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Bustamante-Amador J, Mellado-Sola I, Romero-Gómez MP, Cabrera-Lafuente M, de la Calle-Fernández-Miranda M, Sainz-Costa T, Mellado-Peña MJ, Escosa-García L. Congenital cytomegalovirus infection, is more prevalent in our country in newborns exposed to HIV? Rev Esp Quimioter 2022; 35:482-491. [PMID: 35841598 PMCID: PMC9548071 DOI: 10.37201/req/037.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objectives. Congenital cytomegalovirus infection (cCMV) has been considered more prevalent among HIV-exposed children during pregnancy. Spanish national guidelines recommend the cCMV screening in these newborns. Nowadays, pregnant women have a better control of HIV infection compared to previous decades. We aim to analyze the prevalence and associated risk factors to cCMV in these children. Patients and methods. A retrospective cross-sectorial study was performed. All newborns exposed to HIV were assisted in a third-level hospital (2014-2020). Epidemiological and clinical data of the mother and newborn were recorded. Shell vial urine culture and/or CRP were performed along the two first weeks of life for the neonatal screening of cCMV. Results. Overall 69 newborns were enrolled. A high proportion (82.4%) of the mothers had been diagnosed with HIV before getting pregnant. All women received ART during the pregnancy. Median T-CD4 lymphocytes before delivery was 641/mm3 (IQR: 480-865) and the viral load was undetectable in 83.6%. Serological test for CMV along the first trimester of pregnancy was performed in 73.5% (positive IgG in 96%). There were no congenital cases of HIV neither cCMV (CI 95%:0-5.3%). Conclusions. The cCMV prevalence in newborns exposed to HIV was 0%, lower than reported before, probably related to a better and earlier ART during pregnancy, leading to a better immunological status.
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Affiliation(s)
| | | | | | | | | | | | | | - L Escosa-García
- Luis Escosa-García. Servicio de Pediatría y enfermedades infecciosas y tropicales. Hospital Infantil Universitario La Paz, P.º de la Castellana, 261, 28046 Madrid. Spain.
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Ara-Montojo MF, Bustamante J, Sainz T, Pérez S, Jiménez-Moreno B, Ruiz-Carrascoso G, Rodríguez-Molino P, Villota J, García-López-Hortenano M, Mellado-Peña MJ. Intestinal giardiasis in children: Five years' experience in a reference unit. Travel Med Infect Dis 2021; 42:102082. [PMID: 34020030 DOI: 10.1016/j.tmaid.2021.102082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Giardiasis is highly prevalent in children and is often mildly symptomatic. First-line treatment is metronidazole, but treatment failure is not uncommon. We describe a paediatric series, to identify risk factors for treatment failure and to analyse the safety and effectiveness of other treatment strategies. METHODS Retrospective observational study, including children diagnosed with giardiasis from 2014 to 2019. Diagnosis was based on direct visualisation by microscopy after concentration using an alcohol-based fixative, antigen detection and/or DNA detection by polymerase chain reaction in stool. Treatment failure was considered when GI was detected 4 weeks after treatment. RESULTS A total of 120 patients were included, 71.6% internationally adopted, median age 4.2 (2.3-7.3) years. Only 50% presented with symptoms, mainly diarrhoea (35%) and abdominal pain (14.1%); co-parasitism was frequent (45%). First-line treatment failure after a standard dose of metronidazole was 20%, lowering to 8.3% when a higher dose was administered (p < 0.001). Quinacrine was administered in 10 patients, with 100% effectiveness. Children <2 years were at higher risk of treatment failure (OR 3.49; 95% CI 1.06-11.53; p = 0.040). CONCLUSIONS In children with giardiasis, treatment failure is frequent, especially before 2 years of age. Quinacrine can be considered as a second-line treatment. After treatment, eradication should be confirmed.
