Imaging of supra-thoracic tuberculosis.

Tuberculosis (TB) typically affects the lungs, but may involve many extra-pulmonary sites; with the latter especially prone in patients with human immunodeficiency virus infection. The clinical features of extra-pulmonary TB are often non-specific, mimicking many different disease entities. Application of the most appropriate imaging modality and knowing the imaging findings with clinical context awareness help initiation of further investigations, diagnosis and early treatment. This pictorial essay highlights the imaging spectrum of extra-pulmonary TB affecting the supra-thoracic region, i.e. brain, neck, and ear, nose and throat.

A retrospective study of magnetic resonance sialography imaging applied in the prognostic evaluation of chronic obstructive parotitis.

Background: Magnetic resonance sialography (MRS) can be used to clearly examine the main duct of the parotid and is widely applied in the diagnosis of chronic obstructive parotitis (COP). However, there are few studies on the classification, treatment options and prognosis of COP using MRS. Methods: Clinical and imaging data were retrospectively collected from 41 patients with COP between January 2010 and December 2020 at the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine. All patients underwent MRS and were treated with intraductal irrigation. The patients were divided into 2 groups according to the presence or absence of symptomatic relapse during the 6-month follow-up period. The imaging features of parotid MRS included three parts: gland volume, stenosis classification and dilatation classification. The location/length of dilatation, the widest diameter of the dilated duct, and the condition of the branch ducts were also recorded and compared between the groups. Results: A mean of 14.8±12.3 irrigations were performed. There were 15 patients with recurrence and 26 without recurrence. There was no significant difference in the parotid volume (P=0.460), stenosis grade (P=0.738) or maximum diameter of dilatation of the branch duct (P=0.723) between the recurrence and non-recurrence groups. Statistically significant differences were found in dilatation classification (P=0.009), length of dilatation (P=0.043), condition of the branch ducts (P=0.017) and dexamethasone use (P=0.031). Conclusions: MRS is an available diagnostic and grading modality for COP. The imaging features and classification of the parotid main duct in MRS could be helpful for treatment selection. Patients who accept irrigation could be less likely to experience recurrence with a low dilatation grade and no branch duct dilatation.

Fistula Salival: presentación atípica en parotiditis bacteriana, a propósito de un caso / Salival Fistula, atypical presentation of bacterial parotiditis, by the purpose of a case

Introducción: La fístula salival es la comunicaciónde la glándula salival o el conducto parotídeo hacia la piel,debido a una lesión traumática del parénquima o del conducto deexcreción; no suele ser una complicación frecuente en parotiditisaguda. El objetivo de este trabajo es destacar la presentaciónatípica de un caso de parotiditis bacteriana asociado a fistulasalival hacia el conducto auditivo externo y cavidad oral, y aparálisis facial periférica. Caso clínico: Paciente masculino de15 años de edad, quien consulta por otalgia y otorrea derechaasociado a aumento de volumen en región parotídea ipsilateralde 5 días de evolución. Al examen físico se evidencia, caraasimétrica con desviación de comisura labial hacia la izquierda ycierre palpebral completo sin esfuerzo, con aumento de volumende parótida derecha con signos de flogosis, otorrea purulentaderecha . solución de continuidad en tercio medio de pisode conducto auditivo externo. Ecosonograma de piel y partesblandas, reveló cambios inflamatorios en glándula parótida concolección de 112 cc., Los hallazgos tomográficos de oído medioy mastoides corroboraron hallazgos del ecosonograma. se realizódrenaje quirúrgico del absceso y se trató con Clindamicina600 mg vía endovenosa cada 6 horas y Penicilina Cristalina200 mg/kg/ peso cada 6 horas y su evolución fue satisfactoria.Conclusión:Los abscesos parotídeos pueden presentarse demanera atípica o en raras ocasiones con drenaje a través delconducto auditivo externo(AU)

Introduction: Salivary fistula is the communicationof the salivary glands or the parotid duct to the skin, due toa traumatic injury to the parenchyma or the excretion duct; Itis not usually a frequent complication in acute parotitis. the eobjective of this work is to highlight the atypical presentation of acase of bacterial parotitis associated with salivary fistula towardsthe external auditory canal and oral cavity, and peripheralfacial paralysis. Clinical case: A 15-year-old male patient, whoconsulted due to otalgia and right otorrhea associated with anincrease in volume in the ipsilateral parotid region of 5 days ofevolution. On physical examination, an asymmetrical face withdeviation of the lip corner to the leth and complete palpebralclosure without effort, with increased volume of the rightparotid gland with signs of phlogosis, right purulent otorrhea and continuity solution in the middle third of the external auditory canal are evident. Ultrasound of the skin and so the tissues revealed inflammatory changes in the parotid glands with a collection of 112 cc. yhe tomographic findings of the middle ear and mastoids corroborated the findings of the echosonogram; Surgical drainage of the abscess was performed and he was treated with clindamycin 600 mg intravenously every 6 hours and crystalline penicillin 200 mg/kg/weight every 6 hours, and his evolution was satisfactory. Conclusion: Parotid abscesses can present atypically or rarely with drainage through the external auditory canal(AU)

Análisis de la seroprevalencia frente a sarampión, rubeola y parotiditis en trabajadores sanitarios / Analysis of seroprevalence against measles, rubella and mumps in health workers of two health departments of the Valencian Community (Spain)

