Comparación de las características clínicas y diagnósticas de los subgrupos A y B del virus respiratorio sincitial / Comparison of clinical features and diagnosis between the A and B subgroups of respiratory syncytial virus

Fundamento: La infección del tracto respiratorio inferior por virus respiratorio sincitial (VRS) es la causa más frecuente de ingreso en menores de 2 años. Los subgrupos de VRS A y B pueden circular indistintamente. Nuestro objetivo fue determinar si existían diferencias clínicas entre los VRS subgrupo A y B, y si la sensibilidad del test de detección rápida de antígeno del VRS por inmunocromatografía difiere de la técnica de referencia (RT-PCR). Material y métodos: Estudio retrospectivo, observacional realizado en el hospital terciario desde octubre de 2013 a marzo de 2014. Se consultó la historia clínica y las analíticas de los niños menores de 5 años ingresados en por infección respiratoria de vías bajas con RT-PCR positivo a VRS en una muestra de lavado nasal. De la misma muestra previamente se había realizado el test de detección rápida de antígeno de VRS. Resultados: Se confirmaron 198 niños menores de 5 años para VRS mediante RT-PCR: 55 (28%) fueron VRS-A, 132 (67%) VRS-B y 11 (5%) fueron positivos para ambos subgrupos. No encontramos diferencias entre subgrupos en antecedentes, clínica, radiología, analítica y gravedad. La sensibilidad del test de detección rápida fue 52%, mayor para VRS-A (69%) que para VRS-B (44%, p=0,001). Conclusiones: Los dos subgrupos de VRS fueron indistinguibles por su presentación clínica y pronóstico. La sensibilidad del test rápido en comparación con la RT-PCR fue baja, lo que limita su utilidad en la toma de decisiones clínicas (AU)

Background: Lower respiratory tract infection by respiratory syncytial virus (RSV) is the most frequent cause of admission in children under 2 years old. The RSV subgroups A and B may circulate simultaneously. We aimed to determine whether clinical differences exist between RSV subgroups A and B. Additionally, we tested the sensitivity of the rapid antigen detection test (RADT) based on immunochromatography in diagnosing subgroups A and B, taking the polymerase chain reaction assay (RT-PCR) as reference. Methods: A retrospective observational study was performed in a tertiary hospital from October 2013 to March 2014. Clinical records and analytical variables of all children under 5 admitted with lower respiratory tract infection and RT-PCR positive for RSV in nasal lavage were consulted. Previously, the RADT for RSV had been performed from the same sample. Results: A total of 198 children under 5 were diagnosed with RSV by RT-PCR: 55 (28%) were RSV-A, 132 (67%) RSVB and 11 (5%) were positive for both subgroups. No differences were observed between subgroups in medical history, symptoms, radiological and analytical findings, and severity. The sensitivity of RADT for RSV was 52%, higher for RSV-A (69%) than for RSV-B (44%, p=0.001). Conclusions: The two RSV subgroups were indistinguishable in symptoms and prognosis. The sensitivity of RADT compared to RT-PCR was low and limits its usefulness for clinical decision-making (AU)

[Septic arthritis of the hip by Haemophilus Influenzae type F in childhood: a case report]. / Artritis séptica de cadera por Haemophilus influenzae tipo f en la infancia: a propósito de un caso.

Septic arthritis of the hip is an acute infection, predominantly of bacterial etiology. Although Staphylococcus aureus is the primary pathogen in any age group, other potentially pathogenic microorganisms exist. We describe the case of an 18-month patient with septic arthritis of the hip with a rare causal agent (Haemophilus influenzae type F) and a good outcome. This case highlights the importance of considering other less common etiologic agents for septic arthritis in children, performing arthrocentesis with synovial fluid culture before starting antibiotic treatment, whenever this is possible. In addition, as in this case, it should be noted that a positive synovial fluid culture for Haemophilus influenzae forces typification of the bacteria in order to rule out or confirm a vaccine failure.

