Estado de vacunación en pacientes con riesgo de enfermedades invasoras por bacterias capsuladas en un hospital pediátrico de Buenos Aires / Vaccination status in patients at risk for invasive disease with encapsulated bacteria at a children's hospital in the City of Buenos Aires

Introducción. El Ministerio de Salud contempla vacunas específicas para personas con riesgo elevado de infecciones invasoras por bacterias capsuladas (BC). En la actualidad se desconoce el cumplimiento del programa. El objetivo fue evaluar el estado de vacunación para BC en ≤ 18 años con factores de riesgo. Población y métodos. Estudio observacional, analítico, mediante encuesta a padres de ≤ 18 años con VIH, asplenia y/o déficit de complemento que concurrieron al vacunatorio de un hospital pediátrico de octubre de 2020 a septiembre de 2021. Se recabaron datos sociodemográficos y clínicos. Se evaluó el estado de vacunación para BC: neumococo, meningococo y Haemophilus influenzae b (Hib), calendario regular y antigripal. Se administró la escala de reticencia a la vacunación (ERV): rango 10-50. Se analizó la asociación entre las variables estudiadas y la vacunación para BC mediante regresión logística (OR, IC95%). Se utilizó la base datos REDCap® y STATA vs14®. Resultados. Participaron 104 sujetos, media 9,9 años (DE 4,4). Asplenia: 91,3 %, VIH: 7,6 % y déficit de complemento: 0,9 %. Nivel socioeconómico: pobreza relativa: 38,4 %, seguido por clase media: 37,5 %. Estado de vacunación completa para meningococo: 45 %, neumococo: 42 %, Hib: 97 %. El 77,9 % tenía al día el calendario regular y el 61,5 %, el antigripal. Media ERV: 41,9 (DE 3,2). No se encontraron asociaciones significativas entre las variables y el estado de vacunación para BC. Conclusiones. Un elevado porcentaje no tenía vacunación completa para BC, tampoco el calendario regular y antigripal. La confianza en la vacunación de los cuidadores fue elevada.

Introduction. The Ministry of Health has established specific vaccines for people at high risk for invasive infections with encapsulated bacteria (EB). There is currently no information about compliance with the vaccination schedule. Our objective was to assess EB vaccination status in subjects ≤ 18 years with risk factors. Population and methods. Observational, analytical study with a survey to parents of subjects aged ≤ 18 years with HIV, asplenia and/or complement deficiency attending a vaccination center at a children's hospital between October 2020 and September 2021. Sociodemographic and clinical data were collected. Their vaccination status for the EB pneumococcus, meningococcus, and Haemophilus influenzae type b (Hib), their regular vaccination and flu vaccination schedules were assessed. The vaccine hesitancy scale (VHS) was administered: range 10­50. The association between the study variables and EB vaccination was analyzed using logistic regression (OR, 95% CI). The REDCap® database and the STATA® v.14 software were used. Results. A total of 104 subjects participated; mean age: 9.9 years (SD: 4.4). Asplenia: 91.3%, HIV: 7.6%, and complement deficiency: 0.9%. Socioeconomic level: relative poverty: 38.4%, followed by middle class: 37.5%. Complete vaccination status: meningococcal vaccine 45%, pneumococcal vaccine: 42%, Hib: 97%. The regular vaccination and flu vaccination schedules were up-to-date in 77.9% and 61.5% of cases, respectively. Mean VHS score: 41.9 (SD: 3.2). No significant associations were observed between variables and EB vaccination status. Conclusions. A high percentage of subjects had not completed neither their EB vaccination nor their regular or their flu vaccination schedules. Caregivers' confidence in vaccines was high.

Avaliação do complemento na doença meningocócica / Assessment of complement in meningococcical disease

Avaliar aspectos do sistema imunológico inato na doençameningocócica, com enfase nas frações C3, C4 e o CH50 do sistema imunológico e lectina ligadora de manose (MBL) com ênfase na pediatria. Fonte de dados: Revisão narrativa de periódicos na área de infectologia e imunologia sobre o assunto nos últimos 10 anos e pesquisas anteriores a esta data com relevância segundo a avaliação dos autores. Síntese dos dados: O acometimento da imunidade humoral é predominante nas Imunodeficiências Primárias, mas quando se considera apenas os casos de doença meningocócica as deficiências de complementosão presumivelmente as mais frequentes. Conclusões: A deficiência de componentes do sistema complementoe alterações decorrentes do polimorfismo gênico da MBL 2 são possíveis explicações para o desenvolvimento de doença meningocócica em algunspacientes. Assim a avaliação do complemento pode ser necessária para indivíduos que foram acometidos por esta grave doença.

Evaluate some aspects of the innate immune system of patients with a history of meningococcal disease, being chosen from among them the complement fractions C3, C4 and CH50 than the evaluation of the mannose-binding lectin (MBL) gene with emphasis on pediatrics. Data source: Review of journals in the field of infectious diseases and immunology on the subject in the last 10 years or before that dateby relevance. Data synthesis: Involvement of humoral immunity is predominant in primary immunodeficiencies, but complement deficiencies are presumably the most frequent when considering only cases of meningococcal disease.Epidemiological aspects, clinical and immunological designed to discuss the subject. Conclusions: Complement deficiency and polymorphism in the MBL2 gene are possible explanations for the development of meningococcaldisease in some patients. So the evaluation of the supplement maybe suggestible with exceptions for individuals affected by this seriousdisease.

Advance in immunopathogenesis for systemic lupus erythematosus / 国际儿科学杂志

Systemic lupus erythematosus is a typical autoimmune disease commonly seen in childhood, the immunnopathogenesis of which is complicated. Along with the rapid advances of immunology and molecular biology, all the associated research has found that the onset of systemic lupus erythematosus is associated with dysfunction of T cells and B cells. They focus on the break of the normal autoimmune immunity and the form of malgenic autoantibody. It is also connected with primary immunodeficiency. The dysfunction of inherent immunity contributes to the break of autoimmune and the progression of the disease.

A Case of Membranoproliferative Glomerulonephritis Associated with Complement Deficiency and Meningococcal Meningitis

Hypocomplementemia is found in all types of membranoproliferative glomerulonephritis (MPGN) but not in all patients. Hypocomplementemia can be ascribed to at least two circulating complement reactive modalities. The activation of the classical pathway produced by circulating immune complexes and the presence in the blood of anticomplement autoantibodies, called "nephritic factor"(NF). The activation of the classical pathway by circulating immune complexes is probably the major mechanism responsible for hypocomplementemia in idiopathic MPGN type I. Nephritic factors have been shown to be responsible for the hypocomplementemia in both MPGN type II and III. NFa is probably the major mechanism responsible for the hypocomplementemia of idiopathic MPGN type II. NFt appears to be solely responsible for the hypocomplementemia in MPGN type III. Judging from the complement profile, NFt also may be present in some patients with MPGN type I. Although infection by meningococcus has been associated with deficiency of any of the plasmatic proteins of complement, it more commonly involves deficiency of the terminal components of the complement pathway(C5-C9). We experienced a patient who had MPGN and meningococcal meningitis. We examined the complement level and significantly lower levels of C3, C5 were found persistently. C7 was low at first and it returned to normal range after 2 months. C9 was normal at first, and was low after 2 months. This is the first reported case in which MPGN with meningococcal meningitis occurred.