ABSTRACT
INTRODUCCIÓN: La diarrea aguda continúa siendo una de las principales causas de morbilidad en niños; sin embargo, el diagnóstico etiológico presenta limitaciones dada la baja sensibilidad de los métodos tradicionales. OBJETIVO: Describir los microorganismos identificados en niños que acudieron al Servicio de Urgencia (SU) de un hospital universitario en Santiago, Chile, por diarrea aguda y a los que se le solicitó panel molecular gastrointestinal. MÉTODOS: Se revisaron fichas clínicas y resultados de panel gastrointestinal realizados entre junio de 2017 y marzo de 2020. RESULTADOS: Se incluyeron 198 pacientes, edad promedio de 54,5 meses y 60,6% (120/198) de sexo masculino. La positividad del panel fue de 78,8% (156/198) con 35,3% (55/156) de las muestras polimicrobianas. Se identificaron 229 microorganismos, de los cuales 72,9% (167/229) corresponden a bacterias, 25,8% (59/229) a virus y 1,3% (3/229) a parásitos. Destacaron Campylobacter spp. y Escherichia coli enteropatógena (ECEP) como las bacterias más frecuentemente identificadas. Los pacientes con detección de Campylobacter spp. presentaron con mayor frecuencia fiebre (p = 0,00). ECEP se aisló principalmente (82,5%) en muestras polimicrobianas. DISCUSIÓN: Los resultados enfatizan el potencial que poseen los estudios moleculares para mejorar el diagnóstico etiológico de la diarrea, pero a la vez llevan a cuestionar el rol patogénico de algunos microorganismos identificados.
BACKGROUND: Acute diarrhea continues to be one of the main causes of morbidity in children, however the etiologica diagnosis presents limitations given the low sensitivity of traditional methods. AIM: To describe the microorganisms identified in children who attended the emergency department (ED) in Santiago, Chile, due to acute diarrhea and to whom a gastrointestinal panel was requested as part of their study. MATERIAL AND METHODS: Clinical records and results of the gastrointestinal panel carried out between June 2017 and March 2020 were reviewed. RESULTS: 198 patients were included, the average age was 54.5 months and 60.6% (120/198) were males. Positivity was 78.8% (156/198) with 35.3% (55/156) of the samples being polymicrobial. 229 microorganisms were identified, of which 72.9% (167/229) corresponded to bacteria, 25.8% (59/229) to viruses, and 1.3% (3/229) to parasites. Campylobacter spp. and enteropathogenic Escherichia coli (EPEC) were the most frequently identified bacteria. Patients with detection of Campylobacter spp. presented a higher frequency of fever (p = 0.00). EPEC was isolated in 82.5% of the cases in polymicrobial samples. DISCUSSION: The results emphasize the potential of molecular studies to improve the etiological diagnosis of diarrhea and at the same time lead to question the pathogenic role of some microorganisms.
Subject(s)
Humans , Male , Female , Diarrhea/diagnosis , Feces/microbiology , Parasites/isolation & purification , Seasons , Bacteria/isolation & purification , Viruses/isolation & purification , Chile , Retrospective Studies , Diarrhea/etiology , Diarrhea/epidemiology , Emergency Service, Hospital , Feces/parasitologyABSTRACT
INTRODUCCIÓN: La linfohistiocitosis hemofagocítica (HLH en inglés) es un síndrome clínico grave, potencialmente fatal, caracterizado por una activación patológica del sistema inmune y una respuesta hiperinflamatoria extrema. Según su etiología se clasifica en primario (genético o familiar) y secundario (gatillado por causas infecciosas, oncológicas o reumatológicas). OBJETIVOS: Describir y analizar las características clínicas y laboratorio, tratamiento recibido y seguimiento en pacientes pediátricos con diagnóstico de HLH. PACIENTES Y MÉTODOS: Se describió una cohorte pediátrica en pacientes hospitalizados con diagnóstico de HLH en un centro terciario universitario entre enero de 2000 y febrero de 2019. RESULTADOS: Se reclutaron 23 pacientes pediátricos con una mediana de edad de 36 meses. Los hallazgos clínicos y de laboratorio más frecuentes fueron fiebre, citopenias e hiperferritinemia. La etiología más frecuente fue infecciosa (virus Epstein Barr/citomegalovirus) e inmunológica/reumatológica. La mortalidad global fue de 35%, sin diferencias significativas según etiología. DISCUSIÓN: Dada su alta mortalidad es relevante un alto índice de sospecha que permita instaurar terapia de forma precoz. Son necesarios estudios multicéntricos para determinar predictores clínicos y de laboratorio con valor pronóstico.
BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a severe syndrome, potentially lethal, with a pathological activation of the immune system and an extreme hyperinflammatory response. The etiology is classified in primary HLH (familiar or genetic) and secondary (infectious, oncological, and rheumatological diseases). AIM: To analyze clinical and laboratory characteristics, treatment, and follow-up rates in pediatric patients with HLH. METHODS: A pediatric cohort of patients with HLH diagnosis attending in a tertiary hospital between January 2000 to February 2019 was analysed. RESULTS: 23 hospitalized patients were recruited with a median of 36 months of age. The most frequent clinical and laboratory findings were fever, cytopenias, and hyperferritinemia. The most frequent aetiologies were infectious (Epstein Barr virus and citomegalovirus) and rheumatological diseases. The global mortality was 35%, there was no significant difference between etiologies. DISCUSSION: Considering the high mortality of HLH it is very important to have a high grade of suspicion that allows treating at an early stage. It would be important to determine clinical and laboratory predictors in multicentric studies.
Subject(s)
Humans , Male , Female , Child , Epstein-Barr Virus Infections , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/etiology , Follow-Up Studies , Herpesvirus 4, Human , Tertiary Care CentersABSTRACT
Resumen Introducción: Los sistemas de vigilancia pasiva de los eventos supuestamente atribuidos a vacunación o inmu nización (ESAVI) permiten monitorizar efectos adversos (EA) conocidos y pesquisar EA infrecuentes. El objetivo de este estudio fue describir los ESAVI notificados en Chile entre los años 2014 y 2016. Material y Método: Estudio de vigilancia epidemiológica. Se realizó un análisis general y un sub-análisis para vacuna pentavalente. Se calculó la tasa de reporte (TR) global de ESAVI cada 100.000 dosis de vacunas, la TR de ESAVI considerados de interés y el odds ratio de reporte (ROR) de apneas para pentavalente. Resultados: El total de ESAVI notificados fue de 2.552 con una TR global de 9,13. Un 13,4% de los ESAVI fueron serios. La TR de eventos de interés fue en general menor a las tasas de referencia. La vacuna con mayor TR (44,3) fue pentavalente, con un ROR de apnea versus otras vacunas de 10,5 (IC 95% 3,77-29,47). Discusión: Este estudio entrega una visión general de los ESAVI notificados en Chile. La TR global fue similar a otras reportadas, pero las de eventos de interés fueron menores a las referencias internacionales. Se muestra una posible asociación entre apneas y vacuna pentavalente.
Background: Passive surveillance systems for adverse events following immunization (AEFI) allow the monitoring of known adverse effects (AE) and the investigation of infrequent AE. Aim: To describe the AEFI notified in Chile between 2014 and 2016. Methodology: This was a study of epidemiological surveillance. A general analysis of AEFI and sub-analysis for pentavalent vaccine was carried out. It was calculated the global reporting rate of AEFI every 100,000 doses of vaccines, the reporting rate of AEFI considered of interest and the odds ratio of reporting (ROR) of apneas for pentavalent. Results: The total AEFI reported was 2,552 with a global reporting rate of 9,13. 13.4% of AEFI were serious. The vaccine reporting rate of events of interest was generally lower than the reference rates. The vaccine with the highest reporting rate (44.3) was pentavalent, with an ROR of apnea versus other vaccines of 10.5 (95% CI 3.77-29.47). Discussion: This study provides an overview of the AEFI notified in Chile. The global reporting rate was similar to other studies, but those of events of interest were lower than international references. A possible association between apnea and pentavalent vaccine is shown.
Subject(s)
Humans , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Young Adult , Vaccination/adverse effects , Vaccination/statistics & numerical data , Adverse Drug Reaction Reporting Systems/statistics & numerical data , Severity of Illness Index , Vaccines/adverse effects , Chile/epidemiology , Population Surveillance , Disease NotificationABSTRACT
Pseudomonas aeruginosa, is an opportunistic organism widely distributed in both environmental and nosocomial settings. Invasive infections typically occur in immunocompromised patients, but this agent can also produce sepsis in the immunocompetent host. We report the case of an 8 months old infant, previous healthy, who presented septic shock by P. aeruginosa. Lesions of ecthyma gangrenosum in his limbs required surgical debridement. The patient presented transitory neutropenia and reduced C4 levels but subsequent study of immune defects was normal.
Pseudomonas aeruginosa es un microorganismo oportunista de amplia distribución ambiental y nosocomial. Las infecciones invasoras se producen generalmente en pacientes inmunocomprometidos; sin embargo, este agente ocasionalmente puede ser causa de sepsis en pacientes inmunocompetentes. Presentamos el caso de un lactante de 8 meses de edad, sin antecedentes médicos, que cursó con un shock séptico por P. aeruginosa. Durante su evolución presentó lesiones de ectima gangrenoso en sus cuatro extremidades, que requirieron múltiples desbridamientos quirúrgicos. En el período agudo presentó neutropenia y complemento C4 bajo, que normalizó posteriormente. El estudio de inmunidad para descartar inmunodeficiencia fue normal.
