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Introduction: Invasive Pneumococcal Disease (IPD) causes significant morbidity and mortality in children under 5 y. Colombia introduced PCV10 vaccination in 2012, and the Neumocolombia network has been monitoring IPD in pediatric patients since 2008. Materials and methods: This study is a secondary analysis of a prospective cohort involving pediatric patients with IPD admitted to 17 hospitals in Colombia, from January 1st, 2017, to December 31st, 2022. We present data on serotypes (Spn), clinical characteristics, and resistance patterns. Results: We report 530 patients, 215 (40.5%) were younger than 24 months. Among these, 344 cases (64.7%) presented with pneumonia, 95 (17.9%) with primary bacteremia, 53 (10%) with meningitis, 6 (1.1%) had pneumonia and meningitis, and 32 (6%) had other IPD diagnosis. The median hospital stay was 12 days (RIQ 8-14 days), and 268 (50.6%) were admitted to the ICU, of whom 60 (11.3%) died. Serotyping was performed in 298 (56.1%). The most frequent serotypes were Spn19A (51.3%), Spn6C (7.7%), Spn3 (6.7%), Spn6A (3.6%), and Spn14 (3.6%). Of 495 (93%) isolates with known susceptibility, 46 (9.2%) were meningeal (M) and 449 (90.7%) non-meningeal (NM). Among M isolates, 41.3% showed resistance to penicillin, and 21.7% decreased susceptibility to ceftriaxone. For NM isolates, 28.2% had decreased susceptibility to penicilin, and 24.2% decreased susceptibility to ceftriaxone. Spn19A showed the highest resistant to penicillin at 47% and was linked to multiresistance. Conclusion: The prevalence of PCV10-included serotypes decreased, while serotypes 19A and 6C increased, with Spn19A being associated with multiresistance. These findings had played a crucial role in the decision made by Colombia to modify its immunization schedule by switching to PCV13 in July 2022.
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Lock therapy is useful for preserving indwelling catheters. Few lock therapy studies have been published in Latin America. OBJECTIVE: To describe the clinical characteristics of pediatric patients using therapeutic and prophylactic lock therapy for six years in a high-complexity hospital in Colombia. PATIENTS AND METHOD: Cross-sectional descriptive study of patients aged < 18 years who received lock therapy. Collected variables included demographic data, clinical characteristics, blood test results, therapeutic interventions, frequency of admission to the pediatric critical care unit, and mortality. Descriptive analysis was performed. RESULTS: 54 patients were included in the study, most of them males, with 67 episodes of therapeutic lock therapy use. The most frequent diagnosis was hematological neoplasm (61%). Among these patients, 88% presented neutropenia while receiving lock therapy. Catheter preservation was achieved in 75% of the cases. Aminoglycosides were the most commonly used antibiotics (38%). Mortality due to catheter-related bacteremia was 6%. Catheter preservation using ethanol solution 70% was achieved in 62% of the patients with prophylactic lock therapy, all of whom had chronic gastrointestinal pathology. CONCLUSION: Catheter preservation rates were 75% and 62% in patients with therapeutic and prophylactic lock therapy, respectively, with a higher rate achieved among cancer patients with neutropenia (80%). Aminoglycosides and vancomycin were the most commonly used antibiotics.
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Cateteres Venosos Centrais , Neutropenia , Masculino , Humanos , Criança , Cateteres Venosos Centrais/efeitos adversos , Estudos Transversais , Antibacterianos/uso terapêutico , AminoglicosídeosRESUMO
SARS-CoV-2 surveillance of viral populations in wastewater samples is recognized as a useful tool for monitoring epidemic waves and boosting health preparedness. Next generation sequencing of viral RNA isolated from wastewater is a convenient and cost-effective strategy to understand the molecular epidemiology of SARS-CoV-2 and provide insights on the population dynamics of viral variants at the community level. However, in low- and middle-income countries, isolated groups have performed wastewater monitoring and data has not been extensively shared in the scientific community. Here we report the results of monitoring the co-circulation and abundance of variants of concern (VOCs) of SARS-CoV-2 in Uruguay, a small country in Latin America, between November 2020-July 2021 using wastewater surveillance. RNA isolated from wastewater was characterized by targeted sequencing of the Receptor Binding Domain region within the spike gene. Two computational approaches were used to track the viral variants. The results of the wastewater analysis showed the transition in the overall predominance of viral variants in wastewater from No-VOCs to successive VOCs, in agreement with clinical surveillance from sequencing of nasal swabs. The mutations K417T, E484K and N501Y, that characterize the Gamma VOC, were detected as early as December 2020, several weeks before the first clinical case was reported. Interestingly, a non-synonymous mutation described in the Delta VOC, L452R, was detected at a very low frequency since April 2021 when using a recently described sequence analysis tool (SAM Refiner). Wastewater NGS-based surveillance of SARS-CoV-2 is a reliable and complementary tool for monitoring the introduction and prevalence of VOCs at a community level allowing early public health decisions. This approach allows the tracking of symptomatic and asymptomatic individuals, who are generally under-reported in countries with limited clinical testing capacity. Our results suggests that wastewater-based epidemiology can contribute to improving public health responses in low- and middle-income countries.
