RESUMEN
A 3-month-old, full-term female infant was hospitalized with pneumonia and bronchiolitis. Laboratory studies revealed a profoundly low level of IgG (41 mg/dL) and low level of IgA (< 6.67 mg/dL). Other causes of immunodeficiency were ruled out, and there was no evidence of protein loss to account for the low immunoglobulin levels. The immunoglobulin levels normalized over time. Our patient had a transient hypogammaglobulinemia of infancy, with severely low IgG and low IgA levels. We found no other reports of cases with such low values of IgG that proved to be transient.
Asunto(s)
Agammaglobulinemia/inmunología , Inmunoglobulina A/análisis , Inmunoglobulina G/análisis , Femenino , Humanos , Deficiencia de IgA , Deficiencia de IgG , Inmunoglobulina M/análisis , Lactante , Remisión Espontánea , Factores de TiempoRESUMEN
Hyperimmunoglobulin E syndrome (HIE) is a disorder characterized by extremely elevated serum levels of IgE and recurrent infections. Patients are particularly predisposed to have staphylococcal abscesses, usually involving skin, lungs, and joints; but they are also at risk for infections with other bacteria and fungi. We report the case of a 46-month-old boy with HIE who had Candida endocarditis and sepsis with a large fungal mass extending through the tricuspid valve and into the surrounding heart tissue, requiring surgical excision and replacement with a prosthetic valve. He had an indwelling central line for previous antibiotic therapy and had oral thrush for a month before presentation, which had been treated with oral nystatin. He was first seen with very dark urine, a new murmur, petechial rash, in shock, and disseminated intravascular coagulation. The white blood cell count was 38,700 with 70% segmented neutrophils, 9% banded neutrophils, 15% lymphocytes, 4% monocytes, and 2% eosinophils. Hemoglobin was 7.1, and platelet count was 14,000. Prothrombin time was 15.5, and partial thromboplastin time was 31; fibrinogen level was 110 mg/ml, and fibrin degradation products were greater than 40 mg/ml. Serum IgE was 38,664 and 44,510 on repeat measurement. He has had recurrent staphylococcal pneumonias with pneumatoceles, twice requiring segmental lung resection. Blood and tricuspid valve cultures grew Candida albicans. He was treated with amphotericin and flucytosine, and later switched to fluconazole, with good response to therapy. A literature search revealed no other reported case of Candida endocarditis in patients with HIE. Fungai endocarditis is a rare complication, which may occur in patients with HIE and indwelling central catheters.
Asunto(s)
Candidiasis/inmunología , Endocarditis/inmunología , Endocarditis/microbiología , Síndrome de Job/microbiología , Preescolar , Endocarditis/tratamiento farmacológico , Humanos , Hipergammaglobulinemia/tratamiento farmacológico , Hipergammaglobulinemia/inmunología , Hipergammaglobulinemia/microbiología , Inmunoglobulina E/biosíntesis , Síndrome de Job/tratamiento farmacológico , Síndrome de Job/inmunología , MasculinoRESUMEN
Management of chronic asthma has changed significantly in recent years. Most of the changes in management are the result of an increased recognition of the importance of the inflammatory component in the pathogenesis and treatment of asthma. The National Heart, Lung, and Blood Institute issued guidelines for the management of asthma in 1991. Beta agonists, cromolyn and nedocromil are mainstays of treatment in patients with mild to moderate asthma. Inhaled steroids are useful in the treatment of patients with moderate to severe asthma. Nonpharmacologic management of asthma includes avoidance of allergens and irritants, the use of peak flow meters, and patient and family education.
Asunto(s)
Asma/terapia , Enfermedad Aguda , Asma/tratamiento farmacológico , Asma/fisiopatología , Niño , Preescolar , Enfermedad Crónica , Árboles de Decisión , Humanos , Lactante , Calidad de Vida , Índice de Severidad de la EnfermedadRESUMEN
Allergy to insect venom is a major health problem for a significant number of people. Immunotherapy can reduce the risk of subsequent reaction from about 60% to less than 5%. Standard preventive care should include (1) advice concerning avoidance of insects, (2) prescription of an epinephrine kit or syringe for self-administration (unless medically contraindicated), and (3) referral for evaluation. Results of several studies from various regions of the country raise concern about the preventive care and advice given these patients and suggest a need for continuing medical education to improve preventive management of allergy to insect stings.