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Resumen Shigella spp. es el aislamiento microbiológico más frecuente en las diarreas bacterianas en Argentina. Clínicamente puede causar desde una diarrea acuosa hasta disentería. En forma infrecuente causa complicaciones extraintestinales, con una incidencia de bacteriemia desde 0,4 a 7,3%; asociado a factores de riesgo como niños menores de un año de edad e inmunodeficiencias, entre otros. Presentamos los casos clínicos de dos lactantes con bacteriemia por Shigella flexneri, que consultaron por fiebre y diarrea, uno de ellos con diagnóstico de inmunodeficiencia primaria.

Kawasaki disease (EK) is an acute systemic vasculitis with a risk of developing coronary aneurysms.To describe the clinical and epidemiological characteristics of children with EK in Argentina and to analyse the risk factors for the development of coronary's complications (CC).Multicenter, retrospective, cross-sectional, observational and analytical study. It included patients younger than 18 years of age diagnosed with EK in hospitals in Argentina, between January the 1st, 2010 and December the 31th, 2013.N = 193 subjects. Age: medium: 29 months. Total incidence 5 cases / 10,000 hospital discharges. CC was observed in 15.5% of patients. Increased risk factors for CC: Elevated number of days with fever at the time of treatment placement (p = 0.0033); Increased of: heart frequency (p = 0.0021), erythrosedimentation (ESR) (p = 0.005), C-reactive protein (CRP) (p0.0001), leukocytes (p = 0.0006), neutrophils (p = 0.0021); Decreased of hematocrit (p = 0.0007) and hemoglobin (p0.0001).Association with CC: non-coronary cardiological alterations (OR = 10,818); PCR greater than 68 mg /L (OR = 11,596); leukocytes greater than 20,000 / mm3 (OR = 4.316); and ESR greater than 64 mm / 1 hour (OR = 4.267).The most frequent form of presentation was complete EK, the risk of CC was higher in males, younger than 5 years old, the risk factors (clinical and laboratory) were similar to those described in the literature.

Shigella spp. is the most frequent micro-biological isolation in bacterial diarrhea in Argentina. It causes a watery diarrhea or dysenteric disease. It rarely causes extraintestinal problems. It has an incidence of bacteremia of 0,4-7,3%, and its appearance compels us to look for associated risk factors, as children under one year of age and immunodeficiency, among others. We describe two children with Shigella flexneri bacteremia. They presented with fever and diarrhea. One of them had primary immune deficiency.

Invasive Streptococcus pyogenes infections (ISpIs) cause a high morbidity and mortality, even at present; however, at a regional level there are few publications on this subject in the field of pediatrics.To describe the prevalence, predisposing factors and clinical characteristics of children hospitalized for ISpI, and analyze risk factors associated with bacteremia and lethality. Material and methods. Retrospective, descriptive study on ISpIs in children18 years old hospitalized in the Pediatric Ward of 20 healthcare facilities across Argentina between 2010 and 2012. Assessed outcome measures: age, gender, early and late clinical sources of infection, prior chronic condition, predisposing factors, treatment and evolution.To describe the prevalence, predisposing factors and clinical characteristics of children hospitalized for ISpI, and analyze risk factors associated with bacteremia and lethality. Material and methods. Retrospective, descriptive study on ISpIs in children18 years old hospitalized in the Pediatric Ward of 20 healthcare facilities across Argentina between 2010 and 2012. Assessed outcome measures: age, gender, early and late clinical sources of infection, prior chronic condition, predisposing factors, treatment and evolution.Most ISpIs were observed in patients without a prior chronic condition. The most common manifestation was, frequently with bacteremia, in the skin and soft tissue. A statistically significant association was observed between bacteremia and ≥2 early sources of infection and no surgery. Fatality rate, in association with streptococcal toxic shock syndrome and necrotizing fasciitis, was similar to that observed in other publications.Las infecciones invasivas por Streptococcus pyogenes (IISP) presentan elevada morbimortalidad aún en la actualidad; no obstante, a nivel regional, existen escasas publicaciones en pediatría.Describir la prevalencia, los factores predisponentes y las características clínicas de niños internados por IISP, analizar los factores de riesgo asociados a bacteriemia y letalidad. Material y métodos. Estudio retrospectivo, descriptivo de IISP en niños ≤ 18 anos, internados en Pediatría de 20 centros asistenciales del país, entre 2010 y 2012. Variables evaluadas: edad, sexo, focos clínicos iniciales y tardíos, patología crónica previa, factores predisponentes, tratamiento y evolución.Se analizaron 143 pacientes. Incidencia de 4,97 casos/10 000 egresos. Mediana de edad 54 meses; tenían patología crónica previa 11,2%. Tuvieron factores predisponentes 67,1%. Las formas de presentación más frecuentes fueron la piel y las partes blandas en 77, sepsis en 30, osteoarticulares en 19, fascitis necrotizante en 13, síndrome de shock tóxico en 11. Se aisló Streptococcus pyogenes en 56,6% de los hemocultivos; la presencia de más de un foco clínico y la ausencia de cirugía se asociaron a bacteriemia (OR 4,8; p= 0,003 y OR 3,1; p= 0,0012, respectivamente). El promedio de internación fue 13,4 días. La tasa de letalidad fue 7,6% asociada a síndrome de shock tóxico (OR 10; p= 0,005), fascitis necrotizante (OR 104; p0,0001) e ingreso a la Unidad de Cuidados Intensivos Pediátricos (OR 26; p0,001).La mayoría de las IISP se presentaron en pacientes sin patología crónica previa. Los focos de presentación, frecuentemente con bacteriemia, fueron la piel y las partes blandas. Hubo asociación estadísticamente significativa entre bacteriemia y ≥ 2 focos iniciales y ausencia de cirugía. La letalidad, asociada a SSTS y fascitis necrotizante, fue similar a otras publicaciones.

Introduction: Kawasaki disease (KD) is a vasculitis that affects vessels of small and medium caliber. Objectives: 1 Determine clinical and epidemiology of KD in children in 22 pediatric referral centers in Argentina. 2 Identify risk factors for coronary complications (CC). Material and Methods: A retrospective and analytical study from 01/01/2010 to 31/12/2013. Variables: age, sex, heart rate (HR), clinic features, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), leukocytes (Gb), neutrophils, hemoglobin (Hb) and CC. Color Doppler echocardiography: acute phase and 4-6 weeks. Results: Subjects: 191, age (Md) 29 months (R: 2-144) .Ratio v / m: 1.8 / 1. Clinical: fever 100% (191/191) more frequent and adenopatía: 57% (110/191) less frequent. CC: 15.7% (30/191). Mortality: 0.52% (1/191 cases). Increased risk of CC: leukocytosis> 20,000 / mm3 Odds ratio (OR) = 4.235 (95% CI 1704-10529). Hematocrit Conclusions: Increased frequency in males. Increased risk of CHD in subjects from western Argentina. Low mortality. Increased risk of CC: low hematocrit and hemoglobin; leukocytes, neutrophils, ESR, CRP, FC, high, Presence of other heart alterations and more days of fever at the time of establishing of treatment. Risk factors for coronary involvement

Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of community-originated skin and soft tissue infections in immunocompetent patients under the age of 19.