Search

OBJETIVO: Mejorar la calidad de la atención hospitalaria de los niños con infecciones respiratorias agudas bajas, aumentar los conocimientos sobre esa patología y mejorar la eficiencia en el uso de los recursos asistenciales, por medio de una estrategia que se denominó Plan de Invierno.MÉTODOS: La estrategia se basó en la utilización de protocolos de diagnóstico y tratamiento, internación por cuidados progresivos y por enfermedad, adecuación de los recursos asistenciales y creación de un sistema de registro permanente, informatizado. Se incorporó la investigación sistemática de la etiología viral para racionalizar el uso de la medicación y reducir las infecciones intrahospitalarias. RESULTADOS: Durante la aplicación del Plan (19/V-19/IX/99) ingresaron 3.317 niños; 1.347 (40.61%) presentaban infecciones respiratorias agudas bajas. Se captaron 1.096 (81%), de los cuales 71% eran menores de un año. Predominaron las infecciones respiratorias virales (68%). Los criterios de ingreso fueron saturación de oxígeno

We analyzed the effects of stratification changes due to wind on the vertical cyanobacteria distribution and microcystin-LR concentrations in a reservoir and assessed the implications for water management. Under stratified conditions, the highest microcystin concentrations (up to 4.16 µg/L) and toxic cyanobacteria biovolume occurred in the epilimnion (~ 1 m). The lowest microcystin concentrations were between 0.02 and 1.28 µg/L and occurred in the hypolimnion (~ 20 m). A cold front passage associated with high wind velocities induced water column mixing, promoting the redistribution of microcystin-LR and cyanobacteria throughout the water column and increasing their concentrations in deeper zones. Microcystin-LR concentration was positively correlated with cyanobacteria biovolume (r = 0.747) and chlorophyll a concentration (r = 0.798). Changes in thermal profile due to wind would imply a greater challenge for drinking water treatment plants, since high cyanobacterial and microcystin concentrations could reach deep-water intakes.

Introduction: The Latin American Society of Pediatric Infectious Diseases (SLIPE), with the support of the Americas Health Foundation (AHF), has developed a position paper on varicella prevention in Latin America and Caribbean countries (LAC). This article summarizes the most relevant aspects of varicella in LAC, and emphasizes the need to include the varicella vaccine in the national immunization programs in the Region and evaluate its impact disease burden., Areas Covered: A systematic review was conducted of the medical evidence published and presented at various regional medical conferences on the disease burden in LAC, the advances made by prevention programs, the available vaccines in the Region, and their immunogenicity, efficacy, effectiveness, and safety. The different national varicella-prevention vaccination programs were reviewed, as was available information regarding the impact of these programs on the epidemiology of varicella in those countries implementing a varicella vaccine strategy. Following that initial publication, an update was conducted, including data from additional countries in the Region., Expert Commentary: Varicella is a vaccine-preventable infectious disease, considered a 'benign disease' because of lower complication rates when compared with measles, pertussis. The incorporation of a two-dose varicella vaccine in national immunization schedules in all countries throughout LAC would be of great benefit to the health of the children.

Background: Salmonella can cause asymptomatic infections, diarrhea, bacteremia and focal infections such as meningitis and osteomyelitis., Aim: To describe clinical and microbiological aspects of infections by Salmonella spp. in children in a pediatric referral hospital: Centro Hospitalario Pereira Rossell, in Montevideo, Uruguay., Materials and Methods: Descriptive and retrospective study of 46 patients, from which Salmonella spp was isolated between January 1, 2005 and December 31, 2010., Results: Salmonella spp was isolated in 46 children younger than 15 years old. 18 were below 2 years old and 5 children below three months. 24% of the children had risk factors, such as HIV infection, oncological diseases and malnutrition; low birth weight and pneumonia were associated conditions. No deaths were reported. The serotypes more frequently found were: Typhimurium and Enteritidis. Most of the strains were susceptible to ampicillin and third generation of cephalosporins., Discussion: Diarrhea with blood was the predominant clinical presentation, and there were no outbreaks. Typhimurium and Enteritidis were the most common serotypes. Based on the profiles of susceptibility antimicrobial, we could maintain the same recommendations until the moment suggested., Conclusions: we must consider the Salmonella infection in febrile children under risk of an invasive bacterial disease, with or without focal infection.

