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Pulmonary complications in children with human immunodeficiency virus infection Pulmonary complications in children infected by human immunodeficiency virus (HIV) are common and may be the first manifestation of acquired immunodeficiency syndrome (AIDS). The aim of our study was to review pulmonary diseases and complications in pediatric patients with HIV infection in a large tertiary hospital in Santiago, Chile. We performed a retrospective, descriptive analysis of 17 patients with HIV infection controlled at the Hospital Dr. Sótero del Río. Respiratory complications/diseases were: overall pneumonia (n: 14), recurrent pneumonia (n: 10), citomegalovirus associated pneumonia (n: 4), Pneumocystis jiroveci associated pneumonia (n: 1) pulmonary tuberculosis (n: 1), lymphoid interstitial pneumonia (n: 3) and chronic pulmonary disease (n: 7). Microorganisms isolated were mostly atypical and frequently associated with severe and chronic pulmonary damage. A high degree of suspicion is required to detect atypical microorganisms promptly, in order to rapidly implement pathogen targeted therapy that could potentially decrease the possibility of sequelae.

Selective treatment of febrile neutropenia in pediatric cancer patients Management of pediatric patients with cancer and febrile neutropenia (FN) requires appropriate identification of children at high or low risk of acquiring invasive bacterial infections (IBI), in order to implement selective treatment strategies. Based on international and our own research experience, we propose recommendations for diagnostic screening and management of children with cancer and FN according to their risk of IBI. All pediatric patients with FN must be admitted to hospital for at least 24 hours. During this period clinical and laboratory evaluations are aimed to determine their risk of IBI and to identify potential infectious focii. High risk patients should be managed in the hospital until recovery. Low risk patients can be managed as outpatients. Antimicrobial selection and possible adjustments to therapy will depend on the identification of an infectious focus, and/or local epidemiology and susceptibility patterns. Patients will require periodic clinical and laboratory reevaluation (day 3, 5 and 7 of evolution or more frequently if clinically indicated) irrespective of their risk category; response to treatment can be defined as favorable or unfavorable based in preestablished clinical and laboratory criteria in order to monitor the success of selected strategies.

Etiology of Prolonged Fever in Children Background: Prolonged fever (PF) is an uncommon entity in children, produced by diverse etiologies that differ according to geographic areas and national socioeconomical status. Objective: To determine etiologic diagnosis of PF in children from the southeast area of Santiago. Methods: A prospectivedescriptive study performed in 35 patients with PF, age between 6 months-15 years, referred to the Pediatrics Infectious Diseases Unit of Hospital Sótero del Río during 2005 and 2006. Results: In 74% of cases an etiologic diagnosis was established, predominantly infectious diseases (68%) and rheumatologic disorders (6%). The most frequent infections observed were Bartonella henselae (17%), urinary tract infection (11%) and Epstein Barr virus infection (5.7%). Conclusions: PF in children from the southeast area of Santiago is caused by multiple etiologies, mainly infections with a high incidence of Bartonella henselae.

Objective: To describe the feasibility, effectiveness and safety of intravenous (iv) outpatient treatment in 2 to 24 month-old children with febrile urinary tract infection (UTI). Method: Children presenting to the ER, between April 2003-2005, with fever and no identifiable focus who had a diagnosis of UTI were randomized to receive iv antibiotic in the hospital or in an outpatient facility. Children were started on amikacin or ceftriaxona according to physician criteria followed by antimicrobial adjustment based on urine culture result and a later switch to an oral antimicrobial. Urine cultures were performed during and after completing the antimicrobial course. Adherence and effectiveness of antimicrobial treatment and treatment-associated complications were analyzed. Results: The study included 112 patients, 58 inpatient children and 54 outpatient children, with an average age of 7.7 months. Duration of iv treatment did not differ among groups (2.8 days (SD 1.2) 2.7 +0.91 days in inpatients vs 2.9 + 1.9 days in outpatients (p = 0.22). In 100% of outpatient children and 100% of inpatient children (overall 101/101) urine cultures were negative on day 5. None of the children had a treatment-associated complication. Cost analysis yielded 73% of saving money (overall cost for inpatient treatment US 9,815 vs outpatient treatment US 2,650). Conclusions: Outpatient iv treatment in patients between 2 and 24 months with UTI and fever was effective, safe and of lower cost Key words: Urinary tract infection, children, outpatient parenteral antimicrobial treatment. Palabras clave: Infección del tracto urinario, niños, tratamiento antimicrobiano parenteral ambulatorio. IntroducciónL a infección del tracto urinario (ITU) corresponde a una de las patologías infecciosas más frecuentes de la infancia, presentándose en ~ 8% de los niñas y ~ 2% de los varones bajo siete años de edad [1][2][3][4][5] . En nuestro medio, es un motivo frecuente de visita a los servicios de urgencia, alcanzando a 1,35% del total de consultas y una tasa de hospitalización de 10% en una experiencia nacional 6 . En lactantes con síndrome febril sin foco, la ITU es su causa en ~7,5% de los casos bajo ocho semanas de vida, 5,3% bajo un año de edad y 4,1% bajo dos años 7,8 . En estudios nacionales se ha reportado que en niños entre seis semanas y tres años de edad con infección bacteriana confirmada, la ITU representa el 80,2% de ellas 9 . Algunas investigaciones han demostrado que la probabilidad de daño de parénquima renal secundario a infección urinaria varía de acuerdo a la edad, siendo mayor en niños bajo dos años, lo que justifica el tratamiento inicial apropiado en este grupo etario 10 .De acuerdo a algunos autores, la hospitalización de los pacientes con ITU debería considerarse siempre en las primeras seis semanas de vida, en pacientes bajo cinco años con compromiso sistémico o hemodinámico y cuando no sea posible asegurar una buena tolerancia (vómitos, rechazo), adherencia a la terapia oral y accesibilidad al servicio de salud. Así mismo, se podr...