Acute Abdomen and Appendicitis in 1010 Pediatric Patients With COVID-19 or MIS-C: A Multinational Experience from Latin America.

BACKGROUND: To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C). METHODS: Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes. FINDINGS: One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant. CONCLUSIONS: Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C. Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions and at the same time, minimize unnecessary surgical approaches.

Paediatric snakebite envenoming: recognition and management of cases.

Snakebite in children can often be severe or potentially fatal, owing to the lower volume of distribution relative to the amount of venom injected, and there is potential for long-term sequelae. In the second of a two paper series, we describe the pathophysiology of snakebite envenoming including the local and systemic effects. We also describe the diagnosis and management of snakebite envenoming including prehospital first aid and definitive medical and surgical care.

Toxocariosis humana en el Perú: aspectos epidemiológicos, clínicos y de laboratorio / Human toxocariasis: epidemiology, clinical and laboratory aspects

Toxocariosis es una infección causada por larvas de nemátodos del género Toxocara siendo T. canis o Toxocara cati, nemátodos del perro y gato respectivamente, los más importantes para el ser humano. Las especies del Género Toxocara pertenecen a la orden Ascaridida, superfamilia Ascaridiodea, familia Toxocaridae. La enfermedad es ocasionada principalmente por T. canis. La toxocariosis humana fue descrita por primera vez por Wilder en 1950, quien identificó un nemátodo de especie desconocida en un granuloma de retina de un niño. En 1952, Beaver reportó casos de una enfermedad multisistémica, crónica y severa, asociada a hipereosinofilia . En el Perú, en 1991, Maguiña y col reportaron los primeros casos de Larva migrans visceral y en 1999, Miranda y col, reportaron los primeros casos de Larva migrans ocular.

Toxocariasis is an infection caused by nematode larvae from Toxocara genus, and the most important infective agents for humans are Toxocara canis and Toxocara cati, parasites from dogs and cats, respectively. Toxocara species belong to Ascaridida order, Ascaridodea super-family, Toxocaridae family. The disease in humans is mainly caused by T. canis. Human toxocariasis was described for the .rst time by Wilder in 1950, who identi.ed a then-unknown nematode in a child presenting with a granulomatous lesion in one of his eyes. In 1952, Beaver reported cases of a multi-systemic, chronic, and sever disease, associated to hypereosinophilia. In Peru, in 1991, Maguiña et al. reported the very. rst cases of visceral larva migrans, and in 1999, Miranda et al. reported the very .rst cases of ocular larva migrans.

Validez del tacto materno en el reconocimiento de fiebre en niños menores de 36 meses / Validity of maternal palpation in the detection of fever in children under 36 months

Objetivo: Determinar la validez del tacto materno como método de detección de la presencia o no de fiebre en los niños. Material y métodos: Se seleccionaron por conveniencia a 269 madres y sus respectivos niños menores de 36 meses que acudieron al Servicio de Emergencias Pediátricas del Hospital Nacional Cayetano Heredia por cualquier molestia. Se preguntó a las madres si su niño presentaba fiebre o no (detectado por tacto), y luego se procedió con la medición de la temperatura rectal de cada niño. Resultados: Se incluyeron 269 participantes. El tacto materno para la detección de fiebre tuvo una sensibilidad de 79,3% (69,6% a 86,5%), especificidad 91,8% (86,8% a 94,9%), VPP 82,1% (72,6% a 88,9%) y VPN 90,3% (85,1% a 93,8%); el likelihood ratio positivo fue 9,62 (5,86 a 15,81) y el likelihood ratio negativo fue 0,23 (0,15 a 0,34). La correlación (índice Kappa) de fiebre o no fiebre determinada por la madre y la medida por termómetro fue de 0,72 (p:0,0000). Conclusiones: Las madres tienen una buena capacidad discriminativa en la determinación de la presencia o ausencia de fiebre mediante la palpación, por lo que la detección de fiebre por tacto materno es un eficiente método de despistaje.

