is the main aetiologic agent of osteoarticular infections (OAIs) in paediatric patients. The aim of this prospective unicenter study was to describe the phenotypic and genotypic characteristics of
...isolates obtained from OAIs in paediatric patients admitted to tertiary care hospital. Through a surveillance program called
, a multidisciplinary team was created and we identified 27 patients with OAIs caused by
from 2019 to 2021. The susceptibility profile, virulence factors, biofilm formation, pulsed-field gel electrophoresis (PFGE), clonal complex (CC) and sequence type (ST) were determined. In addition, the clinical characteristics and evolution of the patients presented six months after the diagnosis of OAIs were described. Ninety-two percent of the isolates were methicillin-sensitive
(MSSA). In methicillin-resistant
(MRSA), SCC
II and SCC
V were detected. The
gene was only observed in MSSA (18.5%) and was associated with highest fever (
=0.015), multiple localization (
0.017), and soft tissue sites of infection beyond the bone (pyomyositis, pulmonary abscess) (
0.017). Biofilm formation was detected in 55.6% of isolates. The most common CC were CC5 and CC30 which represent the most common linages for bone and joint infections worldwide. The isolates were distributed in different STs, and ST672 was predominant. MRSA were associated with a longer duration of intravenous treatment and a prolonged hospital stay (
0.023). Recurrent infection occurred in five children and orthopaedic complications in 33.3% of patients. This is the first study that reflects the epidemiology of
in OAIs in paediatric patients in Mexico; a clear predominance of MSSA distributed in different STs was observed. Our findings highlight that a multidisciplinary team is required for the diagnosis and treatment of OAIs.
Mendelian susceptibility to mycobacterial disease (MSMD) is a rare genetic disorder characterized by impaired immunity against intracellular pathogens, such as mycobacteria, attenuated
Mycobacterium ...bovis
-Bacillus Calmette–Guérin (BCG) vaccine strains, and environmental mycobacteria in otherwise healthy individuals. Retrospective study reviewed the clinical, immunological, and genetic characteristics of patients with MSMD in Mexico. Overall, 22 patients diagnosed with MSMD from 2006 to 2021 were enrolled: 14 males (64%) and eight females. After BCG vaccination, 12 patients (70%) developed BCG infection. Furthermore, 6 (22%) patients developed bacterial infections mainly caused by
Salmonella
, as what is described next in the text is fungal infections, particularly Histoplasma. Seven patients died of disseminated BCG disease. Thirteen different pathogenic variants were identified in
IL12RB1
(
n
= 13),
IFNGR1
(
n
= 3), and
IFNGR2
(
n
= 1) genes. Interleukin-12Rβ1 deficiency is the leading cause of MSMD in our cohort. Morbidity and mortality were primarily due to BCG infection.
En esta carta al editor se comentan estrategias preventivas para prevenir la infección por COVID-19, que complementan a las universalmente aceptadas (lavado de manos, aseo bucal frecuente, el manejo ...correcto de la tos y/o el estornudo, mantener la sana distancia, el uso constante de cubre bocas), si se está frente una población infanto-juvenil con alguna comorbilidad o ante una población aparentemente sana.
Niño de 1 año 10 meses de edad, originario de Irapuato, Guanajuato, sin antecedentes de importancia para el padecimiento actual. Inició dos meses previos a su ingreso con crisis convulsivas ...tónico-clónicas generalizadas de 15 segundos de duración durante el sueño. Se realizó electroencefalograma que reportó actividad epileptiforme, por lo que se dio tratamiento con ácido valproico. Una semana previa al ingreso se agregó ataxia troncal impidiendo la marcha, por lo que se realizó una tomografía axial computarizada de cráneo en la que se observó un tumor en fosa posterior con densidad heterogénea y áreas de necrosis central que obliteraba el cuarto ventrículo, ocasionando efecto de masa y desplazamiento ventral del tallo cerebral. Por tal motivo, fue referido a nuestra institución.
