Características clínicas y microbiológicas de infecciones de piel y partes blandas en pacientes pediátricos de dos hospitales de Buenos Aires / Skin and soft tissue infections in pediatrics

Las infecciones de piel y partes blandas (IPPB) en niños son una de las principales causas de prescripción de antimicrobianos. El objetivo del estudio fue describir las características clínicas y microbiológicas de las IPPB ambulatorias de niños asistidos en dos hospitales zonales. Se realizó un estudio prospectivo entre el 1/11/2017 y el 1/11/2018. Se incluyeron pacientes entre 1 mes y 15 años internados en dos hospitales. Se evaluó: edad, sexo, localidad, factores predisponentes, tipo de IPPB, muestras biológicas realizadas, aislamiento microbiológico, tratamiento empírico indicado y evolución del cuadro. Se realizó antibiograma y determinación genética. Se calculó chi2, IC95, OR; α=5%. N= 94. 58,7% masculinos. 12 pacientes <1 año, 85 >1 año (promedio de edad 4 años, 1-15). El 36% de Tandil y 63,8% de Florencio Varela. El 59,6% corresponden a IPPB purulentas. Se aislaron microorganismos en un 59,6%. Los aislamientos principales: SAMR (40,4%), SAMS (7,4%), S. agalactiae (2,1%) y S. pyogenes (2,1%). El 100% de SAMR son portadores de gen mecA y SCCmec tipo IV, sin multirresistencia. No hubo diferencia estadística entre los factores de riesgo evaluados para el desarrollo de IPPB por SAMR. El 52,1% de los niños recibió tratamiento antibiótico combinado, siendo la más indicada TMS-SMX + CLI en 36 eventos. (38,3%). La evolución fue favorable: no hubo diferencia significativa entre el subgrupo que se aisló SAMR y el que no se aisló SAMR; 91,9% (34/37) y 92,6% (50/54) correspondientemente (chi2: 0,01; p= 0,97 IC95: 0,26-3,88). El principal agente etiológico fue SAMRco, debiendo adecuar los tratamientos a este microorganismo.

Skin and soft tissue infections (SSIs) in children are one of the main causes of antimicrobial prescription. The aim of the study was to describe the clinical and microbiological characteristics of outpatient SSIs in children attended in two hospitals. A prospective study was conducted between 11/1/2017 and 11/1/2018. Patients between 1 month and 15 years old, hospitalized were included. We evaluated: age, sex, locality, predisposing factors, type of IPPB, biological samples taken, microbiological isolation, empirical treatment indicated and evolution of the condition. An antibiogram and genetic determination were performed. Chi2, CI95, OR; α=5% were calculated. N= 94. 58.7% male. 12 patients <1 year, 85 >1 year (mean age 4 years, 1-15). 36% were from Tandil and 63.8% from Florencio Varela. 59.6% corresponded to purulent SSIs. The diagnostic yield was 59.6%. Main isolates: MRSA (40.4%), MSSA (7.4%), S. agalactiae (2.1%) and S. pyogenes (2.1%). 100% of MRSA carried the mecA gene and SCCmec type IV, with no multidrug resistance. There was no statistical difference between the risk factors evaluated. 52.1% of children received combined antibiotic treatment, the most indicated being TMS-SMX + CLI in 36 events. (38,3%). Evolution was favorable: there was no significant difference between the subgroup that isolated MRSA and the subgroup that did not isolate MRSA; 91.9% (34/37) and 92.6% (50/54) respectively (chi2: 0.01; p= 0.97 CI95: 0.26-3.88). The main etiological agent was MRSA, and treatments should be adapted to this microorganism

Causes infectieuses de décompensation du diabète: « un prédateur infectieux se cache chez tout diabétique en Afrique¼ / Infectious causes of diabetes decompensation: "an infectious predator hides in any diabetic in Africa"

