Alejandro Donoso

Pertussis and fatal pulmonary hypertension: A discouraged entity

Fatal myocardial failure secondary to pulmonary hypertension is reported in 5 young infants who presented with Bordetella pertussis infection. All cases showed severe leukocytosis. Three of the 5 patients died early despite intensive management. The autopsy revealed signs of pulmonary hypertension. In addition to acquiring further knowledge of its pathogenesis, it is necessary to develop some new therapeutic approaches to Bordetella pertussis infection in susceptible populations.

Coqueluche grave: Estado del arte

La coqueluche (tos ferina) es una enfermedad infecto-contagiosa, que ha resurgido en los ultimos anos como problema de salud publica en nuestro pais. La presentacion clinica no ha cambiado, siendo los lactantes bajo un ano el principal grupo de riesgo, evolucionando, en ocasiones hacia un cuadro altamente letal denominada coqueluche maligna o grave. En la presente revision se discute su epidemiologia, mecanismos de patogenicidad como tambien se describen los factores de riesgo, caracteristicas clinicas de esta evolucion y su fisiopatologia. Se presenta la evidencia actual, utilidad de nuevos tratamientos y una propuesta de algoritmo terapeutico.

Respiratory and hemodynamic effects of a stepwise lung recruitment maneuver in pediatric ARDS: A feasibility study

Little is known about the efficacy and safety of recruitment maneuvers (RMs) in pediatric patients with acute respiratory distress syndrome (ARDS). We therefore assessed the effects on gas exchange and lung mechanics and the possible detrimental effects of a sequential lung RMs and decremental positive end‐expiratory pressure (PEEP) titration in pediatric ARDS patients.

Mild hypothermia attenuates lung edema and plasma interleukin-1β in a rat mechanical ventilation-induced lung injury model

ABSTRACT Recent data suggest that deep hypothermia has protective effects on experimental induced lung injury. It is not well known if these effects persist with mild hypothermia. The authors hypothesized that mild hypothermia may attenuate lung injury and decrease local and systemic proinflammatory cytokines in a rat model of injurious mechanical ventilation (MV). Twelve Sprague-Dawley male adult rats were anesthetized, intubated, and randomly allocated to normothermia group (37°C) (NT) or mild hypothermia group (34°C) (MH). After 2 hours of deleterious MV (peak inspiratory pressure [PIP] 40 cm H2O, zero end-expiratory pressure [ZEEP], and inspiratory fraction of oxygen [Fio2] 100%), arterial blood gases, lung gravimetry, and histological study were obtained. Protein content, interleukin (IL)-1β, and tumor necrosis factor (TNF)-α were measured in plasma and bronchoalveolar lavage (BAL) fluid. Subjects that underwent MH had a significant lower wet-to-dry lung weight ratio (8.32 ± 0.28 vs. 10.8 ± 0.49, P = .01), IL-1β plasma concentration (0.6 ± 0.6 vs. 10.27 ± 2.80 pg/mL, P = .0048) and Paco2. There were no differences in terms of Pao2, histological injury, or BAL protein content. In this model of injurious mechanical ventilation, subjects treated with mild hypothermia had less lung edema and lower plasma IL-1β. Some of known beneficial effects of deep hypothermia can be obtained with mild hypothermia.

Surfactant deactivation in a pediatric model induces hypovolemia and fluid shift to the extravascular lung compartment.

Surfactant deficiency is the pivotal abnormality in Neonatal and Acute Respiratory Distress Syndrome. Surfactant deactivation can produce hypoxemia, loss of lung compliance, and pulmonary edema, but its circulatory consequences are less understood.

Fatal hemorrhagic pneumonia caused by human metapneumovirus in an immunocompetent child

© 2008 Japan Pediatric Society Human metapneumovirus (hMPV) was recently discovered in 2001 in Holland. This agent causes acute respiratory tract infections in children and adults. 1 The range of clinical manifestations varies from asymptomatic infection to severe pneumonia and acute respiratory failure. 1 – 3 When this agent coexists with the respiratory syncytial virus (RSV) in bronchiolitis, symptoms are more severe. 4 Williams et al. found, in more than 25 years of investigation, that 12% of lower respiratory tract infections in children was caused by hMPV. 2

