[Family impact of rotavirus gastroenteritis in children under two years]. / Impacto familiar de la gastroenteritis por rotavirus en menores de dos años.

INTRODUCTION: Acute gastroenteritis (AGE) in infants has a significant impact on the quality of life of their parents. MATERIAL AND METHODS: Cross-sectional study on the sociological family impact related to rotavirus AGE in children under 2 years. The study was carried out in 25 hospitals and 5 primary care centres in Spain. Sociodemographic, epidemiological and clinical data were recorded, as well as the symptomatology of AGE and its severity measured by the Clark scale. Stool samples were tested to determine rotavirus positive (RV+) or negative (RV-). The parents were asked to complete a a family impact questionnaire. RESULTS: Stool specimens were tested in 1087 AGE cases (584 RV+ vs 503 RV-). The 99.5 % of parents whose children were RV+ reported more worries vs. the 97.7 % of RV-, and RV+ had a higher importance score (p < 0.05). A higher percentage of RV+ parents and those with a high importance score reported more time dedicated to dehydration treatment (p < 0.05). The 82.5 % vs. 73.9 % had disruption of their household tasks, with more importance scores (p < 0.05). RV+ had a higher percentage and importance score than RV- ones in all aspects of their child's AGE symptoms, except loss of appetite. CONCLUSION: AGE produces important dysfunctional experiences in daily family life. According to parental perceptions, RV+ produces greater worries and dysfunctions in child behaviour.

[Hospitalizations for varicella in the Hospital Infantil La Fe, Valencia,Spain, 2001-2004]. / Hospitalizaciones por varicela en el Hospital Infantil La Fe (Valencia 2001-2004).

INTRODUCTION: Varicella is a common, highly contagious disease. It is usually benign but has potentially serious complications. PATIENTS AND METHODS: To assess the clinical characteristics and the associated cost of varicella hospitalization, we reviewed the medical records of children hospitalized for varicella between 2001 and 2004. Children with coincidental varicella hospitalized for a different reason were excluded. RESULTS: Of 1177 children with varicella attended at the emergency room, 101 (8.6 %) were hospitalized. The median age was 3.2 years (21 days to 18.9 years). Twenty-eight children had underlying disease. Thirty-seven children had no complications and the reason for admission was: a) risk of severe varicella (21 immunocompromised children, three neonates), and b) high fever or observation (13 cases). The 64 remaining children were admitted for 66 complications of varicella. The most common complications were skin/soft tissue infections (33 patients) and the leading cause was Streptococcus pyogenes (n = 13) and Staphylococcus aureus (n = 10) isolated in blood or the site of infection. Other complications were pneumonia (13 children), neurological (febrile seizures in nine, meningoencephalitis in two, acute disseminated encephalomyelitis in one, cerebellitis in one), hematological (neutropenia in one, Henoch-Schönlein purpura in one and thrombopenic purpura in three) and osteoarticular (synovitis in one and septic arthritis in one). One patient died of multiorgan failure. During the study period, the rate of emergency room visits due to varicella doubled and the number of admissions for complications tripled. The mean length of hospital stay was 6.8 days (range: 1-28 days) and the total associated cost was 397,314.14 Euro, excluding symptomatic treatment. CONCLUSIONS: The high morbidity associated with varicella and its complications, as well as the high social costs of this disease, support the implementation of routine varicella vaccination. This could reduce the total number of cases, their severity, direct costs, generated by medical care, and indirect costs, generated by the disease and hospitalization.

[Skin and soft tissue infections caused by Haemophilus influenzae type b over a 30 year period]. / Infecciones graves de piel y tejidos blandos por Haemophilus influenzae tipo b a lo largo de 30 años.

