Resumo Objetivo: Descrever as características clínicas e os diferentes fenótipos de crianças com síndrome inflamatória multissistêmica na criança temporalmente relacionada com a COVID-19 (do inglês multisystem inflammatory syndrome in children — MIS-C) e avaliar as condições de risco que favorecem a maior gravidade da doença durante um período de 12 meses em um hospital pediátrico de referência na Colômbia. Métodos: Estudo retrospectivo de 12 meses de observação de crianças menores de 18 anos que cumprem os critérios para o MIS-C. Resultados: Vinte e oito crianças foram apresentadas com os critérios do MIS-C. A idade média era de sete anos, e 54% eram do sexo masculino. Para além da febre (100%) (com início quatro dias antes da admissão), as características clínicas mais frequentes eram gastrointestinais (86%) e mucocutâneas (61%). Quatorze crianças (50%) apresentavam sintomas semelhantes aos de Kawasaki. As anomalias ecocardiográficas mais frequentes foram derrame pericárdico (64%), envolvimento valvar (68%), disfunção ventricular (39%) e anomalias coronárias (29%). Tinham linfopenia 75% das crianças. Todas tinham algum teste de coagulação anormal. A maioria recebeu imunoglobulina intravenosa (89%), glucocorticoides (82%), vasopressores (54%) e antibióticos (64%). Tiveram envolvimento mais grave 61% dos pacientes, que precisaram ser internados em unidade de terapia intensiva (mediana de quatro dias, média de seis dias); os preditores de gravidade foram pacientes com fenótipo inflamatório/ MIS-C (odds ratio — OR 26,5; intervalo de confiança — IC95% 1,4–503,7; p=0,029) e erupção cutânea (OR 14,7; IC95% 1,2–178,7; p=0,034). Dois pacientes (7%) apresentavam síndrome de ativação macrofágica. Conclusões: Alteração da artéria coronária, disfunção ventricular e internação na unidade de terapia intensiva foram frequentes, o que nos alerta sobre a importância da suspeita clínica precoce.

Abstract Objective: This study aimed to describe the clinical characteristics and the different phenotypes of children with multisystem inflammatory syndrome in children (MIS-C) temporally related to COVID-19 and to evaluate the risk conditions that favored a greater severity of the disease during a 12-month period at a pediatric reference hospital in Colombia. Methods: A 12-month retrospective observational study of children under the age of 18 years who met criteria for MIS-C. Results: A total of 28 children presented MIS-C criteria. The median age was 7 years. Other than fever (100%) (onset 4 days prior to admission), the most frequent clinical features were gastrointestinal (86%) and mucocutaneous (61%). Notably, 14 (50%) children had Kawasaki-like symptoms. The most frequent echocardiographic abnormalities were pericardial effusion (64%), valvular involvement (68%), ventricular dysfunction (39%), and coronary artery abnormalities (29%). In addition, 75% had lymphopenia. All had at least one abnormal coagulation test. Most received intravenous immunoglobulin (89%), glucocorticoids (82%), vasopressors (54%), and antibiotics (64%). Notably, 61% had a more severe form of the disease and were admitted to an intensive care unit (median 4 days, mean 6 days); the severity predictors were patients with the inflammatory/MIS-C phenotype (OR 26.5; 95%CI 1.40–503.7; p=0.029) and rash (OR 14.7; 95%CI 1.2–178.7; p=0.034). Two patients had macrophage activation syndrome. Conclusions: Coronary artery abnormalities, ventricular dysfunction, and intensive care unit admission were frequent, which needs to highlight the importance of early clinical suspicion.

Kawasaki disease is the leading cause of acquired cardiac disease in children. Although the epidemiology of the disease has been well described in Japan, other Asian countries, Europe, Australia and North America, the epidemiology and disease burden in Latin American children is unknown. For this reason, the idea of establishing a research network on Kawasaki disease in children from Latin America was born, becoming this the largest Kawasaki disease international multinational research network and in which 20 countries of the region will be integrated.

Presentamos el caso de un niño de 12 meses de edad referido al Hospital Nacional de Niños con diagnóstico presuntivo de exantema súbito, meningitis aséptica y choque incipiente. El paciente se ingresa, tras múltiples consultas a un hospital periférico, al día 14 de fiebre como síntoma más importante. A su ingreso se documentó meningitis aséptica, induración y enrojecimiento en el sitio de aplicación de la vacuna de la BCG, aparte de los criterios clásicos para Síndrome de Kawasaki. El ecocardiograma inicial mostró dilatación coronaria. El Síndrome de Kawasaki debe formar parte del diagnóstico diferencial del infante y niño con enfermedad eruptiva febril, y debe tenerse un alto índice de sospecha clínica de esta entidad.

