Fatal Pediatric Meningococcal Invasive Disease Caused by Neisseria meningitidis Serogroup C and Co-Infected With SARS-CoV-2: Report of a Case in Tijuana, Mexico

Invasive meningococcal disease (IMD) is a severe infection caused by Neisseria meningitidis, with mortality rates ranging from 10% to 40%. IMD has been confirmed to be an endemic disease in Tijuana, Mexico, right across the border from San Diego, California. To date, coronavirus disease 2019 (COVID-19) is the most severe pandemic, causing more than 5.5 million deaths globally. Prior or co-infections of influenza with IMD has been reported previously; however, the participation of other respiratory viruses facilitating the invasiveness of N. meningitidis is either not shown or remains unclear. Here, we report the case of an unvaccinated (for IMD and COVID-19) seven-year-old child who had confirmed fatal IMD caused by N. meningitidis, serogroup C, and was co-infected by severe acute respiratory syndrome coronavirus 2.

Kawasaki disease presenting with hoarseness: A multinational study of the REKAMLATINA network

BACKGROUND

Recently, hoarseness affecting the supraglottic structure has been reported in Kawasaki disease (KD). The objective of this study was to characterize the frequency of hoarseness in acute KD patients in Latin America.

METHODS

We used prospective data from the multinational Red de Enfermedad de Kawasaki en America Latina (REKAMLATINA) network. A total of 865 patients from 20 countries were enrolled during the 3 year study period. Data on hoarseness were available in 858 (99.2%) patients. The clinical and laboratory characteristics between hoarse and non-hoarse KD were compared.

RESULTS

Hoarseness was documented in 100 (11.6%) patients. Hoarse patients were younger than those with KD without hoarseness (median age 18 vs 26 months; P = 0.002) and presented with lower hemoglobin (10.7 g/dL vs 11.3 g/dL; P = 0.040) and hematocrit levels (32% vs 33%, P = 0.048).

CONCLUSIONS

Hoarseness was found to be prevalent as a presenting sign of acute KD in younger children. Anemia may indicate the presence of active inflammation.

Use of Adjunctive Therapy in Acute Kawasaki Disease in Latin America

Objective: To characterize the use of adjunctive therapy in Kawasaki disease (KD) in Latin America. Methods: The study included 1,418 patients from the Latin American KD Network (REKAMLATINA) treated for KD between January 1, 2009, and May 31, 2017. Results: Of these patients, 1,152 received only a single dose of IVIG, and 266 received additional treatment. Age at onset was similar in both groups (median 2 vs. 2.2 years, respectively). The majority of patients were male (58 vs. 63.9%) and were hospitalized with the first 10 days of fever (85.1 vs. 84.2%). The most common adjunctive therapy administered was steroids for IVIG-resistance, followed by additional doses of IVIG. The use of biologics such as infliximab was limited. KD patients who received adjunctive therapy were more likely to have a lower platelet count and albumin level as well as a higher Z score of the coronary arteries. Conclusion: This is the first report of adjunctive therapies for KD across Latin America. IVIG continues to be the initial and resistance treatment, however, steroids are also used and to a lesser extent, biological therapy such as infliximab. Future studies should address the barriers to therapy in children with acute KD throughout Latin America.

Lack of knowledge about mother-to-child HIV transmission prevention in pregnant women at Tijuana General Hospital, Baja California, Mexico

The objective of this study was to identify determinants of human immunodeficiency virus (HIV) knowledge regarding mother-to-child transmission (MTCT) among pregnant women at Tijuana General Hospital, Baja California, Mexico. Between March and November 2003, patients from the prenatal care (n = 1294) and labor and delivery (L&D) units (n = 495) participated in a cross-sectional study to measure HIV knowledge. Less than one-third (30%) knew that HIV could be transmitted to a child during delivery, and 36% knew that HIV could be transmitted by breast-feeding. Only 27% knew that an MTCT could be prevented. Prenatal patients were more likely to know that MTCT was preventable (prenatal: 31% versus L&D 25%; P = .02). Logistic regression indicated that prenatal patients (odds ratio = 1.49, confidence interval 1.07-2.07) were more likely to know that HIV could be transmitted through breast-feeding. Overall, both groups had poor knowledge regarding MTCT of HIV.

