RESUMO
INTRODUCTION: The aim of our study was to analyse the frequency of primary mutations associated with HIV drug resistance in a population of children born to HIV-infected mothers. DESIGN: A prospective study included newly HIV-diagnosed children treated at two public paediatric hospitals. PATIENTS AND METHODS: Clinical and antiretroviral therapy (ART) data were collected in mother-child pairs. HIV-1 subtyping and ART resistance mutations were assayed in children by sequencing a region of HIV pol gene. RESULTS: A total of 67 children were enrolled: 22 less than 12 months of age, 20 between 1 and 5 years and 25 between 6 and 14 years. Six (9.0%) children had viral strains with at least one primary mutation associated with resistance to reverse transcriptase and protease inhibitors. A significantly (P = 0.019) higher frequency of resistance (22.7%, n = 5/22) was found among children aged < 12 months. Fourteen children (20.9%) had a subtype B HIV-1 strain and 53 (79.1%) had an inter-subtype B/F recombinant variant. DISCUSSION: A high percentage of recently diagnosed infants were found to carry primary ART resistance mutations. Limited options for ART of HIV-infected children might lead to increased HIV-associated morbidity and mortality. Thus, consideration should be given to mandatory screening for primary ART resistance before initiating therapy for infants aged < 12 months in countries where HIV mother-to-child transmission is still present, such as in Argentina. This will allow for the rationalized and individualized use of drugs and will contribute to the increased cost-effectiveness of local health systems.
Assuntos
Fármacos Anti-HIV/farmacologia , Farmacorresistência Viral/genética , Infecções por HIV/virologia , HIV/genética , Mutação , Adolescente , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Dados de Sequência Molecular , Estudos ProspectivosRESUMO
BACKGROUND: Meningococcal disease (MD) is a medical emergency and a serious public health problem. As new meningococcal vaccines become available, MD surveillance is crucial to provide baseline epidemiologic data before implementing preventive measures. We estimated MD incidence and epidemiology in Argentina using hospital-based surveillance. METHODS: Three-year prospective active surveillance in patients ≤15 years of age was conducted at 6 pediatric hospital sentinel units (March 2012 to February 2015). RESULTS: Of 184,360 hospitalized patients, 1444 (0.78%) had suspected meningitis or MD. Of these, 268 (19%) presented probable acute bacterial meningitis or MD, 168 (63%) were culture positive and 51 (30%) tested positive for Neisseria meningitidis. Of 100 culture-negative cases, 30 had positive meningococcal polymerase chain reaction. Thirteen patients presented other uncommon MD manifestations, resulting in a total of 94 MD cases and an annual incidence of 5.1/10 hospitalized patients [95% confidence interval (CI): 4-6]. Fifty-four (57%) patients were males, 48% were <1 year of age and the median age was 12.5 months (1 month to 15 years). Clinical presentations were the following: meningococcemia and meningitis (37%), meningitis (30%), meningococcemia (16%), arthritis (10%), bacteremia (5%) and pneumonia (2%). Twenty-eight percent had complications. Nine children died (case fatality rate: 10%), and 8 had sequelae. Serogroups were identified for 84 isolates. Serogroup W was associated with age <1 year (odds ratio: 3.18; 95% CI: 1.14-8.99); meningococcemia was associated with mortality (P = 0.0038). CONCLUSIONS: Highest rates of MD were observed among young infants. This study provides baseline data to estimate the impact of introducing meningococcal vaccines in Argentina.
Assuntos
Infecções Meningocócicas/epidemiologia , Neisseria meningitidis , Adolescente , Argentina/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Infecções Meningocócicas/diagnóstico , Infecções Meningocócicas/microbiologia , Infecções Meningocócicas/mortalidade , Estudos Prospectivos , Vigilância de Evento Sentinela , SorogrupoRESUMO
HIV-1 infection in children less than 15 years of age is mainly due to mother-to-child transmission. The aim of this work was to investigate molecular evidence to prove father-to-be horizontal transmission in two possible events of transmission. In the first event a boy was identified as HIV infected at 2-3 years of age. At the same time infection was confirmed in the father, while mother and siblings were negative. In the second event a girl was negative for HIV at age 1 and identified as HIV-1 infected at age 6. The father's HIV infection was diagnosed in the same period while the mother was repeatedly negative. No evidence of sexual assault or transfusion was recorded in any case. Peripheral blood mononuclear cells were obtained from both fathers and children. After PCR amplification, the C2V3 region of the envelope gene and the region coding for amino acid 132 of p24 up to amino acid 40 of p7 of the gag gene were sequenced. Genetic distance measurements and phylogenetic tree analysis showed that in both cases the father's and child's viral sequences were closely related. They were distinct when compared to Argentina sequences including sequences from the same geographic region. Epidemiological and molecular data strongly suggest that horizontal transmission had occurred, probably related to the close father-to-child contact.
Assuntos
Infecções por HIV/transmissão , HIV-1/isolamento & purificação , Transmissão Vertical de Doenças Infecciosas , Adulto , Pré-Escolar , Feminino , Proteína do Núcleo p24 do HIV/genética , Infecções por HIV/epidemiologia , HIV-1/genética , Humanos , Lactente , Masculino , Dados de Sequência Molecular , Receptores CCR5/genéticaRESUMO
We are reporting the case of an 8-year-old boy with history of seizures in whom the pathology exam of 2.5 by 3 cm surgical specimen obtained from a cortical-subcortical area of the de right occipital lobe showed a chronic granulomatous inflammatory process with a Spirometras pp larva. The patient was born and lived several years at a rural area of Tarija (Bolivia). This appears to represent the first reported case of this parasitic infection localized to the brain of a child in Argentina.
