Enfermedad invasiva por Streptococcus pyogenes: ingresos durante 6 años / Invasive disease by Streptococcus pyogenes: patients hospitalized for 6 years

INTRODUCCIÓN Y OBJETIVO: En los últimos años se ha detectado un incremento de los casos graves de enfermedad invasiva (EI) por Streptococcus pyogenes o estreptococo beta-hemolítico del grupo A (SGA). El objetivo del estudio fue determinar la epidemiología y las características clínicas de las EI por SGA en un hospital pediátrico de tercer nivel. MATERIAL Y MÉTODOS: Estudio retrospectivo realizado en un hospital urbano materno-infantil de tercer nivel. Se incluyeron los pacientes ingresados con diagnóstico final de EI por SGA durante 6 años (2009-2014). Se consideró EI cuando SGA se aisló en muestras estériles, en pacientes con fascitis necrosante cuando se aisló en muestras de la zona de la lesión y en pacientes con síndrome shock tóxico estreptocócico (SSTS) cuando se aisló en cualquier muestra. Se recogieron datos demográficos, tipo de infección, factores de riesgo, presentación clínica, datos analíticos al ingreso, tratamiento, necesidad de ingreso en unidad de cuidados intensivos pediátricos (UCIP), datos microbiológicos, estancia hospitalaria y evolución. RESULTADOS: Se incluyeron 52 casos (12/10.000 ingresos); edad mediana de 3 años (p25-75: 1,4-6,9 años); 28 (53,8%) eran varones. Presentaban factores de riesgo 14 (26,9%) casos. El motivo de consulta incluía fiebre en 51 (98,1%); la clínica acompañante más frecuente fue la cutánea (21; 40,4%). En 50 (96%) casos se aisló SGA en al menos un medio estéril. Se diagnosticaron 14 (26,9%) infecciones de piel y partes blandas, 14 (26,9%) neumonías, 12 (23,1%) infecciones osteoarticulares, 10 (19,2%) SSTS, 6 (11,5%) bacteriemias ocultas, 4 (7,7%) meningitis y 2 (3,8%) sepsis. Requirieron cirugía 18 (34,6%) casos y 17 (32,7%) ingreso en unidad de cuidados intensivos. La mediana de estancia hospitalaria fue de 9,5 días (p25-75: 8-15 días). Presentaron secuelas 3 pacientes y hubo un fallecimiento. CONCLUSIÓN: La EI por SGA fue un motivo poco frecuente aunque grave de hospitalización. Las infecciones de piel y partes blandas, y las pleuroneumonías fueron las formas de EI más habituales. A pesar de la gravedad, la mortalidad en la serie fue baja

INTRODUCTION AND OBJECTIVE: The last years an increase of severe cases of invasive disease (ID) due to Streptococcus pyogenes or streptococcus b-hemolytic group A (SGA) had been detected. The aim of this study was to analyze the epidemiology and the clinical features of ID due to SGA in a tertiary Pediatric Hospital. MATERIAL AND METHODS: Retrospective study in a Pediatric hospital, of all in-patients with final diagnosis of ID due to SGA during 6 years (2009-2014). To consider ID, SGA had to be isolated in sterile samples; in patients with fascitis necroticans in skin samples or in any sample in patients with the diagnostic of Streptococcal Toxic Shock Syndrome (STSS). The SSTS was defined as hypotension and at least 2 of these criteria: renal failure, hepatic failure, acute respiratory distress, tissue necrosis or desquamative erythematous rash. Demographic data, type of infection, risk factors, clinical presentation, analytical data at admission, treatment, need for admission to a pediatric intensive care unit, microbiological data, hospital stay and evolution were collected. RESULTS: Fifty-two (52) cases were included (12/10,000 of all inpatients); 3 years-old was the medium age (p25-75: 1.4-6.9 years); 28 (53.8%) were boys. Fourteen patients (26.9%) had risk factors. Fever was the major symptom (51 patients, 98.1%). The skin lesions were the most frequent clinical manifestations found (21; 40.4%). In 50 (96%) cases, SGA was isolated in at least one sterile sample. Skin and soft tissue infections were diagnosed in 14 patients (26.9%), 14 (26.9%) pneumonias, 12 (23.1%) bones and joints infections, 10 (19.2%) SSTS, 6 (11.5%) occult bacteremia, 4 (7.7%) meningitis and 2 (3.8%) sepsis. Surgery was required in 18 cases (34.6%) and 17 patients (32.7%) needed intensive care. The medium hospital stay was 9.5 days (p25-75: 8-15 days). Three patients presented sequels and one patient died. CONCLUSION: The ID due to SGA was a rare but serious reason for hospital admission. Skin and soft tissue infections, and pleuroneumonia were the most common forms of ID. The mortality of our sample was low despite the serious clinical manifestations

