ABSTRACT
La hidatidosis pancreática representa el 0,2-0,6 % de los casos, siendo la población pediátrica la de mayor riesgo. Las lesiones suelen localizarse en cabeza del páncreas (50-58 %); la localización en cuerpo y cola del páncreas se encuentra en el 24-34 % y el 19 %, respectivamente. Dada la posibilidad de complicaciones, suele realizarse tratamiento quirúrgico. Se sugiriere indicar albendazol antes y después del acto quirúrgico por los riesgos de ruptura y diseminación de los protoescólices. Se presenta el caso de una niña de 5 años de edad con dolor abdominal progresivo y lesión quística en páncreas compatible con hidatidosis en la ultrasonografía. En la tomografía computada se observa compresión de la vía biliar. La hemoaglutinación indirecta fue negativa. Presentó elevación de la bilirrubina total, con franco predominio de bilirrubina directa, y aumento de enzimas hepáticas. Se realizó laparotomía exploradora, colecistectomía y destechamiento del quiste. Evolucionó favorablemente, continuó con albendazol durante 3 meses luego de la cirugía.
Pancreatic echinococcosis accounts for 0.20.6% of cases, with the pediatric population being at a higher risk. Most commonly, pancreatic lesions occur in the head of the pancreas (5058%); and in the body and tail in 2434% and 19% of cases, respectively. Given the potential complications, surgery is usually performed. Albendazole is recommended before and after the surgery due to the risks for rupture and dissemination of protoscolices. Here we describe the case of a 5-year-old girl with progressive abdominal pain and cystic lesion in the pancreas compatible with echinococcosis in the ultrasound. The computed tomography showed bile duct compression. Indirect hemagglutination was negative. She had elevated total bilirubin, with a clear predominance of direct bilirubin, and high liver enzymes. Exploratory laparotomy, cholecystectomy, and unroofing of the cyst were performed. The patient had a favorable course and continued with albendazole for 3 months after the surgery.
Subject(s)
Humans , Female , Child, Preschool , Pancreatic Diseases/surgery , Pancreatic Diseases/complications , Pancreatic Diseases/diagnosis , Echinococcosis/surgery , Echinococcosis/complications , Echinococcosis/diagnosis , Pancreas , Albendazole/therapeutic use , AbdomenABSTRACT
Pancreatic echinococcosis accounts for 0.2-0.6% of cases, with the pediatric population being at a higher risk. Most commonly, pancreatic lesions occur in the head of the pancreas (50-58%); and in the body and tail in 24-34% and 19% of cases, respectively. Given the potential complications, surgery is usually performed. Albendazole is recommended before and after the surgery due to the risks for rupture and dissemination of protoscolices. Here we describe the case of a 5-year-old girl with progressive abdominalpain and cystic lesion in the pancreas compatible with echinococcosis in the ultrasound. The computed tomography showed bile duct compression. Indirect hemagglutination was negative. She had elevated total bilirubin, with a clear predominance of direct bilirubin, and high liver enzymes. Exploratory laparotomy, cholecystectomy, and unroofing of the cyst were performed. The patient had a favorable course and continued with albendazole for 3 months after the surgery.
La hidatidosis pancreática representa el 0,2-0,6 % de los casos, siendo la población pediátrica la de mayor riesgo. Las lesiones suelen localizarse en cabeza del páncreas (50-58 %); la localización en cuerpo y cola del páncreas se encuentra en el 24-34 % y el 19 %, respectivamente. Dada la posibilidad de complicaciones, suele realizarse tratamiento quirúrgico. Se sugiriere indicar albendazol antes y después del acto quirúrgico por los riesgos de ruptura y diseminación de los protoescólices. Se presenta el caso de una niña de 5 años de edad con dolor abdominal progresivo y lesión quística en páncreas compatible con hidatidosis en la ultrasonografía. En la tomografía computada se observa compresión de la vía biliar. La hemoaglutinación indirecta fue negativa. Presentó elevación de la bilirrubina total, con franco predominio de bilirrubina directa, y aumento de enzimas hepáticas. Se realizó laparotomía exploradora, colecistectomía y destechamiento del quiste. Evolucionó favorablemente, continuó con albendazol durante 3 meses luego de la cirugía.
