Peritonitis primaria por neumococo en un hospital pediátrico de Argentina / Primary pneumococcal peritonitis in a pediatric hospital from Argentina

Resumen La peritonitis por neumococo comprende un pequeno subconjunto de pacientes con enfermedad invasiva (ENI). Durante 15 años (2005-2020) de vigilancia de ENI en un hospital de pediatría, se detectaron 5 casos de peritonitis primaria. Los pacientes, 3 ninas y 2ninos con una media de edad de 5 anos, experimentaron signos y síntomas peritoneales; 3 de ellos presentaban síndrome nefrótico. En coincidencia con los perfiles locales, todos los aislamientos fueron sensibles a betalactámicos, una cepa expresó resistencia a tetraciclina y cotrimoxazol y otra solo a cotrimoxazol. Los serotipos encontrados en 4/5 cepas (una resultó no viable) fueron 1, 19F, 15C y 23A. Los ninos fueron tratados con cefalosporinas de tercera generación o con ampicilina, gentamicina y metronidazol; todos evolucionaron favorablemente. Se destaca la importancia del hallazgo de Streptococcus pneumoniae en peritonitis primarias en niños. Este trabajo contribuye al conocimiento de esta enfermedad en particular y al de la epidemiología local de la ENI.

Abstract Pneumococcal peritonitis represents a small subset of patients suffering from inva-sive pneumococcal disease (IPD). We describe 5 cases of primary peritonitis documented in the pediatric hospital over 15 years (2005-2020) of IPD surveillance. The patients, 3girls and 2boys with a mean age of 5 years, experienced peritoneal signs and symptoms; 3of them suffered from nephrotic syndrome. Based on the local resistance profiles, all isolates were sensitive to beta-lactams, one strain showed resistance to cotrimoxazole and tetracycline while another strain, to cotrimoxazole only. Serotypes found in 4/5 strains (one was non-viable) were: 1, 19F, 15C and 23A. Children were treated with third-generation cephalosporins or ampicillin, gentamicin and metronidazole and all of them evolved favorably. Pneumococcal etiology should be included in the differential diagnosis of acute abdominal pain in children. Our study aims to contribute to the knowledge of this condition and to the local epidemiology of IPD.

[Primary pneumococcal peritonitis in a pediatric hospital from Argentina]. / Peritonitis primaria por neumococo en un hospital pediátrico de Argentina.

Pneumococcal peritonitis represents a small subset of patients suffering from invasive pneumococcal disease (IPD). We describe 5 cases of primary peritonitis documented in the pediatric hospital over 15 years (2005-2020) of IPD surveillance. The patients, 3girls and 2boys with a mean age of 5 years, experienced peritoneal signs and symptoms; 3of them suffered from nephrotic syndrome. Based on the local resistance profiles, all isolates were sensitive to beta-lactams, one strain showed resistance to cotrimoxazole and tetracycline while another strain, to cotrimoxazole only. Serotypes found in 4/5 strains (one was non-viable) were: 1, 19F, 15C and 23A. Children were treated with third-generation cephalosporins or ampicillin, gentamicin and metronidazole and all of them evolved favorably. Pneumococcal etiology should be included in the differential diagnosis of acute abdominal pain in children. Our study aims to contribute to the knowledge of this condition and to the local epidemiology of IPD.

[Pneumococcal osteoarticular infections in children admitted to a Pediatric Reference Hospital from Misiones, Argentina. Thirteen years of surveillance]. / Infección neumocócica osteoarticular en niños atendidos en un hospital pediátrico de referencia de Misiones, Argentina. Trece años de vigilancia.

Streptococcus pneumoniae is a rare cause of osteoarticular infections. We describe 5documented cases that occurred in 2005, 2009, 2011, 2015 and 2017 in patients admitted to the Pediatric Provincial Reference Hospital of Misiones. These cases corresponded to a 4-year-old boy and 4 girls aged 11, 10, 6 years and 4 months with a diagnosis of osteomyelitis of the scapula and humerus, arthritis of the hip, ankle and osteomyelitis of the distal fibula. All of them were in good general condition on admission and one of them was seropositive for human immunodeficiency virus. All the recovered isolates were susceptible to ß-lactams and only one isolate showed joint resistance to macrolides and tetracycline. Three isolates were serotyped, 2of which carried vaccine serotypes (19F and 7F). Despite its low frequency, the etiology of S.pneumoniae should be considered among the osteoarticular infections. Our findings enhance the role of the Bacteriology laboratory in the diagnosis by microbiological culture and contribute to documenting the epidemiological behavior of this pathogen.

