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1.
Nutrients ; 13(7)2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34371920

RESUMO

Nutraceuticals, including vitamin D, vitamin A, zinc, lactoferrin, polyphenols coenzyme Q, magnesium, and selenium, are implicated in the modulation of the complex molecular pathways involved in the immune response against viral pathogens. A common element of the activity of nutraceuticals is their ability to enhance the innate immune response against pathogens by acting on the major cellular subsets and inducing the release of pro-inflammatory cytokines and antimicrobial peptides. In some cases, this action is accompanied by a direct antimicrobial effect, as evidenced in the specific case of lactoferrin. Furthermore, nutraceuticals act through complex molecular mechanisms to minimize the damage caused by the activation of the immune system against pathogens, reducing the oxidative damage, influencing the antigen presentation, enhancing the differentiation and proliferation of regulatory T cells, driving the differentiation of lymphocyte subsets, and modulating the production of pro-inflammatory cytokines. In this paper, we review the main molecular mechanisms responsible for the immunomodulatory function of nutraceuticals, focusing on the most relevant aspects for the prevention and treatment of viral infections.


Assuntos
Antivirais/uso terapêutico , Suplementos Nutricionais , Sistema Imunitário/efeitos dos fármacos , Fatores Imunológicos/uso terapêutico , Viroses/tratamento farmacológico , Vírus/efeitos dos fármacos , Animais , Antivirais/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Interações Hospedeiro-Patógeno , Humanos , Sistema Imunitário/imunologia , Sistema Imunitário/metabolismo , Sistema Imunitário/virologia , Fatores Imunológicos/efeitos adversos , Resultado do Tratamento , Viroses/imunologia , Viroses/metabolismo , Viroses/virologia , Vírus/imunologia , Vírus/patogenicidade
2.
Nutrients ; 13(6)2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34205445

RESUMO

In the last decade, the role of nutritional management in pediatric gastrointestinal diseases has gained increasing popularity. Disease-specific diets have been introduced as conventional treatments by international guidelines. Patients tend to more willingly accept food-based therapies than drugs because of their relatively "harmless" nature. Apart from a diet's therapeutic role, nutritional support is crucial in maintaining growth and improving clinical outcomes in pediatric patients. Despite the absence of classical "side effects", however, it should be emphasized that any dietary modification might have negative consequences on children's growth and development. Hence, expert supervision is always advised, in order to support adequate nutritional requirements. Unfortunately, the media provide an inaccurate perception of the role of diet for gastrointestinal diseases, leading to misconceptions by patients or their caregivers that tends to overestimate the beneficial role of diets and underestimate the potential adverse effects. Moreover, not only patients, but also healthcare professionals, have a number of misconceptions about the nutritional benefits of diet modification on gastrointestinal diseases. The aim of this review is to highlight the role of diet in pediatric gastrointestinal diseases, to detect misconceptions and to give a practical guide for physicians on the basis of current scientific evidence.


Assuntos
Gastroenteropatias/dietoterapia , Terapia Nutricional , Dor Abdominal , Animais , Bovinos , Criança , Pré-Escolar , Dieta , Enterite/dietoterapia , Enterite/fisiopatologia , Eosinofilia/dietoterapia , Eosinofilia/fisiopatologia , Hipersensibilidade Alimentar , Gastrite/dietoterapia , Gastrite/fisiopatologia , Gastroenteropatias/fisiopatologia , Microbioma Gastrointestinal/fisiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Recém-Nascido , Doenças Inflamatórias Intestinais/dietoterapia , Doenças Inflamatórias Intestinais/fisiopatologia , Leite/efeitos adversos , Leite/imunologia , Necessidades Nutricionais , Guias de Prática Clínica como Assunto , Probióticos
3.
Eur Respir J ; 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210789

