Mastoiditis enmascarada: Reporte de caso en un hospital pediátrico de alta complejidad / Masked mastoiditis: case report in a high-complexity pediatric hospital

La mastoiditis enmascarada es una forma poco frecuente dentro de las complicaciones de las otitis medias, ya sean aguda o crónicas. Su principal característica es presentar poca o mínima sintomatología ótica y tener un curso larvado en el tiempo. Este diagnóstico debe ser correctamente sospechado, ya que eventualmente puede generar consecuencias otológicas graves y presentar complicaciones mayores a nivel intra o extratemporal. En este trabajo se presenta el caso clínico de una paciente pediátrica sana, a la cual se diagnostica mastoiditis enmascarada de tres meses de evolución complicada con absceso de Bezold. Se inicia desde el ingreso hospitalario esquema antibiótico bi-asociado y se realiza mastoidectomía simple, evolucionando de forma satisfactoria.

Masked mastoiditis is a rare complication of acute or chronic otitis media. Its main characteristic is to present little or minimal otic symptoms and has a slowly progressive course over time. This diagnosis must be suspected correctly because it can eventually generate serious otological consequences and present major complications at intra or extratemporal levels. We report the clinical case of a healthy pediatric patient, who was diagnosed with masked mastoiditis complicated with a Bezold's abscess. A bi-associated antibiotic scheme was started from admission and a timpanomastoidectomy was performed, with a satisfactory outcome.

Successful medical management of perinephric abscess and urosepsis following urethral obstruction in a cat.

OBJECTIVE: To describe the clinical presentation and medical management of a cat with perinephric abscessation and urosepsis following urethral obstruction and catheterization. CASE SUMMARY: A 2-year-old intact male domestic shorthaired cat presented to an emergency and referral center for lethargy, vomiting, and hematuria. Severe azotemia and hyperkalemia were observed on a serum biochemistry panel. The patient was diagnosed with urethral obstruction and was treated with urethral catheterization, calcium gluconate, IV fluid therapy, buprenorphine, and prazosin. The patient's azotemia improved, and the hyperkalemia resolved. Urinary catheterization was discontinued. The patient developed pyrexia, worsening azotemia, hypoalbuminemia, hyperbilirubinemia, and dysuria. Urethral catheterization was repeated. Abdominal radiographs showed left renomegaly, and abdominal ultrasound revealed left perinephric fluid. Ultrasound-guided centesis of the perinephric fluid revealed septic inflammation, and the sample was consistent with urine based upon sample creatinine. Fluid from the perinephric abscess and urine from the bladder both grew Pasturella spp. The patient was treated with perinephric catheterization, saline lavage, and a continuous infusion of cefotaxime for 72 h. The patient's azotemia quickly resolved, and the patient was discharged after 6 days of hospitalization. The patient was reported to have made a full recovery. NEW OR UNIQUE INFORMATION PROVIDED: This is the first described case of perinephric abscess and urosepsis following urethral obstruction in a cat and its successful medical management. Perinephric abscess not associated with intrarenal abscess has not previously been identified. Additionally, continuous antimicrobial infusion to treat overwhelming infection and the use of the RapidBac Vet immunoassay for point-of-care detection of urinary tract infection has not been described in cats.

Community-acquired meningitis caused by a CG86 hypervirulent Klebsiella pneumoniae strain: first case report in the Caribbean.

BACKGROUND: Community-acquired bacterial meningitis due to Klebsiella pneumoniae has mainly been described in Southeast Asia and has a poor prognosis. Severe invasive infections caused by K. pneumoniae, including meningitis, are often due to hypervirulent strains (hvKP), which are characterized by capsular serotypes K1 and K2, a gene responsible for hypermucoviscosity, and the cluster for synthesis of the siderophore aerobactin. CASE PRESENTATION: A 55 year old man with a history of essential hypertension, benign prostate hyperplasia, hyperlipidemia, obstructive sleep apnea, and chronic alcoholism was admitted for meningitis due to Klebsiella pneumoniae with a wild-type susceptibility profile. Its genomic features were consistent with a capsular K2 strain belonging to clonal group 86 (CG86) displaying the large virulence of Klebsiella plasmid (pLVPK) with heavy metal resistance gene clusters, aerobactin, rmpA. CONCLUSION: This is the first case of community-acquired meningitis caused by a hypervirulent strain of hvKP ever reported in the Caribbean.