[Description of 3 cases of skin and soft tissue infections caused by Streptococcus pneumoniae]. / Descripción de 3 casos de infecciones de piel y tejidos blandos por Streptococcus pneumoniae.

The role of Streptococcus pneumoniae as a causative agent of skin and soft tissue infections (SSTI) is unusual and its clinical interpretation is difficult. We describe here three cases of SSTI due to S. pneumoniae in patients admitted to the Provincial Pediatric Hospital of Misiones, Argentina that were detected during 10 years of invasive disease (ID) surveillance documented in 2010, 2011 and 2015. These cases involved two girls aged 8 and 7 months old, and a two-year-old male child with diagnoses of gluteal abscess, preseptal cellulites and pyoderma respectively. All the patients were eutrophic and in good general condition on admission; one of them was seropositive for HIV. Antimicrobial susceptibility and serotypes were framed within the local epidemiology of invasive pneumococcal disease. Despite its low frequency, S. pneumoniae as an etiological agent of SSTI must be considered. Our findings revalue the role of the diagnostic laboratory and contribute to document the behavior of this pathogen.

Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections in a pediatric hospital in Argentina.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) emerged at the Pediatric Hospital of Misiones Province, north Argentina, in 2003 as a cause of community-acquired (CA) infections, mostly associated with skin and soft tissue infections (SSTIs). This study aimed to assess the microbiological, epidemiological, and clinical features of CA-MRSA SSTIs treated at the hospital. METHODOLOGY: From 2003 through 2006, a longitudinal study on CA-MRSA SSTIs was conducted. Clinical, bacteriological, and molecular data were collected and analyzed by multiple correspondences and cluster analysis (MCCA). RESULTS: A total of 138 children were enrolled; 55.8% of the children required hospitalization. The main clinical presentation was abscesses (51%). Antibiotic therapy in the previous six months was registered in 41% of the patients, and 72% of the patients had relatives with similar symptoms. Resistance to non-b-lactam antibiotics was found in less than 12% of patients. All 44 isolates carried staphylococcal cassette chromosomemec (SCCmec) type IV, and 30/44 had Panton-Valentine leucocidin (PVL) coding genes. Six pulsed-field gel electrophoresis (PFGE) patterns were detected from 17 isolates. MCCA hierarchic classification resulted in four distinctive patient classes (new variable). No relationship could be observed regarding the PVL detection, as PVL (+) isolates were detected in all classes; the same lack of significance was observed concerning the distribution of resistance to non-ß-lactam antibiotics. CONCLUSIONS: This study increases the understanding and knowledge about CA-MRSA skin and soft tissue infections in pediatric patients. Continuous efforts should be made to control this significant public health problem.

[Pneumococcal meningitis in children under 15 years of age in Misiones (Argentina). Sixteen year's epidemiological surveillance]. / Meningitis neumocócica en niños menores de 15 años. Dieciséis años de vigilancia epidemiológica en Misiones, Argentina.

We report the results of pneumococcal meningitis surveillance conducted at the Provincial Pediatric Hospital of Posadas, Misiones (Argentina), before the conjugate vaccine was introduced into the national vaccination schedule. Between January 1994 and December 2009, 167 cases of Streptococcus pneumoniae meningitis were diagnosed in children aged 1 month to 15 years. The attack rate/100,000 children ranged from 19.2 (1997) to 4.3 (2009), with a mean of 10.6 and a tendency to decrease (y=-0.689x+16.52). The number of cases per 100,000 children decreased from 146.6 to 34.8 and particularly involved the group of children aged 1 to 11 months (94/167, 56%). Thirty point seven percent (30.7%) (46/150) of the isolates were resistant to penicillin whereas 16.7% (25/150) were non-susceptible to cefotaxime. ß-lactam resistance increased as from 1997 and began to decline in 2005. Nineteen serotypes were detected; type 14 was predominant and accounted for 32% (40/125). Eighty four point eight percent (84.8%) of the isolates were circumscribed to nine serotypes: 14, 5, 1, 7F, 18C, 6B, 9N, 9V and 4. Theoretical coverage for patients aged <2 years and >2 years was 84.1% (74/88) and 83.8% (31/37) for the 10-valent vaccine and 89.8 % (79/88) and 83.8% (31/37) for the 13-valent vaccine respectively. Penicillin resistance was restricted to 8 serotypes (14, 6B, 6A, 9V, 4, 23B, 19A1) and nonsusceptibility to cefotaxime was circumscribed to 3 serotypes (14, 9V and 1). This study will allow to evaluate the impact of the implementation of conjugate vaccines on our area.

