Detección molecular de patógenos en deposiciones en niños consultantes por diarrea aguda en Servicios de Urgencia

Introducción: La diarrea aguda continúa siendo una de las principales causas de morbilidad en niños; sin embargo, el diagnóstico etiológico presenta limitaciones dada la baja sensibilidad de los métodos tradicionales. Objetivo: Describir los microorganismos identificados en niños que acudieron al Servicio de Urgencia (SU) de un hospital universitario en Santiago, Chile, por diarrea aguda y a los que se le solicitó panel molecular gastrointestinal. Métodos: Se revisaron fichas clínicas y resultados de panel gastrointestinal realizados entre junio de 2017 y marzo de 2020. Resultados: Se incluyeron 198 pacientes, edad promedio de 54,5 meses y 60,6% (120/198) de sexo masculino. La positividad del panel fue de 78,8% (156/198) con 35,3% (55/156) de las muestras polimicrobianas. Se identificaron 229 microorganismos, de los cuales 72,9% (167/229) corresponden a bacterias, 25,8% (59/229) a virus y 1,3% (3/229) a parásitos. Destacaron Campylobacter spp. y Escherichia coli enteropatógena (ECEP) como las bacterias más frecuentemente identificadas. Los pacientes con detección de Campylobacter spp. presentaron con mayor frecuencia fiebre (p = 0,00). ECEP se aisló principalmente (82,5%) en muestras polimicrobianas. Discusión: Los resultados enfatizan el potencial que poseen los estudios moleculares para mejorar el diagnóstico etiológico de la diarrea, pero a la vez llevan a cuestionar el rol patogénico de algunos microorganismos identificados.

Background: Acute diarrhea continues to be one of the main causes of morbidity in children, however the etiologica diagnosis presents limitations given the low sensitivity of traditional methods. Aim: To describe the microorganisms identified in children who attended the emergency department (ED) in Santiago, Chile, due to acute diarrhea and to whom a gastrointestinal panel was requested as part of their study. Material and Methods: Clinical records and results of the gastrointestinal panel carried out between June 2017 and March 2020 were reviewed. Results: 198 patients were included, the average age was 54.5 months and 60.6% (120/198) were males. Positivity was 78.8% (156/198) with 35.3% (55/156) of the samples being polymicrobial. 229 microorganisms were identified, of which 72.9% (167/229) corresponded to bacteria, 25.8% (59/229) to viruses, and 1.3% (3/229) to parasites. Campylobacter spp. and enteropathogenic Escherichia coli (EPEC) were the most frequently identified bacteria. Patients with detection of Campylobacter spp. presented a higher frequency of fever (p = 0.00). EPEC was isolated in 82.5% of the cases in polymicrobial samples. Discussion: The results emphasize the potential of molecular studies to improve the etiological diagnosis of diarrhea and at the same time lead to question the pathogenic role of some microorganisms.

[Hemophagocytic syndrome: Clinical characterization and follow-up of a Chilean pediatric cohort]. / Síndrome hemofagocítico: Caracterización clínica y seguimiento de una cohorte pediátrica chilena.

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a severe syndrome, potentially lethal, with a pathological activation of the immune system and an extreme hyperinflammatory response. The etiology is classified in primary HLH (familiar or genetic) and secondary (infectious, oncological, and rheumatological diseases). AIM: To analyze clinical and laboratory characteristics, treatment, and follow-up rates in pediatric patients with HLH. METHODS: A pediatric cohort of patients with HLH diagnosis attending in a tertiary hospital between January 2000 to February 2019 was analysed. RESULTS: 23 hospitalized patients were recruited with a median of 36 months of age. The most frequent clinical and laboratory findings were fever, cytopenias, and hyperferritinemia. The most frequent aetiologies were infectious (Epstein Barr virus and citomegalovirus) and rheumatological diseases. The global mortality was 35%, there was no significant difference between etiologies. DISCUSSION: Considering the high mortality of HLH it is very important to have a high grade of suspicion that allows treating at an early stage. It would be important to determine clinical and laboratory predictors in multicentric studies.