Artritis séptica de cadera por Haemophilus influenzae tipo f en la infancia: a propósito de un caso / Septic arthritis of the hip by Haemophilus Influenzae type F in childhood: a case report

La artritis séptica de cadera es una infección aguda, predominantemente de etiología bacteriana. A pesar de que el patógeno principal en cualquier grupo de edad es Staphylococcus aureus, existen otros microorganismos potencialmente patógenos. Describimos el caso de una paciente de 18 meses con artritis séptica de cadera por un agente causal infrecuente (Haemophilus influenzae tipo f) de buena evolución. Este caso pone de manifiesto la importancia de considerar otros agentes etiológicos menos frecuentes en las artritis sépticas infantiles, realizando artrocentesis con cultivo de líquido articular antes de iniciar el tratamiento antibiótico, siempre que sea posible. Además, como ocurrió en este caso, conviene tener en cuenta que el resultado positivo del cultivo del líquido sinovial para Haemophilus influezae obliga a tipificar la bacteria para descartar o confirmar un fracaso vacunal (AU)

Septic arthritis of the hip is an acute infection, predominantly of bacterial etiology. Although Staphylococcus aureus is the primary pathogen in any age group, other potentially pathogenic microorganisms exist. We describe the case of an 18-month patient with septic arthritis of the hip with a rare causal agent (Haemophilus influenzae type F) and a good outcome. This case highlights the importance of considering other less common etiologic agents for septic arthritis in children, performing arthrocentesis with synovial fluid culture before starting antibiotic treatment, whenever this is possible. In addition, as in this case, it should be noted that a positive synovial fluid culture for Haemophilus influenzae forces typification of the bacteria in order to rule out or confirm a vaccine failure (AU)

[Imported infectious diseases in fever of unknown origin in migrant children: 2 cases]. / Patología infecciosa importada en síndrome febril de origen desconocido en niño inmigrante: 2 casos.

The increase in migratory movements has increased the incidence of infectious diseases that were infrequent in our setting. In the presence of fever in children from endemic areas, imported infectious diseases must be ruled out in the first place. We present two cases of typhoid fever in immigrant children, recently diagnosed in our centre. Both from countries with a high prevalence of the disease were admitted for study of fever of unknown origin. The two patients had been living in our country for less than one month. Isolation of the gram-negative bacillus in the blood cultures provided the key for reaching the etiological diagnosis. In both cases endovenous antibiotherapy was established and both the blood cultures and stools became negative before discharge. At present the two children are free of the disease.

Patología infecciosa importada en síndrome febril de origen desconocido en niño inmigrante: 2 casos / Imported infectious diseases in fever of unknown origin in migrant children: 2 cases

El auge de los movimientos migratorios ha aumentado la incidencia de enfermedades infecciosas infrecuentes en nuestro medio. Ante la presencia de un proceso febril en niños procedentes de áreas endémicas, se deben descartar en primer lugar enfermedades infecciosas importadas. Presentamos dos casos de fiebre tifoidea en niños inmigrantes, diagnosticados recientemente en nuestro centro. Ambos procedían de países con alta prevalencia de la enfermedad e ingresaron para estudio de fiebre de origen desconocido. Los dos pacientes residían en nuestro país desde hacía menos de un mes. El aislamiento de bacilo gran negativo en los hemocultivos fue clave para llegar al diagnóstico etiológico. En los dos casos se instauró antibioterapia endovenosa y se negativizaron tanto los hemocultivos como los coprocultivos de forma previa al alta. En la actualidad los dos niños se encuentran libres de enfermedad(AU)

