Clinical patterns and seasonal trends in respiratory syncytial virus hospitalizations in São Paulo, Brazil.

The respiratory viruses are recognized as the most frequent lower respiratory tract pathogens for infants and young children in developed countries but less is known for developing populations. The authors conducted a prospective study to evaluate the occurrence, clinical patterns, and seasonal trends of viral infections among hospitalized children with lower respiratory tract disease (Group A). The presence of respiratory viruses in children's nasopharyngeal was assessed at admission in a pediatric ward. Cell cultures and immunofluorescence assays were used for viral identification. Complementary tests included blood and pleural cultures conducted for bacterial investigation. Clinical data and radiological exams were recorded at admission and throughout the hospitalization period. To better evaluate the results, a non- respiratory group of patients (Group B) was also constituted for comparison. Starting in February 1995, during a period of 18 months, 414 children were included- 239 in Group A and 175 in Group B. In Group A, 111 children (46.4%) had 114 viruses detected while only 5 children (2.9%) presented viruses in Group B. Respiratory Syncytial Virus was detected in 100 children from Group A (41.8%), Adenovirus in 11 (4.6%), Influenza A virus in 2 (0.8%), and Parainfluenza virus in one child (0.4%). In Group A, aerobic bacteria were found in 14 cases (5.8%). Respiratory Syncytial Virus was associated to other viruses and/or bacteria in six cases. There were two seasonal trends for Respiratory Syncytial Virus cases, which peaked in May and June. All children affected by the virus were younger than 3 years of age, mostly less than one year old. Episodic diffuse bronchial commitment and/or focal alveolar condensation were the clinical patterns more often associated to Respiratory Syncytial Virus cases. All children from Group A survived. In conclusion, it was observed that Respiratory Syncytial Virus was the most frequent pathogen found in hospitalized children admitted for severe respiratory diseases. Affected children were predominantly infants and boys presenting bronchiolitis and focal pneumonias. Similarly to what occurs in other subtropical regions, the virus outbreaks peak in the fall and their occurrence extends to the winter, which parallels an increase in hospital admissions due to respiratory diseases.

Risk factors for nosocomial infections in a critically ill pediatric population: a 25-month prospective cohort study.

We studied risk factors for nosocomial infections among 500 critically ill children who were admitted to a pediatric intensive care unit from August 1994 through August 1996 and who were prospectively followed until death, transfer, or discharge. Age, gender, postoperative state, length of stay, device-utilization ratio, pediatric risk of mortality score, and total parenteral nutrition were the risk factors studied. Through multivariate analysis, we identified three independent risk factors for nosocomial infection: device-utilization ratio (odds ratio [OR], 1.6; 95% confidence interval [CI95], 1.10-2.34), total parenteral nutrition (OR, 2.5; CI95, 1.05 5.81) and length of stay (OR, 1.7; CI95, 1.31-2.21).

[Acute fever without source in infants and children less than 36 months of age] / Febre aguda sem sinais de localização em crianças menores de 36 meses de idade.

OBJECTIVES: The objective of this article is to review current information about fever without source in children less than 36 months of age and to discuss the practical aspects of diagnosis and management.METHODS: Articles from the specific area were reviewed and presented in a practical form with recommendations from the authors.RESULTS: Febrile children comprise a substantial proportion of ambulatory pediatric visits. The majority of children are less than 3 years old. At first examination, there may be considerable overlap in the clinical appearance of children with fever due to viral illness, occult bacteremia and serious bacterial infection. The authors present the recommendations and protocols cited in the literature to assist physicians in managing infants and children with fever without source.CONCLUSION: Although many approaches to the evaluation and management of the febrile infant exist, no diagnostic protocol or therapeutic scheme is optimal for all patients. Pediatricians may individualize their management of these patients, depending on their experience, or interpretation of the recommendations presented in the literature.

[Viral infections in hospitalized children affected by acute lower respiratory tract disease] / Infecções virais em crianças internadas por doença aguda do trato respiratório inferior.