Introduction : Les infections survenant chez les sujets diabétiques ont été longtemps considérées comme une des causes de l'accroissement de la morbidité et de la mortalité. Elles représentent un motif de plus en plus fréquent d'admission dans le service de médecine interne du Centre Hospitalier Régional et Universitaire de Thiès. Les mécanismes sont plus ou moins élucidés par l'influence de l'hyperglycémie sur les fonctions des polynucléaires neutrophiles. Le but de cette étude est de déterminer les particularités épidémiologiques des infections chez les diabétiques. Patients et Méthode : Il s'agissait d'une étude rétrospective avec recueil de données réalisée sur 24 mois (1er janvier 2016 au 31 décembre 2018) au service de Médecine Interne du Centre Hospitalier Régional et Universitaire de Thiès. Cette étude incluait tous les patients diabétiques quel que soit le genre et le type de diabète, âgés de 15 ans et plus, présentant une infection comme facteur principal de décompensation. Résultats : Durant la période d'étude 2350 patients ont été hospitalisés dans le service de médecine interne dont 390 diabétiques. Parmi eux, 138 patients ont répondu à nos critères d'inclusion soit une prévalence de 35,38%. La moyenne d'âge de nos malades était de 53,49 ans ± 15,65 ans avec un sex-ratio H/F était de 0,70 en faveur des femmes (81 femmes contre 57 hommes). Les infections responsables de la décompensation étaient à localisation cutanéo-muqueuse (30,4%), pulmonaire (22,4%), uro-génitale (18,11%), buccodentaire (10,11%), ORL (1,44%), phanérienne (0,72%). Ailleurs, une infection aux pieds était retrouvée chez 43 patients soit 31,15% des cas. Plusieurs infections pouvaient être présentes chez un même malade. Le diabète était déséquilibré dans 86,2 % (n=94) des cas avec une HbA1c moyenne à 10, 5 % à l'admission Nous n'avons pas noté de corrélation entre l'infection et l'ancienneté du diabète (p =0, 60), l'infection et le type de diabète (p = 0,50) et paradoxalement entre l'infection et le déséquilibre du diabète (p=0,70). Conclusion : Le dépistage des infections chez le diabétique en déséquilibre chronique ou diabétique de novo doit être systématique car généralement ces infections peuvent être asymptomatiques.

Introduction: Infections in people with diabetes have long been considered one of the causes of increased morbidity and mortality. They represent an increasingly frequent reason for admission to the Department of Internal Medicine of the Regional and University Hospital of Thies. The mechanisms are more or less elucidated by the influence of hyperglycemia on neutrophil polynuclear functions. The purpose of this study is to determine the epidemiological characteristics of infections in diabetics. Method: This was a retrospective study with data collected over 24 months (1 January 2016 to 31 December 2018) at the Internal Medicine Department of the Regional and University Hospital of Thies. This study included all diabetic patients, regardless of gender and type of diabetes, aged 15 years and older, with an infection as the primary decompensation factor. Result: During the study period 2,350 patients were hospitalized in the Internal Medicine Department, 390 of whom were diabetic. Of these, 138 patients met our inclusion criteria, a prevalence of 35.38%. The average age of our patients was 53.49 years 15.65 years with a sex-ratio H/F was 0.70 in favor of women (81 Women versus 57 Men). The infections responsible for decompensation were dermal localization (30.4%), pulmonary (22.4%), urogenital (18.11%), oral (10.11%), ENT (1.44%), phanerian (0.72%). Elsewhere, a foot infection was found in 43 patients or 31.15% of cases. Several infections could be present in the same patient. Diabetes was unbalanced in 86.2% (n=94) of cases with an average HbA1c of 10.5% at admission We did not find a correlation between the infection and the age of diabetes (p =0, 60), the infection and the type of diabetes (p = 0.50), and paradoxically between the infection and the imbalance of diabetes (p = 0.70). Conclusion: The detection of infections in diabetics in chronic imbalance or de novo diabetics must be systematic because generally these infections can be asymptomatic.

Case for diagnosis. Ulcer and papular lesions in a patient with diabetes mellitus. protothecosis

Abstract Protothecosis is a rare disease caused by achlorophilic algae of the genus Prototheca spp. In general, three clinical forms are observed: cutaneous, articular and systemic. The cutaneous form is the most common one. This study describes a patient with isolated erythematous papules and erythematous papular plaques in the scapular regions, with a previous histopathological diagnosis of cryptococcosis. New tests were conclusive for the diagnosis of protothecosis, caused by Prototheca wickerhamii.

Enfrentamiento de las infecciones de piel en el adulto / Managing adult skin infections

En la actualidad, las infecciones de piel y partes blandas forman parte de un alto porcentaje de las consultas en salud. Estas van desde infecciones leves, donde el manejo se realiza con tratamiento tópico, hasta aquellas con severo compromiso sistémico, requiriendo terapia antibiótica sistémica e incluso el desbridaje quirúrgico. En general, son producto de un desbalance entre los mecanismos de defensa de la barrera cutánea y los factores de virulencia y patogenicidad de los microorganismos que la afectan. Se pueden clasificar según distintos criterios, como por ejemplo, profundidad, gravedad, microorganismos involucrados y si estas son purulentas o no. El reconocer estas entidades clínicas es de suma importancia para llevar a cabo un adecuado tratamiento en los pacientes que presentan estas afecciones, ya que los diagnósticos erróneos llevan a las múltiples consultas con el consiguiente aumento de costos asociados en atención en salud.

