Safety and Effectiveness of COVID-19 Vaccines During Pregnancy: A Living Systematic Review and Meta-analysis.

BACKGROUND: Pregnant persons are susceptible to significant complications following COVID-19, even death. However, worldwide COVID-19 vaccination coverage during pregnancy remains suboptimal. OBJECTIVE: This study assessed the safety and effectiveness of COVID-19 vaccines administered to pregnant persons and shared this evidence via an interactive online website. METHODS: We followed Cochrane methods to conduct this living systematic review. We included studies assessing the effects of COVID-19 vaccines in pregnant persons. We conducted searches every other week for studies until October 2023, without restrictions on language or publication status, in ten databases, guidelines, preprint servers, and COVID-19 websites. The reference lists of eligible studies were hand searched to identify additional relevant studies. Pairs of review authors independently selected eligible studies using the web-based software COVIDENCE. Data extraction and risk of bias assessment were performed independently by pairs of authors. Disagreements were resolved by consensus. We performed random-effects meta-analyses of adjusted relative effects for relevant confounders of comparative studies and proportional meta-analyses to summarize frequencies from one-sample studies using R statistical software. We present the GRADE certainty of evidence from comparative studies. Findings are available on an interactive living systematic review webpage, including an updated evidence map and real-time meta-analyses customizable by subgroups and filters. RESULTS: We included 177 studies involving 638,791 participants from 41 countries. Among the 11 types of COVID-19 vaccines identified, the most frequently used platforms were mRNA (154 studies), viral vector (51), and inactivated virus vaccines (17). Low to very low-certainty evidence suggests that vaccination may result in minimal to no important differences compared to no vaccination in all assessed maternal and infant safety outcomes from 26 fewer to 17 more events per 1000 pregnant persons, and 13 fewer to 9 more events per 1000 neonates, respectively. We found statistically significant reductions in emergency cesarean deliveries (9%) with mRNA vaccines, and in stillbirth (75-83%) with mRNA/viral vector vaccines. Low to very low-certainty evidence suggests that vaccination during pregnancy with mRNA vaccines may reduce severe cases or hospitalizations in pregnant persons with COVID-19 (72%; 95% confidence interval [CI] 42-86), symptomatic COVID-19 (78%; 95% CI 21-94), and virologically confirmed SARS-CoV-2 infection (82%; 95% CI 39-95). Reductions were lower with other vaccine types and during Omicron variant dominance than Alpha and Delta dominance. Infants also presented with fewer severe cases or hospitalizations due to COVID-19 and laboratory-confirmed SARS-CoV-2 infection (64%; 95% CI 37-80 and 66%; 95% CI 37-81, respectively). CONCLUSIONS: We found a large body of evidence supporting the safety and effectiveness of COVID-19 vaccines during pregnancy. While the certainty of evidence is not high, it stands as the most reliable option available, given the current absence of pregnant individuals in clinical trials. Results are shared in near real time in an accessible and interactive format for scientists, decision makers, clinicians, and the general public. This living systematic review highlights the relevance of continuous vaccine safety and effectiveness monitoring, particularly in at-risk populations for COVID-19 impact such as pregnant persons, during the introduction of new vaccines. CLINICAL TRIAL REGISTRATION: PROSPERO: CRD42021281290.

Invasive pneumococcal disease in Latin America and the Caribbean: Serotype distribution, disease burden, and impact of vaccination. A systematic review and meta-analysis.

