SÍNDROME HEMOFAGOCÍTICO O LINFOHISTIOCITOSIS HEMOFAGOCÍTICA POR VIRUS EPSTEIN BARR

Niña de dos años y 10 meses de edad con fiebre, citopenia, hipertrigliceridemia, hipofibrinogenemia y ferritinemia. Tiene mielograma con hemofagocitosis, se identifica virus de Epstein Barr. Paciente evoluciona desfavorablemente, ingresa a ventilación mecánica y fallece. DOI:https://doi.org/10.25176/RFMH.v16.n2.67

Clinical phenotypes of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19

The multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C) is infre-quent but potentially lethal. There are few reports of this disease and its phenotypes in Latin America. Objective: To describe the characteristics of the clinical phenotypes of MIS-C in hospitalized patients in Lima, Peru. Patients and Method: A descriptive and retrospective study in patients under 14 years old with a diagnosis of MIS-C at the Hospital Nacional Edgardo Rebagliati Martins (Lima, Perú), from April 2020 to August 2021. Clinical-demographic and microbiological variables were recorded. According to these, patients with MIS-C were classified into the shock phenotype, Kawasaki disease (KD) without shock, and the fever and inflammation phenotype, analyzing their clinical outcomes. Results: 58 patients were analyzed. 32 (55.2%) presented the shock phenotype, 15 (25.8%) Kawasaki disease (KD) phenotype without shock, and 11 (19%) fever and inflammation phenotype. In the shock phenotype, 17 had KD. The mean age was 7 ± 3.5 years and 67.2% were males. Gastrointes-tinal and mucocutaneous manifestations predominated in all phenotypes. The mortality was 3.5%. The frequency of coronary aneurysms was 10.2%. Most patients received immunomodulatory and antiplatelet treatment. Patients with shock phenotype showed greater involvement in inflammatory markers, hematological dysfunction, and myocardial injury, with a higher frequency of respiratory failure and invasive mechanical ventilation. Conclusions: In our case series, patients with shock phenotype were the most frequent and had worse clinical outcomes. Active surveillance of clinical phenotypes is needed to make an early diagnosis and management to improve the prognosis in these patients.Revisión por pare

Características clínicas y supervivencia en pacientes pediátricos oncohematológicos con COVID-19 en un hospital de referencia del Seguro Social de Salud del Perú, durante el 2020-2021

Introduction: In Latin America, there are few studies and heterogeneous results on pediatric oncohematology patients with COVID-19. Objective: To describe the clinical characteristics and survival of pediatric oncohematology patients with COVID-19 in a hospital in Lima-Peru, 2020-2021. Methods: Retrospective longitudinal study of hospitalized patients under 14 years of age. The data was collected from the medical records. Results: We included 30 patients, mostly men and schoolchildren, predominantly fever, respiratory and gastrointestinal symptoms, hematological neoplasia, and advanced oncological disease. The majority developed mild-moderate disease, but they also presented severe evolution requiring critical areas, with high mortality in hospitalization (13.3%) and low survival during follow-up (at 526 days, 59.26%, 95% CI 36 .53 to 76.20%). Survival increased with the start of chemotherapy, and decreased in patients in palliative condition, with respiratory support and shock. Conclusion: Most developed mild-moderate disease. However, SARS-CoV-2 can also cause severe involvement, death, and poor survival in oncohematological patients.Introducción: En Latinoamérica, existen pocos estudios y resultados heterogéneos sobre pacientes pediátricos oncohematológicos con COVID-19. Objetivo: Describir las características clínicas y la supervivencia de pacientes pediátricos oncohematológicos con COVID-19 en un hospital de Lima-Perú, 2020-2021. Métodos: Estudio longitudinal retrospectivo de pacientes menores de 14 años hospitalizados. Los datos se recolectaron de las historias clínicas.  Resultados: Incluimos 30 pacientes, mayoría hombres y escolares, predominando la fiebre, síntomas respiratorios y gastrointestinales, la neoplasia hematológica, y la enfermedad oncológica avanzada. La mayoría desarrolló enfermedad leve-moderada, pero también presentaron evolución severa con requerimiento de soporte crítico, con mortalidad alta en hospitalización (13,3%) y baja supervivencia durante el seguimiento (a los 526 días, 59,26%, IC95% 36,53 a 76,20%). La supervivencia aumentó con reinicio de la quimioterapia , y disminuyó en pacientes de condición paliativa, con soporte respiratorio y shock. Conclusiones: La mayoría desarrolló enfermedad leve-moderada. Sin embargo, el SARS-CoV-2 también puede causar afectación severa, muerte y baja supervivencia en pacientes oncohematológicos

