Rotavirus: vieja enfermedad, nuevas vacunas / No disponible

El rotavirus es la causa más importante de diarrea en la infancia. En países en vías de desarrollo presenta una gran morbimortalidad, siendo responsable de casi 500.000 muertes en niños menores de 5 años cada año. Por otro lado, en Europa y Norteamérica cerca de la tercera parte de todos los ingresos hospitalarios por gastroenteritis se deben a este microorganismo. La infección por rotavirus afecta prácticamente a la totalidad de los niños hasta los 5 años de edad, aunque las formas graves de la enfermedad ocurren sobre todo entre los 3 meses y los 3 años. El virus aparece en altas concentraciones en las heces de los niños enfermos y tiene una gran capacidad de transmisión entre individuos. La carga de la enfermedad y el costo social y económico son muy elevados, alcanzando los 1.600 euros por cada ingreso. En 2006 se han comercializado en nuestro país dos nuevas vacunas orales. Ambas demuestran un muy buen perfil de seguridad y una elevada eficacia en la prevención de enfermedad grave, deshidratación y hospitalizaciones por gastroenteritis en población infantil

Rotavirus is a major cause of diarrhoea in childhood. It shows an enormous morbidity and mortality in developing countries, being responsible for approximately half a million deaths per year among children aged less than five years. In the other hand in Europe and United States of America nearly one third of admissions by gastroenteritis are due to this microorganism. Rotavirus infects almost all infants by the age of five years, although severe disease appears almost always in children of three to thirty-six months. Rotavirus appears in high concentrations in the stools of infected children having an increasing capacity of transmission person to person. Burden of the disease and its social and economic cost are extremely high reaching one thousand and six hundred euros by each hospitalization. Two new oral vaccines have been commercialized in our country last year. Both of them report an excellent profile of security and a high efficacy in the prevention of severe disease, dehydration and admissions to hospital because of gastroenteritis in the childhood population (AU)

[Why are HIV-infected infants still being born in Spain?]. / Por qué se infectan aún niños con el virus de la inmunodeficiencia humana en España?

INTRODUCTION: Despite the success of preventive measures against mother-to-child transmission (MTCT) of human immunodeficiency virus-1 and -2 (HIV-1 and -2) in developed countries, HIV-infected infants continue to be born. The aim of this study was to evaluate failures in the prevention of MTCT and the clinical characteristics of infected infants. METHODS: The Foundation for the Investigation and Prevention of AIDS in Spain (FIPSE) Cohort in Madrid prospectively follows up children at risk of MTCT HIV born in eight public hospitals in Madrid. From May 2000 to December 2005, 632 children born to HIV-infected mothers were evaluated. Data from pregnancy follow-up, antiretroviral therapy (ART), and symptoms at diagnosis in infected infants were analyzed. RESULTS: Nine infants were infected. The rate of vertical transmission was 1.42 (95% CI 0.7-2.68). Of the nine mothers, seven had not received ART during pregnancy (and five had not received ART at delivery). Of the mothers who received ART, one had only done so for the last month of pregnancy. Two infants were given three drugs as prevention of MTCT, one received bitherapy and six received monotherapy. The median age at diagnosis was 2.4 months (range 7 days-2 years). The mean plasma viral load at diagnosis was 276,000 copies/ml (range: 11,900-1,000,000). Five of the infants were symptomatic at diagnosis (P. jirovaci pneumonia in two, sepsis in one, recurrent bacterial infections in one, hepatosplenomegaly in one). Four of the nine infants had been admitted to hospital prior to HIV diagnosis. DISCUSSION: Missed opportunities for the prevention of MTCT were identified in eight of the nine HIV-infected infants (89%). Administration of AZT during labor in HIV-infected mothers and triple therapy for the prevention of MTCT in high risk infants is not universal. Hospital admission in young infants at risk might lead to suspicion of infection in infants born to HIV-infected mothers. Improved implementation of all the preventive measures for MTCT should be encouraged.

¿Por qué se infectan aún niños con el virus de la inmunodeficiencia humana en España? / Why are HIV-infected infants still being born in Spain?

