Clinical-Demographic and Laboratory Profile of the Mother-Child Binomial With Syphilis in a Tertiary-Level Hospital in Mexico.

BACKGROUND: Congenital syphilis (CS) remains a major public health problem, and its incidence is increasing worldwide. METHODS: Retrospective, observational, and descriptive study of cases with CS and their mothers at a tertiary-level hospital in Mexico from 2017 to 2022. Medical records of patients with CS and a structured collection of epidemiological, clinical, and laboratory data were analyzed and classified in the Centers for Disease Control scenarios as confirmed, probable, less probable, or unlikely. RESULTS: One hundred eighty cases were diagnosed with a compatible definition of congenital syphilis, and we identified 43 (21.21%) confirmed proven. Among those proven cases, 15.6% had hematological, 13.3% skin, 12.2% liver, 6.7% pulmonary, 6.6% neurological, 5.8% eye, 5.6% bone, and 0.6% hearing involvements. According to the clinical stages of maternal syphilis, 119 (66.1%) were in the late latent phase, 49 (27.2%) in the early latent phase, 7 (3.9%) in the secondary stage, and 5 (2.8%) in the primary stage. Mothers with tertiary syphilis were not detected. CONCLUSION: Regardless of negative antenatal screening, health care workers should consider the diagnosis of congenital syphilis. Infants are still undiagnosed at birth, and only a tiny percentage exhibits symptoms. The wide range of clinical manifestations of this preventable infection can be misdiagnosed for various other diseases, causing diagnostic delays that can have serious consequences.

Chryseobacterium indologenes bacteremia in children with comorbidities / Bacteriemia por Chryseobacterium indologenes en niños con comorbilidades

Introduction We describe a series of pediatric cases of bacteremia, all of them with a history of heart disease, use of central venous catheter and coinfections. A review of the published literature was carried out in order to enrich the available information. Material and methods Pediatric observational retrospective study in which three cases of catheter-related bloodstream infection due to Chryseobacterium indologenes were reported in a period of two years in a tertiary care hospital. The analysis was performed with the cases previously reported in the literature. Results Three cases were reported in our center in a period of two years. We found 26 cases reported in the literature. Overall mortality was 26.92% (7/26). Conclusions This microorganism with characteristics of multidrug resistance is associated with the use of medical devices in hospitalized patients. Early identification of this pathogen is crucial to starting treatment (AU)

Introducción Describimos una serie de casos pediátricos de bacteriemias, todos ellos con antecedentes de cardiopatías, uso de catéter venoso central y coinfecciones. Se realizó la revisión de la literatura publicada para enriquecer la información disponible. Material y métodos Estudio retrospectivo observacional pediátrico, en el cual se reportaron 3 casos de bacteriemias asociadas a catéter por Chryseobacterium indologenes en un periodo de 2 años en un hospital de tercer nivel. Se realizó el análisis con los casos previamente reportados en la literatura. Resultados Se reportaron 3 casos en nuestro centro en un periodo de 2 años. Se encontraron 26 casos reportados en la literatura. La mortalidad global fue del 26,92% (7/26). Conclusiones Este microorganismo con características de multirresistencia se asocia al uso de dispositivos médicos en pacientes hospitalizados (AU)

First report of pediatric ehrlichiosis in Mexico.

BACKGROUND: Ehrlichia chaffeensis is responsible for most cases of human ehrlichiosis, an acute febrile tick-borne disease. This clinical entity is more commonly reported in adults from the United States. Therefore, it is of special interest to characterize this disease in children, given that very few cases in children have been reported outside of this country. CASE REPORT: We describe the case of a 15-year-old female from northeastern Mexico with a five-day history of myalgias, arthralgias, fever, abdominal pain, rash, and somnolence. The possibility of tick-borne disease was suspected considering that she lived with three tick-infested dogs that had recently died and a neighbor with similar symptoms who deteriorated rapidly and died a week earlier. Ehrlichia spp. was detected in blood samples by polymerase chain reaction. The patient completed a seven-day course of doxycycline and was discharged with complete resolution of symptoms. CONCLUSIONS: This case is the first report of ehrlichiosis in a pediatric patient in Mexico, illustrating the importance of considering tick-borne diseases as a differential diagnosis in patients with rash, fever, and altered level of consciousness. This initial clinical presentation may be indistinct from other conditions such as dengue, meningococcemia, and multisystem inflammatory syndrome in children (MIS-C), among others.

