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INTRODUCTION: Acute fever of unknown origin (FUO) in children under 29 days is a worrying situation because of the risk of serious bacterial infection (SBI). OBJECTIVE: to study the main clinical and laboratory characteristics of a group of hospitalized children under 29 days with diagnosis of FUO. PATIENTS AND METHOD: Retrospective study of children under 29 days hospitalized due to FUO. The clinical records of the patients were reviewed, recording age, sex, history of fever before consultation, temperature at admission, estimated severity at admission and discharge, discharge diagnoses, laboratory tests, and indicated treatments. Patients were classified according to the severity of the discharge diagnosis, as severe (S) and non-severe (NS). The inclusion criteria were term newborn, age less than 29 days, fe ver > 38°C registered at home or admission, and history of < 4 days. RESULTS: 468 children with FUO were admitted. Concordance between severity at admission and discharge was low (Kappa = 0.125; p = 0.0007). 26.1% of children were S and 73.9% NS. In the S group, urinary tract infection domínate (70.5%) and in the NS, FUO (67.6%). The cut-off levels for leukocytes/mm3, C-reactive protein, and neutrophils/mm3 showed negative predictive values to rule out severe bacterial infection. Conclu sions: Most of the newborns presented mild severity at admission, but 24% of them had SBI, thus hospitalization and close clinical observation are always necessary. Laboratory tests, such as CRP, white blood cell and neutrophils count are not good predictors of SBI. Early treatment with antibio tics for patients who meet the low-risk criteria is debatable.

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INTRODUCTION: Acute fever of unknown origin (AFUO) is established when the anamnesis and physical examination cannot identify the cause. In infants less than 3 months-old this is situation for concern, due to the risk of a serious bacterial infection. OBJECTIVE: To describe the clinical and laboratory variable of patients with AFUO, in order to look for clues in order to base studies on the decisions arising drom this problem. PATIENTS AND METHODS: A report is presented on a retrospective study conducted on a cohort of children less than three months-old admitted to the Hospital Roberto del Río (2007-2011) due to an AFUO. Clinical histories were reviewed and the patients were grouped, according to the severity of the admission diagnosis, into severe and non-severe. They were compared in strata determined by the variables of clinical interest. RESULTADOS: A total of 550 children were admitted with AFUO during the study period. There was low agreement between the severity on admission and at discharge (kappa=0.079; P=.26). There were 23.8% of children in the severe group and 76.2% in the non-severe group. Urinary tract infection predominated in the severe group (68.7%) and 40.7% with acute febrile syndrome in the non-severe group. The cut-off levels for C-reactive protein, white cells, and neutrophils per mm(3), to calculate the fixed and variable indices, only showed negative predictive values of some use for ruling out serious bacterial infection. The ROC curves with white cell and neutrophil counts and C-reactive protein, did not provide andy fixed indices of clinical use. More than one-third (34.6%) of lumbar punctures were traumatic or failures. CONCLUSIONS: According to the results of this study, there is an obvious excess of hospital admissions, little usefulness in the examinations to identify serious bacterial infection, a high percentage lumbar punctures traumatic and lumbar punctures failures, and an excess of antibiotic treatments. A review of clinical criteria and procedures is needed.

