Uso de macrólidos en niños hospitalizados en unidades de cuidados moderados e intensivos durante 2018 / Use of macrolides in children hospitalized in Intensive and moderate care units in 2018 / Uso de macrólidos em crianças hospitalizadas em unidades de cuidados intermediários e intensivos no 2018

Introducción: se describe a nivel mundial un aumento en la prescripción de macrólidos en niños y adolescentes, generando el riesgo de emergencia de cepas resistentes. Objetivo: caracterizar el uso de macrólidos en niños de 1 mes a 14 años hospitalizados en cuidados moderados e intensivos del Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR). Metodología: estudio descriptivo transversal de niños hospitalizados tratados con macrólidos en el HP-CHPR en 2018. Variables: tipo de macrólido, duración del tratamiento, estudios y hallazgos microbiológicos y diagnóstico al egreso. Resultados: recibieron macrólidos 334 niños, mediana de edad 13 meses, 58,4% varones. 71,0% en Unidad de Terapia Intensiva (UTI). Predominó la prescripción de claritromicina (72,8%), durante los dos últimos cuatrimestres del año (77,5%) y por patología respiratoria (94%): bronquiolitis (23,3%), infección aguda no especificada de las vías respiratorias inferiores (21,9%) y crisis asmática (19,1%). Mediana de tratamiento con azitromicina y claritromicina 5 y 8 días respectivamente. Se realizaron estudios microbiológicos en 96,1% sin determinarse microorganismo en 58,3%. Conclusiones: se destaca el uso de macrólidos principalmente en la UTI y por patología respiratoria. La prescripción por fuera de las recomendaciones nacionales vigentes y la baja confirmación microbiológica que apoye el uso fueron los mayores problemas detectados, por lo que parece fundamental establecer estrategias tendientes a promover un uso racional de estos antibióticos.

Introduction: literature has described a global increase in the prescription of macrolides to children and adolescents , which has increased the risk of emergence of resistant strains. Objective: to characterize the use of macrolides in children from 1 month to 14 years of age hospitalized at the moderate and intensive care units of the Pereira Rossell Pediatric Hospital Center (HP-CHPR). Methodology: descriptive cross-sectional study of hospitalized children treated with macrolides at the HP-CHPR in 2018. Variables: macrolide type, treatment duration, microbiological studies and findings, and diagnosis at discharge. Results: 334 children received macrolides, median age 13 months, 58.4% males. 71.0% hospitalized atnan Intensive Care Unit (ICU). Clarithromycin was mainly prescribed in 72.8% of the cases, during the last two quarters of the year (77.5%), due to respiratory disease (94%): bronchiolitis (23.3%), lower respiratory tract unspecified acute infection (21.9%) and asthma crisis (19.1%). Median treatment included Azithromycin and Clarithromycin for 5 and 8 days respectively. Microbiological studies were carried out in 96.1% of the cases and 58.3% did not show the presence of microorganisms. Conclusions: the use of macrolides stands out, mainly at ICUs and due to respiratory pathologies. The main problems identified were prescriptions made outside the framework of the present national recommendations and the low microbiological confirmation for their use, which suggests it is essential to set strategies to promote a more rational use of these antibiotics.

