Anales Espanoles De Pediatria最新文献

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.

Aim: To report the epidemiology, clinical features, management and complications of orbital and periorbital cellulitis; to evaluate the use of imaging tests in the detection of complications.

Methods: Retrospective study of 107 pediatric patients admitted to the San Joan de Déu Pediatric Hospital with orbital or periorbital cellulitis from January 1991 to January 1999.

Results: The incidence of cellulitis was highest in the second year of life and during winter. No significant differences were found between the sexes. In 68 patients (63.6%) the cause of cellulitis was identified as sinusitis. The most frequently identified organisms were Staphylococcus aureus, Streptococcus pneumoniae and S. pyogenes. Computed tomography identified retroseptal damage in 36 patients with 23 super osteal abscesses, 3 orbital abscesses and 3 intracranial complications. Sixty nine percent of the patients were treated with a single antibiotic (cefotaxime, cefuroxime or amoxicillin clavulanic acid) while 31% underwent multiple antibiotic therapy. Only 8.4% required surgery.

Conclusions: Orbital cellulitis is a relatively common and potentially serious disease in children. The early use of CT to assess the extent of damage is important in establishing prognosis and in assessing the need for surgical therapy.

We report a new case of monosomy r13 in a male newborn infant with prenatal diagnosis. He was the fourth child of a healthy couple of normal lineage. On physical examination typical dysmorphism and multiple congenital anomalies were found. Chromosome analysis revealed a 46, XY, r(13) (p11.2q32) /45, XY,13 karyotype. Our observations are almost identical to those of previously published reports and confirm that the clinical severity of the symptoms depends on the location of the chromosome breakpoint. The clinical and cytogenetics features of this disorder are reviewed.