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Introducción: La fiebre aguda de origen no precisado (FAONP) es planteada cuando la anamnesis y el examen físico no permiten identificar la causa. En menores de 3 meses esta situación es preocupante, por el riesgo de una infección bacteriana grave. Objetivo: Describir variables clínicas y de laboratorio de pacientes con FAONP, buscando pistas para basar estudios sobre las decisiones a que da lugar este problema. Pacientes y Método: Describimos retrospectivamente una cohorte de menores de 3 meses internados en el Hospital Roberto del Río (2007-2011) por FAONP. Se revisaron las historias clínicas y se efectuó una dicotomización de los pacientes según gravedad del diagnóstico de egreso, en graves y no graves. Se compararon en estratos determinados por variables con interés clínico. Resultados: Durante el periodo de estudio se ingresaron 550 niños con FAONP. La concordancia entre gravedad al ingreso y egreso fue baja (kappa = 0,079; p = 0,26). El 23,8% de los niños fueron graves y el 76,2% no graves. En el grupo de los graves predominó la infección del tracto urinario (68,7%) y en los no graves el síndrome febril agudo (40,7%). Los niveles de corte para la proteína C reactiva, leucocitos y neutrófilos/mm³, para calcular índices fijos y variables, solo mostraron valores predictivos negativos de alguna utilidad para descartar infección bacteriana grave. Las curvas ROC con recuento de leucocitos, neutrófilos y proteína C reactiva, no ofrecen índices fijos de utilidad clínica. El 34,6% de las punciones lumbares fueron traumáticas o fallidas). Conclusiones: De acuerdo a nuestros resultados, parece evidente un exceso de hospitalizaciones, la poca utilidad de exámenes para identificar infección bacteriana grave, un alto porcentaje de punciones lumbares traumáticas o fallidas y excesos de terapias antibióticas. Se hace necesaria una revisión de criterios y procedimientos clínicos.

Introduction: Acute fever of unknown origin (AFUO) is established when the anamnesis and physical examination cannot identify the cause. In infants less than 3 months-old this is situation for concern, due to the risk of a serious bacterial infection. Objective: To describe the clinical and laboratory variable of patients with AFUO, in order to look for clues in order to base studies on the decisions arising drom this problem. Patients and Methods: A report is presented on a retrospective study conducted on a cohort of children less than three months-old admitted to the Hospital Roberto del Río (2007-2011) due to an AFUO. Clinical histories were reviewed and the patients were grouped, according to the severity of the admission diagnosis, into severe and non-severe. They were compared in strata determined by the variables of clinical interest. Resultados: A total of 550 children were admitted with AFUO during the study period. There was low agreement between the severity on admission and at discharge (kappa = 0.079; P = .26). There were 23.8% of children in the severe group and 76.2% in the non-severe group. Urinary tract infection predominated in the severe group (68.7%) and 40.7% with acute febrile syndrome in the non-severe group. The cut-off levels for C-reactive protein, white cells, and neutrophils per mm³, to calculate the fixed and variable indices, only showed negative predictive values of some use for ruling out serious bacterial infection. The ROC curves with white cell and neutrophil counts and C-reactive protein, did not provide andy fixed indices of clinical use. More than one-third (34.6%) of lumbar punctures were traumatic or failures. Conclusions: According to the results of this study, there is an obvious excess of hospital admissions, little usefulness in the examinations to identify serious bacterial infection, a high percentage lumbar punctures traumatic and lumbar punctures failures, and an excess of antibiotic treatments. A review of clinical criteria and procedures is needed.

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Background: Penicillin and third generation cephalosporin resistant pneumococcal isolates have emerged in Chile, mainly in the pediatric population. These isolates complicate therapeutic alternatives, specially among patients with central nervous system infections. Aim: To assess the frequency of penicillin and third generation cephalosporin resistance among isolates obtained from pediatric patients with invasive pneumococcal infections, and to study serotypes and clinical risk factors associated with resistance. Material and methods: Microbiological isolates obtained from children between April 1994 and May 1999 with pneumococcal invasive infections, were serotyped and analyzed according to their susceptibility to penicillin and cefotaxime by E-test and broth microdilution testing. Potential risk factors studied included patient's age, previous antibiotic use or admissions, comorbidity, and serotypes. Results: Seventy eight patients were studied. Penicillin-resistant pneumococcal isolates were detected in 35.9 percent of cases (21.8 percent with intermediate and 14.1 percent with high level resistance) without significant variation among different clinical conditions. Most of the high level penicillin-resistant pneumoccocal isolates had MIC ü4 µg/mL (8 out of 11 strains). One third of penicillin-resistant isolates also expressed cefotaxime resistance. Multivariate analysis indicated an age ²36 months (OR=6.8; IC 95 percent: 1.4 to 33.5) and serotype 14 (OR=6.3; IC 95 percent: 1.7 to 23.3) as factors associated with penicillin resistance. Conclusions: One third of the invasive pneumococcal isolates obtained from pediatric patients were resistant to penicillin. Risk factors involved a younger age and pneumococcal isolates belonging to serotype 14

