Endobronchial atypical mycobacteria in an immunocompetent child.

Endobronchial granulomas in children are mainly caused by mycobacterial infections. In addition to Mycobacterium tuberculosis, other organisms such as nontuberculous mycobacteria (NTM) have emerged. These organisms cause a broad spectrum of pulmonary diseases. An isolated endobronchial NTM infection in a child is reported. After bronchoscopic removal, a decision not to add drug treatment was made, with satisfactory results. Treatment options are not well established in children and remain a source of controversy. Different options are discussed.

Neumonía afebril del lactante / Afebrile pneumonia syndrome of the unweaned baby

La infección por Chlamydia trachomatis es una de las enfermedades de transmisión sexual más frecuentes. El neonato puede infectarse en el canal del parto, y puede desarrollar una neumonía o una conjuntivitis posteriormente. La neumonía suele presentarse entre el primer y el tercer mes de vida, y cursa con accesos de tos y congestión nasal. Dada su similitud clínica con la bronquiolitis, debemos tenerla en cuenta en el diagnóstico diferencial, especialmente en los primeros 3 meses de vida. El diagnóstico puede hacerse tanto por cultivo de C. trachomatis como por la detección de antígeno en muestras de aspirado nasofaríngeo o mediante la determinación de anticuerpos en sangre. El tratamiento de elección para su erradicación es la eritromicina oral durante 14 días (AU)

The Chlamydia trachomatis infection is one of the most frequent diseases of sexual transmission. The newborn can be infected through the birth canal, and develop a pneumonia or a conjunctivitis later. Pneumonia can appear between the first and third month of life, and is manifested with coughing fit and nasal congestion. Given its clinical similarity with the bronchiolitis, it should be considered in its differential diagnosis, especially during the first three months of age. The diagnosis can be performed either by culture of C. trachomatis or by the detection of antigens in nasopharyngeal aspirate samples or determination of antibodies in blood. A 14-day course of oral erythromycin is the best treatment option for its eradication (AU)

Artritis meningocócica como presentación de enfermedad invasiva insospechada / Meningococcal arthritis as the form of presentation of unsuspected invasive disease

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[Bladder hyporeflexia caused by vinca alkaloids]. / Hiporreflexia vesical producida por los alcaloides de la vinca.

Presentation of one case of hyporreflexic bladder like a first step of neurotoxicity due to Vinca alkaloids. These drugs produces peripheral neuropathies as usual, but in some rare occasions they may affect to the autonomic nervous system with its effects in the bladder producing hyporreflexic. This disease reverts spontaneously after suppressing drugs.

Hiporreflexia vesical producida por los alcaloides de la vinca / Hyporreflexic bladder due to vinca alkaloids

Se presenta un caso de hiporreflexia vesical como primera manifestación de neurotoxicidad, debida a la administración de los alcaloides de la Vinca; estas sustancias comúnmente producen neuro-patía periférica, pero en raras ocasiones afectan al sistemas nervioso autónomo con su correspondiente efecto sobre la vejiga produciendo hiporreflexia, dicha alteración se corrige espontáneamente tras la supresión del fármaco (AU)

[Streptococcal gangrene and so-called "flesh-eating bacteria disease". A rare and devastating disease]. / La gangrena estreptocócica y la así llamada "enfermedad de las bacterias devoradoras de carne". Una infección rara y devastadora.

Streptococcal gangrene, an unusual form of necrotizing fasciitis with fatal outcome, has been recently rediscovered and has gained popularity with the name "disease of flesh eating bacteria". The incidence of this and other severe diseases caused by Streptococcus pneumoniae has been suggested to be increasing. Only three patients with this disease have been studied at our institution in the last 12 years and in a review of a bacteremic infections caused by beta-hemolytic streptococci a significant increase of these infections was not observed. We report here the clinical and pathological characteristics of streptococcal gangrene as well as a review of the more recent literature.

[The treatment results in children diagnosed with non-Hodgkin's lymphomas and acute B-cell lymphoblastic leukemias treated by the BFM protocols. The report of the POGM (Pediatric Oncology Group of Madrid)]. / Resultados del tratamiento de niños diagnosticados de linfomas no Hodgkin y leucemias linfoblásticas agudas de células B tratados con protocolos BFM. Informe del GOPM (Grupo de Oncología Pediátrica de Madrid).

OBJECTIVE: The purpose of this study was to reproduce the results obtained by the "BFM Group" in children with NHL and B-ALL treated with BFM 86 and 90 protocols. PATIENTS AND METHODS: From April 1987 until January 1997, we have treated a total of 82 children, 22 with non-B NHL, 49 B-NHL and 11 B-ALL. Forty-four of them were treated according to BFM 86 and 38 according to BFM 90 protocols. RESULTS: Ninety-four percent of the patients achieved complete remission (CR) and 15% of these relapsed, 12% of the cases of B NHL/ALL and 23% of the non-B NHL. The 5 year overall survival (Kaplan Meier) was 81% for the B NHL/ALL it was 83% and for non-B NHL 77%. The event-free survival was 75% for B-NHL, stages I and II it was 80% and stages II and IV 78%, for B-ALL 72% and for non-B NHL 68%. The median follow-up time was 50 months (12-106). CONCLUSIONS: Treatment of NHL and B-ALL with BFM protocols is an effective therapeutic choice, with reproduction of the results of the "BFM group" being feasible.

[The results of treatment by the Madrid Pediatric Oncology Group according to the BFM protocols in non-Hodgkin's B-cell lymphoma and acute B-cell lymphoblastic leukemia in pediatric patients]. / Resultados del tratamiento según protocolos BFM del linfoma no Hodgkin B y de la leucemia linfoblástica aguda de células B en pacientes pediátricos por el GOPM.

The objective of this report is to present the results of the BFM group in the treatment of 41 children with non-Hodgkin's B cell lymphoma and acute B cell lymphoblastic leukemia according to the BFM 86 and 90 protocols. Forty-one children, between 2 and 16 years of age, were treated from November 1987 to October 1993. Of these, 25 were treated with the BFM 86 protocol (18 non-Hodgkin's B cell lymphomas and 7 acute B cell lymphoblastic leukemias) and the rest with the BFM 90 protocol (15 non-Hodgkin's B cell lymphomas and 1 acute B cell lymphoblastic leukemia). Complete remission was achieved in 97.5% of the patients. A relapse occurred in 12.5% of the cases. Currently, 80.4% remain in continuous complete remission and 17% have died. The 5 year actuarial survival rate of those treated with the BFM 86 and 90 protocols was 79% and 87%, respectively, and event free survival in the same period was 76% and 87%, respectively. There was no statistically significant difference in the results obtained with the two treatment protocols.

[Treatment of infantile acute lymphoblastic leukemia with protocol ALL-BFM 83]. / Tratamiento de la leucemia aguda linfoblástica infantil con el protocolo ALL-BFM 83.

The outcome of 63 children with non-B acute lymphoblastic leukemia treated with ALL-BFM 83 protocol is analyzed. 95% achieved complete remission with the initial treatment. For the entire group the event free survival (EFS) was 66% (+/- 9%) at 48 months. These results were close to those obtained by the BFM group. Haematological toxicity was the main adverse effect, but there where no therapy related deaths. Persistence of more than 1,000 blast cells per microl in peripheral blood after 7th days of prednisone monotherapy, and spleen size greater than or equal to 5 cm under the costal margin, were identified as independent risk factors of high significance. The EFS in patients with poor clinical response to steroids (greater than or equal to 1,000 blast/microl at day 8) was 22% (+/- 18%), instead of 69% (+/- 12%) in those with adequate response.