Disseminated Tuberculosis and Chronic Mucocutaneous Candidiasis in a Patient with a Gain-of-Function Mutation in Signal Transduction and Activator of Transcription 1.

In humans, recessive loss-of-function mutations in STAT1 are associated with mycobacterial and viral infections, whereas gain-of-function (GOF) mutations in STAT1 are associated with a type of primary immunodeficiency related mainly, but not exclusively, to chronic mucocutaneous candidiasis (CMC). We studied and established a molecular diagnosis in a pediatric patient with mycobacterial infections, associated with CMC. The patient, daughter of a non-consanguineous mestizo Mexican family, had axillary adenitis secondary to BCG vaccination and was cured with resection of the abscess at 1-year old. At the age of 4 years, she had a supraclavicular abscess with acid-fast-staining bacilli identified in the soft tissue and bone, with clinical signs of disseminated infection and a positive Gene-X-pert test, which responded to anti-mycobacterial drugs. Laboratory tests of the IL-12/interferon gamma (IFN-γ) circuit showed a higher production of IL-12p70 in the whole blood from the patient compared to healthy controls, when stimulated with BCG and BCG + IFN-γ. The whole blood of the patient produced 35% less IFN-γ compared to controls assessed by ELISA and flow cytometry, but IL-17 producing T cells from patient were almost absent in PBMC stimulated with PMA plus ionomycin. Signal transduction and activator of transcription 1 (STAT1) was hyperphosphorylated at tyrosine 701 in response to IFN-γ and -α, as demonstrated by flow cytometry and Western blotting in fresh blood mononuclear cells and in Epstein-Barr virus lymphoblastoid cell lines (EBV-LCLs); phosphorylation of STAT1 in EBV-LCLs from the patient was resistant to inhibition by staurosporine but sensitive to ruxolitinib, a Jak phosphorylation inhibitor. Genomic DNA sequencing showed a de novo mutation in STAT1 in cells from the patient, absent in her parents and brother; a known T385M missense mutation in the DNA-binding domain of the transcription factor was identified, and it is a GOF mutation. Therefore, GOF mutations in STAT1 can induce susceptibility not only to fungal but also to mycobacterial infections by mechanisms to be determined.

Chikungunya fever: current status in Mexico / Enfermedad por virus de chikungunya: actualidad en México

Abstract: Chikungunya fever is a tropical vector-borne disease that has been spreading rapidly around the world during the last 10 years, and which has been usually misdiagnosed as dengue. Nowadays, this disease is increasing in Mexico, mainly in the southern and central zones of the country, being significantly more common in women, children and young adults (28% in < 20 years of age). The classical presentation includes fever, arthralgia, polyarthritis, back-pain, and skin rashes. Although symptoms and treatment are similar to those for dengue, there are key clinical features to differentiate these two diseases.

Resumen: La enfermedad por el virus chikungunya es una enfermedad tropical transmitida por vector, que en los últimos 10 años ha tenido una gran diseminación mundial y ha sido históricamente subdiagnosticada debido a las características en común con el dengue. Actualmente la incidencia en México ha ido en aumento, sobre todo en el centro-sur del país. Es más común en mujeres, adultos jóvenes y niños (28% son menores de 20 años). El cuadro clínico suele presentarse con fiebre, artralgia, poliartritis, dolor de espalda, cefalea y erupciones cutáneas. A pesar de que el tratamiento es sintomático y similar al del dengue, existen datos clínicos clave para diferenciarlas.

Chikungunya fever: current status in Mexico.

Chikungunya fever is a tropical vector-borne disease that has been spreading rapidly around the world during the last 10 years, and which has been usually misdiagnosed as dengue. Nowadays, this disease is increasing in Mexico, mainly in the southern and central zones of the country, being significantly more common in women, children and young adults (28% in<20 years of age). The classical presentation includes fever, arthralgia, polyarthritis, back-pain, and skin rashes. Although symptoms and treatment are similar to those for dengue, there are key clinical features to differentiate these two diseases.

Prevalence and genotypes of the adenovirus infection as well detection of co-infection with bocavirus in Mexican immunosuppressed and non-immunosuppressed children with pneumonia.

