Tuberculosis in a Spanish cohort of children living with HIV: the CHOTIS study (Childhood HIV & TB study)

National Network of HIV-infected Children (CORISPE); National Pediatric TB Network (pTBred) of Spain; Translational Research Network in Pediatric Infectious Diseases (RITIP).[Background] Tuberculosis (TB) is the leading opportunistic infection in children with human immunodeficiency virus (HIV), but is uncommon in low prevalence regions. We aim to describe the changing epidemiology and clinical presentation of TB-HIV co-infection in a cohort of HIV-infected children in Spain.[Methods] Children diagnosed with TB between 1995 and 2016 in the paediatric HIV cohort were identified. The incidence and clinical presentation were compared in three periods: 1995–1999 (P1, before initiation of combined antiretroviral therapy, cART), 2000–2009 (P2, increase in immigration), and 2010–2016 (P3, decrease in immigration).[Results] We included 29 TB cases among 1183 children aged 10 years (20% vs. 23.1% vs. 83.3%, P = 0.01). TB was diagnosed at HIV presentation in 11/29 children (37.9%). Foreign-born children accounted for respectively 0%, 8% and 67% of the total number of children in each period (P ≤ 0.0001). One third had extrapulmonary TB; four children died (13.8%).[Conclusion] In our cohort, the incidence of TB-HIV co-infection decreased with decline in immigration. In regions with adequate cART coverage and low TB transmission, paediatric TB-HIV coinfection is uncommon, but associated with significant morbidity. Strategies for TB surveillance, diagnosis and treatment in this vulnerable population should be reinforced.This study was supported by the Spanish National Pediatric Network for HIV infected Children and Adolescents (CoRISpe) integrated in the Spanish AIDS Research Network (RIS), and supported by Instituto de Salud Carlos III, Spanish Health Ministry [Grant n8 RD16/0025/0024 and RD06/0025] as part of the Plan RþDþI; and co-financed by ISCIII-Subdirecci ´on General de Evaluaci ´on and Fondo Europeo de Desarrollo Regional (FEDER ‘‘Una manera de hacer Europa’’), RIS-EPICLIN-18/2015. TS and BS are funded by Spanish Ministry of Health - Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union (FEDER) [Contratos Juan Rod´es, Grant JR16/00021 (TS) and JR16/00036 (BSG)]

Epidemiological and clinical features of Kawasaki disease in Spain over 5 years and risk factors for aneurysm development. (2011-2016): KAWA-RACE study group

BACKGROUND: Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology affecting mainly children less than 5 years of age. Risk factors for cardiac involvement and resistance to treatment are insufficiently studied in non-Japanese children. OBJECTIVE: This study aimed to investigate the epidemiology, clinical features and risk factors for resistance to treatment and coronary artery lesions (CAL) in KD in Spain. METHODS: Retrospective study (May 2011-June 2016) of all patients less than 16 years of age diagnosed with KD included in KAWA-RACE network (84 Spanish hospitals). RESULTS: A total of 625 cases were analyzed, 63% were males, 79% under 5 year-olds and 16.8% younger than 12 months. On echocardiographic examination CAL were the most frequent findings (23%) being ectasia the most common (12%). Coronary aneurysms were diagnosed in 9.6%, reaching 20% in infants under 12 months (p 900,000 cells/mm3, maximum temperature 10 days and fever before treatment >/= 8 days as independent risk factors for developing coronary aneurysms. CONCLUSIONS: In our population, children under 12 months develop coronary aneurysms more frequently and children with KD with anemia and leukocytosis have high risk of cardiac involvement. Adding steroids early should be considered in those patients, especially if the treatment is not started before 8 days of fever. A score applicable to non-Japanese children able to predict the risk of aneurysm development and IVIG resistance is necessary