RESUMO
During a 2-year period after the introduction of an intensive chemotherapeutic protocol, alpha-hemolytic streptococci accounted for 75% of all episodes of sepsis among children with acute nonlymphocytic leukemia at our institution. Only one case had occurred in the previous 8 years. Fourteen of 15 episodes of streptococcal sepsis occurred after therapy with either continuous or large dosage intermittent cytosine arabinoside. Eleven episodes occurred at two specific treatment points. Septic episodes were complicated by shock (2 of 15), encephalopathy (2 of 15), pneumonia (3 of 15) and death (1 of 15). Oral mucosal lesions may provide a portal of entry for alpha-hemolytic streptococci. These data suggest that children receiving continuous or large dosage intermittent cytosine arabinoside for treatment of acute nonlymphocytic leukemia may be at increased risk for alpha-hemolytic streptococcal sepsis. Empiric antimicrobial therapy in these children when febrile and neutropenic should include antibiotics effective against alpha-hemolytic streptococci.
Assuntos
Citarabina/uso terapêutico , Leucemia Mieloide Aguda/complicações , Sepse/etiologia , Infecções Estreptocócicas/etiologia , Antibacterianos/uso terapêutico , Criança , Citarabina/efeitos adversos , Humanos , Tolerância Imunológica , Leucemia Mieloide Aguda/tratamento farmacológico , Fibrose Pulmonar/etiologia , Estudos Retrospectivos , Sepse/complicações , Sepse/tratamento farmacológico , Choque Séptico/etiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológicoAssuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Cuidados Críticos/métodos , Infecções Bacterianas/prevenção & controle , Criança , Pré-Escolar , Humanos , Hospedeiro Imunocomprometido , Lactente , Recém-Nascido , Meningites Bacterianas/tratamento farmacológico , Resistência às Penicilinas , Infecções Pneumocócicas/tratamento farmacológico , Sepse/diagnóstico , Sepse/tratamento farmacológicoRESUMO
Lawn dart injuries account for an estimated 675 emergency department visits per year. Seventy-six patients are described herein. The victims ranged from 1 to 18 years of age and were predominantly male (male to female ratio is 3.1:1). The most common sites of injury were head (54%), eye (17%), and face (11%). Hospitalization was required for 54% (41/76) of these patients. Sequelae included unilateral blindness and brain damage. The case fatality rate was 4%. The extent of a head injury was not always clinically apparent at the initial presentation and should be promptly defined by computed tomographic scan. Despite the recent ban on the sale of lawn darts, there remain an estimated 10 to 15 million sets of lawn darts in the homes of Americans. Pediatricians should encourage parents to discard all lawn darts.