Revisión de los casos de paludismo de los últimos 12 años en el Hospital Universitario de Getafe / Malaria in the South of Madrid: A clinical and epidemiological review

Introducción: La incidencia del paludismo está creciendo en España y es potencialmente grave en niños. Hay poca información sobre el paludismo infantil en España. El objetivo de este estudio es evaluar las características clínicas y epidemiológicas, así como el tratamiento efectuado en los casos de paludismo en el Hospital Universitario de Getafe. Pacientes y métodos: Estudio descriptivo y retrospectivo de los casos diagnosticados en el hospital desde 1995 hasta 2007. Se analizaron datos sobre epidemiología, clínica, métodos diagnósticos y tratamiento en 2 períodos comparativos de 6 años: antes y después de enero de 2001. Resultados: Se confirmaron 18 casos de paludismo, con predominio de mujeres (2:1). El rango de edad osciló entre 13 meses y 13 años, con una mediana de 60 meses. Todos habían realizado un viaje reciente a un país endémico. Se detectó un aumento en la incidencia (p<0,01) a partir del año 2001. La clínica más frecuente fue fiebre y síntomas gastrointestinales, con hepatomegalia o esplenomegalia en el 75%. La trombopenia y la anemia fueron hallazgos frecuentes. Se realizó un examen microscópico (frotis fino) en el 100% de los casos. La identificación de la especie de Plasmodium se obtuvo mediante PCR (polymerase chain reaction ‘reacción en cadena de la polimerasa’) en 16 casos, y se detectó Plasmodium falciparum en un 89% de éstos. Se trataron con sulfato de quinina y clindamicina un 72% de los casos. No hubo ningún caso de malaria complicada o fallecimiento. Conclusiones: La incidencia del paludismo importado está aumentando en el área sur de Madrid, y el agente causal mayoritario es el P. falciparum. La visualización del protozoo en el examen microscópico y la detección de su antígeno en sangre son buenos métodos de diagnóstico, pero es fundamental realizar una PCR al ingreso para conocer la especie de Plasmodium y para identificar posibles parasitaciones mixtas. Dada su potencial gravedad en la infancia, se debe tener un alto índice de sospecha para iniciar de forma precoz un adecuado tratamiento, lo que condiciona un mejor pronóstico (AU)

Introduction: Malaria has increased in Spain, and is potentially severe in children. Information on pediatric malaria in Spain is scarce. The aim is to evaluate the clinical, therapeutic and epidemiological characteristics of children diagnosed with malaria in our hospital. Patients and methods: A retrospective descriptive study was performed on all pediatric cases of malaria diagnosed in Getafe University Hospital, from January 1995 to November 2006. Epidemiological and clinical features, as well as diagnostic methods, treatments and outcome were studied. An analysis of two comparative periods (before and after January 2000) was carried out. Results: Eighteen cases of confirmed malaria were identified, twelve girls and six boys. The age range was from 13 months to 13 years with a median age of 60 months. All patients had recently travelled to or from endemic countries. Despite having a stable number of admissions to hospital over time, all but two patients were diagnosed in the second period (P<0.01).Fever and gastrointestinal symptoms were the most common symptoms, with liver or spleen enlargement in 75%. Thrombocytopenia and anemia were common. No cases of complicated malaria or death occurred. Plasmodium identification by microscopic examination was used in all cases. Identification of Plasmodium species with PCR was carried out in 16 children. P. falciparum was found in 89% of these cases. Quinine-sulphate and clindamycin were used in 72%. Conclusions: The incidence of pediatric malaria is increasing in the southern area of Madrid, with P. falciparum as the most frequently identified species. Microscopic visualization or identification of its antigen are gold-standard diagnostic methods, however, identification with PCR is essential upon admission to determine the species and discard possible multiple infestations. Pediatricians must learn to suspect this potentially severe disease, in order to establish an early treatment that may improve the prognosis (AU)

[Malaria in the South of Madrid: a clinical and epidemiological review]. / Revisión de los casos de paludismo de los últimos 12 años en el Hospital Universitario de Getafe.

INTRODUCTION: Malaria has increased in Spain, and is potentially severe in children. Information on pediatric malaria in Spain is scarce. The aim is to evaluate the clinical, therapeutic and epidemiological characteristics of children diagnosed with malaria in our hospital. PATIENTS AND METHODS: A retrospective descriptive study was performed on all pediatric cases of malaria diagnosed in Getafe University Hospital, from January 1995 to November 2006. Epidemiological and clinical features, as well as diagnostic methods, treatments and outcome were studied. An analysis of two comparative periods (before and after January 2000) was carried out. RESULTS: Eighteen cases of confirmed malaria were identified, twelve girls and six boys. The age range was from 13 months to 13 years with a median age of 60 months. All patients had recently travelled to or from endemic countries. Despite having a stable number of admissions to hospital over time, all but two patients were diagnosed in the second period (P<0.01). Fever and gastrointestinal symptoms were the most common symptoms, with liver or spleen enlargement in 75%. Thrombocytopenia and anemia were common. No cases of complicated malaria or death occurred. Plasmodium identification by microscopic examination was used in all cases. Identification of Plasmodium species with PCR was carried out in 16 children. P. falciparum was found in 89% of these cases. Quinine-sulphate and clindamycin were used in 72%. CONCLUSIONS: The incidence of pediatric malaria is increasing in the southern area of Madrid, with P. falciparum as the most frequently identified species. Microscopic visualization or identification of its antigen are gold-standard diagnostic methods, however, identification with PCR is essential upon admission to determine the species and discard possible multiple infestations. Pediatricians must learn to suspect this potentially severe disease, in order to establish an early treatment that may improve the prognosis.

