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Antibiotics for common respiratory infections with unclear causes and undifferentiated symptoms in children up to five years of age | Cochrane

Antibiotics for common respiratory infections with unclear causes and undifferentiated symptoms in children up to five years of age | Cochrane | GPI AEPap | Scoop.it
Review question
Do antibiotics prevent more severe infections in children up to five years old with common upper acute respiratory infections (ARIs)?

Background
Common upper ARIs are a large and varied groups of infections. They occur in any part of the upper respiratory system, last for up to seven days and have a wide variety of causes. They may lead to complications such as ear, throat and sinus infections. More common in pre-school children, they are the most frequent reason for parents to seek medical assistance. Furthermore, they are responsible for 75% of the total prescribed antibiotics in high-income countries. One possible rationale for prescribing antibiotics is the wish to prevent bacterial complications.

Methods
This review focuses on the use of antibiotics to prevent clinical bacterial complications in children up to five years of age with common and undifferentiated ARIs. This is an update of a review previously published in 2014. The evidence is current to August 2015. In this update we retrieved 616 new studies, but none met our inclusion criteria.

Studies characteristics
We included four trials (1314 children) in this review. Three trials (414 children, during seven days) investigated the use of an antibiotic (amoxicillin/clavulanic acid) to prevent otitis media. One trial (889 children, during two weeks) investigated the use of another antibiotic (ampicillin) to prevent pneumonia. Only one trial addressed harms. However, we could not analyse the data as it was expressed in percentages rather then absolute terms. No studies assessed other severe complications (mastoiditis, quinsy, abscess, meningitis), hospital admission or death.

Key results
Current evidence does not provide support for the use of antibiotics to prevent otitis media and pneumonia in children up to five years of age with common upper ARIs.

Quality of the evidence
In the trials treating otitis media, the quality of the evidence was moderate as the methods for avoiding bias were not clearly stated. Furthermore, in one trial a pharmaceutical company prepared the placebo syrup used in the trial.

In the study treating pneumonia, we classified the quality of the evidence as moderate, because the families previously knew if their children were receiving antibiotics or not. Furthermore, the methods for avoiding bias were not clearly stated by the trial authors.

Further high-quality research is needed to provide more definitive evidence of the effectiveness of antibiotics in this population.

Authors' conclusions: 
There is insufficient evidence for antibiotic use as a means of reducing the risk of otitis or pneumonia in children up to five years of age with undifferentiated ARIs. Further high-quality research is needed to provide more definitive evidence of the effectiveness of antibiotics in this population.
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Presentación y objetivos | Grupo de Patología Infecciosa de AEPap

La patología infecciosa ocupa una gran parte de la actividad, tanto asistencial como preventiva,  que realizamos los pediatras desde las consultas de Atención Primaria. Cada día valoramos, diagnosticamos y tratamos a niños cuyos síntomas pueden corresponder a procesos infecciosos.  En ocasiones se trata de situaciones difíciles por presentar una clínica no habitual o compleja como ocurre en los casos de patología importada, o aquellos de manejo inicialmente hospitalario.
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A Monovalent Chimpanzee Adenovirus Ebola Vaccine Boosted with MVA — NEJM

A Monovalent Chimpanzee Adenovirus Ebola Vaccine Boosted with MVA — NEJM | GPI AEPap | Scoop.it

BACKGROUND
The West African outbreak of Ebola virus disease that peaked in 2014 has caused more than 11,000 deaths. The development of an effective Ebola vaccine is a priority for control of a future outbreak.
METHODS
In this phase 1 study, we administered a single dose of the chimpanzee adenovirus 3 (ChAd3) vaccine encoding the surface glycoprotein of Zaire ebolavirus (ZEBOV) to 60 healthy adult volunteers in Oxford, United Kingdom. The vaccine was administered in three dose levels — 1×1010 viral particles, 2.5×1010 viral particles, and 5×1010 viral particles — with 20 participants in each group. We then assessed the effect of adding a booster dose of a modified vaccinia Ankara (MVA) strain, encoding the same Ebola virus glycoprotein, in 30 of the 60 participants and evaluated a reduced prime–boost interval in another 16 participants. We also compared antibody responses to inactivated whole Ebola virus virions and neutralizing antibody activity with those observed in phase 1 studies of a recombinant vesicular stomatitis virus–based vaccine expressing a ZEBOV glycoprotein (rVSV-ZEBOV) to determine relative potency and assess durability.
RESULTS
No safety concerns were identified at any of the dose levels studied. Four weeks after immunization with the ChAd3 vaccine, ZEBOV-specific antibody responses were similar to those induced by rVSV-ZEBOV vaccination, with a geometric mean titer of 752 and 921, respectively. ZEBOV neutralization activity was also similar with the two vaccines (geometric mean titer, 14.9 and 22.2, respectively). Boosting with the MVA vector increased virus-specific antibodies by a factor of 12 (geometric mean titer, 9007) and increased glycoprotein-specific CD8+ T cells by a factor of 5. Significant increases in neutralizing antibodies were seen after boosting in all 30 participants (geometric mean titer, 139; P<0.001). Virus-specific antibody responses in participants primed with ChAd3 remained positive 6 months after vaccination (geometric mean titer, 758) but were significantly higher in those who had received the MVA booster (geometric mean titer, 1750; P<0.001).
CONCLUSIONS
The ChAd3 vaccine boosted with MVA elicited B-cell and T-cell immune responses to ZEBOV that were superior to those induced by the ChAd3 vaccine alone.