FUNDAMENTOS: El personal sanitario es un colectivo profesional expuesto a riesgos ocupacionales. El objetivo de este trabajo fue estimar la ausencia de seroprotección frente a sarampión, rubeola y parotiditis de los trabajadores sanitarios vinculados a dos Departamentos de Salud de la Comunidad Valenciana, considerando edad, sexo, categoría profesional, riesgo laboral y área de desempeño. MÉTODOS: Se realizó un estudio observacional transversal. Los datos fueron recogidos de informes de vigilancia de la salud, que incluían resultados serológicos de 2.674 trabajadores. Las variables sociodemográficas fueron: sexo; grupos de edad (18-34; 35-49; >50 años); clasificación del servicio (riesgo/no riesgo); categoría profesional; área de desempeño profesional (atención primaria/ atención hospitalaria). La variable dependiente fue la ausencia de inmunización frente a sarampión, rubeola y parotiditis identificada por ausencia de niveles serológicos. Para las enfermedades estudiadas se estimó la prevalencia de ausencia de seroprotección y se evaluó la asociación entre la no inmunización con el resto de variables. RESULTADOS: La prevalencia de no inmunización fue del 7,8%, 3,7% y 16,1% para sarampión, rubeola y parotiditis, respectivamente. El análisis mediante regresión logística mostró diferencias estadísticamente significativas en la prevalencia de no inmunización a sarampión en función de grupos de edad (ORa 11,8 y ORa 5,8) y área de desempeño (ORa 0,5), frente a parotiditis en función de grupos de edad (ORa 4,9 y ORa 3,6) y categoría profesional 1 (médicos, farmacéuticos, odontólogos y psicólogos) (ORa 0,6) y frente a rubeola en función del sexo (ORa 4,6). CONCLUSIONES: Es necesario potenciar la vacunación entre los sanitarios, especialmente en aquellos que ejercen sus funciones en áreas de riesgo y entre el personal de menor edad. La vacunación debe promoverse dentro de políticas de seguridad laboral.(AU)

BACKGROUND: Health Personnel are a professional group exposed to occupational risks. The aim of this paper was to estimate the absence of seroprotection against measles, rubella and mumps in health workers linked to two Health Departments of the Valencian Community (Spain) and to study the relationship with age, sex, professional category, occupational risk and performance área. METHODS: A cross-sectional observational study was made. Data were collected from health surveillance reports, which included serological results from 2,674 health workers. The socio-demographic variables were: sex, age groups (18-34; 35-49; >50 years), service classification (risk/no risk), professional category, professional performance area (primary care/hospital care) and the dependent variable was absence of immunization against measles, rubella and mumps identified by the absence of serological levels. For the diseases studied, the prevalence of absence of seroprotection was estimated and the association between non-immunization and the rest of variables was evaluated. RESULTS: Prevalence of non-immunization was 7.8%, 3.7% and 16.1% for measles, rubella and mumps, respectively. Logistic regression analysis showed a significant differences in the prevalence of non-immunization to measles according to age groups (adjusted OR 11.8 and adjusted OR 5.8) and professional performance area (adjusted OR 0.5), compared to mumps according to age groups (adjusted OR 4.9 and adjusted OR 3.6) and professional category 1 (doctors, pharmacists, dentists and psychologists) (adjusted OR 0.6) and against rubella according to sex (adjusted OR 4.6). CONCLUSIONS: It is necessary to maintain vaccination among health workers, especially those who perform their functions in risk areas and among younger personnel. Vaccination should be promoted within occupational safety policies.(AU)

Evaluación neuroepidemiológica a partir de anticuerpos antivirales de memoria generados por la vacuna triple viral / Neuro-Epidemiological Evaluation From Memory Antiviral Antibodies Generated By The MMR Vaccine

Introducción: La vacuna contra sarampión-parotiditis-rubéola es administrada en Cuba con un 99 por ciento de cobertura vacunal. Actualmente se plantea la baja inmunogenicidad de la cepa de parotiditis con que se fabrica por lo que resulta importante velar por la eficacia de las vacunas y su respuesta inmune protectora. Objetivos: Evaluar el comportamiento de los índices de anticuerpo antirubéola, antiparotiditis y antisarampión de acuerdo con la edad, y analizar la variación de la respuesta de anticuerpos antiparotiditis con respecto a estudios anteriores. Materiales y métodos: Se estudiaron muestras de suero y líquido cefalorraquídeo de 42 pacientes pediátricos con procesos neuroinflamatorios y se les cuantificó IgG total y albúmina y anticuerpos específicos contra los tres virus a partir de ensayos innmunoenzimáticos tipo ELISA. Se realizaron los reibergramas correspondientes e índices de anticuerpos específicos. Resultados: Se observó un incremento sostenido de anticuerpos contra los tres inmunógenos de forma general, sin diferencias significativas por razones de edad ni cambios notables posrevacunación. Existió un decrecimiento del índice de anticuerpos a medida que se alejaba de la fecha de revacunación por lo que se debe mantener una vigilancia en esos grupos de edades. La velocidad de producción de anticuerpos antiparotiditis fue mayor que frente a los otros virus, aunque no de forma significativa. Conclusiones: Esta vacuna garantiza protección por la uniformidad de la respuesta inmune de memoria inducida en todos los grupos de edades. Se demostró un aumento de protección de la población estudiada frente a la parotiditis con respecto a estudios previos(AU)

Introduction: The measles-mumps-rubella vaccine is administered in Cuba with 99 percent vaccination coverage. Currently, the low immunogenicity of the strain of mumps with which it is manufactured is raised, so it is important to ensure the effectiveness of vaccines and their protective immune response. Objectives: Evaluate the behavior of the anti-rubella, anti-mumps and anti-measles antibody indices according to age, and to analyze the variation of the anti-mumps antibody response with respect to previous studies. Materials and methods: Serum and cerebro-spinal fluid samples from 42 pediatric patients with neuro-inflammatory processes were studied and total IgG and albumin and specific antibodies against the three viruses were quantified from immunoenzymatic assays ELISA type. Corresponding reibergrams and specific antibody indices were performed. Results: A sustained increase in antibodies against the ethree immunogens was observed in general, without significant differences due to age or notable post-vaccination changes. There was a decrease in the antibody index as it moved away from the date of revaccination, so surveillance should be maintained in these age groups. The rate of production of anti-mumps antibodies was higher than against the other viruses, although not significantly. Conclusions: This vaccine guarantees protection by the uniformity of the memory induced immune response in all age groups. An increase in the protection of the studied population against mumps was demonstrated with respect to previous studies(AU)

