RESUMO
Objetivo: Describir las complicaciones más frecuentes y la carga económica asociada con la varicela en el Perú. Material y métodos: Estudio multicéntrico de revisión de historias clínicas de pacientes de 1 a 14 años con diagnóstico de varicela entre 2011 y 2016. El uso de recursos de atención médica (URAM) asociados con la varicela, los costos unitarios y la pérdida de trabajo se utilizaron para estimar los costos directos e indirectos, presentados en USD ($). Los datos de costos y URAM se combinaron con estimaciones de carga de enfermedad para calcular el costo total anual de la varicela en el Perú. Resultados: Se incluyeron un total de 179 niños con varicela (101 ambulatorios, 78 hospitalizados). Entre los pacientes ambulatorios, el 5,9 % presentó una o más complicaciones, en comparación con 96,2 % de pacientes hospitalizados. El URAM incluyó el uso de medicamentos de venta libre (72,3 % frente a 89,7 % de pacientes ambulatorios y hospitalizados, respectivamente), medicamentos con receta (30,7 % frente a 94,9 %) y análisis y procedimientos (0,0 % frente a 80,8 %). Los costos directos e indirectos por caso ambulatorio fueron $36 y $62 respectivamente y por caso hospitalizado fueron $548 y $222. El costo anual total asociado con la varicela se estimó en $13 907 146. Conclusión: La varicela está asociada con complicaciones clínicas importantes y elevado URAM en Perú, lo que respalda la necesidad de implementación de un plan de vacunación universal. (AU)
Objective: The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Peru. Methods: This was a multicenter, retrospective chart review study of patients aged 1-14 years with a varicella diagnosis between 2011 and 2016. Healthcare resource utilization (HCRU) associated with varicella, unit costs, and work loss were used to estimate direct and indirect costs, presented in USD ($). The cost and HCRU data was combined with estimates of varicella disease burden to estimate the overall annual costs of management of varicella in Peru. Results: A total of 179 children with varicella (101 outpatients, 78 inpatients) were included. Among outpatients, 5.9% experienced â¥1 complication, compared with 96.2% of inpatients. HCRU estimates included use of over-the-counter (OTC) medications (72.3% vs. 89.7% of outpatient and inpatients, respectively), prescription medications (30.7% vs. 94.9%), tests/procedures (0.0% vs. 80.8%). Among outpatients, direct and indirect costs per case were $36 and $62, respectively; among inpatients, respective costs were $548 and $222. The total annual cost associated with varicella was estimated at $ 13 907 146. Conclusion: Varicella is associated with substantial clinical complications and high HCRU in Peru, supporting the need for implementation of a routine childhood varicella vaccination plan. (AU)
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Peru , Varicela/economia , Custos de Cuidados de Saúde , Gastos em Saúde , Programas de Imunização , Custos e Análise de Custo , Estudos Retrospectivos , Estudos Multicêntricos como Assunto , Estudos Observacionais como AssuntoRESUMO
BACKGROUND: Acute respiratory infections (ARIs) represent an important cause of morbidity and mortality in children, remaining a major public health concern, especially affecting children under 5 years old from low-income countries. Unfortunately, information regarding their epidemiology is still limited in Peru. METHODS: A secondary data analysis was performed from a previous cross-sectional study conducted in children with a probable diagnosis of Pertussis from January 2010 to July 2012. All samples were analyzed via Polymerase Chain Reaction (PCR) for the following etiologies: Influenza-A, Influenza-B, RSV-A, RSV-B, Adenovirus, Parainfluenza 1 virus, Parainfluenza 2 virus, Parainfluenza 3 virus, Mycoplasma pneumoniae and Chlamydia pneumoniae. RESULTS: A total of 288 patients were included. The most common pathogen isolated was Adenovirus (49%), followed by Bordetella pertussis (41%) from our previous investigation, the most prevelant microorganisms were Mycoplasma pneumonia (26%) and Influenza-B (19.8%). Coinfections were reported in 58% of samples and the most common association was found between B. pertussis and Adenovirus (12.2%). CONCLUSIONS: There was a high prevalence of Adenovirus, Mycoplasma pneumoniae and other etiologies in patients with a probable diagnosis of pertussis. Despite the presence of persistent cough lasting at least two weeks and other clinical characteristics highly suspicious of pertussis, secondary etiologies should be considered in children under 5 years-old in order to give a proper treatment.
