Revisión de la transmisión vertical del VIH en nuestro medio, periodo 2000-2012

Durante el estudio se observa una mejoría y homogeneización paulatina en la profilaxis de la TV del VIH, no obstante, todavía se producen “oportunidades perdidas” o fallos en la cadena de prevención, así como abandonos en el seguimiento, siendo la población migrante la más vulnerable. Se observa concordancia de los datos de prematuridad y antropométricos entre nuestra serie con otras series similares. De forma importante también se constata que una terapia antirretroviral correcta durante la gestación supone un factor asociado a un mejor peso del RN-VIH, mientras que una CV detectable se asocia de forma significativa a ser pequeño para la edad gestacional. La toxicidad secundaria a la profilaxis neonatal con tres AR, probada eficaz y segura en nuestra muestra, se asocia con la presencia de anemia. Otros efectos adversos como la neutropenia, se asocia al antecedente de prematuridad, pero no a la exposición a la triple terapia.Farmacología y Pediatría Resumen tesis: El control de la infección por el VIH en pediatría comienza con la prevención de la transmisión vertical (TV). El empleo de fármacos antirretrovirales durante el embarazo, el parto y el periodo neonatal, así como el empleo de la cesárea electiva en casos de alto riesgo, ha reducido la tasa de transmisión vertical, que en nuestro medio es actualmente inferior a un 1 %. En nuestro centro, hospital universitario de tercer nivel con una maternidad de referencia para toda la provincia, se atiende un promedio de 16 recién nacidos hijos de madre con infección por el VIH al año. Principalmente en los últimos años, presenta un alto índice de madres migrantes procedentes de países donde el VIH es endémico. Todo ello nos proporciona la capacidad de análisis de una muestra local, pero de tamaño significativo y constitución heterogénea. Se plantea un estudio descriptivo retrospectivo de todos los recién nacidos hijos de madre con infección por el VIH, nacidos en nuestro centro, durante el periodo 2000-2012. Con el fin de determinar las características epidemiológicas, clínicas, diagnósticas y terapéuticas tanto de las gestantes infectadas por el VIH como de sus recién nacidos; la repercusión del tratamiento en los resultados antropométricos neonatales, así como la presencia de efectos secundarios asociados a la profilaxis en los recién nacidos. Se busca a su vez, analizar el impacto de las diferentes medidas incluidas en los protocolos de profilaxis de TV del VIH en la población estudiada, los factores implicados en su fracaso y los posibles puntos de mejora. Nuestra serie muestra cambios epidemiológicos concordantes con lo ocurrido en nuestro país y en otras series europeas. Inicialmente, con prevalencias altas de gestantes consumidoras de drogas, sobre todo de vía parenteral, cuya proporción desciende a la par que se produce un aumento de las gestantes migrantes

Neonatal invasive candidiasis in low-and-middle-income countries: data from the NeoOBS study

Neonatal invasive candidiasis (NIC) has significant morbidity and mortality. Reports have shown a different profile of those neonates affected with NIC and of fluconazole resistant Candida spp. isolates in low-and-middle-income -countries (LMICs) compared to high-income-countries (HIC). We describe the epidemiology, Candida spp. distribution, treatment and outcomes of neonates with NIC from LMICs enrolled in a global, prospective, longitudinal, observational cohort study (NeoOBS) of hospitalised infants < 60 days postnatal age with sepsis (August 2018-February 2021). 127 neonates from 14 hospitals in 8 countries with Candida spp. isolated from blood culture were included. Median gestational age of affected neonates was 30 weeks (IQR: 28-34) and median birth weight was 1270 g (IQR: 990-1692). Only a minority had high risk criteria, such as being born < 28 weeks, 19% (24/127), or birth weight < 1000 g, 27% (34/127). The most common Candida species were C. albicans (n = 45, 35%), C. parapsilosis (n = 38, 30%) and Candida auris (n = 18, 14%). The majority of C. albicans isolates were fluconazole susceptible, whereas 59% of C. parapsilosis isolates were fluconazole resistant. Amphotericin B was the most common antifungal used [74% (78/105)], followed by fluconazole [22% (23/105)]. Death by day 28 post-enrolment was 22% (28/127). To our knowledge, this is the largest multi-country cohort of NIC in LMICs. Most of the neonates would not have been considered at high risk for NIC in HICs. A substantial proportion of isolates was resistant to first choice fluconazole. Understanding the burden of NIC in LMIC is essential to guide future research and treatment guidelines

Serum Beta-D-Glucan in the Diagnosis of Invasive Fungal Disease in Neonates, Children and Adolescents: A Critical Analysis of Current Data

