Características de niños con infección por virus de la inmunodeficiencia humana-1 que reciben tratamiento antirretroviral de gran actividad: estudio de corte transversal / Characteristics of human immunodeficiency virus-1 infected children receiving Highly active antiretroviral therapy: a cross-sectional study

Introducción: Desde 1996, cuando se inició el tratamiento antirretroviral de gran actividad (TARGA), se ha producido un cambio en el curso de la infección por el VIH, convirtiéndose en una enfermedad crónica. Nuestro objetivo fue describir las características de los niños seguidos en nuestro hospital. Pacientes y métodos: Se realizó un estudio de corte transversal, de 32 niños infectados por VIH, seguidos hasta diciembre de 2010, en el Hospital Universitario de Getafe. La evaluación de los pacientes se efectuó con datos clínicos y de laboratorio, recogidos de la última visita. Resultados: Se siguió a 32 niños con infección por VIH, 29 de ellos infectados por transmisión vertical. La edad media fue de 14 años. De acuerdo con la clasificación de los CDC, el 56% (18/32) de los niños estaban en la categoría A, el 28% (9/32) en la B y el 16% (5/32) en la C. Dentro de la categoría inmunológica, 24 (75%) se encontraban en la categoría 3, 3 (9%) en la categoría 2 y 5 (16%) en la categoría 1. La mediana del nadir de CD4 fue de 337 (12%). La mediana de CD4 en la última determinación fue de 749 (31%). Solo una adolescente con mala adherencia tenía un recuento absoluto de CD4 menor de 200 células/ml. Veintiocho pacientes (87%) recibían TARGA y 4 estaban sin tratamiento antirretroviral. De los pacientes en tratamiento, 26 (93%) presentaban cargas virales <200 copias/ml. La mediana de carga viral fue <20 copias/ml, y la mediana del tiempo de tratamiento antirretroviral fue de 10 años. La combinación más frecuente fue la de dos inhibidores de la transcriptasa inversa análogos de nucleósidos (ITIAN) y un inhibidor de la proteasa (IP), que la recibieron 15 pacientes (47%), seguida de 2 ITIAN y un inhibidor de la transcriptasa inversa no análogo (ITINN), que la recibieron 8 pacientes (29%). Dos niños con terapia de rescate recibieron raltegravir, uno con tipranavir y el otro darunavir. Un total de 12 pacientes (43%) recibían pautas una vez al día, de ellos con pautas fijas combinadas en un único comprimido se encontraron 7 pacientes (25%). Se observaron complicaciones metabólicas como hiperlipidemia o lipodistrofia en 17 niños (53%). Conclusiones: La mayoría de nuestros pacientes reciben TARGA, con un buen control inmunovirológico. La prevalencia de alteraciones metabólicas es elevada. Es necesario desarrollar estrategias para mejorar la adherencia y disminuir la toxicidad en los niños con infección por VIH de transmisión vertical (AU)

Introduction: Since 1996, when HAART became available, there has been a change in the course of HIV-infection, leading it to become a chronic disease. Our aim was to describe the characteristics of the children followed up in our hospital. Patients and methods: A cross-sectional study was conducted on 32 HIV-infected children followed up until December-2010, at the University-Hospital de Getafe. Clinical and laboratory information from the last visit was collected for the evaluation of patients. Results: Thirty-two children with HIV-1 were evaluated, 29 infected through vertical-transmission. The median age was 14 years. According to the CDC classification, 56% (18/32) of children were in category A, 28% (9/32) B and 16% (5/32) C. Immunological class was 3 in 75% of children, class 2 in 9% and class 1 in 16%. The median nadir of CD4 was 337 cells/ml (12%). The median current CD4 was 749 (31%). Only one adolescent had a CD4% below 200 cells/ml due to lack of adherence. Twenty-eight patients (87%) were receiving HAART, and 4 patients were off antiretroviral treatment. Among the patients treated, 26 (93%) had viral loads <200copies/ml. The median viral-load was<20 copies/ml. Median time on antiretroviral treatment was 10 years. The combination more frequently used was two nucleoside reverse transcriptase inhibitors (NRTI) and one protease inhibitor (PI), that was given to 15 patients (47%), followed by 2 NRTI, and one non-nucleoside reverse transcriptase inhibitor (NNRTI) in 8 patients (29%). Two children received rescue therapy including raltegravir, one with tipranavir and the other with darunavir. A total of 12 patients (43%) received medication once a day, 7 of them with fixed-dose combinations in a single tablet (25%). There were metabolic complications, including hyperlipidaemia or lipodystrophy were observed in 17 children (53%). Conclusions: Most of our patients are receiving HAART, with good virological and immunological control. The prevalence of metabolic abnormalities was high. Strategies to improve adherence and decrease toxicities are needed in perinatally-acquired HIV-infected children (AU)

