Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents / Andrea Victoria Restrepo Gouzy ; Mónica Rosa Trujillo Honeysberg    

Público ISBD Título : Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents Tipo de documento : documento electrónico Autores : Andrea Victoria Restrepo Gouzy, ; Mónica Rosa Trujillo Honeysberg, Fecha de publicación : 2022 Títulos uniformes : BMC Pediatrics Idioma : Inglés (eng) Palabras clave : Pneumonia  Diagnosis  Etiology  Multiplex PCR  Serology  Induced sputum  Nasopharyngeal swab  Urine antigen  Children Resumen : Background: Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. Methods: Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. Results: Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. Conclusions: Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population. Mención de responsabilidad : Zulma Vanessa Rueda, Yudy Aguilar, María Angélica Maya, Lucelly López, Andrea Restrepo, Carlos Garcés, Olga Morales, Claudia Roya-Pabón, Mónica Trujillo, Catalina Arango, Ángela Rocio Copete, Cristian Vera, Margarita Rosa Giraldo, Mariana Herrera & Lázaro A. Vélez Referencia : BMC Pediatr. 2022 Mar 31;22(1):169. DOI (Digital Object Identifier) : 10.1186/s12887-022-03235-z PMID : 35361166 Derechos de uso : CC BY En línea : https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03235-z Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6029 Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents [documento electrónico] / Andrea Victoria Restrepo Gouzy, ; Mónica Rosa Trujillo Honeysberg,  . - 2022. Obra : BMC Pediatrics Idioma : Inglés (eng) Palabras clave : Pneumonia  Diagnosis  Etiology  Multiplex PCR  Serology  Induced sputum  Nasopharyngeal swab  Urine antigen  Children Resumen : Background: Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. Methods: Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. Results: Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. Conclusions: Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population. Mención de responsabilidad : Zulma Vanessa Rueda, Yudy Aguilar, María Angélica Maya, Lucelly López, Andrea Restrepo, Carlos Garcés, Olga Morales, Claudia Roya-Pabón, Mónica Trujillo, Catalina Arango, Ángela Rocio Copete, Cristian Vera, Margarita Rosa Giraldo, Mariana Herrera & Lázaro A. Vélez Referencia : BMC Pediatr. 2022 Mar 31;22(1):169. DOI (Digital Object Identifier) : 10.1186/s12887-022-03235-z PMID : 35361166 Derechos de uso : CC BY En línea : https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03235-z Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6029

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Reproducibility of a protocol for standardized reading of chest X-rays of children household contact of patients with tuberculosis / Lina Marcela Cadavid Álvarez ; Lucila Beatriz Molinares Arevalo    

