Nirsevimab para la prevención de la enfermedad por virus respiratorio sincitial en niños. Posicionamiento de la Sociedad Española de Infectología Pediátrica / Nirsevimab for the prevention of respiratory syncytial virus disease in children: Statement of the Spanish Society of Paediatric Infectious Disease (SEIP)

Introducción: Recientemente se ha aprobado en Europa y en España el uso de nirsevimab, un anticuerpo monoclonal (AcM) para la prevención de la enfermedad por virus respiratorio sincitial (VRS). Objetivos: Facilitar unas recomendaciones para la administración de nirsevimab para la prevención de la enfermedad por VRS. Métodos: Para la elaboración de estas recomendaciones, se decidió realizar una revisión crítica de la literatura, utilizando la metodología Delphi y la metodología GRADE. Se definió un grupo de expertos. Se realizaron tres rondas para definir las preguntas, manifestarse a favor o en contra, graduar la recomendación, y definir el acuerdo o el desacuerdo con las conclusiones. Resultados: En la población general de recién nacidos, se recomienda administrar rutinariamente nirsevimab para reducir la enfermedad y la hospitalización por bronquiolitis y enfermedad de vías bajas por VRS. Se recomienda administrar nirsevimab a todos los lactantes que nazcan en la estación de alta incidencia de VRS y aquellos que cuando esta comience, tengan menos de seis meses de edad. En los pacientes prematuros de 29 a 35 semanas de edad gestacional, en los lactantes con cardiopatía hemodinámicamente significativa y lactantes con enfermedad pulmonar crónica se recomienda rutinariamente administrar nirsevimab para reducir la enfermedad y la hospitalización por bronquiolitis y enfermedad de vías bajas por VRS. En los pacientes con indicación actual de palivizumab, se recomienda sustituir palivizumab por nirsevimab para reducir la carga de enfermedad de bronquiolitis. Conclusiones: Se recomienda administrar rutinariamente nirsevimab a todos los recién nacidos menores de seis meses nacidos en la estación de VRS o que tengan menos de seis meses cuando entran en la estación invernal, para reducir la carga de enfermedad y la hospitalización por bronquiolitis. (AU)

Introduction: Nirsevimab, a monoclonal antibody for the prevention of disease caused by respiratory syncytial virus (RSV), has recently been approved for use in Europe and Spain. Objectives: To provide recommendations for the administration of nirsevimab for prevention of RSV disease. Methods: The approach chosen to develop these recommendations involved a critical review of the literature and the use of the Delphi and GRADE methods. An expert group was formed. The group engaged in three rounds to define the questions, express support or opposition, grade recommendations and establish the agreement or disagreement with the conclusions. Results: In the general neonatal population, routine administration of nirsevimab is recommended to reduce the frequency of illness and hospitalisation for bronchiolitis and RSV lower respiratory tract infection. Nirsevimab is recommended for all infants born in high-incidence RSV season and infants aged less than 6 months at the season onset. In infants born preterm between 29 and 35 weeks of gestation, with haemodynamically significant heart disease or with chronic lung disease, routine administration of nirsevimab is recommended to reduce the incidence of disease and hospitalisation due to bronchiolitis and RSV lower respiratory tract infection. In patients in whom palivizumab is currently indicated, its substitution by nirsevimab is recommended to reduce the burden of bronchiolitis. Conclusions: Routine administration of nirsevimab to all infants aged less than 6 months born during the RSV season or aged less than 6 months at the start of the winter season is recommended to reduce the burden of disease and the frequency of hospitalization due to bronchiolitis. (AU)

Nirsevimab for the prevention of respiratory syncytial virus disease in children. Statement of the Spanish Society of Paediatric Infectious Disease (SEIP).