Meningitis neumocócica en niños menores de 15 años: Dieciséis años de vigilancia epidemiológica en Misiones, Argentina / Pneumococcal meningitis in children under 15 years of age in Misiones (Argentina): Sixteen year's epidemiological surveillance

Se presentan en este trabajo los resultados de 16 años de vigilancia epidemiológica de meningitis neumocócica llevada a cabo en el Hospital Provincial de Pediatría de Misiones (Argentina), antes de la introducción de la vacuna conjugada al calendario nacional. En el período que va de enero de 1994 a diciembre de 2009 se diagnosticaron 167 casos de meningitis por Streptococcus pneumoniae en niños (1 mes-15 años). La tasa de ataque cada 100 000 niños varió entre 19,2 (1997) y 4,3 (2009), con una media de 10,6 y una tendencia en disminución (y = ""0,689x + 16,52). Esto fue a expensas del grupo de niños entre 1 y 11 meses (94/167, 56 %), en el que disminuyó de 146,6 a 34,8 casos cada 100 000 niños. El 30,7 % de los aislamientos (46/150) fueron resistentes a penicilina y el 16,7 % (25/150) no sensibles a cefotaxima. La resistencia a β-lactámicos se incrementó a partir de 1997 y comenzó a disminuir en 2005. Se detectaron 19 serotipos, predominó el 14 (32 %; 40/125). El 84,8 % de los aislamientos quedaron circunscriptos a nueve serotipos: 14, 5, 1, 7F, 18C, 6B, 9N, 9V y 4. La cobertura teórica en los niños < 2 años y > 2 años fue de 84,1 % (74/88) y 83,8 % (31/37) con la vacuna 10-valente, y de 89,8 % (79/88) y 83,8 % (31/37) con la vacuna 13-valente, respectivamente. La resistencia a penicilina estuvo circunscripta a 8 serotipos (14, 6B, 6A, 9V, 4, 23B, 1 y 19A), y la no sensibilidad a cefotaxima a 3 serotipos (14, 9V y 1), el más importante fue en ambos casos el serotipo 14. Este estudio permitirá evaluar el impacto de la implementación de las vacunas conjugadas en nuestra zona.

We report the results of pneumococcal meningitis surveillance conducted at the Provincial Pediatric Hospital of Posadas, Misiones (Argentina), before the conjugate vaccine was introduced into the national vaccination schedule. Between January 1994 and December 2009, 167 cases of Streptococcus pneumoniae meningitis were diagnosed in children aged 1 month to 15 years. The attack rate/100,000 children ranged from 19.2 (1997) to 4.3 (2009), with a mean of 10.6 and a tendency to decrease (y=""0.689x+16.52). The number of cases per 100,000 children decreased from 146.6 to 34.8 and particularly involved the group of children aged 1 to 11 months (94/167, 56%). Thirty point seven percent (30.7%) (46/150) of the isolates were resistant to penicillin whereas 16.7% (25/150) were non-susceptible to cefotaxime. β-lactam resistance increased as from 1997 and began to decline in 2005. Nineteen serotypes were detected; type 14 was predominant and accounted for 32% (40/125). Eighty four point eight percent (84.8%) of the isolates were circumscribed to nine serotypes: 14, 5, 1, 7F, 18C, 6B, 9N, 9V and 4. Theoretical coverage for patients aged <2 years and >2 years was 84.1% (74/88) and 83.8% (31/37) for the 10-valent vaccine and 89.8 % (79/88) and 83.8% (31/37) for the 13-valent vaccine respectively. Penicillin resistance was restricted to 8 serotypes (14, 6B, 6A, 9V, 4, 23B, 19A1) and nonsusceptibility to cefotaxime was circumscribed to 3 serotypes (14, 9V and 1). This study will allow to evaluate the impact of the implementation of conjugate vaccines on our area.

Meningitis neumocócica en niños menores de 15 años: Dieciséis años de vigilancia epidemiológica en Misiones, Argentina / Pneumococcal meningitis in children under 15 years of age in Misiones (Argentina): Sixteen years epidemiological surveillance