BACKGROUND: Invasive pneumococcal diseases (IPD) are associated with high morbidity, mortality, and health costs worldwide, particularly in Latin America and the Caribbean (LAC). Surveillance about the distribution of serotypes causing IPD and the impact of pneumococcal vaccination is an important epidemiological tool to monitor disease activity trends, inform public health decision-making, and implement relevant prevention and control measures. OBJECTIVES: To estimate the serotype distribution for IPD and the related disease burden in LAC before, during, and after implementing the pneumococcal vaccine immunization program in LAC. METHODS: Systematic literature review following Cochrane methods of studies from LAC. We evaluated the impact of the pneumococcal vaccine on hospitalization and death during or after hospitalizations due to pneumococcal disease and serotype-specific disease over time. We also analyzed the incidence of serotyped IPD in pneumococcal conjugate vaccine PCV10 and PCV13. The protocol was registered in PROSPERO (ID: CRD42023392097). RESULTS: 155 epidemiological studies were screened and provided epidemiological data on IPD. Meta-analysis of invasive diseases in children <5 years old found that 57%-65% of causative serotypes were included in PCV10 and 66%-84% in PCV13. After PCV introduction, vaccine serotypes declined in IPD, and the emergence of non-vaccine serotypes varied by country. CONCLUSIONS: Pneumococcal conjugate vaccines significantly reduced IPD and shifted serotype distribution in Latin America and the Caribbean. PCV10/PCV13 covered 57-84% of serotypes in children under 5, with marked decline in PCV serotypes post-vaccination. Continuous surveillance remains crucial for monitoring evolving serotypes and informing public health action.

Nasopharyngeal carriage of Streptococcus pneumoniae in Latin America and the Caribbean: A systematic review and meta-analysis.

BACKGROUND: Streptococcus pneumoniae is a leading cause of morbidity and mortality globally, causing bacteremic pneumonia, meningitis, sepsis, and other invasive pneumococcal diseases. Evidence supports nasopharyngeal pneumococcal carriage as a reservoir for transmission and precursor of pneumococcal disease. OBJECTIVES: To estimate the pneumococcal nasopharyngeal burden in all age groups in Latin America and the Caribbean (LAC) before, during, and after the introduction of pneumococcal vaccine conjugate (PVC). METHODS: Systematic literature review of international, regional, and country-published and unpublished data, together with reports including data from serotype distribution in nasopharyngeal carriage in children and adults from LAC countries following Cochrane methods. The protocol was registered in PROSPERO database (ID: CRD42023392097). RESULTS: We included 54 studies with data on nasopharyngeal pneumococcal carriage and serotypes from 31,803 patients. In children under five years old, carriage was found in 41% and in adults over 65, it was 26%. During the study period, children under five showed a colonization proportion of 34% with PCV10 serotypes and 45% with PCV13 serotypes. When we analyze the carriage prevalence of PCV serotypes in all age groups between 1995 and 2019, serotypes included in PCV10 and those included in PCV13, both showed a decreasing trend along analysis by lustrum. CONCLUSION: The data presented in this study highlights the need to establish national surveillance programs to monitor pneumococcal nasopharyngeal carriage to monitor serotype prevalence and replacement before and after including new pneumococcal vaccines in the region. In addition, to analyze differences in the prevalence of serotypes between countries, emphasize the importance of approaches to local realities to reduce IPD effectively.

Management and outcomes of bronchiolitis in Italy and Latin America: a multi-center, prospective, observational study.

We aimed to describe differences in the epidemiology, management, and outcomes existing between centers located in countries which differ by geographical location and economic status during to post-pandemic bronchiolitis seasons.  This was a prospective observational cohort study performed in two academic centers in Latin America (LA) and three in Italy. All consecutive children with a clinical diagnosis of bronchiolitis were included, following the same data collection form.  Nine hundred forty-three patients have been enrolled: 275 from the two Latin American Centers (San Jose, 215; Buenos Aires, 60), and 668 from Italy (Rome, 178; Milano, 163; Bologna, 251; Catania, 76). Children in LA had more frequently comorbidities, and only rarely received palivizumab. A higher number of patients in LA had been hospitalized in a ward (64% versus 23.9%, p < 0.001) or in a PICU (16% versus 6.2%, p < 0.001), and children in LA required overall more often respiratory support, from low flow oxygen to invasive mechanical ventilation, except for CPAP which was more used in Italy. There was no significant difference in prescription rates for antibiotics, but a significantly higher number of patients treated with systemic steroids in Italy. CONCLUSIONS: We found significant differences in the care for children with bronchiolitis in Italy and LA. Reasons behind such differences are unclear and would require further investigations to optimize and homogenize practice all over the world. WHAT IS KNOWN: • Bronchiolitis is among the commest cause of morbidity and mortality in infants all over the world. WHAT IS NEW: • There are significant differences on how clinicians care for bronchiolitis in different centers and continents. Differences in care can be principally due to different local practices than differences in patients severity/presentations. • Understanding these differences should be a priority to optime and standardize bronchiolitis care globally.