INTRODUCTION: Nirsevimab, a monoclonal antibody for the prevention of disease caused by respiratory syncytial virus (RSV), has recently been approved for use in Europe and Spain. OBJECTIVES: To provide recommendations for the administration of nirsevimab for prevention of RSV disease. METHODS: The approach chosen to develop these recommendations involved a critical review of the literature and the use of the Delphi and GRADE methods. An expert group was formed. The group engaged in three rounds to define the questions, express support or opposition, grade recommendations and establish the agreement or disagreement with the conclusions. RESULTS: In the general neonatal population, routine administration of nirsevimab is recommended to reduce the frequency of illness and hospitalisation for bronchiolitis and RSV lower respiratory tract infection. Nirsevimab is recommended for all infants born in high-incidence RSV season and infants aged less than 6 months at the season onset. In infants born preterm between 29 and 35 weeks of gestation, with haemodynamically significant heart disease or with chronic lung disease, routine administration of nirsevimab is recommended to reduce the incidence of disease and hospitalisation due to bronchiolitis and RSV lower respiratory tract infection. In patients in whom palivizumab is currently indicated, its substitution by nirsevimab is recommended to reduce the burden of bronchiolitis. CONCLUSIONS: Routine administration of nirsevimab to all infants aged less than 6 months born during the RSV season or aged less than 6 months at the start of the winter season is recommended to reduce the burden of disease and the frequency of hospitalization due to bronchiolitis.

Natural history of primary syphilis: clinical and serological aspects of chancre concurrent with Follmann's balanitis / Evolução natural dos aspectos clínicos e sorológicos de um caso de cancro duro concomitante com balanite de Follmann

Introduction: Primary syphilis is classically represented by a hard chancre, but other rare forms such as Follmann's balanitis are occasionally described. Objective: To show an iconography of the clinical presentations of the classic hard chancre and Follmann's balanitis, in parallel with the serological results in the course of diagnosis and treatment. Methods: Descriptive case report of a patient of an outpatient clinic for sexually transmitted infections in a tertiary hospital in the city of São Paulo, SP, Brazil. Conclusion: Syphilis lesions acquire different clinical expressions according to the natural evolution of the disease. Recognizing these presentations, as well as knowing how to interpret the serological results, is essential for the diagnosis and adequate treatment of the infection.

Introdução: A sífilis primária é representada classicamente pelo cancro duro, porém outras formas raras, como a balanite de Follmann, são ocasionalmente descritas. Objetivo: Apresentar uma iconografia dos estágios evolutivos da lesão clássica de cancro duro e da balanite de Follmann em paralelismo com os resultados sorológicos no curso do diagnóstico e do tratamento. Métodos: Relato descritivo evolutivo de paciente atendido em ambulatório de atendimento de infecções sexualmente transmissíveis de hospital terciário da cidade de São Paulo (SP), Brasil. Conclusão: As lesões da sífilis adquirem expressões clínicas diversas conforme a evolução natural da doença. Reconhecer essas apresentações, bem como saber interpretar os resultados sorológicos, é fundamental para o diagnóstico e o tratamento adequado da infecção.

Prognostic factors of a lower CD4/CD8 ratio in long term viral suppression HIV infected children.

BACKGROUND: Combination antiretroviral therapy (cART) is associated with marked immune reconstitution. Although a long term viral suppression is achievable, not all children however, attain complete immunological recovery due to persistent immune activation. We use CD4/CD8 ratio like a marker of immune reconstitution. METHODS: Perinatal HIV-infected children who underwent a first-line cART, achieved viral suppression in the first year and maintained it for more than 5 years, with no viral rebound were included. Logistic models were applied to estimate the prognostic factors, clinical characteristics at cART start, of a lower CD4/CD8 ratio at the last visit. RESULTS: 146 HIV-infected children were included: 77% Caucasian, 45% male and 28% CDC C. Median age at cART initiation was 2.3 years (IQR: 0.5-6.2). 42 (30%) children received mono-dual therapy previously to cART. Time of undetectable viral load was 9.5 years (IQR: 7.8, 12.5). 33% of the children not achieved CD4/CD8 ratio >1. Univariate analysis showed an association between CD4/CD8 <1 with lower CD4 nadir and baseline CD4; older age at diagnosis and at cART initiation; and a previous exposure to mono-dual therapy. Multivariate analysis also revealed relationship between CD4/CD8 <1 and lower CD4 nadir (OR: 1.002, CI 95% 1.000-1.004) as well as previous exposure to mono-dual therapy (OR: 0.16, CI 95% 0.003-0.720). CONCLUSIONS: CD4/CD8 >1 was not achieved in 33% of the children. Lower CD4 nadir and previous exposure to suboptimal therapy, before initiating cART, are factors showing independently association with a worse immune recovery (CD4/CD8 < 1).

