Clinical standards for drug-susceptible TB in children and adolescents.

BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents.METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document.RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent.CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB.

Pregnancy outcomes after maternal Zika virus infection in a non-endemic region: prospective cohort study.

OBJECTIVES: The aim was to describe pregnancy outcomes after Zika virus (ZIKV) infection in a non-endemic region. METHODS: According to the Spanish protocol issued after the ZIKV outbreak in Brazil in 2015, all pregnant women who had travelled to high-burden countries were screened for ZIKV. Serological and molecular tests were used to identify ZIKV-infected pregnant women. They were classified as confirmed ZIKV infection when reverse transcription (RT) PCR tested positive, or probable ZIKV infection when ZIKV immunoglobulin M and/or immunoglobulin G and ZIKV plaque reduction neutralization tests were positive. Women found positive using molecular or serological tests were prospectively followed-up with ultrasound scans and neurosonograms on a monthly basis until delivery; magnetic resonance imaging and amniotic fluid testing were performed after signed informed consent. Samples of placenta, and fetal and neonatal tissues were obtained. RESULTS: Seventy-two pregnant women tested positive for ZIKV infection: ten were confirmed by RT-PCR, and 62 were probable cases based on serological tests. The prevalence of adverse perinatal outcomes was 33.3% (three out of nine, 95% CI 12.1-64.6%): two cases of congenital ZIKV syndrome (CZS) and one miscarriage, all born to women infected in the first trimester of gestation. All ZIKV-confirmed women had persistent viraemias beyond 2 weeks (median 61.50 days; IQR 35.50-80.75). Amniotic fluid testing was only positive in the two fetuses with anomalies. CONCLUSION: The prevalence of perinatal adverse outcomes for women with ZIKV-confirmed infection was 33.3%. Amniocentesis for ZIKV RT-PCR is recommended when fetal abnormalities are found. Intensive prenatal and postnatal follow-up of ZIKV-infected pregnancies is advised in confirmed cases.

Migrant women living with HIV in Europe: are they facing inequalities in the prevention of mother-to-child-transmission of HIV?: The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) study group in EuroCoord.

Background: In pregnancy early interventions are recommended for prevention of mother-to-child-transmission (PMTCT) of HIV. We examined whether pregnant women who live with HIV in Europe and are migrants encounter barriers in accessing HIV testing and care. Methods: Four cohorts within the European Pregnancy and Paediatric HIV Cohort Collaboration provided data for pooled analysis of 11 795 pregnant women who delivered in 2002-12 across ten European countries. We defined a migrant as a woman delivering in a country different from her country of birth and grouped the countries into seven world regions. We compared three suboptimal PMTCT interventions (HIV diagnosis in late pregnancy in women undiagnosed at conception, late anti-retroviral therapy (ART) start in women diagnosed but untreated at conception and detectable viral load (VL) at delivery in women on antenatal ART) in native and migrant women using multivariable logistic regression models. Results: Data included 9421 (79.9%) migrant women, mainly from sub-Saharan Africa (SSA); 4134 migrant women were diagnosed in the current pregnancy, often (48.6%) presenting with CD4 count <350 cells/µl. Being a migrant was associated with HIV diagnosis in late pregnancy [OR for SSA vs. native women, 2.12 (95% CI 1.67, 2.69)] but not with late ART start if diagnosed but not on ART at conception, or with detectable VL at delivery once on ART. Conclusions: Migrant women were more likely to be diagnosed in late pregnancy but once on ART virological response was good. Good access to antenatal care enables the implementation of PMTCT protocols and optimises both maternal and children health outcomes generally.

In utero negativization of Zika virus in a foetus with serious central nervous system abnormalities.

We describe a case of a pregnant woman with Zika virus (ZIKV) infection and a foetus with severe brain malformations. ZIKV tested positive in amniotic fluid at 19 weeks but was negative at delivery. The newborn did not meet the case definition of congenital ZIKV syndrome because neither ZIKV RNA nor IgM antibodies were detected; however, prenatal brain lesions were confirmed after birth (Graphical Abstract).

