ABSTRACT
BACKGROUND: For the last 14 years the Pan American Health Organization has been promoting surveillance of invasive pneumococcal disease in Latin American children for better understanding of the disease tendencies regarding capsular types circulation in each country and susceptibility to antimicrobials. METHODS: Laboratory-based surveillance data from 10 Latin American countries collected from 2000 to 2005 were analyzed, including serotype distribution and susceptibility to beta-lactam antibiotics. RESULTS: Although 61 different capsular types were identified during the 6-year surveillance, 13 serotypes accounted for 86% of all isolates. These were consistently the most prevalent throughout the study period with serotype 14 predominating. Diminished susceptibility to penicillin was detected in 38% of all Streptococcus pneumoniae isolates, with the highest prevalence in Dominican Republic and Mexico. Decreased susceptibility to penicillin increased in Brazil and Colombia whereas decreased high resistance rates was recorded in Chile. CONCLUSIONS: These data indicate that 10 countries of the Region continue to have high quality laboratory-based surveillance for pneumococcal disease thus generating valuable information so that healthcare decision makers may prioritize interventions. The heptavalent vaccine will potentially cover from 52.4% to 76.5% of strains causing invasive pneumococcal disease and the 13 valent from 76.7% to 88.3%.
Subject(s)
Pneumococcal Infections/epidemiology , Pneumococcal Infections/microbiology , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/isolation & purification , Anti-Bacterial Agents/pharmacology , Bacterial Typing Techniques , Child, Preschool , Female , Humans , Infant , Latin America/epidemiology , Male , Microbial Sensitivity Tests , Penicillin Resistance , Population Surveillance/methods , Prevalence , Serotyping , Streptococcus pneumoniae/drug effects , beta-Lactams/pharmacologyABSTRACT
OBJECTIVE: The objective of the current study was to identify risk factors for intrathoracic tuberculosis among children living in migrant populations in the Dominican Republic. DESIGN: Cross-sectional study. SETTING: Dominican Republic bateyes, economic migrant communities of Haitian origin. PARTICIPANTS: Children 18 months to 18 years of age. MAIN EXPOSURE: Unpasteurized milk consumption. OUTCOME MEASURES: Probable or possible intrathoracic tuberculosis. Probable intrathoracic tuberculosis was defined as any child with a tuberculin skin test >or=10 mm (or >5 mm in the presence of a known immunocompromising condition or household contact with intrathoracic tuberculosis) or malnutrition in the setting of an abnormal chest radiograph with features of tuberculosis or lymph node disease. The diagnosis of "possible intrathoracic tuberculosis" was assigned if an abnormal chest radiograph had features that did not meet the definition of "probable intrathoracic tuberculosis." RESULTS: Probable or possible tuberculosis was diagnosed in 83 (20.8%) of 400 children. Unpasteurized milk consumption was identified as an independent risk factor for intrathoracic tuberculosis (adjusted odds ratio, 3.2; 95% confidence interval: 1.4-7.4) even after adjusting for Bacille Calmette-Guérin vaccination, household size, tuberculosis contacts and age and under varying assumptions about children diagnosed with "possible" tuberculosis. CONCLUSIONS: Our data raise the possibility that the high prevalence of tuberculosis in the Dominican Republic bateyes may be attributable to Mycobacterium bovis rather than Mycobacterium tuberculosis infection.
