Clinical Characteristics and Diagnostic Correlation of Pediatric Lymphadenopathy in a Secondary-Level Hospital in Colombia.

Infection arising from the use of epidural catheters for postoperative analgesia is a major source of anxiety. The routine culture of epidural catheter tips were studied in 100 consecutive children aged 1 day to 15 years. Epidural catheters were inserted aseptically in accordance with an agreed protocol. The catheter site was inspected regularly and the tip sent for microbiological culture following removal. Local signs of inflammation at the epidural site were seen in 16% of children, and bacteria were isolated from catheter tip culture in 32%. Positive catheter tip culture was found in 43% of children with local signs of inflammation and of the remaining children with no local signs, organisms were isolated from the catheter tip in 30%. Culture of skin swabs and catheter tips in two patients with purulent discharge at the epidural site yielded the same organism. No correlation between the number of attempts at catheter insertion and either local signs of inflammation or positive catheter tip cultures were found. Minor local signs of inflammation and infection are common in pediatric patients during continuous epidural infusion. Epidural catheter tips are also frequently culture positive in patients with and without local signs and who may not go on to develop further signs or symptoms of infection. Routine culture of catheter tips is unnecessary as it is not a good predictor of epidural space infection.

Evaluation of Systemic and Local Inflammatory Parameters and Manifestations of Pain in an Equine Experimental Wound Model

Background: Tuberculosis is still a global health concern. Most common presentation of extra pulmonary tuberculosis is tubercular lymphadenitis. In our setting, keeping huge burden of tuberculosis in mind, clinicians have to rely on pathological diagnosis of enlarged lymph nodes i.e. cytomorphology with acid fast staining in diagnosing these cases so that diagnosis and management of such cases can be initiated quickly. Fine needle aspiration cytology (FNAC) of lymph nodes has been a simple, rapid and cost effective procedure for diagnosis of various causes of lymphadenopathies. Our study is the first one in its type in J&K reporting the incidence and pattern of Tubercular Lymphadenitis in secondary level health care hospital. Aims: To report the incidence and describe various cytomorphological patterns of tubercular lymphadenitis in secondary care level Government Hospital, Gandhi Nagar, Jammu. Material and Methods: In a study period of two and a half years, two hundred and thirty one consecutive enlarged lymph nodes were aspirated and subjected to cytomorphological evaluation with Papanicolaou(PAP), Giemsa ,and Ziehl- Neelsen (Z-N) stained smears. Results: Incidence of tubercular lymphadenitis was reported as 34.6% (C.I 0.285-0.411). Around 80% of cases were in the second to fourth decades of life with mean age as 27.08 years and male to female ratio of 1:1.6 .Cervical region was the most common site of involvement with multiple unilateral lymphadenopathy as the most common presentation. The most common cytological picture was epithelioid granulomas with caseous necrosis (52.5%). Overall AFB positivity was seen in 65% cases. Conclusions: FNAC has proved as a very useful first line of investigation in patients presenting with lymphadenopathy, especially in secondary care centres. Key words: Cytomorphological patterns, FNAC, Incidence, Secondary level Hospital, Tubercular lymphadenitis, Z-N staining.

The risk of bacterial contamination related to epidural analgesia in patients cared for in the intensive care unit has not been assessed. Thus the authors studied patients who received care in the intensive care unit who were given epidural analgesia for more than 48 h to determine the rates of local, epidural catheter, and spinal space infection and to identify risk factors. Each patient receiving epidural analgesia for longer than 48 h was examined daily for local and general signs of infection. A swab sample for culture was taken if there was local discharge; all epidural catheters were cultured on withdrawal. All patients underwent weekly neurologic monitoring for 1 month; those with positive epidural catheter cultures had one spinal magnetic resonance image scan. The 75 patients cared for in the intensive care unit who were studied had been receiving epidural analgesia for a median of 4 days (interquartile range, 3.5 to 5 days). Twenty-seven patients had signs of local inflammation (erythema or local discharge), and nine of these had infections. All the patients who had both local signs also had infection. All nine infections were local (12%), but four patients also had epidural catheter infections (5.3%). No patient with erythema alone or without local signs had a positive epidural catheter culture. No spinal space infection was diagnosed. Staphylococcus epidermidis was the most frequently cultured microorganism. Local infection was treated by removing the epidural catheter without any antibiotics. Concomitant infection at other sites (21 of 75 patients, or 28%), antibiotic therapy (64 of 75 patients, or 85%), the duration of epidural analgesia, and the insertion site level of the epidural catheter were not identified as risk factors for epidural analgesia-related infections. The risk of epidural analgesia-related infection in patients in the intensive care unit seems to be low. The presence of two local signs of inflammation is a strong predictor of local and epidural catheter infection.

