The current prevalence of asthma, allergic rhinitis, and eczema related symptoms in school-aged children in Costa Rica.

OBJECTIVE: Asthma prevalence in Costa Rica is among the highest worldwide. We aimed to determine the prevalence of asthma among school-age children in the Central Highland Area of Costa Rica. METHODS: Cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was performed. Parents or guardians of children aged 6-13 years completed written questionnaires. RESULTS: Total of 2817 school-aged children returned these questionnaires (74.1% return rate). The prevalence of asthma, rhinitis, and eczema was 21.9%, 42.6%, and 19.2%, respectively. The co-existence of the 3 diseases was seen in 22.6% of children with asthma. Boys had a slightly higher prevalence of these conditions, and younger children had higher prevalence of asthma and eczema, but lower prevalence of rhinitis than older children. The use of acetaminophen and antibiotics in the first 12 months of life showed a significant association with the prevalence of asthma, rhinitis, and eczema. Wheezing with exercise, dry cough at night, and ever rhinitis was highly associated with asthma symptoms in the last 12 months. In contrast, no association was found between children exposed to smoking at home. Frequent traffic next to the house was reported more frequently by the parents of children with asthma, although no significant association was found. CONCLUSION: The prevalence of asthma showed a significant decrease compared to previous studies. However, there was an unexpected high prevalence of rhinitis. Exposure to acetaminophen and antibiotic during the first year of life was highly associated with asthma symptoms.

[Postvaricella cerebellar ataxia in children in Costa Rica]. / Ataxia aguda cerebelosa posvaricela en niños costarricenses.

INTRODUCTION: Postvaricella cerebellar ataxia (PVCA) and meningoencephalitis are the most common acute neurological complications of chickenpox. The objective of this study was to describe the clinical presentation, management, and outcome of children hospitalized with PVCA in the only pediatric hospital of this developing country, where routine varicella immunization is not yet available. METHODS: We performed a retrospective chart review of children aged 1-12 years old admitted to the National Children's Hospital of Costa Rica from January 1997 to June 2004 with a diagnosis of PVCA. RESULTS: Among the 441 immunocompetent patients admitted for varicella zoster virus-associated complications during this period, 37 (8.4%) had PVCA. Twenty-four of the 37 (64.9%) patients were boys. The mean (range) age was 5 (1-10) years. The median (range) interval from rash onset to admission was 2 (1-3) days. Cerebrospinal fluid analysis was available in 22 (59.5%) patients and was normal in all. Head computed tomography showed cerebral edema in six out of 18 patients (33.3%). Intravenous acyclovir was administered to 23 patients but no significant differences in clinical manifestations or outcomes were observed in treated versus untreated patients. The mean (range) length of ataxia was 4 (1-10) days, and seven (19%) patients were still ataxic on discharge. The mean (range) length of hospital stay was 4.4 (2-11) days. Minor sequelae were documented in 13 out of 24 (54.2%) patients during follow-up visits and telephone contacts. CONCLUSIONS: PVCA is usually associated with a favorable prognosis; however, neurological sequelae can occur. The real utility of acyclovir treatment and brain imaging studies in these children remains controversial.

Ataxia aguda cerebelosa posvaricela en niños costarricenses / Postvaricella cerebellar ataxia in children in Costa Rica

Introducción. La ataxia cerebelosa aguda posvaricela (ACAPV) y la meningoencefalitis son las complicaciones neurológicas agudas más comunes de la varicela. El objetivo del estudio es describir la presentación clínica, el tratamiento médico y el pronóstico de la ACAPV en niños costarricenses hospitalizados en el único hospital pediátrico de nuestro país, donde la vacunación contra la varicela aún no es sistemática. Métodos. Estudio descriptivo retrospectivo; se incluyeron pacientes de entre 1 y 12 años de edad, egresados del Hospital de Nacional Niños de Costa Rica entre enero de 1997 y junio de 2004, con el diagnóstico de ACAPV. Resultados. De los 441 pacientes inmunocompetentes que fueron hospitalizados por presentar complicaciones asociadas a virus varicela zóster durante este período, 37 pacientes (8,4 %) tuvieron ACAPV, y 24/37 (64,9 %) fueron varones. La edad media (rango) fue de 5 años (1-10 años). La media (rango) de aparición de la ataxia tras el inicio del brote fue de 2 días (1-30). El análisis del líquido cefalorraquídeo (LCR) se realizó en 22 pacientes (59,5 %) y en todos fue normal. La tomografía computarizada (TC) mostró edema cerebral en 6/18 pacientes (33,3 %). Un total 23 niños de 37 recibieron aciclovir intravenoso, aunque no se observaron diferencias significativas (p > 0,05) entre ambos grupos en cuanto a beneficio con la terapia. La duración media (rango) de la ataxia fue de 4 días (1-10) y 7 pacientes (19 %) fueron dados de alta atáxicos. La estancia hospitalaria media (rango) fue de 4,4 días (2-11). Se documentaron secuelas menores en 13/24 pacientes (54,2 %) durante las visitas de seguimiento y contactos telefónicos. Conclusiones. La ACAPV usualmente se asocia con un pronóstico favorable; sin embargo, pueden producirse secuelas neurológicas. La utilidad real del aciclovir y de realizar estudios de imágenes cerebrales en estos niños es controvertida

Introduction. Postvaricella cerebellar ataxia (PVCA) and meningoencephalitis are the most common acute neurological complications of chickenpox. The objective of this study was to describe the clinical presentation, management, and outcome of children hospitalized with PVCA in the only pediatric hospital of this developing country, where routine varicella immunization is not yet available. Methods. We performed a retrospective chart review of children aged 1-12 years old admitted to the National Children's Hospital of Costa Rica from January 1997 to June 2004 with a diagnosis of PVCA. Results. Among the 441 immunocompetent patients admitted for varicella zoster virus-associated complications during this period, 37 (8.4 %) had PVCA. Twenty-four of the 37 (64.9 %) patients were boys. The mean (range) age was 5 (1-10) years. The median (range) interval from rash onset to admission was 2 (1-3) days. Cerebrospinal fluid analysis was available in 22 (59.5 %) patients and was normal in all. Head computed tomography showed cerebral edema in six out of 18 patients (33.3 %). Intravenous acyclovir was administered to 23 patients but no significant differences in clinical manifestations or outcomes were observed in treated versus untreated patients. The mean (range) length of ataxia was 4 (1-10) days, and seven (19 %) patients were still ataxic on discharge. The mean (range) length of hospital stay was 4.4 (2-11) days. Minor sequelae were documented in 13 out of 24 (54.2 %) patients during follow-up visits and telephone contacts. Conclusions. PVCA is usually associated with a favorable prognosis; however, neurological sequelae can occur. The real utility of acyclovir treatment and brain imaging studies in these children remains controversial

Neurocisticercosis en niños costarricenses: experiencia clínica e importancia de la vigilancia epidemiológica / Neurocysticercosis in Costa Rica children: clinical experience and the importance of epidemiological surveillance

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