BACKGROUND: Adenovirus (AdV) causes respiratory infection; recent observations suggest that some subtypes have more ability to develop fatal disease. AdV infection has been associated with co-infection with human bocavirus (HBoV). We analysed the frequency of AdV infection, its subtypes and the presence of co-infection with HBoV, as well the clinical characteristics of such co-infection in Mexican paediatric immunosuppressed (IP) and non-immunosuppressed patients (non-IP) diagnosed with pneumonia. METHODS: A total of 5185 nasopharyngeal swabs from two groups of children with pneumonia, one IP and the other non-IP, were analysed for the detection of AdV by immunofluorescence and confirmed by PCR and culture. HBoV was identified by PCR. Positive samples for AdV and AdV/HBoV were typed using PCR sequencing, the clinical characteristics of the AdV/HBoV co-infection were analysed. RESULTS: Thirty-seven of the 5185 (0.71%) samples were positive for AdV, of those 27/37 (73%) were detected in non-IP and 10/37 (27%) in the IP group. Twelve were typed as follows: 9/12 (75%) as Species B1 subtype 3, of those 8/9 (88.9%) in non-IP and 1/9 in the IP group. One of twelve AdV2 subtype B11a was identified in one non-IP and the remaining two out of 12 successfully typed, were identified as Species C subtypes 2 and 6 in the group of non-IP. The presence of both AdV and HBoV1 in co-infection was observed in 2/37 (5.4%) non-IP with a syndrome like influenza. CONCLUSIONS: In this 5 year analysis of samples from non-IP and IP hospitalized paediatric patients with a diagnosis of pneumonia, a low incidence of AdV was found. B1 was the most frequent subtype and frequently found in non-IP, and two cases of co-infection AdV/HBoV1 were detected in two non-IP with a influenza-like syndromes. This is the first report of HBoV and AdV co-infection in Mexico. The frequency of AdV and HBoV co-infection was lower than that reported in other populations.

Detection and gB genotyping of CMV in Mexican preterm infants in the context of maternal seropositivity.

INTRODUCTION: Congenital (CI) and perinatal cytomegalovirus (CMV) infections (PI) can be linked to maternal CMV seropositivity, with fatal consequences in preterm newborns. GB genotyping has been used to analyze genotypic similarity in mothers and infants. The frequency of CMV infection in the context of maternal seropositivity and the viral gB genotypes as well as the genotypic similarity in mothers and preterm infants were investigated. METHODOLOGY: Saliva samples and dry blood spots (DBS) were taken weekly from preterm newborns  from birth until the first month of life, and breast milk samples were taken from their mothers weekly during the first month of lactation. CMV IgG seroprevalence of the mothers and CI or PI in the infants were established. The gB status and genotypic similarities were established retrospectively in DBS and in the breast milk samples. RESULTS: In total, 387 neonates and 375 mothers were enrolled. The maternal CMV-positive IgG serology was 97.3% (365/375). Neonatal CMV was found in 5.1% (20/387) of newborns, and one infant presented with CMV-compatible symptoms. CI was 2.5% and PI in the first month after birth was 11.8%. GB2 was the most prevalent genotype and was also the genotype preferentially transmitted to newborns by mothers with mixed infections. CONCLUSIONS: CMV PI and CI in preterm infants from highly seropositive mothers was high, but the rate of symptomatic infection was low. The prevalent genotype was gB2, and this genotype was preferentially transmitted to newborns by mothers with mixed infections.

Detection of Epstein-Barr virus and genotyping based on EBNA2 protein in Mexican patients with hodgkin lymphoma: a comparative study in children and adults.

