RESUMO
BACKGROUND: Kawasaki disease (EK) is an acute systemic vasculitis with a risk of developing coronary aneurysms. AIM: To describe the clinical and epidemiological characteristics of children with EK in Argentina and to analyse the risk factors for the development of coronary's complications (CC). METHODS: Multicenter, retrospective, cross-sectional, observational and analytical study. It included patients younger than 18 years of age diagnosed with EK in hospitals in Argentina, between January the 1st, 2010 and December the 31th, 2013. RESULTS: N = 193 subjects. Age: medium: 29 months. Total incidence 5 cases / 10,000 hospital discharges. CC was observed in 15.5% of patients. Increased risk factors for CC: Elevated number of days with fever at the time of treatment placement (p = 0.0033); Increased of: heart frequency (p = 0.0021), erythrosedimentation (ESR) (p = 0.005), C-reactive protein (CRP) (p < 0.0001), leukocytes (p = 0.0006), neutrophils (p = 0.0021); Decreased of hematocrit (p = 0.0007) and hemoglobin (p < 0.0001).Association with CC: non-coronary cardiological alterations (OR = 10,818); PCR greater than 68 mg /L (OR = 11,596); leukocytes greater than 20,000 / mm3 (OR = 4.316); and ESR greater than 64 mm / 1 hour (OR = 4.267). CONCLUSION: The most frequent form of presentation was complete EK, the risk of CC was higher in males, younger than 5 years old, the risk factors (clinical and laboratory) were similar to those described in the literature.
Assuntos
Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Argentina/epidemiologia , Sedimentação Sanguínea , Proteína C-Reativa/análise , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Incidência , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estações do Ano , Estatísticas não ParamétricasRESUMO
Resumen Introducción: La enfermedad de Kawasaki (EK) es una vasculitis sistémica aguda con riesgo de desarrollar aneurismas coronarios. Objetivos: Describir características clínico-epidemiológicas en niños con diagnóstico de EK en Argentina. Analizar factores de riesgo para el desarrollo de complicaciones coronarias (CC). Población y Métodos: Estudio multicéntrico, retrospectivo, transversal, observacional y analítico. Incluyó pacientes bajo 18 años de edad, con diagnóstico de EK en hospitales de Argentina, entre el 1 de enero de 2010 y el 31 de diciembre de 2013. Resultados: N = 193 sujetos. Edad: mediana: 29 meses. Tasa promedio total país 5 casos/10.000 egresos hospitalarios. Presentaron CC 15,5%. Mayor riesgo de CC: Mayor cantidad de días de fiebre al momento de colocación del tratamiento (p = 0,0033); Aumento de: frecuencia cardíaca (p = 0,0021), eritrosedimentación (VSG) (p = 0,005), proteína C reactiva (PCR) (p < 0,0001), leucocitosis (p = 0,0006), neutrofilia (p = 0,0021); Disminución de hematocrito (p = 0,0007) y hemoglobina (p < 0,0001). Asociación con CC: alteraciones cardiológicas no coronarias (ORv10.818); PCR mayor de 68 mg/L (OR = 11.596); leucocitos mayores a 20.000/mm3 (OR= 4.316); y VSG mayor de 64 mm/1° hora (OR = 4.267). Conclusión: La forma de presentación más frecuente fue EK completa, el riesgo de CC fue mayor en varones, menores de 5 años de edad, los factores de riesgo (clínicos y de laboratorio) fueron semejantes a los descritos en la bibliografía.