Assuntos
Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia , Coqueluche/etiologia , Infecções por Adenoviridae/epidemiologia , Infecções por Adenoviridae/etiologia , Bordetella pertussis/genética , Bordetella pertussis/isolamento & purificação , Pré-Escolar , Infecções por Chlamydophila/epidemiologia , Infecções por Chlamydophila/etiologia , Chlamydophila pneumoniae/genética , Chlamydophila pneumoniae/isolamento & purificação , Tosse/microbiologia , Estudos Transversais , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Influenza Humana/epidemiologia , Influenza Humana/etiologia , Masculino , Mycoplasma pneumoniae/isolamento & purificação , Vírus da Parainfluenza 3 Humana/genética , Vírus da Parainfluenza 3 Humana/isolamento & purificação , Peru/epidemiologia , Pneumonia por Mycoplasma/epidemiologia , Pneumonia por Mycoplasma/microbiologia , Infecções Respiratórias/epidemiologia , Infecções por Respirovirus/epidemiologia , Infecções por Respirovirus/etiologia , Coqueluche/diagnóstico , Coqueluche/epidemiologiaRESUMO
OBJECTIVES: To report the incidence, epidemiology, and clinical features of Bordetella pertussis in Peruvian infants under 1 year old. PATIENTS AND METHODS: A prospective cross-sectional study was conducted in five hospitals in Peru from January 2010 to July 2012. A total of 392 infants under 1 year old were admitted with a clinical diagnosis of whooping cough and tested for B. pertussis by PCR. RESULTS: The pertussis toxin and IS481 genes were detected in 39.54% (155/392) of the cases. Infants aged less than 3 months were the most affected, with a prevalence of 73.55% (114/155). The most common household contact was the mother, identified in 20% (31/155) of cases. Paroxysm of coughing (89.03%, 138/155), cyanosis (68.39%, 106/155), respiratory distress (67.09%, 104/155), and breastfeeding difficulties (39.35%, 61/155) were the most frequent symptoms reported. CONCLUSION: An increase in pertussis cases has been reported in recent years in Peru, despite national immunization efforts. Surveillance with PCR for B. pertussis is essential, especially in infants less than 1 year old, in whom a higher rate of disease-related complications and higher mortality have been reported.
Assuntos
Bordetella pertussis/genética , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Estudos Transversais , Feminino , Hospitais , Humanos , Imunização , Lactente , Recém-Nascido , Masculino , Vacina contra Coqueluche/imunologia , Peru/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , Vacinação , Coqueluche/diagnóstico , Coqueluche/microbiologiaRESUMO
El presente trabajo describe la forma de presentación clínica, laboratorio y respuesta al tratamiento con itraconazol de la paracoccidioidomicosis en cuatro niños hospitalizados en el Instituto de Salud del Niño entre los años de 1990 y 1997. Todos los pacientes presentaron la forma diseminada de la enfermedad . La sintomatología más frecuente fue fiebre y linfadenopatías tanto supeficiales como intrabdominales y compromiso gastrointestinal caracterizado por diarrea disentérica. Uno de ellos tuvo diagnóstico de tuberculosis pulmonar probable. El examen directo de aspirado ganglionar con KOH al 10 por ciento, por ser de fácil acceso, rápido y por tener una sensibilidad que llega al 100 por ciento, fue la prueba diagnóstica de elección. La respuesta al tratamiento y tolerancia al itraconazol fueron buenas.
Assuntos
Humanos , Masculino , Feminino , Itraconazol/uso terapêutico , Paracoccidioidomicose/complicações , Paracoccidioidomicose/terapiaRESUMO
Se reporta un caso de Meningoencefalitis neonatal a Salmonela, ocurrido en un niño de 4 dias de edad, nacido en un Centro Hospitalario, con un peso de 4,250 g. y 52 cm. de talla, quién presentó sintomatología precoz, caracterizada por diarrea, vómitos y fiebre desde el cuarto día de nacida, convulsisonando al sexto. El cultivo del líquido céfalo raquídeo demostró Salmonela Grupo I Enteriditis. A pesar del tratamiento la evolución fue desfavorrable, falleciendo a los cuarenticinco dias de hospitalización. Recibió como tratamiento antibiótico: Penicilina, Cloranfenicol, Ampicilina, Amicacina, Cefalosporina (Cefotaxima). Se comenta el riesgo de la Salmonela como condicionante de infecciones sistémicas severas en el neonato, el problema de la prevalencia del gérmen en nuestros Hospitales y su resistencia antibiótica