[Prevalence of resistance to antiretroviral drugs in Spain]. / Prevalencia de resistencia a fármacos antirretrovirales en España.

INTRODUCTION: The development of resistance to antiretroviral therapy (ART) reduces the effectiveness of these drugs in HIV-infected children. METHODS: We performed a cross-sectional study in 86 vertically HIV-infected children, divided into four groups according to prior treatment: group 1: nucleoside reverse transcriptase inhibitor (NRTI), group 2: NRTI and non-nucleoside reverse transcriptase inhibitor (NNRTI), group 3: NRTI and protease inhibitor (PI), group 4: NRTI, NNRTI and PI. RESULTS: In group 1 (11 children), the median treatment duration was 35 months (26 to 108). Nucleoside-associated mutations (NAMs) were found in 10 of these patients and the Q151M multiresistance mutation was found in two. The three children in group 2 were treated for 9, 32 and 42 months with NRTI and NNRTI. One child showed three NAMs and another showed Q151M. Two children had the K103N mutation. Group 3 (36 children) received treatment with NRTI and PI for 48.0 +/- 27.6 and 23.0 +/- 14.6 months, respectively. NAMs were observed in 94 % of the patients in this group, and one child showed the Q151M mutation. In group 4 (36 children) total treatment duration was 70.0 +/- 36.1 months (13.0 +/- 12.1 months with NNRTI, and 39.0 +/- 14.3 months with PI). NAMs were observed in all patients in this group, and Q151M was found in three children. K103N and Y181C were detected in 24 (67%) and 10 (28%) of the children respectively, while 32 (90%) showed primary mutations to PI. CONCLUSIONS: A high prevalence of resistance mutations to NRTI and early appearance of resistance to NNRTI were observed in treated children.

[Skin tumor as presentation form of lung actinomycosis]. / Tumoración cutánea como forma de presentación de la actinomicosis pulmonar.

We report three cases of thoracic actinomycosis whose symptoms were cutaneous tumors on the thorax. Clinical signs and images are described, along with diagnostic procedures. The excellent outcome after antibiotic treatment, which must last at least 6 months, is emphasized as well as the need to keep this disease in mind when certain symptoms and images coincide.

[Study of contacts in children and adolescents using the QuantiFERON®-TB Gold In-Tube]. / Estudio de contactos en niños y adolescentes usando el QuantiFERON-TB(®) gold in-tube.

OBJECTIVE: To compare the results of the Mantoux Tuberculin Test (TT) and the QuantiFERON TB® Gold In-Tube (QFT-GIT) in a population of children and adolescents with TB contacts. MATERIAL AND METHODS: A prospective study using data collected on children and adolescents (< 17years) from a Health District of 300,000 inhabitants in the Basque Country (Spain) recruited into a TB contact study over a period of almost three years. The study included performing the Tuberculin Test using the Mantoux technique (with 2-TU of RT-23 PPD RT23 and Tween 80), and the QFT-GIT simultaneously, and collecting the demographic and clinical data. RESULTS: Of the 160 children included in the study, 14% had a positive TT (≥ 5mm) and 11% a positive QFT-GIT. There was 95%-96% agreement between the tests, depending on the TT cut-off point chosen, and was higher in non-vaccinated children (100%) and in children less than 5 years-old (100%). A significant relationship was observed between a positive result for both tests with exposure in the home. The use of QFT-GIT in the screening of latent TB infection could reduce preventive treatments by 28%-34% compared with conventional screening with the TT. CONCLUSIONS: The behaviour of QFT-GIT was comparable to the TT in identifying children with a tuberculosis infection; therefore it could potentially replace the TT.

Reduction in pediatric invasive pneumococcal disease in the Basque Country and Navarre, Spain, after introduction of the heptavalent pneumococcal conjugate vaccine.