Background: Kawasaki disease (EK) is an acute systemic vasculitis with a risk of developing coronary aneurysms. Aim: To describe the clinical and epidemiological characteristics of children with EK in Argentina and to analyse the risk factors for the development of coronary's complications (CC). Methods: Multicenter, retrospective, cross-sectional, observational and analytical study. It included patients younger than 18 years of age diagnosed with EK in hospitals in Argentina, between January the 1st, 2010 and December the 31th, 2013. Results: N = 193 subjects. Age: medium: 29 months. Total incidence 5 cases / 10,000 hospital discharges. CC was observed in 15.5% of patients. Increased risk factors for CC: Elevated number of days with fever at the time of treatment placement (p = 0.0033); Increased of: heart frequency (p = 0.0021), erythrosedimentation (ESR) (p = 0.005), C-reactive protein (CRP) (p < 0.0001), leukocytes (p = 0.0006), neutrophils (p = 0.0021); Decreased of hematocrit (p = 0.0007) and hemoglobin (p < 0.0001).Association with CC: non-coronary cardiological alterations (OR = 10,818); PCR greater than 68 mg /L (OR = 11,596); leukocytes greater than 20,000 / mm3 (OR = 4.316); and ESR greater than 64 mm / 1 hour (OR = 4.267). Conclusion: The most frequent form of presentation was complete EK, the risk of CC was higher in males, younger than 5 years old, the risk factors (clinical and laboratory) were similar to those described in the literature.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Doença das Coronárias/etiologia , Doença das Coronárias/epidemiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Argentina/epidemiologia , Estações do Ano , Sedimentação Sanguínea , Proteína C-Reativa/análise , Incidência , Estudos Transversais , Estudos Retrospectivos , Fatores de Risco , Imunoglobulinas Intravenosas/uso terapêutico , Estatísticas não Paramétricas , Medição de Risco , Síndrome de Linfonodos Mucocutâneos/terapiaRESUMO
Introducción. Las infecciones invasivas por Streptococcus pyogenes (IISP) presentan elevada morbimortalidad aún en la actualidad; no obstante, a nivel regional, existen escasas publicaciones en pediatría. Objetivo. Describir la prevalencia, los factores predisponentes y las características clínicas de niños internados por IISP, analizar los factores de riesgo asociados a bacteriemia y letalidad. Material y métodos. Estudio retrospectivo, descriptivo de IISP en niños ≤ 18 años, internados en Pediatría de 20 centros asistenciales del país, entre 2010 y 2012. Variables evaluadas: edad, sexo, focos clínicos iniciales y tardíos, patología crónica previa, factores predisponentes, tratamiento y evolución. Resultados. Se analizaron 143 pacientes. Incidencia de 4,97 casos/10 000 egresos. Mediana de edad 54 meses; tenían patología crónica previa 11,2%. Tuvieron factores predisponentes 67,1%. Las formas de presentación más frecuentes fueron la piel y las partes blandas en 77, sepsis en 30, osteoarticulares en 19, fascitis necrotizante en 13, síndrome de shock tóxico en 11. Se aisló Streptococcus pyogenes en 56,6% de los hemocultivos; la presencia de más de un foco clínico y la ausencia de cirugía se asociaron a bacteriemia (OR 4,8; p= 0,003 y OR 3,1; p= 0,0012, respectivamente). El promedio de internación fue 13,4 días. La tasa de letalidad fue 7,6% asociada a síndrome de shock tóxico (OR 10; p= 0,005), fascitis necrotizante (OR 104; p < 0,0001) e ingreso a la Unidad de Cuidados Intensivos Pediátricos (OR 26; p < 0,001). Conclusiones. La mayoría de las IISP se presentaron en pacientes sin patología crónica previa. Los focos de presentación, frecuentemente con bacteriemia, fueron la piel y las partes blandas. Hubo asociación estadísticamente significativa entre bacteriemia y ≥ 2 focos iniciales y ausencia de cirugía. La letalidad, asociada a SSTS y fascitis necrotizante, fue similar a otras publicaciones.
