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Bustamante J, Sainz T, Pérez S, Rodríguez-Molino P, Montero Vega D, Mellado MJ, García López-Hortelano M. Toxocariasis in migrant children: A 6 years' experience in a reference pediatric unit in Spain. Travel Med Infect Dis 2022; 47:102288. [PMID: 35247580 DOI: 10.1016/j.tmaid.2022.102288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 12/21/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Toxocariasis is a worldwide distributed zoonosis that affects characteristically children. Clinical presentation is highly variable, often asymptomatic, and treatment duration is controversial. METHODS A retrospective descriptive study (January 2014-December 2019) was performed in a referral Unit for Pediatric Tropical Diseases. Patients younger than 18 years of age diagnosed with toxocariasis were included. RESULTS Out of 931 children screened for toxocariasis, 49 (5.3%) were seropositive. The median age was 11.0 years, 55.1% male and 30.6% referred contact with puppies. Overall, 34.7% were Latin-American, 24.5% Asiatic, 20.4% European, and 20.4% African. Only 34.7% presented symptoms, gastrointestinal the most common (52.9%). The 57.1% of children presented eosinophilia and 50% elevated total IgE. Most cases (95.9%) corresponded to covert toxocariasis. All children were treated with albendazole for 5-14-21 days, and 4 children required a second course. Follow-up data were available in 32 children (65.3%) for a median of 7 months, showing a progressive decline in eosinophils, IgE-titers and ELISA optical density. CONCLUSION Toxocariasis is mostly asymptomatic in children and eosinophilia is not always present. Serological tests should be included in migrant health screening and in the diagnostic assessment of eosinophilia. Eosinophil count, IgE-titers and ELISA optical-density could be useful during follow-up.
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Affiliation(s)
- J Bustamante
- Department of Pediatrics and Infectious Diseases, Hospital Universitario Doctor José Molina Orosa, Las Palmas, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain.
| | - T Sainz
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain; Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - S Pérez
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Hospital de Torrejón, Madrid, Spain.
| | - P Rodríguez-Molino
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain.
| | - D Montero Vega
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Department of Microbiology and Parasitology, Hospital La Paz Madrid, Spain.
| | - M J Mellado
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain; Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - M García López-Hortelano
- La Paz Research Institute (IdiPAZ), Madrid, Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain; Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain.
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Torres-Fernandez D, Casellas A, Mellado MJ, Calvo C, Bassat Q. Acute bronchiolitis and respiratory syncytial virus seasonal transmission during the COVID-19 pandemic in Spain: A national perspective from the pediatric Spanish Society (AEP). J Clin Virol 2021; 145:105027. [PMID: 34781241 PMCID: PMC8575537 DOI: 10.1016/j.jcv.2021.105027] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES The COVID-19 pandemic and the widespread associated use of non-pharmaceutical interventions have impacted viral circulation and the incidence of respiratory tract infections. We compared Pediatric Emergency Department visits, bronchiolitis admissions, and respiratory syncytial virus (RSV) cases in 2020 with those documented for the preceding four years. METHODS This was a retrospective multicentric national survey study, driven by the Pediatric Spanish Society, and gathering monthly data from Spanish hospitals between 1st January 2016 and 31st December 2020. An Interrupted Time Series Analysis and Poisson regression models were performed for each index. RESULTS Thirty-eight hospitals representing most of the different regions of Spain participated. Compared to the preceding four years, in 2020, Pediatric emergency department visits significantly decreased immediately after initiation of the national lockdown. The median number of visits averted per month was 39,754 (IQR 26,539-50,065). RSV diagnoses during the 2020 winter season nearly disappeared with only 21 cases being documented among participating hospitals. The expected seasonal peak of bronchiolitis hospitalizations never occurred. The median number of admissions in 2020 averted per month was 100 (IQR 37-185) compared to 2016-2019. Only 3 hospitalized cases were RSV-confirmed. Reopening of schools and kindergarten was not associated with a remarkable increase in RSV cases or bronchiolitis hospitalizations. CONCLUSION A dramatic reduction of bronchiolitis admissions and near disappearance of RSV cases was observed in Spanish hospitals coinciding with the peak of the COVID-19 pandemic.
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Affiliation(s)
| | - Aina Casellas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Maria José Mellado
- Pediatric Infectious Diseases Unit, Pediatrics Department, University Hospital La Paz, Madrid (Spain). Fundación IdiPaz. Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain; Asociación Española de Pediatría (AEP), Spain
| | - Cristina Calvo
- Pediatric Infectious Diseases Unit, Pediatrics Department, University Hospital La Paz, Madrid (Spain). Fundación IdiPaz. Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain; Asociación Española de Pediatría (AEP), Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Asociación Española de Pediatría (AEP), Spain.
