[Infectious disease epidemics in pediatrics]. / Les maladies infectieuses épidémiques en pédiatrie.

In winter, the main infectious diseases causing epidemics in young children are bronchiolitis, influenza and gastroenteritis. Knowledge of the symptomatology and the ways in which these diseases are spread is essential for the effective care of the child and their family. The implementation of hygiene rules helps to limit the spread.

Factors influencing neurological outcome of children with bacterial meningitis at the emergency department.

We performed a cohort study of children who survived bacterial meningitis after the neonatal period at a single pediatric center in France over a 10-year period (1995-2004) to identify predictors of death and long-term neurological deficits in children with bacterial meningitis. We performed multivariate regression to determine independent predictors of death and neurologic deficits. We identified 101 children with bacterial meningitis of which 19 died during initial hospitalization. Need for mechanical ventilation [hazard ratio (HR) 11.5, 95 % confidence interval (CI) 2.4-55.5)] and thrombocytopenia defined as a platelet count <150 × 10(9) per liter (HR 0.6, 95 % CI 0.4-0.9) at presentation were associated with death during initial hospitalization. At final assessment, 42 of the 70 survivors had no neurologic deficits identified; 20 had a single deficit, and eight had multiple deficits. A delay in initiation of antibiotics (HR 1.3, 95 % CI 1.1-1.7) and hydrocephalus on computed tomographic scan (HR 2.6, 95 % CI 1.1-6.0) were associated with having one or more long-term neurologic deficits. Identification of children at risk of death or long-term neurologic sequelae may allow therapeutic interventions to be directed to children at the highest risk.

[Clinical exam of children from 3 to 12 years]. / Examen de l'enfant âgé de 3 à 12 ans.

The specific aims of clinical exams of children from 3 to 12 years of age are to assess: growth including weight and height, and body mass index (BMI) to prevent obesity, neurodevelopment both motor and intellectual including sensorial impairment to detect early learning disabilities, immunization adequacy by assessing routine schedule of vaccination and booster. The GP or paediatrician should cooperate with specialised services and nursery or primary schools to match the system of education to the needs of a given child, particularly in case of learning disabilities (normally, entry into kindergarden at 6 years of age).

Molecular diagnosis of Saksenaea vasiformis cutaneous infection after scorpion sting in an immunocompetent adolescent.

We report the first case of cutaneous mucormycosis after a scorpion sting in Tunisia. Histopathology showed broad aseptate hyphae suggestive of a Zygomycete. Saksenaea vasiformis was identified by PCR amplification and sequencing of the fungal DNA on a cutaneous biopsy. Successful treatment was obtained by surgery and liposomal amphotericin B.

[Tired children and school]. / L'enfant fatigué et l'école.

Fatigue is a commonly observed symptom in school environments. Its clinical diagnosis is established based on symptomatology, which varies depending on the age. At school, daily rhythm disorders followed by breakdowns are common causes of school fatigue, requiring adequate corrective measures. Organic causes of school fatigue are uncommon in school environments. They are mostly infectious and suggest in rare occasions a severe condition. Detecting fatigue requires a thorough anamnestic investigation, which most of the time enables to identify the factors responsible for asthenia and suggest correctives measures. Chronic fatigue syndrome affects first and foremost teenagers and its pathophysiological assessment can lead to a better understanding of lasting fatigue in children.

[Acute bronchiolitis in infants]. / Bronchiolites aiguës du nourrisson.

Clinical criteria used to define acute broncholitis in infants are not worldwide consensual diagnostic criteria. Respiratory failures as well as young age account for the severity of the disease. Laboratory analyses are useless in community medical practice. Infectious complications are due to secondary infection with usual respiratory pathogenic bacteria. In France the treatment mainly consists in physical therapy whose efficiency is currently being evaluated by randomized studies. Prevention of the disease relies on hygiene measures and in an integrated physician-physiotherapist collaboration.

Report of two cases of aseptic meningitis with persistence of pneumococcal cell wall components in cerebrospinal fluid after Pneumococcal meningitis.