[Perforated peptic ulcer: is the form of methamphetamine known as "crystal meth" a new risk factor?]

BACKGROUND

The emergence of new synthetic drugs related to peptic ulcer perforation has been reported. Recently an increase in the use of inhaled methamphetamine has been observed and we have described an association of frequent use with peptic disease symptomatology and perforation.

AIMS

To determine whether methamphetamine use is a factor related to peptic acid disease and perforation and to establish its demographic variables.

MATERIAL AND METHODS

A retrospective, comparative, descriptive, and observational study was carried out through the evaluation of medical records of patients admitted to the Surgery Service with perforated ulcer, within the time frame of January 2002 to March 2005. A descriptive analysis was carried out, along with the Z test, odds ratio, confidence interval, p value and the Student's t test.

RESULTS

Forty-two patients were divided into 2 groups: methamphetamine users (n=25) and nonusers (n=17). There was a statistically significant difference in relation to age, which was lower in the methamphetamine user group (38,7 years vs 58,88 years, p=0.0001). In addition, there was a trend in the user group to develop peptic ulcer perforation at earlier ages compared with the nonuser group (p=0.0001). There were no statistically significant differences between the two groups in regard to clinical presentation.

CONCLUSIONS

Methamphetamine use is related to ulcer perforation in age groups of younger patients when compared with nonuser patients.

Clinical Outcomes and Hospitalizations among Children Perinatally Infected with HIV-1 in Baja California, Mexico

This study characterizes temporal trends in HIV disease progression among perinatally infected children at a clinic in Baja California, Mexico. A total of 73 children were followed, 52% were categorized under US Centers for Disease Control and Prevention (CDC) classification group C with a mean age of 2.3 years (SD ± 3.16) at HIV diagnosis. For the years 1998 to 2001, 2002 to 2003, 2004 to 2005, and 2006 to 2007, highly active antiretroviral therapy (HAART) use increased to 60%, 75%, 83%, and 94% ( P < .001) as did mean CD4 percentage of 23.4%, 23.2%, 26.9%, and 29.0%, respectively ( P = .009), while HIV plasma RNA log10 decreased significantly (4.49, 4.23, 4.00, and 3.79, respectively; P = .019). Overall mortality was 31% (23 of 73), with pneumonia being the most common cause of death (43% of all deaths) followed by tuberculosis (22%). Mortality rates declined from 30.4% to 25%, 8.9%, and 9.3% ( p = 0.035) for the years 1998 to 2001, 2002 to 2003, 2004 to 2005, and 2006 to 2007, respectively. Kaplan-Meier survival analysis showed that median survival was 11.2 years; 1-, 2-, and 5-year survival was 87%, 83%, and 67%, respectively. These findings document a high but improving trend in morbidity and mortality of children perinatally infected with HIV in Tijuana, Baja California, Mexico.

Mother-to-Child HIV Transmission in a Cohort of Pregnant Women Diagnosed by Rapid HIV Testing at Tijuana General Hospital, Baja California, Mexico

This study evaluated an obstetrical program using rapid HIV testing for the prevention of mother-to-child HIV transmission (MTCT) in Baja California, Mexico. Between 2003 and 2005, 45 women in labor and 17 prenatal care women were HIV infected. Among labor patients, 14 (31%) delivered by cesarean section compared with 17 (100%) prenatal care patients (P < .001). Intravenous maternal zidovudine (ZDV) and infant oral ZDV were more frequently administered in prenatal care compared to labor patients: 94% versus 33% (P < .001) and 100% versus 79% (P < .001), respectively. All prenatal care women received combination therapy. All 10 HIV-infected infants were in the labor group, resulting in a MTCT rate of 23% (95% confidence interval [CI] 9.5-34.8) compared to 0% (95% CI 0-1.8; P < .001) among the prenatal care group. Five (50%) of the HIV-infected infants had an AIDS diagnosis and 2 (20%) died within 18 months of birth. Women diagnosed during labor had a high HIV MTCT and poor postnatal outcome.

