Anales Espanoles De Pediatria最新文献

Background: Streptococcus pneumoniae causes significant morbidity in children, but data on the incidence of invasive pneumococcal disease in Spain are scarce. The objectives of this study were: 1) to describe the clinical and epidemiological features of invasive pneumococcal disease in our health district and 2) to determine factors predictive of invasive pneumococcal disease in febrile children seen at a hospital Emergency Department.

Material and methods: Design. Observational, retrospective, case-control study, from 1 October, 1992 to 31 March, 2001.

Location: Community Hospital in the north of Spain. Entry criteria for cases: febrile children under 14 years of age, seen at the Emergency Department during the study period, with growth of S. pneumoniae in the blood culture. Eligibility criteria for controls: febrile children under the age of 14 years seen at the Emergency Department during the study period with no bacterial growth in the blood culture. The first eligible child seen after each case was included as a control.

Statistical analysis: descriptive analysis of patients with invasive pneumococcal disease and univariate analysis of each variable in relation to the dependent variable (blood culture positive for S. pneumoniae); multivariate analysis was performed using logistic regression techniques.

Results: Seventy-six cases of invasive pneumococcal disease were studied. The mean incidence of invasive pneumococcal disease (cases/100,000 children/year) was 174.1 for children under 24 months of age, 38.9 for children aged 24-59 months, and 5.9 for children older than 59 months. The incidence of pneumococcal meningitis in children under 24 months of age was 14.8 cases/100,000 children/ year. The most common diagnoses were occult bacteremia (64.5 %), pneumonia (17.1 %), and meningitis (9.2 %). Mortality was 1.3 %. A total of 56.5 % of the S. pneumoniae strains showed penicillin resistance (11.8 % high-grade resistance) and 12.2 % showed cefotaxime resistance. Predictive factors for invasive pneumococcal disease were temperature greater than or equal to 39 degrees C (OR: 2.09; 95 % CI:91-4.79), generalized malaise (OR: 2.61; 95 % CI: 1.1-6.21), age between 6 and 36 months (OR: 4.06; 95 % CI: 1.79-9.21), and absolute neutrophil count (ANC) greater than or equal to 10,000 cells/mm3 (OR: 8.16; 95 % CI: 3.54-18.79).

Conclusions: 1. The incidence of invasive pneumococcal disease in our health district is high and is greater than that reported for other European regions. 2. In contrast, the incidence of pneumococcal meningitis is similar to that in other European countries. 3. The most frequent diagnosis was occult bacteremia. 4. In the case-control study, four variables showed significant independent association with the risk of invasive pneumococcal disease: temperature greater than or equal to 39 degrees C, gener

Objective: To investigate the incidence and characteristics of lymphoproliferative disorders of Waldeyer's ring in our pediatric patients.

Material and methods: We retrospectively reviewed 20 children under 14 years of age who underwent surgery in our department for adenoidectomy and/or tonsillectomy between 1 January 1996 and 30 November 2000. In non-immunocompromised children, surgical indication was the recent development of progressive unilateral tonsillar hyperplasia, and in immunocompromised patients indication was mainly the enlargement of adenoids and/or tonsils, although eradication of local Ebstein-Barr virus infection and recurrent acute tonsillitis were also indications.

Results: The mean age was 4.6+/-2.3 years (range: 16.9 months-13.9 years). Sixteen patients (80.0 %) were male. In the nine patients with unilateral hyperplasia, histopathological diagnosis was diffuse lymphoid hyperplasia. Of the 11 immunocompromised patients, 5 (45.5 %) had some type of lymphoproliferative disorder.

Discussion and conclusions: Lymphoproliferative disorders of Waldeyer's ring are relatively frequent in immunocompromised children who have undergone surgery of the adenoids and/or tonsils. Although no cases of unilateral hyperplasia of the tonsils were diagnosed in our series, tonsillectomy is indicated in patients with this diagnosis, independent of their immunological status.

Periodic fever can be defined as recurrent episodes of fever lasting from a few days to several weeks separated by symptom-free intervals of variable duration, recurring throughout several months. Although these clinical pictures are unusual in clinical practice, in some instances the differential diagnosis with recurrent infections, malignancies and connective tissue diseases is difficult. The aim of this review is to group together these different clinical pictures, which are dispersed in the literature, to obtain an overall and detailed perspective.We classified these processes in two categories: hereditary (familial Mediterranean fever, hyper-IgD syndrome, tumor necrosis factor-receptor-associated periodic syndrome, Muckle-Wells syndrome and familial cold urticaria) and non-hereditary (periodic fever, aphthous stomatitis, pharyngitis, and adenopathy syndrome [PFAPA syndrome], cyclic neutropenia, chronic infantile neurological cutaneous and articular syndrome [CINCA syndrome], Castleman's disease, early onset sarcoidosis and Blau syndrome). Although diagnosis is essentially clinical, in recent years many advances have been made in the knowledge of the molecular and genetic bases of hereditary diseases, which may be of considerable help in establishing the diagnosis and improving treatment.