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COVID-19 , Águas Residuárias , Humanos , SARS-CoV-2/genética , Vigilância Epidemiológica Baseada em Águas Residuárias , COVID-19/epidemiologia , Genômica , Sequenciamento de Nucleotídeos em Larga EscalaRESUMO
Background and Purpose: Disseminated fusariosis is an opportunistic infection caused by the hyaline fungus Fusarium spp. and occurs mainly in patients with leukemia. Case report: Two cases of disseminated fusariosis in pediatric patients are presented. Profound and prolonged neutropenia, fever, myalgia, and skin lesions in the legs were present in two girls with leukemia undergoing chemotherapy. In the first case, infection by Fusarium spp. was confirmed by anatomopathological findings, pathogen isolation, and polymerase chain reaction. In the second case, Fusarium solani infection was confirmed by mass spectrometry using blood cultures and skin lesion samples. Conclusion: It is important to consider disseminated fusariosis in high-risk patients who present with profound and prolonged neutropenia and persistent fever that does not resolve after broad-spectrum antibiotics to initiate antifungal therapy in a timely manner.
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Introduction: Acute bacterial meningitis (ABM) is a public health problem. The disease has reemerged after the introduction of pneumococcal conjugate vaccines (PCVs) due to an increase in serotypes that are not covered. The objective was to determine the changes in the disease incidence before and after the introduction of the 10-valent vaccine (PCV10) in Colombia. Methods: This multicenter study was conducted in 17 hospitals in Colombia. Data were collected from January 2008 to December 2019 in 10 hospitals in Bogotá and from January 2017 to December 2019 in seven hospitals in Cali, Medellín and Cartagena. The data were grouped into three periods: 2008-2011, 2012-2015, and 2016-2019. Results: Of the 706 cases of invasive pneumococcal disease, 81 (11.4%) corresponded to meningitis. The relative incidence in Bogotá in the first period was 0.6 per 100,000 patients ≤ 5 years, decreased to 0.4 per 100,000 patients ≤ 5 years in the second period and increased in the third period to 0.7 per 100,000 patients ≤ 5 years. Serotypes covered by PCV10 decreased from 75 to 9.1%, with Spn19A (31.8%) and Spn34 (13.6%) emerging in the third period. Increased resistance to penicillin (13 to 37%) and to ceftriaxone (5.9 to 16%) was due to the emergence of multidrug-resistant Spn19A. The total mortality rate was 23.5% and increased from 12 to 33%. Conclusions: ABM due to pneumococcus has high morbidity and mortality rates. Reemergence of the disease has been observed due to the inclusion of polymerase chain reaction (PCR) for diagnosis and replacement of circulating serotypes after the introduction of PCV10, with an increase in Spn19A, which causes death and exhibits antimicrobial resistance. Continued surveillance is needed.
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Introducción: Ante las complicaciones que presentan los pacientes diabéticos surge la necesidad de desarrollar estrategias educativas de autocuidado que mejoren la calidad de vida. Objetivo:determinar el efecto de una intervención educativa sobre la técnica correcta de la autoadministración de insulina en personas insulinorrequirientes para la prevención de lipohipertrofias en el municipio de San Gil. Metodología:estudio epidemiológico cuasiexperimental; se utilizó un instrumento de medición con prueba antes y después, con una muestra conformada por 86 personas diabéticas insulinorrequirientes con diabetes mellitus tipo 1 y 2.Resultados:en el pretest, el nivel de conocimiento sobre la administración de insulina presenta nivel bajo en el 19,5 %, nivel medio en el 5,2 % y nivel alto en el 75,3 %; en el postest el 100 % presentó nivel de conocimiento alto.Conclusión: La intervención educativa sobre la técnica correcta de la autoadministración de insulina en personas insulinorrequirientes para la prevención de lipohipertrofias tuvo un efecto positivo ya que los pacientes lograron alcanzar un nivel alto en sus conocimientos que mejoraron la técnica de administración de insulina para un tratamiento eficaz.
