ABSTRACT
Central nervous system infections in children caused by group A Streptococcus are rare. This study, conducted across 52 hospitals in Spain from 2019 to 2023, identified 32 cases of central nervous system infections in children caused by group A Streptococcus, with a significant increase from October 2022 onward (1.1% vs. 5.9%, P = 0.002). Half required pediatric intensive care unit admission, 12.5% exhibited sequelae and the mortality rate was 6.2%. Mastoiditis was the predominant primary infection.
ABSTRACT
BACKGROUND: To assess the prevalence and characteristics of nonsevere TB among children in Spain. It has been recently demonstrated that these children can be treated with a 4-month regimen instead of the classical 6-month treatment regimen, with the same effectivity and outcomes, decreasing toxicity and improving adherence. METHODS: We conducted a retrospective cohort study in a cohort of children ≤16 years of age with TB. Nonsevere TB cases included smear-negative children with respiratory TB confined to 1 lobe, with no significant airway obstruction, no complex pleural effusion, no cavities and no signs of miliary disease, or with peripheral lymph-node disease. The remaining children were considered to have severe TB. We estimated the prevalence of nonsevere TB and compared the clinical characteristics and outcomes between children with nonsevere and severe TB. RESULTS: A total of 780 patients were included [46.9% males, median age 5.5 years (IQR: 2.6-11.1)], 477 (61.1%) of whom had nonsevere TB. Nonsevere TB was less frequent in children <1 year (33% vs 67%; P < 0.001), and >14 years of age (35% vs 65%; P = 0.002), mostly diagnosed in contact tracing studies (60.4% vs 29.2%; P < 0.001) and more frequently asymptomatic (38.3% vs 17.7%; P < 0.001). TB confirmation in nonsevere disease was less frequent by culture (27.0% vs 57.1%; P < 0.001) and by molecular tests (18.2% vs 48.8%; P < 0.001). Sequelae were less frequent in children with nonsevere disease (1.7 vs 5.4%; P < 0.001). No child with nonsevere disease died. CONCLUSIONS: Two-thirds of children had nonsevere TB, mostly with benign clinical presentation and negative microbiologic results. In low-burden countries, most children with TB might benefit from short-course regimens.
Subject(s)
Tuberculosis, Pulmonary , Tuberculosis , Male , Humans , Child , Child, Preschool , Female , Tuberculosis, Pulmonary/diagnosis , Retrospective Studies , Prevalence , Spain/epidemiology , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/epidemiologyABSTRACT
OBJECTIVES: To calculate the incidence of invasive pneumococcal disease (IPD) in the paediatric population of Gran Canaria (Spain), its clinical and epidemiological characteristics, serotype distribution, antibiotic resistance, and variations in these variables before and after the introduction of the PCV13 vaccine. METHODS: Prospective hospital-based study including all patients (190) aged 0-14 years admitted with confirmed IPD between January 2001-May 2010 (152 cases) and June 2010-December 2016 (38 cases). Patients were divided into 3 age groups (<2 years; 2-5 years; and > 5 years). Clinical symptoms were mutually-exclusively classified as meningitis, bacteraemic pneumonia, pleural effusion (PE), empyema or bacteraemia without a focus. RESULTS: Most cases occurred in boys (59.47%), during autumn-winter (65.79%), in children aged < 2 years (55.79%) and with mean age increasing from the pre-PCV13 to the post-PCV13 period (2.5 vs 3.1 years). Incidence between periods reduced by 66.4% (p < 0.001): from 13.1/100,000 to 4.4/100,000. PEs (3.9% vs 18.4%, p < 0.005) and empyemas (1.5% vs 16.7%, p = NS) increased in the post-PCV13 period whereas all other symptoms decreased, although this was not statistically significant. Vaccine serotypes (77% vs 40.6%, p = 0.000), particularly serotypes 19A (23.9% vs 12.5%) and 14 (14.2% vs 9.4%), as well as erythromycin resistance (57.2% vs 7.9%, p = 0.000) decreased in the post-PCV13 period. CONCLUSION: IPD incidence, vaccine serotypes and erythromycin resistance decreased in the post-PCV13 period whereas PEs increased
