COVID-19, rinovirus y asma... ¿Una mala combinación? / COVID-19, rhinovirus and asthma... a bad conmbination?

La pandemia de COVID-19 enfrentó a la humanidad a un gran desafío y hemos ido aprendiendo a medida que avanzó. La aparición de este virus, su comportamiento por si solo y en conjunto con los otros virus nos mantuvo alerta.. Los pacientes pediátricos asmáticos, a pesar de lo que se pensó en un principio, son menos afectados y hacen un cuadro clínico más leve. Objetivo: presentar un caso clínico de un paciente asmático, con una evolución tortuosa por co-infección SARS-CoV-2 y Rinovirus (RV) y revisión de la litaratura. Se trata de un escolar de 6 años, asmático con mal control, con 2 dosis de vacuna anti SARS-CoV-2, que presento un estado asmático por rinovirus y posterior evolución con neumonía grave por SARS-CoV-2, requiriendo ventilación mecánica invasiva y estadía en UCI Pediátrica. Es probable que la gravedad del caso presentado se deba al mal control del asma antes de la infección, ya que se ha visto que los niños asmáticos alérgicos presentan un factor protector para infección grave por SARS-CoV-2, lo cual esta supeditado a un buen control de su enfermedad basal.

The COVID-19 pandemic presented a great challenge and we have been learning as it has progressed. The appearance of this virus, its behavior by itself and in conjunction with the other viruses kept us alert. Pediatric asthmatic patients, despite what was initially thought, are less affected and present a milder clinical picture. Objective: to present a clinical case of an asthmatic patient, with a tortuous evolution due to SARS-CoV-2 and Rhinovirus (RV) co-infection and a literature review. This is a 6-year-old schoolboy, asthmatic with poor control, with 2 doses of the SARS-CoV-2 vaccine, who presents asthmatic status due to rhinovirus and subsequent evolution with severe pneumonia due to SARS-CoV-2, requiring invasive mechanical ventilation and stay in Pediatric ICU. It is likely that the severity of the case presented is due to poor asthma control before infection, since it has been seen that allergic asthmatic children present a protective factor for severe infection by SARS-CoV-2, which is subject to good control of his basal disease.

Virus más frecuentemente aislados en la exacerbación de asma y su correlación con nivelesde eosinófilos e inmunoglobulina E sérica total / Most commonly isolated viruses in asthma exacerbation and their correlation with eosinophil and total serum immunoglobulin E levels

Antecedentes. Las exacerbaciones de asma continúan siendo una causa de hospitalización en el Servicio de Urgencias. Los desencadenantesson alérgenos e infecciones, principalmente, de tipo viral. El objetivo fue determinar la relación entre los virus detectados durante la exacerbación asmática y los niveles de eosinófilos e inmunoglobulina E (IgE) sérica en pacientes pediátricos. Población y métodos. Estudio transversal analítico. Se incluyeron niños de cinco a quince años atendidos en Urgencias de Pediatría con exacerbación de asma, en el período de marzo de 2013 a febrero de 2016. Se obtuvo ácido ribonucleico viral en el aspirado nasofaríngeo con el kit CLART PneumoVir. Se cuantificaron los eosinófilos en la sangre periférica y los niveles de IgE sérica total. Se consideró eosinofilia un conteo ≥ 0,4 x 103/mm3 e IgE elevada, ≥ 350 UI/L. Se realizó la correlación de Pearson. Se definió significancia con valor de p ≤ 0,05.Resultados. De 211 niños con exacerbación de asma, en el 20%, se aisló un virus. Los virus aislados más frecuentemente fueron el rinovirus, el enterovirus y el virus sincitial respiratorio. Se encontró una correlación entre los niveles de eosinófilos e IgE sérica total en los niños con exacerbación de asma y rinovirus de 0,89, con una p= 0,0001.Conclusiones. Las infecciones por rinovirus, enterovirus y virus sincitial respiratorio son más frecuentes en las exacerbaciones de asma en menores de 15 años. Se observó una correlación entre los niveles de eosinófilos e IgE en presencia de rinovirus.