Subject(s)
Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Bovine/epidemiology , Tuberculosis, Pulmonary/epidemiology , Adolescent , Animals , Cattle , Child , Child, Preschool , Cross-Sectional Studies , Dominican Republic/epidemiology , Emigrants and Immigrants , Feeding Behavior , Female , Humans , Infant , Male , Milk , Radiography, Thoracic , Risk Factors , Tuberculin Test , Tuberculosis, Bovine/microbiology , Tuberculosis, Pulmonary/microbiologyABSTRACT
OBJECTIVE: To examine the development of resistance to erythromycin, chloramphenicol, trimethoprim-sulfamethoxazole (TMP-SMZ), and vancomycin of the invasive isolates of Streptococcus pneumoniae obtained from children in 10 Latin American/Caribbean countries during six years of surveillance. METHODS: Analysis of 8 993 isolates of S. pneumoniae recovered in 2000-2005 from children with invasive infections, who were less than 6 years of age, and from Argentina, Brazil, Chile, Colombia, Cuba, Dominican Republic, Mexico, Paraguay, Uruguay, or Venezuela. Antibiotic susceptibility was determined through the methods established and standardized by the SIREVA project. Multidrug resistance was defined as: resistance to three or more antibiotics of the same class; to the non-beta-lactams analyzed by this study; or, to the beta-lactams evaluated by a previous study, in which 37.8% of these isolates showed decreased susceptibility to penicillin. RESULTS: Some degree of resistance was found to TMP-SMZ and erythromycin (56.4% and 15.4% of the isolates studied, respectively), with 4.6% highly resistant to chloramphenicol. All isolates were susceptible to vancomycin. The highest prevalence of TMP-SMZ resistance was observed in the pneumonia isolates; and that of erythromycin, in cases of sepsis (61.6% and 25.5%, respectively; P < 0.01). The highest prevalence of TMP-SMZ resistance was found in Brazil (71.9%), and that of erythromycin, in Mexico (38.2%) and Venezuela (32.9%). The 14, 6B, 19F, and 23F serotypes were most often associated with resistance to the antibiotics in the study. CONCLUSIONS: High and increasing rates of isolates resistant to TMP-SMZ and erythromycin were observed, as well as a decreasing percentage of isolates resistant to chloramphenicol. These trends highlight differences among the countries studied.
Subject(s)
Drug Resistance, Bacterial , Streptococcus pneumoniae/drug effects , Humans , Latin America , Microbial Sensitivity TestsABSTRACT
BACKGROUND: Trovafloxacin is a new fluoroquinolone that exhibits good penetration into the central nervous system and excellent antimicrobial activity against common meningeal pathogens, including beta-lactam-resistant pneumococci. PURPOSE AND DESIGN: A multicenter, randomized clinical trial was conducted in children with bacterial meningitis to compare the safety and efficacy of trovafloxacin with that of ceftriaxone with or without vancomycin therapy. RESULTS: A total of 311 patients, ages 3 months to 12 years, were enrolled, of whom 203 were fully evaluable, 108 treated with trovafloxacin and 95 with the conventional regimen. Both groups were comparable with regard to baseline characteristics: age; cerebrospinal fluid findings; use of dexamethasone; history of seizures; and etiologic agents. No significant differences between trovafloxacin and the comparator, respectively, were detected in any of the following outcome measures: clinical success at 5 to 7 weeks after treatment (79% vs. 81%); deaths (2% vs. 3%); seizures after enrollment (22% vs. 21%); and severe sequelae (14% vs. 14%). Only 4 of 284 children developed joint abnormalities up to 6 months after treatment, 1 (0.9%) child received trovafloxacin and 3 (3.1%) received the comparator regimen. None of the evaluable patients experienced significant abnormalities of liver function during treatment. One nonevaluable patient who received trovafloxacin for 5 days and ceftriaxone for 11 days was readmitted to the hospital with hepatitis of unknown etiology 1 day after discharge. The episode resolved with liver function tests returning to normal within 2 months. CONCLUSIONS: We conclude that trovafloxacin is an effective antibiotic for treatment of pediatric bacterial meningitis. These favorable results support further evaluation of fluoroquinolone therapy for children with meningitis or other serious bacterial infections.
