Meningitis por Salmonella tras toxiinfección alimentaria en lactante alimentado con lactancia artificial / Meningitis due to Salmonella after food poisoning in an infant fed with formula milk

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Dilatación y fisuras anales: ¿abuso sexual? / Dilation and anal fissures: sexual abuse?

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Discitis: ¿podemos mejorar su evolución?. Resultado de un estudio retrospectivo / Diskitis: can we improve its course? Results of a retospective study

Objetivo: Describir el diagnóstico y el tratamiento de esta entidad. Pacientes y métodos: Revisión retrospectiva de 19 casos consecutivos diagnosticados de discitis no tuberculosa en nuestro centro en 16 años. Resultados: Un 58% de la muestra eran varones y un 74%menores de 4 años. Se observó un discreto aumento de incidencia en verano. La demora media del diagnóstico fue de 20días. Los hallazgos clínicos fueron los siguientes: rechazo a la sedestación (57,9%), fiebre (42,1%), contractura muscular para espinal (31,5%), lumbalgia (31,5%), irritabilidad (26,3%), rechazo a la deambulación (21%) y dolor abdominal (15,7%). En los estudios analíticos destacó un aumento de la velocidad de sedimentación globular de forma prácticamente constante. El hemocultivo fue positivo en un 11,2% de los casos. La única punción-aspiración de disco realizada aisló colonias de Staphylococcusaureus. Las pruebas de imagen más sensibles fueron la gammagrafía ósea (91%) y la resonancia magnética (RM) de columna (86,6%). Las localizaciones más frecuentes fueron: L4-L5 (31,5%), L5-S1 (21%) y L3-L4 (15,8%). Todos los casos se trataron con reposo y un 89% de los pacientes recibió antibioterapia. La estancia media hospitalaria fue de 17 días. Hubo un caso de recidiva. Cuatro casos presentaron secuelas no limitantes. Conclusiones: La discitis es un cuadro más frecuente en la época preescolar. La clínica más frecuente al inicio es el rechazo a la sedestación y fiebre. La escasa incidencia y la inespecificidad de los síntomas explican la demora diagnóstica. La localización más frecuente es el área lumbosacra. La RM y la gammagrafía ósea son de gran utilidad en el diagnóstico de la discitis. El tratamiento se basa en antibioterapia, reposo e inmovilización(AU)

Aim: To describe the diagnosis and therapeutic management of childhood diskitis. Patients and methods: A retrospective review of 19 consecutive cases of diskitis diagnosed in our center over a 16-year period. Results: Fifty-eight percent of the patients were boys, 74%of them younger than 4 years old. A slight increase in the incidence was observed in summer. The mean delay in diagnosis was 20 days. The clinical findings were refusal to stand (57.9%), fever (42.1%), paraspinal muscle spasm (31.5%), back pain (31.5%), irritability (26.3%), refusal to walk (21%) and abdominal pain (15.7%). The analytical studies revealed an increase in the erythrocyte sedimentation rate in nearly every case. The blood culture was positive in 11.2% of the cases. In the one case in which aspiration of the disk space was performed, Staphylococcus aureus was isolated. Radionuclide bones can and magnetic resonance imaging were the most sensitive tests (91% and 86.6%, respectively). The most common sites were L4-L5 (31.5%), L5-S1 (21%) and L3-L4 (15.8%). All the patients were treated with immobilization and 89% received antibiotics. The mean hospital stay was 17 days. There was one case of recurrence. Four patients presented sequelae. Commentaries: Diskitis is more frequent among preschool children. The most common onset symptoms are refusal tostand and fever. The low incidence and lack of specificity of the symptoms explain the diagnostic delay. The lumbar region is the most frequent location. Radionuclide bone scan and magnetic resonance imaging are of great utility in the diagnosis of diskitis. Treatment is based on antibiotics and immobilization(AU)

[Toxic shock syndrome: experience in a pediatric intensive care unit]. / Síndrome de shock tóxico: experiencia en una UCIP.

