RESUMO Objetivo: Streptococcus do grupo A (SGA) são cocos gram-positivos que colonizam a nasofaringe e/ou a pele e em casos raros podem causar infecções graves. Embora essas infecções tenham diminuído durante a pandemia da COVID-19, alguns países observaram um aumento no número de doenças invasivas pelo SGA nos últimos anos. O objetivo deste estudo foi descrever uma série de doenças invasivas pelo S. pyogenes em crianças internadas em um hospital de referência para tratamento de doenças infecciosas em Minas Gerais, Brasil, entre setembro de 2022 e agosto de 2023. Os dados foram obtidos dos prontuários médicos. O SGA foi isolado do sangue, líquido pleural, cerebrospinal ou fluido articular. Descrição do caso: O total de nove pacientes, quatro do sexo masculino e cinco do sexo feminino, com idade entre oito meses e dez anos, foram admitidos. Ao todo, três (33%) tiveram pneumonia, três (33%) síndrome do choque tóxico, três (33%) artrite séptica, um (11%) osteomielite, dois (22%) meningite e dois (22%) celulite. A maioria dos pacientes (5) apresentou complicações, incluindo derrame pleural, choque séptico, vasculite cerebral e amputações de membros. Ao todo, sete (75%) pacientes foram admitidos na unidade de terapia intensiva, e um paciente morreu. Comentários: É importante estar atento à possibilidade de infeção por S. pyogenes em crianças com infecções pulmonares, neurológicas, osteoarticulares, cutâneas ou em casos graves de choque séptico. Diante da ausência de sinais clínicos específicos, dados epidemiológicos que demonstrem o aumento da incidência da doença são de grande importância e devem servir de alerta para o diagnóstico da doença. Objetivo (SGA grampositivos gram positivos eou COVID19, COVID19 COVID 19, 19 COVID-19 anos S Gerais Brasil 202 2023 médicos sangue pleural articular caso feminino todo 33% 33 (33% pneumonia tóxico séptica 11% 11 (11% osteomielite 22% 22 (22% celulite 5 (5 complicações séptico membros 75% 75 (75% intensiva morreu Comentários pulmonares neurológicas osteoarticulares específicos COVID1 1 COVID-1 20 3 (33 (11 2 (22 ( 7 (75 COVID- (3 (1 (2 (7

ABSTRACT Objective: Group A Streptococcus (GAS) are Gram-positive cocci that colonize the nasopharynx and/or skin and in rare cases may cause severe invasive infections. Although these infections decreased during the COVID-19 pandemic, some countries have observed an increased number of invasive GAS (iGAS) diseases in recent years. The objective of this study was to describe a series of iGAS diseases in a referral hospital for the treatment of pediatric infectious disease in Minas Gerais State, Brazil, between September 2022 and August 2023. The data were obtained from medical records, and GAS was isolated from blood, pleural, cerebrospinal, or joint fluid. Case description: A total of nine patients, four male and five female, between eight months and ten years of age, were admitted. Of the patients observed, three (33%) had pneumonia, three (33%) had toxic shock syndrome, three (33%) had septic arthritis, one (11%) had osteomyelitis, two (22%) had meningitis, and two (22%) cellulitis. The majority of patients (5) experienced complications, including pleural effusion, septic shock, cerebral vasculitis, and limb amputations. In total, seven (75%) patients were admitted to the intensive care unit, and one patient died. Comments: It is important to be aware of the possibility of S. pyogenes infection in children with pulmonary, neurological, osteoarticular, skin infections or in severe cases of septic shock. Given the absence of specific clinical signs, epidemiological data showing an increase in the local incidence of S. pyogenes infections is of great importance and should serve as an alert for the diagnosis of the disease. Objective (GAS Grampositive Gram positive andor COVID19 COVID 19 COVID-1 pandemic (iGAS State Brazil 202 2023 records blood cerebrospinal fluid description female age 33% 33 (33% pneumonia syndrome arthritis 11% 11 (11% osteomyelitis 22% 22 (22% meningitis cellulitis 5 (5 complications effusion vasculitis amputations 75% 75 (75% unit died Comments S pulmonary neurological osteoarticular signs COVID1 1 COVID- 20 3 (33 (11 2 (22 ( 7 (75 (3 (1 (2 (7

