ABSTRACT
OBJECTIVE: Cases of septic arthritis in paediatric population by Streptococcus pneumoniae in the Health Area of Santiago de Compostela (Spain) were reviewed. METHODS: A retrospective study from January 2005 to March 2014 was conducted for all S. pneumoniae isolates obtained from joint fluids in children. RESULTS: From the 7,416 joint fluids received in the Microbiology Department, 77 belonged to paediatric patients, and of these, only 8 had positive culture. In total, there were three positive cases for S. pneumoniae, two with positive culture and a third with positive antigen detection. In the three patients (two of them under 15 months) the affected joint was hip, antibiotic treatment was combined with surgical drainage and evolution was favourable. CONCLUSIONS: We conclude that pneumococcal arthritis is an entity that must be taken into account since most cases of arthritis in paediatric population appear as a complication of bacteraemia after a common cold or an ear infection. The greatest risk of sequel is associated with delays in diagnosis, so it is essential clinical and microbiological early diagnosis.
Subject(s)
Arthritis, Infectious/epidemiology , Pneumococcal Infections/epidemiology , Adolescent , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/drug therapy , Arthritis, Infectious/microbiology , Bacteremia/complications , Body Fluids/microbiology , Child , Child, Preschool , Common Cold/complications , Drainage , Hip Joint/microbiology , Hip Joint/surgery , Humans , Infant , Joints/microbiology , Male , Pneumococcal Infections/drug therapy , Pneumococcal Infections/microbiology , Retrospective Studies , Spain/epidemiologyABSTRACT
Caso clínico: Hombre de 38 años remitido de otro centro por presentar queratitis fúngica por Alternaria 25 días después de realizarle una queratoplastia penetrante postraumática en ojo derecho. Se instaura tratamiento con voriconazol tópico y oral con buena evolución posterior. Discusión: Las queratitis fúngicas por Alternaria son poco frecuentes. Su tratamiento es difícil porque la evolución clínica no se correlaciona con la susceptibilidad in vitro del hongo. Producen cuadros clínicos que requieren un rápido diagnóstico y tratamiento, para evitar la pérdida de visión. La combinación de voriconazol tópico y sistémico puede ser una buena alternativa en caso de hongos resistentes al tratamiento convencional
Clinical case: A 38-year-old man with fungal Alternaria keratitis was referred from another hospital 25 days after post-traumatic penetrating keratoplastia surgery on his right eye. We commenced treatment with topical voriconazole and the condition resolved. Discussion: Fungal Alternaria keratitis is rare, and treatment is difficult because the clinical response does not correlate well with the antibiotic in vitro sensitivity of the fungus. Clinical cases need to be diagnosed and treated quickly if visual loss is to be avoided. The combination of topical and systemic voriconazole has been shown to be an effective treatment for this condition (Arch Soc Esp Oftalmol 2008; 83: 493-496)
Subject(s)
Humans , Male , Adult , Keratitis/diagnosis , Keratitis/therapy , Alternaria/isolation & purification , Alternaria/physiology , Alternaria/pathogenicity , Keratoplasty, Penetrating/methods , Immunosuppression Therapy/methods , Keratoplasty, Penetrating/pathology , Keratoplasty, Penetrating/trends , Keratoplasty, Penetrating , Eukaryotic Cells/pathologyABSTRACT
CLINICAL CASE: A 38-year-old man with fungal Alternaria keratitis was referred from another hospital 25 days after post-traumatic penetrating keratoplastia surgery on his right eye. We commenced treatment with topical voriconazole and the condition resolved. DISCUSSION: Fungal Alternaria keratitis is rare, and treatment is difficult because the clinical response does not correlate well with the antibiotic in vitro sensitivity of the fungus. Clinical cases need to be diagnosed and treated quickly if visual loss is to be avoided. The combination of topical and systemic voriconazole has been shown to be an effective treatment for this condition
