Ana Méndez-Echevarría

Oseltamivir treatment for influenza in hospitalized children without underlying diseases.

Aim: To determine whether the treatment with oseltamivir improves the outcome of children with confirmed influenza infection and no other underlying disease. Methods: Multicentric, retrospective study performed in 10 hospitals of Madrid between September 2010 and June 2012. All children admitted to the hospitals with confirmed influenza infections were eligible. Children with risk factors for serious disease and nosocomial influenza infections were excluded. Asthma was not considered an exclusion factor. The study compared patients treated and untreated with oseltamivir. Fever duration, oxygen support, antibiotics administration, length of hospital stay, intensive care admission and bacterial complications were analyzed. To compare variables, &khgr;2 test, Fisher exact test, ANOVA or Mann-Whitney U test were used. Results: Two hundred eighty-seven children were included and 93 of them were treated with oseltamivir (32%). There were no significant differences between treated and untreated patients in days of fever after admission (1.7u2009±u20092; 2.1u2009±u20092.9, P > 0.05), length of stay (5.2u2009±u20093.6; 5.5u2009±u20093.4, P > 0.05), days of hypoxia (1.6u2009±u20092.3; 2.1u2009±u20092.9, P > 0.05), diagnosis of bacterial pneumonia (10%; 17%, P > 0.05), intensive care admission (6.5%; 1.5%,P > 0.05) or antibiotic prescription (44%; 51%, P > 0.05). There were no differences when the population was stratified by age (below or over 1 year) or by the presence or absence of asthma. Conclusions: There were no proven benefits of treatment with oseltamivir in hospitalized pediatric patients without the underlying diseases or risk factors for developing a serious illness, including those with asthma.

Acute Lung Toxicity After Intralesional Bleomycin Sclerotherapy

In this article, we report the second case of lung toxicity observed after bleomycin intralesional administration, and the one reported after the lowest dose of the drug to date. Bleomycin has progressively been used to treat low-flow vascular malformations in children. No significant systemic side effects have been reported in large series after low doses, but some authors are still concerned about its use. We report a case of a severe acute lung toxicity after a low dose of a second bleomycin intralesional injection in a 5-year-old girl. She had no risk factors and presented a cervical low-flow venous malformation. Twenty-four hours after this second administration, she presented with fever and respiratory distress. A chest radiograph showed bilateral opacities and computerized tomography revealed extensive and diffuse lung ground-glass opacities. The patient started to receive intravenous methylprednisolone, but she experienced progressively increased dyspnea, and montelukast was added. She improved and was discharged from the hospital without oxygen support, with montelukast and prednisolone for tapering doses during months. Five months after onset, the patient is developing well, is active, and walks and talks without dyspnea. A new low-dose computed tomography shows improvement in radiologic findings. This is the second case of pulmonary toxicity observed in a child after bleomycin intralesional administration, and the first reported after the lowest dose of this drug to date (7 mg: 0.28 mg/kg; 10 U: 0.4 U/kg). A delay in the diagnosis and treatment of this complication can be fatal. Any physician who treats these patients must be alert and consider this complication in children with respiratory symptoms after bleomycin sclerotherapy. Early detection of pulmonary toxicity would allow prompt therapy and could avoid pulmonary damage.

Escolar con fiebre, inflamación parotídea, otorrea y fístula retroauricular

A 5-year-old child with agenesis of the external ear canal and deformity of the left ossicular chain, was brought to the emergency department due to fever, left jaw stiffness, preauricular pain and trismus starting 24 h prior. Left preauricular and left parotid inflammation were found on examination, with no otorrhoea observed in the external ear canal, which ended in a cul-de-sac. Blood tests showed leukocytosis at 15,900/mm3 with 53% neutrophils, C-reactive protein (CRP) at 175 mg/L and normal amylase. The ultrasound showed parotid gland inflammation with no collections. Given the suspicion of acute parotitis, it was decided to admit the patient with intravenous amoxicillin–clavulanic acid. After 4 days of treatment, the patient improved clinically, remained afebrile and the blood tests normalised. The patient was discharged with oral amoxicillin–clavulanic acid for 10 days. Five days after being discharged, while still under treatment with antibiotics, the patient was seen due to a recurrence of the inflammatory signs in the left parotid region and abundant purulent otorrhoea. A new left retroauricular skin fistula was observed (Fig. 1). A CT scan was performed which showed an extensive left parotid abscess, middle and external ear occupation by purulent material and a fistula communicating between the parotid abscess and the retroauricular skin (Fig. 2). A blood culture and a sample of the ear discharge were taken, and it was decided to admit the patient.