[Characteristics of human immunodeficiency virus-1 infected children receiving highly active antiretroviral therapy: a cross-sectional study]. / Características de niños con infección por virus de la inmunodeficiencia humana-1 que reciben tratamiento antirretroviral de gran actividad: estudio de corte transversal.

INTRODUCTION: Since 1996, when HAART became available, there has been a change in the course of HIV-infection, leading it to become a chronic disease. Our aim was to describe the characteristics of the children followed up in our hospital. PATIENTS AND METHODS: A cross-sectional study was conducted on 32 HIV-infected children followed up until December-2010, at the University-Hospital de Getafe. Clinical and laboratory information from the last visit was collected for the evaluation of patients. RESULTS: Thirty-two children with HIV-1 were evaluated, 29 infected through vertical-transmission. The median age was 14 years. According to the CDC classification, 56% (18/32) of children were in category A, 28% (9/32) B and 16% (5/32) C. Immunological class was 3 in 75% of children, class 2 in 9% and class 1 in 16%. The median nadir of CD4 was 337 cells/ml (12%). The median current CD4 was 749 (31%). Only one adolescent had a CD4% below 200 cells/ml due to lack of adherence. Twenty-eight patients (87%) were receiving HAART, and 4 patients were off antiretroviral treatment. Among the patients treated, 26 (93%) had viral loads <200 copies/ml. The median viral-load was<20 copies/ml. Median time on antiretroviral treatment was 10 years. The combination more frequently used was two nucleoside reverse transcriptase inhibitors (NRTI) and one protease inhibitor (PI), that was given to 15 patients (47%), followed by 2 NRTI, and one non-nucleoside reverse transcriptase inhibitor (NNRTI) in 8 patients (29%). Two children received rescue therapy including raltegravir, one with tipranavir and the other with darunavir. A total of 12 patients (43%) received medication once a day, 7 of them with fixed-dose combinations in a single tablet (25%). There were metabolic complications, including hyperlipidaemia or lipodystrophy were observed in 17 children (53%). CONCLUSIONS: Most of our patients are receiving HAART, with good virological and immunological control. The prevalence of metabolic abnormalities was high. Strategies to improve adherence and decrease toxicities are needed in perinatally-acquired HIV-infected children.

Surveillance of Chagas disease in pregnant women in Madrid, Spain, from 2008 to 2010.

One of the most important modes of transmission of Trypanosoma cruzi infection in areas where it is not endemic is vertical transmission: from mother to child. The objective of this report is to assess the efficacy of different programmes of serological screening to monitor infection with T. cruzi in pregnant Latin American women living in Madrid (Spain). To achieve this, a retrospective study was undertaken from January 2008 to December 2010 in seven hospitals in the Autonomous Community of Madrid. Serological screening programmes were classified in two main strategies: a selective one (pregnant women from Bolivia) and a universal one (pregnant women from Latin America). A total of 3,839 pregnant women were tested and the overall prevalence was 3.96%. The rate of congenital transmission was 2.6%. The current monitoring programmes have variable coverage ranging between 26% (selective screening) and 100% (universal screening). Monitoring of pregnant women from Latin America only reaches full coverage if universal screening of pregnant women is carried out at any moment of pregnancy, including at delivery. A common national regulation is necessary in order to ensure homogenous implementation of screening.

