Osteoarticular infections in pediatrics / Infecções osteoarticulares em pediatria

Abstract Objective To collect the most up-to-date information regarding pediatric osteoarticular infections, including the epidemiological and microbiological profiles, diagnosis, and treatment. Source of data A non-systematic review was performed on the search engines PubMed, SciELO, LILACS, and Google Scholar, using the keywords "bone and joint infection", "children", "pediatric", "osteomyelitis", "septic arthritis" and "spondylodiscitis" over the last ten years. The most relevant articles were selected by the authors to constitute the database. Synthesis of data Osteoarticular infections are still a major cause of morbidity in pediatrics. Their main etiology is Staphylococcus aureus, but there has been an increase in the detection of Kingella kingae, especially through molecular methods. Microbiological identification allows treatment direction, while evidence of inflammatory activity assists in treatment follow-up. Imaging tests are especially useful in the initial diagnosis of infections. Empirical treatment should include coverage for the main microorganisms according to the age and clinical conditions of the patient, while considering the local resistance profile. Surgical procedures can be indicated for diagnosis, focus control, and function preservation. Acute complications include sepsis, deep venous thrombosis, and pulmonary embolism. Deaths are rare. Late complications are uncommon but may lead to deformities that compromise motor development. Conclusion A correct and early diagnosis, prompt implementation of adequate antimicrobial therapy, and focus control, when indicated, are critical to a better prognosis.

Resumo Objetivo Compilar as informações mais atuais referentes às infecções ostoarticulares em pediatria, inclusive perfil epidemiológico e microbiológico, diagnóstico e tratamento. Fonte dos dados Feita revisão não sistemática nos mecanismos de busca Pubmed, Scielo, Lilacs e Google Scholar, com as palavras-chave bone and joint infection, children, pediatric, osteomyelitis, septic arthritis e espondylodiscitis nos últimos 10 anos. Os artigos mais relevantes foram selecionados pelos autores para compor a base de dados. Síntese dos dados As infecções osteoarticulares ainda são causa importante de morbidade na pediatria. A sua principal etiologia é o Staphylococcus aureus, porém há um aumento na detecção de Kingella kingae, especialmente através de métodos moleculares. A identificação microbiológica possibilita direcionamento de tratamento, enquanto que as provas de atividade inflamatória auxiliam no acompanhamento do tratamento. Exames de imagem são especialmente úteis no diagnóstico inicial das infecções. O tratamento empírico deve incluir cobertura para os principais microrganismos, de acordo com a faixa etária e as condições clínicas do paciente, considerando o perfil de resistência local. Procedimentos cirúrgicos podem ser indicados para diagnóstico, controle do foco e preservação da função. As complicações agudas incluem sepse, trombose venosa profunda e embolia pulmonar. Óbitos são raros. As complicações tardias são incomuns, mas podem levar a deformidades que comprometem o desenvolvimento motor. Conclusão O diagnóstico correto e precoce, com pronta instituição de terapia antimicrobiana adequada e controle do foco, quando indicado, é fundamental para um melhor prognóstico.

Enfermedades auto-inmunes producidas por el estreptococo beta hemolítico del grupo a (streptocococus pyogenes) / Self-immune diseases produced by the beta hemolytic breast streptocco of group a (streptocococus pyogenes)

Streptococcus pyogenes o estreptococo beta-hemolítico del grupo A (EBHGA) es una bacteria que produce enfermedades de gran importancia médica debido a lasaltas tasas de incapacidad y mortalidad a nivel mundial. EBHGA produce reacciones autoinmunes que afectan a un sin número de órganos y tejidos de los pacientes, lo que está relacionado con mimetismos moleculares entre las células del hospedero y moléculas que se hallan en la bacteria. Esta revisión estuvo enfocada en las enfermedades autoinmunes desencadenadas por S. pyogenes. Se ofrece información sobre las manifestaciones clínicas y la reacción inmune desencadenada en los pacientes, además de la epidemiología de las enfermedades.