This study evaluated the incidence of invasive pneumococcal disease, identified the causal serotypes, and tracked the evolution of the antibiotic susceptibility of Streptococcus pneumoniae isolates in the regions of the Basque Country and Navarre, Spain, before and after the introduction of the heptavalent pneumococcal conjugate vaccine. The study included all children aged between birth and 5 years diagnosed with bacteremia, meningitis, or bacteremic pneumonia caused by pneumococci. By the second year after introduction of the heptavalent pneumococcal conjugate vaccine, compared with the period 1998-2001, the incidence of invasive disease decreased by 64.3% in children less than 12 months of age, by 39.7% in children less than 24 months of age, and by 37.5% in children less than 60 months of age. The prevalence of clinical isolates of S. pneumoniae that lacked susceptibility to penicillin decreased by 58.2% among children less than 60 months of age. With an estimated coverage by four-dose heptavalent pneumococcal conjugate vaccine of 28-45% in 2003, the number of invasive pneumococcal infections in the Basque Country and in Navarre fell significantly after just 2 years of immunization, underscoring the importance of improving vaccination coverage under a universal childhood immunization program.

[Description of 31 pediatric cases of infection caused by human Parvovirus B 19]. / Descripción de 31 casos pediátricos de infección por Parvovirus humano B19.

FUNDAMENTALS: [corrected] Human Parvovirus B19 has been identified as the etiological agent implicated in several clinical forms of disease. The aim of this study was to define the clinical aspects observed in the children with human parvovirus infection in our hospital. METHODS: A retrospective study was done in 31 pediatric cases observed in our hospital from January-92 to July-94; all had positive IgM against Parvovirus (determined by enzymoinmunoanalysis). RESULTS: The most frequent signs and symptoms were fever in 66.6% of the cases and skin findings in 48%, manifested as typical infectious erythema in 26% and polimorphic nonspecific exanthema in the rest. There were variable blood manifestations, observed in 11 children (35%): Immune Thrombocytopenic purpura, Chronic anemia in immunocompromised hosts, bone marrow erithrophagocytosis and hemolytic crises in non-hemolytic anemia patients. The abnormal blood findings were mostly observed in children with compromised immunity. Articular disease was presented in four children (12%). Long lasting fever was observed in only one case. CONCLUSIONS: In our sample the diversity of clinical forms of presentation of Parvovirus B19 infection is well documented as it is reported by several authors. Although other studies as polymerase chain reaction (PCR), nucleic acid hybridization, direct visualization of the virus or its particles, or viral antigen detection are desirable to confirm the serologic studies.

Disseminated bacillus Calmette-Guerin infection in an HIV-infected child: a case with cutaneous lesions.

A boy born to a mother with unknown HIV infection was immunized with BCG in his first month of life. Seven months later axillary adenopathy developed. At the age of 10 months, 2 months after HIV infection had been diagnosed, papular skin lesions appeared all over his body. Mycobacterium bovis, BCG strain, was cultured from a lymph node and blood. Ziehl-Neelsen stain of a skin biopsy specimen showed histiocytes loaded with numerous acid-fast bacilli. The patient died 10 days later, before the infection was confirmed. This is the first reported case of disseminated BCG infection in an HIV-infected child presenting with cutaneous lesions.

[Round Table: Urticaria in relation to infections]. / Mesa Redonda: Urticaria en relación con infecciones.

