ABSTRACT
Candida albicans remains the most common agent associated with invasive Candida infection (ICI), but with increasing number of non-albicans species. An epidemiological, observational study exploring host criteria, clinical characteristics and mortality of ICI was performed in 24 pediatric intensive care units (PICU) in Spain. Patients were analyzed in global and distributed by infecting species (for groups with ≥ 15 patients). A total of 125 ICI were included: 47 by C. albicans, 37 by C. parapsilosis, 19 by C. tropicalis, 4 C. glabrata, and 18 others. Up to 66% of ICI by C. albicans and 75.7% by C. parapsilosis occurred in children ≤ 24 months, while the percentage of children >60 months was higher in ICI by C. tropicalis. Bloodstream infection was most common among C. tropicalis (78.9%) or C. parapsilosis (83.8%) ICI, but urinary infections were almost as common as bloodstream infections among C. albicans ICI (31.9% and 38.3%, respectively). Fever refractory to antimicrobials was the most frequent host criterion (46.4% patients), but with equal frequency than prolonged neutropenia in C. tropicalis ICI. Thrombopenia was more frequent (p<0.05) in C. parapsilosis (60.7%) or C. tropicalis (66.7%) ICI than in C. albicans ICI (26.5%). Uremia was more frequent (p<0.05) in C. albicans (78.3%) or C. tropicalis (73.3%) than in C. parapsilosis ICI (40.7%). Multiple organ failure and heart insufficiency was higher in C. tropicalis ICI. Short duration (≤ 7 days) of PICU stay was more frequent in C. albicans ICI. Mortality rates were: 8.5% (C. albicans ICI), 13.5% (C. parapsilosis ICI) and 23.3% (C. tropicalis ICI). ICI by different Candida species showed different clinical profiles and mortality, making essential identification at species level.
Subject(s)
Candida albicans , Candida tropicalis , Candida , Candidiasis/microbiology , Cross Infection/microbiology , Intensive Care Units, Pediatric , Adolescent , Candidiasis/drug therapy , Candidiasis/mortality , Child , Child, Preschool , Cross Infection/drug therapy , Cross Infection/mortality , Female , Humans , Infant , Infant, Newborn , Male , Prognosis , Risk Assessment , Risk Factors , Spain/epidemiologyABSTRACT
El cloruro de etilo es un anestésico tópico de acción rápida que produce analgesia por enfriamiento local del área en que se aplica. Objetivo: Evaluar la eficacia del cloruro de etilo pulverizado para reducir el dolor de las punciones venosas en niños. Pacientes y Método: Realizamos un estudio prospectivo, de 80 pacientes pediátricos vistos en el servicio de urgencias observación de nuestro hospital, que precisaron punción en antebrazo. Los pacientes se distribuyeron en dos grupos: grupo A: 40 pacientes a los que se aplicó cloruro de etilo previo a la punción venosa; grupo B: 40 pacientes a los que no se aplicó cloruro de etilo. Las variables analizadas fueron edad, sexo, reflejo de retirada, evaluación del dolor experimentado en la punción y rendimiento de la extracción de sangre venosa. Se realizó estadística básica para las variables cuantitativas y comparación de los grupos mediante chi-cuadrado o t de student. Se consideró significativa una p<0,05). No se encontraron diferencias estadísticamente significativas en cuanto a la variable refluir la sangre. Conclusiones: La aplicación de cloruro de etilo pulverizado durante 5-10 segundos en el antebrazo, previa a la realización de la punción venosa, disminuye la sensación dolorosa y sin efectos secundarios significativos. El reflejo de retirada del brazo al pinchar es menos frecuente tras la aplicación de cloruro de etilo. El enfriamiento local que produce no interfiere con el rendimiento de extracción de sangre de manera significativa (AU)
No disponible
Subject(s)
Humans , Male , Female , Child , Ethyl Chloride/therapeutic use , Anesthesia, Local , Punctures/methods , /methods , Prospective Studies , Pain/prevention & controlABSTRACT
Los pacientes con sepsis severa desarrollan déficit adquirido de proteína C, existiendo una correlación entre el grado de deficiencia y la evolución clínica negativa. El reemplazamiento de dicha proteína puede contribuir a evitar este proceso. En el mercado existen dos tipos de proteína C, concentrada y activada. Ninguna de ellas están registradas para el tratamiento de sepsis grave en pediatría. La experiencia con proteína C en este grupo de edades es limitada. Se requiere ensayos clínicos adecuados que establezcan su eficacia y seguridad y que clarifiquen el lugar de cada tipo de proteína C en la terapéutica de esta patología en pediatría. En el presente artículo se describe la experiencia del uso de concentrado de proteína C como terapia coadyuvante a la terapia convencional en el tratamiento de tres niños con sepsis grave en la Unidad de Cuidados Intensivos Pediátrica. En los tres casos de nuestro estudio, los niveles altos de proteína C se correlacionan con normalización de los parámetros de coagulación y con disminución de los niveles de dímero D. Dos de los tres pacientes evolucionaron favorablemente en el curso del tratamiento, mientras que la tercera paciente murió al entrar en shock séptico y disfunción multiorgánica (AU)
Subject(s)
Child, Preschool , Infant , Female , Humans , Sepsis , Protein C , Severity of Illness IndexABSTRACT
Patients with severe sepsis develop acquired protein C deficiency, and the extent of such deficiency and negative clinical outcomes correlate. Replacing this protein may help prevent such a condition. Two protein C types are commercially available - concentrated and activated proteins. None is registered for the treatment of severe sepsis in the pediatric setting. Experience with protein C in this group of conditions is limited. Appropriate clinical trials are required to establish effectiveness and safety, and to elucidate the role of either protein C type in the management of this condition in the pediatric setting. This paper discusses experience with the use of protein C concentrate as an adjuvant treatment in addition to conventional therapy in three children with severe sepsis at a Pediatric Intensive Care Unit. In all 3 cases of our study, high levels of protein C correlated to coagulation parameter normalization and reduced dimer D levels. Two out of three had a favorable outcome following treatment, whereas the third patient died as a result of septic shock and multiple organ dysfunction.
