Post Infection Constrictive Bronchiolitis in an Infant after SARS-CoV-2

La bronquiolitis obliterante se caracteriza por ser una enfermedad respiratoria obstructiva crónica con cambios histológicos irreversibles y de presentación inusual en la población pediátrica por lo cual usualmente es sub diagnosticada, sin embargo, en episodios broncoobstructivos de evolución atípica o severa debe ser considerada como probable diagnóstico. La bronquiolitis obliterante se considera una enfermedad crónica inflamatoria de los bronquiolos que puede presentarse de dos formas histopatológicas ya sea por afectación peribronquiolar desde el epitelio hacia la luz de forma concéntrica (constrictiva) o por ocupación del lumen del bronquiolo dado por proliferación del tejido endoluminal (proliferativa). El diagnóstico se realiza según criterios clínicos y criterios radiológicos (TC de tórax), un puntaje mayor de 7 predice con alta precisión el diagnóstico de bronquiolitis obliterante. Dado que se trata de una enfermedad inflamatoria crónica mediada por la respuesta inmune, el tratamiento esta dirigido a suprimir la respuesta inflamatoria para evitar el daño pulmonar por cambios irreversibles sin embargo, una vez instaurada la enfermedad el tratamiento será sintomático, de soporte y seguimiento de la función pulmonar. A continuación, se presenta el caso de un lactante de 2 meses de edad con antecedente en su periodo neonatal de infección respiratoria por SARS-CoV-2 (COVID-19) en quien se evidenció cambios radiológicos y clínicos compatibles con bronquiolitis constrictiva post infecciosa en su evolución clínica.Q4Neonatos con Bronquiolitis constrictivaBronchiolitis obliterans is a chronic and irreversiblepulmonary disease that leads to obstruction andobliteration of the small airways and that can present by peribronchiolar involvement, from the epitheliumtowards the lumen in a concentric (constrictive), orby occupation of the lumen of the bronchiole, given by proliferation of the endoluminal tissue (proliferative). The lesion at the level of the small airway can occurafter lung or bone marrow transplantation, infections, inhalation of toxic substances, connective tissue diseasesor secondary to drugs. In the pediatric population, the constrictive form secondary to severe respiratory tractinfections, and known as post-infectious bronchiolitisobliterans (PIBO), is the most common and its clinicalpresentation can be highly variable from mild to severe airway obstruction that does not respond to treatmentwith bronchodilators, in addition to hypoxemia, cough andtachypnea. Diagnosis is difficult given the previous need for a lung biopsy, the current absence of biomarkers, andsince its pathophysiology is not clearly understood. The CT as well as a clinical score predict with high precisionthe diagnosis of obliterative bronchiolitis. Treatment isaimed at suppressing the inflammatory response to preventlung damage. We report a case of a 2-month-old infant with a history of respiratory infection due to SARS-CoV-2(COVID-19) in his neonatal period is presented, in whomradiological and clinical changes compatible with PIBO were evidenced.https://orcid.org/0000-0002-5917-8212https://orcid.org/0000-0002-3037-9715https://orcid.org/0000-0003-1627-7971https://orcid.org/0000-0003-3870-4102https://orcid.org/0000-0002-1923-3934Revista Nacional - IndexadaS

Characterization of cytomegalovirus lung infection in non-HIV infected children

Cytomegalovirus (CMV) is a prevalent pathogen in the immunocompromised host and invasive pneumonia is a feared complication of the virus in this population. In this pediatric case series we characterized CMV lung infection in 15 non-HIV infected children (median age 3 years; IQR 0.2–4.9 years), using current molecular and imaging diagnostic modalities, in combination with respiratory signs and symptoms. The most prominent clinical and laboratory findings included cough (100%), hypoxemia (100%), diffuse adventitious breath sounds (100%) and increased respiratory effort (93%). All patients had abnormal lung images characterized by ground glass opacity/consolidation in 80% of cases. CMV was detected in the lung either by CMV PCR in bronchoalveolar lavage (82% detection rate) or histology/immunohistochemistry in lung biopsy (100% detection rate). CMV caused respiratory failure in 47% of children infected and the overall mortality rate was 13.3%. Conclusion: CMV pneumonia is a potential lethal disease in non-HIV infected children that requires a high-index of suspicion. Common clinical and radiological patterns such as hypoxemia, diffuse adventitious lung sounds and ground-glass pulmonary opacities may allow early identification of CMV lung infection in the pediatric population, which may lead to prompt initiation of antiviral therapy and better clinical outcomes