Infección fúngica invasora en niños: diferencias y homologías con el adulto / Invasive fungal infections in children: similarities and differences with adults

La infección fúngica invasora (IFI) se produce en niños con profunda inmunosupresión o ingresados en cuidados intensivos, acompañándose de una elevada morbimortalidad. El objetivo de esta revision es actualizar la información existente sobre las características epidemiológicas, clínicas y terapéuticas de las IFI en niños, comparándolas con las de los adultos. Aunque existen diferencias con respecto a los adultos, la epidemiología, clínica y factores de riesgo de IFI en niños son comparables. Los grupos de riesgo de IFI en pediatría incluyen a los pacientes hemato-oncológicos, de características similares a los adultos con predominio de infecciones por Candida spp. y Aspergillus spp.; a las inmunodeficiencias primarias, entre las que destaca la enfermedad granulomatosa crónica que tiene una elevada susceptibilidad para Aspergillus spp., y a los grandes prematuros en quienes predominan infecciones diseminadas por C. albicans y C. parapsilosis. En ellos existe un elevado riesgo de diseminación, incluyendo a sistema nervioso central. Existen peculiaridades radiológicas y en biomarcadores en IFI en niños. En la aspergilosis pulmonar habitualmente están ausentes los signos radiológicos clásicos en el CT. Existe escasa información sobre PCR y beta-D-glucano, y más limitada sobe galactomanano, cuya rentabilidad diagnóstica es similar a la de los adultos. Existe un retraso en el desarrollo de antifúngicos en pediatría, lo que limita su uso a diferentes edades. Con la mayoría de azoles es necesario monitorización de niveles terapéuticos para optimizar eficacia y seguridad. Las recomendaciones de profilaxis y tratamiento antifúngico son extrapoladas en su mayoría de estudios de adultos. No hay evidencias del beneficio del tratamiento anticipado en niños. La elevada mortalidad de las IFI, obliga a profilaxis antifúngica a pacientes de alto riesgo, y tratamiento empírico precoz, por lo que es necesario fomentar la realización de más estudios específicos de farmacocinética, seguridad y eficacia de antifúngicos a las diferentes edades pediátricas (AU)

Invasive fungal infections (IFI) are a major cause of morbidity and mortality in immunocompromised adults and children. The purpose of this review was to update the epidemiological, clinical and therapeutic options in children, and to compare them with the adult population. Although there are important differences, the epidemiology, clinical features and risk factors for IFI have many similarities. Patient at risk include neutropenic hematology children, in whom Candida spp. y Aspergillus spp. predominate; primary immunodeficiencies, particularly chronic granulomatous disease with high susceptibility for Aspergillus spp.; and extremely premature infants, in whom C. albicans y C. parapsilosis are more prevalent. Premature babies are prone to dissemination, including the central nervous system. There are peculiarities in radiology and diagnostic biomarkers in children. In pulmonary aspergillosis, clasical signs in CT are usually absent. There is scant information on PCR and beta-D-glucan in children, and more limited on the performance of galactomannan enzyme immunoassay, that does not appear to be much different in neutropenic patients. There is a delay in the development of antifungals, limiting their use in children. Most azoles require therapeutic drug monitoring in children to optimize its safety and effectiveness. Pediatric treatment recommendations are mainly extrapolated from results of clinical trials performed in adults. There is no evidence for the benefit of preemptive therapy in children. It is necessary to foster specific pediatric studies with current and new antifungals to evaluate their pharmacokinetics, safety, and effectiveness at different ages in the pediatric population (AU)

Is bio-identical hormone therapy fact or fairy tale?

Bio-identical hormone replacement therapy (BHRT) is becoming more popular among women, and providers should have adequate knowledge regarding this treatment. This article reviews traditional hormone replacement therapy, BHRT, its premise, treatment options, and its overall strengths and weaknesses.