Subject(s)
Alternaria , Antifungal Agents/administration & dosage , Eye Infections, Fungal/drug therapy , Keratitis/drug therapy , Mycoses , Pyrimidines/administration & dosage , Triazoles/administration & dosage , Administration, Oral , Adult , Eye Infections, Fungal/microbiology , Eye Injuries/surgery , Humans , Keratitis/microbiology , Keratoplasty, Penetrating , Male , Mycoses/drug therapy , Ophthalmic Solutions , Time Factors , Treatment Outcome , VoriconazoleABSTRACT
En el Área Sanitaria de Santiago de Compostela, durante un periodo de tres años (2004-2006) se estudiaron 218 cepas de Streptococcuspneumoniae productoras de enfermedad invasiva (10 LCR, 133 hemocultivos, 7 líquidos pleurales, 9 úlceras corneales y 59 de vías respiratoriasbajas), para conocer los serotipos predominantes y la sensibilidad antimicrobiana. Un 77,1% de las cepas procedían de adultos y un 22,9%de niños. Se encontraron 33 serotipos diferentes, seis de los cuales se aíslan con una frecuencia superior al 5%, y son, por orden decreciente,el 19 (16,97%), el 3 (11,46%), el 1 (10,55%), el 14 (10,55%), el 23 (6,88%) y el 6 (6,88%). En muestras de LCR predomina el serogrupo19 y en hemocultivos el 19, el 1, el 14 y el 3. De las 218 cepas, un 63,76% fueron sensibles a todos los antibióticos. Los fenotipos de no sensibilidadmás frecuentes fueron a la eritromicina (24,31%) y la penicilina (18,34%). Ambos fenotipos se asocian a los serotipos 19, 14 y 6. Lasensibilidad a la cefotaxima fue del 99,5%. La resistencia al levofloxacino fue del 0,9%. No hemos encontrado resistencias a la vancomicina(AU)
In the Health Care Area of Santiago de Compostela, during three years (2004-2006), we studied 218 Streptococcus pneumoniae isolates frominvasive disease (10 CSF, 133 blood culture, 7 pleural fluid, 9 corneal ulcer and 59 lower respiratory tract), to determine the predominantserotypes and antimicrobial susceptibility. 77.1% of the isolates were from adults and 22.9% from pediatric patients. There were 33 differentserotypes, six of them occurring in more than 5% of cases, in decreasing order: 19 (16.97%), 3 (11.46%), 1 (10.55%), 14 (10.55%), 23(6.88%) and 6 (6.88%). The predominant serogroup in CSF was 19 and in blood culture predominant serogroups were 19, 1, 14 and 3.63.76% of the isolates were susceptible to all antibiotics tested. The most frequent resistance phenotypes were to erythromycin (24.31%),followed by penicillin (18.34%). Both phenotypes were associated with serotypes 19, 14 and 6. The resistance to levofloxacin was 0.9% and0.5% to cefotaxime. We did not find any vancomycin resistance(AU)
Subject(s)
Humans , Streptococcal Infections/drug therapy , Anti-Bacterial Agents/pharmacokinetics , Streptococcus pneumoniae/pathogenicity , Serotyping , Microbial Sensitivity Tests , Drug Resistance, BacterialABSTRACT
The need for an access to the venous system, in order to infuse chemotherapeutic treatments or parenteral nutrition, has increased the number of central venous access systems (CVAS) implanted in the past years. Between February 1985 and December 1990, 87 devices were implanted in 76 patients (from 11 months to 15 years of age), with a median function time of 349 days (range: 7 to 1887 days). The overall incidence of complications was 0.10 per 10 days of catheterization, with complication rates for infection and thrombosis of 0.02 and 0.03, respectively. Nineteen systems were removed because of complications and 11 because of completion of the treatment. Of the cases, 97.7% included a follow-up period. The present study confirms the advantages of these devices, with a long working life and a low complication rate, being a good alternative for chronically ill children requiring long-term and/or cyclic intravenous therapy.
