Increased risk of group B streptococcal sepsis and meningitis in HIV-exposed uninfected infants in a high-income country.

The purpose of this study is to compare group B Streptococcus (GBS) infection incidence in HIV-exposed uninfected (HEU) and HIV-unexposed (HU) infants in a Spanish cohort. We conducted a retrospective study in 5 hospitals in Madrid (Spain). Infants ≤ 90 days of life with a GBS infection were included from January 2008 to December 2017. Incidence of GBS infection in HEU and HU children was compared. HEU infants presented a sevenfold greater risk of GBS infection and a 29-fold greater risk of GBS meningitis compared to HU, with statistical significance. Early-onset infection was tenfold more frequent in HEU children, with statistical significance, and late-onset infection was almost fivefold more frequent in the HUE infants' group, without statistical significance. CONCLUSION: HEU infants presented an increased risk of GBS sepsis and meningitis. One in each 500 HEU infants of our cohort had a central nervous system infection and 1 in each 200, a GBS infection. Although etiological causes are not well understood, this should be taken into account by physicians when attending this population. WHAT IS KNOWN: • HIV-exposed uninfected infants are at higher risk of severe infections. • An increased susceptibility of these infants to group B Streptococcus infections has been described in low- and high-income countries, including a higher risk of meningitis in a South African cohort. WHAT IS NEW: • Group B Streptococcal meningitis is more frequent in HIV-exposed uninfected infants also in high-income countries. • Physicians should be aware of this increased risk when attending these infants.

Anemia en un lactante con síndrome de inmunodeficiencia adquirida: a propósito de un caso / Anemia in an infant with acquired immunodeficiency syndrome: A case report

Introducción: En la actualidad, a pesar del cribado universal de VIH en embarazadas, se siguen diagnosticando niños en la fase sintomática de la infección. Caso clínico: Describimos el caso de un lactante diagnosticado en estadio avanzado de infección por el VIH, con anemia hemolítica secundaria, su evolución y tratamiento. Conclusión: En nuestro medio es una prioridad mantener un alto índice de sospecha en poblaciones de riesgo de infección por el VIH, siendo el objetivo del pediatra que sean diagnosticados en estadios iniciales de la enfermedad

Introduction: Currently, in spite of universal screening of HIV in pregnant women, children are still being diagnosed in the symptomatic phase of the infection. Clinical case: We describe the case of an infant diagnosed at an advanced stage of HIV infection, with secondary he-molytic anemia, its volution and treatment. Conclusion: In our setting it is a priority to maintain a high index of suspicion in populations at risk of HIV infection, being the goal of the pediatrician make the diagnosis in the initial stages of the disease

[Kingella kingae as a common cause of arthritis septic in children]. / Kingella kingae como agente causal frecuente de artritis séptica en Pediatría.

OBJECTIVE: Kingella kingae is a common colonizer of the oropharynx in children that may lead to invasive infection, mainly osteoarticular infections. Invasive infections occur almost exclusively in young children, fundamentally fewer than two years old. K. kingae infections in children are probably underdiagnosed due to the difficulty in growing in routine cultures and the absence of systematic realization of molecular techniques to identify it. It is the most common bacteria involved in childhood osteoarticular infections in recent series and increasingly being recognized in Spain. We report our experience on the epidemiological and clinical characteristics of osteoarticular infections in children in recent years. METHODS: Retrospective analysis of septic arthritis by K. kingae identified by PCR in joint fluid in children during 2010-2016. Epidemiological, clinical and laboratory characteristics are presented. RESULTS: Five arthritis by K. kingae were identified, all of them in ≤6 years old children. Median leukocytes, CRP and ESR were 12950 leukocytes/µL, 4.84 mg/dL and 58 mm/h respectively, and 61,322 leukocytes /µL in joint fluid. All patients evolved favorably. CONCLUSIONS: Osteoarticular infections by K. kingae in children usually present low increase of inflammatory markers despite being invasive infections. The development of PCR in sterile samples has greatly improved the diagnostic yield of K. kingae infections improving the management of osteoarthritis in children.