Identificación de desórdenes autoinmunes e inmunodeficiencias a través de la evaluación neuroepidemiológica del índice de anticuerpos antiparotiditis, antirubéola y antisarampión / Identification of autoimmune disorders and immunodeficiencies by neuroepidemiological evaluation of the measles, mumps and rubella antibody index

Introducción: El esquema nacional de vacunación cubano presenta coberturas superiores al 99 por ciento que incluye la vacuna contra parotiditis, rubéola y sarampión. Así, cuando existe un proceso neuroinflamatorio se produce una amplia síntesis intratecal de anticuerpos antiparotiditis, antirubéola y antisarampión, que permite realizar evaluaciones neuroepidemiológicas de las campañas de vacunación y el sesgo de casos extremos, desde el punto de vista inmunológico. Objetivos: Correlacionar el índice de anticuerpos antirubéola, antiparotiditis y antisarampión con procesos autoinmunes asociados y en la identificación de posibles pacientes con inmunodeficiencias en la muestra estudiada. Métodos: Se realizó un estudio aplicado y descriptivo de corte transversal en 42 niños evaluados en los servicios de cuerpo de guardia de los hospitales pediátricos de La Habana del 2015 al 2018. La muestra fue dividida según los tres intervalos del índice de anticuerpos (menor o igual a 0,6; de 0,6 a 1,5 y mayor o igual a 1,5). Se procedió a detectar en los segmentos extremos pacientes con posible autoinmunidad (mayor o igual a 1,5) e inmunodeficiencia (se tomó el intervalo inferior a una desviación estándar). Resultados: En el grupo con índice de anticuerpos mayor o igual a 1,5, el 75 por ciento fue positivo a la reacción MRZ, indicativo de una enfermedad autoinmune activa. En el grupo con índice de anticuerpos menor o igual a 0,6 preponderó una clínica con prevalencia de enfermedades tumorales e infecciosas asociadas a un alto índice de hospitalización, test de inmunodeficiencia positivo y bajos niveles de IgG en suero. Conclusiones: Es posible identificar pacientes pediátricos con desórdenes autoinmunes y sospecha de inmunodeficiencias, a partir de la estrategia de la evaluación neuroepidemiológica de los índices de anticuerpos antiparotiditis, antirubéola y antisarampión(AU)

Introduction: The Cuban national vaccination scheme has a coverage of more than 99 percent of the population, and includes the measles-mumps-rubella vaccine. Therefore, in the presence of a neuroinflammatory process, a broad intrathecal synthesis of measles, mumps and rubella antibodies takes place which makes it possible to conduct neuroepidemiological evaluations of the vaccination campaigns and the bias of extreme cases, from an immunological perspective. Objectives: Correlate the measles, mumps and rubella antibody index with associated autoimmune processes and in the identification of patients with possible immunodeficiencies in the study sample. Methods: An applied cross-sectional descriptive study was conducted of 42 children attending the emergency services of Havana children's hospitals in the period 2015-2018. The sample was divided according to the three antibody index intervals: smaller than or equal to 0.6, from 0.6 to 1.5, and greater than or equal to 1.5. Extreme segments were examined to detect patients with possible autoimmunity (greater than or equal to 1.5) and immunodeficiency (the interval below a standard deviation was taken as reference). Results: 75 percent of the group with an antibody index greater than or equal to 1.5 was positive to the MRZ reaction, indicative of an active autoimmune disease. In the group with an antibody index lower than or equal to 0.6, the prevailing clinical status showed a prevalence of tumoral and infectious diseases associated to a high hospitalization index, a positive immunodeficiency test and low serum IgG levels. Conclusions: It is possible to identify pediatric patients with autoimmune disorders and suspicion of immunodeficiencies applying the strategy of neuroepidemiological evaluation of the measles, mumps and rubella antibody indices(AU)

Brote de parotiditis relacionado con el fumar en un narguile de uso público / Mumps virus outbreak related to a water pipe (narghile) shared smoking

Introducción: En este estudio se describe un brote de parotiditis que afectó a un grupo de jóvenes que compartieron un narguile para fumar. Métodos: La notificación de un caso de parotiditis dio lugar a una investigación epidemiológica. Se recabó información de otras 6personas sintomáticas que se habían reunido en una discoteca en la que habían fumado en un mismo narguile. Se obtuvieron muestras de saliva para RT-PCR y sangre para serología de parotiditis de otros 3de estos casos. Las muestras RT-PCR positivas se genotipificaron por secuenciación. Resultados: Los 7 pacientes residían en 3municipios diferentes. Hacía más de un mes que no habían coincidido hasta que estuvieron en la discoteca. Cuatro casos se confirmaron por RT-PCR o IgM específica. La investigación genómica mostró secuencias idénticas. Conclusiones: Este brote es consecuencia de un uso compartido de un narguile. Consideramos que se debería regular la utilización pública de estas pipas.(AU)

Introduction: This study describes a mumps outbreak among a group of young people who shared a same narghile to smoking. Saliva and blood samples were obtained from 3cases for RT-PCR and serology respectively. Methods: The notification of a mumps case started an epidemiological investigation. Information of other 6additional symptomatic persons who had gathered with the case in a discotheque where they smoking in a same narghile was achieved. RT-PCR positive samples were genotyped by sequencing. Results: The 7patients resided in 3different municipalities, and they do not have get together for more than a month until the meeting in the discotheque. Four cases were confirmed by RT-PCR and/or IgM determinations. The genomic investigation showed identical nucleic sequences. Conclusions: This outbreak is consequence of the common use of a narghile to smoking. The public usage of these water pipes should be regulated.(AU)

Alteraciones inmunológicas asociadas a parotiditis crónica recurrente juvenil / Immune disorders associated with juvenile recurrent chronic parotitis