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¿Que influencia tiene la lactancia materna en la incidencia de las infecciones digestivas de los lactantes?

Se ha encontrado en la búsqueda, 2 Revisiones Sistemáticas (RS), 1 Sumario de Evidencias de Uptodate (SE), 2 documentos de consenso y 1 de información al usuario de MedlinePlus. Todos coinciden en que entre los diferentes beneficios de la Lactancia Materna (LM) sobre la salud de los lactantes se encuentra la incidencia en la disminución de infecciones gastrointestinales.
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Evidencias en Pediatria - El palivizumab no parece tener efecto a largo plazo sobre la función pulmonar

Justificación: la profilaxis de infecciones respiratorias por virus respiratorio sincitial (VRS) con palivizumab se sustenta en la reducción de ingresos hospitalarios observada en un ensayo clínico1. El alto coste de palivizumab ha planteado restricciones de financiación selectiva a grupos de alto riesgo2. En la evaluación del coste-efectividad del tratamiento se han considerado efectos sobre el riesgo de ingreso, infecciones respiratorias, sibilantes recurrentes, asma y, a pesar de que no se ha demostrado, reducción de la mortalidad. El efecto sobre episodios respiratorios, sibilantes recurrentes o asma apenas afecta a las estimaciones de coste-efectividad, lo que sí ocurre con la mortalidad. Existe evidencia indirecta, basada en estudios de cohortes no comparables con análisis ajustados, de que palivizumab podría reducir el riesgo de sibilantes recurrentes en los primeros años de vida. El presente estudio pretende aclarar si hay efecto a largo plazo, especialmente sobre la función pulmonar.

Validez o rigor científico: estudio de cohortes con una adecuada definición de la población de estudio, la exposición y las medidas de efecto. La exposición tiene un control histórico, por lo que no se puede garantizar que las diferencias encontradas no se vean influidas por otros factores ambientales. No se define una medida principal de efecto, aunque, si consideramos la variable usada en el cálculo del tamaño muestral, podría ser la función pulmonar. Otras medidas de efecto, fundamentalmente los episodios de sibilancias, podrían verse influenciadas por diferencias entre periodos epidémicos. Los grupos comparados son pequeños, un reducido porcentaje de las cohortes originales, y con alta incidencia de sibilancias, especialmente el grupo control, muy superior a la observada en otros estudios3, por lo que existen dudas sobre su validez externa. No se indica que se haya realizado enmascaramiento en la valoración del efecto, aunque la medición de la función pulmonar parece objetiva.

Importancia clínica: si consideramos el efecto en los primeros dos años de vida la cohorte tratada presentó una menor frecuencia de episodios de sibilantes (reducción absoluta del riesgo [RAR] 43%; intervalo de confianza del 95% [IC 95]: 21 a 65%; proporción prevenible en expuestos [PPE]: 62%; IC 95: 28 a 80), e ingreso (RAR 36%; IC 95: 13 a 59). El efecto es cuantitativamente importante, aunque las estimaciones son imprecisas. El alto riesgo encontrado en el grupo control, mayor que el observado en otros estudios3, cuestiona la representatividad de la muestra. Estos resultados contrastan con la ausencia de efecto a largo plazo, tanto a nivel clínico como en la función pulmonar.

