ABSTRACT
La hiperplasia endotelial papilar intravascular (IPEH) es una lesión vascular benigna poco frecuente que se presenta habitualmente como una neoformación subcutánea eritemato-violácea inespecífica. El estudio histopatológico, necesario para el diagnóstico de confirmación, muestra proliferación papilar de células endoteliales asociada con material trombótico. La IPEH puede simular otras lesiones como el angiosarcoma, por lo que el diagnóstico correcto de esta entidad es esencial para evitar tratamientos agresivos. La resección con márgenes amplios suele ser suficiente
Intravascular papillary endothelial hyperplasia (IPEH) is a rare benign vascular lesion that usually presents as a nonspecific erythematous-violaceous subcutaneous neoformation. The histopathological study, necessary for the confirmatory diagnosis, shows papillary proliferation of endothelial cells associated with thrombotic material. IPEH can simulate other lesions such as angiosarcoma, so the correct diagnosis of this entity is essential to avoid aggressive treatments. The resection with wide margins is usually enough
Subject(s)
Humans , Male , Child , Hyperplasia/diagnosis , Hyperplasia/pathology , Vascular Neoplasms/diagnosis , Neoplasms, Vascular Tissue/pathology , Skin Diseases/pathology , Endothelium, Vascular/pathology , Hyperplasia/surgery , Vascular Neoplasms/pathology , Cell Proliferation , Valsalva Maneuver/physiology , BiopsyABSTRACT
INTRODUCCIÓN: se analizan las características clínicas, pruebas complementarias y tratamientos recibidos por los pacientes con diagnóstico de tosferina que son valorados en Urgencias de Pediatría. MATERIAL Y MÉTODOS: estudio descriptivo retrospectivo de los casos de tosferina que consultaron en Urgencias de Pediatría de un hospital de tercer nivel entre marzo de 2014 y octubre de 2017. RESULTADOS: se analizaron 89 casos (55% mujeres) con edad media de 1,67 ± 2,9 años. El 98,9% presentó tos, el 33% gallo inspiratorio y el 34,8% apneas. En el 64% de los casos había entorno epidémico de tos o tosferina. La media de visitas en urgencias durante el mismo proceso fue 1,4. Diagnósticos más frecuentes en la primera visita a urgencias: tos (36%), sospecha de tosferina (22,5%), infección respiratoria de vías altas (19,1%) y bronquiolitis (9%). Ingresaron 56 pacientes (62,9%), con una edad media de 0,38 ± 1,2 años. Se realizó cultivo para Bordetella en 88 casos (positivo para B. pertussis en 38 y B. parapertussis en tres) y reacción en cadena de la polimerasa en 73 (positivo para B. pertussis en 70 y B. parapertussis en tres). CONCLUSIONES: el diagnóstico de tosferina habitualmente es difícil, ya que la sintomatología inicialmente es inespecífica. El diagnóstico precoz es fundamental para iniciar un tratamiento inmediato y realizar una adecuada profilaxis de contactos
INTRODUCTION: the aim of the study was to analyse the clinical characteristics, diagnostic tests performed and treatment used in patients with pertussis evaluated in the paediatric emergency setting. MATERIAL AND METHODS: we conducted a retrospective descriptive study of patients with pertussis that sought care in the paediatric emergency department of a tertiary care hospital between March 2014 and October 2017. RESULTS: the sample included 89 patients with a mean age of 1.67 ± 2.9 years. Of the total, 98.9% presented with cough, 33% with inspiratory whoop and 34.8% with apnoea. Sixty-four percent of cases occurred in the context of an epidemic of cough or pertussis. The mean number of emergency visits made during a single episode of disease was 1.4. The most frequent diagnoses in the initial emergency visit were cough (36%), suspected pertussis (22.5%), upper respiratory tract infection (19.1%) and bronchiolitis (9%). Fifty-six patients were admitted to hospital (62.9%) with a mean age of 0.38 ± 1.2 years. Cultures for detection of Bordetella were performed in 88 cases (positive for B. pertussis in 38 and B. parapertussis in 3), and PCR tests in 73 (positive for B. pertussis in 70 and B. parapertussis in 3). CONCLUSIONS: the diagnosis of pertussis is usually challenging, as its initial symptoms are nonspecific. Early diagnosis is essential for early initiation of treatment and adequate contact prophylaxis
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Whooping Cough/diagnosis , Whooping Cough/epidemiology , Emergency Service, Hospital/statistics & numerical data , Bordetella pertussis/genetics , Polymerase Chain Reaction , Whooping Cough/drug therapy , Retrospective StudiesABSTRACT
El virus del herpes simple (VHS) produce una encefalitis necrotizante aguda, afectando típicamente al lóbulo temporal. La existencia de un fármaco antiviral específico, así como el uso de medicación adyuvante como la corticoterapia, han mejorado el pronóstico de las infecciones graves. El retraso en el inicio del tratamiento con aciclovir es un factor claramente relacionado con mala evolución, así como las pautas cortas de tratamiento que se han asociado con mayor riesgo de recidivas