Método rápido para la detección de la sensibilidad a cefotaxima en enterobacterias / Rapid test for detection of susceptibility to cefotaxime in Enterobacteriaceae

En este trabajo se evalúa una prueba rápida in house para la detección de enterobacterias sensibles a cefotaxima, basada en el cambio de pH del rojo fenol debido a la hidrólisis de este antibiótico. Las cepas de enterobacterias procedentes de 1.947 urocultivos se evaluaron mediante los paneles MicroScan y esta prueba in house. Mediante los paneles de MicroScan se estudiaron 499 aislados de enterobacterias, entre los cuales había 27 aislados de Escherichia coli productora de β-lactamasa de espectro extendido (BLEE), 16 de Klebsiella pneumoniae BLEE y una de Klebsiella oxytoca BLEE. La prueba in house mostró una sensibilidad del 98% y una especificidad del 97%, con un valor predictivo negativo del 100% y un valor predictivo positivo del 78%. La prueba in house basada en el cambio de pH es útil en nuestro medio para detectar presuntivamente de forma rápida cepas de enterobacterias con cierta resistencia a cefotaxima.

In this work an "in house" rapid test based on the change in pH that is due to hydrolysis for detecting Enterobacteriaceae susceptible to cefotaxime is evaluated. The strains of Enterobacteriaceae from 1947 urine cultures were assessed using MicroScan panels and the "in house" test. This rapid test includes red phenol solution and cefotaxime. Using MicroScan panels, 499 Enterobacteriaceae isolates were evaluated, which included 27 isolates of Escherichia coli producing extended-spectrum beta-lactamases (ESBL), 16 isolates of Klebsiella pneumoniae ESBL and 1 isolate of Klebsiella oxytoca ESBL. The "in house" test offers the following values: sensitivity 98% and specificity 97%, with negative predictive value 100% and positive predictive value 78%. The "in house" test based on the change of pH is useful in our area for detecting presumptively cefotaxime-resistant Enterobacteriaceae strains.

Efectividad y seguridad de cefotaxima como primera línea para el tratamiento intrahospitalario de neumonía asociada a la comunidad no complicada por Streptococcus pneumoniae resistente en niños / Effectiveness and safety of cefotaxime as the first line for the in-hospital treatment of community-associated pneumonia not complicated by resistant Streptococcus pneumoniae in children

