Prevalence and clinical characteristics of human metapneumovirus infections in hospitalized infants in Spain.

Human metapneumovirus (hMPV), a condition recently described in the Netherlands, causes lower respiratory infections, particularly in young children and among the elderly. The objective of this study was to describe the characteristics of hMPV infections in hospitalized infants <2 years of age and to compare them to those of infections caused by respiratory syncytial virus (RSV). A prospective study was conducted on the clinical characteristics of infants admitted to hospital for respiratory infection through 5 years. Simultaneous detection of influenza A, B, and C viruses, RSV, and adenoviruses was performed in clinical samples by multiple reverse transcription nested-PCR assay. The presence of hMPV was tested in all samples using two separate RT-PCR tests. Some respiratory virus was detected in 70.5% of the 1,322 children included in the study. hMPV was found in 101 of the positive nasopharyngeal aspirates (10.8%), and was the most common virus after RSV and rhinovirus. Peak incidence was found in March. Over 80% of children were <12 months. The more common diagnoses were bronchiolitis (49.5%) and recurrent wheezing (45.5%). Fifty-four percent of cases required oxygen therapy and, one percent, assisted ventilation. Thirty percent were co-infections, with clinical characteristics indistinguishable from single infections. Seventy-one hMPV single infections were compared to 88 RSV single infections. hMPV infections were significantly more frequent than RSV in infants older than 6 months (P = 0.04). Recurrent wheezing was diagnosed more frequently in hMPV patients (P = 0.001). All other variables tested were similar, in both groups. hMPV was the third most frequent virus after RSV and rhinovirus in infants <2 years of age, hospitalized for respiratory infection, and was associated with bronchiolitis and recurrent wheezing. hMPV predominantly occurred in spring. Co-infections were frequent and clinically similar to single infections and RSV infections.

Role of emerging respiratory viruses in children with severe acute wheezing.

BACKGROUND: Acute wheezing episodes are frequently associated with respiratory viral infections in children. However, the role of the recently described respiratory viruses is not yet fully understood. OBJECTIVE: The main objective of this study was to estimate the frequency of human metapneumovirus (HMPV), human bocavirus (HBoV), and 14 other respiratory viruses in hospitalized children with acute wheezing. METHODS: A prospective study was conducted on children <14 years old, admitted with an acute expiratory wheezing episode from September 2005 to June 2008. Viruses were detected in nasopharyngeal aspirates by polymerase chain reaction. Clinical data were prospectively recorded. RESULTS: A viral pathogen was identified in 444 (71%) out of 626 hospitalized acute wheezing episodes. Respiratory syncytial virus (RSV) was the most frequently detected (27%), followed by rhinovirus (24%), adenovirus (17.8%), HBoV (16%), and HMPV (4.7%). The rate of viral detection was significantly higher in infants (77.3%), than in older children (59.8%) (P < 0.001). RSV and HBoV were more prevalent in infants (P < 0.001) than in older children. CONCLUSION: The most prevalent viruses found in severe acute wheezing episodes were RSV and rhinovirus not only in childhood, but also in infancy. However, other emerging viruses such as HBoV and metapneumovirus also play an important role in wheezing episodes.

Biochemical features of dietary chloride deficiency syndrome: a comparative study of 30 cases.

The diagnosis in one infant of a severe state of chloride deficiency after ingesting a diet consisting exclusively of a modified cow milk formula containing only 0.5 mEq/100 kcal chloride ion led to the identification of 30 additional infants (age 2.6 +/- 0.7 months) fed the same commercial formula. The total absence of chloride in the urine was used as a biochemical index of subclinical dietary chloride deficiency. Serum and urine values were studied at diagnosis and 10 to 12 days after chloride replenishment, and compared statistically with the values obtained in a control group of 40 infants (age 2.8 +/- 1.2 months) fed exclusively a different modified formula containing an adequate chloride concentration. The outstanding laboratory abnormalities noted in the infants ingesting a low chloride formula were hypochloremia and metabolic alkalosis. Mean serum concentrations of potassium, urea, creatinine, and uric acid were in the normal range, but group values were statistically different from normal. A previously unreported finding was the demonstration of a significant elevation in the serum concentrations of calcium and phosphate and in the urinary excretions of calcium and magnesium, which persisted after almost complete recovery of the remaining biochemical disturbances. These results indicate the potential risk of nephrocalcinosis after dietary chloride deficiency.

[Ebstein's anomaly of the tricuspid valve. Study of 13 cases in childhood]. / Anomalía de Ebstein de la válvula tricúspide. Estudio de 13 casos en la infancia.

We describe 13 cases of Ebstein's anomaly of the tricuspid valve. Seventy percent of there cases were detected at one month of age. Ten patients died and 9 presented associated cardiac anomalies. Signs of right heart failure were the clinical date that made possible the diagnosis of the disease in the most severe cases in the neonatal period. Only two patients had alteration of the cardiac rhythm: One had tachycardia that ended with ventricular fibrillation and the other had a 2:1 heart block. Echocardiography was very useful to establish the diagnosis: one hundred percent of the patients showed a delay in closing of the tricuspid in relation to the mitral valve, with a range of 0,03 to 0,06 seconds. Angiocardiographic studies revealed a tricuspid valve displacement in 8 cases, and double contour image in 6. The septal and posterior leaflets were hypoplasic in the 10 anatomic cases and in 80 percent of them it was possible to differentiate the cords from the papillary muscles.