Human case of swine influenza A (H1N1), Aragon, Spain, November 2008.

A human case of swine influenza A (H1N1) in a 50-year-old woman from a village near Teruel (Aragon, in the north-east of Spain), with a population of about 200 inhabitants, has been reported in November 2008.

[Clinical characteristics and management of children hospitalized for influenza in four epidemic seasons (2002-2006)]. / Características clínicas y actuaciones en los niños ingresados por gripe en cuatro períodos epidémicos gripales (2002-2006).

INTRODUCTION: Influenza is frequent during childhood, affecting approximately 30-40 % of children. OBJECTIVES: To identify the most frequent causes of hospitalization in children admitted to hospital for influenza, as well as the main symptoms and clinical diagnoses at discharge, and to relate these factors with the type of influenza virus and patients' age. A further aim was to evaluate the use of the diagnostic and therapeutic methods. MATERIAL AND METHODS: We performed a retrospective descriptive study through a review of the medical records of children admitted to the Miguel Servet Children's Hospital in Zaragoza (Spain) for influenza in four epidemic seasons (2002-2006). RESULTS: A total of 178 influenza cases were found, 132 due to influenza A and 46 due to influenza B. Hospital admission was mainly due to fever without focus, especially in infants aged less than 6 months, followed by convulsions and shortness of breath. The main symptoms were fever, cough, rhinitis, and vomiting. The latter was especially frequent in children older than 3 years and in patients with influenza B virus. The main discharge diagnoses were upper respiratory tract infection, pharyngitis-tonsillitis, and otitis. Diagnosis of bronchitis was more frequent in children aged less than 2 years old. Chest X-ray was performed in 80% of the patients and lung consolidation was found in 10.5%. Antibiotic therapy was administered in 59% of the patients, mainly amoxicillin-clavulanic acid. CONCLUSIONS: The causes of admission for influenza and clinical presentation of this infection vary widely, sometimes depending on age and the type of influenza virus.

Características clínicas y actuaciones en los niños ingresados por gripe en cuatro períodos epidémicos gripales (2002-2006) / Clinical characteristics and management of children hospitalized for influenza in four epidemic seasons (2002-2006)

La gripe es un proceso muy frecuente en la infancia que afecta al 30-40 % de los niños. Objetivos Entre los niños ingresados por virus de la gripe, determinar las causas más frecuentes de hospitalización, los síntomas principales y el diagnóstico clínico al alta relacionados con la edad y el tipo de virus de la gripe, así como valorar el uso de métodos diagnósticos y terapéuticos. Material y métodos Estudio descriptivo retrospectivo obtenido mediante la revisión de historias clínicas de niños hospitalizados con diagnóstico de gripe en el Hospital Infantil Miguel Servet de Zaragoza durante cuatro períodos epidémicos anuales (2002-2006). Resultados Se observaron 178 casos de gripe, de los que 132 correspondieron al virus de la gripe A y 46 al B. El principal motivo de ingreso en el hospital fue fiebre sin foco, sobre todo en menores de 6 meses, seguido por convulsión febril y dificultad respiratoria. La sintomatología predominante fue fiebre, tos y rinitis, y vómitos en mayores de 3 años, especialmente en los casos de gripe B. Los diagnósticos principales al alta fueron infección respiratoria de vías altas, faringoamigdalitis y otitis. El diagnóstico de bronquitis/bronquiolitis fue más frecuente en los pacientes menores de 2 años. Se realizó radiografía de tórax en el 80 %, con condensación neumónica en el 10,5 % y se administró antibioterapia en el 59 % de los pacientes, principalmente amoxicilina- ácido clavulánico. Conclusiones Existe una gran variación en las causas de ingreso y presentación clínica de la gripe, en algunos casos determinado por la edad y el tipo de virus gripal

Introduction Influenza is frequent during childhood, affecting approximately 30-40 % of children. Objectives To identify the most frequent causes of hospitalization in children admitted to hospital for influenza, as well as the main symptoms and clinical diagnoses at discharge, and to relate these factors with the type of influenza virus and patients’ age. A further aim was to evaluate the use of the diagnostic and therapeutic methods. Material and methods We performed a retrospective descriptive study through a review of the medical records of children admitted to the Miguel Servet Children’s Hospital in Zaragoza (Spain) for influenza in four epidemic seasons (2002-2006). Results A total of 178 influenza cases were found, 132 due to influenza A and 46 due to influenza B. Hospital admission was mainly due to fever without focus, especially in infants aged less than 6 months, followed by convulsions and shortness of breath. The main symptoms were fever, cough, rhinitis, and vomiting. The latter was especially frequent in children older than 3 years and in patients with influenza B virus. The main discharge diagnoses were upper respiratory tract infection, pharyngitis-tonsillitis, and otitis. Diagnosis of bronchitis was more frequent in children aged less than 2 years old. Chest X-ray was performed in 80 % of the patients and lung consolidation was found in 10.5 %. Antibiotic therapy was administered in 59 % of the patients, mainly amoxicillin- clavulanic acid. Conclusions The causes of admission for influenza and clinical presentation of this infection vary widely, sometimes depending on age and the type of influenza virus

[Retrospective diagnosis of congenital infection by cytomegalovirus in the case of one infant]. / Diagnóstico retrospectivo de infección congénita por citomegalovirus en un caso clínico infantil.