Introdução: a literatura descreve um aumento a nível global na prescrição de macrolídeos para crianças e adolescentes, o que tem aumentado o risco de surgimento de cepas resistentes. Objetivo: caracterizar o uso de macrolídeos em crianças de 1 mês a 14 anos de idade internadas nas unidades de terapia moderada e intensiva do Centro Hospitalar Pediátrico Pereira Rossell (HP-CHPR). Metodologia: estudo transversal descritivo de crianças hospitalizadas tratadas com macrolídeos no HP-CHPR em 2018. Variáveis: tipo de macrolídeo, duração do tratamento, estudos e achados microbiológicos e diagnóstico no momento da alta. Resultados: 334 crianças receberam macrolídeos, idade mediana de 13 meses, 58,4% do sexo masculino. 71,0% internados em Unidade de Terapia Intensiva (UTI). A Claritromicina foi prescrita principalmente em 72,8% dos casos, nos últimos dois trimestres do ano (77,5%), devido a doença respiratória (94%): bronquiolite (23,3%), infecção aguda não especificada do trato respiratório inferior (21,9%) e crise de asma (19,1%). O tratamento médio incluiu Azitromicina e Claritromicina por 5 e 8 dias, respectivamente. Estudos microbiológicos foram realizados em 96,1% dos casos e 58,3% não evidenciaram a presença de microrganismos. Conclusões: destaca-se o uso de macrolídeos, principalmente em UTIs, e devido a patologias respiratórias. Os principais problemas identificados foram as prescrições feitas fora das atuais recomendações nacionais e a baixa confirmação microbiológica para sua utilização, o que sugere que é essencial definir estratégias para promover uma utilização mais racional destes antibióticos.

Mycobacterium abscessus urinary tract infection: case report / Infecção urinária por Mycobacterium abscessus: relato de caso

Abstract Urinary tract infection is a serious public health issue that predominantly affects women. In men, it is more often associated with prostatic hyperplasia and bladder catheterization. Urogenital tuberculosis presents with nonspecific with nonspecific symptoms and the diagnosis can be made in the presence of sterile leukocyturia and recurrent infection with acid urine. Non-tuberculous mycobacteria or other non-tuberculosis mycobacteria are opportunistic pathogens that inhabit the soil, water or environment surfaces, and usually cause diseases in immunocompromised individuals. Mycobacterium abscessus is an agent that causes lung, skin and soft tissue hospital infections. Urinary tract infections by this pathogen are rare.

Resumo Infecção do trato urinário é um sério problema de saúde pública que acomete predominantemente as mulheres. Em homens, está mais relacionada com hiperplasia prostática e cateterismo vesical. A tuberculose urogenital cursa com sintomas inespecíficos e o diagnóstico pode ser aventado na presença de leucocitúria estéril, e infecção recorrente com urina ácida. Micobactérias não tuberculosas ou mycobacteria other than tuberculosis são patógenos oportunistas que habitam o solo, a água ou superfícies do meio ambiente, e geralmente causam doenças em imunodeprimidos. Mycobacterium abscessus é um agente que causa infecções nosocomiais, pulmonares, de pele e de tecidos moles. Infecção urinária decorrente desse patógeno é considerada rara.

Delftia acidovorans pneumonia with lung cavities formation / Neumonia con formación de cavidades pulmonares causada por Delftia acidovorans

Abstract Case Description: A 52-year-old female patient was admitted to our clinic with complaints of cough, sputum, fever and fatigue. The patient has been receiving immunosuppressive therapy for thrombocytopenic purpura for 5 years. Clinical Finding: Inspiratory crackles were heard on both hemithorax. Oxygen saturation measured with the pulse oximeter was 97%. Chest X-ray showed diffuse reticular opacities that were more prominent in the upper zones of both lungs. WBC counts were 17,600 mm3 and Platelet counts were 29,000 mm3. Thorax CT showed that there were many thin-walled cavities and millimetric nodules accompanied by ground-glass infiltrates in the upper and middle lobes. Gram staining of bronchial fluid, taken by bronchoscopy, revealed Gram-negative bacilli and intense polymorphonuclear leukocytes. The bacteria were defined as Delftia acidovorans by BD Phoenix automated system. Treatment and outcomes: The patient was hospitalized with suspicion of opportunistic pulmonary infections and cavitary lung disease. After the empirical treatment of intravenous piperacillin-tazobactam and oral clarithromycin, her clinical and radiological findings significantly regressed, and she was discharged with outpatient follow-up. Clinical Relevance: This is the first example of cavitary pneumonia due to Delftia acidovorans in an immunocompromised patient. We would like to emphasize that Delftia pneumonia should be considered in the differential diagnosis of pulmonary cavitary involvement in such patients.

