[Candida endocarditis in the first year of life]. / Endocarditis por Candida en el primer año de vida.

Candida is an increasing problem as a causal agent of nosocomial infection in neonates and infants. We report 15 cases of infective endocarditis caused by Candida spp treated at the Hospital Infantil de Mexico between 1980 and 1991. The diagnosis of endocarditis was established by the identification of Candida in at least two blood cultures and echocardiographic assessment. From 110 cases of systemic candidiasis during the eleven years period of study, fifteen patients presented endocarditis (13.6%), all had a central venous catheter. Three had antecedent of congenital heart disease. Candida isolation was obtained an average of 28 days after admission. The major clinical findings were: fever in 13 patients, respiratory distress and cardiac murmurs observed in nine respectively. Thrombocytopenia was present in eight children. The echocardiographic evaluation showed vegetations located in the superior vena cava in six, right atrium in five, tricuspid valve in two, inferior vena cava and right ventricle in one respectively. Three cases were subjected to surgical treatment. Nine patients died for a case fatality rate of 60%. The echocardiographic evaluation practiced in all patients with suspicion of systemic candidiasis is critical for the prognosis. The identification of endocardiac involvement coupled with the opportune administration of antifungal therapy and surgical treatment may improved the survival.

[Neurologic manifestations in pediatric patients with AIDS]. / Manifestaciones neurológicas en pacientes pediátricos con síndrome de inmunodeficiencia adquirida.

Since the first cases of childhood AIDS were reported, the neurological involvement has been more frequently recognized. Several motor, intellectual and conductual changes as well as unexplained abnormalities have been described due to CNS infections. Findings have shown HIV to affect the CNS although it is unknown as to when the viral invasion actually occurs. This report describes the neurological manifestations found in pediatric patients with HIV infection at the Hospital Infantil de Mexico and their correlations with CT scans, EEGs, auditory evoked potentials, I.Q.s and postmortem findings. The medical records of 60 symptomatic HIV infected children, stages P0 to P2, are reviewed. Neurological abnormalities were found in 51 patients, 20 of which (39.2%) were due to perinatal infection with symptoms starting, on the average at 11 months 7 days (from the initial contact) taking into consideration in utero exposure. Nine cases (17.6%) were patients infected through transfusions with symptoms appearing on the average at 24 months 8 days; 2 cases (3.9%) were of unknown origin. The CT scans, EEGs and psychometric evaluations of the HIV infected patients correlated well with the clinical findings.

[Bacterial infections in children with AIDS]. / Infecciones bacterianas en niños con síndrome de inmunodeficiencia adquirida.

The importance of bacterial infections in children with AIDS was emphasized when they were included within the CDC classification system for children under 13 years of age infected with the HIV. The information available in Mexico on frequency, types of infections and causative agents is scarce. In this study, the frequency and microbiology of bacterial infections in children with AIDS seen at the Hospital Infantil de Mexico Federico Gomez is reported. From September 1985 to December 1991, we found 72 HIV infected children, 6 were classified P0, 6 as asymptomatic (P1) and 60 as symptomatic infections (P2). From this last group, 50 were secondarily infected with bacteria; there was a total of 129 episodes of bacterial infections, averaging 2.5 episodes per patient. Respiratory infections were the most frequent (74.41%), followed by septicemia (10.07%), skin and underlying tissue infections (6.96%) and urinary tract infections (6.17%). Infections of the CNS and deep abscesses were less frequent. Overall mortality rate was 76%, however only in 18 children (36%) was it directly attributed to the bacterial infections. Etiology was documented in 46 episodes (33.65%) of which 30 (65.31%) were gram-negative bacteria and 16 (34.78%) were gram-positive. The best possible methodology must be used for the etiologic diagnosis of bacterial infections in children with AIDS in order to select the most appropriate treatment for severe or recurrent bacterial infections.

[Nephrotic syndrome associated with AIDS in children]. / Síndrome nefrótico asociado al síndrome de inmunodeficiencia adquirida en niños.

Several renal and renal-related disturbances have been described in patients with AIDS (acquired immune deficiency syndrome), in adults and children as well. These are mainly electrolyte and acid-base imbalance, acute renal failure and nephrotic syndrome. The latter is usually steroid non-responder. The renal histopathological lesions described more commonly are minimal change, mesangial hyperplasia and focal segmental glomerulosclerosis. Herein, we describe a 5 year-old with AIDS, that developed nephrotic syndrome, characterized by edema, ascites, hypoalbuminemia and massive proteinuria. A percutaneous renal biopsy showed mesangial proliferation. She did not respond to a 6 week treatment with prednisone. She died with sepsis after several viral and bacterial infections.