Antimicrobial resistance of Streptococcus pneumoniae from invasive pneumococcal diseases in Latin American countries: a systematic review and meta-analysis.

Background: Invasive pneumococcal disease has declined since pneumococcal conjugate vaccine introduction in Latin America and the Caribbean (LAC). However, serotype distribution and antimicrobial resistance patterns have changed. Methods: We conducted a systematic review to evaluate the frequency of antimicrobial resistance of Streptococcus pneumoniae from invasive disease in LAC. Articles published between 1 January 2000, and 27 December 2022, with no language restriction, were searched in major databases and gray literature. Pairs of reviewers independently selected extracted data and assessed the risk of bias in the studies. The quality of antimicrobial resistance (AMR) studies was evaluated according to WHO recommendations (PROSPERO CRD42023392097). Results: From 8,600 records identified, 103 studies were included, with 49,660 positive samples of S. pneumoniae for AMR analysis processed. Most studies were from Brazil (29.1%) and Argentina (18.4%), were cross-sectional (57.3%), reported data on AMR from IPD cases (52.4%), and were classified as moderate risk of bias (50.5%). Resistance to penicillin was 21.7% (95%IC 18.7-25.0, I2: 95.9), and for ceftriaxone/cefotaxime it was 4.7% (95%IC 3.2-6.9, I2: 96.1). The highest resistance for both penicillin and ceftriaxone/cefotaxime was in the age group of 0 to 5 years (32.1% [95%IC 28.2-36.4, I2: 87.7], and 9.7% [95%IC 5.9-15.6, I2: 96.9] respectively). The most frequent serotypes associated with resistance were 14 for penicillin and 19A for ceftriaxone/cefotaxime. Conclusion: Approximately one-quarter of invasive pneumococcal disease isolates in Latin America and the Caribbean displayed penicillin resistance, with higher rates in young children. Ongoing surveillance is essential to monitor serotype evolution and antimicrobial resistance patterns following pneumococcal conjugate vaccine introduction.

Ataxia cerebelosa aguda y COVID-19: presentación de un caso clínico / Ataxia cerebelosa aguda y COVID-19: presentación de un caso clínico

COVID-19 es una enfermedad viral principalmente respiratoria y/o gastrointestinal. Las manifestaciones neurológicas tienen una frecuencia variable en pediatría. Presentamos un varón de 10 años de edad, previamente sano, que presentó una ataxia cerebelosa durante un cuadro agudo de COVID-19. El SARS-CoV-2 fue detectado por hisopado nasofaríngeo por antígeno y RPC. El LCR fue normal y el cultivo bacteriológico y estudio viral fueron negativos. La TC y RM encefálica fueron normales. No requirió tratamiento específico y tuvo una evolución favorable, con resolución completa de los síntomas neurológicos al mes. Debe considerarse la infección por SARS-CoV-2 como un diagnóstico diferencial entre las causas de ataxia cerebelosa aguda, según la situación epidemiológica.

COVID-19 is a disease that mainly produces respiratory and/or gastrointestinal symptoms. Neurological manifestations occur with a variable frequency in children. We present a previously healthy 10-year-old boy who presented acute cerebellar ataxia during an acute COVID-19. SARS-CoV-2 was detected in a nasopharyngeal sample by antigen and PCR. The CSF was normal, the bacteriological culture and the viral PCR were negative. CT of the brain and gadolinium MRI of the brain were normal. He did not require specific treatment and had a favorable evolution, with complete resolution of neurological symptoms at one month. SARS-CoV-2 infection should be considered as a differential diagnosis between the causes of acute cerebellar ataxia, according to the epidemiological situation.

