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Studies have shown increased invasive Group A Streptococcus (GAS) disease, including bloodstream infections (GAS-BSI). However, the epidemiological data of GAS-BSI are limited in children. We aimed to describe GAS-BSI in children in Madrid, over 13 years (2005-2017). Multicenter retrospective cohort study from 16 hospitals from Madrid, Spain. Epidemiology, symptomatology, laboratory, treatment, and outcome of GAS-BSI in children ≤ 16 years were analyzed. 109 cases of GAS-BSI were included, with incidence rate of 4.3 episodes/100,000 children attended at the emergency department/year. We compared incidence between two periods (P1: 2005-June 2011 vs P2: July 2011-2017) and observed a non-significant increase along the study period (annual percentage change: + 6.0% [95%CI: -2.7, + 15.4]; p = 0.163). Median age was 24.1 months (IQR: 14.0-53.7), peaking during the first four years of life (89/109 cases; 81.6%). Primary BSI (46.8%), skin and soft tissue (21.1%), and osteoarticular infections (18.3%) were the most common syndromes. We compared children with primary BSI with those with a known source and observed that the former had shorter hospital stay (7 vs. 13 days; p = 0.003) and received intravenous antibiotics less frequently (72.5% vs. 94.8%; p = 0.001) and for shorter duration of total antibiotic therapy (10 vs. 21 days; p = 0.001). 22% of cases required PICU admission. Factors associated with severity were respiratory distress, pneumonia, thrombocytopenia, and surgery, but in multivariate analysis, only respiratory distress remained significant (adjusted OR:9.23 [95%CI: 2.16-29.41]). Two children (1.8%) died.   Conclusion: We observed an increasing, although non-significant, trend of GAS-BSI incidence within the study. Younger children were more frequently involved, and primary BSI was the most common and less severe syndrome. PICU admission was frequent, being respiratory distress the main risk factor. What is known: • In recent decades, several reports have shown a worldwide increase in the incidence of invasive Group A streptococcal disease (GAS), including bloodstream infection (BSI). Recently, there have been a few reports showing an increase in severity as well. • There needs to be more information on the epidemiology in children since most studies predominantly include adults. What is new: • This study, carried out in children with GAS-BSI in Madrid, shows that GAS-BSI affects mostly younger children, with a broad spectrum of manifestations, needing PICU admission frequently. Respiratory distress was the leading risk factor for severity, whereas primary BSI seemed to be less severe. • We observed an increasing, although non-significant, trend of GAS-BSI incidence in recent years (2005-2017).

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El eructo es un síntoma frecuente en Pediatría que socialmente está mal considerado y puede tener consecuencias negativas en la calidad de vida del paciente. No obstante, no son muchas las publicaciones pediátricas al respecto. Según su origen, se pueden clasificar como eructos supragástricos o gástricos, con una fisiología distinta y que pueden ser síntomas de patologías subyacentes tanto físicas como psicológicas. Se revisa la fisiología del eructo y el diagnóstico diferencial a propósito de dos casos diagnosticados de eructos supragástricos.Caso clínico 1: varón de 14 años con cuadro de 15 días de eructos hasta 20-30 por minuto, sensación de imputación esofágica y dolor abdominal. El dolor mejora con omeprazol, pero los eructos persisten; se realiza endoscopia y tránsito esofágico superior que resultan normales. Mejora tras logopedia e inicio de técnicas de relajación.Caso clínico 2: varón de 10 años con cuadro de 19 días de eructos de más de 15 por minuto, sin otros síntomas digestivos, pero con sintomatología ansiosa. Mejoría tras tratamiento psicológico.Ambos tipos de eructo presentan una fisiología distinta, de manera que en el eructo supragástrico el aire no proviene del estómago. El esfínter esofágico inferior permanece cerrado. Los dos tipos son distinguibles mediante pH-impedanciometría. Conclusión: una cuidadosa anamnesis puede establecer el diagnóstico de sospecha del origen del eructo antes de recurrir a pruebas complementarias y permite orientar el tratamiento más adecuado para cada paciente. (AU)

Belching is a frequent symptom in paediatrics that is negatively perceived in our society and can have a negative impact on the quality of life of patients. However, there is a dearth of data on the subject for the paediatric population. Depending on the origin, belching can be classified as supragastric or gastric, has a different physiology and may be a manifestation of underlying physical or psychological disorders. We review the physiology of belching and the differential diagnosis of 2 cases of supragastric belching.Clinical case 1: male patient aged 14 years presenting with belching of 15 days’ duration at a rate of 20 to 30 burps per minute, sensation of oesophageal impaction and abdominal pain. The pain improved with omeprazole but the belching persisted, the findings of endoscopy and upper oesophageal transit were normal. The patient improved with speech therapy and initiation of relaxation techniques.Clinical case 2: male patient aged 10 years-old male presenting with belching of 19 days’ duration at a rate of more than 15 burps per minute, with no other digestive symptoms but with anxiety symptoms. The patient improved with psychological treatment.The underlying physiology of belching was different in each patient, as in supragastric belching the air does not come from the stomach and the lower oesophageal sphincter remains closed. These 2 types can be differentiated by pH-impedance. Conclusion: A careful anamnesis can establish the suspected diagnosis of the origin of the belching before resorting to diagnostic tests, and can guide the most appropriate treatment for each patient. (AU)

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Las crisis parainfecciosas ocurren asociadas a procesos infecciosos banales y tienen en la mayoría de las ocasiones un pronóstico favorable, existen pocas series de casos descritas en la literatura. Recogemos las características de una serie de ocho pacientes de nuestro hospital (AU)

Parainfectious seizures occur associated with banal infectious processes and have in most cases a favorable prognosis, there are few case series described in the literature. We collect the characteristics of a series of 8 patients from our hospital. (AU)

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La parotiditis recurrente juvenil puede tener multitud de causas, es importante tener en cuenta, dentro de la etiología, el estudio de las subpoblaciones linfocitarias, ya que puede haber una relación patogénica con la deficiencia de células natural killer. Se presenta el caso clínico de una paciente de diez años con parotiditis recurrente secundaria a dicho proceso

Juvenile recurrent parotitis may have many causative factors. It is important to make an study of lymphocyte subsets, due to natural killer cells deficiency could be pathogenic. The clinical case of a 10-year-old patient with recurrent parotitis secondary to this process is presented

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