Aplicabilidad en la práctica clínica: los resultados de este estudio, por su diseño (observacional con control histórico), la muestra pequeña y poco representativa y los resultados discordantes a corto y largo plazo, no permiten establecer la eficacia de palivizumab a largo plazo sobre síntomas respiratorios o función pulmonar. Aunque sí que podría haber cierto efecto sobre episodios de sibilantes a corto plazo, las estimaciones de riesgo no son lo suficientemente precisas para ser aplicadas en la práctica clínica.
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AEPap Algoritmos: Exantemas vesículo-ampollosos.

AEPap Algoritmos: Exantemas vesículo-ampollosos. | GPI AEPap | Scoop.it
Vesícula: lesión elevada, circunscrita, de contenido seroso o hemorrágico, de menos de 0,5 cm de diámetro. Ampolla: lesión elevada, circunscrita, de contenido seroso o hemorrágico, de más de 0,5 cm de diámetro.
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Grupo de Patología Infecciosa | Asociación Española de Pediatría de Atención Primaria. Novedades Mayo

Grupo de Patología Infecciosa | Asociación Española de Pediatría de Atención Primaria. Novedades Mayo | GPI AEPap | Scoop.it
Las enfermedades exantemáticas son frecuentes en los niños. Solo algunas de ellas presentan datos que permiten identificar su etiología y aunque suelen tener una evolución favorable, algunas circunstancias del niño o el entorno (contacto con embarazadas), hacen necesario orientar su diagnóstico de forma precoz. Presentamos también un caso clínico.
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Neurologic Manifestations of Enterovirus 71 Infection in Korea

Neurologic Manifestations of Enterovirus 71 Infection in Korea | GPI AEPap | Scoop.it
Enterovirus 71 frequently involves the central nervous system and may present with a variety of neurologic manifestations. Here, we aimed to describe the clinical features, magnetic resonance imaging (MRI) findings, and cerebrospinal fluid (CSF) profiles of patients presenting with neurologic complications of enterovirus 71 infection. We retrospectively reviewed the records of 31 pediatric patients hospitalized with acute neurologic manifestations accompanied by confirmed enterovirus 71 infection at Ulsan University Hospital between 2010 and 2014. The patients’ mean age was 2.9 ± 5.5 years (range, 18 days to 12 years), and 80.6% of patients were less than 4 years old. Based on their clinical features, the patients were classified into 4 clinical groups: brainstem encephalitis (n = 21), meningitis (n = 7), encephalitis (n = 2), and acute flaccid paralysis (n = 1). The common neurologic symptoms included myoclonus (58.1%), lethargy (54.8%), irritability (54.8%), vomiting (48.4%), ataxia (38.7%), and tremor (35.5%). Twenty-five patients underwent an MRI scan; of these, 14 (56.0%) revealed the characteristic increased T2 signal intensity in the posterior region of the brainstem and bilateral cerebellar dentate nuclei. Twenty-six of 30 patients (86.7%) showed CSF pleocytosis. Thirty patients (96.8%) recovered completely without any neurologic deficits; one patient (3.2%) died due to pulmonary hemorrhage and shock. In the present study, brainstem encephalitis was the most common neurologic manifestation of enterovirus 71 infection. The characteristic clinical symptoms such as myoclonus, ataxia, and tremor in conjunction with CSF pleocytosis and brainstem lesions on MR images are pathognomonic for diagnosis of neurologic involvement by enterovirus 71 infection.
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Diario de una mamá pediatra: Alerta de salud y alarma social: el caso de las infecciones por enterovirus

Diario de una mamá pediatra: Alerta de salud y alarma social: el caso de las infecciones por enterovirus | GPI AEPap | Scoop.it

Hace 24h saltó la alarma en la prensa tras un comunicado del Departament de Salut que expresaba que en las últimas semanas se habían conocido unos cuarenta casos entre niños menores de 6 años de una enfermedad vírica que evoluciona con síntomas neurológicos...

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Development and Evaluation of an Enterovirus D68 Real-Time Reverse Transcriptase PCR Assay

We have developed and evaluated a real-time reverse transcriptase PCR (RT-PCR) assay for the detection of human enterovirus D68 (EV-D68) in clinical specimens. This assay was developed in response to the unprecedented 2014 nationwide EV-D68 outbreak in the United States associated with severe respiratory illness. As part of our evaluation of the outbreak, we sequenced and published the genome sequence of the EV-D68 virus circulating in St. Louis, MO. This sequence, along with other GenBank sequences from past EV-D68 occurrences, was used to computationally select a region of EV-D68 appropriate for targeting in a strain-specific RT-PCR assay. The RT-PCR assay amplifies a segment of the VP1 gene, with an analytic limit of detection of 4 copies per reaction, and it was more sensitive than commercially available assays that detect enteroviruses and rhinoviruses without distinguishing between the two, including three multiplex respiratory panels approved for clinical use by the FDA. The assay did not detect any other enteroviruses or rhinoviruses tested and did detect divergent strains of EV-D68, including the first EV-D68 strain (Fermon) identified in California in 1962. This assay should be useful for identifying and studying current and future outbreaks of EV-D68 viruses.
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Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014

