Bronchiolitis in children is associated with significant rates of morbidity and mortality. Many studies have been performed using samples from hospitalized bronchiolitis patients, but little is known ...about the immunological responses from infants suffering from mild/moderate bronchiolitis that do not require hospitalization. We have studied a collection of nasal lavage fluid (NLF) samples from outpatient bronchiolitis children as a novel strategy to unravel local humoral and cellular responses, which are not fully characterized. The children were age-stratified in three groups, two of them (GI under 2-months, GII between 2-4 months) presenting a first episode of bronchiolitis, and GIII (between 4 months and 2 years) with recurrent respiratory infections. Here we show that elevated levels of pro-inflammatory cytokines (IL1β, IL6, TNFα, IL18, IL23), regulatory cytokines (IL10, IL17A) and IFNγ were found in the three bronchiolitis cohorts. However, little or no change was observed for IL33 and MCP1, at difference to previous results from bronchiolitis hospitalized patients. Furthermore, our results show a tendency to IL1β, IL6, IL18 and TNFα increased levels in children with mild pattern of symptom severity and in those in which non RSV respiratory virus were detected compared to RSV+ samples. By contrast, no such differences were found based on gender distribution. Bronchiolitis NLFs contained more IgM, IgG1, IgG3 IgG4 and IgA than NLF from their age-matched healthy controls. NLF from bronchiolitis children predominantly contained neutrophils, and also low frequency of monocytes and few CD4
and CD8
T cells. NLF from infants older than 4-months contained more intermediate monocytes and B cell subsets, including naïve and memory cells. BCR repertoire analysis of NLF samples showed a biased VH1 usage in IgM repertoires, with low levels of somatic hypermutation. Strikingly, algorithmic studies of the mutation profiles, denoted antigenic selection on IgA-NLF repertoires. Our results support the use of NLF samples to analyze immune responses and may have therapeutic implications.
Polymicrobial anaerobic meningitis is a rare event secondary to a contiguous infection in the head or neck. Anaerobic meningitis due to a meningo-intestinal fistula is a rare event with only two ...cases reported in the literature. We describe a new case of adult polymicrobial anaerobic meningitis after colorectal surgery and radiotherapy and review the previous two cases.
Trimethylaminuria: three different mutations in a single family Hernangómez Vázquez, Susana; González González, Cristina; Lancho Monreal, Encarna M ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
2019-Apr-10, Volume:
36, Issue:
2
Journal Article
Open access
Background: primary trimethylaminuria or fish odor syndrome is a genetic metabolopathy characterized by the accumulation of trimethylamine, a very volatile compound in body secretions. Case report: ...we present the case of a healthy 8-month-old patient who, after the introduction of fish in the diet, starts a bad body odor that does not disappear with bathing. The mother visits the pediatrician repeatedly but no disorder is identified. The diagnosis is delayed until the patient is three years old. Due to maternal insistence, the patient is referred to our hospital unit, where genetic diagnostic tests are performed, enabling the paternal diagnosis that had gone unnoticed for 35 years and detecting three different mutations in the family. Discussion: primary trimethylaminuria is a genetic disease with specific symptomatology of bad body odor that can go unnoticed for many years. An adequate clinical suspicion and the request of adequate complementary tests allow its diagnosis and facilitate its clinical management.
Trimetilaminuria: tres mutaciones distintas en una sola familia Hernangómez Vázquez, S.; González-González, C.; Lancho Monreal, E. M. ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
04/2019, Volume:
36, Issue:
2
Journal Article
Open access
Resumen Introducción: la trimetilaminuria primaria (TMAP) o síndrome de olor a pescado es una metabolopatía genética caracterizada por acumulo en secreciones corporales de un compuesto muy volátil, ...la trimetilamina. Caso clínico: presentamos el caso de una paciente sana de ocho meses de edad que, tras la introducción del pescado, inicia mal olor corporal que no desaparece con el baño. La madre acude repetidamente al pediatra sin que se identifique el trastorno. El diagnóstico se retrasa hasta los tres años de edad cuando, por insistencia materna, es derivada a nuestra unidad hospitalaria. Aquí se le realizan pruebas genéticas diagnósticas y se posibilita el diagnóstico paterno que había pasado desapercibido dsurante 35 años, detectándose tres mutaciones distintas en la familia. Discusión: la trimetilaminuria primaria es una enfermedad de causa genética con sintomatología concreta de mal olor corporal que puede pasar desapercibida durante muchos años. Una sospecha clínica adecuada y la solicitud de pruebas complementarias permiten su diagnóstico y facilitan su manejo clínico.