Introduction: Given the complications experienced by diabetic patients, there is a need to develop educational strategies for self-care to improve their quality of life.Objective: To determine the effect of an educational intervention on the correct technique for self-administration of insulin in insulin-requiring diabetic patients to prevent lipohypertrophy in the municipality of San Gil.Methods: This was a quasi-experimental epidemiological study; a measurement instrument with pre- and posttest evaluation was used in a sample of 86 insulin-requiring diabetic patients with type 1 and 2 diabetes mellitus.Results: In the pretest, the level of knowledge of insulin administration was low in 19.5% of the participants, middle in 5.2%, and high in 75.3%; in the posttest, 100% showed a high level of knowledge.Conclusion: The educational intervention on the correct technique of insulin self-administration in insulin-requiring diabetic patients to prevent lipohypertrophy had a positive effect as patients could reach a high level of knowledge and improved the insulin administration technique for effective treatment
ntrodução: Diante das complicações apresentadas pelos pacientes diabéticos, surge a necessidade de desenvolver estratégias educativas de autocuidado que melhorem a qualidade de vida.Objetivo: determinar o efeito de uma intervenção educativa sobre a técnica correta de auto-aplicação de insulina em pessoas que necessitam de insulina para prevenção de lipohipertrofia no município de San Gil.Metodologia: estudo epidemiológico quase experimental. Utilizou-se um instrumento de medida com teste antes e depois, com amostra composta por 86 diabéticos insulino-requerentes com diabetes mellitus tipo 1 e 2.Resultados: no pré-teste, o nível de conhecimento sobre administração de insulina apresenta baixo nível em 19 ,5%, nível médio em 5,2% e nível alto em 75,3%; no pós-teste, 100% apresentaram alto nível de conhecimento.Conclusão: A intervenção educativa sobre a técnica correta de autoadministração de insulina em pessoas insulino-requerentes para prevenção de lipohipertrofia teve um efeito positivo, pois os pacientes conseguiram atingir um alto nível de conhecimento que melhorou a técnica de administração de insulina para um tratamento efetivo
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Tuberculosis (TB) in the pediatric population is a major challenge. Our objective was to describe the clinical and microbiological characteristics, radiological patterns, and treatment outcomes of children and adolescents (from 1 month to 17 years) with community-acquired pneumonia (CAP) caused by TB. We performed a prospective cohort study of a pediatric population between 1 month and 17 years of age and hospitalized in Medellín, Colombia, with the diagnosis of radiologically confirmed CAP that had ≤ 15 days of symptoms. The mycobacterial culture of induced sputum was used for the bacteriological confirmation; the history of TB contact, a tuberculin skin test, and clinical improvement with treatment were used to identify microbiologically negative TB cases. Among 499 children with CAP, TB was diagnosed in 12 (2.4%), of which 10 had less than 8 days of a cough, 10 had alveolar opacities, 9 were younger than 5 years old, and 2 had close contact with a TB patient. Among the TB cases, 50% (6) had microbiological confirmation, 8 had viral and/or bacterial confirmation, one patient had multidrug-resistant TB, and 10/12 had non-severe pneumonia. In countries with an intermediate TB burden, Mycobacterium tuberculosis should be included in the etiological differential diagnosis (as a cause or coinfection) of both pneumonia and severe CAP in the pediatric population.
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Introduction: The parks importance as green environments for healthy recreation is not assumed in their real dimension given their health benefits, although the World Health Organization recommends the availability of a minimum of 9 m2 of green space per person. Various international organizations recognize that the park's main essential services for communities are economic value, health and environmental benefits. Objective: To determine the health semiosphere in emblematic parks of Quito and Madrid. Methods: A mixed investigation was carried out using semiotics as the main tool. For the information gathering, the citizen survey technique of Quito and Madrid was applied, as a basis for a comparative analysis that allowed measuring the perception modes. Results: Intrinsic health activities were determined as part of the park's semiosphere, both in Quito and Madrid. In the first city, recreation was recognized as the main one, and sports in the second city; as well as cultural and recreational activities such as the relevant ones to be enhanced. Conclusions: The park's main activities are intrinsically linked to citizen's health, so their semiosphere is based on their determination with the aim of repowering them(AU)
