ABSTRACT
Introducción: La fiebre de origen desconocido en la edad pediátrica plantea un diagnóstico diferencial entre procesos infecciosos y enfermedades autoinmunes, entre otras causas. Caso clínico: Presentamos el caso de un varón de 24 meses de edad remitido a nuestro centro por un cuadro de fiebre de larga evolución asociado a dolor abdominal recurrente. Recibió diversos tratamientos antibióticos y una primera tanda de pruebas complementarias con resultado normal. A las 5 semanas, ante el empeoramiento clínico del paciente y la sospecha de zoonosis, se inició tratamiento con gentamicina intravenosa. Los resultados de las nuevas pruebas mostraron una seroconversión frente a Bartonella henselae, IgM frente al virus de Epstein-Barr (VEB), una elevación de la calprotectina fecal y un engrosamiento transmural ileocecal mediante estudio ecográfico. El estudio de un ganglio mesentérico mostró una alta carga viral de VEB, y el estudio anatomopatológico de la biopsia ileal proporcionó el diagnóstico de enfermedad inflamatoria intestinal (EII). Conclusión: La exposición a determinados microorganismos puede desempeñar un papel como desencadenante en el inicio o la reactivación de la enfermedad autoinmune latente, como podría haber sucedido en este caso con la infección por B. henselae/VEB y la EII. No obstante, es importante realizar el diagnóstico diferencial entre la EII desencadenada por una infección y las formas atípicas de infección que simulen una EII (AU)
Introduction: The fever of unknown origin in children represents, among other causes, a differential diagnosis between common and opportunistic infections. Case report: We report the case of a 24-month-old boy with prolonged fever associated with recurrent abdominal pain. The patient had received different antibiotic treatments and the initial diagnostic tests were normal. At 5 weeks, treatment with gentamicin was started due to deterioration of the patient as well as clinical suspicion of zoonosis. New laboratory findings included seroconversion against Bartonella henselae, IgM against EBV (Epstein-Barr virus) and elevated fecal calprotectin. Abdominal ultrasonography detected a distal ileum wall thickening. Pathological examination of mesenteric adenopathy showed a high viral load of EBV and ileum biopsies provided the diagnosis of inflammatory bowel disease (IBD). Conclusions: Exposure to certain infectious agents may play a role as a trigger for reactivation of latent autoimmune disease, as in the case reported, with the possible association between B. henselae/EBV infection and the onset of IBD. However, it is important to make the differential diagnosis between IBD triggered by an infection, and atypical forms of infection that mimic IBD (AU)
Subject(s)
Humans , Male , Child, Preschool , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/drug therapy , Epstein-Barr Virus Infections/complications , Abdominal Pain/etiology , Biopsy , Crohn Disease/diagnosis , Crohn Disease/drug therapy , Bartonella henselae , Bartonella henselae/isolation & purification , Gentamicins/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Fever of Unknown Origin/diagnosis , Colonoscopy/methods , Diagnosis, DifferentialABSTRACT
The increase in the number of clinical isolates of multiresistant Enterobacteriaceae and Pseudomonas aeruginosa raises problems in decision-making on empirical treatments for severe Gram-negative bacilli-associated infections. The aim of our study is to determine the resistance of meropenem in our setting and the co-resistance of a combination of this compound with two antibiotics from different families: amikacin and ciprofloxacin. Between 2009 and 2013, a total of 81,310 clinical isolates belonging to the main species of Enterobacteriaceae and 39,191 clinical isolates of P. aeruginosa isolated in 28 hospitals in the Valencian Community on the South East Mediterranean Coast of Spain were analyzed using data provided by RedMiva (microbiological surveillance network of the Valencian Community). Meropenem resistance in Enterobacteriaceae increased from 0.16 % in 2009 to 1.25 % in 2013. Very few Enterobacteriaceae strains resistant to meropenem were sensitive to ciprofloxacin; in contrast, the combination of meropenem and amikacin led to a marked decrease in the risk of the microorganisms being resistant to both drugs (RR = 34 in 2013). In the case of P. aeruginosa, meropenem resistance also increased (from 14.32 % in 2009 to 24.52 % in 2013). Most meropenem-resistant P. aeruginosa isolates were also resistant to fluoroquinolones. However, the addition of amikacin led to a more than three-fold decrease in the risk of resistance. In our setting, empirical treatment with meropenem is adequate in enterobacterial infections, but poses difficulties when infection due to P. aeruginosa is suspected, in which case a combination of meropenem and amikacin has been shown to have a higher microbiological success rate.