INTRODUCTION: The skin and soft tissue infections caused by Haemophilus influenzae type b (Hib) are usually mild but can be potentially serious due to the high probability of bacteremia. Prompt instauration of empiric intravenous antibiotic therapy according to the localization and characteristics of the lesion is mandatory to prevent severe complications. PATIENTS AND METHODS: Of 257 children admitted to the Children's Hospital of La Fe due to invasive Haemophilus influenzae type b disease (1973 to 2003), we reviewed 15 cases (5.8%) of skin and soft tissue infections, their outcome, complications and sequelae. RESULTS: Ten children (66.7%) were aged < 2 years old. In eight patients (53.3%) there was a history of upper respiratory tract infection. Localization was in the head in 9 children (60%) and blood culture was positive in 10 patients (66.7%). Meningitis was a complication in 2 children (13.3%) and limited mobility of the hand was a sequel in one child (6.6%). After the universal establishment of the Hib vaccine in 1997, 3 new patients were admitted; 2 children with an infected thyroglossal cyst and another with cellulitis in the left leg. Of these children, one had received only the three primary doses of the vaccine but not the booster dose, and the remaining two were unvaccinated immigrant children. CONCLUSION: Skin and soft tissue infections caused by Hib are potentially severe diseases with a risk of complications and sequelae. Due to the increase in unvaccinated immigrants and possible vaccine failures, universal immunization and epidemiological surveillance of carriers should be carried out to achieve total eradication.

[Short course treatment for visceral leishmaniasis with liposomal amphotericin B in immunocompetent patients]. / Tratamiento de corta duración de la leishmaniasis visceral con anfotericina B liposómica en pacientes inmunocompetentes.

INTRODUCTION: Visceral leishmaniasis is endemic in southern Europe. Traditional treatment consists of pentavalent antimonial compounds. However, treatment failures, the treatment's long duration, and toxicity have led to the introduction of new therapies, such as liposomal amphotericin B (LAB). In this study we evaluate the safety and efficacy of LAB at a maximum dose of 4 mg/kg/day on days 1, 2, 3, 4, 5, and 10. PATIENTS AND METHODS: A prospective, observational, open study was conducted in 13 Spanish centers. The diagnosis of visceral leishmaniasis was based on visualization of Leishmanias sp. in bone marrow aspirate or culture or positive serology together with compatible clinical symptoms. RESULTS: Thirty-two immunocompetent children aged from 7 months to 7 years were treated. All the children had rapid clinical response and bone marrow aspirate performed on day 21 was normal in the 24 patients (100 %) who underwent this procedure. In the remaining eight children efficacy was assessed by clinical response. Two relapses were observed. Cure was achieved in 18 patients (90.0 %) and in 87.5 % of the patients with microbiological confirmation of the disease. No adverse events were detected. CONCLUSIONS: A total dosage of 24 mg/kg of liposomal amphotericin B administered in 6 doses within 10 days is safe and effective for the treatment of visceral leishmaniasis and reduces the length of hospital stay.

[Epidemiologic study of 245 cases of children hospitalized with measles]. / Estudio epidemiológico de 245 casos de niños ingresados por sarampión.

OBJECTIVE: The object of the present study is an analysis of the characteristics common to children hospitalised because of measles. DESIGN: A retrospective descriptive study was made of all the children in hospital with measles over a six month period. SITE. The study was carried out in the Hospital Infantil La Fe, in Valencia. PATIENTS OR OTHERS PARTICIPANTS: All of the children taken into hospital between January 1983 and December 1988, with diagnosed measles as a stated factor in their hospitalisation, aged between 4 months and ten years. INTERVENTION: Treatments were extremely varied, depending on the symptoms of the patient. In most cases an antithermic or analgesic was administered (70%). MEASUREMENTS AND MAIN RESULTS: The data was compiled from clinical histories. We note two epidemics, in 1983 and 1987. 58% of the children were less than 3 years old, and the average age observed was 2.73 years (SD = 2.40). The standard rate of body mass, (PE-IMC) in 81% of the cases, averaged -1.129, and the SD was 1.431, significant with respect to the general population (p 0.001). Only 14% of the children had been previously vaccinated. 76% of the children presented complications. CONCLUSIONS: New risk factors were not identified. Most notable was the importance of nutritional state and correct vaccination.

[Single or double dose of vaccine needed for the eradication of measles in Spain?]. / Una o dos dosis de vacuna para erradicar el sarampión en España?

A descriptive and retrospective epidemiological study of measles vaccinations was realized. This study involved 112 children hospitalized in Valencia (Spain) for measles during the period from January 1983 to December 1988. We compared children that had received vaccination and those children that had not. Statistically significant differences were observed in regards to the age of the child (p < 0.025) and the year in which the cases were diagnosed (p < 0.05). The evolution of measles in Spain and in the United States shows the need for revaccinations, as well as the need to augment the coverage of vaccinations in order to eradicate this disease.

[Nutritional status in HIV infection in infancy]. / Estado nutricional en la infección por el virus de la inmunodeficiencia humana en la edad pediatría.

