Molecular epidemiology of paediatric invasive pneumococcal disease in Andalusia, Spain.

This study aimed to assess the impact of the introduction of pneumococcal conjugate vaccine 13 (PCV13) on the molecular epidemiology of invasive pneumococcal disease (IPD) in children from Andalusia. A population-based prospective surveillance study was conducted on IPD in children aged <14 years from Andalusia (2018-2020). Pneumococcal invasive isolates collected between 2006 and 2009 in the two largest tertiary hospitals in Andalusia were used as pre-PCV13 controls for comparison of serotype/genotype distribution. Overall IPD incidence rate was 3.55 cases per 100 000 in 2018; increased non-significantly to 4.20 cases per 100 000 in 2019 and declined in 2020 to 1.69 cases per 100 000 (incidence rate ratio 2020 vs. 2019: 0.40, 95% confidence interval (CI) 0.20-0.89, P = 0.01). Proportion of IPD cases due to PCV13 serotypes in 2018-2020 was 28% (P = 0.0001 for comparison with 2006-2009). Serotypes 24F (15%) and 11A (8.3%) were the most frequently identified non-PCV13 serotypes (NVT) in 2018-2020. Penicillin- and/or ampicillin-resistant clones mostly belonged to clonal complex 156 (serotype 14-ST156 and ST2944 and serotype 11A-ST6521). The proportion of IPD cases caused by PCV13 serotypes declined significantly after the initiation of the PCV13 vaccination programme in 2016. Certain NVT, such as serotypes 24F and 11A, warrant future monitoring in IPD owing to invasive potential and/or antibiotic resistance rates.

Distinct Laboratory and Clinical Features of Secondary Hemophagocytic Lymphohistiocytosis in Pediatric Visceral Leishmaniasis: A Retrospective Analysis of 127 Children in Andalusia, Spain (2004-2019).

BACKGROUND: Visceral leishmaniasis (VL) is an endemic in Southern Europe. However, details regarding disease burden, clinical presentations, laboratory markers, management and outcome in children are scarce. METHODS: Medical records of children (<14 years) admitted with VL to 10 pediatric units in Andalusia (2004-2019) were retrospectively reviewed. VL diagnosis was based on clinical presentation, serology, microscopy and molecular methods. Diagnosis of secondary hemophagocytic lymphohistiocytosis (sHLH) was established using the hemophagocytic lymphohistiocytosis-2004 criteria. RESULTS: A total of 127 patients were identified. Median age was 14.5 months; the main clinical presentations were fever and splenomegaly (95.3% each). Cytopenias were the most common laboratory abnormalities. Diagnostics as well as treatment regimens varied over time and the participating centers. Liposomal amphotericin B was prescribed in 97.6%; relapses as well as adverse events were rarely observed (3.1% each). Thirty-seven patients, diagnosed with sHLH required longer hospital admission (P = 0.001), an increased number of platelet (P < 0.006) and red blood cell (P = 0.0001) transfusions and pediatric intensive care unit admission (P = 0.007). Monocytopenia (P = 0.011) and high C-reactive protein levels (P = 0.031), variables not included in the hemophagocytic lymphohistiocytosis-2004 criteria, were associated with sHLH. One patient deceased in the context of the Leishmania infection. CONCLUSIONS: We report data on the largest pediatric VL cohort from Europe, commonly associated with sHLH. Raised C-reactive protein levels and monocytopenia appear to be associated with sHLH. The latter may help to identify these patients and to guide decisions regarding need of additional supportive clinical care and immunomodulatory therapies. The observed high rate of heterogeneity in terms of diagnosis and management warrants the establishment of appropriate guidelines.

Calprotectina fecal como apoyo al diagnóstico en la alergia a las proteínas de leche de vaca no IgE mediada / Faecal calprotectin as an aid to the diagnosis of non-IgE mediated cow's milk protein allergy