Subject(s)
Echinococcosis , Pancreatic Diseases , Female , Humans , Child , Child, Preschool , Albendazole/therapeutic use , Pancreatic Diseases/diagnosis , Pancreatic Diseases/surgery , Pancreatic Diseases/complications , Echinococcosis/diagnosis , Echinococcosis/surgery , Echinococcosis/complications , Abdomen , PancreasABSTRACT
Existen numerosas entidades en la población pediátrica que pueden presentarse en forma de quistes o como lesiones de similares características. De estas patologías, las infecciosas son las más frecuentes. Se presenta el caso de una paciente oriunda de Bolivia con migración reciente a la Argentina que presentó una coinfección con tuberculosis e hidatidosis pulmonar. Ambas infecciones se pueden presentar con signos y síntomas similares y, aunque la asociación citada es poco frecuente en la bibliografía, ciertos mecanismos inmunitarios podrían intervenir en la coinfección de parásitos helmintos y micobacterias. Ambas patologías son infecciones prevalentes en nuestra región y deben ser tenidas en cuenta entre los diagnósticos diferenciales ante pacientes con imágenes quísticas o cavitarias pulmonares.
Numerous entities in the pediatric population can present in the form of cysts or as lesions with similar characteristics. Of the pathologies that can cause these images in children, infectious diseases are the most frequent. We present the case of a native of Bolivia with recent immigration to Argentina who presented a pulmonary co-infection with tuberculosis and hydatidosis. Both infections can present with similar signs and symptoms and although this association is rarely reported in the literature, certain immunological mechanisms could intervene in the causal association of co-infection between helminth parasites and mycobacteria. Both pathologies are very prevalent infections in our region and should be taken into account among the differential diagnoses in patients with cystic or cavitary pulmonary diseases.
Subject(s)
Humans , Female , Adolescent , Tuberculosis/complications , Tuberculosis/diagnosis , Cysts , Echinococcosis/diagnosis , Coinfection/diagnosis , Lung DiseasesABSTRACT
Numerous entities in the pediatric population can present in the form of cysts or as lesions with similar characteristics. Of the pathologies that can cause these images in children, infectious diseases are the most frequent. We present the case of a native of Bolivia with recent immigration to Argentina who presented a pulmonary co-infection with tuberculosis and hydatidosis. Both infections can present with similar signs and symptoms and although this association is rarely reported in the literature, certain immunological mechanisms could intervene in the causal association of co-infection between helminth parasites and mycobacteria. Both pathologies are very prevalent infections in our region and should be taken into account among the differential diagnoses in patients with cystic or cavitary pulmonary diseases.
Existen numerosas entidades en la población pediátrica que pueden presentarse en forma de quistes o como lesiones de similares características. De estas patologías, las infecciosas son las más frecuentes. Se presenta el caso de una paciente oriunda de Bolivia con migración reciente a la Argentina que presentó una coinfección con tuberculosis e hidatidosis pulmonar. Ambas infecciones se pueden presentar con signos y síntomas similares y, aunque la asociación citada es poco frecuente en la bibliografía, ciertos mecanismos inmunitarios podrían intervenir en la coinfección de parásitos helmintos y micobacterias. Ambas patologías son infecciones prevalentes en nuestra región y deben ser tenidas en cuenta entre los diagnósticos diferenciales ante pacientes con imágenes quísticas o cavitarias pulmonares.
Subject(s)
Coinfection , Cysts , Echinococcosis , Lung Diseases , Tuberculosis , Humans , Child , Coinfection/diagnosis , Echinococcosis/diagnosis , Tuberculosis/complications , Tuberculosis/diagnosisABSTRACT
Background: There are scarce data of Treponema pallidum subsp. pallidum (TPA) characterization in children with syphilis. Nonsexually acquired transmission (NSAT) of TPA is possible in infants through close contact. Methods: A descriptive study in five families with NSAT of syphilis was conducted. Polymerase chain reaction detection of TPA in pediatric index cases (n = 6) and their relatives (n = 44) were conducted followed by multilocus sequence typing (MLST). Results: TPA was detected in swab samples in 16 cases and 12 were characterized by MLST. Nichols lineage was identified in two of five families and SS14-lineage in three of five. In four families, MLST profiles linked index cases to relatives. Conclusion: This is the first report of TPA characterization in children infected by NSAT.
