Síndrome de reacción a drogas con eosinofilia y síntomas sistémicos asociado a herpesvirus humano 6. Caso pediátrico tratado con ciclosporina y corticoides / Drug reaction with eosinophilia and systemic symptoms syndrome associated with human herpesvirus 6. A pediatric case treated with cyclosporine and corticosteroids

La reacción a drogas con eosinofilia y síntomas sistémicos es una reacción adversa cutánea rara, potencialmente grave. Puede presentar fiebre, erupción cutánea polimorfa, edema facial y/o linfoadenopatías. La reactivación del virus herpes humano tipo 6 se asocia a un curso más grave y/o prolongado.Un lactante de 22 meses en tratamiento con fenobarbital presentó lesiones eritematopapulares, fiebre, leucocitosis, proteína C reactiva elevada y alteración de pruebas hepáticas. Se realizó biopsia de piel compatible con reacción adversa a drogas. Se trató con corticoides sistémicos e inmunoglobulina intravenosa sin respuesta. La reacción en cadena de la polimerasa para virus herpes humano tipo 6 resultó positiva. Se inició ciclosporina más prednisona, con buena respuesta. Existe poca evidencia del uso de ciclosporina en adultos, cuando los corticoides sistémicos son inefectivos. Este es el primer reporte pediátrico Podría ser una alternativa efectiva o un complemento de los corticosteroides sistémicos cuando no responde a tratamientos convencionales.

Drug reaction with eosinophilia and systemic symptoms is a rare and potentially serious skin adverse reaction, with fever, polymorphous skin rash, facial edema, and/or lymphadenopathy. Reactivation of human herpes virus type 6 has been associated with a more severe and/or prolonged course. A 22-month-old infant under phenobarbital treatment developed erythematous-papular lesions, fever, leukocytosis, elevated C-reactive protein, and abnormal liver tests. The skin biopsy was compatible with an adverse drug reaction. Treatment with systemic corticosteroids and intravenous immunoglobulin had no response. Polymerase chain reaction for human herpesvirus type 6 was positive, and cyclosporine plus prednisone was started with a good response. There is little evidence for the use of cyclosporine in adults when systemic corticosteroids are ineffective. This is the first report of pediatric drug reaction with eosinophilia and systemic symptoms treated with cyclosporine, which could be an effective alternative or an adjunct to systemic corticosteroid therapy unresponsive to conventional treatments.

Método de clasificación de mortinatos según condición obstétrica relevante de la muerte fetal, en un hospital público de Chile (Método CORM) / A new fetal death classification system

Background: Stillbirth is the mayor contributor to perinatal mortality. Aim: To report a system for classification of fetal deaths. Material and Methods: Retrospective cohort study of 29,916 births with 258 fetal deaths that occurred in a public hospital. Data were obtained from audit reports of stillbirths. The method for classification “obstetric condition relevant to the death” was applied, based on obstetric and placental pathological findings analyzed exclusively by a single obstetrician and a single pathologist. Results: Ninety two percent of obstetric conditions causing fetal death were identified. The most commonly reported were ascending bacterial infection in 26%, congenital anomalies in 19%, arterial hypertension in 12% and placental pathology in 12%. Fetal growth restriction was identified in 50% of stillbirths. Ninety percent were secondary to a primary obstetric condition and 10% had an unexplained cause. Placental abruption as the final cause of fetal death was identified in 60% of cases with arterial hypertension, 43% of cases with placental pathology and 37% of ascending infections. Fetal deaths occurred during pregnancy in 82% of cases and during labor in 17%. Intrapartum asphyxia occurred in 0.8% of stillbirths and presented in term pregnancies. Conclusions: The “obstetric condition relevant to the death” method for classification of fetal death is effective to identify the originating obstetric cause of stillbirth and reduces the impact of fetal growth restriction and intrapartum asphyxia as the leading causes of death.

Obesidad, factor de riesgo de infección bacteriana ascendente durante el embarazo / Obesity, a risk factor for ascending bacterial infection during pregnancy

Background: Obesity in pregnancy is associated with significantly higher rates of infection. Aim: To compare the infectious morbidity in pregnant women with normal and altered body mass index (BMI). Material and Methods: Cross sectional retrospective study of 6,150 patients who had delivery or second trimester abortion during 2012. The patients were classified according to BMI as underweight, normal weight, overweight and obese. We compared the frequency of pregnancy and perinatal complications related to ascending bacterial infection (ABI). The data was obtained from the hospital’s databases. Results: Obese patients had higher rates of pregnancy and perinatal complications related to ABI compared to patients with normal weight. The odds ratios (OR) and 95% confidence intervals (CI) for second trimester abortion were 3.45 (1.63-7.31) p < 0.01, for preterm delivery 2.42 (1.51-3.87) p < 0.01, for labor and puerperium infections 3.42 (2.06-5.68) p < 0.01 and for early neonatal infectious and perinatal mortality 4.46 (1.75-11.37) p < 0.01. A logistic regression analysis revealed that obesity is an independent risk factor for second trimester abortion related to ABI with an OR of 3.18 (CI 95% 1.46-6.91), premature delivery related to ABI with an OR of 2.51 (CI 95% 1.54-4.09) and for delivery and postpartum infections with an OR of 4.44 (CI 95% 2.62 to 7.51). Conclusions: Obese pregnant women had a 2.5 to 4.5 times increased risk of infectious morbidity compared to normal weight patients. Obesity is an independent risk factor for second trimester abortion and preterm delivery related to ABI and delivery and postpartum infectious.