OBJETIVOS: Calcular la incidencia de enfermedad neumocócica invasiva (ENI) pediátrica en Gran Canaria (España), sus características clínicas y epidemiológicas, distribución de serotipos, resistencias antibióticas, y las variaciones en estas variables antes y después de la introducción de la vacuna PCV13. MÉTODOS: Estudio hospitalario prospectivo que incluye todos los pacientes con edades entre 0-14 años (190) ingresados con un diagnóstico confirmado de ENI entre enero 2001 - mayo 2010 (152 casos) y junio 2010 - diciembre 2016 (38 casos). Los pacientes se dividieron en 3 grupos de edad (< 2 años; 2-5 años; y >5 años). Los síntomas clínicos se clasificaron de manera mutuamente exclusiva en meningitis; neumonía bacterémica, derrame pleural (DP), empiema, o bacteremia sin foco. RESULTADOS: La mayoría de los casos se concentró en en varones (59.47%), durante otoño-invierno (65.79%), en < 2 años (55.79%) y con un aumento de la edad media entre periodos (2.5vs3.1 años). La incidencia entre periodos se redujo un 66.4% (P < 0.001): de 13.1/100,000 a 4.4/100,000. Los DPs (3.9%vs18.4%, P < 0.005) y empiemas (1.5%vs16.7%, P = NS) aumentaron durante el periodo post-PCV13 mientras que el resto de síntomas se redujeron pero de manera no estadísticamente significativa. Los serotipos vacunales (77%vs40.6%, P = 0.000), especialmente los serotipos 19A (23.9%vs12.5%) y 14 (14.2%vs9.4%), así como la resistencia a la eritromicina (57.2%vs7.9%, P = 0.000) se redujeron en el periodo post-PCV13
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pneumococcal Infections/prevention & control , Heptavalent Pneumococcal Conjugate Vaccine/administration & dosage , Pneumococcal Infections/epidemiology , Prospective Studies , Spain/epidemiology , Seasons , IncidenceABSTRACT
OBJECTIVE: Describe the epidemiological and clinical pattern of Bordetella pertussis infection (whooping cough) among hospitalised infants less than one year-old in a paediatric hospital in Gran Canaria. PATIENTS AND METHODS: A retrospective review of the patient hospital records was performed, and recording only those with a microbiological diagnosis of pertussis infection detected using polymerase chain reaction, from January 2008 to December 2016. RESULTS: A total of 110 patients were identified, of which 105 (95.4%) were less than 6 months old, and 59.1% were males. The annual incidence of hospital admissions was estimated between 13.7 and 425.0 cases per 100 000 infants <12 months old, with 2 peaks in 2011 and 2015. Household members were the main potential sources of infection. Main clinical features were pertussis cough associated with signs of catarrh, cyanosis, and lymphocytosis. Complications occurred in 15.4% of the patients (mainly pneumonia), but the outcome was favourable in all the cases. A lower age and non-vaccination were associated with an increased risk of developing complications (p < .05). Viral co-infection occurred in 31.6% of infants diagnosed with pertussis. CONCLUSIONS: The incidence of pertussis has increased in the last years in Gran Canaria, with a lower development of complications and mortality rates compared with the previous period. Lower age and non-vaccination status are considered risk factors for developing complications. Vaccination in pregnant women will probably lead to a decline in the incidence in the future, especially in infants younger than 6 months.
OBJETIVO: Describir el patrón epidemiológico y clínico de la infección por Bordetella pertussis (tosferina) en niños menores de un año hospitalizados en un hospital pediátrico de Gran Canaria. PACIENTES Y MÉTODOS: Se revisaron retrospectivamente las historias clínicas de los pacientes con diagnóstico microbiológico de infección por B. pertussis mediante reacción en cadena de la polimerasa, de enero de 2008 a diciembre de 2016. RESULTADOS: Se identificaron 110 pacientes, de los cuales 105 (95,4%) fueron menores de 6 meses y el 59,1% eran varones. La incidencia anual de hospitalización se estimó entre 13,7 y 425,0 casos por cada 100.000 lactantes menores de 12 meses, con 2 picos en 2011 y 2015. Los familiares cercanos fueron las principales fuentes de contagio potenciales. Las principales manifestaciones fueron la tos pertusoide asociada con signos catarrales, cianosis y linfocitosis. El 15,4% de los pacientes presentaron complicaciones (principalmente neumonía), pero la evolución fue favorable en todos los casos. La menor edad y la no vacunación se asociaron con un mayor riesgo de desarrollar complicaciones (p < 0,05). La coinfección viral ocurrió en el 31,6% de los pacientes diagnosticados de infección por B. pertussis. CONCLUSIONES: La incidencia de infección por B. pertussis ha aumentado en los últimos años en nuestra área, con un menor desarrollo de complicaciones y con tasas de mortalidad inferiores al período anterior. La menor edad y la no vacunación previa se consideran factores de riesgo para el desarrollo de complicaciones. La vacunación en mujeres embarazadas probablemente disminuirá la incidencia en el futuro, sobre todo en niños menores de 6 meses.