The increase in migratory movements has increased the incidence of infectious diseases that were infrequent in our setting. In the presence of fever in children from endemic areas, imported infectious diseases must be ruled out in the first place. We present two cases of typhoid fever in immigrant children, recently diagnosed in our centre. Both from countries with a high prevalence of the disease were admitted for study of fever of unknown origin. The two patients had been living in our country for less than one month. Isolation of the gram-negative bacillus in the blood cultures provided the key for reaching the etiological diagnosis. In both cases endovenous antibiotherapy was established and both the blood cultures and stools became negative before discharge. At present the two children are free of the disease(AU)

Empiema subdural secundario a sinusitis. Descripción de un caso pediátrico / Subdural empyema secondary to sinusitis. A pediatric case report

Presentamos el caso de un varón de 9 años derivado al servicio de Urgencias por proptosis ocular derecha y cefalea progresiva en el contexto de una sinusitis, diagnosticado dos días antes por clínica y radiología compatible y en tratamiento con amoxicilina-clavulánico. A la exploración física destaca proptosis derecha con ligera limitación para la mirada conjugada. Con la sospecha de una posible complicación neurológica de la sinusitis, se realiza tomografía axial computarizada (TAC) craneal, observando empiema subdural frontal derecho. Ingresa para tratamiento antibiótico endovenoso con cefotaxima, vancomicina y metronidazol. Es valorado por los servicios de Neurocirugía, Cirugía Maxilofacial y Otorrinolaringología (ORL) infantil, decidiéndose únicamente drenaje del foco primario, con actitud neuroquirúrgica expectante. El paciente evoluciona favorablemente con progresiva desaparición de los síntomas. Se realizan resonancias magnéticas periódicas, que muestran clara mejoría hasta resolución completa del empiema. Tras 4 semanas de antibioterapia iv., y tras la normalización clínica y radiológica, el paciente es dado de alta (AU)

We present the case of 9 year old male referred to the A and E service with right ocular proptosis and progressive migraine in the context of a sinusitis diagnosed two days earlier by compatible clinical and radiological tests, and receiving treatment with amoxicillin-clavulanic acid. Physcial exploration revealed right ocular proptosis with a slight limitation for conjugate gaze. Facing the suspicion of a possible neurological complication of the sinusitis, cranial computer aided tomography (CAT) was carried out, with right frontal subdural empyema observed. He was admitted for intravenous antibiotic treatment with cefotaxime, vancomicin and metronidazole. He was evaluated by child Neurosurgery, Maxillofacial Surgery and Otorhinolaryngology (ORL) services; the decision was taken to only drain the primary focus, while an expectant neurosurgical attitude was maintained. The patient evolved favourably with a progressive disappearance of the symptoms. Periodical magnetic resonances were carried out, which showed a clear improvement up until the complete resolution of the empyema. Following four weeks of antibiotherapy iv., and after clinical and radiological normalization, the patient was discharged (AU)

Epidemiologic impact of blood culture practices and antibiotic consumption on pneumococcal bacteraemia in children.

This study examined the roles of two different diagnostic approaches to children with fever of unknown origin in determining the patterns of pneumococcal bacteraemia in two Spanish regions by comparing their main epidemiologic characteristics. Whereas a blood culture is routinely obtained in this setting in Navarre, this is not generally the case in Majorca. Additionally, the potential role of antibiotic consumption in each region was also analysed. Cumulative incidences in children under the age of 14 years were 26.6 per 100,000 child-years in Navarre (121.1 in children <2 years of age) and 7.3 per 100,000 child-years in Majorca (33.3 in children <2 years of age). In contrast, the incidences per 1,000 blood cultures were similar in both regions. The relative risks of occult bacteraemia, bacteraemic pneumonia and meningitis among the children of Navarre compared to Majorcan children were 11.8, 2.6 and 0.8, respectively. The risk for less virulent (vaccine serotypes plus 6A, 19A and 23A) and for more virulent serotypes (1 and 7) was 4.9 and 3.1 times higher in Navarre, respectively. The number of 7-valent pneumococcal conjugate vaccine (PCV7) doses administered between 2003 and 2004 were also higher in Navarre. Conversely, antibiotic resistance and paediatric prescriptions for broad-spectrum antibiotics were greater in Majorca. Although the most salient differences between both regions, including the effectiveness of pneumococcal conjugate vaccine in Navarre, appeared to be confounded by the higher frequency of blood cultures taken there, certain differences in serotype composition may be explained by the higher antibiotic consumption in Majorca.

