[Family outbreak of brucellosis. The importance of epidemiological suspicion.] / Brote familiar de brucelosis. La importancia de la sospecha epidemiológica.

OBJECTIVE: Brucellosis is the most widespread zoonosis in the world. In Spain its incidence has decreased considerably in recent years thanks to the social and health measures carried out. 40 cases of brucellosis have been reported in humans in 2018, representing a rate of 0.09 per 100,000 inhabitants. The objective of the study was to highlight the importance of epidemiological suspicion, as well as the screening of relatives for the diagnosis of the disease. METHODS: A descriptive study of a family outbreak of imported brucellosis was carried out. Five members of the same family were evaluated after the diagnosis of brucellosis in a patient in the Health Area III of Zaragoza, in May 2019. The relatives of the patient and the health center were contacted by telephone to investigate the possibility of involvement of the relatives with whom he had traveled and lived in Morocco. RESULTS: In a scenario with a low frequency of disease such as our country at the present time, family screening, after an initial diagnosis of imported brucellosis, allowed the detection and treatment of four members of the same family of Maghreb origin. They were infected during a trip to their place of origin in April 2019, a month in which they lived in rural areas in contact with animals (sheep, goats, cows) and consumed dairy and meat products. The appearance of presented symptoms was temporally consistent with the incubation period of the disease. CONCLUSIONS: Emphasize the importance of active surveillance and screening in relatives of patients diagnosed with Brucellosis, since they generally share exposures to a common source.

OBJETIVO: La brucelosis es la zoonosis más extendida en el mundo. En España su incidencia ha disminuido considerablemente en los últimos años gracias a las medidas sociosanitarias llevadas a cabo. Se han comunicado 40 casos de brucelosis en humanos en 2018, lo que representa una tasa de 0,09 por cada 100.000 habitantes. El objetivo de este estudio fue destacar la importancia de la vigilancia activa y del cribado en familiares de pacientes diagnosticados de brucelosis. METODOS: Se realizó un estudio descriptivo de un brote familiar de brucelosis importada. Se evaluaron cinco miembros de una misma familia tras el diagnóstico de brucelosis de un paciente en el Área III de Salud de Zaragoza, en mayo de 2019. Se contactó telefónicamente con los familiares del paciente y el centro de salud para investigar la posibilidad de afectación de los familiares con quienes había viajado y convivido en Marruecos. RESULTADOS: En un escenario de escasa frecuencia de enfermedad como es nuestro país en el momento actual, el cribado familiar, tras un diagnóstico inicial de brucelosis importada, permitió detectar y tratar a cuatro miembros de una misma familia de origen magrebí. Resultaron contagiados durante un viaje en abril de 2019 a su lugar de origen, un mes en el que convivieron en el ámbito rural en contacto con animales (ovejas, cabras, vacas) y consumieron productos lácteos y cárnicos. La aparición de síntomas presentados concordó temporalmente con el periodo de incubación de la enfermedad. CONCLUSIONES: Destaca la importancia de la vigilancia activa y del cribado en familiares de pacientes diagnosticados de brucelosis, ya que comparten, por lo general, exposiciones a una fuente común.

[Painful nodules on the soles in a pediatric patient: A diagnostic challenge]. / Nodulos plantares dolorosos tras ejercicio intenso en paciente pediátrica: Un reto diagnóstico.

INTRODUCTION: Idiopathic Palmoplantar Eccrine Hidradenitis (IPPH) is a rare neutrophilic derma tosis, with painful erythematous nodules of sudden onset in the plantar or palmoplantar region, in children without other underlying diseases. OBJECTIVE: To present a case that shows the main clinical and histological characteristics of this entity. CLINICAL CASE: 11-year-old girl with a 48-hours history of painful erythematous-violaceous nodules on the right foot plant associated with fever of up to 38.2 °C, with no history of interest except hyperhidrosis and intense exercising on previous days. Given the clinical suspicion of IPPH, a skin biopsy was performed, which showed inflammatory neutrophil infiltration around eccrine sweat glands and neutrophilic abscesses, confirming the diagnosis. Oral NSAIDs and rest were prescribed, with resolution of the lesions in 7 days. CONCLUSIONS: This case demonstrates the most important aspects of this entity, in many cases underdiagnosed, since it can be confused with other pathologies that occur with painful acral nodules, but have different pathogenic and therapeutic implications. To properly identify the IPPH allows preventing an unnecessary alarm, both patients and their parents, as in dermatologists and pediatricians themselves.