ABSTRACT
OBJECTIVE: Describe the epidemiological and clinical pattern of Bordetella pertussis infection (whooping cough) among hospitalised infants less than one year-old in a paediatric hospital in Gran Canaria. PATIENTS AND METHODS: A retrospective review of the patient hospital records was performed, and recording only those with a microbiological diagnosis of pertussis infection detected using polymerase chain reaction, from January 2008 to December 2016. RESULTS: A total of 110 patients were identified, of which 105 (95.4%) were less than 6 months-old, and 59.1% were males. The annual incidence of hospital admissions was estimated between 13.7 to 425.0 cases per 100,000 infants <12 months old, with 2peaks in 2011 and 2015. Household members were the main potential sources of infection. Main clinical features were pertussis cough associated with signs of catarrh, cyanosis, and lymphocytosis. Complications occurred in 15.4% of the patients (mainly pneumonia), but the outcome was favourable in all the cases. A lower age and non-vaccination were associated with an increased risk of developing complications (P<.05). Viral co-infection occurred in 31.6% of infants diagnosed with pertussis. CONCLUSIONS: The incidence of pertussis has increased in the last years in Gran Canaria, with a lower development of complications and mortality rates compared with the previous period. Lower age and non-vaccination status are considered risk factors for developing complications. Vaccination in pregnant women will probably lead to a decline in the incidence in the future, especially in infants younger than 6 months.
Subject(s)
Whooping Cough/diagnosis , Whooping Cough/epidemiology , Female , Humans , Incidence , Infant , Male , Retrospective Studies , Spain/epidemiology , Time FactorsABSTRACT
OBJECTIVES: To calculate the incidence of invasive pneumococcal disease (IPD) in the paediatric population of Gran Canaria (Spain), its clinical and epidemiological characteristics, serotype distribution, antibiotic resistance, and variations in these variables before and after the introduction of the PCV13 vaccine. METHODS: Prospective hospital-based study including all patients (190) aged 0-14 years admitted with confirmed IPD between January 2001-May 2010 (152 cases) and June 2010-December 2016 (38 cases). Patients were divided into 3 age groups (<2 years; 2-5 years; and >5 years). Clinical symptoms were mutually-exclusively classified as meningitis, bacteraemic pneumonia, pleural effusion (PE), empyema or bacteraemia without a focus. RESULTS: Most cases occurred in boys (59.47%), during autumn-winter (65.79%), in children aged <2 years (55.79%) and with mean age increasing from the pre-PCV13 to the post-PCV13 period (2.5 vs 3.1 years). Incidence between periods reduced by 66.4% (p<0.001): from 13.1/100,000 to 4.4/100,000. PEs (3.9% vs 18.4%, p<0.005) and empyemas (1.5% vs 16.7%, p=NS) increased in the post-PCV13 period whereas all other symptoms decreased, although this was not statistically significant. Vaccine serotypes (77% vs 40.6%, p=0.000), particularly serotypes 19A (23.9% vs 12.5%) and 14 (14.2% vs 9.4%), as well as erythromycin resistance (57.2% vs 7.9%, p=0.000) decreased in the post-PCV13 period. CONCLUSION: IPD incidence, vaccine serotypes and erythromycin resistance decreased in the post-PCV13 period whereas PEs increased.
Subject(s)
Pneumococcal Infections/microbiology , Adolescent , Child , Child, Preschool , Drug Resistance, Bacterial , Female , Humans , Incidence , Infant , Male , Pneumococcal Infections/epidemiology , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines , Prospective Studies , Spain/epidemiology , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/drug effects , Time FactorsABSTRACT
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