Herpes simplex virus (HSV) causes acute necrotizing encephalitis, typically affecting the temporal lobe. The existence of a specific antiviral drug as well as the use of adjuvant medication such as corticotherapy, have improved the prognosis of severe infections. The delay in the start of treatment with acyclovir is a factor clearly related to poor evolution, as well as short treatment guidelines that have been associated with an increased risk of recurrence
Subject(s)
Humans , Female , Infant , Encephalitis, Herpes Simplex/drug therapy , Acyclovir/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Encephalitis, Herpes Simplex/diagnosis , Antiviral Agents/therapeutic use , Time-to-Treatment/statistics & numerical data , Radiography, Thoracic/methods , Spinal Puncture/methods , Cerebrospinal Fluid/immunologyABSTRACT
In 2016, a new interferon-gamma release assay, QuantiFERON-TB Gold Plus, was introduced. We conducted a cross-sectional multicenter study, involving 158 children and adolescents with tuberculosis disease. The overall sensitivity of the assay was 82.9% (IQR 77.0%-88.8%), indicating that in children this test does not have higher sensitivity than previous generation interferon-gamma release assays.
Subject(s)
Interferon-gamma Release Tests/methods , Mycobacterium tuberculosis/isolation & purification , Tuberculosis/diagnosis , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Retrospective Studies , Tuberculin Test/methods , Tuberculosis/microbiologyABSTRACT
El síndrome de shock tóxico estreptocócico (SSTS) es un cuadro grave e infrecuente en Pediatría. Sin embargo, en las últimas décadas está aumentando la incidencia de infecciones invasivas por Streptococcus pyogenes o estreptococo del grupo A. Aparece más frecuentemente en niños preescolares, ya que el diagnóstico de enfermedad estreptocócica es más complicado a esta edad. Es fundamental el diagnóstico y tratamiento precoz debido a su potencial gravedad, precisando en algunas ocasiones medidas intensivas de soporte vital y prevención del fallo multiorgánico
Streptococcal toxic shock syndrome (STSS) is a serious and uncommon disease in Pediatrics. However, in the last decades the incidence of invasive infections by Streptococcus pyogenes of group A streptococcus has increased. It appears more frequently in preschool children since the diagnosis of streptococcal disease is more complicated at this age. Early diagnosis and treatment are essential due to its potential severity, sometimes requiring intensive life support measures and prevention of multiorgan failure
Subject(s)
Humans , Male , Child, Preschool , Shock, Septic/diagnosis , Streptococcal Infections/diagnosis , Streptococcus pyogenes/isolation & purification , Streptococcal Infections/complications , Emergency Treatment/methods , Fever/etiology , Fluid Therapy/methods , Acute-Phase Proteins/analysis , Antistreptolysin/bloodABSTRACT
BACKGROUND: In adults, anti-tumor necrosis factor-α (TNF-α) therapy is associated with progression of latent tuberculosis (TB) infection (LTBI) to TB disease, but pediatric data are limited. METHODS: Retrospective multicenter study within the Paediatric Tuberculosis Network European Trials Group, capturing patients <18 years who developed TB disease during anti-TNF-α therapy. RESULTS: Sixty-six tertiary healthcare institutions providing care for children with TB participated. Nineteen cases were identified: Crohn's disease (n = 8; 42%) and juvenile idiopathic arthritis (n = 6; 32%) were the commonest underlying conditions. Immune-based TB screening (tuberculin skin test and/or interferon-γ release assay) was performed in 15 patients before commencing anti-TNF-α therapy but only identified 1 LTBI case; 13 patients were already receiving immunosuppressants at the time of screening. The median interval between starting anti-TNF-α therapy and TB diagnosis was 13.1 (IQR, 7.1-20.3) months. All cases presented with severe disease, predominantly miliary TB (n = 14; 78%). One case was diagnosed postmortem. TB was microbiologically confirmed in 15 cases (79%). The median duration of anti-TB treatment was 50 (IQR, 46-66) weeks. Five of 15 (33%) cases who had completed TB treatment had long-term sequelae. CONCLUSIONS: LTBI screening is frequently false-negative in this patient population, likely due to immunosuppressants impairing test performance. Therefore, patients with immune-mediated diseases should be screened for LTBI at the point of diagnosis, before commencing immunosuppressive medication. Children on anti-TNF-α therapy are prone to severe TB disease and significant long-term morbidity. Those observations underscore the need for robust LTBI screening programs in this high-risk patient population, even in low-TB-prevalence settings.