Diagnóstico y tratamiento de la leishmaniasis visceral infantil / Visceral childhood leishmaniasis: Diagnosis and treatment

Introducción: La leishmaniasis visceral es una enfermedad potencialmente grave y endémica en España. Recientes avances en las técnicas diagnósticas y el tratamiento permiten mejorar el abordaje de la enfermedad. Objetivos: Analizar las características clínicas y epidemiológicas de los pacientes diagnosticados de leishmaniasis visceral, evaluar las técnicas diagnósticas utilizadas y la eficacia y la seguridad de los tratamientos empleados. Métodos: Se revisaron de forma retrospectiva las historias clínicas de los niños diagnosticados de leishmaniasis visceral desde enero de 1994 hasta diciembre de 2007 en un hospital de tercer nivel del área sur de Madrid. Se consideró diagnóstico de enfermedad la existencia de clínica compatible y la visualización del parásito, o el aislamiento en cultivo del aspirado de médula ósea (AMO) o la detección del ADN del parásito mediante técnicas moleculares (reacción en cadena de la polimerasa). Resultados: En el periodo de tiempo estudiado se diagnosticó de leishmaniasis visceral a 11 pacientes. La mediana de edad fue de 21 meses (rango: 4 meses–13 años). La fiebre estaba presente en todos los casos, y la hepatomegalia y esplenomegalia en el 91%. La anemia fue el hallazgo hematológico más frecuente (100%). El AMO se realizó en todos los pacientes. El examen microscópico del AMO detectó la presencia de amastigotes intracelulares en el 73% de los casos. Se detectó la presencia de ADN del parásito en todos los casos. Los títulos de inmunofluorescencia indirecta fueron superiores a 1/40 en el momento del diagnóstico en el 63%. La determinación del antígeno del parásito en la orina fue positiva en 4 de 6 pacientes (67%). Se trató a 3 pacientes con antimoniato de N-metil-glucamina y a 8 pacientes (73%) con anfotericina B liposómica. Se observó una respuesta clínica precoz en todos los pacientes. Un paciente tratado con anfotericina B liposómica presentó una recaída de la enfermedad. No se registraron reacciones adversas graves al tratamiento. Conclusiones: La leishmaniasis visceral sigue siendo una enfermedad frecuente en nuestro medio. Las características clínicas y analíticas al diagnóstico son similares a las observadas en otros estudios del área mediterránea. La técnica de reacción en cadena de la polimerasa en el AMO mostró una sensibilidad mayor que las técnicas tradicionales. Las técnicas no invasivas pueden ser de utilidad en pacientes con cuadro clínico compatible. La anfotericina B liposómica en pauta corta se mostró segura y eficaz en el tratamiento de la leishmaniasis visceral (AU)

Introduction: Visceral leishmaniasis is endemic in Spain. New diagnostic tools and shorter regimens of treatment are been increasingly being used in children. Objectives: To analyze the clinical and epidemiological characteristics of cases of visceral leishmaniasis, to evaluate the diagnostic techniques tested and the safety and efficacy of treatments used. Methods: We retrospectively reviewed the medical records of children diagnosed with visceral leishmaniasis between January 1994 and December 2007 in a tertiary public Hospital in the South of Madrid. The diagnosis of visceral leishmaniasis was based on visualization of Leishmania sp. in bone marrow aspirate or culture or positive PCR analysis of the bone marrow aspirate. Results: Eleven immunocompetent children were identified. Median age was 21 months (range: 4 months – 13 years). Fever was present in all cases, and hepatomegaly and splenomegaly in 10 (91%). Anemia was the most frequent haematological finding (100%). A bone marrow aspirate was obtained in all cases. Leishmania amastigotes were observed in 8 (73%) cases. Leishmania DNA in the bone marrow aspirate was detected in all patients who underwent this procedure. Positive immunofluorescent-antibody test (IFAT) analysis at baseline was observed in 63% of cases tested. The threshold titer for positivity was 1/40. Urinary antigen detection test was positive in 4 out of 6 (67%) children in whom I was performed. Initial treatment consisted of meglumine antimoniate in 3 patients and liposomal amphotericin B (LAB) in 8 (73%) patients. All children had an early clinical response. Only one child treated with LAB relapsed. No severe adverse events were observed with treatment. Conclusions: Visceral leishmaniasis is still a common disease in our area. Clinical and laboratory findings of visceral leishmaniasis are similar to other Mediterranean area reports. PCR analysis of the bone marrow aspirate was more sensitive than traditional diagnostic techniques. Non-invasive diagnostic techniques may be used as an aid in the diagnosis of visceral leishmaniasis in children. Short course treatment of visceral leishmaniasis with liposomal amphotericin B has been safe and effective (AU)

