RESUMEN
OBJECTIVE AND DESIGN: Risk factors for severe measles are poorly investigated in high-income countries. The Italian Society for Paediatric Infectious Diseases conducted a retrospective study in children hospitalised for measles from January 2016 to August 2017 to investigate the risk factors for severe outcome defined by the presence of long-lasting sequelae, need of intensive care or death. RESULTS: Nineteen hospitals enrolled 249 children (median age 14.5 months): 207 (83%) children developed a complication and 3 (1%) died. Neutropaenia was more commonly reported in children with B3-genotype compared with other genotypes (29.5% vs 7.7%, p=0.01). Pancreatitis (adjusted OR [aOR] 9.19, p=0.01) and encephalitis (aOR 7.02, p=0.04) were related to severe outcome in multivariable analysis, as well as C reactive protein (CRP) (aOR 1.1, p=0.028), the increase of which predicted severe outcome (area under the receiver operating characteristic curve 0.67, 95% CI 0.52 to 0.82). CRP values >2 mg/dL were related to higher risk of complications (OR 2.0, 95% CI 1.15 to 3.7, p=0.01) or severe outcome (OR 4.13, 95% CI 1.43 to 11.8, p<0.01). CONCLUSION: The risk of severe outcome in measles is independent of age and underlying conditions, but is related to the development of organ complications and may be predicted by CRP value.
Asunto(s)
Sarampión/complicaciones , Niño , Preescolar , Encefalitis Viral/etiología , Femenino , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Italia/epidemiología , Masculino , Sarampión/mortalidad , Sarampión/patología , Virus del Sarampión/genética , Neutropenia/etiología , Pancreatitis/etiología , Curva ROC , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: Several pieces of evidence indicate that HIV-infected adults undergo premature aging. The effect of HIV and antiretroviral therapy (ART) exposure on the aging process of HIV-infected children may be more deleterious since their immune system coevolves from birth with HIV. DESIGN: Seventy-one HIV-infected (HIV+), 65 HIV-exposed-uninfected (HEU), and 56 HIV-unexposed-uninfected (HUU) children, all aged 0-5 years, were studied for biological aging and immune senescence. METHODS: Telomere length and T-cell receptor rearrangement excision circle levels were quantified in peripheral blood cells by real-time PCR. CD4 and CD8 cells were analysed for differentiation, senescence, and activation/exhaustion markers by flow cytometry. RESULTS: Telomere lengths were significantly shorter in HIV+ than in HEU and HUU children (overall, Pâ<â0.001 adjusted for age); HIV+ ART-naive (42%) children had shorter telomere length compared with children on ART (Pâ=â0.003 adjusted for age). T-cell receptor rearrangement excision circle levels and CD8 recent thymic emigrant cells (CD45RACD31) were significantly lower in the HIV+ than in control groups (overall, Pâ=â0.025 and Pâ=â0.005, respectively). Percentages of senescent (CD28CD57), activated (CD38HLA-DR), and exhausted (PD1) CD8 cells were significantly higher in HIV+ than in HEU and HUU children (Pâ=â0.004, Pâ<â0.001, and Pâ<â0.001, respectively). Within the CD4 cell subset, the percentage of senescent cells did not differ between HIV+ and controls, but programmed cell death receptor-1 expression was upregulated in the former. CONCLUSIONS: HIV-infected children exhibit premature biological aging with accelerated immune senescence, which particularly affects the CD8 cell subset. HIV infection per se seems to influence the aging process, rather than exposure to ART for prophylaxis or treatment.
Asunto(s)
Envejecimiento Prematuro , Infecciones por VIH/patología , Fenómenos del Sistema Inmunológico , Biomarcadores/análisis , Linfocitos T CD4-Positivos/química , Linfocitos T CD4-Positivos/fisiología , Linfocitos T CD8-positivos/química , Linfocitos T CD8-positivos/fisiología , Diferenciación Celular , Senescencia Celular , Preescolar , Femenino , Reordenamiento Génico , Humanos , Lactante , Leucocitos Mononucleares/fisiología , Masculino , Reacción en Cadena en Tiempo Real de la Polimerasa , Receptores de Antígenos de Linfocitos T/genética , Acortamiento del TelómeroRESUMEN
We describe the case of a young girl with vertically-transmitted HIV infection who presented with chronic ocular inflammation characterized by several relapses and remissions. Good viral and immunological status made infective or neoplastic causes unlikely; the diagnosis was challenging and finally spontaneous remission was observed after several months. Clinical and histopathological findings made idiopathic orbital inflammatory syndrome the most probable diagnosis for our patient.
Asunto(s)
Infecciones por VIH/complicaciones , Músculos Oculomotores/patología , Seudotumor Orbitario/diagnóstico , Adolescente , Terapia Antirretroviral Altamente Activa , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Transmisión Vertical de Enfermedad Infecciosa , Seudotumor Orbitario/complicaciones , Resultado del TratamientoRESUMEN
We present a dramatic case of a patient presenting with disseminated intravascular coagulation related to meningococcal sepsis who developed heparin-induced thrombocytopenia following heparin administration during continuous renal replacement therapy. Association of these two prothrombotic conditions led to severe limbs ischemia and finally to bilateral legs amputation. We stress the importance of suspect heparin-induced thrombocytopenia in intensive care unit patients, especially when an improvement of other coagulation parameters is observed, and heparin therapy was started.
Asunto(s)
Anticoagulantes/efectos adversos , Heparina/efectos adversos , Infecciones Meningocócicas/complicaciones , Trombocitopenia/inducido químicamente , Trombocitopenia/complicaciones , Amputación Quirúrgica , Preescolar , Coagulación Intravascular Diseminada/inducido químicamente , Coagulación Intravascular Diseminada/complicaciones , Coagulación Intravascular Diseminada/fisiopatología , Humanos , Pierna/cirugía , Masculino , Infecciones Meningocócicas/fisiopatología , Recuento de Plaquetas , Transfusión de Plaquetas , Flujo Sanguíneo Regional/fisiología , Terapia de Reemplazo Renal , Trombocitopenia/fisiopatologíaRESUMEN
In this study we monitored renal, hepatic and muscular oxygen saturations by near-infrared spectroscopy and we evaluated the correlation with variables that could affect tissue oxygenation in 16 paediatric patients during surgical heart procedure. We considered the following phases: 1) basal time (after induction of anaesthesia and before median sternotomy), 2) before starting cardiopulmonary bypass, 3) 15 min after starting it, 4) at half time, 5) 15 min before the end, 6) at the end, 7) 15 min after the end, and 8) 10 min before paediatric intensive care unit admission. Heart rate, mean arterial pressure, peripheral oxygen saturation, serum lactate, haemoglobin, blood gas analysis, and rectal temperature were registered. We found a decrease of all monitored regional saturations (rSO(2)) (cerebral P = 0.006, hepatic P = 0.005) before starting the bypass. After this time, cerebral saturation gradually increased without reaching the basal value; renal and liver saturations increased after starting bypass; muscular rSO(2) increased in the second half (P = 0.005). A statistically significative inverse correlation between cerebral rSO(2) and pH was observed. In conclusion, during paediatric heart surgery a vulnerable period was identified. We underline the necessity to monitor this phase.