Syphilis is a disease caused by the bacterium Treponema pallidum subsp. pallidum (TPA). Although it is considered a sexually transmitted disease, syphilis can also be transmitted by nonsexual close contact with active lesions. There are clinical reports of this route of transmissions in children; however, there are no molecular characterizations of TPA in this population. A multidisciplinary study (epidemiological, clinical, social and molecular) was performed in six children from five families with clinical diagnosis of nonsexually transmitted syphilis. As a result, 18 infected persons were detected. In 16 individuals the presence of the bacterium genetic material was confirmed by molecular biology techniques, and in 12, its strain was analyzed. When we compared the data, we observed that in four families, the child's strain coincided with the one found in close contact, while in one family, this could not be determined. To our knowledge, this is the first report of TPA characterization in children, which underscore the importance of including molecular biology techniques in complex clinical scenarios such as these.
Subject(s)
Syphilis , Treponema pallidum , Child , Globus Pallidus , Humans , Infant , Multilocus Sequence Typing , Syphilis/diagnosis , Treponema pallidum/geneticsABSTRACT
Chagas disease (CD) is a worldwide problem, with over 8 million people infected in both rural and urban areas. CD was first described over a century ago, but only two drugs are currently available for CD treatment: benznidazole (BZN) and nifurtimox (NF). Treating CD-infected patients, especially children and women of reproductive age, is vital in order to prevent long-term sequelae, such as heart and gastrointestinal dysfunction, but this aim is still far from being accomplished. Currently, the strongest data to support benefit-risk considerations come from trials in children. Treatment response biomarkers need further development as serology is being questioned as the best method to assess treatment response. This article is a narrative review on the pharmacology of drugs for CD, particularly BZN and NF. Data on drug biopharmaceutical characteristics, safety and efficacy of both drugs are summarized from a clinical perspective. Current data on alternative compounds under evaluation for CD treatment, and new possible treatment response biomarkers are also discussed. Early diagnosis and treatment of CD, especially in paediatric patients, is vital for an effective and safe use of the available drugs (i.e. BZN and NF). New biomarkers for CD are urgently needed for the diagnosis and evaluation of treatment efficacy, and to guide efforts from academia and pharmaceutical companies to accelerate the process of new drug development.
Subject(s)
Chagas Disease , Trypanosoma cruzi , Biomarkers , Chagas Disease/chemically induced , Chagas Disease/diagnosis , Chagas Disease/drug therapy , Child , Female , Humans , Nifurtimox/adverse effects , Treatment OutcomeABSTRACT
El pseudoaneurisma arterial es la dilatación de un vaso, producto de la lesión de la pared. Es generado, principalmente, por traumatismos y, en menor medida, por patologías inflamatorias del endotelio. Se presenta como un hematoma pulsátil y doloroso. Su diagnóstico suele realizarse debido a que, ante una ecografía Doppler, se observa una imagen hipoecoica adyacente a un vaso con flujo en su interior. Su baja prevalencia, asociada a su presentación clínica variable, puede generar confusión con infecciones de piel y partes blandas o trombosis. El manejo puede ser desde la compresión extrínseca hasta la cirugía abierta, y no existen algoritmos terapéuticos en la actualidad. Se describeel caso de un paciente de 13 años con un pseudoaneurisma en una rama muscular de la arteria femoral superficial, secundario a un traumatismo cortante en el que se realizó exitosamente el abordaje endovascular con colocación de microcoils para la exclusión del saco pseudoaneurismático.
