Infecciones fúngicas invasoras en niños con cáncer y portadores de aplasia medular severa en nueve hospitales de la red PINDA, Chile. 2016-2020

Introducción: La infección fúngica invasora (IFI) es una causa importante de morbilidad y mortalidad en pacientes oncológicos pediátricos y portadores de aplasia medular (AM) severa. Objetivo: Describir la epidemiología de la IFI desde el año 2016 al 2020 en niños con cáncer y AM para evaluar la necesidad de profilaxis antifúngica. Métodos: Estudio retrospectivo, multicéntrico, en pacientes pediátricos con cáncer y AM severa. Se incluyeron IFI probables y probadas. Resultados: Se diagnosticaron 57 casos de IFI, mediana de edad 9 años, 70% probadas y 30% probables. Hubo 42% de infecciones por levaduras y 56% por hongos filamentosos. Los sitios de infección más frecuentes fueron pulmón 38%, sangre 36% y rinosinusal 21%. La frecuencia global fue 5,4%; de ellas 21% en AM severa, 10% en leucemia mieloide aguda (LMA), 6,9% en recaída de LMA, 5,4% en recaída de leucemia linfática aguda (LLA), 3,8% en LLA. Las infecciones por hongos filamentosos predominaron en LMA, recaída de LMA. y AM severa. La mortalidad en pacientes con IFI fue de 11%. Conclusión: La frecuencia de IFI concuerda con la literatura médica. Recomendamos profilaxis antifúngica contra hongos filamentosos en pacientes con AM severa, LMA y recaída de LMA. Considerar en recaída de LLA de alto riesgo en etapa de inducción.

Background: Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in pediatric oncology patients and severe aplastic anemia (SAA). Aim: To describe the epidemiology of IFI from 2016 to 2020 in children with cancer and SAA to assess the indication of antifungal prophylaxis. Methods: Multicenter, retrospective study of IFIs in pediatric oncology patients and SAA. Probable and proven IFIs were included. Results: Over the 5-year period, 57 IFIs were found, median age 9 years, 70% were proven and 30% were probable. Yeast infections were 42% and mold infections 56%. The most frequent infection sites were lung 38%, blood 36% and rhinosinusal 21%. The total IFI frequency was 5.4%, 21% in SAA, 10% in acute myeloid leukemia (AML), 6.9% in relapsed AML, 5.4% in relapsed acute lymphoblastic leukemia (ALL), 3.8% in ALL. Mold infections were predominant in AML, relapsed AML, and SAA. IFIs mortality was 11%. Conclusion: Frequency of IFI was consistent with the literature. We strongly recommend antifungal prophylaxis against mold infections in patients with SAA, AML, and relapsed AML. Would consider in high risk ALL relapse in induction chemotherapy.

Long term platinum-induced ototoxicity in pediatric patients.

OBJECTIVES: Platinum-based chemotherapy treatments are effective against a variety of pediatric malignancies. However, its use can lead to permanent hearing loss. The aim of this study was to evaluate the long-term effect of platinum chemotherapy on hearing and evaluate its progression. METHODS: Prospective cohort study. All records of pediatric patients receiving platinum-based chemotherapy between 2001 and 2006 were reviewed. Demographics and audiograms performed before, during, and following chemotherapy were analyzed. An updated audiogram and a video head impulse test were performed. A hearing ability questionnaire was also completed. RESULTS: Thirty-nine patients met the inclusion criteria. Of these, 12 patients were included in the study; 14 were deceased, 8 had incomplete data and 5 were excluded for other reasons. Median age at chemotherapy was 4.3 years (range 10 months-14.2 years). Seven patients had received cisplatin, two received carboplatin and three received both agents. Five had also received cranial irradiation. With a median follow-up time of 11.9 years, 58.3% had developed hearing loss and two patients wore bilateral hearing aids; 67% of the patients with hearing loss had worsening of their hearing in the long-term. All patients referred difficulties in various subscales measured by the questionnaire. Three patients had decreased vestibulo-ocular reflex gains. CONCLUSION: Platinum-induced hearing loss in pediatric patients can be progressive and debilitating. A long term audiometric follow-up of at least 10 years is suggested for these patients.

[Sore throat, streptococcal etiology? Use of etiological screening and antimicrobial prescription in two university pediatric centers]. / Faringitis aguda, estreptocóccica? Empleo del estudio etiológico y de antimicrobianos en dos centros pediátricos universitarios.

The diagnosis and treatment of sore throat in pediatric patients attending one of two facilities at a university hospital: pediatric ambulatory facility (PAF) and emergency unit (EU) in a period of 14 months are described. There were 421 patients at the PAF and 289 at the EU, of whom 65% and 76% were studied for Streptococcus pyogenes respectively. Streptococcus were detected in both centers in 37% of cases, with a peak detection of 50% at ages 6 to 10 years. There were 217 patients without any bacteriological study, of whom 162 (75%) received antibiotics. The importance of bacteriological confirmation prior to antibiotic prescription in this disease is emphasized.

Estudio de padrones dermatoglificos en poblaciones bolivianas: grupo mestizo / Dermatogliphic patterns in mestizos from Bolivia

El estudio comprende la evaluacion frecuencial de padrones dermatoglificos en una muestra de 280 individuos de ambos sexos, definidos operacionalmente, como mestizos: por la presencia de ancestrales pertenecientes a por lo menos dos grupos etnicos-linguisticos diferentes, residentes en el pais y por los nombre patronimicos. Las impresiones digitales palmares, fueron realizados mediante el metodo de Hollister modificado y la clasificacion de los padrones de acuerdo a la sistematica propuesta por Penrose. Se efecturaon comparaciones intersexuales y comparaciones con otras etnias concurrentes del grupo. Se presentan los valores dermatoglificos del grupo mestizo fenotipicamente normales.