Background. Asthma exacerbations are still a cause of hospitalization at the Emergency Department. The triggers of asthma exacerbations include allergens and infections ­mostly viral­. The objective of this study was to establish the relationship between viruses detected during an asthma exacerbation and eosinophil and serum immunoglobulin E (IgE) levels in pediatric patients. Population and methods. Cross-sectional. analytical study. Children aged 5-15 years seen at the Pediatric Emergency Department with an asthma exacerbation in the period between March 2013 and February 2016 were included. Viral ribonucleic acid was extracted from nasopharyngeal aspirates using the CLART Pneumo Vir kit. Eosinophil levels were measured in peripheral blood and total IgE levels, in serum. Eosinophilia was defined as a count ≥ 0.4 x 103/mm3 and high IgE. as a level ≥ 350 IU/L. The Pearson's correlation was carried out. A value of p ≤ 0.05 was considered significant.Results. Out of 211 children with asthma exacerbation, a virus was isolated in 20%. The most commonly isolated viruses were rhinovirus. enterovirus, and respiratory syncytial virus. A correlation of 0.89 was established between eosinophil and total serum IgE levels in children with asthma exacerbation and rhinovirus, with a p value of 0.0001. Conclusions. Rhinovirus, enterovirus, and respiratory syncytial virus were the most common viruses in asthma exacerbations in children younger than 15 years. A correlation was established between eosinophil and IgE levels in the presence of rhinovirus.

Impact and seasonality of human rhinovirus infection in hospitalized patients for two consecutive years / Impacto e sazonalidade da infecção por rinovírus humano em pacientes internados por dois anos consecutivos

Abstract Objectives: To report epidemiological features, clinical characteristics, and outcomes of human rhinovirus (HRV) infections in comparison with other community acquired respiratory virus (CRV) infections in patients hospitalized for two consecutive years. Methods: This was a cross-sectional study. Clinical, epidemiological, and laboratory data of patients hospitalized with acute respiratory syndrome in a tertiary care hospital from 2012 to 2013 were reviewed. Results: HRV was the most common CRV observed (36%, 162/444) and was present in the majority of viral co-detections (69%, 88/128), mainly in association with human enterovirus (45%). Most HRV-infected patients were younger than 2 years (57%). Overall, patients infected with HRV had a lower frequency of severe acute respiratory infection than those infected with other CRVs (60% and 84%, respectively, p = 0.006), but had more comorbidities (40% and 27%, respectively; p = 0.043). However, in the adjusted analysis this association was not significant. The mortality rate within the HRV group was 3%. Detection of HRV was more prevalent during autumn and winter, with a moderately negative correlation between viral infection frequency and temperature (r = −0.636, p < 0.001) but no correlation with rainfall (r = −0.036, p = 0.866). Conclusion: HRV is usually detected in hospitalized children with respiratory infections and is often present in viral co-detections. Comorbidities are closely associated with HRV infections. These infections show seasonal variation, with predominance during colder seasons.

Resumo Objetivos: Relatar as características epidemiológicas, as características clínicas e os resultados das infecções por rinovírus humano (RVH) em comparação a outras infecções por vírus respiratórios adquiridos na comunidade (VRCs) em pacientes internados por dois anos consecutivos. Métodos: Este foi um estudo transversal. Foram revisados os dados clínicos, epidemiológicos e laboratoriais de pacientes internados com síndrome respiratória aguda em um hospital terciário de 2012 a 2013. Resultados: O RVH foi o VRC mais comum observado (36%, 162/444) e esteve presente na maior parte das codetecções virais (69%, 88/128), principalmente em associação ao enterovírus humano (45%). A maioria dos pacientes infectados por RVH possuía menos de 2 anos (57%). De modo geral, os pacientes com RVH apresentaram uma menor frequência de infecção respiratória aguda grave que os pacientes infectados por outros VRCs (60% e 84%, respectivamente, p = 0,006), porém mais comorbidades (40% e 27%, respectivamente; p = 0,043). Contudo, em uma análise ajustada, essa associação não foi significativa. A taxa de mortalidade no grupo RVH foi 3%. A detecção de RVH foi mais prevalente durante o outono e inverno, com uma correlação negativa moderada entre a frequência de infecção viral e a temperatura (r = -0,636, p < 0,001), porém nenhuma correlação com a precipitação (r = −0,036, p = 0,866). Conclusão: O RVH é normalmente detectado em crianças internadas com infecções respiratórias e normalmente está presente em codetecções virais. As comorbidades estão estreitamente associadas a infecções por RVH. Essas infecçõesmostram variação sazonal, com predominância durante as estações mais frias.