Subject(s)
Protein C/therapeutic use , Sepsis/drug therapy , Child, Preschool , Female , Humans , Infant , Severity of Illness IndexSubject(s)
Compartment Syndromes/etiology , Snake Bites/complications , Viperidae , Animals , Child , Female , HumansABSTRACT
Macrophage activation syndrome, or hemophagocytic syndrome, is a rare disease with high morbidity and mortality. It is a disorder of the mononuclear phagocyte system. Two forms have been described; primary or familial hemophagocytic lymphohistiocytosis and secondary or sporadic hemophagocytic syndrome. Diagnosis of macrophage activation syndrome poses a real challenge for the pediatrician and in many cases is only made at autopsy. We describe two patients with hemophagocytic syndrome associated with parvovirus B19 and Epstein-Barr virus infection.
Subject(s)
Epstein-Barr Virus Infections/diagnosis , Herpesvirus 4, Human , Histiocytosis, Non-Langerhans-Cell/diagnosis , Histiocytosis, Non-Langerhans-Cell/virology , Parvoviridae Infections/diagnosis , Parvovirus B19, Human , Child , Child, Preschool , Diagnosis, Differential , Epstein-Barr Virus Infections/physiopathology , Fatal Outcome , Female , Fever , Humans , Multiple Organ Failure/etiology , Parvoviridae Infections/physiopathology , SplenomegalyABSTRACT
El síndrome de activación del macrófago (SAM) o síndrome hemofagocítico es una enfermedad rara y con una alta morbimortalidad. Se encuentra incluido dentro de las histiocitosis de la clase II y se distinguen dos formas: una familiar y otra secundaria a enfermedades subyacentes.El diagnóstico de SAM supone un verdadero reto y muchos casos no llegan a diagnosticarse ante mortem. Se presentan 2 casos de SAM asociados a infecciones por parvovirus B19 y virus de Epstein-Barr (AU)
Subject(s)
Child , Child, Preschool , Female , Humans , Parvovirus B19, Human , Herpesvirus 4, Human , Splenomegaly , Histiocytosis, Non-Langerhans-Cell , Fatal Outcome , Multiple Organ Failure , Parvoviridae Infections , Epstein-Barr Virus Infections , Diagnosis, Differential , FeverABSTRACT
OBJECTIVE: To analyze the epidemiological and clinical features of pneumococcal meningitis. PATIENTS AND METHODS: We performed a retrospective study of 53 cases of pneumococcal meningitis that occurred in 47 pediatric patients in our hospital between 1977 and 2000. Four children had recurrent meningitis. In all patients Streptococcus pneumoniae was isolated from cerebrospinal fluid culture. The epidemiological, bacteriological and clinical characteristics were studied. RESULTS: Pneumococcal meningitis represented 6 % of bacterial meningitis in our environment with 2-3 cases registered per year. Seventy-two percent of cases occurred in winter and spring. The age of affected children was between 1 month and 13 years. Sixty-five percent of children older than 2 years had a predisposing disease. Penicillin-resistant strains were detected in 1990 and cefotaxime-resistant strains were isolated in 1994. Seven children (13 %) had severe neurological sequels and two (4 %) died. CONCLUSIONS: Pneumococcal meningitis produces higher morbidity and mortality than other types of bacterial meningitis. The disease usually affects children younger than 2 years and older children with a predisposing disease. In the last few years, the importance of pneumococcal meningitis has increased due to the lower incidence of other types of bacterial meningitis. Because of beta-lactam resistant strains, initial empirical treatment should include vancomycin. The above data suggest the advisability of the generalized use of heptavalent pneumococcal conjugate vaccine in the pediatric population in our environment.