Poor outcome is associated with delayed tuberculosis diagnosis in HIV-infected children in Baja California, Mexico

OBJECTIVE

To describe the morbidity and mortality associated with tuberculosis (TB) in human immunodeficiency virus (HIV) infected children in Baja California, Mexico.

METHODS

Retrospective review of the medical records of all children with perinatally acquired HIV infection evaluated at Tijuana General Hospital with a diagnosis of TB between 1998 and 2007. The Stegen-Toledo (ST) clinical criteria for the diagnosis of TB were used.

RESULTS

A total of 73 HIV-infected children were followed during the study period. Thirteen (18%) children were diagnosed with TB; one was confirmed by culture to be positive. Among these children, the mean ages at HIV and TB diagnosis were respectively 3.6 and 5.3 years. The mean ST score was 8.1; 10/13 had a score of >or=7, or highly probable TB. There were a cumulative 29 hospital admissions prior to TB diagnosis; 24 of these were due to pneumonia. The mean duration of symptoms at TB diagnosis was 73 days. The most common symptoms were cough (92%) and anorexia (85%). Seven patients (54%) had disseminated TB and five (39%) died as a consequence of TB.

CONCLUSIONS

We observed high morbidity, hospital utilization and high mortality associated with TB among HIV-infected children in Baja California.

Performance of rapid HIV testing using Determine HIV-1/2 for the diagnosis of HIV infection during pregnancy in Tijuana, Baja California, Mexico

The aim of this study was to evaluate the performance of the rapid antibody test Determine HIV-1/2, in pregnant women at Tijuana General Hospital. Pregnant women seeking prenatal care or admitted in labour had blood drawn for a rapid HIV test (Determine HIV-1/2), enzyme immunoassay (EIA) and Western blot. Between March and November 2003, 1068 women in labour and 1529 women in prenatal care were enrolled. The sensitivity, specificity, positive and negative predictive values were 100%, 99.8%, 77% and 100%, respectively. For women in labour, the mean time between blood collection and rapid test results was 92 minutes (range: 20-205 minutes) compared with 41 hours (range 24-120 hours) for HIV EIA (P = 0.012). All HIV-exposed infants received oral zidovudine. These findings indicate that the rapid test Determine HIV-1/2 has a high sensitivity and specificity in pregnant women. Rapid HIV testing greatly diminishes the time to diagnosis and enables prompt intervention with antiretrovirals at delivery.

Perinatal HIV Counseling and Rapid Testing in Tijuana, Baja California, Mexico

OBJECTIVE

To evaluate the acceptance of counseling and rapid HIV testing and to determine the associated risk factors for HIV infection in pregnant women in Baja California, Mexico.

METHODS

Pregnant women attending Tijuana General Hospital who consented to participate in the study had blood drawn for a rapid HIV test (Determine HIV-1/2; Abbott Diagnostics, North Chicago, IL). A confirmatory enzyme immunoassay and Western blot were performed and demographic and risk factor data were obtained.

RESULTS

From March to November 2003, 1529 (92.5%) of 1653 women who sought prenatal care and 1068 (95.2%) of 1122 women in labor consented to participate. HIV seroprevalence was significantly higher among women screened during labor (12/1068, 1.12%) compared with those seeking prenatal care (5/1529, 0.33%). HIV-infected women were significantly more likely to use injection drugs (12% vs. 1%, P = 0.02), "other" drugs, including methamphetamine, marijuana, and cocaine (65% vs. 6%, P < 0.001), to have more sex partners (3.6 vs. 2.6, P = 0.0002), to not have received prenatal care (41% vs. 13%, P = 0.03), and to have a spouse/partner who used injection drugs (36% vs. 4%, P < 0.001) or "other" drugs (73% vs. 23%, P < 0.001). In multivariate regression analysis, use of methamphetamine (adjusted odds ratio, 17.8, 95% CI, 5.6-56) was independently associated with the risk of HIV infection.

CONCLUSIONS

These findings indicate a wide acceptance of HIV counseling and testing and document a higher HIV seroprevalence among pregnant women delivering at Tijuana General Hospital than current established estimates in Mexico.