Se presentan en este trabajo los resultados de 16 años de vigilancia epidemiológica de meningitis neumocócica llevada a cabo en el Hospital Provincial de Pediatría de Misiones (Argentina), antes de la introducción de la vacuna conjugada al calendario nacional. En el período que va de enero de 1994 a diciembre de 2009 se diagnosticaron 167 casos de meningitis por Streptococcus pneumoniae en niños (1 mes-15 años). La tasa de ataque cada 100 000 niños varió entre 19,2 (1997) y 4,3 (2009), con una media de 10,6 y una tendencia en disminución (y = ""0,689x + 16,52). Esto fue a expensas del grupo de niños entre 1 y 11 meses (94/167, 56 %), en el que disminuyó de 146,6 a 34,8 casos cada 100 000 niños. El 30,7 % de los aislamientos (46/150) fueron resistentes a penicilina y el 16,7 % (25/150) no sensibles a cefotaxima. La resistencia a β-lactámicos se incrementó a partir de 1997 y comenzó a disminuir en 2005. Se detectaron 19 serotipos, predominó el 14 (32 %; 40/125). El 84,8 % de los aislamientos quedaron circunscriptos a nueve serotipos: 14, 5, 1, 7F, 18C, 6B, 9N, 9V y 4. La cobertura teórica en los niños < 2 años y > 2 años fue de 84,1 % (74/88) y 83,8 % (31/37) con la vacuna 10-valente, y de 89,8 % (79/88) y 83,8 % (31/37) con la vacuna 13-valente, respectivamente. La resistencia a penicilina estuvo circunscripta a 8 serotipos (14, 6B, 6A, 9V, 4, 23B, 1 y 19A), y la no sensibilidad a cefotaxima a 3 serotipos (14, 9V y 1), el más importante fue en ambos casos el serotipo 14. Este estudio permitirá evaluar el impacto de la implementación de las vacunas conjugadas en nuestra zona.(AU)

We report the results of pneumococcal meningitis surveillance conducted at the Provincial Pediatric Hospital of Posadas, Misiones (Argentina), before the conjugate vaccine was introduced into the national vaccination schedule. Between January 1994 and December 2009, 167 cases of Streptococcus pneumoniae meningitis were diagnosed in children aged 1 month to 15 years. The attack rate/100,000 children ranged from 19.2 (1997) to 4.3 (2009), with a mean of 10.6 and a tendency to decrease (y=""0.689x+16.52). The number of cases per 100,000 children decreased from 146.6 to 34.8 and particularly involved the group of children aged 1 to 11 months (94/167, 56%). Thirty point seven percent (30.7%) (46/150) of the isolates were resistant to penicillin whereas 16.7% (25/150) were non-susceptible to cefotaxime. β-lactam resistance increased as from 1997 and began to decline in 2005. Nineteen serotypes were detected; type 14 was predominant and accounted for 32% (40/125). Eighty four point eight percent (84.8%) of the isolates were circumscribed to nine serotypes: 14, 5, 1, 7F, 18C, 6B, 9N, 9V and 4. Theoretical coverage for patients aged <2 years and >2 years was 84.1% (74/88) and 83.8% (31/37) for the 10-valent vaccine and 89.8 % (79/88) and 83.8% (31/37) for the 13-valent vaccine respectively. Penicillin resistance was restricted to 8 serotypes (14, 6B, 6A, 9V, 4, 23B, 19A1) and nonsusceptibility to cefotaxime was circumscribed to 3 serotypes (14, 9V and 1). This study will allow to evaluate the impact of the implementation of conjugate vaccines on our area.(AU)

Meningitis neumocócica en niños menores de 15 años. Dieciséis años de vigilancia epidemiológica en Misiones, Argentina. / [Pneumococcal meningitis in children under 15 years of age in Misiones (Argentina). Sixteen years epidemiological surveillance].

We report the results of pneumococcal meningitis surveillance conducted at the Provincial Pediatric Hospital of Posadas, Misiones (Argentina), before the conjugate vaccine was introduced into the national vaccination schedule. Between January 1994 and December 2009, 167 cases of Streptococcus pneumoniae meningitis were diagnosed in children aged 1 month to 15 years. The attack rate/100,000 children ranged from 19.2 (1997) to 4.3 (2009), with a mean of 10.6 and a tendency to decrease (y=-0.689x+16.52). The number of cases per 100,000 children decreased from 146.6 to 34.8 and particularly involved the group of children aged 1 to 11 months (94/167, 56

). Thirty point seven percent (30.7

) (46/150) of the isolates were resistant to penicillin whereas 16.7

(25/150) were non-susceptible to cefotaxime. ß-lactam resistance increased as from 1997 and began to decline in 2005. Nineteen serotypes were detected; type 14 was predominant and accounted for 32

(40/125). Eighty four point eight percent (84.8

) of the isolates were circumscribed to nine serotypes: 14, 5, 1, 7F, 18C, 6B, 9N, 9V and 4. Theoretical coverage for patients aged <2 years and >2 years was 84.1

(74/88) and 83.8

(31/37) for the 10-valent vaccine and 89.8

(79/88) and 83.8

(31/37) for the 13-valent vaccine respectively. Penicillin resistance was restricted to 8 serotypes (14, 6B, 6A, 9V, 4, 23B, 19A1) and nonsusceptibility to cefotaxime was circumscribed to 3 serotypes (14, 9V and 1). This study will allow to evaluate the impact of the implementation of conjugate vaccines on our area.

