ABSTRACT
La lectina de unión a la manosa (mannose-binding lectin [MBL]) es una proteína sérica perteneciente al sistema inmunitario innato. Se une a los azúcares de las membranas de múltiples microorganismos, favoreciendo su opsonización y eliminación. El déficit de MBL resulta del polimorfismo del gen MBL2 y se asocia a una amplia variedad de infecciones recurrentes, incluidas las infecciones del tracto respiratorio. Presentamos un caso de displasia ectodérmica anhidrótica asociada a un déficit de MBL, inmunodeficiencia nunca descrita en pacientes afectados de displasia ectodérmica anhidrótica(AU)
Mannose-binding lectin (MBL) is a serum protein of the innate immune system.MBL enhances opsonophagocytosis by binding to carbohydrates expressed by multiple pathogens.MBL deficiency is due to polymorphisms in the structural and promoter sequences of the MBL2 gene and is associated with variety of recurrent infections, including respiratory tract infections. We present a case of anhidrotic ectodermal dysplasia associated with severe mannose-binding lectin deficiency, never described in patients with anhidrotic ectodermal dysplasia(AU)
Subject(s)
Humans , Ectodermal Dysplasia/complications , Mannose-Binding Lectins/deficiency , Opsonin Proteins/physiology , Polymorphism, Genetic/genetics , Infections/physiopathology , Immunologic Deficiency Syndromes/complicationsABSTRACT
Mannose-binding lectin (MBL) is a serum protein of the innate immune system. MBL enhances opsonophagocytosis by binding to carbohydrates expressed by multiple pathogens. MBL deficiency is due to polymorphisms in the structural and promoter sequences of the MBL2 gene and is associated with variety of recurrent infections, including respiratory tract infections. We present a case of anhidrotic ectodermal dysplasia associated with severe mannose-binding lectin deficiency, never described in patients with anhidrotic ectodermal dysplasia.
Subject(s)
Ectodermal Dysplasia/etiology , Mannose-Binding Lectin/deficiency , Humans , Infant , MaleABSTRACT
La neumonía adquirida en la comunidad (NAC) es una enfermedad frecuente en la infancia, en cuyo diagnóstico y tratamiento participan diversas especialidades pediátricas. Esto ha motivado que la Sociedad Española de Neumología Pediátrica (SENP) y la Sociedad Española de Infectología Pediátrica (SEIP) elaboren un documento de consenso sobre el diagnóstico de la NAC, revisando mediante la medicina basada en la evidencia aquellos aspectos prácticos sobre el mismo. Se analizan la etiología y la epidemiología, con los cambios actuales, así como la validez de ciertas pruebas complementarias, como los reactantes de fase aguda, los métodos microbiológicos y los métodos de imagen, orientando al pediatra en la utilidad real de los mismos(AU)
Community Acquired Pneumonia (CAP) is a common childhood disease, involving several paediatric subspecialties in its diagnosis and treatment. This has prompted the Spanish Society of Paediatric Pulmonology (SENP) and the Spanish Society of Paediatric Infectious Diseases (SEIP) to prepare a consensus document on the diagnosis of CAP, assessing the practical aspects by means of evidence-based medicine. It discusses the aetiology and epidemiology, with the current changes and the validity of certain laboratory tests, such as acute phase reactants, microbiological and imaging techniques, guiding the paediatricians in the real value of these tests(AU)
Subject(s)
Humans , Community-Acquired Infections/diagnosis , Pneumonia/diagnosis , Risk Factors , Disease Outbreaks , Pleural Effusion/epidemiology , Biomarkers/analysis , Microbiological TechniquesABSTRACT
Introducción: Los abscesos retro y parafaríngeos son procesos infrecuentes aunque asociados con morbilidad significativa y potencial mortalidad. El objetivo del estudio es revisar nuestra experiencia en el manejo diagnóstico y terapéutico de los abscesos retro y parafaríngeos y comparar el resultado entre los pacientes tratados con antibioterapia exclusiva con aquellos que requirieron drenaje quirúrgico. Pacientes y métodos: Estudio retrospectivo de pacientes diagnosticados de abscesos retro y parafaríngeos en nuestro hospital terciario durante el periodo 2000-2009. Resultados: Treinta y un casos fueron identificados. Diecisiete presentaron absceso retrofaríngeo, 11 abscesos parafaríngeos y 3 ambos. Encontramos un incremento de la frecuencia media anual (1,4 casos/años en el periodo 2000-2004 versus 4,8 casos/año en el periodo 2005-2009, p=0,006). La mediana de edad fue 3 años (rango 1-10). Dieciocho (58%) pacientes recibieron antibioterapia por vía oral previa al ingreso (betalactámicos 84%). La clínica de presentación fue: fiebre (93%), linfadenopatías cervicales (93%), dolor cervical (90%), tortícolis (74%), odinofagia (64%), trismus (32%), sialorrea (22%) y estridor (6%). En 13 niños se realizó drenaje quirúrgico, siendo positivo el cultivo microbiológico en 8 casos; Streptococcus pyogenes fue el germen más frecuente (n=4). Todos los pacientes recibieron antibioterapia por vía intravenosa. No hubo diferencias en la estancia hospitalaria, complicaciones o recurrencias al comparar los tratados con antibioterapia exclusiva y los tratados con cirugía. Conclusiones: La frecuencia media anual de casos se incrementó durante la segunda mitad del periodo de estudio. La mayoría de niños fueron tratados satisfactoriamente con manejo conservador. La indicación quirúrgica debe basarse en la presentación clínica y la respuesta al tratamiento antibiótico (AU)
Introduction: Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. This study reviews our experience in the diagnosis and management of retro- and parapharyngeal abscesses and compares children treated conservatively with those undergoing surgical intervention. Material and methods: A retrospective analysis of children diagnosed with retro- and parapharyngeal abscess from 2000 to 2009 in our tertiary-care centre. Results: Thirty-one children were identified. There were 17 retropharyngeal abscesses and 11 parapharyngeal abscesses; 3 children suffered from both conditions. The mean annual frequency increased significantly from 1.4 cases/year during 2000-2004 to 4.8 cases/year during 2005-2009 (P=0.006). Median age was 3 years (range 1-10). A total of 18 (58%) children had received pre-admission oral antibiotics (beta-lactams in 84%). Clinical findings at presentation were: fever (93%), cervical lymphadenopathy (93%), neck pain (90%), torticollis (74%), odynophagia (64%), trismus (32%), drooling (22%) and stridor (6%). Thirteen (42%) children underwent surgical intervention, of those, microbiological culture was positive in 8 children; S. pyogenes being the most commonly isolated organism (n=4). All the patients received parenteral antibiotic therapy. There were no significant differences in the length of hospital stay, complication or recurrence rates between children treated conservatively compared to those undergoing surgical intervention. Conclusions: Retro- and parapharyngeal abscesses were increasingly observed during the 2nd part of the study period. The majority of children (58%) were treated conservatively with excellent clinical response. Indication for surgical intervention should be made based on the clinical presentation and response to antibiotic therapy (AU)
Subject(s)
Humans , Male , Female , Child , Retropharyngeal Abscess/complications , Retropharyngeal Abscess/diagnosis , Retropharyngeal Abscess/drug therapy , Anti-Bacterial Agents/therapeutic use , Retropharyngeal Abscess/physiopathology , Retropharyngeal Abscess/surgery , Retropharyngeal Abscess , Retrospective Studies , Streptococcus pyogenes/isolation & purification , Antibiotic ProphylaxisABSTRACT
INTRODUCTION: Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. This study reviews our experience in the diagnosis and management of retro- and parapharyngeal abscesses and compares children treated conservatively with those undergoing surgical intervention. MATERIAL AND METHODS: A retrospective analysis of children diagnosed with retro- and parapharyngeal abscess from 2000 to 2009 in our tertiary-care centre. RESULTS: Thirty-one children were identified. There were 17 retropharyngeal abscesses and 11 parapharyngeal abscesses; 3 children suffered from both conditions. The mean annual frequency increased significantly from 1.4 cases/year during 2000-2004 to 4.8 cases/year during 2005-2009 (P=.006). Median age was 3 years (range 1-10). A total of 18 (58%) children had received pre-admission oral antibiotics (beta-lactams in 84%). Clinical findings at presentation were: fever (93%), cervical lymphadenopathy (93%), neck pain (90%), torticollis (74%), odynophagia (64%), trismus (32%), drooling (22%) and stridor (6%). Thirteen (42%) children underwent surgical intervention, of those, microbiological culture was positive in 8 children; S. pyogenes being the most commonly isolated organism (n=4). All the patients received parenteral antibiotic therapy. There were no significant differences in the length of hospital stay, complication or recurrence rates between children treated conservatively compared to those undergoing surgical intervention. CONCLUSIONS: Retro- and parapharyngeal abscesses were increasingly observed during the 2(nd) part of the study period. The majority of children (58%) were treated conservatively with excellent clinical response. Indication for surgical intervention should be made based on the clinical presentation and response to antibiotic therapy.
