The present score accurately discriminated the probability of death in children hospitalized with CAP, and it could be a useful tool to select candidates for admission to intensive care unit and for adjunctive therapy in clinical trials.

This study validated most of the clinical variables present in the current WHO guidelines as markers of severe disease and add additional variables that can help to predict the risk of progression to shock.

During the 2011 dengue outbreak, 123 children were admitted with a mean age of 11 ± 3 years. By the 2009 classification system, 119 cases (97%) were classified as dengue requiring intervention [89 patients (75%) with warning signs and 30 patients (25%) with severe signs], whereas by the old system 67 patients (54%) were classified as dengue requiring intervention (P < 0.001). Further, by the 1997 classification, only 13 patients (10%) were classified as dengue hemorrhagic fever III/IV (severe cases), whereas with the 2009 classification 30 patients (24%) were considered as having severe dengue infection (P < 0.05) CONCLUSIONS:: This study confirms that the 2009 WHO dengue classification provides better detection of severe cases of dengue than the earlier 1997 WHO dengue system.

Summarybackground Over the last decade Streptococcus pneumoniae has emerged as the most common bacterial pathogen for meningitis in all age groups, beyond the neonatal period.objective To determine the epidemiological and clinical characteristics; and risk factors for mortality of pneumoccocal meningitis in children in a developing transitional country.materials and methods A retrospective study that included patients <15 years of age admitted at the Instituto de Medicina Tropical of Paraguay, from January 1990 until December 2003 with the diagnosis of bacterial meningitis caused by S. pneumoniae. Clinical and laboratory data were collected and analysed in order to identify risk factors associated with morbidity and mortality outcomes of this infection.results Seventy-two patients (between the ages of 35 days and 14 years) were identified. Forty-two per cent of patients had seizures prior to or at the time of admission, 36% were admitted in a comatose state, and 19% with shock. Mortality was 33% (24/72), and 18% of the survivors (11/60) developed severe sequelae. Upon admission, the following variables were strongly correlated with mortality: age <12 months (P ¼ 0.007), the presence of seizures (P ¼ 0.0001) or development of seizures 48 h after admission (P ¼ 0.01), a cerebrospinal fluid (CSF) glucose level of <10 mg/dl (P ¼ 0.01), CSF albumin >200 mg/dl (P ¼ 0.0003), an absolute blood neutrophil count <2000/mm 3 (P ¼ 0.006) and a haemoglobin value of <9 g/dl (P ¼ 0.0001).conclusions This study confirms the high morbidity and mortality associated with S. pneumoniae meningitis in Paraguay. Certain clinical parameters and laboratory findings in blood and CSF at the time of admission could be used as predictors for mortality or severe sequelae among survivors.

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Introduction: Dengue virus (DENV) infection is currently a major cause of morbidity in the world, and its incidence has mainly increased during the last years in Latin America, including Paraguay. The objective of this study was to compare the clinical and laboratory findings of dengue and assess whether the serotype is a risk factor for severity. Methodology: We included patients ≤ 15 years old hospitalized with dengue at the Institute of Tropical Medicine, from Paraguay, from 2007 to 2018. Patients were classified according to the 2009 WHO dengue classification guidelines and were stratified by serotype into three groups according to the hospitalization period: the 2007 epidemic (DENV-3), the 2012-2013 epidemic (DENV-2) and the 2016-2018 epidemic (DENV-1). Results: Of 784 children hospitalized for dengue, 50 cases (6.3%) were caused by DENV-3, 471 (60%) by DENV-2, and 263 (33.5%) by DENV-1. Myalgias and headache were associated with DENV-3 cases and abdominal pain was associated with DENV-2 cases. Bleeding was observed mainly in DENV-1 and 2 cases. Patients with DENV-2 infections experienced more severe disease, required fluid expansion more frequently, and exhibited more often shock and admission in the ICU. Secondary cases of dengue were more severe that primary cases. Patients with infection by DENV-2 had longer hospital stays (5.1 ± 2.8 days) when compared to DENV-3 o DENV-1 infection cases (2.9 ± 1.6 days and 4.36 ± 2.7 days, respectively) (p < 0.05). Conclusions: The DENV serotype has a profound impact on the clinical manifestations and severity of dengue. DENV-2 infections were associated more frequently to requirement of fluid expansion, shock, and longer hospital stay.

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