RESUMO

BACKGROUND: The long-term sequelae of coronavirus disease 2019 (Covid-19) in children remain poorly characterised. This study aimed to assess long-term outcomes in children previously hospitalised with Covid-19 and associated risk factors. METHODS: This is a prospective cohort study of children (≤18 years old) admitted with confirmed Covid-19. Children admitted to the hospital between April 2, 2020 and August 26, 2020, were included. Telephone interview using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Covid-19 Health and Wellbeing paediatric follow-up survey. Persistent symptoms (>5 months) were further categorised by system(s) involved. FINDINGS: 518 of 853 (61%) of eligible children were available for the follow-up assessment and included in the study. Median age was 10.4 years (IQR, 3-15.2) and 270 (52.1%) were girls; median follow-up since hospital discharge was 256 (223-271) days. At the time of the follow-up interview 126 (24.3%) participants reported persistent symptoms among which fatigue (53, 10.7%), sleep disturbance (36, 6.9%,) and sensory problems (29, 5.6%) were the most common. Multiple symptoms were experienced by 44 (8.4%) participants. Risk factors for persistent symptoms were: older age "6-11 years" (odds ratio 2.74 (95% confidence interval 1.37 to 5.75) and "12-18 years" (2.68, 1.41 to 5.4); and a history of allergic diseases (1.67, 1.04 to 2.67). INTERPRETATION: A quarter of children experienced persistent symptoms months after hospitalization with acute covid-19 infection, with almost one in ten experiencing multi-system involvement. Older age and allergic diseases were associated with higher risk of persistent symptoms at follow-up.

4.
Minerva Pediatr (Torino) ; 73(2): 111-114, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33880902

RESUMO

From an evolutionary and nutritional standpoint, exclusive human milk feeding for the first 6 months of life, with continued breastfeeding for 1 to 2 years of life, is recognized as the gold standard nourishment for the infant: it is a species-specific food, with a composition designed by nature to better respond to the biological and psychological needs of the newborn/infant. Human milk contains many hundreds of bioactive molecules that protect newborn against infection and inflammation and contribute to immune maturation, organ development, and healthy microbial colonization. Compared with formula feeding, breastfeeding has been associated with decreased morbidity and mortality in infants and to lower incidence of gastrointestinal infections and inflammatory, respiratory and allergic disease. Here, we briefly review the nutritional and functional composition of human milk and provide an overview of its varied bioactive factors.

5.
Allergol Immunopathol (Madr) ; 49(2): 133-154, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33641305

RESUMO

The current systematic review presented and discussed the most recent studies on pediatric chronic cough. In addition, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to a pediatric patient with chronic cough.Several algorithms on chronic cough management have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, from birth until adulthood. Based on our findings, children and adolescents with chronic cough without cough pointers can be safely managed, initially using the watchful waiting approach and, successively, starting empirical treatment based on cough characteristics. Unlike other algorithms that suggest laboratory and instrumental investigations as a first step, this review highlighted the importance of a "wait and see" approach, consisting of parental reassurance and close clinical observation, also due to inter-professional collaboration and communication between general practitioners and specialists that guarantee better patient management, appropriate prescription behavior, and improved patient outcome. Moreover, the neonatal screening program provided by the Italian National Health System, which intercepts several diseases precociously, allowing to treat them in a very early stage, helps and supports a "wait and see" approach.Conversely, in the presence of cough pointers or persistence of cough, the patient should be tested and treated by the specialist. Further investigations and treatments will be based on cough etiology, aiming to intercept the underlying disease, prevent potentially irreversible tissue damage, and improve the general health of patients affected by chronic cough, as well as the quality of life of patients and their family.


Assuntos
Alergia e Imunologia/normas , Tosse/terapia , Guias de Prática Clínica como Assunto , Qualidade de Vida , Antitussígenos/uso terapêutico , Criança , Doença Crônica/terapia , Terapia Combinada/métodos , Terapia Combinada/normas , Tosse/complicações , Tosse/diagnóstico , Tosse/imunologia , Humanos , Itália , Sociedades Médicas/normas , Conduta Expectante/normas
6.
Allergol Immunopathol (Madr) ; 49(2): 155-169, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33641306