[Clinical characteristics of tuberculosis in childhood]. / Características de la enfermedad tuberculosa en la infancia.

Tuberculosis is a serious disease for world health and there has been an increase in the number of cases in recent years. Children are the most vulnerable to infection, with a greater risk of developing the disease and with a greater frequency of its serious forms. In spite of that, it is exceptional for them to develop bacilliferous TB, with its treatment not playing a great role in the epidemiological control of the disease. However, the treatment of latent tuberculosis infection in children avoids development of the disease and the study of familial contacts can help the diagnosis, treatment and control of the contagious adult. This paper reviews tuberculosis in childhood, with emphasis on some of its peculiarities. We analyse TB infection and disease, the behaviour towards the child by the infected or diseased mother, and aspects of prevention through chemo and immunoprofilaxis.

Reduction in pediatric invasive pneumococcal disease in the Basque Country and Navarre, Spain, after introduction of the heptavalent pneumococcal conjugate vaccine.

This study evaluated the incidence of invasive pneumococcal disease, identified the causal serotypes, and tracked the evolution of the antibiotic susceptibility of Streptococcus pneumoniae isolates in the regions of the Basque Country and Navarre, Spain, before and after the introduction of the heptavalent pneumococcal conjugate vaccine. The study included all children aged between birth and 5 years diagnosed with bacteremia, meningitis, or bacteremic pneumonia caused by pneumococci. By the second year after introduction of the heptavalent pneumococcal conjugate vaccine, compared with the period 1998-2001, the incidence of invasive disease decreased by 64.3% in children less than 12 months of age, by 39.7% in children less than 24 months of age, and by 37.5% in children less than 60 months of age. The prevalence of clinical isolates of S. pneumoniae that lacked susceptibility to penicillin decreased by 58.2% among children less than 60 months of age. With an estimated coverage by four-dose heptavalent pneumococcal conjugate vaccine of 28-45% in 2003, the number of invasive pneumococcal infections in the Basque Country and in Navarre fell significantly after just 2 years of immunization, underscoring the importance of improving vaccination coverage under a universal childhood immunization program.

Características de la enfermedad tuberculosa en la infancia / Clinical characteristics of tuberculosis in childhood

La tuberculosis es un problema grave de salud mundial, con un incremento de los casos en los últimos años. Los niños son más vulnerables a la infección, con mayor riesgo de progresión a enfermedad y mayor frecuencia de formas graves de la misma. A pesar de ello es excepcional que sean bacilíferos, no teniendo su tratamiento un gran papel en el control epidemiológico de la enfermedad. Sin embargo, el tratamiento de la infección tuberculosa latente en los niños evita su progresión a enfermedad y el estudio familiar de contactos puede permitir el diagnóstico, tratamiento y control del adulto contagioso. En este trabajo se repasa la tuberculosis en la infancia, haciendo énfasis en algunas de sus peculiaridades. Se analizan la infección y la enfermedad tuberculosa, la conducta ante el hijo de madre con infección o enfermedad tuberculosa y aspectos de la prevención por medio de la quimio e inmunoprofilaxis

Tuberculosis is a serious disease for world health and there has been an increase in the number of cases in recent years. Children are the most vulnerable to infection, with a greater risk of developing the disease and with a greater frequency of its serious forms. In spite of that, it is exceptional for them to develop bacilliferous TB, with its treatment not playing a great role in the epidemiological control of the disease. However, the treatment of latent tuberculosis infection in children avoids development of the disease and the study of familial contacts can help the diagnosis, treatment and control of the contagious adult. This paper reviews tuberculosis in childhood, with emphasis on some of its peculiarities. We analyse TB infection and disease, the behaviour towards the child by the infected or diseased mother, and aspects of prevention through chemo and immunoprofilaxis