Subject(s)
Latent Tuberculosis , Tuberculosis , Adolescent , Adult , Child , Humans , Interferon-gamma Release Tests , Latent Tuberculosis/diagnosis , Latent Tuberculosis/epidemiology , Necrosis , Retrospective Studies , Tuberculin Test , Tuberculosis/epidemiology , Tumor Necrosis Factor-alphaABSTRACT
El síndrome de Lemierre es una patología poco frecuente y potencialmente letal, que se origina como complicación de una infección localizada a nivel de cabeza y cuello que se extiende al espacio carotídeo. Se asocia a tromboflebitis séptica de la vena yugular interna y con frecuencia produce embolias sépticas a distancia. Se presenta generalmente como un cuadro de fiebre y odinofagia de varios días de evolución tras el antecedente de una infección orofaríngea aparentemente resuelta. Otros focos infecciosos menos frecuentes pueden corresponder a mastoiditis, sinusitis u otitis media aguda. El diagnóstico es fundamentalmente clínico y apoyado en las pruebas de imagen, como la ecografía Doppler y la tomografía computarizada cervical con contraste. El tratamiento consiste en antibioterapia prolongada con adecuada cobertura para anaerobios, especialmente Fusobacterium necrophorum, el patógeno más frecuente. El papel de la anticoagulación en el síndrome de Lemierre es controvertido. Se presenta un caso de síndrome de Lemierre secundario a una otitis media aguda
Lemierre's syndrome is a rare and potentially lethal disease that originates as a complication of a localized infection at the head and neck level that extends to the carotid space. It is associated with septic thrombophlebitis of the internal jugular vein and often produces septic emboli at a distance. It usually presents as a picture of fever and odynophagia several days after the history of an apparently resolved oropharyngeal infection. Other less frequent infectious foci may correspond to mastoiditis, sinusitis or acute otitis media. The diagnosis is fundamentally clinical and supported by imaging tests such as Doppler ultrasound and cervical CT with contrast. The treatment consists of prolonged antibiotic therapy with adequate coverage for anaerobes, especially Fusobacterium necrophorum, which is the most frequent pathogen. The role of anticoagulation in Lemierre's syndrome is controversial. We present a case of Lemierre's syndrome secondary to acute otitis media
Subject(s)
Humans , Female , Adolescent , Lemierre Syndrome/diagnosis , Otitis Media/complications , Thrombophlebitis/complications , Anti-Bacterial Agents/therapeutic use , Cellulitis/diagnosis , Streptococcus intermedius/isolation & purification , Diagnosis, Differential , Embolism/diagnosis , Mastoiditis/diagnosis , Jugular Veins/physiopathology , Adenoma/diagnosis , Streptococcal Infections/diagnosisABSTRACT
La principal manifestación clínica del herpesvirus 6 es el exantema súbito (también conocido como roséola o sexta enfermedad) y el síndrome febril. Las manifestaciones en el sistema nervioso central no son infrecuentes en la infección por herpesvirus 6, y su fisiopatología no está esclarecida, pero precisan diagnóstico y tratamiento temprano para evitar secuelas potencialmente graves. Se presenta el caso de una niña inmunocompetente de 2 años con cuadro de encefalitis como complicación de infección por herpesvirus 6. Se destaca la importancia del diagnóstico oportuno a fin de instaurar un adecuado tratamiento y seguimiento para evitar complicaciones secundarias a la afectación del sistema nervioso central.