Subject(s)
Abscess , Pharyngeal Diseases , Retropharyngeal Abscess , Abscess/diagnosis , Abscess/therapy , Child , Child, Preschool , Female , Humans , Infant , Male , Pharyngeal Diseases/diagnosis , Pharyngeal Diseases/therapy , Retropharyngeal Abscess/diagnosis , Retropharyngeal Abscess/therapy , Retrospective Studies , Spain , Time FactorsSubject(s)
Humans , Male , Infant , Asphyxia/etiology , Apnea/etiology , Epiglottis/pathology , Cysts/complications , Resuscitation , Muscle Hypotonia/etiology , Cyanosis/etiologySubject(s)
Cysts/complications , Epiglottis , Laryngeal Diseases/complications , Apnea/etiology , Emergencies , Humans , Infant , Male , Severity of Illness IndexABSTRACT
Brucellosis is a relatively common disease in the Mediterranean area and may present with prolonged fever without focus, however it remains an important diagnostic challenge to most pediatricians. We report the case of a 10-year-old male patient who presented with fever without a focus of 10-day duration, hepatomegaly, ascites, a small elevation in transaminases and acute-phase reactants indicating cholestasis, leukopenia, and thrombocytopenia. Imaging tests showed many small, rounded, hypodense focal lesions in the liver and spleen. After eliminating a wide range of diseases, positive results for the Rose Bengal test and indirect immunofluorescence assay for Brucella melitensis made it possible to establish a diagnosis of hepatosplenic brucellosis. A review of the family history revealed direct contact with farm animals. The patient made good progress on treatment with doxycycline and streptomycin, with complete resolution of both clinical symptoms and imaging signs. The prevalence of brucellosis is gradually increasing, mainly due to migratory movements. It should always be eliminated as a source of unknown fever in endemic areas and should also be taken into account in other geographical areas where it is not common whenever a patient presents with prolonged fever and unspecific symptoms. Standard therapy is highly effective, even in relapse cases, and early diagnosis leads to a rapid recovery and favorable outcome. The unusual presentation in the case reported here reminds us that it is possible to encounter a Brucella infection in a case of fever without a focus, irrespective of the existence of a clear epidemiological history, which is very often omitted by the family. All differential diagnostic protocols for fever without a focus should include a diagnostic test for Brucella in order to achieve early detection of the disease and initiate therapy promptly.
Subject(s)
Brucella melitensis , Brucellosis/complications , Brucellosis/diagnosis , Cholestasis/complications , Animals , Animals, Domestic , Anti-Bacterial Agents/therapeutic use , Brucellosis/drug therapy , Child , Doxycycline/therapeutic use , Fever/etiology , Humans , Male , Streptomycin/therapeutic useABSTRACT
Introducción: Recientemente se ha descrito en diversas áreas geográficas un incremento tanto en la incidencia de mastoiditis agudas como en su gravedad, sin que sus causas hayan sido del todo aclaradas. El objetivo de nuestro estudio es revisar nuestra experiencia reciente y compararla con aquello que otros autores han descrito. Paciente y métodos: Estudio retrospectivo de 145 pacientes diagnosticados de mastoiditis aguda en hospital terciario durante el periodo 19992008. Se analizan variables epidemiológicas, clínicas, microbiológicas, tratamiento y resultado. Resultados: La frecuencia anual de mastoiditis aguda presentó importantes variaciones a lo largo del estudio. La media anual fue de 14,5 casos/año. La mediana de edad fue de 3 años. Un 57,9% fueron varones. Un 53,8% recibió antibioterapia oral previa, principalmente B-lactámicos. La clínica más frecuente fue fiebre (77,9%), desplazamiento pabellón auricular (73,8%), otalgia (71,7%) edema/hinchazón retroauricular (70,3%). Se realizó cultivo exudado ótico en 53 pacientes, siendo Streptococcus pneumoniae el germen más frecuente. Se realizó TC en el 56,6% casos. El 100% de pacientes recibió antibioterapia intravenosa con una mediana de duración de 5 días. La cirugía otorrinolaringológica se realizó en 47 (32,4%) pacientes. Diecinueve (13,1%) pacientes presentaron complicaciones extracraneales. Doce (8,2%) pacientes presentaron complicaciones intracraneales, observándose un incremento significativo en su proporción al comparar los primeros con los segundos 5 años del estudio. Conclusiones: Encontramos importantes variaciones interanuales en la frecuencia de mastoiditis aguda. Subrayamos el aumento de la proporción de complicaciones intracraneales en los segundos 5 años del estudio (AU)