Factores asociados con el parto prematuro entre 22 y 34 semanas en un hospital público de Santiago / Risk factors for preterm deliveries in a public hospital

Background: Preterm births are responsible for 75 to 80% of perinatal mortality. Aim: To determine the factors associated with preterm births, using maternal clinical data, laboratory results and pathological placental findings. Patients and Methods: Retrospective study of 642 preterm single births at 22-34 weeks' gestation. Four hundred and seven cases with pathological placental studies were included. Births were subdivided into preterm births as a consequence of a medical indication and spontaneous births with or without premature rupture of membranes (PROM). Risk factors for preterm births were classified as maternal, fetal, placental, indeterminable and unclassifiable. Results: The proportions of preterm births were spontaneous 69% (with PROM 27% and with intact membranes 42%) and medically indicated births 31%. A risk factor associated with prematurity was identified in 98 and 85% of medically indicated and spontaneous births, respectively. Ascending bacterial infection (ABI) was the most frequently associated factor with spontaneous preterm delivery in 51% of women (142/280, p < 0.01) and with preterm births of less than 30 weeks in 52% of women (82/157, p < 0.01). Vaginal or urinary infection with Group B Streptococcus, was the most common clinical condition associated with ABI related deliveries. Hypertension was present in 94 of 127 medically indicated preterm deliveries (preeclampsia in 62% and chronic hypertension in 12%), and in 29% (preeclampsia 24%) of preterm births of more than 30 weeks. Congenital anomalies were mainly associated with a maternal age over 35 years in 15% (14/92) of women. The frequency of placental diseases was higher in spontaneous preterm deliveries (14%) and in pregnancies of more than 30 weeks in (14%). Conclusions: ABI was the most common factor associated with spontaneous preterm births at 2234 weeks, while preeclampsia is the most common factor associated with medically indicated preterm births.

Sepsis neonatal precoz causada por transmisión vertical de Morganella morganii, en un embarazo de término / Fatal neonatal sepsis caused by vertical transmission of Morganella morganii. Report of one case

We report a term neonate who developed early-onset sepsis due to Morganella morganii. The child was vaginally delivered after a short labor, and presented signs of perinatal asphyxia. Blood cultures taken soon after birth and from mother's lochia were positive for this microorganism. The infection was unresponsive to treatment with cefotaxime, to which the microorganism was susceptible, and the infant died at 17 days of age. M morganii is an opportunistic and uncommon pathogen, causing disease mainly in patients with underlying illness or after surgery. It is a rare perinatal pathogen, causing severe disease in premature infants, in association with maternal chorioamnionitis and premature rupture of the membranes (RevMéd Chile 2009; 137: 1201-4).

Relación entre enfermedad periodontal, infección bacteriana ascendente y patología placentaria con parto prematuro / Relationship between periodontal diseases and ascending bacterial infection with preterm delivery

Background: There is an association between periodontal diseases and preterm delivery. Aim: To assess the relationship between periodontal diseases, ascending bacterial infection and placental pathology with preterm delivery. Patients and methods: A periodontal examination and collection of amniotic fluid and subgingival plaque samples were performed in women with preterm labor with intact membranes, without an evident clinical cause or preterm premature rupture of membranes, without clinical chorioamnionitis or labor and a gestational age between 24 and 34 weeks. Microbial invasion of the amniotic cavity was defined as the presence of a positive amniotic fluid culture. Cervicovaginal infection was defined as a bacterial vaginosis or positive culture of cervix or vagina with a high neutrophil count. Ascending bacterial infection was diagnosed as the microbial invasion of the amniotic cavity by ascending bacteria or cervicovaginal infection. Corioamnionitis, funisitis or vellositis were diagnosed. Results: Fifty-nine women were included: fortytwowith preterm labor with intact membranes and seventeen with preterm premature rupture of membranes. The prevalence of periodontal diseases was 93.2%. Microbial invasion of the amniotic fluid was detected in 27.1% of patients. Periodontal pathogenic bacteria were isolated in 18.6% of amniotic fluid samples and 71.2% of subgingival plaque samples. The prevalence of ascending bacterial infection was 83.1% and in 72.9% of women it was associated with periodontal disease. Preterm delivery (<37 weeks) occurred in 64.4% of patients and was significantly associated with generalized periodontal disease and with the association of ascending bacterial infection and periodontal diseases. Patients with preterm delivery and generalized periodontal disease had a higher frequency of chorioamnionitis and funisitis...

