Clinical and Epidemiological Characteristics of Paediatric Patients Diagnosed with COVID-19 in a Tertiary Hospital in Mexico City

COVID-19 affects the paediatric population less frequently than adults. A retrospective study was performed in a tertiary paediatric hospital in Mexico City in children <18 years of age who were hospitalized with a positive reverse transcription-polymerase chain reaction for SARS-CoV-2. Included in the study were 86 patients with a median age of 10 years old (IQR 2.6-14.3 years), who were classified in three groups: previously healthy, with chronic disease and immunosuppressed patients. The principal signs and symptoms were fever (81%), cough (51%) and headache (35%). A total of 20 patients (23%) required management in the paediatric intensive care unit (PICU) and 17% needed mechanical ventilation for an average of 12.7 days (IQR 2-29 days). There was no statistically significant difference between the three clinical classification groups in those patients admitted to the PICU, most of which were previously healthy patients. The mortality rate was 5% (four patients). Given that the paediatric population is susceptible to infection, potential transmitters and to clinical presentations with variable degrees of severity, it is important to continue reinforcing social distancing measures.

Medidas de prevención SARS-CoV-2

En este artículo se definen las medidas de prevención para SARS-CoV-2 con el propósito de disminuir y controlar la trasmisión de este agente, para garantizar la seguridad del paciente, familiares y el personal de salud.

Case Report: Chest Wall Tuberculosis without Pulmonary Involvement in Three Pediatric Immunocompetent Patients

Primary rib cage tuberculosis (TB) is an infrequent form of presentation and represents 1% of all cases of osteoarticular TB. We report three cases of children who were previously healthy and who began with swelling of the anterior surface of the rib as initial manifestation of TB. The most important clinical presentations in this series were swelling and pain, with lytic lesions and a soft tissue mass in image studies simulating oncologic pathologies. Because none of the cases had positive epidemiological contact, TB was initially not considered, so the delay in diagnosis from the onset of symptoms was 4, 1, and 2 months, respectively. The diagnosis was made through histomorphological analyses. Treatment was administered during 12, 10, and 9 months. Posttreatment studies did not show any evidence of extrapulmonary TB and until date, the patients remained without relapse or active disease. The findings in our cases illustrate that the diagnosis of chest wall TB should be suspected in all patients from endemic areas who present rib injury.

Co-infection with Streptococcus anginosus and Mycobacterium tuberculosis in an immunocompetent pediatric patient. A case report

BACKGROUND

Simultaneous infection in tuberculosis (TB) is rare. The mixed infection between Streptococcus anginosus group (SAG) and M. tuberculosis (MTB) has not been reported in children. The aim of this report was to describe a pediatric case with a pulmonary abscess caused by the duality SAG-MTB co-infection.

CASE PRESENTATION

An 11-year-old boy with an acute onset of throbbing pain of two-day evolution located in the anterior chest wall. The patient reported a history of fever, cough and rhinorrhea during the last seven days. An anterior chest radiography revealed a heterogenic opacity at the lower right lobe while the lateral projection showed an obliteration at the anterior diaphragmatic insertion. Parenteral Ceftriaxone (100 mg/kg/day) and Dicloxacillin (200 mg/kg/day) was started. The abscess was subsequently drained and analyzed. After a year of follow-up, the patient remained asymptomatic.

CONCLUSION

This case represents the first reported case of pulmonary co-infection involving MTB and SAG in an immunocompetent pediatric patient.

1347. Tuberculosis Caused by Mycobacterium bovis in Children: A Retrospective Review of Cases From 2010 to 2019 in a Pediatric Tertiary-care Center in Mexico

Background

Tuberculosis (Tb) is a leading cause of death worldwide. The most common cause of Tb is due to M. tuberculosis, however, M. bovis is considered a public health issue and an often-undetected cause of Tb. Information regarding Tb by M. bovis in children is scarce.

Methods

Retrospective analysis of culture-proven cases of Tb by M. bovis from 2010 to 2019 in a pediatric tertiary-care center in Mexico. Clinical and paraclinical characteristics were compared.

