RESUMO

Introducción: La hepatoesplenomegalia es el agrandamiento simultaneo del hígado y del bazo, aunque es frecuente en edad pediátrica su literatura se centra en causa infecciosa, siendo también importante otras causas sobre todo en el paciente afebril Método: revisión de literatura actual confrontando con artículos de revisiones de temas en búsqueda electrónica en bases de datos de RIMA, MEDLINE, PUB-MED, MEDSCAPE, de 1981 a 2018. Resultados: La hepatomegalia en paciente afebril se puede encontrar en afectación sistémica o enfermedades hereditarias, algunas prevalentes o extremadamente raras, por lo cual se desarrolló esta revisión para agrupar las causas de esta en un paciente pediátrico afebril.

Introduction: Hepatosplenomegaly is the simultaneous enlargement of the liver and spleen, although it is frequent in pediatric age, its literature focuses on an infectious cause, and other causes are important, especially in the afebrile patient. Method: review of current literature comparing articles from subject reviews. in electronic search in RIMA, MEDLINE, PUB-MED, MEDSCAPE databases, from 1981 to 2018. Results: Hepatomegaly in afebrile patient can be found in systemic involvement or hereditary diseases, some prevalent or extremely rare, for which reason developed this review to group the causes of this in an afebrile pediatric patient.

Assuntos

RESUMO

OBJECTIVE: To compare the risk of serious bacterial infection between infants aged ≤60 days who are febrile in the emergency department (ED) and those who have only a history of fever and are afebrile on arrival to the ED. STUDY DESIGN: In this secondary analysis of a multicenter prospective study using data collected between December 2008 and May 2013, we compared the rate of serious bacterial infection (urinary tract infection [UTI], bacteremia, and/or bacterial meningitis) between infants who have a history of fever but are afebrile on arrival to the ED and those with fever documented in the ED (rectal temperature ≥38.0 °C) using relative risk (RR) with 95% CI. Stratified analyses were performed for age (≤28 and 29-60 days) and serious bacterial infection type. Infants born prematurely and those with a clinical focal infection or serious illness were excluded. RESULTS: A total of 3825 infants (mean age, 35.2 days; 56.9% male) were included. Of the 1233 (32.2%) who were afebrile in the ED, 108 (8.8%) had a serious bacterial infection (UTI, n = 94 [7.6%]; bacteremia, n = 19 [1.5%]; bacterial meningitis, n = 8 [0.6%]). Of the 2592 infants (67.8%) who were febrile in the ED, 331 (12.8%) had a serious bacterial infection (UTI, n = 285 [11.0%]; bacteremia, n = 61 [2.4%]; bacterial meningitis, n = 17 [0.7%]). The RR for serious bacterial infection for afebrile vs febrile infants was 0.68 (95% CI, 0.56-0.84). A lower risk of serious bacterial infection was also seen among afebrile vs febrile infants aged ≤28 days (RR, 0.69; 95% CI, 0.52-0.93) and age 29-60 days (RR, 0.67; 95% CI, 0.50-0.89). CONCLUSIONS: The prevalence of serious bacterial infection is lower in infants aged ≤60 days with a history of fever compared with those who are febrile on arrival to the ED. The small risk reduction in this group is unlikely to alter decision making.

Assuntos

RESUMO

El Rotavirus es causa habitual de diarrea grave en niños pequeños a nivel mundial. Las manifestaciones clínicas incluyen: diarrea líquida, fiebre, y vómitos, llevando a estados de deshidratación y típica gastroenteritis; además pueden presentar múltiples complicaciones neurológicas, como convulsiones febriles o afebriles. La prevalencia real de estas convulsiones oscilaría entre el 2 y 6%. La fisiopatología de las mismas es aún incierta, pero se han propuesto teorías que intentan explicar un posible mecanismo, entre las que estarían involucrados factores genéticos, raciales, distribución de serotipos, factores pro-convulsivos e incluso alteraciones de la barrera hematoencefálica. Si bien este es un síndrome cuya etiología no es única, se tomará en cuenta la infección por rotavirus ya que este se ha identificado con mayor frecuencia, sobre todo en pacientes afebriles, evitando así procedimientos e intervenciones innecesarias para su diagnóstico.

The Rotavirus is common cause of severe diarrhea in young children worldwide. Clinical manifestations include: liquid diarrhea, fever, and vomiting, leading to states of dehydration and typical gastroenteritis; In addition, they may present multiple neurological complications, such as febrile seizures or afebrile seizures. The actual prevalence of these seizures would range between 2 and 6%. Their pathophysiology is still uncertain, but theories have been proposed that try to explain a possible mechanism, including genetic factors, racial, serotype distribution, pro-convulsive factors and even alterations of the blood-brain barrier. Although this is a syndrome whose etiology is not unique, rotavirus infection will be taken into account since it has been identified more frequently, especially in afebrile patients, thus avoiding unnecessary procedures and interventions for its diagnosis.

