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Resumen Fundamento y objetivo La tos ferina sigue siendo una importante causa de morbimortalidad a pesar de las actuales estrategias vacunales. Se diseno este estudio para describir los resultados y las caracteristicas de los contactos estrechos de casos de tos ferina diagnosticados en menores de 16 anos en un hospital de tercer nivel de Barcelona. Pacientes y metodo Estudio transversal. Los datos se recogieron a partir de las historias clinicas de los contactos de los casos pediatricos diagnosticados de tos ferina en el Hospital Universitario Vall d’Hebron de 2005 a 2009. Se incluyeron solo pacientes con estudio microbiologico realizado. Se calculo la odds ratio (OR) con su intervalo de confianza del 95% (IC 95%) como medida de asociacion. Resultados Fueron estudiados 91 casos indice y 404 contactos. La prevalencia de casos positivos entre los contactos fue del 33,2%. Los contactos de los casos indice menores de 6 meses presentaron mas riesgo de ser positivos que los contactos de los ninos mayores (OR 3,38; IC 95% 1,88-6,10). Se identificaron como casos primarios el 16,7% de los contactos estudiados. Estos representaron la fuente de contagio para el 67,7% de los casos indice menores de 6 meses y para el 26,9% de los ninos mayores. Conclusiones El estudio de contactos de casos pediatricos de tos ferina es una actividad clinica necesaria. Es mas probable hallar casos primarios en el estudio de contactos de ninos menores de 6 meses. Las estrategias preventivas deben ir dirigidas fundamentalmente a los contactos frecuentes de este grupo.

Pertussis remains an important cause of morbimortality despite current vaccination strategies. This study was designed to describe the results and characteristics of close contacts of pertussis cases diagnosed in children less than 16 years in a tertiary hospital in Barcelona.Cross-sectional study. Data were collected from chart review of contacts of paediatric cases of pertussis in Vall d'Hebron University Hospital from 2005 to 2009. Only patients with microbiological study done were included. The odds ratio (OR) and 95% confidence interval (95% CI) were calculated as association measure.Ninety-one index cases and 404 contacts were studied. The prevalence of positive cases among contacts was 33.2%. Contacts of index cases younger than 6 months had a higher risk of being positive for pertussis than contacts of older children (OR: 3.38; 95% CI: 1.88-6.10). Primary cases were identified as 16.7% of the contacts studied, who were the source of infection for 67.7% of index cases younger than 6 months and for 26.9% of older index cases.Contact tracing of paediatric pertussis cases is a necessary clinical activity. It is more likely to find primary cases in the contact investigation of children less than 6 months. Preventive strategies should be targeted primarily to frequent contacts of this age group.

Ureaplasma urealyticum is associated with respiratory pathology in the neonates and preterm neonates. However, this association has been poorly studied in infants and during early infancy. To address this issue, a clinic evaluation of patients with whooping cough and isolation of U. urealyticum in their nasopharyngeal aspirates has been done.Over a period of 11 years, 1063 nasopharyngeal aspirates from 905 infants were studied. Clinical samples were cultured for Bordetella spp., other bacteria, viruses and mycoplasma. Data of patients with positive cultures for U. urealyticum were obtained from clinical records.U. urealyticum was isolated from 26 patients with a median age of 5 months (range: 23 days-22 months). The gestational age of 9 patients (34.6%) was less than 37 weeks. All the patients were hospitalised because of pertussis-like syndrome, which was associated with respiratory distress due to bronchospasm in 18 patients (69.2%). Twelve patients (46.1%) had fever and 15 (57.7%) showed lymphocytosis. The chest roentgenogram was abnormal in 18 patients (69.2%): pulmonary hyperaeration, with or without atelectasis. Clinical evolution was good in all patients. In 16 patients (61.5%) U. urealyticum was isolated together with other microorganisms: in 9 samples with bacteria (H. influenzae, S. pneumoniae, B. pertussis, M. catarrhalis), in 5 with viruses (respiratory syncytial virus, cytomegalovirus, adenovirus, enterovirus) and in 2 samples with respiratory syncytial virus and S. pneumoniae and B. pertussis respectively.Likely U. urealyticum cannot be considered clearly as the etiologic agent of whooping cough, mainly because in the 61.5% of patients U. urealyticum has been isolated together with other microorganisms considered pathogens or potentially pathogens. Future studies would be necessary in order to establish the pathogenic role of U. urealyticum after the neonatal period.

To study the microbiology of cystic fibrosis in our hospital for the period from 1985 to 1992.The number of samples analyzed totalled 1,034, most of which were sputum and nasopharyngeal aspirates belonging to 113 patients (49 women and 64 men). The average age was 10 years (range: 15 days-33 years).Only 1.7% of the samples were negative. Normal flora were found in 10.8% and one or more potentially pathogenic microorganisms were found in the remaining 87.4%. Colonies were over 10(6) UFC/ml in size in 77.8% of the quantified cultures. The most frequently identified microorganisms in the population overall were P. aeruginosa (53.9%), S. aureus (30.3%) and H. influenzae (22.0%). In patients less than 12 months old, however, the most common isolations were of S. pneumoniae and B. catarrhalis; cultures from patients older than 16 years old most often yielded filiform fungi, mainly Aspergillus spp. We found no strains of Legionella spp. and P. cepacia was found in only 3 cases, in which the clinical outcome was good. In addition to the 3 most common organisms, we recorded several consecutive isolations of Proteus mirabilis, Xanthomonas maltophilia and Serratia marcescens in patients older than 11 years old; this finding suggests that given the improved survival of cystic fibrosis patients over the coming years and the antibiotic pressure placed on them, there may be slight changes in the bacterial ecology typical of this disease. No strain of S. aureus proved resistant to methicillin, but P. aeruginosa was shown to be resistant to gentamycin (58.2%) among the aminoglycosides and also to some of the beta-lactams considered to be effective, as follows: 25.2% to piperacillin, 22.6% to ceftazidime and even 19.8% to aztreonam. There was slight resistance of ciprofloxacin (6.3%).

We present 19 cases of pertussis in infants under 4 months of age. In all cases, Bordetella pertussis was isolated from nasopharyngeal swabs. A whooping cough, cyanotic episodes and eating disturbances were the most characteristic clinical findings. Treatment included: supportive care, salbutamol, beclomethasone, and josamycin. Lymphocyte counts higher than 40,000/mm2 were associated with a greater severity of illness. The most frequent complications were: recurrent cough and pneumonia. None of the patients died.

Branhamella catarrhalis is a nasopharyngeal commensal which is being increasingly recognised as a pathogen, causing mainly infective exacerbations of chronic lung disease. It can also originate serious infections, like septicaemia, in patients with chronic predisposing conditions. During the period from 1979 to 1987, 22,501 respiratory tract samples from children were evaluated. Ninety nine isolated of Branhamella catarrhalis were identified (0.44%). Patients' age extended from 12 days to 9 years, with patients younger than two years representing 73%. Sixty three out of 77 cases investigated (82%) were positive for beta-lactamase. The most frequent finding was the recovery of Branhamella catarrhalis in tracheal aspirates from children with a tracheotomy or prolonged nasotracheal intubation. One of these children had a septic episode during which Branhamella catarrhalis was isolated from blood. Also remarkable is a case of pneumonia in a patient with congenital hypogammaglobulinaemia. Branhamella catarrhalis was also recovered in a wide variety of acute upper and lower respiratory tract infections in children without previous predisposing conditions. It is less clear its pathogenic role in these cases.