Carmen arrañaga L

Casos fatales de infección por adenovirus

Sixteen fatal cases of adenovirus infection in infants (n:10 aged 1 to less than 12 months) and children (n:6 aged 1 to 3, 8/12 years) are reported. Diagnosis were confirmed by direct viral isolation, viral immunofluorescence or both in 15 patients, and by autopsy in 12 of them, including one without positive virological workup. Evidence of multisystemic compromise, particularly that of severe lower respiratory tract infection was observed and lead to death by acute respiratory failure in all cases. White blood cell counts and erythrocyte sedimentation rate did not help to label initially the etiology as either viral or bacterial. Chest roentgenograms showed pulmonary over-inflation and evidence of pneumonitis as well as extensive and rapidly progressive lung opacifications. Most prominent pathologic findings were necrotizing bronchitis, bronchiolitis and broncopneumonia. Several cells containing typical intranuclear inclusion bodies were documented in ten cases and pneumonitis was the only finding in two. Hepatic fat infiltration and lymphocitic depletion of thymus, spleen and lymphatic nodes occurred in all cases. The need of rapid diagnostic tools to avoid nosocomial spread of this kind of infections with such serious consequences is stressed.

Tratamiento selectivo de los episodios de neutropenia febril en niños con cáncer: Comité de Infectología, Programa Infantil Nacional de Drogas Antineoplásicas (PINDA)

El manejo de los pacientes pediatricos con cancer y neutropenia febril (NF) requiere de su clasificacion en alto o bajo riesgo de adquirir infecciones bacterianas invasoras (IBI), con el fin de implementar estrategias selectivas de tratamiento. Basados en nuestra experiencia y publicaciones internacionales al respecto, proponemos recomendaciones para el diagnostico y manejo de ninos con cancer y NF, categorizadas segun riesgo de IBI. Todos los pacientes pediatricos que presenten episodios de NF deben ser ingresados al hospital por al menos 24 horas. Durante este lapso se efectuara su evaluacion clinica y de laboratorio con el objeto de clasificar el riesgo de este episodio y precisar el (los) posible(s) foco(s). Los pacientes de alto riesgo deben continuar internados hasta su recuperacion. Los de bajo riesgo pueden ser manejados en forma ambulatoria. La eleccion de la terapia antimicrobiana inicial y los criterios para su ajuste deberan basarse en el hallazgo o no de focos infecciosos y en los patrones epidemiologicos e institucionales de susceptibilidad. La reevaluacion de ambos grupos debe ser periodica (al menos en los dias 3, 5 y 7 de evolucion), y la respuesta terapeutica sera clasificada como favorable o desfavorable segun criterios clinicos y parametros de laboratorio preestablecidos

Meningomielitis asociadas a infección por herpes virus humano 7. Comunicación de dos casos

and 75 mg protein per dl. Viral RNA detection was positive for HHV-7. The patient was managed with analgesia and rest and was discharged with the diagnosis of viral meningitis. Our comunication supports the notion that HHV-7 may be considered as pathogen factor in humans, even in immunocompetent ones. (Rev Med Chile 2011; 139: 1588-1591).

Mucormicosis en Pediatría

Resumen La mucormicosis es una infeccion infrecuentecausada por hongos oportunistas que pertenecen alorden Mucorales, familia Mucoraceae , cuyas carac-teristicas son invasion vascular por hifas, lo quedetermina trombosis e infartos. En general afectapacientes con enfermedades subyacentes y produ-ce infecciones severas invasoras y a menudo fulmi-nantes. Algunas condiciones de riesgo para con-traer la mucormicosis son: cetoacidosis diabetica,terapia inmunosupresora, leucemia y linfomas conneutropenia prolongada. Se describen varias pre-sentaciones clinicas, segun su localizacion anatomi-ca, siendo la forma rinocerebral la mas frecuente,especialmente en pacientes diabeticos. Aunque estainfeccion tiene una alta morbimortalidad, su pronos-tico ha mejorado los ultimos anos, en base a medidasterapeuticas como la oportuna correccion de losfactores predisponentes, uso de anfotericina B yuna cirugia precoz y agresiva. Es muy importantesospechar esta infeccion en pacientes con factorespredisponentes de manera de hacer un diagnosticoprecoz.

Virus respiratorios en lactantes con infecciones respiratorias alias y bajas

Detection of respiratory sincitial virus, adenovirus and influenza A and B virus was carried out in ambulatoryand hospitalized patients younger than two years old Two nasopharyngeal aspirates were obtained from 165 am-bulatory infants presenting acute upper or mild lower respiratory tract infections and from 361 infants hospitalizedfor severe acute lower respiratory tract infections, from june throughout november 1991. Indirect monoclonalimmunofluorescent assay was used for specific diagnosis. Epidemics of respiratory sincitial and influenza A virusinfections were respectively demonstrated along winter and spring. Distribution of viral detections was similaramong outpatients with either upper or lower respiratory symptoms; positive results were obtained in 36% and34% of ambulatory and hospitalized children respectively. Viral antigens were not found among a healthy controlgroup. Both ambJlatory and hospitalized children populations could be successfuly used for epidemiological sur-veillance of respiratory viral infections , but the latter offer advantages in sample collection.(Key words: Virus, respiratory tract infections , irnrnunofluorescence, indirect.}

Patología digestiva en niños infectados con el virus de inmunodeficiencia humana (VIH), en Santiago de Chile

