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.

Objective: To determine the incidence, as well as the implicated serotypes and patterns of antibiotic resistance of Streptococcus pneumoniae meningitis in Spanish children.

Material and method: We performed a prospective, multicenter study in five Autonomous Communities (Catalonia, Galicia, Madrid, Navarre and the Basque Country) for 1 year (1 February 2000 31 January 2001). All children aged 0-14 years with pneumococcal meningitis from all the hospitals in the Autonomous Communities studied were included. Diagnosis was based on clinical findings and isolation of S. pneumoniae in the cerebrospinal fluid/blood using routine methods or polymerase chain reaction. Serotyping was performed using the guellung reaction and/or immunoblotting and susceptibility to antibiotics was evaluated by the technique of agar dilution. The pediatric population aged 0-14 years in the Autonomous Communities studied comprises 2,290,304 children.

Results: Fifty-two cases were identified. One patient was aged less than 2 months old, 25 (48 %) were aged 2-12 months, and 12 patients (23 %) were aged 12-24 months. The annual incidence per 100,000 children aged between 1 and 2 years was 17.75 cases (95 % CI: 11.59 26.01) and 8.39 cases (95 % CI: 4.67 15.79) respectively, and that for children in the first 2 and 5 years of life was 13.13 (95 % CI: 9.29 18.02) and 6.29 (95 % CI: 4.57 8.,45) cases respectively. Nearly half the strains isolated (47.6 %) showed reduced sensitivity to penicillin. The most frequent serotype was 19F (12 cases [28.6 %]). Eighty percent of the isolated serotypes were included in the formula of the heptavalent conjugate vaccine.

Conclusions: The incidence of pneumococcal meningitis in children from five Spanish Autonomous Communities is high, nearly twice that found in a prior retrospective studied performed in the same population 1-3 years previously. Almost all the isolated serotypes were included in the heptavalent conjugate vaccine. Half the strains showed reduced sensitivity to penicillin.