Epidemiologic impact of blood culture practices and antibiotic consumption on pneumococcal bacteraemia in children.

This study examined the roles of two different diagnostic approaches to children with fever of unknown origin in determining the patterns of pneumococcal bacteraemia in two Spanish regions by comparing their main epidemiologic characteristics. Whereas a blood culture is routinely obtained in this setting in Navarre, this is not generally the case in Majorca. Additionally, the potential role of antibiotic consumption in each region was also analysed. Cumulative incidences in children under the age of 14 years were 26.6 per 100,000 child-years in Navarre (121.1 in children <2 years of age) and 7.3 per 100,000 child-years in Majorca (33.3 in children <2 years of age). In contrast, the incidences per 1,000 blood cultures were similar in both regions. The relative risks of occult bacteraemia, bacteraemic pneumonia and meningitis among the children of Navarre compared to Majorcan children were 11.8, 2.6 and 0.8, respectively. The risk for less virulent (vaccine serotypes plus 6A, 19A and 23A) and for more virulent serotypes (1 and 7) was 4.9 and 3.1 times higher in Navarre, respectively. The number of 7-valent pneumococcal conjugate vaccine (PCV7) doses administered between 2003 and 2004 were also higher in Navarre. Conversely, antibiotic resistance and paediatric prescriptions for broad-spectrum antibiotics were greater in Majorca. Although the most salient differences between both regions, including the effectiveness of pneumococcal conjugate vaccine in Navarre, appeared to be confounded by the higher frequency of blood cultures taken there, certain differences in serotype composition may be explained by the higher antibiotic consumption in Majorca.

[Study of the clinical and epidemiological characteristics of respiratory infections caused by adenovirus in a pediatric population (1997-2003)]. / Estudio de las características clínicas y epidemiológicas de las infecciones respiratorias por adenovirus en una población infantil (1997-2003).

INTRODUCTION: Infections due to adenoviruses are highly prevalent in pediatric patients. Because the clinical manifestations of the respiratory infections caused by adenoviruses are indistinguishable from those caused by other respiratory viruses, virological methods are required to establish their etiology. We present a retrospective study of the clinical and virological characteristics of patients with isolation of adenovirus in respiratory samples. MATERIAL AND METHODS: From 1997 to 2003 we analyzed 5,746 respiratory samples from pediatric patients (< 15 years old), of which 2,122 (36.9 %) were considered positive. The adenoviruses were isolated in the Hep-2 cell line culture by the shell vial method. RESULTS: Adenovirus was isolated in 100 clinical samples (4.7 % of all positive samples and 1.7 % of all samples studied) in a group of pediatric patients with a mean age of 14 months. The clinical diagnoses of patients were bronchiolitis (61 %), pneumonia (10 %), pertussis-like syndrome (16 %) and asthmatic crisis (11 %). Adenovirus infections mainly presented between December and March. Seventy-two percent of patients had a history of other viral respiratory tract infections and/or bronchial asthma. None of the patients had clinical conjunctivitis and only five patients had diarrhea due to adenoviruses. Seventy percent of the patients received artificial feeding and 30 % were breast-fed. Ninety percent of the patients were hospitalized and treatment mainly consisted of bronchodilator agents and antibiotics. CONCLUSIONS: Respiratory tract infections caused by adenoviruses mainly affected patients aged less than 14 months, in the first four months of the year, and with clinical manifestations of bronchiolitis or pneumonia without conjunctivitis. Clinically, these infections are difficult to differentiate from other viral respiratory infections.

[Bronchiolitis caused by influenza type A virus. An emerging infectious disease]. / Bronquiolitis causadas por el virus influenza tipo A. Una enfermedad infecciosa emergente.

OBJECTIVES: To prospectively study the emergence and diagnostic problems of bronchiolitis caused by influenza A virus among children durign the 1999-2000 influenza epidemic. MATERIALS AND METHODS: Negative respiratory syncitial virus (RSV) specimens (ELISA dot-blot) were seeded in the MDCK cell line for the isolation of influenza A virus, by the shell-vial technique. Vials were revealed by indirect immunofluorescence with antibodies directed against the influenza A virus nucleoprotein (Monofluookit IA, Pasteur Diagnostics). The clinical and epidemiologic features of patients with viral recovery were studied. A theoretical cost/benefit study was performed on the usefulness of the rapid antigenic detection of the influenza A virus. RESULTS: A total of 117 cases of respiratory infection caused by influenza A virus were detected. In 62 cases (52.9%) the diagnosis was bronchiolitis. Of them, 80.6% of cases were aged less than 6 years. Subtype H3N2 predominated in all respiratory infections, paticularly in bronchiolitis. During the 1999-2000 season, a significant emergence of bronchiolitis caused by influenza A virus was observed (week 3, 30% cases of influenza A versus 24% of RSV). The cost/benefit study disclosed that the antigenic detection of RSV and influenza A virus in all respiratory specimens would amount up to 30.83 Euros/specimen. CONCLUSIONS: During the last influenza epidemic, an emergence of bronchiolitis caused by influenza A virus among children was observed and confirmed. Based upon this observation, a dual strategy should be followed. On the one hand, a prophylactic approach (immunization of pregnant women); on the other hand, a diagnostic approach with a rapid antigenic detection of the influenza A virus.

[False diagnosis of myocardial infarction due to inversion of the electrocardiographic leads in the right limbs (author's transl)]. / Infarto de miocardio: falso diagnóstico por inversión de los electrodos del electrocardiógrafo en las extremidades derechas.

An abnormal ECG suggested the diagnosis of myocardial infarction in a 65-year-old man who had suffered a transient chest pain. When the patient was admitted to the Hospital a new ECG and biochemical enzymes were normal, but and identical pathologic ECG was registered following inversion of the electrocardiographic leads in the right superior and inferior extremities. A prospective study of 160 adult patients has demonstrated that inversion of the leads in the right limbs frequently causes the appearance of pathologic Q waves (37.14 percent) and ischemic T waves (51.22 percent), especially in lead I and aVL. Number of pathologic Q and T waves may vary when they are present in the basal register, but we never observed their disappearance in all the precordial lead series. A constant finding was the marked low voltage of P, QRS and T in lead II due to the "distance" of the electrocardiographic leads right leg-left leg. Technical recognition may be difficult because P waves and QRS complex are frequently negative or isoelectric in aVR.

[Survival of children and results obtained with a new chemotherapic combination in disseminated neuroblastoma treatment (author's transl)]. / Resultados de una nueva combinación poliquimioterápia en los neuroblastomas en estadio IV

A new polichemotherapic combination, including B.C.N.U., is essayed at six patients with disseminated neuroblastoma. Survival of these children and secundaries effects of the drugs are presented.