RESUMEN
Since 2013, wounded and ill children from Syria have received treatment in Israel. Screening cultures indicated that multidrug-resistant (MDR) pathogens colonized 89 (83%) of 107 children. For 58% of MDR infections, the pathogen was similar to that identified during screening. MDR screening of these children is valuable for purposes of isolation and treatment.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Farmacorresistencia Bacteriana Múltiple , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Grampositivas/efectos de los fármacos , Traumatismo Múltiple/tratamiento farmacológico , Adolescente , Amicacina/uso terapéutico , Conflictos Armados , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/patología , Niño , Preescolar , Colistina/uso terapéutico , Enfermedad Crítica , Femenino , Bacterias Gramnegativas/patogenicidad , Bacterias Gramnegativas/fisiología , Bacterias Grampositivas/patogenicidad , Bacterias Grampositivas/fisiología , Hospitalización , Humanos , Lactante , Recién Nacido , Israel , Masculino , Meropenem , Traumatismo Múltiple/microbiología , Traumatismo Múltiple/patología , Siria , Tienamicinas/uso terapéuticoRESUMEN
INTRODUCTION: As the civil war in Syria enters its fifth year, the Israeli government continues to provide humanitarian aid to Syrian civilians in Israeli hospitals. Many wounded Syrian children are treated at the Galilee Medical Center (GMC). Due to the patients' incomplete medical history and increasing infection rates in Syria, contact isolation and screening cultures for multi-drug resistant bacteria (MDR's) are conducted upon admission for all Syrian children. AIMS: To describe the rate of MDR carriage in Syrian children and compare it to hospitalized Israeli children. METHODS: Prospective collection of screening culture data of Syrian patients admitted to GMC between 6/2013-11/2014 and comparison with Israeli children admitted between 1-3/2014. Extended-spectrum beta- lactamase-producing Enterobateriaceae (ESBL), Vancomycin-resistant Enterococcus (VRE), Carbapenem-resistant Enterobacteriaceae (CRE), and Methicillin-resistant Staphylococcus aureus (MRSA) were considered MDR's. RESULTS: Of 47 pediatric Syrian patients, 41 were severely wounded. MDR's were found in 37 (79%) children; most of the isolates were ESBL+ Escherichia coli. Over half of the ESBL's were resistant to additional antibiotics such as sulfa and quinolones; no resistance to amikacin was found. In comparison, in 6 of 40 (15%) Israeli children, MDR's (all ESBL's) were found (p<0.001). CONCLUSIONS: In hospitalized Syrian children, contact isolation and screening cultures for MDR's have an important role in the prevention of nosocomial transmission and establishment of empiric antimicrobial protocols. In suspected infections in Syrian children, amikacin and carbapenems are the antimicrobials of choice. MDR's are carried to a lesser extent in Israeli children but due to their importance, further largescale research is needed.
Asunto(s)
Antibacterianos/farmacología , Portador Sano , Farmacorresistencia Bacteriana Múltiple , Heridas y Lesiones/microbiología , Niño , Recuento de Colonia Microbiana , Hospitales , Humanos , Israel , Staphylococcus aureus Resistente a Meticilina , Estudios Prospectivos , Siria/etnología , Heridas y Lesiones/tratamiento farmacológicoRESUMEN
BACKGROUND: Pertussis is an important cause of infant death worldwide and continues to be a public health concern even in countries with high vaccination coverage. Severe (critical) pertussis with hyperleukocytosis is a severe form of the disease with up to 80% mortality rate. Attempts have been reported to reduce the white blood cell burden by exchange transfusion (ET) with conflicting conclusions. CASE REPORT: We report a case of critical pertussis in a neonate who was treated with ET, in view of a comprehensive literature review. RESULTS: The patient was discharged without any sequelae. CONCLUSION: ET should be considered in all infants suffering from critical pertussis and hyperleukocytosis, even in secondary care community hospitals.
Asunto(s)
Recambio Total de Sangre/métodos , Leucocitosis/terapia , Tos Ferina/terapia , Femenino , Humanos , LactanteRESUMEN
Respiratory syncytial virus is the most common pathogen causing lower respiratory tract infection in infants. Respiratory syncytial virus infection is also associated with a number of extrapulmonary manifestations, including the cardiac system. Pericardial effusion, however, is a very rare occurrence with respiratory syncytial virus infection. We report a very young infant with respiratory syncytial virus bronchiolitis whose clinical course was associated with pericardial effusion, treated conservatively.