Subject(s)
Amikacin/pharmacology , Anti-Bacterial Agents/pharmacology , Ciprofloxacin/pharmacology , Drug Resistance, Bacterial , Enterobacteriaceae/drug effects , Pseudomonas aeruginosa/drug effects , Thienamycins/pharmacology , Amikacin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Ciprofloxacin/therapeutic use , Drug Therapy, Combination/methods , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/microbiology , Humans , Meropenem , Pseudomonas Infections/drug therapy , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/isolation & purification , Retrospective Studies , Spain , Thienamycins/therapeutic useABSTRACT
La dermatitis perianal estreptocócica es una infección cutánea superficial del área perianal, descrita casi exclusivamente en niños, causada por el estreptococo betahemolítico del grupo A. Los síntomas incluyen prurito anal y dolor rectal, estreñimiento secundario y deposiciones con hebras de sangre. Existe a menudo una erupción perianal bien delimitada y brillante. La enfermedad resulta con frecuencia infradiagnosticada, y en ocasiones se trata inadecuadamente. Se exponen los casos de 2 niños, de 2 y 4 años, con la forma típica de presentación de la enfermedad
Perianal streptococcal dermatitis is a superficial skin infection of the perianal region, almost exclusively reported in children, that is caused by group A beta-hemolytic streptococci. Symptoms include perianal itching and rectal pain, secondary constipation and blood-streaked stools. There is usually a well demarcated, bright red perianal rash. The disease is often misdiagnosed and is sometimes treated inappropriately. We report the cases of a 4-year-old and a 2-year-old patient who presented the typical manifestations of the disease
Subject(s)
Male , Child, Preschool , Humans , Dermatitis/microbiology , Anus Diseases/diagnosis , Streptococcal Infections/diagnosis , Streptococcus pyogenes/pathogenicity , Diagnosis, Differential , Amoxicillin/therapeutic use , Mupirocin/therapeutic useSubject(s)
Rickettsia Infections/diagnosis , Rickettsia/isolation & purification , Animals , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Clarithromycin/therapeutic use , Female , Humans , Insect Bites and Stings , Rickettsia Infections/blood , Rickettsia Infections/drug therapy , Tick-Borne Diseases/blood , Tick-Borne Diseases/diagnosis , Tick-Borne Diseases/drug therapy , Ticks , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Animals , Female , Child, Preschool , Humans , Rickettsia/isolation & purification , Rickettsiaceae Infections/diagnosis , Anti-Bacterial Agents/therapeutic use , Clarithromycin/therapeutic use , Insect Bites and Stings , Rickettsiaceae Infections/drug therapy , Rickettsiaceae Infections/blood , Tick-Borne Diseases/blood , Tick-Borne Diseases/diagnosis , Tick-Borne Diseases/drug therapy , Treatment Outcome , TicksABSTRACT
La tinea capitis es una infección del cuero cabelludo causada por dermatófitos, que afecta principalmente a niños prepúberes. El querion de Celso es una forma inflamatoria de la tinea capitis, debida, en la mayoría de las ocasiones, a la infección por especies zoofílicas. Se expone el caso de un varón de 5 años que presentaba una lesión inflamatoria en el cuero cabelludo, y otra lesión no sobreelevada en el hombro. El estudio microbiológico determinó Trichophyton mentagrophytes. Tras recibir tratamiento oral con griseofulvina durante 10 semanas, las lesiones curaron, dejando un área de alopecia residual en el cuero cabelludo. La tinea capitis debe considerarse en todo niño con alopecia y/o descamación en el cuero cabelludo, ya que la infección es relativamente común y las manifestaciones son variables
Tinea capitis is a dermatophyte infection of the scalp-that mainlyaffects prepubertal children. Kerion Celsi is an inflammatory form of tinea capitis that, in the majority of cases, is produced by infection by zoophilic dermatophyte species. We report the case of a 5-year-old boy who presented an inflammatory lesion on his scalp and another flat lesion on his left shoulder. The microbiological study enabled the identification of Trichophyton mentagrophytes. After 10 weeks of oral griseofulvin therapy, the lesions were cured, leaving an alopecic patch on the scalp. Tinea capitis should be considered in every child with alopecia and/or scaling of the scalp because it is a relatively common infection and the clinical manifestations vary
Subject(s)
Male , Child, Preschool , Humans , Trichophyton/pathogenicity , Tinea Capitis/diagnosis , Trichophyton/isolation & purification , Tinea Capitis/drug therapy , Griseofulvin/therapeutic use , Dermatomycoses/drug therapyABSTRACT
Tularemia is a zoonosis caused by Francisella tularensis; it mainly affects wild animals and only occasionally affects human beings. Uncontrolled trade involving "exotic" animals could become a new route of acquisition. We report the case of a 3-year-old boy who contracted the disease through a bite from a prairie dog. Outbreaks of tularemia have recently been described in some of these animals captured in Texas (USA) and subsequently sold to other countries. Infection due to Yersinia pestis has also been described in humans through contact with prairie dogs with the disease. Streptomycin and gentamicin are currently the drugs of choice against tularemia infection.
Subject(s)
Francisella tularensis , Sciuridae/microbiology , Tularemia/transmission , Animals , Bites and Stings , Child, Preschool , Humans , MaleABSTRACT
La tularemia es una zoonosis causada por Francisella tularensis, que afecta principalmente a animales silvestres, y de forma casual al ser humano. La comercialización incontrolada de animales de origen "exótico" puede suponer una nueva vía de adquisición. Presentamos el caso de un varón de 3 años que presentó la enfermedad tras la mordedura de un perro de la pradera. Recientemente se han descrito brotes de tularemia en estos animales capturados en Texas (EE.UU.), y distribuidos comercialmente en varios países. También se ha descrito la infección en humanos por Yersinia pestis tras el contacto con perros de la pradera enfermos. La estreptomicina y la gentamicina son actualmente los fármacos de elección frente a las infecciones por tularemia (AU)
