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IntroductionMultisystem inflammatory syndrome in children associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death.MethodsThis multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis (LCA) to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression.ResultsThe study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysms were found in 5.7% and 13.2% of the patients in whom coronary artery diameter was measured, respectively. Any cause in-hospital mortality was 5.4%. Hospitalization after ten days of symptoms was associated with coronary artery abnormalities (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2.0). Age ≥10 years (OR: 5.6, 95% CI: 1.4–2.04), severe underlying condition (OR: 9.3, 95% CI: 2.8–31.0), platelet count 3 (OR: 4.2, 95% CI: 1.2–14.7), international normalized ratio >1.2 (OR: 3.8, 95% CI: 1.05–13.9), and serum ferritin concentration >1,500 mg/dl at admission (OR: 52, 95% CI: 5.9–463) were risk factors for death.DiscussionMortality in patients with MIS-C was higher than reported in other series, probably because of a high rate of cases with serious underlying diseases.

Multisystem inflammatory syndrome in children temporally associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death. This multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression. The study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysm were found in 5.7% and 13.2% of the patients, respectively. The rate of mortality due to SARS-CoV-2-related factors was 4.6%. Delay of ≥10 days in hospital admission was associated with coronary artery aneurysm or dilatation (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2.0). Age ≥ 10 years (OR 5.6, 95% CI 1.4–2.04), severe underlying condition (OR 9.3, 95% CI 2.8–31.0), platelet count < 150,000/mm3(OR 4.2, 95% CI 1.2–14.7), international normalized ratio > 1.2 at admission (OR 3.8, 95% CI 1.05–13.9), and serum ferritin concentration > 1500 mg/dL (OR 52, 95% CI 5.9–463) were risk factors for death.

Prior invasive fungal infection (IFI) in children with malignancies was considered a contraindication for hematopoietic stem cell transplant (HSCT). This review summarizes the current evidence in safety of allogeneic HSCT with prior IFI in children. In adult population, some studies have shown that pre-transplant IFI should not be considered a contraindication to allogeneic HSCT, but, in the pediatric population, there is limited information about safety of HSCT in children with prior IFI. Epidemiological studies in adults with prior IFI show that allogeneic HSCT is safe. There is no sub-analysis in children within these databases. Studies evaluating risk factors for developing IFI in children with allogeneic HSCT have not found that prior IFI is associated with the reactivation of the fungal infection. A proper control of IFI, the correct choice of conditioning regimen, and secondary prophylaxis make allogeneic HSCT feasible in children with prior IFI. There is an urgency of studies in children evaluating other outcomes to establish HSCT safety in children with prior IFI.

BackgroundPediatric inflammatory multisystem syndrome (PIMS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children that resembles Kawasaki syndrome and places them at high risk of cardiorespiratory instability and/or cardiac damage. This study aims to describe the clinical presentation and outcomes of patients with PIMS in Mexico City.MethodsThis was an observational study of children hospitalized for PIMS based on the Centers for Disease Control and Prevention case definition criteria, in a single tertiary care pediatric center in Mexico City between May 1, 2020, and September 30, 2021. Demographic characteristics, epidemiological data, medical history, laboratory tests, cardiologic evaluations, treatment, and clinical outcomes were analyzed.ResultsSeventy-five cases fulfilled the case definition criteria for PIMS [median age: 10.9 years, Interquartile range (IQR): 5.6–15.6]. Fifteen (20%) patients had a severe underlying disease, 48 (64%) were admitted to the intensive care unit, 33 (44%) required invasive mechanical ventilation and 39 (52%) received vasopressor support. The patients were clustered through latent class analysis based on identified symptoms: Cluster 1 had rash or gastrointestinal symptoms (n = 60) and cluster 2 were those with predominantly respiratory manifestations (n = 15). Two patients (2.7%) died, and both had severe underlying conditions. Five patients (6.7%), all from cluster 1, developed coronary aneurysms.ConclusionThere were a high proportion of patients with severe respiratory involvement and positive RT-PCR SARS-CoV-2 and very few cases of coronary aneurysms in our study which suggests that a high proportion of the children had severe acute COVID-19. The clinical manifestations and outcomes are comparable to previously reported international studies.