We evaluated the upgraded Amplified Mycobacterium Tuberculosis Direct Test kit (AMTD) (Gen-Probe Inc.) for the direct detection of
Mycobacterium tuberculosis in respiratory and non-respiratory ...specimens, and compared the results between the traditional 30,000 RLUs cutoff criteria (C) and three equivocal ranges (30,000–100,000, R1; 30,000–500,000, R2; and 30,000–1,000,000, R3). We tested 663 respiratory and 238 non-respiratory samples from 464 patients. The gold standard was considered to be the combination of culture and clinical data. One hundred and nineteen samples were from 56 patients with pulmonary tuberculosis, and 36 samples were from 19 patients with extrapulmonary tuberculosis. When C criteria was applied, the sensitivity and specificity values were 90.8 and 93.0% for respiratory specimens, while they were 88.9 and 92.1% for non-respiratory specimens (
p = NS). The sensitivity was significantly higher in smear-positive specimens (96.7%) than in smear-negative ones (81.0%) (
p < 0.05). When compared with C criteria, the overall sensitivity was maintained at 90.3% for R1 criteria, and slightly decreased to 89.7% for R2 and R3 criteria (
p = NS). Overall, specificity increased significantly from 92.9% (C) to 97.5% (R1), 99.1% (R2), and 99.2% (R3). Application of R2 or R3 criteria improved significantly the specificity of the test with little decrease in sensitivity.
Objectives: To understand the role of
Gemella species as a pathogen causing extra-abdominal infections in the Hospital General Universitario Gregorio Marañón.
Materials and Methods: Between 1994 and ...1998, one or more isolates of
Gemella sp. were found in 128 patients. The 113 patients with isolates from nonsignificant specimens or representing intra-abdominal infections were excluded. The clinical records of the remaining 15 patients were reviewed as well as the more recent literature.
Results: Mean age of patients was 41 years. The underlying conditions most frequently noted were intravenous drug users (n=6; 3 positive for human immunodeficiency virus), alcoholism (n=2), cardiovascular disease (n=2), chronic lung disease (n=2), diabetes (n=1), kidney transplant (n=1). The extra-abdominal infections were skin and soft tissue abscess (n=5), empyema (n=4), brain abscess (n=2), primary bacteremia (n=1), lung abscess (n=1), septic thrombophlebitis (n=1), complicated urinary tract infection (n=1). The infection was monomicrobial in six and polymicrobial in nine cases. Surgical drainage and betalactam antibiotics were used. The outcome was favorable in almost all cases.
Conclusions:
Gemella sp. should be included as a cause of localized soft-tissue abscesses, empyema, and bloodstream infection. No case of infective endocarditis was found. Although it is susceptible to several antibiotics,
Gemella sp. requires a careful microbiologic diagnosis and a subtle clinical interpretation.
Causa rara de papiledema Hernangómez Vázquez, Susana; Alonso Cristobo, Mercedes Eugenia; Sanz Tellechea, Enrique ...
Pediatría Atención Primaria,
03/2016, Volume:
18, Issue:
69
Journal Article
Peer reviewed
Open access
El papiledema es la inflamación del nervio óptico causada por un aumento de la presión intracraneal. Existen otras patologías que pueden dar imágenes fundoscópicas con elevación de la cabeza del ...nervio óptico, semejantes al papiledema, que deben diferenciarse debido a la importancia de dicho signo clínico. Presentamos un caso de una paciente en que la imagen fundoscópica, con la presencia bilateral de drusas del nervio óptico, precisó realizar un diagnóstico diferencial con papiledema.
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