PRESENTACIÓN La infección por VSR sigue siendo la primera causa de hospitalización por infección de vías aéreas inferiores en niños en nuestro país y a nivel global. Se calculan más de 3.6 millones ...de hospitalizaciones por esta causa en todo el mundo y más de 26,000 defunciones anualmente. La mayor incidencia de hospitalizaciones ocurre en lactantes menores de seis meses, y ciertos grupos son particularmente vulnerables, los cuales tienen un riesgo incrementado de hospitalizaciones y muerte asociadas a infección por VSR. Este grupo de pacientes, que será definido y tratado en este documento, es candidato a recibir estrategias de prevención que hayan demostrado disminuir el riesgo de un mal desenlace en salud. Este documento constituye la Guía de Práctica Clínica (GPC) elaborada por iniciativa de la Academia Mexicana de Pediatría en colaboración con la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con el objetivo de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario de expertos clínicos y metodológicos. Las meta este documento son brindar recomendaciones para disminuir el riesgo de infección por VSR tanto en la comunidad como en el ámbito hospitalario, principalmente en lactantes que tienen un riesgo incrementado de complicaciones y muerte. Este documento cumple con estándares internacionales de calidad, como los descritos por el Instituto de Medicina de Estados Unidos de América (EUA) (IOM, por sus siglas en inglés), el Instituto de Excelencia Clínica de Gran Bretaña (NICE, por sus siglas en inglés), la Red Colegiada para el Desarrollo de Guías de Escocia (SIGN, por sus siglas en inglés) y la Red Internacional de Guías de Práctica Clínica (G-I-N, por sus siglas en inglés). Se integró un Grupo de Desarrollo interdisciplinario de expertos clínicos y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Se condujo un proceso de panel Delphi modificado para extraer la opinión de los expertos y lograr un nivel de consenso adecuado en cada una de las cinco recomendaciones clave contenidas en este documento. Esperamos que este documento contribuya a apoyar la toma de decisiones de profesionales de la salud, elaboradores de políticas públicas, representantes de pacientes y sus cuidadores para lograr una mejor calidad en la atención y sobre todo disminuir la carga de la enfermedad por infección por VSR en este grupo vulnerable.
Abstract
Background
Osteoarticular infections are serious invasive pathologies in the pediatric population. They have high morbidity, especially if antimicrobial treatment is inadequate and late. ...Based on pediatric series patients with osteomyelitis require prolonged antibiotic schemes, long stay and high hospital costs, multiple surgical procedures and develop short and long-term sequelae.
Methods
A retrospective, observational, longitudinal and analytical study was conducted in patients under 17 years of age diagnosed with osteomyelitis at the National Institute of Pediatrics from January 2009 to January 2019. Demographic information, clinical presentation, microbiological, treatment and six-month follow-up were recorded.
Results
A total of 109 patients were included, 57 (52%) males with median age of 98 (1-205) months with predominance in previous healthy (66%). By temporality, the chronic form predominated in 72%. The history of trauma was identified in 26% and fracture 19%. The most affected bone was femur 26%. Blood culture was performed in 55%, secretion culture in 52.2% with isolation in 56%. Methicillin-susceptible Staphylococcus aureus (MSSA) was the main agent identified. Complications occurred in 37%, the most frequent was surgical wound infection in 13% followed by fracture 11%. Risk factors for complications were chronic osteomyelitis RR 5.7 (CI 1.8-17.9), Sepsis/Shock RR 3.8 (CI 1.08-13-8) and MSSA infections RR 2.7 (CI 1.01-7.5); Risk factors for surgical site infection included initial fracture RR 3.5 (CI 1-11), local ulcer RR 4.2 (CI 1.3-13.06) and MSSA infection RR 5.9 (CI 1.8-19.4). Risk factors for limitation to movement included chronic osteomyelitis RR 4.87 (CI 1.6-14), fever RR 2.5 (CI 1.15-5.5), Sepsis/shock RR 5.3 (CI 1.3-20) (p 0.013) and MSSA infection RR 4.1 (CI 1.4-11.9).
Conclusion
Osteomyelitis is still a health problem in our country. The diagnosis of osteomyelitis may be challenging as lack of suspicion often leads to delayed diagnosis. Knowledge of the risk factors for complications in pediatric patients could be useful to give early and proper antibiotic and surgical treatment. It is a priority to have a multidisciplinary team for the diagnosis and treatment of osteoarticular infections.
Disclosures
All Authors: No reported disclosures
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