ABSTRACT
Background There is no consensus on the optimal dosage use of posaconazole (PSC) for invasive fungal infection (IFI) in pediatric patients and normally it is adjusted with drug levels (DLs) ≥ 0.7 µg/ml and ≥ 1.25 µg/ml for prophylaxis and treatment, respectively. Objective To describe the experience of monitoring DLs of PSC in immunocompromised pediatric patients with IFI and to determine if the recommended doses reach CP effective in prophylaxis (≥ 0.7 µg/mL) and treatment (≥ 1.25 µg/mL). Method A retrospective analysis in children who received PSC from January 2012 to October 2016, in the Oncology and Bone Marrow Transplant units at Hospital Calvo Mackenna was done Six patients with 78 DLs were reviewed (4 prophylaxis and 4 treatment). Median PSC dose was 12.5 and 18.8 mg/kg/d for prophylaxis and treatment, resulting in mean DLs of 0.97 and 1.8 µg/mL respectively. In prophylaxis 40/67 (60%) were recorded with DLs ≥ 0.70 µg/mL receiving a median dose of 12.5 mg/kg/d. While for treatment: 5/11 (46%) presented DLs ≥ 1.25 µg/mL, receiving a median dose of 18 mg/kg/d. Conclusion Our results are in line with the recommended for PSC dosage, but individualized monitoring is required to maintain adequate DLs.
Subject(s)
Antifungal Agents/pharmacokinetics , Immunocompetence/drug effects , Invasive Fungal Infections/drug therapy , Invasive Fungal Infections/prevention & control , Triazoles/pharmacokinetics , Adolescent , Antifungal Agents/administration & dosage , Antifungal Agents/blood , Child , Child, Preschool , Dose-Response Relationship, Drug , Drug Interactions , Drug Monitoring , Female , Hospitals, Pediatric , Humans , Immunocompromised Host/drug effects , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology , Retrospective Studies , Treatment Outcome , Triazoles/administration & dosage , Triazoles/bloodABSTRACT
Resumen Introducción En pediatría no existe consenso en la dosificación de posaconazol (PSC) para profilaxis y tratamiento de la infección fúngica invasora (IFI), usándose la medición de concentraciones plasmáticas (CPs) del fármaco. Objetivo Describir la experiencia de monitoreo de las CPs de PSC en niños inmunocomprometidos con IFI y determinar si las dosis recomendadas alcanzan CPs efectivas en profilaxis (≥ 0,7 µg/mL) y tratamiento (≥ 1,25 µg/mL). Método Análisis retrospectivo en niños que recibieron PSC suspensión como profilaxis o tratamiento entre enero de 2012 y octubre de 2016, en las unidades de Oncología y Trasplante de Médula Ósea del Hospital Calvo Mackenna. Resultados 78 CPs en seis pacientes (4 indicaciones de profilaxis y 4 tratamientos) fueron revisados. La mediana de dosis de PSC fue de 12,5 y 18,8 mg/kg/d para profilaxis y tratamiento, respectivamente, resultando CP mediana de 0,97 y 1,8 μg/mL, respectivamente. En profilaxis, se registraron 40/67 (60%) con CP ≥ 0,70 μg/mL recibiendo una mediana de dosis de 12,5 mg/kg/d. Mientras que para el tratamiento: 5/11 (46%), presentaron CP ≥ 1,25 μg/mL, recibiendo una mediana de dosis de 18 mg/kg/d. Conclusión Nuestros resultados se ajustan a lo recomendado para la dosificación de PSC, pero evidencian una necesidad de realizar una monitorización individualizada para mantener adecuadas CPs.