OBJECTIVES: To review patients with toxic shock syndrome (TSS) in a pediatric intensive care unit. METHODS: We performed a retrospective study of patients with TSS admitted to the intensive care unit in the previous 15 years. The patients included were those that met the clinical and microbiological criteria for TSS proposed by the Centers for Disease Control and Prevention. RESULTS: There were nine patients (four boys). The mean age was 7 years. The most frequent findings were fever (100 %), hypotension (100 %), erythroderma (100 %), multisystem organ failure [coagulopathy (100 %), lethargy (89 %), hypertransaminasemia (89 %), increased creatine phosphokinase levels (78 %), renal failure (66 %)] and cutaneous desquamation (100 %). Laboratory studies showed changes in the leukocyte count and C-reactive protein value in all patients. The etiology was as follows: Staphylococcus was detected in six patients (S. epidermidis in three and S. aureus in three) and Streptococcus was detected in two patients (S. pyogenes in one and S. pneumoniae in one); no microorganisms were detected in only one patient. The origin of the infection was identified in seven patients (cutaneous in six patients and tonsillar in one). All patients received life support and antibiotic treatment. Six patients received corticosteroid treatment and one received intravenous immunoglobulins. Patients with TSS secondary to Streptococcus showed the greatest severity, exhibiting renal failure and requiring greater respiratory and circulatory support. All patients recovered well from the infection, without serious long-term sequelae. CONCLUSION. TSS should be included in the differential diagnosis of patients with fever, exanthema and shock, since early diagnosis has been shown to improve outcomes. S. pneumoniae should be included among the microorganisms that cause TSS. Treatment is based on life support measures and antibiotic therapy.

[Optic pathway astrocytoma: an unusual cause of failure to thrive in infants]. / Astrocitoma de vías ópticas: una causa infrecuente de retraso ponderal en el lactante.

Failure to thrive is a frequent cause of consultation in pediatric services. The main objective in these patients is the early detection of an organic cause, if present. We report a case of low-grade astrocytoma of the optic pathway in a 2-month-old child whose main symptoms at diagnosis were failure to thrive and anorexia. Unfortunately, despite therapeutic efforts, the tumor showed local and metastatic progression refractory to chemotherapy. The patient died 3 months after diagnosis. We conclude that diencephalic tumors must be considered in the differential diagnosis of failure to thrive during the first year of life, especially when, after initial investigations, a cause is not found.

Síndrome de shock tóxico: experiencia en una UCIP / Toxic shock syndrome: experience in a pediatric intensive care unit

Objetivos. Revisar los casos de síndrome de shock tóxico (SST) admitidos en una unidad de cuidados intensivos pediátricos. Métodos. Estudio retrospectivo de los casos de SST ingresados en los últimos 15 años. Se incluyeron aquellos casos que cumplían los criterios clínico-microbiológicos propuestos por el Center for Disease Control and Prevention (CDC). Resultados. Revisión de un total de 9 casos (4 varones). Edad media de 7 años. Hallazgos más frecuentes: fiebre (100 %), hipotensión (100 %), eritrodermia (100 %), fallo multiorgánico (coagulopatía 100 %, depresión del sensorio 89 %, hipertransaminemia 89 %, aumento de creatinfosfocinasa (CPK) 78 %, insuficiencia renal 66 %, etc.) y descamación cutánea (100 %). En la analítica sanguínea se detectaron alteraciones en la fórmula leucocitaria y la proteína C reactiva de forma constante. Etiología: en 6 casos se aislaron Staphylococcus (tres S. epidermidis, tres S. aureus); en 2 casos Streptococcus (uno S. pyogenes, uno S. pneumoniae), tan sólo en un caso no se detectó microorganismo. El origen de la infección se evidenció en 7 casos: seis de origen cutáneo y uno amigdalar. Todos los pacientes recibieron soporte vital y antibioterapia. Recibieron corticoterapia 6 casos y uno gammaglobulina. Los casos secundarios a Streptococcus presentaron mayor gravedad: insuficiencia renal, mayor soporte ventilatorio y vasoactivo. Todos los casos evolucionaron correctamente del cuadro infeccioso, sin existir secuelas de gravedad a largo plazo. Conclusión. Es necesario incluir el SST en el diagnóstico diferencial de aquellos casos que cursan con fiebre, exantema y shock, ya que un diagnóstico precoz ha demostrado mejorar el pronóstico. S. pneumoniae debe incluirse dentro de los microorganismos causantes de SST. El tratamiento se fundamenta en medidas de soporte y antibioterapia

