Asociación temporal entre la circulación de virus respiratorios y hospitalizaciones por enfermedad de Kawasaki / Temporal association between the circulation of respiratory viruses and hospitalizations due to Kawasaki disease

INTRODUCCIÓN: La etiología de la enfermedad de Kawasaki (EK) es desconocida, planteándose que infecciones virales la gatillan en pacientes susceptibles. OBJETIVO: Estudiar la asociación temporal entre la circulación de virus respiratorios y hospitalizaciones por EK en la Región Metropolitana (RM), Chile, entre 2010-2017. METODOLOGÍA: Estudio ecológico retrospectivo de casos de EK en pacientes bajo 18 años de edad, en base a egresos hospitalarios. La circulación de virus se analizó mediante el reporte de la red de vigilancia metropolitana. Se utilizaron promedios móviles para EK (PMEK) y virus respiratorios (PMVR). RESULTADOS: Se registraron 14.902 casos de infecciones virales respiratorias entre 2010-2017. Se observó correlación directa entre PMVR-virus respiratorio sincicial (VRS) de un mes y año y PMEK del mes subsiguiente (coeficiente de correlación (ρ) = +0,441; p < 0,001), y una asociación similar para PMVR-influenza A (FLU A) (ρ = +0,362; p < 0,001). PMVR-influenza B (FLU B) y PMVR-metapneumovirus (MPV) presentan correlaciones directas con PMEK (ρ = +0,443; p < 0,001 y ρ = +0,412; p < 0,001, respectivamente), siendo contemporáneo en mes y año con EK para FLU B, mientras que MPV presenta un desfase de un mes entre PMVR y PMEK. CONCLUSIÓN: Existe correlación temporal directa entre la circulación de VRS, FLU A, FLU B y MPV con EK en niños de la RM, Chile.

BACKGROUND: The etiology of Kawasaki disease (KD) is unknown. It is believed that viral infections could trigger the disease in susceptible patients. AIM: To study the temporal association between the circulation of respiratory viruses and KD hospitalizations in the Metropolitan Region (MR), Chile, between 2010-2017. METHODS: Ecologic study consisting of a review of KD cases in children under 18 years of age based on hospital discharges. The circulation of respiratory viruses was analyzed using the report of the metropolitan surveillance network. Moving averages for KD (MAKD) and respiratory viruses (MARV) were used. RESULTS: 14,902 cases of respiratory virus infections were recorded between 2010-2017. A direct correlation was found between MARV-respiratory syncytial virus (RSV) of one month and year and MAKD of the subsequent month (correlation coefficient (ρ) = +0.441; p < 0.001). A similar association was found for MARV-influenza A (FLU A) (ρ = + 0.362; p < 0.001). MARV-influenza B (FLU B) and MARV-metapneumovirus (MPV) had direct correlations with MAKD (ρ = +0.443; p < 0.001 and ρ = +0.412; p < 0.001, respectively), being FLU B contemporary in month and year with KD, and MPV presenting a one-month lag. CONCLUSION: There is a direct temporal correlation between RSV, FLU A, FLU B and MPV circulation and KD in children from RM, Chile.

Letalidad en lactantes con cardiopatías congénitas hospitalizados por virus respiratorio sincicial / Case fatality in infants with congenital heart disease hospitalized for respiratory syncytial virus

INTRODUCCIÓN. Las cardiopatías congénitas son un factor de riesgo para desarrollar enfermedad severa por virus respiratorio sincicial (VRS). En Chile no se conoce la hospitalización o letalidad por esta causa. El objetivo de este estudio fue determinar la letalidad de niños menores de 2 años con cardiopatías congénitas hospitalizados por infección por VRS en el hospital de niños Roberto del Río, Santiago, Chile. MÉTODO. Estudio descriptivo retrospectivo de revisión de fichas clínicas de niños menores de 24 meses con cardiopatía congénita, hospitalizados por infección respiratoria baja por VRS. Se registró edad, género, tipo de cardiopatía congénita, comorbilidades, días de hospitalización, ingreso a unidad de paciente crítico y letalidad en Hospital Roberto del Río durante los años 2014 a 2016. Se analizaron resultados mediante Stata 13. Aprobado por Comité de ética del Servicio de Salud Metropolitano Norte RESULTADOS: Se estudian 94 pacientes hospitalizados, mediana de edad de 7,3 meses, 45 (48%) hombres. Los casos de cardiopatía congénita cianótica fueron 7 (7,4%), obstructivas izquierdas 3 (3,2%) y no obstructivas 84 (89,3%). Las comorbilidades fueron: 17 (18,08%) trisomía 21, 10 (10,6%) patología neurológica, 6 (6,38%) reflujo gastroesofágico. Sin comorbilidad 48 pacientes (51,06%). La mediana de hospitalización es 8 días y la necesidad de ventilación mecánica de 1 día, siendo mayor en las cianóticas. Requieren ingreso a unidad de paciente crítico 49 (52,12%). La letalidad fue de un 8,5%. CONCLUSIÓN: La morbimortalidad de la infección por VRS observada en pacientes con cardiópatas congénitas es elevada, por lo que la prevención con anticuerpos monoclonales podría tener impacto. En el 2019 Chile implementa el uso de anticuerpos monoclonales anti VRS en niños con cardiopatías congénitas por lo que será interesante medir el impacto de esta medida.

