Virome and bacteriome characterization of children with pneumonia and asthma in Mexico City during winter seasons 2014 and 2015.

BACKGROUND: Acute asthma exacerbations and pneumonia are important causes of morbidity and mortality in children and may coexist in the same children, although symptom overlap may lead to difficulties in diagnosis. Microbial and viral diversity and differential abundance of either may play an important role in infection susceptibility and the development of acute and chronic respiratory diseases. OBJECTIVES: To describe the virome and bacteriome present in the upper respiratory tract of hospitalized children with a clinical diagnosis of asthma and pneumonia during an acute exacerbation and an acute respiratory illness ARI episode respectively. METHODS: During the winter seasons of 2013-2014 and 2014-2015, 134 nasopharyngeal swabs samples of children <15 years of age with ARI hospitalized at a referral hospital for respiratory diseases were selected based on clinical diagnosis of asthma or pneumonia. The virome and bacteriome were characterized using Whole Genome Sequencing (WGS) and in-house bioinformatics analysis pipeline. RESULTS: The Asthma group was represented mainly by RV-C, BoV-1 and RSV-B and the pneumonia group by Bacteriophage EJ-1 and TTMV. TTV was found in both groups with a similar amount of reads. About bacterial composition Moraxella catarrhalis, Propionibacterium acnes and Acinetobacter were present in asthma and Veillonella parvula and Mycoplasma pneumoniae in pneumonia. Streptococcus pneumoniae and Haemophilus influenzae were mostly found with both asthma and pneumonia. CONCLUSIONS: Our results show a complex viral and bacterial composition in asthma and pneumonia groups with a strong association of RV-C presence in asthmatic children. We observed Streptococcus pneumoniae and Haemophilus influenzae concurrently in both groups.

EV-D68 infection in children with asthma exacerbation and pneumonia in Mexico City during 2014 autumn.

BACKGROUND: Human enterovirus D68 (EV-D68) recently caused an increase in mild-to-severe pediatric respiratory cases in North America and some European countries. Even though few of these children presented with acute paralytic disease, direct causal relationship cannot yet be assumed. OBJECTIVES: The purposes of this report were to describe the clinical findings of an outbreak of EV-D68 infection in Mexico City and identify the genetic relationship with previously reported strains. PATIENTS/METHODS: Between September and December 2014, 126 nasopharyngeal samples (NPS) of hospitalized children <15 years of age with ARI were tested for the presence of respiratory viruses using a multiplex RT-qPCR and EV-D68-specific RT-qPCR. Clinical, epidemiological, and demographic data were collected and associated with symptomatology and viral infections. Phylogenetic analyses were performed using VP1 region. RESULTS: Enterovirus/rhinovirus infection was detected in 40 patients (31·7%), of which 24 patients were EV-D68-positive. EV-D68 infection prevailed over September and October 2014 and was associated with neutrophilia and lymphopenia, and patients were more likely to develop hypoxemia. Phylogenetic analyses showed that Mexican EV-D68 belongs to the new B1 clade. CONCLUSIONS: This is the first EV-D68 outbreak described in Mexico and occurred few weeks after the United States reported similar infections. Although EV-D68 belongs to new B1 clade, no neurological affection was observed.

Detection and characterization of respiratory viruses causing acute respiratory illness and asthma exacerbation in children during three different seasons (2011-2014) in Mexico City.

BACKGROUND: Viral infections play a significant role in causing acute respiratory infections (ARIs) and exacerbations of chronic diseases. Acute respiratory infections are now the leading cause of mortality in children worldwide, especially in developing countries. Recently, human rhinovirus (HRV) infection has been emerged as an important cause of pneumonia and asthma exacerbation. OBJECTIVES: To determine the role of several viral agents principally, respiratory syncytial virus, and HRV in children with ARIs and their relationship with asthma exacerbation and pneumonia. METHODS: Between October 2011 and March 2014, 432 nasopharyngeal samples of children <15 years of age with ARI hospitalized at a referral hospital for respiratory diseases were tested for the presence of respiratory viruses using a multiplex RT-qPCR. Clinical, epidemiological, and demographic data were collected and associated with symptomatology and viral infections. RESULTS: Viral infections were detected in at least 59·7% of the enrolled patients, with HRV (26·6%) being the most frequently detected. HRV infections were associated with clinical features of asthma and difficulty in breathing such as wheezing (P = 0·0003), supraesternal (P = 0·046), and xiphoid retraction (P = 0·030). HRV subtype C (HRV-C) infections were associated with asthma (P = 0·02). CONCLUSIONS: Human rhinovirus was the virus most commonly detected in pediatric patients with ARI. There is also an association of HRV-C infection with asthma exacerbation, emphasizing the relevance of this virus in severe pediatric respiratory disease.