On August 19, 2014, CDC was notified by Children's Mercy Hospital in Kansas City, Missouri, of an increase (relative to the same period in previous years) in patients examined and hospitalized with severe respiratory illness, including some admitted to the pediatric intensive care unit. An increase also was noted in detections of rhinovirus/enterovirus by a multiplex polymerase chain reaction assay in nasopharyngeal specimens obtained during August 5–19. On August 23, CDC was notified by the University of Chicago Medicine Comer Children's Hospital in Illinois of an increase in patients similar to those seen in Kansas City. To further characterize these two geographically distinct observations, nasopharyngeal specimens from most of the patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. Enterovirus D68* (EV-D68) was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Since these initial reports, admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. Investigations into suspected clusters in other jurisdictions are ongoing.
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CDC - Lo que los padres deben saber sobre el enterovirus D68 - Especiales CDC - CDC en Español

CDC - Lo que los padres deben saber sobre el enterovirus D68 - Especiales CDC - CDC en Español | GPI AEPap | Scoop.it
Cada año, millones de niños en los Estados Unidos contraen enterovirus que pueden causar tos, estornudos y fiebre. En el 2014, el enterovirus que con más frecuencia causó enfermedad respiratoria en los niños en todo el país fue el enterovirus D68 (EV-D68). Tome medidas básicas para que su hijo no contraiga ni propague el EV-D68.

Las infecciones por enterovirus son comunes en los Estados Unidos durante el verano y el otoño. En agosto del 2014 un par de estados empezaron a observar más niños en los hospitales con enfermedad respiratoria grave causada por el EV-D68. En los meses después de este hallazgo, los CDC y los estados hicieron más pruebas y descubrieron que el EV-D68 estaba enfermando a personas en casi todos los estados. La mayoría de esos casos se presentaron en niños, muchos de los cuales tenían asma o antecedentes de sibilancias. El EV-D68 no es nuevo, pero en el pasado no fue tan frecuente como en el 2014. Aunque el 2014 fue un año en que se presentaron gran cantidad de infecciones por EV-D68, los CDC no pueden predecir si el enterovirus D68 será un tipo común de enterovirus causante de enfermedad en las temporadas futuras. Esto se debe a que anualmente circulan una mezcla de tipos de enterovirus, y diferentes tipos pueden ser comunes en años distintos.  
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Non-Polio Enterovirus | About EV-D68 Spanish language | Enterovirus D68 | CDC

Non-Polio Enterovirus | About EV-D68 Spanish language | Enterovirus D68 | CDC | GPI AEPap | Scoop.it
P: ¿Qué es el enterovirus D68?

R: El enterovirus D68 (EV-D68) es uno de más de 100 tipos de enterovirus no-polio. El virus se identificó por primera vez en California en 1962.
P: ¿Cuáles son los síntomas de la infección por el EV-D68?

R: El EV-D68 puede causar enfermedad respiratoria de leve a grave.

Los síntomas de la forma leve pueden incluir fiebre, secreción nasal, estornudos, tos y dolores corporales y musculares.
Los síntomas graves pueden incluir sibilancias y dificultad para respirar.
Toda persona con una enfermedad respiratoria debe contactar a su médico si presenta dificultades para respirar, o si sus síntomas empeoran.
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Eurosurveillance - EVALUATION OF THE ENTEROVIRUS LABORATORY SURVEILLANCE SYSTEM IN DENMARK, 2010 TO 2013

