Invasive fungal infections (IFI) are a major cause of morbidity and mortality in immunocompromised adults and children. The purpose of this review was to update the epidemiological, clinical and therapeutic options in children, and to compare them with the adult population. Although there are important differences, the epidemiology, clinical features and risk factors for IFI have many similarities. Patient at risk include neutropenic hematology children, in whom Candida spp. y Aspergillus spp. predominate; primary immunodeficiencies, particularly chronic granulomatous disease with high susceptibility for Aspergillus spp.; and extremely premature infants, in whom C. albicans y C. parapsilosis are more prevalent. Premature babies are prone to dissemination, including the central nervous system. There are peculiarities in radiology and diagnostic biomarkers in children. In pulmonary aspergillosis, clasical signs in CT are usually absent. There is scant information on PCR and beta-D-glucan in children, and more limited on the performance of galactomannan enzyme immunoassay, that does not appear to be much different in neutropenic patients. There is a delay in the development of antifungals, limiting their use in children. Most azoles require therapeutic drug monitoring in children to optimize its safety and effectiveness. Pediatric treatment recommendations are mainly extrapolated from results of clinical trials performed in adults. There is no evidence for the benefit of preemptive therapy in children. It is necessary to foster specific pediatric studies with current and new antifungals to evaluate their pharmacokinetics, safety, and effectiveness at different ages in the pediatric population.

Galactomannan

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Citations (11)

[Treatment of HIV infection in childhood].

PubMed (1990)

Jesús Ruíz-Contreras Ramos Amador Jt

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Citations (0)

PubMed (1987)

Negreira Cepeda S Ramos Amador Jt Albert Piñole Jl García-Peñuela Negron Fuertes Ortiz A

Recently some cases of AIDS and AIDS-related disorders in children have been published. Some of them had received blood transfusions, others were secondary to AIDS in the mother (vertical transmission). Authors report a case of an 18-month old male infant who became seriously ill when he was 13-month old, and which proved particularly difficult to diagnose until specific serology for HTLV-III, was performed at the age of 16 months. Authors believe that due to growing incidence of AIDS and AIDS-related diseases it is essential to dismiss this diagnosis in infants with a history of transfusion, maternal transfusions or family drug abuse or promiscuity.

Promiscuity

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[Antiretroviral treatment of HIV infection in children].

PubMed (1998)

Ramos Amador Jt Saavedra Lozano J de José Gómez Mi

Antiretroviral treatment

Antiretroviral drug

ANTIRETROVIRAL AGENTS

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[Radiologic features of lung diseases in HIV infection in children].

PubMed (1997)

Oliver Jm González de Orbe G Ramos Amador Jt Jesús Ruíz-Contreras Gómez Ansón B

The purpose of this study was to assess the incidence of respiratory involvement in HIV-infected children, along with the radiological manifestations of the various HIV-related diseases.A retrospective review of the medical records of 65 HIV-infected children (63 vertically-infected and 2 through blood transfusion) has been carried out. The mean time of follow-up since the diagnosis of HIV infection was 32 +/- 27 months, beginning January 1987. Patients have been classified into 5 categories: Pneumocystis carinii (PC) pneumonia, lymphoid interstitial pneumonitis (LIP), lobar pneumonia, acute respiratory distress and a miscellaneous group. Plain chest radiographies were performed according to clinical criteria and at least every 6 months in asymptomatic patients. Diagnosis into categories was based upon chest X-ray findings, along with several etiological diagnostic criteria depending on the category.Respiratory involvement occurred in 32 children (49%). The most common diseases were PC pneumonia in 7 patients, LIP in 8 children, and lobar pneumonia and acute respiratory distress in 6 and 7 cases, respectively. PC pneumonia in children younger than one year had a good clinical and radiological correlation. LIP diagnosis has been based only on radiological criteria with the typical pattern. We want to highlight the disappearance of the radiological findings in 3 cases over time. Interestingly, several patients had other etiologic diagnosis, such as S. pneumoniae pneumonia, miliary tuberculosis, and two patients had acute respiratory distress, one caused by adenovirus and the other by enterovirus.Respiratory involvement is common in HIV-infected children. Clinical and radiological manifestations are variable. Plain chest radiography plays a very important role in the management and follow-up of these patients.

Lobar pneumonia

Etiology

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Citations (1)

[Perineal bag versus urethral catheterization of suprapubic aspiration for the diagnosis of urinary tract infections in infants in emergency units].

PubMed (1999)

Martín Puerto Mj Cela de Julián Me Mendoza Soto A Sánchez del Pozo J Ramos Amador Jt

Our objective was to determine the utility of urine cultures collected by sterile perineal bags as a method of diagnosis of urinary tract infection in infants.Forty-two patients, aged 0 to 27 months, were diagnosed with urinary tract infections based on the growth of more than 100,000 colonies/ml in two urine cultures collected by sterile bags. Confirmation of the infection was done by urine cultures obtained by suprapubic aspiration or urethral catheterization. A urinalysis was simultaneously performed.Urinary tract infection was confirmed in only 6 out of 42 patients. The positive predictive value of the sterile bag was 14%, increasing to 42% combined with an abnormal urinalysis.The sterile perineal bag is not an accurate method to collect urine for diagnosis of urinary tract infections in febrile infants or those who need prompt diagnosis and treatment.

Urinary catheterization

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Citations (4)

[Pneumococci: a new microorganism in the newborn?].

PubMed (2001)

de Alba Romero C Ramos Amador Jt Gómez Del Castillo E

To study the clinical characteristics and susceptibility to antimicrobial agents of Streptococcus pneumoniae invasive infection in our neonatal unit.Data from newborns with Streptococcus pneumoniae invasive infection in the last 12 years were retrospectively collected.Eight cases of invasive infection were identified. Gestational age ranged from 30 to 38 weeks (median: 34 weeks) and birth weight ranged from 1,680g to 4,460g (median: 2,480g). Risk factors related to infection were identified in 7 patients. Although infection manifested as shock in 4 patients and meningitis in 1, evolution was favorable in all patients. Penicillin resistance was found in 3 patients.Streptococcus pneumoniae produces serious disease in neonates. Because of the increasing prevalence of penicillin-resistant pneumococci, the relationship between the percentage of mothers colonized with pneumococci and neonatal infection should be determined to develop new prevention and treatment strategies in newborn infants.

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[Experience with ventriculitis at a neonatology department].

PubMed (2000)

Nieto Del Rincón N de Alba Romero C Egea Nadal P Mateos Beato F Peralta Ibáñez Ml

To study the characteristics, treatment and follow-up of patients with ventriculitis in our neonatal unit.Retrospective study of patients diagnosed with ventriculitis from January 1990 to December 1997. Diagnostic criteria were the identification of any bacteria in the ventricular fluid and pleocytosis (> or = 100 leukocytes per microl). Personal history, clinical and analytical findings and evolution after diagnosis were studied.We recorded ten cases of ventriculitis in nine patients. Six of them occurred as a complication of previous meningitis and four occurred after neurosurgical treatment. The mean age at diagnosis was of 38.8 days (range 8-130), and mean gestational age was 29.4 weeks (range 25-38). Clinical and ventricular fluid anomalies were seen in six cases and in four the diagnosis was made at autopsy. Treatment was systemic antibiotics. In two cases intraventricular antibiotics were added. Six patients died, ventriculitis being the direct cause of death in five. Of the three survivors, one had mental retardation and cerebral palsy and the other two had minor disabilities.During the neonatal period, a high degree of clinical suspicion and techniques for an early diagnosis and treatment are needed for ventriculitis.

Ventriculitis

Spiramycin

Neonatology

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Citations (1)