Dengue más allá del trópico: estudio de series temporales 2015-2016 versus 2019-2020 en un hospital pediátrico de la Ciudad de Buenos Aires / Dengue beyond the tropics: a time-series study comprising 2015-2016 versus 2019-2020 at a children's hospital in the City of Buenos Aires

Introducción. El dengue es un problema de salud pública a nivel mundial. Confinado en sus orígenes a las zonas tropicales y subtropicales, en la actualidad se presenta en otras regiones como Argentina. Desde el año 2008 se presenta con brotes epidémicos en la Ciudad Autónoma de Buenos Aires, con escasos reportes en niños. Objetivo. Analizar y comparar las características clínicas, epidemiológicas, de laboratorio y evolutivas de los dos últimos brotes de dengue fuera del área endémica. Población y métodos. Estudio de series temporales. Se incluyeron pacientes menores de 18 años con dengue probable o confirmado, evaluados en un hospital pediátrico de la Ciudad de Buenos Aires durante los períodos 2015-2016 y 2019-2020. Resultados. Se incluyeron 239 pacientes, 29 (12 %) con antecedente de viaje. La mediana de edad fue de 132 meses (rango intercuartílico: 102-156). Todos tuvieron fiebre. Otros síntomas fueron: cefalea en 170 (71 %), mialgias en 129 (54 %) y exantema en 122 (51 %). Cuarenta pacientes (17 %) tenían comorbilidades. Presentaron signos de alarma 79 pacientes (33 %) y 14 (6 %) tenían dengue grave. Requirieron internación 115 pacientes (45 %) y ninguno falleció. El serotipo DENV-1 fue el más frecuente. El antecedente de viaje y la necesidad de internación predominaron en el primer período; el dengue grave y la infección previa, en el segundo. Conclusiones. Ningún paciente falleció de dengue en los períodos estudiados. Se observaron diferencias estadísticamente significativas en la frecuencia de internación; el antecedente de viaje fue más frecuente en el período 2015-2016 y el dengue grave, en el 2019-2020.

Introduction. Dengue is a public health problem worldwide. It was originally confined to tropical and subtropical areas, but it is now present in other regions, such as Argentina. Epidemic outbreaks have been observed in the City of Buenos Aires since 2008, with few reports in children. Objective. To analyze and compare the clinical, epidemiological, laboratory, and evolutionary characteristics of the latest 2 dengue outbreaks outside the endemic area. Population and methods. Time-series study. Patients under 18 years of age with probable or confirmed dengue and evaluated in a children's hospital of the City of Buenos Aires during the periods 2015-2016 and 2019-2020 were included. Results. A total of 239 patients were included; 29 (12%) had a history of travel. Their median age was 132 months (interquartile range: 102156). All had a fever. Other symptoms included headache in 170 (71%), myalgia in 129 (54%), and rash in 122 (51%). Forty patients (17%) had comorbidities. Warning signs were observed in 79 patients (33%); 14 (6%) developed severe dengue; 115 (45%) were hospitalized; none died. DENV-1 was the most common serotype. A history of travel and hospitalization prevailed in the first period; severe dengue and prior infection, in the second period. Conclusions. No patient died due to dengue in either study period. Statistically significant differences were observed in the frequency of hospitalization; a history of travel was more common in the 2015-2016 period and severe dengue, in the 2019-2020 period.

