[Helicobacter pylori infection in the child population in Spain: prevalence, related factors and influence on growth]. / Infección por Helicobacter pylori en población infantil: prevalencia, factores asociados e influencia sobre el crecimiento.

INTRODUCTION: A causal relationship between Helicobacter pylori infection and the occurrence of digestive diseases in adults and children has been proven. Worldwide, the prevalence of H. pylori varies and it is possibly influenced by differences in the level of development. The goals of this study were a) to ascertain the prevalence of H. pylori infection in the child population in Spain, b) to study several factors related to this infection, and c) to establish its possible influence on growth. PATIENTS AND METHODS: We performed a descriptive, cross-sectional survey of a representative sample of children aged 1 to 14 years old. The sample consisted of 284 children (prevalence 5 15 %; accuracy 5 4 %; CI > 95 %), selected at random and stratified by age and sex. A pre-coded questionnaire was used for data collection. Diagnosis of H. pylori was established by detection of H. pylori antigen in stools with enzyme immunoassay. RESULTS: The sample consisted of 144 boys and 140 girls, with a mean age of 6.89 6 4.25 years. The prevalence of H. pylori infection was 15.8 % and progressively increased with age: 1- to 3-year-olds (8.4 %), 4- to 9-year-olds (13.9 %), 10- to 14-year-olds (24 %) (p < 0.05). The prevalence was significantly higher in boys (p < 0.01). Analysis of socio-environmental variables showed a higher H. pylori infection rate in children from families with a low socioeconomic level (p < 0.01), a high rate of overcrowding (p < 0.05), and in immigrants (p < 0.001). The H. pylori infection rate was higher in children with recurrent abdominal pain (p < 0.001) and in those whose parents had suffered from gastroduodenal disease (p < 0.001). H. pylori infection was more frequent in children aged 10 to 14 years old with weight and height percentiles below the 25th percentile (p < 0.05). Comparison of means revealed no significant differences. CONCLUSIONS: The prevalence of H. pylori infection found in our study was slightly lower than that found in other studies carried out in Spain; our data were more similar to those of industrialized countries. H. pylori infection was linked to age, sex and deprived socioeconomic environments, and was more frequent in children with recurrent abdominal pain and in those whose parents suffered from gastroduodenal disease. H. pylori infection did not seem to negatively affect growth in our child population.

Infección por Helicobacter pylori en población infantil: prevalencia, factores asociados e influencia sobre el crecimiento / Helicobacter pylori infection in the child population in Spain: Prevalence, related factors and influence on growth

Introducción: Está demostrado que hay relación de causalidad entre la infección por Helicobacter pylori y la aparición de patología digestiva en adultos y niños. La prevalencia mundial es variable y posiblemente está influida por el grado de desarrollo. Los objetivos de este estudio son conocer la prevalencia de infección por H. pylori en nuestra población infantil, analizar diversos factores asociados a esta infección y estudiar su posible influencia sobre el crecimiento. Pacientes y métodos: Estudio descriptivo transversal realizado en una muestra representativa de la población de niños con edades entre 1 y 14 años. El tamaño muestral es de 284 niños (prevalencia 5 15 %; precisión 5 4 %; IC > 95 %). La muestra fue elegida de manera aleatoria y estratificada por edades y sexo. Se recogen datos en un cuestionario precodificado. El diagnóstico de infección por H. pylori se realiza por detección de antígeno de H. pylori en heces mediante enzimoinmunoanálisis. Resultados: La muestra estaba formada por 144 niños y 140 niñas con una media de edad de 6,89 6 4,25 años. La prevalencia de infección por H. pylori fue del 15,8 %. Esta aumenta progresivamente con la edad: 1-3 años (8,4 %); 4-9 años (13,9 %), y 10-14 años (24 %) (p < 0,05) y es más frecuente en varones (p < 0,01). El análisis de las variables socioambientales demuestran elevada frecuencia de infección por H. pylori en niños de familias con bajo nivel socioeconómico (p < 0,01), alto índice de hacinamiento (p < 0,05) e inmigrantes (p < 0,001). Se observa mayor frecuencia de H. pylori en niños que presentan dolor abdominal recurrente (DAR) (p < 0,001) y cuyos padres presentan patología gastroduodenal (p < 0,001). Con más frecuencia de la esperada aparece H. pylori en niños de 10 a 14 años con percentiles de peso y talla < P25 (p < 0,05). En el contraste de medias no se observan diferencias significativas. Conclusiones: La prevalencia de infección por H. pylori en nuestro estudio es algo menor de lo encontrado en otros estudios realizados en nuestro país, ya que se acerca al patrón de países industrializados. Está asociado a la edad, sexo y ambientes socioeconómicos poco favorecidos. Es más frecuente esta infección en niños con DAR y cuando los padres sufren patología gastroduodenal. Esta infección parece no influir negativamente en el crecimiento de los niños de nuestra población infantil