The pandemic caused by the new coronavirus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is currently affecting more than 200 countries. The most lethal clinical presentation is respiratory insufficiency, requiring attention in intensive care units (ICU). The most susceptible people are over 60 years old with comorbidities. The health systems organization may represent a transcendental role in survival.Objective: To analyze the correlation of sociodemographic factors, comorbidities and health system organization variables with survival in cases infected by SARS-CoV-2 during the first 7 months of the pandemic in Mexico.Methods: The cohort study was performed in a health system public basis from March 1st to September 30th, 2020. The included subjects were positive for the SARS-CoV-2 test, and the target variable was mortality in 60 days. The risk variables studied were: age, sex, geographic distribution, comorbidities, health system, hospitalization, and access to ICU. Bivariate statistics (X2-test), calculation of fatality rates, survival analyses and adjustment of confusing variables with Cox proportional-hazards were performed.Results: A total of 753,090 subjects were analyzed, of which the 52% were men. There were 78,492 deaths (10.3% of general fatality and 43% inpatient). The variables associated with a higher risk of hospital mortality were age (from 60 years onwards), care in public sectors, geographic areas with higher numbers of infection and endotracheal intubation without management in the ICU.Conclusions: The variables associated with a lower survival in cases affected by SARS-CoV-2 were age, comorbidities, and respiratory insufficiency (with endotracheal intubation without care in the ICU). Additionally, an interaction was observed between the geographic location and health sector where they were treated.

Introduction Streptococcus pneumoniae (Sp) is the main cause of community-acquired pneumonia in the elderly, hence the importance to establish the prevalence of nasopharyngeal colonization by different Sp serotypes in adults. Methods from December 2009 to June 2010, nasopharyngeal cultures were taken from adults living in rural communities in Mexico for the isolation and serotyping of Sp by the Quellung reaction. Penicillin and ceftriaxone susceptibility tests were performed by the microdilution method. Results two hundred and thirty-six adults over 50 years old, were included. The prevalence of colonization by Sp was 21.6%. The most frequent serotypes were 19A (21%), 6A (13%), 6B and 11A (11%). All isolates were susceptible to ceftriaxone, and 52.8% of the isolates showed penicillin minimal inhibitory concentrations ≥0.12 mg/L. Conclusion this is the first study analyzing the nasopharyngeal colonization by Sp in adults in Mexico. Serotypes not included in any of the pneumococcal vaccines were frequently identified.

Background: \ud While there have been studies in adults reporting discordant empiric antibiotic treatment associated with poor outcomes, this area is relatively unexplored in children and neonates despite evidence of increasing resistance to recommended first-line treatment regimens.\ud \ud Methods: \ud Patient characteristics, antibiotic treatment, microbiology, and 30-day all-cause outcome from children

Overview of the pandemic In December 2019, a new virus named SARS-CoV-2 was reported in Wuhan province, China. The first case of COVID-19 in Mexico was confirmed on February 28, 2020, and the World Health Organization declared the pandemic on March 11.

Varicella-zoster virus causes varicella (chicken-pox), mainly in young children. Most cases are mild but serious complications can occur, resulting in significant morbidity and mortality. The objective of this study was to estimate the cost burden of varicella hospitalizations in two pediatric reference hospitals in Mexico. This retrospective observational study collected data on patients aged

Health care-associated infections can affect up to a third of all patients in low- and middle-income countries and represent a serious financial burden. Nevertheless, their control by means of hand hygiene faces various obstacles in this context such as the lack of adequately chlorinated water supplies, poor access to alcohol-based hand rub, lack of proper regulations and guidelines, and the scarcity of data on the impact of the hand hygiene programs on health care-associated infections in this setting. Notwithstanding the foregoing, there have been numerous efforts to implement strategies to improve hand hygiene. Outstanding among these is the World Health Organization strategies, which have been successfully implemented taking into account local context and resources. In addition to the WHO strategy is that of the International Nosocomial Infection Control Consortium (INICC) which implies hand hygiene guidelines for implementation exclusively in low- and middle-income countries. Moreover, various hospitals and health care facilities have developed their own multimodal strategies by using available resources with considerable success. There have been multiple efforts to implement hand hygiene programs around the world taking into account international strategies, while adapting them to local circumstances. This paper reviews these efforts to face the threat posed by HCAI in low- and middle-income countries.