La comunicación interauricular: causa subyacente poco común de neumonía recurrente. Caso clínico y revisión de la bibliografía médica / Atrial septal defect: a rare underlying cause of recurrent pneumonia. Case report and literature review

Presentamos el caso de una lactante con infecciones respiratorias de repetición de las vías bajas y neumonías recurrentes (NR) en los 8 primeros meses de vida. Tras el estudio protocolizado inicial, no se encuentra una causa subyacente. Tras aparecer en una de las radiografías una dilatación de la aurícula derecha y el tronco pulmonar, se realiza una valoración cardiológica, incluida una eco-Doppler color, donde se aprecia una comunicación interauricular (CIA) grande, tipo ostium secundum, con repercusión hemodinámica. Las CIA pueden predisponer por diversos motivos (hiperaflujo, compresión extrínseca, aumento de secreciones, etc.) a la aparición de NR, aunque en algunas series extensas y en los protocolos diagnósticos se descartan a menudo las cardiopatías congénitas como causas subyacentes de NR

We report the case of a female infant with recurrent lower tract respiratory infections and recurrent pneumonia (RP) during her first eight months of life. Despite an exhaustive diagnostic work-up, no underlying cause was found. When a chest roentgenogram showed a dilated right atrium and pulmonary trunk, Doppler echocardiography was performed, revealing an ostium secundum atrial septal defect (ASD), with severe leftto- right shunt. There are several mechanisms by which ASD can cause RP: hyperperfusion, extrinsic compression, increased secretions, etc., although in some large series and in most diagnostic protocols, congenital heart diseases are often ruled out as the underlying cause of RP

Tumor estromal gástrico de estirpe neural: ¿neoplasia aislada o primera manifestación del complejo de Carney? / Gastrointestinal autonomic nerve tumor: isolated neoplasm or first manifestation of Carney’s complex?

Los tumores gastrointestinales de naturaleza estromal son especialmente infrecuentes en niños. Presentan de forma genérica 2 vías de diferenciación: hacia la estirpe muscular (variante mioide) o como célula neural. Carney publicó en 1978 el primer caso de un tumor de este tipo asociado a neoplasia pulmonar (condroma) y neural (paraganglioma extradrenal). Los 3 tumores presentan un origen ectodérmico común, lo que daría origen a la aparición sinérgica o secuencial de éstos a lo largo de la vida del individuo, y obligaría a realizar un estudio completo ante la aparición de cualquiera de ellos. Comunicamos el caso de una niña de 11 años que presentó un tumor estromal gástrico, cuya única manifestación clínica fue una anemia sintomática

Gastrointestinal stromal tumors (GIST) are highly uncommon in childhood. There are two specific differentiation patterns: toward a smooth muscle cell lineage (myoid variant) or toward a neural lineage (gastrointestinal autonomic nerve tumors [GANT]). In 1978, Carney reported the first case of this type of tumor associated with two other neoplasms, pulmonary chondroma and extraadrenal paraganglioma. All three tumors seem to have a common ectodermal origin, and their synergic or sequential presentation throughout the individual’s life may be observed. Thus, the detection of any of these three tumors should lead to a complete study of the patient. We report the case of an eleven-year-old girl with a GIST in whom the only clinical sign at presentation was symptomatic anemia

Cojera súbita en un lactante afebril / Sudden lameness in an afebrile infant

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Fiebre periódica, estomatitis aftosa, faringitis y adenitis cervical: a propósito de tres casos / Periodic fever, apththous stomatitis, pharyngitis and cervical adenitis: report of three cases

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[Vulvovaginitis in premenarche girls. A preliminary study]. / Vulvovaginitis en niñas premenárquicas. En atención primaria.

The study population consisted of 832 premenarcheal girls. Vaginal cultures are performed on 40 premenarcheal girls suffering from vulvovaginitis. All were less than 7 years old. This patients were seen in primary cares. In 23 cases (57.5%) E. coli was isolated, Enterococcus (30%), mixed flora (10%) and G. vaginalis (2.5%). Common clinical characteristics were pruritus (97.5%), vaginal discharge (67.5%). Dysuria and abdominal pain constituted accompanying symptoms. Only in one case masturbation was observed.