Introduction: An increase in both the incidence and severity of acute mastoiditis (AM) has been recently recorded in many different geographical areas. Causes remain unclear. This study aims to evaluate our clinical and epidemiological data in paediatric patients with AM and to compare them with recent reports. Material and methods: Retrospective chart review of 145 patients diagnosed of AM from 1999 to 2008 in our tertiary-care centre, including clinical, epidemiological, microbiological, treatment and outcome data. Results: The annual incidence showed a changeable trend throughout the study period. The average number of cases was 14.5 cases per year, with a median age of 3 years, and 57.9% males. A total of 53.8% received pre-admission oral antibiotics, mainly beta-lactamics. Most frequent presenting clinical findings were fever (77.9%), ear displacement (73.8%), otalgia (71.7%), and postauricular swelling (70.3%). Microbiological cultures were performed in 53 cases; S. pneumoniae was the most isolated microorganism. CT scans were performed in 56.6% cases. All patients received parenteral antibiotic treatment with a median duration of treatment of 5 days. Surgery was performed on 32.6%. Complications were seen in 20% of patients: 13.1% had extracranial complications, and 8.2% had intracranial complications. A significant increase in intracranial complications was detected in the second half of the study period. Conclusions: A changeable trend in the annual incidence of AM throughout the time of study was observed. A higher proportion of intracranial complications was detected in the last five years of the study period (AU)
Subject(s)
Humans , Male , Female , Child , Mastoiditis/epidemiology , Otitis Media/complications , Mastoiditis/etiology , Retrospective Studies , Anti-Bacterial Agents/therapeutic use , Streptococcus pneumoniae/isolation & purification , Pseudomonas aeruginosa/isolation & purification , Otitis Media with Effusion/microbiologyABSTRACT
INTRODUCTION: An increase in both the incidence and severity of acute mastoiditis (AM) has been recently recorded in many different geographical areas. Causes remain unclear. This study aims to evaluate our clinical and epidemiological data in paediatric patients with AM and to compare them with recent reports. MATERIAL AND METHODS: Retrospective chart review of 145 patients diagnosed of AM from 1999 to 2008 in our tertiary-care centre, including clinical, epidemiological, microbiological, treatment and outcome data. RESULTS: The annual incidence showed a changeable trend throughout the study period. The average number of cases was 14.5 cases per year, with a median age of 3 years, and 57.9% males. A total of 53.8% received pre-admission oral antibiotics, mainly beta-lactamics. Most frequent presenting clinical findings were fever (77.9%), ear displacement (73.8%), otalgia (71.7%), and postauricular swelling (70.3%). Microbiological cultures were performed in 53 cases; S. pneumoniae was the most isolated microorganism. CT scans were performed in 56.6% cases. All patients received parenteral antibiotic treatment with a median duration of treatment of 5 days. Surgery was performed on 32.6%. Complications were seen in 20% of patients: 13.1% had extracranial complications, and 8.2% had intracranial complications. A significant increase in intracranial complications was detected in the second half of the study period. CONCLUSIONS: A changeable trend in the annual incidence of AM throughout the time of study was observed. A higher proportion of intracranial complications was detected in the last five years of the study period.
Subject(s)
Mastoiditis , Acute Disease , Child, Preschool , Female , Hospitals , Humans , Male , Mastoiditis/diagnosis , Mastoiditis/epidemiology , Mastoiditis/therapy , Retrospective Studies , Spain , Time FactorsABSTRACT
INTRODUCTION: Intracranial complications (ICC) secondary to otitis media are unusual but potentially life-threatening. We report an unusually high frequency of these events, and describe their clinical and epidemiological features. MATERIAL AND METHOD: A retrospective study of all pediatric patients with ICC admitted to our tertiary hospital from April 2004 to November 2007. RESULTS: Eight patients had ICC: Sigmoid sinus thrombosis (4), lateral sinus thrombosis (1), meningitis (2), epidural abscess (1), otitic hydrocephalus (1). Four of the patients had acute mastoiditis. Pre-admission oral antibiotics were administered in 87.5% of the patients. Fever, otalgia, headache and VI and VII cranial nerves paralysis were the most frequent symptoms associated. The microorganism could be isolated in 3 patients: S pyogenes (2) and P mirabilis (1); the remaining patients had negative cultures. All of the patients received broad-spectrum parenteral antibiotics and 2 of them underwent a radical mastoidectomy. CONCLUSIONS: We report an unusually high incidence of cranial complications secondary to acute otitis media. Multicenter studies are needed in order to assess whether there is an increase in the incidence of these events.