Introduction: Healthcare-associated infections are an important cause of morbidity and mortality, are among the most common adverse events in healthcare, and of them, pneumonia is the most commonly reported. Our objective was to evaluate the incidence and clinical outcome of respiratory viruses in hospital-acquired pneumonia (HAP). Methods: This was a prospective cohort study, include patients aged between 0 and 18 who fulfilled Centers for Diseases Control and Prevention (CDC) criteria for HAP. Demographic and clinical data were obtained, and a nasopharyngeal swab specimen was taken for the detection of respiratory viruses. All included patients were monitored until discharge to collect data on the need for mechanical ventilation, intensive care unit (ICU) admission, and mortality. All-cause 30-day mortality was also ascertained. Results: Four thousand three hundred twenty-seven patients were followed for 42,658 patient-days and 5,150 ventilator-days. Eighty-eight patients (2.03%) met the CDC criteria for HAP, 63 patients were included, and clinical and epidemiological characteristics showed no statistically significant differences between patients with virus associated healthcare-associated pneumonia (VAHAP) and those with non-viral healthcare-associated pneumonia (NVHAP). At least one respiratory virus was detected in 65% [95% CI (53-77)] of episodes of HAP, with a single viral pathogen observed in 53.9% and coinfection with 2 viruses in 11.1% of cases. The outcome in terms of ICU admission, mechanical ventilation and the 30-day mortality did not show a significant difference between groups. Conclusions: In two-thirds of the patients a respiratory virus was identified. There was no difference in mortality or the rest of the clinical outcome variables. About half of the patients required mechanical ventilation and 10% died, which emphasizes the importance of considering these pathogens in nosocomial infections, since their identification can influence the decrease in hospital costs and be taken into account in infection control policies.

Introduction In Pediatrics, adverse drug reactions (ADRs) affect morbidity and mortality. In Mexico, the characteristics of ADRs and suspect drugs have not been described in hospitalized children. Objective To estimate the frequency of ADRs and describe them, as well as suspect drugs, in a tertiary care pediatric hospital in Mexico. Methods A total of 1,649 Hospital Infantil de Mexico Federico Gomez ADR reports were analyzed. Completeness of the information was assessed, and ADRs severity and seriousness were assigned based on NOM-220-SSA1-2012, with causality being established according to the Naranjo algorithm. ADRs were classified with WHO Adverse Drug Reaction Terminology (WHO-ART). The drugs involved in ADRs were categorized according to the Anatomical Therapeutic Chemical (ATC) classification. Descriptive analysis was performed using the SPSS 20 statistical package. Results Of all the reports, 5.8% lacked sufficient information for the analysis (grade 0). ADRs frequency ranged from 2.12% to 8.07%. ADRs occurred most commonly in children (56.9%), in the female gender (52%), in subjects with normal BMI Z-score (46.6%) and malnutrition (35.3%), diagnosed with neoplasms (72.2%) and in the Emergency Department (70.0%). ADRs were severe in 14.4% of cases, in 81.0% they were serious and 2.1% were classified as definite. Most common serious ADR was febrile neutropenia (44.5%). The 0.7% of patients recovering with sequelae; 1.1% died (with the medication being associated) and 70.3% were admitted to the hospital as a result of an ADR. Antineoplastic and immunomodulating agents were more commonly associated with serious ADRs. Conclusion ADRs affected morbidity and mortality, which is why strengthening pharmacovigilance programs in Mexican pediatric hospitals is necessary.

The Respiratory Syncytial Virus (RSV) is the most important viral pathogen in children under 2 years of age, which warrants hospitalization for a low respiratory infection. 0.5% of children under 5 with RSV infection require hospitalization. The aim of this case is to reaffirm the importance of this virus as a cause of severe disease and to emphasize the importance of adequate diagnosis and management to improve prognosis.Child of 1 year 3 months old, without risk factors for severe infection by respiratory viruses. A 3-day course of respiratory failure, requiring mechanical ventilation with a pulmonary protection strategy due to the development of intra-pulmonary ARDS, was considered a mixed infection and received antibacterial treatment. During his hospitalization, RSV infection was documented. He was graduated without pulmonary sequelae.Respiratory syncytial virus is the respiratory virus that causes a greater burden of disease, even above influenza. Unfortunately for children without risk factors for severe infection there are no options for prevention or treatment, so in subjects with severe disease the only option is the management of support in specialized units and the timely detection of bacterial overinfection. The development of a vaccine is necessary.El virus sincicial respiratorio (VSR) es el patógeno viral más importante en niños menores de 2 años que ameritan hospitalización por infección respiratoria baja. Un 0.5% de los menores de 5 años con infección por VSR requiere ingreso hospitalario. El objetivo de este caso es reafirmar la importancia de este virus como causa de cuadros graves y recalcar la importancia de un diagnóstico y manejo adecuados para mejorar el pronóstico.Paciente de 1 año 3 meses de edad, sin factores de riesgo para infección grave por virus respiratorios. Padecimiento de 3 días de evolución hacia falla respiratoria, requirió ventilación mecánica con estrategia de protección pulmonar por desarrollo de SDRA intrapulmonar, se consideró infección mixta por lo que recibió tratamiento antibacteriano, durante su hospitalización se documentó infección por VSR. Fue egresado sin secuelas pulmonares.El virus sincicial respiratorio es el virus respiratorio que ocasiona mayor carga de la enfermedad, incluso por arriba de influenza. Desafortunadamente, para los niños sin factores de riesgo para infección grave no hay opciones de prevención ni de tratamiento, por lo que en los sujetos con enfermedad grave la única opción es el manejo de soporte en unidades especializadas y la detección oportuna de sobreinfección bacteriana. Es necesario el desarrollo de una vacuna.