INTRODUCCIÓN: Ehrlichia chaffeensis es responsable de la mayoría de los casos de ehrlichiosis humana, una enfermedad febril aguda transmitida por garrapatas. Esta entidad clínica se reporta con mayor frecuencia en adultos de Estados Unidos. Por lo tanto, es de especial interés caracterizarla en niños, dado que se han reportado muy pocos casos en niños fuera de este país. CASO CLÍNICO: Se describe el caso de una paciente de sexo femenino de 15 años, originaria y residente del noreste de México con una historia de cinco días de mialgias, artralgias, fiebre, dolor abdominal, erupción cutánea y somnolencia. Se sospechó la posibilidad de una enfermedad transmitida por garrapatas considerando que convivió con tres perros infestados de garrapatas que habían muerto recientemente y una vecina con síntomas similares, quien se deterioró rápidamente y murió una semana antes. Ehrlichia spp. se detectó en una muestra sérica mediante reacción en cadena de la polimerasa. La paciente completó un curso de siete días de doxiciclina y fue dada de alta con resolución de los síntomas. CONCLUSIONES: Este caso es el primer reporte de ehrlichiosis en un paciente pediátrico en México que ilustra la importancia de considerar enfermedades transmitidas por garrapatas dentro del diagnóstico diferencial de pacientes con exantema, fiebre y alteración del estado de conciencia. Esta presentación clínica inicial puede ser indistinguible de otras entidades como dengue, meningococcemia y síndrome multisistémico inflamatorio, entre otras.

Weight Gain After 12 Months of Switching to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Virologically Suppressed HIV Patients.

Recent studies suggest that the introduction of antiretroviral agents such as integrase strand transfer inhibitors (INSTI) may lead to weight gain in people living with HIV (PLHIV). In this retrospective observational study, we report the weight changes observed in virologically suppressed HIV patients after 12 months of switching to bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) due to a national change in public policy in Mexico. Patients on prior regimens based on TDF/FTC or ABC/3TC plus non-nucleoside retrotranscriptase inhibitor, INSTI, or protease inhibitor were included. In the 399 patients analyzed, a significant weight increase was found, as well as an increase in body mass index (BMI), total cholesterol, low-density lipoprotein cholesterol (LDL-C), glucose, creatinine, and CD4+ cells after 12 months of switching treatment (all p ≤ .001). Mean weight gain was 1.63 kg [confidence interval (95% CI): 1.14-2.11], whereas the average percentage of weight gained was 2.5% (95% CI: 1.83-3.17). After considering the confounding effect of baseline weight status, the change in weight and BMI did not present significant differences between any of the prior treatment schemes. In conclusion, PLHIV switching to BIC/F/TAF therapy experienced weight gain after the first year of switching treatment. Although this weight gain could be due to the switch in treatment regimen, it cannot be excluded that it was caused by other factors since no comparable control group could be used for comparison.

"Blueberry muffin": Manifestación atípica de una infección congénita frecuente

El síndrome "blueberry muffin" es una dermatosis maculopapular eritematoviolácea como resultado de una hematopoyesis extramedular. Se ha asociado con infecciones del espectro TORCH y causas no infecciosas. Presentamos el caso de un recién nacido pretérmino, quien desde el control prenatal presentó una ecografía con signos sugerentes de infección congénita por citomegalovirus (microcefalia, ventriculomegalia y calcificaciones intracerebrales). Al examen físico presentaba una dermatosis macular violácea compatible con síndrome "blueberry muffin". Se detectó carga viral de citomegalovirus en orina (81,200 copias/ml) e inició tratamiento con ganciclovir, con desenlace fatal. La infección congénita por CMV debe considerarse ante el síndrome "blueberry muffin"; el adecuado abordaje diagnóstico debe ser oportuno y debe incluir antecedentes maternos y perinatales, así como estudios serológicos para infecciones por TORCH con el fin del inicio precoz de tratamiento para evitar complicaciones y secuelas.