[Visceral childhood leishmaniasis: diagnosis and treatment]. / Diagnóstico y tratamiento de la leishmaniasis visceral infantil.

INTRODUCTION: Visceral leishmaniasis is endemic in Spain. New diagnostic tools and shorter regimens of treatment are been increasingly being used in children. OBJECTIVES: To analyze the clinical and epidemiological characteristics of cases of visceral leishmaniasis, to evaluate the diagnostic techniques tested and the safety and efficacy of treatments used. METHODS: We retrospectively reviewed the medical records of children diagnosed with visceral leishmaniasis between January 1994 and December 2007 in a tertiary public Hospital in the South of Madrid. The diagnosis of visceral leishmaniasis was based on visualization of Leishmania sp. in bone marrow aspirate or culture or positive PCR analysis of the bone marrow aspirate. RESULTS: Eleven immunocompetent children were identified. Median age was 21 months (range: 4 months - 13 years). Fever was present in all cases, and hepatomegaly and splenomegaly in 10 (91%). Anemia was the most frequent haematological finding (100%). A bone marrow aspirate was obtained in all cases. Leishmania amastigotes were observed in 8 (73%) cases. Leishmania DNA in the bone marrow aspirate was detected in all patients who underwent this procedure. Positive immunofluorescent-antibody test (IFAT) analysis at baseline was observed in 63% of cases tested. The threshold titer for positivity was 1/40. Urinary antigen detection test was positive in 4 out of 6 (67%) children in whom I was performed. Initial treatment consisted of meglumine antimoniate in 3 patients and liposomal amphotericin B (LAB) in 8 (73%) patients. All children had an early clinical response. Only one child treated with LAB relapsed. No severe adverse events were observed with treatment. CONCLUSIONS: Visceral leishmaniasis is still a common disease in our area. Clinical and laboratory findings of visceral leishmaniasis are similar to other Mediterranean area reports. PCR analysis of the bone marrow aspirate was more sensitive than traditional diagnostic techniques. Non-invasive diagnostic techniques may be used as an aid in the diagnosis of visceral leishmaniasis in children. Short course treatment of visceral leishmaniasis with liposomal amphotericin B has been safe and effective.

Brote de neumonía y urticaria por Mycoplasma pneumoniae en dos colegios de un municipio de la Comunidad de Madrid / Outbreak of pneumonia and urticaria caused by Mycoplasma pneumoniae in two schools in a town of the Community of Madrid

El Mycoplasma pneumoniae es una causa frecuente de infecciones respiratorias superiores e inferiores en niños y adultos jóvenes. Se presenta un brote de neumonía, y urticaria asociada en algunos de los casos, en 41 niños de un municipio del sur de la Comunidad de Madrid. Los casos se agruparon fundamentalmente en torno a dos colegios, con 26 niños afectados en un colegio y 9 en otro. Se produjeron pocos casos por clase y pocos casos secundarios en las familias, lo que puede indicar, en este caso, la baja transmisión del microorganismo. Se describen los síntomas clínicos, los hallazgos radiológicos y analíticos de estas neumonías adquiridas en la comunidad: todos los casos cursaron con tos seca intensa, 14 (34,1%) niños afectados presentaron neumonía sin fiebre llamativa, 5 (12,1%) niños asociaron urticaria, solo 2 niños presentaron polipnea (4,8%) y ninguno de ellos rinitis. En las imágenes radiológicas predominó claramente el patrón alveolar en lóbulos inferiores. Ningún niño presentó leucocitosis ni neutrofília en la analítica. Una paciente con anemia hemolítica hereditaria presentó una crisis de hemólisis coincidiendo con la neumonía. Otra paciente presentó artralgias, urticaria, leucopenia y neutropenia. Hubo un único ingreso hospitalario. El diagnóstico etiológico de la infección pudo efectuarse en 21 niños (51,2%), y se realizó por técnicas serológicas. La realización de una prueba serológica rápida y de fácil ejecución que permita detectar los anticuerpos IgM anti-Mycoplasma pneumoniae puede constituir una herramienta útil para realizar el diagnóstico etiológico de este tipo de infecciones. En la bibliografía existen descritos pocos brotes de infección por M. pneumoniae en centros escolares. El objetivo de este estudio es describir las características clínicas de la infección respiratoria producida por M. pneumoniae para facilitar su reconocimiento y el tratamiento precoz, actitudes que contribuyen al control del brote y a la disminución de la transmisión entre los contactos (AU)