[Whooping cough: clinical and epidemiological characteristics of 20 confirmed cases of the Paediatric Hospital of Misiones province]. / Tos convulsa: características clinicoepidemiológicas de 20 casos confirmados atendidos en el Hospital Pediátrico de la provincia de Misiones.

Pertussis or whooping cough is a respiratory disease that has emerged in recent years in several countries including Argentina. The aim is to retrospectively describe clinical and epidemiological characteristics of 20 patients in the Pediatric Hospital of Misiones with confirmed diagnosis of whooping cough, according to criteria set by WHO and CDC, during the years 2005 and 2006. The median age was 4 months, 13 were male (65%). Fourteen patients (70%) were younger than 6 months and 9 (45%) younger than 3 months. All had cough (average duration of 7.6 days), 5 (25%) paroxysmal cough and 1 (5%) apnea and cyanosis. Two children died. Sixteen (80%) had not the three doses of vaccine quadruple, 7 children (35%) were younger than 3 months and had no dose. The disease remains a public health problem affecting not only children but also adults.

Tos convulsa: características clinico epidemiológicas de 20 casos confirmados atendidos en el Hospital Pediátrico de la provincia de Misiones / Whooping cough: clinical and epidemiological characteristics of 20 confirmed cases of the Paediatric Hospital of Misiones province

La tos convulsa (coqueluche o pertussis) es una enfermedad respiratoria que ha resurgido en los últimos años en varios países, incluida la Argentina. El objetivo de este trabajo es describir, en forma retrospectiva, las características clínicas y epidemiológicas de 20 pacientes del Hospital Pediátrico de Misiones con diagnóstico confirmado de coqueluche, según criterios establecidos por la OMS y el CDC, atendidos durante 2005 y 2006. La mediana de edad fue de 4 meses, 13 pacientes eran varones (65 por ciento). Catorce (70 por ciento) eran menores de 6 meses y 9 (45 por ciento) menores de 3 meses. Todos presentaron tos (duración promedio: 7,6 días), 5 (25 por ciento) tos paroxística y 1 (5 por ciento) apnea y cianosis. Dos niños fallecieron. Dieciséis (80 por ciento) no tenían las tres dosis de vacuna cuádruple, 7 niños (35 por ciento) menores de 3 meses, no tenía ninguna dosis. La enfermedad continúa siendo un problema para la salud pública y afecta no sólo a niños sino también a adultos.

Pertussis or whooping cough is a respiratory disease that has emerged in recent years in several countries including Argentina. The aim is to retrospectively describe clinical and epidemiological characteristics of 20 patients in the Pediatric Hospital of Misiones with confirmed diagnosis of whooping cough, according to criteria set by WHO and CDC, during the years 2005 and 2006. The median age was 4 months, 13 were male (65 percent). Fourteen patients (70%) were younger than 6 months and 9 (45 percent) younger than 3 months. All had cough (average duration of 7.6 days), 5 (25 percent) paroxysmal cough and 1 (5 percent) apnea and cyanosis. Two children died. Sixteen (80 percent) had not the three doses of vaccine quadruple, 7 children (35 percent) were younger than 3 months and had no dose. The disease remains a public health problem affecting not only children but also adults.

Tos convulsa: características clinico epidemiológicas de 20 casos confirmados atendidos en el Hospital Pediátrico de la provincia de Misiones / Whooping cough: clinical and epidemiological characteristics of 20 confirmed cases of the Paediatric Hospital of Misiones province

La tos convulsa (coqueluche o pertussis) es una enfermedad respiratoria que ha resurgido en los últimos años en varios países, incluida la Argentina. El objetivo de este trabajo es describir, en forma retrospectiva, las características clínicas y epidemiológicas de 20 pacientes del Hospital Pediátrico de Misiones con diagnóstico confirmado de coqueluche, según criterios establecidos por la OMS y el CDC, atendidos durante 2005 y 2006. La mediana de edad fue de 4 meses, 13 pacientes eran varones (65 por ciento). Catorce (70 por ciento) eran menores de 6 meses y 9 (45 por ciento) menores de 3 meses. Todos presentaron tos (duración promedio: 7,6 días), 5 (25 por ciento) tos paroxística y 1 (5 por ciento) apnea y cianosis. Dos niños fallecieron. Dieciséis (80 por ciento) no tenían las tres dosis de vacuna cuádruple, 7 niños (35 por ciento) menores de 3 meses, no tenía ninguna dosis. La enfermedad continúa siendo un problema para la salud pública y afecta no sólo a niños sino también a adultos.(AU)

