Impact of immigration on pulmonary tuberculosis in Spanish children: a three-decade review.

BACKGROUND: Tuberculosis causes significant morbidity and mortality worldwide. In the last years, international travel and immigration have led to important changes in the epidemiology of this disease. Drug resistance has emerged as an important threat to tuberculosis control. Data regarding the impact of immigration and the incidence of drug-resistant strains in children are lacking. METHODS: Retrospective review of patients diagnosed with pulmonary tuberculosis at La Paz Children's Hospital in a 30-year period. Data were collected with regard to the clinical, radiologic, microbiologic, and demographic characteristics of patients, and data from the 3 decades of the study were compared using chi test and Fisher exact test. RESULTS: A total of 507 cases of tuberculosis were identified, 414 of which had pulmonary involvement. During the study, there was a significant decrease in tuberculous meningitis: 10.4% in 1978-1987, 5.6% in 1988-1997, and 2.9% in 1998-2007 (P < 0.05). The most frequent reason for a consultation was case contact investigation. The adult source case was identified in 64% of patients. We observed an increase in extrafamilial contacts (8% in 1978-1987 and 18% in 1998-2007, P < 0.01), including 4 cases of immigrant caretakers. Tuberculosis in immigrant children has increased with time: 2% in the period 1978-1987, 6% in 1988-1997, and 46% in 1998-2007 (P < 0.001). The primary resistance rate to isoniazid in our population was 6.5%. CONCLUSIONS: Tuberculosis in our area continues to be a major health problem, especially among foreign-born children. As drug-resistant strains are increasing, initial therapy with 4 drugs is recommended in our population.

Coronary involvement in infants with Kawasaki disease treated with intravenous gamma-globulin.

AIM: To analyze the clinical spectrum and the incidence of coronary involvement in infants with typical Kawasaki's disease (KD). PATIENTS AND METHODS: A retrospective study was performed on children one year of age or younger diagnosed from February 1992 to January 2006 with typical KD. Children with incomplete forms of the disease were not included. RESULTS: Twenty-five infants were diagnosed with KD during the study period. The median age of the patients was 10 months (range, 4-12 months). All children but one received intravenous gammaglobulin (IVIG), 84% before the 10th day of disease. Seven patients (28%) required the administration of more than one dose of IVIG, because persistence of fever. Coronary artery disease (CAD) was recorded in 6 cases (24%), five of them being boys. All patients with CAD were treated with ASA plus IVIG and 84% of them received this therapy within the first 10 days of the KD onset. CONCLUSIONS: In spite of the exclusion of our study of incomplete presentations and of an early administration of IVIG in our patients, we have observed a high rate of infants who developed CAD, which is similar to the one reported in children who do not receive IVIG.

Prevalence of fat redistribution and metabolic disorders in human immunodeficiency virus-infected children.

UNLABELLED: In this study we assessed the prevalence of fat redistribution and metabolic disorders in a population of HIV-infected children on antiretroviral treatment. To make associations with epidemiological parameters, clinical-immune status, viral load and highly active antiretroviral therapy (HAART), we performed a cross-sectional study in HIV-infected children. Epidemiological parameters (age, sex, family history), clinical and immune status, viral load, and duration of antiretroviral treatment (ART) and HAART, including protease inhibitors, were recorded. Presence of clinical signs of fat redistribution and lipid, glucose and lactic acid levels were evaluated. A total of 56 HIV-infected children, including 30 boys (54%), aged between 21 months and 18 years (mean 9.5 years) were studied. In all, 49 patients (87.5%) were receiving ART (mean duration 4 years) and 43 (77%) were receiving HAART (mean duration 3.6 years). Fat redistribution or lipodystrophy was present in 14 patients (25%); seven had lipohypertrophy (12.5%), two lipoatrophy (3.5%) and five a mixed pattern (8.9%). Fat redistribution was higher in children older than 11 years (50%). Of the lipodystrophic patients, 71.4% presented hypertriglyceridaemia (> 130 mg/dl) and 57% hypercholesterolaemia (> 180 mg/dl). We found significant associations between lipodystrophy and age, ART and HAART duration and hypertriglyceridaemia ( P < 0.001, 0.002, 0.016 and < 0.001, respectively), but no significant association with sex, family history, clinical or immune status and viral load. CONCLUSION: The prevalence of lipodystrophy was 25% (95% confidence interval 14.8-34.6) with lipohypertrophy being the commonest pattern. Clinical fat redistribution was significantly associated with older age, duration of antiretroviral treatment and highly active antiretroviral therapy and hypertriglyceridaemia.

Combined systemic and intrapleural treatment of Aspergillus pulmonary empyema after invasive aspergillosis.

A 12-year-old immunocompromised boy was hospitalized because of invasive aspergillosis with lung and central nervous system involvement. He was treated with surgery and liposomal amphotericin B, but he developed a pulmonary empyema and a bronchopleural-cutaneous fistula. A catheter was placed through the fistula, and amphotericin B (up to 50 mg in 10 ml of 5% dextrose) was instilled daily into the pleural cavity for 45 days. Treatment was well-tolerated, and the empyema resolved completely, with no evidence of recurrence after 2 years of follow-up.

Encefalitis como primera manifestación de herpes-zóster / Encephalitis as the first manifestation of herpes zoster

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Twenty years of pulmonary tuberculosis in children: what has changed?

OBJECTIVES: To compare the frequency, clinical and radiologic manifestations and source of infection of pulmonary tuberculosis in children treated in our hospital during two decades (1978 through 1987 and 1988 through 1997) and to evaluate the influence of the emergence of HIV infection (since 1985) and the effect of the discontinuation of Calmette-Guérin bacillus (BCG) vaccination (since 1987) on childhood tuberculosis. METHODS: We reviewed 324 children diagnosed with pulmonary tuberculosis in our hospital during the 20 years (1978 through 1997). The data from 2 decades, 1978 through 1987 and 1988 through 1997, were compared. BCG vaccination in Spain was discontinued in 1987, and HIV infection emerged significantly as a public health problem. RESULTS: An increase in the number of children with single hilar adenopathy was observed (32.2% in 1978 through 1987 vs. 43.4%, in 1988 through 1997, P < 0.05) in comparison with those with parenchymal involvement or a mixed pattern (62.4% in 1978 through 1987 vs. 45.7% in 1988 to 1997). Frequency in extrapulmonary manifestations in both periods was similar, with a nonsignificant trend toward a lower rate of tuberculous meningitis in the latter decade (10.4 vs. 5.6%, P = 0.07). We were able to identify an adult source case for 67.1% of the children (100 of 149) in the first decade vs.58.3% (102 of 175) in the second (P = NS); 10.8% of adult contacts but only 2.3% of children (all of them in the second period) were HIV-positive. CONCLUSIONS: Discontinuation of BCG vaccination and emergence of HIV infection have had little influence on childhood tuberculosis in our area.