Resumen Descripción del caso: Una mujer de 52 años llegó a la clínica con tos, esputo, fiebre y fatiga. El paciente estuvo recibiendo terapia inmunosupresora durante 5 años para el tratamiento de la púrpura trombocitopénica. Hallazgo clínico: se escucharon crepitaciones inspiratorias en ambos hemitórax. La saturación de oxígeno fue del 97%. La radiografía de tórax mostró opacidades reticulares difusas que eran más prominentes en las zonas superiores de ambos pulmones. Los recuentos de leucocitos fueron de 17,600 mm3 y los recuentos de plaquetas fueron de 29,000 mm3. La TC de tórax mostró muchas cavidades de pared delgada y nódulos milimétricos acompañados de infiltrados vitrales en los lóbulos superior y medio. La tinción de Gram del líquido bronquial reveló bacilos gramnegativos y leucocitos polimorfonucleares. Las bacterias fueron identificadas como Delftia acidovorans. Tratamiento y resultados: La paciente fue hospitalizado con una sospecha de infección oportunista pulmonar y enfermedad pulmonar cavitaria. Después del tratamiento empírico de piperacilina-tazobactam intravenosa y claritromicina oral, los síntomas y signos retrocedieron significativamente, y fue dada de alta con seguimiento ambulatorio. Relevancia clínica: este es el primer registro de neumonía cavitaria causado por Delftia acidovorans en una paciente inmunocomprometida. Enfatizamos que la neumonía por Delftia debe considerarse en el diagnóstico diferencial de la afectación de la cavidad pulmonar en tales pacientes.

Pitiriasis liquenoide crónica en un adulto mayor: reporte de un caso / Pityriasis lichenoides in an older adult: report of a case

La pitiriasis liquenoide crónica (PLC) es una enfermedad benigna, que se caracteriza por tener un curso gradual, con aparición de múltiples pápulas con escamas adherentes de predominio en tronco y extremidades proximales. Con el objetivo de describir la presentación clínica, discutir el diagnóstico, diagnósticos diferenciales, tratamiento y revisar la literatura se presenta el caso de un hombre de 88 años que presentó múltiples lesiones papuloescamosas en extremidades inferiores. Se realizó biopsia cutánea que confirmó el diagnóstico de PLC. El paciente recibió tratamiento con emulsión hidratante, clobetasol tópico y claritromicina con resolución completa de las lesiones. La pitiriasis liquenoide crónica es un trastorno inflamatorio poco frecuente, de etiología desconocida que ocurre más comúnmente en adultos jóvenes y niños. Si bien la clínica es sugerente, se requiere biopsia cutánea para su confirmación diagnóstica. Es un trastorno benigno, a menudo asintomático y autolimitado, por lo que se debe valorar su tratamiento paciente a paciente. Principalmente se utilizan corticoides tópicos y antibióticos orales (tetraciclinas y eritromicina). Se ha vinculado en escasas publicaciones con el desarrollo de linfoma cutáneo y como síndromes paraneoplásicos, por lo que se sugiere realizar seguimiento.

Chronic lichenoid pityriasis (PLC) is a benign disorder, characterized by a gradual course with the appearance of multiple squamous papules with adherent scales predominating in the trunk and proximal extremities. With the objective to describe its clinical presentation, diagnosis, differential diagnosis, treatment and review literature, we present an 88-yearold male with multiple lesions in the lower extremities of one year of evolution, with papules and adherent scales. A skin biopsy was performed that confirmed the diagnosis of PLC. The patient received treatment with moisturizing emulsion, clobetasol topical and clarithromycin with complete resolution of the lesions. Chronic lichenoid pityriasis is a rare inflammatory disease of unknown etiology that occurs most commonly in young adults and children. Although the clinic is suggestive, a skin biopsy is required for diagnostic confirmation. It is a benign disorder, often asymptomatic and self-limiting, so its patientto- patient treatment should be assessed. Topical corticosteroids and oral antibiotics (tetracyclines and erythromycin) are used. It has been linked in few publications with the development of cutaneous lymphoma and as paraneoplastic syndromes, so it is suggested to follow up.

