[Clinical and radiological characteristics of primary pulmonary tuberculosis in adolescents]. / Características clínicas y radiológicas de la tuberculosis pulmonar primaria en el adolescente.

OBJECTIVE: The aim of this study was to investigate the incidence, clinical and radiological particularities of primary pulmonary tuberculosis in children between 10 to 16 year-old in our community. PATIENTS AND METHODS: The medical records and chest X-ray of all children under 16 years old diagnosed of primary pulmonary tuberculosis between 1982 to 1996, and a similar characteristics control group diagnosed of bacterial pneumonia were reviewed. The difference between teenager with tuberculosis and pneumonia and between patients with tuberculosis under 10 years and order were analysed. RESULTS: Between January 1982 and December 1996, 83 children with age range from 10 to 16 years were diagnosed of primary pulmonary tuberculosis. The incidence has been 15,5 cases/100000 h < 16 years/year. The primary pulmonary tuberculosis whole incidence in children under 16 year-old has been 17 cases/100000 h/year (182 cases). The adolescents fits to 40.5% of the hold group. 51.2% were girls and 49.8% were boys. Middle age has been 14.2+/-0.18 years with a progressive increased with the age. Anorexia (38% vs. 16.6%) and asthenia (38% vs 19.4%) have been more frequents in teenagers with tuberculosis. Cough has been the most frequent symptom in both groups (61.9% and 77.7%), and respiratory distress has been the most characteristic of tuberculosis (17.8% vs 2.7%). Thoracic pain was more frequent in patients with tuberculosis 10 years or older (57.8% and 7.8%). Laboratory values are not specific. Pleural effusion (46.4% vs 22.2%) and mediastinal lymphadenophaty (60.1% vs. 40.4%) were the most characteristic X-ray finding in teenagers and children under 10 years with primary pulmonary tuberculosis respectively. CONCLUSIONS: Primary pulmonary tuberculosis has a high incidence in the teenager population in our community with a progressive increased with the age. The clinical and laboratory values are unspecific in this age group. The most characteristic X-ray finding is pleural effusion (46.4% of the patients).

Características clínicas y radiológicas de la tuberculosis pulmonar primaria en el adolescente / Clinical and radiological particularities of primary pulmonary tuberculosis in teenagers

Objetivo: Valorar la incidencia, características clínicas y radiológicas de los niños de 10-16 años diagnosticados de tuberculosis pulmonar primaria en nuestra comunidad. Pacientes y métodos: Estudio retrospectivo mediante revisión de historias clínicas y radiografías de los pacientes menores de 16 años diagnosticados de tuberculosis pulmonar primaria entre 1982 y 1996, junto con un grupo control de similares características con neumonitis bacteriana durante el mismo período. Se analizan las diferencias entre los pacientes adolescentes con tuberculosis y neumonía, así como entre los pacientes con tuberculosis menores de 10 años y mayores de dicha edad. Resultados Ochenta y tres niños de 10-16 años fueron diagnosticados de tuberculosis pulmonar primaria entre enero de 1982 y diciembre de 1996, lo que corresponde a una incidencia de 15,5 casos/100.000 habitantes entre 10 y 16 años/año. La incidencia global de tuberculosis pulmonar primaria en menores de 16 años es de 17 casos/100.000 habitantes/año (182 casos). Los adolescentes corresponden a un 40,5 por ciento del total. Un 51,2 por ciento fueron varones y un 49,8 por ciento mujeres. La edad media de la muestra fue de 14,2 ñ 0,18 años con un incremento progresivo de la incidencia con la edad. La anorexia (38 frente a 16,6 por ciento) y la astenia (38 frente a 19,4 por ciento) fueron más frecuentes en los adolescentes con tuberculosis. La tos fue el síntoma más frecuente en ambos grupos (61,9 y 77,7 por ciento) y el distrés respiratorio el más característico de tuberculosis (17,8 frente a 2,7 por ciento). El dolor torácico fue significativamente más frecuente en los pacientes mayores con tuberculosis que en los menores de 10 años (57,8 y 7,8 por ciento). Los datos analíticos fueron inespecíficos. El patrón radiológico más frecuente en los adolescentes con tuberculosis fue el derrame pleural (46,4 y 22,2 por ciento). En los menores de 10 años la linfadenopatía mediastínica fue la alteración radiológica más frecuente (60,1 por ciento). Conclusiones La tuberculosis pulmonar primaria tiene una elevada incidencia en los adolescentes de nuestra comunidad, con un incremento progresivo de la incidencia con la edad. Tanto los síntomas clínicos como los datos analíticos son inespecíficos a esta edad, lo que concuerda con el resto de los pacientes con tuberculosis. El patrón radiológico más característico es el derrame pleural detectado hasta en un 46,4 por ciento de los pacientes (AU)

[Neonatal sepsis caused by Streptococcus agalactiae. What should be done?]. / Sepsis neonatal por Streptococcus agalactiae. Qué hacer?

OBJECTIVE: Within the common pathogenic flora responsible for neonatal sepsis, streptococci group B (SGB) is the most frequently found etiological agent. The fact that it is a frequent colonizer of the female perigenital area has resulted in a whole host of detection and eradication strategies via preventative measures applied to the pregnant woman to eliminate vertical transmission to the newborn. PATIENTS AND METHODS: We present a revision of SGB sepsis and our protocol based on the intrapartum treatment of those pregnant women with risk factors and the study in the newborn at risk of infection with early detection of particles of Latex in urine for SGB (Slidex Strepto B bioMerieux), as well as the customary analytical and bacteriological tests. We have also revised the different strategies in medical scientific publications and several neonatal units for the management of this infection and compare this with our protocol. RESULTS: During the period 1986-1996 the incidence of SGB sepsis was 0.9/1,000 (19 cases), with an incidence of neonatal sepsis of 4.08/1,000. The incidence of sepsis caused by Streptococcus agalactiae in our environment is low, although it has increased from 15.9% to 28% comparing the first five years with the following six years, with a fatality rate of 10.5%. We believe that the most effective strategy for this problem is intrapartum identification and treatment of the pregnant woman at risk and early diagnosis of the newborn resulting from this pregnancy. CONCLUSIONS: We based our strategy on two vias, intrapartum treatment of mothers included in the high risk infection group and in the neonatal unit by early routine detection of SGB in urine. We have obtained a low incidence rate, low mortality rate and avoid false negatives of carrier mothers.