ABSTRACT
Introducción: Anisakis simplex es un parásito helminto del pescado y cefalópodos, de distribución mundial, siendo causante de la anisakiasis o parasitación del hombre por la larva viva y/o de cuadros de reacciones alérgicas por hipersensibilidad frente a diferentes proteínas parasitarias. Este trabajo revisa los estudios existentes sobre este parásito, su ciclo biológico, manifestaciones clínicas, métodos diagnósticos y medidas preventivas a adoptar. El ciclo biológico incluye una forma adulta y tres estadios larvarios, siendo el ser humano huésped accidental. Existen tres grupos de moléculas antigénicas: somática, secretora/excretora y de superficie. Se sospecha el diagnóstico relacionando clínica e ingesta de pescado con buena tolerancia al alimento en otras ocasiones. Disponemos de 2 tipos básicos de pruebas diagnósticas: prick test y determinación de Ig E específica (CAP, RAST), con menor sensibilidad que las pruebas cutáneas. La provocación oral controlada con larva muerta del parásito confirma el diagnóstico de alergia clínica. Hay numerosas reacciones cruzadas entre Anisakis y otros parásitos dificultando el diagnóstico y siendo posible causa de la alta prevalencia de sensibilización en España. Conclusiones: La infestación del pescado por Anisakis representa un problema de salud pública. Sospechar alergia en casos de reacciones compatibles relacionadas con la ingesta de distintos tipos de pescado. La mejor forma de prevención es el cocinado o la congelación del pescado. En España el cumplimiento de la normativa de conservación y manipulación del pescado es incompleta (AU)
Subject(s)
Humans , Anisakis/parasitology , Anisakis/pathogenicity , Food Hypersensitivity/parasitology , Anisakiasis/parasitology , Food Hypersensitivity/diagnosis , Food Hypersensitivity/prevention & control , Anisakiasis/diagnosis , Anisakiasis/prevention & controlABSTRACT
Se presenta el caso de un niño de 4 años con una fístula traqueoesofágica adquirida, una entidad rara en la edad pediátrica. Se comenta el tratamiento de dicha entidad y se efectúa una revisión de la bibliografía (AU)
Subject(s)
Child, Preschool , Male , Humans , Foreign Bodies/etiology , Foreign Bodies/surgery , Tracheoesophageal Fistula/surgery , Tracheoesophageal Fistula/complications , Tracheoesophageal Fistula/diagnosisSubject(s)
Celiac Disease , Scurvy , Ascorbic Acid/therapeutic use , Celiac Disease/drug therapy , Humans , Scurvy/drug therapyABSTRACT
No disponible
Subject(s)
Child , Male , Humans , Hip , Vancomycin , Pyelonephritis , Amoxicillin-Potassium Clavulanate Combination , Arthritis, Infectious , Acute Disease , Drug Therapy, Combination , Anti-Bacterial AgentsABSTRACT
We present the case of a four year-old girl diagnosed of moderate extrinsic asthma that in the course of an episode of asthmatic status, she presented after treatment with respiratory physiotherapy an abrupt worsening of its clinical state, with appearance of a pneumotorax that precised intensive care treatment. The use of respiratory physiotherapy is dissuaded as part of the treatment in the initial phase of acute asthma, being reserved this treatment later in the recovery phase, anytime when a component of hypersecretion exists and the intensity of the bonchoconstriction has diminished (AU)
Se presenta el caso clínico de una niña de cuatro años de edad, diagnosticada de asma extrínseca moderada que en el curso de un estatus asmático, tras la realización de tratamiento con fisioterapia respiratoria, presentó un brusco empeoramiento de su estado clínico con aparición de neumotórax que precisó asistencia intensiva. Se desaconseja la utilización de la fisioterapia respiratoria como parte del tratamiento en la fase aguda inicial de las crisis de asma, reservándose para el período posterior de recuperación siempre y cuando exista un componente secretor importante (AU)
Subject(s)
Child, Preschool , Female , Humans , Status Asthmaticus , Anti-Asthmatic Agents , Critical Care , Respiratory TherapyABSTRACT
We present the case of a four year-old girl diagnosed of moderate extrinsic asthma that in the course of an episode of asthmatic status, she presented after treatment with respiratory physiotherapy an abrupt worsening of its clinical state, with appearance of a pneumotorax that precised intensive care treatment. The use of respiratory physiotherapy is dissuaded as part of the treatment in the initial phase of acute asthma, being reserved this treatment later in the recovery phase, anytime when a component of hypersecretion exists and the intensity of the bonchoconstriction has diminished.
Subject(s)
Respiratory Therapy/adverse effects , Status Asthmaticus/therapy , Anti-Asthmatic Agents/therapeutic use , Child, Preschool , Critical Care , Female , Humans , Respiratory Therapy/methodsABSTRACT
The purpose of this study was to verify the statistical validity of the score proposed by Thomé et al. for the differential diagnosis between bacterial and viral meningitis and to study the utility of two new parameters (CRP and the patient's age). A retrospective review of 136 consecutive cases of meningitis was made. The cases were classified into three groups according to the culture results and the use or not of intravenous antibiotics. There were 20 cases of bacterial meningitis, 60 non-bacterial and 56 cases of meningitis of uncertain etiology. Considering only the patients in the first two groups, the capacity for differential diagnosis between bacterial and non-bacterial meningitis of the 8 parameters in the original score, the CRP and the patient's age was analyzed with a numeric value of 0, 1, or 2 assigned to each parameter. Finally, the results of applying the score that includes the two new parameters with the original score are compared. We found that all parameters showed statistical significance for the differential diagnosis between bacterial and viral meningitis. The resulting score can be used in order to decide the need for intravenous antibiotic therapy, with only a few cases being uncertain. The score with the two new parameters correctly classified 78 of the 80 cases, while leaving only two case uncertain as compared to the four that remained unclassified with the original score. We conclude that the score is a useful instrument in the differential diagnosis between bacterial and viral meningitis. Furthermore, the introduction of CRP and the patient's age improves the diagnostic value of the test.
