Sin conflictos de interés. Este estudio no recibió financiamiento.

Objective: To evaluate the differential characteristics of SARS-COV-2 associated inflammatory multisystem syndrome (MIS-C) in children. Methods: A retrospective cohort study was conducted. The definition of MIS-C was based on WHO criteria. Temporally related COVID-19 patients were included as controls. Results: 25 patients with MIS-C and 75 controls were included. Multivariate multiple logistic regression model of variables that showed to be significant in univariate analysis revealed that age ≥2 years (OR 24.7; 95% CI 1.03 -592.4; P=0.048), lymphopenia (OR 9.03, 95%CI 2.05-39.7; P=0.004), and platelet count <150x10 9 / L (OR 11.7; 95% CI 1.88-75.22; P=0.009) were significantly associated with MIS-C. Presence of underlying disease seemed to reduce the risk of MIS-C (OR 0.06; 95% CI 0.01-0.3). Conclusion: MIS-C was more common in patients older than 2 years and in those with lymphopenia or thrombocytopenia. Underlying disease appears to reduce the risk of MIS-C.

The objective was to describe the epidemiological, clinical, microbiological, and evolutionary characteristics and the risk factors for mortality. Retrospective, cohort study. A total of 100 patients were included. Of these, 42 (42 %) had septic shock upon admission and 56 (56 %) were admitted to the intensive care unit. Bacteremia was primary in 17 patients (17 %); catheter-related, in 15 (15 %); and secondary, in 68 (68 %). The most common source of infection was the skin and mucous membrane. Resistance to one or more antibiotic groups was 38 %. Thirtyone patients died (31 %). Risk factors for mortality were septic shock (p < 0.0005), admission to the intensive care unit (p < 0.0001), primary bacteremia (p < 0.009) or secondary, non-catheter-related bacteremia (p < 0.003), presence of mucocutaneous or pulmonary source of infection (p < 0.004), and multidrug resistance (p < 0.01) or resistance to carbapenems (p < 0.01).

An 8-month-old child was admitted to a paediatric intensive care unit in Guinea-Bissau with severe blistering dermatosis. He was treated with broad spectrum antibiotics and dressings, without improvement. After 2 weeks, linear IgA bullous dermatosis was suspected. Owing to lack of dapsone, the child was treated with prednisolone and improved. To avoid corticosteroids side effects, 2 months after starting prednisolone we switched to colchicine, but the boy’s condition worsened for reasons of poor adherence, requiring intravenous corticosteroids and antibiotics. After complete resolution of the skin lesions, we continued with colchicine monotherapy, then changed to dapsone after 3 months. The child did not show any further signs of dermatosis, but his follow-up ended abruptly, because he did not return to the hospital. IgA bullous dermatosis is a challenging diagnosis in settings where pathological studies cannot be conducted. Multidisciplinary treatment is required and colchicine is a good option if dapsone is not available.

RESUMENEl síndrome de Horner está caracterizado por la siguiente tríada de signos clínicos: miosis, ptosis y anhidrosis facial. A su vez, pueden aparecer heterocromía del iris, inyección conjuntival, eritema facial, mucosa nasal congestiva y enoftalmos aparente secundario a la disminución de la hendidura palpebral. Es causado por una interrupción de la vía simpática, que se extiende desde el hipotálamo hasta la órbita. Debido a que dicha vía no se decusa, los signos son homolaterales a la lesión de esta. Tradicionalmente, se lo clasifica en congénito y adquirido. En ocasiones, se asocia a neoplasias, como el neuroblastoma. Sigue siendo controversial qué estudios de imágenes se deberían solicitar en forma protocolizada frente a un paciente con este síndrome neurológico. Se presenta el caso de un lactante de 45 días de vida con síndrome de Horner congénito. Palabras clave: síndrome de Horner, neuroblastoma. ABSTRACTHorner syndrome is characterized by the following triad of clinical signs: miosis, ptosis and facial anhidrosis. In addition, iris heterochromia, conjunctival injection, facial erythema, congestive nasal mucosa and apparent enophthalmos secondary to the reduction of the palpebral fissure can appear. It is caused by an interruption of the sympathetic pathway that extends from the hypothalamus to the orbit. Because there is no decussation, the signs are homolateral to the lesion. Traditionally, it is classified as congenital and acquired. Occasionally, it is associated with neoplasias such as neuroblastoma. It remains controversial what imaging studies should be requested as a protocolized workup of this neurological syndrome in a patient. We report the case of a 45-day-old infant with congenital Horner syndrome.