Aspergilosis pulmonar invasiva: reporte de un caso

The fungus Aspergillus spp. causes infections in immunocompromised hosts and produces a variety of clinical syndromes including lung tracheobronchial, chronic necrotizing pulmonary and allergic bronchopulmonary manifestations, as well as aspergilloma, depending on the type of host-fungus relationship involved. Aspergilloma is usually colonized by Aspergillus spp. lesions in the bronchial tree, while invasive forms are characterized by the presence of hyphae below its basement membrane. The objective of the present study was to describe the case of a pediatric patient with invasive pulmonary aspergillosis in the form of pseudomembranous tracheobronchitis, including the clinical course, diagnostic approach and paraclinical care provided.The patient was a 5-year-old female with a history of Fanconi anemia who presented with febrile neutropenia and pneumonia. Antibiotic treatment with cefepime provided no improvement in the patient’s condition and computed tomography of the thorax revealed bibasilar pulmonary opacities. Bronchoalveolar lavage and a lesion biopsy were performed after diagnostic bronchoscopy showed a white exophytic lesion. Since pathologic examination revealed numerous septate fungal hyphae exhibiting 45° branching compatible with Aspergillus spp., the patient was treated with voriconazole. Bronchoalveolar lavage culture produced fungi of the Aspergillus flavi complex. A review of pulmonary Aspergillus spp. infection in children is also included, with emphasis on the management and treatment of clinical syndromes. In pediatric patients with hematological diseases who present with febrile neutropenia and respiratory symptoms, it is essential to consider fungi as potential etiologic agents including Aspergillus spp., which is common and causes a variety of clinical syndromes. El hongo Aspergillus spp. causa infecciones oportunistas en huéspedes inmunocomprometidos. Cursa con una variedad de síndromes clínicos en el pulmón, que incluyen aspergilosis invasiva, aspergilosis pulmonar necrótica crónica, aspergilosis broncopulmonar alérgica y aspergiloma, cuya manifestación depende del tipo de relación con el huésped. El aspergiloma resulta de lesiones colonizadas por Aspergillus spp. en el árbol bronquial, en tanto que las formas invasivas se caracterizan por la presencia de hifas por debajo de la membrana basal del árbol bronquial.El objetivo de este trabajo es describir el caso de una paciente con aspergilosis pulmonar invasiva en su forma de traqueobronquitis seudomembranosa, considerando el curso clínico, el diagnóstico y el manejo paraclínico.Se trató de una paciente de cinco años de edad con antecedentes de anemia de Fanconi, que fue llevada a consulta con neutropenia febril y neumonía. Se inició el tratamiento antibiótico con cefepime, sin mejoría clínica.La tomografía computadorizada (TC) de tórax reveló opacidades parenquimatosas en ambas bases pulmonares. En una fibrobroncoscopia se encontró una lesión exofítica blanquecina en el bronquio principal derecho, que se sometió a biopsia, y se practicó un lavado broncoalveolar. En el examen de histopatología se hallaron hifas tabicadas a 45°, y el resultado del cultivo reveló la presencia del complejo Aspergillus flavi, por lo que se inició la administración de voriconazol. Se revisaron los reportes en la literatura científica sobre la infección pulmonar por Aspergillus spp. en niños, con énfasis en los síndromes clínicos, y en su manejo y tratamiento.Ante la presencia de síntomas respiratorios en pacientes pediátricos con enfermedades hematológicas que cursen con neutropenia febril, es indispensable considerar como agentes etiológicos los hongos, entre los cuales Aspergillus spp. se presenta frecuentemente causando diferentes síndromes clínicos

Recommendations from the Asociación Colombiana de Medicina del Sueño for the practice of sleep medicine in Colombia during the COVID-19 pandemic

