Respiratory pathogens in infants less than two months old hospitalized with acute respiratory infection.

Lower acute respiratory infections (ARI) are a frequent cause of morbidity and mortality in infants, respiratory viruses being the major causative agents. The aim of this work was to determine the respiratory pathogen frequency, the clinical characteristics and the outcome in infants <2 months old hospitalized with ARI. A retrospective study was performed during a five-year period (2008-2011, 2014-2016). Respiratory viruses and atypical bacteria were studied using the FilmArray-Respiratory Panel. Demographic and clinical characteristics, hospitalization course and outcomes were evaluated. Of the 137 infants <2 months old hospitalized with ARI studied, a 94.9% positivity rate as determined in 117 infants with community-acquired infection and 20.0% in 20 infants who acquired the infection during their birth hospitalization in the neonatal intensive care units (NICU) (nosocomial ARI) (p<0.001). In infants with community-acquired infection, Respiratory syncytial virus (RSV) (52.1%) and Rhinovirus/Enterovirus (RV/EV) (41.0%) were the most frequent detected pathogens. Coinfections were determined in one quarter of the infants, RSV-RV/EV being the most frequent combination. In infants with nosocomial infection, RV/EV, RSV or Parainfluenza-3 were detected as single pathogens. Most infants with community-acquired infection presented lower ARI (81.2%) while most infants in the NICU had upper ARI (55.0%). The median length of stay (LOS) in infants with community-acquired ARI was 4 days (IQR: 2-6). Positive infants with nosocomial infection had longer median LOS (71 days [IQR:42-99]) compared to negative infants (58 days [IQR: 49-71]) (p=0.507). Respiratory viruses were detected as the major causative agents of community-acquired infection in hospitalized infants <2-months old, RSV and RV/EV being the most frequently detected. Although a low pathogen positivity rate was observed in infants with nosocomial infection, they may prolong the LOS.

[Clinical- epidemiological characteristics and predictors of coronary complications in children of Argentina with Kawasaki disease]. / Características clínico-epidemiológicas y predictores de complicaciones coronarias en niños de Argentina con enfermedad de Kawasaki.

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.

Características clínico-epidemiológicas y predictores de complicaciones coronarias en niños de Argentina con enfermedad de Kawasaki / Clinical- epidemiological characteristics and predictors of coronary complications in children of Argentina with Kawasaki disease

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.

Encefalomielitis aguda diseminada por Mycoplasma pneumoniae en un niño previamente sano / Acute disseminated encephalomyelitis due to Mycoplasma pneumoniae in a previously healthy boy

Se presenta el caso de un niño de 5 años sin antecedentes de enfermedad, que se internó en terapia intensiva por convulsiones tónico-clónicas focalizadas en la cara y en el hemicuerpo derecho, con documentación de temperatura axilar de 37,4°C. Se descartó la presencia de gérmenes comunes y la etiología viral a través de estudios de muestras de líquido cefalorraquídeo (LCR). Se sospechó la presencia de Mycoplasma pneumoniae por comprobarse inmunofluorescencia positiva en suero para anticuerpos de clase IgM. El diagnóstico se confirmó mediante la detección del ADN de dicho patógeno sobre la biopsia cerebral efectuada por el método de la reacción en cadena de la polimerasa (PCR) y una histología compatible con encefalomielitis aguda diseminada. El paciente recibió tratamiento con claritromicina y su evolución fue favorable. Al menos dentro de nuestros conocimientos, este es el primer caso en el que se detectó ADN de M. pneumoniae en una biopsia cerebral por el método de PCR.

We present here the case of a previously healthy 5 year-old boy hospitalized in an intensive care unit due to tonic-clonic seizures focused on the face and right side of the body, and axillary temperature of 37.4 °C. Common bacterial and viral etiology was ruled out through studies of cerebrospinal fluid (CSF) samples. Mycoplasma pneumoniae was suspected by a positive immunofluorescence serum test for IgM class antibodies. Finally, with a brain biopsy, M. pneumoniae was confirmed by polymerase chain reaction (PCR) and acute disseminated encephalomyelitis by pathological anatomy. The patient was treated with clarithromycin and had an uneventful evolution. At least to our knowledge, this is the first case in which M. pneumoniae DNA was detected by PCR in a brain biopsy.