Background There is no consensus on the optimal dosage use of posaconazole (PSC) for invasive fungal infection (IFI) in pediatric patients and normally it is adjusted with drug levels (DLs) ≥ 0.7 μg/ml and ≥ 1.25 μg/ml for prophylaxis and treatment, respectively. Objective To describe the experience of monitoring DLs of PSC in immunocompromised pediatric patients with IFI and to determine if the recommended doses reach CP effective in prophylaxis (≥ 0.7 μg/mL) and treatment (≥ 1.25 μg/mL). Method A retrospective analysis in children who received PSC from January 2012 to October 2016, in the Oncology and Bone Marrow Transplant units at Hospital Calvo Mackenna was done Six patients with 78 DLs were reviewed (4 prophylaxis and 4 treatment). Median PSC dose was 12.5 and 18.8 mg/kg/d for prophylaxis and treatment, resulting in mean DLs of 0.97 and 1.8 μg/mL respectively. In prophylaxis 40/67 (60%) were recorded with DLs ≥ 0.70 μg/mL receiving a median dose of 12.5 mg/kg/d. While for treatment: 5/11 (46%) presented DLs ≥ 1.25 μg/mL, receiving a median dose of 18 mg/kg/d. Conclusion Our results are in line with the recommended for PSC dosage, but individualized monitoring is required to maintain adequate DLs.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Triazoles/pharmacokinetics , Invasive Fungal Infections/prevention & control , Invasive Fungal Infections/drug therapy , Immunocompetence/drug effects , Antifungal Agents/pharmacokinetics , Triazoles/administration & dosage , Triazoles/blood , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/immunology , Retrospective Studies , Treatment Outcome , Immunocompromised Host/drug effects , Drug Monitoring , Dose-Response Relationship, Drug , Drug Interactions , Hospitals, Pediatric , Antifungal Agents/administration & dosage , Antifungal Agents/bloodABSTRACT
INTRODUCTION: Gastrointestinal infections remain a major public health problem worldwide and its etiologic diagnosis is one of the main challenges. In molecular diagnostic techniques recently developed, the Filmarray GI® panel allows detection of 23 pathogens (14 bacteria, virus 5 and 4 parasites) within an hour. OBJECTIVE: To describe the experience of Filmarray GI® panel in the Molecular Biology Laboratory of Clinica Las Condes. METHOD: A cross-sectional observational study that includes the results of 305 stool samples tested by Filmarray GI® panel was performed. RESULTS: Of the 305 tests requested 99 (32.5%) were negative and 206 were positive (67.5%). Of the positive samples, in 107 samples (51.9%) one pathogen was detected and in 99 samples (48.1%) more than one pathogen was found. CONCLUSIONS: Describe the experience of using FilmArray GI® panel in stool specimens, which highlights the large number of positive samples for a microorganism and co-detection of enteric pathogens.
Subject(s)
Feces/microbiology , Feces/parasitology , Gastrointestinal Diseases , Molecular Diagnostic Techniques/methods , Adolescent , Adult , Bacterial Infections/microbiology , Child , Child, Preschool , Coinfection , Cross-Sectional Studies , Gastrointestinal Diseases/microbiology , Gastrointestinal Diseases/parasitology , Gastrointestinal Diseases/virology , Humans , Infant , Intestinal Diseases, Parasitic/parasitology , Middle Aged , Virus Diseases/virology , Young AdultABSTRACT
Herpes simplex encephalitis is a diagnostic challenge and causes high morbidity and mortality in children. Early suspicion of the disease and a rapid, safe and useful diagnostic test are relevant because up to 70% of the cases may die. We report the case of a newborn girl aged 25 days, who presented with a clinical picture that was compatible with herpes simplex encephalitis where the confirmation of the etiological diagnosis was delayed. Only by repeated real-time polymerase chain reaction it was possible to confirm the presence of herpes simplex virus type 1 in the cerebrospinal fluid.
Subject(s)
Encephalitis, Herpes Simplex/diagnosis , Herpes Simplex/diagnosis , Herpesvirus 1, Human , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Delayed Diagnosis , Encephalitis, Herpes Simplex/cerebrospinal fluid , Female , Humans , Infant, Newborn , Real-Time Polymerase Chain ReactionABSTRACT
Herpes simplex encephalitis is a diagnostic challenge and causes high morbidity and mortality in children. Early suspicion of the disease and a rapid, safe and useful diagnostic test are relevant because up to 70% of the cases may die. We report the case of a newborn girl aged 25 days, who presented with a clinical picture that was compatible with herpes simplex encephalitis where the confirmation of the etiological diagnosis was delayed. Only by repeated real-time polymerase chain reaction it was possible to confirm the presence of herpes simplex virus type 1 in the cerebrospinal fluid.
La encefalitis herpética genera un desafío diagnóstico y es causa de alta morbi-mortalidad en niños. Se requiere de una sospecha clínica precoz y una prueba diagnóstica útil, rápida y segura, ya que sin tratamiento oportuno y adecuado, hasta 70% de los casos puede fallecer. Comunicamos el caso de una recién nacida de 25 días de vida, que presenta un cuadro clínico compatible con encefalitis herpética, donde el diagnóstico etiológico tardó en ser confirmado y sólo la técnica de reacción de la polimerasa en cadena en tiempo real (RPC-TR) aplicada de forma repetida permitió certificar la presencia de virus herpes simplex tipo 1 en el LCR.