El lavado de manos frecuente, el uso obligatorio de mascarilla por parte de la población general en sitios públicos, el distanciamiento físico y social, y el confinamiento obligatorio de la mayoría de la población en sus casas son las medidas que hasta el momento han ayudado a frenar la propagación del nuevo coronavirus (SARS-CoV-2), causante de la actual pandemia por COVID-19. Sin embargo, la adopción de algunas de estas medidas ha generado retraso en el diagnóstico y tratamiento de diferentes enfermedades, incluyendo los trastornos del sueño, por lo que es urgente que los especialistas en medicina del sueño y los centros de sueño retomen sus actividades gradualmente, siempre que se implementen estrictos protocolos de bioseguridad que mitiguen el riesgo de contagio. En este contexto, y con el fin de ayudar a los somnólogos a reabrir los centros de sueño y reanudar los procedimientos allí realizados, la Asociación Colombiana de Medicina del Sueño propone en la presente reflexión una serie de recomendaciones para tener en cuenta durante el proceso de reactivación. Estas recomendaciones se basan en las estrategias de mitigación establecidas por las autoridades sanitarias del país, las directrices de la American Academy of Sleep Medicine, y la literatura disponible sobre el tema, la cual fue revisada luego de realizar una búsqueda en las bases de datos PubMed, SciELO y Google Scholar usando los términos “sleep” “sleep medicine” y “COVID-19”.Measures such as frequent handwashing, mandatory use of face masks by the general population in public spaces, social and physical distancing, and mandatory confinement of most people at their homes have contributed to slowing down the spread of the new coronavirus (SARS-CoV-2), which is the source of the current COVID-19 pandemic. However, adopting some of these measures has caused delays in the diagnosis and treatment of various diseases, including sleep disorders. There-fore, it is urgent for sleep specialists and sleep centers to gradually resume activities, as long as strict biosecurity protocols aimed at reducing the risk of contagion are implemented. In this scenario, and in order to help somnologists reopen sleep centers and resume the proce-dures performed there, the Asociación Colombiana de Medicina del Sueño (Colombian Association of Sleep Medicine) proposes through this reflection paper several recommendations that should be considered during the reactivation process. These recommendations are based on the COVID-19 spread mitigation strategies established by the Colombian health authorities, the guidelines issued by the American Academy of Sleep Medicine, and relevant literature on this subject, which was re-viewed after performing a search in the PubMed, SciELO, and Google Scholar databases using the search terms “sleep” “sleep medicine” and “COVID-19

RECOMENDACIONES DE LA ASOCIACION COLOMBIANA DE MEDICINA DE SUEÑO PARA EL EJERCICIO DE LA MEDICINA DEL SUEÑO EN COLOMBIA DURANTE LA CONTINGENCIA PANDEMIA COVID-19.

The Asociación Colombiana de Medicina del Sueño (ACMES) in order to help somnologists evaluate the sleep unit and the procedures carried out on it in response to the outbreak of COVID-19 issues this guide. This is based on the mitigation strategies recommended by the country's health authorities and the bibliographic review of the available medical evidence and current AASM recommendations. Colombia is in the phase of sustained transmission of COVID-19 and frequent hand-washing measures, the use of a mask by the general population in public places, physical distancing and home confinement, supported by local sanitary norms, have helped to stop the spread of the virus. However, the economic crisis associated with this outbreak makes it urgent that the country returns little by little with the implementation of the necessary biosecurity measures to a relative normality. In this current context of the pandemic in Colombia, ACMES has designed this guide so that somnologists and local sleep units have a minimum orientation in their practice during this outbreak and once the public health measures to lower the speed of contagion have been overcome gradually reopen the economy and contain the speed of spread to get back to normal if possible.La Asociación Colombiana de Medicina del Sueño (ACMES) con el fin de ayudar a los somnólogos a evaluar la unidad de sueño y los procedimientos que se llevan a cabo en la misma en respuesta al brote del COVID-19 emite la presente guía. Esta se fundamenta en las estrategias de mitigación recomendadas por las autoridades sanitarias del país y de la revisión bibliográfica de la evidencia médica disponible y recomendaciones actuales AASM.  Colombia se encuentra en la fase de transmisión sostenida del COVID-19 y las medidas de lavado de manos frecuente, de uso de mascarilla por la población general en sitios públicos, de distanciamiento físico y confinamiento en los hogares, respaldada por normas sanitarias locales han ayudado a frenar la propagación del virus. Sin embargo, la crisis económica asociada a este brote hace urgente que el país retorne poco a poco con la implementación de las medidas de bioseguridad necesaria a una relativa normalidad. En este contexto actual de la pandemia en Colombia la ACMES ha diseñado esta guía para que los somnólogos y las unidades de sueño locales tengan una orientación mínima en su práctica durante este brote y una vez superadas las medidas de salud pública para bajar la velocidad del contagio del virus, reabrir poco a poco la economía y contener la velocidad de la propagación para volver a la normalidad en lo posible

