Papers by rolando gutierrez
Paediatrics & Child Health, 2003
Human metapneumovirus (hMPV) was recently identified as a cause of acute upper and lower respirat... more Human metapneumovirus (hMPV) was recently identified as a cause of acute upper and lower respiratory tract infection in children and adults. The epidemiology is similar to that exhibited by respiratory syncytial virus, with most episodes occurring during the winter months. The virus likely has a worldwide distribution. Almost all children have been infected by five years of age. The suspicion of hMPV infection should be higher in infants or children presenting with symptoms compatible with a viral etiology and in whom screening tests for other common viral pathogens have been negative. Clinical manifestations may be subtle or severe, including life-threatening bronchiolitis or pneumonia. Fever, rhinorrhea, cough, retractions, tachypnea and wheezing are common findings. Bronchiolitis is perhaps the most common manifestation among hospitalized children. Currently, there is no antiviral treatment or vaccine available and management is simply supportive.
Pediatric Infectious Disease Journal, 2015
Pertussis has reemerged as a problem across the world. To better understand the nature of the res... more Pertussis has reemerged as a problem across the world. To better understand the nature of the resurgence, we reviewed recent epidemiologic data and we report disease trends from across the world. Published epidemiologic data from January 2000 to July 2013 were obtained via PubMed searches and open-access websites. Data on vaccine coverage and reported pertussis cases from 2000 through 2012 from the 6 World Health Organization regions were also reviewed. Findings are confounded not only by the lack of systematic and comparable observations in many areas of the world but also by the cyclic nature of pertussis with peaks occurring every 3-5 years. It appears that pertussis incidence has increased in school-age children in North America and western Europe, where acellular pertussis vaccines are used, but an increase has also occurred in some countries that use whole-cell vaccines. Worldwide, pertussis remains a serious health concern, especially for infants, who bear the greatest disease burden. Factors that may contribute to the resurgence include lack of booster immunizations, low vaccine coverage, improved diagnostic methods, and genetic changes in the organism. To better understand the epidemiology of pertussis and optimize disease control, it is important to improve surveillance worldwide, irrespective of pertussis vaccine types and schedules used in each country.
Medicina, 2007
We conducted this open study to evaluate the immunogenicity and safety of the inactivated influen... more We conducted this open study to evaluate the immunogenicity and safety of the inactivated influenza vaccine, Imovax Gripe in 154 children between 6 and 36 months of age at high risk of influenza-related complications, and in a reference group of 64 healthy children. The study was conducted over two flu seasons, in which the vaccine contained the same A strains but different B strains. The results for the A/H3N2 and A/H1N1 strains from the two flu seasons were pooled, but those for the B strains were not. Anti-hemagglutinin (HA) antibody titers were determined before, and one month after each vaccination, and safety was evaluated based on diary card reporting any adverse event observed, either included or not in the list of "solicited events". Within each group of vaccines, the seroconversion rates, seroprotection rates, and ratio of post- to prevaccination geometric mean titers (GMTR) for the A/H3N2 and the A/H1N1 strains fulfilled all requirements of the criteria of the E...
Pediatrics, 2005
Group A beta-hemolytic streptococcus and Staphylococcus aureus are the 2 most common pathogens im... more Group A beta-hemolytic streptococcus and Staphylococcus aureus are the 2 most common pathogens implicated in secondary invasive bacterial disease after varicella. We describe a 3-month-old male infant from British Columbia, Canada, who presented on day 5 of varicella skin rash with fever, seizures, lethargy, and evidence of intracranial hypertension. A prominent subdural empyema was documented, and Streptococcus pyogenes was recovered from the subdural fluid. Central nervous system bacterial complications should be part of the differential diagnosis for infants and children with chickenpox who present with fever, lethargy, focal seizures, or similar neurologic findings. This case illustrates the importance of universal varicella vaccination to prevent associated bacterial complications of chickenpox.
Anales de Pediatría, 2015
Revista chilena de infectología, 2014
Kawasaki disease is the leading cause of acquired cardiac disease in children. Although the epide... more Kawasaki disease is the leading cause of acquired cardiac disease in children. Although the epidemiology of the disease has been well described in Japan, other Asian countries, Europe, Australia and North America, the epidemiology and disease burden in Latin American children is unknown. For this reason, the idea of establishing a research network on Kawasaki disease in children from Latin America was born, becoming this the largest Kawasaki disease international multinational research network and in which 20 countries of the region will be integrated.