INTRODUCTION. Congenital heart disease is a risk factor for developing severe disease due to respiratory syncytial virus (RSV). In Chile the rate of hospitalization or lethality due to this cause is not known. The objective of this study was to determine lethality of infants with congenital heart disease hospitalized for RSV infection. METHOD. Retrospective descriptive study, through review of clinical records of infants under 24 months with congenital heart disease, hospitalized due to low RSV respiratory infection. We recorded age, gender, type of congenital heart disease, comorbidities, days of hospitalization, admission to a critical patient unit and lethality in Roberto del Río Hospital between 2014 to 2016. The research had approved bay the ethical Comitee Servicio de Salud Metropolitano Norte. Results were analyzed through Stata 13. RESULTS. 94 hospitalized patients were studied, median age of 7.3 months, 45 (48%) men. The cases of congenital cyanotic heart disease were 7 (7.4%), left obstructive 3 (3.2%) and non-obstructive 84 (89.3%). The comorbidities were: 17 (18.08%) trisomy 21, 10 (10.6%) neurological pathology, 6 (6.38%) gastroesophageal reflux and 48 patients (51.06%) did not present. The hospitalization median is 8 days and the need for 1-day mechanical ventilation is greater in cyanotic patients. They require admission to the critical patient unit 49 (52.12%). The lethality is 8.5%. CONCLUSION: The lethality of RSV infection observed in patients with congenital heart disease is high. In 2019 Chile implemented the use of RSV monoclonal antibodies congenital heart disease. New studies are needed to measure the impact of this new policy. Keywords: congenital heart disease, respiratory syncytial virus

Bronquiolitis aguda: tratamiento de la insuficiencia respiratoria / Acute bronchiolitis: treatment of respiratory insufficiency

The severe respiratory insufficiency (SRI) caused by acute bronchitis whose main etiology is the respiratory syncytial virus is the main cause of under 2-year-old children hospitalization during the winter months, especially in the risk groups. Its treatment is mainly based in general measures, administration of respiratory support with standard oxygen therapy, non-invasive ventilation, invasive mechanical ventilation or the emerging high flow nasal cannula therapy, which these past few years has become an easy alternative of use, well tolerated, secure to be used in emergency rooms, basic rooms and pediatric intensive care units. The election of therapy will depend of the patient severity, the level of complexity of the healthcare center and the experience in the different treatment modalities of the health team. It is essential to carry out protocols and guidelines for the management of SRI treatment caused by acute bronchitis for emergency services, basic rooms and pediatric intensive care.

La insuficiencia respiratoria aguda (IRA) causada por bronquiolitis aguda (BA), cuya principal etiología es el virus respiratorio sincicial (VRS), es la principal causa de hospitalizaciones en menores de 2 años durante los meses de invierno, especialmente en grupos de riesgo. Su manejo se basa principalmente en medidas generales, administración de soporte respiratorio con oxigenoterapia estándar, ventilación no invasiva (VNI), ventilación mecánica invasiva (VMI) o la emergente terapia con cánula nasal de alto flujo (CNAF), que se ha transformado en los últimos años en una alternativa de fácil uso, bien tolerada, segura para ser usada en los servicios de urgencia, salas básicas y unidades de cuidados intensivos pediátricos (UCIP). La elección de la terapia a utilizar dependerá de la gravedad del paciente, del nivel de complejidad del centro asistencial y de la experiencia en las distintas modalidades de tratamiento del equipo de salud. Es fundamental realizar protocolos y guías de manejo de tratamiento de la IRA causada por BA tanto para servicios de urgencia, salas básicas como cuidados intensivos pediátricos.

Infecciones respiratorias agudas bajas en niños menores de 2 años: hospitalizaciones durante el invierno del año 2014 / Low acute respiratory infections in children under 2 years: 2014 winter hospitalizations / Infecções agudas das vias respiratórias inferiores em crianças menores de 2 anos: hospitalizações em 2014