An overview of malaria transmission from the perspective of Amazon Anopheles vectors

In the Americas, areas with a high risk of malaria transmission are mainly located in the Amazon Forest, which extends across nine countries. One keystone step to understanding the Plasmodium life cycle in Anopheles species from the Amazon Region is to obtain experimentally infected mosquito vectors. Several attempts to colonise Ano- pheles species have been conducted, but with only short-lived success or no success at all. In this review, we review the literature on malaria transmission from the perspective of its Amazon vectors. Currently, it is possible to develop experimental Plasmodium vivax infection of the colonised and field-captured vectors in laboratories located close to Amazonian endemic areas. We are also reviewing studies related to the immune response to P. vivax infection of Anopheles aquasalis, a coastal mosquito species. Finally, we discuss the importance of the modulation of Plasmodium infection by the vector microbiota and also consider the anopheline genomes. The establishment of experimental mosquito infections with Plasmodium falciparum, Plasmodium yoelii and Plasmodium berghei parasites that could provide interesting models for studying malaria in the Amazonian scenario is important. Understanding the molecular mechanisms involved in the development of the parasites in New World vectors is crucial in order to better determine the interaction process and vectorial competence.

Post-operative sinus formation due to Mycobacterium abscessus: A case report.

Summary: Mycobacterium abscessus is ubiquitously found rapidly growing mycobacteria. Although it is an uncommon pathogen, it has been known to cause cutaneous infection following inoculation, minor trauma or surgery. This communication reports an immuno-competent patient developing multiple sinuses due to Mycobacterium abscessus in the post- operative period.

Successful treatment of recurrent follicular B-cell lymphoma with clarithromycin, prednisolone, and cyclophosphamide

No abstract available.

Effect of Helicobacter pylori eradication therapy in iron deficiency anaemia of pregnancy – A pilot study.

Background & objectives: Despite routine iron supplementation and promotion of diet modification, iron deficiency anaemia (IDA) remains widely prevalent in our antenatal population. Recent studies in pediatric population have highlighted the role of Helicobacter pylori infection in IDA. This study was undertaken to study the effect of eradication therapy in H. pylori infected pregnant women with IDA. Methods: Randomized placebo-controlled double blind clinical trial was done on 40 antenatal women between 14-30 wk gestation, with mild to moderate IDA and having H. pylori infection, as detected by stool antigen test. These women were randomly divided into group I (n=20): H. pylori treatment group (amoxicillin, clarithromycin, omeprazole for 2 wk) and group II (n=20): placebo group. Both groups received therapeutic doses of iron and folic acid. Outcome measures were improvement in haematological parameters and serum iron profile after 6 wk of oral iron therapy. Results: The prevalence of iron deficiency in pregnant women with mild to moderate anaemia was 39.8 per cent (95% CI 35.7, 44.3); and 62.5 per cent (95% CI 52, 73) of these pregnant women with IDA were infected with H. pylori. After 6 wk of therapeutic oral iron and folic acid supplementation, the rise in haemoglobin, packed cell volume, serum iron and percentage transferrin saturation was significantly (P<0.05) higher in the group given H. pylori eradication therapy as compared to the placebo group. Interpretation & conclusions: Our results showed a high occurrence of H. pylori infection in pregnant women with IDA. Eradication therapy resulted in significantly better response to oral iron supplementation among H. pylori infected pregnant women with IDA.