Parechovirus como agente etiológico de meningitis y/o sepsis viral en lactantes / Parechovirus as etiologic agent of meningitis and/or sepsis like illness in infants

Introduction: Human parechovirus (HPeV) belongs to the Picornaviridae family and has been described in viral meningoencephalitis and sepsis like illness in infants. Until now, 16 genotypes have been recognized, the most common are HPEV 1, 2 and 3; type 3 is most severe. Aims: To estimate the frequency of HPEV etiology in viral meningoencephalitis and sepsis in infants and characterize clinical and molecular aspects of infection. Methods: Between October 2013 and March 2015 we collected CSF samples, plasma, nasopharyngeal swabs and/or stools of patients younger than two years with suspected sepsis and/or viral meningitis. Samples were obtained from laboratory storage sites and from hospitalized patients. HPeV was diagnosed by real-time polymerase chain reaction (PCR) assay against the 5'UTR region. Positive samples were genotyped by sequencing a 304pb segment in VP3/VP1 overlapping region obtained with a nested PCR. Results: Overall HPeV detection rate was 18,6% (11/59 patients), distributed in 8.7% (4/46) laboratory's samples and 53.8% (7/13) of samples from hospitalized patients; mean age was 49 days (SD?). Most common clinical signs were irritability (%), inappetance and fever (algo mas? Magnitude? %). All six samples genotyped were HPeV 3. Conclusions: HPeV should be considered as a relatively significant etiologic agent of viral meningoencephalitis and sepsis in infants.

Introducción: Parechovirus humano (HPeV) pertenece a la familia Picornaviridae; ha sido descrito en sepsis viral y meningoencefalitis en niños de dos años o menos (lactantes). Se conocen 16 genotipos, siendo los más frecuentes HPeV 1, 2 y 3; el más grave es el tipo 3. Objetivos: Estimar la frecuencia de HPeV como agente causal de meningoencefalitis o sepsis viral en lactantes; caracterizar clínica y molecularmente los HPeV encontrados. Material y Métodos: Estudio descriptivo. Se utilizaron muestras de LCR, plasma, hisopado nasofaríngeo y/o deposiciones de lactantes con sospecha de sepsis y/o meningoencefalitis viral entre octubre 2013 y marzo 2015. Se estudiaron muestras almacenadas en laboratorio y de pacientes hospitalizados. Como diagnóstico, se realizó RPC-TR en tiempo real para HPeV dirigido a sector 5'UTR. Para la caracterización molecular, se secuenció un sector de 304 pb en unión VP3/VP1 mediante una RPC-TR anidada. Resultados: Se reclutó un total de 59 pacientes con frecuencia de HPeV de 18,6% (11/59), correspondientes a 8,7% (4/46) en muestras de colección y 53,8% (7/13) en hospitalizados, edad promedio 49 días. En la presentación clínica destacó la irritabilidad, el rechazo alimentario y la fiebre. Seis casos fueron genotipificados, todos correspondieron al tipo HPeV 3. Conclusiones: HPeV debe ser considerado como agente causal en sepsis y/o meningoencefalitis en lactantes.

Prevalence of rhinovirus in wheezing children: a comparison with respiratory syncytial virus wheezing

Abstract Objective To explore the distribution and clinical manifestations of rhinovirus infection in wheezing children, and compare the clinical differences between rhinovirus- and respiratory syncytial virus-induced wheezing. Materials and methods This prospective cohort study was carried out in Children's Hospital of Soochow University from Dec 2012 to Nov 2014. We enrolled consecutive hospitalized children <60 months of age presented with wheezing. Clinical data including cough, fever, dyspnea, crackles were recorded by pediatricians on the first day of admission. Meanwhile, nasopharyngeal aspirates were obtained to test for respiratory viruses, by using polymerase chain reaction method for rhinovirus, human bocavirus, and human metapneumovirus, and direct immunofluorescence assay to test for respiratory syncytial virus, adenovirus, parainfluenza virus types 1–3, and influenza virus types A and B. Results Rhinovirus was a main causative agent isolated in 14.7% of the hospitalized wheezing children in Suzhou, China, being second to respiratory syncytial virus (21.0%). Different from respiratory syncytial virus infection, which peaked in winter months, rhinovirus could be detected all year round, peaked between July and September, and in November. Children with rhinovirus infection were older and presented with more often allergic sensitizations, blood eosinophilia, and leukocytosis than those of respiratory syncytial virus infection. Logistic regression analysis revealed that rhinovirus-infected children experienced earlier wheezing more often than respiratory syncytial virus children (odds ratio, 3.441; 95% confidence interval, 1.187–9.979; p = 0.023). Conclusion Rhinovirus was a main viral pathogen in wheezing children, especially in summer time. Rhinovirus-induced wheezing was different from respiratory syncytial virus, apart from seasonal epidemics; these two groups differed with regard to age, allergic sensitizations, laboratory test, and history of wheezing episodes.