Durante el invierno las infecciones respiratorias agudas bajas (IRAB) determinan un incremento en la demanda asistencial, afectando sobre todo a los niños más pequeños. El objetivo de la investigación fue describir las características clínicas, modalidades de tratamiento y evolución de los menores de 2 años hospitalizados en el Hospital Pediátrico-Centro Hospitalario Pereira Rossell por IRAB de etiología viral durante el invierno de 2014. Se realizó un estudio descriptivo, retrospectivo, describiendo las características de los menores de 2 años hospitalizados del 9/6 al 21/9/2014 por IRAB de probable etiología viral. Se describieron las características epidemiológicas y clínicas, el tratamiento realizado y la evolución de los pacientes. En el período evaluado egresaron 742 niños (34% de los egresos de la institución). Tenían una mediana de edad de 4 meses; 18% presentaba al menos un factor de riesgo de IRAB grave. Se identificó al virus respiratorio sincicial en 59,6%. La estadía hospitalaria tuvo una mediana de 4 días. En las salas de cuidados moderados se aplicó ventilación no invasiva a 46 niños, y oxigenación de alto flujo a 129 niños, logrando una mejoría clínica en el 87,0% y el 87,6% respectivamente. Ingresaron a unidades de cuidados intensivos 217 niños, 54% requirió asistencia ventilatoria mecánica. Dos pacientes fallecieron. En el período evaluado los niños pequeños con IRAB representaron una importante proporción de los egresos, con importante carga asistencial. La mayoría eran niños sin factores de riesgo. La aplicación de las técnicas de tratamiento en cuidados moderados fue efectiva, permitiendo disminuir la demanda de camas de cuidados intensivos.

During the winter, low acute respiratory infections (LARI) determine an increase in care demand, especially affecting younger children. The objective of the research was to describe the clinical characteristics, treatment modalities and evolution of children under 2 years of age hospitalized at the Hospital Pediátrico-Centro Hospitalario Pereira Rossell for viral etiology LARI during the 2014 winter. A descriptive, retrospective study was conducted, describing the characteristics of children under 2 years hospitalized between 9/6 and 9/21/2014 for LARI of probable viral etiology. The following features were described: epidemiological and clinical characteristics, treatment performed and patient's evolution. During the period evaluated, 742 children were discharged (34% of the institution's admissions). They had a median age of 4 months; 18% had at least one risk factor for severe LARI. Respiratory syncytial virus was identified in 59.6%. The hospital stay had a median of 4 days. In moderate care rooms noninvasive ventilation was applied to 46 children, and high flow oxygenation to 129 children, achieving clinical improvement in 87.0% and 87.6%, respectively. Two hundred and seventeen children were admitted 54% required mechanical ventilation. Two patients died. In the evaluated period small children with LARI represented a significant proportion of the discharges, with an important burden of care. The majority were children without risk factors. The application of treatment techniques in moderate care was effective, allowed a decrease in the demand for intensive care beds.

Durante o inverno, as infecções respiratórias agudas baixas (IRAB) determinam o aumento da demanda de cuidados, afetando especialmente as crianças menores. O objetivo da pesquisa foi descrever as características clínicas, as modalidades de tratamento e a evolução de crianças menores de dois anos hospitalizados no Hospital Pediátrico-Centro Hospitalario Pereira Rossell devido a IRAB de etiologia viral, durante o inverno de 2014. Foi realizado um estudo descritivo e retrospectivo, descrevendo as características das crianças menores de 2 anos hospitalizadas entre 9/6 e 21/9/2014 devido a IRAB de provável etiologia viral. Descreveram-se: características epidemiológicas e clínicas, tratamento realizado e evolução dos pacientes. Durante o período avaliado, 742 crianças foram hospitalizadas (34% dos ingressos da instituição). Tinham uma idade média de 4 meses; 18% tinham pelo menos um fator de risco para IRAB severa. O vírus sincicial respiratório foi identificado em 59,6%. A estadia hospitalaria teve uma mediana de 4 dias. Em salas de cuidados moderados, a ventilação não invasiva foi aplicada a 46 crianças e a oxigenação de alto fluxo a 129 crianças, atingindo melhora clínica em 87,0% e 87,6%, respectivamente. Foram internadas em unidades de terapia intensiva 217 crianças, 54% necessitaram de ventilação mecânica. Dois pacientes faleceram. No período avaliado, as crianças pequenas com IRAB representaram uma proporção significativa das despesas, com um carga importante de atendimento. A maioria carecia de fatores de risco. A aplicação de técnicas de tratamento em cuidados moderados foi eficaz, permitindo uma diminuição da demanda por leitos de terapia intensiva.

Potenciales consecuencias neurocognitivas de infección por virus respiratorio sincicial humano / Potential neurocognitive consequences of infection by human respiratory syncytial virus

Human respiratory syncytial virus (RSV) infection remains as a major cause of morbidity and mortality among pediatric population. Immune response is poor and unable to establish a long term effective protection against this virus. Of particular interest has been the description of extrapulmonary manifestations of RSV infection in liver, kidney, endocrine system, heart and brain, associated to infection of peripheral blood. In the central nervous system (CNS), recent studies in animals have suggested long term neurocognitive impairment due to a direct damage from the virus. This was prevented in rats by a recombinant BCG vaccine expressing a nucleoprotein N of RSV that produces an effective immune response against the virus, not allowing its dissemination to the CNS. These findings in animal models highlight the importance of conducting more specific studies in children affected with severe infection by RSV. Therefore, our group is currently conducting an assessment of the possible long-term cognitive impairment in children under 2 years. The results of this study could be a strong argument to continue looking for an effective method for protecting against RSV infection.

