ABSTRACT
El tétanos generalizado es una enfermedad infecciosa altamente mortal sin intervenciones médicas y en nuestro tiempo, prevenible mediante inmunización activa. Se presenta el caso de un preescolar de 4 años quien sufre herida cortante en la palma de la mano izquierda y quien se presenta 4 días más tarde con datos clínicos de tétanos generalizado. Fue intubado y admitido a la terapia intensiva del Hospital del Niño Dr. José Renán Esquivel. Su hospitalización se vio caracterizada por neumonía nosocomial, una lesión anfractuosa lingual e inestabilidad autonómica. Además de la antibioticoterapia con metronidazol y la aplicación de inmunoglobulina antitetánica, precisó apoyo hemodinámico con dobutamina y norepinefrina. Para lograr un completo control de las crisis de hipertonía, se ofreció manejo con infusión de midazolam, levetiracetam, clobazam, baclofeno y toxina botulínica.
Generalized tetanus is a highly fatal infectious disease without medical interventions and in our time, preventable by active immunization. The case of a 4-year-old preschooler is presented who suffers a sharp wound in the palm of the left hand and who presents 4 days later with generalized tetanus. He was intubated and admitted to intensive care unit at Dr. José Renán Esquivel Children's Hospital. His hospitalization was characterized by nosocomial pneumonia, an anfractuous lingual lesion and autonomic instability. In addition to antibiotic therapy with metronidazole and the application of tetanus immunoglobulin, hemodynamic support with dobutamine and norepinephrine was required. To achieve complete control of hypertonic crisis, management with infusion of midazolam, levetiracetam, clobazam, baclofen and botulinum toxin was offered.
ABSTRACT
Introducción: El tétanos es una enfermedad aguda causada por una toxina producida por Clostridium tetanii. La enfermedad puede afectar a personas de cualquier edad, y la tasa de letalidad es alta. Gracias a la inmunización se ha logrado reducir el número de casos de la enfermedad, aunque se siguen presentando casos sobre todo en países con rezago social y económico. Objetivo: Describir caso clínico de un paciente pediátrico con tétanos generalizado, para reforzar la importancia de la profilaxis y diagnóstico precoz. Caso clínico: Escolar femenina de 6 años de edad con antecedente de esquema de inmunizaciones incompleto (una dosis de pentavalente), quien 10 días después de hacerse una herida cortopunzante por astilla de madera en brazo derecho, evolucionó con fiebre, dolor muscular y contracciones generalizadas, diagnosticándose tétanos generalizado en base a los antecedentes y el cuadro clínico. El tratamiento se estableció en base a las últimas recomendaciones de la Organización Mundial de la salud (OMS): esquema antibiótico Penicilina-Metronidazol, toxoide tetánico y gammaglobulina antitetánica a dosis altas. Se da de alta con secuelas motoras leves, las que se remitieron luego de 2 años de seguimiento y terapia de rehabilitación. Conclusión: El tétanos se sigue presentando en la población pediátrica principalmente asociado a falta de vacunación, es necesario conocer la enfermedad para hacer diagnóstico temprano y ofrecer manejo acorde a recomendaciones internacionales.
Introduction: Tetanus is an acute disease caused by a toxin produced by Clostridium tetanii. The disease can affect people of any age, and the fatality rate is high. Thanks to immunization the number of cases of the disease has decreased, although they are still present in isolation in countries with social and economic backwardness. Objective: To describe a case of a pediatric patient with generalized tetanus to reinforce the relevance of prophylaxis and early detection. Case Report: 6 years old female patient, with only one dose of pentavalent vaccine, 10 days after sharps injury by wood chips, starts with fever, muscle pain and generalized contractions, Tetanus was diagnosed by clinical symptoms and history. The management was based on the latest recommendations of the World Health Organization (WHO): Penicillin-Metronidazole antibiotic regimen, tetanus toxoid and tetanus high-dose gammaglobulin. After 2 years of follow-up under physiotherapy support, slight motor sequelae were observed. Conclusion: Tetanus is still presented in the pediatric population, associated with lack of vaccination. It is necessary to know the disease to provide proper diagnosis and management according to international lineaments.
Subject(s)
Humans , Female , Child , Tetanus/diagnosis , Tetanus/etiology , Tetanus/therapy , Tetanus Toxoid , Early DiagnosisABSTRACT
Objective To explore the impact of intrapartum mild asphyxia on motor development in infants. Methods 30 infants with any of the following were as asphyxia group:heart rate more than 160 beats/min in the process of childbirth, and then down to 70-80 beats/min, no cyanose;Apgar score 1 min more than 8. Other 30 normal infants were as control group. They were assessed with Neuropsychologi-cal Development Scale for 0-6 Years Old 3, 6 and 9 months after birth. Results Opisthotonos was more frequent in the asphyxia group than in the control group (P0.05). Sitting forward was more frequent in the asphyxia group 6 months after birth, and the score of motor was less in the asphyxia group than in the control group (P<0.05). More of the asphyxia group couldn't stand with help, and with poor motor score 9 months after birth (P<0.05). Conclusion Intrapar-tum mild asphyxia may infulence the motor development of infant in long-term.
ABSTRACT
@#Objective To explore the impact of intrapartum mild asphyxia on motor development in infants. Methods 30 infants with any of the following were as asphyxia group: heart rate more than 160 beats/min in the process of childbirth, and then down to 70-80 beats/ min, no cyanose; Apgar score 1 min more than 8. Other 30 normal infants were as control group. They were assessed with Neuropsychological Development Scale for 0-6 Years Old 3, 6 and 9 months after birth. Results Opisthotonos was more frequent in the asphyxia group than in the control group (P<0.01) 3 months after birth, but there was no significant difference in total score (P>0.05). Sitting forward was more frequent in the asphyxia group 6 months after birth, and the score of motor was less in the asphyxia group than in the control group (P< 0.05). More of the asphyxia group couldn't stand with help, and with poor motor score 9 months after birth (P<0.05). Conclusion Intrapartum mild asphyxia may infulence the motor development of infant in long-term.
ABSTRACT
Relata-se o caso de intoxicação de uma cadela da raça dálmata tratada cronicamente com o metronidazol, onde o diagnóstico foi baseado no histórico de administração, que pode ser de doses normais a aumentadas, e na resolução dos sinais clínicos após a suspensão da droga e instituição do tratamento de suporte, conforme cita a literatura (KIM et al, 2011; HECKLER et al, 2012). Nesses casos o prognóstico geralmente é favorável, mas alguns cães podem morrer ou desenvolver lesões hepáticas (HECKLER et al, 2012).