Introducción: La parotiditis crónica recurrente juvenil es una enfermedad infrecuente de causa desconocida. Existe un creciente interés por su etiología autoinmune y su relación con disfunciones de la inmunidad celular y humoral aunque no existe un protocolo consensuado de investigaciones complementarias para su estudio. Se presenta una serie consecutiva de casos donde se investigan las alteraciones inmunes y trastornos autoinmunes asociados, proponiendo un algoritmo de estudio. Pacientes y métodos: Se realizó un estudio retrospectivo de pacientes que presentaron parotiditis crónica recurrente juvenil durante el periodo de 2013 a 2016 y seguimiento de al menos 2 años. Tras su diagnóstico clínico y ecográfico se realizaron de forma sistemática exámenes complementarios para investigación de patologías infecciosas, inmunes y autoinmunes asociadas. Resultados: De un total de 36 pacientes con criterios de inclusión, se encontraron 16 (44%) con alguna alteración analítica de carácter inmunológico inespecífico (ANA positivo, IgG elevada, factor 4 del complemento bajo) o asociada a un diagnóstico específico como ocurrió en 11 pacientes: déficit selectivo de IgA (2), síndrome de Sjögren asociado o no a lupus eritematoso sistémico (3), celiaquía asociada o no a diabetes mellitus (4), tiroiditis de Hashimoto (1) y síndrome de inmunodeficiencia adquirida (1). Conclusión: La parotiditis crónica recurrente juvenil puede considerarse un signo centinela de otras enfermedades de etiología inmunológica/autoinmune cuyo diagnóstico, seguimiento y tratamiento precoz puede mejorar su pronóstico. La etiología infecciosa vírica, exceptuando el VIH, no es prioritaria en el estudio de recurrencias. (AU)

Introduction: Juvenile recurrent chronic parotitis is a rare disease of unknown cause. There is a growing interest in its autoimmune aetiology and its relationship with dysfunctions of cellular and humoral immunity, although there is no agreed protocol for complementary investigations for its study. A consecutive series of cases is presented where the immune alterations and associated autoimmune disorders are investigated, proposing a study algorithm. Patients and methods: A retrospective study was carried out on patients who had juvenile recurrent chronic parotitis during the period from 2013 to 2016 and a follow-up of at least 2 years. After its clinical and ultrasound diagnosis, complementary examinations were systematically carried out to investigate infectious, immune, and autoimmune diseases. Results: Of a total of 36 patients with inclusion criteria, 16 (44%) were found with some analytical alteration of a non-specific immunological nature (positive ANA, high IgG, low complement factor 4), or associated with a specific diagnosis, as occurred in 11 patients: Selective IgA deficiency (2), Sjögren's syndrome associated or not with systemic lupus erythematosus (3), coeliac disease associated or not with diabetes mellitus (4), Hashimoto's thyroiditis (1), and acquired immunodeficiency syndrome (1). Conclusion: Juvenile recurrent chronic parotitis can be considered a sentinel sign of other diseases of immunological/autoimmune aetiology for which the diagnosis, monitoring and early treatment can improve its prognosis. Viral infectious aetiology, with the exception of HIV, is not a priority in the study of recurrences. (AU)

Mumps virus outbreak related to a water pipe (narghile) shared smoking.

INTRODUCTION: This study describes a mumps outbreak among a group of young people who shared a same narghile to smoking. Saliva and blood samples were obtained from 3 cases for RT-PCR and serology respectively. METHODS: The notification of a mumps case started an epidemiological investigation. Information of other 6 additional symptomatic persons who had gathered with the case in a discotheque where they smoking in a same narghile was achieved. RT-PCR positive samples were genotyped by sequencing. RESULTS: The 7 patients resided in 3 different municipalities, and they do not have get together for more than a month until the meeting in the discotheque. Four cases were confirmed by RT-PCR and/or IgM determinations. The genomic investigation showed identical nucleic sequences. CONCLUSIONS: This outbreak is consequence of the common use of a narghile to smoking. The public usage of these water pipes should be regulated.

Immune disorders associated with juvenile recurrent chronic parotitis.

INTRODUCTION: Juvenile recurrent chronic parotitis (JRCP) is a rare disease of unknown cause. There is a growing interest in its autoimmune aetiology and its relationship with dysfunctions of cellular and humoral immunity, although there is no agreed protocol for complementary investigations for its study. A consecutive series of cases is presented where the immune alterations and associated autoimmune disorders are investigated, proposing a study algorithm. PATIENTS AND METHODS: A retrospective study was carried out on patients who had JRCP during the period from 2013 to 2016 and a follow-up of at least 2 years. After its clinical and ultrasound diagnosis, complementary examinations were systematically carried out to investigate infectious, immune, and autoimmune diseases. RESULTS: Of a total of 36 patients with inclusion criteria, 16 (44%) were found with some analytical alteration of a non-specific immunological nature (positive ANA, high IgG, low complement factor 4), or associated with a specific diagnosis, as occurred in 11 patients: Selective IgA deficiency (2), Sjögren's syndrome associated or not with systemic lupus erythematosus (3), coeliac disease associated or not with diabetes mellitus (4), Hashimoto's thyroiditis (1), and acquired immunodeficiency syndrome (1). CONCLUSION: Juvenile recurrent chronic parotitis can be considered a sentinel sign of other diseases of immunological/autoimmune aetiology for which the diagnosis, monitoring and early treatment can improve its prognosis. Viral infectious aetiology, with the exception of HIV, is not a priority in the study of recurrences.

Recordando la parotiditis en la era del SARS-CoV-2 / Remembering Parotitis in SARS-CoV-2 era

New 2019-Coronavirus (SARS-CoV-2) pandemic is presenting daily diagnostic challenges to emergency departments (ED) doctors, especially as an increasing number of atypical clinical presentations have been reported, including acute sialadenitis (most of parotid). We present a case of a 46-year-old obese caucasian woman, with no relevant medical history, that presented in ED with complaints suggesting parotitis, with normal laboratory tests, at first with no virus isolation, confirmed by computed tomography. One week later, anosmia and dysgeusia were notice, and SARS-CoV-2 was tested and confirmed. Authors want to alert that SARS-CoV-2 should be excluded as parotitis etiology, highly important, especially in this pandemic phase, as a way of transmission control. (AU)

Parotiditis recurrent juvenil. Caldria pensar-hi més? / Parotiditis recurrente juvenil. ¿Deberíamos pensar más en ella? / Juvenile recurrent parotitis. Should we think more about it?

