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BACKGROUND: Invasive meningococcal disease (IMD) is an unpredictable and severe infection caused by Neisseria meningitidis . Its case fatality rate could vary from 9.7% to 26% and up to 36% of survivors may experience long-term sequelae, representing a challenge for public health. AIMED: To describe the sequelae at hospital discharge caused by IMD in children between years 2009-2019. METHODS: Cross-sectional study performed in 2 pediatric hospitals. Patients with microbiologically confirmed diagnosis of IMD from 2009 to 2019 were included. Bivariate and logistic regression analysis were performed. RESULTS: The records of 61 patients were reviewed and included. Sixty-seven percent were male, median age 9 months (interquartile range 4-27), 72% were admitted to intensive care unit. Thirty-seven (60.5%) had at least 1 sequela (75% and 37% in patients with or without meningitis, respectively). The most frequents sequelae were neurological 72%, hearing loss 32%, and osteoarticular 24%. Significant differences were found comparing patients with and without sequelae: drowsiness 67.6% versus 41.7% ( P = 0.04), irritability 67.6% versus 25% ( P = 0.01), meningeal signs 62.2% versus 29.2% ( P = 0.01). In logistic regression analysis, postdischarge follow-up had OR 21.25 (95% confidence intervals [CI]: 4.93-91.44), irritability had OR 8.53 (95% CI: 1.64-44.12), meningeal signs had OR 8.21 (95% CI: 0.71-94.05), invasive mechanical ventilation had OR 8.23 (95% CI: 0.78-85.95), meningitis plus meningococcemia OR 1.70 (95% CI: 0.18-15.67) to have sequelae, while children with meningococcemia and vomiting had a OR 0.04 (95% CI: 0.00-0.36) and OR 0.27 (95% CI: 0.03-2.14), respectively. N. meningitidis serogroup W (MenW) was isolated in 54.1% (33/61), and N. meningitidis serogroup B (MenB) in 31.1% (19/61) of cases. A significant difference was found in osteoarticular sequelae ( P = 0.05) between MenB and MenW. There was a decrease in cases after the meningococcal conjugate vaccine against serogroups A, C, W and Y was implemented (2015-2019). CONCLUSIONS: IMD remains as a public health concern. A high rate of sequelae was found in pediatric patients in our series, even in the clinical manifestations other than meningitis. Neurological sequelae were the most prevalent. Multidisciplinary follow-up protocols to reduce long-term impact must be urgently established to assess all children with IMD.
Assuntos
Meningite Meningocócica , Infecções Meningocócicas , Vacinas Meningocócicas , Neisseria meningitidis , Assistência ao Convalescente , Criança , Chile/epidemiologia , Estudos Transversais , Progressão da Doença , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Meningite Meningocócica/complicações , Meningite Meningocócica/epidemiologia , Meningite Meningocócica/microbiologia , Infecções Meningocócicas/complicações , Infecções Meningocócicas/epidemiologia , Alta do Paciente , Sorogrupo , VacinaçãoRESUMO
BACKGROUND: Toxoplasma gondii is a protozoan that affects a third of the world population and whose updated seroprevalence in children with cancer in our environment is unknown. AIM: To describe the seroprevalence of IgG anti-T. gondii in pediatric population with cancer treated in hospitals of the Metropolitan Region, Chile. METHOD: Cross-sectional study of the population of pediatric cancer patients treated in Santiago city, A serum sample was taken from 100 patients between June 2016 and May 2019. ELISA IgG T. gondii was performed. RESULTS: Of 100 children, 51% male. 12 were positive (12%), 84 negative (84%) and 4 indeterminate (4%). The stratification by age showed 43% patients between 0-5 years, 29% between 6-10 years, 20% in the group of 11-15 years and 8% in patients > 15 years. Sixty one percent of the samples came from patients with acute leukemia. The percentage of women who tested positive for IgG was 21% compared to 4% in men (P < 0.0011). CONCLUSION: 84% of children undergoing cancer treatment are seronegative for T. gondii, so it is important to educate on the prevention of the acquisition of this parasite in this population, due to the risk of developing serious and fatal disease.
