Aim
Acute Epstein–Barr virus (aEBV) and cytomegalovirus (CMV) infections frequently have similar manifestations. We aim to evaluate the characteristics of aEBV infection, risk factors for ...hospitalisation and differences according to CMV IgM detection (EBV‐CMV co‐detection) in children.
Methods
Retrospective, single‐centre study including patients <16 years diagnosed with aEBV infection (positive anti‐EBV IgM/Paul‐Bunnell test and acute symptomatology). EBV‐CMV co‐detection was defined as positive CMV IgM. Factors associated with age, hospitalisation and EBV‐CMV co‐detection were analysed in a multivariate analysis.
Results
A total of 149 patients were included (median age 4.6 years). Most frequent manifestations were fever (77%), cervical lymphadenopathy (64%) and elevated liver enzymes (54%). Younger children had lower rate of positive Paul‐Bunnell test (35% vs. 87%; p < 0.01), but higher rate of EBV‐CMV co‐detection (54% vs. 29%; p = 0.03). These children tended to have less typical symptoms of infectious mononucleosis and higher hospitalisation rate. The overall antibiotic prescription was 49%. Hospitalisation (27 children; 18%) was independently associated with prior antibiotic therapy and anaemia. Sixty‐two cases (42%) had EBV‐CMV co‐detection, which was independently associated with elevated liver enzymes and younger age.
Conclusion
In this study, younger children with aEBV infection presented more frequently with atypical clinical symptoms, had higher EBV‐CMV co‐detection rates and were more often hospitalised. Hospitalisation was associated with prior antibiotic prescription.
Invasive fungal disease (IFD) is a significant cause of morbimortality in children under chemotherapy or hematopoietic stem cell transplant (HSCT). The purpose of this study is to describe the ...changes in the IFD epidemiology that occurred in a Pediatric Hematology-Oncology Unit (PHOU) with an increasing activity over time.
Retrospective revision of the medical records of children (from 6 months to 18 years old) diagnosed with IFD in the PHOU of a tertiary hospital in Madrid (Spain), between 2006 and 2019. IFD definitions were performed according to the EORTC revised criteria. Prevalence, epidemiological, diagnostic and therapeutic parameters were described. Comparative analyses were conducted using Chi-square, Mann-Whitney and Kruskal-Wallis tests, according to three time periods, the type of infection (yeast vs mold infections) and the outcome.
Twenty-eight episodes of IFD occurred in 27 out of 471 children at risk (50% males; median age of 9.8 years old, IQR 4.9-15.1), resulting in an overall global prevalence of 5.9%. Five episodes of candidemia and 23 bronchopulmonary mold diseases were registered. Six (21.4%), eight (28.6%) and 14 (50%) episodes met criteria for proven, probable and possible IFD, respectively. 71.4% of patients had a breakthrough infection, 28.6% required intensive care and 21.4% died during treatment. Over time, bronchopulmonary mold infections and breakthrough IFD increased (p=0.002 and p=0.012, respectively), occurring in children with more IFD host factors (p=0.028) and high-risk underlying disorders (p=0.012). A 64% increase in the number of admissions in the PHOU (p<0.001) and a 277% increase in the number of HSCT (p=0.008) were not followed by rising rates of mortality or IFD/1000 admissions (p=0.674).
In this study, we found that yeast infections decreased, while mold infections increased over time, being most of them breakthrough infections. These changes are probably related to the rising activity in our PHOU and an increase in the complexity of the baseline pathologies of patients. Fortunately, these facts were not followed by an increase in IFD prevalence or mortality rates.
Abstract
The SARS-CoV-2 pandemic has caused an increase in antibiotic use in different settings. We describe the antibiotic prescribing prevalence, associated factors and trends, as well as ...concomitant bacterial infections in children hospitalized with COVID-19 or multisystemic inflammatory syndrome related to SARS-CoV-2 in Spain.
