[Pulmonary actinomycosis caused by Actinomycesodontolyticus in a two-year-old child]. / Actinomycose pulmonaire à Actinomycesodontolyticus chez un enfant de 2 ans.

INTRODUCTION: Pulmonary actinomycosis due to Actinomyces Odontolyticus is a rare and seldom reported pathology in pediatrics. The unspecific radio-clinical symptomatology and the slow growth of the germ make the diagnosis difficult. CASE REPORT: A 2-year-old boy is admitted to the emergency room for acute respiratory distress in a context of febrile bronchitis that had been evolving for 10days. Quickly, the patient's state deteriorate, invasive ventilation was required. Bronchial fibroscopy was performed immediately and enabled extraction of large mucous filaments, leading to significant improvement. Mechanical ventilation was stopped after 72hours. Five days later, blood culture tested positive for Actinomyces Odontolyticus. In the absence of any other cause and given a compatible clinical picture, the child was treated with long-term antibiotherapy for a total duration of 6months, which was stopped following reassuringly normal endoscopic and radiological control. CONCLUSIONS: This is the second pediatric case of pulmonary actinomycosis due to A. Odontolyticus reported in the literature. The clinical symptoms and imaging are not specific. The presence of sulphide granules on pathological examination or in germ culture at a sterile site confirms the diagnosis. Prolonged antibiotic therapy is still recommended to avoid pulmonary sequels.

[Non-specific interstitial pneumonia : a rare clinical entity in adolescents]. / Pneumopathie interstitielle non spécifique : une entité rare chez l'adolescent.

Non-specific Interstitial Pneumonia (NSIP) is an anatomo-clinical entity within the group of Diffuse Infiltrative Pulmonary Diseases (DPID). It is very rarely found in pediatrics. Main symptoms are dry cough and dyspnea. Bronchoalveolar lavage and biology are non specific. The thoracic CT scan suspects the diagnosis, but histological examination of a lung biopsy remains the reference examination and makes the diagnosis highly probable according to the ATS / ERS criteria. An autoimmune assessment should be performed because NSIPs are often associated with connective tissue disease or may even be the first sign of connectivitive tissues diseases. The treatment of the acute phase is mainly based on the administration of corticosteroids and the prognosis is generally good. In this article, we describe the management of NSIP, based on a pediatric clinical case.

La Pneumopathie Interstitielle Non Spécifique (PINS) est une entité anatomo-clinique au sein du groupe des Pneumopathies Infiltrantes Diffuses (PID). Elle est très rarement retrouvée en pédiatrie. Elle se manifeste principalement par une toux sèche et une dyspnée. Le lavage broncho-alvéolaire et la biologie sont aspécifiques. Le scanner thoracique permet de suspecter le diagnostic, mais c'est l'examen histologique d'une biopsie pulmonaire qui reste l'examen de référence et qui permet, selon les critères de l'ATS/ERS, de poser un diagnostic avec grande probabilité. Un bilan auto-immun doit être réalisé car la PINS est très souvent associée à des connectivites ou peut même en être le premier signe. Le traitement de la phase aiguë repose, essentiellement, sur l'administration de corticoïdes, et le pronostic est, en général, bon. Dans cet article, nous décrivons la prise en charge d'une PINS, à partir d'un cas clinique rencontré en pédiatrie.

[TOBI Podhaler for treating chronic Pseudomonas aeruginosa infection in cystic fibrosis patients]. / TOBI Podhaler dans le traitement de l'infection chronique à Pseudomonas aeruginosa chez le patient mucoviscidosique.

TOBI Podhaler is the first dry powder formulation of tobramycin for inhaled therapy of chronic Pseudomonas aeruginosa infection in cystic fibrosis patients from the age of 6 years. Clinical studies show a safety and efficacy profile comparable to tobramycin inhaled solution (TOBI). The short administration time and the convenient use of the system may significantly decrease the treatment burden. This paper gives a short review of the clinical studies and some practical information.

High-percentage lung delivery in children from detergent-treated spacers.

Pressurized metered-dose inhalers attached to spacers are now the most common form of delivery of anti-asthma medication in children. However, no reliable data are available of how much drug reaches the lungs in children of different ages. This information is crucial, as it determines the efficacy of therapy. In this study, we present information on the amount of drug reaching the lungs in children from a pressurized metered-dose inhaler attached to a detergent-coated spacer. We studied 18 asthmatic children inhaling radiolabeled salbutamol through detergent treated spacers to minimize electrostatic charge on the spacer wall. Lung deposition was much higher than expected when using detergent-coated spacers. Mean (SD) lung deposition, expressed as a percentage of the total actuated dose (five actuations), was 16.4% (5.5) in younger children inhaling through a small volume spacer, and 28.2% (6.7) and 41.8% (3. 8) in older children inhaling with different breathing patterns through a large volume spacer. These findings have major implications for dosage regimens for inhaled anti-asthma medication in children. Lower doses may be sufficient for adequate drugs delivered through spacers treated for static to achieve a desired clinical response.

Washing plastic spacers in household detergent reduces electrostatic charge and greatly improves delivery.

Ionic detergents reduce electrostatic charge on plastic spacers, thereby improving in vitro drug delivery. The aim of this study was to gain practical information on the use of detergents and to evaluate the relevance of this information on in vivo drug deposition. Measurement of electrostatic charge and salbutamol particle size distribution was carried out on detergent-coated and noncoated plastic spacers. The efficiency of four household detergents was compared, and the influence of dilution and the duration of the antistatic effect were studied. In addition, the level of radiolabelled salbutamol deposition in the lungs of eight healthy adults was compared after inhalation through a new versus a detergent-coated spacer. In vitro, all tested detergents reduced the electrostatic charge on the spacer surface. This resulted in a mean increase of 37.4% (range 33.5-41.2) in small particle (<6.8 microm) salbutamol output compared with water-rinsed/drip-dried spacers. Dilution had no influence on the results and the effect lasted for at least four weeks. In vivo, the mean lung deposition of radiolabelled salbutamol in healthy subjects was 45.6% (range 43.4-49.5) through a detergent-coated spacer compared to 11.5% (range 7.6-17.9) through a static spacer (p<0.001). In conclusion, household detergents offer a simple and practical solution to the problem of static on plastic spacers and significantly improve both in vitro and in vivo delivery of salbutamol.

[Eruptive fever of rare cause: familial hemophagocytic lymphohistiocytosis]. / Une fièvre éruptive de cause rare: la lymphohistiocytose hémophagocytaire familiale.

BACKGROUND: Clinical onset of familial lymphohistiocytosis is non-specific so that the diagnosis of this rare and severe disease is difficult. CASE REPORT: An 8 week-old girl was admitted suffering from fever and rash. She had hepatosplenomegaly. She developed pancytopenia (Hb: 6.6 g/100 ml; WBC: 4500/mm3; platelets: 25,000/mm3) impaired liver function tests (prothrombin: 15%, blood bilirubin: 40 mg/l; SGOT: 160 mU/ml) and hypofibrinogenemia (0.3 g/l) within a few days. Bone marrow examination showed diffuse histiocytic infiltration and erythrophagocytosis, suggesting a syndrome of inappropriate macrophage activation. The age of the patient, parental consanguinity and absence of specific infection led to diagnosis of familial erythrophagocytic lymphohistiocytosis. The patient died 18 days after clinical onset. CONCLUSION: The diagnosis of this unusual syndrome in infants is strongly supported by parental consanguinity as seen in our case or a positive family history. In this condition, erythrophagocytosis is often a marked feature.