Subject(s)
Humans , Infant , Male , Pseudomonas Infections/diagnosis , Pseudomonas aeruginosa/isolation & purification , Shock, Septic/microbiology , Gangrene/microbiology , Pseudomonas Infections/pathologyABSTRACT
Objetive: To characterize pet ownership and pet health status in families of immunocompromised (IS) children, with emphasis in zoonotic diseases. Population and Methods: Families of IS children from two hospitals in Santiago, Chile, were interviewed and their pets were evaluated by veterinary examination, coproparasitologic and skin dermatophytes test. In specific cases, other laboratory tests were performed in IS children or their relatives. Results: 47 out of 70 contacted families had pets, 42 participated in the study. Several risk factors for IS children were observed, as having a turtle as a pet and to clean cat or turtle faeces. Lack of adequate veterinary control, immunizations and deparasitation of pets were observed. Some animals showed zoonotic diseases or agents, as Brucella canis, Cryptosporidium sp, Giardia intestinalis, Toxocara canis and scabies. 44 percent of dogs had ticks and 37 percent had fleas, both potential vectors of infections. Conclusions: Our results suggest that policies to provide safer pet contact in IS children are needed.
Objetivo: Caracterizar la tenencia y estado de salud de mascotas de niños inmunocomprometidos (IC), con énfasis en situaciones y agentes infecciosos de potencial riesgo para la salud del niño. Población y Métodos: Se entrevistó a familias de niños IC en tratamiento en dos hospitales de Santiago y se evaluó la salud de sus mascotas mediante examen clínico veterinario, copro-parasitológico y búsqueda de dermatofitos en el pelaje. En casos puntuales, se realizaron algunos exámenes de laboratorio específicos a los niños o sus familiares. Resultados: 47 de 70 familias contactadas tenían mascotas, 42 participaron del estudio. Se detectaron situaciones de alto riesgo para niños IC como poseer tortuga como mascota y limpiar excretas de gatos y tortugas. Se evidenció una mínima adherencia al control veterinario, inmunizaciones y desparasitación de mascotas. Se identificaron animales con enfermedades o agentes con potencial zoonótico, destacando Brucella canis, Cryptosporidium sp, Giardia intestinalis, Toxocara canis y sarna sarcóptica. Un 44 por ciento de los perros presentaban garrapatas y 37 por ciento pulgas, ambos potenciales vectores de infecciones. Conclusiones: Los resultados sugieren que en nuestro medio es necesario implementar medidas que permitan una tenencia más segura de las mascotas en contacto con niños IC.
Subject(s)
Adolescent , Animals , Cats , Child , Child, Preschool , Dogs , Female , Humans , Infant , Male , HIV Infections/immunology , Immunocompromised Host , Neoplasms/immunology , Pets , Transplantation , Zoonoses/transmission , Animal Husbandry , Cat Diseases/diagnosis , Cat Diseases/microbiology , Cat Diseases/parasitology , Dog Diseases/diagnosis , Dog Diseases/microbiology , Dog Diseases/parasitology , Pets/microbiology , Pets/parasitology , Risk Factors , Zoonoses/microbiology , Zoonoses/parasitologyABSTRACT
The article summarizes the scientific evidence related with protection conferred by the 23 valent polysacchar-die vaccine against invasive pneumococcal disease, non bacteriemic pneumococcal pneumonia, and probable pneumococal pneumonia in the elderly. Eider patients with and without risk factors are considered. The impact of herd immunitty conferred by vaccination of children with conjugated pneumococcal vaccine in reduction of penumonia in adults is discussed. Based on this analysis, the Advisory Committee on Immunizations of the Chilean Infectious Disease Society makes recommendations on the most efficient vaccine strategy for reduction of pneumococcal pneumonia in the elderly.
El artículo resume los hallazgos de la evidencia científica en relación a la protección que confiere la vacuna neumocóccica polisacárida 23 valente contra la enfermedad neumocóccica invasora, las neumonías neumocóccicas no bacteriémicas y las neumonías probablemente de etiología neumocóccica en el adulto mayor, estableciendo una categorización entre adultos mayores con factores de riesgo y sin ellos. Se documenta a la vez, el impacto que ha tenido la vacuna neumocóccica conjugada en la población infantil, en reducir las neumonías en el adulto mayor. Basados en la información disponible, el Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología, realiza recomendaciones sobre cuál sería la mejor forma de prevenir las enfermedades neumocóccicas en el adulto mayor.
