[Sepsis due to Pseudomonas aeruginosa in a previously healthy infant]. / Sepsis por Pseudomonas aeruginosa en un lactante previamente sano.

Pseudomonas aeruginosa, is an opportunistic organism widely distributed in both environmental and nosocomial settings. Invasive infections typically occur in immunocompromised patients, but this agent can also produce sepsis in the immunocompetent host. We report the case of an 8 months old infant, previous healthy, who presented septic shock by P. aeruginosa. Lesions of ecthyma gangrenosum in his limbs required surgical debridement. The patient presented transitory neutropenia and reduced C4 levels but subsequent study of immune defects was normal.

[Pet ownership and health status of pets from immunocompromised children, with emphasis in zoonotic diseases]. / Tenencia y estado de salud de mascotas de niños inmunocomprometidos, con énfasis en enfermedades zoonóticas.

OBJECTIVE: To characterize pet ownership and pet health status in families of immunocompromised (IS) children, with emphasis in zoonotic diseases. POPULATION AND METHODS: Families of IS children from two hospitals in Santiago, Chile, were interviewed and their pets were evaluated by veterinary examination, coproparasitologic and skin dermatophytes test. In specific cases, other laboratory tests were performed in IS children or their relatives. RESULTS: 47 out of 70 contacted families had pets, 42 participated in the study. Several risk factors for IS children were observed, as having a turtle as a pet and to clean cat or turtle faeces. Lack of adequate veterinary control, immunizations and deparasitation of pets were observed. Some animals showed zoonotic diseases or agents, as Brucella canis, Cryptosporidium sp, Giardia intestinalis, Toxocara canis and scabies. 44% of dogs had ticks and 37% had fleas, both potential vectors of infections. CONCLUSIONS: Our results suggest that policies to provide safer pet contact in IS children are needed.

[Hemophagocytic syndrome: Clinical characterization and follow-up of a Chilean pediatric cohort]. / Síndrome hemofagocítico: Caracterización clínica y seguimiento de una cohorte pediátrica chilena.

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a severe syndrome, potentially lethal, with a pathological activation of the immune system and an extreme hyperinflammatory response. The etiology is classified in primary HLH (familiar or genetic) and secondary (infectious, oncological, and rheumatological diseases). AIM: To analyze clinical and laboratory characteristics, treatment, and follow-up rates in pediatric patients with HLH. METHODS: A pediatric cohort of patients with HLH diagnosis attending in a tertiary hospital between January 2000 to February 2019 was analysed. RESULTS: 23 hospitalized patients were recruited with a median of 36 months of age. The most frequent clinical and laboratory findings were fever, cytopenias, and hyperferritinemia. The most frequent aetiologies were infectious (Epstein Barr virus and citomegalovirus) and rheumatological diseases. The global mortality was 35%, there was no significant difference between etiologies. DISCUSSION: Considering the high mortality of HLH it is very important to have a high grade of suspicion that allows treating at an early stage. It would be important to determine clinical and laboratory predictors in multicentric studies.

[23-valent pneumococcal vaccine. Statement of the Consultive Committee of Immunizations on behalf of the Chilean Infectious Diseases Society: February 2010]. / Declaración del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología acerca de la eficacia de la vacuna anti-neumocóccica 23 valente en el adulto mayor: Febrero 2010.

The article summarizes the scientific evidence related with protection conferred by the 23 valent polysaccharide vaccine against invasive pneumococcal disease, non bacteraemic pneumococcal pneumonia, and probable pneumococcal pneumonia in the elderly. Eider patients with and without risk factors are considered. The impact of herd immunity conferred by vaccination of children with conjugated pneumococcal vaccine in reduction of pneumonia in adults is discussed. Based on this analysis, the Advisory Committee on Immunizations of the Chilean Infectious Disease Society makes recommendations on the most efficient vaccine strategy for reduction of pneumococcal pneumonia in the elderly.

[Vaccine safety: description of the adverse events reported to the surveillance system in Chile, 2014 to 2016]. / Seguridad en vacunas: descripción de los eventos adversos notificados al sistema de vigilancia en Chile, 2014 a 2016.