Molecular survey of porcine teschovirus, porcine sapelovirus, and enterovirus G in captive wild boars (Sus scrofa scrofa) of Paraná state, Brazil / Estudo molecular de teschovírus suíno, sapelovírus suíno e enterovírus G em javalis (Sus scrofa scrofa) de cativeiro no Paraná

Porcine teschovirus (PTV), porcine sapelovirus (PSV), and enterovirus G (EV-G) are infectious agents specific to pig host species that are endemically spread worldwide. This study aimed to investigate the natural infection by these porcine enteric picornaviruses in wild boars (Sus scrofa scrofa) of Paraná state, Brazil, and to evaluate peccaries (Pecari tajacu and Tayassu pecari) as alternative host species for these viruses. Fecal samples (n=36) from asymptomatic wild boars (n=22) with ages ranging from 2 to 7 months old (young, n=14) and 2 to 4 years old (adult, n=8) and from peccaries (6 to 8 months old, n=14) were collected from a farm and a zoo, respectively, both located in Paraná state. Reverse transcription-polymerase chain reaction (RT-PCR) and nested-PCR (n-PCR) assays targeting the 5'non-translated region of the virus genome were used for screening the viruses. Porcine enteric picornaviruses were detected in 12 out of the 22 wild boar fecal samples. According to each of the viruses, EV-G was most frequently (11/22, 50%) detected, followed by PTV (10/22, 45.5%) and PSV (4/22, 18.2%). Regarding the age groups, young wild boars were more frequently (9/14, 64.3%) infected with PTV, PSV, and EV-G than adult animals (3/8, 37.4%). One n-PCR amplified product for each of the viruses was submitted to sequencing analysis and the nucleotide sequences were compared with the related viruses, which showed similarities varying from 97.7% to 100% for PTV, 92.4% to 96.2% for PSV, and 87.1% to 100% for EV-G. Peccaries tested negative for the viruses and in this study they did not represent infection reservoirs. This study is the first to report the molecular detection of PTV, PSV, and EV-G from captive wild boars in a South American country and the first to screen peccaries as alternative host species for porcine enteric picornavirus.

Teschovírus suíno (PTV), sapelovírus suíno (PSV) e enterovírus G(EV-G) são agentes infecciosos específicos da espécie suína que estão endemicamente disseminados em todo o mundo. O objetivo deste estudo foi investigar a infecção natural por estes picornavírus entéricos suínos em javalis (Sus scrofa scrofa) do estado do Paraná, Brasil e avaliar pecaris (Pecari tajacu e Tayassu pecari) como hospedeiros alternativos para estes vírus. Amostras fecais (n=36) de javalis assintomáticos (n=22) com idades de 2 a 7 meses (jovens, n=14) e 2 a 4 anos (adultos, n=8) e de pecaris (6 a 8 meses de idade, n=14) foram coletadas em um cativeiro e zoológico, respectivamente, ambos localizados no estado do Paraná. A transcrição reversa seguida por reações da polimerase em cadeia (RT-PCR) e nested-PCR com alvo na região 5'-não traduzida do genoma viral foram utilizadas para a identificação dos vírus. Picornavírus entéricos suínos foram detectados em 12 das 22 amostras fecais de javalis. De acordo com cada um dos vírus, EV-G foi mais frequentemente (11/22, 50%) detectado, seguido pelo PTV (10/22; 45,5%) e PSV (4/22; 18,2%). Considerando os grupos de idade, javalis jovens foram mais frequentemente (9/14; 64,3%) infectados com PTV, PSV e EV-G do que os javalis adultos (3/8; 37,4%). Um produto amplificado na nested-PCR para cada um dos vírus foi submetido à análise de sequenciamento e as sequências de nucleotídeos foram comparadas com vírus relacionados, o que mostrou que as similaridades variaram entre 97,7% a 100% para o PTV, 92,4% a 96,2% para o PSV e 87,1% a 100% para o EV-G. Os pecaris foram negativos para as viroses investigadas e neste estudo não se apresentaram como hospedeiros alternativos para as infecções. Este estudo é o primeiro a relatar a detecção molecular de PTV, PSV e EV-G em javalis de cativeiro de um país da América Latina e o primeiro a avaliar pecaris como espécie hospedeira alternativa para picornavírus entéricos suínos.