Subject(s)
Anti-Infective Agents/therapeutic use , Ceftriaxone/therapeutic use , Cephalosporins/therapeutic use , Fluoroquinolones , Meningitis, Bacterial/drug therapy , Naphthyridines/therapeutic use , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/pharmacology , Ceftriaxone/administration & dosage , Ceftriaxone/pharmacology , Cephalosporins/administration & dosage , Cephalosporins/pharmacology , Child , Child, Preschool , Drug Therapy, Combination , Female , Humans , Infant , Infusions, Intravenous , Liver/drug effects , Male , Meningitis, Bacterial/pathology , Naphthyridines/administration & dosage , Naphthyridines/pharmacology , Seizures/etiology , Treatment OutcomeABSTRACT
El presente trabajo es una revisión resumida de los elementos fundamentales que debe cumplir un nuevo medicamento para que pueda ir desde el laboratorio de investigación al mostrador del farmacéutico y ser expendido al público. Identifica las fases que debe cumplir la investigación de una nueva droga (preclínica, registro de investigación de nueva droga, ensayo clínico en sus diferentes fases), así como los elementos técnicos y éticos que deben respetar los protocolos de investigación de nuevos medicamentos
Subject(s)
Pharmaceutical Preparations/economics , Pharmaceutical Preparations/standardsABSTRACT
Se reporta el primer caso de S. pneumoniae relativamente resistente a la penicilina, al presentar una CMI de 0.7 µg/ml, aislándose del LCR y sangre de un lactante masculino de 8 meses de edad, que falleció cinco horas después de su admisión; a partir de este caso, recomendamos hacer prueba de sensibilidad a la penicilina a los neumococos aislados y determinarla mediante el disco de oxacilina
Subject(s)
Humans , Male , Child , Penicillin Resistance , Pneumococcal Infections/drug therapy , Streptococcus pneumoniae/drug effectsABSTRACT
El sarampión es una enfermedad infecciosa cuyas complicaciones principales son la neumonía, la laringotraqueobronquitis y la encefalitis, describiéndose también, aunque en raras ocasiones, el enfisema subcutáneo. El objetivo de este estudio e comunicar las características clínico-epidemiológicas de 14 niños afectados de enfisema subcutáneo post-sarampión, admitidos al Departamento de Enfermedades Infecto-contagiosas de la Clínica Infantil Dr. Robert Reid Cabral de Santo Domingo, los cuales formaron parte de una epidemia de sarampión ocurrida entre 1991 y 1992 en República Dominicana. De 383 niños estudiados con sarampión, 3.6 por ciento presentaron enfisema subcutáneo, todos en la región del cuello. Se destacan además con notoriedad la afectación de infantes menores de 3 años (78.6 por ciento ), la falta de vacunación (85 por ciento ) y la elevada mortalidad de los afectados (50 por ciento ). La alta prevalencia observada de enfisema subcutáneo en niños dominicanos con sarampión, asociada a una elevada mortalidad muy diferente a la comunicada en otros países, llama la atención al estudio más detallado de los mecanismos fisiopatológicos de asociación entre ambas entidades
Subject(s)
Humans , Female , Pregnancy , Infant , Child, Preschool , Subcutaneous Emphysema/etiology , Measles/complications , Retrospective StudiesABSTRACT
Se estudiaron 40 niños procedentes de la consulta externa del Hospital Robert Reid Cabral con otitis media. De ellos, 24(60 por ciento ) eran varones y 16(40 por ciento ) eran hembras. Los cultivos fueron positivos en 32(80 por ciento ) pacientes; se aisló H. influenzae en 11(27. por ciento ) pacientes; Estafilococo episermidis en 10(25 por ciento ); Streptococcus pneumoniae en 6(15 por ciento ); Pseudomonas aeruginosa en 1(2.5 por ciento ) y en 1(9 por ciento ) paciente el H. influenzae mostró resistencia a la Ampicilina. B. catarrhalis no fue aislada. El porcentaje de curación fue alto (94.4 por ciento ) con el uso de amoxilina como única terapia
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Amoxicillin/therapeutic use , Otitis Media/drug therapyABSTRACT
Se revisaron los expedientes clínicos de 49 pacientes en la clínica de Meningitis del Departamento de Enfermedades Infectocontagiosas de la clínica Infantil "Dr. Robert Reid Cabral', desde septiembre 1987 a marzo 1988, con el propósito de evaluar el tipo de secuelas neurológicas en los mismos. Diez casos correspondían a neonatos; 35 entre 1 mes y 3 años de edad; y cuatro entre los 3 y 15 años de edad, con un 60, 80 y 75 por ciento de secuelas neurológicas entre moderadas y graves respectivamente; determinadas mediante la aplicación de test de Denver, evaluación neurológica, oftalmológica, psicológica, neuroquirúrgica, y la prueba de Weshler para inteligencia infantil