Síndrome hemofagocítico: caracterización clínica y seguimiento de una cohorte pediátrica chilena / Hemophagocytic syndrome: clinical characterization and follow-up of a Chilean pediatric cohort

INTRODUCCIÓN: La linfohistiocitosis hemofagocítica (HLH en inglés) es un síndrome clínico grave, potencialmente fatal, caracterizado por una activación patológica del sistema inmune y una respuesta hiperinflamatoria extrema. Según su etiología se clasifica en primario (genético o familiar) y secundario (gatillado por causas infecciosas, oncológicas o reumatológicas). OBJETIVOS: Describir y analizar las características clínicas y laboratorio, tratamiento recibido y seguimiento en pacientes pediátricos con diagnóstico de HLH. PACIENTES Y MÉTODOS: Se describió una cohorte pediátrica en pacientes hospitalizados con diagnóstico de HLH en un centro terciario universitario entre enero de 2000 y febrero de 2019. RESULTADOS: Se reclutaron 23 pacientes pediátricos con una mediana de edad de 36 meses. Los hallazgos clínicos y de laboratorio más frecuentes fueron fiebre, citopenias e hiperferritinemia. La etiología más frecuente fue infecciosa (virus Epstein Barr/citomegalovirus) e inmunológica/reumatológica. La mortalidad global fue de 35%, sin diferencias significativas según etiología. DISCUSIÓN: Dada su alta mortalidad es relevante un alto índice de sospecha que permita instaurar terapia de forma precoz. Son necesarios estudios multicéntricos para determinar predictores clínicos y de laboratorio con valor pronóstico.

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a severe syndrome, potentially lethal, with a pathological activation of the immune system and an extreme hyperinflammatory response. The etiology is classified in primary HLH (familiar or genetic) and secondary (infectious, oncological, and rheumatological diseases). AIM: To analyze clinical and laboratory characteristics, treatment, and follow-up rates in pediatric patients with HLH. METHODS: A pediatric cohort of patients with HLH diagnosis attending in a tertiary hospital between January 2000 to February 2019 was analysed. RESULTS: 23 hospitalized patients were recruited with a median of 36 months of age. The most frequent clinical and laboratory findings were fever, cytopenias, and hyperferritinemia. The most frequent aetiologies were infectious (Epstein Barr virus and citomegalovirus) and rheumatological diseases. The global mortality was 35%, there was no significant difference between etiologies. DISCUSSION: Considering the high mortality of HLH it is very important to have a high grade of suspicion that allows treating at an early stage. It would be important to determine clinical and laboratory predictors in multicentric studies.

[Vaccine safety: description of the adverse events reported to the surveillance system in Chile, 2014 to 2016]. / Seguridad en vacunas: descripción de los eventos adversos notificados al sistema de vigilancia en Chile, 2014 a 2016.

BACKGROUND: Passive surveillance systems for adverse events following immunization (AEFI) allow the monitoring of known adverse effects (AE) and the investigation of infrequent AE. AIM: To describe the AEFI notified in Chile between 2014 and 2016. METHODOLOGY: This was a study of epidemiological surveillance. A general analysis of AEFI and sub-analysis for pentavalent vaccine was carried out. It was calculated the global reporting rate of AEFI every 100,000 doses of vaccines, the reporting rate of AEFI considered of interest and the odds ratio of reporting (ROR) of apneas for pentavalent. RESULTS: The total AEFI reported was 2,552 with a global reporting rate of 9,13. 13.4% of AEFI were serious. The vaccine reporting rate of events of interest was generally lower than the reference rates. The vaccine with the highest reporting rate (44.3) was pentavalent, with an ROR of apnea versus other vaccines of 10.5 (95% CI 3.77-29.47). DISCUSSION: This study provides an overview of the AEFI notified in Chile. The global reporting rate was similar to other studies, but those of events of interest were lower than international references. A possible association between apnea and pentavalent vaccine is shown.

