Impact of migrations in Chile. New challenges for the pediatrician. Are we prepared? Migrations are a worldwide phenomenon, where in South America Chile has become a receiving country of immigrants. The arrival of foreigners to the country, besides being a necessity due to local demographic changes with tendency of investment of the population pyramid, it can cause local epidemiological changes, presenting unknown diseases and increasing others controlled by monitorization epidemiological programs. In Chile, 1.3% of the population are foreigners, mainly becoming from countries like Peru, Argentina, Bolivia, Ecuador, Colombia and recently Palestine. 11.8% of immigrants are younger than 14 years-old, where 40% of them are not enrolled in the Public Health System and 30% do not have identification card. A period of latency of 6 months is estimated since the illegal entry to the country until it is incorporated to the National Health System. General doctors and pediatricians must be prepare for rare diseases in the country.

CONTEXT: Adhesion molecule deficiency type 1 is a rare disease that should be suspected in any patient whose umbilical cord presents delay in falling off, and who presents recurrent severe infections. Early diagnostic suspicion and early treatment improve the prognosis. CASE REPORT: The case of a four-month-old boy with recurrent hospitalizations because of severe bronchopneumonia and several episodes of acute otitis media with non-purulent drainage of mucus and positive bacterial cultures is presented. His medical history included neonatal sepsis and delayed umbilical cord detachment. Laboratory studies showed marked leukocytosis with predominance of neutrophils and decreased CD11b and CD18. These were all compatible with a diagnosis of leukocyte adhesion deficiency type I [LAD type 1].RESUMO CONTEXTO: El deficit de moleculas de adhesión tipo 1 es una enfermedad rara que debe ser sospechada en todo paciente que presente un retardo en la caída del cordón unmbilical, además de infecciones graves a repetición. Un sospecha diagnóstica precoz y un tratamiento oportuno mejorarán el pronóstico. INFORMES DE CASO:Se presenta el caso de un niño de cuatro meses de edad, con hospitalizaciones recurrentes a causa de bronconeumonía severa y varios episodios de otitis media aguda con drenaje mucoso, no purulento, y cultivos bacterianos positivos. Su historial médico incluye la sepsis neonatal y el desprendimiento tardío del cordón umbilical. Los estudios de laboratorio mostraron leucocitosis marcada con predominio neutrofílico y disminución de CD11b y CD18, todos compatibles con el diagnóstico del tipo de deficiencia de adhesión leucocitaria 1 [tipo LAD 1].

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