Clinical relevance of rhinovirus infections among adult hospitalized patients

Human rhinovirus (HRV) is an emerging viral pathogen. Aim: To characterize a group of patients admitted due to infection by this agent in a general hospital in Chile. Methods: Cases were identified by RT-PCR for 1 year through active surveillance of patients admitted with severe respiratory illness. Diagnosis was not available during hospitalization. Thirty-two cases were identified, 90% were ≥60 years old or had co-morbid conditions. Human rhinovirus-related admissions represented 23.7% of hospitalization due to severe acute respiratory infections among adults and ranked second to influenza (37.8%). Patients presented with pneumonia (68.8%), decompensated chronic lung conditions (21.9%), heart failure or influenza-like illness (6.3% each). Admission to intensive or intermediate care units was required by 31.2% and in-hospital mortality reached 12.5%. A CURB-65 score ≥3 was significantly associated to in-hospital mortality (p < 0.05). Most patients received antibiotics (90%). Conclusions: Human rhinovirus infections in elderly patients with co-morbid conditions are associated with hospitalizations, requiring critical or semi-critical antibiotics use. A high CURB-65 score was associated to in-hospital mortality. .

Identificación de virus respiratorios en pacientes pediátricos con infecciones respiratorias en el Hospital Carlos Van Buren, Valparaíso: época estival 2011-2012 / Identification of respiratory viruses in pediatric patients with respiratory tract infections from Carlos Van Buren Hospital, Valparaíso: 2011-2012 summer season

INTRODUCCIÓN: En pediatría, las infecciones respiratorias agudas (IRA) constituyen globalmente una importante causa de morbimortalidad. Los principales agentes etiológicos son los virus respiratorio sincicial, parainfluenza (PIV), influenza y adenovirus. Actualmente existen pruebas de diagnóstico molecular que permiten identificar agentes no convencionales. En este estudio se propuso estudiar la presencia de: PIV, coronavirus (COV), rinovirus (RV) y enterovirus humano (EV), utilizando reacción en cadena de polimerasa previa transcriptasa reversa (RCP-TR) en muestras de niños hospitalizados en el Hospital Carlos Van Buren, negativas a inmunofluorescencia (IF) paravirus respiratorios. MATERIALES Y MÉTODOS: Se analizaron un total de 82 muestras de aspirado nasofaríngeo de pacientes menores de 5 años hospitalizados por IRA en el Hospital Carlos Van Buren, negativos a IF, recolectadas entre Diciembre del 2011y Marzo del 2012. Se utilizó una RCP-TR anidada de tipo múltiplex específica para virus PIV (1, 2, 3, 4AB), COV-OC43 y 229E, y genérica para RV y EV. RESULTADOS: Los virus más frecuentes fueron los PIV, siendo identificados en 9 (10 por ciento) muestras, siendo: un 2 por ciento (n=2) PIV-2, un 7 por ciento (n=6) PIV-3 y un 1 por ciento (n=1) PIV-4AB. Además se detectó COV-OC43 en un 2 por ciento (n=2), RV y EV en un 6 por ciento (n=5). No se detectaron co-infecciones con dos o más virus. No hubo asociación entre edad de los niños y tipo de infección viral. DISCUSIÓN: Se describió la presencia de estos virus respiratorios en niños con IRA. Se logró detectar falsos negativos para PIV y se demostró la existencia de COV, RV y EV en la región.

INTRODUCTION: Acute Respiratory infection (ARI) is a major cause of morbidity and mortality worldwide in pediatrics. The main etiological agents are respiratory syncytial virus, parainfluenzavirus (PIV), influenza virus and adenovirus. Currently there are molecular diagnostic tests that have helped to identify unconventional agents. Our aim was to study the presence of: PIV, coronavirus (hCoV), rhinovirus (hRV) and human enterovirus (hEV), by using Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) in samples of hospitalized children on Carlos Van Buren Hospital negative to immunofluorescence (IF) for respiratory viruses. MATERIALS AND METHODS: A total of 82nasopharyngeal aspirate samples, negative to IF, were collected from children under five years old hospitalized due to ARI at Carlos Van Buren Hospital, between December 2011 and March2012. A Multiplex nested RT-PCR designed for the specifically detection of PIV (1, 2, 3, 4AB), hCoV (OC43 and 229E) and generic detection of RV and EV was used. RESULTS: Parainfluenza was the most frequently identified virus (n=9, 10 percent) specifically PIV-2 (n=2, 2 percent), PIV-3 (n=6, 7 percent) and PIV-4AB (n=1, 1 percent). Followed by hRV and hEV (n=5, 6 percent) and hCoV-OC43 (n=2, 2 percent). There were no co-infections with two or more viruses. There was no correlation between age and type of infection. DISCUSSION: This study described the prevalence of these respiratory viruses in pediatric patients with ARI. It was possible to detect false negative results for parainfluenza virus and also to demonstrate the existence of hCoV, hRV and hEV in the region.

