Abscesos periamigdalino y retrofaríngeo: estudio de 13 años / Peritonsillar and retropharyngeal abscesses: study of 13 years

Introducción Los abscesos periamigdalino y retrofaríngeo son las infecciones más frecuentes de tejidos profundos de cabeza y cuello. Se presenta una casuística sobre estas entidades. Material y métodos Estudio retrospectivo de los abscesos periamigdalino y retrofaríngeo en niños ingresados en la Unidad de Enfermedades Infecciosas de nuestro hospital entre enero de 1991 y enero de 2004. El diagnóstico se realizó fundamentalmente según criterios clínico-analíticos. Resultados Se estudian 54 casos, 10 con absceso retrofaríngeo y 44 con absceso periamigdalino, con edad media de 6,7 y 7,5 años, respectivamente. Se observa un discreto predominio en varones (1,45:1). Hay un aumento de casos diagnosticados desde 1997, con un máximo (9) en 2002. Un total de 29 niños habían recibido antibioterapia previa. Los principales síntomas y signos fueron: fiebre, odinofagia, adenopatías cervicales e hipertrofia amigdalar asimétrica. Todos los niños recibieron antibioterapia intravenosa. Se realizó punción-aspiración en 7 casos. Se practicó amigdalectomía en 11 niños, dos de ellos con absceso retrofaríngeo y nueve periamigdalino. De estos 11 pacientes, cinco tenían antecedentes de faringoamigdalitis de repetición y tres de absceso periamigdalino previo. Habían sido amigdalectomizados con anterioridad al desarrollo del absceso 3 niños. La mayoría de los casos presentaron una evolución favorable. Conclusiones En los últimos años se ha observado un aumento de la frecuencia de los abscesos periamigdalino y retrofaríngeo en la edad infantil. La mayor parte de los niños responden favorablemente al tratamiento conservador. La historia previa de amigdalitis de repetición constituye el principal factor de riesgo de recurrencia del absceso, y son estos pacientes los candidatos a amigdalectomía

Introduction Peritonsillar and retropharyngeal abscesses are the most common deep head and neck infections. We present a series of patients with these infections. Material and methods We performed a retrospective study of peritonsillar and retropharyngeal abscesses in children admitted to the Infectious Diseases Unit of our hospital between January 1991 and January 2004. Diagnosis was based mainly on clinical and laboratory findings. Results We studied 54 patients, 10 with retropharyngeal abscess and 44 with peritonsillar abscess. The mean age was 6.7 and 7.5 years respectively. There was a slight predominance of boys (1.45:1). The number of cases diagnosed increased from 1997, with a maximum (nine cases) in 2002. Twenty-nine children had received previous antibiotic therapy. The main symptoms and signs were: fever, odynophagia, cervical lymphadenitis, and asymmetric tonsillar hypertrophy. All children received intravenous antibiotic therapy. Puncture-aspiration was carried out in seven patients. Eleven children underwent tonsillectomy, two with retropharyngeal abscess and nine with peritonsillar abscess. Of these 11 patients, five had had several episodes of tonsillitis and three had previously had a peritonsillar abscess. Three children who developed an abscess had previously undergone tonsillectomy. In most patients, outcome was favorable. Conclusions In the last few years the frequency of peritonsillar and retropharyngeal abscesses has increased in the pediatric population. Most of the children have a good response to conservative treatment. The main risk factor for abscess recurrence is a previous history of repeated tonsillitis. Consequently, these patients are candidates for tonsillectomy

Documento de consenso sobre el tratamiento de la exposición a tuberculosis y de la infección tuberculosa latente en niños / Treatment of tuberculosis exposure and latent tuberculosis infection in children

Introducción La pobreza, la infección por el virus de la inmunodeficiencia humana (VIH), la resistencia a fármacos y la diseminación a partir de pacientes con infección latente son las causas más importantes de la pandemia actual de tuberculosis. En los países industrializados, la población inmigrante procedente de países en desarrollo y la falta de programas eficaces de control son las causas principales del incremento de la enfermedad. La situación de los niños es todavía más grave por ser más vulnerables a la enfermedad que los adultos. El mayor riesgo de contraer tuberculosis lo tienen los niños autóctonos que conviven con adultos que tienen factores de riesgo de tuberculosis y los niños inmigrantes y adoptados del tercer mundo. A pesar de que los niños desarrollan la enfermedad no son prácticamente nunca bacilíferos, el tratamiento adecuado de la exposición a tuberculosis bacilífera y de la infección tuberculosa latente en niños contribuye a crear una vigilancia estrecha de los núcleos familiares que asegura un riguroso estudio de contactos y contribuye a evitar formas graves de tuberculosis, más frecuentes en el niño. Objetivo El objetivo de este segundo documento de consenso del Grupo de Trabajo de Tuberculosis de la Sociedad de Infectología Pediátrica (SEIP) es unificar criterios para el tratamiento de las situaciones de exposición a tuberculosis e infección tuberculosa latente en niños y sensibilizar a las autoridades sanitarias acerca de la necesidad de acometer programas muy estrictos de detección de tuberculosis en población de riesgo

