Boaventura Antonio dos Santos

Systemic mastocytosis in childhood: report of 3 cases

OBJECTIVE Mastocytosis comprises a group of diseases characterized by accumulation of mast cells on the skin, with the possibility of affecting other systems. Symptoms can be exclusively cutaneous, associated with symptoms of the organs involved or even systemic, due to the release of chemical mediators. Three cases of systemic mastocytosis are described, each case presenting different manifestations of the disorder. DESCRIPTION The first report is about a patient with urticaria pigmentosa that presented persistent lesions until puberty when systemic manifestations initiated with lymphoreticular involvement, splenomegaly and bone marrow infiltration. In the second case, the child had bullous mastocytosis associated with gastrointestinal symptoms, whose investigation showed mast cell infiltration in the intestinal wall. The third patient presented an early and extensive cutaneous manifestation of mastocytosis, with a dramatic evolution to shock and posterior death. DISCUSSION Clinical aspects, treatment and prognosis of such forms of the disease are discussed.

Prevalence of antibodies against measles, mumps, and rubella before and after vaccination of school-age children with three different triple combined viral vaccines, Rio Grande do Sul, Brazil, 1996

OBJECTIVE We evaluated the seroprevalence for measles, mumps, and rubella in school-age children (6-12 years old) before and after the administration of three triple combined viral vaccines. METHODS In two municipal schools of Rio Grande do Sul, Brazil, 692 blood samples were collected before vaccination and 636 samples 21 to 30 days after vaccination during 1996. IgG antibody seropositivity was investigated by enzyme-linked immunosorbent assay (measles and mumps with Enzygnost [Behring, Marburg, Germany]; rubella with Rubenostika [Organon Teknica, Boxtel, the Netherlands]). The vaccines compared were: A: E-Zagreb, L-Zagreb, and Wistar RA 27/3 (Tresivac); B: Moraten, J-Lynn, and Wistar RA 27/3 (M-M-R II); and C: Schwarz, Urabe AM-9, and Wistar RA 27/3 (Trimovax). RESULTS Before vaccination, 79.2% [95% confidence interval (CI)=76.0%-82.2%] of the samples were positive for measles, 69.4% (95% CI=65.8%-72.8%) for mumps, and 55.4% (95% CI=51.6%-59.2%) for rubella. After vaccination with the A, B, and C vaccines, seropositivity was 100.0%, 99.5%, and 100.0%, respectively for measles; 99.5%, 94.5%, and 92.0% for mumps; and 92.6%, 91.3%, and 88.6% for rubella. CONCLUSIONS About one-fifth (20.8%) of the schoolchildren who could have been vaccinated against measles at age 9 months had levels of antibodies insufficient for protection. In the sample of schoolchildren without previous vaccination against mumps and rubella, high proportions of susceptible levels were found. All vaccines were immunogenic, but vaccine A yielded a seroconversion rate of 99.5% for the mumps component, which was significantly higher than the other two vaccines (P<0.01).

Study of in vitro antimicrobial resistance of positive coprocultures to Shigella sp

BACKGROUND The gastroenteritis caused by Shigella sp (shigellosis) represents an important cause of morbimortality, especially in children under two years old. It is well known that the proper antimicrobial therapy can improve clinical state and diminish the disease dissemination. Increasing levels of resistance to drugs commonly used in the treatment of shigellosis have been described, and its sensibility has not been recently evaluated in our setting. OBJECTIVE To evaluate the Shigella antimicrobial resistance in our setting. METHODS A retrospective study was conducted using 106 coprocultures of patients, hospitalized or not, who have been assisted at HCPA and at HPV, during the period of 1994 to 1996, with the sensibility test done through the Kirby-Bauer technique of diffusion discs. RESULTS Out of the 106 coprocultures studied, 35 (33%) came from HPV and 71 (67%), from HCPA. Considering the species, 58.8% were S. flexneri, 39.6%, S. sonnei, 0.9%, S. disenteriae and 0.9%, S. boydii. The resistance levels to usually indicated antibiotics were: ampicillin -57.5%, trimethropim-sulfamethoxazol -75.5%, and nalidixic acid -7.5%. CONCLUSIONS These results show significant (p<0.001) in vitro antimicrobial resistance to ampicillin and trimethoprim-sulfamethoxazol and low resistance to nalidixic acid among Shigella sp. Thus, nalidixic acid may be an option to treat infections caused by resistant organisms.

Coqueluche em crianças menores de 3 anos de idade hospitalizadas em 2011 e 2012

Objetivo : Descrever as caracteristicas demograficas e clinicas de pacientes pediatricos internados com PCR positivo para Bordetella pertussis . Metodos: Estudo retrospectivo, observacional incluindo todos os pacientes pediatricos entre zero e dois anos 11 meses e 29 dias de idade internados em um hospital universitario, com diagnostico de coqueluche confirmado por PCR, no periodo de julho de 2011 a dezembro de 2012. Resultados: Foram incluidos no estudo 155 pacientes com idade media de 7,8 meses. Apenas 22 casos tinham historia de contato com tosse paroxistica ou prolongada (>14 dias). O tempo medio de duracao de sintomas antes da admissao hospitalar foi de 9,87±10,08 dias e o tempo de internacao medio foi de 5,52±9,60 dias. Tosse foi o sintoma mais prevalente (99%), sendo paroxistica em apenas 16,8%. Cianose esteve presente em 29,7% e apneia em 5,8%. Necessitaram oxigenio suplementar 52,2%, ventilacao mecânica 4,9% e foram a obito 2,5% dos pacientes. Conclusao: O estudo corrobora o impacto da coqueluche epidemica sobre as criancas, principalmente lactentes, evidenciando a necessidade da implementacao de novas estrategias de prevencao e controle desta infeccao.