Safe administration of yellow fever vaccine in patients with suspected egg allergy.

Background: The evidence available in the literature on the administration and safety of the yellow fever vaccine in patients with egg allergy is limited. Objective: We sought to describe the administration of yellow fever vaccine in children with suspected egg allergy using a simplified protocol. Methods: Children referred to the service from February 2018 to January 2020 with a history of possible egg allergy were classified as probably egg-allergic or not on the basis of history and specific IgE testing. A vaccine prick test was performed only in those with a history of an anaphylactic reaction to egg ingestion and if the result was positive the vaccine was administered in a 2-step protocol (2 equal doses of 0.25 mL with an interval of 30 minutes between the 2 applications). All other children received the vaccine as a single dose. Results: A total of 435 children were evaluated; 48.27% were probably not allergic, and 51.72% were probably allergic to egg, of which 32.88% were considered anaphylactic. A total of 414 (95.2%) children had no vaccine reactions. Of the 21 (4.8%) children who had some reaction, 10 experienced a local reaction, 9 a mild skin reaction distant from the vaccine site, 1 presented local cutaneous reaction distant to the vaccination site, and 1 patient developed possible anaphylaxis. The vaccine prick test did not predict a vaccine reaction (odds ratio, 1.29; 95% CI, 0.25-6.72; P = .67). Conclusions: Yellow fever vaccine can be safely administered as a single dose in children with a confirmed or suspected egg allergy.

The International Study of Wheezing in Infants: questionnaire validation.

BACKGROUND: There are no internationally validated questionnaires to investigate the prevalence of infant wheezing. This study was undertaken to validate a questionnaire for the International Study on the Prevalence of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL). MATERIAL AND METHODS: Construct and criterion validity were tested for the question 'Has your baby had wheezing or whistling in the chest during his/her first 12 months of life?'. Construct validity (i.e. the ability of parents and doctors to refer to the same symptoms with the same words) was tested in a sample of 50 wheezing and 50 non-wheezy infants 12-15 months of age in each of 10 centres from 6 different Spanish- or Portuguese-speaking countries. Criterion validity (i.e. the ability of parents to correctly detect the symptom in the general population) was evaluated in 2 samples (Santiago, Chile and Cartagena, Spain) of 50 wheezing and 50 non-wheezing infants (according to parents) of the same age, randomly selected from the general population, who were later blindly diagnosed by a paediatric pulmonologist. RESULTS: Construct validity was very high (kappa test: 0.98-1) in all centres. According to Youden's index, criterion validity was good both in Cartagena (75.5%) and in Santiago (67.0%). Adding questions about asthma medication did not improve diagnosis accuracy. CONCLUSIONS: The EISL questionnaire significantly distinguished wheezy infants from healthy ones. This questionnaire has a strong validity and can be employed in large international multicentre studies on wheezing during infancy.

Reticulose medular histiocítica (histiocitose maligna) com comprometimento do sistema nervoso central: relato de um caso / The histiocytic medullary reticulocytosis (malignant histiocytosis) with central nervous system involvement: report of a case

Relata-se o caso de um paciente do sexo masculino, preto, adulto, internado em janeiro de 1985 no Hospital Universitário Antonio Pedro com um quadro de desorientaçäo, febre, irritaçäo meníngea, crises convulsivas e coma. Apresentava lesöes ulceradas de mucosa oral, comprometimento de pele, pancitopenia periférica e retençäo nitrogenada, evoluindo para o óbito após um quadro de hemorragia digestiva e insuficiência respiratória. O diagnóstico de reticulose medular histiocítica (histiocitose maligna) foi feito com base no estudo citológico de medula óssea e a infiltraçäo do SNC pela doença foi comprovada pelo exame citológico do LCR feito em citocentrífuga. A necrópsia revelou infiltraçäo de pele, coraçäo, pulmöes, rins, supra-renais, fígado, pâncreas, baço, linfonodos, tireóide, jejuno, musculatura esquelética, cérebro e medula óssea por células histiocitárias anaplásicas que exibiam fagocitose

Leucemia mielóide aguda complicando gestaçäo: relato de um caso / Acute myeloid leukemia pregnancy: a case repost

Os autores relatam o caso de uma paciente branca, de 23 anos, que foi internada na Clínica Obstétrica do Hospital Universitário Antonio Pedro com gestaçäo de 23 semanas, complicada com febre, tosse produtiva, petéquias, sangramento vaginal e palidez. Encaminhada à Hematologia Clínica, foi feito o diagnóstico de leucemia mielóide aguda, forma M3 (Promielocítica). A paciente foi tratada com Daunomicina, Arabinoside da Citosina, Prednisona, 6-Tioguanina, além de terapêutica suporte. Houve boa tolerância da paciente e do feto à quimioterapia. A evoluçäo fetal foi acompanhada por ultra-sonografia e tococardiografia. A leucemia näo remiu completamente, mas a evoluçäo clínica da doente era boa quando entrou em trabalho de parto entre a 32ª e 33ª semanas de gestaçäo, após ser submetida a procedimento obstétrico desnecessário. Deu a luz a um feto de sexo masculino que desenvolveu síndrome de angústia respiratória 40 minutos após o nascimento, que veio a falecer com 26 horas de vida. A necrópsia näo revelou anomalias congênitas macro ou microscópicas ou ainda lesöes atribuíveis ao uso dos quimioterápicos. A mäe faleceu no 12§ dia de pós-parto com sepse e graves manifestaçöes hemorrágicas conseqüentes ao recrudescimento de sua doença básica

Paracoccidioidomicose disseminada aguda com derrame pleural: relato de um caso / Acute disseminated paracoccidiodomycosis with acute pleural effusion: a case report

Apresenta-se um caso de paracoccidioidomicose disseminada aguda em indivíduo de 30 anos do sexo masculino, no qual constatou-se extenso derrame pleural ocupando o hemitórax esquerdo. O diagnóstico foi estabelecido por biópsia ganglionar. O fungo foi visualizado na biópsia pleural. Discute-se a patogenia do derrame pleural na micose de Lutz e enfatiza-se o diagnóstico diferencial com doenças hematológicas e tuberculose