29 When only biopsy can provide an answer

Systemic <i>Mycobacterium avium</i> Complex Infection During Antitumor Necrosis Factor‐α Therapy in Pediatric Crohn Disease

Background and aims: The systemic form of juvenile idiopathic arthritis (JIA) comprises 10- 20% of all JIA cases. The diagnosis is based on the association of the fever >6 weeks of duration with the arthritis, but the latter can be absent in the beginning. Methods: Discussion of a case. Results: AFAC, 6 years-old female, previously healthy. She went to our hospital because of vesperine fever with 12 days of evolution, accompanied by claudication and bilateral knee pain, without local inflammatory signs. On the admission she was febrile and she had a pinky macular rash in the trunk that resolved spontaneously. The rest of the exam was normal. The analysis revealed mild anemia (10.9g/dL), moderate leukocytosis with neutrophilia, thrombocytosis, elevated reactive Cprotein (9.9mg/dL) and erythrocyte sedimentation rate (113mm). The cultures, immunologic study, viral serologies, Widal, Wright and Weil-Felix reactions did not reveal any change, as well as the chest radiography, echocardiogram and Mantoux test. During the internment she maintained the fever (1 episode/day), accompanied by migratory arthralgia (big joints), with alleviation with ibuprofen (7mg/ kg/dose). At day 6 inflammatory signs (redness and edema) were present in her right elbow. She was discharged only with ibuprofen, but now she is treated with metotrexato and deflazacort, with good response. Conclusions: With this case, we want to emphasize an uncommon disease, which diagnosis is based on the clinical findings, since the laboratory is not specific. The confusion with infection is very frequent and can lead to unnecessary prescription of antibiotics.

Clinical impact of positive Propionibacterium acnes cultures in orthopedic surgery

Background: As a symptom of pyomyositis, sepsis usually follows local inflammation signs. Here, we report pyomyositis with lymphedema of upper extremity in which septic shock and poor local findings initially presented during chemotherapy for breast cancer. Case Report: An 80-year-old woman presented with chronic right shoulder pain during chemotherapy for the recurrent disease. She had a history of postmastectomy lymphedema, diabetes mellitus, and repeated hyaluronic acid injections to the shoulder joint. The pain suddenly worsened with septic shock and no apparent local signs. Magnetic resonance imaging revealed myonecrosis, and no pus was yielded by ultrasound-guided needle aspiration. After 2 weeks of recovery by conservative medical management, surgical drainage was performed. Late formulated massive intramuscular pus showed severe neutrophil infiltration and myonecrosis. Conclusion: Pyomyositis can develop into septic shock with poor local signs. Myelosuppression after chemotherapy can cause myonecrosis without macroabscess, and magnetic resonance imaging was useful for the diagnosis of this condition. When unspecified local pain appears during cancer chemotherapy we should consider this disease, too.

Spinal implant-associated infections: a prospective multicentre cohort study

Nosocomial infections are common in patients receiving extracorporeal membrane oxygenation (ECMO), with ECMO cannula-site infections (ECMO-CSI) being the most frequent infections directly related to the ECMO run. These infections can significantly impact patient outcomes. Currently, no adult guidelines exist for the prevention, diagnosis, and/or treatment of peripheral ECMO-CSI, resulting in heterogeneity in both clinical practice and research findings. We conducted a Delphi study involving 39 international experts in ECMO management. The experts participated in four Delphi rounds to reach consensus on various aspects of ECMO-CSI complicating peripheral ECMO (central ECMO excluded), including definition, clinical suspicion, diagnostic methods, preventive measures, and treatment. Consensus was defined as ≥ 70% agreement among experts on each proposed item. The Delphi process established consensus on key aspects of ECMO-CSI. Experts agreed on clinical scenarios that warrant suspicion of ECMO-CSI, such as purulent discharge and local inflammatory signs. Standardized sampling techniques, including swabs and purulent drainage aspiration, were recommended, while others were rejected. Definitions were clarified, specifying that ECMO-CSI is defined by the isolation of a pathogen through local microbiological sampling and the presence of purulent discharge or local inflammatory signs. Among the preventive measures, the use of chlorhexidine-impregnated or semipermeable polyurethane dressings, unchanged for 7days unless soiled or bleeding, was recommended, whereas systematic antibiotic prophylaxis, even for surgical ECMO, was not recommended. This study presents an international expert consensus focusing on peripheral ECMO-CSI, providing a standardized framework to improve clinical management and facilitate future research. The consensus aims to enhance patient outcomes and support evidence-based guidelines in this complex field.

Infective endocarditis in cardiac implantable electronic devices (pacemakers): Experience of the rhythmology department in Mohammed V military instruction hospital

La tuberculosis osteoarticular no axial en la edad pediátrica

Non-axial osteoarticular tuberculosis in the paediatric age

Digital ulcers in patients with systemic sclerosis (SSc) can be complicated by SSc-related osteomyelitis (SRO). The microbiological data and optimal management of SRO remain unclear. This single-center retrospective study involved patients with SSc aged 18 or older from April 2005 to March 2022. Diagnosis of SRO was based on clinical presentation and MRI findings. The accuracy of the superficial swab culture results was estimated using the bone culture as a reference. Temporal changes in local signs for up to a year were collected, and their association with (1) duration of antimicrobial therapy (> 6 weeks) or (2) surgical interventions was assessed using univariable analyses. Among the 2,126 patients, 46 (2.2%) were diagnosed with SRO. In seven patients whose swab and bone cultures were both available, two (28.6%) had swab cultures identifying all the organisms detected in bone cultures. Resolution of local inflammatory signs consistently preceded wound closure. Three months after therapy initiation, prolonged antimicrobial therapy was not significantly associated with the resolution of local inflammatory signs (16/19 [84.2%] vs. 12/14 [85.7%]; P = 1.00), and surgical intervention was not significantly associated with wound dehiscence (6/9 [66.7%] vs. 20/24 [83.3%]; P = 0.36). Superficial swab cultures may not reliably reflect the true causative organism of SRO. Prolonging antimicrobial therapy beyond six weeks may be of little benefit for patients with SRO when local inflammatory signs improve. Surgical intervention may be a safe and effective option for selected patients with SRO.