[Acute disseminated encephalomyelitis due to Mycoplasma pneumoniae in a previously healthy boy]. / Encefalomielitis aguda diseminada por Mycoplasma pneumoniae en un niño previamente sano.

We present here the case of a previously healthy 5 year-old boy hospitalized in an intensive care unit due to tonic-clonic seizures focused on the face and right side of the body, and axillary temperature of 37.4°C. Common bacterial and viral etiology was ruled out through studies of cerebrospinal fluid (CSF) samples. Mycoplasma pneumoniae was suspected by a positive immunofluorescence serum test for IgM class antibodies. Finally, with a brain biopsy, M. pneumoniae was confirmed by polymerase chain reaction (PCR) and acute disseminated encephalomyelitis by pathological anatomy. The patient was treated with clarithromycin and had an uneventful evolution. At least to our knowledge, this is the first case in which M. pneumoniae DNA was detected by PCR in a brain biopsy.

Estudio multicéntrico de infecciones invasivas por Streptococcus pyogenes en niños de Argentina / Multicenter study on invasive Streptococcus pyogenes infections in children in Argentina

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.

Multicenter study on invasive Streptococcus pyogenes infections in children in Argentina. / Estudio multicéntrico de infecciones invasivas por Streptococcus pyogenes en niños de Argentina.

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.

Epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old at a private institution in the city of Buenos Aires.

INTRODUCTION: Acute gastroenteritis is a common disease in children. Rotavirus is the major etiologic agent. OBJECTIVES: To describe the epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old in a private institution in the City of Buenos Aires. SECONDARY OBJECTIVE: to analyze related costs. MATERIAL AND METHODS: Cross sectional, descriptive, observational study conducted during one year in children younger than 5 years old with gastroenteritis. The presence of rotavirus was diagnosed with the VIKIA® Rota-Adeno test. Demographic, clinical and immunization data were collected. A univariate data analysis was performed. RESULTS: A total of 275 patients were included; 18.5% of them were R+. Rotavirus was more common in children younger than 2 years old and in the period between March and June. The cases of rotavirus gastroenteritis were more severe, required more hospitalizations (OR 2.07; 95% CI 1.17-7.13), and resulted in higher costs. In the sample studied, the immunization outcome measure reduced the risk of rotavirus infection. CONCLUSIONS: Acute gastroenteritis caused by rotavirus were different from other etiologies in that they had a seasonal peak and in relation to the median age of patients, the severity of the condition, the association with hospitalization and the increase in costs.

Características epidemiológicas y clínicas de las gastroenteritis agudas según su etiología por rotavirus u otra en niños menores de 5 años atendidos en una institución privada de la Ciudad Autónoma de Buenos Aires / Epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old at a private institution in the city of Buenos Aires

Introducción. La gastroenteritis aguda es una enfermedad frecuente en pediatría. Rotavirus es el principal agente etiológico. Objetivos. Describir las características epidemiológicas y clínicas de las gastroenteritis agudas según su etiología por rotavirus u otra en niños menores de 5 años en una institución privada de Buenos Aires. Objetivo secundario: evaluar los costos. Material y métodos. Estudio transversal, descriptivo, observacional, de un año de duración, en niños menores de 5 años con gastroenteritis. El rotavirus fue diagnosticado mediante la prueba VIKIA« Rota-Adeno. Se recolectaron datos demográficos, clínicos y de vacunación. Se realizó el análisis univariado de los datos. Resultados. Se incluyeron 275 pacientes; 18,5% fueron R+. Rotavirus fue más frecuente en los menores de 2 años y entre marzo y junio. Las gastroenteritis por rotavirus fueron más graves, requirieron más internaciones (OR 2,07; IC 95% 1,17 a 7,13) y provocaron más costos. En la muestra estudiada la variable vacunación redujo el riesgo de infección por rotavirus. Conclusiones. Las gastroenteritis agudas por rotavirus se diferenciaron de otras etiologías por tener un pico estacional, y por la mediana de edad, la gravedad, la asociación con internación y el aumento de los costos.(AU)