Impact of macrolide therapy on mortality of HIV-infected patients with community-acquired pneumonia in a tertiary teaching hospital

BACKGROUND: Bacterial pneumonia is one of the main causes of morbidity and mortality in patients infected by the human immunodeficiency virus (HIV). The main objective of this study was to evaluate the effect of macrolide therapy in combination with a beta-lactam based empiric regimen for inpatients with community-acquired pneumonia and HIV. METHODS: This is a retrospective cohort study of hospitalized patients. Adult patients who had received treatment with ceftriaxone or ceftriaxone plus clarithromycin were included. RESULTS: 76 patients met the inclusion criteria. Among baseline characteristics analyzed, only respiratory rate showed significant difference: patients who had received clarithromycin were more likely to have a respiratory rate > 30/min than patients who received only ceftriaxone (64 percent versus 36 percent, p = 0.03). ICU admission was the only outcome that showed a significant difference, more frequent in the ceftriaxone plus clarithromycin group (45 percent versus 20 percent, p = 0.03). CONCLUSIONS: This study does not support the addition of a macrolide to a beta-lactam based regimen in HIV-infected patients. This is probably related to the patients' immunodeficiency status, which impairs the immunomodulatory properties of the macrolides.

Erradicación de Helicobacter pylori post-tratamiento en niños con endoscopia control / Eradication of Helicobacter pylori in children post-treatment endoscopy controlled

Introducción: El tratamiento ideal para erradicar el H. pylori en niños, no se ha encontrado. Existe poco consenso sobre indicación de reendoscopia y tratamiento, con preocupación sobre la resistencia bacteriana. Objetivo: determinar la erradicación de H. pylori post-tratamiento en pacientes con indicación de segunda endoscopia, revisión de esquemas terapéutico y seguimiento. Pacientes y Métodos: estudio prospectivo, 73 pacientes seleccionados de 268 niños tratados con triple terapia por 14 días. Variables estudiadas: indicación de segunda endoscopia, tratamiento recibido, porcentaje de erradicación, falla de tratamiento y seguimiento por dos años. Resultados: edad promedio 7,94 años (rango:1-15); 27 (36,98%) varones y 46 (63,01%) hembras. Indicación de segunda endoscopia: dolor abdominal (63,01%), gastritis crónica activa severa (16,43%), cúmulos linfoides (8,21%), atrofia glandular focal (9,58%), metaplasia intestinal (2,73%). Tratamiento inicial indicado: amoxicilina-metronidazol-inhibidores de bomba 47/73 (63,01%), amoxicilinaclaritromicina-inhibidores de bomba 18/73 (24,65%), metronidazol-claritromicina-inhibidores de bomba 6/73/ (8,21%) y amoxicilina-furoxona-inhibidores de bomba 2/73 (2,73%). Se encontró positividad de H. pylori en la segunda biopsia 31/73 (42,46%). Comparando primera y segunda biopsia, una erradicación de 57,53%, (p=0.0001). Una eficacia de amoxicilinaclaritromicina-inhibidores de bomba 77,77% vs. Amoxicilinametronidazol-inhibidores de bomba 48,93%, p= 0.0356. Falla en la erradicación en triple terapia con metronidazol 51,06%. No hubo diferencias significativas con los otros esquemas. En el seguimiento, tercera endoscopia en 10/31(32,25%), en 8/10 la bacteria presente y 4/8 de ellos, con cuarta endoscopia, 3/4 con persistencia de la infección y uno con curación, no pudiéndose determinar si se trataba de recurrencia o re-infección...

