A case of atypical nocardia asteroides sclerouveitis resistant to fourth-generation fluoroquinolones / Um caso atípico de esclero-uveíte por Nocardia Asteroides resistente a fluorquinolona de quarta-geração

ABSTRACT We describe an unusual case of Nocardia spp scleritis in a health girl resistant to topical fourth-generation fluoroquinolones. Clinically, there was only partial response of the scleritis to initial therapy. Treatment was changed to meropenem intravenously and topical amikacin. Following several weeks of antibiotic treatment, the patient's infection resolved but her vision was reduced to no light perception. Nocardia asteroides must be considered as a possible agent in cases of necrotizing scleritis in patients without a clear source. Antibiotic sensitivity testing has a definitive role in view of the resistance to these new medications.

RESUMO Nós descrevemos um raro caso de esclerite por Nocardia spp em uma criança sadia resistente a utilização tópica de fluorquinolona de quarta-geração. Clinicamente, a paciente apresentou apenas uma resposta parcial do quadro de esclerite a terapêutica inicial. O tratamento foi então modificado para meropenem intravenoso e amicacina tópica. Após várias semanas de tratamento com antibiótico, o quadro infeccioso regrediu porém a visao da pacientes evoluiu para perda da percepção luminosa. Em casos de esclerite necrotizante em pacientes sem fatores de risco aparente é necessário considerer a Nocardia Asteroides como possível agente causador. Os testes de sensibilidade medicamentosa apresentam importância significativa em virtude do aparecimento de resistência aos novos medicamentos.

Profile of pediatric eye trauma at Hospital de Base do Distrito Federal (HBDF), Brasília, Brazil.

OBJECTIVE: To describe the epidemiological profile of ocular trauma in children at the HBDF emergency department. METHOD: Descriptive, cross-sectional study. We evaluated 103 cases of ocular trauma in children less than 15 years between July 2012 and January 2013. The factors evaluated through semi-structured questionnaire available online were: age, gender, adult supervision, mechanism, type of trauma, time and place, site and nature of injury, visual acuity, need for hospitalization and/or surgery, type of surgery, mother's level of education, and family income. RESULTS: The average age of patients studied was 7.5 years. Boys (68%) predominate in all age groups. Blunt trauma prevailed (55.3%), followed by open (20%). Most of the cases occurred at home, 14 to 20 hours before seeking hospital care. The most common causes were: wood, stone, bicycle, broken glass, and falls. The cornea was affected in 54%. Visual acuity was ≥20/40 in 68.9%. Primary repair of the eye wall was indicated in 70.37% (p-value=0.022). Open traumas were more severe (p-value=0.005) and had more need for intervention (p-value=0.000). The injuries occurred despite the presence of adult supervision in 54% (p-value=0.002). The most severe injuries predominated in the age range 7-15 years (p=0.001). CONCLUSION: Ocular trauma was more frequent among boys. The mechanisms of injury are the most diverse, and prevail at home. Blunt trauma prevails, but the visual impact is due to open trauma. Programs of prevention and education on child ocular trauma are needed.

Profile of pediatric eye trauma at Hospital de Base do Distrito Federal (HBDF), Brasília, Brazil / Perfil do trauma ocular pediátrico no Hospital de Base do Distrito Federal (HBDF), Brasília, Brasil

Summary Objective: To describe the epidemiological profile of ocular trauma in children at the HBDF emergency department. Method: Descriptive, cross-sectional study. We evaluated 103 cases of ocular trauma in children less than 15 years between July 2012 and January 2013. The factors evaluated through semi-structured questionnaire available online were: age, gender, adult supervision, mechanism, type of trauma, time and place, site and nature of injury, visual acuity, need for hospitalization and/or surgery, type of surgery, mother’s level of education, and family income. Results: The average age of patients studied was 7.5 years. Boys (68%) predominate in all age groups. Blunt trauma prevailed (55.3%), followed by open (20%). Most of the cases occurred at home, 14 to 20 hours before seeking hospital care. The most common causes were: wood, stone, bicycle, broken glass, and falls. The cornea was affected in 54%. Visual acuity was ≥20/40 in 68.9%. Primary repair of the eye wall was indicated in 70.37% (p-value=0.022). Open traumas were more severe (p-value=0.005) and had more need for intervention (p-value=0.000). The injuries occurred despite the presence of adult supervision in 54% (p-value=0.002). The most severe injuries predominated in the age range 7-15 years (p=0.001). Conclusion: Ocular trauma was more frequent among boys. The mechanisms of injury are the most diverse, and prevail at home. Blunt trauma prevails, but the visual impact is due to open trauma. Programs of prevention and education on child ocular trauma are needed.

Resumo Objetivo: descrever o perfil epidemiológico do trauma ocular infantil na urgência do HBDF. Método: estudo transversal, descritivo. Avaliaram-se 103 casos de trauma ocular em menores de 15 anos entre julho de 2012 e janeiro de 2013, por meio de aplicação de questionário semiestruturado disponível online: idade, sexo, presença de supervisão, mecanismo, tipo do trauma, local e hora, sítio e natureza da injúria, acuidade visual, necessidade de internação e/ou cirurgia, tipo de cirurgia, escolaridade materna e renda familiar. Resultados: a média de idade dos pacientes analisados foi 7,5 anos. Os meninos (68%) predominaram em todas as faixas etárias. O trauma fechado prevaleceu (55,3%), seguido do aberto (20%). A maioria dos casos ocorreram em casa, no período de 14 às 20 horas. As causas mais comuns foram: madeira, pedra, bicicleta, caco de vidro e quedas. A córnea foi acometida em 54%. A acuidade visual foi ≥20/40 em 68,9%. Indicou-se sutura primária da parede em 70,37% (p-valor=0,022). O trauma mais grave (p-valor=0,005) e que mais necessitou de intervenção (p-valor=0,000) foi o aberto. As injúrias ocorreram, apesar da presença de supervisão de um adulto, em 54% (p-valor=0,002). Os traumas mais graves predominaram entre 7-15 anos (p-valor=0,001). Conclusão: o trauma ocular infantil foi mais frequente nos meninos. Os mecanismos de lesão são os mais diversos e predominaram no domicílio. O trauma fechado prevaleceu; porém, o maior impacto visual decorreu do trauma aberto. São necessários programas de prevenção e educação em trauma ocular infantil.