OBJECTIVES: 1) To study the clinical and analytic features of infectious disease associated to urticaria in children. 2) To look into the probable etiology of the infectious disease. 3) To determine atopic predisposition and previous urticarial episodes and to rule out the involvement of antibiotics. DESIGN: Transversal and observational study. SETTING: Pediatric Allergy Outpatient Clinic of a tertiary Hospital. PATIENTS: Forty-four children, aged 1 to 12 years with acute urticaria associated to clinically infectious or febrile illness attending an Emergency Pediatric Department. INTERVENTION: Symptoms evaluation and physical examination in the seventh first days and follow over 3-6 weeks by the same physician. MEASUREMENTS: Clinical features of urticaria (duration, angioedema associated); Clinic diagnosis of illness infectious (acute respiratory infection, gastroenteritis, febrile syndrome); white blood cells count, C-reactive protein, aminotransferases (AST, ALT), L-Y-glutamyl transferase; viral culture and antigen detection: enterovirus (EV), adenovirus, respiratory syncytial virus (RSV), parainfluenza 1, 2 and 3, influenza A y B and cytomegalovirus (CMV); serological assay: CMV, enterovirus, mycoplasma pneumoniae, Epstein-Barr, parvovirus B19. RESULT: 22 children (50%) are between 1-2 years old. 40 patients (90,9%) had symptoms of respiratory tract infection and only four patients had a pneumonia. The other 4 children had a gastroenteritis. The analytic was suggestive of viral infection in 35 (79.5%) and unknown on seven patients. In 20 children (45.4%) was identified a probable infection. The viral detection was positive in 3 patients: CMV, herpes simplex 1 and influenza A. Twenty microbiological findings for seventeen patients was found by serological criterion of probable infection: enterovirus (10); parvovirus B19 (4); Epstein-Barr (3) y mycoplasma (3). Evidence of a double serologic infection was found in three patients. In comparison with a serological control group encountered that acute urticaria during a infectious disease is significantly associated (p = 0.0054) to high titer to enterovirus by complement-fixation. The urticaria was associated with angioedema in 38.6% and 9 children (20.4%) related an previous similar episode. Twenty-one (47.7%) had been treated with antibiotics before development the urticaria. All patients was given the suspected antibiotic and no patient developed any adverse reaction. CONCLUSIONS: The clinically infectious associated to urticarial rash in children, usually is a viral respiratory infections. Is more frequent at infant. In spite of antibiotic therapy is often related to development the urticaria, the subsequent challenge with the same antibiotic is good tolerated.

Estudio de contactos en niños y adolescentes usando el QuantiFERON-TB® gold in-tube / Study of contacts in children and adolescents using the QuantiFERON®-TB Gold in-tube

Objetivo: Comparar el comportamiento de la prueba de la tuberculina (PT) y el QuantiFERONTB® gold in-tube (QFT-GIT) en una población infantil integrada por contactos. Material y métodos: Estudio con recogida de datos prospectivo realizado en un distrito sanitario del País Vasco (España) de 300.000 habitantes, en niños y adolescentes (edad < 17 años)reclutados en un estudio de contactos durante un periodo de casi 3 años. El estudio incluyó la prueba de la tuberculina (PT), realizada con la técnica de Mantoux (con 2-TU de PPD RT23 con Tween 80), y el QFT-GIT simultáneamente y la recogida de datos demográficos y clínicos. Resultados: Entre los 160 niños incluidos, el 14% tenía una PT positiva (≥ 5mm) y 11% un QFTGIT positivo. La concordancia entre las pruebas fue del 95-96%, dependiendo del punto de corte de la PT elegido y fue mayor en los niños no vacunados (100%) y en los niños menores de 5 años (100%). Se observó una asociación significativa entre el resultado positivo de ambas pruebas con la exposición en el domicilio. El uso del QFT-GIT en el cribado de la infección tuberculosa latente supondría reducir entre el 28-34% de tratamientos preventivos con respecto al cribado convencional con la PT. Conclusiones: El comportamiento del QFT-GIT fue comparable a la PT en la identificación de niños con infección tuberculosa por lo que podría potencialmente reemplazar a la PT (AU)

Objective: To compare the results of the Mantoux Tuberculin Test (TT) and the QuantiFERONTB® Gold In-Tube (QFT-GIT) in a population of children and adolescents with TB contacts. Material and methods: A prospective study using data collected on children and adolescents (< 17 years) from a Health District of 300,000 inhabitants in the Basque Country (Spain) recruited into a TB contact study over a period of almost three years. The study included performing theTuberculin Test using the Mantoux technique (with 2-TU of RT-23 PPD RT23 and Tween 80), and the QFT-GIT simultaneously, and collecting the demographic and clinical data. Results: Of the 160 children included in the study, 14% had a positive TT (≥ 5mm) and 11% a positive QFT-GIT. There was 95%-96% agreement between the tests, depending on the TT cutoff point chosen, and was higher in non-vaccinated children (100%) and in children less than5 years-old (100%). A significant relationship was observed between a positive result for both tests with exposure in the home. The use of QFT-GIT in the screening of latent TB infection could reduce preventive treatments by 28%-34% compared with conventional screening with the TT. Conclusions: The behaviour of QFT-GIT was comparable to the TT in identifying children with a tuberculosis infection; therefore it could potentially replace the TT (AU)