Assuntos
Antineoplásicos , Neoplasias , Toxoplasma , Toxoplasmose , Adulto , Anticorpos Antiprotozoários , Criança , Chile/epidemiologia , Cidades , Estudos Transversais , Feminino , Humanos , Imunoglobulina G , Imunoglobulina M , Masculino , Neoplasias/epidemiologia , Fatores de Risco , Estudos Soroepidemiológicos , Toxoplasmose/epidemiologiaRESUMO
The coronavirus disease 2019, caused by the SARS-CoV2 virus, was declared a pandemic in March 2020 by the WHO. Protein S from the viral surface has been identified as the optimal antigen for vaccine development. In a pandemic, the traditional vaccine development process has had to be accelerated to advance in an adequate response to the problem, shortening the times. Safety, immunogenicity, protection against infection, antibody dependent enhancement phenomena and duration of protection are studied in parallel, unlike the traditional way in which it was carried out in successive stages. Currently in Phase III there are 4 types of vaccines: inactivated; based on purified or recombinant proteins, based on DNA / RNA nucleic acids and based on viral vectors. The objective of this review is to understand the studies that precede the vaccines that are currently in Phase III studies and to describe the main characteristics of these studies. Currently the world is in a situation unprecedented in the last century. Among the options to face this fact, one vaccine or, ideally, several, safe, effective and immunogenic, seem to be one of the best alternatives to regain lost normality within a reasonable time.
Assuntos
COVID-19 , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Vacinas , Vacinas Virais , Vacinas contra COVID-19 , Humanos , RNA Viral , SARS-CoV-2RESUMO
Bloodstream infections (BSI) are a severe complication of antineoplastic chemotherapy or hematopoietic stem cell transplantation (HSCT), especially in the presence of antibiotic resistance (AR). A multinational, multicenter retrospective study in patients aged ≤ 18 years, treated with chemotherapy or HSCT from 2015 to 2017 was implemented to analyze AR among non-common skin commensals BSI. Risk factors associated with AR, intensive care unit (ICU) admission and mortality were analyzed by multilevel mixed effects or standard logistic regressions. A total of 1291 BSIs with 1379 strains were reported in 1031 patients. Among Gram-negatives more than 20% were resistant to ceftazidime, cefepime, piperacillin-tazobactam and ciprofloxacin while 9% was resistant to meropenem. Methicillin-resistance was observed in 17% of S. aureus and vancomycin resistance in 40% of E. faecium. Previous exposure to antibiotics, especially to carbapenems, was significantly associated with resistant Gram-negative BSI while previous colonization with methicillin-resistant S. aureus was associated with BSI due to this pathogen. Hematological malignancies, neutropenia and Gram-negatives resistant to >3 antibiotics were significantly associated with higher risk of ICU admission. Underlying disease in relapse/progression, previous exposure to antibiotics, and need of ICU admission were significantly associated with mortality. Center-level variation showed a greater impact on AR, while patient-level variation had more effect on ICU admission and mortality. Previous exposure to antibiotics or colonization by resistant pathogens can be the cause of AR BSI. Resistant Gram-negatives are significantly associated with ICU admission and mortality, with a significant role for the treating center too. The significant evidence of center-level variations on AR, ICU admission and mortality, stress the need for careful local antibiotic stewardship and infection control programs.
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INTRODUCCIÓN: Toxoplasma gondii es un protozoo que afecta a un tercio de la población mundial y cuya seroprevalencia actualizada en niños con cáncer en nuestro medio, se desconoce. OBJETIVO: Describir la seroprevalencia de IgG anti-T. gondii en población pediátrica con cáncer atendida en hospitales públicos de la Región Metropolitana, Chile. MÉTODO: Estudio transversal de pacientes pediátricos oncológicos atendidos en la ciudad de Santiago. Se tomó una muestra de suero de 100 pacientes entre junio de 2016 y mayo de 2019. Se les realizó ELISA IgG T. gondii. RESULTADOS: Se analizaron 100 muestras, 51% de sexo masculino. Resultaron 12 positivas, 84 negativas y 4 indeterminadas. Los sueros de los pacientes se estratificaron por edad: 0-5 años 43%, 6-10 años 29%, 11-15 años 20% y > 15 años, 8%. El 61% eran pacientes con leucemia aguda. El porcentaje de mujeres con IgG positiva fue de 21% en comparación a 4% en hombres (P < 0,0011). CONCLUSIÓN: El 84% de los niños en tratamiento por cáncer son seronegativos para T. gondii, por lo que es importante educar en la prevención de la adquisición de este parásito en esta población, por el riesgo de desarrollar enfermedad grave con riesgo de muerte.