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Affiliation(s)
- M F Ara-Montojo
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain
| | - J Bustamante
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - T Sainz
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Translational Research Network in Paediatric Infectious Diseases (RITIP, Red de Investigación Translacional en Infectología Pediátrica), Spain.
| | - S Pérez
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain
| | | | - G Ruiz-Carrascoso
- Department of Microbiology, La Paz University Hospital, Madrid, Spain
| | - P Rodríguez-Molino
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain
| | - J Villota
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - M García-López-Hortenano
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Translational Research Network in Paediatric Infectious Diseases (RITIP, Red de Investigación Translacional en Infectología Pediátrica), Spain
| | - M J Mellado-Peña
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Translational Research Network in Paediatric Infectious Diseases (RITIP, Red de Investigación Translacional en Infectología Pediátrica), Spain
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López-Medina EM, Sainz T, de Ory SJ, Mellado-Peña MJ, González-Tomé MI, Gil EC, Cucurull TV, Neyra F, Frick MA, Martínez-Pérez J, Andrés AGA, Alonso MB, Laleona CG, Hernández MM, Hernández PC, Amador JTR, Gómez MLN, Santiago-García B. Tuberculosis in a Spanish cohort of children living with HIV: the CHOTIS study (Childhood HIV & TB study). Int J Tuberc Lung Dis 2021; 24:303-309. [PMID: 32228760 DOI: 10.5588/ijtld.19.0237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Tuberculosis (TB) is the leading opportunistic infection in children with human immunodeficiency virus (HIV), but is uncommon in low prevalence regions. We aim to describe the changing epidemiology and clinical presentation of TB-HIV co-infection in a cohort of HIV-infected children in Spain.METHODS: Children diagnosed with TB between 1995 and 2016 in the paediatric HIV cohort were identified. The incidence and clinical presentation were compared in three periods: 1995-1999 (P1, before initiation of combined antiretroviral therapy, cART), 2000-2009 (P2, increase in immigration), and 2010-2016 (P3, decrease in immigration).RESULTS: We included 29 TB cases among 1183 children aged <18 years (2.4%, 243/100 000 person-years). The proportion was stable in P1 and P2 (1.3%), but decreased in P3 (0.8%). The median age at TB diagnosis was 6.4 years (IQR 4-10.6); most children in P3 were aged >10 years (20% vs. 23.1% vs. 83.3%, P = 0.01). TB was diagnosed at HIV presentation in 11/29 children (37.9%). Foreign-born children accounted for respectively 0%, 8% and 67% of the total number of children in each period (P ≤ 0.0001). One third had extrapulmonary TB; four children died (13.8%).CONCLUSION: In our cohort, the incidence of TB-HIV co-infection decreased with decline in immigration. In regions with adequate cART coverage and low TB transmission, paediatric TB-HIV coinfection is uncommon, but associated with significant morbidity. Strategies for TB surveillance, diagnosis and treatment in this vulnerable population should be reinforced.
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Affiliation(s)
- E M López-Medina
- Department of Pediatric Infectious Diseases, University Hospital La Fe, Valencia
| | - T Sainz
- Department of Pediatric Infectious Diseases, University Hospital La Paz, and La Paz Research Institute (IdiPAZ), Madrid
| | - S Jiménez de Ory
- University Hospital Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), CoRISpe, Madrid
| | - M J Mellado-Peña
- Department of Pediatric Infectious Diseases, University Hospital La Paz, and La Paz Research Institute (IdiPAZ), Madrid
| | - M I González-Tomé
- Pediatric Infectious Diseases and HIV Unit, University Hospital 12 de Octubre and Research Institute (I+12), Madrid
| | - E Colino Gil
- Pediatric Infectious Diseases Unit, Complejo Hospitalario Insular Materno Infantil Las Palmas, Las Palmas de Gran Canaria
| | - T Vallmanya Cucurull
- Pediatric Infectious Diseases Unit, University Hospital Arnau de Vilanova, Lleida
| | - Falcón Neyra
- Pediatric Infectious Diseases, Immunology and Rheumatology Unit, University Hospital Virgen del Rocío, and Instituto de Biomedicina de Sevilla (IBiS), Sevilla
| | - M A Frick
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona
| | | | - A G Andrés Andrés
- Pediatrics Department, Complejo Asistencial Universitario de León, León
| | - M Bustillo Alonso
- Pediatric Infectious Diseases Unit; Miguel Servet Pediatric Hospital, Zaragoza
| | - C Guerrero Laleona
- Pediatric Infectious Diseases Unit; Miguel Servet Pediatric Hospital, Zaragoza
| | - M Méndez Hernández