Acute respiratory distress syndrome resulting from inhalation of powdered copper

Background. Copper is an essential element. Poisoning with elemental copper is infrequent and manifestations rarely include the ones that our case presented. Case report. A previously healthy 2-year-old female patient unintentionally inhaled copper dust, developed respiratory failure a few hours later, and required mechanical ventilation. On hospital day three, the patient developed acute respiratory distress syndrome and was treated with high-frequency oscillatory ventilation for six days. She also developed hemolytic anemia, liver failure, oliguric renal failure, and evidence of acute tubular injury. During her stay in the intensive care unit she received inotropic support, packed red cells transfusion, and diuretics. A sample of bronchoalveolar lavage showed macrophages that stained positive for copper. Serum and urine copper concentrations were within the normal range after several days. Extubation was successfully achieved after two weeks and the patient was discharged on day 30 without sequelae. This is the first report of acute respiratory distress syndrome secondary to copper aspiration in a pediatric patient. Conclusion. To our knowledge, this is the first case reported of acute respiratory distress syndrome secondary to elemental copper aspiration. It is important to the clinician to be aware of acute respiratory distress syndrome as a differential diagnosis to copper aspiration by treating the patient aggressively in an adequate clinical setting.

Mild hypothermia increases pulmonary anti-inflammatory response during protective mechanical ventilation in a piglet model of acute lung injury

The effects of mild hypothermia (HT) on acute lung injury (ALI) are unknown in species with metabolic rate similar to that of humans, receiving protective mechanical ventilation (MV). We hypothesized that mild hypothermia would attenuate pulmonary and systemic inflammatory responses in piglets with ALI managed with a protective MV.

Sífilis congénita: presentación como shock séptico después del período neonatal

El espectro clinico de la sifilis congenita varia desde la infeccion asintomatica a una sepsis fulminante. Comunicamos el caso de un recien nacido de sexo femenino, de 27 dias de edad, sano, sin antecedentes maternos, con adecuado control obstetrico y screening prenatal negativo. Consulto por fiebre y lesiones cutaneas de 24 h de evolucion. Ingreso a unidad de cuidados intensivos con compromiso sensorial, hiporeactividad, con lesiones descamativas eritematosas peribucales, palmo-plantares y hepato-esplenomegalia. En los examenes de laboratorio destaco la presencia de anemia, leucocitosis, trombo-citopenia y PCR elevada. Evoluciono con shock septico, hipoalbuminemia y acidosis metabolica. Se diagnostico sifilis congenita por VDRL con titulos 1:128 y VDRL en LCR con titulos 1:8; el VDRL materno fue 1:32. Completo terapia con penicilina G i.v. por tres semanas con adecuada respuesta clinica y de laboratorio. La sifilis congenita puede no ser diagnosticada al momento del nacimiento, por ende se debe tener un alto indice de sospecha, considerando los posibles errores en la serologia prenatal y las variadas formas de presentacion clinica, incluida la sepsis neonatal, durante el primer mes de vida.Clinical spectrum of congenital syphilis ranges from asymptomatic infection to fulminant sepsis. Treponema pallidum is acquired crossing the placenta from the mother to the fetus during maternal spirochetemia or through direct contact of the child with an infected lesion at delivery. We report a 27 days-old previously healthy girl diagnosed with congenital syphilis. Her mother had an unremarkable previous history, adequate obstetric care and negative prenatal screening test for syphilis. The patient was brought to the ER due to development of skin lesions and fever in the last 24 h. She was admitted to pediatric ICU lethargic and poorly responsive, with hepa-tosplenomegaly and perioral, palmoplantar erythematous desquamative scaly lesions. Laboratory data revealed anemia, leukocytosis, thrombocytopenia and C-reactive protein of 183 mg/l. Soon after admission she developed septic shock with leukocytosis up to 45,800/mm3 and exacerbation of thrombocytopenia, hypoalbuminemia and metabolic acidosis. Congenital syphilis was diagnosed at the second day of admission with VDRL titers of 1:128 in serum and 1:8 in cerebrospinal fluid. Maternal serum VDRL was positive with titers of 1:32. The patient was treated with penicillin for three weeks with adequate clinical and laboratory response. Congenital syphilis is a life threatening infection, but cannot always be diagnosed at birth. Health care workers must be aware of the difficulties in obtaining a definitive diagnosis and must have a high index of suspicion, considering the possible errors of prenatal serology and the diverse possible clinical presentations, including neonatal sepsis during the first month of life.

Botulismo infantil. Comunicación de un caso clínico y revisión de la literatura

Botulism is a rare disease in Chile and of the known clinical presentation, infant botulism is the most common. We report the case of a previously healthy seven month old male infant with a two weeks history of rinorrea, cough, fatigue, constipation and progressive weakness after the consumption of honey. Stool cultures were positive for Clostridium botulinum group 1 type A and electromyography was compatible with the diagnosis. The patient evolved with arterial hypertension, interpreted as secondary to autonomic dysfunction, which responded to calcium channel blockers. Muscle tone improved progressively during the following four weeks. Infant botulism is a potentially fatal disease; diagnosis can be difficult given the broad clinical manifestations. Prevention should focus on education of parents of infants as well as medical personnel.