BACKGROUND: Passive surveillance systems for adverse events following immunization (AEFI) allow the monitoring of known adverse effects (AE) and the investigation of infrequent AE. AIM: To describe the AEFI notified in Chile between 2014 and 2016. METHODOLOGY: This was a study of epidemiological surveillance. A general analysis of AEFI and sub-analysis for pentavalent vaccine was carried out. It was calculated the global reporting rate of AEFI every 100,000 doses of vaccines, the reporting rate of AEFI considered of interest and the odds ratio of reporting (ROR) of apneas for pentavalent. RESULTS: The total AEFI reported was 2,552 with a global reporting rate of 9,13. 13.4% of AEFI were serious. The vaccine reporting rate of events of interest was generally lower than the reference rates. The vaccine with the highest reporting rate (44.3) was pentavalent, with an ROR of apnea versus other vaccines of 10.5 (95% CI 3.77-29.47). DISCUSSION: This study provides an overview of the AEFI notified in Chile. The global reporting rate was similar to other studies, but those of events of interest were lower than international references. A possible association between apnea and pentavalent vaccine is shown.

[Ramsay Hunt syndrome in children: four cases and review]. / Síndrome de Ramsay-Himt en pediatría: reporte de cuatro casos y revisión de la literatura.

Ramsay-Hunt Syndrome (RHS) is a rare affection characterized by peripheral facial paralysis (PFP), skin eruption in the auricular canal and cochleovestibular symptoms. It is produced by varicella-zoster virus (VZV) reactivation at the geniculate ganglia. We report four patients between 3 and 17 years-old with RHS. Earache was the first symptom in two cases and three had cochleovestibular compromise. The direct immunofluorescence from the vesicular lesion was positive for VZV in two of them. All patients received treatment with aeyelovir and in three cases, this was associated with steroids. Three children had complete resolution of the PFP. RHS is an infrequent disease in the pediatric population and it should be suspected in children with PFP, erythema, vesicles and/or auricular pain. Early treatment with aeyelovir therapy could improve the recovery rate of facial nerve palsy.

[Invasive pneumococcal disease and consolidated pneumonia in infants: one year of surveillance in three Chilean health care centers]. / Infección neumocóccica invasora y neumonía consolidante en lactantes: Un año de vigilancia en tres centros hospitalarios chilenos.

OBJECTIVE: To describe frequency and type of invasive pneumococcal diseases (IPD) and consolidated pneumonia (CP) in Chilean infants. PATIENTS AND METHODS: One-year prospective surveillance in three health care centers. PID surveillance: blood culture in infants with suspected invasive bacterial disease or with fever higher than 39 degrees C axillary without focus or with acute otitis media. CP surveillance: blood culture and independent evaluation of chest X-ray in infants with suspected pneumonia. RESULTS: IPD: in 4,369 infants studied, 58 cases of invasive bacterial diseases were identified, 37 (64%) due to S. pneumoniae. Rates of IPD: 110/100,000 (Chilian) and 288/100,000 (Valparaiso). Serotypes identified: 18C(n: 8), 14 (n: 8), 19A(n: 5), others (n: 12). CP: in 3,005 infants 762 CP were detected. Rates of CP: 2,918/100,000 (Chilian) and 5,547/100,000 (Valparaiso). DISCUSSION: Results support the relevance of S. pneumoniae as the main cause of invasive bacterial disease and the high frequency of CP in this age group in Chile.

[Disseminated and fatal adenovirus infection in an immunocompromised child]. / Infección diseminada por adenovirus de curso fatal en un niño inmunocomprometido.

Severe adenovirus (ADV) infections have become increasingly important in immunocompromised patients, mainly in pediatric stem cell transplant recipients. We report a case of disseminated ADV infection leading to death in a 12-year-old stem cell transplant recipient. The diagnosis was confirmed by viral isolation and viral genome detection in tissues and blood. Main issues associated with infection, diagnosis and therapeutic alternatives are reviewed. This case should alert clinicians to suspect and study this agent in high risk patients and highlights the importance of having antiviral drugs for ADV available in Chile.