Subject(s)
Adult , Humans , Middle Aged , Evidence-Based Medicine , Meta-Analysis as Topic , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines/administration & dosage , Streptococcus pneumoniae/immunology , Advisory Committees , Chile , Pneumococcal Vaccines/adverse effects , Pneumococcal Vaccines/immunology , Pneumonia, Pneumococcal/prevention & control , Societies, MedicalABSTRACT
Background: During 2005, the surveillance system of the Chilean Immunization Program detected an increased number of adverse reaction notifications associated to diphtheria, pertussis and tetanus whole-cell vaccine (DPT), coincidentiy with a change in the vaccine manufacturer. Aim: To compare the reactogenicity of two DPT formulations (vaccines 1 and 2) in 18-month-old infants and 4-year-old children. Material and methods: Severe adverse reactions to DPT were studied at the emergency room of two hospitals of Santiago in a case-control study (110 cases and 171 controls, who consulted for other causes). Simultaneously the incidence of total adverse reactions (mild and severe) for vaccine 1 and 2 was estimated in a cohort of 1,017 children vaccinated in an ambulatory health center of the same área. The formulation of DPT received by all participants was verífied, as well as the temporal relation with consultation or symptoms referred by their caregivers. Results: There was a greater probability of consulting at the emergency rooms for severe adverse reactions among children who received vaccine 1 (odds ratio (OR) =7.1; p <0.001), being greater among 4-year-old children (OR =18.9; p <0.001). Coincidentiy, in the cohort of vaccinated children, those who received vaccine 1 had a higher risk of presenting adverse reactions (RR =2.9; p <0.001), being high fever the commonest. Conclusions: We confirmed that vaccine 1 was associated to a higher risk of adverse reactions, especially among 4-year-old children. These results allowed the sanitary authority to adopt an informed decisión. The usefulness of observational studies in vaccine adverse reactions is confirmed.
Subject(s)
Humans , Adverse Drug Reaction Reporting Systems/statistics & numerical data , Diphtheria-Tetanus-Pertussis Vaccine/adverse effects , Diphtheria/prevention & control , Immunization Programs/standards , Tetanus/prevention & control , Whooping Cough/prevention & control , Adverse Drug Reaction Reporting Systems/standards , Case-Control Studies , Chile , Incidence , Population SurveillanceABSTRACT
The article briefly reviews the epidemiology of human papillomavirus (HPV) infection and associated diseases in the world and in Chile and the scientific information of the licensed HPV vaccines: Gardasil® and Cervarix®. Considering the available information, the Consultive Committee of Immunizations of the Chilean Society of Infectious Diseases, summarizes its conclusions and makes recommendations for vaccination against HPV in Chile.
El artículo revisa brevemente la epidemiología de las infecciones por virus papiloma humano (VPH) y las enfermedades asociadas, tanto en el mundo como en Chile y la información científica de las vacunas contra VPH licenciadas: Gardasil® y Cervarix®. Considerando la información disponible, el Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología, resume sus conclusiones y hace sus recomendaciones para la vacunación contra VPH en Chile.
Subject(s)
Adolescent , Adult , Female , Humans , Middle Aged , Young Adult , Advisory Committees , Alphapapillomavirus/immunology , Papillomavirus Vaccines , Papillomavirus Infections/prevention & control , Chile/epidemiology , Papillomavirus Infections/epidemiology , Papillomavirus Vaccines/adverse effects , Papillomavirus Vaccines/immunology , Societies, Medical , Young AdultABSTRACT
Ramsay-Hunt Syndrome (RHS) is a rare affection characterized by peripheral facial paralysis (PFP), skin eruption in the auricular canal and cochleovestibular symptoms. It is produced by varicella-zoster virus (VZV) reactivation at the geniculate ganglia. We report four patients between 3 and 17 years-old with RHS. Earache was the first symptom in two cases and three had cochleovestibular compromise. The direct immunofluorescence from the vesicular lesión was positive for VZV in two of them. All patients received treatment with aeyelovir and in three cases, this was associated with steroids. Three children had complete resolution of the PFP. RHS is an infrequent disease in the pediatric population and it should be suspected in children with PFP, erythema, vesicles and/or auricular pain. Early treatment with aeyelovir therapy could improve the recovery rate of facial nerve palsy.
El síndrome de Ramsay-Hunt (SRH) corresponde a una inusual afección caracterizada por parálisis facial periférica (PFP), erupción en el pabellón auricular ipsilateral y compromiso cocleo-vestibular. Es producida por reactivación del virus varicela zoster (VVZ) a nivel del ganglio geniculado. Se reporta una serie de cuatro pacientes entre 3 y 17 años de edad con SRH. La otalgia fue el primer síntoma en dos casos, tres de ellos presentaron sintomatología vestibular periférica y uno déficit cócleo-vestibular. La inmunofluorescencia directa de hisopado de lesión vesicular fue positiva para VVZ en dos niños. Todos recibieron tratamiento con aciclovir y tres recibieron además corticoesteroides. Tres niños tuvieron recuperación clínica completa. El SRH es una entidad poco frecuente en pediatría y debe sospecharse en niños con PFP, eritema, vesículas y/o dolor auricular, ya que el tratamiento precoz con aciclovir pudiera mejorar la evolución de la PFP.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Herpes Zoster Oticus/diagnosis , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Herpes Zoster Oticus/drug therapy , Prednisone/therapeutic use , Retrospective Studies , Severity of Illness IndexABSTRACT
