[Peritonsillar and retropharyngeal abscesses: study of 13 years]. / Abscesos periamigdalino y retrofaríngeo: estudio de 13 años.

INTRODUCTION: Peritonsillar and retropharyngeal abscesses are the most common deep head and neck infections. We present a series of patients with these infections. MATERIAL AND METHODS: We performed a retrospective study of peritonsillar and retropharyngeal abscesses in children admitted to the Infectious Diseases Unit of our hospital between January 1991 and January 2004. Diagnosis was based mainly on clinical and laboratory findings. RESULTS: We studied 54 patients, 10 with retropharyngeal abscess and 44 with peritonsillar abscess. The mean age was 6.7 and 7.5 years respectively. There was a slight predominance of boys (1.45:1). The number of cases diagnosed increased from 1997, with a maximum (nine cases) in 2002. Twenty-nine children had received previous antibiotic therapy. The main symptoms and signs were: fever, odynophagia, cervical lymphadenitis, and asymmetric tonsillar hypertrophy. All children received intravenous antibiotic therapy. Puncture-aspiration was carried out in seven patients. Eleven children underwent tonsillectomy, two with retropharyngeal abscess and nine with peritonsillar abscess. Of these 11 patients, five had had several episodes of tonsillitis and three had previously had a peritonsillar abscess. Three children who developed an abscess had previously undergone tonsillectomy. In most patients, outcome was favorable. CONCLUSIONS: In the last few years the frequency of peritonsillar and retropharyngeal abscesses has increased in the pediatric population. Most of the children have a good response to conservative treatment. The main risk factor for abscess recurrence is a previous history of repeated tonsillitis. Consequently, these patients are candidates for tonsillectomy.

[False negative diagnosis of HIV-1]. / Falso negativo en el diagnóstico de VIH-1.

We report a case of a false negative diagnosis of HIV-1 infection in an African girl. Two HIV-1 DNA polymerase chain reaction (PCR) tests were negative at the second and fourth months of life. Because anti-HIV antibodies persisted when the patient was 18 months old, the HIV-1 RNA PCR test was performed with a positive result, confirming HIV-1 non-B subtype, recombinant A-G. The prevalence of non-B HIV-1 subtypes are increasing in Spain, which could be related to the phenomenon of immigration. Approximately one-third of HIV-infected foreigners have non-B subtypes and the percentage increases to 70 % of the African population in Spain. In non-B HIV-1 subtypes, false negative results and inconsistencies between viral load and CD4 count are more frequent. These subtypes also show a higher rate of resistance to protease inhibitors, which can have therapeutic implications.

[Disseminated histoplasmosis]. / Histoplasmosis diseminada.

We describe two cases of disseminated histoplasmosis, which are of interest due to their severity and the infrequency of this infection in our environment. Both children were immunocompromised immigrants from Latin America who developed prolonged fever, weight loss, hepatosplenomegaly and pancytopenia. One patient had respiratory symptoms with associated alterations on x-ray, while no radiological alterations were found in the other patient. Despite administration of broad-spectrum antibiotics and extraction of samples for microbiological analysis, both patients had a rapid and fatal outcome and the diagnosis was made post mortem. Because of its severity, disseminated histoplasmosis should be considered in the differential diagnosis of fever, hepatosplenomegaly and pancytopenia, with or without alterations on chest x-ray, in immunosuppressed children who were born in or have visited endemic regions. In these patients, therapy should be started immediately without waiting for the results of diagnostic tests.