Público ISBD Título : Reproducibility of a protocol for standardized reading of chest X-rays of children household contact of patients with tuberculosis Tipo de documento : documento electrónico Autores : Lina Marcela Cadavid Álvarez, ; Lucila Beatriz Molinares Arevalo, Fecha de publicación : 2022 Títulos uniformes : BMC Pediatrics Idioma : Inglés (eng) Palabras clave : Tuberculosis  Pulmonary  Latent Tuberculosis  Clinical Protocols  Radiography  Thoracic  Observer Variation  Reproducibility of Results Resumen : Background: The interpretation of the chest radiograph may vary because it depends on the reader and due to the non-specificity of findings in tuberculosis (TB). We aim to assess the reproducibility of a standardized chest radiograph reading protocol in contacts of patients with pulmonary TB under the 5 years of age. Methods: Descriptive, cross-sectional study with children under the age of five, household contacts of patients with confirmed pulmonary TB from Medellín, Bello and Itagüí (Colombia) between Jan-01-2015 and May-31-2016. Standardized reading protocol: two radiologists, blinded independent reading, use of template (Dr. Andronikou design) in case of disagreement a third reading was performed. Kappa coefficient for intra and inter observer agreement, and prevalence ratio were estimated of sociodemographic characteristics, TB exposure and interpretation of chest X-ray. Results: From 278 children, standardized reading found 255 (91.7%) normal X-rays, 10 (3.6%) consistent with TB, and 13 (4.7%) other alterations. Global agreement was 91.3% (Kappa = 0.51). Inter-observer agreement between readers 1-2 was 90.0% (Kappa = 0.59) and 1-3 93.2% (Kappa = 0.59). Intra-observer agreement for reader 1 was 95.5% (Kappa = 0.86), 2 84.0% (Kappa = 0.51), and 3 94.7% (Kappa = 0.68). Greater inter-observer disagreement was between readers 1-2 for soft tissue density suggestive of adenopathy (4.6%), airspace opacification (1.17%) and pleural effusion (0.58%); between readers 1-3 for soft tissue density suggestive of adenopathy (4.2%), opacification of airspace (2.5%) and cavities (0.8%). Conclusions: Chest radiographs are an affordable tool that contributes to the diagnosis of TB, so having a standardized reading protocol showed good agreement and improves the reproducibility of radiograph interpretation. Mención de responsabilidad : María Margarita Lozano-Acosta, María Alejandra Rubiano-Arenas, Lina Marcela Cadavid, Guillermo Vélez-Parra, Beatriz Molinares, Diana Marcela Marín-Pineda, María Patricia Arbeláez-Montoya & Dione Benjumea-Bedoya Referencia : BMC Pediatr. 2022 May 24;22(1):307. DOI (Digital Object Identifier) : 10.1186/s12887-022-03347-6 PMID : 35610599 Derechos de uso : CC BY En línea : https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03347-6 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6082 Reproducibility of a protocol for standardized reading of chest X-rays of children household contact of patients with tuberculosis [documento electrónico] / Lina Marcela Cadavid Álvarez, ; Lucila Beatriz Molinares Arevalo,  . - 2022. Obra : BMC Pediatrics Idioma : Inglés (eng) Palabras clave : Tuberculosis  Pulmonary  Latent Tuberculosis  Clinical Protocols  Radiography  Thoracic  Observer Variation  Reproducibility of Results Resumen : Background: The interpretation of the chest radiograph may vary because it depends on the reader and due to the non-specificity of findings in tuberculosis (TB). We aim to assess the reproducibility of a standardized chest radiograph reading protocol in contacts of patients with pulmonary TB under the 5 years of age. Methods: Descriptive, cross-sectional study with children under the age of five, household contacts of patients with confirmed pulmonary TB from Medellín, Bello and Itagüí (Colombia) between Jan-01-2015 and May-31-2016. Standardized reading protocol: two radiologists, blinded independent reading, use of template (Dr. Andronikou design) in case of disagreement a third reading was performed. Kappa coefficient for intra and inter observer agreement, and prevalence ratio were estimated of sociodemographic characteristics, TB exposure and interpretation of chest X-ray. Results: From 278 children, standardized reading found 255 (91.7%) normal X-rays, 10 (3.6%) consistent with TB, and 13 (4.7%) other alterations. Global agreement was 91.3% (Kappa = 0.51). Inter-observer agreement between readers 1-2 was 90.0% (Kappa = 0.59) and 1-3 93.2% (Kappa = 0.59). Intra-observer agreement for reader 1 was 95.5% (Kappa = 0.86), 2 84.0% (Kappa = 0.51), and 3 94.7% (Kappa = 0.68). Greater inter-observer disagreement was between readers 1-2 for soft tissue density suggestive of adenopathy (4.6%), airspace opacification (1.17%) and pleural effusion (0.58%); between readers 1-3 for soft tissue density suggestive of adenopathy (4.2%), opacification of airspace (2.5%) and cavities (0.8%). Conclusions: Chest radiographs are an affordable tool that contributes to the diagnosis of TB, so having a standardized reading protocol showed good agreement and improves the reproducibility of radiograph interpretation. Mención de responsabilidad : María Margarita Lozano-Acosta, María Alejandra Rubiano-Arenas, Lina Marcela Cadavid, Guillermo Vélez-Parra, Beatriz Molinares, Diana Marcela Marín-Pineda, María Patricia Arbeláez-Montoya & Dione Benjumea-Bedoya Referencia : BMC Pediatr. 2022 May 24;22(1):307. DOI (Digital Object Identifier) : 10.1186/s12887-022-03347-6 PMID : 35610599 Derechos de uso : CC BY En línea : https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03347-6 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6082

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Systematic review and meta-analysis of efficacy and safety of continuous positive airways pressure versus high flow oxygen cannula in acute bronchiolitis / Mauricio Fernández Laverde    