This article briefly reviews the epidemiology of human papillomavirus (HPV) infection and associated diseases globally and in Chile, and the scientific ínformatíon of the licensed HPV vaccines: Gardasil® and Cervarix®. Considering the available information, the Advisory Committee on Immunizations of the Chilean Society of Infectious Diseases recommends vaccination of teenage girls, ideally before initiating sexual actívíty, Le. approximately at the age of 12 to 13 years and vaccination of women of any age if they have not started sexual activity. If women are vaccinated after initiating sexual activity, they should be informed of the lower efficacy of immunization if HPV infection has occurred. Education on responsible sexuality and sexually transmitted diseases should be maintained as a priority. Vaccination should be highly considered for inclusion in the National Immunization Program.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Advisory Committees , Immunization , Papillomaviridae , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines , Chile/epidemiology , Papillomaviridae/classification , Papillomaviridae/genetics , Papillomaviridae/immunology , Papillomavirus Infections/epidemiology , Papillomavirus Infections/virology , Papillomavirus Vaccines/adverse effects , Papillomavirus Vaccines/immunology , Societies, Medical , Young AdultABSTRACT
Objectives and Methods: To find more evidence of human exposure to Anaplasma sp in Chile, we studied 108 contaets of dogs with canine ehrlichiosis (CE) (risk group) and 61 persons without tick or CE cases contact (control group). A survey including risk factors and history of diseases compatible with ehrlichiosis/ anaplasmosis was applied to the risk group. Serum IgG anti-Anaplasma sp antibodies were determined in both groups. Results: A significant difference was found in the prevalence of anti-Anaplasma sp antibodies in the risk group compared with the control group (18,5 versus 3,3 percent), p < 0,005. No risk factors associated to seropositivity were found, ñor persons with history suggesting ehrlichiosis/anaplasmosis. Ninety four percent of the houses of the risk group had tick infestation. Discussion: A greater risk of exposition to Anaplasma sp is documented in people living in cióse contact with CE cases and in houses with tick infestation.
Objetivos y Método: Con el propósito de buscar mayor evidencia de exposición humana a Anaplasma sp en Chile, se estudiaron 108 personas en contacto con perros con ehrlichiosis canina (EC) (grupo de riesgo) y 61 personas sin antecedente de contacto con garrapatas ni con perros con EC (grupo control). Se aplicó encuesta sobre factores de riesgo e historia de cuadros sugerentes de ehrlichiosis/anaplasmosis al grupo de riesgo. En ambos grupos se determinó presencia de IgG anti-Anaplasma sp. Resultados: Se encontró significativa mayor prevalencia de anticuerpos anti-Anaplasma sp en el grupo de riesgo que en el grupo control (18,5 versus 3,3 por ciento), p < 0,005. No se encontraron factores de riesgo asociados a sero-positividad, ni personas con historia sugerente de ehrlichiosis/anaplasmosis clínica. Noventa y cuatro por ciento de las viviendas del grupo de riesgo presentaba infestación por garrapatas. Discusión: Se evidencia mayor riesgo de exposición humana a Anaplasma sp en personas en contacto cercano con perros con EC y que habitan viviendas con infestación por garrapatas.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Animals , Child , Child, Preschool , Dogs , Female , Humans , Male , Middle Aged , Young Adult , Anaplasma/immunology , Anaplasmosis/epidemiology , Antibodies, Bacterial/blood , Dog Diseases/microbiology , Ehrlichia canis/immunology , Ehrlichiosis/veterinary , Anaplasmosis/transmission , Bites and Stings , Case-Control Studies , Chile/epidemiology , Disease Reservoirs , Dog Diseases/immunology , Ehrlichiosis/epidemiology , Ehrlichiosis/immunology , Immunoglobulin G/blood , Risk Factors , Seroepidemiologic Studies , Tick Infestations/epidemiology , Tick Infestations/veterinary , Young AdultABSTRACT
Background: Influenza cause high hospitalization rates and complications in children. Objective: To describe clinical and epidemiological characteristics of influenza infection in hospitalized children. Patients and methods: In Universidad Católica Hospital, all hospitalizations due to influenza in children aged 15 days to 14 years, ocurring between January 2001 and December 2005 were reviewed. Results: Of a total of 3570 admissions associated with a respiratory illness, 124 (3.5 percent) were due to influenza, of which 75 percent presented between the months of April and June. Median age was 20.5 months (60 percent younger than 2 years) and 24 percent had an underlying risk factor. Most common symptoms were fever (94 percent) and dry cough (61 percent) and 75 percent of the children required oxygen. The most frequent complication was pneumonia (53 percent). The mean duration of hospitalization and oxygen use were 4.4 and 2.5 days respectively. Fifty two children (49.1 percent) received an antibiotic and nine children were admitted to intensive care unit. No deaths were recorded. Conclusion: Influenza virus cause serious complications and affects mostly healthy children younger than 2 years.