Características de los niños con enfermedad tuberculosa en Meki (Etiopía): el reto del diagnóstico con recursos limitados / Characteristics of children with tuberculosis in Meki (Ethiopia): the challenge of diagnosis with limited resources

Introducción: La tuberculosis (TB), una enfermedad prevenible y curable, es la primera causa de morbimortalidad en Etiopía. El diagnóstico en niños presenta importantes retos, debido al carácter paucibacilar de la enfermedad. Describimos las características de los niños diagnosticados de enfermedad tuberculosa (ETB) en la clínica Let Children Have Health de Meki, Etiopía. Métodos: Estudio descriptivo-retrospectivo de los niños diagnosticados de ETB desde enero hasta diciembre de 2013. Se incluyeron las características antropométricas, clínicas, analíticas y radiológicas. Se clasificó la ETB confirmada, probable y posible según los criterios en el momento del diagnóstico, y la afectación de ETB en pulmonar y extrapulmonar (cualquier forma de manifestación extratorácica, incluida la TB miliar). Resultados: Se diagnosticaron 38 niños: 35 con TB probable y 3 con TB posible. El cultivo de icobacterias no estuvo disponible. La mediana de edad fue de 8 años. El 50% presentó TB pulmonar, el 37% ETB mixta, 4 niños formas extrapulmonares y 1 TB miliar. En el momento del diagnóstico, 32 niños (84%) referían tos, 31 (81%) fiebre y 15 (39%) adenitis; 15 (39,5%) tenían antecedentes familiares de ETB, y ninguno de ellos había recibido quimioprofilaxis como contacto. Se detectó desnutrición aguda (diagnosticada a partir del perímetro medio del brazo o de la relación peso/talla) en 13 niños (31%). Cuatro niños presentaron baciloscopia en esputo positiva (todos mayores de 7 años). En 1 niño se confirmó el diagnóstico por baciloscopia positiva mediante punción-aspiración con aguja fina de adenopatía, y otro precisó cirugía por obstrucción intestinal, con baciloscopia positiva en las muestras quirúrgicas. Se realizó el test de Mantoux a 13 niños, que resultó positivo en 9. Se realizó el test rápido del virus de la inmunodeficiencia humana a 22 niños, cuyos resultados fueron todos negativos. La evolución de todos los niños fue buena. Conclusiones: El diagnóstico de ETB continúa siendo tardío. Debe promoverse la identificación y la administración de quimioprofilaxis a los niños expuestos, además de la búsqueda activa de ETB en programas ya implementados, como el programa de desnutrición local. La presentación extrapulmonar es muy prevalente, por lo que siempre debe tenerse en cuenta (AU)

Introduction: Tuberculosis (TB), a preventable and curable disease, is the first cause of morbidity and mortality in Ethiopia. The diagnosis in children presents important challenges due to paucibacillary character of the disease. We describe the characteristics of children diagnosed of TB at the Pediatric Clinic Let Children Have Health in Meki, Ethiopia. Methods: Retrospective study of children diagnosed of TB from January to December 2013. Anthropometric, clinical, laboratory and radiological findings at the time of diagnosis were included. TB was classified as confirmed TB, probable TB and possible TB for categories at diagnostic. And by involvement: pulmonary TB and extrapulmonary TB (any form of extrathoracic manifestations, including TB miliary). Results: 38 children were diagnosed: 35 probable TB, 3 possible TB; mycobacterium culture was not available. The median age was 8 years. 50% of them had pulmonary TB, 37% mixed TB, 4 children extra-pulmonary forms and 1 miliary TB. At the time of diagnosis, 32 (84%) reported cough, 31 (81%) fever, 15 (39%) lymphadenitis. 15 (39.5%) had a family history of TB, none of them had received quimioprophylaxis contact. Malnutrition (defined by mid upper arm circumference or weight/height) was detected in 13 children (34%). Four children had positive smear sputum (all of them older than 7 years). In a child diagnosis was confirmed by smear-positive in lymph node biopsy, and one required surgery due to intestinal obstruction, smear positive in surgical specimens. Mantoux was performed in 13 children, remaining positive in 9. HIV rapid test was conducted to 22 children, all of them were negative. The evolution of all children was good. Conclusions: Diagnosis of TB continues being delayed. Identification of exposed children and active searching in other programs already implemented such as local program malnutrition should be promoted. Extrapulmonary presentation is very prevalent and should always be considered (AU)