RESUMENLa piomiositis es una infección bacteriana aguda del músculo esquelético que resulta en abscesos localizados, únicos o múltiples. El agente etiológico más frecuente es el Staphylococcus aureus, principal patógeno emergente de infecciones invasivas del músculo esquelético en pacientes pediátricos previamente sanos. Es importante el alto índice de sospecha, ya que el diagnóstico precoz y el tratamiento empírico eficaz permiten evitar la progresión hacia un cuadro de mayor gravedad. Presentamos el caso de un niño de 8 años de edad, previamente sano, con piomiositis de muslo bilateral por Staphylococcus aureus meticilino resistente de la comunidad. Palabras clave: piomiositis, Staphylococcus aureus meticilino resistente de la comunidad. ABSTRACTPrimary pyomyositis is an acute bacterial infection of skeletal muscle leading to single or multiple abscess formation. The etiologic agent most frequently identified is Staphylococcus aureus, principal emerging pathogen of invasive musculoskeletal infections in otherwise healthy children. It is important to maintain a high level of suspicion, since early diagnosis and effective empirical treatment may prevent progression to a more severe disease. We present a case of bilateral thigh pyomyositis caused by community-acquired methicillin-resistant Staphylococcus aureus in an otherwise healthy eight-year-old child. 3 Suele afectar a pacientes entre los 5 y los 9 años de edad y es más frecuente en el sexo masculino.1 Es una infección de diseminación hematógena y el Staphylococcus aureus es el agente etiológico aislado en el 75-90% de los casos; la cepa meticilino resistente de la comunidad es el principal patógeno emergente. 4 CASO CLÍNICOPaciente de sexo masculino, de 8 años de edad, que presenta un forúnculo nasal y celulitis en la cara posterior de muslo izquierdo de una semana de evolución. Consulta al departamento de urgencia y, con diagnóstico de celulitis, inicia tratamiento con trimetoprima-sulfametoxazol (TMP-SMX) a 10 mg/kg/día por vía oral de TMP.Evoluciona con dolor en la región anterior del muslo contralateral y refiere el antecedente de un traumatismo deportivo en dicha zona. Se realiza ecografía de partes blandas, que evidencia "imagen de contenido particulado tubular paralela a las fibras musculares en tercio medio del músculo crural"; se interpreta como hematoma intramuscular y se indica continuar con igual esquema terapéutico.Al quinto día de tratamiento, por presentar impotencia funcional del miembro inferior derecho, empeoramiento de la lesión facial y comenzar con registros febriles, se decide su internación. Al momento del ingreso, el paciente se encuentra en regular estado general, febril y presenta una lesión indurada, eritematosa, dolorosa en mejilla derecha extendida hacia el ala de la nariz, asociada a un edema en el labio superior con supuración en mucosa yugal.

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Background Enterococcus spp. (E) is an important cause of nosocomial bacteremia. The emergence of vancomycin-resistant E in the nosocomial setting conditions the empirical treatment and limits therapeutic options.MethodsA retrospective cohort study of children ≥1 month with E bacteremia in a reference pediatric hospital was performed. Study period January 1, 2016–December 31, 2018. Outcome: to describe clinical and epidemiological characteristics of children with bacteremia due to Enterococcus spp. resistant to vancomycin (VRE) vs. sensitive (VSE). Identify variables associated with VRE. STATA 13 was used.Results N = 82 patients. Median age was 37.6 months (IQR 2–48), 45 patients (54.9%) were male; 76 patients (92.7%) had underlying disease (intestinal failure (21.9%), heart disease (17.1%), preterm births (12.2%), hematological disease (10.9%), and liver failure (7.3%); 16 patients (19.5%) received immunosuppressive therapy. Sixty bacteremia (73.2%) were by E. faecalis and 22 (26, 8%) by E. faecium. Vancomycin resistance was documented in 13 patients (15.8%), all of which were E. faecium. In the bivariate analysis, patients with VRE bacteremia were significantly older in months than those with VSE bacteremia [75.4 (IQR 6–151) vs. 30.5 (IQR 2–33), P <0.02]; had more frequency of previous colonization with VRE [n: 8 (61.5%) vs. n: 4 (5.8%) P < 0.001], hematological disease [n: 5 (38.5%) vs. n: 5 (5.8%), P = 0.01], liver failure [n: 3 (23.1%) vs. n: 3 (4.4%), P = 0.02] and immunosuppressive therapy [n: 6 (46.2%) vs. n: 10 (14.5%) P = 0.008]. Patients with VRE bacteremia had a lower median white blood cell count [7040 (IQR 2150–10250) vs. 14474 (IQR 6160–17090), P <0.03]. Mortality in P with VRE was 15.4% (n: 2) and 4.3% in P with VSE (n: 3), P = 0.1. No statistically significant differences were found according to history of surgery, previous hospitalization, antibiotic therapy in the last 3 months or clinical presentation. In the multivariate model, predictors of VRE bacteremia adjusted for the rest of the significant variables were hematological disease OR 11.1 (95% CI 2.3–53.8) P = 0.003, and liver failure OR 7.7 (95% CI 1.2–50.4), P = 0.03.ConclusionIn this cohort of children with enterococcal bacteremia, hematological disease and liver failure were predictive variables of VRE bacteremia.Disclosures All authors: No reported disclosures.