Introducció. La parotiditis recurrent juvenil (PRJ) és una entitat poc freqüent, però representa la segona causa de patologia de les glàndules salivals de la infància. Es caracteritza per episodis repetits de tumefacció i dolor local, de vegades acompanyats de febre, sense causa que ho justifiqui. La seva etiologia és desconeguda, probablement multifactorial, però diferents estudis relacionen la malaltia amb processos autoimmunitaris. El seu tractament habitualment és simptomàtic i conservador, però pot arribar a requerir tractament quirúrgic en alguns casos. Cas clínic. Es presenta el cas d’un nen de cinc anys amb episodis repetits de dolor a l’angle mandibular dret, habitualment autolimitats en menys de 24 hores, de dos anys d’evolució. Es practica una ecografia parotídia que mostra la presència d’imatges hipoecogèniques bilaterals característiques de la PRJ. Comentaris. No hi ha cap algoritme diagnòstic i d’abordatge de la tumefacció parotídia de repetició, però sembla apropiat estudiar la presència de litiasis parotídies, infeccions víriques, sobretot pel virus de la immunodeficiència humana (VIH), processos autoimmunitaris i immunodeficiències. (AU)

Introducción. La parotiditis recurrente juvenil (PRJ) es una entidad poco frecuente, pero representa la segunda causa de patología de las glándulas salivales en la infancia. Se caracteriza por episodiosrepetidos de tumefacción y dolor local, en ocasiones acompañados de fiebre, sin causa que los justifique. Su etiología es desconocida, probablemente sea de origen multifactorial, pero diferentes estudios relacionan la enfermedad con procesos autoinmunes. Su tratamiento habitualmente es sintomático y conservador, pero puede llegar a precisar tratamiento quirúrgico en algunos casos. Caso clínico. Se presenta el caso de un niño de cinco años con episodios repetidos de dolor en el ángulo mandibular derecho, habitualmente autolimitados en menos de 24 horas, de dos años de evolución. Se practica una ecografía parotídea que muestra la presencia de imágenes hipoecogénicas bilaterales características de la parotiditis recurrente juvenil (PRJ). Comentarios. No existe un algoritmo diagnóstico y de abordaje de la tumefacción parotídea de repetición, pero parece apropiado estudiar la presencia de litiasis parotídeas, infecciones víricas, sobretodo por virus de la inmunodeficiencia humana (VIH), procesosautoinmunes e inmunodeficiencias. (AU)

Introduction. Juvenile recurrent parotitis (JRP) is a rare condition but is the second most common childhood disease of the salivary glands. JRP usually presents with recurrent swelling and pain of the parotid glands, sometimes with fever, with no apparent cause. There is no conclusive aetiology; it is probably multifactorial, but multiple studies suggest an autoimmune phenomenon. Management has focused on the symptomatic and conservativetreatment of acute episodes but sometimes surgical procedures may be needed. Case report. A five-year-old boy presented with a two-year history of recurrent episodes of pain and swelling in the right mandibular angle that usually resolved within 24 hours. Ultrasound showed multiple hypoechoic lesions in both parotid glands, suggestive ofjuvenile recurrent parotitis. Comments. A management algorithm of recurrent parotid swelling should include the study of parotid lithiasis, viral infections, especially human immunodeficiency virus (HIV), autoimmune diseasesand immunodeficiencies. (AU)

Parotiditis recurrente benigna de la infancia: experiencia en el diagnóstico en un hospital de alta complejidad en Latinoamérica

Objetivo: la parotiditis recurrente benigna de la infancia (PRBI) es una enfermedad de importancia clínica. Sin embargo, su diagnóstico puede no realizarse correctamente debido al desconocimiento de esta entidad. El propósito de este estudio es describir los aspectos clínicos fundamentales de esta condición y proponer un enfoque terapéutico simple. Materiales y métodos: se realizó un análisis descriptivo de pacientes pediátricos con diagnóstico de parotiditis viral y PRBI entre los años 2008 y 2018, en el Hospital Universitario San Ignacio de Bogotá, Colombia. Resultados: se encontraron 41 pacientes con diagnóstico de PRBI; de estos, el 51,2 % fueron de sexo femenino, con una edad media de 7,1 años. A 32 pacientes (78 %) con diagnóstico de PRBI se les realizaron imágenes diagnósticas, a pesar de que la tasa de complicaciones fue baja (19,5 %). El diagnóstico fue hecho por los servicios de pediatría y otorrinolaringología en el 80 % de los casos. Conclusiones: hasta donde sabemos, este es el estudio con mayor número de pacientes con diagnóstico de PRBI en Latinoamérica. Es indispensable conocer esta enfermedad y tener en cuenta su curso benigno y pocas complicaciones, con el fin de destinar menos recursos en el uso de imágenes innecesarias y evitar el sobrediagnóstico de parotiditis por paramixovirus.

SUMMARY Objectives: Benign recurrent parotitis of childhood (BRPC) is a clinically relevant disease in childhood. Its diagnosis, however, is usually not made due to the lack of knowledge regarding such a condition. The aim of this study is to describe the most relevant aspects of this condition and propose a simple therapeutic approach. Materials and Methods: We did a descriptive analysis of pediatric patients diagnosed with viral parotitis and BRPC between 2008 and 2018, at the Hospital Universitario San Ignacio in Bogotá, Colombia. Results: 41 patients with BRPC where included; 51.2% were female, with a mean age of 7.1 years. Thirty-two patients (78%) with diagnosis of BRPC underwent diagnostic imaging, despite the low rate of complications (19,5%). The diagnosis was made by otolaryngologists or pediatricians in 80% of the cases. Conclusions: To our knowledge, this is the study with the largest number of BRPC cases in Latin America. It is essential to know about this disease and take into account its benign course and few complication rates, in order to avoid both wasting of resources in the use of unnecessary imaging and the overdiagnosis of mumps.

