ABSTRACT
A 8-year-old girl, born and resident of Guárico state, was referred to our Department because of a history of recurrent pneumonia and a history of deceased sister by unspecified lung disease. At the age of 4 years she had suffered several episodes of pneumonia requiring hospitalization. These episodes were no-responsive to antibiotic therapy and treatment for tuberculosis. Subsequently, At the age of 8 years she was hospitalized again for an episode of left lower lobe pneumonia that did not improve. Studies were performed to rule out pulmonary pathology disease: Cystic Fibrosis was discarded and also Pulmonary Tuberculosis. Serology for HIV and Fungi were negative. Because serological studies were inconclusive, a videobronchoscopy plus Bronchoalveolar lavage and lung tissue biopsy were performed, which reported bronchitis and chronic granulomatous and caseous necrosis. Special stains were observed that suggest fungus infection. Primary immunodeficiency was suspected in the patient, because the presence of recurrent pneumonia of different etiologies. The presence of the granuloma observed by the videobronchoscopy. A positive culture for Histoplasma and Aspergillus fungi, and the result of the oxidative capacity test, where the deficiency was observed in the microbicidal activity of macrophages. They were strong evidence that corroborated the immunodeficiency called Chronic Granulomatous Disease.
Escolar femenino de 8 años de edad, natural y procedente del Estado Guárico, con antecedente de hospitalizaciones por neumonías recurrente desde los 4, recibió antibioticoterapia endovenosa y cumplió tratamiento antifímico en dos oportunidades, persistiendo con sintomatología respiratoria. A los 8 años precisó nueva hospitalización por diagnóstico de neumonía del lóbulo inferior izquierdo. Por no presentar mejoría y antecedente de hermana fallecida por patología pulmonar no precisada fue referida a nuestro centro. Se realizaron estudios por patología pulmonar crónica: se descartó Fibrosis Quística y Tuberculosis Pulmonar. Serología para HIV y Hongos Negativa. Por no ser concluyentes los estudios serológicos se realizó Videobroncoscopia más lavado y biopsia, la cual reportó bronquitis crónica granulomatosa y necrosis caseosa. Coloraciones especiales: hongos intracitoplasmáticos sugestivos de Histoplasma Sp. y en el cultivo presentó crecimiento de Aspergillus fumigatus. Ante la presencia de paciente con neumonía recurrente por diferentes etiologías se sospechó la presencia de Inmunodeficiencia Primaria, planteando en base al reporte de la videobroncoscopia de granuloma y la confirmación de Infección por Histoplasma y Aspergillus una Enfermedad Granulomatosa Crónica que fue documentada al medir la deficiencia en la actividad microbicida dependiente de oxigeno evaluada a través del Test de Capacidad Oxidativa.
Subject(s)
Humans , Female , Child , Granulomatous Disease, Chronic/complications , Granulomatous Disease, Chronic/diagnosis , Lung Diseases, Fungal/complications , Lung Diseases, Fungal/microbiology , Antifungal Agents/therapeutic use , Aspergillus fumigatus/isolation & purification , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Fatal Outcome , Pneumonia/etiology , Pulmonary Aspergillosis , Radiography, Thoracic , Immunologic Deficiency Syndromes/complications , Tomography, X-Ray ComputedABSTRACT
El arsenal antimicrobiano ha aumentado en los últimos años, debido principalmente a que nos encontramos en la era de la resistencia bacteriana. Han aparecido nuevos agentes antimicrobianos, especialmente para infecciones hospitalarias, aunque también para infecciones adquiridas en la comunidad. La Tigeciclina es un antimicrobiano de amplio espectro con actividad antibacteriana, especialmente contra patógenos multirresistentes. Tiene estructura similar a las tetraciclinas. Es un derivado de la minociclina y por ello no ha sido aprobado su uso en niños menores de 8 años. Sin embargo, aunque no se justifica su uso rutinario o como antibiótico de primera línea; se puede indicar en casos seleccionados, preferiblemente en combinación con otros antibióticos
The antimicrobial arsenal has increased in recent years, mainly because we are in the era of bacterial resistance. There are new agents antimicrobials, especially for hospital infections, but also for community-acquired infections. Tigecycline is a broad-spectrum with antibacterial activity, especially against multidrug-resistant pathogens. Has structure similar to tetracyclines. It is a derivative of minocycline and therefore has not been approved for use in children younger than 8 years. However, although there is no justification for routine use or as first-line antibiotic, may be indicated in selected cases, preferably in combination with other antibiotics