Antecedentes: La Neumonía Asociada a la Comunidad (NAC) es una enfermedad resultante de la inflamación del parénquima pulmonar generada por un agente infeccioso fuera del ambiente hospitalario (1). El cuadro clínico se caracteriza por tos, fiebre y signos de consolidación al examen físico, pero puede ser muy variable y mostrar otros síntomas locales como disnea, dolor torácico, expectoración, taquipnea, o generales como fiebre, escalofríos confusión y taquicardia. Cefotaxima es un antibiótico semisintético de amplio espectro, pertenece al grupo de las cefalosporinas de tercera generación. Está indicada para el tratamiento de infecciones de huesos y articulaciones; genitourinarias, del sistema nervioso central, del tracto respiratorio bajo; de la piel y tejidos blandos; ginecológicas, bacteriemia y septicemia; infecciones intraabdominales y profilaxis en intervenciones quirúrgicas con riesgo de contaminación e infección. Evaluación de efectividad y seguridad: Pregunta de evaluación: En niños (menores de 18 años) con neumonía asociada a la comunidad no complicada por Streptococcus pneumoniae resistente, ¿cuál es la efectividad y seguridad de cefotaxima como primera línea de tratamiento intrahospitalario comparada con ceftriaxona, en términos de curación clínica y microbiológica, recaída, mortalidad, estancia hospitalaria y eventos adversos? La pregunta de evaluación fue refinada y validada con base en: autorización de mercadeo de la tecnología para la indicación de interés (registro sanitario INVIMA), listado de medicamentos vitales no disponibles, cobertura de las tecnologías en el Plan Obligatorio de Salud (POS) (Acuerdo 029 de 2011), revisión de grupos terapéuticos (clasificación ATC: Anatomical, Therapeutic, Chemical classification system), recomendaciones de guías de práctica clínica actualizadas, disponibilidad de evidencia sobre efectividad y seguridad (reportes de evaluación de tecnologías y revisiones sistemáticas de la literatura), uso de las tecnologías (listas nacionales de recobro, estadísticas de prescripción, etc), estudios de carga de enfermedad y consulta con expertos temáticos (especialistas clínicos). No se identificaron otros comparadores relevantes para la evaluación. Población: Niños (menores de 18 años) con neumonía asociada a la comunidad no complicada por Streptococcus pneumoniae resistente. Tecnología de interés: Cefotaxima como primera línea de tratamiento intrahospitalario. Metodología: Búsqueda de literatura. Se llevó a cabo una búsqueda sistemática y exhaustiva, con el objetivo de identificar evidencia científica relevante en relación con la pregunta de evaluación. Todo el proceso se acogió a los estándares de calidad internacional utilizados en revisiones sistemáticas de la literatura (16). Las búsquedas fueron llevadas a cabo por personal entrenado. Búsqueda en bases de datos electrónicas: De acuerdo con el tipo de estudios definido en los criterios de elegibilidad, se seleccionaron las siguientes fuentes electrónicas de consulta: MEDLINE (plataforma Ovid), MEDLINE In-Process & Other Non-Indexed Citations (plataforma Ovid), MEDLINE Daily Update (plataforma Ovid), EMBASE.com, The Cochrane Library (plataforma Wiley). Conclusiones: No se identificó evidencia sobre la efectividad y seguridad de la tecnología de interés y su comparador.

[Generalized cutaneous candidiasis in newborn at term]. / Candidiasis cutánea generalizada en recién nacido a término.

INTRODUCTION: Cutaneous candidiasis is a disease that affects children as well as adults. The presentation may be localized or systemic, and with multiple etiological agents. The most prevalent infecting species in children differs from that of the adult. OBJECTIVE: A case is presented where a congenital cutaneous candidiasis was transmitted to the child during birth. MATERIALS AND METHODS: A full term newborn was exposed to a subclinical vaginal candidiasis infection, and 24 hr after birth, developed congenital cutaneous candidiasis. The etiological agent was Candida albicans, and was associated with sepsis and respiratory distress. Blood cultures, cutaneous biopsy of vesicular lesions, blood tests and lumbar puncture were performed. RESULTS: Biochemistry and blood count showed a CRP of 5.7 mg/dl, leukocytosis with left shift and mild anemia. After 24 hr, the blood analyses showed an increase in a CRP (7.8 mg/dl) and increased progressively for three days; consequently, a lumbar puncture was performed. Blood culture was positive for Staphylococcus aureus. Cutaneous biopsy confirmed the cutaneous candidiasis. CONCLUSIONS: The early diagnosis is essential to prevent complications derived by the Candida albicans in newborns.

Spontaneous bacterial peritonitis caused by Listeria monocytogenes: a case report and literature review.

Spontaneous bacterial peritonitis (SBP) is a common and often serious complication of long standing ascites in the presence of advanced liver disease.1 We report a case of a 51- year-old man with alcoholic cirrhosis admitted to our department with jaundice, ascitis and lower limbs edema. A diagnosis of spontaneous bacterial peritonitis was made and empiric therapy with cefotaxime was prescribed with no response. Three days later Listeria monocytogenes was detected in peritoneal fluid culture and amoxicillin was initiated according to in vitro sensibility test. Despite adequate antibiotic therapy, the patient died one week later.