Meningitis aséptica por virus parotídeo asociada a la vacuna

Resumen Comunicamos el caso de un lactante mayor previamente sano, que luego de tres semanas de recibir la vacuna SPR (sarampión, parotiditis, rubeola) presentó fiebre, aumento de volumen parotídeo y compromiso de conciencia. Se diagnosticó una meningitis aséptica, con pleocitosis en el LCR de predominio mononuclear, detectándose virus parotídeo en LCR por biología molecular. En el Instituto de Salud Pública de Chile se realizó serología (IgM e IgG) que resultó positiva. La muestra de saliva confirmó la etiología por virus parotídeo con genotipo N. La evolución fue favorable, sin secuelas al seguimiento a seis meses. Ante esta situación clínica, se revisó la información respecto a la asociación y causalidad de esta entidad clínica y vacuna SPR, focalizado en diferentes cepas del virus parotiditis.

Abstract We report the case of an older infant with no prior morbidity that approximately 3 weeks after receiving MMR vaccination (measles, mumps, rubella) was hospitalized for feverish symptoms, increased parotid volume and compromised consciousness. Aseptic meningitis was diagnosed, detecting pleocytosis in the CSF, predominantly mononuclear, and confirming by molecular biology, presence of parotid virus in CSF. A study was carried out by the Institute of Public Health of Chile, where serology (IgM and IgG) was positive. Saliva sample confirmed the etiology of parotid virus with genotype N. The evolution was favorable and at 6-month follow-up, there were no sequelae. Given this clinical situation, information regarding the association and causality of this clinical entity and the MMR vaccine, focused on different strains of the mumps virus, was reviewed.

[Immune disorders associated with juvenile recurrent chronic parotitis]. / Alteraciones inmunológicas asociadas a parotiditis crónica recurrente juvenil.

INTRODUCTION: Juvenile recurrent chronic parotitis is a rare disease of unknown cause. There is a growing interest in its autoimmune aetiology and its relationship with dysfunctions of cellular and humoral immunity, although there is no agreed protocol for complementary investigations for its study. A consecutive series of cases is presented where the immune alterations and associated autoimmune disorders are investigated, proposing a study algorithm. PATIENTS AND METHODS: A retrospective study was carried out on patients who had juvenile recurrent chronic parotitis during the period from 2013 to 2016 and a follow-up of at least 2 years. After its clinical and ultrasound diagnosis, complementary examinations were systematically carried out to investigate infectious, immune, and autoimmune diseases. RESULTS: Of a total of 36 patients with inclusion criteria, 16 (44%) were found with some analytical alteration of a non-specific immunological nature (positive ANA, high IgG, low complement factor 4), or associated with a specific diagnosis, as occurred in 11 patients: Selective IgA deficiency (2), Sjögren's syndrome associated or not with systemic lupus erythematosus (3), coeliac disease associated or not with diabetes mellitus (4), Hashimoto's thyroiditis (1), and acquired immunodeficiency syndrome (1). CONCLUSION: Juvenile recurrent chronic parotitis can be considered a sentinel sign of other diseases of immunological/autoimmune aetiology for which the diagnosis, monitoring and early treatment can improve its prognosis. Viral infectious aetiology, with the exception of HIV, is not a priority in the study of recurrences.

Mumps virus outbreak related to a water pipe (narghile) shared smoking. / Brote de parotiditis relacionado con el fumar en un narguile de uso público.

INTRODUCTION: This study describes a mumps outbreak among a group of young people who shared a same narghile to smoking. Saliva and blood samples were obtained from 3cases for RT-PCR and serology respectively. METHODS: The notification of a mumps case started an epidemiological investigation. Information of other 6additional symptomatic persons who had gathered with the case in a discotheque where they smoking in a same narghile was achieved. RT-PCR positive samples were genotyped by sequencing. RESULTS: The 7patients resided in 3different municipalities, and they do not have get together for more than a month until the meeting in the discotheque. Four cases were confirmed by RT-PCR and/or IgM determinations. The genomic investigation showed identical nucleic sequences. CONCLUSIONS: This outbreak is consequence of the common use of a narghile to smoking. The public usage of these water pipes should be regulated.

Brotes epidémicos de parotiditis, revisión de la literatura / Mumps outbreaks, literature review

La parotiditis es un infección viral producida por el virus parotídeo. Clínicamente se caracteriza por aumento de volumen de la glándula parótida generalmente bilateral. La estrategia que ha mostrado ser más eficaz para la prevención de esta infección ha sido la implementación de la vacuna tres vírica en los programas de inmunización. En países con población altamente inmunizada como Chile, se logró una importante disminución de la incidencia de esta enfermedad. Sin embargo, a pesar de la efectividad de la vacuna se siguen reportando brotes en todo el mundo, evidenciándose un cambio epidemiológico, trasladándose la edad de presentación clínica desde la niñez y adolescencia hacia los adultos jóvenes. Este aumento en el número de casos ha sido estudiado, determinando que el efecto protector inmunitario de la vacuna decaería con el transcurso del tiempo, contribuyendo a la propagación de los brotes. Con respecto a posibles estrategias para el manejo de los brotes la aplicación de una dosis adicional de la vacunas tres vírica en población expuesta sería una medida que mejoraría el control de los brotes.

Mumps is a viral infection caused by mumps virus. Clinically, it is characterized by increased parotid volume. The most effective strategy for preventing this infection, has been the implementation of measles-mumps-rubella (MMR) vaccine in the national immunization program. Among countries with a highly immunized population, like Chile, there has been an important reduction in the incidence of this disease. Nevertheless, despite the effectivity of the MMR, there are reports of outbreaks worldwide, with an epidemiological change, from clinical presentation in childhood, to adolescents and adults. This outbreaks have been studied, and it has been determined that they are due to the waning of vaccine-derived immunity. Regarding strategies for the management of new outbreaks, the administration of an additional dose of MMR, would be an alternative.

