Immunogenicity and safety of influenza vaccination in patients with juvenile idiopathic arthritis on biological therapy using the microneutralization assay.

BACKGROUND: Seasonal influenza virus vaccination should be considered in all pediatric patients with rheumatic diseases. Few studies have addressed influenza vaccination safety and efficacy in this group. We aim to prospectively evaluate immunogenicity and safety of the trivalent inactivated influenza vaccine including A/H1N1, A/H3N2 and B strains in children with juvenile idiopathic arthritis (JIA) receiving biological therapy. METHODS: Thirty-five children diagnosed with JIA and 6 healthy siblings were included. Serum samples were collected prior to, 4-8 weeks and one year after vaccination. Microneutralization assays were used to determine neutralizing antibody titers. The type and duration of therapy were analyzed to determine its effect on vaccine response. Clinical data of the participants were collected throughout the study including severe adverse events (SAE) and adverse events following immunization (AEFI). RESULTS: Twenty-five patients (74.3%) received biological treatment for JIA; anti TNF-α was prescribed in 15, anti IL-1 receptor in 4 and anti IL-6 receptor therapy in 6 children. The seroprotection rate 4-8 weeks after vaccination in the JIA group was 96% for influenza A/(H1N1)pdm and influenza A/H3N2, and 88% for influenza B. No differences were found in GMT, seroprotection and seroconversion rates for the three influenza strains between the control group and patients receiving biological therapy. Furthermore, long-term seroprotection at 12 months after vaccination was similar in patients receiving either biological or non-biological treatments. No SAEs were observed. CONCLUSIONS: In this study, influenza vaccination was safe and immunogenic in children with JIA receiving biological therapy.

Successful management of Churg-Strauss syndrome using omalizumab as adjuvant immunomodulatory therapy: first documented pediatric case.

Churg-Strauss syndrome (CSS) is an anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis; it is extremely rare in childhood and defined according to the Chapel-Hill Consensus as an eosinophil-rich and granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small to medium-sized vessels. Children commonly have a history of asthma and sinusitis whilst clinical presentation typically involves pulmonary tract and less frequently skin, heart, gastrointestinal tract, and peripheral nerves. Cardiopulmonary disease is higher in children and prognosis is worse. It is associated with significant eosinophilia and raised serum IgE-levels. ANCA are only found in 25% of childhood cases. Here we report the case of a 10-year-old girl who presented to us with vomiting, abdominal pain, and weight loss, paresthesias of lower extremities and breathlessness as well as a history of asthma, sinusitis and allergic rhinitis. She was treated with corticosteroids, cyclophosphamide, intravenous immunoglobulin, mycophenolate mofetil (MMF), and rituximab. However, remission was only achieved after initiation of omalizumab therapy, a recombinant humanized anti-IgE antibody. To the best of our knowledge this is the first pediatric patient suffering from CSS successfully managed with adjuvant anti-IgE therapy resulting in the control of respiratory as well as gastrointestinal symptoms.

Edemas generalizados como forma de presentación de dermatomiositis juvenil / Generalized edema as a form of presentation of juvenile dermatomyositis

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Sustained high prevalence of pneumococcal serotype 1 in paediatric parapneumonic empyema in southern Spain from 2005 to 2009.

The epidemiology and microbiological characteristics of paediatric parapneumonic empyema (PPE) before the introduction of the new generation of conjugate pneumococcal vaccines (10-valent and 13-valent) are described. All patients <14 years old admitted to a tertiary paediatric hospital with a diagnosis of PPE were prospectively enrolled from January 2005 to December 2009. Pneumococcal serotyping of culture-negative pleural fluid samples was performed using a multiplex real-time PCR assay. Overall, 219 patients had PPE. Incidence rates for PPE remained stable during the study period with a not significant increase in 2009 compared with 2005 (p 0.13), and were temporally associated with higher circulation of pandemic influenza A H1N1 during the last quarter in our population (p 0.001). Pneumococci were detected in 72% of culture-positive and 79% of culture-negative samples. Serotypes were determined in 104 PPE cases. Serotype 1 was the most prevalent serotype identified (42%) followed by serotypes 7F (20%), 3 (16%), 19A (8%) and 5 (7%). Serotype distribution remained similar during all time periods. Pneumococcal serotype 1 remained the most common cause of PPE during the 5-year study. The new generation of pneumococcal conjugate vaccines offers potential serotype coverage of 73% (10-valent) and 99% (13-valent) in the population studied suffering from PPE. Continuous epidemiological and molecular studies are paramount to monitor the impact of pneumococcal vaccines on the epidemiology of PPE.

Pyogenic sacroiliitis in children-a diagnostic challenge.