BACKGROUND: Epstein-Barr virus (EBV) is a member of the Herpesviridae family and is associated with Hodgkin lymphoma (HL). Isolates of EBV are classified according to sequence variation in the latency genes such as Epstein-Barr virus nuclear antigen (EBNA). EBNA2 contains the most divergent locus and is classified into type 1 and type 2 or EBNA2A and EBNA2B, respectively. We compared the frequency of EBV and the distribution of EBNA genotypes in Mexican children and adults with HL. PATIENTS AND METHODS: Lymph node biopsy specimens from children and adults with HL were embedded in paraffin. EBV was identified by LMP1 amplification and Epstein-Barr-encoded RNA EBER by in situ hybridization (ISH) and genotyped as EBNA2A or EBNA2B using nested polymerase chain reaction (PCR) and specific primers for the detection of subtype. RESULTS: Sixty-six samples were obtained from 3 hospitals-42 (63%) from children and 24 (37%) from adults with HL. Thirty-two of the 42 samples (76.1%) were positive for EBV in children and 16 of 24 (66.6%) samples were positive in adults (P = .41). In both children and adults, EBV was found more frequently in male patients. Thirty-four of 48 cases could be typed (70.8%). EBNA2A was found in 7/21 (33.3%) children and in 4/13 (30.8%) adults (P = 1.0), and EBNA2B was found in 10/21 (47.6%) children and in 9/13 (69.2%) adults (P = .22). A mix of subtypes was found in 4/21 (19%) children. CONCLUSION: EBV was found frequently in both children and adults with HL. EBNA2B was the most frequent subtype, and a high frequency of mixed subtypes was found in children.

The epidemiology and clinical characteristics of respiratory syncytial virus infection in children at a public pediatric referral hospital in Mexico.

OBJECTIVES: The aim of this study was to determine the epidemiological and clinical characteristics of children with respiratory syncytial virus (RSV) treated at a public referral children's hospital in Mexico. METHODS: We reviewed RSV infection in patients aged 0-18 years who were treated at Hospital Infantil from January 2004 to December 2008. RESULTS: During the 5 years, 2797 samples were tested for respiratory viruses; 356 samples were positive for any virus, including 266 (74.7%) positive for RSV. Complete clinical information was available for 205 RSV patients. The mean age was 22 months, and 33.7% of the infections were nosocomially acquired. Hospitalization occurred in 187 children. Of 14 deaths, nine were directly attributed to RSV infection. During the study, RSV infections were seen throughout the year, predominating in the colder months. Of the 205 patients, 79.0% (162/205) had an underlying disease. Congenital heart disease was found in 30.2% (49/162), including three children (33.3%) who died of RSV. Thirty-three patients (16.1%) with RSV required mechanical ventilation. None of the children with RSV received palivizumab or ribavirin. CONCLUSIONS: RSV caused high hospitalization rates and admission to intensive care units, especially among those with underlying illnesses and young infants. The data presented here will be useful for strategies to improve outcomes in children at risk of complications.

Frecuencia de virus respiratorios y características clínicas de niños que acuden a un hospital en México / Frequency of respiratory viruses and clinical characteristics in children attending a care center in Mexico City

OBJETIVO. Describir la frecuencia de virus respiratorios y características clínicas en niños con cuadros respiratorios de un hospital de tercer nivel en México. MATERIAL Y MÉTODOS. Se incluyeron niños con diagnóstico de infección respiratoria y un resultado positivo por inmunofluorescencia de enero 2004 a octubre 2006. RESULTADOS. De 986 muestras nasofaríngeas, 138 (14 por ciento) fueron positivas. La frecuencia fue: 80 por ciento virus sincicial respiratorio (VSR), 8 por ciento parainfluenza 1, 5 por ciento parainfluenza3, 2 por ciento adenovirus, 2 por ciento influenza A, 1 por ciento parainfluenza 2 y 1 por ciento influenza B. CONCLUSIONES. La frecuencia de virus respiratorios fue de 14 por ciento. El VSR se identificó asociado con más frecuencia, a neumonía y bronquiolitis en menores de 3 años.

OBJECTIVE. To describe the frequency of respiratory viruses and clinical characteristics in children with respiratory signs and symptoms in a tertiary care center in Mexico. MATERIAL AND METHODS. Patients with a clinical diagnosis of respiratory infection and a positive immunofluorescence result (Light Diagnostics) from January 2004 to October 2006 were included. RESULTS. From the 986 nashopharyngeal samples, 138 (14 percent) were positive by immunofluorescence. The frequency was: 80 percent RSV, 8 percent parainfluenza 1, 5 percent parainfluenza 3, 2 percent adenovirus, 2 percent influenza A, 1 percent parainfluenza 2 and 1 percent influenza B. CONCLUSIONS. Respiratory viruses were detected in 14 percent of samples tested. RSV was the most frequently identified virus and was associated with pneumonia and bronchiolitis in children younger than 3 years old.