[Human papillomavirus vaccine. Statement of the Consultive Committee of Immunizations on behalf of the Chilean Infectious Diseases Society. September 2008]. / Declaración del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología respecto a la vacuna anti-virus papiloma humano. Septiembre 2008.

The article briefly reviews the epidemiology of human papillomavirus (HPV) infection and associated diseases in the world and in Chile and the scientific information of the licensed HPV vaccines: Gardasil and Cervarix. Considering the available information, the Consultive Committee of Immunizations of the Chilean Society of Infectious Diseases, summarizes its conclusions and makes recommendations for vaccination against HPV in Chile.

[Seroepidemiological evidence of human exposure to Anaplasma sp in Santiago, Chile]. / Evidencia seroepidemiológica de exposición humana a Anaplasma sp en Santiago, Chile.

OBJECTIVES AND METHODS: To find more evidence of human exposure to Anaplasma sp in Chile, we studied 108 contacts of dogs with canine ehrlichiosis (CE) (risk group) and 61 persons without tick or CE cases contact (control group). A survey including risk factors and history of diseases compatible with ehrlichiosis/ anaplasmosis was applied to the risk group. Serum IgG anti-Anaplasma sp antibodies were determined in both groups. RESULTS: A significant difference was found in the prevalence of anti-Anaplasma sp antibodies in the risk group compared with the control group (18,5 versus 3,3%), p < 0,005. No risk factors associated to seropositivity were found, nor persons with history suggesting ehrlichiosis/anaplasmosis. Ninety four percent of the houses of the risk group had tick infestation. DISCUSSION: A greater risk of exposition to Anaplasma sp is documented in people living in close contact with CE cases and in houses with tick infestation.

[Hospitalization due to influenza in children in Santiago, Chile, 2001-2005]. / Hospitalización por influenza en un Servicio de Pediatría de Santiago de Chile, 2001-2005.

BACKGROUND: Influenza cause high hospitalization rates and complications in children. OBJECTIVE: To describe clinical and epidemiological characteristics of influenza infection in hospitalized children. PATIENTS AND METHODS: In Universidad Católica Hospital, all hospitalizations due to influenza in children aged 15 days to 14 years, occurring between January 2001 and December 2005 were reviewed. RESULTS: Of a total of 3570 admissions associated with a respiratory illness, 124 (3.5%) were due to influenza, of which 75% presented between the months of April and June. Median age was 20.5 months (60% younger than 2 years) and 24% had an underlying risk factor. Most common symptoms were fever (94%) and dry cough (61%) and 75% of the children required oxygen. The most frequent complication was pneumonia (53%). The mean duration of hospitalization and oxygen use were 4.4 and 2.5 days respectively. Fifty two children (49.1%) received an antibiotic and nine children were admitted to intensive care unit. No deaths were recorded. CONCLUSION: Influenza virus cause serious complications and affects mostly healthy children younger than 2 years.

Detección molecular de patógenos en deposiciones en niños consultantes por diarrea aguda en Servicios de Urgencia / Molecular detection of pathogens in stool samples of children consulting for acute diarrhea in emergency services

INTRODUCCIÓN: La diarrea aguda continúa siendo una de las principales causas de morbilidad en niños; sin embargo, el diagnóstico etiológico presenta limitaciones dada la baja sensibilidad de los métodos tradicionales. OBJETIVO: Describir los microorganismos identificados en niños que acudieron al Servicio de Urgencia (SU) de un hospital universitario en Santiago, Chile, por diarrea aguda y a los que se le solicitó panel molecular gastrointestinal. MÉTODOS: Se revisaron fichas clínicas y resultados de panel gastrointestinal realizados entre junio de 2017 y marzo de 2020. RESULTADOS: Se incluyeron 198 pacientes, edad promedio de 54,5 meses y 60,6% (120/198) de sexo masculino. La positividad del panel fue de 78,8% (156/198) con 35,3% (55/156) de las muestras polimicrobianas. Se identificaron 229 microorganismos, de los cuales 72,9% (167/229) corresponden a bacterias, 25,8% (59/229) a virus y 1,3% (3/229) a parásitos. Destacaron Campylobacter spp. y Escherichia coli enteropatógena (ECEP) como las bacterias más frecuentemente identificadas. Los pacientes con detección de Campylobacter spp. presentaron con mayor frecuencia fiebre (p = 0,00). ECEP se aisló principalmente (82,5%) en muestras polimicrobianas. DISCUSIÓN: Los resultados enfatizan el potencial que poseen los estudios moleculares para mejorar el diagnóstico etiológico de la diarrea, pero a la vez llevan a cuestionar el rol patogénico de algunos microorganismos identificados.

