Escorpionismo en pediatría: estudio descriptivo, transversal y retrospectivo de factores predictores de gravedad / Pediatric scorpionism: a descriptive, cross-sectional, and retrospective study of predictors of severity

Introducción. El emponzoñamiento por Tityus carrilloi n. sp. representa una amenaza para la vida. Según las manifestaciones clínicas, se clasifica en leve, moderado y grave. Objetivo. Comparar las características epidemiológicas y bioquímicas en niños con escorpionismo leve, moderado y grave. Población y métodos. Estudio descriptivo, transversal y retrospectivo. Se analizaron las consultas de menores de 15 años picados por Tityus carrilloi n. sp. entre enero de 2017 y diciembre de 2018 en un hospital pediátrico de tercer nivel en Santa Fe (Argentina). Resultados. Se incluyeron 524 niños, el 81 % (421) con dolor local y el 19 % (103) con manifestaciones sistémicas. Los niños con síntomas sistémicos de escorpionismo fueron más pequeños en edad que los que presentaron manifestaciones locales (p <0,001). En el invierno los niños desarrollaron 8 veces más manifestaciones sistémicas de escorpionismo y durante la primavera, 2,4 veces más que durante el verano. De los 103 niños internados, 80 fueron casos moderados y 23, graves. No hubo diferencias entre grupos en edad (p = 0,29) ni en la demora en recibir suero antiescorpiónico (p = 0,81). El tiempo de internación fue mayor en los graves (p <0,001). Los valores de glóbulos blancos o glucemia mayores a 30 000 cel/ml y 300 mg/dl respectivamente estuvieron presentes casi exclusivamente en escorpionismos graves. Conclusión. En niños picados por el escorpión Tityus carrilloi n. sp., el riesgo de desarrollar manifestaciones sistémicas fue mayor cuanto menor fue la edad y durante el invierno y la primavera. Los valores de glóbulos blancos y de glucemia fueron mayores en niños con escorpionismo grave.

Introduction. Scorpion envenomation by Tityus carrilloi n. sp. represents a threat to life. Depending on its clinical manifestations, it is classified as mild, moderate or severe. Objective. To compare the epidemiological and biochemical characteristics among children with mild, moderate, and severe scorpionism. Population and methods. Descriptive, crosssectional, and retrospective study. The consultations at a tertiary care children's hospital in Santa Fe (Argentina) of children under 15 years of age stung by Tityus carrilloi n. sp. between January 2017 and December 2018 were analyzed. Results. In total, 524 children were included, 81% (421) with local pain and 19% (103) with systemic manifestations. Children with systemic symptoms of scorpionism were younger in age than those with local manifestations (p < 0.001). In the winter, children developed 8 times more systemic manifestations of scorpionism; during the spring, 2.4 times more than during the summer. Out of the 103 hospitalized children, 80 were moderate cases and 23 severe cases. There were no differences between age groups (p = 0.29) or in the delay in receiving the anti-scorpion serum (p = 0.81). The length of hospital stay was longer among severe cases (p < 0.001). WBC and blood glucose levels higher than 30 000 cell/mL and 300 mg/dL, respectively, were present almost exclusively in severe scorpionism cases. Conclusion. In children stung by the scorpion Tityus carrilloi n. sp., the younger the age and during winter and spring, the higher the risk for systemic manifestations. WBC and blood glucose levels were higher in children with severe scorpionism.

Pediatric scorpionism: a descriptive, cross-sectional, and retrospective study of predictors of severity. / Escorpionismo en pediatría: estudio descriptivo, transversal y retrospectivo de factores predictores de gravedad.

INTRODUCTION: Scorpion envenomation by Tityus carrilloi n. sp. represents a threat to life. Depending on its clinical manifestations, it is classified as mild, moderate or severe. OBJECTIVE: To compare the epidemiological and biochemical characteristics among children with mild, moderate, and severe scorpionism. POPULATION AND METHODS: Descriptive, crosssectional, and retrospective study. The consultations at a tertiary care children's hospital in Santa Fe (Argentina) of children under 15 years of age stung by Tityus carrilloi n. sp. between January 2017 and December 2018 were analyzed. RESULTS: In total, 524 children were included, 81% (421) with local pain and 19% (103) with systemic manifestations. Children with systemic symptoms of scorpionism were younger in age than those with local manifestations (p < 0.001). In the winter, children developed 8 times more systemic manifestations of scorpionism; during the spring, 2.4 times more than during the summer. Out of the 103 hospitalized children, 80 were moderate cases and 23 severe cases. There were no differences between age groups (p = 0.29) or in the delay in receiving the anti-scorpion serum (p = 0.81). The length of hospital stay was longer among severe cases (p < 0.001). WBC and blood glucose levels higher than 30 000 cell/mL and 300 mg/dL, respectively, were present almost exclusively in severe scorpionism cases. CONCLUSIONS: In children stung by the scorpion Tityus carrilloi n. sp., the younger the age and during winter and spring, the higher the risk for systemic manifestations. WBC and blood glucose levels were higher in children with severe scorpionism.

