| Journal: | Revista mexicana de pediatría |
| Database: | PERIÓDICA |
| System number: | 000458317 |
| ISSN: | 0035-0052 |
| Authors: | Rosales Magallanes, Guillermo Francisco1 |
| Institutions: | 1Hospital ISSSTECALI, Servicio de Infectología, Mexicali, Baja California. México |
| Year: | 2018 |
| Volumen: | 85 |
| Number: | 6 |
| Pages: | 222-225 |
| Country: | México |
| Language: | Español |
| Document type: | Artículo |
| Approach: | Caso clínico, descriptivo |
| Spanish abstract | De los casos de tuberculosis en México, el 8.4% corresponde a menores de 18 años. El riesgo de desarrollar enfermedad invasora es hasta de 24% en menores de dos años no vacunados. La incidencia ha aumentado en Baja California debido al alto índice de migración, pobreza y difi cultad para acceder a servicios de salud. Se presenta un caso de meningitis tuberculosa en lactante no vacunado con BCG. Presentación del caso: Masculino de un año 11 meses de edad, residente de Mexicali, Baja California, nacido en Estados Unidos de Norteamérica, hijo de migrantes sin BCG. Niegan combe. Inicia con fi ebre intermitente e hiporexia de dos meses de evolución, siendo ingresado a hospitalización por fi ebre persistente y evento convulsivo. En exploración física, irritabilidad, hiperrefl exia, Babinski positivo; en citoquímico de LCR: 10 células/dL, predominio celular linfocitos, hiperproteinorraquia (219 mg/dL), glucosa 30 mg/dL (glucemia central 75 mg); tinción de Gram, Ziehl Neelsen negativos. Se inició vancomicina y ceftriaxona con mala evolución; a las 48 h se detecta hidrocefalia y se realiza ventriculostomía. Se sospecha de infección por Mycobacterium tuberculosis por lo que se inicia antifímico y dexametasona. En IRM, evidencia de aracnoiditis basal. Se reportó QuantiFERON TB Gold positivo. El paciente completó tratamiento antifímico y sobrevivió con secuelas neurológicas importantes. Conclusiones: Es fundamental hacer pesquisa de tuberculosis en menores de cinco años con esquema de vacunación incompleto y otros factores de riesgo |
| English abstract | Of the cases of tuberculosis in Mexico, 8.4% corresponds to children under 18 years of age. The risk of developing invasive disease is up to 24% in unvaccinated children under two years of age. The incidence of tuberculosis has increased in Baja California because of the high rate of migration, poverty and poor access to health services. We present the case of tuberculous meningitis in a non-vaccined-BCG infant. Case presentation: One year and eleven months old male, who lives in Mexicali, Baja California, born in the United States of America, son of migrants. Without BCG vaccination. No close contacts with tuberculosis were identifi ed. Prior to hospitalization, the patient had intermittent fever and hyporexia in the past two months; he had admitted for persistent fever and a convulsive event. On physical examination: irritability, hyperrefl exia and Babinski; in CSF cytochemistry: 10 cells/dL, cell predominance were lymphocytes, hyperproteinorrachia (219 mg/dL), glucose 30 mg/dL (glycaemia 75 mg); Gram stain and Ziehl Neelsen were negative. Vancomycin and ceftriaxone were started with poor evolution; at 48 h, hydrocephalus was detected and ventriculostomy was performed. Mycobacterium tuberculosis infection was suspected, so specifi c treatment was started. In MRI, basal arachnoiditis was observed. QuantiFERON TB Gold was positive. The patient completed antifungal treatment and survived with neurological sequelae. Conclusions. It is essential to suspect tuberculosis in children under fi ve years of age with an incomplete vaccination scheme and other risk factors |
| Disciplines: | Medicina |
| Keyword: | Salud pública, Pediatría, Inmunología, Meningitis tuberculosa, Vacuna BCG, Vacunación |
| Keyword: | Public health, Pediatrics, Immunology, Tuberculous meningitis, BCG vaccine, Vaccination |
| Full text: | https://www.medigraphic.com/pdfs/pediat/sp-2018/sp186f.pdf |