Covid-19 in Children and the Influence on the Employment Activity of Their Female Caregivers: A Cross Sectional Gender Perspective Study

INTRODUCTION: During the COVID-19 pandemic, women disproportionately assume more unpaid activities, affecting their employment. OBJECTIVE: Describe the influence of COVID-19 on the employment of caregivers of children and adolescents from a gender perspective. METHODS: Cross-sectional study in three high-complexity hospitals in Bogotá, Colombia from April 2020 to June 2021. A subsample of the FARA cohort was taken, including those patients with a positive test for SARS-COV2. We took as our analysis category children older than 8 years and younger than 18 years who had a positive SARS-COV2 test, as well as, caregivers of all children with a positive SARS-COV2 test. This subsample was drawn from the FARA cohort. A survey was applied to them. We carried out a descriptive and stratified analysis by age group, educational, and socioeconomic level. RESULTS: We included 60 surveys of caregivers and 10 surveys of children. The main caregiver in 94.8% of the cases was a female. At the beginning of the pandemic, 63.3% of the caregivers were employed, and 78.9% of those lost their employment. The vast majority of these caregiver were women (96.6%, CONCLUSION: Caregivers of children with COVID-19 with low educational levels and lower socioeconomic conditions, as well as those with children under 5 years showed greater likelihood of employment loss between the interviewed subsample

Burden of Respiratory Failure in Pediatric Patients: Analysis of a Prospective Multicenter Cohort in Bogotá, Colombia

BACKGROUND AND AIMS: The approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability-adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs. METHODS: This study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed-up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow-up according to the age group. The results were used to calculate DALYs. RESULTS: Six hundred and eighty-five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years. CONCLUSION: ARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients

Use of High-Flow Cannula in Pediatric Patients With Respiratory Failure: A Prospective Cohort Study in Three High-Altitude Hospitals

BACKGROUND AND AIMS: Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high-flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high-flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals. METHODS: It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The follow-up was carried out at 1, 6, and 48 h after starting the management. RESULTS: Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6 h. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%. CONCLUSION: The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies

Brote de adenovirus grave en Colombia: Experiencia de un hospital pediátrico de tercer nivel en 2022

Introduction. During the SARS-CoV2 pandemic, many countries experienced decreased respiratory virus circulation, followed by an out-of-season outbreak. In a pediatric hospital in Colombia, we observed a surge in severe adenovirus infections, leading to concerns about the impact of eased public health restrictions and immune debt in children under 5 years old.Objective. Describe the clinical characteristics of patients with severe Adenovirus infection in a pediatric hospital in Colombia.Materials and methods. We reviewed 227 patients with severe adenovirus infection in Fundación Hospital Pediátrico la Misericordia (HOMI).Results. The study included 196 cases; the median age of patients was 2 years, and 62% were male. Adenovirus was isolated in all patients; 97% were admitted to the pediatric ICU, 94% required respiratory support, and the in-hospital lethality rate was 11%.Conclusion. In 2022 there was an outbreak of severe Adenovirus infection, affecting mainly children under 5 years, with mortality higher than usual.Introducción. Durante la pandemia por SARS-CoV2, muchos países evidenciaron una disminución en la circulación de virus respiratorios, por seguido por un brote fuera de la temporada esperada. En un hospital en Colombia, observamos un aumento en los casos de infección grave por Adenovirus, generando preocupación sobre el impacto que tuvo la disminución de los cuidados establecidos durante pandemia y la posible deuda inmunológica en niños menores de 5 años.Objetivo. Describir las características clínicas de pacientes con infección grave por Adenovirus en un hospital pediátrico en Colombia. Materiales y métodos. Se revisaron 227 pacientes con infección grave por adenovirus en Fundación HOMI, desde el 1 de enero de 2022 hasta el 31 de diciembre de 2022. Resultados: El estudio incluyó 196 casos, la edad media de los pacientes fue de 2 años, 62% eran hombres. El Adenovirus se aisló en todos los pacientes; 97% ingresaron a la unidad de cuidados intensivos, 94% requirió soporte ventilatorio, con una mortalidad del 11%.Conclusiones. En 2022 hubo un brote de Adenovirus que afectó principalmente a los niños menores de 5 años, con una mortalidad mayor a lo reportado con anterioridad en Colombia