Eurosurveillance - EVALUATION OF THE ENTEROVIRUS LABORATORY SURVEILLANCE SYSTEM IN DENMARK, 2010 TO 2013 | GPI AEPap | Scoop.it
The primary aim of the Danish enterovirus (EV) surveillance system is to document absence of poliovirus infection. The conflict in Syria has left many children unvaccinated and movement from areas with polio cases to Europe calls for increased awareness to detect and respond to virus-transmission in a timely manner. We evaluate the national EV laboratory surveillance, to generate recommendations for system strengthening. The system was analysed for completeness of viral typing analysis and clinical information and timeliness of specimen collection, laboratory results and reporting of clinical information. Of 23,720 specimens screened, 2,202 (9.3%) were EV-positive. Submission of cerebrospinal fluid and faecal specimens from primary diagnostic laboratories was 79.5% complete (845/1,063), and varied by laboratory and patient age. EV genotypes were determined in 68.5% (979/1,430) of laboratory-confirmed cases, clinical information was available for 63.1% (903/1,430). Primary diagnostic results were available after a median of 1.4 days, typing results after 17 days, detailed clinical information after 33 days. The large number of samples typed demonstrated continued monitoring of EV-circulation in Denmark. The system could be strengthened by increasing the collection of supplementary faecal specimens, improving communication with primary diagnostic laboratories, adapting the laboratory typing methodology and collecting clinical information with electronic forms.
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Phase 1 Trials of rVSV Ebola Vaccine in Africa and Europe — NEJM

Phase 1 Trials of rVSV Ebola Vaccine in Africa and Europe — NEJM | GPI AEPap | Scoop.it
In August 2014, after the outbreak of Ebola virus disease was declared a public health emergency of international concern by the World Health Organization (WHO), the Canadian government donated 800 vials of the replication-competent recombinant vesicular stomatitis virus (rVSV)–vectored Zaire ebolavirus (rVSV-ZEBOV) candidate vaccine to the WHO. The VSV Ebola Consortium (VEBCON) was created under the auspices of the WHO to initiate phase 1 studies to facilitate rapid progression to phase 2 and 3 trials in affected countries.1
Live replicating viral vaccines elicit humoral and cellular immune responses against viral pathogens.2,3 A single injection of 10 million plaque-forming units (PFU) of rVSV-ZEBOV protected nonhuman primates exposed to lethal doses of ZEBOV.4-7 Vesicular stomatitis virus belongs to the Rhabdoviridae family.8 In livestock, wild-type VSV causes vesicles and ulcerations of the oral tissues, feet, and teats.9 Human infections are rare and asymptomatic or typically cause mild influenza-like illness, although more severe infections have been described.9-14 The wild-type virus is not endemic in Africa and Europe.15,16 The preclinical safety record of the rVSV vector is encouraging: among approximately 80 immunized nonhuman primates, none had detectable toxic effects.3 Viremia associated with rVSV-ZEBOV was detected on day 2 only, suggesting rapid viral clearance through the innate immune response. Safety in immunocompromised hosts was assessed in a few nonhuman primates infected with the human immunodeficiency virus6 and in mice with severe combined immunodeficiency.17 None of the animals had detectable illness after immunization. Viral shedding in saliva and urine was not observed.3
To assess the safety and immunogenicity of various doses of rVSV-ZEBOV in countries with or without previous outbreaks of Ebola virus disease, we initiated parallel, harmonized VEBCON trials in Lambaréné, Gabon; Kilifi, Kenya; Hamburg, Germany; and Geneva, Switzerland. We report the 6-month safety and immunogenicity data from these ongoing studies.
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Zika and the Risk of Microcephaly — NEJM

Zika and the Risk of Microcephaly — NEJM | GPI AEPap | Scoop.it
Zika virus (ZIKV) infection during pregnancy has been linked to birth defects,1 yet the magnitude of risk remains uncertain. Investigators studying the 2013–2014 Zika outbreak in French Polynesia estimated that the risk of microcephaly due to ZIKV infection in the first trimester of pregnancy was 0.95% (95% confidence interval, 0.34 to 1.91), on the basis of eight microcephaly cases identified retrospectively in a population of approximately 270,000 people with an estimated rate of ZIKV infection of 66%
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PREEVID: ¿Cual es la dosis óptima y máxima de la dexametasona oral en el tratamiento del crup agudo en niños?

Basados en varios ensayos clínicos randomizados de muestra pequeña, la dosis oral de dexametasona de 0,15 mg/kg parece ser tan efectiva como la de 0,6 mg/Kg en el tratamiento inmediato en niños diagnosticados de crup laríngeo. Sin embargo, dado que el tema no está resuelto y se precisa de más investigaciones, no hay coincidencia en las recomendaciones en los sumarios de evidencia y guías de práctica clínica revisadas. Sobre la dosis máxima de dexametasona oral casi todos los documentos revisados señalan la cantidad de 10 mg y una guía la cifra en 12 mg.

La revisión sistemática de la Biblioteca Cochrane, sobre el empleo de corticoides en el crup, actualizada en 2011(1), concluyó que: son efectivos como tratamiento iniciales, budesonida nebulizada o dexametasona administrada oral o intramuscularmente; y que la dosis oral de dexametasona óptima (0,15 o 0,6  mg/Kg) no ha podido ser todavía definida siendo necesarias más investigaciones.