Introduction. Invasive Streptococcus pyogenes infections (ISpIs) cause a high morbidity and mortality, even at present; however, at a regional level there are few publications on this subject in the field of pediatrics. Objective. To describe the prevalence, predisposing factors and clinical characteristics of children hospitalized for ISpI, and analyze risk factors associated with bacteremia and lethality. Material and methods. Retrospective, descriptive study on ISpIs in children <18 years old hospitalized in the Pediatric Ward of 20 healthcare facilities across Argentina between 2010 and 2012. Assessed outcome measures: age, gender, early and late clinical sources of infection, prior chronic condition, predisposing factors, treatment and evolution. Results. One hundred and forty-three patients were analyzed. The incidence of ISpI was 4.97 cases/10 000 hospital discharges. Patients' median age was 54 months old, and 11.2% had a prior chronic condition. Also, 67.1% had predisposing factors. The most common clinical manifestations were in the skin and soft tissue in 77 patients, sepsis in 30, bone and joint involvement in 19, necrotizing fasciitis in 13, and toxic shock syndrome in 11. Streptococcus pyogenes was isolated in the blood cultures of 56.6%. More than one clinical source of infection and no surgery were associated with bacteremia (odds ratio [OR]: 4.8, p= 0.003 and OR: 3.1, p= 0.0012, respectively). The average length of stay in the hospital was 13.4 days. Fatality rate was 7.6% in association with toxic shock syndrome (OR: 10, p= 0.005), necrotizing fasciitis (OR: 104, p < 0.0001) and admission to the Pediatric Intensive Care Unit (OR: 26, p < 0.001). Conclusions. Most ISpIs were observed in patients without a prior chronic condition. The most common manifestation was, frequently with bacteremia, in the skin and soft tissue. A statistically significant association was observed between bacteremia and ≥2 early sources of infection and no surgery. Fatality rate, in association with streptococcal toxic shock syndrome and necrotizing fasciitis, was similar to that observed in other publications.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes , Fatores de Risco , Bacteriemia/etiologia , Estudos Transversais , Estudos RetrospectivosRESUMO
INTRODUCTION: Invasive Streptococcus pyogenes infections (ISpIs) cause a high morbidity and mortality, even at present; however, at a regional level there are few publications on this subject in the field of pediatrics. OBJECTIVE: To describe the prevalence, predisposing factors and clinical characteristics of children hospitalized for ISpI, and analyze risk factors associated with bacteremia and lethality. Material and methods. Retrospective, descriptive study on ISpIs in children <18 years old hospitalized in the Pediatric Ward of 20 healthcare facilities across Argentina between 2010 and 2012. Assessed outcome measures: age, gender, early and late clinical sources of infection, prior chronic condition, predisposing factors, treatment and evolution. RESULTS: To describe the prevalence, predisposing factors and clinical characteristics of children hospitalized for ISpI, and analyze risk factors associated with bacteremia and lethality. Material and methods. Retrospective, descriptive study on ISpIs in children <18 years old hospitalized in the Pediatric Ward of 20 healthcare facilities across Argentina between 2010 and 2012. Assessed outcome measures: age, gender, early and late clinical sources of infection, prior chronic condition, predisposing factors, treatment and evolution. CONCLUSIONS: Most ISpIs were observed in patients without a prior chronic condition. The most common manifestation was, frequently with bacteremia, in the skin and soft tissue. A statistically significant association was observed between bacteremia and ≥2 early sources of infection and no surgery. Fatality rate, in association with streptococcal toxic shock syndrome and necrotizing fasciitis, was similar to that observed in other publications.
INTRODUCCIÓN: Las infecciones invasivas por Streptococcus pyogenes (IISP) presentan elevada morbimortalidad aún en la actualidad; no obstante, a nivel regional, existen escasas publicaciones en pediatría. OBJECTIVO: Describir la prevalencia, los factores predisponentes y las características clínicas de niños internados por IISP, analizar los factores de riesgo asociados a bacteriemia y letalidad. Material y métodos. Estudio retrospectivo, descriptivo de IISP en niños ≤ 18 anos, internados en Pediatría de 20 centros asistenciales del país, entre 2010 y 2012. Variables evaluadas: edad, sexo, focos clínicos iniciales y tardíos, patología crónica previa, factores predisponentes, tratamiento y evolución. RESULTADOS: Se analizaron 143 pacientes. Incidencia de 4,97 casos/10 000 egresos. Mediana de edad 54 meses; tenían patología crónica previa 11,2%. Tuvieron factores predisponentes 67,1%. Las formas de presentación más frecuentes fueron la piel y las partes blandas en 77, sepsis en 30, osteoarticulares en 19, fascitis necrotizante en 13, síndrome de shock tóxico en 11. Se aisló Streptococcus pyogenes en 56,6% de los hemocultivos; la presencia de más de un foco clínico y la ausencia de cirugía se asociaron a bacteriemia (OR 4,8; p= 0,003 y OR 3,1; p= 0,0012, respectivamente). El promedio de internación fue 13,4 días. La tasa de letalidad fue 7,6% asociada a síndrome de shock tóxico (OR 10; p= 0,005), fascitis necrotizante (OR 104; p < 0,0001) e ingreso a la Unidad de Cuidados Intensivos Pediátricos (OR 26; p < 0,001). CONCLUSIONES: La mayoría de las IISP se presentaron en pacientes sin patología crónica previa. Los focos de presentación, frecuentemente con bacteriemia, fueron la piel y las partes blandas. Hubo asociación estadísticamente significativa entre bacteriemia y ≥ 2 focos iniciales y ausencia de cirugía. La letalidad, asociada a SSTS y fascitis necrotizante, fue similar a otras publicaciones.
