Enfermedad de Lyme: a propósito de dos casos / Lyme disease: report of two cases

La borreliosis de Lyme es una enfermedad multiorgánica con afectación principalmente dermatológica, reumática, neurológica y cardiaca. La detección y el tratamiento en los primeros estadios son básicos para evitar su progresión. El pediatra, por tanto, debe conocer las manifestaciones clínicas de la enfermedad, así como establecer un correcto diagnóstico y tratamiento. Se exponen dos casos que incluyen las formas más frecuentes de presentación (AU)

Lyme borreliosis is a multisystem disease mainly dermatological, rheumatical, neurological and cardiological. The detection and treatment in the early stages are essential to prevent its progression. The pediatrician, therefore, must be aware of the clinical presentations of the disease as well as to establish a correct diagnosis and treatment. Two cases are presented involving the most common forms of presentation (AU)

Utilidad de una técnica antigénica rápida en el diagnóstico de faringoamigdalitis por Streptococcus pyogenes / Use of the rapid antigen technique in the diagnosis of Streptococcus pyogenes pharyngotonsillitis

Introducción: El Streptococcus pyogenes es la causa bacteriana más importante de faringoamigdalitis aguda. Se analizó la validez de una prueba antigénica rápida para su diagnóstico, en consultas de atención primaria; asimismo se identificó el perfil clínico con mejor rendimiento diagnóstico, se cuantificó el uso innecesario de antibióticos cuando se utilizaba la prueba o solamente diagnóstico clínico y se determinó la sensibilidad microbiana a penicilina, eritromicina y clindamicina. Pacientes y métodos: Estudio descriptivo transversal a niños/as entre 2-14 años con amigdalitis y/o faringitis aguda atendidos en 5 consultas, desde enero de 2008 hasta mayo de 2010. Tras el diagnóstico clínico se realizó frotis faringoamigdalar con 2 hisopos: con el primero se realizó una prueba antigénica rápida y con el segundo cultivo y sensibilidad antibiótica, siendo su análisis ciego al resultado de la prueba. Se ha previsto una muestra de 546 personas y muestreo consecutivo. Resultados: Se incluyó a 192 pacientes. La prevalencia de Streptococcus pyogenes fue del 38,7%(IC del 95%: 31,4-45,7). La odinofagia y el exantema escarlatiniforme fueron más probables con cultivo positivo. En el 100% hubo sensibilidad a la penicilina, en el 97,3% a eritromicina y en el 86,3% a clindamicina. La especificidad de la prueba fue del 91,5% y el valor predictivo negativo del 91,5%. El 49,2% de quienes recibirían antibióticos por sospecha clínica serían tratados innecesariamente, disminuyendo al menos un 29,5% con la prueba. Conclusiones: La prueba permitió un uso más adecuado de antibióticos. Parece recomendable su uso en pediatría de atención primaria, sin necesidad de confirmación con cultivo cuando resulte negativa, en los centros con difícil acceso al laboratorio(AU)

Introduction: Streptococcus pyogenes is the most frequent bacterial cause of acute tonsillopharyngitis. The validity of the rapid antigen test was analysed for its diagnosis in a Paediatric Primary Care setting. The clinical profile with better diagnostic yield was also identified. The unnecessary use of antibiotics was quantified when the rapid antigen test or only the clinical diagnosis was used. The sensitivity of the assay to penicillin, erythromycin and clindamycin was also determined. Patients and methods: Cross-sectional study was conducted on children between 2 to 14 years with acute tonsillitis and/or pharyngitis seen in five Primary Care Centres, from January 2008to May 2010. After a clinical diagnosis, two swabs were taken for pharyngotonsillar smears: the first was used for a rapid antigen test, and the second one for a culture and a study of antibiotic sensitivity, with its analysis being blind to the rapid test result. A total sample of546 consecutive was envisaged and with consecutive sampling. Results: A total 192 patients were included. The prevalence of Streptococcus pyogenes was38.7% (95% CI: 31.4-45.7). Odynophagia and scarlatiniform rash were most likely with positive cultures, the Streptococcus pyogenes was sensitive to penicillin in 100%, to erythromycin in97.3% and to clindamycin in 86.3%. The specificity of the rapid antigen test was 91.5% and with a Negative Predictive Value of 91.5%. About half (49.2%) of those who would have receive antibiotics for clinical suspicion would have been treated unnecessarily, with this decreasing to at least in 29.5% when using the rapid antigen test. Conclusions: The rapid antigen test can lead to a better use of antibiotics. Its use in Paediatric Primary Health Care could be useful when, as when the result is negative, there would be no need to confirm by a culture, in those Health Centres with difficult access to laboratory(AU)