Resistencia a linezolid en Staphylococcus aureus resistente a meticilina y enterococos con elevada resistencia a aminoglucósidos en un hospital pediátrico de tercer nivel / Resistance to linezolid in methicillin-resistant Staphylococcus aureus and Enterococcus with high-level resistance to aminoglycosides in a third-level pediatric hospital

Introducción: El surgimiento de resistencia a oxazolidinonas en Staphylococcus aureus resistentes a meticilina (SAMR) y Enterococcus spp con elevada resistencia a aminoglucósidos (EERA), aún cuando no han sido expuestos al antibiótico, es una de las principales razones para el control en el uso clínico de estos antibióticos. Métodos: Se estudiaron 95 cepas de SAMR y EERA, las cuales fueron aisladas de enero 2003 a diciembre 2007 en el Hospital Infantil de México Federico Gómez; se identificaron por pruebas convencionales. Se evaluó la susceptibilidad a diversos antimicrobianos incluyendo linezolid de acuerdo al Instituto de Estándares Clínicos y de Laboratorio (CLSI). Se comprobó la elevada resistencia a aminoglucósidos al amplificar los genes aac(6')-le, aph(2")-la y ant(6') en enterococos y el tipo de cásete cromosomal estafilocócico mee (SCCmec) asociado a la resistencia a meticilina en S. aureus, por técnicas moleculares previamente descritas. Resultados: Todas las cepas de SAMR mostraron el SCCmec tipo II. El 100% de los enterococos con fenotipo EERA mostraron genes asociados con los niveles elevados de resistencia a aminoglucósidos. El 12% (6/50) de EERA presentó valores intermedios a linezolid (concentración inhibitoria mínima (CIM) de 4 μg/mL) y sólo una cepa fue resistente (CIM 128 μg/mL); un aislamiento fue resistente a vancomicina fenotipo y genotipo van A, pero sensible a linezolid. El 2.2% (1/45) de los SAMR fue resistente a linezolid (CIM 8 μg/mL). Conclusión: Linezolid es una opción terapéutica de gran valor clínico. Sin embargo, son necesarios monitoreos continuos para conocer el riesgo de surgimiento de cepas resistentes y establecer lineamientos en el uso apropiado del antibiótico.

Background: The emergence of resistance to the oxazolidinones by methicillin-resistant Staphylococcus aureus (MRSA) and high-level aminoglycoside-resistant (HLRA) Enterococcus spp not exposed is one of the main reasons for control of the clinical use of these antibiotics. Methods: We studied 95 strains of MRSA and HLAR, which were isolated from January 2003 to December 2007 at the Hospital Infantil de México Federico Gómez. The strains were identified by conventional tests. Antimicrobial susceptibility was evaluated for several antimicrobial agents including linezolid according to the Clinical and Laboratory Standards Institute (CLSI). The high resistance to aminoglycosides was tested by amplification of genes aac (6')-/e, aph (2")-and ant (6') in enterococci. Staphylococcal cassette chromosomal mec (SCCmec) associated with MRSA was identified by molecular techniques described previously. Results: All MRSA strains showed SCCmec type II, and 100% of enterococci strains with phenotype HLAR showed genes associated with high-level aminoglycoside resistance; 12% of HLAR enterococci strains showed intermediate values to linezolid (MIC 4 μg/mL) and only one strain was resistant (MIC 128 μg/mL). Of the MRSA strains, 2.2% were resistant to linezolid (MIC 8 μg/mL). Conclusion: Linezolid is a clinically valuable option as a form of therapy. However, continuous surveillance is necessary to determine the emergent risk of resistance strains and to establish guidelines for appropriate use.

[Frequency of respiratory viruses and clinical characteristics in children attending a care center in Mexico City]. / Frecuencia de virus respiratorios y características clínicas de niños que acuden a un hospital en México.

OBJECTIVE: To describe the frequency of respiratory viruses and clinical characteristics in children with respiratory signs and symptoms in a tertiary care center in Mexico. MATERIAL AND METHODS: Patients with a clinical diagnosis of respiratory infection and a positive immunofluorescence result (Light Diagnostics) from January 2004 to October 2006 were included. RESULTS: From the 986 nashopharyngeal samples, 138 (14%) were positive by immunofluorescence. The frequency was: 80% RSV, 8% parainfluenza 1, 5% parainfluenza 3, 2% adenovirus, 2% influenza A, 1% parainfluenza 2 and 1% influenza B. CONCLUSIONS: Respiratory viruses were detected in 14% of samples tested. RSV was the most frequently identified virus and was associated with pneumonia and bronchiolitis in children younger than 3 years old.