Posterior a la revisión sistemática citada tan solo hemos encontrado un ensayo clínico randomizado que evalúe la efectividad de la dosis de dexametasona en pacientes diagnosticados de crup(2). 70 niños diagnosticados de crup leve a moderado atendidos en urgencias hospitalarias, fueron distribuidos en dos grupos de forma aleatoria: en uno se administró dexametasona en dosis de 0,15 mg/kg y en el otro un placebo. Con la dosis de 0,15 mg/kg dexametasona se obtuvo una mejoría y un beneficio clínico a los 30 minutos de su administración.

En dos bancos de preguntas, la búsqueda realizada para  contestar de forma específica qué dosis de dexametasona que es la efectiva en el crup laríngeo- una actualizada en 2009(3) y otra en 2013(4) -  concluyeron que  la dosis de 0,15 o de 0,30 mg/Kg  son tan efectivas como la de 0,6 mg/Kg. Las conclusiones se basaron en pequeños estudios randomizados que mostraban que no había diferencias con las referidas dosis, ni en la evolución clínica a las seis horas, ni en la tasa de recidivas y de ingresos hospitalarios.

En los sumarios de evidencia(5-8) y guías de práctica clínica(9-13) revisadas, no hay  unanimidad en la recomendación para la dosis óptima de dexametasona en niños diagnosticados de crup:

La dosis máxima se indica en 10 mg, salvo una guía  que señala 12 mg(9).
Varios documentos (5,6,10) recomiendan la dosis de 0,6 mg/kg ; y uno de ellos reserva la dosis de 0,15 mg/Kg  para los casos leves(10).
Otros señalan que la dosis podría oscilar entre 0,15 a 0,60 mg/kg(6,8).
Una guía opta por recomendar, de manera pragmática y para evitar confusiones, la dosis de 0,30 mg/Kg; aunque reconoce que sería efectiva de 0,15 a 0,60 mg/Kg(12).
Una guía recomienda, independientemente de la severidad, la dosis de 0,15mg/Kg(13); mientras que en otra se diferencia la dosis de 0,15 mg/Kg para los casos moderados y la dosis de 0,6 mg/Kg para los severos(9).
Por último una de las  guías no se pronuncia sobre cual sería la dosis recomendada
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AEPap Algoritmos: Exantema petequial-purpúrico

AEPap Algoritmos: Exantema petequial-purpúrico | GPI AEPap | Scoop.it
El exantema petequial o purpúrico constituye un reto diagnóstico ya que puede ser el resultado de enfermedades graves, que precisan un diagnóstico y tratamiento urgentes. Se realizará siempre una valoración sistemática y rigurosa que determinará que pacientes precisan pruebas complementarias
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AEPap Algoritmos: Exantemas maculopapulosos

AEPap Algoritmos: Exantemas maculopapulosos | GPI AEPap | Scoop.it
Los exantemas eritematomaculopapulosos se caracterizan por un rash cutáneo eritematoso, máculas planas coloreadas casi siempre eritematosas y/o pápulas sobreelevadas. La lesión elemental predominante puede ser: mácula (lesión plana caracterizada por cambio de coloraci ón), pápula (elevación circunscrita de la piel con un diámetro inferior a 10 mm, si es mayor de 1 cm se denomina placa ), eritema o eritrodermia (enrojecimiento inflamatorio de grandes zonas o la t otalidad de la piel), habón (pápulas o placas rosa pálido edematosas que en oca siones se unen formando lesiones anulares o serpigin osas con evolución cambiante, duran < 24 h en una localización). En general son manifestaciones cu táneas de aparición brusca. Constituyen el grupo más amplio de las enfermedades exantemáticas. Acompañan a muchas enfermedades, la mayoría infecciosas de origen viral y autolimitadas. Otras causas: bacterias, Rickettsias, fármacos, paravirales, enfermedades sistémicas 1 . Algunas entidades coexisten con lesiones vesiculosas y/o petequiales, por lo que se describen también en los algoritmos respectivos.
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Identificado un enterovirus D68 asociado a un caso de parálisis flácida aguda en Zaragoza | Comité Asesor de Vacunas

Identificado un enterovirus D68 asociado a un caso de parálisis flácida aguda en Zaragoza | Comité Asesor de Vacunas | GPI AEPap | Scoop.it
En el Boletín Epidemiológico Semanal de Aragón (Semana 01/2016), publicado el 14 de enero de 2016, se informa de la detección, por primera vez en España, de un enterovirus D68 (EV D68) asociado a un caso de parálisis flácida aguda (PFA).