Invasive disease by Streptococcus pyogenes: patients hospitalized for 6 years. / Enfermedad invasiva por Streptococcus pyogenes: ingresos durante 6 años.

INTRODUCTION AND OBJECTIVE: The last years an increase of severe cases of invasive disease (ID) due to Streptococcus pyogenes or streptococcus b-hemolytic group A (SGA) had been detected. The aim of this study was to analyze the epidemiology and the clinical features of ID due to SGA in a tertiary Pediatric Hospital. MATERIAL AND METHODS: Retrospective study in a Pediatric hospital, of all in-patients with final diagnosis of ID due to SGA during 6 years (2009-2014). To consider ID, SGA had to be isolated in sterile samples; in patients with fascitis necroticans in skin samples or in any sample in patients with the diagnostic of Streptococcal Toxic Shock Syndrome (STSS). The SSTS was defined as hypotension and at least 2 of these criteria: renal failure, hepatic failure, acute respiratory distress, tissue necrosis or desquamative erythematous rash. Demographic data, type of infection, risk factors, clinical presentation, analytical data at admission, treatment, need for admission to a pediatric intensive care unit, microbiological data, hospital stay and evolution were collected. RESULTS: Fifty-two (52) cases were included (12/10,000 of all inpatients); 3 years-old was the medium age (p25-75: 1.4-6.9 years); 28 (53.8%) were boys. Fourteen patients (26.9%) had risk factors. Fever was the major symptom (51 patients, 98.1%). The skin lesions were the most frequent clinical manifestations found (21; 40.4%). In 50 (96%) cases, SGA was isolated in at least one sterile sample. Skin and soft tissue infections were diagnosed in 14 patients (26.9%), 14 (26.9%) pneumonias, 12 (23.1%) bones and joints infections, 10 (19.2%) SSTS, 6 (11.5%) occult bacteremia, 4 (7.7%) meningitis and 2 (3.8%) sepsis. Surgery was required in 18 cases (34.6%) and 17 patients (32.7%) needed intensive care. The medium hospital stay was 9.5 days (p25-75: 8-15 days). Three patients presented sequels and one patient died. CONCLUSION: The ID due to SGA was a rare but serious reason for hospital admission. Skin and soft tissue infections, and pleuroneumonia were the most common forms of ID. The mortality of our sample was low despite the serious clinical manifestations.

Associations Between Fetal Imprinted Genes and Maternal Blood Pressure in Pregnancy.

In addition to maternal genes and environmental exposures, variation in fetal imprinted genes could also affect maternal blood pressure during pregnancy. Our objective was to test the associations between polymorphic variants in 16 imprinted genes and maternal mean arterial blood pressures in 1160 DNA trios from 2 established birth cohorts (the Cambridge Baby Growth and Wellbeing Studies) and seek replication in 1367 Hyperglycemia and Adverse Pregnancy Outcome Study participants. Significant univariate associations, all independent of fetal sex, were observed in the Cambridge cohorts, including FAM99A rs1489945 transmitted from the mother (P=2×10-4), DLK1 rs10139403 (mother; P=9×10-4), DLK1 rs12147008 (mother; P=1×10-3), H19 rs217222 (father; P=1×10-3), SNRPN rs1453556 (father; P=1×10-3), IGF2 rs6356 (father; P=1×10-3), and NNAT rs6066671 (father; P=1×10-3). In meta-analysis including additional independent Hyperglycemia and Adverse Pregnancy Outcome Study data, the association with maternally transmitted fetal DLK1 rs10139403 reached genome-wide significance (P=6.3×10-10). With the exception of fetal rs1489945 and rs217222, all of other associations were unidirectional and most were statistically significant. To further explore the significance of these relationships, we developed an allele score based on the univariate findings. The score was strongly associated with maternal blood pressure at 31 weeks (P=4.1×10-8; adjusted r2=5.6%) and 37 weeks of pregnancy (P=1.1×10-4; r2=3.6%), and during the last 2 weeks before parturition (P=1.1×10-10; r2=8.7%). It was also associated with gestational hypertension (odds ratio, 1.54 [range, 1.14-2.09] per allele; P=0.005; 45 cases and 549 controls). These data support the concept that fetal imprinted genes are related to the development of gestational hypertension.