Objectives. To review patients with toxic shock syndrome (TSS) in a pediatric intensive care unit. Methods. We performed a retrospective study of patients with TSS admitted to the intensive care unit in the previous 15 years. The patients included were those that met the clinical and microbiological criteria for TSS proposed by the Centers for Disease Control and Prevention. Results. There were nine patients (four boys). The mean age was 7 years. The most frequent findings were fever (100 %), hypotension (100 %), erythroderma (100 %), multisystem organ failure [coagulopathy (100 %), lethargy (89 %), hypertransaminasemia (89 %), increased creatine phosphokinase levels (78 %), renal failure (66 %)] and cutaneous desquamation (100 %). Laboratory studies showed changes in the leukocyte count and C-reactive protein value in all patients. The etiology was as follows: Staphylococcus was detected in six patients (S. epidermidis in three and S. aureus in three) and Streptococcus was detected in two patients (S. pyogenes in one and S. pneumoniae in one); no microorganisms were detected in only one patient. The origin of the infection was identified in seven patients (cutaneous in six patients and tonsillar in one). All patients received life support and antibiotic treatment. Six patients received corticosteroid treatment and one received intravenous immunoglobulins. Patients with TSS secondary to Streptococcus showed the greatest severity, exhibiting renal failure and requiring greater respiratory and circulatory support. All patients recovered well from the infection, without serious long-term sequelae. Conclusion. TSS should be included in the differential diagnosis of patients with fever, exanthema and shock, since early diagnosis has been shown to improve outcomes. S. pneumoniae should be included among the microorganisms that cause TSS. Treatment is based on life support measures and antibiotic therapy

Astrocitoma de vías ópticas: una causa infrecuente de retraso ponderal en el lactante / Optic pathway astrocytoma: an unusual cause of failure to thrive in infants

El retraso ponderal durante la lactancia es un motivo de consulta frecuente en los servicios de pediatría. El principal objetivo a la hora de abordar estos casos radica en distinguir aquellos casos secundarios a una causa orgánica de forma precoz. Aportamos un caso de astrocitoma de bajo grado de vías ópticas en un lactante de 2 meses de edad cuyos síntomas guía en el momento del diagnóstico fueron retraso ponderal y rechazo del alimento. Desafortunadamente, a pesar de los esfuerzos terapéuticos, el tumor presentó una progresión local y metastásica refractaria al tratamiento quimioterápico. Finalmente la paciente falleció a los 3 meses del diagnóstico. Concluimos que los tumores diencefálicos deben contemplarse en el diagnóstico diferencial del fallo de medro durante el primer año de vida; principalmente en aquellos casos en los cuales, tras un estudio inicial, no se encuentra una causa aparente

Failure to thrive is a frequent cause of consultation in pediatric services. The main objective in these patients is the early detection of an organic cause, if present. We report a case of low-grade astrocytoma of the optic pathway in a 2-month-old child whose main symptoms at diagnosis were failure to thrive and anorexia. Unfortunately, despite therapeutic efforts, the tumor showed local and metastatic progression refractory to chemotherapy. The patient died 3 months after diagnosis. We conclude that diencephalic tumors must be considered in the differential diagnosis of failure to thrive during the first year of life, especially when, after initial investigations, a cause is not found

[Scrotal edema: a rare complication of percutaneous central venous atheters]. / Edema escrotal neonatal: rara complicación de catéter venoso central percutáneo.