INTRODUCTION: 10-15% of asymptomatic congenital infections by cytomegalovirus (CMV) in the neonatal period develop persistent problems with varying degrees of severity, fundamentally involving neurological disorders, neurosensory hypoacusis and hypovision, which appear from the age of 6-9 months onwards, when a diagnosis is no longer possible. The PCR (polymerase chain reaction) technique can detect DNA of CMV in blood samples on filter paper used for screening hypothyroidism and metabolic pathologies that were kept from the neonatal period. CASE REPORT: A child aged 3 years and 8 months with delayed intrauterine growth, autism, mental retardation, microcephalus and neurosensory hypoacusis; periventricular calcifications, leukoencephalopathy and bilateral malformation of the temporal lobe; and a diagnosis of congenital CMV confirmed by detection of DNA by PCR in the blood sample on filter paper saved from the neonatal period. CONCLUSIONS: The retrospective study of congenital infection by CMV should be considered when faced with severity and varying association of delayed intrauterine growth, microcephalus, neurosensory hypoacusis, chorioretinitis, mental retardation, autism or other behavioural disorders, intracranial calcifications, encephaloclastic alterations, leukoencephalopathy, cortical dysplasia and malformations of the temporal lobe and the hippocampus. Since the filter papers from neonatal screening are not kept for ever, perhaps the idea of doing so ought to be considered, given the possibilities they offer for retrospective studies.

Diagnóstico retrospectivo de infección congénita por citomegalovirus en un caso clínico infantil / Retrospective diagnosis of congenital infection by cytomegalovirus int he case of one infant

Introduction. 10-15% of asymptomatic congenital infections by cytomegalovirus (CMV) in the neonatal period develop persistent problems with varying degrees of severity, fundamentally involving neurological disorders, neurosensory hypoacusis and hypovision, which appear from the age of 6-9 months onwards, when a diagnosis is no longer possible. The PCR (polymerase chain reaction) technique can detect DNA of CMV in blood samples on filter paper used for screening hypothyroidism and metabolic pathologies that were kept from the neonatal period. Case report. A child aged 3 years and 8 months with delayed intrauterine growth, autism, mental retardation, microcephalus and neurosensory hypoacusis; periventricular calcifications, leukoencephalopathy and bilateral malformation of the temporal lobe; and a diagnosis of congenital CMV confirmed by detection of DNA by PCR in the blood sample on filter paper saved from the neonatal period. Conclusions. The retrospective study of congenital infection by CMV should be considered when faced with severity and varying association of delayed intrauterine growth, microcephalus, neurosensory hypoacusis, chorioretinitis, mental retardation, autism or other behavioural disorders, intracranial calcifications, encephaloclastic alterations, leukoencephalopathy, cortical dysplasia and malformations of the temporal lobe and the hippocampus. Since the filter papers from neonatal screening are not kept for ever, perhaps the idea of doing so ought to be considered, given the possibilities they offer for retrospective studies (AU)

Introducción. Un 10-15% de las infecciones congénitas por citomegalovirus (CMV) asintomáticas en el período neonatal desarrollan problemas persistentes de gravedad variable, fundamentalmente afectación neurológica, hipoacusia neurosensorial e hipovisión, que se manifiestan a partir de los 6-9 meses, cuando ya no es posible efectuar el diagnóstico. La técnica de la PCR (del inglés, polymerase chain reaction) puede detectar el ADN del CMV en las muestras de sangre del papel de filtro que se emplean para el cribaje de hipotiroidismo y metabolopatías, guardadas desde el período neonatal. Caso clínico. Se trata de un niño de 3 años y 8 meses de edad con retraso de crecimiento intrauterino, autismo, retraso mental, microcefalia e hipoacusia neurosensorial, con calcificaciones periventriculares, leucoencefalopatía y malformación bilateral del lóbulo temporal, con confirmación diagnóstica de CMV congénito por detección del ADN mediante PCR en la sangre del papel de filtro guardado desde el período neonatal. Conclusiones. El estudio retrospectivo de infección congénita por CMV debería plantearse ante la presencia de gravedad y asociación variables de retraso de crecimiento intrauterino, microcefalia, hipoacusia neurosensorial, coriorretinitis, retraso mental, autismo u otros problemas de conducta, calcificaciones intracraneales, alteraciones encefaloclásticas, leucoencefalopatía, displasia cortical y malformaciones del lóbulo temporal y el hipocampo. Dado que los papeles de filtro de cribaje neonatal no se guardan indefinidamente, se plantea la posibilidad de hacerlo, dadas las posibilidades de estudios retrospectivos que ofrecen (AU)

[Acute polyarthritis associated with parvovirus B19 infection]. / Poliartritis aguda asociada a infección por parvovirus B19.

