[Arthritis caused by Candida in an immunocompetent infant with a history of systemic candidiasis in the neonatal period]. / Artritis por Candida en lactante inmunocompetente con antecedente de candidiasis sistémica en período neonatal.

We report the case of knee arthritis in an immunocompetent infant man, 10 month-old, caused by Candida albicans. He suffered in the past septic arthritis due to Candida albicans in the neonatal period. Initial management included treatment with liposomal amphotericin B and fluconazole at hospital discharge. Primary immunodeficiency was ruled out. Ongoing follow up during 1 year has been uneventful.

[Usefulness of chemotherapy associated with surgery in the management of nontuberculous mycobacterial adenitis]. / Utilidad de antibioticoterapia asociada a cirugía en el tratamiento de adenopatías por micobacterias no tuberculosas.

BACKGROUND: In recent years, lymphadenitis caused by atypical mycobacteria (also called nontuberculous mycobacteria [NTMB] or, more recently, environmental) have played a significant role in the differential diagnosis of adenitis in non-immunocompromised children. OBJECTIVES: To describe the clinical and pathological findings in childhood NTMB adenitis and study the possible usefulness of antimicrobial therapy in addition to surgery. METHODS: We present eight cases of neck lymphadenitis occurring over a 5-year period. All of the children received combined chemotherapy, and six also underwent surgery. Of the two remaining patients, the parents of one child refused surgery and a watchful approach was adopted in the other. RESULTS: Complete clinical recovery was achieved in all patients except one who did not undergo surgery. CONCLUSIONS: Prolonged administration of two antibiotics (of which one must be clarithromycin) in addition to surgery was well-tolerated and could be useful in patients with NTMB neck lymphadenitis.

Relationship between serotypes, age, and clinical presentation of invasive pneumococcal disease in Madrid, Spain, after introduction of the 7-valent pneumococcal conjugate vaccine into the vaccination calendar.

To assess invasive pneumococcal disease (IPD) clinical presentations and relationships with age and serotype in hospitalized children (<15 years) after PCV7 implementation in Madrid, Spain, a prospective 2-year (May 2007 to April 2009) laboratory-confirmed (culture and/or PCR) IPD surveillance study was performed (22 hospitals). All isolates (for serotyping) and culture-negative pleural/cerebrospinal fluids were sent to the reference laboratory for pneumolysin (ply) and autolysin (lyt) gene PCR analysis. A total of 330 IPDs were identified: 263 (79.7%) confirmed by culture and 67 (20.3%) confirmed by PCR. IPD distribution by age (months) was as follows: 23.6% (<12), 15.8% (12 to 23), 15.5% (24 to 35), 22.4% (36 to 59), and 22.7% (>59). Distribution by clinical presentation was as follows: 34.5% bacteremic pneumonia, 30.3% pediatric parapneumonic empyema (PPE), 13.6% meningitis, 13.3% primary bacteremia, and 8.2% others. Meningitis and primary bacteremia were the most frequent IPDs in children <12 months old, and bacteremic pneumonia and PPE were most frequent in those >36 months old. Frequencies of IPD-associated serotypes were as follows: 1, 26.1%; 19A, 18.8%; 5, 15.5%; 7F, 8.5%; 3, 3.9%; nontypeable/other 30 serotypes, 27.3%. Serotype 1 was linked to respiratory-associated IPD (38.6% in bacteremic pneumonia and 38.0% in PPE) and children of >36 months (51.4% for 36 to 59 months and 40.0% for >59 months), while serotype 19A was linked to nonrespiratory IPDs (31.1% in meningitis, 27.3% in primary bacteremia, and 51.9% in others) and children of <24 months (35.9% for children of <12 months and 36.5% for those 12 to 23 months old), with high nonsusceptibility rates for penicillin, cefotaxime, and erythromycin. After PCV7 implementation, non-PCV7 serotypes caused 95.5% of IPDs. The new 13-valent conjugate vaccine would provide 79.1% coverage of serotypes responsible for IPDs in this series.