Asunto(s)
Bronquiolitis Viral/complicaciones , Derrame Pericárdico/complicaciones , Infecciones por Virus Sincitial Respiratorio/complicaciones , Humanos , Lactante , Masculino , Índice de Severidad de la EnfermedadAsunto(s)
Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Infecciones Bacterianas/epidemiología , Portador Sano/epidemiología , Farmacorresistencia Bacteriana Múltiple , Adolescente , Adulto , Bacterias/aislamiento & purificación , Infecciones Bacterianas/microbiología , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Israel/epidemiología , Siria/etnologíaAsunto(s)
Antivirales/uso terapéutico , Brotes de Enfermedades , Farmacorresistencia Viral , Subtipo H1N1 del Virus de la Influenza A/efectos de los fármacos , Gripe Humana/virología , Oseltamivir/uso terapéutico , Accidentes de Tránsito , Preescolar , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/virología , Contusiones/etiología , Humanos , Gripe Humana/complicaciones , Gripe Humana/tratamiento farmacológico , Gripe Humana/epidemiología , Israel , Lesión Pulmonar/complicaciones , Masculino , Síndrome de Dificultad Respiratoria/etiología , Factores de TiempoAsunto(s)
Implantes Cocleares , Meningitis Bacterianas/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus agalactiae/aislamiento & purificación , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Niño , Implantes Cocleares/efectos adversos , Dexametasona/uso terapéutico , Humanos , Masculino , Meningitis Bacterianas/tratamiento farmacológico , Factores de Riesgo , Infecciones Estreptocócicas/tratamiento farmacológicoRESUMEN
We describe an 8-month-old infant with infantile spasms treated with adrenocorticotropic hormone (ACTH) who presented with fatal Legionella pneumophila and Pneumocystis jirovecii infection. Emphasis is placed on the ensuing immunosuppression and infectious sequelae of ACTH therapy. Given that ACTH therapy may increase the risk of fatal infection, patients undergoing such treatment should be closely monitored, with particular attention paid to the functioning of the immune system.
Asunto(s)
Hormona Adrenocorticotrópica/efectos adversos , Anticonvulsivantes/efectos adversos , Coinfección/etiología , Enfermedad de los Legionarios/etiología , Pneumocystis carinii , Neumonía por Pneumocystis/etiología , Espasmos Infantiles/tratamiento farmacológico , Hormona Adrenocorticotrópica/administración & dosificación , Anticonvulsivantes/administración & dosificación , Coinfección/tratamiento farmacológico , Resultado Fatal , Femenino , Humanos , Tolerancia Inmunológica , Lactante , Legionella pneumophila , Enfermedad de los Legionarios/tratamiento farmacológico , Neumonía por Pneumocystis/tratamiento farmacológico , Neumonía por Pneumocystis/terapiaAsunto(s)
Coinfección/diagnóstico , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/complicaciones , Infecciones Meningocócicas/complicaciones , Neisseria meningitidis/efectos de los fármacos , Resistencia a las Penicilinas , Coinfección/microbiología , Coinfección/patología , Coinfección/virología , Humanos , Lactante , Gripe Humana/patología , Gripe Humana/virología , Masculino , Infecciones Meningocócicas/microbiología , Infecciones Meningocócicas/patología , Neisseria meningitidis/aislamiento & purificaciónRESUMEN
OBJECTIVES: To determine whether acute left ventricular dysfunction (LVD) causes significantly higher elevation of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels than comparable chronic LVD. STUDY DESIGN: Plasma levels of NT-proBNP were measured in 10 pediatric patients diagnosed with acute LVD, in 7 pediatric patients with stable chronic dilated cardiomyopathy (DCM) and comparable levels of echocardiographic dysfunction, and during 5 episodes of acute exacerbation in patients with heart failure. Levels were compared using Mann-Whitney and analysis of variance for rank tests. RESULTS: Plasma levels of NT-proBNP were excessively elevated in patients with acute LVD in the first 24 to 48 hours of hospitalization (median level, 65,600 pg/mL), and were significantly higher than those in patients with chronic DCM (median level, 1125 pg/mL; P < .0001). NT-proBNP levels decreased in the subsequent days in 83% of patients with serial measurements. The NT-proBNP levels were lower In 5 episodes of acute exacerbation than in acute LVD (median level, 7185 pg/mL; P < .003). CONCLUSIONS: Acute LVD is associated with elevated NT-proBNP level in children.