Introduction: A causal relationship between Helicobacter pylori infection and the occurrence of digestive diseases in adults and children has been proven. Worldwide, the prevalence of H. pylori varies and it is possibly influenced by differences in the level of development. The goals of this study were a) to ascertain the prevalence of H. pylori infection in the child population in Spain, b) to study several factors related to this infection, and c) to establish its possible influence on growth. Patients and methods: We performed a descriptive, cross-sectional survey of a representative sample of children aged 1 to 14 years old. The sample consisted of 284 children (prevalence 5 15 %; accuracy 5 4 %; CI > 95 %), selected at random and stratified by age and sex. A pre-coded questionnaire was used for data collection. Diagnosis of H. pylori was established by detection of H. pylori antigen in stools with enzyme immunoassay. Results: The sample consisted of 144 boys and 140 girls, with a mean age of 6.89 6 4.25 years. The prevalence of H. pylori infection was 15.8 % and progressively increased with age: 1- to 3-year-olds (8.4 %), 4- to 9-year-olds (13.9 %), 10- to 14-year-olds (24 %) (p < 0.05). The prevalence was significantly higher in boys (p < 0.01). Analysis of socio-environmental variables showed a higher H. pylori infection rate in children from families with a low socioeconomic level (p < 0.01), a high rate of overcrowding (p < 0.05), and in immigrants (p < 0.001). The H. pylori infection rate was higher in children with recurrent abdominal pain (p < 0.001) and in those whose parents had suffered from gastroduodenal disease (p < 0.001). H. pylori infection was more frequent in children aged 10 to 14 years old with weight and height percentiles below the 25th percentile (p < 0.05). Comparison of means revealed no significant differences. Conclusions: The prevalence of H. pylori infection found in our study was slightly lower than that found in other studies carried out in Spain; our data were more similar to those of industrialized countries. H. pylori infection was linked to age, sex and deprived socioeconomic environments, and was more frequent in children with recurrent abdominal pain and in those whose parents suffered from gastroduodenal disease. H. pylori infection did not seem to negatively affect growth in our child population

Artritis séptica por Kingella kingae: dificultades diagnósticas / Septic arthritis due to Kingella kingae: difficulties of diagnosis

No disponible

Infección por Streptococcus pneumoniae en el Área de Salud de Pamplona (1999-2001) / Streptococcus pneumoniae infection in a health district of Pamplona (Spain)

No disponible

Brote epidémico de tuberculosis / Epidemic outbreak of tuberculosis

Objetivo: Comunicar que la colaboración entre Vigilancia Epidemiológica y los Centros Asistenciales de Atención Primaria y Especializada permitió una rápida actuación en un brote de tuberculosis que se produjo en una guardería. Material y métodos: Se diagnosticó a una cuidadora de guardería de tuberculosis bacilífera. Se identificaron las personas expuestas que fueron 4 adultos (cuidadoras) y 58 niños con edades inferiores a los 4 años. Por medio de los respectivos pediatras de atención primaria, se realizó la prueba de la tuberculina en todos los niños. A los niños con tuberculina positiva se les practicó estudio radiológico y microbiológico para descartar la enfermedad. La misma actuación se tuvo con los adultos. Resultados: La localización de los niños fue rápida. El 32,8% de los alumnos estaban infectados y seis de ellos tenían alteraciones en la radiografía de tórax y se consideraron enfermos. En 3 niños se aisló Mycobacterium tuberculosis que fue similar genéticamente al del caso índice. Se realizó quimioprofilaxis primaria en todos los niños con tuberculina negativa; quimioprofilaxis secundaria en los infectados y tratamiento específico en los enfermos. La evolución de todos los niños fue satisfactoria. Conclusiones: Es necesario llevar a cabo vigilancia periódica de tuberculosis en las personas adultas que trabajan con niños. Es importante la rapidez en el estudio de contactos de los adultos diagnosticados de tuberculosis, en especial si trabajan con personas especialmente susceptibles. El estudio genético de las cepas aisladas facilita y aclara las conclusiones epidemiológicas en estos brotes (AU)

[Epidemic outbreak of tuberculosis]. / Brote epidémico de tuberculosis.

OBJECTIVE: To describe how collaboration between epidemiological surveillance and primary and specialist health care centres enabled rapid intervention during an outbreak of tuberculosis in a nursery school. MATERIAL AND METHODS: A child minder was diagnosed with tuberculosis. The persons exposed were identified. These were four child minders and 58 children under 4 years of age. The respective primary care pediatricians carried out a tuberculin test in all of the children. Children with a positive tuberculin test underwent radiological and microbiological study to rule out the disease. The adults underwent the same procedure. RESULTS: Detection among the children was rapid; 32.8 % were infected and six showed alterations in thoracic x-rays and were considered to be ill. In three children Mycobacterium tuberculosis was isolated and was genetically similar to the index case. Primary chemoprophylaxis was carried out in all children with a negative tuberculin test; secondary chemoprophylaxis was administered to infected children and specific treatment to the ill. In all children, evolution was satisfactory. CONCLUSIONS: Periodic surveillance for tuberculosis should be carried out among adults working with children. Genetic study of the strains isolated facilitates epidemiological analysis of these microepidemics.

