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Resumen Objetivo Analizar las caracteristicas de la sepsis neonatal tardia (SNT) por estreptococo del grupo B (EGB) y la evolucion de su incidencia en 8 hospitales del area de Barcelona a lo largo de los 15 anos de consolidacion de las medidas de prevencion de la infeccion neonatal precoz. Metodos Revision retrospectiva de los pacientes diagnosticados de SNT por EGB desde 1996 a 2010. Resultados Se diagnosticaron 143 pacientes, de los que 51 habian nacido en otros centros. La incidencia global fue del 0,42‰ de recien nacidos vivos (RNV), oscilando entre el 0,14‰ en 2000 y el 0,80‰ en 2009. Se observo una tendencia al incremento del riesgo discreta pero sostenida a lo largo de los anos, del 6,9% en las SNT totales, aunque sin la suficiente significacion estadistica. El 63,6% de los pacientes presentaron sepsis/bacteriemia, el 32,8% meningitis y el 3,5% artritis/osteomielitis. De los casos en los que se pudo obtener informacion sobre los antecedentes obstetricos, el 53% de las madres presentaron cultivo positivo a EGB al final del embarazo, el 53,8% recibieron profilaxis antibiotica intraparto y el 41,2% presentaron algun factor de riesgo, principalmente parto prematuro en el 35,9% de los casos. La mortalidad fue del 2,8%, y los serotipos mayoritarios, el III y el Ia. Conclusiones La incidencia de SNT por EGB no ha disminuido a pesar de las medidas de prevencion de la SNP, y la posibilidad de su aparicion debe ser tenida en cuenta.

Fundamento y objetivo El proposito de este trabajo ha sido estudiar la prevalencia de anticuerpos frente a Toxoplasma en gestantes de nuestra area geografica; la incidencia de toxoplasmosis aguda primaria durante el embarazo, y el numero de infecciones congenitas Sujetos y metodo Se estudio prospectivamente la seroprevalencia en 16.362 gestantes atendidas en 8 hospitales y en 2 centros de asistencia primaria durante 1999. Cada centro participante efectuo la determinacion de anticuerpos especificos IgM, IgA e IgG y test de avidez segun las tecnicas seleccionadas en su practica habitual. Si en la primera determinacion se detecto IgM, se solicito una segunda muestra, la cual se proceso en paralelo con la primera y, en funcion de los resultados obtenidos, se determinaron 3 estadios de la infeccion: aguda, posible y pasada. En los casos en que solo se dispuso de una muestra, no se pudo establecer el momento de la infeccion. La infeccion congenita se determino prenatalmente por tecnicas de amplificacion (reaccion en cadena de la polimerasa [PCR]) en liquido amniotico o posnatalmente, por serologia, al detectar IgM o A en el neonato o persistencia de IgG durante el primer ano de vida Resultados La seroprevalencia fue del 28,6%. La incidencia de la infeccion primaria adquirida durante el embarazo fue del 1,02 por 1.000 gestantes susceptibles. Nueve de las 12 toxoplasmosis agudas se detectaron por seroconversion y la transmision fetal ocurrio en 5 ocasiones (41,6%). Los 4 ninos con toxoplasmosis congenita que nacieron vivos fueron asintomaticos en todos los controles realizados durante el primer ano de vida. Hubo una interrupcion legal del embarazo Conclusiones La seroprevalencia de la toxoplasmosis en esta serie fue baja. La mayoria de las toxoplasmosis agudas se detectaron por seroconversion durante el embarazo y en casi la mitad de los casos se registro transmision fetal

Chagas disease, a potentially fatal parasitic infection, is emerging in Europe in the context of international migration but there is little public health attention and frequent lack of clinicians' awareness. To date, there is no published information about clinical characteristics in children.We reviewed the medical files of all children (18 years) with Chagas disease managed in 2 hospitals in Barcelona, Spain and Geneva, Switzerland between January 2004 and July 2012.Forty-five cases were identified. Two children (4.4%) were diagnosed during the acute phase and the remaining 43 (95.6%) were in the chronic phase of the infection. All but 1 were asymptomatic. Of the 41 treated children, 40 (97.6%) completed 60 days of treatment. Thirty-five (85.4%) received benznidazole, 5 (12.2%) nifurtimox and 1 (2.4%) both drugs consecutively. There were 2 (4.9%) treatment interruptions due to adverse events. The most frequent adverse events were rash (24.4%), anorexia or insufficient weight gain (14.6%) and anemia (2.4%). Twenty-nine (64.4%) children were followed up by serology after 2 years. Five (17.2%) were cured.Pediatric Chagas disease is an emerging health issue in Europe that requires enhanced attention. Greater emphasis should be put on screening pregnant women at risk and their newborns in case of infection along with older children and relatives. Pediatricians have a central role to play in providing families with information and offering testing in situations of risk.

