Browsing by Autor "Carlos N. Teran-Escalera"

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A severe case of erythrodermic psoriasis associated with advanced nail and joint manifestations: a case report
(BioMed Central, 2010) Carlos G. Terán; Carlos N. Teran-Escalera; Carola Balderrama
This case shows clinical features not commonly described or reported in severe cases of erythrodermic psoriasis, including severe and rare nail and arthritic findings in a pediatric scenario.
Herpes zoster in healthy children
(Elsevier BV, 2008) Carlos G. Terán; Patricia Villarroel; Carlos N. Teran-Escalera
A previously healthy, immunocompetent 24-month-old girl was admitted to the Department of Infectology with a 4-day history of painful pruritic blisters that had begun on her right hand. The lesion had spread rapidly to the right forearm, arm, and upper right region of her back. The mother had varicella infection during her third trimester of pregnancy without apparent sequelae in the newborn. The patient was afebrile and had a vesicular rash involving the C7 to D1 dermatomes, with confluent, plaque-like lesions in the upper right zone of the back. The base of a vesicle was scraped and was positive for multinucleated Tzanck cells on microscopic examination (Figure 1). Oral acyclovir was given for 15 days without any complication. The pain, pruritus, and rash were completely resolved within two weeks after treatment without complications. Herpes zoster is uncommon in childhood. Of all patients with zoster, fewer than 10% are younger than 20 years, and 5% are younger than 15 years.1Janniger CK, Driano AN. Zoster. Available at: http://www.emedicine.com/ped/topic996.htm (accessed May 2008).Google Scholar Although zoster is primarily a disease of adults, it has been noted as early as in the first week of life. This occurs in infants born to mothers who had primary varicella zoster virus (VZV) infection during pregnancy. Approximately 2% of infants who have intrauterine exposure to varicella develop zoster in infancy or early childhood.2Leung A.K. Robson W.L. Leong A.G. Herpes zoster in childhood.J Pediatr Health Care. 2006; 20: 300-303Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar Although uncommon, herpes zoster can develop in immunocompetent children as young as a few weeks of age and should be considered in the differential diagnosis of vesicular eruptions in infants.3Fisher R.G. Edwards K.M. Varicella-zoster.Pediatr Rev. 1998; 19: 62-67Crossref PubMed Scopus (13) Google Scholar In contrast with the adult type eruption, pain and post-herpetic neuralgia is rarely seen in children, and if it occurs, is less severe and painful than the adult type.4Feder Jr., H.M. Hoss M.D. Herpes zoster in otherwise healthy children.Pediatr Infect Dis J. 2004; 23: 451-457Crossref PubMed Scopus (70) Google Scholar Immunosuppressed patients or potentially severe VZV infections should be treated with intravenous acyclovir (500 mg/m2 per dose tid for children) for 15 days. Healthy children should be treated with oral acyclovir at a dose of 20 mg/kg qid for 15 days.5Gershon A.A. Varicella-zoster virus infections.Pediatr Rev. 2008; 29: 5-11Crossref PubMed Scopus (34) Google Scholar Conflict of interest: No conflict of interest to declare.
Nitazoxanide vs. probiotics for the treatment of acute rotavirus diarrhea in children: a randomized, single-blind, controlled trial in Bolivian children
(Elsevier BV, 2008) Carlos G. Terán; Carlos N. Teran-Escalera; Patricia Villarroel
Treatment with nitazoxanide and probiotics is effective in the management of children with acute rotavirus diarrhea. Small differences in favor of nitazoxanide were found in comparison with probiotics. Nitazoxanide is an important treatment option for rotavirus diarrhea.
