RESUMO
Tuberculosis (TB) in children is an important warning sign in a community, as it could signal recent infection of a cavitary form in an adult. Thus, while early diagnosis is crucial for effective treatment in children, it is also imperative for the control of tuberculosis at the public health level since it allows rapid identification of contagious adult cases. Here we report four cases of difficult and delayed diagnosis of TB in children. From this experience we highlight the need for an extensive medical history of the patient during diagnostic work-up. This includes: the positive history for contact with infected adults, especially for immigrant children; exclusion of TB diagnosis for persistent respiratory symptoms (2-3 weeks) after antibiotic therapy; and the need for high-definition CT scan when the radiological picture is not specific, especially for children under 5 years of age.
Assuntos
Erros de Diagnóstico , Tuberculose/diagnóstico , Fatores Etários , Pré-Escolar , Diagnóstico Diferencial , Transmissão de Doença Infecciosa , Equador/etnologia , Saúde da Família , Feminino , Humanos , Lactente , Itália/epidemiologia , Libéria/etnologia , Masculino , Neoplasias do Mediastino/diagnóstico , Meningite/complicações , Neuroblastoma/diagnóstico , Peru/etnologia , Tuberculose/epidemiologia , Tuberculose/transmissão , Tuberculose dos Linfonodos/diagnóstico , Tuberculose Miliar/complicações , Tuberculose Miliar/diagnóstico , Tuberculose Pulmonar/diagnósticoRESUMO
Because hepatitis A infection may be more severe in patients with chronic liver disease, we vaccinated 33 children who were chronic HBsAg carriers against hepatitis A virus. Anti-hepatitis A virus seroconversion rates after the first, second, and third doses were 90.9%, 96.9%, and 100%, respectively.
Assuntos
Hepatite A/prevenção & controle , Antígenos de Superfície da Hepatite B/análise , Vírus da Hepatite B/imunologia , Hepatite B Crônica/imunologia , Vacinas contra Hepatite Viral/administração & dosagem , Adolescente , Portador Sadio , Criança , Pré-Escolar , Feminino , Hepatite A/imunologia , Vacinas contra Hepatite A , Humanos , Masculino , Vacinação , Vacinas contra Hepatite Viral/imunologiaRESUMO
OBJECTIVE: To evaluate the epidemiologic features of chronic hepatitis C virus (HCV) infection in children. STUDY DESIGN: All 106 children with chronic HCV infection consecutively observed in 3 Italian pediatric centers between 1991 and 1997 entered the study. RESULTS: Fifteen children had a history of non-A, non-B hepatitis, and 5 complained of nonspecific symptoms. The 86 remaining patients were free of symptoms and were recruited after HCV screening for intercurrent diseases, maternal infection, or other putative exposure; 39% (none of 30 children born after 1990) had received transfusions, whereas 44%, had a mother with HCV infection. Of the 47 infected mothers, 36% were or had been intravenous drug users, 15% had received transfusions, and 45% had no history of exposure. CONCLUSIONS: Children with chronic HCV infection are often free of symptoms, and thus HCV screening for putative risk has greatly increased the chances of diagnosis. Vertical transmission seems to now be the most common route of infection. Both current and past maternal intravenous drug abuse are risk factors for pediatric infection; however, in an area with relatively high prevalence of anti-HCV in the general population such as Italy, a consistent proportion of infectious mothers have no risk factors of HCV exposure.
Assuntos
Hepatite C Crônica/epidemiologia , Adolescente , Transfusão de Sangue , Criança , Pré-Escolar , Exposição Ambiental , Feminino , Hepacivirus/classificação , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/transmissão , Anticorpos Anti-Hepatite C/sangue , Hepatite C Crônica/prevenção & controle , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas , Itália/epidemiologia , Masculino , Programas de Rastreamento , Prevalência , RNA Viral/análise , RNA Viral/genética , Fatores de Risco , Abuso de Substâncias por Via IntravenosaRESUMO
Seventy mother-newborn pairs were studied for hepatitis C viremia to evaluate the risk of vertical transmission of hepatitis C virus from human immunodeficiency virus-negative mothers. Forty-five mothers were hepatitis C virus-RNA positive: 4 to 45 children were positive at birth and during follow-up. The level of viremia plays an important role in vertical transmission.