Introducción: El virus influenza produce elevadas tasas de hospitalización y complicaciones en niños. Objetivo: Describir el perfil clínico-epidemiológico de los niños hospitalizados por influenza en un hospital universitario. Pacientes y Métodos: Estudio descriptivo de las hospitalizaciones respiratorias y por influenza entre enero 2001 y diciembre 2005 en el Hospital Clínico de la Pontificia Universidad Católica. Resultados: Se hospitalizaron 3.570 niños por alguna causa respiratoria, 124 (3,5 por ciento) correspondieron a influenza confirmada, 75 por ciento ocurrieron entre abril y junio. La edad promedio fue 20,5 meses (60 por ciento) < 2 años), 24 por ciento tenían algún factor de riesgo identificado. Los síntomas más frecuentes fueron: fiebre (94 por ciento) y tos seca (61 por ciento). El 75 por ciento) presentó hipoxemia, siendo la complicación más frecuente la neumonía (53 por ciento). El promedio (días) de hospitalización y oxígeno fue 4,4 y 2,5; respectivamente. En 52/109 se indicaron antibacterianos, 9 niños ingresaron a cuidados intensivos. No hubo fallecidos. Conclusión: La hospitalización por influenza se asoció a serias complicaciones y afecta especialmente a niños sanos menores de 2 años.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Hospitalization/statistics & numerical data , Influenza A virus , Influenza B virus , Influenza, Human/epidemiology , Respiratory Tract Infections/epidemiology , Chile/epidemiology , Hospitals, University , Influenza A virus/isolation & purification , Influenza B virus/isolation & purification , Influenza, Human/drug therapy , Influenza, Human/virology , Prospective Studies , Retrospective Studies , Risk Factors , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/virologyABSTRACT
Objetivo: Describir la frecuencia y tipo de enfermedad neumocóccica invasora (ENI) y neumonía consolidante (NC) en lactantes chilenos. Pacientes y Métodos: Vigilancia prospectiva durante un año en tres centros. Vigilancia de ENI: hemocultivo en lactantes con sospecha clínica de enfermedad bacteriana invasora (EBI) o fiebre > 39 °C axilar, sin foco o con otitis media aguda. Vigilancia de NC: hemocultivo y evaluación independiente de la radiografía en lactantes con sospecha clínica de neumonía. Resultados: ENI: en 4.369 lactantes enrolados se detectaron 58 casos de EBI, 37 (64 por ciento) por Streptococcus pneumoniae. Tasas de ENI: 110/100.000 (Chillan) y 288/100.000 (Valparaíso). Serotipos de S. pneumoniae identificados: 18C (n: 8), 14 (n: 8), 19A (n: 5), otros (n: 12). NC: en 3.005 niños enrolados se detectaron 762 NC. Tasas de NC: 2.918/ 100.000 (Chillan) y 5.547/100.000 (Valparaíso). Discusión: Se confirma la relevancia de S. pneumoniae como agente de EBI así como la elevada frecuencia de NC en lactantes en Chile.
Objective: To describe frequency and type of invasive pneumococcal diseases (IPD) and consolidated pneumonia (CP) in Chilean infants. Patients and Methods: One-year prospective surveillance in three health care centers. PID surveillance: blood culture in infants with suspected invasive bacterial disease or with fever higher than 39°C axillary without focus or with acute otitis media. CP surveillance: blood culture and independent evaluation of chest X-ray in infants with suspected pneumonia. Results: IPD: in 4,369 infants studied, 58 cases of invasive bacterial diseases were identified, 37 (64 percent) due to S. pneumoniae. Rates of IPD: 110/100,000 (Chilian) and 288/100,000 (Valparaiso). Serotypes identified: 18C(n: 8), 14 (n: 8), 19A(n: 5), others (n: 12). CP: in 3,005 infants 762 CP were detected. Rates of CP: 2,918/100,000 (Chilian) and 5,547/100,000 (Valparaiso). Discussion: Results support the relevance of S. pneumoniae as the main cause of invasive bacterial disease and the high frequency of CP in this age group in Chile.
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Pneumococcal Infections/epidemiology , Population Surveillance/methods , Streptococcus pneumoniae , Anti-Bacterial Agents/therapeutic use , Chile/epidemiology , Prospective Studies , Pneumococcal Infections/classification , Pneumococcal Infections/diagnosis , Pneumonia, Pneumococcal/diagnosis , Pneumonia, Pneumococcal/epidemiology , Serotyping , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/isolation & purificationABSTRACT
Las infecciones graves por adenovirus (ADV) tienen una importancia creciente en pacientes inmuno-comprometidos, en especial en niños sometidos a trasplante de precursores hematopoyéticos (TPH). Se reporta un caso de infección por ADV inicialmente gastrointestinal y luego diseminada, de curso fatal, en un niño de 12 años, post LPH. El diagnóstico se confirmó mediante aislamiento viral y detección de genoma viral en tejidos y sangre. Se revisan los principales aspectos de la infección por ADV, su diagnóstico y las posibilidades terapéuticas. Este caso debe alertar a los médicos clínicos para sospechar y estudiar este agente viral en pacientes de alto riesgo y enfatiza la importancia de disponer en Chile de antivirales para su tratamiento.