Streptococcus pyogenes or group A beta-hemolytic streptococcus (GABHS) is a bacterium that produces diseases of great medical importance due to the high rates of disability and mortality worldwide. EBHGA produces autoimmune reactions that affect a number of organs and tissues of patients, which is related to molecular mimicry between the cells of the host and molecules found in the bacteria. This review focused on the autoimmune diseases triggered by S. pyogenes. Information is offered on the clinical manifestations and the immune reaction triggered in patients, in addition to the epidemiology of the diseases.

Clinical assessment of azithromycin dihydrate in the treatment of pediatric impetigo / Avaliação clínica de azitromicina di-hidratada no tratamento de impetigo pediátrico

The primary objective of this double-blind, randomized, controlled clinical trial was to assess the use of azithromycin dihydrate in oral suspension form in the treatment of impetigo in children. The secondary objectives were to compare the efficacy and safety of two presentations of azithromycin dihydrate in the treatment of impetigo in children, on wound healing and on wound pruritus. After screening and obtaining informed consent of the parents or legal guardians, a total of 100 patients ranging in age from 2-8 years old and presenting impetigo were randomized to one of two groups for a 3-day treatment period using azithromycin dihydrate in oral suspension in single doses of 10mg/kg/day: Group A (manufactured by Merck S.A.), and Group B (manufactured by Pfizer). Patients returned to the study center at the end of the 3-day treatment (Visit 2) and 7 days after the Pretreatment visit (Visit 3) for efficacy assessments and safety monitoring. Pretreatment demographic data and impetigo characteristics (type, location, number of lesions, pruritus) were homogenous between treatment groups. At the end of the study, all patients in both groups presented either ?improvement? or ?cured? lesions, with the majority (72.9%) of the patients presenting ?cured? lesions. We observed a statistically significant decrease in pruritus severity at Visit 2 and Visit 3 in relation to pretreatment, with no significant between-group difference at either study visit. Reported adverse events were transient and mild-to moderate in severity in both treatment groups, with no serious adverse events reported during the study. Based on the data collected during this study, we conclude that the two presentations of azithromycin were safe and effective in the treatment of impetigo in the population evaluated.

Distribution and Upper Limit of Normal Antistreptolysin O Concentrations of School / 감염

BACKGROUND: Antistreptolysin O (ASO) is very useful as an indicator of recent streptococcal infections and their sequelae, such as rheumatic fever and acute glomerulonephritis. To interpret single ASO level of patients, the upper limit of normal (ULN) ASO from the same age group in the area should be known. As Streptococcus pyogenes infections are quite common in elementary school, we measured ASO and analyzed them by the results of throat culture to determine upper limit of normal ASO of school children in Chinju area. METHODS: ASO concentrations were measured quantitatively by nephelometry on 436 sera of healthy elementary school children in Chinju area. Throat cultures were taken at the same time to evaluate the relationship between ASO concentrations and throat culture results, including serogroup, colony forming units (CFU), and M types. RESULTS: The mean ASO concentration was 285IU/ml and the upper limit of normal ASO was 433IU/ml. The ASO levels were even (253-285IU/ml) through whole school grades except the 5th grade (350IU/ml). Not only the carriers of group A streptococci, but also those of group C or group G streptococci had higher ASO levels. The children from whom more than 10 CFU of S. pyogenes were isolated showed higher ASO levels than those who had less than 10 CFU. The ASO levels were higher in M type 6 or 22 compared to M type 12 or 28. CONCLUSIONS: The upper limit of normal ASO of children in Chinju was 433IU/ml, that is between Seoul(326IU/ml) and Chungnam (499IU/ml). The children who had more than 10 CFU tended to have higher ASO levels, which indicate asymptomatic infections, are associated with burden of bacteria. Group C or group G streptococci may induce serum response like group A streptococci. Certain M types may be implicated as strong producer of streptolysin O.