Blueberry muffin syndrome is characterized by an erythematousviolaceous maculopapular dermatosis due to extramedullary hematopoiesis. This entity has been associated with TORCH spectrum infections and noninfectious causes. We present the case of a preterm newborn, who since the prenatal control gave an ultrasound with data suggestive of congenital infection by cytomegalovirus (microcephaly, ventriculomegaly, intracerebral calcifications). On physical examination, he presented a violaceous macular dermatosis compatible with blueberry muffin syndrome. Cytomegalovirus viral load was detected in urine (81,200 copies/ml), with fatal outcome. Congenital cytomegalovirus infection should be considered in the presence of a blueberry muffin syndrome; an adequate diagnostic approach that includes maternal and perinatal history is essential, as well as serology studies for diseases of the TORCH spectrum in order to start early with treatment and avoid major comorbidities.

Chryseobacterium indologenes bacteremia in children with comorbidities.

INTRODUCTION: We describe a series of pediatric cases of bacteremia, all of them with a history of heart disease, use of central venous catheter and coinfections. A review of the published literature was carried out in order to enrich the available information. MATERIAL AND METHODS: Pediatric observational retrospective study in which three cases of catheter-related bloodstream infection due to Chryseobacterium indologenes were reported in a period of two years in a tertiary care hospital. The analysis was performed with the cases previously reported in the literature. RESULTS: Three cases were reported in our center in a period of two years. We found 26 cases reported in the literature. Overall mortality was 26.92% (7/26). CONCLUSIONS: This microorganism with characteristics of multidrug resistance is associated with the use of medical devices in hospitalized patients. Early identification of this pathogen is crucial to starting treatment.

Pediatric Phaeohyphomycosis: A 44-Year Systematic Review of Reported Cases.

BACKGROUND: Phaeohyphomycosis is an infection caused by pigmented fungi, which can be life-threatening in immunocompromised hosts and in disseminated disease. In adults with disseminated disease, mortality is as high as 79%. Data in children are derived from case reports and series. We conducted this study to review the characteristics of phaeohyphomycoses in children. METHODS: We conducted this study following the PRISMA 2020 guideline for reporting systematic reviews. We performed a review of the reported cases of pediatric phaeohyphomycoses in core bibliographic databases published in the English and Spanish language, between June 1977 and October 2021. We included all eligible cases in patients <18 years to determine the clinical characteristics, diagnosis, treatment, and outcomes. RESULTS: A total of 130 cases were reviewed. The mean age was 8 years. The most common underlying conditions and risk factors included hematologic malignancies (32.5%), neutropenia (26.9%), steroid therapy (24.6%), trauma or surgery (23.1%), and children that received a transplant (14.6%). The most common presentation was localized infection (61.5%); skin and soft tissue infections were the most prevalent (25.4%). Exserohilum spp (20.8%) and Exophiala spp (17.7%) were the most common organisms isolated. Antifungal therapy remains as the most frequent treatment (87%). Overall mortality rate was 22.3% (localized 13.7% vs disseminated 37.3%). CONCLUSION: The findings of this review suggest that phaeohyphomycoses in children have a better outcome compared to adults. We report a lower mortality rate in children when compared with adults in disseminated infection (37.3% vs 79%) and CNS infection (50% vs 60-70%). However, there is a wide variation in mortality rates according to the infection site, treatment, and underlying conditions. Prospective studies are needed.