Introduction The most important causes of the current tuberculosis pandemic are poverty, HIV infection, drug resistance, and the spread of infection by patients with latent tuberculosis infection. In industrialized countries, the main reasons for the increase of this disease are immigration from developing countries and the lack of effective surveillance programs. The situation of children is even more serious as they are more vulnerable to the disease than adults. The children most at risk are those who live with adults at risk for tuberculosis, immigrant children, and adoptees from developing countries. Although children are bacilliferous only exceptionally, the appropriate management of bacilliferous tuberculosis exposure and latent tuberculosis infection in children contributes to the creation of close surveillance of nuclear families and rigorous study of contacts. Moreover, it could prevent serious forms of the disease, which are more frequent in children. Objective The principal objective of this second consensus document of the Spanish Society of Pediatric Infectious Diseases (Sociedad Española de Infectología Pediátrica [SEIP]) is to unify the criteria for the treatment of tuberculosis exposure and latent tuberculosis infection in children. A further aim is to increase awareness of the need for strict detection measures in high-risk populations among health authorities

Ataxia cerebelosa aguda, eritema nodoso y orquiepididimitis tras gastroenteritis pro “Salmonella” D9 / Acute cerebellar ataxia, erythema nododum adn epidídimo-orchitis are complications of gastrointestinal infection by Salmonella D9

Se presenta el cado de un niño de siete años que sufre una gastroenteritis por Salmonella D9. A los quince dias de empezar la clínica, aparecen mialgias e inestabilidad en la marcha, dolor testicular y lesiones cutáneas. Fue diagnosticado de ataxia cerebelosa aguda, orquiepididimitis y eritema nodoso. Aunque todas estas complicaciones están descritas en la bibliogradía, resulta excepcional encontrarlas juntas en un mismo paciente

We present the case of a seve-year-old boy with gastroenteritis caused by Salmonella D9. Fifteen days after the clinical onset, he began to develop muscular pain, unsteady gait, testicular pain and skin lesions. The diagnoses were acute cerebellar ataxia, epididymo-orchitis and erythema nodosum. Each of these complications has been reported in the literature, but it is highly unusual to find all of them in the same patient

Pericarditis tuberculosa diagnosticada por PCR en biopsia pericárdica / Tuberculous pericarditis diagnosed by PCR in pericardiac biopsy

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Fibrobroncoscopia en la tuberculosis endobronquial / Fiberoptic bronchoscopy in childhood endobronchial tuberculosis

La tuberculosis endobronquial (TBE) es una manifestación típica de la tuberculosis primaria infantil. La fibrobroncoscopia es una técnica que ayuda a su diagnóstico, pero ni su utilidad ni sus indicaciones están claramente definidas. Objetivos Analizar las fibrobroncoscopias llevadas a cabo a lo largo de 11 años (1992-2003) en niños con diagnóstico de tuberculosis, y realizar una revisión de la literatura especializada. Intentar establecer la utilidad actual de la fibrobroncoscopia en la tuberculosis infantil, y proponer unos criterios para determinar la indicación de esta técnica en estos niños. Métodos Se presenta una serie retrospectiva de 16 pacientes. Se indicó fibrobroncoscopia a los niños que presentaban en la radiografía de tórax: a) consolidación parenquimatosa persistente; b) adenopatía y consolidación; c) hiperinsuflación (enfisema); d) atelectasia, o e) estrechamiento de las vías respiratorias por adenopatías. Se revisaron las series publicadas sobre este tema, rescatándose 6 con valor para la comparación con la nuestra. Resultados Se encontró TBE en 7 niños (43 por ciento) y en tres (18 por ciento) compresión exclusivamente extrínseca. Los resultados de la microbiología a través de la fibrobroncoscopia no mejoraron a los métodos diagnósticos clásicos. La sensibilidad de los criterios radiológicos utilizados para sospechar TBE fue del 71 por ciento. Los hallazgos endoscópicos justificaron un cambio en el tratamiento en el 50 por ciento de los niños (adición de corticoides o cirugía), cifra similar a otras series. Conclusiones La fibrobroncoscopia no suele mejorar el diagnóstico microbiológico de la tuberculosis, pero es una herramienta útil en nuestro medio para decidir el tratamiento más adecuado de los niños con sospecha de TBE. En algunos casos, la tomografía computarizada (TC) puede hacerla innecesaria, pero en otros la fibrobroncoscopia puede ser, además, terapéutica (obstrucción por caseum, atelectasias). Es difícil establecer indicaciones de fibrobroncoscopia en casos de tuberculosis infantil, pero los criterios propuestos pueden ser una guía aceptable para determinar qué pacientes se beneficiarían más. No todos los niños con TBE necesitan corticoides (AU)