Seguridad en vacunas: descripción de los eventos adversos notificados al sistema de vigilancia en Chile, 2014 a 2016 / Vaccine safety: description of the adverse events reported to the surveillance system in Chile, 2014 to 2016

Resumen Introducción: Los sistemas de vigilancia pasiva de los eventos supuestamente atribuidos a vacunación o inmu nización (ESAVI) permiten monitorizar efectos adversos (EA) conocidos y pesquisar EA infrecuentes. El objetivo de este estudio fue describir los ESAVI notificados en Chile entre los años 2014 y 2016. Material y Método: Estudio de vigilancia epidemiológica. Se realizó un análisis general y un sub-análisis para vacuna pentavalente. Se calculó la tasa de reporte (TR) global de ESAVI cada 100.000 dosis de vacunas, la TR de ESAVI considerados de interés y el odds ratio de reporte (ROR) de apneas para pentavalente. Resultados: El total de ESAVI notificados fue de 2.552 con una TR global de 9,13. Un 13,4% de los ESAVI fueron serios. La TR de eventos de interés fue en general menor a las tasas de referencia. La vacuna con mayor TR (44,3) fue pentavalente, con un ROR de apnea versus otras vacunas de 10,5 (IC 95% 3,77-29,47). Discusión: Este estudio entrega una visión general de los ESAVI notificados en Chile. La TR global fue similar a otras reportadas, pero las de eventos de interés fueron menores a las referencias internacionales. Se muestra una posible asociación entre apneas y vacuna pentavalente.

Background: Passive surveillance systems for adverse events following immunization (AEFI) allow the monitoring of known adverse effects (AE) and the investigation of infrequent AE. Aim: To describe the AEFI notified in Chile between 2014 and 2016. Methodology: This was a study of epidemiological surveillance. A general analysis of AEFI and sub-analysis for pentavalent vaccine was carried out. It was calculated the global reporting rate of AEFI every 100,000 doses of vaccines, the reporting rate of AEFI considered of interest and the odds ratio of reporting (ROR) of apneas for pentavalent. Results: The total AEFI reported was 2,552 with a global reporting rate of 9,13. 13.4% of AEFI were serious. The vaccine reporting rate of events of interest was generally lower than the reference rates. The vaccine with the highest reporting rate (44.3) was pentavalent, with an ROR of apnea versus other vaccines of 10.5 (95% CI 3.77-29.47). Discussion: This study provides an overview of the AEFI notified in Chile. The global reporting rate was similar to other studies, but those of events of interest were lower than international references. A possible association between apnea and pentavalent vaccine is shown.

Sepsis por Pseudomonas aeruginosa en un lactante previamente sano / Sepsis due to Pseudomonas aeruginosa in a previously healthy infant

Pseudomonas aeruginosa, is an opportunistic organism widely distributed in both environmental and nosocomial settings. Invasive infections typically occur in immunocompromised patients, but this agent can also produce sepsis in the immunocompetent host. We report the case of an 8 months old infant, previous healthy, who presented septic shock by P. aeruginosa. Lesions of ecthyma gangrenosum in his limbs required surgical debridement. The patient presented transitory neutropenia and reduced C4 levels but subsequent study of immune defects was normal.

Pseudomonas aeruginosa es un microorganismo oportunista de amplia distribución ambiental y nosocomial. Las infecciones invasoras se producen generalmente en pacientes inmunocomprometidos; sin embargo, este agente ocasionalmente puede ser causa de sepsis en pacientes inmunocompetentes. Presentamos el caso de un lactante de 8 meses de edad, sin antecedentes médicos, que cursó con un shock séptico por P. aeruginosa. Durante su evolución presentó lesiones de ectima gangrenoso en sus cuatro extremidades, que requirieron múltiples desbridamientos quirúrgicos. En el período agudo presentó neutropenia y complemento C4 bajo, que normalizó posteriormente. El estudio de inmunidad para descartar inmunodeficiencia fue normal.

[Pet ownership and health status of pets from immunocompromised children, with emphasis in zoonotic diseases]. / Tenencia y estado de salud de mascotas de niños inmunocomprometidos, con énfasis en enfermedades zoonóticas.

