Cristina O. Rodrigues

Pneumococcal meningitis: epidemiological profile pre- and post-introduction of the pneumococcal 10-valent conjugate vaccine

OBJECTIVES To evaluate the possible effects of the introduction of the pneumococcal conjugate 10-valent vaccine schedule in the state of Parana on pneumococcal meningitis cases and to assess the distribution of serotypes among cases. METHOD Cross-sectional study with retrospective data collection of cases of pneumococcal meningitis in the state of Paraná reported to Sistema de Informação de Agravos de Notificação (SINAN), from 1998 to 2011. A total of 1,339 cases of pneumococcal meningitis were analyzed; 1,205 cases from the pre-vaccine period (1998-2009) were compared to 134 cases from the post-vaccine period (2010-2011). Descriptive and comparative statistical analyses (chi-squared test and prevalence ratio) were performed using JMP 5.1.2 statistical software (JMP Statistical Discovery, North Carolina, USA) and EPI INFO 6 (Centers for Disease Control and Prevention, Georgia, EUA). RESULTS There was a significant reduction in the mean rates of incidence and mortality in the general population. The analysis of cases in the pre- and post-vaccination periods in the age groups covered by vaccination (younger than 2 years) showed significant reductions in incidence rates (6.01 cases/100,000 to 2.49 cases/100,000 individuals) and mortality (1.85 cases/100,000 population to 0.47 cases/100,000 population), while the mean lethality rate did not change significantly. There was a significant reduction in cases whose serotypes are included in the vaccine (80.7% to 53.3%). CONCLUSION Even after a short time of use, the 10-valent pneumococcal conjugate vaccine has already had a significant impact in reducing the incidence and mortality of meningitis cases among infants, as well as the reduction of cases whose serotypes are included in the vaccine.

Onychomycosis by Fusarium oxysporum probably acquired in utero

Fusarium oxysporum has been described as a pathogen causing onychomycosis, its incidence has been increasing in immunocompetent and disseminated infection can occur in immunosuppressed individuals. We describe the first case of congenital onychomycosis in a child caused by Fusarium oxysporum. The infection being acquired in utero was proven by molecular methods with the identification of the fungus both in the nail and placenta, most probably as an ascending contamination/infection in a HIV-positive, immunosuppressed mother.

Esquemas de tratamento da tuberculose na infância e eventos adversos relacionados

The World Health Organization (WHO) recommends an initial treatment regimen for tuberculosis in children that is comparable to that for adults, with directly monitored multiple-drug therapy for 6 months. Early initiation of treatment in younger children is essential due to the possibility of rapid dissemination of the disease, severe sequelae, and death. Children and adolescents usually tolerate antituberculosis drugs very well. This article aims to review the main therapeutic regimens, dosages, and adverse effects associated with first-line drugs used in treatment regimens for tuberculosis in children and to provide some practical recommendations for the follow-up of children and adolescents undergoing treatment. The article reviews current guidelines from the WHO and the Brazilian Ministry of Health as well as currently used therapeutic regimens and their main adverse effects. The reviewed literature states that at recommended doses, antituberculosis drugs are well tolerated by the pediatric population, and severe adverse effects are rare and mostly temporary. The frequency of toxic effects may be related to disease severity. Isoniazid is the most extensively studied drug and the most commonly used in children because it is also used in the treatment of latent tuberculosis. Liver toxicity is the primary described adverse effect. In most cases, when treatment is started adequately on time, it proceeds without severe adverse effects that require the therapy to be suspended. A high degree of suspicion is required to establish the diagnosis and consequently the adequate treatment, aiming for a long-term change in the course of the disease in children. Palavras-chave:1 Physician, Master’s Candidate in the Graduate Program in Child and Adolescent Health of the Sector of Health Sciences of the Federal University of Paraná (UFPR), Curitiba, Brazil. 2 Physician of the Service of Pediatric Infectology of the Clinics Hospital Complex of the Federal University of Paraná (CHC-UFPR), Curitiba, Brazil. 3 Professor of the Department of Medicine State University of Ponta Grossa, Brazil. 4 Professor of Department of Pediatrics of the Federal University of Paraná (UFPR), Curitiba, Brazil. 5 Professor of the Department of Clinical Medicine of the Federal University of Paraná (UFPR), Curitiba, Brazil.