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Mellado MJ. Impact of COVID on pediatrics. "AEP's pandemic term". An Pediatr (Barc) 2021; 95:287-289. [PMID: 34711533 PMCID: PMC8547802 DOI: 10.1016/j.anpede.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Maria José Mellado
- Presidenta de la Asociación Española de Pediatría (AEP) 2017-2021, Madrid, Spain.
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Mellado MJ. [Impact of COVID on pediatrics. «AEP's pandemic term»]. An Pediatr (Barc) 2021; 95:287-289. [PMID: 34630574 PMCID: PMC8486591 DOI: 10.1016/j.anpedi.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Maria José Mellado
- Presidenta de la Asociación Española de Pediatría (AEP) 2017-2021, Madrid, España
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De la Calle M, Baquero-Artigao F, Rodríguez-Molino P, Cabanes M, Cabrera M, Antolin E, Mellado MJ, Bartha JL. Combined treatment with immunoglobulin and valaciclovir in pregnant women with cytomegalovirus infection and high risk of symptomatic fetal disease. J Matern Fetal Neonatal Med 2020; 35:3196-3200. [PMID: 32933353 DOI: 10.1080/14767058.2020.1815188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Congenital cytomegalovirus (CMV) infection is one of the most common during pregnancy. The infection, particularly in the first trimester, is associated with important sequelae in up to half of the children. Valaciclovir and immunoglobulin have been tested separately for the treatment of fetal CMV infection with relative success. Nevertheless, there is no experience with the simultaneous use of both therapies. METHODS combination therapy (oral valaciclovir 2 g/6h until the end of pregnancy and intravenous hyperimmune gamma globulin 200 UI/kg) was offered to pregnant women with CMV infection acquired during pregnancy and viral load (VL) in amniotic fluid above 105 copies/ml and/or brain injuries in the ultrasonography. Additional immunoglobulin monthly doses were used in case of ultrasonography or MRI evidence of persistent fetal involvement. Neurological and hearing evaluations of infants were performed at birth and every 3 months during follow-up. RESULTS 15 pregnant women were enrolled: primary infection, 14, non-primary infection, 1; first trimester, 11, second trimester, 4. Mean gestational age at the start of combination treatment were 23.2 weeks and 29.3 weeks, depending on the infection being diagnosed in the first or the second trimester, respectively. Median VL of CMV-DNA in amniotic fluid was 62.5 × 105 copies/ml. Intrauterine progression of fetal brain lesions was only observed in two cases in which the dose of CMV-HIG was repeated, slowing their progression. Although the treatment has failed to reverse ultrasound fetal lesions, only 3 children were born with hearing impairment and their psychomotor development was consistent with chronological age in all patients but one. Combination therapy was not associated with adverse effects in either the mothers or the fetuses. CONCLUSION Combination therapy with immunoglobulin and valaciclovir may be a useful alternative in CMV fetal infection, particularly if changes in cerebral echography or high VL in the amniotic fluid are present.
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Affiliation(s)
- Maria De la Calle
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
| | | | | | - Maria Cabanes
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
| | - Marta Cabrera
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Eugenia Antolin
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
| | - Maria José Mellado
- Department of Pediatric Infectology, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
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Jiménez de Ory S, Ramos JT, Fortuny C, González-Tomé MI, Mellado MJ, Moreno D, Gavilán C, Menasalvas AI, Piqueras AI, Frick MA, Muñoz-Fernández MA, Navarro ML. Sociodemographic changes and trends in the rates of new perinatal HIV diagnoses and transmission in Spain from 1997 to 2015. PLoS One 2019; 14:e0223536. [PMID: 31647824 PMCID: PMC6812742 DOI: 10.1371/journal.pone.0223536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/22/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There are not enough nationwide studies on perinatal HIV transmission in connection with a combination of antiretroviral treatments in Spain. Our objectives were to study sociodemographic changes and trends in the rates of HIV diagnoses and perinatal transmission in Spain from 1997 to 2015. METHODS A retrospective study using data from Spanish Paediatric HIV Network (CoRISpe) and Spanish Minimum Basic Data Set (MDBS) was performed. HIV- diagnosed children between 1997 and 2015 were selected. Sociodemographic, clinical and immunovirological data of HIV-infected children and their mothers were studied in four calendar periods (P1: 1997-2000; P2: 2001-2005; P3: 2006-2010; P4: 2011-2015). Rates of perinatal HIV diagnoses and transmission from 1997 to 2015 were calculated. RESULTS A total of 532 HIV-infected children were included in this study. Of these children, 406 were Spanish (76.3%) and 126 immigrants (23.7%). A decrease in the number of HIV diagnoses, 203 (38.2%) children in the first (P1), 149 (28%) in the second (P2), 130 (24.4%) in the third (P3) and 50 (9.4%) in the fourth (P4) calendar periods was studied. The same decrease in the Spanish HIV-infected children (P1, 174 (46.6%), P2, 115 (30.8%), P3, 65 (17.4%) and P4, 19 (5.1%)) was monitored. However, an increase in the number of HIV diagnoses by sexual contact (P1: 0%; P2: 1.3%; P3: 4.6%; P4: 16%) was observed. The rates of new perinatal HIV diagnoses and perinatal transmission in Spanish children decreased from 0.167 to 0.005 per 100,000 inhabitants and 11.4% to 0.4% between 1997 and 2015, respectively. CONCLUSIONS A decline of perinatal HIV diagnoses and transmission was observed. However, an increase of teen-agers HIV diagnoses with sexual infection was studied. Public awareness campaigns directed to teen-agers are advisable to prevent HIV infection by sexual contact.