Introducción. El emponzoñamiento por Tityus carrilloi n. sp. representa una amenaza para la vida. Según las manifestaciones clínicas, se clasifica en leve, moderado y grave. Objetivo. Comparar las características epidemiológicas y bioquímicas en niños con escorpionismo leve, moderado y grave. Población y métodos. Estudio descriptivo, transversal y retrospectivo. Se analizaron las consultas de menores de 15 años picados por Tityus carrilloi n. sp. entre enero de 2017 y diciembre de 2018 en un hospital pediátrico de tercer nivel en Santa Fe (Argentina). Resultados. Se incluyeron 524 niños, el 81 % (421) con dolor local y el 19 % (103) con manifestaciones sistémicas. Los niños con síntomas sistémicos de escorpionismo fueron más pequeños en edad que los que presentaron manifestaciones locales (p <0,001). En el invierno los niños desarrollaron 8 veces más manifestaciones sistémicas de escorpionismo y durante la primavera, 2,4 veces más que durante el verano. De los 103 niños internados, 80 fueron casos moderados y 23, graves. No hubo diferencias entre grupos en edad (p = 0,29) ni en la demora en recibir suero antiescorpiónico (p = 0,81). El tiempo de internación fue mayor en los graves (p <0,001). Los valores de glóbulos blancos o glucemia mayores a 30 000 cel/ml y 300 mg/dl respectivamente estuvieron presentes casi exclusivamente en escorpionismos graves. Conclusión. En niños picados por el escorpión Tityus carrilloi n. sp., el riesgo de desarrollar manifestaciones sistémicas fue mayor cuanto menor fue la edad y durante el invierno y la primavera. Los valores de glóbulos blancos y de glucemia fueron mayores en niños con escorpionismo grave.

Trypanocidal therapy among children infected by Trypanosoma cruzi. Serological and electrocardiographic changes over a mean twenty-five-years follow-up period.

This study compared the serological and electrocardiographic evolution among patients with chronic T. cruzi infection treated during childhood or left untreated. A retrospective cohort study was conducted during a mean follow-up period of 25 years in 82 patients: half of them underwent treatment (nifurtimox 8, benznidazole 33) before being 15 years old, whereas the other half remained untreated. During the follow-up, negative seroconversion occurred in 92.7% of the treated children, while all the untreated ones remained positive for conventional serology. At baseline, 2 patients from each group had electrocardiographic abnormalities. During the study period, 4/41 (9.75%) and 9/41 (21.95%) of treated and untreated patients displayed an altered electrocardiogram, respectively. In multivariate analyses, the probability of developing electrocardiographic abnormalities was significantly reduced among treated patients (OR = 0.18, 95% CI = 0.04-0.79; p = 0.023). Electrocardiographic abnormalities attributable to Chagas cardiomyopathy were seen in 3 patients from the untreated group (complete right bundle branch block + left anterior fascicular block, frequent ventricular extrasystole, and left anterior fascicular block). The remarkable seronegativization seen in Benznidazole and Nifurtimox recipients underlines the parasiticidal effect of both compounds. Such demonstration along with the fact that CCC-related alterations were only present in the untreated group, reinforces the view of trypanocidal treatment in chronically T. cruzi-infected children as decreasing the risk for cardiomyopathy development.

Levels of anti-B13 antibodies over time in a cohort of chronic infected by Trypanosoma cruzi. Its relationship with specific treatment and clinical status.

The immunodominant B13 protein of Trypanosoma cruzi is found on the surface of trypomastigotes and exhibits cross-reactivity with the human cardiac myosin heavy chain; for which antibodies against this parasitic antigen may be involved in the development of disease pathology. In a cohort of chronically T. cruzi-infected adults, undergoing trypanocidal treatment, or not, we, therefore, decided to evaluate the levels of anti-B13 antibodies (ELISA-B13) and its eventual relationship with heart complaints. Two hundred twenty-eight serum samples from 76 chronically infected adults with an average follow-up of 24 years were analyzed. Thirty of them had received trypanocidal treatment. Among treated patients, anti-B13 Ab levels in successive samples showed a significant decrease in reactivity as the years after treatment increased (ANOVA test, p = 0.0049). At the end of the follow-up, 36.7% became non-reactive for ELISA B13. Untreated patients did not have significant variations in the level of anti-B13 antibodies during follow-up. None of the treated patients had electrocardiographic changes compatible with chronic chagasic cardiomyopathy, whereas 21.7% of those undergoing no treatment did show such kind of pathological electrocardiogram tracings. ELISA-B13 was reactive in all cases with heart involvement. Among untreated patients, there were no significant differences in anti-B13 antibodies when comparing individuals without proven pathology with those with chronic chagasic cardiomyopathy. Although treatment with trypanocidal drugs was followed by decreased anti-B13 antibody levels, such assessment was unhelpful in differentiating the evolution of chronic chagasic heart disease.

