ABSTRACT
La enfermedad de Kawasaki es una vasculitis multisistémica de pequeños y medianos vasos, propia de lactantes y niños pequeños. Es muy frecuente en Japón. Su etiología es desconocida, pero la mayoría de las evidencias epidemiológicas e inmunológicas indican que el agente causal es probablemente infeccioso. El diagnóstico se basa en una serie de criterios clínicos. El exantema polimorfo puede ser confundido con otras entidades clínicas. El tratamiento debe ser lo más precoz posible con el fin de prevenir las complicaciones cardiacas (AU)
Kawasaki disease is a multisystemic vasculitis syndrome of small and medium vessel typical in breast fed babies and early childhood. It is very common in Japan. The aetiology is unknown however most epidemiologic and immunologic evidences indicate that the causal agent is probably infectious. The diagnosis is based on clinical criteria. Polymorphous exanthema can be mistaken with other clinical forms. The treatment must be done as soon as possible with the aim of preventing any cardiac complications (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Mucocutaneous Lymph Node Syndrome , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/epidemiology , Mucocutaneous Lymph Node Syndrome/etiology , Mucocutaneous Lymph Node Syndrome/mortality , Mucocutaneous Lymph Node Syndrome/pathology , Mucocutaneous Lymph Node Syndrome/therapy , ExanthemaABSTRACT
Antecedentes: El virus respiratorio sincitial (VRS) y otros virus son causas conocidas de hospitalización en lactantes. Menos conocido es el patrón de virus en infecciones extrahospitalarias en menores de 6 meses. Objetivo: El objetivo de este estudio es describir las características clínicas y los factores epidemiológicos asociados con las infecciones respiratorias virales de ámbito extrahospitalario en menores de 6 meses. Pacientes y métodos: Estudio prospectivo en cohorte de niños de las áreas 8 y 9 de Madrid controlados desde el nacimiento mediante llamadas telefónicas quincenales durante una temporada invernal. Se registraron datos clínicos y epidemiológicos en cuestionarios prediseñados. Se exploró y recogió el aspirado nasofaríngeo (ANF) cuando el paciente presentó sintomatología compatible con una infección respiratoria. El diagnóstico de los virus más comunes se realizó con inmunofluorescencia directa (IFD) y amplificación genómica (PCR). Resultados: Fueron seleccionados 316 recién nacidos. Se realizaron 1.865 llamadas telefónicas (mediana 4), y 106 visitas, en 89 de las cuales se confirmó la enfermedad. Los síntomas más frecuentes fueron rinitis (91 %) y tos (69 %). El diagnóstico clínico principal fue infección respiratoria de vías altas (82 %); 17 de 72 ANF realizados (23,2 %) fueron positivos. Se detectaron rinovirus (41,1 %) y VRS (35,2 %). Ingresaron un 16 % (17/106) de los niños atendidos por enfermedad (el 5,3 % de la cohorte), diagnosticados de síndrome febril y de bronquiolitis. No encontramos ningún factor epidemiológico asociado con la infección respiratoria viral en los casos positivos. Conclusiones: En nuestro medio las infecciones respiratorias de los lactantes son en su mayoría banales y no precisan atención hospitalaria. El rinovirus y el VRS son los principales agentes etiológicos. No se encontraron factores epidemiológicos relacionados con la infección respiratoria asociada a virus (AU)
Background: Respiratory syncytial virus and Influenza virus infections are known causes of hospital admission in infants. It is less well known the pattern of virus infections in infants under 6 months of age in the outpatient setting. Objective: To describe the clinical and epidemiological pattern of community-acquired viral respiratory infections in infants under 6 months. Patients and methods: A cohort of infants from the 8 and 9 Madrid Health Districts was followed by telephone calls every two weeks since birth during the epidemic winter season. Clinical and epidemiological data were collected in pre-designed questionnaires. Nasopharyngeal aspirate was obtained in every patient with symptoms compatible with respiratory infection. Diagnosis of the more common virus was made with direct immunofluorescence and nucleic acid amplification test (PCR). Results: Were recruited 316 newborns. The 1,865 phone calls made (median 4 for every child), produced 106 visits, and the illness confirmed in 89 illness. Rhinitis (91 %) and cough (69 %) were the most common symptoms. Upper respiratory infection was the principal clinical diagnosis (84.5 %), and 17 of the 72 samples (23.2 %) were positive. Most common viruses were RSV (41.1 %) and rhinovirus (35.2 %). Of the children visited, 17 out of 106 (16 %) (5.3 % of the cohort) were admitted to hospital. Diagnoses were febrile syndrome and bronchiolitis. We did not find any epidemiological factor associated with viral respiratory infection in positive cases. Conclusions: In our population most of the respiratory infections in infants are minor and do not need hospital assistance. Rhinovirus and RSV are the major pathogens. We did not find any epidemiological factor associated with viral respiratory infection (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Respiratory Tract Diseases/epidemiology , Respiratory Tract Diseases/prevention & control , Respiratory Syncytial Virus, Human/immunology , Respiratory Syncytial Virus Infections/epidemiology , Fluorescent Antibody Technique, Direct/instrumentation , Fluorescent Antibody Technique, Direct , Bronchiolitis/diagnosis , Bronchiolitis/epidemiology , Rhinitis/epidemiology , Rhinovirus/isolation & purification , Rhinovirus/pathogenicity , Respiratory Syncytial Virus Infections/etiology , Prospective Studies , Bronchial Spasm/complications , Bronchial Spasm/diagnosisABSTRACT