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Affiliation(s)
- Santiago Jiménez de Ory
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), CoRISpe, Madrid, Spain
| | - José Tomas Ramos
- Servicio de Pediatría, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Claudia Fortuny
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat, Spain
| | - María Isabel González-Tomé
- Servicio de Infecciosas Pediátricas, Hospital Universitario Doce de Octubre, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria José Mellado
- Pediatrics, Immunodeficiencies and Infectious Diseases Unit, Hospital Universitario La Paz, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - David Moreno
- Department of Pediatrics, Regional Maternal-Child University Hospital, Malaga, Spain
- IBIMA Multidisciplinary Group for Pediatric Research, Malaga, Spain, Malaga University, Malaga, Spain
| | - César Gavilán
- Department of Paediatrics, University Clinical Hospital of San Juan de Alicante, San Juan de Alicante, Alicante, Spain
- Department of Paediatrics, Miguel Hernández University of Elche, Campus of Sant Joan d'Alacant, Alicante, Spain
| | | | - Ana Isabel Piqueras
- Department of Pediatric Surgery, and Department of Pediatrics, Hospital La Fe, Valencia, Spain
| | - M. Antoinette Frick
- Tropical Medicine and International Health Unit. Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Angeles Muñoz-Fernández
- Section Immunology, Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain, Spanish HIV HGM BioBank, Madrid, Spain
| | - Maria Luisa Navarro
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Medical School, Universidad Complutense de Madrid, Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
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Prieto LM, Fernández McPhee C, Rojas P, Mazariegos D, Muñoz E, Mellado MJ, Holguín Á, Navarro ML, González-Tomé MI, Ramos JT. Pregnancy outcomes in perinatally HIV-infected young women in Madrid, Spain: 2000-2015. PLoS One 2017; 12:e0183558. [PMID: 28841701 PMCID: PMC5571961 DOI: 10.1371/journal.pone.0183558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/07/2017] [Indexed: 01/22/2023] Open
Abstract
Background An increasing number of perinatally HIV-infected women (PHIV) are reaching adulthood and becoming pregnant. Most PHIV women have been exposed to a high number of antiretroviral regimens, and they may have difficulties to achieve viral suppression. Psychosocial problems are not uncommon and could be an important barrier for treatment adherence. The effects of chronic HIV infection and long-term exposure to antiretroviral treatment of PHIV women cause concerns on the developing fetus. The aims of this study were to describe the prevention of mother-to-child transmission strategies in PHIV women and the infant outcomes in the Madrid Cohort of HIV-infected mother-infant pairs. Methods All PHIV pregnant women registered in the Cohort that gave birth from 2000 to 2015 were included in the study. Results Twenty-eight pregnancies in twenty-two perinatally infected women were registered. Most women were Caucasian and heavily treatment-experienced. Nine cases (32.1%) were at high risk of HIV mother-to-child transmission. Maternal HIV-1 viral load was detectable close to delivery in four women (14.3%). The management of these cases was described, and the treatment strategies were discussed. None of the newborns acquired HIV infection. Eight infants (28.6%) were small for gestational age. Conclusions This study included a large series of pregnancies among PHIV women attended according to a youth-centered care model. The challenges in the management of this population by health-care providers were described. Specific strategies to minimize perinatal transmission risks should be addressed in future collaborative studies.
