Manifestaciones clínicas Covid-19 / Clinical manifestations of Covid-19

The current SARS-CoV-2 pandemic originated in China in late 2019, when an outbreak of pneumonia cases of unknown cause raised suspicions of an emerging infectious agent. More than 1 year after the identification of this new coronavirus, it has already caused more than 100 million cases worldwide. Coronavirus Disease 2019 (Covid-19), as defined by the WHO in February 2020, has a diverse clinical presentation from asymptomatic individuals to multi-organ failure and death. In this review, we will describe the main clinical manifestations of Covid-19 in adults. (AU)

Patogenia de la infección por SARS-CoV-2 / Pathogenesis of SARS-CoV-2 infection

Covid-19 is an infectious disease whose etiological agent called SARS-CoV-2. It has a high contagion rate, high morbidity and mortality, and potential multi-organ compromise. Its main route of infection is by droplets, however, the infection can be acquired by other routes such as aerosols, fecal-oral and contact with fomites. Although the immune response is essential for defense against any infection, in severe Covid-19 infection, a dysregulation of the immune system occurs, which leads to marked increases of cytokines and the consequent systemic inflammatory state. Inflammation, infection, and viral shedding can compromise the lungs, blood vessels, brain, gastrointestinal (GI) tract, kidneys, heart, and liver, ultimately leading to multiple organ dysfunction and failure. (AU)

Alergia a ß-lactámicos en niños / Allergy to Betalactams in children

Allergy to Betalactams is a widely suspected pathology, which is not regularly studied in Chile, leading to a misusage of antibiotics of other families. In this article a case report in a pediatric patient will be described, and a discussion about the studies needed for this pathology, and treatment will be made in accordance to the experiences and tools available in Chile, and specifically in University of Chile Clinical Hospital. In our Hospital we study these cases following international guidelines for the diagnosis of allergy to Betalactams. (AU)

Alergia alimentaria a maní: conceptos clínicos, diagnósticos y terapéuticos / Food allergy to peanuts: clinical, diagnostic and therapeutic concepts

The prevalence of food allergy (FA) is about 2-8 percent, with clinical manifestations ranging from localized symptoms, to severe anaphylactic reactions. FA is generally caused by milk, eggs, soybeans, tree nuts, peanuts, wheat, fish and crustacean; being peanut one of the main foods involved in Western countries. Although in other parts of the world peanut allergy (PA) is not a problem, probably due to timing of introduction into the diet, form and preparation, genetics, and the hygiene hypothesis. Unfortunately, in Chile there are no epidemiological data about FA or PA. A number of food allergens have been identified, which has improved patient diagnosis and treatment assessment. Regarding peanut, 9 allergens have been identified, Ara h 1 to Ara h 9 (Arachis hypogaea). The diagnosis of IgE-mediated PA is based on a consistent history and evidence of peanut-specific IgE sensitization, carried out by skin-prick testing or in vitro determination. PA treatment consists of peanuts avoidance, which often becomes difficult due to inadvertent consumption. Today promising treatments are under development, including oral induction tolerance or sublingual immunotherapy. These treatments offer the possibility of at least raising the threshold of the amount of peanut that would be necessary to cause a life-threatening allergic reaction.

Eritroblastopenia transitoria de la infancia: presentación de tres casos clínicos / Transient childhood erythroblastopenia: three cases and a literature review

Transient childhood erythroblastopenia is a benign hematological condition, characterized by non-regenerative anemia and transient marrow aplasia. It is seen among post-viral infected children 1 through 14 years of age. Incidence is 4 in 100,000, and recovery is shown in 2-4 weeks. Objective: Three cases are presented, as a reminder due to low incidence, limited national literature and need for review of this subject. Clinical cases: Three patients, 1-4 years old, with similar symptoms including severe anemia, reticulocytopenia, and myelogram showing erythroblastopenia (2 cases) and one in recovery phase. No infectious etiology was identified. Hemogram, reactive protein C, hepatic and renal function studies, myelogram, bone marrow parvovirus B19 PCR, and Epstein-Barr IgM. Conclusions: Our experience is similar to that shown in the literature, with unidentified etiology, benign course, and emphasize on the differential diagnosis from congenital hypoplastic anemia.

Eritroblastopenia transitoria de la infancia es una enfermedad hematológica benigna, caracterizada por anemia arregenerativa y aplasia medular transitoria de la serie roja, afecta a niños entre 1 y 4 años, está relacionada con una infección viral previa, incidencia de 4 por 100 000 y recuperación en 2 a 4 semanas. Objetivo: Presentación de 3 casos clínicos debido a baja incidencia, escasa literatura nacional al respecto y necesidad de revisión del tema. Casos clínicos: Tres pacientes entre 1 y 4 años con cuadros clínicos similares caracterizados por anemia severa, reticulocitopenia y mielograma con eritroblastopenia (dos casos) y en fase de recuperación (un caso). Sin etiología infecciosa identificada. Estudio: Hemograma, proteína C reactiva, función hepática, función renal, mielograma, PCR parvovirus B19 en médula ósea, IgM Epstein-Barr. Conclusión: Nuestra experiencia es similar a lo descrito en la literatura, con etiología no identificada, evolución satisfactoria y énfasis en el diagnóstico diferencial con anemia hipoplásica congénita.