RESUMO

The current systematic review presented and discussed the most recent studies on acute cough in pediatric age. After that, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to pediatric patients, such as infants, children, and adolescents, with acute cough. An acute cough is usually consequent to upper respiratory tract infections and is self-resolving within a few weeks. However, an acute cough may be bothersome, and therefore remedies are requested, mainly by the parents. An acute cough may significantly affect the quality of life of patients and their family.Several algorithms for the management of acute cough have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, and, also, in accordance to the Italian National Health System, which regularly follows the child from birth to all lifelong. Based on our findings, infants from 6 months, children, and adolescents with acute cough without cough pointers can be safely managed using well-known medications, preferably non-sedative agents, such as levodropropizine and/or natural compounds, including honey, glycerol, and herb-derived components.


Assuntos
Alergia e Imunologia/normas , Antitussígenos/uso terapêutico , Tosse/tratamento farmacológico , Guias de Prática Clínica como Assunto , Qualidade de Vida , Doença Aguda/terapia , Adolescente , Apiterapia/métodos , Criança , Pré-Escolar , Tosse/complicações , Tosse/diagnóstico , Tosse/imunologia , Glicerol/uso terapêutico , Mel , Humanos , Lactente , Itália , Extratos Vegetais/uso terapêutico , Propilenoglicóis/uso terapêutico , Sociedades Médicas/normas , Conduta Expectante/normas
7.
Ital J Pediatr ; 47(1): 32, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588905

RESUMO

BACKGROUND: The role of the immune system and inflammatory response in the pathogenesis of the severe manifestations of coronavirus disease 2019 (COVID-19) is well known. Currently, different therapies active on the immune system are used for the management of COVID-19. The involvement of the immune system also opens the opportunity for the use of nutritional supplements with antimicrobial and immunomodulatory activity. MAIN ASPECTS: Nutritional supplements with antimicrobial and immunomodulatory activity are promising therapeutic adjuvants for the treatment of COVID-19, and also for the prevention of viral spreading. In particular, the role of vitamin D, probiotics, lactoferrin, and zinc is of significant clinical interest, although there are only a few data on their use in COVID-19 patients. Their molecular actions, together with the results of studies performed on other respiratory infections, strongly suggest their potential utility in COVID-19. This article discusses the main properties of these nutritional supplements and their potential applicability in the prevention and treatment of COVID-19. CONCLUSION: The supplementation with vitamin D, probiotics, lactoferrin and zinc could have a role both in preventing SARS-CoV-2 infection and in mitigating the clinical course in infected patients, contributing in the prevention of immune-mediated organ damage.


Assuntos
COVID-19/tratamento farmacológico , COVID-19/imunologia , Suplementos Nutricionais , Humanos , Lactoferrina/uso terapêutico , Pandemias , Probióticos/uso terapêutico , SARS-CoV-2 , Vitamina D/uso terapêutico , Zinco/uso terapêutico
8.
Pediatr Allergy Immunol ; 31 Suppl 26: 43-45, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33236423

RESUMO

The use of probiotic supplements might change the composition of the intestinal flora of children, subsequently modulating the immune system's reactivity. The effects of probiotic administration for the prevention/treatment of allergic diseases and atopic dermatitis, in particular, are still so controversial that no definitive recommendation can be made at this stage. Differences in strain specificity, timing, and length of administration all contribute to diversifying the conclusions of this review.

9.
Front Pediatr ; 8: 480, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33014920

RESUMO

Asthma is the most frequent chronic disease in children, and its pathogenesis involves genetic, epigenetic, and environmental factors. The rapid rise in the prevalence of asthma registered over the last few decades has stressed the need to identify the environmental and modifiable factors associated with the development of the disease. In particular, there is increasing interest in the role of modifiable nutritional factors specific to both the prenatal and post-natal early life as, during this time, the immune system is particularly vulnerable to exogenous interferences. Several dietary factors, including maternal diet during pregnancy, the duration of breastfeeding, the use of special milk formulas, the timing of the introduction of complementary foods, and prenatal and early life supplementation with vitamins and probiotics/prebiotics, have been addressed as potential targets for the prevention of asthma. In this review, we outline recent findings on the potential role of prenatal and perinatal dietary and nutritional interventions for the primary prevention of pediatric asthma. Moreover, we addressed unmet needs and areas for future research in the prevention of childhood-onset asthma.