Severe genital human papillomavirus infection in a sexually abused child
(Elsevier BV, 2008) Carlos G. Terán; Patricia Villarroel; Carlos N. Teran-Escalera
A two-year-old female child was admitted to the emergency room for a mild respiratory infection. Surprisingly, physical examination of the genital area revealed large verrucous lesions spreading around the vulva and perianal zone (Figure 1). No relevant medical history of the child was noted. The mother declared to have no sexually transmitted disease and additional physical examination was negative for genital lesions or skin warts. A PAP smear was normal, as was the one performed six months previously. The parents were divorced and only weekend visits were permitted to the father. The case was reported to the local child sexual assault service; later investigations concluded in a sexual abuse case, after finding similar lesions and obtaining a confession from the father. Other family members were also examined without abnormal findings. A diagnosis of condyloma acuminata was made based on the physical examination and the investigation conducted by the pertinent authorities. As the best treatment option, surgical excision was performed successfully. Condyloma acuminata is one of the most common sexually transmitted diseases in adults, but its presence in children is rare and could be associated with sexual abuse.1Jayasinghe Y. Garland S.M. Genital warts in children: what do they mean?.Arch Dis Child. 2006; 91: 696-700Crossref PubMed Scopus (48) Google Scholar, 2Syrjanen S. HPV infections in children.Papillomavirus Report. 2003; 14: 93-110Crossref Scopus (15) Google Scholar Even though association can vary from 0 to 80% according to studies,3Moscicki A. Genital infections with human papillomavirus (HPV).Pediatr Infect Dis J. 1998; 17: 651-652Crossref PubMed Scopus (9) Google Scholar, 4Pitche P. Kombate K. Gbadoe A.D. Tchangai-Walla K. Anogenital warts in young children in hospital consultation in Lome (Togo). Role of transmission by sexual abuse.Med Trop (Mars). 2001; 61: 158-162PubMed Google Scholar appropriate investigation in all cases to rule out sexual abuse is still controversial, as similar lesions in the mother or siblings are frequently observed in sexual and non-sexual transmission.4Pitche P. Kombate K. Gbadoe A.D. Tchangai-Walla K. Anogenital warts in young children in hospital consultation in Lome (Togo). Role of transmission by sexual abuse.Med Trop (Mars). 2001; 61: 158-162PubMed Google Scholar, 5Jones V. Smith S.J. Omar H.A. Nonsexual transmission of anogenital warts in children: a retrospective analysis.ScientificWorldJournal. 2007; 7: 1896-1899Crossref PubMed Scopus (40) Google Scholar According to some epidemiological studies, sexual transmission is more frequent among patients older than two years of age, reaching the highest prevalence at over eight years old.6Sinclair K. Woods C. Kirse D. Sinal S.H. Anogenital and respiratory tract human papillomavirus infections among children: age, gender, and potential transmission through sexual abuse.Pediatrics. 2005; 116: 815-825Crossref PubMed Scopus (118) Google Scholar Under two years old, transmission is more commonly through direct contact with infected genital maternal tract during delivery or transplacentally, as postulated in some studies.6Sinclair K. Woods C. Kirse D. Sinal S.H. Anogenital and respiratory tract human papillomavirus infections among children: age, gender, and potential transmission through sexual abuse.Pediatrics. 2005; 116: 815-825Crossref PubMed Scopus (118) Google Scholar, 7Hornor G. Ano-genital warts in children: sexual abuse or not?.J Pediatr Health Care. 2004; 18: 165-170Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 8Tang C. Shermeta D. Wood D. Congenital condyloma acuminata.Am J Obstet Gynecol. 1978; 131: 912-913PubMed Scopus (83) Google Scholar, 9Tseng C. Lin C. Wang R. Chen L.J. Chang Y.L. Hsieh T.T. Pao C.C. Possible transplacental transmission of human papillomavirus.Am J Obstet Gynecol. 1992; 166: 35-40Abstract Full Text PDF PubMed Scopus (91) Google Scholar The management of this problem is not solely medical. Social, legal and psychosocial implications for the future of the nuclear family and child development should be considered.1Jayasinghe Y. Garland S.M. Genital warts in children: what do they mean?.Arch Dis Child. 2006; 91: 696-700Crossref PubMed Scopus (48) Google Scholar It is important that primary-care providers and pediatricians have an understanding of the potential for human papillomavirus genital infections in children and the need to report these cases to the appropriate authorities as soon as a clinical diagnosis is made and relevant social history is suspected. Conflict of interest: No conflict of interest to declare.