La infección por virus respiratorio sincicial humano (VRS) es una de las principales causas de morbimortalidad en población pediátrica. La respuesta inmune generada contra VRS es poco eficiente para su eliminación y logra establecer sólo protección parcial contra infecciones posteriores. De especial interés en los últimos años ha sido la descripción de manifestaciones extra-pulmonares de la infección por VRS en hígado, riñón, sistema endocrino, corazón y cerebro. A nivel de sistema nervioso central (SNC), estudios recientes en modelos animales han sugerido problemas neurocognitivos a largo plazo derivados de un daño directo del virus en el cerebro. Este daño logró ser prevenido con vacuna experimental BCG recombinante, que expresa la nucleoproteína N de VRS e induce inmunidad efectiva, impidiendo la diseminación del virus hacia el SNC. Estos hallazgos en modelo animal han dado cuenta de la importancia de efectuar estudios más detallados en niños afectados por VRS grave. Por tal motivo, actualmente se está realizando una evaluación de la posible alteración cognitiva a largo plazo en niños bajo dos años de edad por parte de nuestro grupo. Los resultados de este estudio podrían significar un argumento muy importante para continuar en la búsqueda de un método efectivo de protección contra esta infección.

Rabdomiólisis recurrente en un niño: Presentación de un caso / Recurrent rhabdomyolysis in a child: Case presentation

La miositis viral asociada a infecciones raramente produce rabdomiólisis. En las publicaciones científicas no se describe ningún caso pediátrico de rabdomiólisis grave recurrente inducida por infecciones. En este artículo presentamos el caso de un niño de sexo masculino de dos años de edad hospitalizado en tres ocasiones debido a rabdomiólisis grave asociada a miositis viral durante el invierno. Esta es la primera presentación de un caso pediátrico de rabdomiólisis grave inducida por infecciones. En este paciente, el tratamiento con prednisolona e inmunoglobulinas por vía i.v. fue ineficaz.

Viral myositis associated with infections rarely may cause rhabdomyolysis. There is no any pediatric case with severe recurrent rhabdomyolysis triggered by infections in the literature. We reported a two-year-old boy who was hospitalized three times due to severe rhabdomyolysis associated with viral myositis in the winter months. This is the first child case presentation with severe rhabdomyolysis triggered by infections. Prednisolone and intravenous immunoglobulin treatments were ineffective in this case.

Características epidemiológicas e genéticas associadas à gravidade da bronquiolite viral aguda pelo vírus sincicial respiratório / Epidemiological and genetic characteristics associated with the severity of acute viral bronchiolitis by respiratory syncytial virus

OBJETIVO: avaliar os fatores epidemiológicos e genéticos associados à gravidade da Bronquiolite Viral Aguda (BVA) pelo Vírus Sincicial Respiratório (VSR). FONTE DOS DADOS: foram utilizados descritores "bronchiolitis", "risk factor", "genetics" e "respiratory syncytial virus" e todas as combinações entre eles, nas bases de dados PubMed, SciELO e Lilacs publicados após o ano de 2000 e que incluíram indivíduos menores de dois anos de idade. SÍNTESE DOS DADOS: foram encontrados 1.259 artigos e lidos seus respectivos resumos. Destes foram selecionados 81 que avaliaram fatores de risco para a gravidade da BVA para leitura na íntegra, e foram incluídos os 60 estudos mais relevantes. Os fatores epidemiológicos associados com a gravidade da BVA pelo VSR foram: prematuridade, tabagismo passivo, baixa idade, ausência de aleitamento materno, doença pulmonar crônica, cardiopatia congênita, sexo masculino, etnia, coinfecção viral, baixo peso na admissão hospitalar, tabagismo materno na gestação, dermatite atópica, ventilação mecânica no período neonatal, antecedente materno de atopia e/ou asma na gestação, estação do nascimento, baixo nível socioeconômico, síndrome de Down, poluição ambiental, morar em altitude acima de 2.500 metros do nível do mar e parto cesariana. Em contrapartida, algumas crianças com BVA grave não apresentam nenhum desses fatores de risco. Neste sentido, estudos recentes têm verificado a influência de fatores genéticos relacionados à gravidade da BVA pelo VSR. Polimorfismos dos genes TLRs, RANTES, JUN, IFNA5, NOS2, CX3CR1, ILs e VDR têm-se mostrado associados com a evolução mais grave da BVA pelo VSR. CONCLUSÃO: a gravidade da BVA pelo VSR é um fenômeno dependente da interação entre variáveis epidemiológicas, ambientais e genéticas em seus diferentes graus de interação.