- Pediatric Infectious Diseases Unit, Hospital Germans Trias y Pujol, Universitat Autònoma de Barcelona, Badalona
| | - P Collado Hernández
- Pediatrics Department, Hospital Clínico Lozano Blesa, Universidad Zaragoza, Zaragoza
| | - J T Ramos Amador
- Pediatrics Department, Clínico San Carlos University Hospital and Research Institute (IDISSC), Universidad Complutense de Madrid, Madrid
| | - M L Navarro Gómez
- Department of Pediatric Infectious Diseases, Pediatrics Department, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - B Santiago-García
- Department of Pediatric Infectious Diseases, Pediatrics Department, University Hospital Gregorio Marañón and Gregorio Marañón Research Institute (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
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Ara-Montojo MF, Escosa-García L, Alguacil-Guillén M, Seara N, Zozaya C, Plaza D, Schuffelmann-Gutiérrez C, de la Vega Á, Fernández-Camblor C, Ramos-Boluda E, Romero-Gómez MP, Ruiz-Carrascoso G, Losantos-García I, Mellado-Peña MJ, Gómez-Gil R. Predictors of mortality and clinical characteristics among carbapenem-resistant or carbapenemase-producing Enterobacteriaceae bloodstream infections in Spanish children. J Antimicrob Chemother 2021; 76:220-225. [PMID: 33038895 DOI: 10.1093/jac/dkaa397] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging problem in the paediatric population worldwide with high mortality rates in bloodstream infection (BSI). OBJECTIVES To evaluate predictors of 30 day mortality in CRE BSI in a paediatric cohort. METHODS A retrospective observational single-centre study (December 2005-August 2018) was conducted. Cases of CRE BSI in children 0 to 16 years were included. Microbiological identification (MALDI Biotyper) and antimicrobial susceptibility testing (Vitek2® and MicroScan panel NBC44) according to EUCAST breakpoints were performed. PCR OXVIKP® was used to confirm carbapenemase genes (OXA-48, VIM, KPC, NDM). Demographic characteristics, underlying diseases, source of bacteraemia, antimicrobial therapy and outcomes were collected from medical records. Survival analysis to establish predictors of 30 day mortality was performed. RESULTS Thirty-eight cases were included; 76.3% were hospital-acquired infections and 23.7% related to healthcare. All patients had at least one underlying comorbidity and 52.6% were recipients of an organ transplant. VIM carbapenemase was the predominant mechanism (92.1%). Previous CRE colonization or infection rate was 52.6%. Intestinal tract (26.3%) and vascular catheter (21.1%) were the most common sources of infection. Crude mortality within 30 days was 18.4% (7/38); directly related 30 day mortality was 10.5%. Conditions associated with an increment in 30 day mortality were intensive care admission and inadequate empirical therapy (P < 0.05). Combination-antibiotic targeted treatment and a low meropenem MIC were not related to improved survival. CONCLUSIONS CRE BSI mortality rate is high. The most important factor related to 30 day survival in our CRE BSI cohort in children was empirical treatment that included at least one active antibiotic.
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Affiliation(s)
- M F Ara-Montojo
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, Hospital Universitario La Paz, Madrid, Spain
| | - L Escosa-García
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, Hospital Universitario La Paz, Madrid, Spain.,RITIP (Red de Investigación Translacional en Infectología Pediátrica), Spain
| | - M Alguacil-Guillén
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - N Seara
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - C Zozaya
- Department of Neonatology, Hospital Universitario La Paz, Madrid, Spain
| | - D Plaza
- Department of Paediatric Haematology and Oncology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Á de la Vega
- Department of Hepatology and Liver Transplantation, Hospital Universitario La Paz, Madrid, Spain
| | - C Fernández-Camblor
- Department of Nephrology and Kidney Transplantation, Hospital Universitario La Paz, Madrid, Spain
| | - E Ramos-Boluda
- Paediatric Intestinal Rehabilitation and Bowel Transplantation, Hospital Universitario La Paz, Madrid, Spain
| | - M P Romero-Gómez
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - G Ruiz-Carrascoso
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | - I Losantos-García
- Department of Biostatistics, Hospital Universitario La Paz, Madrid, Spain
| | - M J Mellado-Peña
- Paediatric Tropical and Infectious Diseases, Department of Paediatrics, Hospital Universitario La Paz, Madrid, Spain.,RITIP (Red de Investigación Translacional en Infectología Pediátrica), Spain
| | - R Gómez-Gil
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
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