F. Baquero-Artigao

Diagnostico de la tuberculosis en la edad pediatrica

Tuberculosis is one of the most important health problems worldwide. There are an increasing number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration from highly endemic areas. Measures to optimise early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Paediatric Association (Spanish Society of Paediatric Infectology and Spanish Society of Paediatric Pneumology) have agreed this Consensus Document in order to homogenise diagnostic criteria in paediatric patients.

Diagnostico de la tuberculosis en la edad pediatrica. Documento de consenso de la Sociedad Espanola de Infectologia Pediatrica (SEIP) y la Sociedad Espanola de Neumologia Pediatrica (SENP)

Tuberculosis is one of the most important health problems worldwide. There are an increased number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration coming from high endemic areas. Measures to optimize early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Pediatric Association (Spanish Society of Pediatric Infectology and Spanish Society of Pediatric Pneumology) have agreed this Consensus Document in order to homogenize diagnostic criteria in pediatric patients.

Guía de la Sociedad Española de Infectología Pediátrica para el diagnóstico y tratamiento de la toxoplasmosis congénita

Congenital toxoplasmosis is the result of transplacental fetal infection by Toxoplasma gondii after the primary maternal infection. The severity of the disease depends on the gestational age at transmission. First trimester infections are more severe, but less frequent, than third trimester infections. Acute maternal infection is diagnosed by seroconversion or by the detection of IgM antibodies and a low IgG avidity test. In these cases, spiramycin should be initiated to prevent transmission to the fetus. For identification of fetal infection, polymerase chain reaction (PCR) testing of amniotic fluid after 18 weeks gestation should be performed. If fetal infection is confirmed, the mothers should be treated with pyrimethamine, sulfadiazine and folinic acid. Most infants infected in utero are born with no obvious signs of toxoplasmosis, but up to 80% developed learning and visual disabilities later in life. Neonatal diagnosis with IgM/IgA antibodies or blood/cerebrospinal fluid PCR may be difficult because false-negative results frequently occur. In these cases diagnosis is possible by demonstrating a rise in IgG titers during follow-up or by the detection of antibodies beyond one year of age. Early treatment with pyrimethamine and sulfadiazine may improve the ophthalmologic and neurological outcome. Congenital toxoplasmosis is a preventable disease. Pre-pregnancy screening and appropriate counseling regarding prevention measures in seronegative women may prevent fetal infection.

Pandemic H1N1 influenza-associated hospitalizations in children in Madrid, Spain.

Please cite this paper as: del Rosal et al. (2011) Pandemic H1N1 influenza‐associated hospitalizations in children in Madrid, Spain. Influenza and Other Respiratory Viruses 5(6), e544–e551.

Documento de consenso de la Sociedad Española de Infectología Pediátrica sobre la tuberculosis resistente a fármacos

Drug resistant tuberculosis (TB-R), and in particular, multidrug resistant tuberculosis (MDR-TB) is a global public health problem, as well as a problem in our country. Cases of TB-R and MDR-TB have increased mainly in HIV, immigrant and socially disadvantaged populations, but a notable increase in the general population has also been observed. This aspect reinforces the need for a systematic study of sensitivity of all the isolates in a reference laboratory to optimally guide the treatment. Children are especially vulnerable to this severe disease due to the limited knowledge of second line anti-tuberculous drugs, in terms of their pharmacokinetic data, optimal doses, or their long term toxicity, all this eventually resulting in the compassionate use of drugs. Another aspect which further complicates the management of R-TB in children is the limited yield of cultures, which frequently leads to clinician designing drug combinations according to the sensitivity of the initial strain. The epidemiological pattern in our country has currently changed. There is a reported increase in isoniazid-resistant strains; therefore, a four drugs regime is mandatory for the initial period in children, until reliable sensitivity results are available. Treatment should be directly observed or at least supervised by paediatricians. The management of latent infections or exposure to a resistant TB case also requires an accurate, strict and prolonged supervision by expert paediatricians. Authorities and health care professionals who deal with TB should be prepared to face this new phenomenon with appropriate measures. The knowledge of second line drugs for children, as well as mechanisms to ensure the therapeutic adherence and long term control of disease, are essential.