Candidiasis cutánea generalizada en recién nacido a término / Generalized cutaneous candidiasis in newborn at term

Introducción. La candidiasis cutánea es una enfermedad que afecta tanto a población infantil como adulta. Las forma de presentación puede ser localizada o sistémica y el agente etiológico múltiple, siendo las especies infecciosas de Candida albicans más prevalentes en niños. Objetivo. Presentar un caso de candidiasis cutánea congénita cuya causa aparente fue la transmisión vertical durante el parto. Material y metodología. Se describe el caso de un recién nacido a término expuesto a una candidiasis vaginal subclínica, que desarrolló una candidiasis cutánea congénita por C. albicans asociada a sepsis y dificultad respiratoria en las primeras 24 horas de vida. Se practicaron hemocultivos, biopsia cutánea de las lesiones pápulopústulo-vesiculosas, análisis de sangre y punción lumbar. Resultados. En la bioquímica y el hemograma se encontró una proteína C reactiva de 5,7 mg/dl, leucocitosis con desviación a la izquierda y anemia leve. A las 24 horas, en el control se encontró una proteína C reactiva (7,82 mg/dl) que fue en aumento progresivo durante tres días, por lo que se practicó punción lumbar. El hemocultivo fue positivo para Staphylococcus aureus. La biopsia cutánea dio como resultado histológico la candidiasis cutánea. Conclusiones. El diagnóstico precoz es fundamental para prevenir complicaciones derivadas del cuadro producido por C. albicans en neonatos.

Introduction. Cutaneous candidiasis is a disease that affects children as well as adults. The presentation may be localized or systemic, and with multiple etiological agents. The most prevalent infecting species in children differs from that of the adult. Objective. A case is presented where a congenital cutaneous candidiasis was transmitted to the child during birth. Materials and methods. A full term newborn was exposed to a subclinical vaginal candidiasis infection, and 24 hr after birth, developed congenital cutaneous candidiasis. The etiological agent was Candida albicans, and was associated with sepsis and respiratory distress. Blood cultures, cutaneous biopsy of vesicular lesions, blood tests and lumbar puncture were performed. Results. Biochemistry and blood count showed a CRP of 5.7 mg/dl, leukocytosis with left shift and mild anemia. After 24 hr, the blood analyses showed an increase in a CRP (7.8 mg/dl) and increased progressively for three days; consequently, a lumbar puncture was performed. Blood culture was positive for Staphylococcus aureus. Cutaneous biopsy confirmed the cutaneous candidiasis. Conclusions. The early diagnosis is essential to prevent complications derived by the Candida albicans in newborns.

Nefritis aguda focal: caso clínico / Focal acute nephritis: a case report

Focal acute nephritis (FAN) or acute lobar nephronia is a rare clinical picture characterized by an infection localized in the kidney, with an inflammatory mass without liquefaction. Of variable clinical manifestations, diagnosis is achieved through CT scanning. Histologically, unlike acute pyelonephritis, it does not present a diffuse infíltrate. Objective: Case report of FAN in a pediatric patient. Case Report: Ten year old male complaining of abdominal pain, presents painful percussion in the right lumbar fossa. Urinary analysis and culture were negative, renal sonogram was negative. Abdominal CT sean showed múltiple hypodense renal foci. He responded well to cephotaxim, being discharged in the third day of hospitalization with completion of treatment as outpatient. Differential diagnosis with Acute Pyelonephritis is very important, as it requires controlled and opportune treatment to prevent renal absceses. Diagnosis of this pathology must be pursued despite a normal UA.

La nefritis aguda focal o nefronia lobar aguda constituye un cuadro poco común caracterizado por una infección localizada en el riñon, la que corresponde a una masa inflamatoria sin licuefacción. Posee una clínica variable, siendo la tomograña computada (TAC) la prueba más sensible y específica para el diagnóstico de esta enfermedad. Esta patología se diferencia histológicamente de la pielonefritis aguda por no presentar un infiltrado inflamatorio difuso. Objetivo: presentar un caso de nefronia aguda multifocal en un paciente pediátrico. Caso clínico: Escolar de 10 años que consultó por dolor abdominal, al examen destacaba la presencia de percusión dolorosa en fosa lumbar. Los exámenes de orina y urocultivo fueron negativos. Al ingreso no se detectó cambios renales ecográficamente evidenciables. Se realizó un TAC de abdomen que mostraba múltiples focos renales hipodensos. Respondió favorablemente a terapia antibiótica con cefotaxima siendo dado de alta al tercer día, completando terapia en forma ambulatoria. La diferenciación de este cuadro de otros procesos renales como la pielonefritis aguda (PNA) es muy importante, ya que precisa un tratamiento oportuno y controlado por el riesgo de evolucionar a absceso renal. El diagnóstico de esta patología debe ser buscado a pesar de contar con exámenes de orina negativos.