Introduction. Acute gastroenteritis is a common disease in children. Rotavirus is the major etiologic agent. Objectives. To describe the epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old in a private institution in the City of Buenos Aires. Secondary objective: to analyze related costs. Material and Methods. Cross sectional, descriptive, observational study conducted during one year in children younger than 5 years old with gastroenteritis. The presence of rotavirus was diagnosed with the VIKIA« Rota-Adeno test. Demographic, clinical and immunization data were collected. A univariate data analysis was performed. Results. A total of 275 patients were included; 18.5% of them were R+. Rotavirus was more common in children younger than 2 years old and in the period between March and June. The cases of rotavirus gastroenteritis were more severe, required more hospitalizations (OR 2.07; 95% CI 1.17-7.13), and resulted in higher costs. In the sample studied, the immunization outcome measure reduced the risk of rotavirus infection. Conclusions. Acute gastroenteritis caused by rotavirus were different from other etiologies in that they had a seasonal peak and in relation to the median age of patients, the severity of the condition, the association with hospitalization and the increase in costs.(AU)

Características epidemiológicas y clínicas de las gastroenteritis agudas según su etiología por rotavirus u otra en niños menores de 5 años atendidos en una institución privada de la Ciudad Autónoma de Buenos Aires / Epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old at a private institution in the city of Buenos Aires

Introducción. La gastroenteritis aguda es una enfermedad frecuente en pediatría. Rotavirus es el principal agente etiológico. Objetivos. Describir las características epidemiológicas y clínicas de las gastroenteritis agudas según su etiología por rotavirus u otra en niños menores de 5 años en una institución privada de Buenos Aires. Objetivo secundario: evaluar los costos. Material y métodos. Estudio transversal, descriptivo, observacional, de un año de duración, en niños menores de 5 años con gastroenteritis. El rotavirus fue diagnosticado mediante la prueba VIKIA® Rota-Adeno. Se recolectaron datos demográficos, clínicos y de vacunación. Se realizó el análisis univariado de los datos. Resultados. Se incluyeron 275 pacientes; 18,5% fueron R+. Rotavirus fue más frecuente en los menores de 2 años y entre marzo y junio. Las gastroenteritis por rotavirus fueron más graves, requirieron más internaciones (OR 2,07; IC 95% 1,17 a 7,13) y provocaron más costos. En la muestra estudiada la variable vacunación redujo el riesgo de infección por rotavirus. Conclusiones. Las gastroenteritis agudas por rotavirus se diferenciaron de otras etiologías por tener un pico estacional, y por la mediana de edad, la gravedad, la asociación con internación y el aumento de los costos.

Introduction. Acute gastroenteritis is a common disease in children. Rotavirus is the major etiologic agent. Objectives. To describe the epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old in a private institution in the City of Buenos Aires. Secondary objective: to analyze related costs. Material and Methods. Cross sectional, descriptive, observational study conducted during one year in children younger than 5 years old with gastroenteritis. The presence of rotavirus was diagnosed with the VIKIA® Rota-Adeno test. Demographic, clinical and immunization data were collected. A univariate data analysis was performed. Results. A total of 275 patients were included; 18.5% of them were R+. Rotavirus was more common in children younger than 2 years old and in the period between March and June. The cases of rotavirus gastroenteritis were more severe, required more hospitalizations (OR 2.07; 95% CI 1.17-7.13), and resulted in higher costs. In the sample studied, the immunization outcome measure reduced the risk of rotavirus infection. Conclusions. Acute gastroenteritis caused by rotavirus were different from other etiologies in that they had a seasonal peak and in relation to the median age of patients, the severity of the condition, the association with hospitalization and the increase in costs.

Viral etiology of acute respiratory infections in hospitalized and outpatient children in Buenos Aires, Argentina.