10.
Acta Biomed ; 91(11-S): e2020002, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-33004772

RESUMO

The control of asthma is the objective of asthma management. However, it is difficult to obtain in clinical practice. The Italian Society of Allergy and Clinical Immunology promoted the nationwide project "ControL'Asma" to investigate the real situation in a group of children and adolescents with asthma. The preliminary outcomes demonstrated that many asthmatic subjects do not achieve adequate asthma control. Moreover, asthma in Italian children and adolescents was usually more frequent in males, had an early onset and allergic phenotype with very frequent rhinitis comorbidity, uncontrolled and partly controlled asthma affected about the half of subjects. However, this project suggested that the assessment of asthma symptom perception by VAS could be a reliable tool in the asthma management.


Assuntos
Asma , Hipersensibilidade , Rinite , Adolescente , Asma/epidemiologia , Asma/terapia , Criança , Comorbidade , Humanos , Itália/epidemiologia , Masculino
11.
Front Pediatr ; 8: 545, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33042906

RESUMO

Nutrients in foods are not eaten in isolation and food intake interacts in a complex manner, affecting health and disease outcomes. For this reason, focusing on the whole "pattern" of dietary intake instead of the single nutrients or groups of nutrients when studying diseases outcomes is increasingly appealing and growing. Diet diversity refers to the variety of foods being eaten, and the terms, diversity or variety, are often used interchangeably. When the overall diet is characterized by healthy foods, diet diversity will reflect a diversity/variety of healthy foods eaten over a period of time. The introduction of solid foods in the 1st year of life is considered a measure of increased diet diversity. Consuming a diverse range of foods and food allergens in the first year of life may increase intake of important nutrients and positively affect the gut microbiome structure and function. Intake of omega-3 fatty acids and fibers/prebiotics may be particularly important but more information is required about dose and which individuals are most likely to benefit. Increased diet diversity in the first year of life is also associated with reduced food allergy outcomes. In addition to diet diversity, diet indices are considered measures of overall diet quality and can be used as a simple assessment of dietary intake. The focus of this paper is to review and critically address the current knowledge of the association between diet diversity and diet indices and allergy outcomes. Based on the current evidence, we recommend the introduction of solid foods, including common allergenic solids, during the 1st year of life, according to the infant's neuro-developmental abilities and familial or cultural habits. For infants with severe AD and/or FA, medical assessment may be advisable before introducing common food allergens into the diet. Limited evidence exist about the role of diet indices in pregnancy and allergic disease in the offspring, and the most promising results indicate a reduction in childhood wheeze and/or asthma intake.

12.
Front Immunol ; 11: 1485, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760404

RESUMO

Novel methods in immunological research and microbiome evaluation have dramatically changed several paradigms associated with the pathogenesis of allergic asthma (AAS). Ovalbumin and house dust mite-induced AAS in germ-free or specific pathogen-free mice are the two leading experimental platforms that significantly contribute to elucidate the relationship between AAS and gut microbiota. Beyond the exacerbation of T helper (Th) 2 responses, a complex network of immunological interaction driven by gut microbiota could modulate the final effector phase. Regulatory T cells are abundant in gastrointestinal mucosa and have been shown to be pivotal in AAS. The gut microbiota could also influence the activity of other T cell subsets such as Th9, Th17, and populations of effector/memory T lymphocytes. Furthermore, gut microbiota metabolites drive the hematopoietic pattern of dendritic cells and ameliorate lung Th2 immunity in AAS models. The administration of probiotics has shown conflicting results in AAS, and limited evidence is available on the immunological pathways beyond their activity. Moreover, the impact of early-life gut dysbiosis on AAS is well-known both experimentally and clinically, but discrepancies are observed between preclinical and clinical settings. Herein, our aim is to elucidate the most relevant preclinical and clinical scenarios to enlighten the potential role of the gut microbiota in modulating T lymphocytes activity in AAS.


