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2.
Pediatr Dermatol ; 2023 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-38018255

RESUMEN

We describe a case of congenital syphilis in an adopted infant with a unique dermatologic presentation of scalp granulomas, along with lymphadenopathy, anemia, and elevated liver transaminases. To our knowledge, this cutaneous morphology has not been previously reported in the literature. This case highlights the varied clinical presentation of congenital syphilis and the diagnostic challenge it poses for clinicians, especially in the context of unknown prenatal history/unknown risk factors, or if syphilis is acquired during pregnancy after routine screening is performed. As the incidence of congenital syphilis has more than tripled in recent years, this diagnosis should be considered when a neonate or infant presents with unexplained skin nodules.

3.
Vaccine ; 41(33): 4899-4906, 2023 07 25.
Artículo en Inglés | MEDLINE | ID: mdl-37385888

RESUMEN

Questions remain regarding the effect of baseline host and exposure factors on vaccine efficacy (VE) across pathogens and vaccine platforms. We report placebo-controlled data from four Phase 3 COVID-19 trials during the early period of the pandemic. This was a cross-protocol analysis of four randomized, placebo-controlled efficacy trials (Moderna/mRNA1273, AstraZeneca/AZD1222, Janssen/Ad26.COV2.S, and Novavax/NVX-CoV2373) using a harmonized design. Trials were conducted in the United States and international sites in adults ≥ 18 years of age. VE was assessed for symptomatic and severe COVID-19. We analyzed 114,480 participants from both placebo and vaccine arms, enrolled July 2020 to February 2021, with follow up through July 2021. VE against symptomatic COVID-19 showed little heterogeneity across baseline socio-demographic, clinical or exposure characteristics, in either univariate or multivariate analysis, regardless of vaccine platform. Similarly, VE against severe COVID-19 in the single trial (Janssen) with sufficient endpoints for analysis showed little evidence of heterogeneity. COVID-19 VE is not influenced by baseline host or exposure characteristics across efficacy trials of different vaccine platforms and countries when well matched to circulating virus strains. This supports use of these vaccines, regardless of platform type, as effective tools in the near term for reducing symptomatic and severe COVID-19, particularly for older individuals and those with common co-morbidities during major variant shifts. Clinical trial registration numbers: NCT04470427, NCT04516746, NCT04505722, and NCT04611802.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Adulto , Humanos , COVID-19/prevención & control , Ad26COVS1 , ChAdOx1 nCoV-19 , Vacuna nCoV-2019 mRNA-1273
4.
Cureus ; 13(7): e16299, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34381655

RESUMEN

A seven-month-old previously healthy female infant presented with acute onset encephalopathy and left focal weakness in the setting of three months of non-productive cough. She was diagnosed with pulmonary tuberculosis (TB), and neuroimaging showed multifocal non-enhancing T2 hyperintensities in the brain and longitudinal T2 hyperintensity in the spinal cord consistent with acute disseminated encephalomyelitis (ADEM). However, her cerebrospinal fluid (CSF) did not show evidence of TB infection. She was treated with high-dose steroids for five days with a steroid taper along with antitubercular medications with a remarkable recovery in gross motor function. This case suggests a previously unreported association between TB and an immune-mediated demyelinating syndrome in children that is clinically distinct from other more common forms of TB-associated central nervous system (CNS) complications.

5.
Clin Perinatol ; 48(3): 485-511, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34353577

RESUMEN

Maternal pathogens can be transmitted to the fetus resulting in congenital infection with sequelae ranging from asymptomatic infection to severe debilitating disease and still birth. The TORCH pneumonic (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus) is used widely, but it provides a limited description of the expanding list of pathogens associated with congenital infection. This article focuses on the evaluation and management of infants with common congenital infections such as cytomegalovirus, and infections that warrant early diagnosis and treatment to prevent serious complications, such as toxoplasmosis, human immunodeficiency virus, and syphilis. Zika virus and Chagas disease remain uncommon.


Asunto(s)
Enfermedades Fetales , Herpes Simple , Complicaciones Infecciosas del Embarazo , Rubéola (Sarampión Alemán) , Sífilis , Toxoplasmosis Congénita , Toxoplasmosis , Infección por el Virus Zika , Virus Zika , Femenino , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológico , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Rubéola (Sarampión Alemán)/diagnóstico , Toxoplasmosis Congénita/diagnóstico , Toxoplasmosis Congénita/tratamiento farmacológico , Toxoplasmosis Congénita/epidemiología , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/epidemiología
7.
J Child Neurol ; 34(4): 184-188, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30628536

