[Incontinentia pigmenti. Initial and long-term characteristics]. / Incontinentia pigmenti. Manifestaciones iniciales y a largo plazo.

We report two cases of incontinentia pigmenti diagnosed in the neonatal period. Both patients presented with disseminated vesicular lesions. Neither patient had extra-dermatological symptoms at diagnosis. The definitive diagnosis was established by cutaneous biopsy. In the initial phase of the disease, the lesions can be similar to those of herpes simplex infection, but characteristic distribution and clinical course allow the differential diagnosis to be established. This disease should be included in the differential diagnosis of vesicular rashes because early detection allows better management of the possible associated systemic manifestations.

[Parapneumonic pleural effusion: an 11-year review]. / Derrame pleural paraneumónico: revisión de 11 años.

INTRODUCTION: In the last few years, the incidence of parapneumonic effusions in children with community-acquired pneumonia seems to have increased. The aim of this study was to determine the clinical features and incidence of parapneumonic effusions throughout an 11-year period. MATERIAL AND METHODS: We retrospectively reviewed the medical records of patients aged < 15 years old with parapneumonic effusions from 1993 to 2003. Annual incidence rates were calculated per 100,000 children < 15 years old from Health Area 5 of Madrid and per 100 children hospitalized in the Infectious Diseases Department of our hospital. The linear association test was used to compare the incidence rates over the previous 11 years. RESULTS: There were 130 patients with parapneumonic pleural effusions. The mean age was 4.7 years. Forty-one percent received antibiotics before diagnosis. The causative organisms were identified in 42 patients (32.3%). The most effective diagnostic method was pleural-fluid culture (18/58, 31%). The most common organisms were Streptococcus pneumoniae (18), Mycoplasma pneumoniae (8), Staphylococcus aureus (4), Streptococcus pyogenes (3), Haemophilus influenzae (3) and Mycobacterium tuberculosis (2). Thirty-two percent of the patients required pleural drainage and 16% underwent video-assisted thoracoscopic surgery. Of 12 S. pneumoniae antibiograms available, 91.7% showed full susceptibility to penicillin and 75% were susceptible to erythromycin. The annual incidence of parapneumonic effusions rose from 18.1 in 1993 to 42.9 in 2003 (p < 0.001) per 100,000 children and from 0.76 in 1993 to 3.3 in 2003 (p < 0.001) per 100 children hospitalized in our unit. CONCLUSION: The incidence of parapneumonic effusions in children with community-acquired pneumonia showed a statistically significant increase between 1993 and 2003. The most common causal organism was S. pneumoniae, with a low rate of penicillin resistance.

[Tuberculous meningitis: a review of 27 years]. / Meningitis tuberculosa: revisión de 27 años.

OBJECTIVES: To analyze the features and outcome of children with tuberculous meningitis (TM) in a tertiary hospital in Madrid, with special emphasis on the possible influence of HIV infection, immigration and withdrawal of the Bacille-Calmette-Guérin (BCG) vaccine in Madrid in 1987. METHODS: We reviewed the medical records of patients with TM diagnosed over a 27-year period (1977-2003). TM was diagnosed on the basis of compatible cytochemical findings in cerebrospinal fluid (CSF), plus a) isolation of Mycobacterium tuberculosis in CSF or gastric fluid; b) positive Mantoux test, or c) previous contact with active tuberculosis. RESULTS: Twenty-eight cases of TM were diagnosed. There were 24 cases (85 %) in the first 14 years versus only four cases (15 %) in the last 13 years. None of the children was co-infected with HIV. The median age was 3 years and 4 months. Only two of these had received the BCG vaccine. The source of infection was identified in 64 %. At admission, 57 % had nuchal rigidity, 46 % had neurological focality, and 54 % had an abnormal chest roentgenogram. The Mantoux purified protein derivative (PPD) test was positive in 89 % at diagnosis. Zhiel-Nielsen smear in CSF was positive in 3.5 %, and a positive culture from CSF was obtained in 32 %. Computed tomography scan was performed in 22 children and showed hydrocephalus in 90 %. All patients were treated with four drugs, with no significant adverse events. Corticoids (89 %), ventricular-peritoneal shunt (43 %) and antiepileptic drugs (39 %) were widely used as complementary treatments. Mortality was 12 %. Half of the patients had sequels, which were mostly permanent. The most frequent and severe complication was neurodevelopmental delay (21 %). Severe sequels occurred in children with more advanced stages of illness. CONCLUSIONS: The frequency of TM has decreased in the last 15 years, despite the emergence of HIV and immigration from countries where tuberculosis is endemic. These data are in agreement with the general reduction of the incidence of TM in our environment. Withdrawal of the BCG vaccine in Madrid in 1987 did not increase cases of TM in our hospital; on the contrary, these have decreased. A considerable percentage of children with advanced stages of TM show severe sequels.