¿Dengue, siempre una enfermedad importada en España? / Dengue? Always an imported disease in Spain?

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Tos ferina, una enfermedad reemergente / Whooping cough, a re-emerging disease

Objetivo. Estamos asistiendo a una reemergencia de la tos ferina. Los lactantes que no han completado la primo-vacunación son el grupo de riesgo más vulnerable. La transmisión de la infección se asocia normalmente a un contacto domiciliario. Para ponerlo de manifiesto hemos desarrollado esta revisión. Material y métodos. Estudios descriptivo, retrospectivo, mediante revisión de serie de casos de pacientes con diagnóstico microbiológico de tos ferino ingresados en el Hospital Universitario Virgen Macarena desde Enero de 2006 a Junio de 2013. Resultados. Total de pacientes diagnosticados de tos ferina: 49. Aumento de la incidencia de la enfermedad en los últimos años, con un 75,5% de los casos entre enero de 2010 a junio de 2013. Un 83,7% de los pacientes fueron menores de 6 meses. Dos de ellos son diagnosticados de tos ferina maligna con evolución favorable tras exanguinotransfusión. Mayor días de ingreso para los pacientes de menor edad. El estudio mediante PCR en secreción nasofaríngea fue positivo en un 53,8% de los familiares estudiados. Conclusiones. Parece importante plantear un cambio en la estrategia de vacunación actual frente a la tos ferina, para disminuir la incidencia de la misma en los distintos grupos de edad y sus complicaciones como la tos ferina maligna (AU)

Goal. We are witnessing a resurgence of pertussis, being the infants who have not completed the primary vaccination yet the most vulnerable risk group. The transmission of the infection is usually associated to a household contact. To show it, we have developed this review. Material and methods. A Descriptive, retrospective study based on the review of a number of cases of patients with microbiological diagnosis of pertussis admitted to the Virgen Macarena University Hospital from January 2006 to June 2013. Results. The total number of patients diagnosed with pertussis was 49. It shows an increase in the incidence of the disease in recent years, with 75.5% of cases between January 2010 to June 2013. Most patients, 83,7%, were less than 6 moths. Two of them are diagnosed with malignant pertussis favorable outcome after exchange transfusion. The average time of hospitalization is higher for younger patients. The study by PCR in nasopharyngeal secretions was positive in 53,8% of the relatives studied. Conclusions. In view of the data presented, it seems important to change the current vaccination strategy with respect to the pertussis to reduce its incidence in the different age groups and its complications such as malignant pertussis (AU)

Síndrome del lóbulo medio y tuberculosis endobronquial. Aportación de la fibrobroncoscopia / Middle lobe syndrome and endobronchial tuberculosis. Contribution of fiberoptic bronchoscopy

El síndrome del lóbulo medio es una patología frecuente en el niño, sobre todo en relación con el asma y/o la hiperreactividad bronquial, aunque existen otras muchas causas, como los cuerpos extraños, la tuberculosis endobronquial, etc. Presentamos el caso de un niño de 5 años de edad, con atelectasia persistente en la base derecha con participación del lóbulo medio, que se diagnosticó de tuberculosis. La tomografía computarizada confirmó la lesión y, ante una prueba de la tuberculina positiva, se realizó una fibrobroncoscopia para descartar una tuberculosis endobronquial, que demostró la presencia de una lesión polipoidea en el bronquio intermediario a la entrada del lóbulo medio. Se describen las diversas formas de tuberculosis endobronquial, así como el tratamiento con corticoides sistémicos. Se aconseja la realización de una fibrobroncoscopia en los casos de tuberculosis pulmonar con alteraciones radiológicas persistentes (atelectasia, atrapamiento aéreo, etc.) y/o falta de mejoría clínica pese al tratamiento adecuado(AU)

Middle lobe syndrome is a common condition in children, mainly related to asthma and/or bronchial hyperresponsiveness, although there are many other causes, such as foreign bodies, endobronchial tuberculosis, etc. We report a 5-year-old child with persistent atelectasis involving the right middle lobe, and diagnosed with tuberculosis. Computed tomography confirmed the injury and after a positive tuberculin skin test, fiberoptic bronchoscopy is performed to rule out endobronchial tuberculosis showing a polypoid lesion in the bronchus intermedius at the entrance of the middle lobe. It describes the various forms of endobronchial tuberculosis, and treatment with systemic corticosteroids. Fiberoptic bronchoscopy is recommended in cases of pulmonary tuberculosis with persistent radiographic abnormalities (atelectasis, air trapping, etc.) and/or a lack of clinical improvement with an adequate treatment(AU)

[Acute meningococcal disease. Its prognostic assessment]. / Enfermedad meningocócica aguda. Valoración pronóstica.

We have studied 50 children affected with acute meningococcal disease (AMD). The ages of the children varied between 4 months and 12.58 years, with a mean age of 4.58 years. By using the shock state and DIC syndrome, both of which are indications of the severity of the illness, an evaluation of the discriminatory capacity was done with regard to significantly associate variables and 3 scores, Bjorvatn, Leclerc and PRISM, throughout 8 intervals within the first 48 hours of hospital treatment. We observed a very high survival rate (98%) associated with the early treatment for shock. Leukopenia and disseminated purpura were the best variables in order to discriminate shock and DIC, respectively. The greatest capacity for the diagnosis of the shock state and DIC syndrome were registered during the 0-6 hour period and the 0-12 hour period, respectively. The prognosis improved if the child remained alive 12 hours after the treatment had begun.