We describe a 12-month-old infant referred to the Hospital Nacional de Niños with a presumptive diagnosis of exanthema subitum, aseptic meningitis, and early schock. On day 14 of fever as the predominant symptom and after multiple visits to a peripheral hospital, he was admitted to the children’s hospital. At admission, the patient fulfilled Kawasaki syndrome’s diagnostic criteria, besides aseptic meningitis and local changes in the BCG scar. A baseline echocardiogram showed coronary dilation. Kawasaki syndrome should be part of the differential diagnosis of infants and children with febrile eruptive diseases; a high index of suspicion should be maintained.

Alrededor del mundo, Bordetella pertussis representa la quinta causa de muertes prevenibles por vacunación en niños menores de 5 años. Durante las últimas décadas se ha producido un cambio importante en la epidemiología de la enfermedad, donde actualmente los adolescentes y adultos son la fuente de transmisión más importante para infantes menores de 6 meses de edad. La morbimortalidad, complicaciones y número de hospitalizaciones son mayores sobre todo en infantes menores de 2 meses, quienes aún no han recibido su primera inmunización. Por esta razón, dentro de las recomendaciones actuales para tratar de disminuir el impacto de esta enfermedad en este grupo etario, se incluyen la vacunación a personas de alto riesgo de transmisión tales como los adolescentes, adultos, y mujeres en posparto inmediato (estrategia "capullo"). Esta revisión analiza las últimas recomendaciones al respecto, y se discuten otras estrategias potenciales como la vacunación a embarazadas, recién nacidos, ó el aceleramiento del esquema de vacunación contra tosferina. Igualmente se discute su potencial impacto en Costa Rica, donde desde finales del año 2005 se ha presentado el brote más severo de tosferina durante las últimas 4 décadas, con 18 infantes fallecidos a la fecha.

Bordetella pertussis represents the fifth cause of death among vaccine-preventable diseases in children younger than 5 years of age worldwide. During the last decades an important change in pertussis epidemiology has occurred, where adolescents and adults are now the most important source of transmission to infants younger than 6 months of age. Morbidity, mortality, hospitalizations, and complications rates are higher in infants younger than 2 months of age, who have not received yet their first vaccine dose. For these reasons, current recommendations to try to decrease the impact of pertussis in this age group include vaccination to adults at high risk of transmission such as adolescents, adults, and women in immediate postpartum ("cocoon strategy"). This review analyses the latest updated recommendations in pertussis vaccination, as well as other potential strategies including vaccination to pregnant women, newborns, and vaccine acceleratedschedules. Its potential impact in Costa Rica is also discussed, where the most severe outbreak in the last 4 decades has occurred since the end of year 2005, with now 18 confirmed pertussis infant deaths until today.

We conducted this open study to evaluate the immunogenicity and safety of the inactivated influenza vaccine, Imovax Gripe® in 154 children between 6 and 36 months of age at high risk of influenza- related complications, and in a reference group of 64 healthy children. The study was conducted over two flu seasons, in which the vaccine contained the same A strains but different B strains. The results for the A/H3N2 and A/H1N1 strains from the two flu seasons were pooled, but those for the B strains were not. Anti-hemagglutinin (HA) antibody titers were determined before, and one month after each vaccination, and safety was evaluated based on diary card reporting any adverse event observed, either included or not in the list of "solicited events". Within each group of vaccines, the seroconversion rates, seroprotection rates, and ratio of post- to prevaccination geometric mean titers (GMTR) for the A/H3N2 and the A/H1N1 strains fulfilled all requirements of the criteria of the European Union Committee for Proprietary Medicinal Products (CPMP). The immune responses in high-risk and in healthy children were similar, and consistent with those observed in previous studies conducted in healthy children. The vaccine was equally well tolerated by all study groups. Reactogenicity was low and similar in both high-risk and healthy children. Overall from 9.5% to 15.4% of at-risk children and 12% of healthy children reported a solicited local reaction; 23.0 to 28.8% of high-risk and 25.3% of healthy children reported a solicited systemic reaction. The study results provide support for vaccination of children at high-risk of influenza related complications.