OBJECTIVE: to assess the epidemiological and genetic factors associated with severity of acute viral bronchiolitis (AVB) by respiratory syncytial virus (RSV). DATA SOURCE: the key words ''bronchiolitis'', ''risk factor'', ''genetics'' and ''respiratory syn-cytial virus'', and all combinations among them were used to perform a search in the PubMed,SciELO, and Lilacs databases, of articles published after the year 2000 that included individualsyounger than 2 years of age. DATA SYNTHESIS: a total of 1,259 articles were found, and their respective summaries were read. Of these, 81 were selected, which assessed risk factors for the severity of AVB, and were read in full; the 60 most relevant studies were included. The epidemiologic factors associated with AVB severity by RSV were prematurity, passive smoking, young age, lack of breastfeeding, chronic lung disease, congenital heart disease, male gender, ethnicity, viral coinfection, low weight at admission, maternal smoking during pregnancy, atopic dermatitis, mechanical ventilation in the neonatal period, maternal history of atopy and/or asthma during pregnancy, season of birth, low socioeconomic status, Down syndrome, environmental pollution, living at an altitude > 2,500 meters above sea level, and cesarean section birth. Conversely, some children with severe AVB did not present any of these risk factors. In this regard, recent studies have verified the influence of genetic factors on the severity of AVB by RSV. Polymorphisms of the TLRs, RANTES, JUN, IFNA5, NOS2, CX3CR1, ILs, and VDR genes have been shown to be associated with more severe evolution of AVB by RSV. CONCLUSION: the severity of AVB by RSV is a phenomenon that depends on the varying degrees of interaction among epidemiological, environmental, and genetic variables.

Infecção por vírus sincicial respiratório como causa de internação na população com menos de 1 ano na Colômbia / Respiratory syncytial virus infection as a cause of hospitalization in population under 1 year in Colombia

OBJETIVO: determinar a frequência, as complicações e a sazonalidade com que a infecção pelo vírus sincicial respiratório (VSR) do trato respiratório inferior causa hospitalização em neonatos com um ano de idade ou menos, em seis cidades da Colômbia. MÉTODOS: estudo observacional prospectivo multicêntrico de um ano que incluiu 717 pacientes, que compareceram ao serviço de emergência com sintomas respiratórios em seis cidades da Colômbia. As crianças hospitalizadas foram testadas para verificar a existência de VSR com teste de imunofluorescência das secreções nasofaríngeas. Foram realizadas análises descritivas e estatísticas da população. RESULTADOS: a população estudada incluiu 717 pacientes com uma idade média de 3,6 meses (DP 3,25), na proporção de 4:3 do sexo masculino para o sexo feminino e uma prevalência de ITRI por VSR de 30% (216 neonatos/cidade, faixa 26-49%). Os fatores de risco para ITRI por VSR foram encontrados em 8,2% da população, dos quais 28,8% foram positivos para VSR. Os grupos positivo e negativo para VSR foram comparados utilizando um teste t bicaudal com IC de 95%, p < 0,05. Não foram constatadas diferenças estatisticamente significativas. Todas as cidades apresentaram trimestres anuais específicos para ocorrência de ITRI por VSR. CONCLUSÕES: o VSR causou uma em três internações de ITRI na população, com uma incidência de 30%. Isso confirma uma circulação contínua do VSR na Colômbia, que varia pela localização geográfica.

OBJECTIVE: to determine the frequency, complications and seasonality at which respiratory syncytial virus (RSV) infection of the lower respiratory tract causes hospitalization in infants of age 1 year or less in 6 cities of Colombia. METHODS: one-year prospective multicentric observational study that included 717 patients presenting to the emergency department with respiratory symptoms in 6 cities of Colombia. Hospitalized children were tested for RSV with an immunofluorescence rapid test in nasopharyngeal secretions. Descriptive and statistical analyses of the population were conducted. RESULTS: the study population included 717 patients with a mean age of 3.6 months (SD 3.25), 4:3 male: female ratio and a positive RSV LRTI prevalence of 30.0% (216 infants/City, range 26.0 - 49.0%). Risk factors for RSV LRTI were found in 8.2% of the population, of which 28.8% were RSV positive. RSV positive and negative groups were compared using a two-tailed t test with 95.0%CI, p < 0.05. No statistically significant differences were found. All cities presented specific year trimesters in the occurrence of RSV LRTI. CONCLUSIONS: the RSV caused 1 in 3 LRTI hospitalizations in the population, with an incidence of 30.0%. This confirms a continuous circulation of RSV in Colombia varying by geographic location.

Estudio temporal de diabetes mellitus tipo 1 en Chile: asociación con factores ambientales durante el período 2000-2007 / Association of the incidence of type 1 diabetes mellitus with environmental factors in Chile during the period 2000-2007

Background: Pollution and viral infections could be associated with the incidence of type 1 diabetes mellitus. Aim: To look for associations between the temporal patterns of Type 1 Diabetes Mellitus (T1D) in infants younger than the age of 15years, and environmental factors, such as air pollution and viruses. Material and Methods: Data registries from hospitals, emergency services, and the Infantile Diabetes Foundation were reviewed, corresponding to children aged less than 15years, who received their first insulin injection between 2000 and 2007. The incidence of type 1 diabetes was computed for each epidemiological week. Environmental ozone and particulate matter rates for each week were obtained from Environmental services. Rates of influenza and respiratory syncytial virus infections were obtained from the epidemiological department of the Ministry of Health. An ecological Bayesian Poisson regression model was fitted, introducing the covariates, lagged covariates and errors, to estimate the incidence by epidemiological week. Results: Three factors were significant by the proposed model: particulate matter PPM 2.5 (relative risk (RR): 1.003) lagged by two weeks, influenza (RR: 0.1808) and RSV (RR: 1.021). Trends and seasonality were clearly controlled by these covariates, considering the epidemiological week as a counting period. Conclusions: These results show that environmental factors could be related to peaks of type 1 diabetes incidence.