Introduction: The ideal treatment to eradicate H. pylori in children has not been found. There is little consensus on the indication of reendoscopy and treatment, with concern over bacterial resistance. Objective: To determine the eradication of H. pylori after treatment in patients with an indication of second endoscopy, review of therapeutic and monitoring schemes. Patients and Methods: A prospective study, 73 patients selected from 268 children treated with triple therapy for 14 days. Studied variables: indication of second endoscopy, treatment received, percentage of eradication, failure of treatment and monitoring for two years. Results: Mean age 7.94 years (range: 1-15); 27 (36.98%) males and 46 (63.01%) females. Indication of second endoscopy: abdominal pain (63.01%), severe active chronic gastritis (16.43%), lymphoid clusters (8.21%), focal glandular atrophy (9.58%), intestinal metaplasia (2.73%). Initial treatment indicated: amoxicillin-metronidazole-pump inhibitors 47/73 (63.01%), amoxicillin-clarithromycin-pump inhibitors 18/73 (24.65%), metronidazole-clarithromycin-pump inhibitors 6 / 73 / ( 8.21%) and amoxicillin-Furoxone-pump inhibitors for 2 / 73 (2.73%). Were positive for H. pylori in the second biopsy 31/73 (42.46%). Comparing first and second biopsy, an eradication of 57.53% (p = 0.0001). Efficacy of amoxicillin-clarithromycin-pump inhibitors 77.77%. vs. amoxicillin-metronidazole-pump inhibitors 48.93%, p = 0.0356. Failure to eradicate metronidazole triple therapy 51.06%. There were no significant differences with the other schemes. Upon follow up, a third endoscopy in 10/31 (32.25%), in 8/10 the bacteria were present and 4/8 of them, with fourth endoscopy, 3/4 with persistent infection and one with healing, unable to determine whether it was a recurrence or reinfection. Eradication therapy is complex, it requires improving the therapeutic strategy and monitoring to increase the healing of the infection.

Treatment Outcome of Combination Therapy Including Clarithromycin for Mycobacterium avium Complex Pulmonary Disease

BACKGROUND/AIMS: The frequency of nontuberculous mycobacteria pulmonary disease in HIV-negative patients is increasing; the most common pathogen in Korea is the Mycobacterium avium complex (MAC). However, few studies have evaluated the treatment outcome of MAC pulmonary disease in Korea. METHODS: The efficacy of a clarithromycin-containing regimen for MAC pulmonary disease was studied in 42 patients treated for more than 6 months between January 2005 and December 2008. All patients were treated with a regimen consisting of clarithromycin, rifampin, and ethambutol. Streptomycin was added in 10 patients. RESULTS: Among the 42 patients, a negative culture conversion was achieved in 33 (78.6%), and the median duration of treatment in these patients was 19 months (interquartile range [IQR], 16 to 22). Of the 33 patients with a negative culture conversion, 14 completed treatment. During the follow-up period (median, 10 months; IQR, 4 to 20) for the 14 patients, one relapsed at 24 months after treatment completion. The culture conversion rate was significantly higher in patients who were treated with more than 500 mg/day clarithromycin (87.1% vs. 54.5%, p = 0.038). CONCLUSIONS: The combined regimen including clarithromycin was effective against MAC pulmonary disease. High-dose clarithromycin of more than 500 mg/day may improve the outcome of patients with MAC pulmonary disease.

Efficacy of Levofloxacin and Rifaximin based Quadruple Therapy in Helicobacter pylori Associated Gastroduodenal Disease: A Double-Blind, Randomized Controlled Trial

The aim of this study was to evaluate the efficacy of levofloxacin and rifaximin based quadruple regimen as first-line treatment for Helicobacter pylori infection. A prospectively randomized, double-blinded, parallel group, comparative study was performed. Three hundred consecutive H. pylori positive patients were randomized to receive: omeprazole, amoxicillin, clarithromycin (OAC); omeprazole, amoxicillin, levofloxacin (OAL); and omeprazole, amoxicillin, levofloxacin, rifaximin (OAL-R). The eradication rates in the intention to treat (ITT) and per protocol (PP) analyses were: OAC, 77.8% and 85.6%; OAL, 65.3% and 73.6%; and OAL-R, 74.5% and 80.2%. The eradication rate achieved with OAC was higher than with OAL on the ITT (P = 0.05) and PP analysis (P = 0.04). OAL-R regimen was not inferior to OAC. The frequency of moderate to severe adverse effects was significantly higher in OAC treatment group. Especially, diarrhea was most common complaint, and there was a significantly low rate of moderate to severe diarrhea with the rifaximin containing regimen. In conclusion, the levofloxacin and rifaximin based regimen comes up to the standard triple therapy, but has a limited efficacy in a Korean cohort. The rifaximin containing regimen has a very high safety profile for H. pylori eradication therapy.

