RESUMEN
Wide spectrum of infectious causes should be considered while diagnosing febrile states in infants.The aim of study is to present the case of 3-month-old infant with febrile states. Boy was admitted to Department of Pediatrics to Infant Unit because of the febrile states lasting for 4 weeks. Perinatal history: first pregnancy, cesarean section in 39 weeks of gestation due to mother's pointed condyloma, birth weight 3140 g, Apgar score 10 in first minute. There was no information about the course of pregnancy, mother's diseases, father was unknown. The child was ambulatory cured with several antibiotics because of the respiratory tract infections. On admission to hospital the general status of the infant was quite good, there was respiratory tract infection, hepatomegaly, and aphthae found in physical examination. Increased levels of inflammation markers and elevated activity of liver enzymes were observed in laboratory tests. Perihilar inflammatory density was found in chest radiogram. After finishing pharmacological treatment there were no pathological changes on auscultation of the lungs. The hospital course was complicated with Rotaviral infection. As the febrile states and hyperactivity of liver enzymes persisted, the diagnostics was extended. There was sepsis, neuroinfection, number of bacterial and viral infections excluded. There was also urine collected for the levels of catecholamines, the result was normal. Due to reverse proportion of the CD4 and CD8 lymphocytes, persistent active CMV infection and clinical status of the child, HIV test was performed. There was confirmed presence of p24 antigen of HIV in immunological test. The child was transfered to Child's Infectious Diseases Unit of Stefan Zeromski Hospital in Cracow to verify the result of laboratory test and start therapy.
Asunto(s)
Fiebre/etiología , Seropositividad para VIH/complicaciones , Seropositividad para VIH/diagnóstico , Hepatomegalia/diagnóstico , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/diagnóstico , Preescolar , Diagnóstico Diferencial , Hepatomegalia/etiología , Humanos , Masculino , Infecciones por Rotavirus/complicaciones , Infecciones por Rotavirus/diagnósticoRESUMEN
Bronchoalveolar lavage taken from 46 patients (ranging in age from 21 to 71 years, mean 50.6 +/- 13.9) was examined for aerobic and anaerobic bacterial flora. Sera taken from 39 of patients as well as sera taken from 25 healthy blood donors of similar age (P = 0.99) were examined to determine IgG and IgA antibodies to C. pneumoniae. Bacterial flora was routinely cultured and determined using ATB computer system (bioMérieux,). IgG and IgA antibodies were tested by the enzyme immunoassays (Labsystems, Finland, Helsinki). Sera containing anti -C. pneumoniae IgG antibodies with titers of 45 EIU or higher and IgA with titers of 12 EIU or higher were considered positive. 143 of aerobic and 74 of anaerobic bacterial strains were cultured. Streptococci group viridans, pneumococci, enteric bacilli, Haemophilus spp., Prevotella spp., Actinomyces spp., Bifidobacterium spp. and Veilonella spp. were most often cultured. 66.6% of patients had IgG or IgA antibodies, in contrast, to the control group in which 60.0% and 44.0% of examined blood donors had IgG and IgA antibodies respectively. COPD patients were more frequently positive for specific anti-C. pneumoniae antibodies than the healthy donors (p = 0.003). The difference in a seropositivity rate of specific IgA and IgG antibodies was significant (p = 0.00002 and p = 0.003 respectively). Bronchoalveolar lavage of patients suffering from COPD can be contaminated with high number of aerobic and anaerobic bacterial species, and immunological status of the patients indicated persistent infection caused by C. pneumoniae more often than in controls.