La gripe es una amenaza constante que en ocasiones puede producir cuadros clínicos graves. Las mayores tasas de incidencia por grupos de edad ocurren en los menores de 15años, especialmente en los ...menores de 5años, en los que además las tasas de hospitalización son similares a las de las personas de 65años en adelante. Además, los niños son los principales vectores de transmisión de la enfermedad. En España están autorizadas cinco vacunas antigripales en la edad pediátrica: tres inactivadas tetravalentes procedentes de cultivos en huevos embrionados, una inactivada tetravalente procedente de cultivos celulares, y una atenuada tetravalente de administración intranasal, que para la temporada 2024-2025 pasará a ser trivalente, al no incluir el linaje BYamagata, como recomienda la OMS. El CAV-AEP recomienda la vacunación sistemática en: niños de 6 a 59meses, niños y adolescentes pertenecientes a grupos de riesgo, personas que puedan transmitir la gripe a los grupos que tienen riesgo de gripe complicada, y convivientes o entorno familiar de menores de 6meses. A partir de los 2años de edad se recomienda preferentemente la vacuna atenuada intranasal por su mayor aceptabilidad y por facilitar la mejora de las coberturas. El CAV-AEP considera también que la vacunación antigripal de niños y adolescentes de 5-18años sanos es una medida recomendable, por cuanto les proporciona protección individual y favorece la protección familiar y comunitaria. Es especialmente importante la vacunación antigripal de todos los profesionales sanitarios y la vacunación de las gestantes en cualquier momento del embarazo.
The flu is a constant threat that can sometimes cause severe forms of disease. The highest incidence rates by age group occur in children under 15years of age, especially in those under 5years, in whom the rate of hospitalization is also similar to the population aged 65years and older. In addition, children are the main transmitters of the infection. In Spain, five influenza vaccines are authorized for the paediatric age group: three inactivated tetravalent vaccines harvested from fertilised eggs, one tetravalent inactivated vaccine obtained from cell cultures, and one attenuated tetravalent vaccine for intranasal administration, which will become trivalent in the 2024-2025 season by excluding the BYamagata lineage as recommended by the WHO. The CAV-AEP recommends systematic vaccination in children aged 6 to 59months, children and adolescents belonging to risk groups, people who can transmit the flu to groups at risk of complicated flu, and household contacts or close family of infants under 6months. From 2years of age, the intranasal attenuated vaccine is preferred due to its greater acceptability and thus contribution to greater vaccination coverage. The CAV-AEP also considers that vaccination against influenza of healthy children and adolescents aged 5 to 18years is advisable, as it provides individual protection and promotes protection at the family and community levels. It is especially important to vaccinate all health care professionals against influenza as well as pregnant women at any time during the pregnancy.
Thanks to advances in antiretroviral treatment, children with HIV infections through vertical transmission have improved their life expectancy. However, new challenges have emerged. We propose this ...study in order to determine the psychosocial aspects and knowledge of infections in a cohort of adolescents with vertically transmitted HIV infections.
Patients with vertically-acquired HIV infection between 12 and 19 years old were included. Data were obtained through semi-structured interviews and a Strengths and Difficulties Questionnaire for emotional and behavioral disorders screening.
We evaluated 96 patients (58% females) with a median age of 15 years (11-19.1) and a median age at diagnosis of 1.70 years (0-12.2). The median CD4 count was 626cells/mm(3) (132-998), and the viral load was<50cp/ml in 72% of patients. Among them, 90% attended school and 60% repeated at least one course. Although 81% of them knew of their diagnosis, only 30% understood their disease, with 18.2% having discussed it with friends. Six unwanted pregnancies occurred during the study period. Strengths and Difficulties Questionnaire showed hyperactivity risk in 33%.
A high percentage of adolescents show difficulties in several areas (disease knowledge, peer relationship, school failure...) that can have an impact on their adult lives. Further studies are needed to evaluate their origin and development in depth, as well as interventions to modify this situation.
BACKGROUND:Kingella kingae is an emergent pathogen causing septic arthritis (SA) in children.The objective of this study was to analyze the etiology of SA in children before and after the ...implementation of universal 16S rRNA gene polymerase chain reaction and sequencing (16SPCR) in synovial fluid.
METHODS:Children ≤14 years with acute SA from a Madrid cohort (2002–2013) were reviewed. Differences in etiology were analyzed before (period 1) and after (period 2) the implementation of bacterial 16SPCR in 2009. A comparison in epidemiology, clinical syndromes, therapy and outcome between infections caused by K. kingae and other bacteria was performed.