Chagas congénito en atención primaria de la salud en la Provincia de Santa Fe / Congenital Chagas disease in primary health care in Santa Fe province

Actualmente, la transmisión transplacentaria es la vía más frecuente de infección por Trypanosoma cruzi. El diagnóstico y tratamiento temprano de hijos infectados evita el riesgo de desarrollar miocardiopatía y las niñas dejan de ser potenciales fuentes de transmisión congénita. En este estudio se evaluó el seguimiento de hijos de mujeres infectadas por T. cruzi en Centros de Salud de la provincia de Santa Fe. Se estudiaron 19 madres y sus 51 hijos. 45% (23/51) de los hijos no habían sido estudiados previamente, y de éstos 21/23 resultaron negativos mientras que dos niñas de 3 y 7 años estaban infectadas. Los 28 niños restantes ya habían sido estudiados en los Centros de Salud, siendo positivas dos gemelas de 22 meses y una niña de 9 años; los otros 25/28 hijos no estaban infectados. Un 47% (9/19) de las madres tenían como único antecedente la serología materna positiva, y de las 4 mujeres que transmitieron la infección, tres pertenecían a este grupo. La edad promedio de diagnóstico fue: 20±6 años en las madres y 7,4±6,7 años en los hijos. Se requieren estrategias sanitarias que favorezcan el estudio para la infección por T. cruzi en mujeres antes del embarazo y el seguimiento de todos los hijos para no perder la oportunidad de tratamiento

Transplacental transmission is currently the most frequent route of infection by Trypanosoma cruzi. Early diagnosis and treatment of infected children avoids the risk of developing cardiomyopathy, and girls are no longer potential sources of congenital transmission. This study evaluated the follow-up of children of women infected with T. cruzi in Primary Care Centres of the province of Santa Fe. Nineteen mothers and their 51 children were studied. Among the 51 children, 23 had no previous diagnosis (45%). Of these, 21 were negative while 2 girls, ages 3 and 7, were infected. The remaining 28 children already had a diagnosis at the Health Centres, with 2 twins of 22 months and a 9-year-old girl who were positive; the other 25 children were not infected. Among the 19 mothers, 9 (47%) had the positive maternal serology as the only antecedent. Of the 4 women who transmitted the infection, 3 belonged to this group. The average age of diagnosis was: 20 ± 6 years in mothers and 7.4 ± 6.7 years in children. Health strategies are required to promote the detection of infected women before pregnancy and the monitoring of all children so as not to miss the opportunity for treatment

Maternal risk factors for the transmission of congenital chagas disease

The present article looks at the association between the epidemiological history of women infected with Trypanosoma cruzi and the risk of vertical transmission. Eighty-three chronically infected mothers and their 237 children were studied, using a cohort design. All patients reside in Santa Fe city, Argentina. Twenty-five women transmitted the infection to 38 children. The potential risk factors evaluated in the mothers were exposure to vector transmission, blood transfusion history, maternal seropositivity, parasitemia and age at birth of the child. 72% (18/25) of the mothers who transmitted the infection to their children, had little or no contact with the vector, while only 28% (7/25) of the mothers presented a history of medium or high risk of vector infection. The differences were significant (p < 0.05). Forty-one percent of the women who presented maternal history as the probable route of infection, transmitted the parasite to more than one child (1.86 ± 0.33; CI95% = 1.03-2.68). In addition, the most frequent history, among the women who transmitted the disease to their children, was the absence of exposure to vector transmission and transfusion with unknown maternal serology. The route of infection was probably transplacental. These observations suggest that there are family genetic characteristics involved in vertical transmission. The parasite was found in 71% of the mothers who transmitted the infection to their children and were able to perform xenodiagnoses. After controlling for the other variables, the logistic regression analysis showed that xenodiagnosis (+) is a risk factor for congenital transmission; the relative risk was 12.2 (95% confidence interval: 2.9 - 50.1). No differences were found when analyzing the mother's age and transfusion history. The highest risk of congenital transmission was associated with detectable parasitemia and less maternal exposure to the vector.