Tratamiento de corta duración de la leishmaniasis visceral con anfotericina B liposómica en pacientes inmunocompetentes / Short course treatment for visceral leishmaniasis with liposomal amphotericin B in immunocompetent patients

Introducción: La leishmaniasis visceral es una enfermedad endémica en el sur de Europa y los antimoniales pentavalentes han constituido su tratamiento clásico. Sin embargo, la aparición de fracasos terapéuticos, la larga duración del tratamiento y su toxicidad, han condicionado la introducción de nuevas terapias, como la anfotericina B liposómica (ABL). En este estudio se evalúa la eficacia y seguridad de ABL a una dosis máxima de 4 mg/kg/día los días 1 a 5 y 10. Pacientes y métodos: Estudio abierto, prospectivo y observacional realizado en 13 hospitales en España. El diagnóstico de leishmaniasis visceral se basó en la visualización de amastigotes de Leishmania sp. en el aspirado o promastigotes de Leishmania sp. en el cultivo de médula ósea o serología positiva, junto con la presencia de cuadro clínico compatible. Resultados: Se trataron 32 niños inmunocompetentes de edades comprendidas entre 7 meses y 7 años. Todos tuvieron una rápida respuesta clínica y el aspirado de médula ósea a los 21 días fue normal en el 100 por ciento de los 24 pacientes en quienes se realizó. En 8 niños la eficacia se evaluó por la respuesta clínica. Se detectaron dos recidivas, con lo que se logró la curación de 18 pacientes (90,0 por ciento) y del 87,5 por ciento de los pacientes con documentación microbiológica de la enfermedad. No se produjeron acontecimientos adversos. Conclusiones: Una dosis total de 24 mg/kg de ABL administrada en 6 dosis a lo largo de 10 días, es eficaz y segura en el tratamiento de la leishmaniasis visceral y permite además reducir la estancia hospitalaria (AU)

[Short course treatment for visceral leishmaniasis with liposomal amphotericin B in immunocompetent patients]. / Tratamiento de corta duración de la leishmaniasis visceral con anfotericina B liposómica en pacientes inmunocompetentes.

INTRODUCTION: Visceral leishmaniasis is endemic in southern Europe. Traditional treatment consists of pentavalent antimonial compounds. However, treatment failures, the treatment's long duration, and toxicity have led to the introduction of new therapies, such as liposomal amphotericin B (LAB). In this study we evaluate the safety and efficacy of LAB at a maximum dose of 4 mg/kg/day on days 1, 2, 3, 4, 5, and 10. PATIENTS AND METHODS: A prospective, observational, open study was conducted in 13 Spanish centers. The diagnosis of visceral leishmaniasis was based on visualization of Leishmanias sp. in bone marrow aspirate or culture or positive serology together with compatible clinical symptoms. RESULTS: Thirty-two immunocompetent children aged from 7 months to 7 years were treated. All the children had rapid clinical response and bone marrow aspirate performed on day 21 was normal in the 24 patients (100 %) who underwent this procedure. In the remaining eight children efficacy was assessed by clinical response. Two relapses were observed. Cure was achieved in 18 patients (90.0 %) and in 87.5 % of the patients with microbiological confirmation of the disease. No adverse events were detected. CONCLUSIONS: A total dosage of 24 mg/kg of liposomal amphotericin B administered in 6 doses within 10 days is safe and effective for the treatment of visceral leishmaniasis and reduces the length of hospital stay.

Achromobacter xylosoxidans bacteremia: a 10-year analysis of 54 cases.

Fifty-four cases of Achromobacter xylosoxidans bacteremia diagnosed over a 10-year period in patients from 2 months to 87 years of age were reviewed. Fifty-two episodes were nosocomial. The most frequent underlying condition was neoplasm (solid or hematological). The source of infection was a contaminated intravenous catheter in 35 patients (60%) and pneumonia in 6 patients. Eight (15%) patients died. The only risk factors significantly associated with mortality were age over 65 years and neutropenia. The results of in vitro susceptibility studies of the isolates showed that antibiotic therapy with antipseudomonal penicillins or carbapenems would be a reasonable choice. An epidemiological study conducted in the hemodialysis unit showed Achromobacter xylosoxidans in tap water and on the hands of two healthcare workers but not in the hemodialysis systems. Patients were probably contaminated when healthcare workers manipulated the intravenous catheters without wearing gloves.