Vibrio cholerae sepsis is infrequent, especially in neonates although sporadic cases have been reported in older patients. We report the case of a neonate who was admitted to the intensive care unit for hypovolemic shock secondary to diarrhea caused by V. cholerae that developed into bacteremia. The predisposing factors were low socioeconomic status, home delivery, delayed presentation at the health center, and active maternal gastrointestinal infection with V. cholerae. The organism identified in blood and feces culture was identified as V. cholerae 0 -1, biotype Thor, serotype Ogawa, which correlated with the clinical presentation.

Background: Since March 2000, a series of infants with serious gastrointestinal and neurological symptoms have been observed in Spain. These symptoms were suspected to be associated with the use of star anise infusion. We performed an epidemiological study to determine the characteristics of these patients and to evaluate the association between the symptoms and anise consumption.

Method: From February to September 2001, a matched case-control study (1:2) was performed among infants aged less than 3 months admitted to the pediatric emergency departments of two hospitals in Madrid. Mantel-Haenszel and conditional logistic regression odds ratios (OR) were calculated to quantify the association and the dose-response relationship. Laboratory analyses of the implicated substances were performed.

Results: Twenty-three cases were studied. The mean age was 29.2 days (SD: 25.5). The symptoms observed were irritability, abnormal movements, vomiting and nystagmus. Eighteen cases and 36 controls were included in the case-control study. Nine controls (25 %) consumed anis infusion (consumption was high in five and low in four). The Mantel-Haenszel OR was 18.0 (2.03-631) and the OR for the dose-response relationship was 11.7 (95 % CI: 1.3-188.5) for low levels of consumption and 18.2 (95 % CI: 1.8-183.5) for high levels. Laboratory analyses revealed contamination of Illicium verum by Illicium anisatum.

Conclusions: This study confirms the association between the symptoms described and the use of anise infusion. The dose response analyses provide further evidence for the association. Cross-contamination was found between the product and other anise species. We recommend destruction of the contaminated products, avoidance of anise infusions among infants, and dissemination of the results among pediatricians.

Background: Streptococcus pneumoniae is the most commonly reported bacterial cause of bacteremia and bacteremic pneumonia and the second most frequent cause of meningitis.

Objective: To establish the incidence, characteristics and serotypes causing invasive pneumococcal disease in children aged less than 5 years in two Autonomous Communities in Spain, the Basque country and Navarre, between 31 May 1988 and 1 June 2001.

Patients and methods: We performed a descriptive, observational and retrospective study. The study population was composed of children diagnosed with invasive pneumococcal disease in the public and private hospitals with a pediatrics departments. Invasive pneumococcal disease was defined as isolation of S. pneumoniae in blood, cerebrospinal fluid or any other sterile biological fluid. Medical records were reviewed and demographic and diagnostic variables were analyzed. Age-adjusted frequency rates were established for both regions using direct standardization. Confidence intervals were obtained by Poisson distribution. SPSS for Windows 10.0 and Epidat 2.1 were used for the analysis. Data were obtained from the 1999 municipal population census.

Results: One hundred seventy-one children aged 0-5 years were included. A total of 40.9 % (70 patients) were aged less than 12 months and 68.4 % were aged 0-2 years; 16.4 % had received drug therapy before diagnosis. The most common forms of presentation were occult bacteremia (45.6 %), bacteremic pneumonia (27.5 %) and meningitis (14.6 %). The most frequent complications involved the respiratory tract, with pleural effusion in 23 % of cases of pneumonia. The standardized annual incidence rate of invasive pneumococcal disease (cases per 100,000) in children aged 0-59 months was 58.82 (95 % CI: 27.99-89.65) in Navarre and 55.35 (95 % CI: 38.81-71.88) in the Basque Country. In children aged 0-23 months, the overall incidence was 93.49 cases per 100,000 children (95 % CI: 77.32-112.04) and in infants aged 0-11 months, it was 110,21 cases per 100,000 children (95 % CI: 85.91-139.24). The incidence rates for meningitis and bacteremia in children aged 0-23 months was 15.98 (95 % CI: 9.76-24.68) and 51.14 (95 % IC: 39.38-65.30) cases per 100.000 children. Fifty-nine strains were serotyped. The most frequent serotypes/groups were 1, 4, 6B, 14, 18C, 19 and 23F. A total of 52.15 % of the serotypes were penicillin-susceptible and 93 % were cefotaxime-susceptible. The serotypes/groups with the highest rates of resistance were 6B, 14,19, 23F and 35.

Conclusion: Our incidence rates are similar to those observed in other countries such as the United States and are higher than those reported for the rest of Europe. Vaccine coverage is similar to that described in other articles.