Introducción A pesar del éxito en la prevención de la transmisión vertical (TV) del virus de la inmunodeficiencia humana tipos 1 y 2 (VIH-1 y 2) en los países desarrollados, todavía siguen naciendo niños infectados. El propósito de este análisis es evaluar los fallos en la prevención de la TV y las características de los niños infectados Métodos La Cohorte FIPSE de Madrid sigue prospectivamente a los niños hijos de gestantes VIH que nacen en 8 hospitales públicos de Madrid. Desde mayo de 2000 hasta diciembre de 2005, se siguieron 632 niños. Se han analizado los datos de la gestación, seguimiento, tratamiento antirretroviral (TAR), y clínica al diagnóstico de los casos de TV. Resultados Se infectaron 9 niños. La tasa de TV fue del 1,42 % (intervalo de confianza [IC] 95 %: 0,7-2,68). 7/9 madres no recibieron TAR durante la gestación (y de ellas, cinco tampoco lo recibieron en el parto). De las madres que recibieron TAR, una sólo cumplió un mes de tratamiento. Dos niños recibieron triple terapia como prevención de la TV, un niño recibió biterapia y, el resto, monoterapia. La mediana de edad al diagnóstico fue de 2,4 meses (rango: 7 días-2 años). La carga viral media en el momento del diagnóstico fue de 276.000 copias/ml (rango: 11.900-1.000.000). Un total de 5/9 de los casos eran sintomáticos al diagnóstico (2 neumonías por Pneumocystis jiroveci, una sepsis, una infección bacteriana de repetición, una hepatoesplenomegalia). Un total de 4/9 requirieron ingreso hospitalario antes del diagnóstico de VIH. Discusión Se identificaron "oportunidades perdidas" de prevención de la TV en 8 de los 9 niños infectados (89 %). El uso de zidovudina durante el parto y la triple terapia al recién nacido de riesgo no están universalmente extendidos. El ingreso hospitalario de lactantes en riesgo de TV debería hacer sospechar una posible infección. Se debería reforzar el acceso y la implementación de todas las medidas de prevención de la TV en el sistema sanitario

Introduction Despite the success of preventive measures against mother-to-child transmission (MTCT) of human immunodeficiency virus-1 and -2 (HIV-1 and -2) in developed countries, HIV-infected infants continue to be born. The aim of this study was to evaluate failures in the prevention of MTCT and the clinical characteristics of infected infants. Methods The Foundation for the Investigation and Prevention of AIDS in Spain (FIPSE) Cohort in Madrid prospectively follows up children at risk of MTCT HIV born in eight public hospitals in Madrid. From May 2000 to December 2005, 632 children born to HIV-infected mothers were evaluated. Data from pregnancy follow-up, antiretroviral therapy (ART), and symptoms at diagnosis in infected infants were analyzed. Results Nine infants were infected. The rate of vertical transmission was 1.42 (95 % CI 0.7-2.68). Of the nine mothers, seven had not received ART during pregnancy (and five had not received ART at delivery). Of the mothers who received ART, one had only done so for the last month of pregnancy. Two infants were given three drugs as prevention of MTCT, one received bitherapy and six received monotherapy. The median age at diagnosis was 2.4 months (range 7 days-2 years). The mean plasma viral load at diagnosis was 276,000 copies/ml (range: 11,900-1,000,000). Five of the infants were symptomatic at diagnosis (P. jirovaci pneumonia in two, sepsis in one, recurrent bacterial infections in one, hepatosplenomegaly in one). Four of the nine infants had been admitted to hospital prior to HIV diagnosis. Discussion Missed opportunities for the prevention of MTCT were identified in eight of the nine HIV-infected infants (89 %). Administration of AZT during labor in HIV-infected mothers and triple therapy for the prevention of MTCT in high risk infants is not universal. Hospital admission in young infants at risk might lead to suspicion of infection in infants born to HIV-infected mothers. Improved implementation of all the preventive measures for MTCT should be encouraged

Comorbilidad en el paludismo en pediatría / Comorbidity in malaria in the pediatric population

No disponible

[Evaluation of twenty-three episodes of acute thoracic syndrome in patients with sickle cell anemia]. / Evaluación de veintitrés episodios de síndrome torácico agudo en pacientes con drepanocitosis.

INTRODUCTION: Acute thoracic syndrome (pneumonia and/or lung infarction) is a significant cause of morbidity and mortality in sickle cell anemia. OBJECTIVE: To review the clinical manifestations, management and outcome of episodes of acute thoracic syndrome in our hospital. METHODS: We performed a retrospective review of all the episodes of acute thoracic syndrome diagnosed at our center in patients younger than 18 years of age with sickle cell anemia. Clinical, laboratory and radiological findings, outcome and treatment were analyzed. Data from patients < 3 years and > 3 years of age were compared (Fisher's exact test and the Mann-Whitney U test). RESULTS: Twenty-three episodes of acute thoracic syndrome were evaluated in eight out of 12 patients with sickle cell anemia followed-up in our hospital. These episodes represented 36 % of the total time of admission in these patients. The most frequent cause was infection. The most frequent symptoms were fever (87 %), cough (61 %) and cold (35 %) symptoms. Seventy-four percent of the patients were not diagnosed at admission, either because the chest X-ray was normal (52 %) or because it was not performed (22 %) due to the absence of pulmonary manifestations. Patients aged more than 3 years old had more severe episodes, with greater clinical compromise and radiological involvement and increased use of analgesia. Transfusions were administered in 65 % of the episodes and in five patients (> 3 years) a partial exchange transfusion was performed. In five patients corticoid treatment was associated with febrile relapses. CONCLUSIONS: Acute thoracic syndrome is frequent in sickle cell disease and is more severe in children older than 3 years. Its diagnosis requires a high index of suspicion, due to multiple forms of clinical presentations and normal chest radiology at admission.