A 7-year-old boy with acute onset of breathing difficulty.

Group A streptococcus (GAS) is a major bacterial pathogen affecting children globally. Approximately 15% of school-age children experience a symptomatic episode of GAS culture-positive pharyngitis each year. Although the incidence of invasive GAS disease under these circumstances is low (0.5%-2%), an increasing number of invasive GAS cases have been reported over the last 2 decades. This report describes a 7-year-old boy who, after being treated for GAS pharyngitis, developed a fatal streptococcal toxic shock syndrome.

[Neonatal meningitis caused by atypical Streptococcus pneumoniae: case report and review]. / Meningitis neonatal por Streptococcus pneumoniae atípico: Reporte de un caso y revisión.

Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis and/or meningitis, but it is associated with substantial morbidity and mortality. Traditionally, S. pneumoniae is identified in the laboratory by demonstrating susceptibility to optochin. However, the emergence of optochin-resistant organisms makes definite identification difficult when only phenotypic tests are taken as markers. We present the case of a severe early-onset neonatal meningitis due to an atypical strain of S. pneumoniae. Laboratory methods utilized to certify this species diagnosis are discussed.

Meningitis neonatal por Streptococcus pneumoniae atípico: Reporte de un caso y revisión / Neonatal meningitis caused by atypical Streptococcus pneumoniae: Case report and review

Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis and/or meningitis, but it is associated with substantial morbidity and mortality. Traditionally, S. pneumoniae is identified in the laboratory by demonstrating susceptibility to optochin. However, the emergence of optochin-resistant organisms makes definite identification difficult when only phenotypic tests are taken as markers. We present the case of a severe early-onset neonatal meningitis due to an atypical strain of S. pneumoniae. Laboratory methods utilized to certify this species diagnosis are discussed.

Streptococcus pneumoniae es una causa infrecuente de infección en el recién nacido y se caracteriza por gran capacidad invasora (sepsis, meningitis) y alta mortalidad. Tradicionalmente, esta bacteria se diagnostica en base a su susceptibilidad a optoquina. Sin embargo, la emergencia de cepas de S. pneumoniae resistentes a optoquina (atípicas) dificulta el diagnóstico sin utilizar varias pruebas diagnósticas, incluyendo las de biología molecular. Se describe el caso de una neonata con infección invasora causada por una cepa de S. pneumoniae atípico y se discuten los métodos empleados para certificar el diagnóstico de esta especie.

A fatal case of community acquired methicillin resistant Staphylococcus aureus brain abscess in a previously healthy adolescent.

A 16-year-old adolescent presented with fever, lethargy and vomiting associated with mild dehydration. This was followed less than 24-hours later by loss of consciousness, seizures and clinical brain death. She had no prior medical illness, no hospital or frequent antibiotic exposure. There was no evidence of soft tissue or skin infection. Management included intravenous fluids, ampicillin and cefotaxime parenterally, dexamethasone, endotracheal intubation and mechanical ventilation. Her neurologic examination remained unchanged with areflexia, flaccid paralysis and fixed pupils. Post-mortem examination revealed an eight-centimetre right fronto-parietal lobe brain abscess. Cultures were positive for methicillin resistant Staphylococcus aureus. Although formerly a nosocomial pathogen affecting debilitated patients in the hospital setting, S aureus that is methicillin resistant is emerging as a community acquired pathogen affecting previously well patients.