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La enfermedad de Kawasaki (EK) es conocida en niños chilenos, sin embargo, continuas publicaciones informan de altas tasas de aneurismas coronarios (AC) en esta población, lo que sugeriría ineficacia del tratamiento con inmunoglobulina endovenosa (IGEV). Objetivo: estudiar las características clínico epidemiológicas de la EK en nuestro medio y tratar de encontrar una explicación a las altas tasas de compromiso cardiovascular. Pacientes y método: se analizaron 60 pacientes egresados del Hospital de Niños Roberto del Río, entre enero de 1987 y mayo de 1999, evaluando variables de edad, sexo, inicio de fiebre, días de evolución al diagnóstico y terapia, exámenes de laboratorio y tratamiento con inmunoglobulina y aspirina. Resultados: 12 casos (20 por ciento) presentaron AC, los que afectaron a casos típicos, mientras que no aparecieron en los incompletos. La tasa de ataque de EK del Area Norte de Santiago fue estimada en 3,9 x 100.000 < 5 años. La aparente ineficacia de la IGEV podría ser aplicada por fallas de detección, 60 por ciento de los casos diagnosticados más allá del 5º día de enfermedad (rango 6 a > 16), retraso terapéutico (mediana 8, rango 5 a 15 días), así como sesgo de selección al decidir iniciar el tratamiento. Estas cifras no han variado significativamente en los últimos 10 años. Conclusiones: se plantea que existen posibles fallas clínicas en el diagnóstico de EK y se sugieren propuestas para mejorar la detección y el momento del tratamiento

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La enfermedad de Kawasaki (EK) es una importante causa de enfermedad cardiovascular adquirida en niños. La terapia con gammaglobulina endovenosa (IVGG) administrada precozmente disminuiría la incidencia y severidad del compromiso coronario (CC). Objetivo: describir el compromiso cardiovascular (CCV) en nuestro medio mediante un estudio retrospectivo de 60 pacientes que presentaron EK entre enero de 1987 y mayo de 1999. 23 pacientes (38 por ciento) manifestaron CCV. De estos 20 por ciento (n:12) evidenciaron compromiso coronario (5 dilataciones y 7 aneurismas), pericarditis 15 por ciento, miocarditis 11,6 por ciento, alteración valvular 1,6 por ciento, arritmias 3,3 por ciento y un paciente con infarto agudo al miocardio. No hubo fallecidos. 43/60 (71,6 por ciento) se trataron con IVGG, en promedio a los 7,6 días, de estos 25,5 por ciento (n:11) desarrollaron CC, y en 75 por ciento de estos pacientes CC regresó espontáneamente. Conclusiones: se observó un alto porcentaje de CC, pese al tratamiento con IVGG con una evolución relativamente benigna. Se observó como factores de riesgo para el desarrollo de CC la trombocitosis > 700,000/mm al cubo, y CC fue más severo en el sexo masculino. Faltan estudios prospectivos a largo plazo para determinar la real implicancia de la EK en la edad adulta

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Background: The prognosis of acute bacterial meningitis continues to be poor in our country. Previous studies suggest that the delay in diagnosis has an important prognostic value. Aim: To study the influence of diagnosis timing and the clinical conditions of children with acute bacterial meningitis on admission on death and incidence of gross sequelae. Patients and methods: Charts of children deceased or discharged with gross sequelae as consequence of an acute bacterial meningitis were selected. To each of these cases, 4 children with the same diagnosis but discharged in good conditions were selected as controls. Variables recorded were time and number of visits previous to the diagnosis, etiology of meningitis, neurological, respiratory, digestive and hemodynamic involvement on admission. Results: Fifty seven cases and 224 controls were studied. Most cases were 12 months old or less (OR 4.1, 95 percent CI= 1.97-8.7). Diagnosis made on the first visit or within the first 24 hours of disease, improved prognosis (OR 0.25, 95 percent CI= 0.07-0.78). An age of less than 12 months and a diagnosis made after more than 12 hours of disease or after more than one consultation interacted multiplying their effect on a dismal prognosis. Coma on admission (OR 7 95 percent CI=3-14.3) and S Pneumoniae etiology (OR 7, CI 95 percent= 3.4, 14.3) were also associated with a bad prognosis. Conclusions: Early diagnosis of acute bacterial meningitis is protective for death or gross sequelae at discharge. Age, coma and S Pneumoniae etiology are the main factors associated with a poor prognosis

