RESUMO
Is the most commun and serious complication of the diabetes mellitus in the childhood and adolescent, the current mortality rate in most tertiary hospitals for children is about 2 percent. Is the metabolic consequence of a deficiency of insulin, it can be precipitating for stress, or inappropriate knowledge of the management and in some cases of subclinical diabetes or it still has not been diagnostic. The majority of instances of diabetic ketoacidosis can be prevented by early recognition of ketosis, and on appropriate ambulatory management.
Assuntos
Cetoacidose Diabética/etiologia , Desequilíbrio Ácido-Base/etiologia , Desequilíbrio Ácido-Base/metabolismo , Desequilíbrio Ácido-Base/terapia , Adolescente , Bicarbonatos/uso terapêutico , Criança , Cetoacidose Diabética/metabolismo , Cetoacidose Diabética/terapia , Hidratação , Humanos , Insulina/uso terapêutico , Corpos Cetônicos/biossínteseRESUMO
In June, 1989, an outbreak of nosocomial listeriosis occurred in Costa Rica. Listeria monocytogenes was isolated from 9 ill infants 4 to 8 days old who were born after the delivery of an infant with early onset listeriosis. One nosocomial infection was fatal, 2 required mechanical ventilation and 1 resulted in hemiparesis. A higher proportion of cases than other infants born during the outbreak were delivered by cesarean section (55% vs. 24%, P = 0.04). Compared with the mothers of 36 random controls, case mothers were more often primiparous (odds ratio, 6.2, P = 0.03) or received general anesthesia before delivery (odds ratio, 4.4, P = 0.09). All infants were bathed with mineral oil from a multidose container. Culture of the oil by cold enrichment grew L. monocytogenes 4b with the same electrophoretic enzyme type as the outbreak strain. We hypothesize that aspiration of contaminated oil may have resulted in systemic listeriosis. General anesthesia may have increased the risk of aspiration. Lung tissue from the infant who died showed lipid-laden macrophages consistent with oil aspiration and had evidence of L. monocytogenes DNA detected by polymerase chain reaction. This is the first nosocomial outbreak of listeriosis in which a common source suggested epidemiologically was microbiologically confirmed. The high attack rate (greater than 200 times the United States rate of perinatal listeriosis) emphasizes the susceptibility of healthy neonates to L. monocytogenes. The results of our study led to the discontinuation of the use of mineral oil for bathing neonates in Costa Rica.
Assuntos
Infecção Hospitalar/etiologia , Surtos de Doenças , Listeriose/etiologia , Óleo Mineral/efeitos adversos , Estudos de Casos e Controles , Costa Rica/epidemiologia , Coleta de Dados , Contaminação de Medicamentos , Feminino , Humanos , Recém-Nascido , Listeriose/epidemiologia , MasculinoRESUMO
Rotaviruses, enterotoxigenic Escherichia coli, Salmonella, Shigella, and parasites were investigated in outpatient diarrheic children, and in hospitalized diarrheic and non-diarrheic children, between January 1976 and June 1979. In outpatient cases studied within 4 days of onset of symptoms, rotaviruses were the most common agents (45.3%); E. coli heat-stable enterotoxin ranked second (13.4%); Shigella was third (8.1%); Salmonella was fourth (7.3%). In 63.2%, one or more enteric agents were detected. In hospitalized non-diarrheic children, asymptomatic shedding of pathogens was rarely observed. A later survey of outpatient diarrheic children revealed Campylobacter fetus jejuni in 8%. In 5.5 years of observation rotaviruses were endemic with excess frequency in the dry and cooler months of December and January. The excess occurrence of bacterial pathogens did not coincide with that of rotaviruses.
Assuntos
Infecções por Campylobacter/epidemiologia , Diarreia/etiologia , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Rotavirus/epidemiologia , Costa Rica , Disenteria Bacilar/epidemiologia , Infecções por Escherichia coli/epidemiologia , Humanos , Lactente , Infecções por Nematoides/epidemiologia , Infecções por Protozoários/epidemiologia , Infecções por Salmonella/epidemiologia , Estações do AnoRESUMO
Clinical features and treatment evaluation of 38 children with disseminated histoplasmosis were studied. Thirty-six cases presented the severe form and two of them showed the mild chronic type. A higher incidence of this disease was found in infants (65%) and in severe malnutrition (68%) and lethality in the overall group was 61%. Patients died either because they did not receive specific treatment or were given amphotericin for less than 15 days. These figures stress the importance of this treatment in disseminated histoplasmosis.