Assuntos

RESUMO

Neurocysticercosis (NCC) is one of the major causes of childhood seizures in developing countries including India and Latin America. In this study neurological pediatric cases presenting with afebrile seizures were screened for anti-Cysticercus antibodies (IgG) in their sera in order to estimate the possible burden of cysticercal etiology. The study included a total of 61 pediatric afebrile seizure subjects (aged one to 15 years old); there was a male predominance. All the sera were tested using a pre-evaluated commercially procured IgG-ELISA kit (UB-Magiwell Cysticercosis Kit ™). Anti-Cysticercus antibody in serum was positive in 23 of 61 (37.7%) cases. The majority of cases with a positive ELISA test presented with generalized seizure (52.17%), followed by complex partial seizure (26.08%), and simple partial seizure (21.73%). Headaches were the major complaint (73.91%). Other presentations were vomiting (47.82%), pallor (34.78%), altered sensorium (26.08%), and muscle weakness (13.04%). There was one hemiparesis case diagnosed to be NCC. In this study one child without any significant findings on imaging was also found to be positive by serology. There was a statistically significant association found between the cases with multiple lesions on the brain and the ELISA-positivity (p = 0.017). Overall positivity of the ELISA showed a potential cysticercal etiology. Hence, neurocysticercosis should be suspected in every child presenting with afebrile seizure especially with a radio-imaging supportive diagnosis in tropical developing countries or areas endemic for taeniasis/cysticercosis.

Neurocisticercose é uma das causas mais comuns de crises em crianças em países em desenvolvimento incluindo Índia e América Latina. Neste estudo casos neurológicos pediátricos, apresentando crises afebris foram selecionados através de anticorpos anti-Cysticercus (IgG) no seu soro para avaliar possível etiologia de Cysticercus. O estudo incluiu total de 61 casos pediátricos de indivíduos com crises afebris (idade de um a 15 anos); houve predominância de pacientes do sexo masculino. Todos os soros foram testados usando um kit comercial IgG-ELISA (UB-Magiwell Cysticercosis kit™) avaliado previamente. O anticorpo anti-Cysticercus no soro foi positivo em 23 de 61 casos (37,7%). A maioria dos casos com teste de ELISA positivo apresentava crises generalizadas (52,17%), seguida por casos de crises parciais complexas (26,08%) e crises parciais simples (21,73%). Dores de cabeça foram a queixa principal (73,91%). Outras manifestações foram vômitos (47,82%), palidez (34,78%), sensório alterado (26,08%) e fraqueza muscular (13,04%). Houve um caso de hemiparesia diagnosticado como NCC. Neste estudo uma criança sem quaisquer achados significantes às imagens apresentou sorologia positiva. Houve associação estatística significante entre os casos com múltiplas lesões no cérebro e a positividade pelo ELISA (p = 0,017). No seu conjunto a positividade pelo ELISA demonstra etiologia potencial para a cisticercose. Portanto neurocisticercose deve ser suspeitada em qualquer criança apresentado crises afebris com imagem que sugira diagnóstico em países tropicais em desenvolvimento ou em áreas endêmicas para teníase/cisticercose.

Assuntos

RESUMO

La gastroenteritis por rotavirus es la más frecuente de las diarreas infecciosas y ocasiona una importante morbimortalidad en los niños pequeños, además de deshidratación grave y desequilibrios electrolíticos; los signos extraintestinales son infrecuentes. Recientemente se han comunicado convulsiones afebriles asociadas con gastroenteritis por rotavirus, sin encefalopatía, deshidratación, desequilibrio electrolítico o hipoglucemia. Comunicamos el caso de un paciente con convulsiones durante una gastroenteritis por rotavirus, una infección habitual en nuestro país (Turquía), con diversas manifestaciones clínicas, entre ellas, las convulsiones, que pueden verse no sólo en los niños con enfermedades neurológicas o sistémicas sino también en los niños sanos.(AU)

Rotavirus is the most common infectious diarrhea that causes important mortality and morbidities in small children, severe dehydration and electrolyte imbalance. Extraintestinal signs are rare in rotavirus infections. Recently, afebrile seizures associated with rotavirus gastroenteritis but without encephalopathy, dehydration, electrolyte imbalance or hypoglycemia have being reported. In this article, the fact that rotavirus, which is seen commonly in our country, can be confronted with various clinical manifestations was emphasized by reminding that it can be seen not only in infants with neurologic and systemic disease but also in healthy infants.(AU)

Assuntos

RESUMO

La gastroenteritis por rotavirus es la más frecuente de las diarreas infecciosas y ocasiona una importante morbimortalidad en los niños pequeños, además de deshidratación grave y desequilibrios electrolíticos; los signos extraintestinales son infrecuentes. Recientemente se han comunicado convulsiones afebriles asociadas con gastroenteritis por rotavirus, sin encefalopatía, deshidratación, desequilibrio electrolítico o hipoglucemia. Comunicamos el caso de un paciente con convulsiones durante una gastroenteritis por rotavirus, una infección habitual en nuestro país (Turquía), con diversas manifestaciones clínicas, entre ellas, las convulsiones, que pueden verse no sólo en los niños con enfermedades neurológicas o sistémicas sino también en los niños sanos.

Rotavirus is the most common infectious diarrhea that causes important mortality and morbidities in small children, severe dehydration and electrolyte imbalance. Extraintestinal signs are rare in rotavirus infections. Recently, afebrile seizures associated with rotavirus gastroenteritis but without encephalopathy, dehydration, electrolyte imbalance or hypoglycemia have being reported. In this article, the fact that rotavirus, which is seen commonly in our country, can be confronted with various clinical manifestations was emphasized by reminding that it can be seen not only in infants with neurologic and systemic disease but also in healthy infants.

Assuntos