The main clinical manifestation of human herpesvirus 6 is exanthema subitum (also known as roseola infantum) and febrile syndrome. Central nervous system manifestations are not unusual in herpesvirus 6 infection, and even though the pathophysiology is not clear, they need to be early diagnosed and treated in order to avoid potentially serious damage. We present the case of an immunocompetent 2-year-old girl with encephalitis as a complication of herpesvirus 6 infection. We want to emphasize the significance of an early diagnosis and treatment in order to prevent further complications due to the central nervous system extension.
Subject(s)
Humans , Female , Child, Preschool , Herpesvirus 6, Human/isolation & purification , Encephalitis, Viral/diagnosis , Exanthema Subitum/diagnosis , Encephalitis, Viral/virology , Exanthema Subitum/complicationsABSTRACT
The main clinical manifestation of human herpesvirus 6 is exanthema subitum (also known as roseola infantum) and febrile syndrome. Central nervous system manifestations are not unusual in herpesvirus 6 infection, and even though the pathophysiology is not clear, they need to be early diagnosed and treated in order to avoid potentially serious damage. We present the case of an immunocompetent 2-year-old girl with encephalitis as a complication of herpesvirus 6 infection. We want to emphasize the significance of an early diagnosis and treatment in order to prevent further complications due to the central nervous system extension.
La principal manifestación clínica del herpesvirus 6 es el exantema súbito (también conocido como roséola o sexta enfermedad) y el síndrome febril. Las manifestaciones en el sistema nervioso central no son infrecuentes en la infección por herpesvirus 6, y su fisiopatología no está esclarecida, pero precisan diagnóstico y tratamiento temprano para evitar secuelas potencialmente graves. Se presenta el caso de una niña inmunocompetente de 2 años con cuadro de encefalitis como complicación de infección por herpesvirus 6. Se destaca la importancia del diagnóstico oportuno a fin de instaurar un adecuado tratamiento y seguimiento para evitar complicaciones secundarias a la afectación del sistema nervioso central.
Subject(s)
Encephalitis, Viral/diagnosis , Exanthema Subitum/diagnosis , Herpesvirus 6, Human/isolation & purification , Child, Preschool , Encephalitis, Viral/virology , Exanthema Subitum/complications , Female , HumansABSTRACT
La enfermedad granulomatosa crónica es una inmunodeficiencia primaria, con una incidencia de 1/200 000-250 000recién nacidos vivos. Afecta, principalmente, a varones; la mayoría de las mutaciones son ligadas al cromosoma X y las formas autosómicas recesivas ocurren, con más frecuencia, en comunidades con mayor número de matrimonios consanguíneos. Se caracteriza por sensibilidad a infecciones recurrentes y graves, bacterianas y fúngicas, con formación de granulomas, debido a la incapacidad de los fagocitos para generar compuestos reactivos de oxígeno, necesarios para la muerte intracelular de microorganismos fagocitados. Se presentan tres casos de enfermedad granulomatosa crónica en los que se aisló Serratia marcescens y, tras una anamnesis minuciosa y obtener resultados de pruebas de funcionalidad de neutrófilos, se llegó a un diagnóstico molecular de la enfermedad. La enfermedad granulomatosa crónica puede manifestarse de formas muy variadas, por lo que el alto índice de sospecha y una buena anamnesis son fundamentales para alcanzar un diagnóstico.
Chronic granulomatous disease (CGD) is a primary immunodeficiency with an incidence of 1/200,000-250,000 live births. CGD affects mainly male patients, most of the mutations being X-linked, and autosomal recessive forms occur more frequently in communities with greater numbers of consanguineous marriages. CGD is characterized by sensitivity to recurrent and severe bacterial and fungal infections, with formation of granulomas due to the inability of phagocytes to generate reactive oxygen compounds, necessary for the intracellular death of phagocytic microorganisms. We report three cases of CGD in which Serratia marcescens was isolated, and after detailed anamnesis and performance of neutrophil function tests, a molecular diagnosis of the disease was reached. CGD can be manifested in a wide variety of ways, so that high suspicion and a meticulous anamnesis are essential to reach a diagnosis.