Estudio multicéntrico de casos confirmados de COVID-19: datos preliminares de 2690 pacientes pediátricos en Argentina durante el primer año de la pandemia / A multicenter study of confirmed COVID-19 cases: preliminary data on 2690 pediatric patients in Argentina during the first year of the pandemic

Introducción. La evidencia actual indica que la gravedad de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) es menor en la población pediátrica, los datos locales aún son limitados. Objetivo: caracterizar los aspectos clínicos y epidemiológicos de la infección por COVID-19 en menores de 18 años en Argentina. Población y métodos. Estudio transversal, observacional y analítico de casos confirmados de COVID-19 entre 0 y 18 años asistidos entre marzo de 2020 y marzo de 2021 en 19 centros pediátricos de referencia de Argentina. Se realizó un análisis multivariado para identificar las variables predictoras de cuadros graves. Resultados. Se incluyeron 2690 casos de COVID-19: 77,7 % residentes del área metropolitana de Buenos Aires, 50,1 % de sexo masculino, mediana de edad de 5,6 años. El 90 % ocurrió entre las semanas epidemiológicas 20-47 del 2020; 60,4 % con antecedente de contacto con personas con COVID-19; y 96,6 % en el entorno familiar. El 51,4 % presentó síntomas respiratorios; 61,6 % síntomas generales; 18,8 % síntomas gastrointestinales; 17,1 % síntomas neurológicos; 7,2 % otros y 21,5 % fueron asintomáticos. El 59,4 % fue hospitalizado; 7,4 fueron graves o críticos. Se registraron 57 casos de síndrome inflamatorio multisistémico. El antecedente de asma, displasia broncopulmonar, cardiopatía congénita, desnutrición moderada a grave, obesidad, enfermedad neurológica crónica y/o edad menor de 6 meses resultaron predictores independientes de gravedad. Residir en barrios vulnerables resultó protector. Conclusiones. Más de la mitad de los casos refirieron antecedente de contacto con personas con COVID-19 en el entorno familiar. La hospitalización no respondió a criterios clínicos de gravedad. La gravedad se encuentra asociada a la existencia de ciertas comorbilidades.

Introduction. The current evidence indicates that the severity of the coronavirus disease 2019 (COVID-19) is lower in the pediatric population but local data are still limited. Objective: To characterize the clinical and epidemiological aspects of COVID-19 infection in patients younger than 18 years in Argentina. Population and methods. Cross-sectional, observational, and analytical study of confirmed COVID-19 patients aged 0-18 years seen between March 2020 and March 2021 at 19 referral children's hospitals of Argentina. A multivariate analysis was done to identify predictors of severe cases. Results. A total of 2690 COVID-19 cases were included: 77.7% lived in the Metropolitan Area of Buenos Aires; 50.1% were males; patients' median age was 5.6 years. Of them, 90% were seen during epidemiological weeks 20-47 of 2020; 60.4% had a history of contact with COVID-19 patients; and 96.6% in their family setting. Also, 51.4% had respiratory symptoms; 61.6%, general symptoms; 18.8%, gastrointestinal symptoms; 17.1%, neurological symptoms; 7.2%, other symptoms; and 21.5% were asymptomatic. In addition, 59.4% of patients were hospitalized and 7.4% had a severe or critical course. A total of 57 patients developed multisystem inflammatory syndrome. A history of asthma, bronchopulmonary dysplasia, congenital heart disease, moderate to severe malnutrition, obesity, chronic neurological disease and/or age younger than 6 months were independent predictors of severity.Livinginavulnerableneighborhoodwas a protective factor. Conclusions. More than half of cases referred a history of contact with COVID-19 patients in the family setting. Hospitalization was not based on clinical criteria of severity. Severity was associated with the presence of certain comorbidities

Toxoplasmosis congénita en gemelos / Congenital toxoplasmosis in twins: case report