Results

We included 22 cases of Tb by M. bovis in children younger than 18 years of age. 64 percent were men, mean age was 3.8 years. All subjects had a positive history of BCG immunization. Eight subjects (36.4%) consumed unpasteurized dairy products, 3 (13.6%) referred contact with Tb-infected people, and none had contact with cattle. Twelve patients (54.5%) had an immunodeficiency (ID). The most common ID was defects in the IL-12/IFN-γ axis (36.3%), followed by severe-combined ID (9%). All of the subjects presented any form of extrapulmonary Tb, and 8 (36.4%) had disseminated Tb. The most common extrapulmonary presentations were lymph-node (40.9%), abdominal (18.2%), and skeletal Tb (13.6%). Fever was present in 21.3% of the cases, weight-loss in 12%, and diaphoresis in 9.3%. Hepatomegaly was present in 83% of patients with abdominal Tb (P = 0.001). We found a negative association between lymph-node enlargement and skeletal Tb by M. bovis (P = 0.01). Five cases (22.7%) were identified as M. bovis BCG strain. Infection by BCG strain was associated with a shorter time of presentation (< 4 months) (P = 0.005). Polydrug resistance (resistance to ≥2 drugs, excluding those classified as MDR) was observed in five strains (22.7%). We detected 3 RIF-resistant strains (19%), 2 INH-resistant strains (9.1%), and 1 EMB-resistant strain (4.5%). No MDR strains were detected. We report an 86% cure rate, and 5% mortality. Nine percent are still in treatment.

Conclusion

We report 22 cases of culture-proven cases of Tb by M. bovis, from 2010 to 2019 in a pediatric tertiary-care center in Mexico. Disseminated presentation was common, as well as extrapulmonary involvement. Infection by M. bovis BCG strain was associated with a shorter time of presentation. Further studies are required in order to expand our knowledge on M. bovis infection in children.

Disclosures

All authors: No reported disclosures.

Vacunación durante el embarazo

En las últimas décadas, las vacunas se convirtieron en una de las estrategias más útiles para alcanzar reducciones sustanciales en la mortalidad infantil asociada con enfermedades infecciosas susceptibles de prevención. Sin embargo, la disminución de la mortalidad ha sido menor en pacientes que aún no alcanzan la edad para recibir ciertas vacunas. La falta de adiestramiento para aplicar ciertas vacunas a neonatos y lactantes menores deja un margen de baja inmunidad que resulta en mayor proporción de hospitalizaciones y muertes susceptibles de prevención por vacunas en comparación con otros grupos de edad.

Higiene respiratoria. Etiqueta de tos

Las enfermedades respiratorias son causa importante de atención en los centros hospitalarios y en la consulta externa. En México, el Sistema Nacional de Vigilancia Epidemiológica de la Secretaría de Salud reportó 1,724,742 casos de infección de vías respiratorias en enero de 2017 y 1,866,660 en enero de 2018.De estas enfermedades, la influenza fue la que dio importancia al uso de la estrategia “Etiqueta de tos”, que consiste en dar a conocer y aplicar las medidas generales que deben tomar familiares, acompañantes, visitantes y todo el personal de salud de la institución para evitar la trasmisión de infecciones respiratorias.

Carbapenemase-producing Enterobacteriaceae in Mexico: report of seven non-clonal cases in a pediatric hospital

Background

Carbapenemases-producing Enterobacteriaceae (CPE) are a worldwide public health emergency. In Mexico, reports of CPE are limited, particularly in the pediatric population. Here, we describe the clinical, epidemiological, and molecular characteristics of seven consecutive cases in a third-level pediatric hospital in Mexico City over a four-month period during 2016.

Results

The Enterobacteriaceae identified were three Escherichia coli strains (producing OXA-232, NDM-1 and KPC-2), two Klebsiella pneumoniae strains (producing KPC-2 and NDM-1), one Klebsiella oxytoca strain producing OXA-48 and one Enterobacter cloacae strain producing NDM-1. The majority of patients had underlying disesases, three were immunocompromised, and three had infections involved the skin and soft tissues. Half patients died as a result of CPE infection.

Conclusions

This study represents the first report of E. coli ST131-O25b clone producing NDM-1 in Latin America. In addition, this study is the first finding of K. oxytoca producing OXA-48 and E. coli producing OXA-232 in Mexican pediatric patients.