[Invasive aspergillosis: a study of 20 cases]. / Aspergilosis invasiva: estudio de 20 casos.

OBJECTIVE: To assess the epidemiology of invasive aspergillosis (IA) and the frequency of recognition of this clinical entity. PATIENTS AND METHODS: Retrospective analysis of patients with the diagnosis of IA in the last three years. The diagnostic criteria of the American Institute of Infectious Diseases Mycoses Group were followed. RESULTS: During this period, 20 patients were diagnosed of IA: 9 (45%) had a hematologic malignancy, 14 (70%) had received corticosteroids, five (25%) had neutropenia, and three (15%) had no factors for immunosuppression. The disease was suspected in 15 cases (75%). Aspergillus spp. was recovered from sputum samples of the 16 patients who had the sample obtained. Seventeen patients (85%) died, 12 of them in spite of receiving antifungal therapy. Time relapsed since the beginning of symptoms and therapy was 14 days. CONCLUSIONS: The proportion of patients without neutropenia or severe immunosuppression is higher than usually thought. IA is a clinical entity of difficult diagnosis and occasionally it is diagnosed only at post-mortem examination. The high sensitivity of sputum culture may be due to the selection of cases with more severe infections as stringent diagnostic criteria were used. To improve the prognosis of IA it is necessary to initiate antifungal therapy early in the course of the disease and therefore, a high suspicion index is required, not only of the immunocompromised but also of the immunocompetent patient.

Aspergilosis invasiva: estudio de 20 casos / Invasive aspergillosis: study of 20 cases

Fundamento. Conocer la epidemiología de la aspergilosis invasiva (AI) y la frecuencia con la que reconocemos esta entidad. Material y métodos. Análisis retrospectivo de los pacientes diagnosticados de AI en los últimos tres años. Se siguieron los criterios diagnósticos del Grupo de Micosis del Instituto Americano de Enfermedades Infecciosas. Resultados. En este período 20 pacientes fueron diagnosticados de AI: 9 (45 por ciento) tenían una neoplasia hematológica, 14 (70 por ciento) habían recibido esteroides, 5 (25 por ciento) presentaban neutropenia y en 3 (15 por ciento) no existía ningún factor de inmunodepresión. La enfermedad fue sospechada en 15 casos (75 por ciento). Se aisló Aspergillus spp. en esputo en los 16 pacientes en los que se obtuvo dicha muestra. Fallecieron 17 pacientes (85 por ciento), 12 a pesar del tratamiento antifúngico. El tiempo transcurrido entre el inicio de los síntomas y el del tratamiento fue de 14 días. Conclusiones. La proporción de pacientes sin neutropenia o severa inmunodepresión es mayor que la habitualmente reconocida. La AI es una entidad de difícil diagnóstico clínico que incluso a veces sólo se diagnostica tras el estudio necrópsico. La elevada sensibilidad del cultivo de esputo puede deberse a haber seleccionado los casos con infección más severa al haber usado criterios diagnósticos estrictos. Para mejorar el pronóstico de la AI es necesario el inicio precoz del tratamiento antifúngico y para ello es imprescindible tener un alto índice de sospecha, no sólo en el paciente inmunocomprometido, sino también en el inmunocompetente. (AU)

[Hodgkin's disease in patients with infection caused by the human immunodeficiency virus. Study of 9 cases]. / Enfermedad de Hodgkin en pacientes con infección por el virus de la inmunodeficiencia humana. Estudio de 9 casos.

Nine young males with Hodgkin's disease (HD) and antibodies against the human immunodeficiency virus were evaluated. They had been diagnosed since 1984 in three Madrid hospitals: Hospital 12 de Octubre, Hospital Ramón y Cajal, and Clínica Puerta de Hierro. Eight patients were intravenous heroin abusers and one was homosexual. In 8 patients (88.8%) HD presented in advanced stages (III and IV), and in 5 cases (55.5%) the histology corresponded to mixed cell type. Four patients (44.4%) developed opportunistic infections. In the immunological study a reduction of CD4+ lymphocytes below 0.4 X 10(3)/l was found in 5 of 7 patients (71.4%), and an inversion of CD4+/CD8+ ratio in 6 of 7 patients (85.7%). The response to therapy was poor. Five patients died (55.5%). In 4, the direct cause of death was an opportunistic infection. The reasons why we think that HD in patients with HIV infections should be considered as indicating acquired immunodeficiency syndrome are discussed.