Human rhinovirus infections in symptomatic and asymptomatic subjects

The role of rhinovirus asymptomatic infections in the transmission among close contacts subjects is unknown. We tested health care workers, a pair of one child and a family member and immunocompromised patients (n =191). HRV were detected on 22.9% symptomatic and 3.6% asymptomatic cases suggesting lower transmission among contacts.

Rhinovirus detection using different PCR-based strategies

Human rhinoviruses (HRVs) are the major cause of the common cold. HRVs were recently reclassified into the Enterovirus genus (HEV) in the Picornaviridae family. HRVs and other members of the HEV genus share many common features, including sense RNA genomes and partial nucleotide sequence identity. The aim of this study was to evaluate different HRV detection strategies. Samples from adults with acute respiratory infection (n = 291) who were treated in Sao Paulo Hospital (2001-2003) were tested using three assays. The first assay detected picornaviruses by RT-PCR and hybridization, the second detected rhinoviruses using RT-PCR/sequencing, and the third differentiated HRV from HEV using duplex semi-nested-RT-PCR. Analysis of the results obtained from the first two strategies revealed 83% concordance. Discordant samples were then evaluated by the third protocol, and 82% were negative. The picornavirus detection protocol was more sensitive but less specific than the rhinovirus detection protocols. The semi-nested protocol utilized in the present study was less sensitive and was not useful in differentiating HRV from HEV. Sequencing assays examining different genes would address the best strategy of confirming rhinovirus and enterovirus infections.

Rinovirus: Frecuencia en niños con infección respiratoria aguda, no internados / Rhinoviruses: Frequency in nonhospitalized children with acute respiratory infection

Los métodos moleculares para diagnosticar rinovirus humanos (RVH) han aumentado la sensibilidad de detección. Esto ha permitido documentar la asociación entre los RVH y las infecciones respiratorias agudas (IRA) altas y bajas. La infección por RVH durante la infancia se asoció con posterior desarrollo de asma. Se estudió la frecuencia de RVH en 186 niños menores de 6 años ambulatorios con IRA (alta o baja), durante 2 años consecutivos (1/6/2008 - 31/5/2010). Se correlacionó la presencia de RVH con los antecedentes y características clínico-epidemiológicas. La detección de RVH se realizó con una RT-PCR en tiempo real que amplifica parte de la región 5' no codificante del genoma. Los virus respiratorios clásicos se estudiaron por inmunofluorescencia. En el 61% de los niños se detectó etiología viral. Las frecuencias fueron: RVH 27%, virus sincicial respiratorio (VSR) 16%, influenza A y B 9%, parainfluenza 8%, metapneumovirus 7% y adenovirus 0.5%. Se observaron coinfecciones duales en 8 casos, siendo RVH el más frecuente (en 4 de ellos). Los RVH circularon durante todo el período estudiado, con picos en invierno y primavera. No se observaron diferencias clínico-epidemiológicas significativas entre pacientes con o sin RVH, excepto un mayor porcentaje de niños afebriles con RVH. Los RVH fueron los virus más detectados en niños ambulatorios, principalmente en menores de 2 años, los segundos virus asociados a bronquiolitis, luego del VSR, y detectados tres veces más en los niños expuestos a tabaquismo pasivo (OR: 2,91; p = 0.012) que en el resto. Fueron identificados como único agente en el 28% de las bronquiolitis.