Implicación de las sustancias psicoactivas en las consultas de adolescentes en urgencias / Psychoactive drugs use and - related visits of adolescents to the emergency department

Fundamento y objetivos: Describir la consultas relacionadas con el consumo de sustancias psicoactivas (SP) generadas por adolescentes en un servicio de urgencias (SU) y valorar posibles características diferenciales en el perfil de los pacientes en función de la SP consumida. Pacientes y método: Estudio analítico y observacional. Se incluyeron durante 30 meses las consultas de adolescentes a un SU relacionadas con consumo de SP; se compararon las intoxicaciones etílicas aisladas (grupo 1) con las de otras SP (grupo 2). Resultados: Se incluyeron 333 consultas de 321 pacientes. Su edad media fue 16,1 años (DE: 1,1). Doscientos sesenta y dos pacientes (78,7%) habían consumido alcohol y 110 (33%) habían consumido otras SP. En total, en el grupo 1 se incluyeron 223 consultas y en el grupo 2 se incluyeron 110 consultas. En el grupo 2 se detectó mayor proporción de varones, más residentes en centros de menores y más adolescentes con antecedentes psiquiátricos que en el grupo 1. Asimismo, la distribución de las consultas del grupo 2 fue menos previsible que la del grupo 1. Conclusiones: Las SP generan frecuentemente consultas en el SU. Parece que los adolescentes con problemas psicosociales consumen más SP diferentes del alcohol y sus consultas son menos predecibles en el tiempo (AU)

Background and objectives: To describe psychoactive substances (PS)-related visits of adolescents to the emergency department and to explore possible differential features in patients according to the kind of PS consumed. Patients and methods: Observational and analytic study. PS-related visits of adolescents to the emergency department during 30 months were studied. Patients were divided in two groups: those with alcohol intoxication only (Group_1) and those with other PS (Group_2) and they were compared. Results: 333consults were included, corresponding to 321 patients. Their mean age was 16,1years (SD:1,1years). Two hundred sixty-two(78,7%) were alcohol-related visits, and 110(33%) were related with another PS consumption. Of the 262 alcohol-related visits, 223 were only related with alcohol(Group_1), while the other 110visits made up Group_2. Group_2 was composed of more males, more adolescents placed in Institutional Care and more adolescents with psychiatric records than Group_1. Likewise, distribution of Group_2 visits was less predictable than distribution of Group_1. Conclusions: PS consumption is a frequent major complaint in an Emergency Department. There are more poly-intoxications in males with psycho-social problems. In those cases, consumption seems to happen regardless of the time in the day or the day of the week (AU)

[Psychoactive drugs use and related visits of adolescents to the emergency department]. / Implicación de las sustancias psicoactivas en las consultas de adolescentes en urgencias.

BACKGROUND AND OBJECTIVES: To describe psychoactive substances (PS)-related visits of adolescents to the emergency department and to explore possible differential features in patients according to the kind of PS consumed. PATIENTS AND METHODS: Observational and analytic study. PS-related visits of adolescents to the emergency department during 30 months were studied. Patients were divided in two groups: those with alcohol intoxication only (Group_1) and those with other PS (Group_2) and they were compared. RESULTS: 333 consults were included, corresponding to 321 patients. Their mean age was 16,1 years (SD:1,1 years). Two hundred sixty-two(78,7%) were alcohol-related visits, and 110(33%) were related with another PS consumption. Of the 262 alcohol-related visits, 223 were only related with alcohol(Group_1), while the other 110 visits made up Group_2. Group_2 was composed of more males, more adolescents placed in Institutional Care and more adolescents with psychiatric records than Group_1. Likewise, distribution of Group_2 visits was less predictable than distribution of Group_1. CONCLUSIONS: PS consumption is a frequent major complaint in an Emergency Department. There are more poly-intoxications in males with psycho-social problems. In those cases, consumption seems to happen regardless of the time in the day or the day of the week.