Asunto(s)
Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Disfunción Ventricular Izquierda/sangre , Enfermedad Aguda , Adolescente , Adulto , Cardiomiopatías/sangre , Niño , Preescolar , Enfermedad Crónica , Insuficiencia Cardíaca/sangre , Hospitalización , Humanos , Lactante , Factores de TiempoRESUMEN
OBJECTIVE: N-terminal pro-B-type natriuretic peptide has been shown to be a marker for cardiac dysfunction. The peptide level is also elevated in patients with sepsis. The purpose of this study was to assess whether N-terminal pro-B-type natriuretic peptide levels can differentiate pediatric patients with sepsis from patients with acute left ventricular dysfunction. PATIENTS AND METHODS: Pediatric patients admitted to an ICU with sepsis or acute left ventricular dysfunction were evaluated clinically, and the grade of systemic inflammatory-response syndrome was determined. Echocardiography was performed, and their levels of N-terminal pro-B-type natriuretic peptide were measured. The N-terminal pro-B-type natriuretic peptide level was also measured in patients with simple febrile illness. RESULTS: There were 10 patients with sepsis and 10 with acute left ventricular dysfunction. The age of the patients was similar, and systemic inflammatory-response syndrome grading was not different (sepsis: 2.8 +/- 0.4; acute left ventricular dysfunction: 2.6 +/- 0.7). N-terminal pro-B-type natriuretic peptide levels were elevated in patients with sepsis (median: 6064 pg/mL; range: 495-60,417 pg/mL) but were significantly higher in patients with acute left ventricular dysfunction (median: 65,630 pg/mL; range: 15,125-288,000). The area under the receiver operating characteristics curve for the diagnosis of acute left ventricular dysfunction was 0.9. N-terminal pro-B-type natriuretic peptide levels of patients with sepsis and impaired systolic function were not different from those of patients with sepsis and normal systolic function. The N-terminal pro-B-type natriuretic peptide levels of 20 patients with simple febrile illness were significantly lower. CONCLUSIONS: N-terminal pro-B-type natriuretic peptide levels are elevated in pediatric patients with sepsis but are higher in some, but not all, patients with acute left ventricular dysfunction. The overlap between N-terminal pro-B-type natriuretic peptide levels in sepsis and acute left ventricular dysfunction precludes the use of the peptide's level as a sole means to differentiate between these conditions. Excessive elevation in N-terminal pro-B-type natriuretic peptide levels, however, suggests cardiac etiology for acute hemodynamic deterioration in infants and children.
Asunto(s)
Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Sepsis/sangre , Sepsis/diagnóstico , Disfunción Ventricular Izquierda/sangre , Disfunción Ventricular Izquierda/diagnóstico , Enfermedad Aguda , Niño , Preescolar , Enfermedad Crítica , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Valores de Referencia , Sensibilidad y EspecificidadAsunto(s)
Antivirales , Farmacorresistencia Viral/genética , Subtipo H1N1 del Virus de la Influenza A/efectos de los fármacos , Gripe Humana/tratamiento farmacológico , Oseltamivir , Antivirales/farmacología , Antivirales/uso terapéutico , Niño , Humanos , Gripe Humana/complicaciones , Gripe Humana/fisiopatología , Gripe Humana/virología , Israel , Masculino , Oseltamivir/farmacología , Oseltamivir/uso terapéutico , Neumonía Estafilocócica/complicaciones , Neumonía Estafilocócica/microbiología , Índice de Severidad de la Enfermedad , Staphylococcus aureus , Resultado del TratamientoRESUMEN
AIM: The aim of this study was to evaluate the yield of clinical symptoms, signs, and radiological studies in the diagnosis of foreign body aspiration (FBA) in children. METHODS: During the 2-year study, we performed on all children admitted to the pediatric department for suspected FBA a protocol that included the following: thorough medical history, physical examination, radiological studies (chest x-ray and fluoroscopy), and rigid bronchoscopy by a senior otolaryngologist. The yield of these measures for the diagnosis of FBA was evaluated. RESULTS: Foreign bodies were found in 56 (57%) of the 98 children with suspected FBA. Thirty-three (59%) children were boys and 23 (41%) girls (P < .05), with a mean age of 24 months (range, 8-84 months). Main symptoms in the children with FBA were the following: choking (76.8%), prolonged cough (14.3%), dyspnea (3.6%), and nonresolving pneumonia (1.8%). Physical examination, chest x-ray, and fluoroscopy findings were abnormal in 80.4%, 67.9%, and 46.9% of the children with FBA, respectively. The diagnostic yield of physical examination and radiological studies increased 24 hours after the event of FBA. In 45.2% of the children with positive history but with normal findings from physical examination and radiological studies, foreign bodies were found. Of the children with "doubtful" history, physical examination, chest x-ray, and fluoroscopy findings were abnormal in 58%, 38%, and 12.5%, respectively. Foreign bodies were found in 9.5% of these children. CONCLUSION: Medical history is the key for the diagnosis of FBA. Choking followed by an acute episode of coughing is the most common presentation of FBA. The yield of physical examination and radiological studies in the diagnosis of FBA is relatively low but is increased when the presentation is delayed and when history is doubtful. If FBA is suspected, bronchoscopy should be performed.