OBJECTIVE: To characterize pet ownership and pet health status in families of immunocompromised (IS) children, with emphasis in zoonotic diseases. POPULATION AND METHODS: Families of IS children from two hospitals in Santiago, Chile, were interviewed and their pets were evaluated by veterinary examination, coproparasitologic and skin dermatophytes test. In specific cases, other laboratory tests were performed in IS children or their relatives. RESULTS: 47 out of 70 contacted families had pets, 42 participated in the study. Several risk factors for IS children were observed, as having a turtle as a pet and to clean cat or turtle faeces. Lack of adequate veterinary control, immunizations and deparasitation of pets were observed. Some animals showed zoonotic diseases or agents, as Brucella canis, Cryptosporidium sp, Giardia intestinalis, Toxocara canis and scabies. 44% of dogs had ticks and 37% had fleas, both potential vectors of infections. CONCLUSIONS: Our results suggest that policies to provide safer pet contact in IS children are needed.

Tenencia y estado de salud de mascotas de niños inmunocomprometidos, con énfasis en enfermedades zoonóticas / Pet ownership and health status of pets from immunocompromised children, with emphasis in zoonotic diseases

Objetive: To characterize pet ownership and pet health status in families of immunocompromised (IS) children, with emphasis in zoonotic diseases. Population and Methods: Families of IS children from two hospitals in Santiago, Chile, were interviewed and their pets were evaluated by veterinary examination, coproparasitologic and skin dermatophytes test. In specific cases, other laboratory tests were performed in IS children or their relatives. Results: 47 out of 70 contacted families had pets, 42 participated in the study. Several risk factors for IS children were observed, as having a turtle as a pet and to clean cat or turtle faeces. Lack of adequate veterinary control, immunizations and deparasitation of pets were observed. Some animals showed zoonotic diseases or agents, as Brucella canis, Cryptosporidium sp, Giardia intestinalis, Toxocara canis and scabies. 44 percent of dogs had ticks and 37 percent had fleas, both potential vectors of infections. Conclusions: Our results suggest that policies to provide safer pet contact in IS children are needed.

Objetivo: Caracterizar la tenencia y estado de salud de mascotas de niños inmunocomprometidos (IC), con énfasis en situaciones y agentes infecciosos de potencial riesgo para la salud del niño. Población y Métodos: Se entrevistó a familias de niños IC en tratamiento en dos hospitales de Santiago y se evaluó la salud de sus mascotas mediante examen clínico veterinario, copro-parasitológico y búsqueda de dermatofitos en el pelaje. En casos puntuales, se realizaron algunos exámenes de laboratorio específicos a los niños o sus familiares. Resultados: 47 de 70 familias contactadas tenían mascotas, 42 participaron del estudio. Se detectaron situaciones de alto riesgo para niños IC como poseer tortuga como mascota y limpiar excretas de gatos y tortugas. Se evidenció una mínima adherencia al control veterinario, inmunizaciones y desparasitación de mascotas. Se identificaron animales con enfermedades o agentes con potencial zoonótico, destacando Brucella canis, Cryptosporidium sp, Giardia intestinalis, Toxocara canis y sarna sarcóptica. Un 44 por ciento de los perros presentaban garrapatas y 37 por ciento pulgas, ambos potenciales vectores de infecciones. Conclusiones: Los resultados sugieren que en nuestro medio es necesario implementar medidas que permitan una tenencia más segura de las mascotas en contacto con niños IC.

[Sepsis due to Pseudomonas aeruginosa in a previously healthy infant]. / Sepsis por Pseudomonas aeruginosa en un lactante previamente sano.

Pseudomonas aeruginosa, is an opportunistic organism widely distributed in both environmental and nosocomial settings. Invasive infections typically occur in immunocompromised patients, but this agent can also produce sepsis in the immunocompetent host. We report the case of an 8 months old infant, previous healthy, who presented septic shock by P. aeruginosa. Lesions of ecthyma gangrenosum in his limbs required surgical debridement. The patient presented transitory neutropenia and reduced C4 levels but subsequent study of immune defects was normal.

[23-valent pneumococcal vaccine. Statement of the Consultive Committee of Immunizations on behalf of the Chilean Infectious Diseases Society: February 2010]. / Declaración del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología acerca de la eficacia de la vacuna anti-neumocóccica 23 valente en el adulto mayor: Febrero 2010.