Ventilación de alta frecuencia en infección respiratoria grave por VRS / High frequency oscillatory ventilation in severe RSV infection

High frequency oscillatory (HFOV) has been progressively useful in children with severe hypoxemic and Iry-percapnic respiratory insufficiency, at Pediatric Intensive Care Units. Objectives: To describe our experience in treatment of children with severe RSV infection unresponsive to conventional ventilation (CV), to describe effectiveness in gas exchange and to evaluate the safety of the method. A descriptive and prospective study set at two paediatric intensive care units, in Hospital Roberto del Río and Clínica Santa María of Santiago, Chile between January 2001 and December 2004. Results: 36 patients between 0.5 and 10 months of age with severe RSV infection and respiratory failure unresponsive to mechanical ventilation were connected to HFOV after an average time of conventional ventilation of 2.6 days. Arterial pH improved during the first hour in HFOV from 7.18 to > 7.3. Initial PaO2/FiO2 in average was 104.8, there was a slow and progressive improvement until 72 hours (138). FiO2 diminished since an average of 74 percent till 63.6 percent at 72 hours pCO2 went down from an average of 88 mm de Hg pre HFOV to 50 mmHg at 12 hours, remaining low. Oxygenation Index, preHFOV, was in average 18 and it maintained in 17 at 72 hours, with a FiO2 < 60 percent. Patients were hold in HFOV between 2-18 days. 3/36 patients died after 1.5, 4 and 18 days of HFOV. 8,3 percent presented air leak. One of these patients is oxygen dependent after 12 months of following. Conclusions: High frequency oscillatory ventilation is a useful method in the management of acute respiratory failure in children with severe infection for RSV unresponsive to conventional ventilation. It can improve gas exchange slowly and progressively with a low risk of air leak, secuelae and death.

La ventilación de alta frecuencia oscilatoria (VAFO) es un modo ventilatorio cada vez más utilizado en el manejo del paciente pediátrico con insuficiencia respiratoria grave, tanto hipoxémica como hipercápnica, en unidades de paciente crítico. Objetivos. Describir nuestra experiencia en el uso de VAFO en niños con infección respiratoria aguda grave por Virus Respiratorio Sincicial (VRS), su efectividad en el intercambio gaseoso y la seguridad del método. Método: Estudio descriptivo, retrospectivo, realizado en unidades de cuidado intensivo pediátricos de Hospital Roberto del Río y Clínica Santa María de Santiago, Chile, entre los meses de Enero 2001 y Diciembre 2004. Resultados: Se conectaron a VAFO 36 pacientes de 0,5 a 10 meses de edad con falla respiratoria aguda por infección por VRS y sin respuesta a VMC, luego de un promedio de 2,6 días. El pH arterial mejora durante la primera hora en VAFO, de 7,18 a 7,3. PaO2/FiO2 inicial promedio fue de 104,8, se observó una lenta y progresiva mejoría hasta las 72 horas (138). FiO2 disminuyó de 74 por ciento hasta 63,6 por ciento en las primeras 72 horas. La PCO2fue disminuyendo desde un promedio en VMC de 88 a 50 mmHg a las 12 horas, permaneciendo luego en rangos bajos. El índice de oxigenación pre VAFO, fue en promedio 18 y se mantuvo en 17 a las 72 horas de conexión, con una FiO2 < 60 por ciento. El tiempo de VAFO fue de 2-18 días. 3/36 pacientes fallecieron a los 1,5, 4 y 18 días de VAFO, 8,3 por ciento presentaron escape aéreo. 1/36 paciente es oxígeno dependiente luego de 12 meses de seguimiento. Conclusiones: VAFO se constituyó en un método eficaz en el manejo de la falla respiratoria aguda en niños con una infección grave por VRS, que no respondieron a la VMC. Podría mejorar rápidamente la hipercapnia, y la oxigenación lenta y progresivamente, con un bajo riesgo de escape aéreo, secuelas y mortalidad.

