ABSTRACT
La actividad deportiva en niños y adolescentes ha presentado un aumento sostenido en nuestro país en los últimos años; esto ha generado un aumento de las lesiones deportivas por sobreuso. Éstas pueden tener múltiples orígenes, dependiendo de la edad y la actividad del paciente. La mayoría son de manejo conservador, sin embargo, algunas requieren manejo quirúrgico. Lo más importante es la prevención de estas lesiones mediante el uso de equipo apropiado, regulando la intensidad y tipo de entrenamiento y tratando precozmente las lesiones.
Sports activity in children and adolescents has presented a sustained increase in our country in recent years, generating an increase in sports-related overuse injuries. These injuries vary in nature, depending on the patient Ìs age and level of training. Most are conservatively managed; although, some will require surgical treatment. It is important, however, to try to prevent these injuries by using appropriate equipment, regulating the intensity and type of training and treating injuries early
Subject(s)
Humans , Child , Adolescent , Cumulative Trauma Disorders/diagnosis , Cumulative Trauma Disorders/physiopathology , Cumulative Trauma Disorders/therapy , Cumulative Trauma Disorders/prevention & controlABSTRACT
Although infrequent, Trypanosoma cruzi reactivation is possible among patients with HIV/AIDS infection that develop a tumor-like or granulomatous lesion in the CNS. We report the case of a 60 years old male patient with HIV/AIDS and low CD4 lymphocytes count with cerebellar symptoms and mild paresis, associated to supra and infratentorial hypodense lesions and positive serology tests both to T. gondii and Trypanosoma cruzi. Empirical therapy against toxoplasmosis was prescribed together with antiretroviral therapy but without a favorable response. Brain Chagas disease was confirmed by quantitative PCR in the CSF but he died despite nifurtimox treatment. Despite its rare occurrence, Chagas disease affecting the CNS is possible among patients with HIV/AIDS infection. Epidemiological exposure, a positive Chagas serological test and the image pattern of brain lesions support the suspicion. Diagnosis can be confirmed by molecular test in CSF samples, including new quantitative methods. Despite an adverse prognosis, specific therapy can be attempted besides antiretroviral treatment.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Central Nervous System Protozoal Infections/diagnosis , Chagas Disease/diagnosis , Trypanosoma cruzi/genetics , AIDS-Related Opportunistic Infections/parasitology , CD4 Lymphocyte Count , Central Nervous System Protozoal Infections/parasitology , Cerebrospinal Fluid/parasitology , Diagnosis, Differential , Fatal Outcome , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Polymerase Chain Reaction , Trypanosoma cruzi/isolation & purification , Viral LoadABSTRACT
Although infrequent, Trypanosoma cruzi reactivation is possible among patients with HIV/AIDS infection that develop a tumor-like or granulomatous lesion in the CNS. We report the case of a 60 years old male patient with HIV/AIDS and low CD4 lymphocytes count with cerebellar symptoms and mild paresis, associated to supra and infratentorial hypodense lesions and positive serology tests both to T. gondii and Trypanosoma cruzi. Empirical therapy against toxoplasmosis was prescribed together with antiretroviral therapy but without a favorable response. Brain Chagas disease was confirmed by quantitative PCR in the CSF but he died despite nifurtimox treatment. Despite its rare occurrence, Chagas disease affecting the CNS is possible among patients with HIV/AIDS infection. Epidemiological exposure, a positive Chagas serological test and the image pattern of brain lesions support the suspicion. Diagnosis can be confirmed by molecular test in CSF samples, including new quantitative methods. Despite an adverse prognosis, specific therapy can be attempted besides antiretroviral treatment.
La reactivación de la infección por Trypanosoma cruzi es un diagnóstico infrecuente pero posible en pacientes con infección por VIH/SIDA y una lesión de tipo tumoral o granulomatosa en el sistema nervioso central. Presentamos el caso clínico de un paciente de 60 años con VIH/SIDA y recuentos bajos de linfocitos CD4, con síntomas cerebelosos y paresia leve, lesiones hipodensas supra e infratentoriales y serología positiva para Toxoplasma gondii y T. cruzi. Se trató empíricamente como una toxoplasmosis cerebral y con terapia antiretroviral, sin respuesta clínica. La enfermedad de Chagas cerebral se confirmó por RPC cuantitativa en el LCR. El paciente falleció a pesar de recibir terapia con nifurtimox. Apoyan la posibilidad de un Chagas cerebral en pacientes con VIH/SIDA, la exposición epidemiológica, la serología positiva y el patrón de distribución de las lesiones en las imágenes. El diagnóstico puede mejorarse con técnicas moleculares cuantitativas en LCR. A pesar de su mal pronóstico, se puede intentar una terapia específica junto al tratamiento antiretroviral.
Subject(s)
Humans , Male , Middle Aged , Trypanosoma cruzi/genetics , Chagas Disease/diagnosis , AIDS-Related Opportunistic Infections/diagnosis , Central Nervous System Protozoal Infections/diagnosis , Trypanosoma cruzi/isolation & purification , Magnetic Resonance Imaging , Cerebrospinal Fluid/parasitology , Polymerase Chain Reaction , AIDS-Related Opportunistic Infections/parasitology , Fatal Outcome , CD4 Lymphocyte Count , Viral Load , Central Nervous System Protozoal Infections/parasitology , Diagnosis, DifferentialABSTRACT
Disseminated encephalomyelitis (ADEM) is an infrequent condition with considerable morbidity and mortality in adult patients. It requires a high level of suspicion and diagnosis emerges by gathering clinical information, laboratory exams and images studies. ADEM is related to an immunological phenomena occurring after a bacterial/viral infection or recent vaccination. Glucocorticoids are the first line treatment, reserving immunoglobulins and plasmapheresis to refractory cases. We report a male patient aged 25, with ADEM associated to parainfluenza 3 virus respiratory infection that required mechanical ventilation and that had a complete recovery only after plasmapheresis.
Subject(s)
Encephalomyelitis, Acute Disseminated/virology , Parainfluenza Virus 3, Human , Respirovirus Infections/complications , Adult , Encephalomyelitis, Acute Disseminated/therapy , Humans , Magnetic Resonance Spectroscopy , Male , Plasmapheresis , Respiration, Artificial , Respirovirus Infections/therapy , Severity of Illness IndexABSTRACT
Disseminated encephalomyelitis (ADEM) is an infrequent condition with considerable morbidity and mortality in adult patients. It requires a high level of suspicion and diagnosis emerges by gathering clinical information, laboratory exams and images studies. ADEM is related to an immunological phenomena occurring after a bacterial/viral infection or recent vaccination. Glucocorticoids are the first line treatment, reserving immunoglobulins and plasmapheresis to refractory cases. We report a male patient aged 25, with ADEM associated to parainfluenza 3 virus respiratory infection that required mechanical ventilation and that had a complete recovery only after plasmapheresis.
La encefalomielitis aguda diseminada es una enfermedad infrecuente pero de elevada morbi-mortalidad en pacientes adultos. Demanda una sospecha y diagnóstico precoz que requiere el concurso de información clínica, pruebas de laboratorio y estudio de imágenes. De sustrato inmunológico, se puede relacionar a una infección viral, bacteriana o inmunización reciente. Los glucocorticoides son el tratamiento de elección, mientras que la inmunoglobulina intravenosa y la plasmaféresis se reservan para casos refractarios. Se presenta el caso de una encefalomielitis aguda diseminada grave, en un paciente de sexo masculino de 25 años, asociado a una infección respiratoria por virus parainfluenza 3. Requirió conexión a ventilación mecánica y tuvo una respuesta completa con plasmaféresis.