Molecular methods for human rhinoviruses (HRV) have increased the sensitivity in their diagnosis. HRV may cause acute respiratory infections (ARI) of the upper and lower respiratory tract. HRV infection during childhood is a predictor of asthma development. In this study, the HRV frequency in outpatient children with ARI was determined, and their clinical features and previous conditions were evaluated. A total of 186 respiratory samples of children under 6 year old attending the CEMIC pediatric emergency room from June 1, 2008 to May 31, 2010, were studied. Classical respiratory viruses were detected by immunofluorescence. A real time RT-PCR that amplifies part of the 5' non coding genomic region was used for HRV detection. Viral detection was obtained in 61% of children. The frequency was: 27% for HRV, 16% for respiratory syncytial virus (RSV), 9% for influenza, 8% for parainfluenza, 7% for metapneumovirus and 0.5% for adenovirus. Dual coinfection was detected in 8 children and HRV were the most frequent, detected in 4 of them. HRV circulated during the two year period of the study, with peaks during winter and spring. No clinical difference was observed between patients with or without HRV, except an increase percent of children with HRV without fever. HRV were the most frequent viruses detected in this population, mainly in children under 2 year old, the second cause of bronchiolitis after RSV and more frequently detected in children exposed to passive smoking (OR = 2.91; p = 0.012), and were detected as the sole etiologic agent in 28% of bronchiolitis.

Hepatitis A bifásica en niños colombianos: reporte de nueve casos y revisión de la literatura / Biphasic hepatitis A in colombian children: report of nine cases and literature review

La hepatitis A tiene una prevalencia o incidencia en los países en desarrollo de 50 a 100 por cada 100000 personas. La presentación atípica de la hepatitis A bifásica, es rara. El objetivo es presentar 9 casos de niños con hepatitis A bifásica. Se estudiaron nueve niños de edades comprendidas entre los 7 y 13 años (edad media 8,6 años); 5 varones con antecedentes de fiebre, vómito, ictericia, dolor abdominal y coluria de 3 a 5 días de evolución, e IgM para la hepatitis A (IgM VHA) positivo. Después de un mes de evolución asintomáticos, se volvieron a presentar iguales manifestaciones clínicas del primer episodio, con la presencia de IgM VHA positiva otra vez. La media de las pruebas de función hepática en el segundo cuadro fueron: ALT 1258 U/L,AST 986 U/l, bilirrubina directa 5,87 mg/dl, y fosfatasa alcalina 580 U/L. En ninguno se informó anomalías a la ecografía abdominal y la serología de hepatitis autoinmune fue negativa. No hubo morbilidad en los niños. La hepatitis agudaApuede tener entre un 3% a 20% de casos con más de un pico de aminotransferasas, que se eleva entre las 2 y 8 semanas después del primer cuadro. Las hipótesis para explicar ello, son fenómenos de reinfección y autoinmunes. En general, la evolución es satisfactoria.

Hepatitis A has a prevalence or incidence in developing countries from 50 to 100 per 100,000 people. The atypical presentation of biphasic hepatitis A, is rare. The objective was to report 9 cases of children with biphasic hepatitis A. We studied 9 children aged between 7 and 13 years (mean age 8.6 years), including 5 males with a history of fever, vomiting, jaundice, abdominal pain, and coluria for about 3 to 5 days of evolution, and IgM to hepatitisA(IgMVHA) positive. After a mean month evolution asymptomatic, again showed the same clinic manifestations for the second time in the presence of IgM VHA positive again. The median liver function tests in the second frame were ALT 1258 U/L, AST 986 U/L, direct bilirubin 5.87 mg/dL, FA 580 U/L. In all reported no abdominal ultrasound abnormalities and autoimmune hepatitis serology was negative. There was no morbidity in children. Acute hepatitisAcan take on 3%-20% of cases with more than 1 peak of aminotransferases, which can be raised between 2 and 8 weeks after the first frame. Hypotheses to explain this, are reinfection and autoimmune phenomena. In general, evolution is satisfactory.

High rate of viral identification and coinfections in infants with acute bronchiolitis

OBJECTIVES: To determine the viruses and risk factors associated with hospital and intensive care unit (ICU) admissions in infants with acute bronchiolitis. INTRODUCTION: Bronchiolitis is a major cause of morbidity in infants. Widespread use of molecular-based methods has yielded new insights about its etiology, but the impact of viral etiologies on early outcomes is still unclear. METHODS: Seventy-seven infants with bronchiolitis who were under two years of age and visited an emergency unit were included. Using molecular-based methods, samples were tested for 12 different respiratory viruses. Logistic regression models were used to identify clinical and virological variables associated with the main endpoints: hospital admission and ICU admission. RESULTS: We identified at least one virus in 93.5 percent of patients, and coinfections were found in nearly 40 percent of patients. RSV was the most common pathogen (63.6 percent), followed by rhinovirus (39 percent). Identification of RSV was only associated with an increased risk of hospital admission in the univariate model. Younger age and enterovirus infection were associated with an increased risk of hospital admission, while atopy of a first-degree relative showed a protective effect. Prematurity was associated with an increased risk of admission to the ICU. Coinfections were not associated with worse outcomes. CONCLUSIONS: Molecular-based methods resulted in high rates of viral identification but did not change the significant role of RSV in acute bronchiolitis. Younger age and enterovirus infection were risk factors for hospital admission, while prematurity appeared to be a significant risk factor for admission to the ICU in acute viral bronchiolitis.