BACKGROUND: Acute diarrhea continues to be one of the main causes of morbidity in children, however the etiologica diagnosis presents limitations given the low sensitivity of traditional methods. AIM: To describe the microorganisms identified in children who attended the emergency department (ED) in Santiago, Chile, due to acute diarrhea and to whom a gastrointestinal panel was requested as part of their study. MATERIAL AND METHODS: Clinical records and results of the gastrointestinal panel carried out between June 2017 and March 2020 were reviewed. RESULTS: 198 patients were included, the average age was 54.5 months and 60.6% (120/198) were males. Positivity was 78.8% (156/198) with 35.3% (55/156) of the samples being polymicrobial. 229 microorganisms were identified, of which 72.9% (167/229) corresponded to bacteria, 25.8% (59/229) to viruses, and 1.3% (3/229) to parasites. Campylobacter spp. and enteropathogenic Escherichia coli (EPEC) were the most frequently identified bacteria. Patients with detection of Campylobacter spp. presented a higher frequency of fever (p = 0.00). EPEC was isolated in 82.5% of the cases in polymicrobial samples. DISCUSSION: The results emphasize the potential of molecular studies to improve the etiological diagnosis of diarrhea and at the same time lead to question the pathogenic role of some microorganisms.

[Vaccines: adverse events surveillance]. / Vigilancia de eventos adversos a vacunas.

The objective of the surveillance systems of vaccine adverse events is monitoring events temporally related to vaccination, to evaluate their causality with the vaccine and to detect events after the introduction of new vaccines. The ultimate goal of these systems is to provide the population with the best safety standard of the vaccines. The surveillance system can be passive (spontaneous reports) or active (active follow up of vaccinees); the majority of them are passive. The article gives a brief review of the most known vaccine adverse events surveillance systems, including the American Vaccine Adverse Events Report System (VAERS), the Canadian and European systems, a commentary about the Chilean one, highlighting its main advantages and also its limitations.

[Influenza: immunization to new age groups]. / Influenza: Vacunación a nuevos grupos etarios.

Influenza immunization is a main tool to prevent this important viral illness. Traditional vaccine recommendations, mainly focused to elderly and people with chronic medical conditions, have been expanded during last years. The article summarizes the fundament of lowering the age cut off in adults and of the incorporation of healthy infants between 6 and 24 months. The performance of the vaccine in those new age groups is analyzed. Finally, new groups to possibly be incorporated in future vaccine recommendations are mentioned.

[Clinical and serological evidence of canine rickettsiosis in Chile]. / Evidencia clínica y serológica de rickettsiosis canina en Chile.

UNLABELLED: Rickettsial infections in pets have not been documented in Chile. Some of those infections have relevant zoonotic potential. OBJECTIVES: To report two serologically confirmed cases of canine rickettsiosis. To determine seroprevalence to Rickettsia sp in a group of dogs. METHODS: IgG antibodies anti-R. conorii and anti-A. phagocitophilum by IFI in two dogs with clinical rickettsiosis. IgG antibodies anti-R. conorii in a group of 77 dogs. CLINICAL CASES: a dog presented with fever, myalgias and melena, another dog with bleeding and neurological involvement. Seroprevalence: 35% of the dogs had antibodies against Rickettsia. DISCUSSION: This is the first evidence of canine rickettsiosis in Chile, both clinical and serological. Co-infection with two tickborne agents: Rickettsia and Anaplasma, is documented. Molecular studies are needed to confirm the rickettsial species present in Chile. The zoonotic role of these infections must be also studied.