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Affiliation(s)
- Luis M. Prieto
- Paediatrics Department, Hospital Universitario de Getafe, Madrid, Spain
- * E-mail:
| | - Carolina Fernández McPhee
- Infectious Diseases Unit, Paediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Rojas
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBER-ESP, Madrid, Spain
| | - Diana Mazariegos
- Paediatrics Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Eloy Muñoz
- Obstetrics and Ginecology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria José Mellado
- Tropical and Infectious Diseases Unit, Paediatrics Department, Hospital Universitario La Paz, Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBER-ESP, Madrid, Spain
| | - María Luisa Navarro
- Infectious Diseases Unit, Paediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - José Tomás Ramos
- Paediatrics Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
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Martínez-Bonet M, Puertas MC, Fortuny C, Ouchi D, Mellado MJ, Rojo P, Noguera-Julian A, Muñoz-Fernández MA, Martinez-Picado J. Establishment and Replenishment of the Viral Reservoir in Perinatally HIV-1-infected Children Initiating Very Early Antiretroviral Therapy. Clin Infect Dis 2015; 61:1169-78. [PMID: 26063721 PMCID: PMC4560905 DOI: 10.1093/cid/civ456] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/21/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) generally suppresses the replication of the human immunodeficiency virus type 1 (HIV-1) but does not cure the infection, because proviruses persist in stable latent reservoirs. It has been proposed that low-level proviral reservoirs might predict longer virologic control after discontinuation of treatment. Our objective was to evaluate the impact of very early initiation of cART and temporary treatment interruption on the size of the latent HIV-1 reservoir in vertically infected children. METHODS This retrospective study included 23 perinatally HIV-1-infected children who initiated very early treatment within 12 weeks after birth (n = 14), or early treatment between week 12 and 1 year (n = 9). We measured the proviral reservoir (CD4(+) T-cell-associated HIV-1 DNA) in blood samples collected beyond the first year of sustained virologic suppression. RESULTS There is a strong positive correlation between the time to initiation of cART and the size of the proviral reservoir. Children who initiated cART within the first 12 weeks of life showed a proviral reservoir 6-fold smaller than children initiating cART beyond this time (P < .01). Rapid virologic control after initiation of cART also limits the size of the viral reservoir. However, patients who underwent transient treatment interruptions showed a dramatic increase in the size of the viral reservoir after discontinuation. CONCLUSIONS Initiation of cART during the first 12 weeks of life in perinatally HIV-1-infected children limits the size of the viral reservoir. Treatment interruptions should be undertaken with caution, as they might lead to fast and irreversible replenishment of the viral reservoir.
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Affiliation(s)
- Marta Martínez-Bonet
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN)
- Spanish HIV HGM BioBank
| | - Maria Carmen Puertas
- AIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Claudia Fortuny
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat
| | - Dan Ouchi
- AIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
| | - Maria José Mellado
- Servicio de Pediatría Hospitalaria y E. Infecciosas y Tropicales Pediátricas. Hospital Universitario Infantil LA PAZ- H. Carlos III, Madrid
| | - Pablo Rojo
- Servicio de Pediatría. Hospital 12 de Octubre, Madrid
| | - Antoni Noguera-Julian
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat
| | - Ma Angeles Muñoz-Fernández
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN)
- Spanish HIV HGM BioBank
| | - Javier Martinez-Picado
- AIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona
- Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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Fernández-Cooke E, Rojas P, Holguin A, Tomé MIG, Jimenez de Ory S, Mellado MJ, Navarro ML, Rojo P, Ramos JT. Description and consequences of prescribing off-label antiretrovirals in the Madrid Cohort of HIV-infected children over a quarter of a century (1988-2012). Antivir Ther 2015; 21:65-70. [PMID: 26079937 DOI: 10.3851/imp2973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Licensing data for paediatric dosing is often sparse and subsequent studies may result in changes to recommended doses. We measured the extent and consequences of off-label antiretroviral (ARV) use in an HIV-infected paediatric cohort. METHODS In this multicentre cohort study involving 318 HIV-infected children and adolescents from the Madrid Cohort, all off-label prescriptions from March 1988 to March 2012 were recorded from the clinical records. The reasons for prescribing ARV off-label, the side effects and the consequences of incorrect dosing of ARVs are discussed. RESULTS Among the 318 patients of the cohort, 221 (69%) received off-label ARVs according to EMA licensing at the time of prescription, representing 23% (540) of the 2,353 prescribed ARVs. The main reason for starting an off-label drug was treatment failure. Adverse events led to treatment discontinuation in 12% of the prescriptions. Problems taking the drug led to withdrawal in 5%, more likely when formulation was not suitable for age (P<0.05). Up to 10% were overdosed and 10% underdosed, defined as 25% above or below the current recommended dose, respectively. Treatment failure occurred significantly more frequently among underdosed compared to overdosed patients (50% versus 26%; P<0.05). CONCLUSIONS Off-label use of ARVs was common in our HIV-1 paediatric patients. Adverse events were common but rarely led to withdrawal. Suitable formulation is important in younger children. Pharmacokinetic studies are needed as frequent incorrect dosing may occur when prescribing off-label and underdosing may lead to treatment failure.
