[Comparison of clinical features and diagnosis between the A and B subgroups of respiratory syncytial virus.] / Comparación de las características clínicas y diagnósticas de los subgrupos A y B del virus respiratorio sincitial.

BACKGROUND: Lower respiratory tract infection by respiratory syncytial virus (RSV) is the most frequent cause of admission in children under 2 years old. The RSV subgroups A and B may circulate simultaneously. We aimed to determine whether clinical differences exist between RSV subgroups A and B. Additionally, we tested the sensitivity of the rapid antigen detection test (RADT) based on immunochromatography in diagnosing subgroups A and B, taking the polymerase chain reaction assay (RT-PCR) as reference. METHODS: A retrospective observational study was performed in a tertiary hospital from October 2013 to March 2014. Clinical records and analytical variables of all children under 5 admitted with lower respiratory tract infection and RT-PCR positive for RSV in nasal lavage were consulted. Previously, the RADT for RSV had been performed from the same sample. RESULTS: A total of 198 children under 5 were diagnosed with RSV by RT-PCR: 55 (28%) were RSV-A, 132 (67%) RSV-B and 11 (5%) were positive for both subgroups. No differences were observed between subgroups in medical history, symptoms, radiological and analytical findings, and severity. The sensitivity of RADT for RSV was 52%, higher for RSV-A (69%) than for RSV-B (44%, p=0.001). CONCLUSIONS: The two RSV subgroups were indistinguishable in symptoms and prognosis. The sensitivity of RADT compared to RT-PCR was low and limits its usefulness for clinical decision-making. Key words. Respiratory syncytial virus. RSV subgroups. Rapid antigen detection test. Reverse transcription polymerase chain reaction.

Comparación de las características clínicas y diagnósticas de los subgrupos A y B del virus respiratorio sincitial / Comparison of clinical features and diagnosis between the A and B subgroups of respiratory syncytial virus

Fundamento: La infección del tracto respiratorio inferior por virus respiratorio sincitial (VRS) es la causa más frecuente de ingreso en menores de 2 años. Los subgrupos de VRS A y B pueden circular indistintamente. Nuestro objetivo fue determinar si existían diferencias clínicas entre los VRS subgrupo A y B, y si la sensibilidad del test de detección rápida de antígeno del VRS por inmunocromatografía difiere de la técnica de referencia (RT-PCR). Material y métodos: Estudio retrospectivo, observacional realizado en el hospital terciario desde octubre de 2013 a marzo de 2014. Se consultó la historia clínica y las analíticas de los niños menores de 5 años ingresados en por infección respiratoria de vías bajas con RT-PCR positivo a VRS en una muestra de lavado nasal. De la misma muestra previamente se había realizado el test de detección rápida de antígeno de VRS. Resultados: Se confirmaron 198 niños menores de 5 años para VRS mediante RT-PCR: 55 (28%) fueron VRS-A, 132 (67%) VRS-B y 11 (5%) fueron positivos para ambos subgrupos. No encontramos diferencias entre subgrupos en antecedentes, clínica, radiología, analítica y gravedad. La sensibilidad del test de detección rápida fue 52%, mayor para VRS-A (69%) que para VRS-B (44%, p=0,001). Conclusiones: Los dos subgrupos de VRS fueron indistinguibles por su presentación clínica y pronóstico. La sensibilidad del test rápido en comparación con la RT-PCR fue baja, lo que limita su utilidad en la toma de decisiones clínicas (AU)

Background: Lower respiratory tract infection by respiratory syncytial virus (RSV) is the most frequent cause of admission in children under 2 years old. The RSV subgroups A and B may circulate simultaneously. We aimed to determine whether clinical differences exist between RSV subgroups A and B. Additionally, we tested the sensitivity of the rapid antigen detection test (RADT) based on immunochromatography in diagnosing subgroups A and B, taking the polymerase chain reaction assay (RT-PCR) as reference. Methods: A retrospective observational study was performed in a tertiary hospital from October 2013 to March 2014. Clinical records and analytical variables of all children under 5 admitted with lower respiratory tract infection and RT-PCR positive for RSV in nasal lavage were consulted. Previously, the RADT for RSV had been performed from the same sample. Results: A total of 198 children under 5 were diagnosed with RSV by RT-PCR: 55 (28%) were RSV-A, 132 (67%) RSVB and 11 (5%) were positive for both subgroups. No differences were observed between subgroups in medical history, symptoms, radiological and analytical findings, and severity. The sensitivity of RADT for RSV was 52%, higher for RSV-A (69%) than for RSV-B (44%, p=0.001). Conclusions: The two RSV subgroups were indistinguishable in symptoms and prognosis. The sensitivity of RADT compared to RT-PCR was low and limits its usefulness for clinical decision-making (AU)

Hemosiderosis pulmonar idiopática: a propósito de dos casos / Idiopathic pulmonary hemosiderosis: base don two cases

La hemosiderosis pulmonar idiopática es una enfermedad muy poco frecuente, de inicio fundamentalmente en edad pediátrica. A pesar de su baja incidencia, debemos tenerla en cuenta ante un caso de anemia microcítica ferropénica persistente, a la que se asocie sintomatología respiratoria. El diagnóstico es de sospecha, apoyándonos en la radiología, siendo fundamental el lavado broncoalveolar y la exclusión de otras causas de hemorragia alveolar difusa. Revisamos los aspectos clínicos, diagnósticos y terapéuticos a propósito de 2 casos de esta entidad (AU)

Idiopathic pulmonary hemosiderosis is an infrequent disease, with debut mainly in childhood. In spite of its low incidence, we should consider this disease in case of persistent microcytic iron deficiency anemia, with respiratory symptoms associated. The diagnosis is supported by the combination of compatible clinical and radiologycal findings, the ending of hemosiderin-laden alveolar macrophages on the broncoalveolar lavage, and is essential to exclude other causes of alveolar haemorrhage. The diagnostic and therapeutic features are reviewed after the presentation of two clinical cases of this entity (AU)

Parotiditis crónica recurrente juvenil / Infantile recurrent parotitis

La parotiditis crónica recurrente es una patología que cursa con inflamación parotídea unilateral o bilateral. Afecta a edades pediátricas y tiende a desaparecer con la edad. El objetivo es presentar esta patología infrecuente que, sin embargo, es de fácil diagnóstico y manejo de forma ambulatoria. Se presentan dos casos de esta patología de nuestro centro. Esta patología puede ser tratada de forma ambulatoria con analgesia, antiinflamatorios y, en caso de sobreinfección bacteriana, adjuntando antibioterapia. Las pruebas complementarias indicadas son la ecografía y la analítica sanguínea. Es una patología con buen pronóstico y tratamiento simple. Es importante realizar un buen diagnóstico diferencial. Suele desaparecer conforme el paciente se acerca a la edad adolecente (AU)

Infantile recurrent parotitis is a disease characterized by unilateral or bilateral parotid swelling. It appears in childhood and usually disappears during adolescence. The objective is to present this rare disease which has an easy treatment and diagnosis. We report two cases of this disease from our hospital. This condition can be treated with outpatient treatment, with analgesics, anti-inflammatory drugs and, if there is bacterial infection, also with antibiotics. As additional tests, blood tests and ultrasound are recommended. It is a disease with good prognosis and simple treatment. Differential diagnosis is very important. It usually disappears as the patient approaches the adolescence (AU)