Currently, skin and soft tissue infections are part of a high percentage of health consultations. These range from mild infections, where management is performed with topical treatment, to those with severe systemic compromise requiring systemic antibiotic therapy and even surgical debridement. In general, they are the product of an imbalance between the defense mechanisms of the skin barrier and the virulence and pathogenicity factors of the microorganisms that affect it, which can vary from bacterial, viral, fungal and parasites agents. Skin and soft tissue infections can be classified according to different criteria, such as depth, severity, microorganisms involved and whether they are purulent or not. Recognizing these clinical entities is of utmost importance to carry out adequate treatment in patients with these conditions, since erroneous diagnoses lead to multiple consultations with the consequent increase in costs associated with health care

Dermatite de contato agravada por outra sensibilidade em automedicação / Contact dermatitis aggravated by other sensitivity in self-medication

RESUMO: Dermatite alérgica de contato é uma doença cutânea inflamatória, não infecciosa, cuja base do tratamento é a identificação e eliminação do agente causal. Cocoamidopropil betaína é um surfactante muito utilizado nos produtos de uso pessoal, notadamente de uso capilar. Essa substância não está presente na bateria padrão brasileira. Neomicina é um antibiótico usado em preparações tópicas. Objetivamos mostrar paciente que desenvolveu alergia no couro cabeludo e que fez erroneamente automedicação com produto que continha substância a qual era ainda mais sensível. O caso é de uma mulher, 36 anos, evoluindo há dois meses com eczema pruriginoso, em áreas de implantação capilar e nuca. Relatava progressiva piora. Diante da suspeita de dermatite de contato, foi realizado teste de contato, utilizando-se da bateria padrão Latino-Americana. Com 96 horas (D4) evidenciou-se positividade leve (+) para cocoamidopropil betaína e forte (++) para neomicina. O resultado positivo para a neomicina foi intrigante, uma vez que a observação do rótulo dos produtos de uso pessoal não a continha. Diante do resultado do teste, após ser questionada novamente, ela confirmou a omissão da automedicação diária com pomada de neomicina. Em conclusão, mostramos a alergia a produtos de uso capilar. Reforçamos a necessidade de se fazer um teste de contato com bateria padrão atualizada. Por fim, alertamos sobre o risco da automedicação. (AU)

ABSTRACT: Allergic contact dermatitis is an inflammatory, non-infectious skin disease. The treatment is based on the identification and elimination of the causal agent. Cocamidopropyl betaine is a surfactant widely used in products for personal use, especially capillary use. This substance is not present in the Brazilian baseline series. Neomycin is an antibiotic used in topical preparations. We aimed to show a patient who developed na allergy in the scalp and mistakenly self-medicated with a product that contained a substance to which it was even more sensitive. The case is of a woman, 36 years old, evolving for 2 months with pruritic eczema, in areas of capillary and nape implantation. She reported progressive worsening. When contact dermatitis was suspected, a contact test was performed using the Latin American baseline series. At 96 hours (D4) there was mild positivity (+) for cocamidopropyl betaine and strong (++) for neomycin. The positive result for neomycin was intriguing, since the observation of the label of products for personal use did not contain it. In view of the test result, after being questioned again, she confirmed the omission of daily self-medication with neomycin ointment. In conclusion, we showed the allergy to hair products. We reinforced the need for an updated baseline series patch test. Finally, we warned about the risk of self-medication. (AU)

Morbilidad por infecciones de partes blandas superficiales en el servicio de clínicas pediátricas de Manzanillo, Granma 2018 / Morbidity caused by soft tissue infections in the services of pediatric clinic in Manzanillo, Granma, 2018