Incontinentia pigmenti. Manifestaciones iniciales y a largo plazo

We report two cases of incontinentia pigmenti diagnosed in the neonatal period. Both patients presented with disseminated vesicular lesions. Neither patient had extra-dermatological symptoms at diagnosis. The definitive diagnosis was established by cutaneous biopsy. In the initial phase of the disease, the lesions can be similar to those of herpes simplex infection, but characteristic distribution and clinical course allow the differential diagnosis to be established. This disease should be included in the differential diagnosis of vesicular rashes because early detection allows better management of the possible associated systemic manifestations.

Bacteriemia por Salmonella no typhi en niños: revisión de 11 años

OBJECTIVES: To review the clinical and bacteriological features of pediatric patients with non-typhi Salmonella (NTS) bacteremia. METHODS: We reviewed the medical records of children aged less than 14 years with culture-proven NTS bacteremia in the previous 11 years in a referral hospital in Madrid, Spain. RESULTS: A total of 29 cases of NTS bacteremia were diagnosed. Of these, 27 were used for study purposes. The mean age was 11.1 months (range: 3 days to 11 years); 48% were infants aged 39 C (85%), diarrhea (67%), and vomiting (37%). Seven patients had occult bacteremia. Three children (11 %) required intensive care management for severe sepsis. Five patients presented extraintestinal focal infections: arthritis in two, osteomyelitis in one, urinary tract infection in one, and pneumonia in one. None of the children had meningitis or died as a result of NTS infection. The most common serogroups isolated were Salmonella D9, and B4-5 (38% each). Eleven strains (38%) were resistant to amoxicillin and five (17%) were resistant to cotrimoxazole. Only one patient developed persistent bacteremia. All the children made a complete recovery without further complications. CONCLUSIONS: NTS bacteremia is an uncommon entity but it should be considered in infants and immunocompromised children. Although focal complications may occur, the usual outcome with appropriate antimicrobial treatment is a full recovery.

Parotiditis aguda neonatal por Streptococcus agalactiae

Presentamos 2 casos de parotiditis aguda neonatal por Streptococcus agalactiae. Ambos presentaron una tumefaccion aguda en la region parotidea en el contexto de un cuadro septico tardio, sin celulitis acompanante, ni supuracion por el conducto de Stenon. Ninguno de los casos tuvo meningitis acompanante, aislandose S. agalactiae en el hemocultivo. El diagnostico diferencial con el sindrome celulitis-adenitis se realizo por la clinica y las pruebas de imagen, que pusieron de manifiesto aumento del tamano de la glandula parotidea y de su vascularizacion. Los 2 ninos se trataron con cefotaxima durante 2 semanas con evolucion favorable. Aunque el agente etiologico mas frecuente de la parotiditis aguda bacteriana es Staphylococcus aureus, debemos incluir a S. agalactiae en el diagnostico diferencial, especialmente en el contexto de una sepsis neonatal tardia.

Bases para el uso clínico de fármacos para niños. Situación actual de uso de fármacos pediátricos en España

Antonio F. Medina-Clarosa,b, María José Mellado-Peñaa y Fernando Baquero-Artigaoc aServicio de Pediatría. Unidad de Pediatría Tropical. Hospital Carlos III. Madrid. España. Coordinadora en España de la Red de Excelencia Europea TEDDY (Task-Force in Europe for Drugs Development for the Young. EU.FP06: Life Sciences, Genomics and Biotechnology for the Health. Proyect Number: LSHB-CT-2005-005216). bServicio de Pediatría. Hospital Universitario San Cecilio. Granada. España cServicio de Pediatría. Unidad de Enfermedades Infecciosas. Hospital Infantil La Paz. Madrid. España. medinantonio1@gmail.com; mmellado.hciii@salud.madrid.org

Brote de 22 casos de sarampión autóctono en la zona norte de Madrid

After being virtually eradicated in Europe, thousands of cases of measles in the population of Spanish origin have appeared in the last 3 years. We describe the cases diagnosed in the north of Madrid between January and June 2011. A total of 22 cases are reported, 18 of them grouped in 2 outbreaks (2 nurseries). The primary attack rate was 29% in the main outbreak. All cases were in unvaccinated patients (median = 14 months). Genotype D4 was predominant (95%). There was a 45% complication rate and 45% were admitted to hospitals. The Public Health Service recommended isolating cases and vaccinating susceptible contacts in advance. Health Centres established a specific protocol to respond to suspected cases. The Measles vaccination has been brought forward from 15 to 12 months in Madrid. Measles is a re-emerging disease in Europe. The coordinated management between public health and health facilities is essential to limiting outbreaks.