We reviewed the spectrum of infections due to nontuberculous mycobacteria (NTM) in children with leukemia. Three children acquired such infections. One patient developed pneumonia after the cessation of chemotherapy when Mycobacterium xenopi was identified in his lung biopsy specimen. He required 2 years of treatment with antituberculous agents and clarithromycin. Cultures of central and peripheral blood specimens from two patients yielded Mycobacterium fortuitum and Mycobacterium chelonae, respectively. Broviac catheters were likely the source of infection. Removal of the catheters and antibiotic treatment resulted in cure. Central venous catheters in leukemic children are potential sources of infection. For febrile neutropenic children with leukemia who do not respond to antibiotic therapy, cultures positive for diphtheroids or negative routine bacterial and fungal cultures should raise a suspicion for infections due to NTM. Systemic infections may require up to 2 years of therapy. Removal of the infected catheters during persistent or recurrent infections in necessary for control of the infection.
The spleen is the most frequently injured organ in blunt abdominal trauma (BAT). Contrast-enhanced computed tomography (CT) is approximately 95% sensitive and specific for detection of splenic injury. In children, nonoperative treatment is well-established. The basic tenet of such management is an obligatory period of rest to prevent recurrent bleeding and allow splenic healing. Splenic preservation prevents post-splenectomy sepsis. At our level I trauma center, pediatric patients (N=54) with BAT between 1993 and 1998 were retrospectively studied. Two (3.7%) died of associated injuries; 2 underwent splenectomy before transfer to our hospital. All had been diagnosed with splenic injury by CT. The mean age was 11.3 years. The mechanisms of injury were motor vehicle accidents (66%), bicycle accidents (26%), and falls (8%). All 50 remaining patients were followed by ultrasound (US) after the initial diagnosis by CT. The mean hospital stay was 6 days. One patient developed the rare complication of an arterio venous (AV) fistula within the damaged spleen; 47 (94%) had normal, homogeneous parenchymal echogenicity at healing (including the patient with the AV fistula). The remaining 3 demonstrated a visible echogenic scar. Imaging documentation of healing blunt splenic trauma should ideally minimize cost and relative risk. Our results add further evidence that US is well-suited to the task. No delayed complications with this approach were recorded in this series.
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