[Confronting bioterrorism: Epidemiologic, clinical, and preventive aspects of smallpox]. / Enfrentando el bioterrorismo: aspectos epidemiológicos, clínicos y preventivos de la viruela.

The worldwide eradication of smallpox, a major achievement in public health, is currently threatened by the risk of bioterrorism. The debate on the destruction of the Variola virus in the two reference laboratories of the World Health Organization has dramatically switched to the preservation of the remaining virus after the September 2001 terrorist events in the U.S. along with the intentional release of Bacillus anthracis in the U.S. The risk of intentional release of Variola virus constitutes a minimal, yet possible risk. A smallpox epidemic could have a devastating impact due to its elevated morbidity and mortality that would inflict in non-immune human population, in addition to the ensuing panic and social unrest. Therefore, the development of national preparedness and response plans along with the availability of smallpox vaccine to be used in the post-exposure phase represent a fundamental part of the preventive efforts to cope with bioterrorism. Reestablishing a preventive vaccination program was recently recommended by the Advisory Committee on Immunization Practices (ACIP). However, the vaccine currently available has historically been associated with serious adverse reactions, even death. Thus, this recommendation has not been universally accepted. To counter an epidemic of smallpox, medical personnel in the frontline need to be prepared with updated smallpox information to identify, diagnose, isolate, and treat cases if a bioterrorist attack should occur. Herein we present an indepth review for health care personnel with relevant epidemiologic, clinical, and preventive information on smallpox.

Enfrentando el bioterrorismo: aspectos epidemiológicos, clínicos y preventivos de la viruela / Confronting bioterrorism: epidemiologic, clinical, and preventive aspects of smallpox

Uno de los grandes logros de la salud pública mundial, la erradicación de la viruela, puede verse mermado por el posible riesgo de bioterrorismo. El debate acerca de la destrucción de los restos del virus en los dos laboratorios de referencia de la Organización Mundial de la Salud ha cambiado diametralmente debido a los eventos terroristas y a la dispersión intencional de Bacillus anthracis ocurridos en poblaciones civiles en Estados Unidos de América en el año 2001. La liberación del virus Variola con fines terroristas constituye un riesgo mínimo no cuantificable, pero desafortunadamente real. El impacto podría ser devastador debido a la elevada morbimortalidad de la enfermedad aunada al pánico y a la desestabilización social que podría ocasionar. Es por ello que el establecimiento de un plan de respuesta, sumado a disponibilidad de vacuna para ser utilizada pos-exposición, es importante dentro de los planes de contingencia contra el bioterrorismo. El reiniciar un programa limitado de vacunación contra la viruela, como parte de dicho plan, ha sido recientemente recomendado por el Comité Asesor de Vacunación, del Centro para el Control de las Enfermedades, pero la vacuna disponible puede causar complicaciones graves e incluso la muerte, por lo que dicha recomendación no ha sido universalmente aceptada. No obstante, el personal médico y de salud pública requiere de información actualizada sobre la viruela y su prevención, ya que ellos son la primera línea de defensa en caso de un posible brote a consecuencia de un ataque bioterrorista. El presente artículo presenta una revisión dirigida a proporcionar al personal de salud un enfoque clínico, epidemiológico y preventivo sobre la viruela

[Severe acute respiratory syndrome: a global overview of the epidemic]. / Síndrome agudo respiratorio severo: un panorama mundial de la epidemia.