Introduction Healthcare personnel (HP) are frequently exposed to influenza and can be a source of transmission to patients and other workers, resulting in high-cost outbreaks for healthcare institutions. Objectives To analyse the presentation of HP with influenza-like illness (ILI) and the differences between individuals with influenza confirmed by polymerase chain reaction (PCR) and those with a negative test. The secondary objective was to evaluate the duration of symptomatology and work absenteeism as well as the vaccination rate of HP at a paediatric referral hospital. Methods A cross-sectional, descriptive study was conducted at a paediatric referral hospital. Clinical and epidemiological data on HP with ILI were collected between January and April 2016. Nasopharyngeal swab for influenza PCR was obtained from one in every three workers with ILI. Telephone follow-up was conducted to document duration of symptoms, complications and absenteeism. Results A total of 164 ILI episodes were evaluated in 162 HP. A swab was obtained in 59 cases, and influenza was detected in 30 cases. The clinical picture of HP with confirmed influenza was similar to that of HP with a negative PCR. Arthralgia was more common in those with influenza (90% vs. 58%), with a tendency towards statistical significance. No HP required hospitalization, and 78.5% were absent from work at least one day. Conclusions Influenza causes significant morbidity and absenteeism among HP. Influenza infection was confirmed in only half of HP with an ILI on whom a PCR was performed, suggesting that other respiratory viruses can cause a similar pattern. This article is protected by copyright. All rights reserved.

Background Mucormycosis is a fungal infection caused by species of the Mucorales order. These microorganisms are angioinvasive, with rapid disease progression and potentially lethal in its rhinocerebral form. Case report We present the case of a 12-year-old female with trisomy 21, acute lymphoblastic leukemia and diabetes, with fever and neutropenia who developed rhinocerebral mucormicosis. After treatment with amphotericin B lipid complex and extensive surgery, disease progressed and posaconazole was added as salvage treatment with full remission of the infection. Four years after diagnosis the patient continues without relapse of mucormycosis or leukemia. Conclusions This case highlights the use of posaconazole as either monotherapy or combined therapy. Although it is still debated, it can be considered an option for salvage treatment in children with non-responding mucormycosis, despite lack of standard dosage in pediatric patients.

Biennial H1N1pdm09 influenza A virus (IAV) epidemics have been associated with major severity of respiratory disease in Mexico. Atypically and in contrast with what happened in USA, Canada and Europe during 2017, an increase of infections due to the H1N1pdm09 pandemic virus instead of H3N2 was observed. In order to determine the viral contribution to severe acute respiratory disease, we characterized the pathogenicity determinants of IAV in Mexico during the 2015–2016 and 2016–2017 seasons. The RNA segments of 20 IAV samples were sequenced by NGS platform and phylogenetic analysis was conducted. The analysis of the hemagglutinin (HA) sequences established that all virus samples, except one, belong to clade (6B.1). The IAVs presented the substitution S162 N, which introduces a new glycosylation site in the hemagglutinin. We also found the D222 G substitution, which has been associated with a higher tropism towards the lower respiratory tract, and a non-reported insertion of one Ile in NS1 (Ile113). The IAVs from 2016 to 2017 in Mexico belong to the new clade 6B.1. The new glycosylation site in HA (S162 N) is a major change that may affect the efficacy of the current vaccine. We detected in several patients pathogenicity determinants associated with the severity of the respiratory disease.

To assess the impact of pneumococcal conjugate vaccine (PCV7) immunization on pneumococcal nasopharyngeal colonization with S. pneumoniae (SPN).We studied two groups with different vaccination schedules, group I (2-6 months of age) 3+1 and group II (7 -11 months) 2+1, with a booster at 15 months. Nasopharyngeal cultures were obtained before administering each vaccination dose and after booster. Paired and global analyses were carried out of the proportions of children colonized by SPN, vaccine serotype, no vaccine serotype and resistance to penicillin.A total of 183 children were enrolled; 93 in group I and 90 in group II. In group I, there was a decrease in vaccine serotypes in the third sample. In group II, there was an increase in non-vaccine serotypes and a decrease in vaccine serotypes before booster. Both groups showed a trend toward decreased resistance to penicillin.PCV7 caused serotype replacement in nasopharyngeal colonization before the booster.