We describe one female with acute polyarthritis and transitory rash. The arthritis of sudden onset, is localized in large and small joints and accompanied by significant stiffness, particularly noted in early morning. The symptoms only improvement a few with nonsteroidal anti-inflammatory drugs and the arthritis resolved within a few days. The diagnosis is based in the presence of anti-B19 IgM. The differential diagnosis of the acute polyarthritis is extensive, serological test should be made when we suspect the presence of a viral arthritis.

Poliartritis aguda asociada a infección por parvovirus B19 / Acute polyarthritis associated with parvovirus B19 infection

Presentamos el caso de una mujer con poliartritis aguda por parvovirus B19 que se acompañó al inicio de un exantema fugaz. La artritis de aparición brusca afectó a grandes y pequeñas articulaciones con rigidez preferentemente matinal. Los síntomas fueron tratados con AINE con respuesta irregular y remitió completamente en varios días sin secuelas y sin apreciarse recidiva posterior. El diagnóstico se realizó por la determinación de anticuerpos IgM anti PV-B19. En las poliartritis agudas donde el diagnóstico diferencial es amplio, hay que pensar en la presencia de los virus, y para ello, realizar una búsqueda sistemática ayudados por las manifestaciones clínicas y complementado por las técnicas serológicas (AU)

[Parvovirus B19 infection in patients with congenital blood coagulation disorders]. / Infección por Parvovirus B19 en pacientes afectados de coagulopatías congénitas.

BACKGROUND: The aim of this study is to assess the prevalence of Parvovirus B19 infection in a group of patients affected by congenital coagulation disorders and its association with epidemiological aspects. PATIENTS AND METHODS: We have analyzed a group of 50 patients (median age 28) diagnosed with haemophilia or any other congenital coagulation disorder and 111 healthy non-transfused controls (median age 30) for IgG and IgM antibodies to Parvovirus B19 (Dako A/S, Glostrup, Dinamarca). Other issues analysed were HIV coinfection, the use of virally inactivated or non-inactivated plasma products and clinical symptoms of the infection. RESULTS: 84% of the patients (93.3% of those previously transfused) and 60.3% of the controls subjects showed IgG antibodies against Parvovirus B19. None of them had specific IgM antibodies. Five patients (all of them seronegative) had never been exposed to any plasma derivative and 11 were HIV-positive. The differences found between the prevalence of parvoviral infection in patients and controls are statistically significant, but those differences are only confirmed in younger patients (< 30) when age groups are compared. However, the severity of the haemostatic disorder, the type of plasma products infused or HIV coinfection had no influence on prevalence rates. The infection was clinically asymptomatic in all the cases. CONCLUSIONS: Haemophilic patients of any age are exposed to a higher risk of Parvovirus B19 infection than general population, although this infection had no clinical relevance in our study. The use of virally inactivated factor concentrates or the severity of the haemostatic disorder has no influence on this infectious risk.

[Rheumatic manifestations associated with infection by the hepatitis C virus]. / Manifestaciones reumáticas asociadas a la infección por el virus de la hepatitis C.

The development in the past few years of laboratory test for hepatitis C virus allow us to associate it with a broad range of autoimmune manifestations such as cryoglobulinemia and Sjögren syndrome. As in other virus' infections, rheumatic manifestations have been described during VHC infection, but there are no large studies enough to know their true frequency and characteristic. The three reported patients in this issue presented and HCV related arthropathy once clinical picture, laboratory test and following, allowed us to exclude other diagnostics. Clinical manifestations ranged from arthralgias and intermittent arthritis to symmetric polyarthritis without any kind of join damage.

[Brain stem encephalitis due to herpes simplex]. / Encefalitis de troncoencéfalo por herpes simple.

Brainstem encephalitis is an unusual infection caused by a variety of agents, among them the herpes simplex (HS) virus. The difficulty of establishing a diagnosis by neurophysiological and radiological examination is greater in this type of encephalitis than in the usual form produced by HS. We describe a fatal case of brainstem encephalitis. Inflammatory and necrotic lesions in the pous and medulla confirmed the clinical diagnosis, while the etiology was determined by immuno-histo-chemical techniques and viral culture of the cerebral parenchyma. Early diagnosis of this form of encephalitis, based on new virological techniques, allows more effective antiviral treatment.

[Type 4 echovirus meningitis in childhood. Epidemiologic and clinical aspects apropos of an epidemiologic outbreak]. / Meningitis por echovirus tipo 4 en la infancia. Aspectos epidemiológicos y clínicos a propósito de un brote epidémico.

In the first half of 1988 we observed 13 cases of lymphocytic meningitis from which echovirus type 4 was isolated in the CSF. We found a higher infection rate in the 6-9 years old group (54%) and in the masculine sex (69%). Almost all of the cases occurred during the springtime. The clinical and CSF characteristics of this epidemic do not differ much from those that have appeared in the literature. Throughout 1988, in our hospital, 46 cases of lymphocytic meningitis took place and in 20 of them an etiologic diagnosis was done. We think that the introduction of enterovirus cultures can help to know the etiology of many of these cases of meningitis since this virus is responsible for a great part of them.