OBJECTIVE: To evaluate the frequency of the main respiratory viruses in hospitalized children affected by acute lower respiratory tract disease at a university hospital. METHODS: This is a prospective trial that included two cohorts of hospitalized children in the period from April to July 1996. The groups were selected according to the presence of lower respiratory tract disease on admission: Group A- with acute disease (history of less than 7 days) and B- without present or recent respiratory disease. The parameters for defining lower respiratory tract disease included physical and/or radiological pulmonary changes. Clinical and radiological criteria were established for the classification of lower respiratory tract diseases in group A. Nasopharyngeal swab was collected from all children on admission for viral detection by cellular cultures and direct immunofluorescence. RESULTS: 201 cases were selected, 126 in group A and 75 in group B. Viruses were identified in 71 children from groupA(56.4%) and only in 3 from group B (4.0%). The predominant agent in group A was respiratory syncytial virus, identified in 66 cases; adenovirus (4) and influenza (1) were detected in other patients. In group B two patients with respiratory syncytial virus and one with adenovirus were identified. The patients from group A affected by respiratory syncytial virus were younger (median age 3 months versus 13 months) and more wheezy on physical examination (78.7%) than the other patients of the group (33.3%). This virus was associated to most of the bronchiolitis cases (84%) and to half of the pneumonia cases (46.4%). CONCLUSION: The authors found a significant presence of viruses in the majority of children hospitalized with acute lower respiratory tract disease. The respiratory syncytial virus was the predominant agent identified. These results are similar to others previously reported both in developed and some developing countries. The authors emphasize that the present study evaluated only partially the possibility of simultaneous infection by other pathogens and that the present protocol was conducted during the season with the highest incidence of respiratory syncytial virus.

[Primary psoas abscess in a child. Case report and review of the literature]. / Abscesso primário do psoas em criança: relato de caso e revisão da literatura.

Primary psoas abscess is an uncommon disease. In children, clinical manifestations is often inspecific leading to diagnostic delay. The authors relate a primary pyogenic abscess of the psoas muscle in a 7-year-old girl with secondary septic arthritis of the hip. Confirmation of diagnosis was established by computerized tomography (CT) of the abdominal and pelvic areas. A review of the literature is presented about clinical manifestations, pathogenesis, differential diagnosis, etiology, diagnostic and therapeutic management of this infrequent entity.

[Idiopathic primary pulmonary hemosiderosis: treatment with cyclophosphamide and prednisone]. / Hemossiderose pulonmar idiopática tratada com ciclofosfamida e prednisona.

The authors present the case of a child diagnosed as having idiopathic pulmonary hemosiderosis at five years of age who had a good clinical outcome at the age of ten years. Initially the patient was treated with prednisone and chloroquine with poor results. When cyclophosphamide was added to prednisone, the patient demonstrated clinical and radiological remission. To date, the patient has been followed for one year without any medication, and has had only one limited episode of hemosiderosis. The authors also suggest that the therapeutic regimen with cyclophosphamide and prednisone may be useful for some selected cases.

Adenovirus genome types isolated from stools of children with gastroenteritis in São Paulo, Brazil.

In a prospective one-year study of acute gastroenteritis in hospitalized children less than 2 years of age, in São Paulo (Brazil), adenoviruses were detected by specific enzyme immunoassay (El-ARA) in 7 of 67 (10%) ill children and in 9 of 79 (11.4%) controls. They were the sole recognizable agent of diarrhea in 6 ill children. In another child these viruses were detected in a dual infection with astrovirus. Enteric adenoviruses (Ad40/41) were the most common serotypes detected in children with diarrhea (3/7) and Ad7 the serotype most detected in the controls (5/9), associated with lower respiratory tract infection. Thirteen adenovirus strains, isolated in HEp2 or HEK-293 cells, were characterized by seroneutralization and restriction enzyme analysis. The established adenoviruses were typed as AV-7-D5 (five associated to lower respiratory tract infection and one to diarrhea), AV-1-D10 (one diarrhea case), AV-31-D2 (two controls with respiratory infection), and two isolates as AV-12-D7, a new genome type. One subgenus D isolate, serotype 28, with restriction patterns different from those of the prototype, remained untyped. Only one enteric adenovirus could be typed. The restriction patterns of this isolated were similar to those of the prototype AV-41-D1. The genome type of the other three enteric adenoviruses could not be determined.

[Occurrence of human astrovirus in São Paulo City, Brazil]. / Ocorrência de astrovírus humanos na cidade de São Paulo, Brasil.

Human astrovirus was detected during a 13-month longitudinal study of the incidence of diarrhoea viruses among hospitalized children (less than 2 years of age) in a pediatric clinic of the city of S. Paulo (University Hospital). Serial fecal samples (intervals of 4 days) were collected from 146 children with and without acute diarrhoea at admission and during their stay in the hospital. Two (3%) of the 67 children with diarrhoea were positive at admission to the clinic by the highly sensitive ASTROVIRUS BIOTIN-AVIDIN ELISA, using CDC monoclonal antibodies (MAb SE7). All 79 children without diarrhoea (controls) were negative for astrovirus at admission. However, astrovirus was detected in 7 (4.8%) of the 146 hospitalized children during their stay in the clinic. Three of the positives shed astroviruses in 2 successive stool samples. All children positive for astrovirus were negative for rotavirus, adenovirus and bacterial and parasitic enteric agents. This is the first study of the detection of human astrovirus in Brazil. Astrovirus appears to be a significant cause of infantile gastroenteritis among young children in this country.