Nodulos plantares dolorosos tras ejercicio intenso en paciente pediátrica: un reto diagnóstico / Painful nodules on the soles in a pediatric patient: a diagnostic challenge

Resumen: Introducción: La Hidradenitis palmoplantar ecrina idiopática (HPPI) es una dermatosis neutrofílica infrecuente, que cursa con nódulos eritematosos dolorosos de comienzo brusco en regiones plantares o palmoplantares, en niños que no tienen otra enfermedad subyacente. Objetivo: Presentar un caso que ilustra las principales características clínicas e histológicas de la HPPI. Caso Clínico: Niña de 11 años evaluada por nódulos eritematovioláceos dolorosos en planta de pie derecho de 48 horas de evo lución y fiebre de hasta 38,2 °C, sin antecedentes de interés salvo hiperhidrosis y práctica intensa de ejercicio en los días previos. Ante la sospecha clínica de HPPI se realizó biopsia cutánea, que mostró infiltrado inflamatorio neutrofílico alrededor de glándulas sudoríparas ecrinas y abscesos de neutrófilos, confirmando el diagnóstico. Se indicaron antiinflamatorios no esteroidales orales y reposo, con resolución de las lesiones en 7 días. Conclusiones: Este caso demuestra los aspectos más importantes de la HPPI. Esta entidad en muchos casos es infradiagnosticada, dado que puede confundirse con otras patologías que también cursan con nódulos acrales dolorosos, pero tienen distintas implicacio nes patogénicas y terapéuticas. Identificar apropiadamente la HPPI permite evitar la alarma innece saria, tanto en pacientes y sus padres, como en los propios dermatólogos y pediatras.

Abstract: Introduction: Idiopathic Palmoplantar Eccrine Hidradenitis (IPPH) is a rare neutrophilic derma tosis, with painful erythematous nodules of sudden onset in the plantar or palmoplantar region, in children without other underlying diseases. Objective: To present a case that shows the main clinical and histological characteristics of this entity. Clinical Case: 11-year-old girl with a 48-hours history of painful erythematous-violaceous nodules on the right foot plant associated with fever of up to 38.2 °C, with no history of interest except hyperhidrosis and intense exercising on previous days. Given the clinical suspicion of IPPH, a skin biopsy was performed, which showed inflammatory neutrophil infiltration around eccrine sweat glands and neutrophilic abscesses, confirming the diagnosis. Oral NSAIDs and rest were prescribed, with resolution of the lesions in 7 days. Conclusions: This case demonstrates the most important aspects of this entity, in many cases underdiagnosed, since it can be confused with other pathologies that occur with painful acral nodules, but have different pathogenic and therapeutic implications. To properly identify the IPPH allows preventing an unnecessary alarm, both patients and their parents, as in dermatologists and pediatricians themselves.

Brote familiar de brucelosis. la importancia de la sospecha epidemiológica / Family outbreak of brucellosis. The importance of epidemiological suspicion

OBJETIVO: La brucelosis es la zoonosis más extendida en el mundo. En España su incidencia ha disminuido considerablemente en los últimos años gracias a las medidas sociosanitarias llevadas a cabo. Se han comunicado 40 casos de brucelosis en humanos en 2018, lo que representa una tasa de 0,09 por cada 100.000 habitantes. El objetivo de este estudio fue destacar la importancia de la vigilancia activa y del cribado en familiares de pacientes diagnosticados de brucelosis. MÉTODOS: Se realizó un estudio descriptivo de un brote familiar de brucelosis importada. Se evaluaron cinco miembros de una misma familia tras el diagnóstico de brucelosis de un paciente en el Área III de Salud de Zaragoza, en mayo de 2019. Se contactó telefónicamente con los familiares del paciente y el centro de salud para investigar la posibilidad de afectación de los familiares con quienes había viajado y convivido en Marruecos. RESULTADOS: En un escenario de escasa frecuencia de enfermedad como es nuestro país en el momento actual, el cribado familiar, tras un diagnóstico inicial de brucelosis importada, permitió detectar y tratar a cuatro miembros de una misma familia de origen magrebí. Resultaron contagiados durante un viaje en abril de 2019 a su lugar de origen, un mes en el que convivieron en el ámbito rural en contacto con animales (ovejas, cabras, vacas) y consumieron productos lácteos y cárnicos. La aparición de síntomas presentados concordó temporalmente con el periodo de incubación de la enfermedad. CONCLUSIONES: Destaca la importancia de la vigilancia activa y del cribado en familiares de pacientes diagnosticados de brucelosis, ya que comparten, por lo general, exposiciones a una fuente común

OBJECTIVE: Brucellosis is the most widespread zoonosis in the world. In Spain its incidence has decreased considerably in recent years thanks to the social and health measures carried out. 40 cases of brucellosis have been reported in humans in 2018, representing a rate of 0.09 per 100,000 inhabitants. The objective of the study was to highlight the importance of epidemiological suspicion, as well as the screening of relatives for the diagnosis of the disease. METHODS: A descriptive study of a family outbreak of imported brucellosis was carried out. Five members of the same family were evaluated after the diagnosis of brucellosis in a patient in the Health Area III of Zaragoza, in May 2019. The relatives of the patient and the health center were contacted by telephone to investigate the possibility of involvement of the relatives with whom he had traveled and lived in Morocco. RESULTS: In a scenario with a low frequency of disease such as our country at the present time, family screening, after an initial diagnosis of imported brucellosis, allowed the detection and treatment of four members of the same family of Maghreb origin. They were infected during a trip to their place of origin in April 2019, a month in which they lived in rural areas in contact with animals (sheep, goats, cows) and consumed dairy and meat products. The appearance of presented symptoms was temporally consistent with the incubation period of the disease. CONCLUSIONS: Emphasize the importance of active surveillance and screening in relatives of patients diagnosed with Brucellosis, since they generally share exposures to a common source