[Characteristics of human immunodeficiency virus-1 infected children receiving highly active antiretroviral therapy: a cross-sectional study]. / Características de niños con infección por virus de la inmunodeficiencia humana-1 que reciben tratamiento antirretroviral de gran actividad: estudio de corte transversal.

INTRODUCTION: Since 1996, when HAART became available, there has been a change in the course of HIV-infection, leading it to become a chronic disease. Our aim was to describe the characteristics of the children followed up in our hospital. PATIENTS AND METHODS: A cross-sectional study was conducted on 32 HIV-infected children followed up until December-2010, at the University-Hospital de Getafe. Clinical and laboratory information from the last visit was collected for the evaluation of patients. RESULTS: Thirty-two children with HIV-1 were evaluated, 29 infected through vertical-transmission. The median age was 14 years. According to the CDC classification, 56% (18/32) of children were in category A, 28% (9/32) B and 16% (5/32) C. Immunological class was 3 in 75% of children, class 2 in 9% and class 1 in 16%. The median nadir of CD4 was 337 cells/ml (12%). The median current CD4 was 749 (31%). Only one adolescent had a CD4% below 200 cells/ml due to lack of adherence. Twenty-eight patients (87%) were receiving HAART, and 4 patients were off antiretroviral treatment. Among the patients treated, 26 (93%) had viral loads <200 copies/ml. The median viral-load was<20 copies/ml. Median time on antiretroviral treatment was 10 years. The combination more frequently used was two nucleoside reverse transcriptase inhibitors (NRTI) and one protease inhibitor (PI), that was given to 15 patients (47%), followed by 2 NRTI, and one non-nucleoside reverse transcriptase inhibitor (NNRTI) in 8 patients (29%). Two children received rescue therapy including raltegravir, one with tipranavir and the other with darunavir. A total of 12 patients (43%) received medication once a day, 7 of them with fixed-dose combinations in a single tablet (25%). There were metabolic complications, including hyperlipidaemia or lipodystrophy were observed in 17 children (53%). CONCLUSIONS: Most of our patients are receiving HAART, with good virological and immunological control. The prevalence of metabolic abnormalities was high. Strategies to improve adherence and decrease toxicities are needed in perinatally-acquired HIV-infected children.

Surveillance of Chagas disease in pregnant women in Madrid, Spain, from 2008 to 2010.

One of the most important modes of transmission of Trypanosoma cruzi infection in areas where it is not endemic is vertical transmission: from mother to child. The objective of this report is to assess the efficacy of different programmes of serological screening to monitor infection with T. cruzi in pregnant Latin American women living in Madrid (Spain). To achieve this, a retrospective study was undertaken from January 2008 to December 2010 in seven hospitals in the Autonomous Community of Madrid. Serological screening programmes were classified in two main strategies: a selective one (pregnant women from Bolivia) and a universal one (pregnant women from Latin America). A total of 3,839 pregnant women were tested and the overall prevalence was 3.96%. The rate of congenital transmission was 2.6%. The current monitoring programmes have variable coverage ranging between 26% (selective screening) and 100% (universal screening). Monitoring of pregnant women from Latin America only reaches full coverage if universal screening of pregnant women is carried out at any moment of pregnancy, including at delivery. A common national regulation is necessary in order to ensure homogenous implementation of screening.

[Visceral childhood leishmaniasis: diagnosis and treatment]. / Diagnóstico y tratamiento de la leishmaniasis visceral infantil.

INTRODUCTION: Visceral leishmaniasis is endemic in Spain. New diagnostic tools and shorter regimens of treatment are been increasingly being used in children. OBJECTIVES: To analyze the clinical and epidemiological characteristics of cases of visceral leishmaniasis, to evaluate the diagnostic techniques tested and the safety and efficacy of treatments used. METHODS: We retrospectively reviewed the medical records of children diagnosed with visceral leishmaniasis between January 1994 and December 2007 in a tertiary public Hospital in the South of Madrid. The diagnosis of visceral leishmaniasis was based on visualization of Leishmania sp. in bone marrow aspirate or culture or positive PCR analysis of the bone marrow aspirate. RESULTS: Eleven immunocompetent children were identified. Median age was 21 months (range: 4 months - 13 years). Fever was present in all cases, and hepatomegaly and splenomegaly in 10 (91%). Anemia was the most frequent haematological finding (100%). A bone marrow aspirate was obtained in all cases. Leishmania amastigotes were observed in 8 (73%) cases. Leishmania DNA in the bone marrow aspirate was detected in all patients who underwent this procedure. Positive immunofluorescent-antibody test (IFAT) analysis at baseline was observed in 63% of cases tested. The threshold titer for positivity was 1/40. Urinary antigen detection test was positive in 4 out of 6 (67%) children in whom I was performed. Initial treatment consisted of meglumine antimoniate in 3 patients and liposomal amphotericin B (LAB) in 8 (73%) patients. All children had an early clinical response. Only one child treated with LAB relapsed. No severe adverse events were observed with treatment. CONCLUSIONS: Visceral leishmaniasis is still a common disease in our area. Clinical and laboratory findings of visceral leishmaniasis are similar to other Mediterranean area reports. PCR analysis of the bone marrow aspirate was more sensitive than traditional diagnostic techniques. Non-invasive diagnostic techniques may be used as an aid in the diagnosis of visceral leishmaniasis in children. Short course treatment of visceral leishmaniasis with liposomal amphotericin B has been safe and effective.

[The prevalence of Escherichia coli susceptibility to quinolones and other antibiotics in community-acquired bacteriurias in Madrid]. / Prevalencia de susceptibilidad de Escherichia coli a quinolonas y otros antibióticos en bacteriurias extrahospitalarias de Madrid.

BACKGROUND: The empiric treatment of extrahospitalary urinary infections must keep in mind the patterns of susceptibility of the potentially causative bacteria. The consumption of antibiotics is one of the most important causes of change in the susceptibility of the bacteria. The recent introduction of fluorquinolones and the widespread use of those antibiotics makes knowledge of new patterns of sensitivity necessary in order to determine whether there are changing sensitive pattern among the different geographic zones. METHODS: During a period of two weeks randomly chosen 379 strains of Escherichia coli isolated from extrahospitalary bacteria were collected in 11 laboratories in 4 health areas in Madrid. Sensitivity to 11 antibiotics, including four of the quinolone group was determined by the agar dilution method. The existence of significant differences of sensitivity among the different areas was analyzed by the chi 2 test. RESULTS: The prevalence of sensitivity to ampicillin and cotrimoxazol was 42 and 73% respectively. Nineteen percent of the strains were resistant to amoxycillin/clavulanic acid. No strain was found to be resistant to cefotaxime. Four percent of the sample studied was not sensitive to the new fluorquinolones and almost 10% were resistant to nalidixic acid latter having decreased sensitivity to the fluorquinolones. No significant differences were observed in sensitivity among the areas, except with amoxycillin/clavulanic acid and cotrimoxazole. CONCLUSIONS: The high prevalence of the resistance of E. coli to ampicillin recently leads to the recommendation of its use in empiric treatments of urinary infections. In the zone in Madrid studied a high prevalence of resistance and decreased sensitivity of E. coli to fluoroquinolones was observed. It is therefore advisable to moderate their use to thereby prolong use over time.