Abstract Objectives: Identify potential barriers, delays, and missed opportunities in the prevention and diagnosis of childhood TB. Methods: Scoping review according to the PRISMA extension. The definitions considered for the selection followed the acronym PCC where the population (P) is children under 18years of age with TB disease, the concept (C) refers to missed opportunities for prevention and diagnosis, and context (C) is defined as a diagnosis of TB disease. The authors searched systematically in the databases; VHL/Lilacs, Medline via PubMed, Cochrane, Scopus, and Web of Science, without date or language limitation. Results: Seven studies were included. In developed countries, with low disease burden, the main shortcoming is the delay in diagnosing bacilliferous adults in contact with young children. This problem is concentrated in the portion of the population with socioeconomic vulnerability. In underdeveloped countries, with a high burden of disease, the biggest challenge is tracking children who come into contact with bacilliferous patients. Conclusions: There are still many missed opportunities in the prevention and diagnosis of childhood TB. The positive legacy of the COVID-19 pandemic should be taken advantage of and the encouragement of scientific development in the management of infectious diseases should be taken. Objectives barriers delays Methods extension P (P years C (C databases VHLLilacs VHL Lilacs VHL/Lilacs PubMed Cochrane Scopus Science limitation Results included countries vulnerability patients Conclusions COVID19 COVID 19 COVID-1 COVID1 1 COVID-

ABSTRACT Yellow fever vaccine (YFV) is a live attenuated vaccine that can cause a mild infection in immunocompetent patients. However, it may not be self-limiting in patients with inborn errors of immunity (IEI) and may be the first and most severe presentation in these patients. A 10-month-old female infant sought emergency care presenting fever for three days and diffuse exanthema. She was a previous healthy child of consanguineous parents. The child had received YFV 28 days before the onset of symptoms. Upon hospital admission, petechial rash on the limbs and hepatosplenomegaly were noted on physical exam. Laboratory tests showed thrombocytopenia, increased serum aminotransferases and elevated gamma-glutamyl transferase (GGT) and alkaline phosphatase levels. During hospitalization she developed hypoactivity, drowsiness, and hypotonia. The possibility of viscerotropic and neurotropic vaccine associated disease was suspected and a possible primary immunodeficiency disease considered. The patient was tested for antibodies against the yellow fever virus (MAC ELISA) on serum and cerebrospinal fluid (CSF) samples, showing positive IgM results. Immunophenotyping showed low levels of lymphocytes and absence of T-cell receptor excision circles (TREC), leading to diagnose of severe combined immunodeficiency disease (SCID). Despite treatment, after 35 days of hospitalization, she evolved to cardiorespiratory arrest and death. Serious adverse events after administration of the YFV are rare and associated with neurological or visceral involvement in most cases. The unfavorable outcome highlights the importance of neonatal screening for SCID and the clinical suspicion of primary immunodeficiencies in infants who have serious adverse events to live virus vaccines. (YFV However selflimiting self limiting IEI (IEI 10monthold monthold 10 month old exanthema parents 2 symptoms admission exam thrombocytopenia gammaglutamyl gamma glutamyl GGT (GGT hypoactivity drowsiness hypotonia considered MAC ELISA CSF (CSF samples results Tcell T cell TREC, TREC , (TREC) SCID. . (SCID) treatment 3 death cases vaccines 1 (TREC (SCID

RESUMO Objetivo: Avaliar as taxas de aleitamento materno exclusivo e o crescimento dos recém-nascidos (RN) pré-termo e/ou de baixo peso ao nascer à alta da terceira etapa do Método Canguru (TEMC). Métodos: Estudo retrospectivo realizado em maternidade pública de referência entre janeiro/2014 e dezembro/2017, que incluiu os RN pré-termo (<37 semanas) e/ou de baixo peso (<2.500 g). As informações foram coletadas de prontuários médicos e analisadas pelo programa Statistical Package for the Social Sciences (SPSS). Resultados: Foram seguidos 482 RN, com mediana da idade gestacional de 33 semanas (variação: 24–39 sem) e peso ao nascer 1.715 g (variação: 455–2.830 g). O aleitamento materno exclusivo (AME) ocorreu em 336 (70,1%) RN à alta hospitalar e em 291 (60,4%) à alta da TEMC. Cada dia a mais de permanência hospitalar aumentou a chance do uso de fórmula infantil em 9,3% à alta hospitalar e em 10,3% à alta da TEMC. Permanecer na Unidade de Cuidados Intermediários Canguru (UCINCA) favoreceu o AME à alta hospitalar e da TEMC (p<0,001). Não realizar a Posição Canguru aumentou em 11% a chance de o RN utilizar fórmula infantil à alta hospitalar. O ganho de peso e crescimento do perímetro cefálico foram maiores nos RN em uso de fórmula infantil (p<0,001). Conclusões: O tempo de permanência hospitalar e a não realização da Posição Canguru favoreceram o uso de fórmula infantil à alta hospitalar e da TEMC. Permanecer na UCINCA favoreceu o AME à alta hospitalar e da TEMC. O ganho de peso e crescimento do PC foram maiores nos RN em uso de fórmula infantil. Objetivo recémnascidos recém nascidos (RN prétermo pré termo eou ou . (TEMC) Métodos janeiro2014 janeiro 2014 janeiro/201 dezembro2017 dezembro 2017 dezembro/2017 <37 37 (<3 <2.500 2500 2 500 (<2.50 g. g) SPSS. SPSS (SPSS) Resultados 48 3 variação (variação 2439 24 39 24–3 sem 1715 1 715 1.71 4552830 455 830 455–2.83 (AME 70,1% 701 70 (70,1% 29 60,4% 604 60 4 (60,4% 93 9 9,3 103 10 10,3 (UCINCA p<0,001. p0001 p p<0,001 0 001 (p<0,001) 11 Conclusões (TEMC janeiro201 201 janeiro/20 dezembro201 dezembro/201 <3 (< <2.50 250 50 (<2.5 (SPSS 243 24– 171 71 1.7 455283 45 83 455–2.8 70,1 7 (70,1 60,4 6 (60,4 9, 10, p000 p<0,00 00 (p<0,001 janeiro20 20 janeiro/2 dezembro20 dezembro/20 < ( <2.5 25 5 (<2. 17 1. 45528 8 455–2. 70, (70, 60, (60, p00 p<0,0 (p<0,00 janeiro2 janeiro/ dezembro2 dezembro/2 <2. (<2 4552 455–2 (70 (60 p0 p<0, (p<0,0 dezembro/ <2 455– (7 (6 p<0 (p<0, p< (p<0 (p< (p