Prevalencia de resistencia a fármacos antirretrovirales en España / Prevalence of resistance to antiretroviral drugs in Spain

Introducción La aparición de resistencias a los antirretrovirales (ARV) compromete la eficacia del tratamiento antirretroviral (TAR) en los niños infectados por el virus de la inmunodeficiencia humana (VIH). Métodos Se realizó un estudio transversal en 86 niños divididos en 4 grupos según su historia de TAR previo: 1. inhibidores de la retrotranscriptasa análogos de nucleósido (NRTI); 2. NRTI e inhibidores de la retrotranscriptasa no análogos de nucleósido (NNRTI); 3. NRTI e inhibidores de la proteasa (IP); 4. NRTI, NNRTI e IP. Resultados En el grupo 1 (11 niños) la mediana de TAR fue de 35 meses (26-108). En 10 pacientes se detectaron mutaciones asociadas a los análogos de timidina (NAM) y en 2 pacientes se halló el complejo de multirresistencia Q151M. Los 3 niños del grupo 2, recibieron 9, 32 y 42 meses respectivamente de TAR con NNRTI. En un paciente de este grupo se aislaron 3 NAM y en otro el complejo Q151M. 2 pacientes tenían la mutación K103N. En el grupo 3 (36 niños) la media de duración de tratamiento con NRTI e IP era de 48,0 ± 27,6 y 23,0 ± 14,6 meses, respectivamente. El 94 % de los pacientes de este grupo, tenían NAM y un paciente tenía el complejo Q151M. En el grupo 4 (36 niños) el tiempo previo de TAR era de 70,0 ± 36,1 meses (NNRTI: 13,0 ± 12,1 meses; IP: 39,0 ± 14,3 meses). Todos los pacientes tenían NAM y 3 pacientes tenían el complejo Q151M. Las mutaciones K103N y Y181C se hallaron en 24 (67 %) y 10 (28 %) de los pacientes, respectivamente. Un total de 32 pacientes (90 %) tenían alguna mutación primaria a IP. Conclusiones La aparición de resistencias a los ARV es frecuente en niños, siendo de rápida aparición con los NNRTI

Introduction The development of resistance to antiretroviral therapy (ART) reduces the effectiveness of these drugs in HIV-infected children. Methods We performed a cross-sectional study in 86 vertically HIV-infected children, divided into four groups according to prior treatment: group 1: nucleoside reverse transcriptase inhibitor (NRTI), group 2: NRTI and non-nucleoside reverse transcriptase inhibitor (NNRTI), group 3: NRTI and protease inhibitor (PI), group 4: NRTI, NNRTI and PI. Results In group 1 (11 children), the median treatment duration was 35 months (26 to 108). Nucleoside-associated mutations (NAMs) were found in 10 of these patients and the Q151M multiresistance mutation was found in two. The three children in group 2 were treated for 9, 32 and 42 months with NRTI and NNRTI. One child showed three NAMs and another showed Q151M. Two children had the K103N mutation. Group 3 (36 children) received treatment with NRTI and PI for 48.0 ± 27.6 and 23.0 ± 14.6 months, respectively. NAMs were observed in 94 % of the patients in this group, and one child showed the Q151M mutation. In group 4 (36 children) total treatment duration was 70.0 ± 36.1 months (13.0 ± 12.1 months with NNRTI, and 39.0 ± 14.3 months with PI). NAMs were observed in all patients in this group, and Q151M was found in three children. K103N and Y181C were detected in 24 (67 %) and 10 (28 %) of the children respectively, while 32 (90 %) showed primary mutations to PI. Conclusions A high prevalence of resistance mutations to NRTI and early appearance of resistance to NNRTI were observed in treated children