Estudio transversal analítico de las características y desenlaces clínicos de niños hospitalizados con COVID-19 en Lima, Perú

Introduction: Coronavirus 2019 (SARS-CoV-2) infection in children occurred in Peru as of March 2020, leading to pediatric patients' hospitalization in areas adapted for this purpose at the Edgardo Rebagliati Martins National Hospital. In the beginning, the demand for hospitalization was low, but it increased gradually. Consistent with international reports, the majority of patients presented mild or moderate symptoms. Nonetheless, there were also severe cases, even fatal ones. Objectives: To describe the characteristics and clinical outcome of pediatric patients with COVID-19 hospitalized in a referral hospital in Lima, Peru, between March and August 2020. Methods: A descriptive and inferential cross-sectional study was carried out. The population includes all hospitalized patients in the Department of Pediatrics, with clinical and surgical diagnoses associated with COVID-19. Results: We included 100 patients, with an average age of 83.4 ± 54 months, with a predominance of male patients (55%). Hospitalized patients were grouped into five categories: respiratory failure (17%), multisystemic inflammatory syndrome (MIS-C) (31%), neurological presentation (19%), acute abdomen (20%), and patients with oncological problems (13%). Most of the patients (74%) had comorbidities. Regarding the presenting symptoms, intestinal pain predominated in the appendicitis group (90%, p < 0.001), fever was present in most patients with respiratory failure (64.7%); multisystemic inflammatory syndrome (90.3%), neurological manifestations (15.8%), acute abdomen (50%) and oncological conditions (61.5%) were also present in these patients. Kawasaki symptoms were found in 38.7% of the patients with multisystemic inflammatory syndrome. Mortality was 4%. Respiratory problems (29.4%) and multisystemic inflammatory syndrome (22.6%) required admission to intensive care, more frequently than the other presentations (p = 0.008). Conclusions: We conclude that the vulnerability in the pediatric population is the one that has preexisting conditions. We divided our patients according to presentation, diagnosis, and complications, which were predominantly respiratory. We also had oncological patients with COVID-19.Introducción: La infección por coronavirus 2019 (SARS-CoV-2) en niños se presentó en Perú desde marzo del 2020. Desde entonces fue necesario internar pacientes pediátricos en el Hospital Nacional Edgardo Rebagliati Martins, en el área de hospitalización adaptada para dicho propósito. Al inicio, la demanda de hospitalización era baja y se fue incrementando progresivamente. Coincidiendo con los reportes internacionales, la mayoría presentó cuadros leves o moderados, pero también hubo casos graves e incluso mortales. Objetivos: Describir las características y el desenlace clínico de los pacientes pediátricos con COVID-19 hospitalizados en un hospital de referencia en Lima, Perú, entre marzo y agosto de 2020. Métodos: Se realizó un estudio transversal descriptivo e inferencial. La población incluyó a todos los pacientes que se hospitalizaron en el Departamento de Pediatría Clínica, con diagnósticos clínicos y quirúrgicos asociados a COVID-19. Resultados: Incluimos 100 pacientes, con edad promedio de 83,4 ± 54 meses, con predominio de varones (55%). Los pacientes hospitalizados fueron agrupados en cinco categorías: insuficiencia respiratoria (17%), síndrome inflamatorio multisistémico (31%), presentación neurológica (19%), abdomen agudo (20%) y pacientes con problemas oncológicos (13%). La mayoría de los pacientes (74%) tenían comorbilidades. Respecto a los síntomas de presentación, el dolor intestinal predominó en el grupo de apendicitis (90%, p < 0,001), la fiebre estuvo presente en la mayoría de los pacientes con falla respiratoria (64,7%), el síndrome inflamatorio multisistémico se registró en 90,3%, la sintomatología neurológica en 15,8%, el abdomen agudo 50% y oncológicos en 61,5% de los pacientes. Los síntomas de Kawasaki estuvieron presentes en 38,7% de los pacientes con síndrome inflamatorio multisistémico. La mortalidad fue de 4%. En 29,4% de problemas respiratorios y en 22,6% de síndrome inflamatorio multisistémico, se requirió de admisión en cuidados intensivos, lo que fue más frecuente que las otras presentaciones (p = 0,008). Conclusiones: Se concluye que la población pediátrica vulnerable es aquella con comorbilidades preexistentes. La división de pacientes en nuestro estudio fue definida por la presentación, diagnóstico y complicaciones predominantemente con problemas respiratorios, y en pacientes oncológicos con COVID-19.Revisión por pare

Características de los pacientes pediátricos hospitalizados con COVID-19 durante la tercera ola (variante ómicron) en un hospital de referencia del Perú