Assuntos
Infecções Estreptocócicas , Streptococcus pyogenes , Adolescente , Argentina , Bacteriemia/etiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologiaRESUMO
Las infecciones de piel y partes blandas son una causa frecuente de consulta en los centros de atención primaria de la salud. Los datos de la epidemiología local de estas infecciones son escasos; el Staphylococcus aureus y el Streptococcus pyogenes son los principales agentes etiológicos. La emergencia, en los últimos años, de cepas de S. aureus meticilino resistentes provenientes de la comunidad y S. pyogenes resistentes a eritromicina plantea controversia en la elección del tratamiento empírico inicial. Este consenso nacional está dirigido a médicos pediatras, de familia, dermatólogos, infectólogos y otros profesionales de la salud. Trata el manejo clínico, especialmente el diagnóstico y tratamiento, de las infecciones de piel y partes blandas de origen bacteriano provenientes de la comunidad en pacientes inmunocompetentes menores de 19 años de edad.
Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of community-originated skin and soft tissue infections in immunocompetent patients under the age of 19.
Assuntos
Humanos , Criança , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/terapia , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/terapiaRESUMO
Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of community-originated skin and soft tissue infections in immunocompetent patients under the age of 19.
Assuntos
Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/terapia , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/terapia , Criança , HumanosRESUMO
Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of community-originated skin and soft tissue infections in immunocompetent patients under the age of 19.
RESUMO
The objective of this study was to evaluate and compare the immunogenicity, safety, and tolerability of two influenza subunit vaccines, a primarily European-marketed trivalent vaccine (Agrippal®, Novartis Vaccines), and a predominantly U.S.-marketed control trivalent vaccine (Fluvirin®, Novartis Vaccines), in subjects aged 3-64 y. The immunogenicity of both vaccines was evaluated according to the Center for Biologics Evaluation and Research (CBER) criteria. This clinical trial was performed between April and December 2007 in Argentina. A total of 1893 subjects were stratified into three age groups (3-8 y, 9-17 y, and 18-64 y), and randomized in a 2:1 ratio to receive either Agrippal or Fluvirin. Adolescents and adults received one dose of vaccine intramuscularly, whereas children aged 3-8 years received two vaccine doses, administered 4 wk apart. Antibody levels were measured by means of hemagglutination inhibition assay before vaccination (baseline); 21 d after the first vaccination (adults and adolescents); and, for children aged 3-8 y, 28 d after the first vaccination and 21 d after the second vaccine dose. Adverse reactions were solicited via diary cards for 7 d after each vaccination, and unsolicited adverse events were reported throughout the study period. Both vaccines were safe and well-tolerated, and elicited robust immunogenic responses in all age groups, meeting both CBER licensure criteria for all three viral strains after completion of the age-recommended vaccination schedule. These findings support the use of the trivalent subunit influenza vaccines Agrippal and Fluvirin for universal vaccination campaigns on an annual basis. ClinicalTrials.gov: NCT00464672.