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Se estudiaron las características de 541 médicos chilenos (66,2 porciento) y extranjeros en programas de especialización en pediatría (82,4) y capacitación (excluidas cirugía y especialidades derivadas) en el Departamento de Pediatría, Campus Norte de la Universidad de Chile, en el período 1957-96 con especial énfasis en 184 becarios chilenos egresados del Programa de Especialista en Pediatría. Fueron hechos llamativos la disminución significativa del número de varones en beneficio de las mujeres, con una razón que varió desde 4,15 (1957-1966) a 0,52 (1987-1996), (p<0,05), la disminución de los becados primarios (1988-1992 = 72 porciento vs 1993-1996 = 31 porciento; p = 0,00003), la tendencia al menor rendimiento académico asociado a la edad en los médicos de retorno, el mayor interés por el adiestramiento que la educación universitaria y la permanencia en Santiago (sobre el 55 porciento) una vez finalizado el programa

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Las pruebas diagnosticas son una herramienta habitual para tomar decisiones clínicas,a menudo sesgadas por factores, entre los cuales uno es no ajustar los índices variables publicados según las probabilidades preprueba del paciente individual. Objetivo: mostrar las variaciones de las probabilidades postprueba y sus implicaciones clínico epidemiológicas,cuando se consideran las probabilidades preprueba de infección del tracto urinario en niños. Diseño y método: En dos grupos de niños bajo sospecha clínica de infección urinaria basada en signos inflamatorios de la vía urinaria o fiebre de origen no determinado después de la anamnesis y el examen físico, sumados en una tabla 2 x 2 única, según los resultados de probar el comportamiento del examen macroscópico y de una tira reactiva en muestras de orina fresca, se calcularon la sensibilidad, especificidad y razones de verosimilitud de la combinación de las pruebas para descartar infección de la vía urinaria. Los niños fueron luego estratificados por edad y sexo para calcular sus valores predictivos, ventajas (odds) y probabilidades de enfermedad postprueba según las prevalencias determinadas por estas variables. Resultados; se registraron moderadas a grandes variaciones de los valores predictivos y probabilidades postprueba asociados a la edad y sexo, respectivamente. Las razones de verosimilitud, usados para calcular las probabilidades postprueba, se comportaron de modo similar a los valores predictivos. La mayor utilidad de las razones de verosimilitud reside en permitir estos ajustes cuando es necesario calcularlos a partir de una tabla no dicotómica (2 x n). Se subraya la importancia del conocimiento de las probabilidades preprueba para el uso correcto de pruebas diagnósticas

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The sample included 460 controls of a case control study of typhoid fever. The G1m-G2m-G3m most frequent haplotypes were: za,..;g or 1,17;(-);21=0.4493;fn;b or 3;23;5,13=0.2522;f-,..;b or 3;(-);5,13=0.1389; zax;..;g or 1,2,17;(-);21=0.0685;za;..;b or 1,17;(-);5,13=0.0454;za;n;g or 1,17;23;21=0.0207;f;..;g or 3;(-);21=0.0129. The frequencies of Km alleles were 0.2391 and 0.7609 for Km1 and km3 respectively. These frequencies are within those found in Amerindian and Caucasian populations as expected from the origin of the Chilean population. Gm haplotypes did not differ from Hardy-Weinberg equilibrium, while a significant lack of homozygous Km1/km1 was found in Km

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