ABSTRACT
BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of childhood death. There are few published reports of radiographic findings among children with severe CAP. OBJECTIVE: To describe chest X-ray (CXR) findings and assess association between these radiographic findings and pneumococcal isolation in children with severe CAP. METHODS: A prospective, multicenter, observational study was conducted in 12 centers in Argentina, Brazil, and the Dominican Republic. Children aged 3-59 months, hospitalized with severe pneumonia, were included. On admission, blood and pleural effusion cultures were performed. Streptococcus pneumoniae was identified according to standard procedures in the respective national reference laboratory. Chest X-rays were taken on admission and read before the culture results were reported. RESULTS: Out of 2,536 enrolled patients, 283 (11.2%) had S. pneumoniae isolated, in 181 cases (7.1%) from blood. The follow radiographic patterns were observed: alveolar infiltrate (75.2%), pleural effusion (15.6%), and interstitial infiltrate (9.2%). Overall, pleural effusion was associated with pneumococcal isolation and pneumococcal bacteremia (P < 0.001). Infiltrates were unilateral (78.7%) or bilateral (21.3%), right-sided (76%) or left-sided (24%), in the lower lobe (53.6%) or the upper lobe (46.4%). Multivariate analysis including patients with affection of only one lobe showed that upper lobe affection and pleural effusion were associated with pneumococcal isolation (OR 1.8, 95% CI, 1.3-2.7; OR 11.0, 95% CI, 4.6-26.8, respectively) and with pneumococcal bacteremia (OR 1.7, 95% CI, 1.2-2.6; OR 3.1, 95% CI, 1.2-8.0, respectively). CONCLUSIONS: Three-quarters of the patients studied had alveolar infiltrates. Upper lobe compromising and pleural effusion were associated with pneumococcal invasive disease.
Subject(s)
Community-Acquired Infections/diagnostic imaging , Community-Acquired Infections/microbiology , Pneumonia/diagnostic imaging , Pneumonia/microbiology , Child, Preschool , Female , Humans , Infant , Male , Radiography , Severity of Illness Index , Streptococcus pneumoniae/isolation & purificationABSTRACT
Eighty-four cerebrospinal fluid (CSF) samples from different children who presented with signs and symptoms of meningitis were evaluated for the presence of Mycobacterium tuberculosis complex organisms by the Gen-Probe Amplified Mycobacterium tuberculosis Direct Test (MTD; Gen-Probe, San Diego, Calif.). All CSF samples had negative acid-fast smears by the Ziehl-Neelsen staining method. M. tuberculosis was recovered from five samples. M. tuberculosis did not grow from 19 additional samples, but the samples were from patients who fulfilled specific clinical and laboratory criteria for probable tuberculous meningitis (TBM). The remaining samples (n = 60) were from patients with other infections or noninfectious causes of meningitis. The results of the MTD were interpreted as positive or negative on the basis of recommended cutoff values for respiratory specimens. These results were interpreted as true or false positives or true or false negatives on the basis of the results of M. tuberculosis culture or whether the patient fulfilled criteria for probable TBM. The Gen-Probe MTD was 33% sensitive and 100% specific for detecting M. tuberculosis complex organisms in these 84 CSF samples. If the cutoff values for positive results were decreased for the MTD (> or = 11,000 versus > or = 30,000 relative light units), the sensitivity increased to 83% and the specificity remained 100%. These results for the MTD are encouraging considering that TBM is a highly fatal disease and difficult to diagnose by conventional laboratory techniques.
Subject(s)
Cerebrospinal Fluid/microbiology , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Meningeal/diagnosis , Adolescent , Child , Child, Preschool , Culture Media , Evaluation Studies as Topic , Female , Gene Amplification , Humans , Male , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/growth & development , Nucleic Acid Probes , Predictive Value of Tests , Reagent Kits, Diagnostic , Sensitivity and Specificity , Tuberculosis, Meningeal/cerebrospinal fluid , Tuberculosis, Meningeal/microbiologySubject(s)
Adolescent , Adult , Humans , Female , Immunity , Rubella , Hemagglutination Inhibition Tests , Rural Population , Dominican RepublicABSTRACT
Se presentan los resultados audiometricos de 21 ninos que recibieron terapia intensiva en el periodo neonatal. Estan divididos en 3 grupos segun su diagnostico final: sepsis, hiperbilirrubinemia y meningitis, siendo los resultados 27%, 28.5% y 100% de perdida auditiva respectivamente para un total de 38% de perdida si se suman todos los grupos. Se evalua el nivel de ruido producido en la sala de terapia intensiva, encontrandose niveles de hasta 96 decibeles. Se recomienda el tratamiento precoz de las enfermedades del neonato y controlar en lo posible el nivel de ruido de las salas de terapia intensiva
Subject(s)
Humans , Audiometry , Infant, Newborn , Intensive Care Units , NoiseABSTRACT
Se investiga la susceptibilidad a la rubeola en 200 mujeres de un nivel socioeconomico alto, encontrandose que el 44% no tenian titulaciones por IH. El diagnostico clinico no fue corroborado por IH en el 55,5% de los casos que supuestamente padecieron de rubeola.Solo el 10,5% de la muestra, fue vacunada anteriormente, pero el 38,2% carecia de titulaciones por IH
Subject(s)
Adolescent , Adult , Humans , Female , Rubella , Immunity , Socioeconomic FactorsABSTRACT
Se comunican dos casos de sindrome hemolitico uremico (SHU) en dos ninos de 10 meses y 2 anos de edad. Ambos pacientes presentaron insuficiencia renal aguda (IRA), cuya severidad amerito manejo con dialisis peritoneal respondiendo satisfactoriamente. Por otra parte los autores discuten los aspectos relacionados con la fisiopatologia de la trombocitopenia y de la anemia hemolitica microangiopatica. Finalmente se analiza la terapeutica del sindrome
Subject(s)
Hemolytic-Uremic Syndrome , Acute Kidney Injury , Peritoneal DialysisABSTRACT
Se investiga la frecuencia de relacion entre diarrea y bacterias enteropatogenas, encontrandose un 45% de casos con crecimiento de bacterias enteropatogenas, los cuales fueron E.coli (42.7%), shiguellas (2.1%),salmonellas (1%).Se establecen relaciones con la edad, sexo, gravedad, sintomatologia, estado economico y los elementos basicos de salud ambiental de los pacientes.}
Subject(s)
Diarrhea, Infantile , Escherichia coli , Salmonella , ShigellaABSTRACT
Los autores presentan su experiencia en el manejo de 16 ninos con ceto-acidosis diabetica en una unidad de cuidados intensivos, puntualizando que los resultados optimos estan en relacion con la atencion integral, adecuada y permanente durante la etapa critica de las primeras horas. La mortalidad en este grupo fue de 12,5% y relacionada con factores no precisamente dependientes del desorden metabolico propriamente dicho (meningitis purulenta, insuficiencia renal)