INTRODUCCIÓN: El objetivo del estudio es evaluar la utilidad de la calprotectina fecal (CPF) en lactantes con sospecha de alergia a las proteínas de leche de vaca (APLV) no IgE mediada tanto para el diagnóstico como para predecir la respuesta clínica a la supresión láctea. PACIENTES Y MÉTODOS: Estudio prospectivo, de un año de duración, incluyendo 82 lactantes entre 1-12 meses en el Área Este de Málaga-Axarquía. De ellos: 40 se diagnostican de APLV no IgE mediada (síntomas compatibles y respuesta positiva a la supresión láctea), 12 no se confirma APLV y además 30 como grupo control. Se determina CPF al diagnóstico, al mes y a los 3 meses. El análisis estadístico realizado fue ANOVA para medidas repetidas, regresión logística nominal y curvas ROC utilizando los programas SPSS 20 y Medcalc. RESULTADOS: Se analizan diferencias entre los grupos y se objetiva relación estadísticamente significativa entre cifras elevadas de CPF y padecer APLV (p <0,0001). También se constata relación estadísticamente significativa entre cifras de CPF al diagnóstico, al mes y a los 3 meses (p < 0,001). Finalmente se realiza una curva ROC entre cifras de CPF y diagnóstico de APLV resultando una área bajo la curva de 0,89 y siendo 138μg/g el mejor nivel de corte. Sin embargo, para predecir respuesta clínica este valor es únicamente de 0,68. CONCLUSIONES: Cifras de CPF inferiores a 138μg/g podrían ser útiles para descartar el diagnóstico de APLV no IgE mediada. La CPF no es un buen test para predecir respuesta clínica a la exclusión láctea

INTRODUCTION: The aim of the study was to assess the use of faecal calprotectin (FCP) in infants with signs and symptoms of non-IgE-mediated cow's milk protein allergy (CMA) for both diagnosis and prediction of clinical response at the time of withdrawal of milk proteins. PATIENTS AND METHODS: A one year prospective study was conducted on 82 infants between 1 and 12 months of age in the Eastern area of Málaga-Axarquía, of whom 40 of them had been diagnosed with non-IgE-mediated CMA (with suggestive symptoms and positive response to milk withdrawal), 12 not diagnosed with CMA, and 30 of them were the control group. FCP was measured at three different times: time of diagnosis, and one and three months later. ANOVA for repeated measures, nominal logistic regression and ROC curves were prepared using the SPSS.20 package and Medcalc. RESULTS: Differences between diagnostic and control groups were assessed: there was a statistically significant relationship (p<.0001) between high FCP levels and infants suffering CMA, as well as the levels at time of diagnosis, 1 and 3 months (p <.001). A ROC curve was constructed between FCP levels and diagnosis of CMA, with 138 ug/g, with the best cut-off being with an area under the curve of 0.89. However, it is only 0.68 to predict a clinical response. CONCLUSIONS: FCP levels lower than 138ug/g could be useful to rule out non-IgE-mediated CMA diagnosis. Calprotectin is not a good test to predict clinical response to milk withdrawal

[Faecal calprotectin as an aid to the diagnosis of non-IgE mediated cow's milk protein allergy]. / Calprotectina fecal como apoyo al diagnóstico en la alergia a las proteínas de leche de vaca no IgE mediada.

INTRODUCTION: The aim of the study was to assess the use of faecal calprotectin (FCP) in infants with signs and symptoms of non-IgE-mediated cow's milk protein allergy (CMA) for both diagnosis and prediction of clinical response at the time of withdrawal of milk proteins. PATIENTS AND METHODS: A one year prospective study was conducted on 82 infants between 1 and 12 months of age in the Eastern area of Málaga-Axarquía, of whom 40 of them had been diagnosed with non-IgE-mediated CMA (with suggestive symptoms and positive response to milk withdrawal), 12 not diagnosed with CMA, and 30 of them were the control group. FCP was measured at three different times: time of diagnosis, and one and three months later. ANOVA for repeated measures, nominal logistic regression and ROC curves were prepared using the SPSS.20 package and Medcalc. RESULTS: Differences between diagnostic and control groups were assessed: there was a statistically significant relationship (p<.0001) between high FCP levels and infants suffering CMA, as well as the levels at time of diagnosis, 1 and 3 months (p <.001). A ROC curve was constructed between FCP levels and diagnosis of CMA, with 138 ug/g, with the best cut-off being with an area under the curve of 0.89. However, it is only 0.68 to predict a clinical response. CONCLUSIONS: FCP levels lower than 138ug/g could be useful to rule out non-IgE-mediated CMA diagnosis. Calprotectin is not a good test to predict clinical response to milk withdrawal.