The physiopathology of malnutrition among AIDS, ARC and HIV infected children was reviewed. One-hundred eight-three newborns were studied, 152 of which were born at "La Fe" Maternity Hospital. Of these patients, 29% were LBW and 28% preterm. Transfused and hemophiliac patients were excluded from the study. Anorexia, vomiting, fever, infections of the respiratory and GI tracts and drug therapy were the most frequent factors affecting the nutritional status. Fifty-three newborns were infected with the HIV (29%). The children were classified into three groups (G). Group-I was formed by HIV+children > 18 months of age, G-II, P-2 class by children < 18 months of age and G-III was formed by those children that died of AIDS. The most common symptoms were chronic diarrhea and infections of the respiratory tract. Of the HIV+children > 18 months of age, 65% had a weight < the 10th percentile and 61% were < the 10th percentile for height. Of the children that died of AIDS, 80% were in the lower 10th percentile for both weight and height. Hemoglobin, T4/T8, total proteins, seroalbumin and calcium were also negatively affected. Those most severely affected were the dead patients, followed by P-2 < 18 months and finally the HIV+ > 18 months of age. The differences between G-I and G-II-G-III were statistically significant, p < 0.01. The biochemical quantification of the nutritional status was difficult due to the limited amount of blood available. HIV infected children require nutrition supplementation to maintain an adequate nutritional status. Among these patients, malnutrition is a multifactorial phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)

[Social and family characteristics in children born to women infected by the human immunodeficiency virus]. / Características sociofamiliares de los niños nacidos de mujeres infectadas por el virus de la inmunodeficiencia humana.

OBJECTIVES: To evaluate the social and family characteristics of children born to women infected by the human immunodeficiency virus (HIV). As secondary objectives, to analyse their schooling and the number of hospital admissions and lengths of stay that these children required. DESIGN: A prospective observation study. SETTING: HIV unit in a children's hospital. INCLUSION CRITERIA: all the children recruited from the HIV unit who had their infection status defined during the study period, understood as between the first known case in 1985 and April 1994. The sample included 177 children (62 HIV-infected and 115 not infected). MEASUREMENTS AND MAIN RESULTS: Through an interview the social, family and school variables were collected. On comparison between infected and non-infected children, there were no important differences as to the lack of protection of the new-born (8.1% vs 13%), scant mother-child relationship (31.2% vs 36.5%) or people responsible for the custody of these children. Less schooling and greater problems of school integration were detected in infected cases, with odds ratios of 2.68 (p = 0.004) and 11.36 (p = 0.004), respectively. Children infected also needed more admissions (4.3 +/- 5.7) than the non-infected (1.7 +/- 0.9) (p = 0.001), and more days of hospital stay (75.1 +/- 110.3 vs 23.3 +/- 19.6) (p = 0.0003). CONCLUSIONS: Infected children and non-infected children had similar social and family characteristics. However, less schooling, problems of school integration, and more and longer hospital admissions were related to HIV infection in children, and not so much to their status as children of seropositive mothers.

[Vertical transmission rate of the immunodeficiency virus: determinant factors and comparison of results]. / Tasas de transmisión vertical del virus de la inmunodeficiencia humana: factores determinantes y comparación de resultados.

Although all newborns to HIV-seropositive mothers have IgG anti-HIV antibodies, since these antibodies cross the placental barrier, only a small proportion of these children are actually infected with the virus. The main objective of this study consisted in estimating the vertical transmission rate of HIV in our environment. A prospective review was conducted of 236 children with HIV infection risk as they were born to HIV seropositive mothers. To calculate the mother-to child transmission we selected only 121 children controlled from birth and for a minimal time of 18 months at Hospital Infantil La Fe. Twenty-one out of these definitely classified 121 children were infected, representing a rate of 16.5%, similar to the rate reported in other European studies. By means of the stratified analysis some factors related to an increased transmission risk for HIV from mother to child were investigated. The possible causes that can explain the variability in the calculated rates for the different groups of investigation since the first pediatric AIDS case was detected are also discussed.

[Lumbosacral dermal sinus as entry point of purulent meningitis. Report of 3 cases]. / Seno dérmico lumbo-sacro como puerta de entrada de meningitis purulenta. Presentación de tres casos.

