Acute bronchiolitis consists of a viral infection that affects children younger than 2 years old, with the peak of incidence under 6 months. The clinical disease has symptoms of infection of the upper airway, which develops after 2-4 days with fatigue, dyspnea, tachypnea, and respiratory effort. Fever and reduction of dietary compliance, may also occur. Apnea has been reported in severe cases or premature. The diagnosis is based on clinical history and physical examination, reserved additional tests when there is a suspicion of other diagnoses or complications. Treatment is supportive, the oxygen therapy is indicated for patients with oxygen saturation under 90%. Currently, oral corticosteroids has no indication for the treatment. The use of bronchodilators is not routinely indicated and the use of hypertonic saline is controversial. The use of the antiviral ribavirin is indicated in specific cases because there are adverse effects and high costs. Prophylaxis of bronchiolitis is fundamental, and hand-washing, use of alcohol, use of masks and gloves are essential for disease prevention. The use of palivizumab is indicated in selected cases.

One hundred and seventeen children with pulmonary tuberculosis underwent treatment with a 6-month daily regimen of rifampin (15 mg/kg/day) and isoniazid (10 mg/kg/day). The criteria for the diagnosis of pulmonary tuberculosis were (1) clinical symptoms and signs in 93 children (79%), (2) history of direct contact with an adult with tuberculosis in 106 children (91%), (3) tuberculin reaction of 5 mm or more, without previous bacillus Calmette-Guérin (BCG), in 45 children (38%), (4) suggestive radiologic alterations in all patients, and (5) positive bacteriology or histology in four patients (3%). The treatment was completed by 97 children (83%). The mean weight gain during therapy was 2,145 g. There was an excellent clinicoradiologic response to the treatment, and improvement in chest roentgenograms was observed in all patients at the end of therapy. No relapses occurred among the patients followed for an average of 21.4 months. This study indicates that the treatment of primary pulmonary tuberculosis in children with a combination of rifampin and isoniazid daily for 6 months is efficacious and does not result in any relapse.

We monitored the susceptibility to penicillin of invasive strains of Streptococcus pneumoniae in two reference laboratories; 502 positive cultures from patients with an active invasive infectious process were analyzed. Streptococcus pneumoniae was identified through conventional procedures, and the oxacillin disc diffusion method was used to check for penicillin susceptibility. Statistical analysis included calculations of the frequency distribution, with 95% confidence intervals (CI), as well as chi-square tests and chi-square for linear trend for temporal analysis of susceptibility. The bacterium was isolated from patients less than a year old (40.7% of the isolates), from infants (55.9%), and from individuals less than 15 years old (64.4%). The majority (88.2%, 95% CI = 85.5%-91.1%) of the 502 isolates were susceptible to penicillin. There was no significant temporal trend of elevation of resistance rate during the study period (p=0.56). We conclude that resistance of S. pneumoniae to penicillin is not yet an important clinical-epidemiological concern in the State of Minas Gerais. To provide necessary support for the adoption of therapeutic and prophylactic measures, epidemiological surveillance should be implemented at a national level to monitor the profile of susceptibility/resistance of S. pneumoniae to penicillin and other antimicrobials.

There was a low prevalence rate of middle ear alterations in our series of CF patients. The use of aminoglycosides and colonization by P. aeruginosa did not influence the prevalence of middle ear alterations. Our results suggest that a detailed clinical history and a routine otoscopy evaluation may confirm or rule out most middle ear alterations in CF patients.

Objective: To assess the prevalence of middle ear alterations in cystic fibrosis (CF) patients. Methods:In this descriptive study, 120 CF patients aged 5 months to 18 years were assessed by clinical history, otoscopy, and tympanometry. Data on P. aeruginosa colonization and parenteral and/or inhaled aminoglycoside use were also collected from medical charts. Results:Clinical history revealed absence of previous otitis media in 57% of patients. Tympanic membranes were normal in 94% of patients who underwent otoscopic evaluation; chronic otitis media was suggested in about 1% of the cases, otitis media with effusion (OME) in 2%, and Eustachian tube dysfunction in 3%. As for tympanometry, 91% of patients who underwent the exam showed normal results, OME was suggested in 2% of the cases, and Eustachian tube dysfunction in 7%. Conclusion:There was a low prevalence rate of middle ear alterations in our series of CF patients. The use of aminoglycosides and colonization by P. aeruginosa did not influence the prevalence of middle ear alterations. Our results suggest that a detailed clinical history and a routine otoscopy evaluation may confirm or rule out most middle ear alterations in CF patients.J Pediatr (Rio J). 2011;87(1):80-83: Cystic fibrosis, middle ear, tympanometry, tympanoscopy. ResumoObjetivo: Avaliar a prevalência de alterações do ouvido médio em pacientes com fibrose cística (FC). Métodos:Neste estudo descritivo, 120 pacientes com FC com idade entre 5 meses e 18 anos foram avaliados por meio do histórico clínico, da otoscopia e da timpanometria. Dados sobre a colonização por P. aeruginosa e uso de aminoglicosídeos por via parenteral e/ou inalatória também foram coletados a partir dos prontuários médicos.Resultados: O histórico clínico revelou ausência de otite média pré-via em 57% dos pacientes. As membranas timpânicas estavam normais em 94% dos pacientes que se submeteram a avaliação otoscópica; foi sugerida otite média crônica em cerca de 1% dos casos, otite média com derrame (OMD) em 2%, e disfunção da tuba auditiva em 3%. Quanto à timpanometria, 91% dos pacientes que se submeteram ao exame apresentaram resultados normais, foi sugerida OMD em 2% dos casos, e disfunção da tuba auditiva em 7%. Conclusão:Houve uma baixa taxa de prevalência de alterações do ouvido médio na nossa série de pacientes com FC. O uso de aminoglicosídeos e a colonização por P. aeruginosa não tiveram influência na prevalência das alterações do ouvido médio. Nossos resultados sugerem que um histórico clínico detalhado e uma avaliação otoscópica de rotina podem confirmar ou descartar a maior parte das alterações do ouvido médio em pacientes com FC.