Severe adenovirus (ADV) infections have become increasingly important in immunocompromised patients, mainly in pediatric stem cell transplant recipients. We report a case of disseminated ADV infection leading to death in a 12-year-old stem cell transplant recipient. The diagnosis was confirmed by viral isolation and viral genome detection in tissues and blood. Main issues associated with infection, diagnosis and therapeutic alternatives are reviewed. This case should alert clinicians to suspect and study this agent in high risk patients and highlights the importance of having antiviral drugs for ADV available in Chile.
Subject(s)
Child , Humans , Male , Adenovirus Infections, Human/diagnosis , Hematopoietic Stem Cell Transplantation/adverse effects , Immunocompromised Host , Adenovirus Infections, Human/immunology , Fatal Outcome , Immunocompromised Host/immunology , Severity of Illness IndexABSTRACT
El timerosal es un derivado del mercurio utilizado desde 1930 como preservante de vacunas. En las últimas décadas ha sido cuestionada su seguridad, especialmente por la posibilidad de toxicidad neurológica. La revisión de varios estudios realizados en niños que recibieron vacunas que contienen timerosal y la posición de organismos de expertos internacionales en relación al uso de este compuesto en vacunas, permite al Comité Consultivo de Inmunizaciones concluir que no existe evidencia de eventos adversos en lactantes o niños por exposición al timerosal contenido en vacunas rutinarias y, por lo tanto, no habría razón para modificar las actuales prácticas de inmunización en Chile.
Thimerosal is a mercury derivative included in vaccines since 1930 with the aim to prevent microbial contamination. During the last decades, the use of thimerosal has been questioned, specifically because of a potential association with neurotoxicity. After a thorough review of published studies on pediatric use of thimerosal-containing vaccines, and of position papers from international expert groups, the Consultive Committee of Immunizations of the Chilean Society of Infectious Diseases concludes that there is no solid evidence of adverse events associated with the use of thimerosal containing vaccines in infants and children. Therefore, a change in current vaccine practices refererred to thimerosal-containing vaccines is not justified in Chile.
Subject(s)
Child , Humans , Infant , Preservatives, Pharmaceutical , Thimerosal , Vaccines/chemistry , Autistic Disorder/chemically induced , Chile , Preservatives, Pharmaceutical/adverse effects , Reference Standards , Societies, Medical , Thimerosal/adverse effects , Vaccines/adverse effectsABSTRACT
En Chile, no se han documentado infecciones por Rickettsias en mascotas; algunas de ellas tienen importante potencial zoonótico. Objetivos: Reportar dos casos de rickettsiosis canina con confirmación serológica y determinar seroprevalencia de Rickettsia sp un grupo de caninos. Métodos: IgG anti-Rickettsia conorii y anti-Anaplasma phagocitophilum por IFI en dos caninos con cuadro clínico sugerente de rickettsiosis. Determinación de IgG anti-R. conorii en 77 caninos. Resultados: Como casos clínicos hubo un canino con fiebre, mialgias y melena y otro con manifestaciones he-morrágicas y compromiso neurológico. Seroprevalencia: 35% de los caninos presentaban IgG anti-Rickettsia. Discusión: Se reporta por primera vez en Chile la presencia de rickettsiosis canina, tanto clínica como serológica. Se documenta co-infección por Rickettsia y Anaplasma, dos agentes transmitidos por garrapatas. Es necesario realizar estudios de biología molecular para confirmar la especie de rickettsia presente en Chile. Además, debe estudiarse el rol zoonótico de estas infecciones en nuestro medio.
Rickettsial infections in pets have not been documented in Chile. Some of those infections have relevant zoonotic potential. Objectives: To report two serologically confirmed cases of canine rickettsiosis. To determine seroprevalence to Rickettsia sp in a group of dogs. Methods: IgG antibodies anti-R. conorii and anti-A. phagocitophilum by IFI in two dogs with clinical rickettsiosis. IgG antibodies anti-R. conorii in a group of 77 dogs. Results: Clinical cases: a dog presented with fever, myalgias and melena, another dog with bleeding and neurological involvement. Seroprevalence: 35% of the dogs had antibodies against Rickettsia. Discussion: This is the first evidence of canine rickettsiosis in Chile, both clinical and serological. Co-infection with two tickborne agents: Rickettsia and Anaplasma, is documented. Molecular studies are needed to confirm the rickettsial species present in Chile. The zoonotic role of these infections must be also studied.
Subject(s)
Animals , Male , Female , Dogs , Anaplasma phagocytophilum/immunology , Anaplasmosis/epidemiology , Dog Diseases/microbiology , Rickettsia Infections/veterinary , Rickettsia conorii/immunology , Anaplasma phagocytophilum/isolation & purification , Anaplasmosis/diagnosis , Antibodies, Bacterial/blood , Chile/epidemiology , Dog Diseases/diagnosis , Dog Diseases/epidemiology , Fluorescent Antibody Technique, Indirect , Immunoglobulin G/blood , Prevalence , Rickettsia Infections/diagnosis , Rickettsia Infections/epidemiology , Rickettsia conorii/isolation & purification , Seroepidemiologic StudiesABSTRACT
La vacunación anti-influenza es la herramienta fundamental para la prevención de esta importante enfermedad viral. Las indicaciones de vacunación, tradicio-nalmente enfocadas a los adultos a partir de los 65 años y a portadores de enfermedades crónicas, se han ido ampliando en los últimos años. Se presenta el fundamento de la reducción de la edad de vacunación de adultos y de la incorporación de lactantes sanos entre 6 y 24 meses de edad y se analiza el comportamiento de la vacuna en estos grupos etarios. Finalmente, se indican nuevos grupos posibles a incorporar en los programas de vacunación en el futuro.