Pertussis or whooping cough is a respiratory disease that has emerged in recent years in several countries including Argentina. The aim is to retrospectively describe clinical and epidemiological characteristics of 20 patients in the Pediatric Hospital of Misiones with confirmed diagnosis of whooping cough, according to criteria set by WHO and CDC, during the years 2005 and 2006. The median age was 4 months, 13 were male (65 percent). Fourteen patients (70%) were younger than 6 months and 9 (45 percent) younger than 3 months. All had cough (average duration of 7.6 days), 5 (25 percent) paroxysmal cough and 1 (5 percent) apnea and cyanosis. Two children died. Sixteen (80 percent) had not the three doses of vaccine quadruple, 7 children (35 percent) were younger than 3 months and had no dose. The disease remains a public health problem affecting not only children but also adults.(AU)

Infección meníngea por Staphylococcus aureus resistente a la meticilina adquirido en la comunidad / Methicillin-resistant Staphilococcus aureus community-acquired meningeal infections

Staphylococcus aureus es una causa poco frecuentede meningitis adquirida en la comunidad. Desdelos años 90 al presente ha emergido como patógenoen adultos y niños sin factores de riesgo tradicionalespara la adquisición de Staphylococcus aureusmeticilinorresistentes, asociados a infecciones depiel y tejido subcutáneo.Estas cepas difieren notoriamente de los aislamientosprevios de este germen provenientes de infeccioneshospitalarias y comunitarias hasta ahoradescriptas.Presentamos los dos primeros casos de meningitispor Staphylococcus aureus meticilinorresistente de lacomunidad diagnosticados durante el año 2004 enel Hospital de Pediatría de Posadas, Misiones.Llamamos la atención sobre la circulación de estanueva cepa y la necesidad de afianzar la vigilanciaepidemiológica con el fin de reconocer estos cuadrosy brindar los tratamientos adecuados, especialmenteen infecciones graves.

Infección meníngea por Staphylococcus aureus resistente a la meticilina adquirido en la comunidad / Methicillin-resistant Staphilococcus aureus community-acquired meningeal infections

Staphylococcus aureus es una causa poco frecuentede meningitis adquirida en la comunidad. Desdelos años 90 al presente ha emergido como patógenoen adultos y niños sin factores de riesgo tradicionalespara la adquisición de Staphylococcus aureusmeticilinorresistentes, asociados a infecciones depiel y tejido subcutáneo.Estas cepas difieren notoriamente de los aislamientosprevios de este germen provenientes de infeccioneshospitalarias y comunitarias hasta ahoradescriptas.Presentamos los dos primeros casos de meningitispor Staphylococcus aureus meticilinorresistente de lacomunidad diagnosticados durante el año 2004 enel Hospital de Pediatría de Posadas, Misiones.Llamamos la atención sobre la circulación de estanueva cepa y la necesidad de afianzar la vigilanciaepidemiológica con el fin de reconocer estos cuadrosy brindar los tratamientos adecuados, especialmenteen infecciones graves. (AU)

Infección meníngea por Staphylococcus aureus resistente a la meticilina adquirido en la comunidad / Methicillin-resistant Staphilococcus aureus community-acquired meningeal infections

Staphylococcus aureus es una causa poco frecuentede meningitis adquirida en la comunidad. Desdelos años 90 al presente ha emergido como patógenoen adultos y niños sin factores de riesgo tradicionalespara la adquisición de Staphylococcus aureusmeticilinorresistentes, asociados a infecciones depiel y tejido subcutáneo.Estas cepas difieren notoriamente de los aislamientosprevios de este germen provenientes de infeccioneshospitalarias y comunitarias hasta ahoradescriptas.Presentamos los dos primeros casos de meningitispor Staphylococcus aureus meticilinorresistente de lacomunidad diagnosticados durante el año 2004 enel Hospital de Pediatría de Posadas, Misiones.Llamamos la atención sobre la circulación de estanueva cepa y la necesidad de afianzar la vigilanciaepidemiológica con el fin de reconocer estos cuadrosy brindar los tratamientos adecuados, especialmenteen infecciones graves. (AU)

[Distribution of serotypes and antibiotic susceptibility patterns of Streptococcus pneumoniae strains isolated from children in Misiones, Argentina]. / Distribución de serotipos y perfiles de sensibilidad a los antimicrobianos de cepas de Streptococcus pneumoniae aisladas en niños en Misiones, Argentina.