Se trata de un niño de 4 años, residente en la ciudad de Zaragoza, correctamente vacunado frente a la polio, que ingresó en un hospital local el pasado 3 de diciembre de 2015. El 16 de diciembre, el Laboratorio Nacional de Poliovirus (Centro Nacional de Microbiología) confirmó la detección de un EV D68 y la ausencia de poliovirus en las muestras estudiadas. El niño permanece gravemente afectado por una polineuropatía axonal motora difusa.
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Global emergence of enterovirus D68: a systematic review - The Lancet Infectious Diseases

Global emergence of enterovirus D68: a systematic review - The Lancet Infectious Diseases | GPI AEPap | Scoop.it
Since its discovery in California in 1962, reports of enterovirus D68 have been infrequent. Before 2014, infections were confirmed in only 699 people worldwide. In August, 2014, two paediatric hospitals in the USA reported increases in the number of patients with severe respiratory illness, with an over-representation in children with asthma. Shortly after, the authorities recognised a nationwide outbreak, which then spread to Canada, Europe, and Asia. In 2014, more than 2000 cases of enterovirus D68 were reported in 20 countries. Concurrently, clusters of children with acute flaccid paralysis of unknown cause were reported in several US states and in Europe. Enterovirus D68 infection was confirmed in some of the paralysed children, but not all. Complications in patients who were severely neurologically affected resemble those caused by poliomyelitis. In this paper we systematically review reports on enterovirus D68 to estimate its global epidemiology and its ability to cause respiratory infections and neurological damage in children. We extracted data from 70 papers to report on prevalence, symptoms, hospitalisation and mortality, and complications of enterovirus D68, both before and during the large outbreak of 2014. The magnitude and severity of the enterovirus D68 outbreak underscores a need for improved diagnostic work-up of paediatric respiratory illness, not only to prevent unnecessary use of antibiotics, but also to ensure better surveillance of diseases. Existing surveillance systems should be assessed in terms of capacity and ability to detect and report any upsurge of respiratory viruses such as enterovirus D68 in a timely manner, and focus should be paid to development of preventive measures against these emerging enteroviruses that have potential for severe disease.
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Neuropediatra.org. Brote de enterovirus

Neuropediatra.org. Brote de enterovirus | GPI AEPap | Scoop.it
Los Enterovirus producen enfermedades banales en la inmensa mayoría de los casos.

Reconocer los síntomas que indican enfermedad grave es esencial para acudir al médico enseguida.

Las medidas de higiene son la mejor protección para evitar el contagio.

La información es la mejor arma frente a los bulos que corren por las redes
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E- Medicine: Enterovirus D68

E- Medicine: Enterovirus D68 | GPI AEPap | Scoop.it
Enterovirus D68 (EV-D68), also known as enterovirus 68 (EV-68 or EV68), is a non-poliovirus, nonenveloped, positive-sense single-stranded RNA virus that belongs to the Picornaviridae family. See the images below. EV-D68 is transmitted person to person by contact with respiratory and gastrointestinal secretions.


Electron micrograph of a thin section of enterovirus D68 (EV-D68), showing the numerous, spherical viral particles. Courtesy of the CDC.

Electron micrograph of a thin section of numerous spherical enterovirus D68 (EV-D68) viral particles. Some of the particles appear to be "empty," missing their contents of single-stranded RNA. Courtesy of the CDC.
While most of the approximately 100 species of enteroviruses primarily infect the gastrointestinal (GI) tract, EV-D68 has tropism for the respiratory tract. It causes acute respiratory disease ranging from mild upper respiratory tract symptoms to severe pneumonia. In an outpatient setting, EV-D68 disease has manifested most commonly among persons younger than 20 years and adults aged 50-59 years. Inpatients have predominately been children.[1, 2]

EV-D68 was first isolated in 4 pediatric patients with lower respiratory tract infection in California in 1962.[3]

EV-D68, as with other enterovirus species, circulates seasonally in the summer and especially in fall months.[4, 5]

In August 2014, EV-D68 emerged as a cause of severe respiratory infections. Hospitals in Illinois and Missouri reported an increased incidence of rhinovirus and enterovirus infection, with 30 of 36 isolates from the nasopharyngeal secretions of patients with severe respiratory illness identified as EV-D68. Following these reports, an unusually high number of patients with severe respiratory illness were admitted to these facilities, presumably with EV-D68 infection.[2]