Subject(s)
Meningitis, Pneumococcal , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Meningitis, Pneumococcal/diagnosis , Meningitis, Pneumococcal/epidemiology , Meningitis, Pneumococcal/microbiology , Retrospective StudiesABSTRACT
Because conjugate C meningococcal vaccines represent a significant advance in the prevention of meningococcal disease, currently accepted recommendations on vaccination should be revised. The health authorities are responsible for carrying out national surveillance programs and for evaluating the need for vaccination programs. These programs should target all groups at risk for this disease and should confer adequate and lasting protection in vaccinated children.
Subject(s)
Meningococcal Infections/prevention & control , Meningococcal Vaccines , Adolescent , Adult , Child , Child, Preschool , Humans , Infant , Meningococcal Infections/epidemiologyABSTRACT
La vacuna conjugada frente a meningococo C supone un extraordinario avance en las medidas de prevención de esta enfermedad y justifica que se revisen las recomendaciones de vacunación actualmente aceptadas. Las autoridades sanitarias son las responsables de realizar una estrecha vigilancia epidemiológica y valorar la necesidad de establecer campañas de vacunación de la población. Esta actuación sanitaria debe incluir a todos los grupos de población en riesgo de presentar la enfermedad y asegurar la correcta y duradera protección de los niños vacunados (AU)
Subject(s)
Child , Child, Preschool , Adult , Adolescent , Infant , Humans , Meningococcal Vaccines , Meningococcal InfectionsABSTRACT
Thrombolytic therapy of a systemic pulmonary fistula is a rare method of treatment in newborns with thrombosed systemic-pulmonary shunt. We report the case of a newborn girl with a complex congenital heart defect. On the ninth day of life a modified right Blalock-Taussig shunt was performed. The ductus arteriosus was not ligated. Six days later the baby developed severe hypoxemia. The results of echocardiography and cardiac catheterization showed a total thrombosis of the fistula and complete absence of flow throughout the shunt. After insertion of an arterial catheter into the proximal end of the shunt we started fibrinolytic treatment with recombinant tissue plasminogen activator (r-TPA) in continuous infusion. After 14 hours of treatment we confirmed by angiography complete clot dissolution. The baby left the hospital in good condition when she was 23 days old. In the follow-up (4th month of life) the shunt is still permeable. Thrombolytic therapy with r-TPA locally applied in case of acute thrombosis of a systemic-pulmonary shunt appears to be a good therapeutic option avoiding the risks of a new surgical procedure.
Subject(s)
Fibrinolytic Agents/therapeutic use , Pulmonary Artery/surgery , Subclavian Artery/surgery , Thrombosis/drug therapy , Tissue Plasminogen Activator/therapeutic use , Anastomosis, Surgical/adverse effects , Female , Humans , Infant, NewbornABSTRACT
Objetivo: Determinar la eficacia y seguridad de imipenem/cilastatina (I/C) en niños con infecciones bacterianas graves. Material y métodos: Realizamos un estudio retrospectivo de 44 niños con infecciones bacterianas graves, ingresados en la Unidad de Cuidados Intensivos Pediátricos del Hospital Infantil Universitario 'Virgen del Rocío' entre enero de 1989 y diciembre de 1995. Ningún paciente padeció infección del siste-ma nervioso central. Se administró I/C en dosis media de 83 mg/kg de peso y día por vía intravenosa. Resultados: Se obtuvo una respuesta clínica favorable en 31 de los 44 pacientes (70,5 por ciento), y una sensibilidad del 87 por ciento. Imipenem/cilastatina fue efectivo en infecciones causadas por un espectro amplio de patógenos en pacientes con patología muy diversa, incluyendo sepsis, infecciones respiratorias, mediastinitis y peritonitis. La mayoría de los pacientes había recibido otros antibióticos e I/C se pautó como terapia de segunda elección. Este fármaco fue bien tolerado y no causó efectos secundarios graves o irreversibles. Dos pacientes padecieron convulsiones por causas diferentes a su administración. Conclusión: Nuestra experiencia confirma que I/C es una buena alternativa como terapia de segunda elección en pacientes pediátricos con infecciones bacterianas graves (AU)
Subject(s)
Adolescent , Female , Child, Preschool , Infant , Male , Child , Humans , Infant, Newborn , Bacterial Infections/drug therapy , Imipenem/administration & dosage , Cilastatin/administration & dosage , Bacterial Infections/microbiology , Treatment OutcomeABSTRACT
The authors report a case of primary idiopathic chylopericardium in a previously healthy 2-month-old infant. He was treated with continuous pericardial drainage and low-fat total parenteral nutrition. He remains asymptomatic after 14 months of follow-up. This is the first report of primary idiopathic chylopericardium successfully treated nonoperatively.
