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During the COVID-19 pandemic, patients in need of neurosurgical care suffered. Elective procedures were postponed, and emergency care visits decreased. Healthcare-associated ventriculitis (HAV) is a serious problem in children, with poor outcomes and frequent relapses. Our objective was to describe the clinical characteristics and the factors associated with a first HAV in children during two years of the pandemic. A retrospective cross-sectional study was performed from January 2021 to December 2022. The inclusion criteria were patients who developed a first HAV after a primary cerebrospinal fluid diversion procedure. The controls included patients without a first infection. Intraoperative and clinical data were extracted from medical records. A total of 199 CSF diversion surgeries were registered. A first infection occurred in 17 patients (8.5%), including 10 with external ventricular drain (EVD) and 6 with ventricular shunts. Gram-positive cocci were identified in 70.6%. Six patients recovered uneventfully, eight had relapse or superinfections, and three eventually died. Twenty patients were included as controls. Factors associated with a first infection were a younger age (median 9 vs. 102 months, p < 0.01), malnutrition (23.5% vs. 0%, p = 0.03), and an EVD placement (58.8% vs. 10%, p = 0.03). None of the intraoperative factors showed statistically significant differences. The rate of HAV was high. Most cases presented in children <1 year and with an EVD.
RESUMO
Coronaviruses are a family of viruses present in different species of animals, which can infect humans, causing epidemics and pandemics. On January 9th, 2020, a new virus was announced as the cause of an outbreak of severe pneumonia in Wuhan, China. On March 11th, WHO declared the SARS-CoV-2 pandemic, the disease was called COVID-19. The virus is transmitted by droplets, contact and airborne during aerosol-generating procedures. In almost all pediatric cases a household contact was the source of infection. Unlike adults, the disease in children has a mild course, even in those under one year of age. The main symptoms are fever, dry or productive cough, headache, general discomfort, and shortness of breath, which is a sign of severity. The incubation period is 1-12.5 days (media 5-6 days). The most affected age group are school children. The disease may present as a mild acute upper airway infection, or as pneumonia. Very few cases progress to severe pneumonia and other complications such as acute respiratory distress syndrome, shock and multiorgan failure. There is not yet a specific antiviral treatment approved for use in children. This document aims to guide the management of suspected or confirmed pediatric patients of COVID-19.
El 9 de enero de 2020 fue anunciado un nuevo virus como la causa de un brote de neumonía grave en Wuhan, China. El 11 de marzo, la Organización Mundial de la Salud declaró la pandemia por SARS-CoV-2, virus causante de la enfermedad COVID-19. El virus se transmite por gotas, contacto y por vía aérea en procedimientos que generan aerosoles. En el caso de los niños, la fuente de contagio casi siempre es un contacto intradomiciliario. En los pacientes pediátricos, la enfermedad tiene un curso leve, incluso en los menores de un año. Los principales síntomas son: fiebre, tos seca o productiva, cefalea, malestar general y dificultad respiratoria, que es un signo de gravedad. El período de incubación es de 1 a 12.5 días (media 5-6). El grupo de edad más afectado son los escolares. La enfermedad puede presentarse como un cuadro leve de infección aguda de vías aéreas superiores o como neumonía. Muy pocos casos progresan a neumonía grave y a complicaciones como síndrome de distrés respiratorio agudo, choque y falla multiorgánica. Aún no hay tratamiento antiviral específico aprobado para su uso en niños. El presente documento tiene como objetivo guiar el manejo de los pacientes pediátricos sospechosos o confirmados de COVID-19.