Susceptible patients generally have underlying asthma and wheezing. In addition to respiratory illness, EV-D68 has also been associated with rare and lethal central nervous system (CNS) infection with polioviruslike manifestations.
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Non-Polio Enterovirus | EV-D68 Spanish Infographic | Enterovirus D68 | CDC

Non-Polio Enterovirus | EV-D68 Spanish Infographic | Enterovirus D68 | CDC | GPI AEPap | Scoop.it
Evite que su niño contraiga el ENTEROVIRUS D68 o que lo propague
Evite el contacto cercano con personas enfermas.
[Ilustración que muestra la importancia de evitar el contacto con las personas enfermas]
Cúbrase la nariz y la boca cuando tosa y estornude.
[Ilustración que muestra la importancia de cubrirse la nariz y la boca al toser y estornudar]
Lávese las manos con agua y jabón.
[Ilustración que muestra la importancia de lavarse las manos con agua y jabón]
Limpie y desinfecte las superficies.
[Ilustración que muestra la importancia de limpiar y desinfectar las superficies]
Evite tocarse la cara sin haberse lavado las manos.
[Ilustración que muestra la importancia de no tocarse la cara]
Quédese en la casa si está enfermo.
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CDC Features - What Parents Need to Know about Enterovirus D68

CDC Features - What Parents Need to Know about Enterovirus D68 | GPI AEPap | Scoop.it
Every year, millions of children in the United States catch enteroviruses that can cause coughing, sneezing, and fever. In 2014, the enterovirus that most commonly caused respiratory illness in children across the country was enterovirus D68 (EV-D68). Take basic steps to keep your child from getting and spreading EV-D68.

Infections with enteroviruses are common in the United States during summer and fall. In August 2014, a couple of states started seeing more children in hospitals with severe respiratory illness caused by EV-D68. In the months following this discovery, CDC and states did more testing and found that EV-D68 was making people sick in almost all states. Most of the cases were among children, many who had asthma or a history of wheezing. EV-D68 is not new, but it wasn’t as common in the past as it was in 2014. While 2014 was a big year for EV-D68 infections, CDC can’t predict whether EV-D68 will be a common type of enterovirus to cause sickness in future seasons. That’s because a mix of different enteroviruses types circulates every year, and different types can be common in different years. 
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Non-Polio Enterovirus | About EV-D68 | Enterovirus D68 | CDC

Non-Polio Enterovirus | About EV-D68 | Enterovirus D68 | CDC | GPI AEPap | Scoop.it
Enterovirus D68 (EV-D68) is one of more than 100 non-polio enteroviruses. This virus was first identified in California in 1962.

What are the symptoms of EV-D68 infection?

EV-D68 can cause mild to severe respiratory illness.

Mild symptoms may include runny nose, sneezing, cough, and body and muscle aches.
Severe symptoms may include wheezing and difficulty breathing.
Anyone with respiratory illness should contact their doctor if they are having difficulty breathing or if their symptoms are getting worse.
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Eurosurveillance - DETECTION OF ENTEROVIRUS D68 IN PATIENTS HOSPITALISED IN THREE TERTIARY UNIVERSITY HOSPITALS IN GERMANY, 2013 TO 2014

Eurosurveillance - DETECTION OF ENTEROVIRUS D68 IN PATIENTS HOSPITALISED IN THREE TERTIARY UNIVERSITY HOSPITALS IN GERMANY, 2013 TO 2014 | GPI AEPap | Scoop.it
Enterovirus D68 (EV-D68) has been recognised as a worldwide emerging pathogen associated with severe respiratory symptoms since 2009. We here report EV-D68 detection in hospitalised patients with acute respiratory infection admitted to three tertiary hospitals in Germany between January 2013 and December 2014. From a total of 14,838 respiratory samples obtained during the study period, 246 (1.7%) tested enterovirus-positive and, among these, 39 (15.9%) were identified as EV-D68. Infection was observed in children and teenagers (0–19 years; n=31), the majority (n=22) being under five years-old, as well as in adults > 50 years of age (n=8). No significant difference in prevalence was observed between the 2013 and 2014 seasons. Phylogenetic analyses based on viral protein 1 (VP1) sequences showed co-circulation of different EV-D68 lineages in Germany. Sequence data encompassing the entire capsid region of the genome were analysed to gain information on amino acid changes possibly relevant for immunogenicity and revealed mutations in two recently described pleconaril binding sites.
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