Effect of nutritional status on Tuberculin skin testing.

OBJECTIVES: To evaluate Tuberculin skin test (TST) results in a population of immigrants and internationally adopted children from several geographical areas; to analyze whether nutritional status can modify TST results. METHODS: This cross-sectional observational study included adopted children and immigrants evaluated in the authors' unit between January 2003 and December 2008. Children diagnosed with tuberculosis, or vaccinated with live attenuated virus 2 mo earlier, HIV-infected, chronically ill or under treatment with immunosuppressive agents were excluded. TST was considered as dependent variable. Independent variables were gender, age, geographical origin, BCG scar, nutritional status, immune status and intestinal parasitism. RESULTS: One thousand seventy four children were included; 69.6 % were girls. There was a BCG scar in 79 % of children. Mantoux = 0 mm was found in 84.4 %, <10 mm in 4.1 %, and ≥10 mm in 11.4 % of children. Nutrition (McLaren's classification) was normal (≥90 %) in 26.7 % of the subjects, with mild malnutrition (80-89 %) in 36 %, moderate (70-79 %) in 23.2 % and severe (≤69 %) in 14.1 %. There was no difference in TST results among different nutritional status children. CONCLUSIONS: The nutritional status, measured by McLaren's classification, does not changes the results of TST. McLaren's classification only grades protein-caloric malnutrition, so in authors' experience this type of malnutrition does not interfere with TST results. Implementing other nutritional parameters could help to determine whether nutritional status should be taken into account when interpreting TST results.

Is there interference in the interpretation of the tuberculin skin test in children with intestinal parasitic infestation?

BACKGROUND: Infestation by intestinal parasites could be a cause of a false-negative tuberculin skin test (TST) result. OBJECTIVE: To evaluate TST results in a population of immigrants and internationally adopted children and to analyze whether intestinal parasitic infestation may modify or not TST results. METHODS: A cross-sectional observational study which includes adopted children or immigrants evaluated in our hospital between January 2003 and December 2008. The TST was considered as the dependent variable and independent variables were gender, age, geographical origin, bacille Calmette-Guérin scar, nutritional status, immune status, and intestinal parasitism. RESULTS: One thousand and seventy-four children were included, of whom 69·6% were female. There was a bacillus Calmette-Guérin scar in 79% of the children and in 20·3% intestinal parasites were found. There were no differences in TST results among infested and non-infested children. CONCLUSIONS: Intestinal parasitic infestation did not change TST results in our study and these results coincide with recent articles regarding questionable interference that intestinal parasitic infestations may produce on TST results.

Tuberculin skin test in bacille Calmette-Guérin-vaccinated children: how should we interpret the results?

BACKGROUND: The tuberculin skin test (TST) is the most useful method for the diagnosis of tuberculosis (TB). There is no evidence about the effect of bacillus Calmette-Guerin (BCG) vaccine on the interpretation of TST results. OBJECTIVE: The aim of this study was to evaluate TST results in a population of immigrants and adopted children, analyzing the effect of the vaccine on TST. METHODS: Cross-sectional observational study including immigrants or adopted children evaluated in our unit between January 2003 and December 2008 was made. Children diagnosed with TB, live attenuated virus vaccinated 2 months earlier, HIV-infected, chronically ill, or under treatment with immunosuppressive agents were excluded. TST was considered the dependent variable. Independent variables were gender, age, geographical origin, BCG scar, nutritional status, immune status, and intestinal parasites infestation. RESULTS: One thousand seventy-four children were included, 69.6 % are female; their origin includes China (34.7 %), Latin America (20.8 %), India/Nepal (19.4 %), Eastern Europe (15.7 %), and Africa (9.3 %). BCG scar was present in 79 % of children. Mantoux = 0 mm in 84.4 %, <10 mm in 4.1 %, and ≥10 mm in 11.4 %. Only two variables, age and BCG scar, influenced TST result. Risk of a TST false-positive due to BCG disappears 3 years after vaccine administration. CONCLUSIONS: A history of BCG vaccination at birth does not interfere with TST results in children >3 years old. Under 3 years of age, BCG does interfere with and may cause a false-positive TST result. In these cases, the use of interferon-gamma release assays (IGRAs) is recommended. If IGRAs are not available or when results are indeterminate, ignoring the antecedent of the vaccine is recommended.