RESUMEN

Varicella vaccination is now virtually universal in North America, as well as in some European and Asian countries. Since varicella vaccine is a live attenuated virus, the virus replicates in the skin after administration and can travel via sensory nerves or viremia to become latent in the dorsal root ganglia. In some immunized children, virus reactivates within a few months to a few years to cause the dermatomal exanthem known as herpes zoster (shingles). Herpes zoster caused by vaccine virus often reactivates within the same dermatome as the site of the original varicella vaccine injection. We present evidence that occasional cases of herpes zoster following varicella vaccination in immunocompetent children can be as severe as herpes zoster following wild-type varicella. Analysis of the virus in one case disclosed that the vaccine virus causing herpes zoster was a wild-type variant with a mutation in ORF0. With regard to dermatomal localization of the viral eruption, we predict that herpes zoster of the lumbar dermatomes in children is likely to be caused by vaccine virus, because herpes zoster in those dermatomes is rare in children after wild-type varicella. One of the children with herpes zoster subsequently developed asthma, a known risk factor for herpes zoster, but none of the children had an autoimmune disease. Although postherpetic neuralgia is exceedingly rare, children who develop herpes zoster following varicella vaccination are at risk (albeit low) of developing meningoencephalitis and should be carefully observed for a few weeks.


Asunto(s)
Asma/etiología , Vacuna contra la Varicela/efectos adversos , Varicela/prevención & control , Herpes Zóster/etiología , Vacuna contra la Varicela/uso terapéutico , Preescolar , Humanos , Lactante , Masculino , Vacunación/efectos adversos
8.
Curr Opin Pediatr ; 30(3): 438-447, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29745939

RESUMEN

PURPOSE OF REVIEW: Influenza virus can cause severe or life-threatening infection in children. This review provides an update on antiviral medications available to treat and prevent influenza in both healthy children and children with underlying medical conditions, and recommendations on their appropriate use in the outpatient and inpatient settings. RECENT FINDINGS: Despite the significant morbidity and mortality associated with influenza infection, a large number of children hospitalized with influenza do not receive specific antiviral treatment with a neuraminidase inhibitor. Although the effectiveness of this intervention has been debated, several recent observational studies have shown the potential benefits conferred by early antiviral treatment. Oral oseltamivir and inhaled zanamivir remain the best studied antiviral agents for influenza treatment and prevention. In addition, the US Food and Drug Administration recently approved peramivir, a novel neuraminidase inhibitor available for intravenous administration. SUMMARY: Children with suspected or documented influenza infection benefit from early antiviral treatment with neuraminidase inhibitors that can shorten illness duration, decrease symptom severity, and lower the risk of complications leading to hospitalization and death. Unless contraindicated, all hospitalized children, children with underlying medical conditions, and those with severe or progressive symptoms of influenza should receive specific antiviral treatment for influenza with a neuraminidase inhibitor. Additionally, antiviral treatment of influenza-infected children in the outpatient setting should be strongly considered.


Asunto(s)
Antivirales/uso terapéutico , Gripe Humana/tratamiento farmacológico , Atención Ambulatoria , Niño , Esquema de Medicación , Hospitalización , Humanos , Gripe Humana/complicaciones , Resultado del Tratamiento
9.
Pediatr Infect Dis J ; 36(7): 679-684, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28033237

RESUMEN

We present a 7-year-old boy with chronic meningitis caused by Blastomyces dermatitidis. A review of the literature revealed 32 cases of central nervous system blastomycosis in children between 1983 and 2016, of which 18 represented parenchymal disease of the brain or spinal cord. Blastomycosis affecting the central nervous system is rare but should be considered in children with chronic meningitis.


Asunto(s)
Blastomicosis , Meningitis Fúngica , Antifúngicos/uso terapéutico , Blastomyces , Encéfalo/patología , Niño , Humanos , Masculino
10.
MMWR Morb Mortal Wkly Rep ; 64(14): 400, 2015 Apr 17.
Artículo en Inglés | MEDLINE | ID: mdl-25879901

RESUMEN

In June 2013, a male newborn aged 9 days (delivered after a full-term pregnancy) was brought to a hospital emergency department with a 2-day history of constipation, fussiness, and poor feeding. The mother reported her son's symptoms as excessive crying, reluctance to suck, and difficulty in swallowing milk. Within hours of arrival, the infant became less responsive and "floppy," and was intubated for respiratory failure. Infant botulism was suspected and Botulism Immune Globulin Intravenous (Human) (BIG-IV), licensed for the treatment of infant botulism types A and B, was administered on hospital day 2. Results of preliminary stool studies were reported positive for botulinum toxin type F on hospital day 3. Clostridium baratii type F was subsequently isolated in stool culture.