Evaluación de veintitrés episodios de síndrome torácico agudo en pacientes con drepanocitosis / Evaluation of twenty-three episodes of acute thoracic syndrome in patients with sickle cell anemia

Introducción: El síndrome torácico agudo (neumonía y/o infarto pulmonar) es una causa importante de morbimortalidad en la drepanocitosis. Objetivo: Revisar la sintomatología y el manejo de estos episodios en nuestro medio y estudiar las posibles diferencias por grupos de edad. Métodos: Revisión restrospectiva de todos los episodios de síndrome torácico agudo diagnosticados en nuestro hospital en pacientes menores de 18 años con drepanocitosis, y analizar los hallazgos clínicos, analíticos, radiológicos, evolutivos y de tratamiento. Se compararon los datos entre los menores y mayores de 3 años (test exacto de Fisher y U de Mann-Whitney). Resultados: Se evaluaron 23 episodios en 8 de 12 pacientes controlados por drepanocitosis. Los episodios representaron el 36% del tiempo total de ingreso en estos pacientes. La etiología predominante fue la infección. Los síntomas más frecuentes fueron fiebre (87 %), tos (61 %) y síntomas catarrales (35 %). El 74% de los pacientes no fueron diagnosticados al ingreso, bien porque la radiografía de tórax era normal (52 %) o no se realizó (22 %) al no presentar sintomatología pulmonar. Los mayores de 3 años tuvieron episodios más graves, con mayor compromiso radiológico y clínico y mayor empleo de analgesia. Se administraron transfusiones en el 65 % de los episodios y en cinco (> 3 años) se realizó exanguino-transfusión parcial. El tratamiento con corticoides en 5 pacientes se asoció a recaídas febriles. Conclusiones: El síndrome torácico agudo es frecuente en la drepanocitosis y es más grave en mayores de 3 años. El diagnóstico exige un alto índice de sospecha, debido a las múltiples formas de presentación y a la frecuente normalidad del estudio radiológico inicial

Introduction: Acute thoracic syndrome (pneumonia and/or lung infarction) is a significant cause of morbidity and mortality in sickle cell anemia. Objective: To review the clinical manifestations, management and outcome of episodes of acute thoracic syndrome in our hospital. Methods: We performed a retrospective review of all the episodes of acute thoracic syndrome diagnosed at our center in patients younger than 18 years of age with sickle cell anemia. Clinical, laboratory and radiological findings, outcome and treatment were analyzed. Data from patients 3 years of age were compared (Fisher’s exact test and the Mann-Whitney U test). Results Twenty-three episodes of acute thoracic syndrome were evaluated in eight out of 12 patients with sickle cell anemia followed-up in our hospital. These episodes represented 36 % of the total time of admission in these patients. The most frequent cause was infection. The most frequent symptoms were fever (87%), cough (61%) and cold (35%) symptoms. Seventy-four percent of the patients were not diagnosed at admission, either because the chest X-ray was normal (52%) or because it was not performed (22%) due to the absence of pulmonary manifestations. Patients aged more than 3 years old had more severe episodes, with greater clinical compromise and radiological involvement and increased use of analgesia. Transfusions were administered in 65% of the episodes and in five patients (> 3 years) a partial exchange transfusion was performed. In five patients corticoid treatment was associated with febrile relapses. Conclusions: Acute thoracic syndrome is frequent in sickle cell disease and is more severe in children older than 3 years. Its diagnosis requires a high index of suspicion, due to multiple forms of clinical presentations and normal chest radiology at admission -in 1987 did not increase cases of TM in our hospital; on the contrary, these have decreased. A considerable percentage of children with advanced stages of TM show severe sequels

[Massive aortic thrombosis of newborn. One case (author's transl)]. / Thrombose aortique massive chez le nouveau-né. A propos d'un cas.

The authors report a case of aortic massive thrombosis complicating dehydration and neonatal infection in a 30 days old boy. This thrombosis seems have began in ductus arteriosus. Discussion of etio-pathogenesis of such aortic thrombosis is based upon literature review.