Perfil epidemiológico de la infección por SARS-COV-2 en pediatría

Objetivo: Describir el perfil epidemiológico y clínico de los pacientes pediátricos que fueron atendidos por sospecha de infección de COVID-19, entre marzo y octubre del 2020, en el Hospital Universitario San Ignacio (HUSI), en Bogotá, Colombia. Materiales y métodos:Diseño de corte transversal. Descripción de los pacientes con edades comprendidas entre 1 mes de vida hasta 1 día antes de cumplir 18 años, valorados entre en marzo y octubre del 2020, que fueron abordados por cualquier servicio de atención pediátrica de un hospital universitario por sospecha de infección por COVID-19, según los protocolos nacionales e institucionales vigentes. Se registraron variables demográficas y el motivo de consulta de todos los individuos con sospecha de infección. Únicamente cuando se confirmó la infección por SARS-CoV-2 se registraron las variables relacionadas con aspectos clínicos de la enfermedad y su evolución. Resultados: Se evaluaron 920 registros médicos de pacientes pediátricos con sospecha de infección por SARS-CoV-2, de los cuales hubo 157 casos confirmados con infección por COVID-19. El principal motivo de consulta para sospechar infección fue fiebre en un 50% de los casos. En los pacientes con confirmación virológi-ca el 32.48% de los casos atendidos requirieron manejo hospitalario. Se sospechó MIS-C en 5 pacientes que requirieron manejo en unidad de cuidados intensivos. En el lapso evaluado no hubo fallecimientos asociados a la infección por COVID-19. Conclusiones: La infección por SARS-CoV-2 se relaciona en la mayoría de los casos con un espectro de enfermedad leve en la población pediátrica. Este estudio sugiere que podrían ser mayores los pacientes pediátricos que debutan con síntomas gastrointestinales que respiratorios, y que la frecuencia de complicaciones renales debe ser tenida en cuenta en los pacientes en quienes se sospecha el síndrome inflamatorio sistémico asociado al COVID-19Objective: To describe the epidemiological and clinical profile of pediatric patients who were treated for suspected COVID-19 infection, between March and Octo-ber 2020, at the Hospital Universitario San Ignacio (HUSI), in Bogotá, Colombia. Materials and methods: Cross-sectional design. Description of patients aged 1 month to 1 day before their 18th birthday, assessed between March and October 2020, who were approached by any pediatric care service of a university hospital for suspected COVID-infection. 19, according to current national and institutional protocols. Demographic variables and the reason for consultation of all individuals with suspected infection were recorded. Only when SARS-CoV-2 infection was confirmed were variables related to clinical aspects of the disease and its evolution recorded. Results: 920 medical records of pediatric patients with suspected SARS-CoV-2 infection were evaluated, of which there were 157 confirmed cases with COVID-19 infection. The main reason for consultation to suspect infection was fever in 50% of the cases. In patients with virological confirmation, 32.48% of the cases at-tended required hospital management. MIS-C was suspected in 5 patients who required intensive care unit management. In the evaluated period, there were no deaths associated with COVID-19 infection.Conclusions: SARS-CoV-2 infection is related in most cases to a spectrum of mild disease in the pediatric population. This study may be larger than pediatric patients presenting with gastrointestinal rather than respiratory symptoms, and the frequency of renal complications should be taken into account in patients in whom the systemic inflammatory syndrome associated with COVID-19 is suspected.Revista Nacional - IndexadaS