BACKGROUND: Toxoplasma gondii is a protozoan that affects a third of the world population and whose updated seroprevalence in children with cancer in our environment is unknown. AIM: To describe the seroprevalence of IgG anti-T. gondii in pediatric population with cancer treated in hospitals of the Metropolitan Region, Chile. METHOD: Cross-sectional study of the population of pediatric cancer patients treated in Santiago city, A serum sample was taken from 100 patients between June 2016 and May 2019. ELISA IgG T. gondii was performed. RESULTS: Of 100 children, 51% male. 12 were positive (12%), 84 negative (84%) and 4 indeterminate (4%). The stratification by age showed 43% patients between 0-5 years, 29% between 6-10 years, 20% in the group of 11-15 years and 8% in patients > 15 years. Sixty one percent of the samples came from patients with acute leukemia. The percentage of women who tested positive for IgG was 21% compared to 4% in men (P < 0.0011). CONCLUSION: 84% of children undergoing cancer treatment are seronegative for T. gondii, so it is important to educate on the prevention of the acquisition of this parasite in this population, due to the risk of developing serious and fatal disease.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Toxoplasma , Toxoplasmose/epidemiologia , Neoplasias/epidemiologia , Antineoplásicos , Imunoglobulina G , Imunoglobulina M , Anticorpos Antiprotozoários , Estudos Soroepidemiológicos , Chile/epidemiologia , Estudos Transversais , Fatores de Risco , CidadesRESUMO
Resumen La enfermedad por coronavirus 2019, causada por el virus SARS-CoV2, fue declarada pandemia en marzo de 2020 por la OMS. La proteína S, de la superficie viral ha sido identificada como antígeno óptimo para el desarrollo de vacunas. En pandemia, el proceso tradicional de desarrollo de vacunas ha debido acelerarse para avanzar en una respuesta adecuada al problema, acortando los tiempos. La seguridad, inmunogenicidad, protección frente a la infección, fenómeno de "aumento dependiente de anticuerpos", duración de la protección se estudian en paralelo, a diferencia de la manera tradicional en que se llevaba a cabo en etapas sucesivas. Actualmente en Fase III hay 4 tipos vacunas: inactivadas; en base a proteínas purificadas o recombinantes, en base a ácidos nucleicos ADN/ARN y en base a vectores virales. El objetivo de esta revisión es conocer los estudios que preceden a las vacunas que actualmente están en estudios de Fase III y describir las características principales de estos estudios. Actualmente el mundo se encuentra en una situación inédita en el último siglo. Dentro las opciones para enfrentar este hecho, una vacuna o idealmente varias, seguras, eficaces e inmunogénicas, parecen ser una de las mejores alternativas para retomar en un plazo razonable la normalidad perdida.
Abstract The coronavirus disease 2019, caused by the SARS-CoV2 virus, was declared a pandemic in March 2020 by the WHO. Protein S from the viral surface has been identified as the optimal antigen for vaccine development. In a pandemic, the traditional vaccine development process has had to be accelerated to advance in an adequate response to the problem, shortening the times. Safety, immunogenicity, protection against infection, antibody dependent enhancement phenomena and duration of protection are studied in parallel, unlike the traditional way in which it was carried out in successive stages. Currently in Phase III there are 4 types of vaccines: inactivated; based on purified or recombinant proteins, based on DNA / RNA nucleic acids and based on viral vectors. The objective of this review is to understand the studies that precede the vaccines that are currently in Phase III studies and to describe the main characteristics of these studies. Currently the world is in a situation unprecedented in the last century. Among the options to face this fact, one vaccine or, ideally, several, safe, effective and immunogenic, seem to be one of the best alternatives to regain lost normality within a reasonable time.