Características de la enfermedad tuberculosa en la infancia / Clinical characteristics of tuberculosis in childhood

La tuberculosis es un problema grave de salud mundial, con un incremento de los casos en los últimos años. Los niños son más vulnerables a la infección, con mayor riesgo de progresión a enfermedad y mayor frecuencia de formas graves de la misma. A pesar de ello es excepcional que sean bacilíferos, no teniendo su tratamiento un gran papel en el control epidemiológico de la enfermedad. Sin embargo, el tratamiento de la infección tuberculosa latente en los niños evita su progresión a enfermedad y el estudio familiar de contactos puede permitir el diagnóstico, tratamiento y control del adulto contagioso. En este trabajo se repasa la tuberculosis en la infancia, haciendo énfasis en algunas de sus peculiaridades. Se analizan la infección y la enfermedad tuberculosa, la conducta ante el hijo de madre con infección o enfermedad tuberculosa y aspectos de la prevención por medio de la quimio e inmunoprofilaxis

Tuberculosis is a serious disease for world health and there has been an increase in the number of cases in recent years. Children are the most vulnerable to infection, with a greater risk of developing the disease and with a greater frequency of its serious forms. In spite of that, it is exceptional for them to develop bacilliferous TB, with its treatment not playing a great role in the epidemiological control of the disease. However, the treatment of latent tuberculosis infection in children avoids development of the disease and the study of familial contacts can help the diagnosis, treatment and control of the contagious adult. This paper reviews tuberculosis in childhood, with emphasis on some of its peculiarities. We analyse TB infection and disease, the behaviour towards the child by the infected or diseased mother, and aspects of prevention through chemo and immunoprofilaxis

[Evolution of the epidemiological characteristics of tuberculosis in Navarra (1994-2003)]. / Evolución en las características epidemiológicas de la tuberculosis en Navarra (1994-2003).

AIM: To describe the changes in the incidence and the epidemiological profile of tuberculosis in Navarra. METHODS: The cases of tuberculosis in the 1994-2003 period were analysed. Cases reported to the system of obligatory notifiable diseases, completed with the microbiological diagnoses and the cases collected in other health registers. RESULTS: The incidence of tuberculosis fell from 21 per 100,000 inhabitants in the five-year period 1994-1998 to 16 per 100,000 in 1999-2003. In both periods the number of cases in men doubled that in women, and the maximum incidence occurred in the age groups from 25 to 44 and over 65 years of age. The diagnoses of tuberculosis in persons with HIV infection fell from 15.1% to 6.6% and those in immigrants rose from 2.2% to 21.3%. Somewhat over 3% of the cases had received prior anti-tuberculosis treatment and about 6% showed resistance to some medicine, without significant differences between periods. The proportion of potentially transmissible tuberculosis (73%) underwent no significant changes, nor did that of those with positive sputum bacilloscopy. The number of outbreaks (groupings of two or more cases) rose from 18 to 26 and the percentage of cases secondary to another recent case rose from 3.6% to 10.1% (p<0,001). In the 1999-2003 period, pulmonary localisation occurred in isolated form in 67.7% of the patients, and in combination with other localisations in another 5.1%. The isolated pleural form appeared in 9.9% and the meningeal form in 1.5%. CONCLUSION: There has been an advance in the control of tuberculosis although its incidence is still high with respect to other European countries. Control of imported cases is one of the challenges to be faced in coming years, without neglecting control measures in the autochthonous population.