[Brain stem encephalitis in childhood]. / Encefalitis de tronco cerebral en la infancia.

OBJECTIVE: To present two cases of post-infectious encephalitis of the brain stem (ETC) in infancy, which is very infrequent at this age. CLINICAL CASES: Two patients aged 4 months and 9 months respectively had a previous history of a catarrhal illness a few days before the onset of encephalitis. The clinical condition was of subacute onset and torpid course, characterized by ataxia, reduced level of consciousness, involvement of the pyramidal tracts and paralysis of the cranial nerves. No significant information for the diagnosis of either case was obtained from CT. MR showed lesions at the level of the pons. However, the MR image did not correspond in seventy to the clinical condition. The clinical courses of the two patients were different. One case recovered with no sequelae. In the other case the cranial nerves and gait did not return to normal. CONCLUSIONS: In our experience, ETC is rarely seen in infancy. A high degree of suspicion and early treatment of ETC caused by the herpes simplex virus is necessary, since there is usually a high mortality or serious neurological sequelae.

[Chemoprophylaxis of tuberculosis: compliance to treatment in the pediatric population]. / Quimioprofilaxis tuberculosa: grado de cumplimiento en la población pediátrica.

We have reviewed the success of tuberculosis chemoprophylaxis in 369 children. These children ranged from 4 months to 14 years of age and had been prescribed chemoprophylaxis with Isoniazide at 10 mg/kg/day. Out of these, 258 (69.91%) finished the prophylaxis and 111 (30.08%) did not. Taking into account the reason for the consultation, of those who sought assistance due to contact with a patient with tuberculosis, 70.33% performed the treatment and 29.60% did not. For those in which the reason was a positive Mantoux, the data were 68.1% and 30.8%, respectively. No statistically significant differences were found between the two groups. We feel that the relatively high rate of noncompliance in our patients is a matter of concern. At the present time, chemoprophylaxis with Isoniazide is the best method available for the prevention of tuberculosis. We emphasize the need for its proper performance. We report several measures, such as the determination of Isoniazide metabolites in urine, which may be beneficial for better control and follow-up of these patients.

[Pulmonary tuberculosis in infants: apropos of 149 cases]. / Tuberculosis pulmonar en la infancia: a propósito de 149 casos.

One hundred and forty-nine cases of childhood pulmonary tuberculosis were analysed being a 77.6% of the 192 cases of tuberculosis diagnosed at the Pediatric Infectious Diseases Department of "La Paz" Hospital, in a ten year period. The children were aged 3 months to 14 years; 65% of them were less than 6 years of age. The source case was found in 67.1% of the children. The primary means of diagnosis was contact screening (38.1%), followed by a 27.5% that presented with non-specific symptoms, while 18.1% of the cases presented with respiratory symptoms. Gastric aspirates yield the organism in 25.8% of cases. Radiologically the following was found: 38.9% mixed patterns, 32.2% nodal patterns, 23.4% parenchymal patterns, 1.34 miliary tuberculosis, 1.34% caverns and 2.68% pleural effusions. Right lung location was more frequent in parenchymatous forms (68%), as well as in nodal forms (61.5%). The duration of the course of therapy changed along this ten years period: from twelve months initially to ten months posteriorly, subsequently becoming a six month course of treatment. All cases experienced full recovery.

[Kala-azar. Presentation of 7 cases and review of the literature]. / Kala-azar. Presentación de siete casos y revisión de la literatura.

Seven cases of visceral leishmaniasis are reported, whose epidemiologic, clinical, laboratory, evolutive and therapeutical features are presented. Latest findings are described with reference to laboratory tests and new recent possibilities of therapy.

Cellular immunodeficiency with immunoglobulins: treatment with a thymus implant in millipore diffusion chambers.

A 14 month old male affected by cellular immunodeficiency with immunoglobulins underwent implantation of a thymus enclosed in Millipore diffusion chambers. Five days after the implant the percentage of T lymphocytes forming spontaneous rosettes reached normal levels. One month later responsiveness to PHA was demonstrated in the patient's lymphocytes and IgG and IgM serum levels showed a marked increase. Positive skin tests were elicited 6 month's post-implant. An inguinal lymph node biopsy showed developing primary follicles and germinal centers. The patient's condition improved significantly. One year after the implant the patient died from irreversible neurological deterioration. It is suggested that partial immunological reconstitution was achieved by thymic humoral factors.