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Menson EN, Mellado MJ, Bamford A, Castelli G, Duiculescu D, Marczyńska M, Navarro ML, Scherpbier HJ, Heath PT. Guidance on vaccination of HIV-infected children in Europe. HIV Med 2012; 13:333-6; e1-14. [PMID: 22296225 DOI: 10.1111/j.1468-1293.2011.00982.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2011] [Indexed: 02/02/2023]
Affiliation(s)
- E N Menson
- Department of General Paediatrics, Evelina Children's Hospital @St Thomas' Hospital, London, UK.
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Nso Roca AP, Larru B, Bellón JM, Mellado MJ, Ramos JT, González MI, Navarro ML, Muñoz-Fernández MÁ, José MID, José MID. HIV-infected adolescents: relationship between atazanavir plasma levels and bilirubin concentrations. J Adolesc Health 2011; 48:100-2. [PMID: 21185531 DOI: 10.1016/j.jadohealth.2010.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 05/12/2010] [Accepted: 05/13/2010] [Indexed: 11/27/2022]
Abstract
The use of atazanavir (ATV) in adolescents infected with human immunodeficiency virus was analyzed in this study. ATV morning plasma concentrations were determined during regular visits to the outpatient department. Results showed that bilirubin levels were higher among patients with higher ATV plasma concentrations (p = .018). Monitoring plasma levels of ATV could avoid toxicity in these patients.
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Affiliation(s)
- Ana P Nso Roca
- Servicio de Pediatría, Hospital Infantil La Paz, Madrid, Spain.
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Guillén S, García San Miguel L, Resino S, Bellón JM, González I, Jiménez de Ory S, Muñoz-Fernández MA, Navarro ML, Gurbindo MD, de José MI, Mellado MJ, Martín-Fontelos P, Gonzalez-Tomé MI, Martinez J, Beceiro J, Roa MA, Ramos JT. Opportunistic infections and organ-specific diseases in HIV-1-infected children: a cohort study (1990-2006). HIV Med 2010; 11:245-52. [DOI: 10.1111/j.1468-1293.2009.00768.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Palladino C, Bellón JM, Jarrín I, Gurbindo MD, De José MI, Ramos JT, González-Iome MI, Mellado MJ, Beceiro J, Amo JD, Muñoz-Fernández MÁ. Impact of highly active antiretroviral therapy (HAART) on AIDS and death in a cohort of vertically HIV type 1-infected children: 1980-2006. AIDS Res Hum Retroviruses 2009; 25:1091-7. [PMID: 19895191 DOI: 10.1089/aid.2009.0070] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We evaluated the population effectiveness of highly active antiretroviral therapy (HAART) on the risk of AIDS and death in a multicenter cohort of 346 HIV-1 vertically infected children born between 1980 and 2006 in the Comunidad Autónoma de Madrid (CAM), Spain. Risks of AIDS and death in patients with the same duration of HIV infection were compared in different calendar periods [CP1: 1980-1989, CP2: 1990-1993 (reference), CP3: 1994-1996, CP4: 1997-1998, CP5: 1999-2006] through cumulative incidence curves and Cox proportional hazards models, allowing for late entry, that included the calendar period as the time-dependent covariate and adjusting for gender and mother's transmission category. The median follow-up was 11.8 years [interquartile range (IQR), 6.3-15.9]. Median CD4+ T cell percentage increased up to 26.5 in CP5 (IQR, 19.5-36.7) while the viral load decreased (median log(10) copies/ml in CP5, 3.66; IQR, 3.07-4.22). Multivariate analysis showed significant reduction in the risk of death since 1997 onward [CP4: adjusted hazard ratios (AHR), 0.29; 95% confidence interval (CI), 0.12-0.69; CP5: AHR, 0.06; 95% CI, 0.03-0.15]. Reduction in progression to AIDS reached borderline significance in CP4 (AHR, 0.49; 95% CI, 0.23-1.05) and was more marked in the last period (CP5: AHR, 0.30; 95% CI, 0.16-0.59). The reductions in the incidence of AIDS and death observed since 1996 were largely attributable to HAART.