Evolución en las características epidemiológicas de la tuberculosis en Navarra (1994-2003) / Evolution of the epidemiological characteristics of tuberculosis in Navarra (1994-2003)

Objetivo. Describir los cambios en la incidencia y en el perfil epidemiológico de la tuberculosis en Navarra. Métodos. Se analizaron los casos de tuberculosis del período 1994-2003 según el sistema de enfermedades de declaración obligatoria, completado con los diagnósticos microbiológicos y con los casos captados por otros registros sanitarios.Resultados. La incidencia de tuberculosis disminuyó desde 21 por 100.000 habitantes en el quinquenio 1994-1998 hasta 16 por 100.000 en 1999-2003. En ambos períodos los casos en hombres duplicaron a los de mujeres, y la máxima incidencia se produjo en los grupos de 25 a 44 y mayores de 65 años. Los diagnósticos de tuberculosis en personas con infección por el VIH disminuyeron del 15,1 al 6,6% y los realizados en personas inmigrantes aumentaron del 2,2 al 21,3%. Algo más del 3% de los casos había recibido tratamiento antituberculoso previo y en torno al 6% presentaban resistencia a algún fármaco, sin diferencias significativas entre periodos. La proporción de tuberculosis potencialmente transmisibles (73%) no experimentó cambios significativos, ni la de aquellas con baciloscopia de esputo positiva (53%). El número de brotes (agrupaciones de dos o más casos) pasó de 18 a 26 y el porcentaje de casos secundarios a otro reciente aumentó desde 3,6 a 10,1% (p<0,001). En el período 1999-2003, la localización pulmonar se presentó de forma aislada en el 67,7% y combinada con otras localizaciones en otro 5,1%. La forma pleural aislada apareció en el 9,9% y la meníngea en el 1,5% de los pacientes.Conclusión. Se ha avanzado en el control de la tuberculosis aunque todavía la incidencia es alta respecto a otros países europeos. El control de los casos importados es uno de los retos para los próximos años, sin descuidar las medidas de control en la población autóctona

Aim. To describe the changes in the incidence and the epidemiological profile of tuberculosis in Navarra. Methods. The cases of tuberculosis in the 1994-2003 period were analysed. Cases reported to the system of obligatory notifiable diseases, completed with the microbiological diagnoses and the cases collected in other health registers. Results. The incidence of tuberculosis fell from 21 per 100,000 inhabitants in the five-year period 1994-1998 to 16 per 100,000 in 1999-2003. In both periods the number of cases in men doubled that in women, and the maximum incidence occurred in the age groups from 25 to 44 and over 65 years of age. The diagnoses of tuberculosis in persons with HIV infection fell from 15.1% to 6.6% and those in immigrants rose from 2.2% to 21.3%. Somewhat over 3% of the cases had received prior anti-tuberculosis treatment and about 6% showed resistance to some medicine, without significant differences between periods. The proportion of potentially transmissible tuberculosis (73%) underwent no significant changes, nor did that of those with positive sputum bacilloscopy. The number of outbreaks (groupings of two or more cases) rose from 18 to 26 and the percentage of cases secondary to another recent case rose from 3.6% to 10.1% (p<0,001). In the 1999-2003 period, pulmonary localisation occurred in isolated form in 67.7% of the patients, and in combination with other localisations in another 5.1%. The isolated pleural form appeared in 9.9% and the meningeal form in 1.5%. Conclusion. There has been an advance in the control of tuberculosis although its incidence is still high with respect to other European countries. Control of imported cases is one of the challenges to be faced in coming years, without neglecting control measures in the autochthonous population

Síndrome febril sin foco en lactantes menores de 3 meses / Fever without source in breastfeed babies

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[The Aicardi syndrome]. / Síndrome de Aicardi.

The authors present a case of a girl who showed flexion spasms, chorio-retinopathy and agenesis of corpus callosum, an association known as the Aicardi syndrome. They have made a wide revision of the literature, examining in detail the clinical aspects and diagnosis with other malformations and infections. Lastly, they comment the aspects of etiology and pathology of the disease which still remain unclear.