BACKGROUND: The aim of this study was to assess the local resistance patterns and serotypes of Streptococcus pneumoniae implicated in invasive infections in children in Hospital Provincial de Pediatría in Misiones, Argentina. METHODS: A total of 101 strains isolated from sterile sites between June 1998 and June 2001 were studied. Strains were identified according to standard methods. Resistance patterns were determined by disk diffusion and a macrodilution method according to NCCLS guidelines. Capsular typing was based on the Quellung technique. RESULTS: Among the total, 62% of pneumonia cases, 70% of pneumonia with pleural effusion and meningitis, and 78% of sepsis occurred in children younger than 2 years old (74% of the total). Twelve serotypes were detected among 71 strains analyzed. Types 14 (37.1%), 5 (21.4%), 1 (10%), 6A/6B (7.1%), 9N and 19A (5.7%) and 9V (4.3%), were the most frequent. Penicillin (PEN) resistance was detected in 39% of isolates: 17.5% had intermediate levels and 21.5% high levels of resistance. None of the strains had PEN MICs of > 4 microg/ml. PEN resistance was limited to 5 serotypes, with 84% corresponding to type 14. Among the 71 strains, in 50 CTX MICs were < or = 0.5 microg/ml, in 18 the MIC was 1 mg/ml and in 3 the MIC was 2 microg/ml. None of the strains had CTX MICs of > 2 microg/ml. Twenty-two percent of strains were resistant to tetracycline, 48% to trimethoprim-sulfamethoxazole (TMS), 11% to chloramphenicol (CLO) and 6.8% to erythromycin. None of the isolates were resistant to vancomycin, ofloxacin or rifampin. The most common combined resistance patterns were PEN-TMS (20%), PEN-CTX-TMS (7%, 3 strains with a CTX MIC of 2 .g/ml) and PEN-TMS-CLO (5%). CONCLUSIONS: The local drug resistance patterns and serotype distribution defined in this study allow appropriate empirical therapy to be established in our area and provide information that can be used assess vaccination strategies as a preventive tool for the control of invasive pneumococcal infections.

Distribución de serotipos y perfiles de sensibilidad a los antimicrobianos de cepas de Streptococcus pneumoniae aisladas en niños en Misiones, Argentina / Distribution of serotypes and antibiotic susceptibility patterns of Streptococcus pneumoniae strains isolated from children in Misiones, Argentina

ANTECEDENTES. El objetivo de este trabajo fue evaluar los patrones de resistencia antibiótica local y los serotipos de Streptococcus pneumoniae implicados en enfermedades invasivas en pacientes pediátricos del Hospital Provincial de Pediatría de Misiones, Argentina. MÉTODOS. Se estudiaron 101 cepas aisladas de niños a partir de muestras estériles, entre junio de 1998 y junio de 2001. Las muestras se procesaron por el método habitual, y los patrones de resistencia antibiótica se determinaron según pautas del National Committee for Clinical Laboratory Standards (NCCLS), por técnicas de difusión y dilución. La serotipificación se efectuó mediante la reacción de Quellung. RESULTADOS. El 62% de las neumonías, el 70% de las neumonías con derrame y de las meningitis y 78% de las sepsis correspondieron a niños menores de 2 años de edad (74% del total de pacientes). Se identificaron 12 serotipos entre 71 cepas analizadas. Los tipos 14 (37,1%), 5 (21,4%), 1 (10%), 6A/6B (7,1%),9N y 19A (5,7%) y 9V (4,3%) fueron los más frecuentes. Se observó sensibilidad disminuida a penicilina en el 39% de los aislamientos, el 17,5% de los cuales presentó resistencia intermedia y el 21,5% alto nivel de resistencia. Para ningún aislamiento la concentración inhibitoria mínima (CIM) fue superior a 4 mg/ml. La resistencia a penicilina quedó circunscrita a cinco serotipos, correspondiendo en el 84% de los casos al 14. Entre 71 aislamientos en que se efectuó la CIM a cefotaxima, 50 presentaron un valor menor o igual a 0,5 mg/ml;18 una CIM de 1 mg/ml y tres de 2 mg/ml. No se detectaron cepas cuya CIM fuera superior a 2 mg/ml. El 22% de los aislamientos fue resistente a tetraciclina, el 48% a trimetoprima-sulfametoxazol, el 11% acloranfenicol y el 6,8% a eritromicina. Ningún aislamiento fue resistente a vancomicina, ofloxacino ni rifampicina. Los patrones de resistencia combinada más comunes, entre las cepas no sensibles a penicilina, fueron: penicilina-trimetoprima-sulfametoxazol (20%) seguido de penicilina-cefotaxima-trimetoprima-sulfametoxazol (7%; 3 aislamientos con CIM a cefotaxima = 2 mg/ml)y penicilina-trimetoprima-sulfametoxazol-cloranfenicol(5%). CONCLUSIONES. Los patrones de resistencia y los tipos capsulares circulantes locales observados en este trabajo permiten adecuar esquemas terapéuticos a nuestra realidad y brindan información al equipo médico para evaluar el uso de vacunas como herramienta de prevención y control de las infecciones invasivas por S. pneumoniae (AU)