Defects of neural tube closure, although minimal, can provide access for infections of the central nervous system. All skin alterations in rear middle line of the body, however, minimal, must be carefully investigated as they could give access to bacterial meningitis. We present three new cases of dermal lumbosacral sinus which went unnoticed in the neonatal period later becoming the access point for bacterial meningitis.

[Delay in childhood tuberculosis detection as a negative factor in the anti-tuberculosis struggle]. / El retraso en la detección de tuberculosis infantil como factor negativo en la lucha antituberculosa.

Childhood morbidity due to tuberculosis infection in Spain is not diminishing at the expected rate in relation with available knowledge and facilities. An important factor is the delay in diagnosis, which evaluation constitutes the objective of this publication. Said delay is due to several causes, patient does not consult on time (mean value between onset of symptoms and consult is 34.3 days), or physician does not think in tuberculosis as first diagnosis, which meant an added mean delay of 7.6 days more. These delays mean an important detriment for the patient, and one of the objectives in the anti-tuberculosis struggle is to shorten delays through information to the lay public and health professionals on the highly important current issue of tuberculosis.

[Haemophilus influenzae type b osteoarthritis. A report of 7 cases and a review of the literature]. / Osteoartritis por Haemophilus influenzae tipo b. Presentación de 7 casos y revisión de la literatura.

OBJECTIVE: The epidemiological and clinical characteristics, treatment and evolution of osteoarthritis by Haemophilus influenzae type b (HIB) are reviewed since there has been little published on this subject in our country. PATIENTS AND METHODS: The clinical histories of the 7 children with osteoarthritis due to Hib infection are reviewed. The diagnostic criteria included classical signs and symptoms of septic arthritis, radiological alterations compatible with joint infection and isolation of microorganisms in joint effusion and/or in the blood. RESULTS: During a 24-year period (1973-1996), 248 cases of invasive infection by Hib were documented. Seven cases (2.82%) had osteoarticular infections. The ages were between 5 and 7 years and there were more males than females (71.4% vs. 28.6%). Four children/58%) had previous upper respiratory infections (URI). The microorganism was isolated in the joint effusion in 5 children and in the blood sample of the other 2. C-reactive protein was high and radiology showed alterations in 100% of the cases. Surgical treatment with articular drainage was necessary in 5 children/71.4%). In 6 cases (85.7%) initial medical treatment was i.v. beta-lactam antibiotics for 2-3 weeks followed by oral antibiotic treatment for a minimum of 6 weeks. Three children (42.8%) had sequelae. CONCLUSIONS: Early diagnosis of bacterial osteoarthritis by Hib is difficult. Final therapeutical success depends on an early clinical diagnosis and aggressive multidisciplinary treatment. Drainage of the hip joint is mandatory for successful outcome. Currently, arthritis by Hib can be avoided and its sequelae prevented by vaccination.

[Pneumonia due to Haemophilus influenzae type b in children: presentation of 24 cases]. / Neumonía por Haemophilus influenzae tipo b en niños: presentación de 24 casos.

OBJECTIVE: Due to the higher incidence in invasive infections, the changes observed in the sensitivity of this microorganism during the last decade and the seriousness of pulmonary infections in children, the objective of this paper is to review the clinical and epidemiological characteristics of Haemophilus influenzae type b (Hib) pneumonia, as well as to give an update of treatment. PATIENTS AND METHODS: Twenty-four children diagnosed between 1973 and 1992 are reviewed using the following criteria: clinical manifestations of pneumonia, radiology and isolation of the microorganism. RESULTS: The annual average was 7.8 cases/100,000 children under 5 years of age. More females were affected (58.3% vs 41.6%). Of the cases studied, 58.3% of the children were under one year and 83.3% under 2 years of age. Fever was the most common clinical manifestation (95.8%). Blood cultures were positive in 21 cases (87.5%); pleural effusion culture contributed to the diagnosis in two other cases (8.3%) and deep bronchial aspirate in one other case. Of the Haemophilus influenzae type b strains 62.5% were resistant to ampicillin and 100% were sensitive to second and third generation cephalosporins. Three infants with chronic illness died (12.5%). CONCLUSIONS: Hib pneumonia is an infection usually affecting children younger than 2 years of age. Its clinical manifestations are indistinguishable from those of other microorganisms. Blood culture is the most useful technique to confirm the diagnosis. The increase in resistance to classical treatment (ampicillin) obliges us to consider amoxicillin-clavulanic as the selected empirical treatment. Second and third generation cephalosporins may be considered a good alternative. There is a high mortality in children with chronic illness.