Público ISBD Título : Systematic review and meta-analysis of efficacy and safety of continuous positive airways pressure versus high flow oxygen cannula in acute bronchiolitis Tipo de documento : documento electrónico Autores : Mauricio Fernández Laverde, Fecha de publicación : 2022 Títulos uniformes : BMC Pediatrics Idioma : Inglés (eng) Palabras clave : Continuous positive airways pressure  High fow oxygen cannula  Children  Bronchiolitis  Severe bronchiolitis  Continuous positive air pressure  High-fow nasal cannula Resumen : Introduction: There are a trend towards increasing use of High-Flow Nasal Cannula (HFNC), outside of paediatric intensive care unit. Give this trend is necessary to update the actual evidence and to assess available published literature to determinate the efficacy of HFNC over Continuous Positive Air Pressure (CPAP) as treatment for children with severe bronchiolitis. Methods: We searched MEDLINE, EMBASE, LILACS, and COCHRANE Central, and gray literature in clinical trials databases (www.clinicaltrials.gov), from inception to June 2022. The inclusion criteria for the literature were randomized clinical trials (RCTs) that included children  Mención de responsabilidad : Jefferson Antonio Buendía, John Edwin Feliciano-Alfonso & Mauricio Fernandez Laverde Referencia : BMC Pediatr. 2022 Dec 3;22(1):696. DOI (Digital Object Identifier) : 10.1186/s12887-022-03754-9 PMID : 36463122 Derechos de uso : CC BY En línea : https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03754-9 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6080 Systematic review and meta-analysis of efficacy and safety of continuous positive airways pressure versus high flow oxygen cannula in acute bronchiolitis [documento electrónico] / Mauricio Fernández Laverde,  . - 2022. Obra : BMC Pediatrics Idioma : Inglés (eng) Palabras clave : Continuous positive airways pressure  High fow oxygen cannula  Children  Bronchiolitis  Severe bronchiolitis  Continuous positive air pressure  High-fow nasal cannula Resumen : Introduction: There are a trend towards increasing use of High-Flow Nasal Cannula (HFNC), outside of paediatric intensive care unit. Give this trend is necessary to update the actual evidence and to assess available published literature to determinate the efficacy of HFNC over Continuous Positive Air Pressure (CPAP) as treatment for children with severe bronchiolitis. Methods: We searched MEDLINE, EMBASE, LILACS, and COCHRANE Central, and gray literature in clinical trials databases (www.clinicaltrials.gov), from inception to June 2022. The inclusion criteria for the literature were randomized clinical trials (RCTs) that included children  Mención de responsabilidad : Jefferson Antonio Buendía, John Edwin Feliciano-Alfonso & Mauricio Fernandez Laverde Referencia : BMC Pediatr. 2022 Dec 3;22(1):696. DOI (Digital Object Identifier) : 10.1186/s12887-022-03754-9 PMID : 36463122 Derechos de uso : CC BY En línea : https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03754-9 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=6080

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Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study) / Laura Fernanda Niño Serna ; Carolina Giraldo Alzate  

Público ISBD Título : Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study) Tipo de documento : documento electrónico Autores : Laura Fernanda Niño Serna, ; Carolina Giraldo Alzate, Fecha de publicación : 2021 Títulos uniformes : BMC Pediatrics Idioma : Inglés (eng) Palabras clave : Sepsis  SARS-CoV2  PIMS-TS  infammatory  mortality Resumen : Background: The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. Methods: An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. Results: There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). Conclusions: Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children. Mención de responsabilidad : Lorena Acevedo, Byron Enrique Piñeres-Olave, Laura Fernanda Niño-Serna, Liliana Mazzillo Vega, Ivan Jose Ardila Gomez, Shayl Chacón, Juan Camilo Jaramillo-Bustamante, Hernando Mulett-Hoyos, Otto González-Pardo, Eliana Zemanate, Ledys Izquierdo, Jaime Piracoca Mejìa, Jose Luis Junco González, Beatriz Giraldo Duran, Carolina Bonilla Gonzalez, Helen Preciado, Rafael Orozco Marun, Martha I Alvarez-Olmos, Carolina Giraldo Alzate, Jorge Rojas, Juan Carlos Salazar-Uribe, Juan-Manuel Anaya & Jaime Fernández-Sarmiento Referencia : BMC Pediatr. 2021 Nov 18;21(1):516. DOI (Digital Object Identifier) : 10.1186/s12887-021-02974-9 PMID : 34794410 Derechos de uso : CC BY En línea : https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02974-9 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5839 Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study) [documento electrónico] / Laura Fernanda Niño Serna, ; Carolina Giraldo Alzate,  . - 2021. Obra : BMC Pediatrics Idioma : Inglés (eng) Palabras clave : Sepsis  SARS-CoV2  PIMS-TS  infammatory  mortality Resumen : Background: The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. Methods: An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. Results: There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). Conclusions: Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children. Mención de responsabilidad : Lorena Acevedo, Byron Enrique Piñeres-Olave, Laura Fernanda Niño-Serna, Liliana Mazzillo Vega, Ivan Jose Ardila Gomez, Shayl Chacón, Juan Camilo Jaramillo-Bustamante, Hernando Mulett-Hoyos, Otto González-Pardo, Eliana Zemanate, Ledys Izquierdo, Jaime Piracoca Mejìa, Jose Luis Junco González, Beatriz Giraldo Duran, Carolina Bonilla Gonzalez, Helen Preciado, Rafael Orozco Marun, Martha I Alvarez-Olmos, Carolina Giraldo Alzate, Jorge Rojas, Juan Carlos Salazar-Uribe, Juan-Manuel Anaya & Jaime Fernández-Sarmiento Referencia : BMC Pediatr. 2021 Nov 18;21(1):516. DOI (Digital Object Identifier) : 10.1186/s12887-021-02974-9 PMID : 34794410 Derechos de uso : CC BY En línea : https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02974-9 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5839

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