Mycoplasma Pneumoniae causes mild respiratory infections in children and young adults. We present a pneumonia outbreak with related urticaria in some children in a village located in the south of the Community of Madrid. The majority of the cases were grouped in two schools, with 26 affected children in one school and 9 in the other. There were few cases in each class and few secondary cases in the families what can indicate, in this case, germ low infectiousity. We describe clinical symptoms, radiographic and analytic findings in these community- acquired pneumonias (CAP): all the cases had intense hacking cough, 14 (34.1%) children presented pneumonia without fever, 5 (12.1%) children had urticaria, only 2 children had polipnea (4.8%) and none of them had rhinitis. In the chest x-ray findings was a clear predominance of alveolar infiltrate in the lower lobes. None of the children had high white blood cell count nor high neutrophils count. One patient with hereditary haemolytic anemia had a haemolytic crisis coinciding with pneumonia. One patient suffered arthralgia, urticaria, leucopenia and neutropenia. There was a unique hospital admission. Twenty-one (51.2%) children were diagnosed by serological essays. A quick and easy serological test for IgM Mycoplasma pneumoniae antibodies could be a useful tool for diagnosis. In medical literature we have found few Mycoplasma outbreaks described in schools. The goal of this study is to describe the clinical appearance of M. pneumoniae infection in order to make easier its diagnosis and early treatment, attitudes that contribute to control the outbreak and lower the transmission between contacts (AU)

[The prevalence of Escherichia coli susceptibility to quinolones and other antibiotics in community-acquired bacteriurias in Madrid]. / Prevalencia de susceptibilidad de Escherichia coli a quinolonas y otros antibióticos en bacteriurias extrahospitalarias de Madrid.

BACKGROUND: The empiric treatment of extrahospitalary urinary infections must keep in mind the patterns of susceptibility of the potentially causative bacteria. The consumption of antibiotics is one of the most important causes of change in the susceptibility of the bacteria. The recent introduction of fluorquinolones and the widespread use of those antibiotics makes knowledge of new patterns of sensitivity necessary in order to determine whether there are changing sensitive pattern among the different geographic zones. METHODS: During a period of two weeks randomly chosen 379 strains of Escherichia coli isolated from extrahospitalary bacteria were collected in 11 laboratories in 4 health areas in Madrid. Sensitivity to 11 antibiotics, including four of the quinolone group was determined by the agar dilution method. The existence of significant differences of sensitivity among the different areas was analyzed by the chi 2 test. RESULTS: The prevalence of sensitivity to ampicillin and cotrimoxazol was 42 and 73% respectively. Nineteen percent of the strains were resistant to amoxycillin/clavulanic acid. No strain was found to be resistant to cefotaxime. Four percent of the sample studied was not sensitive to the new fluorquinolones and almost 10% were resistant to nalidixic acid latter having decreased sensitivity to the fluorquinolones. No significant differences were observed in sensitivity among the areas, except with amoxycillin/clavulanic acid and cotrimoxazole. CONCLUSIONS: The high prevalence of the resistance of E. coli to ampicillin recently leads to the recommendation of its use in empiric treatments of urinary infections. In the zone in Madrid studied a high prevalence of resistance and decreased sensitivity of E. coli to fluoroquinolones was observed. It is therefore advisable to moderate their use to thereby prolong use over time.