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Affiliation(s)
- Claudia Palladino
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario “Gregorio Marañón,” Madrid, Spain
- Istituto Pasteur, Fondazione Cenci-Bolognetti, Università degli Studi di Roma “La Sapienza,” 00185 Rome, Italy
- Università degli Studi di Roma “La Sapienza,” 00185 Rome, Italy
| | - Jose M. Bellón
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario “Gregorio Marañón,” Madrid, Spain
| | - Inmaculada Jarrín
- Centro Nacional de Epidemiología, Instituto de Salud “Carlos III,” Madrid, Spain
| | - Maria Dolores Gurbindo
- Sección Inmuno-Pediatría, Hospital Materno Infantil “Gregorio Marañón,” Madrid, Spain
- Unidad Asociada de Retrovirología Humana, HGUGM-CSIC, Madrid, Spain
| | - M. Isabel De José
- Servicio Infecciosas Infantil, Hospital Universitario “La Paz,” Madrid, Spain
| | - José T. Ramos
- Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain
| | - M. Isabel González-Iome
- Servicio de Infecciosas Pediátricas, Hospital Universitario “Doce de Octubre,” Madrid, Spain
| | - Maria José Mellado
- Servicio de Pediatría, Hospital Universitario “Carlos III,”, Madrid, Spain
| | - José Beceiro
- Servicio de Pediatría, Hospital Universitario “Príncipe de Asturias,” Madrid, Spain
| | - Julia Del Amo
- Centro Nacional de Epidemiología, Instituto de Salud “Carlos III,” Madrid, Spain
| | - M. Ángeles Muñoz-Fernández
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario “Gregorio Marañón,” Madrid, Spain
- Unidad Asociada de Retrovirología Humana, HGUGM-CSIC, Madrid, Spain
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14
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Cilleruelo MJ, de Ory F, Ruiz-Contreras J, González-González R, Mellado MJ, García-Hortelano M, Villota J, García-Ascaso M, Piñeiro R, Martín-Fontelos P, Herruzo R. Internationally adopted children: what vaccines should they receive? Vaccine 2008; 26:5784-90. [PMID: 18786590 DOI: 10.1016/j.vaccine.2008.08.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 08/18/2008] [Accepted: 08/19/2008] [Indexed: 11/29/2022]
Abstract
It is of paramount importance to know the vaccination status in internationally adopted children, so that they can be correctly immunized. This study ascertains the seroprotection rate for vaccine-preventable diseases and the validity of the immunization cards in 637 adopted children. The absence of the immunization card (13% of children) correlated with a poor global vaccine protection. Children with immunization records (87%) had a better global seroprotection but the information obtained from the card did not accurately predict seroprotection for each particular antigen. The best variable to predict the status of seroprotection was the country of origin. The highest rate of protection was found in children from Eastern Europe and, in descending order, India, Latin America, China and Africa. General recommendations for immunization of internationally adopted children are difficult to establish. Actions for vaccination have to be mainly implemented on the basis of the existence of the immunization card and of the country of origin.
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Affiliation(s)
- M J Cilleruelo
- Department of Pediatrics, Hospital Carlos III, Madrid, Spain.
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15
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Polo R, Gómez-Candela C, Miralles C, Locutura J, Alvarez J, Barreiro F, Bellido D, Câncer E, Cánoves D, Domingo P, Estrada V, Fumaz CR, Galindo MJ, García-Benayas T, Iglesias C, Irles JA, Jiménez-Nacher I, Lozano F, Marqués I, Martínez-Alvarez JR, Mellado MJ, Miján A, Ramos JT, Riobo P. Recommendations from SPNS/GEAM/SENBA/SENPE/AEDN/SEDCA/GESIDA on nutrition in the HIV-infected patient. NUTR HOSP 2007; 22:229-43. [PMID: 17416041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
OBJECTIVE to make recommendations on the approach to nutritional problems (malnutrition, cachexia, micronutrient deficiency, obesity, lipodystrophy) affecting HIV-infected patients. METHODS these recommendations have been agreed upon by a group of expertes in the nutrition and care of HIV-infected patients, on behalf of the different groups involved in drafting them. Therefore, the latest advances in pathophysiology, epidemiology, and clinical care presented in studies published in medical journals or at scientific meetings were evaluated. RESULTS there is no single method of evaluating nutrition, and diferent techniques--CT, MRI, and DXA--must be combined. The energy requirements of symptomatic patients increase by 20-30%. There is no evidence to support the increase in protein or fat intake. Micronutrient supplementation in only necessary in special circumstances (vitamin A in children and pregnant woman). Aerobic and resistance excercise is beneficial both for cardiovascular health and for improving lean mass and muscular strength. It is important to follow the rules of food safety at every stage in the chain. Therapeutic intervention in anorexia and cachexia must be tailored, by combining nutritional and pharmacological support (appetite stimulants, anabolic steroids, and, in some cases, testosterone). Artificial nutrition (oral supplementation, enteral or parenteral nutrition) is safe and efficacious, and improves nutritional status and response to therapy. In children, nutritional recommendations must be made early, and are a necessary component of therapy. CONCLUSION appropriate nutritional evaluation and relevant therapeutic action are an essential part of the care of HIV-infected patients.