The article summarizes the scientific evidence related with protection conferred by the 23 valent polysaccharide vaccine against invasive pneumococcal disease, non bacteraemic pneumococcal pneumonia, and probable pneumococcal pneumonia in the elderly. Eider patients with and without risk factors are considered. The impact of herd immunity conferred by vaccination of children with conjugated pneumococcal vaccine in reduction of pneumonia in adults is discussed. Based on this analysis, the Advisory Committee on Immunizations of the Chilean Infectious Disease Society makes recommendations on the most efficient vaccine strategy for reduction of pneumococcal pneumonia in the elderly.

Declaración del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología acerca de la eficacia de la vacuna anti-neumocóccica 23 valente en el adulto mayor: Febrero 2010 / 23-Valent Pneumococcal Vaccine: Statement of the Consultive Committee of Immunizations on behalf of the Chilean Infectious Diseases Society: February 2010

The article summarizes the scientific evidence related with protection conferred by the 23 valent polysacchar-die vaccine against invasive pneumococcal disease, non bacteriemic pneumococcal pneumonia, and probable pneumococal pneumonia in the elderly. Eider patients with and without risk factors are considered. The impact of herd immunitty conferred by vaccination of children with conjugated pneumococcal vaccine in reduction of penumonia in adults is discussed. Based on this analysis, the Advisory Committee on Immunizations of the Chilean Infectious Disease Society makes recommendations on the most efficient vaccine strategy for reduction of pneumococcal pneumonia in the elderly.

El artículo resume los hallazgos de la evidencia científica en relación a la protección que confiere la vacuna neumocóccica polisacárida 23 valente contra la enfermedad neumocóccica invasora, las neumonías neumocóccicas no bacteriémicas y las neumonías probablemente de etiología neumocóccica en el adulto mayor, estableciendo una categorización entre adultos mayores con factores de riesgo y sin ellos. Se documenta a la vez, el impacto que ha tenido la vacuna neumocóccica conjugada en la población infantil, en reducir las neumonías en el adulto mayor. Basados en la información disponible, el Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología, realiza recomendaciones sobre cuál sería la mejor forma de prevenir las enfermedades neumocóccicas en el adulto mayor.

[Adverse reactions to diphtheria-pertussis-tetanus vaccine in the Chilean Immunization Program]. / Reacciones adversas a vacuna DPT del Programa Nacional de Inmunizaciones.

BACKGROUND: During 2005, the surveillance system of the Chilean Immunization Program detected an increased number of adverse reaction notifications associated to diphtheria, pertussis and tetanus whole-cell vaccine (DPT), coincidently with a change in the vaccine manufacturer. AIM: To compare the reactogenicity of two DPT formulations (vaccines 1 and 2) in 18-month-old infants and 4-year-old children. MATERIAL AND METHODS: Severe adverse reactions to DPT were studied at the emergency room of two hospitals of Santiago in a case-control study (110 cases and 171 controls, who consulted for other causes). Simultaneously the incidence of total adverse reactions (mild and severe) for vaccine 1 and 2 was estimated in a cohort of 1,017 children vaccinated in an ambulatory health center of the same area. The formulation of DPT received by all participants was verified, as well as the temporal relation with consultation or symptoms referred by their caregivers. RESULTS: There was a greater probability of consulting at the emergency rooms for severe adverse reactions among children who received vaccine 1 (odds ratio (OR) =7.1; p <0.001), being greater among 4-year-old children (OR =18.9; p <0.001). Coincidently, in the cohort of vaccinated children, those who received vaccine 1 had a higher risk of presenting adverse reactions (RR =2.9; p <0.001), being high fever the commonest. CONCLUSIONS: We confirmed that vaccine 1 was associated to a higher risk of adverse reactions, especially among 4-year-old children. These results allowed the sanitary authority to adopt an informed decision. The usefulness of observational studies in vaccine adverse reactions is confirmed.

