The effect of vitamin A supplementation on the intestinal immune response in Mexican children is modified by pathogen infections and diarrhea.

Vitamin A supplementation has consistently reduced infant mortality and the severity of pathogen-induced diarrhea. The mechanism by which vitamin A modulates the mucosal immune response to produce these effects remains poorly defined. To address this issue, stools collected during the summer months from 127 Mexican children 5-15 mo old enrolled in a larger, randomized, double-blind, placebo-controlled, vitamin A supplementation trial were screened for interleukin (IL)-4, IL-6, interferon-gamma (IFN-gamma), and gastrointestinal pathogens. Fecal cytokine values were categorized into 3 levels (undetectable, or =median). Multinomial regression models were used to determine the probability that vitamin A-supplemented children had higher categorical values of a cytokine than children in the placebo group. Differences in categorical values were also analyzed after stratification by gastrointestinal pathogen infections and diarrheal symptoms. Overall, fecal cytokine categorical levels did not differ between children randomized to the 2 arms. Vitamin A-supplemented children infected with enteropathogenic E. coli (EPEC) had reduced IL-4 and IFN-gamma levels [odds ratio (OR) = 0.3, 95% CI 0.13-0.67 and OR = 0.34, 95% CI 0.14-0.83, respectively] compared with children in the placebo group. Vitamin A-supplemented children had increased IL-4 levels when infected with A. lumbricoides (OR = 12.06, 95% CI 0.95-153.85). In contrast, IL-4 levels increased (OR = 2.14, 95% CI 0.94-4.87) and IFN-gamma levels decreased (OR = 0.51, 95% CI 0.26-0.99) among vitamin A-supplemented children with diarrhea compared with children in the placebo group. These findings suggest that the regulation of the mucosal immune response by vitamin A may depend on the type of enteric pathogen infecting the child and the presence of clinical symptoms.

Mortality associated with systemic candidiasis in children

The purpose of this study was to determine factor asociated with an increased risk of mortality due to systemic Candida infections in children hospitalized at our tertiary care facility. A total of 71 cases of Candida bloodstream infections were identified over a 2-year period. The attack rate was 47 cases of candidemia per 10,000 discharges and the case fatality rate was 46.5 percent. Sixty-one cases occurred in infants under 2 years; 27 were newborns (38 percent). Using logistic regression analysis, we evaluated the independent effects of potential risk factors for death due to candidemia. Three factors were associated with the subsequent risk for death due to systemic candida infection: malnutrition (OR=4.3; 95 percent CI 1.2-14.8), prior surgery (OR=3.8; 95 percent CI 1.2-13.2), and the number of days between the first positive candida blood culture and the onset of antifungal treatment (OR= 1.12; 95 percent CI 1.6-1.25). Newborns showed an almost three times greater risk of death due to candidemias as compared to other age groups, but this association was only marginally significant (OR= 2.8; 95 percent CI 0.9 - 9.3). There was no difference in the rate of candidemia between the 2 years of the study; however, the observed mortality declined significantly from 65 percent in year one to 20 percent in year two (p=0.02). The major finding of this study was to observe that for every day treatment was delayed the risk of death increased significantly. Thus, this study provides support for empirical antifungal therapy early in the course of suspected systemic candidiasis i order to improve survival among children

Eficacia de la vancomicina administrada en forma continua o intermitente en niños en diálisis peritoneal continua ambulatoria con peritonitis / Efficacy of intraperitoneal vancomycin in children on continuous ambulatory peritoneal dialysis: comparison of intermittent and continous therapy

Introducción. Debido a la alta frecuencia de cocos grampositivos como causa de pritonitis en niños con insuficiencia renal crónica terminal en programa de diálisis peritoneal continua ambulatoria (DPCA), se ha indicado en el tratamiento inicial la asociación de vancomicina y amikacina por vía intraperitoneal (IP). Sin embargo, existe poca información respecto al esquema de tratamiento a utilizar en la edad pediátrica. Material y métodos. Se compararon dos métodos de administración de vancomicina por vía IP: el grupo A de pacientes recibió el tratamiento "continuo" con dosis inicial de vancomicina de 500 mg/L IP y dosis en cada recambio de seis horas de 15 mg/L IP; el grupo B recibió el tratamiento "intermitente" con dosis inicial de vancomicina de 30 mg/kg IP que se repitió al séptimo día. Los pacientes fueron asignados aleatoriamente a cada grupo de estudio. Resultados. Once pacientes quedaron incluidos en el grupo A y diez en el grupo B, con edades entre 8 y 17 años. Se observó un fracaso del tratamiento en cada grupo; en el grupo A en un paciente en quien se observó cocos grampositivos en la tinción de Gram inicial del líquido de diálisis; en el grupo B en un paciente con cultivos positivos para Klebsiella pneumoniae y Pseudomonas aeruginosa. Conclusiones. En niños y adolecentes en programa de DPCA con peritonitis son igualmente efectivos el tratamiento "continuo" o "intermitente" con vancomicina, siendo preferible esta última forma de tratamiento debido a su facilidad de administración y posible menor efecto tóxico