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Affiliation(s)
- R Polo
- Plan Nacional sobre el Sida, España
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16
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Mellado MJ, Cilleruelo MJ, Ortiz M, Villota J, García M, Perez-Jurado ML, Barreiro G, Martín-Fontelos P, Bernal A. Viral phenotype, antiretroviral resistance and clinical evolution in human immunodeficiency virus-infected children. Pediatr Infect Dis J 1997; 16:1032-7. [PMID: 9384335 DOI: 10.1097/00006454-199711000-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The syncytium-inducing (SI) viral phenotype and the emergence of viral strains resistant to zidovudine have been described in persons infected with HIV, and in some cases they have been associated with poor prognosis. METHODS HIV isolates obtained from 37 HIV-infected children were analyzed to determine whether the SI viral phenotype and the mutation on the 215 position of the reverse transcriptase (M215) could be used as markers of disease progression. We performed peripheral blood coculture mononuclear cells, and we analyzed the induction of syncytia using the MT-2 cell line. The emergence of mutations on the 215 position was determined by PCR. RESULTS We found a statistically significant association (P < 0.05) between SI viral phenotype and (1) recurrent serious bacterial infections, (2) absolute CD4+ cell counts <2 SD, (3) progression to AIDS and (4) death. Sixty percent of the children treated with zidovudine developed 215 mutant viral strains without statistically significant association with clinical or immunologic findings. The SI viral phenotype was statistically associated with the presence of the 215 mutation (P < 0.05). CONCLUSIONS SI viral phenotype is a marker associated with a poor clinical and immunologic progression of the disease and it may facilitate the emergence of mutant strains in children treated with zidovudine.
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Affiliation(s)
- M J Mellado
- Centro de Investigación Clínica, Servicio de Pediatría, Instituto de Salud Carlos III, Madrid, Spain
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17
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Del Aguila C, Navajas R, Gurbindo D, Ramos JT, Mellado MJ, Fenoy S, Muñoz Fernandez MA, Subirats M, Ruiz J, Pieniazek NJ. Microsporidiosis in HIV-positive children in Madrid (Spain). J Eukaryot Microbiol 1997; 44:84S-85S. [PMID: 9580074 DOI: 10.1111/j.1550-7408.1997.tb05798.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A prospective study was carried out to determine the prevalence rates of microsporidiosis and other enteroparasites in HIV-positive children in the Madrid area. HIV-positive pediatric patients from three hospitals were enrolled in the study. A total of 293 samples (158 stool and 127 urine) were collected from 83 children whose mean age was 6.3 years and had a mean CD4 count of 504.7/mm3 (range 1-2,220/mm3), 48 of whom suffered diarrhea at the time of the study. Microsporidia identification was investigated in stool and urine samples using Weber's chromotrope-based stain, IIF and PCR species-specific tests. Enteric parasites were identified in 32.5% of the children. Cryptosporidium sp. was the most common parasite encountered (14.4%), followed by Blastocytis sp. (9.6%) and Giardia duodenalis (8.4%). Microsporidia was only found in the stools of one child (1.2% of total and 2% of those with diarrhea) and Enterocytozoon bieneusi was demonstrated by PCR. The patient was 10 years old, presented non-chronic diarrhea and his CD4 count was 298/mm3. These data differ from those previously reported by us in HIV-positive adults (13.9%) in the same area, although this group showed more severely depressed CD4 lymphocyte counts than children. New epidemiological studies should be carried out to elucidate whether additional risk factors exist between these groups.