Outcomes of Palivizumab Prophylaxis for Respiratory Syncytial Virus Infection in Preterm Children with Bronchopulmonary Dysplasia at a Single Hospital in Korea from 2005 to 2009

This study was performed to evaluate the utilization and outcomes of palivizumab in high risk children born prematurely with chronic lung disease (CLD). A retrospective review of 128 patients was conducted from September 2004 to March 2009 at the Ajou University Hospital. All patients were diagnosed with CLD, were born at < or =35 weeks of gestation, were <2 yr old at the onset of respiratory syncytial virus (RSV) season, and had received medical therapy within six months prior to the RSV season. Fifty-three patients did not receive palivizumab prophylaxis and 75 patients received at least one dose of palivizumab. There were no statistically significant differences between the patients with and without palivizumab prophylaxis with regard to demographic characteristics and risk factors for RSV infection. There were no systemic adverse responses. Compliance with the course of prophylaxis was 92.2%. Hospitalization associated with RSV occurred in 12 cases (22.6%) in the group without prophylaxis and in three cases (4.0%) with prophylaxis. Palivizumab prophylaxis significantly reduced the frequency of RSV-related hospitalization in preterm children with CLD. This is the first retrospective review of palivizumab prophylaxis in Korea. Palivizumab is effective and well tolerated in high risk prematurely born children.

Afectación cardíaca en el curso de infecciones respiratorias agudas virales: reporte preliminar / Cardiac involvement during acute viral respiratory infections: preliminary report

Las infecciones respiratorias agudas bajas virales constituyen una de las causas más importantes de enfermedad y muerte en niños en todo el mundo. En Uruguay las infecciones respiratorias agudas constituyen la causa más frecuente de admisión hospitalaria en los meses fríos y una causa prevalente de ingreso a cuidados intensivos. La afectación miocárdica ha sido descrita como complicación determinante en la evolución de la enfermedad. Objetivos: conocer la prevalencia y gravedad de la afectación cardíaca en el curso de las infecciones respiratorias agudas bajas virales y evaluar la utilidad de la troponina T para despistar compromiso miocárdico. Material y métodos: estudio descriptivo prospectivo. Se incluyeron lactantes portadores de infecciones respiratorias agudas bajas virales admitidas al hospital. Se realizó en todos los pacientes estudio radiológico de tórax, ECG, test de troponina T sérica y ecocardiograma. Se realizó seguimiento a los que presentaron afectación en el ECG, ECO o en el test de troponina. Resultados: se incluyeron 80 pacientes. El virus sincicial respiratorio (VRS) fue la etiología en el 53%. El ECG evidenció alteraciones inespecíficas de la repolarización en el 17% de los casos Se describió la presencia de derrame pericárdico en el 9% de los casos. Estas alteraciones no se asociaron con la gravedad ni la etiología. La troponina estuvo aumentada en el 4% sin asociaciones significativas con las variables analizadas. La CPK en estos pacientes fue normal. No hubo muertes en esta muestra. Conclusiones: se evidenciaron frecuentes alteraciones cardíacas por el ECG y el ECO que no se asociaron con requerimiento de cuidados intensivos o ventilación mecánica. La troponina estuvo aumentada en el 4% de los casos, lo que se considera una prevalencia menor a lo referido en la bibliografía, lo que no se vinculó con la evolución de los pacientes.

Acute viral respiratory infections are one of the most important causes of illness and death in children around the world. In Uruguay, acute respiratory infections are the cause of hospital admissions in the cold months and a prevalent admission cause to be admitted in intensive care. Myocardial involvement has been described as a major complication in the evolution of the disease. Objectives: to know the prevalence and severity of heart illness in the course of the low viral load acute respiratory infections and assess the usefulness of troponin T to find myocardial compromise. Material and methods: prospective descriptive study. We included IRABV carriers, admitted to the hospital, of up to two years. All RX chest, ECG, troponin T serum and Echocardiogram tests performed. Follow-up to those which presented affectation ECG, ECO or troponin test took place. Results: 80 patients were included. VRS was the etiology in 53%. The ECG evidenced unspecific alterations of the repolarization in 17%. The presence of pericardial effusion was described in 9% of cases. These alterations were not associated with the seriousness or etiology. Troponin was increased by 4% without significant association with the analyzed variables. CPK in these patients was normal. There were no deaths in this sample. Conclusions: frequent heart alterations by the ECG and ECO became apparent but were not associated with requirements of intensive care or mechanical ventilation. Troponin was increased in 4 per cent of cases but it was not linked to the evolution of patients.

Bronchiolitis with montelukast; to determine improvement in symptoms in 02 months to 02 years old children

To assess the efficacy of montelukast in children with bronchiolitis. Experimental-Preventive. Pediatrics department Allied/DHQ hospital affiliated with Punjab Medical College, Faisalabad, from 1[st] Nov 2007 to 30[th] April 2008. One hundred children of bronchiolitis were studied in two equal groups, group A and group B. To group A montelukast along with symptomatic treatment was given. Group B was given only symptomatic treatment. The criteria of treatment efficacy was taken as number of symptoms free days and nights, bronchiodilator rescue therapy, duration of hospital stay and complications like worsening of symptoms, ventilatory support and side effects of drug therapy. Symptoms free days were increased in group A as compare to group B [P value = 0.000] whereas duration of symptoms free nights were significant numerically but not statistically. There was a significant reduction in exacerbations [P = 0.046] and use of rescue therapy [beta 2-agonist] in group A. Leukotriene receptor antagonist [LRTA] reduced the duration and severity of lung symptoms in children with Bronchiolitis

Human metapneumovirus: a new respiratory pathogen.