The use of percutaneous central venous catheters in neonatal intensive care units is becoming increasingly common. Numerous studies support the safety and effectiveness of the use of these catheters for the infusion of parenteral nutrition or medication. We describe a male patient with a gestational age of 32 weeks who showed swelling of the external genitals during the fifth day of life. The etiology was initially thought to be infectious. A review of X-rays revealed the introduction of the silastic catheter to the spermatic vessels. When the catheter was withdrawn, the genital swelling disappeared in a few hours. The most frequently described complications associated with percutaneous central venous catheters are infectious. Other complications that have been described are thrombosis, embolism, and perforation of the catheter with leakage of fluid to the extravascular space. The case described herein is an unusual complication that has not been previously described and resulted from poor positioning of the catheter tip. Diagnostic delay can cause serious complications.

[Ondine syndrome: diagnosis and management]. / Síndrome de Ondine: diagnóstico y seguimiento.

Ondine's syndrome is a congenital central hypoventilation syndrome due to a disorder in the autonomic control of breathing in the absence of any primary disease that would explain it. Although the incidence of this entity is low, it may be underestimated due to the variable clinical expression of this syndrome, depending on its severity. Early diagnosis is of great importance to provide appropriate management to prevent the acute and chronic asphyxia that determines the long-term prognosis of this disease. This review aims to present practical management guidelines to provide doctors unfamiliar with this syndrome with basic knowledge of the diagnosis, treatment and follow-up of these patients.

[Non-invasive ventilation in neonates with Ondine syndrome: a real indication?]. / Ventilación no invasiva en lactantes afectados de síndrome de Ondine: 'una indicación real?

Ondine's syndrome is a congenital central hypoventilation syndrome due to a disorder in the autonomic control of breathing in the absence of any primary disease that would explain it. Noninvasive ventilation (NIV) has been reported to be effective in the management of these patients, thus avoiding the need for tracheotomy for prolonged mechanical ventilation. We describe our experience of NIV in infants with Ondine's syndrome. Two infants with Ondine's syndrome were transferred to our center for management and adjustment of therapy. On admission NIV (BiPAP VISION) was started with nasal interphase in S/T (spontaneous/timed) mode, which failed to provide suitable ventilation (PCO2 > 70 mmHg). Finally, tracheotomy for continuous mechanical ventilation was performed. Although NIV has been reported to be successful in some patients with Ondine's syndrome, its application in patients younger than 5 years does not seem to be the general norm of treatment.

Síndrome de Ondine: diagnóstico y seguimiento / Ondine´s syndrome: diagnosis and treatment

El síndrome de Ondine consiste en un síndrome de hipoventilación central congénita secundario un trastorno del sistema nervioso central en el cual el control autonómico de la respiración está ausente o se encuentra deteriorado en ausencia de una enfermedad primaria que lo justifique. Aunque la incidencia de esta entidad es baja, es probable, dada la variable expresividad clínica según el grado de intensidad, que se trate de una enfermedad infradiagnosticada. En estos casos es de gran importancia un diagnóstico precoz que permita un buen manejo a fin de evitar episodios de hipoxia e hipercapnia que marcarán el pronóstico de esta enfermedad a largo plazo. El objetivo de esta revisión es presentar una guía de manejo práctica que facilite al facultativo poco adiestrado en esta enfermedad un conocimiento básico del diagnóstico, tratamiento y control de estos pacientes

Ondine's syndrome is a congenital central hypoventilation syndrome due to a disorder in the autonomic control of breathing in the absence of any primary disease that would explain it. Although the incidence of this entity is low, it may be underestimated due to the variable clinical expression of this syndrome, depending on its severity. Early diagnosis is of great importance to provide appropriate management to prevent the acute and chronic asphyxia that determines the long-term prognosis of this disease. This review aims to present practical management guidelines to provide doctors unfamiliar with this syndrome with basic knowledge of the diagnosis, treatment and follow-up of these patients