RESUMEN Introducción: Las infecciones de la piel y partes blandas son frecuentes en los niños, con un amplio espectro de gravedad. Objetivo: Describir las características clínico-epidemiológicas de los pacientes con infecciones de partes blandas superficiales hospitalizados en el servicio de clínicas pediátricas del Hospital Pediátrico Docente "Hermanos Cordové". Método: Se realizó un estudio observacional, descriptivo y transversal en el servicio de clínicas pediátricas del Hospital Pediátrico Docente "Hermanos Cordové", de Manzanillo durante el 2018.Se estudiaron todos los pacientes egresados (n=298) con el diagnóstico confirmado de este tipo de infecciones. Se tomaron en cuenta las siguientes variables: localización anatómica, clasificación del tipo deinfección de piel y tejidos blandos, terapéutica utilizada y estadía hospitalaria. Resultados: Predominó el sexo masculino (57,7 %) y el grupo de edad de 10-14 años (34,9 %). Las infecciones en las extremidades estuvieron presentes en 113 pacientes (37,9 %). El impétigo fue la entidad clínica más frecuente (42,3 %), la cefazolina fue el antibiótico más utilizado (77,2 %). Se observó que la mayoría de los pacientes (293) solo permaneció hasta 7 días ingresados, con una evolución satisfactoria. Conclusiones: En el servicio de clínicas pediátricas del Hospital Pediátrico Docente "Hermanos Cordové", los pacientes con IPTB se caracterizan por ser sobre todo varones, más comúnmente con edad entre 10 y 14 años, las lesiones predominaron en las extremidades y la más común fue el impétigo. La cefazolina resultó eficaz para el tratamiento estas infecciones, lo que hizo posible que la estadía hospitalaria generalmente no excediera de siete días.

ABSTRACT Introduction: Infections in the skin and soft tissues are common health concerns in children, with a wide range of severity from patient to patient. Objective: To describe the clinical-epidemiological characteristics of the patients with soft tissue infections hospitalized in the Pediatric Teaching Hospital "Hermanos Cordové". Method: An observational, descriptive, cross-sectional study was carried out in the services of pediatric clinic in the Pediatric Teaching Hospital "Hermanos Cordové", in Manzanillo, Cuba, during the year 2018. All discharged patients who had a confirmed diagnosis of this type of infection were studied (n=298). The following variables were taken into account: anatomical location, classifications of the different types of skin and soft tissue infections, treatment used and hospitalization. Results: Male gender prevailed in the patients (57.7 %), and also the ages ranging between 10 to 14 years old (34.9 %). Infections located on the limbs were described in 113 patients (37.9 %). Impetigo was the most common diagnosis (42.3 %), and the most frequently used antibiotic was cefazolin (77.2 %). Most of the patients were hospitalized up to 7 days (293), with a satisfactory evolution of the disease. Conclusions: Patients with soft tissue infections in the services of pediatric clinic in the Pediatric Teaching Hospital "Hermanos Cordové" are mainly characterized for being male, especially from ages raging between 10 to 14 years old, with impetigo being the most common infection, mostly located on the limbs. Cefalozin resulted very effective for the treatment of these infections, making possible the hospitalization time to be lesser than a week.

Cutaneous protothecosis in kidney transplant recipient

Abstract Protothecosis is a rare condition caused by the aclorophylated algae of the genus Prototheca. In humans, protothecosis, caused mainly by P. wickerhamii, manifests itself in three forms: cutaneous, articular and systemic. It can occur in both immunocompetent and immunosuppressed individuals, being much more common in the latter. We present a new case of protothecosis in Brazil in a kidney transplant recipient.

Abscesos cerebrales por Nocardia spp. en una paciente inmunocompetente / Multiple brain abscesses due to Nocardia spp. in an immunocompetent patient

La infección por Nocardia spp. no es común en pacientes inmunocompetentes. El tratamiento antimicrobiano empírico dirigido según las regiones anatómicas, no contempla las particularidades del germen y el análisis microbiológico se hace necesario para el tratamiento específico. A continuación, se presenta el caso de una paciente previamente sana, inmunocompetente y sin factores de riesgo conocidos para la infección por Nocardia spp., con evidencia de compromiso en el parénquima pulmonar y la piel, que posteriormente desarrolló varios abscesos cerebrales.

The infection by Nocardia spp is not common in immunocompetent patients. The empirical antimicrobial treatment directed by anatomical regions does not contemplate the particularities of the germ and the microbiological analysis is necessary for the specific treatment. We present the case of a previously healthy and immunocompetent patient, without known risk factors for Nocardia spp. infection, with evidence of involvement of the pulmonary parenchyma and the skin and subsequent development of multiple brain abscesses.