We describe two cases of aseptic meningitis occurring some time after pneumococcal meningitis. Both cases may have resulted from an inflammatory response to persistent pneumococcal cell membrane components, as the cerebrospinal fluid samples were positive by the Binax NOW Streptococcus pneumoniae antigen test. Potential mechanisms and diagnostic impact are discussed.

Escherichia coli strains causing urinary tract infection in uncircumcised infants resemble urosepsis-like adult strains.

PURPOSE: Urinary tract infection (UTI) is the most frequent bacterial infection in infants younger than 90 days, and mainly affects uncircumcised males. In an attempt to unravel further the pathophysiology of UTI in this age group we used molecular methods to characterize Escherichia coli strains responsible for community acquired UTI in male and female infants and in adults. MATERIALS AND METHODS: A total of 79 E. coli isolates from uncircumcised male and female infants with UTI and no urinary tract abnormalities and 41 E. coli pyelonephritis isolates from nonhost compromised adults with bacteremia were characterized in terms of phylogenic relatedness and virulence factors. RESULTS: Males were infected by strains with a genetic background and virulence factors different from those affecting females but similar to those of adult pyelonephritis strains. CONCLUSIONS: Our molecular approach indicates that uncircumcised male infants are at higher risk for infection with highly virulent uropathogenic E. coli strains than are females. Preputial colonization may have a key role in the selection of such strains.

[Chemoprophylaxis and vaccine for prevention of bacterial meningitis in children]. / Antibioprophylaxie et vaccins des méningites bactériennes communautaires.

Given the devastating nature of Neisseria meningitidis disease and emergence of resistant strains prevention through chemoprophylaxis and meningococcal vaccine remains the best approach to control this serious infection. Chemoprophylaxis may limited strictly to the contact subjects. Polysaccharide meningococcal serogroups A, C, Y and W135 should be given less than 10 days to patients with prolonged contact with the index case. Meningococcal C conjugate vaccine constitutes an additional advantage in the prevention of meningococcal meningitis in children < 2 years. High Haemophilus serotype B coverage level led to near-disappearance of H. influenzae serotype b meningitis but chemoprophylaxis remains indicated.

[Meningococcal disease due to Neisseria meningitidis serogroup W135 in children. Clinical aspects and outcome]. / Infections à méningocoque W135 chez l'enfant. Particularités cliniques et évolutives.

OBJECTIVE: Meningococcal disease due to Neisseria meningitidis of serogroup W135 (N. meningitidis W135) is increasing in France. Clinical and outcome data concerning these infections in children are scarce. PATIENTS: We report 5 cases of children hospitalised in our unit between June 2000 and December 2002 for N. meningitidis W135 infection. CASE REPORTS: Among these 5 children aged 19 months to 11 years, 3 presented with a primary meningitis and 4 with primary or secondary extra-meningeal involvement, articular in 3 cases, pericardial in 2 cases and ocular in one case. The outcome was favourable without after effects in 4 cases, marked by a resistant prolonged post-meningococcal inflammatory syndrome. COMMENTS: Extra-meningeal septic and/or non septic complications are frequent and a prolonged post meningococcal inflammatory syndrome is reported. In N. meningitidis W135 infections a careful clinical evaluation of potential extra-meningeal complications and a long term follow up of children are needed.

A pediatric cluster of Shigella dysenteriae serotype 1 diarrhea with hemolytic uremic syndrome in 2 families from France.

We report a cluster of pediatric diarrhea due to Shigella dysenteriae serotype 1 involving 11 children in France, including the index case, who had returned from Senegal. Child-to-child transmission was documented by ribotyping. Five children developed hemolytic uremic syndrome (HUS). On the basis of our findings, the choice of antimicrobial treatment for infections with S. dysenteriae serotype 1 should take into account widespread drug resistance and the risk of HUS.

Clinical features and outcome of pediatric Neisseria meningitidis serogroup W135 infection: a report of 5 cases.

We describe 5 pediatric cases of Neisseria meningitidis serogroup W135 infection. Infectious and/or reactive extrameningeal involvement was frequent. One patient had a persistent postmeningococcal inflammatory syndrome. Four of 5 isolates belonged to the clonal complex 37. The important risk of extrameningeal complications must be borne in mind when treating children with N. meningitidis W135 infection.