Assuntos
Hepacivirus/isolamento & purificação , Hepatite C/congênito , Hepatite C/transmissão , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez/virologia , Feminino , Soronegatividade para HIV , Hepatite C/diagnóstico , Humanos , Recém-Nascido , Gravidez , RNA Viral/sangue , Viremia/diagnósticoRESUMO
Infection with the hepatitis G virus (HGV), as indicated by the presence of HGV ribonucleic acid, was sought in 57 children with chronic hepatitis C virus infection. HGV infection was found in 2 children (3.5%), or 14% of the babies whose mothers were former drug abusers. Maternal drug abuse is an important risk factor for hepatitis G and C virus coinfection in children in our area.
Assuntos
Flaviviridae , Hepatite C/complicações , Hepatite Viral Humana/complicações , Hepatite Viral Humana/virologia , Adolescente , Criança , Pré-Escolar , Doença Crônica , DNA Viral , Feminino , Flaviviridae/genética , Genótipo , Hepacivirus/genética , Hepatite C/diagnóstico , Hepatite Viral Humana/diagnóstico , Humanos , Lactente , Masculino , RNA Viral , Fatores de RiscoRESUMO
We used liposomal amphotericin B as first-choice treatment of visceral leishmaniasis in 106 immunocompetent children who acquired the infection in a temperate region of southern Europe (Italy) where Leishmania infantum visceral leishmaniasis is endemic. The aim of the study was to identify the minimum total dose of liposomal amphotericin B needed to cure the infection in children and reduce the period of hospitalization. We conclude that the optimal regimen in immunocompetent children with L. infantum visceral leishmaniasis to be a total dose of 18 mg/kg of liposomal amphotericin B (3 mg/kg per day for 5 days, followed by 3 mg/kg administered as an outpatient regimen on day 10).
Assuntos
Anfotericina B/administração & dosagem , Antiprotozoários/administração & dosagem , Leishmaniose Visceral/tratamento farmacológico , Adolescente , Assistência Ambulatorial , Animais , Medula Óssea/parasitologia , Criança , Pré-Escolar , Esquema de Medicação , Portadores de Fármacos , Eletroforese , Doenças Endêmicas , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Seguimentos , Hospitalização , Humanos , Imunocompetência , Lactente , Isoenzimas/análise , Itália , Leishmania infantum/efeitos dos fármacos , Leishmania infantum/enzimologia , Tempo de Internação , Lipossomos , MasculinoRESUMO
OBJECTIVE: To evaluate the clinical, biochemical, and virologic features associated with hepatitis C virus (HCV) infection acquired early in life from mothers with antibodies to HCV (anti-HCV). STUDY DESIGN: Multicenter prospective-retrospective study in Italian children. PATIENTS: Two groups of children were investigated. Group 1 included 14 infants, born to mothers with anti-HCV but without human immunodeficiency virus infection, who became seropositive for HCV RNA during the first year of life and were thus considered infected. Group 2 included 16 children with chronic hepatitis C, aged 1 1/2 to 14 years, whose mothers were the unique potential source of infection. Both groups were followed for 12 to 48 months. METHODS: Alanine transaminase (ALT), anti-HCV, and HCV RNA were investigated by the polymerase chain reaction on entry to the study and during follow-up. RESULTS: All children in group 1 had anti-HCV throughout follow-up, and all had ALT abnormalities, ranging from 1.5 to 10.5 times the normal value during the first 12 months. During further follow-up, 5 of 10 children had HCV RNA with abnormal ALT values, 3 had a return to normal of the ALT values but continued to have viremia, and 2 eventually had normal ALT values and clearance of HCV RNA. Of the 16 children in group 2, all were free of symptoms and 62% had only slight ALT elevations; 7 who underwent liver biopsy had histologic features of minimal or moderate hepatitis. CONCLUSIONS: HCV infection acquired early in life from mothers with anti-HCV is usually associated with biochemical features of liver damage during the first 12 months of life. Progression to chronicity seems to occur in the majority of cases, although HCV-associated liver disease is likely to be mild throughout infancy and childhood.
Assuntos
Anticorpos/isolamento & purificação , Hepatite C/complicações , Hepatite/etiologia , Alanina Transaminase/sangue , Doença Crônica , Feminino , Soropositividade para HIV/complicações , Humanos , Imunoglobulina M , Lactente , Masculino , Reação em Cadeia da Polimerase , Estudos Prospectivos , RNA Viral , Estudos RetrospectivosRESUMO
Antibodies to hepatitis C virus (HCV), investigated by second- and third-generation assays, were detected in 74% of 43 children with chronic non-A, non-B hepatitis. The polymerase chain reaction identified HCV ribonucleic acid in 26 (93%) of 28 seropositive and in 1 of 10 seronegative cases. Intermittent HCV ribonucleic acid positivity, suggesting low and fluctuating viremia, was frequent in younger patients.