Infections in children with malignant disease in Argentina.

During six-month period, 102 consecutive episodes of fever in 68 children (ranging from 1 month to 14 years of age) with malignant diseases were prospectively evaluated. Sixty-five had acute lymphoblastic leukemia, nine had acute myeloblastic leukemia, nine had malignant lymphoma (four Hodgkin and five non-Hodgkin), five had chronic myeloid leukemia, four had rhabdomyosarcoma, three had CNS tumors, two had neuroblastoma, one had Wilms, and four had other malignant tumors. Forty cases (39.2%) showed severe neutropenia (500 neutrophil/m3) during the episode. S. aureus, E. coli, and S. pyogenes were in 53% of the 75 microbiologic isolates. Twenty-two percent of the viral studies were positive. Mycologic studies were all negative, except one case with C. Albicans. Pneumonia (33 cases), cellulitis (15 cases), pharyngitis (12 cases), and varicella (11 cases) were the most common final diagnosis. Seventy-one percent of the episodes were etiologically documented (by bacterial isolate, characteristic serology, and/or typical clinic picture); 19% of the febrile episodes were probable infections, and 10% were fever of uncertain cause. Ninety percent of the cases responded well to therapy, and mortality of this series was 7%. Gentamicin, Carbenicillin, and Methicilin were the more common antibiotics employed. We conclude that in our population 1) infection is a frequent cause of morbidity in children with malignant diseases; 2) the most common cause of the febrile episodes is bacterial infection; 3) S. aureus, E. coli and S. pyrogenes are the most frequent bacterial isolates, and P. aeruginosa is infrequent; 4)viral infections are relatively frequent in this group of children; and 5) with adequate management, the mortality is low.

[Counterimmunoelectrophoresis in the diagnosis of Bordetella pertussis]. / Contrainmunoelectroforesis para el diagnóstico de Bordetella pertussis.

The serum of 50 patients between 25 days to 15 years old who were admitted with the diagnosis of pertussis syndrome were investigated for precipitating antibodies by means of discontinuous counterimmunolectrophoresis (CIED). The presence of antibodies for Bordetella pertussis antigen was shown in 28 cases. All samples were taken within the first 24/48 hours of admission and at convalescence. The technique is easy to carry out, quick and of low cost. This test offers an adequate and fast means to differentiate a Bordetella pertussis syndrome form others produced by different viral etiologies. Besides, this serologic technique shows earlier results and of lower cost than classic techniques such as agglutination and complement fixation which are more difficult to apply.

[Various aspects of the influence of infection on growth and development]. / Algunos aspectos de la influencia de la infección sobre el crecimiento y desarrollo.

It is pointed out how infections can delay growth and development through an aggressive and long-standing action, through direct action of an infecting agent (virus, bacteria, parasites). or through sequelae in main organs (brain, kidney, growth cartilage, muscular system, etc.). how infections impair nutrients' absortion, metabolism and excretion. The role of the leukocytes is evidenced in the liberation of two factors: MEL and pyrogen factor. Metabolic responses are classified in an anabolic anda catabolic phase. The second mechanism that interfers on growth and development is a specific action of various agents, particularly viruses on different tissues. Intrauterine infection is pointed out as determinant of growth disorders with increased IgM levels in cord blood; confirmed fetal infection on the 6th up to 8th week of gestation interferes with organogenesis. The action of CMV and rubella virus is mentioned as example. The action of viral infections on growth during the first three months of gestation, is mentioned. TBK and typhoid fever are mentioned as causative agents of corporal and urinary nitrogen loss. Negative action of infection on growth and development, particularly in malnourished patients, is discussed. Diarrhea, under certain condition, is pointed out as determinant of the kwashiorkor syndrome. The role of various parasite diseases on growth is mentioned with range according to the action of each agent on nutrients' absortion. A third mechanism which causes fail to thrive through sequelae lesions is considered. This disorders are ruled by the age of the patient with the onset of disease by the causative agent, by the inflammatory process involved, by the early diagnosis and appropriate treatment. The need of enhancing the actions to prevent communicable diseases and to diminish malnutrition rates is pointed out and the significance of taking into account calorie and protein intake in patients with severe and/or long-standing infectious disease.