Septic pulmonary emboli detected by 18 F-FDG PET/CT in children with S. aureus catheter-related bacteremia

PurposeThe role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) in the diagnosis of metastatic infectious foci in children with catheter-related blood stream infection has been hardly studied, although some authors have reported it benefit in the screening of metastatic foci in adult population. Septic pulmonary emboli are among the most difficult to identify, because many cases do not present pulmonary complaints or abnormal chest radiography. However, diagnosis of these foci has important therapeutic consequences. The purpose of this article is to describe the role of 18F-FDG PET/CT in the diagnosis of septic pulmonary embolism in children with S. aureus catheter-related bacteremia.MethodsWe report 3 children with S. aureus catheter-related bacteremia and normal chest X-ray at admission, in whom 18F-FDG PET/CT led to the diagnosis of unsuspected septic pulmonary emboli, with an impact on clinical management.ResultsAll patients had hemophilia and implantable venous access ports and presented with fever and normal lung auscultation. Only 1 reported non-specific symptoms (undifferentiated left chest pain). All patients had normal chest X-ray on admission. Catheters were removed within 48 h after admission in 2 cases, and 5 days after admission in the last case, subsiding fever. In 2 children, paired blood cultures were not able to identify bacteremia. However, in all cases catheter tip and subcutaneous port cultures yielded S. aureus and PET/CT detected unsuspected pulmonary metastatic emboli.Conclusions18F-FDG PET/CT should be considered as a useful tool to diagnose septic pulmonary embolism in S. aureus catheter-related bacteremia, especially if conventional diagnostic imaging techniques have failed to reveal possible metastatic foci. Further studies are needed to clarify the usefulness of PET/CT performance in children with CRBSI.

Difficulties in establishing the source of infection in recurrent neonatal group B streptococcal disease

Recurrent episodes of GBS invasive infections occurred 2, 10, and 50 days after completion of antibiotic therapy. The premature infant recurred 2 days after completion antibiotic therapy and the infant with early onset disease 50 days after completion antibiotic therapy. All patients had sepsis, one of them with meningitis. At the time of recurrence, rectovaginal and throat swabs cultures were positive for GBS in one mother with negative antenatal screening and in her infant’s throat swab culture. Mother’s rectovaginal culture and infant’s and parent’s throat swab cultures from the other two cases were negative, including the preterm case. Breast milk cultures were sterile in all cases. Complete physical examination, cerebral, cardiac and hip ultrasounds, and bone scan did not reveal occult bacterial foci in any case. Penicillin tolerance in GBS strains (from both the first episode and the recurrence) were studied in two cases, observing very low minimal inhibitory and bactericidal concentration (≤0, 25 mcg/ml for penicillin). The three infants were treated with intravenous ampicillin and recovered uneventfully without further relapses. Pathogenesis of recurrent GBS disease is poorly understood [2], and in many infants, the source of reinfection cannot be determined [2]. Matsubara et al. discussed in their article how prematurity could be a risk for recurrence and they suggested that human milk could serve as a source of repeated infant exposures [1, 3]. Prematurity has been reported as an important risk factor for recurrent GBS infection [2, 4]. The use of broad-spectrum antibiotics in GBS colonized premature newborns and the presence of reduced baseline levels of immunoglobulins may likely contribute to intestinal translocation [4]. In Matsubara et al. report, infants with late-onset disease were more likely to be premature [1]. However, analyzing the article data, there are no statistically significant differences between the prematurity rate observed in all GBS infections (27%; We have read with interest the article by Matsubara et al. describing the epidemiology of group B Streptococcus (GBS) disease in infants in Japan [1]. The authors reported 12 GBS recurrent infections, which is the largest series ever reported. We have recently performed a retrospective review of medical records of infants less than 3 months with GBS invasive disease who developed a recurrent infection during a 15-year period (2000–2014). During the study period, 117 GBS neonatal infections were diagnosed in our hospital (53 early onset and 64 late-onset diseases), three of which relapsed. This represents an incidence of recurrent infection of 2.6%, which is similar to that reported by Matsubara et al. and by other authors [1, 2]. Infants with recurrent invasive GBS infection had been born by vaginal delivery without prolonged rupture of membranes. Two of them were full term and one was preterm (born at 31 weeks of gestation). Antenatal rectovaginal cultures were negative in two cases and were not performed in the premature newborn. All infants were breastfed, with no history of mastitis in their mothers. First episodes of GBS invasive infections occurred as late-onset sepsis without meningitis in two infants (at the age of 12 and 23 days) and early onset sepsis in one (during the first day of life). The premature infant developed the disease at the age of 23 days. All patients were treated with intravenous ampicillin (200 mg/kg) for 10 days.