Linfoma malt gástrico: presentación de un caso y revision de literatura / Gastric malt lymphoma: case report and literature review

Escolar masculino de 9 años, con mielomeningocele corregido e hidrocefalia, enfermedad actual de 3 años de evolución, caracterizada por epigastralgia intermitente, recibe tratamiento sin mejoría. Dos días antes del ingreso se asocian vómitos, hematemesis y fiebre. Al examen físico, signos de desnutrición crónica, anemia, hepatomegalia y dolor en epigastrio. Se realiza endoscopia digestiva superior, revela reflujo gastroesofágico, tumoración gástrica ulcerada y duodenitis inespecífica; se realizan ecosonograma abdominal, Rx esófago-estomago-duodeno contrastado y tomografía abdominal, donde se evidenció tumor en antro pilórico de 6 por 7 cm, estenosante y distensión gástrica. Recibe hemoderivados, por anemia aguda. Se realiza laparotomía exploradora, se evidencia gran tumoración friable, se extraen muestras para biopsia gástrica que reveló fragmento fibroadiposo con inflamación crónica y granulosa, reacción gigantocelular de tipo Langhans y tipo cuerpo extraño, necrosis y reagudización focal, las biopsias de ganglios, hígado y epiplón revelaron signos de inflamación crónica multifocal. Hemocultivos negativos, Anticore y Antigeno de superficie VHB negativos, PCR para CMV, estudio para BK y hongos negativos, examen de heces Blastocystis hominis, títulos de IgG contra Helicobacter pylori positivo 1.61 U/L, se inicio terapia con Metronidazol, Claritromicina y Omeprazol VEV, con remisión del tumor gástrico, todo lo cual sugiere Linfoma MALT gástrico o MALTOMA...

Masculine student of 9 years, with mielomeningocele correted and hydrocephaly, present disease of 3 years of evolution, characterized by intermittent epigastralgia, receives treatment without improvement. Two days before the entrance vomits, hematemesis and fever are associated. To the physical examination, signs of chronic undernourishment, anemia, hepatomegalia and pain in epigastrio. Superior digestive endoscopia is made, reveals gastroesfágico ebb tide, ulcerada gastric tumoración and unspecific duodenitis; ecosonograma abdominal, Rx resisted esophagus-stomach-duodeno and tomography abdominal are made, where it demonstrated tumor in pyloric caven of 6 by 7 cm, estenosante and gastric distension. It receives hemoderivados by acute anemia. Exploratory laparotomía is made, demonstrated great coldable tumoración, samples for gastric biopsy are extracted that revealed fibroadiposo fragment with chronic and granular inflammation, reaction to gigantocelular of Langhans type and type strange body, necrosis and focal reagudización, the biopsies of ganflia, liver and epiplón revealed signs of multifocal chronic inflammation. Hemocultivos negative, Anticore and Antigeno of surface VHB negative, negative PCR for CMV, study for BK and fungi, examination Blastocystis hominis and Giardia lamblia positive, titles of IgG and biopsy Helicobacter pylori positive , beginning therapy with Metronidazol, Clarotromicina and Omeprazol VEV, remission of the gastric tumor, which suggests gastric Linfoma MALT or MALTOMA...

Visual hallucinations possibly associated with clarithromycin administration at therapeutic dosage in two children

Our aim was to present 2 children with visual hallucinations possibly associated with clarithromycin administration at therapeutic dosage. Two children were admitted to our hospital with sudden onset of visual hallucinations after taking clarithromycin at therapeutic dosage by mouth. Physical examination, laboratory investigations and imaging studies were normal. The symptoms gradually disappeared once the clarithromycin therapy had been discontinued, making us suspect clarithromycin as the agent responsible for the visual hallucinations. They were observed monthly for a year without any symptoms or further treatment. This report highlights hallucinations due to therapeutic doses of clarithromycin therapy as a possible new side effect in children