Diagnóstico da tuberculose em crianças: qual o papel do hemograma e das provas de atividades inflamatórias?

It is known that childhood tuberculosis (TB) is a global public health problem, although the diagnosis and treatment of TB are neglected. Few cases are confirmed by laboratory tests because TB is paucibacillary in childhood. Therefore, clinical, epidemiological, radiological, and laboratory criteria are used for diagnostic confirmation. This study reviews the literature to determine the role of hemogram and tests of inflammatory markers in diagnosis. Few studies have addressed this subject and the most common findings in the hemogram are anemia of chronic disease (normochromic and normocytic) with a non-specific leukogram and platelet disorders. The most important factor in the clinical suspicion of TB may be the absence of leukocytosis, which is common in acute febrile respiratory illnesses. The levels of inflammatory markers are usually high, but some studies question the value of ESR for the diagnosis of TB. Future studies will help confirm the usefulness of other laboratory parameters in the screening and diagnosis of TB in children. Palavras-chave:

Análises perceptivo-auditiva e acústica das vozes de crianças infectadas pelo HIV

PURPOSE To compare vocal and acoustic parameters of HIV-infected children and non-HIV-infected children. METHODS Vocal samples were submitted to auditory-perceptual and acoustic analysis. Samples of the sustained vowel /ε/ and continuous speech of 74 children between 6 and incomplete 12 years old were analyzed, divided into two groups: 37 HIV-infected children (GHIV) and 37 non-HIV-infected children, the control group (CG), age and gender-matched and without previous vocal evaluation; they were all prepubescent by the Tanner Stages (MS, 2014). The children had their voices recorded and analyzed by VoxMetria 5.1, in the period between 2014 and 2015. The auditory-perceptual analysis assessed the overall degree of the vocal quality and was performed using a 100-point visual analogue scale, transformed into a 4 point numerical scale (0 = no vocal deviation and 4 = severe vocal deviation). The acoustic evaluation was based on the analysis of the vocal sample distribution in the Phonatory Deviation Diagram (PDD). The research was approved by the Ethics Committee under the number 122.746. RESULTS In the auditory-perceptual analysis, most children of both groups were evaluated as with no vocal deviation. No difference between the groups was found in the acoustic analysis using the PDD; most voice samples were within the normality area, in the quadrant 1, with a spread density distribution and a vertical shape. CONCLUSION HIV-infected children presented similar vocal quality to children without the illness, both for the perceptual-auditory and acoustic evaluation.

Aderência ao seguimento no cuidado ao recém-nascido exposto à sífilis e características associadas à interrupção do acompanhamento

Introduction All newborns exposed to syphilis in pregnancy must have outpatient follow-up. The interruption of this follow-up especially threatens those children who were not treated at birth. Objective To describe the clinical, epidemiological, and sociodemographic characteristics of pregnant women with syphilis and their newborns, and to investigate the factors associated with the discontinuation of the follow-up. Methods This is an observational, descriptive, analytical, and retrospective study of medical records of 254 children exposed to syphilis, who were assisted at the Congenital Infectious Clinic of the university hospital of the Universidade Federal do Paraná, between 2000 and 2010. The newborns were classified by reference according to their follow-up. Data were analyzed by means of the binary logistic regression model in order to identify the factors associated to drop out. Results The factors associated to the interruption of the follow-up were maternal age over 30 years, mothers with 3 or more children, and the absence of cross-infections by HIV and/or viral hepatitis. Conclusion Such findings demonstrate the need to identify these families and implement strategies to promote the establishment of bonds. A greater rigor to indicate the treatment of the disease at birth is recommended, as most of them do not properly follow up.