Invasive pneumococcal disease among children in a health district of Barcelona: early impact of pneumococcal conjugate vaccine.

This study evaluated the impact of heptavalent pneumococcal conjugate vaccine (HPCV) on invasive pneumococcal disease (IPD) in children aged < or = 5 years in Barcelona, Spain. The incidence of IPD, vaccine uptake and prevalence of nasopharyngeal colonisation were analysed in two different periods: 1999-2001 (pre-licence period), and 2002-2004 (post-licence period). In total, 121 cases of IPD were identified. The overall incidence of IPD decreased from 96.9 cases/100,000 to 90.6 cases/100,000 (OR 0.93, 95% CI 0.69-1.26, p 0.71) between the two periods. The proportion of cases caused by non-vaccine-related serotypes (NVS) increased from 21% to 43.7% (OR 2.9, 95% CI 1.2-7, p 0.01). IPD was diagnosed in seven vaccinated children, six of whom were infected by NVS. There was a trend of diminishing prevalence of resistance to penicillin and macrolides in 2002-2004. The incidence of empyema increased from 1.7 to 8.5/100,000 (OR 4.5, 95% CI 0.91-18, p 0.06). The rate of vaccination ranged from 4.8% to 34%. It was concluded that the rates of IPD in this area did not decrease following the introduction of HPCV. The low uptake of vaccine and the greater proportion of colonisation/infection by NVS probably explain these findings. A trend of increasing empyema was also apparent. A decrease in the prevalence of penicillin and macrolide resistance paralleled the progressive uptake of vaccine.

[Parainfectious transverse myelitis in an adolescent. Difficulties in the etiological diagnosis]. / Mielitis transversa parainfecciosa en un adolescente. Dificultades para el diagnóstico etiológico.

A diagnostic process in a 13 year-old boy with a parainfectious transverse myelitis is described. Its onset was acute, with L1-location level of lesion. After a mild improvement, a relapse happened 26 days later, with a D6 level and without subsequent recovery. It has not been found criteria for diagnosis of multiple sclerosis, nor data suggesting a vascular or ischaemic anomaly. Likewise, other causes and specific infections were rejected, being cataloguet as parainfectious etiology, due a previous viral infection before its onset.

Predictive factors for invasive disease due to penicillin-resistant Streptococcus pneumoniae: a population-based study.

A prospective population-based study was carried out to determine predictive factors associated with penicillin-resistant pneumococcal invasive disease. A total of 374 patients (250 males and 124 females; mean age, 50.3 +/- 27 years) with invasive pneumococcal infection were admitted to one of the five hospitals in El Vallés County (an industrial area with 800,000 inhabitants in the province of Barcelona, Spain) over a period of 5 years. Of the 374 episodes, 21 (5.6%) were due to highly penicillin-resistant pneumococci and 67 (17.9%) to intermediately penicillin-resistant pneumococci. Multivariate analysis showed a statistically significant association between infection with intermediately penicillin-resistant pneumococci and an age of 0-4 years (odds ratio [OR] = 5.3; 95% confidence interval [CI] = 2.2-12.6), the presence of an immunosuppressive underlying disease (OR = 3.0; 95% CI = 1.5-6.0), and the previous use of beta-lactam antibiotics (OR = 2.1; 95% CI = 1.0-4.5). Infection with highly penicillin-resistant pneumococci was associated only with the previous use of beta-lactam antibiotics (OR = 5.9; 95% 95% CI = 2.2-15.8). Highly resistant strains were of serotypes 6, 9, 14, 15, 19, and 23, of which all but serotypes 9 and 15 are included in the newly formulated conjugated vaccine.

Neisseria meningitidis with reduced sensitivity to penicillin: observations in 10 children.

10/84 strains (11.9%) of Neisseria meningitidis isolated from blood and/or cerebrospinal fluid in children 1986-1987 had reduced sensitivity to benzylpenicillin (MICs 0.1-0.4 mg/l). Group C meningococci predominated among these strains. The clinical course was satisfactory in all cases regardless of the antibiotic treatment used, although the time to abatement of fever was prolonged compared to that of children infected with susceptible strains.

Randomized trial of doxycycline versus josamycin for Mediterranean spotted fever.

We undertook a randomized clinical trial comparing therapeutic efficacy of the 1-day doxycycline regimen with the 5-day josamycin regimen for Mediterranean spotted fever. All 59 patients recovered uneventfully, and results did not significantly differ between the two schedules. One-day doxycycline therapy is an effective, easy, and inexpensive treatment. Josamycin is a useful therapeutic alternative that may be particularly convenient for pregnant women and patients with a history of allergy to tetracyclines.

Neisseria meningitidis strains with decreased susceptibility to penicillin.

Neisseria meningitidis strains relatively resistant to penicillin were recovered from blood or cerebrospinal fluid cultures of four children treated in Barcelona, Spain, and surrounding areas. The four strains had distinct serogrouping and serotyping patterns. The minimal inhibitory concentrations of penicillin were 0.25 microgram/ml for three strains and 0.5 microgram/ml for the fourth strain. These are the first relatively penicillin-resistant meningococcal strains identified in Spain.

Gram-negative germs infections in infancy.

The incidence of systemic or local infections due to gram-negative bacilli in an Infant Ward from September 1969 to December 1976 was 7.9%. The 29.34% were septicemia, most of them as epidemic outbreaks caused by Pseudomonas aeruginosa, Klebsiella-Enterobacter and Serratia marcescens. Two facts are to be emphasized: an almost complete disappearance of systemic infections with Pseudomonas starting from 1972, and the global predominance of the group Klebsiella-Enterobacter, particularly evident from 1970 to 1972.