In early February 2003, the World Health Organization (WHO) began receiving reports of patients with a syndrome characterized by an atypical pneumonia with rapid progression to respiratory failure without an identified cause despite extensive diagnostic workups. Most of these reports pointed out that the outbreak started in Southern China, specifically in the Guandong Province. The initial outbreak in South East Asia has already spread to other Regions in Asia, Europe, North and South America, and South Africa. Many of these cases can be linked through chains of transmission to an index case from the Guandong Province who visited Hong Kong. Although the exact mode of transmission has not been clearly established, the etiology of this syndrome has already been identified. A novel Coronavirus has been identified by electron microscopy and molecular assays in multiple laboratories from respiratory specimens throughout the world. The syndrome has been defined as SARS (Severe Acute Respiratory Syndrome) by WHO, and is characterized by an incubation period between 1 and 10 days (average 5 days) and by a febrile phase that usually lasts approximately 3 days. During the respiratory phase that begins around day 3, patients start developing a dry cough, shortness of breath and hypoxemia. Mechanical ventilatory support is required in about 10 to 40% of cases and the case-fatality rate ranges between 3 and 16%. The laboratory findings in SARS cases include leukopenia, thrombocytopenia, and a rise in transaminases and lactic dehydrogenase levels. Treatment of SARS includes supportive measures and the empiric use of ribavirin. Respiratory isolation, use of respiratory masks, and compulsory hand hygiene constitute the principal preventive measures. The confirmation of a case can be performed at reference laboratories by serologic and molecular assays. From the onset of this epidemic Mexico established a surveillance system as well as clinical guidelines and recommendations for the identification, prevention of secondary spread, and medical management of suspicious and probable cases by health care personnel.

Síndrome agudo respiratorio severo: un panorama mundial de la epidemia / Severe acute respiratory syndrome: a global view of the epidemic

A principios de febrero de 2003 la Organización Mundial de la Salud comenzó a recibir reportes de pacientes con un síndrome caracterizado por neumonía atípica, con rápida progresión hacia insuficiencia respiratoria sin una causa identificada. Los casos aparentemente se iniciaron en el sur de China y se han diseminado a otras regiones en Asia, Europa, Sudáfrica, Norte América y Sur América. La causa de este síndrome es una nueva variedad de Coronavirus, aislado en secreciones respiratorias y en otras. El síndrome ha sido definido en inglés como SARS (Severe acute respiratory syndrome) por la Organización Mundial de la Salud y se caracteriza por un periodo de incubación de 1 a 10 días (promedio de cinco días), una fase febril prodrómica que aparece entre los días 1 a 3. Posteriormente, aparecen síntomas respiratorios como tos, disnea, y signos como hipoxemia, que en 10 a 40 por ciento de los casos requieren de ventilación mecánica. La tasa de letalidad ha variado de 3 por ciento hasta 16 por ciento. Los hallazgos de laboratorio incluyen trombocitopenia, leucopenia, elevación de creatinin-fosfokinasa, y, en ocasiones, de transaminasas hepáticas y deshidrogenasa láctica. El tratamiento incluye medidas de apoyo; la utilización empírica del antiviral ribavirina es controvertida, debido a que hasta el momento no existe un tratamiento específico. Se recomienda el aislamiento respiratorio de los pacientes, la utilización de máscaras protectoras y el lavado estricto de manos como principales medidas de prevención. Desde el inicio de esta epidemia México estableció un sistema de vigilancia, así como recomendaciones al personal de salud para la identificación, prevención de casos secundarios y manejo clínico de casos sospechosos

Infección por VIH en niños mexicanos / HIV infection in Mexican Children

Objetivo: dar a conocer la experiencia de la Clínica de Inmunodeficiencias del Hospital Infantil de México "Fedrerico Gómez" en la atención de niños con infección por VIH/SIDA. Se realizó un estudio retrospectivo de septiembre de 1985 a junio de 1994. Material y métodos: se revisaron los expedientes de 130 pacientes con diagnóstico de infección por VIH/SIDA, con información acerca de antecedentes epidemiológicos, manifestaciones clínicas, infecciones bacterianas y por oportunistas y cáncer secundario. El diagnóstico se estableció en todos los niños mayores de 18 meses de edad por pruebas de ELISA y Western Blot y en los menores de 18 meses por manifestaciones clínicas y/o cultivo viral por VIH o detección de antígeno p24 en dos determinaciones diferentes. Los criterios de diagnóstico para entidades específicas se apegan a los propuestos por los Centros para el Control de Enfermedades (CDC) de los Estados Unidos de América. Resultados: se encontraron 74 pacientes masculinos y 56 femeninos con relación 1.3:1. Mecanismos de transmisión; vertical 62.3 por ciento; transfusional 20.8 por ciento; hemofílicos 8.5 por ciento; vía sexual 6.2 por ciento; y desconocido 2.2 por ciento. Con respecto a factores de riesgo de los padres, se encontró que en 35 casos eran heterosexuales, 18 con antecedentes de transfusión y ocho bisexuales. De acuerdo a la clasificación de los CDC los niños se dividieron en: infección indeterminada (PO) 16, infección asintomática (PI) 9 e infección sintomática (P2) 105. Se encontraron hallazgos inespecíficos en 82 pacientes, manifestaciones neurológicas en 60, neumonitis intersticial linfoide en 18 y cáncer secundario en cuatro. Se documentaron 296 episodios de infección secundaria: 154 bacterianas, 58 por oportunistas y 84 por otros agentes patógenos. Conclusiones: la transmisión vertical adquiere cada vez mayor importancia, reflejando los cambios en la epidemiología de la infección en mujeres adultas. El conocimiento de las manifestaciones clínicas de estos pacientes permite orientar las tareas de diagnóstico y tratamiento