Subject(s)
Humans , Male , Child, Preschool , Child , Adolescent , Serratia Infections/immunology , Granulomatous Disease, Chronic/complications , Granulomatous Disease, Chronic/diagnosisABSTRACT
La reacción paradójica al tratamiento antituberculoso es una entidad poco frecuente en pediatría. Se presenta el caso de una niña de 9 años con fiebre, tos y expectoración de tres semanas de evolución. La prueba de tuberculina y Quantiferon fueron positivos; la velocidad de sedimentación era de 64 mm/h; el cultivo y la reacción en cadena de la polimerasa para M. tuberculosis fueron negativos. La radiografía de tórax mostró ensanchamiento mediastínico derecho. Ante el diagnóstico de tuberculosis, se inició un tratamiento con rifampicina, isoniacida, pirazinamida y etambutol en dosis estándar. A los 21 días, reapareció la fiebre elevada sin otra sintomatología, empeoramiento radiológico junto con normalidad de serologías, analítica sanguínea y resonancia cerebral. Se diagnosticó una reacción paradójica; se inició 1 mg/kg/día de prednisona oral, y quedó afebril a las 24 horas. Es importante considerar esta entidad cuando otras causas de empeoramiento clínico y/o radiológico se han descartado para evitar pruebas complementarias y modificaciones de tratamiento innecesarias.
Paradoxical reaction to antituberculosis treatment is rare in paediatric population. We report a 9-year-old girl with high fever and productive cough for the last three weeks. Tuberculine test and Quantiferon were positive, erythrocyte sedimentation rate was 64 mm/h, culture and polymerase chain reaction for M. tuberculosis negative, and chest X ray showed a widened right mediastinum. Tuberculosis was diagnosed, therefore treatment with standard doses of rifampicin, isoniazid, pyrazinamide and ethambutol was started. Twenty-one days later she presented high fever with no other symptoms, worsening of radiological findings and normal blood tests, serologies and brain magnetic resonance imaging. The patient presented a paradoxical reaction and was given prednisone 1 mg/kg/day, fever disappeared in 24 hours. It is important to consider a paradoxical reaction when other causes of clinical and/or radiological worsening have been ruled out, to avoid unnecessary tests and treatment modifications.
Subject(s)
Humans , Female , Child , Tuberculosis, Pulmonary/drug therapy , Antitubercular Agents/adverse effects , Disease Progression , ImmunocompetenceABSTRACT
Chronic granulomatous disease (CGD) is a primary immunodeficiency with an incidence of 1/200,000-250,000 live births. CGD affects mainly male patients, most of the mutations being X-linked, and autosomal recessive forms occur more frequently in communities with greater numbers of consanguineous marriages. CGD is characterized by sensitivity to recurrent and severe bacterial and fungal infections, with formation of granulomas due to the inability of phagocytes to generate reactive oxygen compounds, necessary for the intracellular death of phagocytic microorganisms. We report three cases of CGD in which Serratia marcescens was isolated, and after detailed anamnesis and performance of neutrophil function tests, a molecular diagnosis of the disease was reached. CGD can be manifested in a wide variety of ways, so that high suspicion and a meticulous anamnesis are essential to reach a diagnosis.
La enfermedad granulomatosa crónica es una inmunodeficiencia primaria, con una incidencia de 1/200 000-250 000 recién nacidos vivos. Afecta, principalmente, a varones; la mayoría de las mutaciones son ligadas al cromosoma X y las formas autosómicas recesivas ocurren, con más frecuencia, en comunidades con mayor número de matrimonios consanguíneos. Se caracteriza por sensibilidad a infecciones recurrentes y graves, bacterianas y fúngicas, con formación de granulomas, debido a la incapacidad de los fagocitos para generar compuestos reactivos de oxígeno, necesarios para la muerte intracelular de microorganismos fagocitados. Se presentan tres casos de enfermedad granulomatosa crónica en los que se aisló Serratia marcescens y, tras una anamnesis minuciosa y obtener resultados de pruebas de funcionalidad de neutrófilos, se llegó a un diagnóstico molecular de la enfermedad. La enfermedad granulomatosa crónica puede manifestarse de formas muy variadas, por lo que el alto índice de sospecha y una buena anamnesis son fundamentales para alcanzar un diagnóstico.
