Pneumococcal serotypes in children, clinical presentation and antimicrobial susceptibility in the PCV13 era.

The aim was to analyse invasive pneumococcal disease (IPD) serotypes in children aged ⩽17 years according to clinical presentation and antimicrobial susceptibility. We conducted a prospective study (January 2012-June 2016). IPD cases were diagnosed by culture and/or real-time polymerase chain reaction (PCR). Demographic, microbiological and clinical data were analysed. Associations were assessed using the odds ratio (OR) and 95% confidence intervals (CI). Of the 253 cases, 34.4% were aged <2 years, 38.7% 2-4 years and 26.9% 5-17 years. Over 64% were 13-valent pneumococcal conjugate vaccine (PCV13) serotypes. 48% of the cases were diagnosed only by real-time PCR. Serotypes 3 and 1 were associated with complicated pneumonia (P < 0.05) and non-PCV13 serotypes with meningitis (OR 7.32, 95% CI 2.33-22.99) and occult bacteraemia (OR 3.6, 95% CI 1.56-8.76). Serotype 19A was more frequent in children aged <2 years and serotypes 3 and 1 in children aged 2-4 years and 5-17 years, respectively. 36.1% of cases were not susceptible to penicillin and 16.4% were also non-susceptible to cefotaxime. Serotypes 14, 24F and 23B were associated with non-susceptibility to penicillin (P < 0.05) and serotypes 11, 14 and 19A to cefotaxime (P < 0.05). Serotype 19A showed resistance to penicillin (P = 0.002). In conclusion, PCV13 serotypes were most frequent in children aged ⩽17 years, mainly serotypes 3, 1 and 19A. Non-PCV13 serotypes were associated with meningitis and occult bacteraemia and PCV13 serotypes with pneumonia. Non-susceptibility to antibiotics of non-PCV13 serotypes should be monitored.

[Eye disease in international adoption: Importance of the region of origin]. / Patología ocular en adopción internacional: importancia de la región de origen.

INTRODUCTION: To describe the ophthalmological conditions seen in children adopted internationally by Spanish families, and to assess the influence of the world region of origin and the preadoption period of institutional care on these conditions. MATERIAL AND METHODS: A descriptive, observational, cross-sectional study was conducted on 232 children divided into 4 groups according to world region of origin: Group 1, eastern Europe (n=95); Group 2, Asia (n=95); Group 3, Central and South America (n=26); and Group 4, Africa (n=16). A complete ophthalmological study was carried out and the groups were compared for the prevalence of ophthalmological conditions. RESULTS: Among the total, 57.8% (134) of children presented ophthalmological abnormalities. The prevalence of ametropia was strongly correlated with the world region of origin, and was significantly higher in Group 3 (65.4%) compared to the remaining groups. Strabismus and optic nerve hypoplasia (15.8% and 3.2%, respectively) were more prevalent in Group 1. The preadoption institutional care period was longer in children in Groups 1 and 3 (24.5 and 27.7 months, respectively). CONCLUSIONS: Children adopted from Central and South America had the highest prevalence of ametropia. Adopted children from eastern Europe showed a weak tendency to present strabismus and optic nerve hypoplasia. Adoptive parents, pediatricians and ophthalmologists should be aware of the high prevalence of ophthalmologic conditions in internationally adopted children and provide the means for a prompt diagnosis and appropriate treatment.

[Chronic and recurrent immune thrombocytopenic purpura]. / Púrpura trombocitopénica inmune crónica y recurrente.

BACKGROUND: Immune thrombocytopenic purpura (ITP) is characterized by a drop in platelet count usually accompanied by hemorrhagic diathesis. In chronic forms the platelet count remains low for six months after diagnosis and in recurrent forms the drop in platelet count appears after a period of normality. OBJECTIVES: To asses outcome and treatment response in patients with chronic or recurrent ITP. METHODS: We performed a retrospective, descriptive study of patients attended in the pediatric hematology outpatient clinic between January 1999 and December 2001. RESULTS: Of 38 patients with chronic ITP, 16 (42 %) presented chronic forms and 22 (58 %) presented recurrent forms. No significant differences were found between the two groups in age, sex, diagnosis, duration of follow-up, previous viral infection, or antiplatelet antibodies. In recurrent forms, the most effective treatment was intravenous immune gamma-globulin (77 % favorable responses) but response time was short (mean: 22.1 weeks). Splenectomy produced complete remission in 63 % of the chronic forms. Good results were obtained in six patients from both groups treated with intravenous anti-D immune globulin. During the study period, 4.5 % of patients with recurrent forms and 31.5 % of those with chronic forms showed spontaneous remission without treatment. CONCLUSIONS: In our experience, the most effective treatment for recurrent forms of ITP was intravenous immune globulin, but none of the treatments achieved long-term responses. In chronic forms, splenectomy is an effective alternative when the risk of hemorrhage is high, while a watchful attitude seems to be the best option when this risk is absent. Although the number of patients treated with intravenous anti-D immune globulin was low, good results were achieved.

[Traumatic pulmonary pseudocyst]. / Seudoquiste pulmonar traumático.

Traumatic pulmonary pseudocyst is an unusual complication that appears after a closed thoracic trauma. It is produced as a consequence of outburst and shear forces released by the impact on the elastic thoracic wall. We present a 14-year-old boy who, after a motorcycle crash, presented a traumatic pulmonary pseudocyst, isolated on the right hemithorax. The patient's evolution was good. The antecedent of trauma, together with radiological examination and the tendency toward spontaneous resolution, suggested the diagnosis as well as the advisability of a conservative approach in most pediatric cases. Recognition of this unusual disorder would help to avoid unnecessary diagnostic and therapeutic procedures.