Psychiatry Research, 2003
The generalizability of research data depends on the degree to which the studied sample represent... more The generalizability of research data depends on the degree to which the studied sample represents the larger population of interest. By influencing the likelihood of research participation, socio-demographic and clinical factors could bias a sample. To evaluate this, we retrospectively identified 155 consecutive admissions over an 18-month period to a general acute male psychiatry inpatient unit in a Veterans Affairs Hospital on which all competent patients were offered the opportunity to participate in low-risk clinical research. Male inpatients who did (N=70) and did not consent (N=85) were compared on 17 variables. Patients who consented to research were somewhat younger (M(difference)=4.6 year) and were significantly more likely to carry a diagnosis of schizophrenia. The groups did not differ in financial resources, living situation or alcohol/drug abuse. We conclude that at least in this setting, general socio-demographic and clinical variables were not major influences on sample selection.
The Pediatric Infectious Disease Journal, 2014
Few reports of infective endocarditis in Latin American children have been published. We describe... more Few reports of infective endocarditis in Latin American children have been published. We describe the epidemiology of infective endocarditis at the only pediatric tertiary hospital in Costa Rica. Methicillin-resistant Staphylococcus aureus rate was isolated in 44% of cases. The case fatality rate was 23%.
Rheumatology International, 2012
We read with great interest the two recent papers on Kawasaki disease (KD) without fever publishe... more We read with great interest the two recent papers on Kawasaki disease (KD) without fever published recently by Kato et al. [1] and Rodriguez-Lozano et al. [2]. We describe a girl with all classic KD symptoms except for fever, seen at the only pediatric tertiary referral and teaching hospital of Costa Rica. A 5-year-old girl was seen four times during a two-week period at the emergency outpatient clinic of our hospital, initially for a cervical lymphadenopathy for which oral amoxicillin was prescribed. She had no clinical improvement, and therefore, one dose of intramuscular benzathine penicillin was added 48 h after. She developed an erythematous skin rash, predominantly in the chest, trunk, neck, extremities, and genital area, and she was switched to oral cephalexin. However, a non-suppurative significant conjunctival injection, oral mucositis, evident strawberry
Pediatrics, 2004
We present the first report in the literature of a child with human metapneumovirus pneumonia who... more We present the first report in the literature of a child with human metapneumovirus pneumonia who required extracorporeal membrane oxygenation for survival. This was a 3-month-old premature boy from British Columbia, Canada, who developed severe respiratory failure, experienced failure of high-frequency oscillatory mechanical ventilation, and required extracorporeal membrane oxygenation support for 10 days. This case illustrates the importance of including this newly discovered pathogen among the causes of childhood pneumonia.
The Pediatric Infectious Disease Journal, 2003
Background. Streptococcus pneumoniae is a leading cause of invasive bacterial disease in children... more Background. Streptococcus pneumoniae is a leading cause of invasive bacterial disease in children worldwide. Although morbidity and mortality associated with invasive pneumococcal disease (IPD) are known to be high in Latin American infants, the current situation for Central American children is unclear. Methods. A 7-year retrospective review of IPD cases (January 1995 to December 2001) treated at the National Children's Hospital in San José , Costa Rica. Results. We analyzed 135 episodes that occurred in 132 patients. The mean age of presentation was 35.7 months (range, 0 to 11.4 ys), with 73.3% of all episodes occurring in patients <5 years of age and 56% occurring in patients <24 months of age. Underlying medical conditions were present in 47% of children. The most common clinical presentations were meningitis in 56 (41.5%) patients, pneumonia in 36 (26.7%), bacteremia alone in 30 (22.2%), peritonitis in 10 (7.4%), septic arthritis in 2 (1.5%) and osteomyelitis in 1 (0.7%). The case fatality rate was 14.4%, and children <2 years of age had the highest rates of complications, sequelae and death. Penicillin or cefotaxime nonsusceptibility was observed in 14.3% (10.7% intermediate, 3.6% resistant) and 4.5% (1.5% intermediate, 3% resistant) of tested isolates, respectively. Conclusions. IPD in Costa Rica is associated with high morbidity and mortality, particularly among young infants. Most prevalent IPD are the ones observed in developed countries before the introduction of current conjugated vaccine. Penicillin and third generation cephalosporin resistance in invasive cases is present at low rates.
Pediatric Infectious Disease Journal, 2009
Pediatric Emergency Care, 2004
We describe 3 previously healthy Costa Rican children who had Listeria monocytogenes meningitis, ... more We describe 3 previously healthy Costa Rican children who had Listeria monocytogenes meningitis, an uncommon cause of bacterial meningitis beyond the newborn period in normal subjects. Two of them had initial normal brain computed tomography, but all 3 developed acute hydrocephalus at days 7, 3, and 5, respectively. All required immediate ventriculostomy placement and only 1 of 3 survived. L. monocytogenes should be considered among the etiologies of bacterial meningitis in children who do not respond initially to conventional antimicrobial treatment or who deteriorate rapidly.
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Papers by rolando gutierrez