Increased Severity of Mycoplasma pneumoniae Infections in Spanish Children.

BACKGROUND: Since the end of 2023, an elevated incidence and severity of Mycoplasma pneumoniae infections among children in Asia has been noted. Subsequently, this trend was observed in several European countries although limited data are currently available. We conducted a national study to delineate the ongoing M. pneumoniae outbreak in our country. METHODS: A multicenter retrospective observational study was conducted across 32 hospitals in Spain, encompassing patients under 18 years old hospitalized for M. pneumoniae infection from January 2023 to March 2024. Infection was confirmed by positive polymerase chain reaction and/or by 2 serological tests. RESULTS: A total of 623 children were included, with 79% of cases diagnosed in the final 3 months of the study period. Pneumonia was the most common diagnosis (87%). Respiratory symptoms were present in 97% of cases, with 62% requiring oxygen supplementation and 14% requiring admission to the pediatric intensive care unit (PICU). Risk factors for PICU admission included the presence of neurological symptoms, hypoxemia and a history of prematurity. Children admitted to the PICU exhibited significantly higher neutrophil counts upon admission. CONCLUSIONS: We have observed a notable increase in hospital admissions, including PICU support by up to 14%, due to M. pneumoniae infection in our country since November 2023, indicative of a more severe clinical course associated with this pathogen.

Isavuconazole use and TDM in real-world pediatric practice.

Isavuconazole (ISA) is approved for treating invasive aspergillosis and mucormycosis in adults, but its use in children remains off-label. We report on the use of ISA in real-world pediatric practice with 15 patients receiving ISA for treatment of invasive fungal infections. Therapeutic drug monitoring (TDM) was performed in all patients, with 52/111 (46.8%) Ctrough determinations out of range, thus supporting the need for TDM in children, especially those receiving extracorporeal membrane oxygenation (ECMO).

Enterocolitis associada a malaltia de Hirschsprung / Enterocolitis asociada a enfermedad de Hirschsprung / Hirschsprung-associated enterocolitis

Introducció: L’enterocolitis associada a la malaltia de Hirschsprung és una entitat clínica greu i potencialment letalque es presenta sovint en pacients amb malaltia de Hirschsprung.Cas clínic: Lactant de quatre mesos, nounat prematur afectat de síndrome de Down i de malaltia de Hirschsprung,que consulta per febre i distensió abdominal. A l’arribadaa urgències es troba inestable hemodinàmicament. En l’exploració física destaca abdomen distès i dolorós a la palpació de forma difusa. L’analítica sanguínia mostra elevaciódels reactants de fase aguda, i la radiografia, una importantdilatació de nanses sense aire a l’ampolla distal. S’iniciatractament antibiòtic empíric amb metronidazole i cefotaxima endovenosos, dieta absoluta i irrigacions rectals. Presenta bona evolució, amb alta al domicili set dies desprésde l’episodi. Presenta recurrència del mateix quadre unmes posterior a l’alta.Comentaris: La presentació clínica i les proves complementàries són suggestives d’enterocolitis associada a malaltiade Hirschsprung. Es classifica en graus segons la gravetat,tenint en compte la clínica, l’exploració física i les troballesradiològiques. El tractament consisteix en antibioteràpiaempírica d’ampli espectre per cobrir enterobacteris associada a metronidazole, per l’associació entre l’enterocolitisassociada a Hirschsprung i el Clostridium difficile.(AU)

Introducción: La enterocolitis asociada a enfermedad de Hirschsprung es una entidad clínica grave y potencialmente letal quese presenta frecuentemente en pacientes con enfermedad deHirschsprung.Caso clínico: Lactante de cuatro meses, recién nacido prematuroafecto de síndrome de Down y de enfermedad de Hirschsprung,que consulta por fiebre y distensión abdominal. A su llegada aurgencias se encuentra inestable hemodinámicamente. En la exploración física destaca abdomen distendido, doloroso a la palpación de forma difusa. La analítica sanguínea muestra elevación de los reactantes de fase aguda y la radiografía de abdomen, importante dilatación de asas sin aire en ampolla distal. Se inicia tratamiento antibiótico empírico con metronidazol y cefotaxima endovenosos, dieta absoluta e irrigaciones rectales. Presenta buenaevolución, con alta a domicilio a los 7 días del episodio. Presentarecurrencia del mismo cuadro un mes posterior al alta.Comentarios: La presentación clínica y las pruebas complementarias son sugestivas de enterocolitis asociada a enfermedad de Hirschsprung. Se clasifica en grados según la gravedad, teniendo encuenta la clínica, la exploración física y los hallazgos radiológicos.El tratamiento consiste en antibioterapia empírica de amplio espectro para cubrir enterobacterias asociada a metronidazol, debidoa la asociación entre la enterocolitis asociada a Hirschsprung y elClostridium difficile.(AU)

Introduction: Hirschsprung-associated enterocolitis is a serious andpotentially fatal clinical entity that occurs frequently in patientswith Hirschsprung disease.Case report: A four-month-old preterm infant with Down syndromeand Hirschsprung disease consulted for fever and abdominal distension. Upon arrival at the emergency room, he was found to behemodynamically unstable. Physical examination was significantfor a distended abdomen that was diffusely tender on palpation.Laboratory evaluation showed elevation of acute-phase proteinsand imaging showed a significant dilatation of the bowel loopswithout air in the distal ampulla. Empirical antibiotic treatmentwas started with intravenous metronidazole and cefotaxime. Hehad a good response to treatment and was discharged 7 days afterthe episode. He presented one month later with recurring enterocolitis.Comments: The clinical presentation and diagnostic studies aresuggestive of Hirschsprung-associated enterocolitis. This diseaseis classified in grades according to severity, considering the clinical presentation, physical examination, and radiological findings.Empirical antibiotic treatment consists of broad-spectrum antibiotic therapy to cover Enterobacteriaceae, associated with metronidazole due to the association between Hirschsprung associatedenterocolitis and Clostridium difficile.(AU)