Reacciones adversas a vacuna DPT del Programa Nacional de Inmunizaciones / Adverse reactions to diphtheria-pertussis-tetanus vaccine in the Chilean Immunization Program

Background: During 2005, the surveillance system of the Chilean Immunization Program detected an increased number of adverse reaction notifications associated to diphtheria, pertussis and tetanus whole-cell vaccine (DPT), coincidentiy with a change in the vaccine manufacturer. Aim: To compare the reactogenicity of two DPT formulations (vaccines 1 and 2) in 18-month-old infants and 4-year-old children. Material and methods: Severe adverse reactions to DPT were studied at the emergency room of two hospitals of Santiago in a case-control study (110 cases and 171 controls, who consulted for other causes). Simultaneously the incidence of total adverse reactions (mild and severe) for vaccine 1 and 2 was estimated in a cohort of 1,017 children vaccinated in an ambulatory health center of the same área. The formulation of DPT received by all participants was verífied, as well as the temporal relation with consultation or symptoms referred by their caregivers. Results: There was a greater probability of consulting at the emergency rooms for severe adverse reactions among children who received vaccine 1 (odds ratio (OR) =7.1; p <0.001), being greater among 4-year-old children (OR =18.9; p <0.001). Coincidentiy, in the cohort of vaccinated children, those who received vaccine 1 had a higher risk of presenting adverse reactions (RR =2.9; p <0.001), being high fever the commonest. Conclusions: We confirmed that vaccine 1 was associated to a higher risk of adverse reactions, especially among 4-year-old children. These results allowed the sanitary authority to adopt an informed decisión. The usefulness of observational studies in vaccine adverse reactions is confirmed.

Declaración del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología respecto a la vacuna anti-virus papiloma humano: septiembre 2008 / Human papillomavirus vaccine: statement of the Consultive Committee of Immunizations on behalf of The Chilean Infectious Diseases Society: September 2008

The article briefly reviews the epidemiology of human papillomavirus (HPV) infection and associated diseases in the world and in Chile and the scientific information of the licensed HPV vaccines: Gardasil® and Cervarix®. Considering the available information, the Consultive Committee of Immunizations of the Chilean Society of Infectious Diseases, summarizes its conclusions and makes recommendations for vaccination against HPV in Chile.

El artículo revisa brevemente la epidemiología de las infecciones por virus papiloma humano (VPH) y las enfermedades asociadas, tanto en el mundo como en Chile y la información científica de las vacunas contra VPH licenciadas: Gardasil® y Cervarix®. Considerando la información disponible, el Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología, resume sus conclusiones y hace sus recomendaciones para la vacunación contra VPH en Chile.

Síndrome de Ramsay-Himt en Pediatría: reporte de cuatro casos y revisión de la literatura / Ramsay Hunt syndrome in children: four cases and review

Ramsay-Hunt Syndrome (RHS) is a rare affection characterized by peripheral facial paralysis (PFP), skin eruption in the auricular canal and cochleovestibular symptoms. It is produced by varicella-zoster virus (VZV) reactivation at the geniculate ganglia. We report four patients between 3 and 17 years-old with RHS. Earache was the first symptom in two cases and three had cochleovestibular compromise. The direct immunofluorescence from the vesicular lesión was positive for VZV in two of them. All patients received treatment with aeyelovir and in three cases, this was associated with steroids. Three children had complete resolution of the PFP. RHS is an infrequent disease in the pediatric population and it should be suspected in children with PFP, erythema, vesicles and/or auricular pain. Early treatment with aeyelovir therapy could improve the recovery rate of facial nerve palsy.

El síndrome de Ramsay-Hunt (SRH) corresponde a una inusual afección caracterizada por parálisis facial periférica (PFP), erupción en el pabellón auricular ipsilateral y compromiso cocleo-vestibular. Es producida por reactivación del virus varicela zoster (VVZ) a nivel del ganglio geniculado. Se reporta una serie de cuatro pacientes entre 3 y 17 años de edad con SRH. La otalgia fue el primer síntoma en dos casos, tres de ellos presentaron sintomatología vestibular periférica y uno déficit cócleo-vestibular. La inmunofluorescencia directa de hisopado de lesión vesicular fue positiva para VVZ en dos niños. Todos recibieron tratamiento con aciclovir y tres recibieron además corticoesteroides. Tres niños tuvieron recuperación clínica completa. El SRH es una entidad poco frecuente en pediatría y debe sospecharse en niños con PFP, eritema, vesículas y/o dolor auricular, ya que el tratamiento precoz con aciclovir pudiera mejorar la evolución de la PFP.