Alfa talasemia e hidrops fetal no inmune a propósito de un caso diagnosticado en la Unidad de Ultrasonografía del Hospital Clínico San Borja Arriarán / Non-immune hydrops fetalis and alfa thalassemia

We report the unique case of a patient of asiatic origin (chinese), who was evaluated, followed and treated at the Sonography Unit of the Maternity Ward, Clinical Hospital San Borja Arriarán (HCSBA), with the collaboration of the Fetal Medicine Unit, Clinical Hospital of the University of Chile. The patient presented a 30 weeks gestation, which at the moment of evaluation showed a fetus with noninmune Hydrops (mother RH(+), Du (-)). Perinatal evaluation discarded cardiopathy, aneuploidiesmarkers and other malformations accounting for this condition. Fetal ultrasonographic evaluation showed severe cardiac insufficiency, middle cerebral artery Doppler (MCA) suggestive of severe anemia and severe oligoamnios with normal kidneys. Dueto these fi ndings and to the asiatic origin of the patient, the ethiological possibilities of viral infection, B19 parvovirus or anemia of genetic origin such as alfa thalassemia were suggested. Cordocentesis shows hematocrite of 39 percent, discordant with the value estimated by MCA Doppler, which reduced the possibility of a viral origin. We sent a fetal blood sample for Hb electrophoresis. Given the critical hemodynamic conditions and having completed the profilaxis of the hyaline membrane, gestation is interrupted by cesarean section, getting a male NB weighing 2.400 gr, in poor condition, who dies at 10 hours from birth. Electrophoresis reported postcesarean section confirms the diagnosis.

Se reporta el caso inédito, de una paciente de origen asiático (China), evaluada, seguida y tratada en la Unidad de Ultrasonografía de la Maternidad del Hospital Clínico San Borja Arriarán (HCSBA), con la colaboración de la Unidad de Medicina Fetal del Hospital Clínico de la Universidad de Chile. La paciente cursaba un embarazo de 30 semanas al momento de ser evaluada en nuestra unidad donde se diagnosticó una gestación única con un feto que presentaba un hidrops no inmune (madre Rh(+), Du (-)). La evaluación perinatal descartó cardiopatía, marcadores de aneuploidía y otras malformaciones que explicaran dicha condición. La evaluación ultrasonográfica fetal mostraba insuficiencia cardiaca severa, Doppler de arteria cerebral media (ACM) sugerente de anemia severa, oligoamnios severo con riñones normales. Debido a estos hallazgos y al origen asiático de la paciente se plantea la posibilidad etiológica de una anemia por infección viral, (parvovirus B19), o una anemia de origen genético, como la alfa talasemia. La cordocentesis muestra un hematocrito de 39 por ciento, discordante con el valor estimado por Doppler de ACM, lo que alejaba la posibilidad de un origen viral y se envía muestra de sangre fetal para electroforesis de hemoglobina(Hb) fetales. Dada las condiciones hemodinámicas críticas y haber completado profilaxis de membrana hialina se interrumpe el embarazo mediante una cesárea obteniéndose un RN de sexo masculino de 2.400 g, hidrópico, en malas condiciones que fallece a las 10 horas de vida. La electroforesis de proteína de sangre fetal, informada post cesárea, confirma el diagnóstico de alfa talasemia.

Calcinosis tumoral en pediatría: reporte de un caso clínico y revisión de la literatura / Tumoral calcinosis in young children: report of a case and literature review

We report a case of tumoral calcinosis in young girl, a quite infrecuent condition, caused by a hereditary dysfunction of phosphate regulation. Our aims are to review imaging signs (plain radiography ultrasound, Computed Tomography and nuclear medicine) and clinical and laboratory findings as well. Finally we made a literature search, oriented to help in diagnosing this disease, specially regarding images.

Presentamos el caso de una niña preescolar portadora de calcinosis tumoral, entidad infrecuente, causada por una disfunción hereditaria en la regulación de la excreción de fosfatos. Damos a conocer los hallazgos radiológicos (radiografía simple, ultrasonografía, tomografia computada y cintigrafía ósea), así como también hallazgos clínicos y laboratorio del caso, además de revisar la literatura para una breve actualización de esta condición, especialmente en lo que respecta al diagnóstico y las imágenes.

Anomalías del cordón umbilical y su asociación con malformaciones fetales / Anomalies of the umbilical cord and its association with fetal malformations

Se presenta una evolución de 1.500 autopsias perinatales; y se relaciona los hallazgos de anomalías del cordón umbilical con malformaciones fetales mayores y menores. Se destacan la arteria umbilical única y las estenosis del cordón. Como las más frecuentes se señala la importancia de un examen acucioso del cordón umbilical y la placenta