 52 patients revealed the fact that they had pancytopenia at the admission phase. Anemia and leukopenia were defined as hemoglobin levels and leukocyte counts below the standard values in terms of ages, thrombocytopenia as thrombocyte counts below 150,000/mm(3), and severe thrombocytopenia as thrombocyte counts below 20,000/mm(3). The most frequent admission symptoms and findings of the patients with pancytopenia were fever (75%), fatigue (50%), splenomegaly (75%), and hepatomegaly (41%). Laboratory results were hemoglobin 9.3±0.96 gram/dL, white blood cell count 2226±735.9/mm(3), and thrombocyte count 70,090±47,961/mm(3). The standard tube agglutination test was positive for all patients, and Brucellosis spp. were isolated in the blood cultures of six (54%) patients. Three of the 11 patients had severe thrombocytopenia, and they were admitted with complaints of epistaxis, gingival bleeding, petechiae, and purpura. At the beginning, two of three cases were misdiagnosed as Crimean-Congo hemorrhagic fever (CCHF), another zoonotic endemic disease in Turkey. Pancytopenia improved with treatment of brucellosis on all patients. In conclusion, brucellosis can show great similarity with hematologic and zoonotic diseases like CCHF. Brucellosis should be considered in the differential diagnosis of pancytopenia, treatment-resistant immune thrombocytopenia, and viral hemorrhagic disease, especially in countries where brucellosis is endemic.
Assuntos
Brucelose/diagnóstico , Pancitopenia/diagnóstico , Trombocitopenia/diagnóstico , Adolescente , Testes de Aglutinação , Animais , Criança , Diagnóstico Diferencial , Doenças Endêmicas , Feminino , Febre , Febre Hemorrágica da Crimeia/diagnóstico , Hepatomegalia , Humanos , Masculino , Esplenomegalia , Turquia , ZoonosesRESUMO
Brucellosis is a systemic infectious disease that leads to various clinical pictures and is still a significant health problem in Turkey. In this study, 52 pediatric patients diagnosed with brucellosis between January 2008 and December 2013 were examined. Clinical and laboratory findings, response to treatment, prognosis and complications were evaluated. Diagnosis of brucellosis was made based on a clinical picture compatible with the disease, together with standard tube agglutination test (SAT) positivity (1/160 or higer titer) or isolation of Brucella spp. in a sterile body fluid culture. The cases comprised 10 females and 42 males. In 75% of cases, there was a history of consumption of unpasteurized milk or dairy products. The most commonly seen symptoms and findings were fever (75%), arthralgia (54%), fatigue (19%), splenomegaly (44%), hepatomegaly (42%) and arthritis (19%). Atypical presentations were seen in one case of epidydymo-orchitis and three cases of bleeding of the nose and gums. In the laboratory examinations, anemia was determined in 56% of cases, leukopenia in 40% and thrombocytopenia in 27%. In blood cultures taken from 41 patients, Brucella spp. were isolated in 23 (56.1%). All patients recovered, and sequelae were seen only in a patient with osteoarthritis. In conclusion, although brucellosis leads to many different clinical pictures, a very good response to treatment can be obtained. If effective treatment cannot be implemented in time, the disease may become chronic, and complications and relapses may be encountered. Therefore, early diagnosis and treatment is of great importance.