Assuntos
Humanos , Vacinas contra COVID-19 , COVID-19/prevenção & controle , RNA Viral , Vacinas Virais , Ensaios Clínicos Fase III como Assunto , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , SARS-CoV-2RESUMO
Background: Invasive fungal infections (IFI) cause prolonged hospitalizations and increase the possibility of death among patients with cancer and febrile neutropenia (FN). Up to 10 percent of febrile neutropenic episodes may be caused by IFI. Aim: To estimate the incidence of IFI among a large group of Chilean children with cancer and FN. Patients and Methods: Clinical and laboratory information was collected from a data base provided by the "Programa Infantil Nacional de Drogas Antineoplásicas" (PINDA) that included 445 FN episodes occurring in five hospitals in Santiago, Chile. This information was used to identify children that presented with signs and symptoms compatible with an IFI. According to predefined criteria based on a literature review, IFI episodes were categorized as "proven", "probable" or "possible". Results: A total of 41/445 episodes (9.2 percent) were compatible with an IFI of which 4 (0.9 percent) were proven, 23 (5.2 percent) probable, and 14 (3.1 percent) possible. Hospitalization was longer (27 vs 8 days, p <.01), new infectious foci appeared with higher frequency (71 vs 38 percent, p <.01), and mortality was higher (10 vs 1.6 percent, p <.001) in children with IFI compatible episodes, when compared to children who did not have an IFI. Conclusions: The estimated incidence of IFI in Chilean children with cancer and FN ranged between 6-9 percent depending on the stringency of criteria selection used for classification. This estimate is similar to that reported by other studies. The low detection yield of clinically compatible IFI underscores the need of improved diagnosis of fungal infections in this population
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Humanos , Masculino , Pré-Escolar , Adolescente , Feminino , Micoses , Neoplasias , Fungemia , Febre , Micoses , Neutropenia , Antineoplásicos/efeitos adversosRESUMO
Se presenta el caso de una paciente boliviana quien acude con el diagnóstico de una osteomielitis de cadera, décima costilla y techo del etmoides, posiblemente secundario a una infección por bacterias anaerobias. Se revisa la evolución y tratamiento y se efectúa una revisión de las etiologías infectológicas que podrían explicar un cuadro de estas características
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Humanos , Feminino , Adolescente , Osteomielite , Sinusite , Drenagem , Quadril , Antibacterianos/uso terapêutico , Osteólise/microbiologiaRESUMO
The risk for invasive bacterial infection (IBI) in cancer pediatric patients with febrile neutropenia, is variable. Clinicians worldwide are increasingly considering selective strategies for children at low risk for IBI, including shortened antimicrobial course, early hospital discharge, oral antimicrobial treatment, and management as outpatients. These strategies would significantly benefit these children and health care systems. The critical issue is to identify the most reliable risk factors useful for selection of those individuals who are at low risk for IBI. In Chile, during the past 10 years, a group of physicians from the Subcommittee of Infectious Diseases of the National Child Program of Antineoplastic Drugs and the University of Chile have worked to develop more selective strategies for pediatric patients with cancer, fever and neutropenia. During 1996-1997 we identified risk factors of IBI in a group of 447 febrile neutropenic episodes. During 1999-2000 we validated these risk factors in a prospective study that included 263 febrile neutropenic episodes. A model of risk prediction was developed and is currently being evaluated for the selection of low risk patients who are treated as inpatients for 24 hours, followed by outpatient treatment
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Humanos , Masculino , Feminino , Febre , Neoplasias , Neutropenia , Estudos Prospectivos , Fatores de Risco , Estudos Multicêntricos como AssuntoRESUMO
Background: Pediatric patients in treatment for cancer can have fatal bacterial infections. Thus, in the presence of fever or other signs infection, antimicrobials have to be prescribed empirically. Aim: To know the causative agents of bacteremia in children with cancer, their changes with time and between different hospitals and their patterns of susceptibility. Material and methods: We reviewed the blood cultores of children with cancer in five hospitals of Santiago, from 1994 at 1998. Results: During the study period, 707 agents were isolated. The most frequently isolated species or genus were coagulase negative Staphylococcus (43 percent), Staphylococcus aureus (16 percent), Escherichia coli (9 percent), Klebsiella spp. (8 percent), Pseudomonas spp. (5 percent) and Candida spp. (4 percent). Coagulase negative Staphylococcus was 55 percent resistant to meticilin and S. aureus was 44 percent resistant. Enterobacteriae had 15 percent resistance to gentamicin and amikacin, 2 percent to imipenem, 26 percent to ceftriaxone, 21 percent to cefotaxim and 20 percent to ceftazidim. Among non fermenting agents resistance was 6 percent for imipenem, 9 percent for amikacin 10 percent for ciprofloxacin, 19 percent for ceftazidim and 22 percent for cefoperazone. The resistance of Streptococcus spp. (non pneumoniae) to penicillin reached 50 percent and that of Enterococcus spp. was of 33 percent. Conclusions: Treatment for pediatric patients with cancer must be modified and new guidelines including more active medications for patients at risk for bacteremia, should be devised