ABSTRACT
El estreptococo B hemolítico del grupo A es una bacteria aerobia Gram +, que puede producir una gran variedad de síndromes infecciosos en el puerperio. Hasta un tercio de las infecciones se complicará con un shock tóxico estafilocócico, caracterizado por shock y disfunción multiorgánica. Cultivos, diagnóstico y tratamiento precoces son vitales para el buen pronóstico. Presentamos el caso de una paciente puerperal con un síndrome de shock tóxico estreptocócico, complicado con una isquemia mesentérica masiva, donde tratamiento antibiótico y cirugía precoz fueron claves para la evolución
B hemolytic group A streptococcus is an aerobic Gram-positive bacteria that can produce a wide variety of infectious syndromes in the puerperium. Up to one-third of infections will be complicated by streptococcal toxic shock, characterized by shock and multiorgan dysfunction. Early cultures, diagnosis and treatment are vital to good prognosis. We present the case of a puerperal patient with streptococcal toxic shock, complicated by massive mesenteric ischemia, in whom antibiotic treatment and early surgery were the key to outcome
Subject(s)
Female , Humans , Pregnancy , Mesenteric Ischemia/metabolism , Mesenteric Ischemia/pathology , Reproductive Tract Infections/diagnosis , Streptococcal Infections/metabolism , Streptococcal Infections/virology , Colitis, Ischemic/metabolism , Colitis, Ischemic/pathology , Erysipelas/physiopathology , Mesenteric Ischemia/complications , Mesenteric Ischemia/diagnosis , Reproductive Tract Infections/metabolism , Streptococcal Infections/complications , Streptococcal Infections/diagnosis , Colitis, Ischemic/complications , Colitis, Ischemic/enzymology , Erysipelas/classificationABSTRACT
Se conoce como histiocitosis a un grupo de enfermedades poco frecuentes que se caracterizan por la proliferación, reactiva o neoplásica, de determinadas células del sistema mononuclear-fagocítico, los histiocitos, como una respuesta inmunitaria anómala de forma localizada en un órgano o tejido o de forma generalizada. Actualmente, se clasifican en 3 grandes grupos: la histiocitosis de células de Langerhans (histiocitosis X); las histiocitosis de célulasfagocito-mononucleares diferentes a las células de Langerhans; y los desórdenes histiocíticosmalignos (leucemia monocítica aguda, histiocitosis maligna y linfoma histiocítico). Cuando la histiocitosis X afecta a los cuerpos vertebrales, habitualmente tras una dorsalgia o lumbalgiasubaguda, pueden aparecer déficit neurológicos agudos que hagan consultar al paciente en el servicio de urgencias (AU)
Histiocytoses form a group of rare diseases characterized by the reactive or neoplastic proliferation of histiocytes. Anabnormal immune response may cause these mononuclear phagocytes to proliferate generally or locally within an organ or tissue. These diseases are currently classified in 3 broad groups: Langerhans cell histiocytosis (histiocytosis X); non-Langerhans cell histiocytoses; and malignant histiocytic disorders (acute monocytic leukemia, malignant histiocytosis, and lymphohistiocytosis. When histiocytosis X affects vertebral bodies, usually following subacute lumbar or other backpain, acute neurologic deficits may lead the patient to seek emergency care (AU)
Subject(s)
Humans , Male , Adult , Histiocytosis, Langerhans-Cell/complications , Paresthesia/etiology , Back Pain/etiology , Eosinophilic Granuloma/diagnosisABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Respiratory Insufficiency/complications , Granulomatosis with Polyangiitis/diagnosis , Radiography, Thoracic , Tomography, X-Ray ComputedABSTRACT
STUDY OBJECTIVES: To prospectively assess the relative risk for phlebitis in a series of consecutive patients with pneumonia and to identify risk factors that predict an increased risk for phlebitis. SETTING: Internal medicine department of a tertiary teaching hospital. PATIENTS: Seven hundred sixty-six consecutive patients with acute pneumonia receiving IV therapy. INTERVENTIONS: Only the first catheter was taken into account. There were 308 short lines (a 51-mm, 18-gauge Teflon catheter); 307 midsized lines (a 28-cm, 16-gauge polyvinyl chloride catheter); and 151 long lines (71-cm, 14-gauge plain polyurethane catheter). Eighteen variables were prospectively evaluated in an open, nonrandomized study for their contribution to the occurrence of phlebitis. RESULTS: The overall phlebitis rate was 39%. Phlebitis developed in 53% of patients with short lines, in 41% of patients with midsized lines, and in 10% of patients with long lines, and these catheters remained in place an average (+/- SD) of 3.0+/-2.4 days, 4.6+/-3.4 days, and 7.8+/-6.6 days, respectively. The variables that influenced the development of phlebitis, as determined by multivariate analysis, were the following: type of catheter; blood hemoglobin levels; and IV therapy with either corticosteroids or erythromycin. CONCLUSIONS: According to our data, when the use of a catheter is expected to be required for < or = 36 h, a short line can be used. If a longer duration is expected, a longer line is warranted. Ours is the first study in which the relationship between blood hemoglobin levels and phlebitis has been reported. Because the use of intravascular devices is increasingly common, a more complete knowledge of the factors that influence their acceptance has become essential.
