Streptococcus equi subspecies zooepidemicus Meningitis, Septicemia, and Brain Infarcts in a Costa Rican Infant.

Streptococcus equi, an equine commensal bacterium, is a rare etiology of septicemia and meningoencephalitis in humans and is extremely infrequent in children. Scarce literature has been published about its clinical presentation, treatment and outcomes in infants. Here, we describe a case of S. equi subsp. zooepidemicus septicemia and meningoencephalitis in a five-month-old Costa Rican infant that was confirmed by peripheral blood and cerebrospinal fluid (CSF) cultures in a regional hospital of the Pacific coast of Costa Rica who developed multiple ischemic cerebral infarcts secondary to infectious vasculitis, a subdural empyema and serious neurological sequelae. We also reviewed the literature on S. equi meningitis in infants under one year of age. This is the first reported case in our country, the fourth reported in infants under one year of age and the second describing multiple cerebral infarcts and subdural empyema in an infant.

Epidemiology, Etiology and Clinical Aspects of Childhood Acute Encephalitis in a Tertiary Pediatric Hospital in Costa Rica.

BACKGROUND: Limited data are available on childhood encephalitis in Latin America. Our study aimed to increase insight on clinical presentation, etiology and outcome of children with acute encephalitis in Costa Rica. METHODS: We conducted a prospective, observational study during an 8-month period at the Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" in Costa Rica. Case definition was according to "International Encephalitis Consortium" in children <13 years. We analyzed demographic characteristics, clinical symptoms, neurologic imaging, etiology, treatment and mortality. RESULTS: Forty patients were identified. Mean age was 5 years and 57.5% were male. Most frequently neurologic symptoms were altered mental status (100.0%), headache (57.5%) and seizures (52.5%). Etiology was determined in 52.5% of cases. Probable or confirmed viral etiology was identified in 6 cases (15.0%) and bacterial etiology in also 6 cases (15.0%). A possible etiology was identified in 7 cases (17.5%). Autoimmune encephalitis was diagnosed in 2 patients (5.0%). Enterovirus and Streptococcus pneumoniae were the most common confirmed agents. No cases of herpes simplex virus were found. Etiology of 19 cases (47.5%) remained unknown. Sequelae were reported in 45.0% of patients. Mortality rate was 15.0% (6 cases), 3 caused by virus (adenovirus, human herpesvirus 6, enterovirus), 2 by bacteria (S. pneumoniae, Haemophilus influenzae type b) and 1 of unknown etiology. Diffuse cerebral edema was the most important mortality predictor (P < 0.001). CONCLUSIONS: Acute encephalitis in our study was associated with significant morbidity and mortality. Early and aggressive antiviral, antibiotic and anticerebral edema treatment is necessary when acute encephalitis is suspected.

Culture-Proven Disseminated and Meningeal Histoplasmosis Presenting as Septic Shock and Autoimmune Hemolytic Anemia in an Infant.

Disseminated histoplasmosis is the most common clinical presentation of histoplasmosis in human immunodeficiency virus (HIV) negative infants from Costa Rica and Latin America. Initial presentation as septic shock and autoimmune hemolytic anemia is uncommon. Even more, detection of Histoplasma capsulatum by culture in peripheral blood and cerebrospinal fluid (CSF) is extremely rare. We describe the case of a three-month-old Costa Rican immunocompetent infant who presented with shock and hemolytic anemia secondary to disseminated histoplasmosis that was confirmed by bone marrow aspirate and positive peripheral blood and CSF cultures.

Human Herpesvirus 6 Associated Encephalitis with Fulminant Brain Edema in a Previously Healthy Child.

Human herpesvirus 6 (HHV-6) is an important cause of roseola and febrile seizures in children. However, it is also a rare cause of encephalitis, most common in immunosuppressed children. We describe a case of HHV-6 encephalitis with fulminant brain edema in a previously healthy child. This severe HHV-6 clinical case with lethal brain edema is the second reported in the literature in a previously healthy child.

El trabajo nocturno y sus implicaciones en la salud de médicos, enfermeras y oficiales de seguridad de los hospitales de la Caja Costaricense del Seguro Social en Costa Rica / Night work and its implications on the health of doctors, nurses and security officers hospitals Costaricense Social Security Fund in Costa Rica

En el presente trabajo se analiza la jornada laboral nocturna y las implicaciones que ésta tiene en la salud de los trabajadores de una institución que por sus características requiere atención las 24 horas, los siete días a la semana, como lo es la Caja Costarricense del Seguro Social. Para ello se escogió una muestra de médicos, enfermeras y oficiales de seguridad y se les interrogó acerca de las enfermedades que padecían, para tratar de establecer su relación con la jornada nocturna...

This paper analyzes the night work and its implications on the health of workers in an institution which by its nature requires 24-hour care, seven days a week, as is La Caja Costarricense de Seguro Social. For this, it was chosen a sample of doctors, nurses and security officers and they were questioned about illnesses they had, to try to establish its relationship with the night shift...

Perforación cardiaca asociada a cirugía de reemplazo valvular mitral / Cardiac perforation related to mitral valve relacement surgery

Se presenta el caso de una mujer de 55 años de edad, con antecedentes de epilepsia, que ingresa para cirugía electiva de reemplazo valvular. Se realizó reemplazo de la válvula mitral con una prótesis biológica, el cual se complicó con una laceración del ventrículo izquierdo, motivo por el que la paciente falleció en el período post-operatorio. Se presentan los hallazgos de la autopsia.

A 55 years old female patient with a history of epilepsy, was admitted for elective cardiac surgery. Mitral valve replacementwas performed with bioprosthesis, The surgery was complicated by a left ventricular laceration that ultimately resulted inthe death of the patient during the postoperative period. The autopsy findings are presented.