Artritis por Candida en lactante inmunocompetente con antecedente de candidiasis sistémica en período neonatal / Arthritis caused by Candida in an immunocompetent infant with a history of systemic candidiasis in the neonatal period

Se describe el caso de un varón de 10 meses, inmunocompetente, que presentó artritis séptica por Candida albicans en el período neonatal. Durante el ingreso recibió tratamiento con anfotericina B liposómica y al alta se le administró fluconazol. La evolución ha sido favorable y tras un año de seguimiento se encuentra asintomático. La aparición de artritis por C. albicans en un lactante inmunocompetente, con el antecedente de candidiasis sistémica en el período neonatal, es excepcional (AU)

We report the case of knee arthritis in an immunocompetent infant man, 10 month-old, caused by Candida albicans. He suffered in the past septic arthritis due to Candida albicans in the neonatal period. Initial management included treatment with liposomal amphotericin B and fluconazole at hospital discharge. Primary immunodeficiency was ruled out. Ongoing follow up during 1 year has been uneventful(AU)

Instrumentos para la detección precoz de los trastornos del espectro autista / No disponible

Una intervención temprana en los trastornos autistas es de suma importancia para mejorarel pronóstico de estos pacientes. La dificultad que supone el diagnóstico en niños pequeñossuele conllevar una demora considerable en su primera valoración por el especialistaen salud mental infantil. Por ello, el propósito de nuestro trabajo ha sido aportar unmaterial que oriente al pediatra en la detección precoz de los trastornos del espectro autistamediante una revisión actualizada de los instrumentos estandarizados y una reconsideración de los criterios clínicos más discriminativos (AU)

An early intervention in the autistic disorders is of supreme importance in order to improvethe prognosis of these patients. The difficulty involved in the diagnosis in the early years of lifeleads to a considerable delay in their first evaluation by a specialist on children mental health.That’s why the purpose of our paper is to facilitate a material that may orientate the paediatricianin the early detection of the autistic spectrum disorders by means of an updated review ofthe standardized instruments and a reconsideration of the most discriminative clinical criteria (AU)

Tratamiento de la linfadenitis. Réplica / Treatment of lymphadenitis. Response

No disponible

Utilidad de antibioticoterapia asociada a cirugía en el tratamiento de adenopatías por micobacterias no tuberculosas / Usefulness of chemotherapy associated with surgery in the management of nontuberculous mycobacterial adenitis

Antecedentes: Las infecciones por micobacterias atípicas (también denominadas no tuberculosas [MNTB] o más recientemente ambientales) están desempeñando en los últimos tiempos un papel preponderante en el diagnóstico diferencial de las adenitis en niños inmunocompetentes. Objetivos: Los objetivos de este estudio han sido describir las características clinicopatológicas de las adenopatías por MNTB y evaluar el posible efecto de la terapia antibiótica asociada a cirugía. Métodos: Se presentan 8 casos recogidos en 5 años, todos ellos con afectación cervical. Todos recibieron antimicrobianos combinados junto a cirugía en seis de los casos. En los dos restantes, en uno existió negativa por parte de los padres del paciente y en otro se mantuvo una actitud expectante. Resultados La evolución fue satisfactoria en todos los pacientes menos uno de los no tratados quirúrgicamente. Conclusiones: La asociación prolongada de dos antibióticos siendo uno de ellos claritromicina junto al tratamiento quirúrgico presenta una adecuada tolerancia y podría ser de utilidad en linfadenitis cervical por MNTB

Background: In recent years, lymphadenitis caused by atypical mycobacteria (also called nontuberculous mycobacteria [NTMB] or, more recently, environmental) have played a significant role in the differential diagnosis of adenitis in non-immunocompromised children. Objectives: To describe the clinical and pathological findings in childhood NTMB adenitis and study the possible usefulness of antimicrobial therapy in addition to surgery. Methods: We present eight cases of neck lymphadenitis occurring over a 5-year period. All of the children received combined chemotherapy, and six also underwent surgery. Of the two remaining patients, the parents of one child refused surgery and a watchful approach was adopted in the other. Results: Complete clinical recovery was achieved in all patients except one who did not undergo surgery. Conclusions: Prolonged administration of two antibiotics (of which one must be clarithromycin) in addition to surgery was well-tolerated and could be useful in patients with NTMB neck lymphadenitis