Osteoarticular infections in paediatric patients are associated with significant morbidity. Pyogenic sacroiliitis is rare and accounts for approximately 1-2% of osteoarticular infections in children. Diagnosis of this disease has been difficult in the past due to its deep location and may be delayed due to the lack of specific clinical signs and symptoms. We identified 11 paediatric patients with clinical-radiological signs of pyogenic sacroiliitis during an 8-year period and observed an unusual cluster of four cases during the last 11 months. Early diagnosis was possible due to a reproducible clinical pattern as well as radiological evidences of infection using magnetic resonance imaging and/or bone scintigraphy; most patients having predisposing factors. Staphylococcus aureus was the sole causative agent identified. All patients including two children with associated muscle abscesses were managed conservatively with antibiotic therapy only and showed good clinical response with no sequelae during follow-up. An algorithm for the correct and prompt diagnosis of this pathology is proposed. Standardised optimal therapy remains to be defined.

Enfermedad de Kikuchi-Fujimoto como causa de linfadenopatías / Kikuchi-Fujimoto disease as a cause of lymphadenopathy

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Osteomielitis pélvica y absceso del músculo aproximador mayor / Pelvic osteomyelitis and adductor magnus muscle abscess

La osteomielitis pélvica es infrecuente, representa aproximadamente un 6-8% del total de osteomielitis agudas hematógenas. Es más frecuente en varones. Su presentación clínica es variable y poco especffica,lo que contribuyea un retraso en el diagnóstico. No existe ninguna prueba de laboratorio específica para su diagnóstico. No es infrecuente encontrar casos de pacientes con osteomielitis y cultivos negativos. Las complicaciones son infrecuentes. Se presenta el caso clínico de un niño de 10 años, sin antecedentes personales de interés, al que que se diagnostica una osteomielitis de la rama isquiopubiana izquierda complicada con un absceso del músculo aproximador mayor

Pelvic osteomyelitis is a rare disease that represents between 6-8% of the cases of acute hematogenous osteomyelitis. It is more frequent in males, and its clinical presentation is variable and non specific, circumstances that contribute to delaying the diagnosis. There is no specific laboratory test to aid in the diagnosis, and patients with osteomyelitis of ten have negative cultures. Complications are unusual. We reportt he case of a ten-year-old boy, whose medical history was unremarkable with acute osteomyelitis of the left ischio pubic region complicated by an abscess in adductor magnums uscle

Osteomielitis hematógena aguda / Acute haematogenous osteomielitis

La osteomielitis es un proceso inflamatorio que se acompaña de destrucción ósea y está causada por un agente infeccioso. La osteomielitis hematógena aguda es la forma más frecuente de osteomielitis en la infancia. Diseñamos un estudio descriptivo transversal del periodo 1994-2004 que incluye a todos los pacientes menores de 15 años diagnosticados de osteomielitis hematógena aguda tonel objetivote determinar la etiología, características clínicas-radiológicas, pautas del manejo clínico-terapéutico y secuelas de la osteomielitis hematógena aguda en esa serie de pacientes. Se incluyeron un total de 40 pacientes con una edad mediana de 7,6 años. Los signos y síntomas más frecuentes fueron dolor, impotencia funcional, inflamación y fiebre. El hueso afectado con más frecuencia fue la tibia. El germen aislado con más frecuencia, el Staphylococcus aurens. Las pruebas de imagen fueron de gran utilidad en el diagnóstico de osteomielitis. El tratamiento antibiótico empírico se instauró ante la sospecha clínica, siguiendo criterios epidemiológicos y microbiológicos. Todos los pacientes recibieron tratamiento antibiótico endovenoso. Cuatro pacientes (10%) quedaron con secuelas (AU)

Osteomyelitis is an inflammatory process of the bone which can lead to its destruction and is caused by an infective organism. Acute haematogerous osteomyelitis is the most frequent form of osteomyelitis in children. We designed a transversal descriptive study covering the period 1994-2004, including all patients under 15 diagnosed with acute haematogenous osteomyelitis, in order to determine the aetiology, clinical and radiological characteristics, therapeutical management and sequelae in this series patients. A total of 40 patients were included with a median age of 7,6 years. The most common signs and symptoms were pain, restriction of movement, inflammation and fever. The tibia was the most frequently affected bone. Staphylococcus aureus was the most frequwntly isolated pathogen. Radiologic imaging was very useful in the diagnosis of osteomyelitis. Empirical antibiotic therapy was given upon clinical suspicion, following epidemiological and microbiological criteria. All patients received intravenous antibiotic therapy. Four patients (10%) remained with sequelae (AU)