Estrutura e localização dos serviços de vacinação influenciam a disponibilidade da tríplice viral no Brasil / La estructura y ubicación de los servicios de vacunación influyen en la disponibilidad de la vacuna triple viral en Brasil / Structure and location of vaccination services influence the availability of the triple viral in Brazil

RESUMO OBJETIVO: analisar a associação de fatores estruturais e diferenças geográficas na disponibilidade da vacina tríplice viral nos serviços de atenção básica no Brasil. MÉTODOS: estudo transversal, com dados secundários do segundo ciclo das avaliações externas do Programa de Melhoria da Qualidade da Atenção Básica (PMAQ-AB) coletados em 19.752 serviços de vacinação de todo o país entre os anos de 2013 e 2014. Razões de prevalência (RP) ajustadas e seus respectivos intervalos de confiança de 95% (IC 95%) foram estimados com a técnica de regressão multivariada de Poisson com variâncias robustas. RESULTADOS: a vacina tríplice viral estava sempre disponível em 93% dos serviços estudados, mas com diferenças regionais, sendo a menor frequência observada na região Norte (87,4%; p<0,001). Os seguintes fatores estruturais dos serviços associaramse positivamente à maior frequência de vacina tríplice viral sempre disponível: possuir sala de vacinação (RP: 1,05; IC 95%: 1,01-1,09), sala de vacinação exclusiva para imunização (RP: 1,04; IC 95% 1,02-1,05), geladeira exclusiva para vacinas (RP: 1,13; IC 95%: 1,10-1,16); cartões de vacinação impressos sempre disponíveis (RP: 1,12 IC 95%: 1,09-1,16) e caixas térmicas para vacinas sempre disponíveis (RP: 1,18 IC 95%: 1,14-1,21). CONCLUSÃO: a localização e a estrutura dos serviços de atenção básica influenciaram na disponibilidade da vacina tríplice viral no Brasil. Serviços da região Norte e com estrutura deficiente para as ações de imunização apresentaram menor frequência da disponibilidade da vacina.

RESUMEN OBJETIVO: analizar la asociación entre los factores estructurales y las diferencias geográficas en la disponibilidad de la vacuna triple viral en los servicios de atención primaria de Brasil. MÉTODO: estudio transversal con datos secundarios del segundo ciclo de evaluaciones externas del Programa de mejora de la calidad de la atención primaria recogidos en 19.752 servicios de vacunación de todo el país entre 2013 y 2014.Las razones de prevalencia ajustadas (PR) y sus respectivos intervalos de confianza del 95% (IC del 95%) se estimaron utilizando la técnica de regresión multivariante de Poisson con varianzas robustas. RESULTADOS: la vacuna triple viral siempre estuvo disponible en el 93% de los servicios estudiados, pero con diferencias regionales, con la menor frecuencia observada en el norte (87,4%; p <0,001). Los siguientes factores estructurales de los servicios se asociaron positivamente con la mayor frecuencia de vacuna triple viral siempre disponible: tener una sala de vacunación (RP: 1.05; IC 95%: 1.01-1.09), sala de vacunación exclusiva para inmunización (RP: 1,04; IC del 95%: 1,02-1,05), refrigerador exclusivamente para vacunas (RP: 1,13; IC del 95%: 1,10-1,16); tarjetas de vacunación impresas siempre disponibles (RP: 1,12 IC 95%: 1,09-1,16) y cajas térmicas para vacunas siempre disponibles (RP: 1,18 IC 95%: 1,14-1,21). CONCLUSIÓN: la ubicación y estructura de los servicios de atención primaria influyó en la disponibilidad de la vacuna triple viral en Brasil. Los servicios de la región norte con estructura deficiente para las acciones de inmunización mostraron menor frecuencia de disponibilidad de vacunas.

ABSTRACT OBJECTIVE: to analyze the association of structural factors and geographical differences in the availability of the measle, mumps, and rubella vaccine in primary care services in Brazil. METHODS: this is a cross-sectional study, with secondary data from the second cycle of external evaluations of the Primary Care Quality Improvement Program (Programa de Melhoria da Qualidade da Atenção Básica - PMAQ-AB) collected from 19,752 vaccination services across the country between 2013 and 2014. We estimated the prevalence ratio (PR) and their respective 95% confidence intervals (CI 95%) using the Poisson multivariate regression technique with robust variances. RESULTS: the MMR vaccine was always available in 93% of the services studied, but with regional differences, with the lowest frequency observed in the North (87.4%; p <0.001). The following structural factors of the services were positively associated with the higher frequency of MMR vaccine always available: having a vaccination room (PR: 1.05; 95% CI: 1.01-1.09), exclusive vaccination room for immunization (PR: 1.04; 95% CI 1.02-1.05), refrigerator exclusively for vaccines (PR: 1.13; 95% CI: 1.10-1.16); printed vaccination cards always available (PR: 1.12 95% CI: 1.09-1.16) and coolers for vaccines always available (PR: 1.18 95% CI: 1.14-1.21). CONCLUSION: the location and structure of primary care services influenced the availability of the MMR vaccine in Brazil. Services in the North region and with a poor structure for immunization actions showed less frequency of vaccine availability.