Resumen La toxoplasmosis congénita en embarazos gemelares es infrecuente. Presentamos el caso de un embarazo gemelar monocigótico, monocorial con una infección materna por toxoplasmosis diagnosticada a las 33 semanas de gestación mediante detección de IgM e IgG reactivas y test de baja avidez de IgG. No pudo realizarse la detección del parásito en líquido amniótico debido a que no se hizo amniocentesis. Las recién nacidas (RN) de término presentaron calcificaciones cerebrales y coriorretinitis activa bilateral, sin otras manifestaciones clínicas asociadas. Tuvieron IgG e IgM reactiva para toxoplasmosis. No se realizó RPC para Toxoplasma gondii en placenta ni en sangre de cordón. Recibieron tratamiento durante el primer año de vida con pirimetamina, sulfadiazina y ácido folínico, sin eventos adversos asociados a la terapia. La metodología diagnóstica y el tratamiento no difieren de los embarazos con feto único. Uno o ambos RN pueden estar comprometidos. Es fundamental el seguimiento multidisciplinario para la detección precoz de reactivaciones o progresión de las lesiones.

Abstract Congenital toxoplasmosis in twin pregnancies is infrequent. We present the case of a monozygotic and monocorial twin pregnancy with maternal toxoplasmosis infection diagnosed at 33 weeks gestation by detecting reactive IgM and IgG and low avidity test for IgG. The detection of the parasite in amniotic fluid could not be performed because the amniocentesis was not done. The term newborns presented cerebral calcifications and bilateral active chorioretinitis without other associated clinical manifestations. They had IgG and IgM reactive for toxoplasmosis. The detection of Toxoplasma gondii was not performed by placental PCR or cord blood. They received treatment during the first year of life with pyrimethamine, sulfadiazine and folinic acid. They had no adverse events associated with the therapy. The diagnostic assessment and treatment does not differ from pregnancies with a single fetus. One or both newborns may be compromised. Multidisciplinary monitoring is essential for the early detection of reactivations or progression of lesions.

Infecciones por bacilos Gram-negativos multirresistentes en neonatología / Multidrug resistant Gram-negative infections in neonatology

Introducción. Las infecciones por bacilos Gram-negativos multirresistentes (BGN-MR) constituyen un problema creciente en las unidades de cuidado intensivo neonatal. El objetivo del estudio fue conocer las características epidemiológicas, clínicas, microbiológicas, evolutivas y los factores de riesgo de infección por BGN-MR resistentes a carbapenemes en el Servicio de Neonatología de un hospital de alta complejidad. Población y método. Se realizó un estudio de cohorte retrospectivo en dicho Servicio, donde se incluyeron los pacientes con infección documentada por BGN-MR del 24/4/2013 al 29/4/2015. Resultados. Se incluyeron 21 pacientes. La mediana de edad gestacional y peso de nacimiento fue 35 semanas y 2070 gramos, respectivamente. Dieciocho pacientes (86 %) tuvieron hemocultivos positivos y el aislamiento microbiológico más frecuente fue Acinetobacter baumannii (17 pacientes, 81 %), seguido por Klebsiella pneumoniae productora de carbapenemasa (3 pacientes, 14 %) y Enterobacter cloacae (1 paciente, 5 %). La mediana de edad al momento del diagnóstico fue de 28 días y todos tenían factores de riesgo para la infección, como cirugía, asistencia respiratoria mecánica, nutrición parenteral, catéter central y antibióticos. El tratamiento antibiótico definitivo fue colistina en todos los casos, combinado en el 84 %. Cinco pacientes (24 %) fallecieron por la infección. La prematurez y el peso < 2000 g fueron factores de riesgo estadísticamente significativos asociados a la mortalidad (p = 0,03 y 0,01, respectivamente). Conclusión. Las infecciones por BGN-MR se presentaron en pacientes con factores predisponentes. Acinetobacter baumannii fue el primer agente etiológico. La mortalidad fue elevada y relacionada con prematurez y bajo peso al nacer.