Assuntos
Asma/microbiologia , Disbiose/imunologia , Microbioma Gastrointestinal/imunologia , Hipersensibilidade/microbiologia , Células Th17/imunologia , Células Th2/imunologia , Animais , Asma/imunologia , Modelos Animais de Doenças , Humanos , Hipersensibilidade/imunologia , Imunomodulação , Camundongos , Probióticos
13.
Diagnostics (Basel) ; 10(7)2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32630227

RESUMO

Cystic fibrosis (CF) is a life-threatening and common genetic disorder. Cystic fibrosis newborn screening (CF NBS) has been implemented in many countries over the last 30 years, becoming a widely accepted public health strategy in economically developed countries. False-negative (FN) cases can occur after CF NBS, with the number depending on the method. We evaluated the delayed diagnosis of CF, identifying the patients who had false-negative CF NBS results over 26 years (1992-2018) in Tuscany, Italy. The introduction of DNA analysis to the newborn screening protocol improved the sensitivity of the test and reduced the FNs. Our experience showed that, overall, at least 8.7% of cases of CF received FNs (18 cases) and were diagnosed later, with an average age of 6.6 years (range: 4 months to 22 years). Respiratory symptoms and salt-loss syndrome (metabolic hypochloremic alkalosis) are suggestive symptoms of CF and were commons events in FN patients. In Tuscany, a region with a high CFTR allelic heterogeneity, the salt-loss syndrome was a common event in FNs. Therefore, we provided evidence to support the claim that the FN patients had CFTR mutations rarer compared with the true-positive cases. We underline the importance of vigilance toward clinical manifestations suggestive of CF on the part of the primary care providers and hospital physicians in a region with an efficient newborn screening program.

14.
Minerva Pediatr ; 72(5): 372-382, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32686924

RESUMO

Asthma is the most common chronic disease in childhood and exposure to tobacco smoke has been long recognized as a risk factor for its onset as well as for exacerbations and poor disease control. Since the early 2000s, electronic cigarettes have been marketed worldwide as a non-harmful electronic alternative to combustible cigarettes and as a device likely to help stop smoking, and their use is continuously rising, particularly among adolescents. However, several studies have shown that vape contains many different well-known toxicants, causing significant cytotoxic and pro-inflammatory effects on the airways in-vitro and in animal models. In humans, a variety of harmful lung effects related to vaping, ranging from bronchoconstriction to severe respiratory distress has been already reported. To investigate the potential effects of vaping in pediatric asthma, we searched relevant published studies in the MEDLINE/PubMed database by combining the adequate Medical Subject Headings terms and key words. At the end of our study selection process, five cross-sectional studies focusing on electronic cigarettes use in adolescents and self-reported asthma and/or other respiratory symptoms, one study focusing on the effects of electronic cigarettes second-hand exposure and one case report were retrieved. These preliminary data support a likely detrimental effect of vaping in asthmatic adolescents. Currently available evidence supports that electronic cigarettes are a potential threat to respiratory health, particularly in adolescents with asthma. High-quality studies on larger population assessing the long-term effects of vape exposure, are urgently needed.

16.
Ital J Pediatr ; 46(1): 84, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32546234

RESUMO

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic.Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases.


Assuntos
Alergia e Imunologia , Betacoronavirus , Consenso , Infecções por Coronavirus/terapia , Gerenciamento Clínico , Pandemias , Pneumonia Viral/terapia , Sociedades Médicas , Adolescente , COVID-19 , Criança , Infecções por Coronavirus/epidemiologia , Tomada de Decisões , Humanos , Itália/epidemiologia , Pneumonia Viral/epidemiologia , Ensaios Clínicos Pragmáticos como Assunto/métodos , SARS-CoV-2
17.
Front Immunol ; 11: 700, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32391012

