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Introducción: Existe evidencia creciente sobre la validez del diagnóstico de trastorno bipolar infantil. Existen múltiples factores que contribuyen a que la enfermedad esté infradiagnosticada y se confunda con facilidad con otros trastornos con conductas de externalización patológica, como el trastorno por déficit de atención con hiperactividad. Caso clínico: Se presenta el caso clínico de un niño con sospecha de trastorno bipolar infantil con el que se ha llevado a cabo un seguimiento semanal desde los 3 hasta los 5 años, con la finalidad de observar su conducta y llevar a cabo un buen diagnóstico diferencial. Conclusiones: El diagnóstico de trastorno bipolar infantil debe ser considerado en aquellos menores con síntomas graves de hiperactividad, distraibilidad, impulsividad y alteración de la conducta, especialmente en aquellos casos en los que encontremos antecedentes familiares de trastorno bipolar, fluctuaciones anímicas llamativas, episodios de agresividad graves y alteración del sueño.

Previous reports hypothesized that cytomegalovirus (CMV) may predispose to non-CMV infection after kidney transplantation (KT). We analysed the incidence of non-CMV infection (overall, bacterial and opportunistic) in 291 KT recipients according to the previous development of any level or high-level (≥1,000 IU/ml) CMV viremia. Exposure to CMV replication was assessed throughout fixed intervals covering first the 30, 90, 180 and 360 post-transplant days (cumulative exposure) and non-overlapping preceding periods (recent exposure). Adjusted Cox models were constructed for each landmark analysis. Overall, 67.7 and 50.5% patients experienced non-CMV and CMV infection, respectively. Patients with cumulative CMV exposure had higher incidence of non-CMV infection beyond days 30 (p-value = 0.002) and 90 (p-value = 0.068), although these associations did not remain after multivariable adjustment. No significant associations were observed for the remaining landmark models (including those based on high-level viremia or recent CMV exposure), or when bacterial and opportunistic infection were separately analysed. There were no differences in viral kinetics (peak CMV viremia and area under curve of CMV viral load) either. Our findings do not support the existence of an independent association between previous CMV exposure and the overall risk of post-transplant infection, although results might be affected by power limitations.

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