Assuntos
Anticorpos Antivirais/sangue , Vacinas contra Influenza , Influenza Humana/imunologia , Influenza Humana/prevenção & controle , Vacinas de Produtos Inativados , Vacinas de Subunidades Antigênicas , Adolescente , Adulto , Argentina , Criança , Pré-Escolar , Feminino , Testes de Inibição da Hemaglutinação , Humanos , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/efeitos adversos , Vacinas contra Influenza/imunologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Vacinação , Vacinas de Produtos Inativados/administração & dosagem , Vacinas de Produtos Inativados/efeitos adversos , Vacinas de Produtos Inativados/imunologia , Vacinas de Subunidades Antigênicas/administração & dosagem , Vacinas de Subunidades Antigênicas/imunologia , Adulto JovemRESUMO
OBJECTIVE: To compare two pediatric recombinant hepatitis B vaccines-the Engerix-B reference vaccine and the Euvax-B vaccine-in terms of immunogenicity and reactogenicity, and also to investigate their interchangeability, that is, whether a three-dose hepatitis B vaccination schedule begun with a first dose of Engerix-B could be completed with two doses of Euvax-B. METHODS: This study was conducted in the city of Córdoba, Argentina, from March 1999 through February 2000. Three groups of Argentine newborns (100 per group) were vaccinated at 0, 1, and 6 months of age with hepatitis B vaccine: group A, three doses of Euvax-B; group B, three doses of Engerix-B; and group C, one dose of Engerix-B followed by two doses of Euvax-B. Reactogenicity was evaluated based on parental reporting of any solicited local or systemic event occurring during the 7-day period following vaccination. Whether Euvax-B and Engerix-B were clinically identical was assessed in terms of the seroprotection rates (antibodies to hepatitis B surface antigen (anti-HBsAg) >/= 10 milli-international units per mL (mIU/mL) 2 months after the third vaccination). RESULTS: Reactogenicity was low in all three groups. Five months after the second dose (that is, immediately prior to the third vaccination), seroprotection rates were 95.9%, 94.7%, and 90.2% for groups A, B, and C, respectively. Two months after the third dose all subjects were seroprotected, with geometric mean concentrations of anti-HBsAg of 2 468.1, 1 714.8, and 2 075.3 mIU/mL for groups A, B, and C, respectively. CONCLUSIONS: Both of the recombinant hepatitis B vaccines that we studied were well tolerated and highly immunogenic. Euvax-B was clinically identical (not inferior) to the EngerixB reference vaccine, and either vaccine could be used to achieve the World Health Organization goal of immunizing all infants against hepatitis B. Further, Euvax-B can be safely used in infants given an initial dose of either Euvax-B or Engerix-B.
Assuntos
Vacinas contra Hepatite B , Vacinas contra Hepatite B/imunologia , Vacinas Sintéticas/imunologia , Argentina , Feminino , Vacinas contra Hepatite B/farmacocinética , Humanos , Recém-Nascido , Masculino , Equivalência TerapêuticaRESUMO
OBJETIVO: Comparar dos vacunas pediátricas recombinantes contra la hepatitis B ùEuvax-B y la vacuna de referencia Engerix-Bù en cuanto a su inmunogenicidad y reactogenicidad, e investigar su intercambiabilidad, es decir, si el esquema de vacunación contra la hepatitis B de tres dosis comenzado con una primera dosis de Engerix-B puede completarse con dos dosis de Euvax-B. MÉTODOS: Este estudio se llevó a cabo en la ciudad de Córdoba, Argentina, entre marzo de 1999 y febrero de 2000. Se vacunó contra la hepatitis B a tres grupos de 100 lactantes argentinos a los 0, 1 y 6 meses de edad. El grupo A recibió tres dosis de Euvax-B; el grupo B, tres dosis de Engerix-B; y el grupo C, una dosis de Engerix-B seguida de dos dosis de Euvax-B. Para evaluar la reactogenicidad se utilizó la información brindada por los padres acerca de determinados fenómenos locales o sistémicos solicitados por los investigadores que hubieran ocurrido durante los siete días posteriores a la vacunación. Para establecer si eran idénticas clínicamente las vacunas Euvax-B y Engerix-B se utilizaron las tasas de seroprotección ùes decir, títulos de anticuerpos contra el antígeno de superficie de hepatitis B (anti-HBsAg) > 10 miliunidades internacionales por mililitro (mUI/mL)ù alcanzados dos meses después de la tercera dosis. RESULTADOS: La reactogenicidad fue baja en los tres grupos de estudio. A los 5 meses de la segunda dosis (es decir, inmediatamente antes de la tercera dosis), las tasas de seroprotección fueron 95,9%, 94,7% y 90,2% en los grupos A, B y C, respectivamente. Dos meses después de la tercera dosis, todos los lactantes se encontraban protegidos, con concentraciones medias geométricas de anti-HBsAg de 2 468,1 mUI/mL en el grupo A, de 1 714,8 mUI/mL en el grupo B y de 2 075,3 mUI/mL en el grupo C. CONCLUSIONES: Las dos vacunas recombinantes contra la hepatitis B estudiadas fueron bien toleradas y altamente inmunogénicas. La vacuna Euvax-B fue clínicamente idéntica (no inferior) a la vacuna de referencia Engerix-B y cualquiera de ellas puede utilizarse para alcanzar la meta propuesta por la Organización Mundial de la Salud de inmunizar a todos los recién nacidos contra la hepatitis B. Además, puede emplearse con seguridad la vacuna Euvax-B en lactantes que recibieron una primera dosis con Euvax-B o Engerix-B.