BACKGROUND: Respiratory syncytial virus and Influenza virus infections are known causes of hospital admission in infants. It is less well known the pattern of virus infections in infants under 6 months of age in the outpatient setting. OBJECTIVE: To describe the clinical and epidemiological pattern of community-acquired viral respiratory infections in infants under 6 months. PATIENTS AND METHODS: A cohort of infants from the 8 and 9 Madrid Health Districts was followed by telephone calls every two weeks since birth during the epidemic winter season. Clinical and epidemiological data were collected in pre-designed questionnaires. Nasopharyngeal aspirate was obtained in every patient with symptoms compatible with respiratory infection. Diagnosis of the more common virus was made with direct immunofluorescence and nucleic acid amplification test (PCR). RESULTS: Were recruited 316 newborns. The 1,865 phone calls made (median 4 for every child), produced 106 visits, and the illness confirmed in 89 illness. Rhinitis (91%) and cough (69%) were the most common symptoms. Upper respiratory infection was the principal clinical diagnosis (84.5%), and 17 of the 72 samples (23.2%) were positive. Most common viruses were RSV (41.1%) and rhinovirus (35.2%). Of the children visited, 17 out of 106 (16%) (5.3% of the cohort) were admitted to hospital. Diagnoses were febrile syndrome and bronchiolitis. We did not find any epidemiological factor associated with viral respiratory infection in positive cases. CONCLUSIONS: In our population most of the respiratory infections in infants are minor and do not need hospital assistance. Rhinovirus and RSV are the major pathogens. We did not find any epidemiological factor associated with viral respiratory infection.
Subject(s)
Respiratory Tract Infections/virology , Humans , Infant , Infant, Newborn , Prospective Studies , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/epidemiologyABSTRACT
Acute lobar nephronia is a focal form of acute bacterial renal infection. The prevalence of this disease is low. We report four cases of acute lobar nephronia. Three patients were diagnosed among 77 patients admitted to hospital for acute pyelonephritis. The fourth case was atypical and associated with epidermolysis bullosa. All cases were diagnosed by renal ultrasonography and the diagnosis was confirmed by computed tomographic examination in two patients with poor clinical course. A small abscess was detected in one patient. Urine cultures were positive in three of the four patients. Acute lobar nephronia is a radiological diagnosis and requires aggressive treatment and strict follow-up due to the risk of renal abscesses. Because the clinical manifestations are insidious and laboratory findings can be contradictory, this entity should be suspected in patients with poor clinical course or alterations on renal ultrasonography. Medical treatment is usually sufficient and prognosis is generally good.
Subject(s)
Bacterial Infections , Kidney Diseases/microbiology , Acute Disease , Bacterial Infections/diagnosis , Bacterial Infections/therapy , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Kidney Diseases/diagnosis , Kidney Diseases/therapy , Male , PrognosisABSTRACT
La nefronía focal aguda (NA) es una infección bacteriana aguda localizada en el riñón. La prevalencia de esta enfermedad es escasa. Presentamos 4 casos de nefronía bacteriana aguda. De ellos, 3 pacientes fueron diagnosticados entre 77 pacientes ingresados por pielonefritis aguda y hubo un caso atípico, asociado con una epidermólisis bullosa. El diagnóstico se realizó por ecografía renal y se confirmó con tomografía computarizada ante la mala evolución de dos de los casos, detectando un pequeño absceso en uno de ellos. El urocultivo fue positivo en 3 de los 4 pacientes. La NA es un diagnóstico radiológico que precisa tratamiento más agresivo y seguimiento más estrecho por el riesgo de evolucionar a absceso renal. Dado que la clínica es insidiosa y las pruebas de laboratorio dispares, es preciso sospecharla ante una evolución tórpida de una pielonefritis o alteraciones en la ecoestructura renal. El tratamiento médico es suficiente y el pronóstico, en general, bueno
Acute lobar nephronia is a focal form of acute bacterial renal infection. The prevalence of this disease is low. We report four cases of acute lobar nephronia. Three patients were diagnosed among 77 patients admitted to hospital for acute pyelonephritis. The fourth case was atypical and associated with epidermolysis bullosa. All cases were diagnosed by renal ultrasonography and the diagnosis was confirmed by computed tomographic examination in two patients with poor clinical course. A small abscess was detected in one patient. Urine cultures were positive in three of the four patients. Acute lobar nephronia is a radiological diagnosis and requires aggressive treatment and strict follow-up due to the risk of renal abscesses. Because the clinical manifestations are insidious and laboratory findings can be contradictory, this entity should be suspected in patients with poor clinical course or alterations on renal ultrasonography. Medical treatment is usually sufficient and prognosis is generally good