Objective: To determine how valid is the maternal palpation as a screening method to determine the presence or absence of fever in children. Material and methods: We selected for convenience 269 mothers and their children under 36 months, who attended the Pediatric Emergency Service of Hospital Nacional Cayetano Heredia for any complaint. Then, we asked the mothers if their child had fever or not (detected by palpation), and then we proceeded with the rectal temperature measurement of each child. Results: We included 269 participants. The maternal palpation for the detection of fever had a sensitivity of 79% (69.6% to 86.5%), specificity 91.7% (86.8% to 94.9%), PPV 82.1% (72.6% to 88.9%) and NPV 90.3% (85.1% to 93.8%); the positive likelihood ratio was 9.62 (5.86 to 15.81) and the negative likelihood ratio was 0.23 (0.15 to 0.34). The correlation (Kappa index) of fever or absence of fever determinated for the mother and thermometer was 0.72 (p:0.0000). Conclusions: Mothers have a well accuracy in determining the presence or absence of fever by palpation, therefore detection of fever by palpation is an efficient screening method.

Sensibilidad antibiótica de Streptococcus pneumoniae en portadores nasofaríngeos en niños sanos menores de un año en Lima, Perú / Antibiotic susceptibility of Streptococcus pneumoniae in nasopharyngeal carriers in healthy children younger than one year of age in Lima, Peru

Introducción: el neumococo es causa importante de morbi-mortalidad en niños en países en vías de desarrollo. En los últimos años han aparecido a nivel mundial cepas de neumococo resistentes a penicilina y a otros antibióticos utilizados frecuentemente en pediatría. A nivel local hay pocos estudios recientes que describen este problema. Objetivo: el objetivo principal del estudio fue determinar el porcentaje de resistencia antibiótica del neumococo en portadores nasofaríngeos en niños sanos entre dos meses y un año en los Consultorios de Crecimiento y Desarrollo y/o Vacunación de los hospitales Cayetano Heredia, Edgardo Rebagliati, San Bartolomé e Instituto Nacional de Salud del Niño en Lima, Perú. Materiales y métodos: se tomaron muestras de hisopado nasofaríngeoen 400 niños (noviembre 2007-junio 2008) para cultivo de neumococo y determinación de su sensibilidad a la penicilina y a otros antibióticos con la prueba de sensibilidad en disco. Resultados: se encontró 28 por ciento (111/400) de portadores nasofaríngeos de neumococo. De las 111 cepas aisladas, 60 (55 por ciento) fueron resistentes a cotrimoxazol, 52 (47 por ciento) a penicilina y 30 (35 por ciento) a azitromicina. No se encontró ninguna asociación entre los factores estudiados y la condición de portador y/o resistencia antibiótica. Conclusión: la resistencia del neumococo al cotrimoxazol y a la penicilina fue alta. Sin embargo, se necesita completar el estudio con la determinación de la concentración inhibitoria mínima para poder usar los nuevos puntos de corte para penicilina para cepas no-meníngeas. Con estos nuevos criterios es muy probable que la penicilina continúe siendo la droga de elección para infecciones no severas fuera del sistema nervioso central.

Introducction: Pneumococcus is a major cause of morbidity and mortality in children in developing countries. Over the last few years, pneumococcal strains resistant to penicillin and other antibiotics commonly used in pediatrics have emerged. There are few recent local studies that describe this problem. Objectives: The main purpose of the study was to determine the pneumococcal resistance rates in healthy nasopharyngeal carriers 2 to12 months of age, who attended the outpatient clinic for a routine well child and/or vaccination visit at Cayetano Heredia, Edgardo Rebagliati, San Bartolomé Hospitals and Instituto Nacional de Salud del Niño in Lima-Peru. Methods: Nasopharyngeal samples were obtained from 400 children (November 2007-June 2008) for S. pneumoniae culture and determination of the susceptibility to penicillin and other antibiotics by disk diffusion. Results: The pneumococcal carriage rate was 28 per cent (111/400). From the 111 strains isolated, 60 (55 per cent) were resistant to cotrimoxazole, 52 (47 per cent) to penicillin and 30 (35 per cent) to azythromycin. We did not find any association between the factors analyzed and the carrier state and/or antibiotic resistance. Conlusions: We found high resistance rates of pneumococcus to cotrimoxazole and penicillin. However, this study needs to be complemented with minimal inhibitory concentrations in order to use the new penicillin breakpoints for non-meningeal strains. With the new breakpoints, it is likely that penicillin will continue to be the drug of choice for non-severe infections outside the central nervous system.