A fatal case of community acquired methicillin resistant Staphylococcus aureus brain abscess in a previously healthy adolescent / Un Caso Fatal de Estafilococo Dorado Resistente a la Meticilina, Adquirido en la Comunidad, por una Adolescente Previamente Sana

A 16-year-old adolescent presented with fever, lethargy and vomiting associated with mild dehydration. This was followed less than 24-hours later by loss of consciousness, seizures and clinical brain death. She had no prior medical illness, no hospital or frequent antibiotic exposure. There was no evidence of soft tissue or skin infection. Management included intravenous fluids, ampicillin and cefotaxime parenterally, dexamethasone, endotracheal intubation and mechanical ventilation. Her neurologic examination remained unchanged with areflexia, flaccid paralysis and fixed pupils. Post-mortem examination revealed an eight-centimetre right fronto-parietal lobe brain abscess. Cultures were positive for methicillin resistant Staphylococcus aureus. Although formerly a nosocomial pathogen affecting debilitated patients in the hospital setting, S aureus that is methicillin resistant is emerging as a community acquired pathogen affecting previously well patients.

Una adolescente de 16 años de edad se presentó con fiebre, letargia y vómitos, asociados con deshi-dratación ligera. Estos síntomas fueron seguidos en menos de 24 horas por pérdida de conciencia, ataques y muerte clínica del cerebro. Con anterioridad, la paciente no había tenido enfermedad médica, ni hospitalización, ni tratamiento frecuente con antibióticos. No había evidencia de tejidos blandos o infección de la piel. El tratamiento incluyó líquidos intravenosos, ampicilina y cefotaxima de forma parenteral, dexametasona, entubación endotraqueal, y ventilación mecánica. El examen neurológico permaneció invariable con areflexia, parálisis flácida, y pupilas fijas. El examen post-mortem reveló un absceso cerebral de ocho centímetros en el lóbulo fronto-parietal derecho. Los cultivos resultaron positivos al Staphylococcus aureus resistente a la meticilina. Aunque visto an-teriormente como un patógeno nosocomial que afecta a los pacientes debilitados en el entorno hos-pitalario, el S aureus resistente a la meticilina está surgiendo como un patógeno extrahospitalario (ie adquirido en la comunidad) y afecta a pacientes previamente sanos. 1Equivalente acuñado aquí para el término inglés caseness, a saber, criterios que definen el estatus de caso sobre la base de la presencia de sintomatologia clinicamente significativa.

Risk factors for mortality in Paraguayan children with pneumococcal bacterial meningitis.

BACKGROUND: Over the last decade Streptococcus pneumoniae has emerged as the most common bacterial pathogen for meningitis in all age groups, beyond the neonatal period. OBJECTIVE: To determine the epidemiological and clinical characteristics; and risk factors for mortality of pneumoccocal meningitis in children in a developing transitional country. MATERIALS AND METHODS: A retrospective study that included patients<15 years of age admitted at the Instituto de Medicina Tropical of Paraguay, from January 1990 until December 2003 with the diagnosis of bacterial meningitis caused by S. pneumoniae. Clinical and laboratory data were collected and analysed in order to identify risk factors associated with morbidity and mortality outcomes of this infection. RESULTS: Seventy-two patients (between the ages of 35 days and 14 years) were identified. Forty-two per cent of patients had seizures prior to or at the time of admission, 36% were admitted in a comatose state, and 19% with shock. Mortality was 33% (24/72), and 18% of the survivors (11/60) developed severe sequelae. Upon admission, the following variables were strongly correlated with mortality: age<12 months (P=0.007), the presence of seizures (P=0.0001) or development of seizures 48 h after admission (P=0.01), a cerebrospinal fluid (CSF) glucose level of <10 mg/dl (P=0.01), CSF albumin>200 mg/dl (P=0.0003), an absolute blood neutrophil count<2000/mm3 (P=0.006) and a haemoglobin value of <9 g/dl (P=0.0001). CONCLUSIONS: This study confirms the high morbidity and mortality associated with S. pneumoniae meningitis in Paraguay. Certain clinical parameters and laboratory findings in blood and CSF at the time of admission could be used as predictors for mortality or severe sequelae among survivors.