Subject(s)
Brain Diseases/epidemiology , Brain Diseases/etiology , Otitis Media/complications , Acute Disease , Child , Child, Preschool , Female , Humans , Infant , Male , Retrospective StudiesABSTRACT
Introducción: las complicaciones intracraneales (CI) secundarias a otitis media son procesos infrecuentes aunque potencialmente graves. Recientemente hemos encontrado una frecuencia inusualmente elevada, cuyas características clínicas y epidemiológicas describimos. Material y método: estudio descriptivo retrospectivo de pacientes con complicaciones intracraneales secundarias a otitis media ingresados en nuestro hospital terciario durante el periodo abril de 2004-noviembre de 2007. Resultados: 8 pacientes han presentado CI: trombosis de seno sigmoideo (4), trombosis de seno lateral (1), meningitis (2), absceso epidural (1) e hidrocefalia otítica (1); 4 de los pacientes presentaban otomastoiditis. El 87,5% de los pacientes había recibido antibioterapia oral previa a la complicación. Los síntomas más frecuentes fueron fiebre, otalgia, cefalea, parálisis del VI par y parálisis facial. Se aisló el germen causal en 3 pacientes: Streptococcus pyogenes (2) y Proteus mirabillis (1). Los demás pacientes tuvieron cultivos negativos. Se realizó mastoidectomía radical en 2 pacientes y tratamiento médico con antibioterapia intravenosa de amplio espectro en todos los pacientes. Se produjo la curación sin secuelas en 6 casos y ninguna muerte. Conclusiones: hemos detectado un incremento en la frecuencia de CI secundarias a otitis media aguda. Para confirmarlo se requieren estudios prospectivos multicéntricos a fin de valorar si se ha producido un cambio epidemiológico en la incidencia de este tipo de complicaciones (AU)
Introduction: Intracranial complications (ICC) secondary to otitis media are unusual but potentially life-threatening. We report an unusually high frequency of these events, and describe their clinical and epidemiological features. Material and method: A retrospective study of all pediatric patients with ICC admitted to our tertiary hospital from April 2004 to November 2007. Results: Eight patients had ICC: Sigmoid sinus thrombosis (4), lateral sinus thrombosis (1), meningitis (2), epidural abscess (1), otitic hydrocephalus (1). Four of the patients had acute mastoiditis. Pre-admission oral antibiotics were administered in 87.5% of the patients. Fever, otalgia, headache and VI and VII cranial nerves paralysis were the most frequent symptoms associated. The microorganism could be isolated in 3 patients: S pyogenes (2) and P mirabilis (1); the remaining patients had negative cultures. All of the patients received broad-spectrum parenteral antibiotics and 2 of them underwent a radical mastoidectomy. Conclusions: We report an unusually high incidence of cranial complications secondary to acute otitis media. Multicenter studies are needed in order to assess whether there is an increase in the incidence of these events (AU)
Subject(s)
Humans , Infant , Child, Preschool , Child , Otitis Media/complications , Intracranial Thrombosis/etiology , Epidural Abscess/etiology , Hydrocephalus/etiology , Meningitis/etiology , Retrospective Studies , Acute DiseaseABSTRACT
No disponible
Subject(s)
Humans , Male , Child , Staphylococcus aureus/isolation & purification , Staphylococcus aureus/pathogenicity , Fever/etiology , Pain/etiology , Pain/therapy , Cloxacillin/therapeutic use , Cefotaxime/therapeutic use , Clindamycin/therapeutic use , Community Health Services/trends , Community Medicine/methods , Carbuncle/complications , Carbuncle/diagnosis , Furunculosis/complications , Osteomyelitis/complications , Epidemiological MonitoringABSTRACT
No disponible