OBJECTIVES: To determine and compare the viral frequency, seasonality and clinical-demographic features in 2 groups of children (hospitalized versus outpatients) with acute respiratory infections. MATERIAL AND METHODS: A cross-sectional, descriptive study was performed from 2008 to 2010 in 620 children <6 years of age with acute respiratory infection. Respiratory samples were studied for classical respiratory viruses by immunofluorescence and for human rhinoviruses (HRV) by real-time reverse transcription polymerase chain reaction. Clinical and demographic data were recorded. RESULTS: Viral detection by immunofluorescence was 48% in 434 inpatients and 37% in 186 outpatients. Viral diagnosis increased to 83% and 62%, respectively, when testing for HRV. HRV (41%) and respiratory syncytial virus (RSV) (27%) were most common viruses identified, followed by metapneumovirus (9%), influenza A and parainfluenza (3%), adenovirus and influenza B (2%). HRV frequency was significantly higher in hospitalized patients (47%) than in outpatients (27%) (P < 0.001). Coinfection was detected in 12% of hospitalized and 4% of outpatients (P < 0.031). HRV and adenovirus circulated throughout the entire year. RSV, influenza A and B predominated in winter, whereas metapneumovirus and parainfluenza predominated in spring. Of 362 patients with bronchiolitis, 84% had a virus identified; HRV (42%) and RSV (38%) were predominant. Of 77 patients with pneumonia, 84% had a virus detected with HRV (43%) and RSV (29%) predominating. CONCLUSIONS: HRV were significant pathogens associated with bronchiolitis and pneumonia, especially in hospitalized patients. Both, HRV and coinfections, were risk factors for hospitalization. These findings support the importance of including HRV detection in children with acute respiratory infection.

Epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old at a private institution in the city of Buenos Aires. / Epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old at a private institution in the city of Buenos Aires.

INTRODUCTION: Acute gastroenteritis is a common disease in children. Rotavirus is the major etiologic agent. OBJECTIVES: To describe the epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old in a private institution in the City of Buenos Aires. SECONDARY OBJECTIVE: to analyze related costs. MATERIAL AND METHODS: Cross sectional, descriptive, observational study conducted during one year in children younger than 5 years old with gastroenteritis. The presence of rotavirus was diagnosed with the VIKIA« Rota-Adeno test. Demographic, clinical and immunization data were collected. A univariate data analysis was performed. RESULTS: A total of 275 patients were included; 18.5

of them were R+. Rotavirus was more common in children younger than 2 years old and in the period between March and June. The cases of rotavirus gastroenteritis were more severe, required more hospitalizations (OR 2.07; 95

CI 1.17-7.13), and resulted in higher costs. In the sample studied, the immunization outcome measure reduced the risk of rotavirus infection. CONCLUSIONS: Acute gastroenteritis caused by rotavirus were different from other etiologies in that they had a seasonal peak and in relation to the median age of patients, the severity of the condition, the association with hospitalization and the increase in costs.

[Acute viral respiratory infection in children under 5 years: Epidemiological study in two centers in Buenos Aires, Argentina]. / Infección respiratoria aguda viral en niños menores de 5 años: Estudio epidemiológico en dos centros de Buenos Aires, Argentina.

INTRODUCTION: Acute respiratory infections (ARI) are a major cause of hospitalization particularly at the extreme ages of life. OBJECTIVES: To determine the viral diagnosis in children < 5 years old with ARI, seasonality, clinical and epidemiological characteristics. POPULATION AND METHODS: A cross-sectional, descriptive and multicenter study was performed. Respiratory samples from patients with ARI hospitalized or outpatients with < 5 days of respiratory symptoms from June 2008 to May 2009 were studied for respiratory viruses. Clinical and demographic data were recorded. RESULTS: A total of 347 patients were enrolled: 234 hospitalized and 112 outpatients. Hospitalized patients were younger compared with outpatients (8 vs. 19 months, p <0.001) and presented more frequently bronchiolitis (74% hospitalized vs. 24% outpatients) and pneumonia (14% hospitalized vs. 5% outpatients). Age was statistically associated with hospitalization (p= 0.01). Viral diagnosis was achieved in 81% hospitalized and 57% of outpatients. Rhinovirus was the most frequent followed by respiratory syncytial virus. The rest of respiratory viruses were observed with lower frequency. Viral circulation was observed throughout the whole year. The median length of stay was 3.5 days. Intensive care was required in 11% of hospitalized patients and 3% required mechanical ventilation. No deaths were recorded. CONCLUSIONS: The use of viral diagnostic techniques allowed the identification of an etiologic agent in most of the hospitalized patients and more than half of outpatients. The addition of RT-PCR for rhinovirus, allowed the identification of this etiologic agent. Viral circulation was observed throughout the whole year. Hospitalized patients presented bronchiolitis and pneumonia more frequently than outpatients.