RESUMO
Resumen: Introducción: La tuberculosis (TB) continúa siendo un reto ya que las formas graves se presentan con mayor frecuencia en los menores de 5 años y el diagnóstico es complejo. El objetivo del presente trabajo fue describir las formas de presentación clínica, frecuencia, métodos de diagnóstico empleados y respuesta al tratamiento en niños con TB atendidos en un hospital de tercer nivel. Métodos: Se diseñó un estudio retrospectivo, descriptivo, de una cohorte de casos consecutivos atendidos desde enero de 2010 hasta diciembre de 2013. Se revisaron 93 expedientes clínicos de niños con diagnóstico de TB de acuerdo con la definición de la NOM-006-SSA2-2013. Se utilizó estadística descriptiva para el análisis. Resultados: El 58% de 93 niños fueron pacientes de sexo masculino con una media de edad de 7 años. El 97% contaba con antecedente de vacunación BCG; el 6% tuvo contacto con algún caso de TB. Las formas clínicas más frecuentes fueron la TB pulmonar (30.1%), ganglionar (24.7%), miliar/diseminada (16.1%), meníngea (13%) y ósea (7.5%). Los síntomas más comunes fueron fiebre y pérdida de peso (50% y 40%, respectivamente). El BAAR y el cultivo fueron positivos en el 26% y el 7% de todos los casos, respectivamente. El estudio histopatológico fue concluyente en el 90%. El tratamiento fue exitoso en el 94.6%, sin mortalidad asociada. Conclusiones: La asociación del cuadro clínico con las alteraciones en la radiografía de tórax y PPD positivo son útiles para establecer el diagnóstico presuntivo e iniciar el manejo oportuno.
Abstract: Background: Tuberculosis (TB) remains a challenge because severe forms occur most frequently in children under 5 years of age and the diagnosis is complex. The objective of this paper was to describe the clinical presentation, frequency, diagnostic methods used and response to treatment in children with TB treated at a tertiary level hospital. Methods: The study was retrospective and descriptive of a cohort of consecutive cases treated from January 2010 to December 2013. Ninety-three medical records of children diagnosed with TB according to the definition of the NOM-006-SSA2-2013 were reviewed. Descriptive statistics were used for the analysis. Results: From 93 children, 58% were male (mean age of 7 years), 97% with a history of BCG vaccination, and 6% had contact with a TB case. The most frequent clinical forms were pulmonary (30.1%), lymph node (24.7%), miliary/disseminated (16.1%), meningeal (13%), and osteal TB (7.5%). The most common symptoms were fever and weight loss (50% and 40%, respectively). BAAR and culture were positive in 26% and 7% of all cases, respectively. The histopathological study was conclusive in 90% of the cases. The treatment was successful in 94.6%, with not associated mortality. Conclusions: The association of clinical symptoms with alterations in chest radiography and positive PPD are useful in establishing the presumptive diagnosis and an early and appropriate treatment.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Tuberculose/epidemiologia , Vacina BCG/administração & dosagem , Redução de Peso , Febre/epidemiologia , Tuberculose/diagnóstico , Tuberculose/terapia , Estudos Retrospectivos , Estudos de Coortes , Resultado do Tratamento , Febre/microbiologia , Centros de Atenção TerciáriaRESUMO
BACKGROUND: Tuberculosis (TB) remains a challenge because severe forms occur most frequently in children under 5 years of age and the diagnosis is complex. The objective of this paper was to describe the clinical presentation, frequency, diagnostic methods used and response to treatment in children with TB treated at a tertiary level hospital. METHODS: The study was retrospective and descriptive of a cohort of consecutive cases treated from January 2010 to December 2013. Ninety-three medical records of children diagnosed with TB according to the definition of the NOM-006-SSA2-2013 were reviewed. Descriptive statistics were used for the analysis. RESULTS: From 93 children, 58% were male (mean age of 7 years), 97% with a history of BCG vaccination, and 6% had contact with a TB case. The most frequent clinical forms were pulmonary (30.1%), lymph node (24.7%), miliary/disseminated (16.1%), meningeal (13%), and osteal TB (7.5%). The most common symptoms were fever and weight loss (50% and 40%, respectively). BAAR and culture were positive in 26% and 7% of all cases, respectively. The histopathological study was conclusive in 90% of the cases. The treatment was successful in 94.6%, with not associated mortality. CONCLUSIONS: The association of clinical symptoms with alterations in chest radiography and positive PPD are useful in establishing the presumptive diagnosis and an early and appropriate treatment.