[Use of the rapid antigen technique in the diagnosis of Streptococcus pyogenes pharyngotonsillitis]. / Utilidad de una técnica antigénica rápida en el diagnóstico de faringoamigdalitis por Streptococcus pyogenes.

INTRODUCTION: Streptococcus pyogenes is the most frequent bacterial cause of acute tonsillopharyngitis. The validity of the rapid antigen test was analysed for its diagnosis in a Paediatric Primary Care setting. The clinical profile with better diagnostic yield was also identified. The unnecessary use of antibiotics was quantified when the rapid antigen test or only the clinical diagnosis was used. The sensitivity of the assay to penicillin, erythromycin and clindamycin was also determined. PATIENTS AND METHODS: Cross-sectional study was conducted on children between 2 to 14 years with acute tonsillitis and/or pharyngitis seen in five Primary Care Centres, from January 2008 to May 2010. After a clinical diagnosis, two swabs were taken for pharyngotonsillar smears: the first was used for a rapid antigen test, and the second one for a culture and a study of antibiotic sensitivity, with its analysis being blind to the rapid test result. A total sample of 546 consecutive was envisaged and with consecutive sampling. RESULTS: A total 192 patients were included. The prevalence of Streptococcus pyogenes was 38.7% (95% CI: 31.4-45.7). Odynophagia and scarlatiniform rash were most likely with positive cultures, the Streptococcus pyogenes was sensitive to penicillin in 100%, to erythromycin in 97.3% and to clindamycin in 86.3%. The specificity of the rapid antigen test was 91.5% and with a Negative Predictive Value of 91.5%. About half (49.2%) of those who would have receive antibiotics for clinical suspicion would have been treated unnecessarily, with this decreasing to at least in 29.5% when using the rapid antigen test. CONCLUSIONS: The rapid antigen test can lead to a better use of antibiotics. Its use in Paediatric Primary Health Care could be useful when, as when the result is negative, there would be no need to confirm by a culture, in those Health Centres with difficult access to laboratory.

Aspiración de cuerpo extraño: a propósito de un caso / Foreign body aspiration: a case report

La aspiración de cuerpo extraño es relativamente frecuente en Pediatría. Su potencial gravedad y la posible aparición de secuelas pulmonares, hace recomendable un diagnóstico y tratamiento precoz. Estos se basan en la historia clínica minuciosa y dirigida, que es el principal determinante para la realización de una broncoscopia rígida, que a su vez es la técnica considerada de elección para el tratamiento de estos pacientes. Se ha de tener un alto índice desospecha puesto que en la mayoría de los casos el episodio de atragantamiento puede pasar desapercibido en primera instancia. El propósito de este artículo es presentar un caso de aspiración de cuerpo extraño, revisando la literatura con el fin de evaluar los métodos diagnósticos y terapéuticos actualmente disponibles (AU)

Foreign body aspiration is relatively frequent in pediatrics. It is recommended an early diagnosis and treatment due to its potential severity and the possibility of pulmonary consequences. They are based on one hand on the directed and detailed clinical history, which is the main determinant to make a rigid bronchoscopy, which is considered to be the treatment of choice in these patients. A high index of suspicion is needed because in most cases the choking episode may not be noticed. The purpose of this article is to report a clinical case, and review the literature to evaluate the diagnostic and therapeutic procedures (AU)

Virus del herpes simple tipo 1 y úlcera péptica / No disponible

No disponible

Vesículas faciales / Facial vesicles

No disponible

Síndrome de Guillain-Barré / Guillain-Barre Syndrome

No disponible