Human metapneumovirus is a recently recognized pathogen of acute respiratory tract infection (ARI) in children as well as elderly and immunocompromised adults.The virus belongs to the family Paramyxoviridae, sub family Pneumovirinae and genus Metapneumovirus. Through genetic analysis it has been characterized into two groups A and B which are further divided into four sub-lineages. The virus is difficult to grow in tissue culture and hence reverse transcriptase-polymerase chain reaction (RT-PCR) for N and L gene is the method of choice for diagnosis. The virus has been seen in all countries with seasonal distribution in winter months for temperate and spring/summer for tropical countries. F gene is the most conserved among different lineages and efforts are underway to design recombination vaccine using F gene.

Respiratory viruses in hospitalized children with acute lower respiratory tract infections, Mazandaran Province, Iran.

We conducted this study to determine the contribution of respiratory viruses in 202 hospitalized children (1 mo-5 yr) with clinical evidence of acute lower respiratory tract illness (ALRI). Nasopharyngeal specimens were assayed for viruses detection by indirect immunoflourescent method. Viral agents were identified from 109 (54%) cases (9 cases had dual infection). The most commonly detected virus was parainfluenza virus 3 in 32 (15.8%) cases followed by respiratory syncytial virus 26 (12.9%) parainfluenza 1 and parainfluenza 2 each 13 (6.4%) influenza A 16 (7.4%), influenza B; 7(3.5%), and adenovirus 12 (5.9%). There were no demographic, clinical, radiologic or laboratory parameters except for recurrent wheeze (OR: 4.47; (95% CI: 1.98-10.73) and fever (OR: 3.27; (95% CI: 1.73-6.20), which could differentiate between patients with or without viral etiology.

Detección de metapneumovirus humano en niños hospitalizados por infección respiratoria aguda baja en Santiago, Chile / Detection of human metapneumovirus in children hospitalized for acute lower respiratory infection in Santiago, Chile

Background: Human metapneumovirus (hMPV) has recently been described as a new causal agent of acute low respiratory infection (ALRI) in children. In South America, detection has been reported only in Brazil and Argentina. Aim: To detect hMPV in children hospitalized for ALRI in Santiago, Chile. Material and Methods: Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect N gene of hMPV in 182 nasopharyngeal aspirates that were negative for common respiratory viruses, obtained from children hospitalized for ALRI during 2003. Results: Ten samples (5.4%) were positive, most of them detected during spring months. Conclusions: Since hMPV was detected among infants with ALRI in Santiago, further studies on their prevalence should be done in South America.

Respiratory syncytial virus infection in patients visiting King Khalid University Hospital

Respiratory syncytial virus [RSV] is a leading cause of lower respiratory tract infections in infants and young children worldwide. The involvement of lower respiratory tract, manifest clinically as bronchiolitis or pneumonia is the hallmark of severe RSV disease. This study aimed to assess the prevalence of RSV among patients visiting King Khalid University Hospital, King Saud University, Riyadh. Nasopharyngeal aspirate samples were obtained from patients with acute respiratory symptoms visiting King Khalid University Hospital in the period between 1999 and 2003. Samples were sent to the virology unit for detection of RSV hntigens using direct immunofluorescence test. 19.3% of the nasopharyngeal aspirate samples were positive for RSV. Most of the cases were in the age group 0-6 months [58.9%], followed by age group > 6- 12 months [19.8%]. Seasonal variation showed that most of the RSV cases were predominant during winter and early spring months. Infections with RSV are a common cause of morbidity and mortality among Saudi patients. A better understanding of the epidemiology of RSV infections may be used for timely, specific antiviral therapy and prophylaxis

Nuevos conocimientos sobre el virus respiratorio sincicial (VRS): a propósito de una gran epidemia / New knowledge on the respiratory syncytial virus (RSV): apropos of a great epidemic

Todos los niños desarrollan la primoinfección por VRS antes de los dos años de edad, habitualmente durante los brotes epidémicos del invierno. La severidad clínica de esta dependerá de muchos factores, como la edad a la que se produzca, los antecedentes de enfermedades crónicas y, muy fundamentalmente, de la respuesta inflamatoria que se desarrolle en la vía aérea del huésped que puede producir alteraciones persistentes, que determinaran la aparición de algún fenotipo de Asma. La comprensión de cómo se produce la infección y de qué forma el virus desencadena fenómenos inflamatorios mediados por las respuestas inmunes innatas y adaptativas, es fundamental para entender el espectro de la enfermedad por VRS, que va desde una infección respiratoria alta, hasta casos muy graves de neumonía y distress, así como las posibilidades de prevención y tratamiento.