To study the characteristics and evolution of group B Streptococcus (GBS) late-onset diseases, over a period of 15years in 8hospitals the Barcelona area and analyze the possible impact of prophylactic measures for the prevention of early-onset neonatal infections.Retrospective review of all patients diagnosed with late-onset neonatal disease due to GBS from 1996 to 2010.A total of 143 patients were diagnosed. Of these, 51 were born in others hospitals. The overalll incidence was 0.42 per 1000 live births, varying between 0.14‰ in the year 2000 and 0.80‰ in 2009. A slight but sustained tendency of increased risk was observed over the years, 6.9% in the overall disease (with no statistical significance). Sepsis/bacteremia was detected in 63.6% of the newborns, meningitis in 32.8%, and arthritis/osteomyelitis in 3.5%. In cases with known obstetrics dates, 53% of mothers had been colonized by GBS during pregnancy, 53.8% received intrapartum antibiotic prophylaxis, and 41.2% had some obstetric risk factors, particularly premature birth in 35.9%. There was a 2.8% mortality rate in the neonates, and predominant serotypes were III and Ia.The incidence of GBS late-onset disease has not decreased despite the control practices of early-onset disease, and possibility of this appearing must be taken into account.

Fundamento Describir mediante metodos molecularesla transmision vertical por el VIH-1. Pacientes Y Metodos Seguimiento prospectivorealizado durante 1995-1998 en dos grupos depacientes: grupo A, 107 recien nacidos hijosde madre que sabian que estaban infectadaspor el VIH-1, y grupo B, 11 lactantes con sospechaclinica de infeccion por el VIH y desconocimientode la infeccion en la madre.Se estudiaron ADN y ARN mediante PCR (reaccionen cadena de la polimerasa). Estudio demutaciones genotipicas del gen RT. Resultados Se diagnosticaron 11 pacientes infectados,4 del grupo A y 7 del B. Todos presentabancarga viral superior a 100.000 copias/ml. En 10 pacientes no se detectaronmutaciones. Conclusion El diagnostico de la transmisionvertical por el VIH-1 puede realizarse de formaprecoz y urgente mediante metodos de amplificacionmolecular. Background To describe the vertical transmissionof HIV-1 by means of molecular methods. Patients and Methods A prospective study between1995 and 1998 of two groups of patients,A: 107 newborn infants to HIV-1 infectedmothers, and B: 11 infants with clinicalsuspicion of HIV infection, born to mothers whodidn't know being infected. DNA and RNA PCRas well as reverse transcriptase gen mutationswere tested. Results Eleven infected patients were identified,four from group A and seven from groupB. Viral load at the moment of diagnosis washigher than 100,000 copies/ml in all patients.Genotypic mutations of the studied codonswere not detected in ten patients. Conclusion Molecular amplification techniquesare useful for early diagnosis and follow-up ofHIV infection acquired by vertical transmission.

We studied 91 strains of Streptococcus pneumoniae isolated in the Children's and Maternity Hospital San Juan de Dios of Barcelona, Spain, from July 1984 to June 1986. All strains were recovered from miscellaneous sites in different patients. We tested their susceptibility to 14 antimicrobial agents: penicillin, gentamicin, chloramphenicol, tetracycline, co-trimoxazole, erythromycin, vancomycin, rifampicin, cephalothin, cefaclor and cefotaxime. In addition, for 56 of the strains, cefonicid, cefoxitin and imipenem were included. We found many strains with decreased penicillin susceptibility (52.8%). Among the beta-lactam antibiotics tested, cefotaxime and imipenem showed the lowest MIC (less than or equal to 1 mg/l). Only 5.5% of the strains showed resistance to erythromycin, and all were susceptible to vancomycin and rifampicin. Tetracycline and co-trimoxazole were the antimicrobials with the highest prevalence of resistance (72.5% and 67%, respectively). Our isolates were distributed in 21 serotypes, serotype 23 being the most frequent among strains with decreased penicillin susceptibility (50%).