Asunto(s)
Proteínas Bacterianas/aislamiento & purificación , Botulismo/diagnóstico , Botulismo/microbiología , Heces/microbiología , Humanos , Recién Nacido , Iowa , Masculino
11.
Int J Food Sci Nutr ; 66(3): 336-41, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25582182

RESUMEN

This study examined the prevalence of vitamin D deficiency in mothers and infants in Tijuana, Mexico and determined the effect of a single oral dose of 50,000 IU vitamin D3 at birth on 25-hydroxyvitamin D (25[OH]D) levels during infancy. Healthy infants were randomized to receive vitamin D3 or placebo at birth. At birth 23% of infants were vitamin D deficient and 77% had vitamin D insufficiency (mean 25[OH]D level 18.9 ng/ml); 10% of mothers were vitamin D deficient and 61% were insufficient. Infants receiving vitamin D3 had higher 25(OH)D levels at two months (N = 29; 33.9 versus 24.2 ng/ml) and six months (N = 21; 36.5 versus 27.4 ng/ml). Exclusively breastfed infants had lower 25(OH)D levels at two months (14.9 versus 33.4 ng/ml). Vitamin D deficiency is common in infants and mothers in Tijuana, Mexico. A single dose of vitamin D3 at birth was safe and significantly increased 25(OH)D levels during infancy.


Asunto(s)
Colecalciferol/administración & dosificación , Suplementos Dietéticos , Complicaciones del Embarazo/epidemiología , Deficiencia de Vitamina D/tratamiento farmacológico , Vitamina D/análogos & derivados , Vitaminas/administración & dosificación , Adulto , Lactancia Materna , Colecalciferol/uso terapéutico , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Lactante , Recién Nacido , Masculino , México/epidemiología , Madres , Embarazo , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/epidemiología , Vitaminas/uso terapéutico , Adulto Joven
12.
Clin Infect Dis ; 57(8): 1145-54, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23839999

RESUMEN

The explosion of medical applications (apps) in the Apple and Google Play app stores has made it increasingly difficult to find relevant and reliable infectious diseases (ID) apps. Apple created a section called "Apps for Healthcare Professionals"; however, several ID apps are missing. Google Play's ID category has several non-ID apps. Many apps involve diagnosis and patient management, creating a need for regulations and oversight by the US Food and Drug Administration. There are no standards to guide accuracy or reliability of medical apps' content. We searched Apple and Google Play app stores to identify new ID apps. Over 1200 apps were identified. We applied several exclusion criteria to identify adult/pediatric apps with data from trustworthy sources that were not reviewed within the last year. Twelve new ID apps were identified with a comprehensive list of 24 ID apps to assist healthcare professionals at the point of care.


Asunto(s)
Teléfono Celular , Computadoras de Mano , Infectología , Aplicaciones de la Informática Médica , Programas Informáticos , Humanos , Internet
13.
Pediatr Infect Dis J ; 32(11): 1230-6, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23736144

RESUMEN

BACKGROUND: Vitamin D deficiency is common in HIV infection and has been associated with advanced disease. This study investigated whether vitamin D-related genetic variants were associated with disease progression in HIV-infected children. METHODS: The Fok-I (C/T), Bsm-I (G/A), GC (A/C), DHCR7 (G/T) and CYP2R1 (G/A) genetic variants were detected by real-time polymerase chain reaction in HIV-infected children who participated in the Pediatric AIDS Clinical Trials Group P152 and P300 protocols, which predated the availability of effective combination antiretroviral therapy. The primary endpoints included time to progression to the first HIV-related disease endpoint (≥2 opportunistic infection, weight growth failure) or death, which constituted the progression-free survival. Analyses were performed for age>2 years and ≤2 years separately adjusting for race and treatment effect. RESULTS: Of the 998 children evaluated, 139 experienced HIV disease progression. For children>2 years, rapid disease progression was associated with the DHCR7 G allele compared with the T allele (G/G vs. T/T: hazard ratio [HR]=5.0, P = 0.035; G/T vs. T/T: HR=4.5, P=0.042; G/G+G/T vs. T/T: HR=4.8, P=0.036) and the Bsm-I A allele compared with the G allele (A/G vs. G/G: HR=2.2, P=0.014 and A/G+A/A vs. G/G: HR=2.0, P=0.026). In children≤2 years, the Bsm-I A allele increased the risk of disease progression in Hispanics (A/A vs. G/A+G/G: HR=2.8, P=0.03 and A/A vs. G/G: HR=2.8, P=0.046) and whites (A/A vs. G/G: HR=6.6, P=0.025 and A/A vs. G/A+G/G: HR=3.6, P=0.038). CONCLUSIONS: Vitamin D-related host genetic variants that alter the availability and activity of vitamin D are associated with risk of HIV disease progression in children and may vary by age and race.


Asunto(s)
Infecciones por VIH/genética , Infecciones por VIH/metabolismo , Vitamina D/genética , Adolescente , Niño , Preescolar , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Lactante , Estimación de Kaplan-Meier , Masculino , Oxidorreductasas actuantes sobre Donantes de Grupo CH-CH/genética , Oxidorreductasas actuantes sobre Donantes de Grupo CH-CH/metabolismo , Polimorfismo de Nucleótido Simple , Ensayos Clínicos Controlados Aleatorios como Asunto , Receptores de Calcitriol/genética , Receptores de Calcitriol/metabolismo , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Vitamina D/metabolismo
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