Daniela Arriagada

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.

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.

Monitorización respiratoria del paciente pediátrico en la Unidad de Cuidados Intensivos

Respiratory monitoring plays an important role in the care of children with acute respiratory failure. Therefore, its proper use and correct interpretation (recognizing which signals and variables should be prioritized) should help to a better understanding of the pathophysiology of the disease and the effects of therapeutic interventions. In addition, ventilated patient monitoring, among other determinations, allows to evaluate various parameters of respiratory mechanics, know the status of the different components of the respiratory system and guide the adjustments of ventilatory therapy. In this update, the usefulness of several techniques of respiratory monitoring including conventional respiratory monitoring and more recent methods are described. Moreover, basic concepts of mechanical ventilation, their interpretation and how the appropriate analysis of the information obtained can cause an impact on the clinical management of the patient are defined.