Bronquiolite aguda por rinovírus em lactentes jovens / Rhinovirus and acute bronchiolitis in young infants

OBJETIVO: Determinar a prevalência de infecção por rinovírus em lactentes menores de 6 meses hospitalizados por bronquiolite aguda. MÉTODOS: Foram selecionados de forma prospectiva lactentes hospitalizados com diagnóstico de bronquiolite aguda, no Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, no período entre maio e setembro de 2002. Foi pesquisada a presença de vírus respiratórios no aspirado nasofaríngeo (ANF), através de imunofluorescência direta para vírus sincicial respiratório, parainfluenza, influenza e adenovírus. Para detecção do rinovírus, foi utilizada a reação de transcrição reversa, seguida de reação em cadeia da polimerase, específicas para picornavírus, seguidas de hibridização com sonda específica para rinovírus. RESULTADOS: Foram selecionados 45 lactentes hospitalizados com diagnóstico de bronquiolite aguda. A mediana da idade dos pacientes selecionados foi de 2 meses. Foram encontradas amostras positivas para vírus respiratórios em 35/45 (77,8 por cento) casos. Foi detectado mais de um vírus em 7/35 (20 por cento) amostras. Das amostras positivas, o vírus sincicial respiratório foi detectado em 33/35 (94 por cento) casos. O rinovírus foi detectado em 6/35 casos (17 por cento). CONCLUSÕES: O rinovírus foi o segundo agente mais freqüentemente detectado em secreção nasal de lactentes jovens hospitalizados por bronquiolite aguda.

Diagnóstico rápido de los principales virus respiratorios en Ciudad de la Habana, 1995-97 / Rapid diagnosis of principal respiratory viruses in the city of Havana, 1995-97

Acute respiratory diseases (ARD) are the most common infections in humans and difficult to prevent. Viruses have been recognized as predominant ethiological agents. In Cuba, ARD constitute a major problem of health and are the first cause of morbidity and important cause of mortality. In this paper, rapid diagnosis was performed to 516 clinical samples which arrived to the Reference Respiratory Viruses Laboratory of the Pedro KourÝ Institute of Tropical Medicine (IPK) from different parts of Havana City during 1995, 1996 and 1997. The results obtained have shown 218 positive samples (Influenza A, 89; respiratory syncytial virus 52; Influenza B, 45; Adenovirus, 13; human parainfluenza virus(HPIV)-1, 6; HPIV-2, 3 and HPIV-3, 10). Influenza A was the virus most frequently found in adults, whereas in closed population of teen-agers and adults, Influenza B was frequently found. Furthermore, respiratory syncytial virus was the most important pathogen in children's under 1 year of age.

Investigación de un brote de hepatitis en el Instituto de Puericultura "Alfredo Guzmán" de Tucumán / Investigation about Hepatitis out-break in the \"Alfredo Guzmán\" Institute in Tucumán

En el Instituto de Puericultura Dr. Alfredo Guzmán, de la Provincia de Tucumán, se produjo en el mes de junio de 1996 un brote de hepatitis. El objetivo de este trabajo es presentar los resultados obtenidos en el estudio realizado por el Laboratorio de Inmunología del Hospital del Niño Jesús a solicitud de la Dirección de Epidemiología del SI.PRO.SA. El propósito fue realizar el diagnóstico y evaluar el status inmunológico para decidir la vacunación. Se procesaron 96 muestras, 13 correspondían a adultos y 83 a niños de 1 mes a 6 años. Se valoraron anticuerpos (Ac) IgM antiHAV y anticuerpos totales antiHAV con una ELISA comercial. En 20 niños (20,8 por ciento) se encontraron Ac IgM anti HAV y en 65 (67,7 por ciento) Ac totales anti HAV. Todos los adultos eran positivos para Ac totales. Los resultados indican: * La fuente de infección sería de origen externo, posiblemente algunos portadores (niños que ingresan o familiares que los visitan). * La alta prevalencia de Hepatitis A en nuestro medio. * La necesidad de vacunar a los niños a temprana edad.