Guía de Práctica Clínica para el Diagnóstico y Manejo de las Infecciones de Piel y Tejidos Blandos en Colombia / Clinical Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections in Colombia

Las infecciones de piel y tejidos blandos (IPTB) representan la tercera causa de consulta por enfermedad infecciosas a los servicios médicos, después de las infecciones respiratorias y urinarias. Se presenta una guía de práctica clínica (GPC) con 38 recomendaciones basadas en la evidencia, graduadas bajo el sistema SIGN, para el diagnóstico y tratamiento de pacientes adultos con IPTB en el contexto colombiano, posterior a un proceso de adaptación de GPC publicadas y la búsqueda sistemática y síntesis de literatura para la actualización de la evidencia científica. Además, se realizó un consenso de expertos para la evaluación de las potenciales barreras para la implementación de las recomendaciones y la evaluación del grado de recomendación en el contexto local.

Skin and soft tissue infections (SSTI) represent the third leading cause of infectious disease consultation for medical services after respiratory and urinary tract infections. This document generates a clinical practice guideline with 38 recommendations based on evidence, graduated under the SIGN system for the diagnosis and treatment for SSTI infections in adult patients in Colombia, following a process of adaptation of guidelines published, and the systematic search and synthesis of literature for the updating of scientific evidence. In addition, a consensus of experts was made for the evaluation of the potential barriers for the implementation of the recommendations and the evaluation of the degree of recommendation in the local context.

Aspectos clínico-epidemiológicos de las infecciones de piel y partes blandas en neonatos / Clinical-epidemiological aspects of skin and soft tissue infections in newborns

Introducción: Las infecciones de piel y partes blandas constituyen una de las causas más frecuentes de consulta pediátrica, de lo cual no está exento el recién nacido, que por sus peculiaridades anatómicas, fisiológicas e inmunológicas, pueden convertirse en afecciones letales. Objetivo: Describir aspectos clínicos y epidemiológicos de los recién nacidos con infecciones de piel y partes blandas. Métodos: Se realizó un estudio observacional, prospectivo y transversal en 256 pacientes que ingresaron en el Departamento de Neonatología del Hospital Pediátrico Universitario William Soler de enero de 2013 a diciembre de 2015. Se determinó la incidencia de las infecciones de piel y partes blandas, formas clínicas de presentación, edad, sexo, estadía, terapéutica utilizada y microorganismos aislados en hemocultivo. Resultados: En la muestra, 95,3 por ciento de los neonatos tenían más de 7 días de nacidos y 59,0 por ciento eran hembras. La tasa de incidencia fue de 16,1 × 100 ingresos y el 75,0 por ciento presentaba mastitis. El microorganismo más aislado en hemocultivos fue Staphylococcus aureus. El 60,9 por ciento de los pacientes recibieron monoterapia con Cefazolina. Conclusiones: La incidencia de las infecciones de piel y partes blandas fue mayor en el año 2014; los recién nacidos inician la enfermedad en la segunda semana de vida, en el sexo femenino, con una estadía hospitalaria menor de una semana. El microorganismo más aislado en hemocultivos es Staphylococcus aureus. Más de la mitad de los pacientes reciben monoterapia con Cefalosporina de primera generación como terapéutica con una evolución favorable(AU)

Introduction: Skin and soft tissue infections constitute one of the most frequent causes of pediatric consultations. Newborns are not exempt of that since their anatomic, physiological and immunological peculiarities can help to become those infections in letal ones. Objective: To describe clinical and epidemiological aspects of newborns presenting skin and soft tissue infections. Methods: An observational, prospective and cross-sectional study was carried out in 256 patients admitted in the Neonatology Department of William Soler Pediatric University Hospital from January, 2013 to Decmeber, 2015. There were determined: the incidence of skin and soft tissue infections, the clinical kinds, age, sex, stay, used therapy, microorganisms isolated in hemocultures. Results: In the sample, 95.3 percent of the newborns were of more than 7 days alive and 59.0 percent were female. The incidence rate was of 16.1 × 100 admissions, and 75.0 percent presented mastitis. The most isolated in hemocultures microorganism was Staphylococcus aureus. 60.9 percent of the patients had monotherapy with Cefazolin. Conclusions: The incidence of skin and soft tissue infections was higher in 2014; the disease onset in newborns in the second week of life, in females, with a hospital stay of less than a week. The most isolated in hemocultures microorganism is Staphylococcus aureus. More tan half of the patients undergone monotherapy with first generation Cephalosporines as a therapy with a favorable evolution(AU)

Series de Pediatría Garrahan. El niño y las infecciones / Garrahan Pediatrics Series. The child and the infections

