RESUMO
BACKGROUND: Visceral leishmaniasis occurring in malnourished subjects can have an uncommon course, which explains difficulties in its diagnosis. CASE REPORT: A 22-month-old infant was admitted because of malnutrition and prolonged fever. The bacteriological investigation was negative. When his nutritional status improved, he developed a splenomegaly. The medullogram confirmed the diagnosis of visceral leishmaniasis. The course was then favorable with treatment by pentavalent antimonial. CONCLUSION: Malnutrition constitutes a risk factor of opportunist parasitic disease such as leishmaniasis. Its diagnosis can be very difficult.
Assuntos
Transtornos da Nutrição do Lactente/complicações , Transtornos da Nutrição do Lactente/diagnóstico , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/etiologia , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Transtornos da Nutrição do Lactente/terapia , Leishmaniose Visceral/tratamento farmacológico , Avaliação Nutricional , Estado Nutricional , Desnutrição Proteico-Calórica/terapia , Fatores de RiscoRESUMO
Urinary tuberculosis is a rare disease in children. It poses major diagnostic problems because of clinical symptoms, which are often atypical and misleading. It causes serious lesions which are often multifocal and extensive, requiring complex surgical excision and urinary tract reconstruction. Prevention of this disease is based on generalized vaccination with BCG and adequate treatment of pulmonary tuberculosis. The authors report a case of urinary tuberculosis in a fourteen-year-old child who presented episodes of cystitis and hematuria refractory to treatment. The diagnosis, confirmed by the positive test for AFB in the urine was established late, at the stage of silent kidney and scleroatrophic bladder. The patient was treated with antituberculous chemotherapy (Isoniazid; Rifampicin, PZA) and nephro-ureterectomy with augmentation enterocystoplasty.