Parotiditis tuberculosa: una presentación poco frecuente de una enfermedad reemergente / Tuberculous parotitis: an uncommon presentation of a reemerging disease / Parotidite tuberculosa: uma apresentação rara de uma doença reemergente

Resumen: Introducción: en Uruguay en los últimos años se ha observado un aumento de la incidencia de la enfermedad en niños. El diagnóstico de TB infantil representa un desafío, la infección suele cursar con manifestaciones clínicas inespecíficas y muchas veces en forma asintomática. Objetivo: describir el caso clínico de un niño con parotiditis tuberculosa. Caso clínico: 5 años, varón, sano, hacinamiento, dos adultos convivientes con TB pulmonar en tratamiento. Vacunas vigentes. Consulta por tumoración de cuello derecha de tres días de evolución, adelgazamiento, subfebril. Diagnóstico al ingreso, adenoflemón de probable etiología bacteriana. Tratamiento con antibióticos, mala evolución, persiste febril y no se modifica tamaño de tumoración. Ecografía de partes blandas: glándula parotídea derecha aumentada de tamaño. Prueba tuberculínica: 14 mm. Velocidad de eritrosedimentación: 75 mm/h. Con planteo de TB parotídea se realiza punción de la glándula, obteniéndose material purulento. Se confirma bacteriológicamente la infección por métodos moleculares y cultivo. Se inicia tratamiento para TB. Recibe nueve meses de tratamiento con resolución completa y sin complicaciones. Conclusiones: las formas de presentación extrapulmonares son más frecuentes en niños que en adultos, su diagnóstico no es sencillo. Es fundamental recordar que el diagnóstico de un caso de TB en un niño representa un evento sanitario centinela de la transmisión reciente a partir de adulto bacilífero que habitualmente convive y debe ser diagnosticado y tratado adecuadamente.

Summary: Introduction: according to the World Health Organization (WHO), Childhood tuberculosis (TB) occurs in children under 15 years of age. An increase in the incidence of this disease was detected in children in recent years. The diagnosis of childhood TB is a challenge because of its non-specific clinical manifestations. Objective: describe a case of a child with tuberculous parotitis. Case report: 5-year-old healthy male living with 2 adults with pulmonary TB under treatment. Vaccination according to his age. Consultation regarding a neck tumor of 3 days of evolution, patient showed weight loss and no history of fever. Diagnosis at admission was cervical adenitis probably with bacterial etiology. Antibiotic treatment, poor evolution, fever persisted and tumor size remained unchanged. Soft tissue ultrasound: enlarged right parotid gland. Tuberculin test: 14mm. Erythrosedimentation rate 75mm / h. With a parotid tuberculosis approach, we performed a gland puncture and obtained purulent material. The infection was bacteriologically confirmed by molecular methods and culture. Treatment for tuberculosis began. Patient received treatment for 9 months and showed complete resolution and no complications. Conclusions: although tuberculosis is a reemerging disease and extra-pulmonary presentation forms are more frequent in children than in adults, diagnosis remains a challenge. It is essential to remember that the TB diagnosis in children usually shows a sentinel health event of recent transmission from a bacilliferous adult who usually lives with the child and must be properly diagnosed and treated.

Resumo: Introdução: segundo a Organização Mundial da Saúde (OMS), a tuberculose infantil (TB) ocorre em crianças menores de 15 anos de idade. Nos últimos anos houve um aumento na incidência desta doença em crianças. O diagnóstico da TB infantil é um desafio devido às suas manifestações clínicas inespecíficas. Objetivo: descrever o caso duma criança com parotidite tuberculosa. Relato de caso: menino de 5 anos, saudável, morava com 2 adultos com TB pulmonar em tratamento. Vacinas de acordo com sua idade. Consulta referente a tumor cervical com 3 dias de evolução, paciente apresentava emagrecimento, sem febre. O diagnóstico na admissão foi adenite cervical de etiologia provavelmente bacteriana. Tratamento antibiótico, má evolução, persistência de febre e tamanho do tumor inalterado. Ultrassom de partes moles: glândula parótida direita aumentada. Teste tuberculínico: 14mm. Taxa de eritrosedimentação 75 mm / h. Com abordagem de tuberculose parotídea, realizou-se punção da glândula e obteve-se material purulento. A infecção foi confirmada bacteriologicamente por métodos moleculares e cultura. Começou-se tratamento para a tuberculose, o paciente recebeu tratamento por 9 meses e apresentou resolução completa e sem complicações. Conclusões: embora a tuberculose seja uma doença reemergente e as formas de apresentação extrapulmonar sejam mais frequentes em crianças do que em adultos, o diagnóstico permanece um desafio. É fundamental lembrar que o diagnóstico de um caso de TB na criança representa um evento sentinela de saúde de transmissão recente de um adulto bacilífero que mora com a criança e que deve ser devidamente diagnosticado e tratado.

Meningitis aguda posterior a vacuna tresvírica / Acute meningitis following mumps vaccine

Resumen En Chile, la cepa del virus parotídeo utilizada en la vacuna es Leningrad-Zagreb (L-Z). Aunque la relación entre meningitis y la cepa L-Z sigue siendo controvertida, la mayoría de los casos reportados han presentado un cuadro de curso benigno y sin secuelas neurológicas. Presentamos el caso de una paciente que tres semanas post-inmunización con la vacuna tresvírica evolucionó con una meningitis aséptica de predominio mononuclear, con serología para IgM positiva contra el virus parotídeo. En este caso clínico, existió una relación temporal entre la vacunación, el inicio del cuadro parotídeo y posteriormente el meníngeo; la curva de inmunoglobulinas demostró una infección aguda posterior a la vacuna. Si bien no se logró aislar el virus en LCR, es razonable atribuir el cuadro a una infección post-vacunal.

In Chile, the strain of the mumps virus used in the vaccine is Leningrad-Zagreb (L-Z). Although the relationship between meningitis and the L-Z strain remains controversial, most of the reported cases have shown a benign course without permanent neurological sequelae. We present a case of a patient who presented an aseptic meningitis three weeks after immunization with a mumps vaccine; and laboratory confirmation showed positive serum mumps IgM antibody. In this clinical case, there was a temporal relationship between vaccination and the onset of the mumps and subsequently the meningeal involvement; the immunoglobulin curve demonstrates acute infection after vaccination. Although it was not possible to isolate the virus in CSF, it is reasonable to attribute the picture to a post-vaccinal infection.