[Kawasaki disease: Diagnosis and treatment]. / Enfermedad de Kawasaki: diagnóstico y tratamiento.

INTRODUCTION: Kawasaki disease is the leading cause of acquired heart disease in children. In spite of the efficacy of intravenous immunoglobulin (IGIV), the absence of a specific diagnostic test and due to there being IGIV-refractory patients, Kawasaki disease is a major cause of coronary artery abnormalities (CAA). OBJECTIVES: To analyze the clinical and epidemiological characteristics of cases of Kawasaki disease, to evaluate the efficacy of treatments used and the CAA observed. METHODS: We retrospectively reviewed the medical records of children diagnosed with Kawasaki disease between January 2002 and December 2008 in a tertiary public Hospital in the South of Madrid. The diagnosis of Kawasaki disease was based on the clinical criteria proposed by the American Academy of Pediatrics in 2004. RESULTS: Twenty three children were identified. Median age was 26 months (range: 2 months-10 years). Nineteen children (82%) were younger than 5 years old. Fever and changes in the lips and oral cavity were present in all cases. Twenty-one patients (91%) received IGIV, all of them before the 10th day of disease. One child (4.7%) required the administration of more than one dose of IGIV, because persistence of fever. CAA was recorded in three patients [13.0%, (95% CI: 1-26%)], including a four month-old boy. All patients with CAA were treated with the recommended dose of IGIV, 2g/kg, between the 5th and 8th day of disease. CONCLUSIONS: Kawasaki disease was more common in children less than five years old. We observed a high rate of CAA in children with Kawasaki disease in spite of appropriate and timely treatment.

[Visceral childhood leishmaniasis: diagnosis and treatment]. / Diagnóstico y tratamiento de la leishmaniasis visceral infantil.

INTRODUCTION: Visceral leishmaniasis is endemic in Spain. New diagnostic tools and shorter regimens of treatment are been increasingly being used in children. OBJECTIVES: To analyze the clinical and epidemiological characteristics of cases of visceral leishmaniasis, to evaluate the diagnostic techniques tested and the safety and efficacy of treatments used. METHODS: We retrospectively reviewed the medical records of children diagnosed with visceral leishmaniasis between January 1994 and December 2007 in a tertiary public Hospital in the South of Madrid. The diagnosis of visceral leishmaniasis was based on visualization of Leishmania sp. in bone marrow aspirate or culture or positive PCR analysis of the bone marrow aspirate. RESULTS: Eleven immunocompetent children were identified. Median age was 21 months (range: 4 months - 13 years). Fever was present in all cases, and hepatomegaly and splenomegaly in 10 (91%). Anemia was the most frequent haematological finding (100%). A bone marrow aspirate was obtained in all cases. Leishmania amastigotes were observed in 8 (73%) cases. Leishmania DNA in the bone marrow aspirate was detected in all patients who underwent this procedure. Positive immunofluorescent-antibody test (IFAT) analysis at baseline was observed in 63% of cases tested. The threshold titer for positivity was 1/40. Urinary antigen detection test was positive in 4 out of 6 (67%) children in whom I was performed. Initial treatment consisted of meglumine antimoniate in 3 patients and liposomal amphotericin B (LAB) in 8 (73%) patients. All children had an early clinical response. Only one child treated with LAB relapsed. No severe adverse events were observed with treatment. CONCLUSIONS: Visceral leishmaniasis is still a common disease in our area. Clinical and laboratory findings of visceral leishmaniasis are similar to other Mediterranean area reports. PCR analysis of the bone marrow aspirate was more sensitive than traditional diagnostic techniques. Non-invasive diagnostic techniques may be used as an aid in the diagnosis of visceral leishmaniasis in children. Short course treatment of visceral leishmaniasis with liposomal amphotericin B has been safe and effective.