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Affiliation(s)
- C Del Aguila
- Sec. Parasitology, Fac. CCEE y Técnicas, Univ. San Pablo CEU, Madrid, Spain
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18
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Bravo R, Gutiérrez M, Soriano V, Mellado MJ, Pérez-Labad ML, Mas A, González-Lahoz J, Martín-Fontelas P. Lack of evidence for viral clearance in children born to HIV-infected mothers. AIDS 1996; 10:1744-5. [PMID: 8970702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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19
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Bravo R, Cilleruelo MJ, Castilla J, Mellado MJ, Villota J, Martín-Fontelos P, Soriano V. Viral load in relation to clinical outcome in HIV-infected children. Eur J Clin Microbiol Infect Dis 1996; 15:900. [PMID: 8997572 DOI: 10.1007/bf01691231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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20
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Ruiz-Contreras J, Ramos JT, Hernández-Sampelayo T, Gurbindo MD, Garcia de José M, De Miguel MJ, Cilleruelo MJ, Mellado MJ. Sepsis in children with human immunodeficiency virus infection. The Madrid HIV Pediatric Infection Collaborative Study Group. Pediatr Infect Dis J 1995; 14:522-6. [PMID: 7667058 DOI: 10.1097/00006454-199506000-00010] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aims of this retrospective study were to review the frequency and patterns of bacterial sepsis in children infected with human immunodeficiency virus. The charts of 233 human immunodeficiency virus-infected children cared for during a 10-year period in 4 tertiary hospitals in Madrid were reviewed. There were 43 episodes of sepsis in 31 (13%) children. Twenty of them had acquired immunodeficiency syndrome, 10 were class PA2 and 1 was class P1B. The most common organisms recovered were: nontyphoidal Salmonella, 10 cases (23%); Streptococcus pneumoniae, 9 cases (21%); Staphylococcus epidermidis, 6 cases (14%); Escherichia coli, 5 cases (12%); Enterococcus faecalis, 4 cases (9%); Campylobacter jejuni, 2 cases (5%). In 28 episodes of bacteremia there were other sites of associated infection: pneumonia, 6 cases; urinary tract infection (UTI), 5 cases; gastrointestinal disease, 4 cases; catheter-related bacteremia, 12 cases. Eight patients had more than 1 episode of bacteremia. The rate of complications was high: 6 children had septic shock; and 2 of them developed disseminated intravascular coagulation. There was 1 death directly related to sepsis.
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Affiliation(s)
- J Ruiz-Contreras
- Department of Pediatrics, Hospital Doce de Octubre, Universidad Complutense, Madrid, Spain
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21
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Temboury MC, Jara P, Mellado MJ, Díaz MC, Vázquez C, García Caballero C. [Pediatric-social aspects of the acute and chronic viral types of hepatitis in childhood]. An Esp Pediatr 1986; 25:177-82. [PMID: 3789551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study analyzes the sanitary, sociofamiliar, cultural and economic aspects of children who have been diagnosed of acute and chronic viral hepatitis. Retrospective data was collected of 249 children. A questionnaire was given to the parents and the information collected was processed in a computer. The results showed that most children had been sent to the hospital without a diagnosis and in chronic hepatitis the diagnosis was delayed for more than a year. The social status did not influence the type of hepatitis. Children with chronic hepatitis active had a worse performance in school. The disease was transmitted to other family members in 30% of cases and hospital expenses were high.
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22
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Mellado MJ, Jara P, Valverde F, Díaz MC, Fuentes E, Larrauri J, Vázquez C. [Hepatic lesions caused by alpha 1-antitrypsin deficiency in childhood. Review of 14 cases]. An Esp Pediatr 1986; 25:5-12. [PMID: 3489428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Fourteen cases of alpha-1-antitrypsin deficiency are presented. All of them had a PIZZ phenotype except two in which a PIMZ phenotype was found. It must be pointed out that histological findings show a great variability among the different patients most of which did not have intracellular PAS-positive amylase inclusions in liver biopsy specimens. Clinical course did not correlate with either the age of onset of the disease or the phenotype found, thus indicating that other additional factors are involved in determining prognosis. We insist on the importance of a careful study of all neonatal hepatitis syndromes in order to rule out a alpha-1-antitrypsin deficiency.
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23
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Polanco I, Mellado MJ, Lama R, Larrauri J, Zapata A, Redondo E, Vázquez C. [Anderson's disease. Apropos of a new case]. An Esp Pediatr 1986; 24:185-8. [PMID: 3706925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A new case of Anderson's disease in a 3-month-old black female infant is presented. This diagnosis should be considered in infants with chronic diarrhoea, fatty stools, failure to gain weight which may be present from birth, low serum cholesterol concentration (less than 70 mg/ml), low plasma triglyceride levels, and hypobetalipoproteinaemia. However, suspicion of diagnosis clinically can be certainly verified by intestinal biopsy showing characteristic epithelial cell pattern. Steatorrhoea may be effectively treated by substituting medium for long-chain triglycerides in the diet. This disorder needs to be distinguished from familial hypobetalipoproteinaemia as well as abetalipoproteinaemia, and it prognosis is good, because of absence of acanthocytosis, neurological involvement and ocular lesions.
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