Diagnóstico tardío de la aspiración de un cuerpo extraño / Delayed diagnosis of foreign body aspiration

Introducción. La aspiración de cuerpos extraños es un problema común en el paciente pediátrico y representa una causa importante de morbilidad y mortalidad. En Estados Unidos se considera la causa de 7% de las muertes accidentales de niños de entre 1 y 3 años de edad. La presentación clínica requiere de un alto grado de sospecha diagnóstica por el médico, sobre todo cuando el antecedente del evento de atragantamiento no es claro en la historia clínica debido a que la exploración física y los hallazgos radiológicos son inespecíficos en la mayoría de las ocasiones. Caso clínico. Se presenta el caso de un adolescente de 14 años que, a pesar de tener el antecedente de la aspiración de un cuerpo extraño, no se le dio importancia y sus síntomas se confundieron con otras entidades. Recibió diversos tratamientos pero sus síntomas se mantuvieron por un año. Fue remitido a la Unidad de Neumología Pediátrica Fernando Katz del Instituto Nacional de Enfermedades Respiratorias donde se realizó el estudio broncoscópico y la extracción del cuerpo extraño del bronquio intermedio. Conclusiones. El diagnóstico tardío ocasiona problemas respiratorios que van desde la obstrucción de las vías aéreas (que pone en riesgo la vida) hasta síntomas respiratorios crónicos como sibilancias e infecciones recurrentes de las vías respiratorias. Es común también que estos síntomas se confundan con otras entidades patológicas como el asma, el reflujo gastroesofágico y la disfunción laríngea.

Background. Aspiration of foreign bodies in the central airway is a common problem in the pediatric population, representing a major cause of morbidity and mortality in our country. In the U.S., foreign body aspiration is the cause for 7% of accidental deaths in children between 1 and 3 years of age. Clinical diagnosis requires a high degree of suspicion in the medical history especially when the choking event is unclear in the clinical history because physical examination and radiological findings have a low sensitivity. Case report. We present the case of a 14-year-old male with a history of foreign body aspiration. The patient's symptoms were given little importance. A 1-year delay in diagnosis occurred due to symptoms mimicking other pathologies. The patient was referred to the Pediatric Pulmonology Unit "Fernando Katz" of the National Institute of Respiratory Diseases where bronchoscopic exploration was performed with removal of foreign body (plastic object) from the intermediary bronchus. Conclusions. Delayed diagnosis causes respiratory problems ranging from life-threatining airway obstruction to chronic respiratory symptoms such as wheezing and recurrent respiratory infections. It has been shown that these symptoms can be confused with other pathologies such as asthma.

[Tuberculous lymphadenopathy. Diagnosis and treatment. Case report]. / Linfadenopatía tuberculosa. Diagnóstico y tratamiento. Informe de un caso.

Tuberculosis is a common cause of morbimortality among children, especially in developing countries, where 95% of cases occur. Child tuberculosis is closely related to tuberculosis in the adult, since the diagnosis is an indicator of poor surveillance, treatment, and effort to eradicate it. Tuberculous lymphadenitis (tuberculosis of the lymph node) is the most common form of extrapulmonary tuberculosis. We describe the case of an infant diagnosed with disseminated tuberculous lymphadenitis, by axillary lymph node excisional biopsy. Medical treatment first line antituberculosis drugs with allowed complete healing of the patient.

Linfadenopatía tuberculosa: diagnóstico y tratamiento: informe de un caso / Tuberculous lymphadenopathy: diagnosis and treatment: case report

La tuberculosis es una causa importante de morbimortalidad en los niños; sobre todo, en los países en vías de desarrollo, en donde se produce el 95 por ciento de los casos. La tuberculosis infantilestá íntimamente ligada a la del adulto, puesto que su diagnóstico es un indicador de una mala vigilancia, un tratamiento deficiente y un magro esfuerzo por erradicarla. La más comúnde las formas extrapulmonares es la linfadenopatía tuberculosa o tuberculosis ganglionar.Presentamos el caso de un lactante con diagnóstico de linfadenitis tuberculosa diseminada, realizado mediante biopsia quirúrgica de ganglio axilar. Medicado con fármacos antituberculosos de primera línea, se logró la curación completa del paciente.

Tuberculosis is a common cause of morbimortality among children, especially in developing countries, where 95% of cases occur. Child tuberculosis is closely related to tuberculosis in the adult, since the diagnosis is an indicator of poor surveillance, treatment, and effort to eradicate it. Tuberculous lymphadenitis (tuberculosis of the lymph node) is the most common form of extrapulmonary tuberculosis. We describe the case of an infant diagnosed with disseminated tuberculous lymphadenitis, by axillary lymph node excisional biopsy. Medical treatment firstline antituberculosis drugs with allowed complete healing of the patient.

Blastoma pulmonar. Reporte de un caso pediátrico / Pulmonary blastoma. A pediatric case

El blastoma pulmonar es una entidad esporádica en niños, siendo un tumor raro, con malignidad primaria para el pulmón y la pleura. Se presenta el caso de un preescolar masculino de tres años de edad cuyo cuadro clínico se manifestó por dolor abdominal, fiebre pérdida importante de peso, ataque al estado general y dificultad respiratoria, diagnosticándose en hospital de segundo nivel como neumonía y derrame pleural. Se discuten las características clínicas y el abordaje diagnóstico en relación a la literatura. Conclusión: nuestro caso demuestra la dificultad para establecer el diagnóstico sin el apoyo del tratamiento quirúrgico. La tomografía computada sugiere la extensión del tumor y la invasión mediastinal, pero es la toracotomía la que de hecho demuestra la posibilidad de resecarse si no existe compromiso mediastinal. Aunque es un tumor con baja frecuencia, las decisiones terapéuticas del blastoma pulmonar son difíciles, sobre todo si tomanos en cuenta que la quimioterapia y radioterapia posteriores al acto quirúrgico, aún están en el plano de la discusión