[Attention deficit and hyperactivity disorder, a current problem]. / Trastorno por déficit de atención e hiperactividad: un problema actual.

INTRODUCTION: Attention deficit disorder and hyperactivity (ADDH), is a condition that affects the normal development of children. The symptoms include difficulty of controlling physical activity, inattention and learning disorders. The ADDH must be diagnosed in accordance with the clinical findings defined in the DSM IV. OBJECTIVE: To describe the epidemiology and clinical characteristics of children diagnosed with ADDH in our hospital. MATERIAL AND METHODS: Biannual observational study. Variables evaluated were: age, sex, personal and family medical history, symptoms, therapy and treatment response. RESULTS: There 83 participants (87 % Male and 13 % Female), of which 32.5 % were diagnosed during the study. Ages ranged from 3-8 years (84 %). There was a family history related to ADDH in 38 % of patients, and personal history of prematurity, acute foetal distress, small for gestational age, convulsions were reported. Association of hyperactivity and attention deficit was found in 65 % of participants. Other related symptoms were cognitive disorder (62 %), language disabilities (41 %) and motor disorders (35 %). Treatment was on-going in 65 % of the patients, 27.7 % of them having adverse effect. Evolution with therapy was favourable in 61 %. CONCLUSIONS: These findings suggest that ADDH is one of the most common childhood psychiatric disorders, mainly affecting boys. There is usually a family history. Failure in school was one of the principal conditions. Association between attention deficit and hyperactivity, mainly hyperactivity, is the most common presentation. Other disorders such as motor and language disabilities are also common in these patients. Methylphenidate showed favourable outcomes in 61 % of the patients studied.

[Late onset group B Streptococcus infection: 7 year experience in a tertiary hospital (2000-2006)]. / Infección tardía por estreptococo del grupo B: experiencia en un hospital de tercer nivel (2000-2006).

INTRODUCTION: Group B Streptococcus (GBS) is a major cause of neonatal infection. Two forms of the disease have been described according to the age of presentation: early, beginning in the first 6 days of life, and late, occurring from day 7 up to 3 months of age. OBJECTIVES: To analyze the epidemiology of the late onset form of GBS disease in a tertiary hospital after implementing preventive strategies aimed to reduce the rate of vertical transmission. METHODS: We retrospectively reviewed the medical records of children diagnosed with late GBS infection between January 2000 and December 2006. Diagnostic criteria included a positive blood culture and/or a positive cerebrospinal fluid (CSF) culture for GBS in any patient aged between 7 and 89 days. RESULTS: 24 patients were identified, most of them presenting after January 2005. Median age was 36.2 days (range 9 to 81). GBS isolates in blood were found in 20 patients, 1 in CSF and 3 in both. Most frequently children presented with fever (70.8 %) and irritability (54.1 %). Five patients (20.8 %) had a cellulitis-adenitis syndrome. Cefotaxime and ampicillin were the most often used antibiotic combination. No ampicillin resistances were found. CONCLUSIONS: The number of children with late GBS disease has increased in our center. Accordingly, the recent recommendations for the prevention of perinatal GBS vertical transmission were not effective for reducing late GBS infection. This may be due to horizontal infections from maternal sources, community or cross infections. It is important to maintain clinical suspicion of late GBS infection and start early antibiotic treatment.