Las consultas pediátricas por temas infectológicos son frecuentes y relevantes durante toda la infancia, desde la etapa neonatal hasta la adolescencia. En este nuevo volumen de las Series Garrahan: El ñino y las infecciones, se han seleccionado temas específicos, sobre la base de la actualización del conocimiento, los cambios epidemiológicos y de las conductas clínicas ocurridos en los últimos años y la necesidad del manejo adecuado de estas afecciones, ya sea ambulatorio o durante la internación. Entre sus aspectos sobresalientes se incluyen: El estudio de temas destacados como el abordaje del niño febril; las infecciones de piel y partes blandas, incluidas las asociadas con mordeduras; las infecciones en el recién nacido; las infecciones respiratorias bajas, incluida la tuberculosis; y las infecciones osteoarticulares, del sistema nervioso central e intraabdominales. La inclusión de un capítulo especial sobre la prevención de infecciones para ayudar a reducir su incidencia. El enfoque práctico, con discusión de casos clínicos y definición de conductas, y ubicando al pediatra en un papel central como coordinador de la atención interdisciplinaria. Aspectos clave y lecturas recomendadas en el cierre de cada capítulo. Una obra actualizada que aporta información científica y la experiencia de los profesionales del Hospital Garrahan, dedicada a todos los miembros del equipo de salud que atienden y cuidan niños dondequiera que trabajen al servicio de la salud infantil

Cutaneous protothecosis: A case report

Introduction@#Cutaneous protothecosis usually presents as pyoderma-like lesions or infiltrating papules and plaques on the extensor side of the extremities. It can be misdiagnosed as eczema, pyoderma, or a fungal infection. Although it has been isolated from a swimming pool, sewers and rivers in the Philippines, there has been no reported case of cutaneous protothecosis in the country.@*Case summary@#A 78-year-old Taiwanese male farmer visited the dermatology clinic due to a six-month history of a large, pruritic erythematous plaque studded with papulopustules on his left forearm. A potassium hydroxide (KOH) examination showed negative for hyphae or spores. And a skin biopsy showed morula-like bodies, which were highlighted by the Periodic acid-Schiff stain.@*Conclusion@#We report a case of cutaneous protothecosis from Taiwan so Filipino dermatologists will be aware of the clinical and histopathologic manifestations and management of cutaneous protothecosis.

Tuberculosis verrucosa cutis en niños: Presentación de dos casos y revisión de la literatura / Tuberculosis verrucosa cutis in children: Two cases report and review

La tuberculosis cutánea (TBC) representa el 1.5% de todas las formas de TB extrapulmonares. Es una enfermedad proteiforme y su diagnóstico constituye un reto al clínico. La TB verrucosa cutis (TBVC) es una variante clínica paucibacilar, de TBC, donde es infrecuente aislar en medios de cultivos el Mycobacterium tuberculosis. Ocurre en niños previamente sensibilizados e inmunocompetentes que se reinfectan con este bacilo de una fuente exógena, algunas veces de un esputo o secreción de un paciente con TB activa, cuando juega en la tierra. La bacteria penetra a la piel a través de pequeñas abrasiones en zonas expuestas a traumas como lo son rodillas, tobillos o glúteos. La lesión se inicia como un papulonódulo verrucoso asintomático, parecido a una verruga común, que evoluciona a una placa verrucosa . Reportamos 2 casos de TBVC, una niña de 6 años de edad y el segundo, un niño de 10 años de edad ambos de la comarca Guna Yala, un área con alta prevalencia de TB en Panamá. En el segundo caso se logró aislar el M. Tuberculosis en medios de cultivo y demostrarse además por la reacción en cadena de la polimerasa (PCR). La respuesta a la terapia antituberculosa fue exitosa, en ambos casos, con completa regresión de las lesiones a los 2 meses de tratamiento

Cutaneous tuberculosis (CTB) comprises 1.5% of all extrapulmonary TB forms. It is a proteiform disease and its diagnosis represents a challenge to the clinician. TB verrucosa cutis (TBVC) a paucibacillary clinical manifestation of CTB, where routine cultures for Mycobacteriun tuberculosis, are commonly negative. Occurs in children previously sentitized with a moderate to high degree of immunity. It represents an exogenous reinfection of M. tuberculosis, sometimes from a contaminated sputum of a patient with active TB, at sites prone to minor abrasions, such as, knees, ankles or buttocks. The lesion begins as a solitary asymptomatic verrucous papulonodule, similar to a common wart, that evolves to a verrucous plaque. The author report 2 cases of TBVC, a 6 year old girl and the second one, a 10 year old boy, both from Guna Yala, an indigenous region, o the coast of Panama, an area with a high prevalence of TB. In the second case, M. tuberculosis was isolated in routine cultures and reported positive in Polimerase chain reaction (PCR). The antituberculous therapy was successfull in both patients, with complete regression of the lesions after 2 months of treatment

