Exogenous Cushing syndrome due to drug interaction of ritonavir and inhaled fluticasone. Report of three pediatric cases

El incremento de la expectativa de vida con el advenimiento de la terapia antirretroviral de alta eficacia plantea desafíos en cuanto a la toxicidad e interacciones medicamentosas. El síndrome de Cushing exógeno por interacción entre ritonavir y fluticasona inhalada en niños con diagnóstico de infección por virus de la inmunodeficiencia humana y patología pulmonar crónica es infrecuente. Hasta el momento, hay 20 casos reportados. Se describen 3 casos pediátricos con diagnóstico de infección por virus de la inmunodeficiencia humana y patología pulmonar crónica que presentaron síndrome de Cushing exógeno con fluticasona inhalada en dosis habituales por la interacción medicamentosa entre esta y ritonavir. Los pacientes resolvieron el cuadro clínico luego de 2-4 meses de suspensión de la fluticasona y permanecieron asintomáticos en el seguimiento.The increase in life expectancy with the advent of highly effective antiretroviral therapy poses challenges in terms of toxicity and drug interactions. Exogenous Cushing syndrome by interaction between ritonavir and inhaled fluticasone in children diagnosed with human immunodeficiency virus infection and chronic pulmonary pathology is rare. So far, there are 20 cases reported. Three pediatric cases are reported, with a diagnosis of human immunodeficiency virus infection and chronic pulmonary pathology who presented exogenous Cushing syndrome with inhaled fluticasone at usual doses due to drug interaction between it and ritonavir. The patients resolved the clinical picture after 2-4 months of fluticasone suspension and remain asymptomatic in the follow-up.Fil: Torrado, Lidia E.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Freire, Analia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Gobierno de la Ciudad de Buenos Aires. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Fundación de Endocrinología Infantil. Centro de Investigaciones Endocrinológicas "Dr. César Bergada"; ArgentinaFil: Martínez, Mayra. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Vieites, Ana María. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Gobierno de la Ciudad de Buenos Aires. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Fundación de Endocrinología Infantil. Centro de Investigaciones Endocrinológicas "Dr. César Bergada"; ArgentinaFil: Bergadá, Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Gobierno de la Ciudad de Buenos Aires. Centro de Investigaciones Endocrinológicas "Dr. César Bergada". Fundación de Endocrinología Infantil. Centro de Investigaciones Endocrinológicas "Dr. César Bergada"; ArgentinaFil: Lopez, Eduardo Luis. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Fallo, Aurelia A.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentin

Prevalence of Pertussis Antibodies in Maternal Blood, Cord Serum, and Infants From Mothers With and Those Without Tdap Booster Vaccination During Pregnancy in Argentina

Fil: Fallo, Aurelia A. Department of Pediatric Infectious Diseases, School of Medicine, Hospital de Niños "Ricardo Gutiérrez," University of Buenos Aires; Argentina.Fil: Neyro, Silvina E. Department of Pediatric Infectious Diseases, School of Medicine, Hospital de Niños "Ricardo Gutiérrez," University of Buenos Aires; Argentina.Fil: Manonelles, Gabriela V. Department of Pediatric Infectious Diseases, School of Medicine, Hospital de Niños "Ricardo Gutiérrez," University of Buenos Aires; Argentina.Fil: Lara, Claudia. Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán” (ANLIS); Argentina.Fil: Hozbor, Daniela. Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular (IBBM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT-CONICET; Argentina.Fil: Zintgraff, Jonathan. Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán” (ANLIS); Argentina.Fil: Mazzeo, Silvina. Departments of Obstetrics and Gynecology, Hospital D. F. Santojanni, Buenos Aires; Argentina.Fil: Davison, Héctor E. Departments of Obstetrics and Gynecology, Hospital D. F. Santojanni, Buenos Aires; Argentina.Fil: González, Susana. Pediatrics, Hospital D. F. Santojanni, Buenos Aires; Argentina.Fil: Zapulla, Estella. Pediatrics, Hospital D. F. Santojanni, Buenos Aires; ArgentinaFil: Canle, Oscar. Blood Center, Hospital de Niños "Ricardo Gutiérrez," Buenos Aires; ArgentinaFil: Huespe, Miguel. Departments of Obstetrics and Gynecology, Hospital D. F. Santojanni, Buenos Aires; Argentina.Fil: Galas, Marcelo. Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán” (ANLIS); Argentina.Fil: López, Eduardo L. Department of Pediatric Infectious Diseases, School of Medicine, Hospital de Niños "Ricardo Gutiérrez," University of Buenos Aires; Argentina.Morbidity and mortality rates for pertussis in infants are high because disease often occurs before the onset of routine immunization or in those who do not complete a primary immunization series. Pertussis immunization is recommended during pregnancy to achieve antibody levels sufficient to protect young infants. To our knowledge, no previous reports of maternal pertussis immunization results in Latin America exist in the literature

Clinical and epidemiologic aspects of human immunodeficiency virus-1-infected children in Buenos Aires, Argentina

Background: Argentina has the sixth largest number of cumulative pediatric cases of acquired immunodeficiency syndrome (AIDS) in the Americas; therefore, this study was designed to characterize human immunodeficiency virus-1 (HIV-1) infection in children in Buenos Aires, Argentina. Materials and Methods: Medical records of 389 children at risk and infected with HIV-1, an urban population followed by the AIDS Reference Center at the Hospital de Niños “Dr. Ricardo Gutiérrez” of Buenos Aires, from February 1990 to June 1997, were retrospectively reviewed. Mother-infant pairs were analyzed according to clinical and epidemiologic patterns. Results: Perinatal transmission occurred in 94.9% of the 389 cases classified as seroreverter (n=104, 26.7%), exposed (n=64, 16.4%), asymptomatic (n=13, 3.4%), and symptomatic patients (n=208, 53.5%); 132 patients met the Centers for Disease Control and Prevention (CDC) criteria for AIDS. The main maternal risk factor was sexual transmission 58.9% (73.4% of their sexual partners were injection drug users [IDU]). Among the AIDS patients, the most common AIDS-defining condition and death-related disease were severe bacterial infection and Pneumocystis carinii pneumonia, respectively. Death occurred in 51 of 221 HIV infected children. Low CD4 was related to death (P < 0.001). Mortality was estimated for two periods: January 1990 to December 1995 (G1) and January 1996 to May 1997 (G2). In G1, 37 of 127 (29.1%) died compared with 14 of 154 (9.1%) in G2 (P=0.001). The median age of death was 10 months for G1 and 29 months for G2 (P=0.01). The 3-year survival rate was 72% for G1 and 87% for G2 (log rank P=0.06). Conclusions: Intravenous drug use is the leading risk factor among parents of children exposed to HIV Infant mortality was related to age less than 12 months, low CD4 count, severe bacterial infection and P. carinii pneumonia. In this study, P. carinii pneumonia prophylaxis and combined antiretroviral therapy routinely implemented since 1996 has demonstrated a trend toward increased survival rates (P=0.06) and a lower mortality rate (P=0.001)