First report of pediatric ehrlichiosis in Mexico / Primer reporte de ehrlichiosis pediátrica en México

Abstract Background: Ehrlichia chaffeensis is responsible for most cases of human ehrlichiosis, an acute febrile tick-borne disease. This clinical entity is more commonly reported in adults from the United States. Therefore, it is of special interest to characterize this disease in children, given that very few cases in children have been reported outside of this country. Case report: We describe the case of a 15-year-old female from northeastern Mexico with a five-day history of myalgias, arthralgias, fever, abdominal pain, rash, and somnolence. The possibility of tick-borne disease was suspected considering that she lived with three tick-infested dogs that had recently died and a neighbor with similar symptoms who deteriorated rapidly and died a week earlier. Ehrlichia spp. was detected in blood samples by polymerase chain reaction. The patient completed a seven-day course of doxycycline and was discharged with complete resolution of symptoms. Conclusions: This case is the first report of ehrlichiosis in a pediatric patient in Mexico, illustrating the importance of considering tick-borne diseases as a differential diagnosis in patients with rash, fever, and altered level of consciousness. This initial clinical presentation may be indistinct from other conditions such as dengue, meningococcemia, and multisystem inflammatory syndrome in children (MIS-C), among others.

Resumen Introducción: Ehrlichia chaffeensis es responsable de la mayoría de los casos de ehrlichiosis humana, una enfermedad febril aguda transmitida por garrapatas. Esta entidad clínica se reporta con mayor frecuencia en adultos de Estados Unidos. Por lo tanto, es de especial interés caracterizarla en niños, dado que se han reportado muy pocos casos en niños fuera de este país. Caso clínico: Se describe el caso de una paciente de sexo femenino de 15 años, originaria y residente del noreste de México con una historia de cinco días de mialgias, artralgias, fiebre, dolor abdominal, erupción cutánea y somnolencia. Se sospechó la posibilidad de una enfermedad transmitida por garrapatas considerando que convivió con tres perros infestados de garrapatas que habían muerto recientemente y una vecina con síntomas similares, quien se deterioró rápidamente y murió una semana antes. Ehrlichia spp. se detectó en una muestra sérica mediante reacción en cadena de la polimerasa. La paciente completó un curso de siete días de doxiciclina y fue dada de alta con resolución de los síntomas. Conclusiones: Este caso es el primer reporte de ehrlichiosis en un paciente pediátrico en México que ilustra la importancia de considerar enfermedades transmitidas por garrapatas dentro del diagnóstico diferencial de pacientes con exantema, fiebre y alteración del estado de conciencia. Esta presentación clínica inicial puede ser indistinguible de otras entidades como dengue, meningococcemia y síndrome multisistémico inflamatorio, entre otras.

First case report of human monkeypox in Latin America: The beginning of a new outbreak.

On 13 May 2022, a familial cluster of two cases of monkeypox was reported in the United Kingdom (UK) by the UK Health Security Agency (UKHSA). These cases had no relation to a case imported from Nigeria that was previously reported on 7 May 2022 in the UK. In the following days, several other European Union (EU) the Member States and other countries have reported cases of monkeypox not linked to travel to endemic countries. The report by the World Health Organization (WHO) until May 26, 2022, is of a total of 257 confirmed cases and 120 suspected cases, without any report of death. This outbreak involves 23 countries that are not endemic to the monkeypox virus. Latin America had no reported cases. We describe a case of imported monkeypox in Mexico City, Mexico.

Facklamia hominis pyelonephritis in a pediatric patient: first case report and review of the literature.

BACKGROUND: Pyelonephritis is one of the most serious bacterial illnesses during childhood. Gram-negative organisms account for up to 90% of the cases. Gram-positive bacteria are uncommon causes of urinary tract infections, and only a few cases caused by Facklamia hominis have been reported in the literature. CASE PRESENTATION: A five-year-old girl with tracheostomy and gastrostomy and past medical history of congenital lymphangioma presented with a two-week history of with intermittent fever, frequent urination, and vesical tenesmus. Diagnosis of pyelonephritis was made. Urine culture reported colonies with alpha-hemolysis in blood agar at 48-h of incubation and Facklamia hominis was identified by MALDI-TOF. The patient was successfully treated with gentamicin. CONCLUSIONS: This is the first reported case of pyelonephritis by Facklamia hominis in a child, and the second involving infection in a pediatric patient. Although this pathogen is uncommon, current treatment of F. hominis is a challenge for physicians. This case illustrates the requirement to standardize identification and treatment of care to avoid treatment failure and antimicrobial resistance.

