Brucellosis infection presenting with cholestasis.

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.

Mastoiditis aguda: experiencia en los últimos 10 años en hospital terciario del sur de España / Acute mastoiditis: experience in a tertiary-care center in the South of Spain during 1999–2008 period

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 1999–2008. 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)

[Acute mastoiditis: experience in a tertiary-care center in the South of Spain during 1999-2008 period]. / Mastoiditis aguda: experiencia en los últimos 10 años en hospital terciario del sur de España.

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.

[Unusually high frequency of complications in acute otitis media]. / Frecuencia inusualmente elevada de complicaciones secundarias a otitis media aguda.

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.

Frecuencia inusualmente elevada de complicaciones secundarias a otitis media aguda / Unusually high frequency of complications in acute otitis media

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)

Infección por Staphylococcus aureus resistente a meticilina de origen comunitario con transmisión intrafamiliar / No disponible

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