Prevalence and Clinical Characteristics of Children With Nonsevere Tuberculosis in Spain.

BACKGROUND: To assess the prevalence and characteristics of nonsevere TB among children in Spain. It has been recently demonstrated that these children can be treated with a 4-month regimen instead of the classical 6-month treatment regimen, with the same effectivity and outcomes, decreasing toxicity and improving adherence. METHODS: We conducted a retrospective cohort study in a cohort of children ≤16 years of age with TB. Nonsevere TB cases included smear-negative children with respiratory TB confined to 1 lobe, with no significant airway obstruction, no complex pleural effusion, no cavities and no signs of miliary disease, or with peripheral lymph-node disease. The remaining children were considered to have severe TB. We estimated the prevalence of nonsevere TB and compared the clinical characteristics and outcomes between children with nonsevere and severe TB. RESULTS: A total of 780 patients were included [46.9% males, median age 5.5 years (IQR: 2.6-11.1)], 477 (61.1%) of whom had nonsevere TB. Nonsevere TB was less frequent in children <1 year (33% vs 67%; P < 0.001), and >14 years of age (35% vs 65%; P = 0.002), mostly diagnosed in contact tracing studies (60.4% vs 29.2%; P < 0.001) and more frequently asymptomatic (38.3% vs 17.7%; P < 0.001). TB confirmation in nonsevere disease was less frequent by culture (27.0% vs 57.1%; P < 0.001) and by molecular tests (18.2% vs 48.8%; P < 0.001). Sequelae were less frequent in children with nonsevere disease (1.7 vs 5.4%; P < 0.001). No child with nonsevere disease died. CONCLUSIONS: Two-thirds of children had nonsevere TB, mostly with benign clinical presentation and negative microbiologic results. In low-burden countries, most children with TB might benefit from short-course regimens.

Adolescent de 13 anys amb dificultat respiratòria sobtada / No disponible

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Is Polymerase Chain Reaction in Neonatal Dried Blood Spots Reliable for the Diagnosis of Congenital Cytomegalovirus Infection?

BACKGROUND: Detection of cytomegalovirus (CMV) DNA by real-time polymerase chain reaction (rt-PCR) in dried blood spots (DBSs) collected for newborn screening has been assessed for retrospective diagnosis of congenital CMV (cCMV) infection, with variable results (sensitivities ranging from 34% to 100%). We aimed to assess the accuracy of this technique in Spain in a large patient series. METHODS: Ambispective, multicenter study including patients with confirmed cCMV from the Spanish Registry of cCMV patients. cCMV was established on the presence of CMV DNA in any body fluid, by positive culture findings or by molecular techniques during the first 2 weeks of life. Children in whom cCMV had been excluded were used as negative controls. Neonatal DBS samples were collected from both groups. The presence of CMV DNA was assessed by rt-PCR (RealStar CMV, Altona, Germany) in a central laboratory. RESULTS: One-hundred three patients and 81 controls from 10 hospitals were included. The performance of CMV DNA determination in DBS for the diagnosis of cCMV was as follows (95% confidence interval): sensitivity 0.56 (0.47-0.65), specificity 0.98 (0.91-0.99), positive likelihood ratio 22.81 (5.74-90.58) and negative likelihood ratio 0.45 (0.36-0.56). Sensitivity increased with the birth viral load (bVL) log category. In cCMV patients, lower bVL was the single variable associated with a negative DBS rt-PCR result (P = 0.017). CONCLUSIONS: The sensitivity of CMV rt-PCR in DBS in our series was low and correlated with the bVL. Thus, a negative DBS result would not rule out cCMV infection, especially in patients with a low viremia level at birth.

Nous gèrmens en l'etiologia de la diarrea aguda en infants? / No disponible

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El aumento de la incidencia de malaria en los últimos cinco años en niños VFRS / Increase in the incidence of malaria among children visiting friends and relative (VFR) over the last five years

Objetivo. La malaria es la enfermedad importada más prevalente, considerada la cuarta causa mundial de mortalidad infantil. El ob- L’augment de la incidència de malària en els últims cinc anys en infants VFR (Visiting Friends and Relatives) Sílvia Franch Salvadó 1, Mireia Villela Sabaté 1, Olga Calavia Garsaball 1, Clara Bras Boqueras 1, Frederic Gómez Bertomeu 2, Antoni Soriano Arandes 1 1 Servei de Pediatria. 2 Servei de Microbiologia. Hospital Universitari Joan XXIII. Tarragona jetivo de esta revisión es describir los casos de malaria infantil diagnosticados en nuestro centro en los últimos cinco años y remarcar la importancia del consejo médico pre-viaje para poder recomendar la profilaxis antimalaria. Método. Describimos los casos de malaria infantil diagnosticados en nuestro hospital en el período 2005-2010. Comparamos el número de casos diagnosticados en este periodo con los cinco años anteriores. Resultados. Se han diagnosticado cinco casos de malaria importada en niños. Todos los casos, excepto uno, son hijos de inmigrantes nacidos en Tarragona que viajaron a su país de origen para visitar familiares y amigos, grupo conocido como VFRs (visiting friends and relatives). Uno de los casos realizó la profilaxis (pero incompleta). La edad media fue de 13 meses. Los pacientes presentaron fiebre durante una media de 5,5 días antes de consultar al sistema de salud. Dos de los casos fueron clasificados como malaria complicada (OMS), ya que presentaban una parasitemia> 5%. En todos los casos, la PCR para Plasmodium falciparum resultó positiva. El menor valor de hemoglobina fue de 5,13 g / dL y el menor hematocrito de 14,6%. Todos los casos fueron tratados con quinina y clindamicina endovenosas, en uno de los casos se añadió tratamiento con amoxicilina-ácido clavulánico por neumonía bacteriana asociada y en otro, cefotaxima por clínica de sepsis. Conclusiones. La malaria en la población infantil de nuestro ámbito se ha incrementado, particularmente en los niños VFRs. Es de gran importancia el consejo médico pre-viaje para poder ofrecer la profilaxis antimalaria(AU)

Objective. Malaria is the most prevalent imported disease, and it is currently considered to be the fourth cause of childhood mortality worldwide. The aim of this report is to describe the cases of imported malaria in children diagnosed in our hospital during the last five years and to emphasize the importance of pre-travel medical advice and the implementation of malaria prophylaxis. Method. All cases of malaria occurring in children diagnosed in our hospital during the period 2005-2010 were analyzed. We then compared the numbers with those of the previous five years. Results. Five cases of malaria were diagnosed during the study period. All cases, except one, were children of immigrants who were born in Tarragona and traveled to their country of origin to visit friends and family, a group known as VFR (visiting friends and relatives). One case had received malaria prophylaxis, but it was not fully completed. The average age was 13 months. Patients had fever for an average of 5.5 days before consulting. Two cases were classified as complicated malaria (WHO), with parasitemia > 5%. In all cases PCR for Plasmodium falciparum was positive. The lowest hemoglobin and hematocrit values detected were 5.13 g/dL and 14.6%, respectively. All cases were treated with intravenous quinine and clindamycin; in one case amoxicillin-clavulanate was added for bacterial pneumonia and in another cefotaxime was administered for clinical sepsis. Conclusions. The incidence of malaria has increased among the children of our area, particularly in VFR children. Medical advice prior to traveling, and the implementation of malaria prophylaxis when indicated, are of paramount importance(AU)