Primary Cutaneous Nocardia brasiliensis in a Spanish Child.

BACKGROUND: We report a case of a primary cutaneous nocardiosis by autochthonous Nocardia brasiliensis in a Spanish immunocompetent 9-year-old boy. METHODS: N. brasiliensis caused cellulitis showing the patient recovery after drainage and treatment with trimethoprim-sulfamethoxazole. Nocardia grew in pure culture and its identification was confirmed by sequencing (16S rRNA) and by MALDI-TOF MS (Bruker, Daltonics, Germany). CONCLUSIONS: In Spain although N. brasiliensis cutaneous infections in children are very infrequent should not be ruled out when an insect bite, stuck with a pine needle or an animal scratch has existed and the wound evolution is torpid.

Maternal prepregnancy obesity is an independent risk factor for frequent wheezing in infants by age 14 months.

BACKGROUND: Maternal prepregnancy obesity has been linked to the offspring's risk for subsequent asthma. We determined whether maternal obesity is associated with increased risk of wheezing phenotypes early in life. METHODS: We used data on 1107 mother-child pairs from two birth cohorts from the INMA-INfancia y Medio Ambiente project. Maternal height was measured and prepregnancy weight self-reported at enrolment (on average at 13.7 ± 2 weeks of gestation). Maternal prepregnancy body mass index was categorised as underweight, normal, overweight and obese according to WHO recommendations. Information on child's wheezing was obtained through questionnaires up to the age of 14 (± 1) months. Wheezing was classified as infrequent (<4 reported wheezing episodes) or frequent (≥ 4 episodes). Weight and length of infants were measured by trained study staff at 14.6 (± 1) months of age and weight-for-length z-scores computed. RESULTS: Although maternal obesity did not increase the risk of the child to have any or infrequent wheezing, children of obese mothers were more likely to have frequent wheezing than children of normal-weight mothers (11.8% vs. 3.8%; P = 0.002). In fully adjusted multinomial logistic regression models, including infants' weight-for-length z-scores and other covariates, maternal prepregnancy obesity was associated with increased risk of frequent [adjusted relative risk (RR) 4.18, 95% confidence interval (CI) 1.55, 11.3] but not infrequent (RR 1.05 [95% CI 0.55, 2.01]) wheezing in their children. CONCLUSIONS: Maternal prepregnancy obesity is independently associated with an increased risk of frequent wheezing in the infant by the age of 14 months. These findings add evidence on the potential effects of in utero exposures on asthma-related phenotypes.

Maternal vitamin D status in pregnancy and risk of lower respiratory tract infections, wheezing, and asthma in offspring.

BACKGROUND: Adequate vitamin D status in mothers during pregnancy may influence the health status of the child later in life. We assessed whether maternal circulating 25-hydroxyvitamin D (25[OH]D) concentrations in pregnancy are associated with risk of lower respiratory tract infections, wheezing, and asthma in the offspring. METHODS: Data were obtained from 1724 children of the INfancia y Medio Ambiente (INMA) Project, a population-based birth cohort study. Maternal circulating 25(OH)D concentrations were measured in pregnancy (mean gestational age = 12.6 [SD = 2.5] weeks). When the child was age 1 year, parents were asked if their child had a physician-confirmed history of lower respiratory tract infections or a history of wheezing. The questions about wheezing were repeated annually thereafter. Asthma was defined as parental report of doctor diagnosis of asthma or receiving treatment at the age of 4-6 years or wheezing since the age of 4 years. RESULTS: The median maternal circulating 25(OH)D concentration in pregnancy was 29.5 ng/mL (interquartile range, 22.5-37.1 ng/mL). After multivariable adjustment, there was a trend for an independent association between higher levels of maternal circulating 25(OH)D levels in pregnancy and decreased odds of lower respiratory tract infections in offspring (for cohort- and season-specific quartile Q4 vs. Q1, odds ratio = 0.67 [95% confidence interval = 0.50-0.90]; test for trend, P = 0.016). We found no association between 25(OH)D levels in pregnancy and risk of wheezing at age 1 year or 4 years, or asthma at age 4-6 years. CONCLUSIONS: Higher maternal circulating 25(OH)D concentrations in pregnancy were independently associated with lower risk of lower respiratory tract infections in offspring in the first year of life but not with wheezing or asthma in childhood.

Enzyme replacement therapy in Hurler syndrome after failure of hematopoietic transplant.

The most severe form of Mucopolysaccharosidosis type I (MPS-I), Hurler syndrome, presents with progressive respiratory, cardiac and musculoskeletal symptoms and cognitive deterioration. Treatment includes enzyme replacement therapy (ERT) and/or hematopoietic stem cell transplantation (HSCT). We describe the case of an 8-year old boy with MPS-I, homozygous for W402X, treated at 10 months of age with HSCT and after failure of the transplant, with ERT during 2 years showing good results, including a positive neuropsychological development.

[Trihalomethane and haloacetic acid concentrations in drinking water and their estimated intake during pregnancy in the INMA cohort (Guipúzcoa, Spain)]. / Concentración de trihalometanos y de ácidos haloacéticos en el agua de consumo y estimación de su ingesta durante el embarazo en la cohorte INMA-Guipúzcoa (España).

OBJECTIVES: To report trihalomethane (THM) and haloacetic acid (HAA) concentrations in drinking water, assess variations in these concentrations depending on source and over time, and estimate individual intake during pregnancy. METHODS: Water taken from 33 representative points of the water supply network of the 25 municipalities in the study area was analyzed from 2006-2008. Water drinking habits were recorded using a questionnaire. RESULTS: Mean total THM concentrations were 16.9 µg/L (standard deviation, 7.9), while the mean value for the sum of concentrations of five HAA (monochloroacetic, dichloroacetic, tricholoroacetic, monobromoacetic, and dicromoacetic acids) was 10.9 µg/L (standard deviation, 4.9). Concentrations were lower in spring waters, which were only chlorinated, compared with dam waters, which were subject to a complete purification treatment: 8.8 µg/L vs 19.1 µg/L (p<0.01) and 8.2 µg/L vs 11.7 µg/L (p<0.01). Concentrations significantly increased with the number of deposits in the network and with their rechlorination and were higher in the summer and fall. Mean intakes of total THM and of the five HAA were lower in women supplied with spring water. Intakes differed depending on supply reservoir. CONCLUSIONS: Disinfection by-products in water are affected by water source, supply network structure, and annual season. The mean intake of these products varies depending on the source of drinking water. Mean intakes of all products were much lower than values recommended by the World Health Organization.