β-D-glucan (BDG) is a cell wall component of many pathogenic fungi. The detection of BDG as an assay is clinically broadly used as a diagnostic tool. However, the current data on BDG in paediatrics are limited, prompting specific considerations about when BDG can be used in neonates and children. We aimed to analyse the available data for the use of serum BDG in neonates and immunocompromised children and adolescents; as well as to understand the extent and characteristics of the use of BDG in children in Europe

Neosartorya udagawae pulmonary infection requiring a surgical treatment in a paediatric haematopoietic progenitor cell recipient

Neosartorya udagawae is a known cause of fungal infection in humans and animals. It is found to be more refractory to antifungal treatment in comparison to other Aspergillus species. With this report we present a case of proven invasive infection with Neosartorya udagawae in a child with chronic myeloid leukaemia after haematopoietic stem cell transplant. The patient received several lines of antifungal therapy including dual therapy appropriate to the antifungal susceptibility profile with progression of the invasive fungal disease requiring left lung upper lobe lobectomy. The case emphasizes the importance of early biopsy with antifungal susceptibility testing for targeted therapy and demonstrates the potential requirement for surgical management in addition to appropriate antifungal treatment

Neonatal invasive candidiasis in low- and middle-income countries: data from the NeoOBS study

Neonatal invasive candidiasis (NIC) has significant morbidity and mortality. Reports have shown a different profile of those neonates affected with NIC and of fluconazole-resistant Candida spp. isolates in low- and middle-income countries (LMICs) compared to high-income countries (HICs). We describe the epidemiology, Candida spp. distribution, treatment, and outcomes of neonates with NIC from LMICs enrolled in a global, prospective, longitudinal, observational cohort study (NeoOBS) of hospitalized infants <60 days postnatal age with sepsis (August 2018–February 2021). A total of 127 neonates from 14 hospitals in 8 countries with Candida spp. isolated from blood culture were included. Median gestational age of affected neonates was 30 weeks (IQR: 28–34), and median birth weight was 1270 gr (interquartile range [IQR]: 990–1692). Only a minority had high-risk criteria, such as being born <28 weeks, 19% (24/127), or birth weight <1000 gr, 27% (34/127). The most common Candida species were C. albicans (n = 45, 35%), C. parapsilosis (n = 38, 30%), and Candida auris (n = 18, 14%). The majority of C. albicans isolates were fluconazole susceptible, whereas 59% of C. parapsilosis isolates were fluconazole-resistant. Amphotericin B was the most common antifungal used [74% (78/105)], followed by fluconazole [22% (23/105)]. Death by day 28 post-enrollment was 22% (28/127). To our knowledge, this is the largest multi-country cohort of NIC in LMICs. Most of the neonates would not have been considered at high risk for NIC in HICs. A substantial proportion of isolates was resistant to first choice fluconazole. Understanding the burden of NIC in LMIC is essential to guide future research and treatment guidelines

Etiology and Outcome of Candidemia in Neonates and Children in Europe: An 11-year Multinational Retrospective Study

Data on Candida bloodstream infections in pediatric patients in Europe are limited. We performed a retrospective multicenter European study of the epidemiology and outcome of neonatal and pediatric candidemia.All first positive blood cultures from patients ≤ 18 years of age with candidemia were registered. Patients' demographic and clinical characteristics and causative Candida species were collected and analyzed. Regression analysis was used to identify factors independently associated with mortality.One thousand three hundred ninety-five episodes of candidemia (57.8% male) were reported from 23 hospitals in 10 European countries. Of the 1395 episodes, 36.4% occurred in neonates (≤ 44 weeks postmenstrual age), 13.8% in infants (> 44 weeks postmenstrual age to 1 year) and 49.8% in children and adolescents. Candida albicans (52.5%) and Candida parapsilosis (28%) were the predominant species. A higher proportion of candidemia caused by C. albicans was observed among neonatal patients (60.2%) with highest rates of C. parapsilosis seen among infants (42%). Children admitted to hematology-oncology wards presented the highest rates of non-albicans Candida species. Candidemia because of C. albicans was more frequent than non-albicans Candida in Northern versus Southern Europe (odds ratio, 2.3; 95% confidence interval, 1.8-2.9; P < 0.001). The all-cause mortality at 30 days was 14.4%. All-cause mortality was higher among patients admitted to the neonatal or pediatric intensive care units than other wards. Over time, no significant changes in species distribution were observed.This first multicenter European study shows unique characteristics of the epidemiology of pediatric candidemia. The insights obtained from this study will be useful to guide clinical management and antifungal stewardship