Se realizó un estudio clínico abierto para evaluar la inmunogenícidad y la seguridad de la vacuna inactivada anti-influenza, Imovax Gripe®, en 154 niños entre 6 y 36 meses de edad con alto riesgo de complicaciones ligadas a la influenza, y en un grupo de referencia de 64 niños sanos. El estudio fue conducido en dos temporadas de gripe, durante las cuales la vacuna utilizada contenia las mismas cepas A pero diferentes cepas B. Los resultados para las cepas A/H3N2 y A/H1N1 de las dos temporadas de gripe fueron combinados ( pool de datos), pero no los de las cepas B. Los títulos de anticuerpos anti-hemaglutinina (HA) fueron determinados inmediatamente antes y un mes despues de cada vacunación, y la seguridad o tolerancia fue evaluada según la información de efectos adversos notificados, en cartillas para llenado diario, que incluían todos los eventos, figuraran o no en la lista de los "eventos solicitados". En cada grupo, las tasas de seroconversion y de seroprotección, y la razón de la media geométrica de títulos post-/ pre-vacunación (GMTR) para las cepas A/H3N2 y A/H1N1 cumplieron con todos los requisitos del Comité de Especialidades Farmacéuticas (CPMP) de la Unión Europea. Las respuestas inmunes fueron similares en los niños con alto riesgo y en los sanos, y consistentes con los resultados observados en los estudios anteriores en los niños sanos. La vacuna fue bien tolerada y la reactogenicidad fue baja y similar en los dos grupos de niños estudiados. Las reacciones locales listadas en la solicitud, fueron observadas en el 9.5 a 15.4% y en el 12% de niños con alto riego y sanos respectivamente; mientras que los síntomas sistémicos solicitados fueron observados en el 23.0 a 28.8% y el 25.3% de niños respectivamente. Los resultados de este estudio proveen informatión adicional a favor de la vacunación de niños con alto riesgo de complicaciones relacionadas con influenza.

Introducción: La fiebre en el niño es uno de los principales motivos de consulta en pediatría. En ocasiones, el temor de los padres produce la conocida "fobia febril", que conlleva al uso de los servicios de emergencias hospitalarios y a tratamientos inadecuados. Objetivo: Conocer la percepción, el conocimiento y el manejo que dan a la fiebre los padres o encargados de familia, de aquellos niños hospitalizados en el servicio de Infectología del Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" de Costa Rica. Materiales y métodos: Se realizó un estudio prospectivo descriptivo, donde se entrevistan a los padres o encargados de niños hospitalizados en el Servicio de SI-HNÑ, entre enero y abril de 2001. A los padres ó encargados que cumplían con los criterios de inclusión y exclusión, se les explicó el propósito del estudio y la dinámica del cuestionario. Resultados: Se recolectaron un total de 100 cuestionarios, donde se documentó que e161 % de los entrevistados consideran necesario el uso del termómetro para hacer el diagnóstico de fiebre, el 43% define como fiebre toda temperatura > a 38 ∞C. La complicación más temida en el 75% de los consultados es la convulsión. El 71 % cuenta con algún tipo de tratamiento, en su hogar, para el manejo de la fiebre. Conclusión: Este estudio demuestra que muchos de los entrevistados no disponen de conocimiento adecuado acerca de la fiebre, sus implicaciones y manejo, lo que hace necesario promover información basada en la evidencia, que ayude a los padres, para que sepan cómo actuar correctamente ante la presencia de este importante y común síntoma.

Introduction: Fever is one on the main reasons for pediatric consultation, and sometimes paren tal concem to it may produce "fever phobia". This may lead to inadequate use of hospital emergency consultations and inappropriate treatments. Objective: To elucidate the degree of perception, knowledge and treatment given by parents to the febrile children admitted to the SI- HNN. Materials and methods: We performed a prospective descriptive study including parents or legal guardians of those children admitted to the Infectious Diseases Division of the Hospital Nacional de Niños de Costa Rica, between January and April of 2001. To those who met inclusion and exclusion criteria, a questionnaire was given prior explanation of the study dynamics. Results: A total of 100 questionnaires were collected. Sixty one percent of those who were interviewed considered as essential the use of a thermometer to make the diagnosis of fever, and 43% defined fever as any temperature above 38°C. Development of seizures was the most feared complication in 75% of parents. At home, seventy one percent of them have some type of treatment for fever. Conclusions: This study demonstrates that many parents who were interviewed do not have an adequate knowledge of fever, its implications and treatment. This raises the necessity of promoting evidence-based information that may help parents to deal with this common and important symptom.

Se describe el caso de una niña de seis años que consultó en varias ocasiones por presentar tos, fiebre alta, dificultad respiratoria y esputo purulento. Recibió múltiples tratamientos antibióticos, vía intramuscular y endovenosa con penicilinas, siendo la respuesta inadecuada. Se documentó clínica y radiológicamente la presencia de una neumonía, razón por la cual se amplió cobertura antibiótico a cefotaxime. Se aisló Streptococcus pneumoniae del cultivo de esputo, mostrando resistencia a penicilina y cefalosporinas de tercera generación. En nuestro medio, constituye el primer caso reportado de neumonía por neumococo con un patrón de resistencia múltiple a penicilina y cefalosporinas de tercera generación.

We describe the case of a six-year-old female that seeked medical attention more than once due to the presence of cough, high fever, respiratory distress and purulent sputum. She received multiple intramuscular and intravenous antibiotics with penicillins, with poor clinical response. Clinical and radiological diagnosis of neumonia was made, and treatment was changed to cefotaxime. Streptococcus pneumoniae was isolated from sputum culture, showing resistance to penicillin and third-generation cephalosporins. In our media, this is the first reported case of pneumococcal pneumonia by a strain exhibiting multiple resistance to penicillins and third-generation cephalosporins.