Résumé
Recurrent infections are a consequence of a series of genetic diseases characterized by deficiency in the immunological response. One of these diseases is the agammaglobulinemia, which is characterized by the basic defect in the maturation of lymphocytes B. The carrier of this kind of immunodeficiency, which is linked to the X (XLA) chromosome, has had primary pneumonias that have evolved into secondary pneumonias (chronic lungs with sequelae) after the third or fourth year of life. The clinical and rehabilitative quest for prophylaxis against the XLA immunodeficiency is accomplished in order to avoid the evolution of the bacterial infection into sequelae and loss of pulmonary function, which propitiates the recurrence of the disease and deteriorates the life quality of the patient. Forty cases of recurrent respiratory infections were studied. Some of them were associated with primary respiratory diseases without investigation of serum immunoglobulins and some were not. Casuistics was performed according to data from medical records with pertinent treatments collected from January 1997 to September 2004 at the Specialized Physiotherapy Center. Age average was 2.7 years of life. It is statistically impossible to precise results concerning only the immunosuppressed patients due to the lack of specific diagnosis. That is explained by the fact that recurrent XLA pneumonias may be attributed to the gastroesophageal reflux disease or to bronchial asthma. However, the improved results showed by the pulmonary function as preventive strategy were attributed to the respiratory physiotherapy, since intravenous immunoglobulin replacement therapies were not performed. Respiratory physiotherapy acts as a supportive factor in the healing process and occupies a fundamental role in the prophylaxis against recurrent respiratory clinical features, especially those of obstructive and secretionary characteristics.
Sujets)
Humains , Agammaglobulinémie , Pneumopathie bactérienne/étiologie , Agammaglobulinémie/complications , Agammaglobulinémie/génétique , Maladies génétiques liées au chromosome X/complications , Maladies génétiques liées au chromosome X/génétique , Mutation , Pneumopathie bactérienne/prévention et contrôle , Pneumopathie bactérienne/rééducation et réadaptation , Protein-tyrosine kinases/génétique , RécidiveRésumé
Las infecciones respiratorias agudas son una de las causas más comunes de muerte entre los niños de los países en desarrollo. A estas de les atribuyen cuatro millones de defunciones de los 15 millones de que se estima ocurren entre menores de cinco años de edad anualmente. Casi todas las muertes por infección respiratoria aguda entre los niños pequeños se deben a infecciones respiratorias inferiores, en particular neumonía. En este artículo se presenta una revisión sobre la importancia de la neumonía bacteriana en pediatría, su clasificación, factores predisponentes, agentes etiológicos, y teniendo en cuenta las dificultades descritas en la literatura para realizar el diagnóstico etiológico, se establece un protocolo de tratamiento antimicrobiano empírico para el manejo de la neumonía en niños adquirida en la comunidad