Objective: to review the experience of the Immunodeficiency Clinic of the Department of Infectious Diseases at Hospital Infantil de México "Federico Gomez", in the management of children with HIV infection and AIDS. Material and methods: the medical records of 130 patients with a clinical and laboratory diagnosis of HIV/AIDS seen between September 1985 and June 1994 were reviewed. Data was obtained regarding diagnosis, epidemiological risk factors, clinical features, types and numbers of bacterial and opportunistic infections, malignancies, hospitalizations, general and specific treatment and outcome. The diagnosis followed CDC guidelines and was established in all 130 patients serologically with ELISA and Western Blot. In infants < 18 months, diagnosis was made by detection of p24 and/or viral culture in two separate occasions. Results: Data from 130 subjects was obtained; 74 were male and 56 female for a M:F ratio of 1.3:1. With regards to mode of transmission, 62.3% was vertical, 20.8% post transfusion, 8.5% hemophiliacs (the latter two males were cases before occurred 1987), 6.2% sexual and 2.2% unknown. With regards to additional risk factors, in 35 cases the parents were heterosexual, in 18 one parent had a history of transfusion, and in eight the father was bisexual. According to the CDC classification; 16 had indeterminate infection or P0; nine were asymptomatic or P1; and 105 were symptomatic or P2. Eighty two patients had nonspecific findings, 60 had neurologic manifestations, 18 had lymphocytic interstitial pneumonia and four had secondary malignancies. It was possible to document 296 episodes of secondary infections: 154 bacterial, 58 opportunistic, and 84 with other pathogens. Conclusions: in Mexico, as in other Western countries, vertical transmission has become the dominant form of acquiring HIV infection in children, reflecting a change in the epidemiology of infection in women of child bearing age. Moreover, since IV drug use is a very limited phenomenon in Mexico, heterosexual transmission is the major form of transmission in women.

Susceptibilidad de cepas de Haemophilus influenzae no tipificable a laracarbef (LY163892) y antimicrobianos de uso común / The susceptibility of strains of non-typable H. influenzae a loracarbef(LY163892) or antimicrobials

La participación de cepas de Haemophilus influenzae no tipificable en infecciones de vías respiratorias superiores es frecuente. En las últimas dos décadas un aumento gradual de resistencia mediada por beta lactamasa de H. infuenzae no tipificable se ha observado. Nosotros evaluamos el patrón de susceptbilidad mediante la técnica de kirby.Bauer, de 150 cepas de H. influenzae no tipificable de niños portadores sanos a cuatro antibióticos de uso común y determinamos la producción de ß-lactamasa por la técnica de cefinasa. Encontramos que 129/150 (86 por ciento) fueron susceptibles y 17 (11 por ciento) resistentes a ampicilina; de estas 17, sólo 7 fueron productoras de ß-lactamasas. La susceptibilidad para cefaclor fue 140/150 (95 por ciento); para trimetroprim/sulfametoxazol 97 por ciento, y para loracarbef el 93 por ciento. En este estudio encontramos que la resistencia de H. influenzae no tipificable a ampicilina fue inferior a lo reportado en Estados Unidos y que de las cepas resistentes menos de la mitad fueron productoras de beta lactamasas. La actividad in vitro de loracarbef contra cepas de H. Influenzae no tipificable mostró ser similar a cefaclor pero inferior trimetropim/sulfametozaxol, aunque con la ventaja de tner adecuada cobertura contra estreptococos