Documento de consenso sobre el abordaje de la enfermedad de Chagas en Atención Primaria de salud de áreas no endémicas / Consensus document for the detection and management of Chagas disease in Primary Health Care in non-endemic areas

La tripanosomiasis americana o enfermedad de Chagas es una enfermedad infecciosa endémica en América Latina continental, causada por el protozoo Trypanosomacruzi. En las últimas décadas, debido a los movimientos poblacionales, se ha expandido más allá de las zonas endémicas, siendo España el país europeo con más inmigrantes latinoamericanos. Durante años puede permanecer asintomática, pero cuando se manifiesta clínicamente puede ser grave (miocardiopatía dilatada, megacolon, megaesófago). Así como, debido a su transmisión vertical, la detección en embarazadas es una alta prioridad. Se han elaborado guías de detección de Trypanosomacruzi en circunstancias específicas (bancos de sangre, maternidades, coinfección con VIH, trasplante de órganos); pero detectamos falta de información dirigida a los profesionales de atención primaria. Para facilitar la detección y manejo de esta enfermedad se consideró la necesidad de realizar este documento, redactado y consensuado por médicos de familia, pediatras de Atención Primaria y especialistas en Salud Internacional (AU)

Chagas disease is caused by the protozoan Trypanosoma cruzi. Although it is commonly transmitted by an insect vector in continental Latin-America, in recent decades, due migration, it has been diagnosed in other countries such as Spain, the European country with a largest immigrant population of Latin Americans. For a long time, the patient remains asymptomatic, but some years after this stage, the symptoms can be serious (dilated cardiomyopathy, megacolon, megaesophagus). In addition, detection in pregnant women has a high priority because of the route of vertical transmission. Several specific guidelines about Chagas disease have been developed (blood banks, maternal hospitals, HIV co-infection, organ transplant). But lack of information to primary care professionals has been detected. We consider this document written and agreed by family physicians, pediatricians and specialists in International Health will be useful (AU)

Valoración del uso de «Lactobacillus reuteri» en el tratamiento de los cólicos del lactante: estudio piloto / Valuation the use of Lactobacillus reuteri in the treatment of infant colic: a pilot study

Introducción: El cólico del lactante es un cuadro de malestar abdominal, definido por Wessel y recogido en los criterios de Roma III. Aunque se considera benigno, guarda cierta relación con los marcadores inflamatorios, y provoca un trastorno en el lactante y una gran ansiedad en sus familiares. Últimamente el uso de probióticos como Lactobacillus reuteri ha obtenido buenos resultados en otras poblaciones europeas. Objetivo: Como la microbiota modula la respuesta inflamatoria intestinal y depende de factores ambientales y genéticos, propusimos un estudio piloto para tratar de reproducir estos resultados en nuestra población. Método: Estudio observacional y prospectivo de la sintomatología relacionada con los cólicos en 17 lactantes sanos, a los que se prescribió L. reuteri DSM 17938, indicación aprobada por la Agencia Española Reguladora de la Alimentación, en todos los casos con el consentimiento informado y escrito de los familiares. Se realizó un seguimiento mediante un cuestionario de datos clínicos y dos visitas presenciales para el control y la determinación de calprotectina en heces. El estudio estadístico se llevó a cabo mediante el programa Stata v11, con el test de la ji al cuadrado y un análisis de regresión lineal. Resultados: Los parámetros clínicos, como el tiempo del llanto y el malestar del lactante, fueron mejorando según pasaban las semanas. La percepción de mejoría y la disminución de los niveles de calprotectina en heces también mostraron una evolución paralela. Las curvas de peso y talla no se vieron afectadas. Conclusiones: El uso de probióticos mejora claramente la sintomatología del lactante, reduce la ansiedad familiar, disminuye los valores de los marcadores inflamatorios intestinales y no interfiere en el desarrollo ponderoestatural de los pacientes (AU)

Introduction: Infantile colic is a picture of abdominal discomfort, defined by Wessel and included in the Rome III criteria. Although considered benign somewhat related inflammatory markers, causing a disorder in infants and a major anxiety in their family. Lately the use of probiotics such as Lactobacillus reuteri have been successful in other European populations. Objective: Microbiota modulates intestinal inflammatory response and depends on genetic and environmental factors. We proposed a pilot study to try to reproduce the European results in our population. Method: Observational prospective study of symptoms associated with colic in 17 healthy infants who were prescribed L. reuteri DSM 17938, indication approved by the Spanish Regulatory Food Agency. In all the written and informed consent of relatives was obteined. Follow-up clinical data using questionnaires and two physical visits to control and determination of calprotectin in feces. Statistical analysis with Stata v11 program chi 2 test and linear regression analysis. Results: Evolution of clinical parameters such as time crying and infant discomfort were lower as the weeks passed. The perception of improvement and the reduction of faecal calprotectin levels also showed a parallel evolution. The height and weight were not affected. Conclusions: The use of L. reuteri clearly improves symptoms and reduces infant family anxiety, and the values of intestinal inflammatory markers. Its use does not interfere with the development of weight-height patients. Studies are necessary with larger populations to confirm these initial data (AU)