Background: The most frequent osteoarticular infections (OAI) etiological agent is Staphylococcus aureus. The prevalence of other microorganisms has changed after the introduction of new vaccines., Aim: To describe the etiology and evolution of the OAIs in children hospitalized in Pediatric Hospital Pereira Rossell between 2009 and 2015., Patients and Methods: Joint fluid and bone puncture studies of hospitalized children suspected of OAI. Epidemiological characteristics, isolated microorganisms, complementary tests, initial treatment, complications, and days of hospitalization were analyzed., Results: 335 patients; the etiology was established in 113. Clinical data could be analyzed in 87 cases. The average age was 6.1 years. They corresponded to: methicillin-sensitive S. aureus (n: 47), community-acquired methicillin-resistant S. aureus (CA-MRSA) (n: 11), Streptococcus pyogenes (n: 6), Streptococcus pneumoniae (n: 1), Haemophilus influenzae type b (n: 2), Gram-negative bacilli (n: 9), Kingella kingae (n: 1) others (n: 6). In 4 cases, more than one microorganism was isolated. CA-MRSA infections were more serious., Discussion: A decrease is observed in the number of CA-MRSA isolates. A fact to be highlighted is the impact of universal vaccination against S. pneumoniae and H. influenzae type b. It is a finding to be monitored the increasing number of Gram-negative bacilli isolates.

Introduction: Streptococcus pyogenes infection causes a wide spectrum of clinical manifestations. Invasive disease (ID) is defined by the isolation of the microorganism from sterile sites., Objective: To analyze the clinical, epidemiological and molecular characteristics of ID by S.pyogenes in children hospitalized at Pediatric Hospital Pereira Rossell, from January 2005 to January 2013., Materials and Methods: A descriptive retrospective study was done in cases with isolation of S.pyogenes from sterile sites. Epidemiological variables, disease characteristics, laboratory parameters, treatment regimen received, hospitalization days and clinical outcome were analyzed. The presence of 4 genes encoding for virulence factors and chromosome profile studied by pulsed-field electrophoresis were done in the isolated strains., Results: A total of 42 cases (rate: 4.6 out of 10,000 admissions) were detected, from which 32 were analyzed. Average age was 44.7 months (14/32 < 2 years of age). In 5 cases, the portal of entry was identified. Clinical presentations were: osteoarticular infections (n = 15), shock (n = 6), skin and soft-tissue infections (n = 5), pneumonia (n = 3) and bacteremias (n = 3). Twenty cases required surgical procedures and 13 required intensive care admission. Average hospital stay was 17 days and one patient died. Molecular studies were performed in five strains; 4 different toxin profiles and pulsotypes were identified., Discussion: The incidence of ID at our hospital is similar to other series in the region. A better knowledge of clinical presentation and its relation with molecular characteristics represents a challenge.

In recent years, the international demand for commodities has prompted enormous growth in agriculture in most South American countries. Due to intensive use of fertilizers, cyanobacterial blooms have become a recurrent phenomenon throughout the continent, but their potential health risk remains largely unknown due to the lack of analytical capacity. In this paper we report the main results and conclusions of more than five years of systematic monitoring of cyanobacterial blooms in 20 beaches of Montevideo, Uruguay, on the Rio de la Plata, the fifth largest basin in the world. A locally developed microcystin ELISA was used to establish a sustainable monitoring program that revealed seasonal peaks of extremely high toxicity, more than one-thousand-fold greater than the WHO limit for recreational water. Comparison with cyanobacterial cell counts and chlorophyll-a determination, two commonly used parameters for indirect estimation of toxicity, showed that such indicators can be highly misleading. On the other hand, the accumulated experience led to the definition of a simple criterion for visual classification of blooms, that can be used by trained lifeguards and technicians to take rapid on-site decisions on beach management. The simple and low cost approach is broadly applicable to risk assessment and risk management in developing countries., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: In the past few years, an increase in methicillin resistant-not multiresistant Staphylococcus aureus was observed in Uruguay among children with community acquired infections. Recommendations for empiric antibiotic treatment required adjustments and new national guidelines were recommended in July 2004. Adherence to these guidelines was indirectly performed by monitoring antibiotic consumption and antimicrobial susceptibility patterns in Uruguay., Objective: To describe and compare antibiotic consumption and antimicrobial susceptibility of Staphylococcus aureus in a Pediatric Hospital of the Centro Hospitalario Pereira Rossell (PH-CHPR) between 2001 and 2006., Methods: Antibiotic consumption in hospitalized children was calculated using the Defined Daily Dose per 100 bed-days (DDD/100). Reference values were obtained from the World Health Organization Collaborating Center for Drug Statistics Methodology of. Consumption. Data were obtained using the WinPharma programme of the Pharmacy Department of CHPR. The fraction of annual occupancy of hospital beds was obtained from the Statistic Division of CHPR. Antibiotic consumption was evaluated between 2001 and 2006 and expressed as DDD/100 and percent change. Antimicrobial susceptibility was evaluated using CHPR's Microbiology Laboratory data during the same time period., Results: After 2003 a significant increase in consumption of clindamycin, ceftriaxone, trimethoprim-sulphamethoxazole, cefuroxime, vancomycin and gentamycin was observed, except for cephradine. Consumption of clindamycin, ceftriaxone and trimethoprim-sulphamethoxazole showed the highest increase (6.15%; 1.44% and 1.17% respectively). Detection of Staphylococcus aureus increased significantly mostly from skin and soft tissue infections. Oxacillin susceptibility of S. aureus strains obtained from different sites had a significant and persistent decrease after 2003 (from 81 % during year 2001 to 40% in year 2006 (p < 0.05). Susceptibility to others antibiotics did not decrease. Between 2004 and 2006 the "D effect" decreased from 28% to 21 %. Antimicrobial susceptibility patterns did not differ by site of infection., Conclusions: Methicillin resistant-not multiresistant Staphylococcus aureus has established itself as a regular community pathogen in Uruguayan children. Changes in antimicrobial consumption patterns reflect the impact of this pathogen in clinical practice and the overall adherence to new recommendations. This change was not associated with an increase in antibiotic resistance. Clindamycin is an alternative treatment although Clindamycin inducible resistance is a worry. Continuous monitoring of antibiotic consumption and local susceptibility patterns are required to promote rational use of antibiotics.