Consultsa urgentes de adolescentes por consumo de alcohol y otras sustancias psicoactivas / Consultations about drugs and alcohol abuse among adolescents in an emergency department

Fundamento. En los últimos años, la edad media de inicio del consumo de alcohol y otras drogas ha disminuido, y las consultas derivadas de su consumo son cada vez más frecuentes en los servicios de urgencias. Objetivo. Documentar el papel del Alcohol y otras Sustancias Psicoactivas (ASP) en las consultas de los adolescentes. Método. Estudio descriptivo observacional de los adolescentes que consultaron en Urgencias durante los años 2007 y 2008 con clínica secundaria al consumo de ASP. Resultados. Se realizaron 263 (1%) consultas con clínica relacionada con ASP (principalmente alteración de la conciencia; 200, 76%). Correspondían a 258 pacientes; cinco (1,9%) consultaron dos veces. La edad media fue de 16,1 (DE 1,1) años; el 50,4% eran chicos. El 76,4% fueron trasladados en ambulancia, con predominio de consultas de viernes a domingo (63,8%) y de 19:00 a 07:00 h (79,1%). En 198 (75,3%) consultas los pacientes presentaban intoxicación etílica, en 149 (75,3%) se determinaron niveles de alcohol en sangre, siendo la concentración media de 191 (DE 53) mg/dl. De las otras drogas, se detectó cannabis en 70 (26,65) consultas, cocaína en 11 (4,2%), anfetaminas en 5 (1,9%), opiáceos en 4 (1,5%) y benzodiacepinas en 3 (1,1%). También hubo dos casos (0,8%) de inhalación de disolventes. Veintiocho (10,6%) casos dieron positivo para dos tóxicos, las combinaciones más frecuentes fueron alcohol-cannabis (14; 50%) y cannabiscocaína (5; 17,8%), y uno (0,4%), por tres (alcohol-cannabis-cocaína). Conclusiones. El consumo abusivo de alcohol es la causa más frecuente de intoxicación en adolescentes. Existe un porcentaje considerable de poli-intoxicaciones. Los fines de semana y las noches son los momentos de más consultas, probablemente por el consumo ligado al tiempo de ocio(AU)

Background. Substance abuse is a public health concern. Lately, the mean age of drug and alcohol consumption initiation has decreased and the number of emergency consultations about their abuse has increased. Objective. To describe the characteristics of adolescents presenting to the emergency department due to drug and alcohol abuse. Method. We conducted an observational and descriptive study of all patients aged 12-18 years presenting to a pediatric emergency department between 1 January 2007 and 31 December 2008 with drugs and/or alcohol abuse symptoms. Results. 263 emergency consultations corresponding to 258 patients were included (there were 5 (1.9%) patients with 2 consultations). Their mean age was 16.1(SD 1.1) years; 50.4% were males. 76.4% of them arrived by ambulance. Patients with substance abuse were overrepresented during the weekend (63.8%) and during the night (79.1%). The decreased level of consciousness was the main symptom in 200 (76%). There were 198 (75.3%) patients with alcohol intoxication, in 149 (75.3%) of them blood ethanol level was determined (mean 191mg/dl; SD 53mg/dl). The other reported drugs were cannabis (70; 26.7%), cocaine (11; 4.2%), amphetamines (5; 1.9%), opiates (4; 1.5%), benzodiazepine (3; 1.1%) and volatile substances (2; 0.8%). In 28 cases (10.6%) two drugs were combined (most frequent combinations: alcohol-cannabis (14; 50%) and cannabis-cocaine (5; 17.8%); and in one (0.4%) three (alcohol-cannabis-cocaine). Conclusions. Abuse of alcohol is the most frequent cause of adolescent intoxication. There is an important proportion of poly-drug abuses. A high number of patients with drug abuse arrive to Emergency Department during weekends and nights, probably in connection with their use of the free time(AU)