RESULTS:Bacteria were detected from 40/81 (49.4%) children, with a higher proportion of diagnosis after 16SPCR establishment (period 2, 63% vs. period 1, 31.4%; P = 0.005). The main etiologies were Staphylococcus aureus (37.5%) and K. kingae (35%), although K. kingae was the most common microorganism in P2 (48.3%). Children with K. kingae SA were less likely to be younger than 3 months (0 vs. 42.3%; P < 0.001), had less anemia (21.4 vs. 50%; P = 0.010), lower C-reactive protein (3.8 vs. 8.9 mg/dL; P = 0.039), less associated osteomyelitis (0 vs. 26.9%; P = 0.033), shorter intravenous therapy (6 vs. 15 days; P < 0.001), and had a nonsignificant lower rate of sequelae (0 vs. 30%; P = 0.15) than children with SA caused by other bacteria. However, they tended to have higher rate of fever (86 vs. 57%; P = 0.083).
CONCLUSIONS:K. kingae was frequently recovered in children with SA after the implementation of bacterial 16SPCR, producing a milder clinical syndrome and better outcome. Therefore, the use of molecular techniques may be important for the management of these children.
We show that a Navigational Logic, i.e., a logic to express properties about graphs and about paths in graphs is a semi-exact institution. In this way, we can use a number of operations to structure ...and modularize our specifications. Moreover, using the properties of our institution, we also show how to structure single formulas, which in our formalism could be quite complex.
The flu is a constant threat that can sometimes cause severe forms of disease. The highest incidence rates by age group occur in children under 15 years of age, especially in those under 5 years, in ...whom the rate of hospitalization is also similar to the population aged 65 years and older. In addition, children are the main transmitters of the infection. In Spain, 5 influenza vaccines are authorized for the paediatric age group: three inactivated tetravalent vaccines harvested from fertilised eggs, one tetravalent inactivated vaccine obtained from cell cultures and one attenuated tetravalent vaccine for intranasal administration, which will become trivalent in the 2024−2025 season by excluding the B Yamagata lineage as recommended by the WHO. The CAV-AEP recommends systematic vaccination in children aged 6–59 months, children and adolescents belonging to risk groups, people who can transmit the flu to groups at risk of complicated flu, and household contacts or close family of infants under 6 months. From 2 years of age, the intranasal attenuated vaccine is preferred due to its greater acceptability and thus contribution to greater vaccination coverage. The CAV-AEP also considers that vaccination against influenza of healthy children and adolescents aged 5–18 years is advisable, as it provides individual protection and promotes protection at the family and community levels. It is especially important to vaccinate all health care professionals against influenza as well as pregnant women at any time during pregnancy.
La gripe es una amenaza constante, que en ocasiones puede producir cuadros clínicos graves. Las mayores tasas de incidencia por grupos de edad ocurren en los menores de 15 años, especialmente en los menores de 5 años, en los que además las tasas de hospitalización son similares a las de las personas de 65 años en adelante. Además, los niños son los principales vectores de transmisión de la enfermedad. En España, están autorizadas cinco vacunas antigripales en la edad pediátrica: tres inactivadas tetravalentes procedentes de cultivos en huevos embrionados, una inactivada tetravalente procedente de cultivos celulares, y una atenuada tetravalente de administración intranasal, que para la temporada 2024−2025 pasará a ser trivalente, al no incluir el linaje B Yamagata como recomienda la OMS. El CAV-AEP recomienda la vacunación sistemática en: niños de 6 a 59 meses, niños y adolescentes pertenecientes a grupos de riesgo, personas que puedan transmitir la gripe a los grupos que tienen riesgo de gripe complicada, y convivientes o entorno familiar de menores de 6 meses. A partir de los 2 años de edad, se recomienda preferentemente la vacuna atenuada intranasal por su mayor aceptabilidad y facilitar la mejora de las coberturas. El CAV-AEP considera también que la vacunación antigripal de niños y adolescentes de 5–18 años sanos es una medida recomendable, por cuanto le proporciona protección individual y favorece la protección familiar y comunitaria. Es especialmente importante la vacunación antigripal de todos los profesionales sanitarios y la vacunación de las gestantes en cualquier momento del embarazo.
The AEP Immunization Calendar for 2024, with its immunization recommendations for pregnant women, children and adolescents residing in Spain, marks the 25th edition since the first one was introduced ...in 1995, being annual since 2003, as a vaccination calendar, and since 2023 as immunization schedule due to the inclusion of a monoclonal antibody for the prevention of RSV disease. Novelties for this year include the following: The rest of the recommendations from the previous calendar remain unchanged.
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