Objective: To evaluate the rates of exclusive breastfeeding (EBF) and growth of preterm and/or low birth weight newborns during the third stage of the Kangaroo Method (TSKM), at discharge. Methods: Retrospective study in a reference public maternity hospital between Jan/2014 and Dec/2017, including the preterm (less than 37 weeks) and/or low birth weight (less than 2500 g) newborn infants. Information was collected from medical records. Statistics analysis was done in SPSS software. Results: 482 infants were included and followed up at the TSKM ambulatory. The average gestational age was 33 weeks (variation: 24-39 weeks) and birth weight, 1715g (variation: 455–2830 g). EBF occurred in 336 (70.1%) infants at hospital discharge, and in 291 (60.4%) at TSKM discharge. Each additional day of hospital stay increased the chance of infant formula (IF) use by 9.3% at hospital discharge and by 10.3% at TSKM discharge. Staying in the Kangaroo Neonatal Intermediate Care Unit (KNICU) favored EBF at hospital discharge and TSKM discharge (p<0.001). Not performing the kangaroo position increased the chance formula administration to the newborn infant at hospital discharge by 11%. Weight gain and head circumference growth were higher in infants using formula (p<0.001). Conclusions: The length of hospital stay and not performing the kangaroo position favored the use of infant formula at hospital and TSKM discharge. Staying in the KNICU favored exclusive breastfeeding at hospital and TSKM discharge. Weight gain and HC growth were higher in newborns receiving infant formula. Objective (EBF andor or TSKM, , (TSKM) Methods Jan2014 Jan 2014 Jan/201 Dec2017 Dec 2017 Dec/2017 less 3 250 g records software Results 48 ambulatory variation (variation 2439 24 39 24-3 4552830 455 2830 455–283 g. . 70.1% 701 70 1 (70.1% 29 60.4% 604 60 4 (60.4% IF (IF 93 9 9.3 103 10 10.3 (KNICU p<0.001. p0001 p p<0.001 0 001 (p<0.001) 11 11% Conclusions (TSKM Jan201 201 Jan/20 Dec201 Dec/201 25 243 2 24- 455283 45 283 455–28 70.1 7 (70.1 60.4 6 (60.4 9. 10. p000 p<0.00 00 (p<0.001 Jan20 20 Jan/2 Dec20 Dec/20 45528 28 455–2 70. (70. 60. (60. p00 p<0.0 (p<0.00 Jan2 Jan/ Dec2 Dec/2 4552 455– (70 (60 p0 p<0. (p<0.0 Dec/ (7 (6 p<0 (p<0. ( p< (p<0 (p< (p

Abstract Introduction Febrile neutropenia (FN) is a serious complication of cancer chemotherapy. The present study aimed to identify risk factors for documented infection in pediatric patients with FN and cancer. Methods This prospective cohort study included patients under 18 years from 2016 to 2018. Infection was defined according to the Centers for Disease Control and Prevention criteria. Results A total of 172 febrile neutropenic episodes were evaluated. From univariate analysis, the risk factors were: female gender; monocyte count < 100 cell/mm³, platelets < 50,000, C-reactive protein (CRP) > 90 mg/dl and hemoglobin < 7mg/dl at the onset of an episode; two or more episodes of FN, and; fever onset; positive blood culture at the fever onset. Independent risk factors according to the multivariate analysis were: CRP at the onset of a febrile episode > 90mg/dl, fever onset and first blood culture with a positive result. The lowest probability of infection was related to first episode and to platelets > 50,000 at the onset of fever. Conclusion A CRP > 90 at the onset of a febrile episode, platelets < 50,000, second episode or more, first fever episode during hospitalization and positive first blood culture were found to be associated with a higher risk of infection and they could be useful for the establishment of risk scores for infection in neutropenic children.