Subject(s)
Granulomatous Disease, Chronic/complications , Serratia Infections/immunology , Adolescent , Child , Child, Preschool , Granulomatous Disease, Chronic/diagnosis , Humans , MaleABSTRACT
Paradoxical reaction to antituberculosis treatment is rare in paediatric population. We report a 9-year-old girl with high fever and productive cough for the last three weeks. Tuberculine test and Quantiferon were positive, erythrocyte sedimentation rate was 64 mm/h, culture and polymerase chain reaction for M. tuberculosis negative, and chest X ray showed a widened right mediastinum. Tuberculosis was diagnosed, therefore treatment with standard doses of rifampicin, isoniazid, pyrazinamide and ethambutol was started. Twenty-one days later she presented high fever with no other symptoms, worsening of radiological findings and normal blood tests, serologies and brain magnetic resonance imaging. The patient presented a paradoxical reaction and was given prednisone 1 mg/kg/day, fever disappeared in 24 hours. It is important to consider a paradoxical reaction when other causes of clinical and/or radiological worsening have been ruled out, to avoid unnecessary tests and treatment modifications.
La reacción paradójica al tratamiento antituberculoso es una entidad poco frecuente en pediatría. Se presenta el caso de una niña de 9 años con fiebre, tos y expectoración de tres semanas de evolución. La prueba de tuberculina y Quantiferon fueron positivos; la velocidad de sedimentación era de 64 mm/h; el cultivo y la reacción en cadena de la polimerasa para M. tuberculosis fueron negativos. La radiografía de tórax mostró ensanchamiento mediastínico derecho. Ante el diagnóstico de tuberculosis, se inició un tratamiento con rifampicina, isoniacida, pirazinamida y etambutol en dosis estándar. A los 21 días, reapareció la fiebre elevada sin otra sintomatología, empeoramiento radiológico junto con normalidad de serologías, analítica sanguínea y resonancia cerebral. Se diagnosticó una reacción paradójica; se inició 1 mg/kg/día de prednisona oral, y quedó afebril a las 24 horas. Es importante considerar esta entidad cuando otras causas de empeoramiento clínico y/o radiológico se han descartado para evitar pruebas complementarias y modificaciones de tratamiento innecesarias.
Subject(s)
Antitubercular Agents/adverse effects , Tuberculosis, Pulmonary/drug therapy , Child , Disease Progression , Female , Humans , ImmunocompetenceABSTRACT
OBJETIVO: Estudiar la epidemiología, las manifestaciones clínicas, el manejo diagnóstico-terapéutico y la evolución de las linfadenitis por micobacterias no tuberculosas en la población pediátrica de Aragón. MATERIAL Y MÉTODOS: Estudio retrospectivo de pacientes menores de 15 años diagnosticados de linfadenitis por micobacteria no tuberculosa entre 2000 y 2015. CRITERIOS DE INCLUSIÓN: pacientes con linfadenitis y cultivo positivo. Los resultados se expresan como medias, rango y desviación típica para las variables cuantitativas, y porcentajes para las cualitativas. RESULTADOS: Se detectan 27 casos, edad media de presentación 39,9 meses (rango 10 meses-8 años). El tiempo desde inicio de los síntomas hasta la primera consulta especializada es 1,7 ± 1,1 meses. La localización más frecuente es submaxilar en 17/27 casos (63%), lado derecho en el 59,3%, con tamaño de 2,96 ± 1,26 cm. Solo 16/27 presentan fistulización. Prueba de tuberculina superior a 10 mm en 7/24 (29,1%). El cultivo es positivo para Mycobacterium avium en 14/27 (51,9%), Mycobacterium intracellulare 3/27 (11,1%), Mycobacterium lentiflavum 3/27 (11,1%). El 92,6% (23/27) es tratado inicialmente con amoxicilina-clavulánico. La combinación de antibióticos y cirugía se aplica en 16/27 casos (59,3%), solo antibioterapia 7/27 (25,9%) y únicamente exéresis 4/27 (14,8%). Dos pacientes precisan reintervención y un caso desarrolla neutropenia grave secundaria a rifabutina. Solo un caso (3,7%) presenta parálisis facial transitoria como secuela. CONCLUSIONES: La combinación de antibioterapia y cirugía es el tratamiento más frecuente. El retraso en el diagnóstico hace que la exéresis como primera opción terapéutica se realice únicamente en uno de cada 7 pacientes