Declaración del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología respecto a la vacuna antivirus papiloma humano: Septiembre 2008 / Human papillomavirus vaccine: Statement of the Advisory Committee of Immunizations on Behalf of the Chilean Infectious Diseases Society: September 2008

This article briefly reviews the epidemiology of human papillomavirus (HPV) infection and associated diseases globally and in Chile, and the scientific ínformatíon of the licensed HPV vaccines: Gardasil® and Cervarix®. Considering the available information, the Advisory Committee on Immunizations of the Chilean Society of Infectious Diseases recommends vaccination of teenage girls, ideally before initiating sexual actívíty, Le. approximately at the age of 12 to 13 years and vaccination of women of any age if they have not started sexual activity. If women are vaccinated after initiating sexual activity, they should be informed of the lower efficacy of immunization if HPV infection has occurred. Education on responsible sexuality and sexually transmitted diseases should be maintained as a priority. Vaccination should be highly considered for inclusion in the National Immunization Program.

[Seroepidemiological evidence of human exposure to Anaplasma sp in Santiago, Chile]. / Evidencia seroepidemiológica de exposición humana a Anaplasma sp en Santiago, Chile.

OBJECTIVES AND METHODS: To find more evidence of human exposure to Anaplasma sp in Chile, we studied 108 contacts of dogs with canine ehrlichiosis (CE) (risk group) and 61 persons without tick or CE cases contact (control group). A survey including risk factors and history of diseases compatible with ehrlichiosis/ anaplasmosis was applied to the risk group. Serum IgG anti-Anaplasma sp antibodies were determined in both groups. RESULTS: A significant difference was found in the prevalence of anti-Anaplasma sp antibodies in the risk group compared with the control group (18,5 versus 3,3%), p < 0,005. No risk factors associated to seropositivity were found, nor persons with history suggesting ehrlichiosis/anaplasmosis. Ninety four percent of the houses of the risk group had tick infestation. DISCUSSION: A greater risk of exposition to Anaplasma sp is documented in people living in close contact with CE cases and in houses with tick infestation.

Evidencia seroepidemiológica de exposición humana a Anaplasma sp en Santiago, Chile / Seroepidemiological evidence of human exposure to Anaplasma sp in Santiago, Chile

Objectives and Methods: To find more evidence of human exposure to Anaplasma sp in Chile, we studied 108 contaets of dogs with canine ehrlichiosis (CE) (risk group) and 61 persons without tick or CE cases contact (control group). A survey including risk factors and history of diseases compatible with ehrlichiosis/ anaplasmosis was applied to the risk group. Serum IgG anti-Anaplasma sp antibodies were determined in both groups. Results: A significant difference was found in the prevalence of anti-Anaplasma sp antibodies in the risk group compared with the control group (18,5 versus 3,3 percent), p < 0,005. No risk factors associated to seropositivity were found, ñor persons with history suggesting ehrlichiosis/anaplasmosis. Ninety four percent of the houses of the risk group had tick infestation. Discussion: A greater risk of exposition to Anaplasma sp is documented in people living in cióse contact with CE cases and in houses with tick infestation.

Objetivos y Método: Con el propósito de buscar mayor evidencia de exposición humana a Anaplasma sp en Chile, se estudiaron 108 personas en contacto con perros con ehrlichiosis canina (EC) (grupo de riesgo) y 61 personas sin antecedente de contacto con garrapatas ni con perros con EC (grupo control). Se aplicó encuesta sobre factores de riesgo e historia de cuadros sugerentes de ehrlichiosis/anaplasmosis al grupo de riesgo. En ambos grupos se determinó presencia de IgG anti-Anaplasma sp. Resultados: Se encontró significativa mayor prevalencia de anticuerpos anti-Anaplasma sp en el grupo de riesgo que en el grupo control (18,5 versus 3,3 por ciento), p < 0,005. No se encontraron factores de riesgo asociados a sero-positividad, ni personas con historia sugerente de ehrlichiosis/anaplasmosis clínica. Noventa y cuatro por ciento de las viviendas del grupo de riesgo presentaba infestación por garrapatas. Discusión: Se evidencia mayor riesgo de exposición humana a Anaplasma sp en personas en contacto cercano con perros con EC y que habitan viviendas con infestación por garrapatas.