Subject(s)
Catheterization, Central Venous/methods , Infusions, Intravenous/instrumentation , Injections, Intravenous/instrumentation , Parenteral Nutrition/methods , Adolescent , Catheterization, Central Venous/instrumentation , Catheters, Indwelling , Chemotherapy, Adjuvant/methods , Child , Child, Preschool , Female , Humans , Infant , Infusion Pumps, Implantable , Infusions, Intravenous/methods , Injections, Intravenous/methods , Male , Neoplasms/therapy , Parenteral Nutrition/instrumentation , Treatment OutcomeABSTRACT
The role of eicosanoids in the development of immune response may be important to the viability of the implanted organ, given their complicated interaction with lymphokines and monokines which regulate the response. Due to this reason, more experiments in vivo are necessary to provide a better understanding of the behaviour of these compounds. This would help to clearly determine the role of these substances in the immune response--more exactly, in the allogenic transplant rejection--creating new ways for its control.
Subject(s)
Eicosanoids/immunology , Graft Rejection/immunology , Leukotrienes/immunology , Transplantation Immunology/immunology , Antigen-Antibody Reactions/immunology , Humans , Immunity, Cellular/immunology , Transplantation, HomologousABSTRACT
A review of the current state of carcinoid tumors is presented, with special attention to the diagnostic, pronostic and new therapeutic aspects. In spite of being a well known entity the diagnosis is difficult being confirmed only by pathologic findings. The current medical therapy and surgical options are described. New surgical alternatives--organ cluster transplantation--seems to be the definitive solution in metastatic disease.
Subject(s)
Carcinoid Tumor/therapy , Carcinoid Tumor/diagnosis , Carcinoid Tumor/metabolism , Carcinoid Tumor/pathology , Humans , Malignant Carcinoid Syndrome/therapy , PrognosisABSTRACT
We present a case of cancer of a choledochal cyst in a patient with antecedents of cholecystectomy, who complained of pain in the right hypochondrium. Echography and CAT disclosed a cystic mass of biliary location, and the diagnosis was confirmed by intraoperative cholangiography and biopsy of the cyst margin. Cysto-jejunostomy on a Roux-en-Y loop was performed. The patient survived 11 months and died of tumoral dissemination. We reviewed 130 cases of cancer of a choledochal cyst published up until 1986 and possible etiopathogenic causes, and we discuss the diagnostic problems and related treatment.
Subject(s)
Adenocarcinoma/complications , Common Bile Duct Diseases/complications , Common Bile Duct Neoplasms/complications , Cysts/complications , Adenocarcinoma/surgery , Common Bile Duct Diseases/diagnosis , Common Bile Duct Neoplasms/surgery , Cysts/diagnosis , Diagnosis, Differential , Echinococcosis, Hepatic/diagnosis , Female , Humans , Middle AgedABSTRACT
In the last decade, the development of the liver grafting in childs, has pointed out the efficacy of this modality as the treatment of several inborns errors of metabolism. Due to the technical limitations of the orthotopic liver transplantation, new modalities have been sought. Among them, liver cells transplantation represent the most attractive. Different studies have confirmed the efficacy of liver cell grafting in the treatment of several experimental models of hepatophathy: acute liver failure experimental cirrhosis and models of enzyme deficiency. These results have established the bases for the future clinical application of this technique in childs. As well as other forms of isolated cell transplantation; liver cell grafting could provide a good model for cryopreservation, immunological manipulation and genetic engineering.
Subject(s)
Liver Transplantation/trends , Pediatrics , Child , Humans , Liver Transplantation/methodsABSTRACT
A case is presented of fibrolamellar hepatocarcinoma in a 12 year-old male treated by liver transplantation; there is no evidence of tumoral recurrence at 28 months. Donos and receptor were ABO incompatible. The immunosuppressive regimen used was cyclosporine A and low doses of steroids. Fibrolamellar hepatocarcinoma is an infrequent histologic variety that usually affects young people and is generally not associated with hepatitis B infection or cirrhosis. It is often a single tumor, is more susceptible to surgical resection than other varieties of hepatocarcinoma, and is characterized by a relatively unagressive tumoral biology.