OBJECTIVE: To study the epidemiology, clinical features, diagnosis, therapeutic management, and outcome of non-tuberculous mycobacterial lymphadenitis in a paediatric population of Aragón (Spain). MATERIAL AND METHODS: A retrospective study was conducted on patients under 15 years-old diagnosed with non-tuberculous mycobacterial lymphadenitis between the years 2000 and 2015. Inclusion criteria: patients with lymphadenitis and positive culture. Quantitative values are shown as mean, rank, and standard deviation, and qualitative data as frequencies. RESULTS: Twenty-seven cases were registered, with a mean age of presentation of 39.9 months (range 10 months-8 years). The mean time between the symptoms onset and first consultation was 1.7 ± 1.1 months. The most frequent location was sub-maxilar in 17/27 cases (63%), on the right side in 59.3%, and size 2.96 ± 1.26 cm. Fistulae were observed in 16/27 cases. Tuberculin test was greater than 10 mm in 7/24 (29.1%). Microbiological cultures were positive for Mycobacterium avium in 14/27 (51.9%), Mycobacterium intracellulare 3/27 (11.1%), and Mycobacterium lentiflavum 3/27 (11.1%). Combined treatment of antibiotics and surgery was given in 16/27 cases (59.8%), medical treatment only in7/27 (25.9%), and surgical exeresis alone in 4/27 (14.8%). Two patients required a new surgery, and one showed severe neutropenia secondary to rifabutin. Only one case (3.7%) suffered from temporary facial palsy as sequel. CONCLUSIONS: The most frequent treatment was the combination of antibiotics and surgery. Delay in diagnosis seemed to be responsible for the limited number of exeresis as first option, only one for every seven patients
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Lymphadenitis/diagnosis , Lymphadenitis/drug therapy , Lymphadenitis/surgery , Tuberculin/analysis , Tuberculin Test/methods , Mycobacterium avium-intracellulare Infection/drug therapy , Early Diagnosis , Nontuberculous Mycobacteria , Nontuberculous Mycobacteria/isolation & purification , Mycobacterium Infections, Nontuberculous/complications , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/microbiology , Retrospective Studies , Radiography, Thoracic/methodsABSTRACT
OBJECTIVE: To study the epidemiology, clinical features, diagnosis, therapeutic management, and outcome of non-tuberculous mycobacterial lymphadenitis in a paediatric population of Aragón (Spain). MATERIAL AND METHODS: A retrospective study was conducted on patients under 15 years-old diagnosed with non-tuberculous mycobacterial lymphadenitis between the years 2000 and 2015. INCLUSION CRITERIA: patients with lymphadenitis and positive culture. Quantitative values are shown as mean, rank, and standard deviation, and qualitative data as frequencies. RESULTS: Twenty-seven cases were registered, with a mean age of presentation of 39.9 months (range 10 months-8 years). The mean time between the symptoms onset and first consultation was 1.7±1.1 months. The most frequent location was sub-maxilar in 17/27 cases (63%), on the right side in 59.3%, and size 2.96±1.26cm. Fistulae were observed in 16/27 cases. Tuberculin test was greater than 10mm in 7/24 (29.1%). Microbiological cultures were positive for Mycobacterium avium in 14/27 (51.9%), Mycobacterium intracellulare 3/27 (11.1%), and Mycobacterium lentiflavum 3/27 (11.1%). Combined treatment of antibiotics and surgery was given in 16/27 cases (59.8%), medical treatment only in7/27 (25.9%), and surgical exeresis alone in 4/27 (14.8%). Two patients required a new surgery, and one showed severe neutropenia secondary to rifabutin. Only one case (3.7%) suffered from temporary facial palsy as sequel. CONCLUSIONS: The most frequent treatment was the combination of antibiotics and surgery. Delay in diagnosis seemed to be responsible for the limited number of exeresis as first option, only one for every seven patients.
Subject(s)
Lymphadenitis/microbiology , Mycobacterium Infections, Nontuberculous , Child , Child, Preschool , Humans , Infant , Lymphadenitis/diagnosis , Lymphadenitis/epidemiology , Lymphadenitis/therapy , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium Infections, Nontuberculous/therapy , Retrospective Studies , Time FactorsABSTRACT
Treatment with tumor necrosis factor α inhibitors is a risk factor for tuberculosis (TB). Despite previous treatment with isoniazid for latent TB, a 9-year-old girl with juvenile idiopathic arthritis developed disseminated TB after changing therapy with etanercept to adalimumab and after new contact with a smear-positive relative. Genotyping strain matches and susceptibility to isoniazid make reinfection more likely than reactivation in our patient.