[Safety of thimerosal containing vaccines. Statement of the Consultive Committee of Immunizations on behalf of the Chilean Infectious Diseases Society]. / Seguridad de las vacunas que contienen timerosal: Declaración del Comité Consultivo de Inmunizaciones (CCI) de la Sociedad Chilena de Infectología.

Thimerosal is a mercury derivative included in vaccines since 1930 with the aim to prevent microbial contamination. During the last decades, the use of thimerosal has been questioned, specifically because of a potential association with neurotoxicity. After a thorough review of published studies on pediatric use of thimerosal-containing vaccines, and of position papers from international expert groups, the Consultive Committee of Immunizations of the Chilean Society of Infectious Diseases concludes that there is no solid evidence of adverse events associated with the use of thimerosal containing vaccines in infants and children. Therefore, a change in current vaccine practices refererred to thimerosal-containing vaccines is not justified in Chile.

[Human metapneumovirus as hospitalization cause in children under 3 years old with acute respiratory infections during 2004]. / Metapneumovirus humano como causa de hospitalización en niños bajo 3 años de edad, con infección respiratoria aguda, durante el año 2004.

Human metapneumovirus was detected in 15 of 123 children (12%) younger than 3 years of age hospitalized for treatment of acute respiratory infection between July and November 2004. The virus was detected by RT-PCR directly from nasopharyngeal swabs and/or from supernatants after cell culture. Children infected with hMPV were mostly younger than one year of age (67%), all presenting with fever and cough. The main cause for hospitalization was the need for oxygen therapy (73%). Four hMPV positive children had an identifiable co-morbid condition but had a similar clinical evolution when compared to previously healthy infants. Chest radiography showed an increase in interstitial infiltrates with focal consolidation in 6 children. Obstructive bronchial syndrome and bronchiolitis, with or without pneumonia, were the most frequent diagnosis associated with hMPV positivity. A rapid and sensitive diagnostic method is required to improve diagnosis and treatment of these patients.

[Flu vaccine in children: state of the art]. / Vacuna anti-influenza en niños: estado del arte.

Influenza is an acute respiratory illness that year to year causes considerable morbidity and mortality. . All children, healthy or at high risk, are susceptible to this infection. Influenza vaccine seems to be effective in preventing influenza-like illness, laboratory-confirmed infection, and hospitalizations and deaths, demonstrating cost-effectiveness. Inactivated and live-attenuated vaccines have a similar efficacy profile. . Due to high influenza associated hospitalization rates in children, some countries have recommended incorporating influenza vaccination into the universal immunization program for healthy infants between 6-24 months of age. Considering that this public-health policy has been incorporated in Chile, local studies assessing its impact are needed.

[Rotavirus Vaccine. Statement of the Consultive Committee of Immunizations on behalf of The Chilean Infectious Diseases Society. March 2006]. / Declaración del Comité Consultivo de Inmunizaciones (CCI) de la Sociedad Chilena de Infectología respecto a vacuna anti-rotavirus. Marzo 2006.

The article briefly reviews the epidemiology of rotavirus infection and the scientific information of the rotavirus vaccines: Rotashield, withdrawn from the market due to its association with intussusception, Rotateq currently in an advanced phase of development, and Rotarix, recently licensed in Chile. Considering the available information, the Consultive Committee of Immunizations of the Chilean Society of Infectious Diseases, summarizes its conclusions and makes recommendations for infants vaccination against rotavirus in our country.

[Guidelines for management of animal bites]. / Recomendaciones para el manejo de mordeduras ocasionadas por animales.

Bites caused by pets or free living animal, including the so called exotic ones are a common cause of medical care request, although its real dimension has not been well defined in the local setting. This paper reviews the epidemiology of the topic placing emphasis in the initial approach and recommendations for the management of dog and cat bites. Due to increasing ownership or contact with other animals, management of bites from hamsters, mice, ferrets, rabbits, prairie dogs, monkeys, bats, lizards and bird bites is also discussed.