High frequency of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in children under 1 year old with skin and soft tissue infections / Alta frequência de S. aureus (MSSA-MRSA) em crianças com menos de um ano deidade com infecções de pele e do tecido mole

Abstract Objective: Staphylococcus aureus is responsible for a large number of infections in pediatric population; however, information about the behavior of such infections in this population is limited. The aim of the study was to describe the clinical, epidemiological, and molecular characteristics of infections caused by methicillin-susceptible and resistant S. aureus (MSSA-MRSA) in a pediatric population. Method: A cross-sectional descriptive study in patients from birth to 14 years of age from three high-complexity institutions was conducted (2008-2010). All patients infected with methicillin-resistant S. aureus and a representative sample of patients infected with methicillin-susceptible S. aureus were included. Clinical and epidemiological information was obtained from medical records and molecular characterization included spa typing, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). In addition, staphylococcal cassette chromosome mec (SCCmec) and virulence factor genes were detected. Results: A total of 182 patients, 65 with methicillin-susceptible S. aureus infections and 117 with methicillin-resistant S. aureus infections, were included in the study; 41.4% of the patients being under 1 year. The most frequent infections were of the skin and soft tissues. Backgrounds such as having stayed in day care centers and previous use of antibiotics were more common in patients with methicillin-resistant S. aureus infections (p ≤ 0.05). Sixteen clonal complexes were identified and methicillin-susceptible S. aureus strains were more diverse. The most common cassette was staphylococcal cassette chromosomemec IVc (70.8%), which was linked to Panton-Valentine leukocidin (pvl). Conclusions: In contrast with other locations, a prevalence of infections in children under 1 year of age in the city could be observed; this emphasizes the importance of epidemiological knowledge at the local level.

Resumo Objetivo: O Staphylococcus aureus é responsável por um grande número de infecções na população pediátrica; contudo, as informações sobre o comportamento dessas infecções nessa população são limitadas. O objetivo do estudo foi descrever as características clínicas, epidemiológicas e moleculares de infecções causadas por Staphylococcus aureus suscetíveis e resistentes à meticilina (MSSA-MSRA) em uma população pediátrica. Método: Um estudo transversal descritivo foi realizado em pacientes entre 0 e 14 anos de idade de três instituições de alta complexidade (2008-2010). Todos os pacientes infectados com S. aureus resistentes à meticilina e uma amostra representativa de pacientes infectados com S. aureus suscetíveis à meticilina foram incluídos. As informações clínicas e epidemiológicas foram obtidas de prontuários médicos, e a caracterização molecular incluiu tipagem spa, Eletroforese em Gel de Campo Pulsado (PFGE) e Tipagem de sequências multilocus (MLST). Além disso, o Cassete Cromossômico Estafilocócico mec (SCCmec) e genes de fatores de virulência foram detectados. Resultados: 182 pacientes, 65 com infecções por S. aureus suscetíveis à meticilina e 117 com infecções por S. aureus resistentes à meticilina, foram incluídos no estudo; 41,4% dos pacientes com menos de um ano de idade. As infecções mais frequentes foram da pele e dos tecidos moles. Os históricos como internações em centros de atendimento e o uso prévio de antibióticos foram mais comuns em pacientes com infecções por S. aureus resistentes à meticilina (p ≤ 0,05). Dezesseis complexos clonais foram identificados, e as cepas de S. aureus suscetíveis à meticilina foram mais diversificadas. O cassete mais comum foi o Cassete Cromossômico Estafilocócicomec IVc (70,8%), relacionado à leucocidina de panton-valentine (pvl). Conclusões: Em comparação a outros locais, observamos uma prevalência de infecções em crianças com menos de um ano de idade na cidade; o que enfatiza a importância de conhecer a epidemiologia em nível local.

