Background: Ralstonia pickettii has gained relevance in pediatric healthcare due to its persistence in water systems, biofilm formation and contamination of medical solutions. This review summarizes current evidence on its epidemiology, environ-mental reservoirs, clinical features, diagnostic limitations and therapeutic considera-tions in children. Methods: A narrative search was conducted in PubMed, Scopus, Web of Science and Embase for studies published from January 1990 to 30 November 2025. Pediatric cases, outbreak reports, environmental studies with clinical relevance and microbiological reviews were included. Heterogeneity in design and reporting justified a narrative synthesis. Results: R. pickettii is the predominant Ralstonia species in pedi-atric infections and is closely linked to contaminated aqueous products and respiratory equipment. Neonates and immunocompromised children are most affected, with man-ifestations ranging from colonization to severe sepsis. Diagnostic systems frequently misidentify the organism, and molecular tools improve accuracy when combined with clinical assessment. Susceptibility patterns are variable and influenced by intrinsic re-sistance mechanisms and biofilm. Effective treatment often requires targeted therapy and device removal. Outbreak investigations consistently identify contaminated solu-tions and water systems as primary sources. Conclusions: R. pickettii is an emerging pathogen in pediatric care. Improving diagnostic accuracy, strengthening environ-mental control and ensuring safe handling of water-based solutions and medical devices are essential to reduce its clinical impact.

Dengue fever and hepatitis A are endemic infections caused by viruses that mostly affect developing countries (Volchkova et al., 2016). Co-infection is rare, and represents a diagnostic challenge due to their overlapping symptoms (Yakoob et al., 2009). The febrile syndrome accompanied by abdominal pain and vomiting are the common clinical manifestations of both pathologies. However, confirmation of diagnosis depends on laboratory tests ( Khetarpal and Khanna, 2016; Abutaleb and Kottilil, 2020). We report a case of a young female with dengue and hepatitis A co-infection.

We present the case of a woman with a history of autoimmune hemolytic anemia (AIHA), untreated for 1 year, who presented with fever, myalgia, arthralgia, anemia, and thrombocytopenia, along with a positive nonstructural protein antigen 1 (NS1Ag) test. During the course of dengue, the patient developed severe hemolytic anemia, posing a potentially life‐threatening scenario due to the rapid decline in hemoglobin levels and the risk of multiorgan failure. Treatment with methylprednisolone was initiated alongside supportive care for dengue, and balancing corticosteroid risks in a viral infection was crucial to stabilize the patient, ultimately leading to a favorable outcome. This case highlights the importance of prompt diagnosis and integrated management of autoimmune diseases and viral coinfections in dengue‐endemic areas.

Introduction: Dengue fever and hepatitis A are viral infections that are prevalent in developing countries. Coinfection with both viruses is a rare occurrence and presents a diagnostic challenge due to their overlapping symptoms. Laboratory tests are required to confirm the diagnosis of each infection. We present a case of a young female with dengue and hepatitis A coinfection. Case presentation: A 25-year-old female presented with abdominal pain, vomiting, and jaundice. Laboratory tests revealed leukopenia, elevated liver enzymes, and positive hepatitis A virus antibodies. During hospitalization, the patient was diagnosed with dengue fever through serological testing. Conclusions: Coinfection with dengue fever and hepatitis A is possible and may result in more severe symptoms and complications. Diagnosis requires laboratory testing, and treatment is primarily supportive care. Healthcare providers should consider testing for both viruses in patients with overlapping symptoms.

Paciente varón de 22 años que acude a emergencia de Hospital III-1 José Cayetano Heredia de Piura por presentar síntomas respiratorios agudos, se hospitaliza como Insuficiencia Respiratoria Aguda asociada a Crisis asmática moderada, Neumonía Adquirida en la Comunidad y Lupus Eritematoso Sistémico como antecedente. A lo largo de su curso hospitalario, se evidencia una interacción compleja entre el asma y las manifestaciones pulmonares del LES. Por tal motivo se planteó como diagnóstico Neumonitis lúpica, con buena respuesta a tratamiento antibiótico y pulsos de corticoides.

Background. Postoperative pulmonary complications (PPCs) are frequent and associated with increased morbidity and mortality. The ARISCAT index offers a preoperative stratification method to identify surgical patients at elevated respiratory risk. Methods. We conducted a prospective observational study in December 2024 at Hospital III-1 José Cayetano Heredia in northern Peru. Adult patients undergoing elective surgery were evaluated using the ARISCAT score and followed for 14 postoperative days. Data were collected through electronic medical records and analyzed with Stata 17. Categorical variables were summarized as frequencies, and continuous variables as medians. Binary logistic regression was used to assess the association between ARISCAT score and PPCs, adjusting for age, sex, comorbidities, surgical site, and ICU admission. The study was approved by the institutional ethics committee, and all patients provided written informed consent. Results. A total of 202 patients were included; 43% developed PPCs, mainly atelectasis and bronchospasm. The ARISCAT index showed a strong association with PPCs. Compared to the low-risk group, patients in the intermediate and high-risk categories had significantly increased odds of complications (aOR: 6.42 and 6.81, respectively; p < 0,001). Comorbidities such as diabetes, asthma, cancer, and COPD were also independently associated with PPCs, confirming the ARISCAT score’s predictive value in this population. Conclusion. The ARISCAT score is a valid tool for predicting postoperative pulmonary complications in elective surgery patients and should be integrated into preoperative assessments to improve perioperative risk stratification.