Pseudoaneurysm or 'false aneurysm' is defined as an abnormal arterial dilatation produced by an injury to its wall that does not affect the three parietal layers like in 'true' aneurysms. In general, false aneurysms are related to traumatisms and, less frequently, to inflammatory disease of vascular endothelium. Clinically, it shows a pulsatile, painful hematoma in the affected region. The initial diagnosis is usually achieved by Doppler ultrasound showing a hypoechoic image in relation to a blood vessel or its wall. Due to the low prevalence of false aneurysm, it is commonly confused with skin and soft tissue's infections or with thrombosis. There are different options of treatment, from extrinsic compression to open surgery. We describe the case of a 13-year-old patient with traumatic false aneurysm of a muscular branch of femoral artery, successfully managed with endovascular exclusion of the lesion with microcoil
Subject(s)
Humans , Male , Adolescent , Aneurysm, False/diagnostic imaging , Femoral Artery , Wounds and Injuries , Ultrasonography, Doppler , Embolization, Therapeutic , Endovascular ProceduresABSTRACT
Pseudoaneurysm or 'false aneurysm' is defined asan abnormal arterial dilatation produced by an injury to its wall that does not affect the three parietal layers like in 'true' aneurysms. In general, false aneurysms are related to traumatisms and, less frequently, to inflammatory disease of vascular endothelium. Clinically, it shows a pulsatile, painful hematoma in the affected region. The initial diagnosis is usually achieved by Doppler ultrasound showing a hypoechoic image in relation to a blood vessel or its wall. Due to the low prevalence of false aneurysm, it is commonly confused with skin and soft tissue's infections or with thrombosis. There are different options of treatment, from extrinsic compression to open surgery. We describe the case of a 13-year-old patient with traumatic false aneurysm of a muscular branch of femoral artery, successfully managed with endovascular exclusion of the lesion with microcoils.
El pseudoaneurisma arterial es la dilatación de un vaso, producto de la lesión de la pared. Es generado, principalmente, por traumatismos y, enmenor medida, por patologías inflamatorias del endotelio. Se presenta como un hematoma pulsátil y doloroso. Su diagnóstico suele realizarse debido a que, ante una ecografía Doppler, se observa una imagen hipoecoica adyacente a un vaso conflujo en su interior. Subajaprevalencia, asociada a su presentación clínica variable, puede generar confusión con infecciones de piel y partes blandas o trombosis. El manejo puede ser desde la compresión extrínseca hasta la cirugía abierta, y no existen algoritmos terapéuticos en la actualidad. Se describe el caso de un paciente de 13 años con un pseudoaneurisma en una rama muscular de la arteria femoral superficial, secundario a un traumatismo cortante en el que se realizó exitosamente el abordaje endovascular con colocación de microcoils para la exclusión del saco pseudoaneurismático.
Subject(s)
Aneurysm, False/diagnosis , Femoral Artery/pathology , Wounds and Injuries/complications , Adolescent , Aneurysm, False/etiology , Aneurysm, False/therapy , Endovascular Procedures/methods , Humans , MaleABSTRACT
La pustulosis exantemática aguda generalizada (PEAG) es una erupción de pequeñas pústulas estériles sobre una base eritematosa edematosa, suele asociarse a fiebre. Es una enfermedad poco frecuente, actualmente vinculada a fármacos, aunque también se asocia con infecciones virales y otras noxas; puede confundirse fácilmente con otros diagnósticos diferenciales en pediatría. Se presenta el caso de un paciente de 4 años, sexo masculino que consulta por fiebre, eritema en área de pliegues y lesiones pustulosas en piel que comenzaron en región peri-orificial, extendiéndose luego a tórax y pliegues. En la anamnesis se destaca el antecedente de ingesta reciente de azitromicina. Se decide su internación e inicia tratamiento parenteral con clindamicina. El laboratorio evidencia leucocitosis con neutrofilia, las serologías para Parvovirus B19, Epstein Barr y Citomegalovirus resultan negativas. Se realiza diagnóstico clínico de PEAG, confirmado con histopatología. El paciente presenta mejoría clínica a las 72 horas con egreso hospitalario
Acute generalized exanthematous pustulosis (PEAG) is a rash of small sterile pustules on an edematous erythematous base, usually associated with fever. It is a rare disease, currently linked to drugs reaction, but is also associated with viral infections and other noxious. It can easily be confused with other differential diagnoses in pediatrics. We present the case of a 4-year-old male patient who consulted for fever, folds erythema and pustular skin lesions that began in the peri-orificial region, then spread to the thorax and folds. The history of recent azithromycin intake stands out in the anamnesis. He was admitted to hospital and began parenteral treatment with clindamycin. The laboratory evidences leukocytosis with neutrophilia and serologies for Parvovirus B19, Epstein Barr and Cytomegalovirus: negative. A clinical diagnosis of PEAG is made, confirmed with histopathology. The patient presents clinical improvement at 72 hours with hospital discharge