BACKGROUND. The aim of this study was to assess the local resistance patterns and serotypes of Streptococcus pneumoniae implicated in invasive infections in children in Hospital Provincial de Pediatría in Misiones, Argentina. METHODS. A total of 101 strains isolated from sterile sites between June 1998 and June 2001 were studied. Strains were identified according to standard methods. Resistance patterns were determined by disk diffusion and a macro dilution method according to NCCLS guidelines. Capsular typing was based on the Quellung technique. RESULTS. Among the total, 62% of pneumonia cases, 70% of pneumonia with pleural effusion and meningitis, and 78% of sepsis occurred in children younger than 2 years old (74% of the total).Twelve serotypes were detected among 71 strains analyzed. Types 14 (37.1%), 5 (21.4%), 1 (10%), 6A/6B(7.1%), 9N and 19A (5.7%) and 9V (4.3%), were the most frequent. Penicillin (PEN) resistance was detected in 39% of isolates: 17.5% had intermediate levels and 21.5% high levels of resistance. None of the strains had PEN MICs of> 4 mg/ml. PEN resistance was limited to 5 serotypes, with 84% corresponding to type 14. Among the 71 strains, in 50 CTX MICs were 2 mg/ml. Twenty-two percent of strains were resistant to tetracycline, 48% totrimethoprim-sulfamethoxazole (TMS), 11% tochloramphenicol (CLO) and 6.8% to erythromycin. None of the isolates were resistant to vancomycin, ofloxacinor rifampin. The most common combined resistance patterns were PEN-TMS (20%), PEN-CTX-TMS(7%, 3 strains with a CTX MIC of 2 mg/ml) and PEN-TMS-CLO (5%).CONCLUSIONS. The local drug resistance patterns and serotype distribution defined in this study allow appropriate empirical therapy to be established in our area and provide information that can be used assess vaccination strategies as a preventive tool for the control of invasive pneumococcal infections (AU)

Prospective study of enteropathogens in two communities of Misiones, Argentina

Ninos menores de cinco anos de edad de dos comunidades de diferente condicion socio-economica (97 del Barrio Zaiman y 55 del Barrio Las Dolores), fueron vigilados epidemiologicamente durante 2 anos, mediante visitas trimestrales del equipo de trabajo, el que realizo la toma de muestras fecales. Durante el estudio, se identificaron uno o mas enteropatogenos en el 73,9 por cento de las muestras de ninos del Barrio Zaiman y en el 58,3 por cento de Las Dolores, estando asociados a diarrea en un 70,5 por cento y en infecciones asintomaticas en un 65,7 por cento. El numero de episodios de diarrea fue superior en Zaiman (15,5 por cento) que en Las Dolores (12,4 por cento), presentandose con mayor frecuencia en los meses de primavera-verano...

Hallazgos bacteriológicos en infecciones pediatricas en Posadas, Misiones en el año 1988 / Bacteriological finding in pediatrics infections in Posadas, Misiones, year 1988

El presente trabajo informa de la calidad y susceptibilidad de los gérmenes involucrados en la infección nosocomial durante el año 1988, en pacientes internados en el Sector Pediatría del Hospital Ramón Madariaga. Sobre un total de 1749 muestras clínicas estudiadas, se obtuvo un 23,44%de positividad. El tipo de infección más frecuente fue heridas quirúrgicas y tejidos blandos superficiales, como es de esperar en la población pediátrica. Los agentes etiológicos predominantes fueron los bacilos gram (-) con marcada resistencia a antibióticos betaláctamicos y gentamicina

Hallazgos bacteriológicos en infecciones pediatricas en Posadas, Misiones en el año 1988 / Bacteriological finding in pediatrics infections in Posadas, Misiones, year 1988

El presente trabajo informa de la calidad y susceptibilidad de los gérmenes involucrados en la infección nosocomial durante el año 1988, en pacientes internados en el Sector Pediatría del Hospital Ramón Madariaga. Sobre un total de 1749 muestras clínicas estudiadas, se obtuvo un 23,44%de positividad. El tipo de infección más frecuente fue heridas quirúrgicas y tejidos blandos superficiales, como es de esperar en la población pediátrica. Los agentes etiológicos predominantes fueron los bacilos gram (-) con marcada resistencia a antibióticos betaláctamicos y gentamicina