Infección respiratoria aguda viral en niños menores de 5 años: Estudio epidemiológico en dos centros de Buenos Aires, Argentina / Acute viral respiratory infection in children under 5 years: Epidemiological study in two centers in Buenos Aires, Argentina

Introducción. Las infecciones respiratorias agudas (IRA) son la mayor causa de hospitalización en edades extremas de la vida. Objetivos. Identifcar los agentes etiológicos de IRA viral en niños < 5 años hospitalizados y ambulatorios; describir estacionalidad y características clínico-epidemiológicas de la enfermedad. Población y métodos. Estudio descriptivo, transversal y multicéntrico en dos centros privados de Buenos Aires, en niños con IRA alta y baja. Se registraron antecedentes, cuadros clínicos y estudios virológicos. Resultados. Se estudiaron 347 pacientes: 235 hospitalizados; 112 ambulatorios. Los hospitalizados fueron menores que los ambulatorios (8 vs. 19 meses, p <0,001), presentaron más frecuentemente bronquiolitis (74% hospitalizados vs. 24% ambulatorios) y neumonía (14% hospitalizados vs. 5% ambulatorios). Solo la edad se asoció signifcativamente a hospitalización (p= 0,01). Se identifcó etiología viral en 81% de los hospitalizados y 57% de los ambulatorios. El virus más frecuente fue rinovirus seguido por virus respiratorio sincicial. Se observó circulación viral durante todo el año, especialmente en otoño e invierno. En pacientes hospitalizados, la mediana de hospitalización fue 3,5 días. Requirieron cuidados intensivos 25 (11%) pacientes, y 7 (3%) recibieron asistencia ventilatoria mecánica. No hubo letalidad. Conclusiones. Las técnicas de diagnóstico virológico permitieron identifcar agentes etiológicos en la mayoría de los pacientes hospitalizados y en más de la mitad de los ambulatorios con IRA. La incorporación de RT-PCR para rinovirus, permitió la identifcación de este agente etiológico. La circulación viral se observó a lo largo de todo el año. La bronquiolitis fue causa de internación en 174/201 (86,5%) niños con IRA y la neumonía en 33/39 (84,6%) niños.

Introduction. Acute respiratory infections (ARI) are a major cause of hospitalization particularly at the extreme ages of life. Objectives. To determine the viral diagnosis in children < 5 years old with ARI, seasonality, clinical and epidemiological characteristics. Population and methods. A cross-sectional, descriptive and multicenter study was performed. Respiratory samples from patients with ARI hospitalized or outpatients with < 5 days of respiratory symptoms from June 2008 to May 2009 were studied for respiratory viruses. Clinical and demographic data were recorded. Results. A total of 347 patients were enrolled: 234 hospitalized and 112 outpatients. Hospitalized patients were younger compared with outpatients (8 vs. 19 months, p <0.001) and presented more frequently bronchiolitis (74% hospitalized vs. 24% outpatients) and pneumonia (14% hospitalized vs. 5% outpatients). Age was statistically associated with hospitalization (p= 0.01). Viral diagnosis was achieved in 81% hospitalized and 57% of outpatients. Rhinovirus was the most frequent followed by respiratory syncytial virus. The rest of respiratory viruses were observed with lower frequency. Viral circulation was observed throughout the whole year. The median length of stay was 3.5 days. Intensive care was required in 11% of hospitalized patients and 3% required mechanical ventilation. No deaths were recorded. Conclusions. The use of viral diagnostic techniques allowed the identifcation of an etiologic agent in most of the hospitalized patients and more than half of outpatients. The addition of RT-PCR for rhinovirus, allowed the identifcation of this etiologic agent. Viral circulation was observed throughout the whole year. Hospitalized patients presented bronchiolitis and pneumonia more frequently than outpatients.