Abstract Background This study aimed to describe the incidence, microbiological profile, and risk factors associated with bacteremia in pediatric patients with hematopoietic stem cell transplantation (HSCT). Methods A retrospective cohort study was performed on patients under 18 years old who underwent HSCT due to any indication, between January 2012 and January 2017. The patient data were collected from the first 100 days post-HSCT. Bacteremia was defined as the isolation of bacteria from at least one blood culture. The relation between bacteremia and associated risk factors was evaluated using univariate and multivariate analysis. Results We enrolled a total of 111 pediatric patients who received HSCT during the period of study. The total number of patients who developed at least one episode of bacteremia was 46 (41.4%), and the total number of bacteremia episodes was 62. Rectal swabs were performed in 44 patients to detect prior colonization and this showed that 25% of them were positive, the main pathogen isolated being carbapenem-resistant enterobacteriaceae. The Gram-negative bacteria cases accounted for 60% of 62 events. The main Gram-negative bacteria isolated were Klebsiella pneumoniae and Escherichia coli and the majority were resistant strains. The mortality rate on day +100 for the whole cohort was 18% (n = 20). Regarding the patients with bacteremia, the mortality rate on day +100 was 30% (n = 14), and the cause of death was related to infection in 10 of them. We did not find any statistically significant risk factor for the development of bacteremia. Conclusion Bacteremia is common after HSCT, and there is a high frequency of resistant Gram-negative infections which is related to high mortality.

Introduction: Streptococcus pneumoniae (S. pneumoniae), also known as pneumococcus, is one of the main bacteria associated with mortality in children under 2 years of age, with a morbidity and mortality incidence that varies according to demographics and exposure to risk, or protective factors. Objective: To describe the child mortality due to invasive pneumococcal disease (IPD) between 2008 -2014 (6 years), in 8 Medical Centres in Bogotá, Colombia. Patients and method: Descriptive observational case series of patients who died of IPD, aged 28 days to 18 years, in 8 tertiary care institutions in Bogota, Colombia. The study period was from 1 January 2008 to 15 January 2014. Sample size: 239 patients. Results: A total of 239 registered cases of IPD were reviewed, showing a mortality of 8% (n 18). The mean age of patients that died was 43.7 months, with an age range from 2 to 176 months (14 years), with 66% of the cases being male. Serotypes were identified in 8 patients, finding: 6A, 6B, 10A, 14, 18C, 23B, 23F, and 35B. The most common clinical presentation of the cases was meningitis with mortality of 33% (6 cases), followed by bacteraemia without focus in 28% (5 cases), and pneumonia with 27% (5 cases). Combined clinical situations were presented, such as pneumonia and meningitis in 11% (2 cases). Two of the patients had clearly documented risk factors for IPD (asplenia and chronic respiratory disease). Conclusions: IPD mortality is particularly high in children under 2 years in male patients, especially when presented with a meningeal focus (44%). Serotyping was not possible in all patients who died, since no strain isolated was sent to the National Institute of Health. Continuous and systematic vigilance is required to evaluate the impact of vaccination and possible changes in the pattern of presentation of disease.