Introducción: La importancia de los parques como entornos verdes de sano esparcimiento no es asumida en su real dimensión dados sus beneficios a la salud, a pesar de que la Organización de la Salud recomienda la disponibilidad de un mínimo de 9 m2 de espacio verde por persona. Diversos organismos internacionales reconocen que los principales servicios esenciales de los parques para las comunidades son el valor económico, la salud y los beneficios ambientales. Objetivo: Determinar la semiósfera de la salud en parques emblemáticos de Quito y Madrid. Métodos: Se realizó una investigación mixta empleándose la semiótica como herramienta principal. Para el levantamiento de información se aplicó la técnica de encuesta a ciudadanos de Quito y Madrid, como base para un análisis comparativo que permitió medir los modos de percepción. Resultados: Se determinaron las actividades intrínsecas a la salud como parte de la semiósfera de los parques, tanto en Quito como en Madrid. En la primera ciudad se reconoció a la recreación como principal, y en la segunda al deporte; así como a las actividades culturales y recreacionales como las relevantes a ser repotenciadas. Conclusiones: Las actividades principales en los parques están intrínsecamente ligadas a la salud de sus ciudadanos, por lo que su semiósfera radica en la determinación de las mismas con el afán de repotenciarlas(AU)
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Humanos , Adolescente , Adulto , BiosferaRESUMO
Objetivo: Comparar la prueba fenotípica para la detección de carbapenemasas (Prueba Tridimensional -THT), con la prueba de biología molecular, reacción de polimerasa en cadena (PCR múltiple), para la detección de genes de resistencia. Materiales y métodos: De un total de 118 aislamientos de cepas de bacterias Gram negativas, del programa de vigilancia de multirresistencia en un hospital de tercer nivel, fueron evaluadas para la detección de carbapenemasas por Test de Hodge tridimensional (THT) y PCR Múltiple. Se hicieron cálculos de sensibilidad, especificidad, VPP, VPN, índice de validez e índice de Youden (IY), con sus intervalos de confianza. Resultados: Se observó que la prueba THT en comparación con PCR, presentó una sensibilidad de 98,41% (IC 95% 94,53 - 100), la especificidad fue de 83,64% (IC 95% 72,95 - 94,32) y los valores predictivos positivo y negativo fueron respectivamente 87,32 (IC 95% 78,88 - 95,77) y 97,87 (IC 95% 92,68 - 100). El índice de Youden fue 0,82 (IC 95% 0,72 - 0,92) y el índice de validez 91,53% (IC 95% 86,08 - 96,97) Conclusión: La prueba tridimensional de Hodge (THT), para detección de resistencia a carbapenémicos, puede ser una prueba de rutina útil en el laboratorio para sugerir resistencia por carbapenemasas
Objective: To compare the phenotypic test for detection of carbapenemases (Three-dimensional Test - THT), with molecular biology test (Multiplex PCR), for the detection of resistance genes. Methods: A total of 118 isolates of Gram-negative bacteria strains from the multiresistant surveillance program at a third-level hospital were evaluated for the detection of carbapenemases by three-dimensional test (THT) and the molecular biology PCR Multiple method . We calculated sensitivity, specificity, PPV, NPV, validity index and Youden index (IY), with their confidence intervals. Results: THT test compared to the multiple PCR test had a sensitivity of 98.41% (95% CI 94.53 - 100), specificity was 83.64% (95% CI 72.95 - 94 , 32) and positive and negative predictive values were respectively 87.32 (95% CI 78.88 - 95.77) and 97.87 (95% CI 92.68 - 100). Conclusion: The Hodge three-dimensional test (THT), for detection of carbapenem resistance, may be a useful routine laboratory test to suggest resistance by carbapenemases.
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Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Carbapenêmicos , Reação em Cadeia da Polimerase , beta-Lactamases , Reação em Cadeia da Polimerase/métodos , Diagnóstico , Bactérias Gram-NegativasRESUMO
PURPOSE: CARD9 deficiency is an inborn error of immunity that predisposes otherwise healthy humans to mucocutaneous and invasive fungal infections, mostly caused by Candida, but also by dermatophytes, Aspergillus, and other fungi. Phaeohyphomycosis are an emerging group of fungal infections caused by dematiaceous fungi (phaeohyphomycetes) and are being increasingly identified in patients with CARD9 deficiency. The Corynespora genus belongs to phaeohyphomycetes and only one adult patient with CARD9 deficiency has been reported to suffer from invasive disease caused by C. cassiicola. We identified a Colombian child with an early-onset, deep, and destructive mucocutaneous infection due to C. cassiicola and we searched for mutations in CARD9. METHODS: We reviewed the medical records and immunological findings in the patient. Microbiologic tests and biopsies were performed. Whole-exome sequencing (WES) was made and Sanger sequencing was used to confirm the CARD9 mutations in the patient and her family. Finally, CARD9 protein expression was evaluated in peripheral blood mononuclear cells (PBMC) by western blotting. RESULTS: The patient was affected by a large, indurated, foul-smelling, and verrucous ulcerated lesion on the left side of the face with extensive necrosis and crusting, due to a C. cassiicola infectious disease. WES led to the identification of compound heterozygous mutations in the patient consisting of the previously reported p.Q289* nonsense (c.865C > T, exon 6) mutation, and a novel deletion (c.23_29del; p.Asp8Alafs10*) leading to a frameshift and a premature stop codon in exon 2. CARD9 protein expression was absent in peripheral blood mononuclear cells from the patient. CONCLUSION: We describe here compound heterozygous loss-of-expression mutations in CARD9 leading to severe deep and destructive mucocutaneous phaeohyphomycosis due to C. cassiicola in a Colombian child.