Epidemiological factors related to hospitalization due to influenza in children below 6 months of age

AbstractThe aim of this study was to address the epidemiological factors associated to hospital admissions due to influenza in infants younger than 6xa0months. A case-control study was performed in a tertiary hospital in Spain. Cases were infants under 6xa0months of age without comorbidities who were admitted due to influenza between October 2010 and March 2015. Controls were healthy infants younger than 6xa0months who were hospitalized due to non-respiratory illness or non-infectious diseases (urinary tract infection was included as controls). Data were retrospectively collected from medical records and phone interviews. A total of 88 cases and 122 controls we included. From univariate analysis, differences were found in relation to maternal age (43.1xa0±xa04.95 vs 32xa0±xa05.3), paternal age (37xa0±xa06.4 vs 34.5xa0±xa06.1), having siblings (79 vs 24%), siblings below 4xa0years old (54 vs 15%), and having vaccinated grandparents (18 vs 39%) (pxa0<xa00.05). After logistic regression, having vaccinated grandparents was an independent protective factor (OR 0.22 [CI95%; 0.05–0.91]), while having siblings was a risk factor (OR 15.8 [CI95% 3.15–79.5]). Vaccination during pregnancy was highly uncommon (3.5 vs 8.3%; pxa0=xa00.3).n Conclusion: This study underlines the importance of increasing influenza immunization among household contacts of infants below 6xa0months to prevent their influenza admission.What is Known:• Infants younger than 6xa0months old are considered a high-risk population.• Vaccination against influenza is not licensed in infants below 6xa0months.What is New:• Increasing vaccination coverage in elderly people could reduce infants’ hospitalization rates.• Cocoon immunization strategy may reduce the admission of infants.

Características de la rotación en Atención Primaria de los residentes de Pediatría

Objetivo: determinar si en la Comunidad de Madrid (CM) la formacion en Atencion Primaria (AP) del medico interno residente (MIR) de Pediatria se adecua a lo establecido en la Orden Ministerial SCO 3148/2006: rotacion obligatoria y duracion minima de tres meses, siendo aconsejable su distribucion en dos periodos (R1-R2 y R3- R4). nMaterial y metodos: se realiza una encuesta telefonica o por correo electronico, cumplimentada por un MIR de Pediatria y supervisada por un medico adjunto tutor de residentes. Se incluyen todos los hospitales de la CM con formacion acreditada en dicha especialidad. nResultados: en la CM existen 19 hospitales con formacion MIR en Pediatria, siendo en todos ellos la rotacion por AP obligatoria. En un 58% (11/19) de ellos la duracion es de tres meses, siendo inferior en el resto. En un 42% (8/19) de los casos la rotacion se divide en dos periodos, aunque solo en cuatro centros segun lo recomendado en la Orden Ministerial. nConclusiones: solo uno de cada cinco hospitales de la CM presenta una formacion en AP de acuerdo a lo que aconseja la Orden Ministerial.