Introducción: El Streptococcus pneumoniae (S. pneumoniae), también denominado neumococo, es una de las principales bacterias asociadas a mortalidad en menores de 2 años, con una incidencia de morbimortalidad variable de acuerdo a la demografía y exposición a factores protectores o de riesgo. Objetivo: Caracterizar los pacientes fallecidos por enfermedad neumocóccica invasiva (ENI) entre el 2008-2014 en la población infantil de 8 instituciones de salud en Bogotá, Colombia. Pacientes y método: Estudio observacional descriptivo tipo serie de casos, en pacientes fallecidos por ENI, mayores de 28 días hasta los 18 años, en 8 instituciones de tercer nivel de atención en Bogotá, Colombia. Periodo del estudio del 1 de enero de 2008 al 15 de enero de 2014. Tamaño de la muestra: 239 pacientes. Resultados: Se revisaron 239 casos registrados de ENI, presentando una mortalidad del 7,5% (n = 18). La edad promedio de los pacientes que fallecieron fue de 43,7 meses, con un rango de edad entre 2 y 176 meses (14 años); el 66% de los casos era de sexo masculino. Se identificaron serotipos en 8 pacientes, encontrando: 6A, 6B, 10A, 14, 18C, 23B, 23F, 35B. La presentación clínica más frecuente de los casos de mortalidad fue meningitis con el 33% (6 casos), seguida por bacteriemia sin foco en el 28% (5 casos) y neumonía con el 27% (5 casos). Se presentaron situaciones clínicas combinadas como neumonía y meningitis en el 11% (2 casos). Dos de los pacientes tenían factores de riesgo para ENI claramente documentados (asplenia y enfermedad respiratoria crónica). Conclusiones: La mortalidad por ENI es especialmente alta en los menores de 2 años y en pacientes de sexo masculino, especialmente cuando presenta foco meníngeo (44%). La serotipificación no fue posible en todos los pacientes fallecidos, ya que no se envió la cepa aislada al Instituto Nacional de Salud. Se requiere una vigilancia continua y sistemática para evaluar el impacto de la vacunación y las posibles modificaciones en el patrón de presentación de la enfermedad.

Introducción. La paracoccidioidomicosis es una de las infecciones micóticas sistémicas más prevalente en los países latinoamericanos. La tasa de incidencia ha ido en incremento y su detección es cada vez más común en viajeros o inmigrantes de las zonas endémicas. Se caracteriza por un cuadro de síntomas respiratorios, linfadenopatías y lesiones cutáneas que progresan paulatinamente, por lo que la enfermedad crónica no tratada puede llevar a la muerte. Objetivo. Describir el enfoque clínico y diagnóstico de una enfermedad tropical exótica en una zona urbana. Caso clínico. Se describe un caso de paracoccidioidomicosis juvenil en área urbana con un cuadro clínico de síndrome febril de un mes de evolución, compromiso ganglionar generalizado, manifestaciones cutáneas y pérdida de peso; el examen físico evidenció episodio febril y hepatoesplenomegalia, cuyo diagnóstico fue difícil. Se inició manejo con itraconazol y trimetoprim-sulfametozaxol con posterior cese de los picos febriles y mejoría significativa de las lesiones en la piel. Se hizo una revisión extensa de la literatura científica con los criterios de búsqueda de Pubmed adaptados para las diferentes bases de datos; la revisión se basó en los estudios hallados en Medline, LILACS, SciELO y Cochrane Library desde 1966 hasta la fecha. Los estudios fueron seleccionados por los autores con base en su relevancia y aporte científico a la discusión del caso en mención. Conclusiones. Son pocos los casos de paracoccidioidomicosis en la población pediátrica a pesar de ser endémica en América Latina. Las crecientes corrientes de urbanización de las zonas endémicas hacen que este cuadro deba sospecharse.

Introduction: Paracoccidioidomycosis is one of the most prevalent systemic fungal infections in Latin American countries. The incidence rate has been increasing and its detection has gotten increasingly common in travelers or immigrants from endemic areas. It is characterized by respiratory symptoms, lymphadenopathies and skin lesions, which gradually progress and subsequently lead to death in some untreated chronic disease cases. Objective: To describe the clinical approach and diagnosis of an exotic tropical pathology in an urban area. Case description: Case description and extended literature review. We made a case report of urban paracoccidioidomycosis in a young patient, with a clinical syndrome of fever for a month, widespread nodal involvement, cutaneous manifestations and weight loss. During the physical examination, hepatosplenomegaly and a febrile episode were evidenced, whose diagnosis was difficult. Management started with itraconazole and trimethoprim sulfamethoxazole, with subsequent cessation of spiking fevers and significant improvement of the skin lesions. We performed a comprehensive literature review, with search criteria performed in PubMed and adapted for different databases. The review was conducted based on the studies found in Medline, LILACS, SciELO and Cochrane Library, from 1966 up to this moment. Studies were selected by the authors based on their relevance and scientific contribution to the discussion of this case. Conclusions: There are few cases of paracoccidiomycosis in the pediatric population despite the endemicity of this entity in Latin America. An increasing population influx from endemic areas makes suspecting of this disease a must.