[Pyriform sinus fistulae]. / Fístulas de seno piriforme.

Pyriform sinus fistulae (PSF) are rare branchial pouch anomalies. In most previously described cases the anomaly is located on the left side. PSF should be suspected in cervical inflammatory processes (cervical abscesses and types of suppurative thyroiditis). We report two cases of acute thyroiditis and deep cervical abscesses secondary to PSF, which were diagnosed and treated in our hospital in the last 2 years. Both presented inflammatory cervical masses associated with painful swallowing, high fever and laboratory findings compatible with acute infection. In both cases the diagnosis of PSF was confirmed by barium esophagogram. Cervical ultrasonography and computed tomography were also performed. The treatment of choice consists of broad-spectrum antibiotic therapy during acute exacerbation and subsequent fistulectomy. Definitive surgical treatment prevents recurrences.

Gastroenteritis vírica en niños hospitalizados. Estudio prospectivo multicéntrico / Viral gastroenteritis in hospitalized children. A multicentre prospective study

Introducción: El objetivo de este estudio fue determinar prospectivamente la etiología vírica de la gastroenteritis aguda (GEA) en lactantes hospitalizados, así como describir las características clínicas de los principales virus. Pacientes y métodos: Desde octubre de 2006 hasta marzo de2007, se realizó el seguimiento de todos los niños de 1-23 meses de edad hospitalizados en tres hospitales, desde el momento de la admisión hasta las 72 horas tras el alta, para detectarla presencia de GEA. Se analizó una muestra de heces de los niños con GEA para la detección de rotavirus, calicivirus (norovirus y sapovirus), astrovirus y adenovirus mediante transcripción inversa y reacción en cadena de la polimerasa. Resultados: De un total de 1.576 pacientes hospitalizados, se pudo realizar el seguimiento de 1.300 (82,5%), que han constituido nuestra cohorte de estudio. Un total de 242 niños tuvieron GEA (un 18,6% de la cohorte), obteniéndose muestra de heces de 217 (89,7%). En 91 casos (42%) se detectaron rotavirus, en 72 norovirus (33,2%), en 7 astrovirus (3,2%) y en2 adenovirus; no se detectó sapovirus en ningún caso. Trece niños (6%) presentaron infecciones mixtas por dos o más virus, y 32 (14,7%) resultaron negativos para todos los virus analizados. En los casos de GEA por norovirus se observa menor apatía y pérdida de peso que en los casos de rotavirus, pero mayorporcentaje de heces con sangre.Conclusiones: Los virus son una causa frecuente de GEA enlos niños menores de 2 años hospitalizados; el principal virus hallado es el rotavirus, seguido del norovirus. Debido a las escasas diferencias clínicas observadas entre rotavirus y norovirus, es necesaria su determinación analítica para su diferenciación (AU)

Introduction: The objective of this study was to determine prospectively the viral etiology of acute gastroenteritis (AGE) in hospitalized weaning babies and describe the clinical characteristics of the principal virus detected. Patients and methods: All children aged 1 to 23 months admitted to 3 hospitals during October 2006-March 2007 were followed for the presence of AGE from the time of hospital admission until 72 hours after hospital discharge. A stool sample of children with AGE was tested for calicivirus (norovirus and sapovirus), rotavirus, adenovirus and astrovirus by RT-PCR. Results: Of the 1,576 hospitalized children, 1,300 (82.5%)were fully monitored being our study cohort. A total of 242children had AGE (18.6% of the cohort) and stool samples from217 children were obtained (89.7%). In 91 cases (42%) were positive to rotavirus, 72 (33.2%) to norovirus, 7 (3.2%) to astrovirus, and in 2 to adenovirus, not detecting sapovirus in any case, 13 children (6%) showed mixed infections by two or more viruses and 32 (14.7%) cases were negative for the analyzed virus. Norovirus AGE have less apathy and weight loss than thecases of rotavirus but a higher percentage of stools with blood. Conclusions: The viruses are a frequent cause of AGE among the hospitalized children of less than 2 years of age being rotavirus the principal virus found followed by norovirus. Few clinical differences were observed between rotavirus and norovirus and analytical determination is necessary for their differentiation (AU)