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Meningitis, Bacterial , Neurologic ManifestationsABSTRACT
Se estudiaron 63 niños que recibieron transfusión sanguínea para investigarles la presencia o no del Virus de la Inmunodeficiencia Humana (VIH) y del antígeno de superficie de la hepatitis B (AgsHB). Se investigó además, motivos de la transfusión, niveles de hemoglobina antes de la transfusión, y estado nutricional de cada paciente. En 2 de 63 muestras (3 por ciento ), hubo positividad para el AgsHB y no hubo ningún caso positivo para el VIH
Subject(s)
Humans , Infant , Child, Preschool , Child , Hepatitis B Surface Antigens/blood , Blood Transfusion , HIV , Nutrition Disorders , Retrospective StudiesABSTRACT
Se evaluaron los expedientes de 70 pacientes que acudieron a la consulta externa de la Clínica Infantil "Dr. Robert Reid Cabral" con Otitis Media Aguda, de los cuales 40(57.14%) eran hembras y 30(42.85%) varones. Hubo un total de 61(87.14%) timpanograms planos y 34(48.5%) cultivos positivos del fluido del oído medio, aislándose 12(35.3%) Hemaphilus influenzae no tipificable; 4(11.8%) Haemophilus influenzae b, 1(2.9%) H. influenzae c, 10(29.4%) Streptococcus pneumoniae y 7(20%) casos de flora mixta: 3 H. influenzae b con Strep. pneumoniae y 4 H. influenzae no tipificable con Strep. pneumoniae. No hubo gérmenes productores de B-lactamasa y no encontramos Neisseriae catarralis. Se concluye que la Ampicilina o Amoxicilina son los antimicrobianos de elección para tratamiento de OMA en niños dominicanos
Subject(s)
Infant, Newborn , Infant , Humans , Male , Female , Otitis Media/diagnosis , Otitis Media/microbiology , Acute Disease , Amoxicillin/therapeutic use , Ampicillin/therapeutic use , Otitis Media/drug therapyABSTRACT
Se estudiaron 50 niños procedentes de la consulta externa de la clínica Infantil Dr. Robert Reid Cabral con diagnóstico clínico de vulvovaginitis. Se aisló N. gonorrheae en 8 (16%) de los casos, de los cuales 5 (62.5%) fueron esistentes a la penicilina por producción de B-lactamasa
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Humans , Female , Neisseria gonorrhoeae , Penicillins/therapeutic use , Vulvovaginitis/drug therapy , beta-Lactamases , Drug Resistance, Microbial , Penicillin ResistanceABSTRACT
Se reportan cinco casos de Meningitis a H. influenzae "b" resistentes a ampicilina y cloranfenicol, llamándonos la atención de que aunque la resistencia del H. influenza a la ampicilina es de un 2% en nuestro país, la mitad de éstos están asociados también a resistencia al cloranfenicol. A pesar de esta asociación aconsejamos el uso inical de ampicilina y cloranfenicol en el tratamiento de la meningitis purulenta manteniendo la atención para detectar cualquier aumento en la resistencia que oblique a un cambio en la políticia actual
Subject(s)
Infant , Child, Preschool , Humans , Male , Female , Ampicillin/therapeutic use , Chloramphenicol/therapeutic use , Haemophilus influenzae/drug effects , Meningitis, Haemophilus/drug therapy , Drug Resistance, MicrobialSubject(s)
Infant , Child, Preschool , Child , Adolescent , Humans , Male , Female , Haemophilus Infections/drug therapy , Meningitis/diagnosis , Meningitis/drug therapy , Dominican Republic , Haemophilus influenzaeSubject(s)
Child , Humans , Male , Dengue , Health Knowledge, Attitudes, Practice , Dominican RepublicABSTRACT
Se comparó la prueba de aglutinación por látex para el diagnóstico de faringitis estreptocóccica vs el cultivo faríngeo en 66 pacientes. El diagnóstico se realizó mediante esta prueba en 14 pacientes de 19 con cultivos positivos. La sensibilidad de la prueba fue de 73% y la especificidad de 93%. El valor predecible de un cultivo positivo, basado en una prueba de látex positiva fue de 80%, mucho más bajo que el de un cultivo negativo fundamentado en una prueba de látex negativa, el cual fue de 96%. Futuras investigaciones definirán el papel de esta prueba rápida en la que aún no se ha establecido su superioridad al cultivo
