[Diagnostic assessment of head nodding in hypoxemia in children with pneumonia]

OBJECTIVE

To assess the clinical usefulness of the head nodding sign (HN) in children with pneumonia.

MATERIAL AND METHODS

Cross-sectional study that included 62 children aged 2-59 months. Hypoxemia was defined as arterial oxygen saturation <94% measured by pulse oximetry. HN was examined with regard to three levels of hypoxemia (<94%, <or= 90%, <or= 84%).

RESULTS

The overall prevalence of hypoxemia was 56.5 %. HN was observed in 64.5% (40) of the patients, 48.4% (30) of those had pneumonia and 73.1% were hypoxemic. HN showed a sensitivity of 73.2% and a specificity of 52.4%. Accuracy of HN was better when a cut off level <94% was used. HN in infants was a better index for hypoxemia than for older children.

CONCLUSIONS

HN was a good predictor of hypoxemia in children with pneumonia. It seems that HN is an easily recognizable sign, and it could be easily taught to parents and health workers.

[Rocky Mountain spotted fever in children: clinical and epidemiological features]

OBJECTIVE

To report the clinical features of the Rocky Mountain spotted fever (RMSF) in children of southern Sonora, Mexico.

MATERIAL AND METHODS

Nine cases were studied at the Sonora State Children's Hospital. One case was defined by clinical features and positive serological tests (indirect immunofluorescence assay or reaction to Proteus OX 19). Demographic and clinical characteristics of the patients were registered.

RESULTS

The study subjects were children from two to twelve years ofage. All patients have had contact with tick-infested dogs and had fever, as well as petechial rash. Laboratory findings included high levels of hepatic aminotransferase, hyponatremia and thrombocytopenia. Therapy with chloramphenicol and doxyciclyne was administered after the first seven days of the onset of illness. The mortality rate was 22%.

CONCLUSIONS

This study supports the presence of RMSF in the state of Sonora, Mexico, which should be considered as a public health hazard, requiring immediate actions for prevention and control.

[Rocky mountain spotted fever: report of two cases]

Rocky Mountain spotted fever (RMSF) is an acute febrile illness caused by infection with Ricketsia Rickettsii, characterized by the presence of petechial rash. Even though the etiology, clinical characteristics and availability of effective antibiotics are known, RMSF related deaths have a prevalence of 4%. In its early stages RMFS can resemble many others infectious conditions and the diagnosis can be difficult. The present paper reports two patients with RMSF; these cases underscore the importance of prompt diagnosis and appropriate antimicrobial therapy, and consider RMSF as a differential diagnosis in any patient who develops fever and rash in an endemic area.