Background: Human immunodeficiency virus (HIV) epidemiology has changed, affecting an increasing number of children. As in adults, the disease predominantly affects the digestive and respiratory systems. Aim: To report the gastrointestinal problems in HIV infected pediatric patients. Patients and methods: Twenty four HIV infected children (nine male, aged 1 to 12 years old, followed for 1 to 170 months), are reported. This group has been under care by a multiprofessional team. Results: Oral candidiasis was present in 21 (88%), esophagic candidiasis in 3 (13%), oral ulcers in 4 (17%). Diarrhea was observed in 18 children (75%) and in eight, it had a chronic evolution. Cryptosporidium parvum was the most frequent agent found in six cases (1 with acute and 5 with chronic diarrhea). Schlerosing cholangiopathy was observed in one case, with a fatal outcome, in association to microsporidiosis. Upper endoscopy was done in 11 patients, demonstrating microscopic inflammatory changes in esophagic, gastric and duodenal epithelia in all. Conclusions: Digestive problems are common in HIV infected pediatric patients. They must be always sought actively. Endoscopy is a valuable tool for the early diagnosis of these problems (Rev Med Chile 2003; 131: 19-24)

Patrones de sensibilidad in vitro y comportamiento clínico de Shigella

Shigella is an important cause of diarrhea in children, with an increasing prevalence of antibiotic resistance during the past years making the choice of an empiric therapy in dysentery difficult. Between 1997 and 1999, 163 isolated Shigella strains were studied in vitro for susceptibility to antibiotics. S. sonnei represented 63% of the isolated strains. Antimicrobial resistance patterns have increased, specially for commonly used antimicrobials. The strains studied were 95% resistant to ampicillin, 84% to chloramphenicol, 43.6% to cotrimoxazole and 3.7% to furazolidone. There was no resistance to ciprofloxacin. Fifty seven children with shigellosis were admited into the hospital, 82.5% of them were older than two years. All the patients were feverish, 56% had dysentery and 8.8% had seizures. Six patient with a torpid evolution and therapeutic failure received ciprofloxacin with eventual clinical success. Ciprofloxacin represents an effective alternative empiric therapy in children with dysenteric diarrhea, which should be evaluated. The need of surveying the local prevalence of antimicrobial resistance to guide therapy in shigellosis is emphasized

Encefalitis herpética neonatal: Caso clínico y revisión del tema

Se presenta a un recien nacido con una encefalitis por herpes virus 1 (HSV-1) adquirida in utero, que se recupero sin secuelas. El tratamiento precoz con Aciclovir se inicio el primer dia de vida, basandose solo en los antecedentes clinicos. La confirmacion diagnostica se tuvo con la reaccion en cadena de la polimerasa (PCR) del liquido cefalorraquideo, cuyo resultado se consiguio a las 48 horas de vida. Se destaca la importancia de la determinacion precoz de la PCR para precisar el diagnostico y la necesidad de controles seriados para asegurarse que esta prueba se vuelva negativa, hecho que indica que ya no hay replicacion del DNA viral. Se comentan las deficiencias de otras tecnicas de laboratorio como el cultivo o las reacciones serologicas que tienen un rendimiento mas bajo o salen positivas mas tardiamente. Se senalan, tambien, las limitaciones de la PCR, en el sentido de que pueden haber tanto falsos negativos, como positivos. Se subraya como hecho interesante que el agente haya sido el HSV-1, siendo que el 90% de las infecciones prenatales son por HSV-2. Se comenta el claro tropismo del HSV-1 por el lobulo temporal, que se puso en evidencia por una actividad electroencefalografica irritativa mientras existio replicacion viral en el LCR

Infección congénita por virus Herpes simples

Prenatal herpes simplex virus infection Five cases of probably intrauterine herpesvirus infection are discussed. Four of them had clinical evidence of neonatal herpes, which was diseminated in two patients, localized to skin in one case and w;th SNC compromised in other. Natal or post natal infections we^e not considered to be possible in these infants due to the presence of symptoms in the first 24 hours of life, which made ascending transcervicat or transplacenta l the most probable route for viral transmission. All cases were treatec with a ten days course of intravenous acyclovir during 10 days. There of them had satisfactory evolution and the other two died at 9 days and at 2 months of life.

Enfermedad por citomegalovirus en niños chilenos infectados por el virus de la inmunodeficiencia humana-1

Resumen Citomegalovirus (CMV) es una infeccion oportu-nista frecuente en ninos infectados con el virus de lainmunodeficiencia humana tipo 1 (VIH 1) y producealtas tasas de morbilidad y mortalidad. El objetivo deeste estudio fue determinar la frecuencia y trascenden-cia de la enfermedad por CMV en la cohorte de ninoschilenos infectados con VIH-1. Se encontro enferme-dad por CMV en 28 de 222 ninos infectados con VIH-1(12,6%); 92% fue clasificado en etapa C y 61% encategoria 3 (CDC 1994). La enfermedad pulmonar fue lamanifestacion mas comun (25). Las muestras clinicasse obtuvieron de tracto respiratorio, sangre, orina ybiopsia. Para la deteccion de CMV se utilizo, preferen-temente, el cultivo acelerado ( shell vial ), (20/28). To-dos fueron tratados con ganciclovir ev. El tiempo pro-medio de sobrevida fue 42 meses hasta el momento deesta evaluacion. Conclusion: La enfermedad por CMVcauso morbilidad y mortalidad en los ninos chilenosinfectados por VIH-1. El diagnostico y tratamientoprecoces son la base para un resultado exitoso.