Introduction. Multidrug resistant Gramnegative (MDRGN) infections are an increasing problem in neonatal intensive care units. The objective of this study was to establish the epidemiological, clinical, microbiological, and evolutionary characteristics of carbapenem-resistant MDRGN infections and the risk factors for them at the Division of Neonatology of a tertiary care hospital. Population and method. A retrospective cohort study was done in this Division in patients with a documented MDRGN infection between 4/24/2013 and 4/29/2015. Results. Twenty-one patients were included. Their median gestational age and birth weight were 35 weeks and 2070 g, respectively. Eighteen patients (86 %) had a positive blood culture; the most commonly isolated microorganism was Acinetobacter baumannii (17 patients, 81 %), followed by carbapenemase-producing Klebsiella pneumoniae (3 patients, 14 %) and Enterobacter cloacae (1 patient, 5 %). The median age at diagnosis was 28 days and all patients had risk factors for infection, including surgery, assisted mechanical ventilation, parenteral nutrition, central venous line, and antibiotics. The definite antibiotic therapy included colistin in all cases; in combination, in 84 %. Five patients (24 %) died due to the infection. Prematurity and a birth weight < 2000 g were statistically significant risk factors associated with mortality (p = 0.03 and 0.01, respectively). Conclusion. MDRGN infections were observed in patients with predisposing factors. Acinetobacter baumannii was the main etiologic agent. Mortality was high and related to prematurity and a low birth weight.

Absceso cerebral en niños: experiencia en diez años en un hospital pediátrico de alta complejidad / Brain abscess in children: ten years of experience in a third level pediatric hospital

El absceso cerebral es una infección focal, que se presenta con una frecuencia de 0,3-1,3 casos cada 100000 personas/año.¹ Se describe la epidemiología, clínica y microbiología de 38 niños con diagnóstico de absceso cerebral internados entre el 1/4/2005 y el 31/12/2015 en el Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" de la Ciudad de Buenos Aires. Veinticuatro pacientes fueron varones. La mediana de edad fue de 132 meses. Se detectaron factores predisponentes en 25 niños. La mediana de evolución entre el inicio de los síntomas y la consulta fue de 7 días. Hubo 27 casos con lesiones únicas. Se realizó un drenaje quirúrgico en 34 pacientes. Las bacterias más frecuentes fueron anaerobios, Streptococcus viridans y Staphylococcus aureus. La mediana de tratamiento antibiótico fue de 56 días y la mediana de internación fue de 43 días. La letalidad fue del 3%.

Brain abscess is a focal infection that occurs with a frequency of 0.3-1.3 cases per 100,000 people/year. We describe the epidemiology, clinical and microbiology characteristics of 38 children diagnosed with brain abscess hospitalized between 4/1/2005 and 12/31/2015 at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" in Buenos Aires City. Twenty-four patients were male. The median age was 132 months. Predisposing factors were detected in 25 children. The median evolution from onset of symptoms to the visit was 7 days. There were 27 cases with single lesions. Surgical drainage was performed in 34 patients. The most frequent bacteria were anaerobes, Streptococcus viridans and Staphylococcus aureus. The median of antibiotic treatment was 56 days and the median of hospitalization was 43 days. The lethality was 3%.

Hidatidosis cerebral: comunicación de seis casos pediátricos / Cerebral hydatid disease: report of six pediatric cases

Hydatid disease is a parasitic infection whose etiologic agent is Echinococcus granulosus. Human is an accidental intermediate host and the most common site is the liver. The brain involvement is unusual and up to 75% of cases are described in the pediatric population. We present six children with cerebral hydatid disease admitted to the Pediatric Hospital J.P. Garrahan. All had neurological involvement on admission. The images showed single cystic lesion in the brain. They did not present involvement in other organs. Serology was negative in all cases. Medical and surgical treatment in all cases. The clinical outcome was favorable without sequelae in five of them and one had a residual paresis right faciobrachiocrural. This infection should be considered in the differential diagnosis of cystic tumor lesions of the central nervous system.

