RESUMO
Legionnaires disease continues to be underreported in the Middle East--a reflection of underdiagnosis, both clinically and by laboratory investigations. We draw the attention to this unusual cause of occasionally fatal, yet severe, pneumonia by reporting an immunocompromised infant who succumbed to Legionella pneumophila pneumonia. The urinary test for Legionella antigen was positive, and this was then confirmed by a bronchoalveolar fluid culture. Moreover we have reviewed the incidence, pathophysiology, association with immunodeficiency, diagnostic tools, and treatment in this case report.
Assuntos
Hospedeiro Imunocomprometido , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/fisiopatologia , Pneumonia Bacteriana/fisiopatologia , Antígenos de Bactérias/urina , Líquido da Lavagem Broncoalveolar/microbiologia , Evolução Fatal , Feminino , Humanos , Lactente , Doença dos Legionários/diagnóstico , Doença dos Legionários/microbiologia , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/microbiologia , Arábia Saudita , Índice de Gravidade de DoençaAssuntos
Analgésicos Opioides/efeitos adversos , Anus Imperfurado/cirurgia , Epilepsia Generalizada/induzido quimicamente , Meperidina/efeitos adversos , Síndromes Neurotóxicas/etiologia , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Feminino , Humanos , Lactente , Infusões Intravenosas , Meperidina/administração & dosagemRESUMO
BACKGROUND: Exhaled nitric oxide (eNO) is elevated in inflammatory airway conditions, e.g. asthma. We measured eNO levels in normal preschool children for whom there is little data available and in whom the prevalence of asthma is high. SUBJECTS AND METHODS: Fifty children, 2-7 years old, undergoing elective surgery, excluding airway procedures, were recruited. Children with known respiratory disease or acute viral infections were excluded. Gas for eNO measurement was collected in a non-diffusion bag via 1) the mask after inhalation induction of anesthesia, 2) endotreacheal tube (ETT) or laryngeal mask airway (LMA), and 3) during emergence. Measurement was off-line by chemiluminescent analyzer. RESULTS: Mean eNO level by mask was 10.23 ppb (mean value+/-SD of 8.8-11.1 ppb) after induction and 8.35 ppb (mean value+/-SD of 5.9-10.8 ppb) on emergence. Mean eNO for the intubated group (n=25) was 0.75 ppb (mean value+/-SD of 0.4-1 ppb) (P<0.0001 vs mask); mean eNO for the LMA group (n=25) was 2.6 ppb (mean value+/-SD of 2-3.2 ppb), which differed from the mask (P<0.0001), and from ETT values (P<0.0001). CONCLUSIONS: Most eNO is produced by the upper airway in healthy pre-school children. The lower airway constitutive eNO production is very low. The LMA does not completely isolate the upper airway and current mask collection techniques allow significant contamination of samples by sino-nasal eNO production in young children.