Diagnóstico diferencial de leishmaniasis mucocutánea. A propósito de un caso de carcinoma basocelular de la piel / Differential diagnosis of mucocutaneous leishmaniasis. Report of a clinical case of basocellular carcinoma of the skin

Introducción. La leishmaniasis es una enfermedad parasitaria causada por aproximadamente veinte especies diferentes del protozoario Leishmania sp. y transmitida al hombre por la picadura de un mosquito hembra del género Phlebotomine sp. Las manifestaciones clínicas son variables y están relacionadas con la especie infectante; su relación con el ambiente y con la respuesta inmune del hospedero. La leishmaniasis mucocutánea (LMC), afecta a piel y mucosas de la estructura de vías respiratorias superiores; está presente en Latinoamérica donde es producida principalmente por la especie Leishmania (Vianna) braziliensis. Los signos iniciales son eritema y ulceraciones en los orificios nasales, seguidos por inflamación destructiva que puede extenderse hasta afectar el septo nasal y en algunos casos, la faringe o la laringe, desfigurando gravemente el rostro y comprometiendo la vida del paciente. Caso clínico. Varón de 90 años proveniente del Noroccidente de Pichincha, quien presenta varias lesiones ulcerativas localizadas en el puente nasal derecho, ángulo interno del ojo derecho y mejilla homolateral cubriendo un área aproximada de 4 cm. de diámetro. Inicialmente se sospechó de LMC y se aplicaron varias dosis de antimonio pentavalente (Glucantime©). Se realizaron exámenes diagnósticos para Leishmaniasis (frotis, cultivo y PCR) los cuales resultaron negativos. Resultados. La muestra de biopsia de piel determinó lesión compatible con carcinoma basocelular refiriéndose al paciente a SOLCA. Discusión. Existen algunos diagnósticos diferenciales de la LMC en zonas endémicas, siendo el carcinoma de piel uno de los cuales los médicos y laboratoristas deberían tener en cuental al momento del diagnóstico. Además deben confirmarse los diagnósticos de LMC con exámenes de laboratorio para evitar el mal uso de antimoniales. Conclusiones. En zonas endémicas de LMC, se debe realizar un adecuado diagnóstico diferencial de otras patologías que causan lesiones ulcerativas como este tipo de carcinoma basocelular de piel, evitando la administración de antimonio pentavalente de manera indiscriminada.

Introduction. Leishmaniasis is a parasitic disease caused about twenty differents species of the Leishmania protozoo.Transmitted to humans by the bite of a female midge of the genus Phlebotomine sp. The clinical manifestations are variable and are related to the infected species, their relationship with the environment and the host immune response. Mucocutaneous leishmaniasis (MCL), affect the skin and mucous membranes of the upper respiratory tract, is present in Latin America, produced mainly by Leishmania (Vianna) braziliensis. The initial signs first signs are erythema and ulcerations in the nostrils, followed by destructive inflammation that can spread to involve the nasal septum, in some cases, pharynx or larynx, severely disfiguring the face and compromise the patient's life. Clinical case. A 90 year old male from the Northwest of Pichincha province, who has several ulcerative lesions in the right nasal bridge, inner corner of the right eye and ipsilateral cheek covering an area of approximately 4 cm in diameter is presented. Multiple doses of pentavalent antimony (Glucantime©) were applied because it was suspected MCL. Diagnostic tests for Leishmaniasis (smear, culture and PCR) were negative. Histopathological examination determined that it was a basal cell skin carcinoma. Results. The skin biopsy sample determined a lesion with basal cell carcinoma, we have referred the patient to SOLCA. Discussion. There are some differential diagnoses of MCL in endemic areas, skin carcinoma being one of which doctors and laboratory technicians should take into account at the time of diagnosis. In addition, MCL diagnoses should be confirmed with laboratory tests to avoid misuse of antimonials. Conclusions. In endemic areas of MCL, a proper differential diagnosis must be performed for ulcerative lesions such as basal cell carcinoma of the skin, avoiding the indiscriminately administration of pentavalent antimony.

PLECT: enfermedades tropicales de manifestación verrucosa / PLECT: tropical manifestation diseases verrucosa

Cada día es más habitual ver en nuestra consulta médica enfermedades dermatológicas endémicas de zonas tropicales, gracias a los flujos migratorios recientes y aumento del turismo hacia el extranjero. Presentamos un acrónimo muy utilizado en Brasil, PLECT, que reúne a enfermedades infecciosas que deben tenerse en mente en el diferencial de lesiones verrucosas, a saber, Paracoccidiodomicosis, Leishmaniasis Tegumentar, Esporotricosis, Cromomicosis y Tuberculosis Cutánea.

Increasingly, it is more common to see dermatological diseases that are endemic in tropical areas in our medical practice, thanks to recent migratory flows and increased tourism abroad. We present an acronym widely used in Brazil, PLECT, which brings together infectious diseases that should be borne in mind in the differential of verrucous lesions, namely, Paracoccidiodomicosis, Cutaneous Leishmaniasis, Sporotrichosis, Chromomycosis and Cutaneous Tuberculosis.