RESUMO

Allergic diseases, such as food allergy (FA), atopic dermatitis (AD), and asthma, are heterogeneous inflammatory immune-mediated disorders that currently constitute a public health issue in many developed countries worldwide. The significant increase in the prevalence of allergic diseases reported over the last few years has closely paralleled substantial environmental changes both on a macro and micro scale, which have led to reduced microbial exposure in early life and perturbation of the human microbiome composition. Increasing evidence shows that early life interactions between the human microbiome and the immune cells play a pivotal role in the development of the immune system. Therefore, the process of early colonization by a "healthy" microbiome is emerging as a key determinant of life-long health. In stark contrast, the perturbation of such a process, which results in changes in the host-microbiome biodiversity and metabolic activities, has been associated with greater susceptibility to immune-mediated disorders later in life, including allergic diseases. Here, we outline recent findings on the potential contribution of the microbiome in the gastrointestinal tract, skin, and airways to the development of FA, AD, and asthma. Furthermore, we address how the modulation of the microbiome composition in these different body districts could be a potential strategy for the prevention and treatment of allergic diseases.


Assuntos
Asma/imunologia , Asma/microbiologia , Dermatite Atópica/imunologia , Dermatite Atópica/microbiologia , Hipersensibilidade Alimentar/imunologia , Hipersensibilidade Alimentar/microbiologia , Microbioma Gastrointestinal/imunologia , Adulto , Animais , Criança , Epiderme/imunologia , Epiderme/microbiologia , Humanos , Imunidade , Mucosa Respiratória/imunologia , Mucosa Respiratória/microbiologia
18.
Pharmacol Res ; 158: 104878, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32417503

RESUMO

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin disease, affecting up to 25% of children. Topical corticosteroids (TCS) are currently used as first-line antiinflammatory treatment for AD, due to their overall therapeutic efficacy, and the availability of different potency classes and a wide array of formulations. Therapeutic efficacy of TCS depends upon selecting the appropriate vehicle and potency, and the frequency of application, also taking into account the duration of treatment and patient preferences. This article focuses on TCS benefits and potential risks and it provides practical tips to properly use these drugs in clinical practice, to make a patient-tailored treatment approach.


Assuntos
Corticosteroides/administração & dosagem , Antialérgicos/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/imunologia , Administração Cutânea , Administração Tópica , Anti-Inflamatórios/administração & dosagem , Criança , Dermatite Atópica/metabolismo , Humanos
20.
Ital J Pediatr ; 46(1): 15, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32014022

RESUMO

BACKGROUND: We report a case of a 4-year-old girl with acute dacryocystitis complicated with giant lacrimal abscess who underwent open dacryocystectomy as resolutive surgery. CASE PRESENTATION: A 4-year-old previously healthy girl presented to the emergency department with a voluminous and erythematous, fluctuant warm mass localized inferiorly to the medial canthus of the right eye. She had a 2-week history of right inferior eyelid oedema and hyperemia, treated firstly with dexamethasone and netilmicin by eye drops, and then with per oral amoxicillin clavulanate. Ultrasound examination showed a well-circumscribed round lesion filled by anechoic fluid with punctate echoes, confirming a diagnosis of acute dacryocystitis complicated by lacrimal abscess. Parents refused a head CT. Systemic antibiotic treatment was started and, on 5th day from admission, open dacryocystectomy was performed with good esthetical result. CONCLUSIONS: Pediatric acute dacryocystitis is a potentially serious condition, which must be treated with intravenous antibiotic therapy followed by surgery tailored to the clinical history. Even if probing and dacryocystorhinostomy are the most used surgery in adults and children, open dacryocystectomy is a safe and successful option, mainly in severe cases where imaging studies are not available.


Assuntos
Abscesso/etiologia , Antibacterianos/uso terapêutico , Dacriocistite/terapia , Dacriocistorinostomia/métodos , Aparelho Lacrimal/diagnóstico por imagem , Abscesso/diagnóstico , Abscesso/terapia , Doença Aguda , Pré-Escolar , Dacriocistite/complicações , Dacriocistite/diagnóstico , Feminino , Humanos , Aparelho Lacrimal/cirurgia , Tomografia Computadorizada por Raios X
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