RESUMEN
In 2019, Burkholderia pseudomallei was isolated from the backyard of 2 siblings with melioidosis in Kerala, India. This finding highlights the value of healthcare providers being aware of risk for melioidosis in febrile patients, of residents taking precautions when outside, and of increasing environmental surveillance for B. pseudomallei in this region.
Asunto(s)
Burkholderia pseudomallei , Melioidosis , Adolescente , Burkholderia pseudomallei/genética , Monitoreo del Ambiente , Humanos , India/epidemiología , Melioidosis/epidemiología , HermanosRESUMEN
MPT64 is a 24-kDa immunogenic protein that is widely used as a diagnostic marker for the differentiation of Mycobacterium tuberculosis complex (MTBC) from nontuberculous Mycobacterium (NTM). Unlike Mycobacterium bovis, Bacillus Calmette-Guerin (BCG) vaccine strains with RD2 deletion do not secrete MPT64. Culture isolates from infections due to these strains may be falsely identified as nontuberculous Mycobacterium in the absence of clinical correlation. Here, we present one case each of BCG adenitis and osteitis, both of which were considered as MPT64 card-negative Mycobacterium spp. (i.e., NTM) and were later identified as M. bovis BCG Danish 1331 strain. The first case was a 4-month-old female infant admitted with swollen lymph nodes in the left supraclavicular and the left axillary region of 1 month duration. The second case was of a 1-year-and-5-month-old male child who presented with a limp on the left leg and soft tissue swelling of 1 month duration on the anterolateral aspect of the left knee joint. In both cases, BCG vaccine was administered at birth on the left deltoid region and had healed without any complication. Clinical samples in both cases were positive by Xpert tuberculosis/RIF for MTBC, and cultures grew acid-fast bacilli which were negative by MPT64 assay. The clinical implication of infections due to M. bovis BCG is immense as they are inherently resistant to pyrazinamide, and the presence of disseminated BCG infection in young children is a hallmark of serious immune deficiency which needs to be ruled out.
Asunto(s)
Vacuna BCG/inmunología , Mycobacterium bovis/aislamiento & purificación , Mycobacterium tuberculosis/inmunología , Micobacterias no Tuberculosas/inmunología , Tuberculosis/diagnóstico , Femenino , Humanos , Lactante , Masculino , Tuberculosis/microbiologíaRESUMEN
We report a child with hypereosinophilic syndrome who presented with cardiogenic shock. In addition, she had skin and joint involvement. The clinical condition improved and eosinophil counts normalized with steroid therapy. However, the skin lesions and hypereosinophilia relapsed on stopping the steroids. The child was subsequently maintained in remission on low dose prednisolone.
Asunto(s)
Síndrome Hipereosinofílico/complicaciones , Choque Cardiogénico/complicaciones , Antiinflamatorios/uso terapéutico , Niño , Exantema/etiología , Femenino , Fiebre/etiología , Humanos , Síndrome Hipereosinofílico/tratamiento farmacológico , Prednisolona/uso terapéutico , Choque Cardiogénico/tratamiento farmacológicoRESUMEN
We describe two cases of Reactive Hemophagocytic syndrome (RHS) occurring in rheumatic diseases in childhood. Patient 1, an adolescent girl with systemic onset Juvenile idopathic arthritis (JRA) presented like severe sepsis with shock, hepatic dysfunction and coagulopathy. Patient 2 presented with cardiac tamponade, she was later detected to have systemic lupus erythematosus (SLE). Her bone marrow aspirate revealed prominent hemophagocytosis. Both cases improved with pulse methylprednisolone therapy.
Asunto(s)
Artritis Juvenil/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Linfohistiocitosis Hemofagocítica/etiología , Adolescente , Trastornos de la Coagulación Sanguínea/etiología , Taponamiento Cardíaco/etiología , Femenino , Glucocorticoides/administración & dosificación , Humanos , Hígado/fisiopatología , Linfohistiocitosis Hemofagocítica/complicaciones , Linfohistiocitosis Hemofagocítica/tratamiento farmacológico , Linfohistiocitosis Hemofagocítica/fisiopatología , Metilprednisolona/administración & dosificación , Quimioterapia por PulsoRESUMEN
A 12-year-old boy presented with fever and sore throat of 6 days duration followed by vomiting and altered sensorium. He had received 4 doses of antirabies vaccine following a dog bite 4 weeks back. Rabies immunoglobulin was not given. History of hydrophobia and aerophobia were strikingly absent. The possibilities of rabies encephalitis and vaccine induced acute disseminated encephalomyelitis (ADEM) were considered. MRI brain showed exclusive grey matter changes characteristic of rabies. The diagnosis was further confirmed by serological tests.