We studied microorganisms associated with infant diarrhea in a group of 256 children admitted to a public pediatric hospital in Montevideo, Uruguay. Diagnostic procedures were updated to optimize detection of potential pathogens, which were found in 63.8% of cases, and to be able to define their characteristics down to molecular or antigenic type. Coinfection with two or more agents was detected in more than one-third of positive studies. Escherichia coli enteric virotypes, especially enteropathogenic E. coli (EPEC), were shown to be prevalent. Rotavirus, Cryptosporidium, Campylobacter (mainly Campylobacter jejuni), and Shigella flexneri were also often identified. Enterotoxigenic E. coli, Salmonella, and Giardia lamblia were sporadically recognized. Unusual findings included two enteroinvasive E. coli strains, one Shigella dysenteriae 2 isolate, and a non-O:1 Vibrio cholerae culture. EPEC bacteria and S. flexneri (but not Salmonella) showed unusually frequent antimicrobial resistance, especially towards beta-lactam antibiotics, which is the subject of ongoing work.

Objective: To report the results of the use of antimicrobial guidelines for the management of children with community-acquired bacterial pneumonia., Methods: Admittance and discharge criteria and algorithms for diagnosis and treatment were established. The decision to treat with antibiotics was based on radiologic findings in pneumonia with pulmonary consolidation and left to the attending physician's criteria in the remaining cases. The use of antibiotics was limited to penicillin and derivatives (ampicillin, amoxicillin) and macrolides., Results: Of the 1163 children treated as bacterial pneumonia, hospitalized in public and private health facilities in Montevideo from September, 1997, through September, 1998, standard case management was applied in 1082 (93%). Age distribution was: <1 month, 1%; between 1 and 11 months, 29%; between 1 and 5 years, 50%; >5 years, 20%. Chest radiography showed evidence of pulmonary consolidation in 843 children (73%). Bacteria were detected in blood culture and/or pleural fluid of 57 children (5%). In 51 the identified microorganism was Streptococcus pneumoniae, susceptible to penicillin in 30, intermediate in 6 and resistant in 5 (maximum MIC, 4 microg/ml); in 10 cases etiologic diagnosis was made by antigen detection. Empyema was present in 62 children (5.3%); 38 (3.27%) required treatment in an intensive care unit; and 5 (0.4%) died., Conclusions: Compliance with standard case management was highly satisfactory. Outcome of children treated with penicillin and derivatives was good, including children with empyema and pneumatocele and two patients with penicillin-resistant S. pneumoniae. At the present time S. pneumoniae resistant to penicillin is not an important problem in children with pneumonia in Uruguay. Surveillance of identified microorganisms and their antimicrobial susceptibility must continue.

Levels of specific antibodies (Ab) and circulating antigens (CAg) were tested by ELISA in sera from 115 surgically confirmed hydatid patients, 41 individuals exhibiting other parasitic and unrelated diseases and 69 healthy subjects. Addition of CAg data to Ab detection in this sera collection increased sensitivity from 85% (only Ab) to 89% (Ab + CAg). Combination of ultrasonography with Ab and CAg serology for diagnosis of asymptomatic population in endemic areas was analyzed. One field survey (163 persons) involved both blood extraction and ultrasonography to all the population. Three people exhibited cyst images and all of them were Ab positive, while 6 Ab and 1 CAg positive individuals exhibited no cyst image. Another survey (1620 persons) involved a selection of 85 subjects for serology according to ultrasound data and record of family hydatid history. Twelve per cent exhibited no hydatid image being serologically positive and 14% were serologically negative but exhibited cyst image. Ultrasonography and serology (Ab and CAg) should be used in combination to maximize the diagnostic yield in asymptomatic population.