Influenza immunization is a main tool to prevent this important viral illness. Traditional vaccine recommendations, mainly focused to elderly and people with chronic medical conditions, have been expanded during last years. The article summarizes the fundament of lowering the age cut off in adults and of the incorporation of healthy infants between 6 and 24 months. The performance of the vaccine in those new age groups is analyzed. Finally, new groups to possibly be incorporated in future vaccine recommendations are mentioned.
Subject(s)
Humans , Infant , Child, Preschool , Adult , Middle Aged , Immunization Programs , Influenza Vaccines , Influenza Vaccines/administration & dosage , Influenza, Human/prevention & control , Vaccination , Chile , Influenza Vaccines/adverse effectsABSTRACT
Metapneumovirus humano (MPVh) fue detectado entre julio y noviembre en 15 de 123 niños bajo 3 años de edad hospitalizados por infección respiratoria aguda (12 por ciento). Las muestras fueron estudiadas mediante técnicas de biología molecular (RPC-TR de muestra de hisopado nasofaríngeo y/o de sobrenadante de cultivo). El 67 por ciento de los niños hospitalizados con MPVh tenían menos de 1 año de edad, todos ellos presentaron tos y fiebre y el principal motivo de hospitalización fue el requerimiento de oxígeno en 73 por ciento de los casos. Si bien un tercio de los pacientes tenía patología previa, su evolución clínica no fue diferente respecto de los niños previamente sanos. El patrón radiológico mostró aumento de la trama intersticial, con focos de consolidación en 6 casos (40 por ciento). El diagnóstico más frecuente fue síndrome bronquial obstructivo o bronquiolitis, asociado o no a neumonía. Destaca la necesidad de un método de diagnóstico rápido para optimizar el diagnóstico diferencial, manejo y control de infecciones en estos pacientes.
Human metapneumovirus was detected in 15 of 123 children (12 percent) younger than 3 years of age hospitalized for treatment of acute respiratory infection between July and November 2004. The virus was detected by RT-PCR directly from nasopharyngeal swabs and/or from supernatants after cell culture. Children infected with hMPV were mostly younger than one year of age (67 percent), all presenting with fever and cough. The main cause for hospitalization was the need for oxygen therapy (73 percent). Four hMPV positive children had an identifiable co-morbid condition but had a similar clinical evolution when compared to previously healthy infants. Chest radiography showed an increase in interstitial infiltrates with focal consolidation in 6 children. Obstructive bronchial syndrome and bronchiolitis, with or without pneumonia, were the most frequent diagnosis associated with hMPV positivity. A rapid and sensitive diagnostic method is required to improve diagnosis and treatment of these patients.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Metapneumovirus/isolation & purification , Paramyxoviridae Infections/epidemiology , Respiratory Tract Infections/epidemiology , Acute Disease , Chile/epidemiology , Hospitalization , Metapneumovirus/genetics , Prospective Studies , Paramyxoviridae Infections/diagnosis , Paramyxoviridae Infections/virology , Reverse Transcriptase Polymerase Chain Reaction , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/virologyABSTRACT
El propósito de los sistemas de vigilancia de eventos adversos a vacunas es monitorizar aquellos temporalmente relacionados con las vacunaciones, para evaluar su causalidad y para describir eventos acaecidos luego de la introducción de nuevas vacunas. El fin último de estos sistemas es proporcionar a la población el mejor estándar de seguridad relativo a vacunas. El sistema de vigilancia puede ser pasivo (reportes espontáneos) o activo (seguimiento activo de los vacunados); la mayoría en ejercicio es pasiva. Este artículo presenta un resumen abreviado de los sistemas de vigilancia de eventos adversos a vacunas más conocidos, incluyendo los sistema empleados en los Estados Unidos de América (Vaccine Adverse Events Report System-VAERS), Canadá y Europa, como así también una referencia al sistema chileno, destacando las principales ventajas y limitaciones en cada caso.
The objective of the surveillance systems of vaccine adverse events is monitoring events temporally related to vaccination, to evaluate their causality with the vaccine and to detect events after the introduction of new vaccines. The ultimate goal of these systems is to provide the population with the best safety standard of the vaccines. The surveillance system can be passive (spontaneous reports) or active (active follow up of vaccinees); the majority of them are passive. The article gives a brief review of the most known vaccine adverse events surveillance systems, including the American Vaccine Adverse Events Report System (VAERS), the Canadian and European systems, a commentary about the Chilean one, highlighting its main advantages and also its limitations.