Assuntos
Encefalopatias/diagnóstico , Encefalopatias/parasitologia , Helmintíase do Sistema Nervoso Central/diagnóstico , Esparganose/diagnóstico , Criança , Humanos , MasculinoRESUMO
Se presenta el caso de un niño de 8 años con antecedentes de epilepsia en quien el examen anatomopatológico del material extraído de una lesión de 2,5 por 3 cm localizada en la zona corticosubcortical del lóbulo occipital derecho reveló la presencia de un proceso inflamatorio crónico granulomatoso con una larva de Spirometras pp. El paciente nació y vivió varios años en una zona rural de Tarija (Bolivia). Es el primer ejemplo pediátrico de esta infestación parasitaria a nivel cerebral reconocido en la Argentina.
We are reporting the case of an 8-year-old boy with history of seizures in whom the pathology exam of 2.5 by 3 cm surgical specimen obtained from a cortical-subcortical area of the de right occipital lobe showed a chronic granulomatous inflammatory process with a Spirometras pp larva. The patient was born and lived several years at a rural area of Tarija (Bolivia). This appears to represent the first reported case of this parasitic infection localized to the brain of a child in Argentina.
Assuntos
Criança , Humanos , Masculino , Encefalopatias/diagnóstico , Encefalopatias/parasitologia , Helmintíase do Sistema Nervoso Central/diagnóstico , Esparganose/diagnósticoAssuntos
Doença de Chagas/transmissão , Coinfecção/transmissão , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas , Argentina , Evolução Fatal , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Masculino , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológicoRESUMO
We have studied the epidemiology of pertussis in two countries, Argentina and France, which have similar histories of long-term mass vaccination with a whole-cell vaccine. Both countries display a comparable epidemiology, with an increase of the incidence of the disease in non-vaccinated newborns. We used pulsed-field gel electrophoresis (PFGE) analysis and genotyping to compare Bordetella pertussis clinical isolates recovered in Argentina and France in 2001-2004. The majority of the isolates harbors prn2 allele and belongs to PFGE IVbeta group. Isolates were found to be very similar genetically suggesting a common evolution of the disease in these two countries using the same vaccine.
Assuntos
Bordetella pertussis/classificação , Bordetella pertussis/genética , Vacina contra Coqueluche/administração & dosagem , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Argentina/epidemiologia , Técnicas de Tipagem Bacteriana , Bordetella pertussis/isolamento & purificação , Eletroforese em Gel de Campo Pulsado , Evolução Molecular , Feminino , França/epidemiologia , Genótipo , Humanos , Esquemas de Imunização , Lactente , Recém-Nascido , Masculino , Vacinação , Coqueluche/microbiologiaAssuntos
Feminino , Humanos , Lactente , Masculino , Gravidez , Doença de Chagas/transmissão , Coinfecção/transmissão , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas , Argentina , Evolução Fatal , Infecções por HIV/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológicoRESUMO
El objetivo de este estudio fue analizar prospectivamente los niveles de resistencia a las drogas antirretrovirales y el progreso de la carga viral plasmática (CV) en niños infectados verticalmente por HIV-1 antes y durante el tratamiento antirretroviral (TARV).
The aim of this study was to prospectively analyze antiretroviral drug resistance and plasma viral load in HIV-1 vertically-infected children beforme and during antiretroviral therapy (ART).
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Anamnese/estatística & dados numéricos , Carga Viral/estatística & dados numéricos , HIV , Estimativa de Kaplan-Meier , Mutação , Resistência a Medicamentos , Terapia Antirretroviral de Alta Atividade/efeitos adversosRESUMO
La enfermedad porel virus de hepatitis A(HAV)en ni-ños es frecuente en nuestro medio. Es rara durante el primer año de vida. Se presenta el caso de un lactante de 4 meses, condiagnostico inicial de síndrome febril prolongado. Durante su internación comienza con manifestaciones clínicas de hepatitis. Se confirma el diagnóstico con serología IgM anti-HAV reactiva
Assuntos
Humanos , Lactente , Hepatite ARESUMO
La enfermedad invasiva por S. pneumoniae es frecuente en la edad pediátrica. Se reseña la bibliografía internacional, en particular la referida a enfermedad por S. pneumoniae resistente a penicilina. Un estudio epidemiológico longitudinal prospectivo fue realizado en el Hospital de Niños Superiora Sor María Ludovica, La Plata, 1993-1995. Fueron estudiados por serotipo y sensibilidad a la penicilina 146 aislamientos de S. pneumoniae a partir de sangre, LCR y líquido pleural que correspondieron a 135 casos. Se analizaron las variables del huésped tales como género, edad, enfermedad de base, tratamiento antibiótico en los 30 días previos. Veintiún serotipos fueron identificados. Los más frecuentes fueron 14, 5 y 1. La resistencia de S pneumoniae a penicilina fue del 20,7 por ciento
Assuntos
Humanos , Criança , Infecções Pneumocócicas/epidemiologia , Resistência às Penicilinas , Streptococcus pneumoniae/efeitos dos fármacos , Argentina , Resistência Microbiana a Medicamentos , Estudos Prospectivos , Sorotipagem/estatística & dados numéricosRESUMO
Se presenta el caso de un niño de 14 años con síndrome meníngeo subagudo, pérdida de peso (> 6 Kg.) en los últimos dos meses e imágen redondeada en el lóbulo frontal derecho que resultó corresponder a una meningoencefalitis por criptotococo en un paciente con SIDA