La hidatidosis es una infección parasitaria causada por Echinococcus granulosus. El ser humano es un hospedero intermediario accidental. La localización más frecuente es la hepática. El compromiso cerebral es inusual, se describe que hasta 75% ocurre en población pediátrica. Se presenta una serie de seis niños con hidatidosis cerebral internados en el Hospital de Pediatría J. P. Garrahan. Todos presentaron compromiso neurológico al ingreso. Las imágenes mostraron lesiones quísticas únicas en el cerebro. No tuvieron compromiso de otros órganos. La serología fue negativa en todos los casos. El tratamiento fue médico-quirúrgico. La evolución clínica fue favorable sin secuelas en cinco de ellos y uno presentó una hemiparesia faciobraquiocrural derecha como secuela. Esta infección debe considerarse entre los diagnósticos diferenciales de lesiones tumorales quísticas del sistema nervioso central.

Infección grave por Staphylococcus aureus meticilino sensible productor de leucocidina de Panton-Valentine: reportes de dos casos / Severe infection by methicillin sensitive Staphylococcus aureus producing Panton-Valentine leukocidin: reports of two cases

Staphylococcus aureus es uno de los principales agentes etiológicos de infecciones en niños provenientes de la comunidad y del ámbito hospitalario. La gravedad de estos cuadros se asocia a factores de virulencia, entre los que se encuentra la leucocidina de Panton-Valentine. Tanto Staphylococcus aureus resistente como sensible a la meticilina producen esta leucocidina, aunque con frecuencia variable. Presentamos a dos niños con infección grave por Staphylococcus aureus sensible a la meticilina productor de leucocidina de Panton-Valentine con complicaciones osteoarticulares y endovasculares. Es fundamental la sospecha diagnóstica, el tratamiento antibiótico adecuado y el manejo quirúrgico precoz para mejorar el abordaje de estas infecciones. Se debe mantener la vigilancia epidemiológica para detectar la frecuencia de las infecciones causadas por estas bacterias.

Staphylococcus aureus is a major etiologic agent of infections in children from the community and the hospital setting. The severity of these conditions is associated with virulence factors, including the Panton-Valentine leukocidin. Both methicillin resistant and sensitive Staphylococcus aureus produce this leukocidin although with varying frequency. We present two children with severe infection by sensitive Staphylococcus aureus producer of Panton-Valentine leukocidin with musculoskeletal and endovascular complications. It is essential the suspected diagnosis, appropriate antibiotic treatment and early surgical management to improve the approach of these infections. Epidemiological surveillance should be mantained to detect the frequency of infections caused by these bacteria.

Actinomicosis torácica: presentación de un caso / Thoracic actinomycosis: report of a case

La actinomicosis es una enfermedad producida por bacterias del género Actinomyces. La forma torácica representa el 30% de los casos. La evolución es habitualmente crónica, con clínica variable. Se presenta una nina de 11 años de edad con tumefacción subescapular derecha de un mes de evolución, asociada a fiebre, hiporexia y pérdida de peso. Se diagnosticó actinomicosis torácica producida por Actinomyces meyeri. Recibió tratamiento antibiótico durante un año, con resolución completa. Aunque es poco frecuente, debe ser tenida en cuenta como diagnóstico diferencial en cuadros de tumoración torácica de larga evolución con compromiso del estado general. Debe informarse al microbiólogo la sospecha diagnóstica por lo difícil de su desarrollo en los medios de cultivo habitual.

Actinomycosis is a disease produced by bacteria of the genus Actinomyces. The thoracic form represents 30% of the cases. Signs and symptoms are generally unspecific. A previously healthy 11 year old girl was admitted with a chest mass of a month of evolution associated with fever, hyporexia and weight loss. Thoracic actinomycosis was diagnosed with the isolation of Actinomyces meyeri in the mass drainage. She received antibiotic treatment for a year with complete resolution. Although rare, it should be taken into account as a differential diagnosis in long evolution thoracic tumor affecting the general condition. The microbiologist must be warned about the suspected diagnosis because it is difficult to find it in routinely used culture media.