[Hospitalization due to influenza in children in Santiago, Chile, 2001-2005]. / Hospitalización por influenza en un Servicio de Pediatría de Santiago de Chile, 2001-2005.

BACKGROUND: Influenza cause high hospitalization rates and complications in children. OBJECTIVE: To describe clinical and epidemiological characteristics of influenza infection in hospitalized children. PATIENTS AND METHODS: In Universidad Católica Hospital, all hospitalizations due to influenza in children aged 15 days to 14 years, occurring between January 2001 and December 2005 were reviewed. RESULTS: Of a total of 3570 admissions associated with a respiratory illness, 124 (3.5%) were due to influenza, of which 75% presented between the months of April and June. Median age was 20.5 months (60% younger than 2 years) and 24% had an underlying risk factor. Most common symptoms were fever (94%) and dry cough (61%) and 75% of the children required oxygen. The most frequent complication was pneumonia (53%). The mean duration of hospitalization and oxygen use were 4.4 and 2.5 days respectively. Fifty two children (49.1%) received an antibiotic and nine children were admitted to intensive care unit. No deaths were recorded. CONCLUSION: Influenza virus cause serious complications and affects mostly healthy children younger than 2 years.

Hospitalización por influenza en un Servicio de Pediatría de Santiago de Chile, 2001-2005 / Hospitalization due to influenza in children in Santiago, Chile, 2001-2005

Background: Influenza cause high hospitalization rates and complications in children. Objective: To describe clinical and epidemiological characteristics of influenza infection in hospitalized children. Patients and methods: In Universidad Católica Hospital, all hospitalizations due to influenza in children aged 15 days to 14 years, ocurring between January 2001 and December 2005 were reviewed. Results: Of a total of 3570 admissions associated with a respiratory illness, 124 (3.5 percent) were due to influenza, of which 75 percent presented between the months of April and June. Median age was 20.5 months (60 percent younger than 2 years) and 24 percent had an underlying risk factor. Most common symptoms were fever (94 percent) and dry cough (61 percent) and 75 percent of the children required oxygen. The most frequent complication was pneumonia (53 percent). The mean duration of hospitalization and oxygen use were 4.4 and 2.5 days respectively. Fifty two children (49.1 percent) received an antibiotic and nine children were admitted to intensive care unit. No deaths were recorded. Conclusion: Influenza virus cause serious complications and affects mostly healthy children younger than 2 years.

Introducción: El virus influenza produce elevadas tasas de hospitalización y complicaciones en niños. Objetivo: Describir el perfil clínico-epidemiológico de los niños hospitalizados por influenza en un hospital universitario. Pacientes y Métodos: Estudio descriptivo de las hospitalizaciones respiratorias y por influenza entre enero 2001 y diciembre 2005 en el Hospital Clínico de la Pontificia Universidad Católica. Resultados: Se hospitalizaron 3.570 niños por alguna causa respiratoria, 124 (3,5 por ciento) correspondieron a influenza confirmada, 75 por ciento ocurrieron entre abril y junio. La edad promedio fue 20,5 meses (60 por ciento) < 2 años), 24 por ciento tenían algún factor de riesgo identificado. Los síntomas más frecuentes fueron: fiebre (94 por ciento) y tos seca (61 por ciento). El 75 por ciento) presentó hipoxemia, siendo la complicación más frecuente la neumonía (53 por ciento). El promedio (días) de hospitalización y oxígeno fue 4,4 y 2,5; respectivamente. En 52/109 se indicaron antibacterianos, 9 niños ingresaron a cuidados intensivos. No hubo fallecidos. Conclusión: La hospitalización por influenza se asoció a serias complicaciones y afecta especialmente a niños sanos menores de 2 años.