[Incidence of infected surgical wound and prophylaxis with cefotaxime in cesarean section]. / Incidencia de herida quirúirgica infectada y profilaxis con cefotaxima en cesárea.

BACKGROUND: Surgical wound infection after cesarean section varies from 2.5 to 16.1%, thus the utilization of antibiotic prophylaxis has increased routinely and irrationally. Despite this, we can still see cases of infections. OBJECTIVE: To determine if the antibiotic prophylaxis with cefotaxime is associated with the decreased incidence of wound infection in patients submitted to cesarean section without risk factors. PATIENTS AND METHODS: This study was carried out as a randomized clinical trial in patients submitted to cesarean section. Two groups were formed: in the first group we administered cefotaxime and the other one did not receive prophylaxis. The follow-up lasted 30 days to evaluate clinical data of infection. RESULTS: We performed 3,300 cesarean in the studied period; 1,000 patients had the inclusion criteria to participate in the study. A surgical wound infection was observed in 31 (0.96%) patients without risk factors. In 14 of these patients we administered cefotaxime, and in 17 patients we did not use prophylaxis. The highest frequency of infection was observed in the group of 24 to 30 years old, with 16 patients (51.6%). The clinical data of infection were: dehiscence in 29 patients (93.5%), pus secretion in 23 (74.2%), and fever in only 3 (9.7%) of them. The hospital stay after the infection was of five days in 75% of the cases. When the use of cefotaxime as prophylaxis was analyzed in both groups we had an odds ratio of 0.82, which was not significant. DISCUSSION: The use of cefotaxime in patients operated of cesarean does not have great transcendence since it does not reduce the infection incidence. The use of antibiotics in an irrational way implies a high cost, since the majority of the post-operation infections are not complicated, involving exclusively the skin and cellular subcutaneous tissue. Then, the cases with risk factors should be analyzed carefully for the cefotaxime administration.

Pharmacokinetics and clinical efficacy of cefotaxime for the treatment of septicaemia in dogs.

Considering the already known pharmacological features of cefotaxime, a study with two approaches of pharmacokinetics and clinical efficacy in septicaemic dogs was carried out. Pharmacokinetic variables were defined for doses of 10 mg/kg, and 20 mg/kg, utilising a quantitative bacteriological analysis. Values for half-life (T1/2 beta) at 10 mg/kg were 0.8, 1.48 and 1.52 h for the i.v., s.c. and i.m. routes, respectively. Corresponding values for the 20 mg/kg dose for the same routes were 0.8, 1.49 and 1.53 h, respectively. Relatively fast clearance (ranging from 0.58 to 0.64 L/kg/h) allowed a maximum dose interval of 12 h. The above-stated doses of cefotaxime were administered i.v. to 40 cases of septicaemia, clinically divided into 20 moderately severe cases treated with 10 mg/kg i.v., of cefotaxime bid, and 20 severe ones, treated with 20 mg/kg i.v. of cefotaxime bid. Injections continued until a previously defined criterion of 'clinically recovered' was obtained. Thereafter, a follow-up treatment was established using the same dose and dose-interval but through the s.c. route. Due to the apparent volumes of distribution obtained (ranging from 0.48 to 0.51 L/kg), considering the overall clinical efficacy obtained (90% for the 10 mg/kg dose and 75% for the 20 mg/kg dose), and due to the rapid improvement observed after a few doses of the drug (1.8 to 2.5 doses to 'clinical improvement'), it is safe to postulate such doses of cefotaxime as excellent choices for the treatment of septicaemia in dogs.

Fulminant Listeria monocytogenes meningitis complicated with acute hydrocephalus in healthy children beyond the newborn period.

We describe 3 previously healthy Costa Rican children who had Listeria monocytogenes meningitis, an uncommon cause of bacterial meningitis beyond the newborn period in normal subjects. Two of them had initial normal brain computed tomography, but all 3 developed acute hydrocephalus at days 7, 3, and 5, respectively. All required immediate ventriculostomy placement and only 1 of 3 survived. L. monocytogenes should be considered among the etiologies of bacterial meningitis in children who do not respond initially to conventional antimicrobial treatment or who deteriorate rapidly.