Disseminated Coccidioidomycosis as the First Presentation of a C-Terminal NFKB2 Pathogenic Variant: A Case Report and Review of the Literature.

INTRODUCTION: Although most cases of coccidioidomycosis are subclinical or self-limited respiratory disease, 1% lead to extrathoracic dissemination and become fatal, especially in patients with an associated immunodeficiency. Up to 30%-50% of patients with defects in cell-mediated immunity, those with AIDS and recipients of solid-organ transplants, may develop disseminated coccidioidomycosis (DC). Within the primary immunodeficiencies, an uncommon group is caused by C-terminal NFKB2 pathogenic variants. MATERIALS AND METHODS: We performed a literature search of core databases. Written informed consent for the study and for publication was obtained. CASE PRESENTATION: A 7-year-old Mexican girl, eldest of 3 sisters, no relevant family history, and a history of recurrent upper respiratory infections and alopecia totalis was admitted with DC involving pulmonary, soft tissue, skin, bone and joint compromise. The immunodeficiency assessment showed low IgM and NK cells. We found an NFKB2 de novo heterozygous nonsense mutation of c.2611C>T (p.Gln871*). She was treated with liposomal amphotericin B and itraconazole with surgical debridement. The clinical phenotype of this primary immunodeficiency is characterized by antibody deficiency and associated broncho-pulmonary predisposition to infection, but moreover also opportunistic infections and autoimmunity, most recognizable alopecia and adrenocorticotropic hormone-deficiency. After 1 year of her discharge, she continues under surveillance with antifungal therapy with itraconazole and replacement intravenous immunoglobulin until today. CONCLUSION: This is the first case report of DC in a patient with an NFKB2 pathogenic variant and it illustrates the importance of screening for primary immunodeficiencies in patients with disseminated fungal infections.

COVID-19 in people living with HIV: a single-center descriptive study.

INTRODUCTION: People living with human immunodeficiency virus (PLHIV) may suffer more severe symptoms of coronavirus disease 2019 (COVID-19) due to their immunocompromised status, even if they are undetectable. Human immunodeficiency virus (HIV) infection has been reported as an independent factor associated with higher mortality in patients with COVID-19. The present study aims to describe the clinical characteristics of PLHIV and COVID-19 in one center in Mexico. METHODOLOGY: We conducted an observational retrospective monocentric cohort study of PLHIV diagnosed with COVID-19 between 1 March 2020 and 30 April 2021. SARS-CoV-2 was detected by polymerase chain reaction (PCR) of a nasopharyngeal swab sample, clinical features, and epidemiological characteristics. RESULTS: We identified 55 PLHIV with COVID-19. The median age was 36 years (IQR 25-41.5 years), and 54 patients were men. The median duration of HIV-1 infection was 4.3 years (Interquartile range, IQR 2.6-7.2 years), and 100% were on antiretroviral therapy (ART). The last HIV-1 RNA viral load analysis of the patients was 52/55 (94.5%) indicating that they were in virological suppression. The median CD4+ T-cell count was 734/mm3 (IQR 541.5-921/mm3). The most frequent pre-existing comorbidities found were obesity (21.8%), hypertension (7.2%), and diabetes (5.4%). Only one death was reported (1.8%). CONCLUSIONS: It has been reported that COVID-19/HIV/AIDS co-infection has a higher risk of mortality, admission to intensive care, and complications. However, our study found that people living with HIV-1 with adequate virological control did not present a severe course of COVID -19.