Subject(s)
Adalimumab/adverse effects , Anti-Inflammatory Agents/adverse effects , Arthritis, Juvenile/drug therapy , Etanercept/adverse effects , Tuberculosis/etiology , Adalimumab/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Arthritis, Juvenile/complications , Child , Etanercept/therapeutic use , Female , Genotype , Humans , Mycobacterium tuberculosis/genetics , Tuberculosis/microbiology , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
La linfadenitis es la manifestación clínica más frecuente de la infección por micobacterias no tuberculosas en niños inmunocompetentes. Se presentan dos casos de linfadenitis por M. lentiflavum diagnosticados en un hospital de tercer nivel en los últimos 10 años. Se realizaron pruebas complementarias de rutina ante adenopatía persistente y se obtuvo una muestra mediante drenaje para el cultivo, que resultó positivo para este germen. Ambos pacientes recibieron tratamiento antibiótico oral durante varias semanas. El caso 1 precisó exéresis completa al quinto mes de evolución, mientras que el caso 2 presentó resolución completa de la lesión a los 4 meses. M. lentiflavum es considerado, de entre las nuevas especies de micobacterias no tuberculosas recientemente descritas, un germen emergente en nuestro medio. Posee unas características microbiológicas y clínicas especiales, diferentes del resto de las micobacterias no tuberculosas. Son pocos los casos publicados hasta la fecha desde que se describió por primera vez la infección en 1997.
Lymphadenitis is the most common clinical feature in nontuberculous mycobacterium infection in immunocompetent children. We present two case reports of M. lentiflavum lymphadenitis diagnosed in a tertiary hospital in the last 10 years. Routine tests were performed after persistent adenopathy, and a sample for culture was obtained, being positive for this microorganism. Both patients received oral antibiotics during several weeks. Case 1 needed complete excision after five months of treatment, whilst Case 2 was cured by medical therapy. M. lentiflavum is considered, among the newly described nontuberculous mycobacterial species, an emergent pathogen in our environment. It has its own microbiological and clinical characteristics, different from the rest of nontuberculous mycobacteria. Case reports are limited in the literature since the infection was described for the first time in 1997.
Subject(s)
Humans , Male , Female , Child, Preschool , Lymphadenitis/microbiology , Mycobacterium Infections, NontuberculousABSTRACT
Lymphadenitis is the most common clinical feature in nontuberculous mycobacterium infection in immunocompetent children. We present two case reports of M. lentiflavum lymphadenitis diagnosed in a tertiary hospital in the last 10 years. Routine tests were performed after persistent adenopathy, and a sample for culture was obtained, being positive for this microorganism. Both patients received oral antibiotics during several weeks. Case 1 needed complete excision after five months of treatment, whilst Case 2 was cured by medical therapy. M. lentiflavum is considered, among the newly described nontuberculous mycobacterial species, an emergent pathogen in our environment. It has its own microbiological and clinical characteristics, different from the rest of nontuberculous mycobacteria. Case reports are limited in the literature since the infection was described for the first time in 1997.
La linfadenitis es la manifestación clínica más frecuente de la infección por micobacterias no tuberculosas en niños inmunocompetentes. Se presentan dos casos de linfadenitis por M. lentiflavum diagnosticados en un hospital de tercer nivel en los últimos 10 años. Se realizaron pruebas complementarias de rutina ante adenopatía persistente y se obtuvo una muestra mediante drenaje para el cultivo, que resultó positivo para este germen. Ambos pacientes recibieron tratamiento antibiótico oral durante varias semanas. El caso 1 precisó exéresis completa al quinto mes de evolución, mientras que el caso 2 presentó resolución completa de la lesión a los 4 meses. M. lentiflavum es considerado, de entre las nuevas especies de micobacterias no tuberculosas recientemente descritas, un germen emergente en nuestro medio. Posee unas características microbiológicas y clínicas especiales, diferentes del resto de las micobacterias no tuberculosas. Son pocos los casos publicados hasta la fecha desde que se describió por primera vez la infección en 1997.
Subject(s)
Lymphadenitis/microbiology , Mycobacterium Infections, Nontuberculous , Child, Preschool , Female , Humans , MaleABSTRACT
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