Análisis de los pacientes readmitidos con ingreso como indicador de calidad asistencial de un servicio de urgencias pediátricas / Analysis of the patients readmitted with hospitalization as an indicator of assistential quality in a pediatric emergency service

Objetivos: Analizar los motivos de readmisión con ingreso de pacientes que han sido atendidos previamente en las anteriores 72 horas en un servicio de urgencias pediátrico. Método: Revisión retrospectiva de 487 historias clínicas correspondientes a los pacientes atendidos en urgencias y readmitidos con ingreso en 72 horas en un período de estudio de 8 meses. Los motivos de ingreso se clasificaron en: progresión de la enfermedad, orientación inicial diagnóstica y/o terapéutica inadecuadas, evaluación médica inicial incompleta, motivos familiares, control, no relacionada con la primera visita y no determinable. Resultados: Durante el período de estudio, se atendieron un total de 49.288 visitas en urgencias, la tasa de nuevas consultas fue del 6,45 por ciento. Un 15,3 por ciento de los pacientes que volvieron a consultar fueron ingresados. El motivo de readmisión con ingreso más frecuente (59,3 por ciento) fue la progresión de la enfermedad (fundamentalmente en patología respiratoria y gastroenteritis agudas), en 6 casos (1,2 por ciento) fue una orientación inicial diagnóstica o terapéutica inadecuada y en 24 (4,9 por ciento) una evaluación inicial incompleta; los factores familiares fueron la causa del ingreso en 87 casos (17,8 por ciento).Conclusiones: Las causas de readmisión con ingreso se deben fundamentalmente a progresión de la enfermedad o a motivos familiares y son, por tanto, poco susceptibles de intervención. No obstante, la aplicación periódica de este indicador puede ser un instrumento útil ya que la detección de variaciones en las causas nos pondría informar sobre la necesidad de implantar programas de mejora específicos (AU)

Hemiparálisis velopalatina idiopática / Idiopathic palatopharyngeal hemiparalysis

La hemiparálisis velopalatina idiopática es una entidad de etiología desconocida excepcional en pediatría; por ello, su diagnóstico exige un alto índice de sospecha. Se aporta un caso de disfunción brusca de los pares craneales inferiores (IX y X) en una paciente de 5 años de edad previamente asintomática. Esta paciente fue diagnosticada de hemiparálisis velopalatina idiopática tras valorar el curso clínico favorable y la normalidad de las exploraciones complementarias realizadas. Nuestro objetivo es comunicar nuestra experiencia en esta entidad a partir de este caso, así como aportar una revisión bibliográfica al respecto. Es importante sospechar esta patología en pacientes de edad comprendida entre los 5 y los 15 años que presentan una paresia brusca del IX y X pares craneales, sin ninguna otra sintomatología acompañante para racionalizar utensilios diagnósticos y terapéuticos. Se trata de un proceso cuyo tratamiento es sintomático. Su pronóstico es excelente, debido al alto porcentaje de remisión completa y la ausencia de recurrencias (AU)

[Idiopathic palatopharyngeal hemiparalysis]. / Hemiparálisis velopalatina idiopática.

Idiopathic velopalatine palsy is a condition of unknown etiology and is rarely seen in childhood. Consequently, diagnosis requires a high degree of suspicion. We report a case of sudden onset dysfunction of the lower cranial pairs (IX and X) in a 5-year-old girl who was previously asymptomatic. The clinical course was favorable and the results of complementary investigations were normal and the patient was diagnosed with velopalatine palsy. Based on this case, we aim to report our experience of this condition and provide a review of the literature. This disease should be suspected in patients aged between 5 and 15 years old who present a palsy of the IX and X cranial nerves of sudden onset and without any other symptoms in order to rationalize diagnostic and therapeutic tools. Treatment is based on support measures. The prognosis is excellent, with a high percentage of complete recovery and absence of recurrences.