El objetivo del presente estudio fue describir las características de los pacientes pediátricos (entre 28 días y 14 años) hospitalizados con COVID-19 durante la tercera ola (variante ómicron) en el Hospital Nacional Edgardo Rebagliati Martins (HNERM) (Lima, Perú). En esta cohorte retrospectiva, se revisaron las historias clínicas de 122 pacientes pediátricos que fueron atendidos en el HNERM entre enero e inicios de abril del 2022 (55% varones, mediana de edad de 5 años), 77,9% durante el primer mes, y la mitad presentaron alguna comorbilidad. Se hospitalizaron principalmente por dificultad respiratoria, comorbilidad descompensada y deshidratación. El 6,6% ingresaron a cuidados  intensivos, 4,9% a ventilación mecánica invasiva, 5,7% requirieron algún vasoactivo y 1,6% fallecieron. Los fármacos más usados fueron antibióticos (43,4%) y corticoides (27,1%). En conclusión, se encontró un incremento rápido de hospitalizaciones en comparación con las olas anteriores, la mayoría con evolución favorable, y con un amplio uso empírico de antibióticos

Short-, mid-, and long-term complications after multisystem inflammatory syndrome in children over a 24-month follow-up period in a hospital in Lima-Peru, 2020–2022

ObjectiveTo determine the short-, mid-, and long-term complications after multisystem inflammatory syndrome in children (MIS-C) over a 24-month follow-up period in a hospital in Lima, Peru, 2020–2022, and to explore differences according to the immunomodulatory treatment received and type of SARS-CoV-2 virus circulating.MethodsAmbispective 24-month follow-up study in children &lt;14 years of age diagnosed with MIS-C at the Hospital Nacional Edgardo Rebagliati Martins (HNERM).ResultsA total of 62 children were admitted with MIS-C. The most common short-term complications and serious events were intensive care unit (ICU) admission, invasive mechanical ventilation (IMV) due to respiratory failure, and shock; predominantly during the second pandemic wave (lambda predominance) and in children that received intravenous immunoglobulin (IVIG) plus a corticosteroid. Two patients died during the first wave due to MIS-C. During prospective follow-up (median of 24 months; IQR: 16.7–24), only 46.7% of patients were followed for &gt;18–24 months. Of the total, seven (11.3%) patients were identified with some sequelae on discharge. Among the 43 remaining children, sequelae persisted in five (11.6%) cases (neurological, hematological, and skin problems). Six patients (13.9%) presented with new onset disease (hematologic, respiratory, neurological, and psychiatric disorders). One patient died due to acute leukemia during the follow-up period. None of them were admitted to the ICU or presented with MIS-C reactivation. Two patients presented persistence of coronary aneurysm until 8- and 24-month post-discharge.ConclusionIn our hospital, children with MIS-C frequently developed short-term complications and serious events during the acute phase, with less frequent complications in the mid- and long-term. More studies are required to confirm these findings

Table1_Short-, mid-, and long-term complications after multisystem inflammatory syndrome in children over a 24-month follow-up period in a hospital in Lima-Peru, 2020–2022.doc

ObjectiveTo determine the short-, mid-, and long-term complications after multisystem inflammatory syndrome in children (MIS-C) over a 24-month follow-up period in a hospital in Lima, Peru, 2020–2022, and to explore differences according to the immunomodulatory treatment received and type of SARS-CoV-2 virus circulating.MethodsAmbispective 24-month follow-up study in children ResultsA total of 62 children were admitted with MIS-C. The most common short-term complications and serious events were intensive care unit (ICU) admission, invasive mechanical ventilation (IMV) due to respiratory failure, and shock; predominantly during the second pandemic wave (lambda predominance) and in children that received intravenous immunoglobulin (IVIG) plus a corticosteroid. Two patients died during the first wave due to MIS-C. During prospective follow-up (median of 24 months; IQR: 16.7–24), only 46.7% of patients were followed for >18–24 months. Of the total, seven (11.3%) patients were identified with some sequelae on discharge. Among the 43 remaining children, sequelae persisted in five (11.6%) cases (neurological, hematological, and skin problems). Six patients (13.9%) presented with new onset disease (hematologic, respiratory, neurological, and psychiatric disorders). One patient died due to acute leukemia during the follow-up period. None of them were admitted to the ICU or presented with MIS-C reactivation. Two patients presented persistence of coronary aneurysm until 8- and 24-month post-discharge.ConclusionIn our hospital, children with MIS-C frequently developed short-term complications and serious events during the acute phase, with less frequent complications in the mid- and long-term. More studies are required to confirm these findings.</p