Assuntos
Histoplasma/isolamento & purificação , Histoplasmose/microbiologia , Anfotericina B/uso terapêutico , Criança , Pré-Escolar , Quimioterapia Combinada , Histoplasmose/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Injeções Intravenosas , Trimetoprima/uso terapêuticoRESUMO
A retrospective hospital chart review of meningococcal meningitis cases in Costa Rica revealed a large number of cases confirmed in the laboratory by Gram-stained smear and/or culture of spinal fluid. A large percentage of the isolates studied were serogroup C and all of these were sulfonamide resistant. The age-specific attack rates were high in the preschool children with the highest attack rate in children 3 to 5 months of age. Case fatality ratios were 14% overall, with the low fatality rates in individuals 10 to 29 years of age. The outbreak of serogroup C meningitis in 1970--1971 was relatively brief, country-wide, and not predominantly a urban outbreak. The few secondary cases observed occurred within the first 2 weeks of the primary case.
Assuntos
Meningite Meningocócica/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Costa Rica , Feminino , Humanos , Lactente , Masculino , Meningite Meningocócica/mortalidade , Pessoa de Meia-IdadeRESUMO
In a randomised double-blind trial, 51 5--10% dehydrated infants were rehydrated with oral electrolyte solutions containing sucrose or glucose. Most infants in both groups were successfully rehydrated, but the sucrose solution produced a slower correction of electrolyte abnormalities and a higher percentage of patients who needed more than 24 h of therapy. Where there is adequate knowledge of the oral therapy method sucrose can substitute for glucose in many cases; where there is a choice glucose is recommended.
PIP: 51 infants aged 3 to 12 months with dehydration due to acute watery diarrhea were randomly assigned to either the glucose or sucrose oral therapy group on admission to the hospital. Oral rehydration and maintenance without any intravenous fluids was successful in 100% and 92% of patients in the glucose and sucrose groups respectively, as evidenced by the subjects' weight gain, fall in plasma proteins and hematocrit, and disappearance of clinical signs of dehydration. There was a greater improvement in mean HC03 in the glucose group than in the sucrose group. Both groups exhibited decline in mean serum osmolarity. The 2 oral treatment failures in the sucrose group occurred in patients who could not absorb the solutions adequately. This study shows that oral therapy with sucrose is less efficient than oral therapy with glucose. However, in areas where only sucrose is available and where knowledge and means of using oral therapy exist, the oral sucrose solution can be used to treat most infants with diarrhea and 5 to 10% dehydration.
Assuntos
Diarreia Infantil/tratamento farmacológico , Solução Hipertônica de Glucose/administração & dosagem , Glucose/administração & dosagem , Sacarose/administração & dosagem , Doença Aguda , Administração Oral , Ensaios Clínicos como Assunto , Costa Rica , Desidratação/tratamento farmacológico , Avaliação de Medicamentos , Infecções por Enterobacteriaceae/tratamento farmacológico , Feminino , Giardíase/tratamento farmacológico , Humanos , Lactente , Masculino , Projetos de Pesquisa , Rotavirus , Soluções , Viroses/tratamento farmacológicoRESUMO
Shigella, toxigenic Escherichia coli (stable toxin) and rotaviruses were frequently found among 50 children hospitalized with diarrhea studied during one year. These agents were less common among 45 controls without diarrhea, of comparable age and from the same wards as the cases reported. There was a greater frequency of respiratory symptoms in the diarrhea associated with rotaviruses. These were characterized by frequent bowel movements and vomiting and often fever. The bacterial diarrheas showed, in general, a more severe clinical picture than the viral ones. The rotaviruses had a low endemic level during April-October, but their prevalence increased in December and January; in such months these viruses were found in more than 50 per cent of the diarrheal cases.