The usefulness of the leuprolide stimulation test as a diagnostic method of idiopathic central precocious puberty in girls.

Central precocious puberty (CPP) diagnosis is based on clinical evaluation, but hormonal evaluation is crucial. The aim of the study was to evaluate the usefulness of the leuprolide stimulation test for diagnosis of idiopathic CPP. Sixty-one girls, aged 5-8 years, were evaluated retrospectively for premature breast development. According to clinical evolution, 28 had progressive puberty and 33 nonprogressive puberty. All underwent a leuprolide stimulation test. Cutoff points, sensitivity, and specificity for gonadotropins and estradiol were determined by receiver operating characteristic (ROC) curves. Cutoff points for CPP were: baseline LH: > 0.1 mUI/l, FSH: > 2.3 mUI/l, LH/FSH ratio: > 0.23, estradiol: > 12 pg/ml; and stimulated LH: > 5.5 mUI/l, LH/FSH ratio: > 0.24, estradiol: > 79.67 pg/ml. The best diagnostic efficiency for progressive puberty were stimulated LH/FSH ratio (sensitivity: 100%, specificity 94%) followed by stimulated LH (sensitivity: 93%, specificity: 100%). Stimulated LH/FSH ratio and LH resulted in the most useful parameters for the diagnosis of CPP. Stimulated estradiol did not add more information.

[Pneumococcal endocarditis in a previously healthy 17-month-old boy]. / Endocarditis neumocócica en niño de 17 meses previamente sano.

Invasive pneumococcal infection is a severe disease and its incidence may be increasing. Endocarditis due to Streptococcus pneumoniae is uncommon, particularly in children without risk factors. Etiologic diagnosis is difficult when cultures are negative. We report the case of a previously healthy, 17-month-old boy not vaccinated against pneumococcus who, during the course of pneumonia treated with beta-lactam antibiotics, developed cardiorespiratory deterioration and heart murmur. Mitral valve vegetation was identified by transthoracic echocardiography. Endocarditis was diagnosed and new antibiotics were given for 6 weeks (cefotaxime, gentamycin and vancomycin). Cultures were negative. Because of lack of improvement, prosthetic mitral replacement was indicated. S. pneumoniae was identified by polymerase chain reaction (PCR) in the pathological specimen. Outcome was favorable, and the patient remained symptom-free after 6 months of follow-up. The possibility of endocarditis as an invasive pneumococcal infection should be considered in children without risk factors. PCR is a useful technique to establish the etiology when cultures are negative.

Endocarditis neumocócica en niño de 17 meses previamente sano / Pneumococcal endocarditis in a previously healthy 17-month-old boy

La enfermedad invasora neumocócica es una entidad grave y cuya incidencia parece en aumento. La endocarditis por Streptococcus pneumoniae es infrecuente, particularmente en niños sin factores de riesgo. Su caracterización etiológica resulta difícil ante cultivos negativos. Se presenta un niño de 17 meses, previamente sano, no vacunado frente a neumococo. Durante una neumonía tratada con betalactámicos aparecen deterioro cardiorrespiratorio progresivo y soplo cardíaco. La ecocardiografía transtorácica muestra una vegetación mitral. Se diagnostica endocarditis y se adecua la antibioterapia (cefotaxima, gentamicina y vancomicina, mantenidas 6 semanas). Los cultivos resultan negativos. Ante la no mejoría se interviene, colocándose una prótesis. En la válvula resecada, mediante técnica de reacción en cadena de polimerasa (PCR), se identifica S. pneumoniae. La evolución es buena, permaneciendo asintomático a los 6 meses de seguimiento. Debe considerarse la posibilidad de endocarditis como forma invasora de infección neumocócica en niños sin factores de riesgo, y la utilidad de la PCR para establecer su etiología ante cultivos negativos

Invasive pneumococcal infection is a severe disease and its incidence may be increasing. Endocarditis due to Streptococcus pneumoniae is uncommon, particularly in children without risk factors. Etiologic diagnosis is difficult when cultures are negative. We report the case of a previously healthy, 17-month-old boy not vaccinated against pneumococcus who, during the course of pneumonia treated with beta-lactam antibiotics, developed cardiorespiratory deterioration and heart murmur. Mitral valve vegetation was identified by transthoracic echocardiography. Endocarditis was diagnosed and new antibiotics were given for 6 weeks (cefotaxime, gentamycin and vancomycin). Cultures were negative. Because of lack of improvement, prosthetic mitral replacement was indicated. S. pneumoniae was identified by polymerase chain reaction (PCR) in the pathological specimen. Outcome was favorable, and the patient remained symptom-free after 6 months of follow-up. The possibility of endocarditis as an invasive pneumococcal infection should be considered in children without risk factors. PCR is a useful technique to establish the etiology when cultures are negative