Inusual complicación en la edad pediátrica: encefalopatía de Wernicke asociada a nutrición parenteral deficiente en tiamina / Unusual complication in a paediatric patient: Wernicke encephalopathy associated with thiamine-deficient parenteral nutrition

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Recurrent infective endocarditis due to Aggregatibacter aphrophilus and Staphylococcus lugdunensis.

Uncommon microorganisms are increasingly being recognized as causative agents of paediatric infectious endocarditis (IE). We report a 4-year old girl with congenital heart disease, who suffered from 2 IE episodes secondary to Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus) and Staphylococcus lugdunensis, both rarely reported pathogens in this age group. The patient was initially successfully treated with prolonged intravenous antibiotic courses, however removal of the Contegra valved conduit during the second episode was required due to recurrence of fever and development of pulmonary embolism despite completion of antibiotic therapy. A. aphrohilus is a member of the fastidious gram negative microorganisms of the HACEK group (Haemophilus spp., Aggregatibacter spp, Cardiobaterium hominis, Eikenella corrodens and Kingella kingae), that colonize the oropharynx and are a recognised cause of IE. Prognosis of children with IE due to HACEK group members varies, half of them suffering from complications and mortality rates of 10-12.5%. Although S. lugdunensis belongs to coagulase negative staphylococci (CONS), it behaves more like S. aureus species rather than CONS. This microorganism is a well-described cause of endocarditis in adult patients, associated with high requirements of surgical procedures and mortality (42-78%). In conclusion, paediatric IE can be caused by uncommon microorganisms associated with severe complications and potential fatality. The isolation of S. lugdunensis or A. aphrophilus in febrile patients should be considered clinically relevant and cardiac involvement must be ruled out. Those patients with proved IE will require prolonged intravenous antibiotic courses and in complicated cases surgical intervention.

Sepsis vertical por Gemella morbillorum / Vertical sepsis due to Gemella morbillrum

Introducción. La sepsis vertical neonatal es un proceso grave, con alta morbi-mortalidad, siendo importante la identificación del germen par aun correcto tratamiento. Caso clínico. Neonato que ingresa por bajo peso para edad gestacional. En los antecedentes obstétricos destacan amniorrexis mayor de 18 horas, oligoamnios y parto mediante cesárea. Durante las primeras 24 horas presenta repetidas hipoglucemias mala perfusión periférica y febrícula junto con leucopenia y trombopenia. Se instaura tratamiento empírico con ampicilina y gentamicina. El cultivo y citoquímica de LCR resultaron negativos. Tras aislar en el hemocultivo Gemella morbillorum, se decide cambiar la pauta antibiótica a vancomicina, manteniéndose durante 14 días. A la semana de vida y como secuela postinfeciosa, la paciente manifiesta leve ictericia mucocutánea secundaria a colestasis, con alteración de las enzimas hepáticas. Al alta presenta valores en descenso de la bilirrubina directa y hemocultivo negativo. Conclusiones. 1) Es importante el diagnóstico etiológico en la sepsis vertical, considerando la aparición de gérmenes poco habituales. 2) Gemella morbillorum no ha sido descrita hasta el momento como causa de sepsis vertical. 3) Ante la sospecha de sepsis vertical, se debe inicial tratamiento precoz parenteral previa extracción dehemocultivo (AU)

Introduction. The neonatal sepsis of vertical transmission is a serious process, with high morbi-mortality, being important the identification of the germ for a correct treatment. Clinical case. Newborn that enters for low weight for gestation age. In the obstetric precedents, stand out amniorhexis major of 18 hours, oligoamnios and childbirth by caesarean. During the first 24 hours she present repeated hypoglcemias, bad peripheral perfusion and febricula together with leucopoenia and thrombopenia. Empirical treatment is established with ampicillin and gentamicin. The culture and cytochemistry of cepahloraquideum liquid turned out to be negative. After isolating in the hemocultive Gemella morbillorum it is decided to change the antibiotic guideline to vancomycin being kept fo 14 days. To the week of life and as postinfectious sequel, the patient manifest slight mucocutaneus jaundice secondary to cholestasis, with alternation of the hepatic enzymes. To the discharge she presents values in decrease of the direct bilirubim and negative hemocultive. Conclusions. 1) It is important the etiologic diagnosis in the vertical sepsis, considering the appearance of slightly habitual germens. 2) Gemella morbillorum has not been described up to the moment as reason of vertical sepsis. 3)In view of the suspicion of vertical sepsis must begin early parenteral treatment after extraction of hemocultive (AU)

Trombosis neonatal de senos venosos cerebrales / Neonatal thrombosis of the cerebral venous sinuses

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