[Acute idiopathic eosinophilic pneumonia in a teenager]. / Le cas clinique du mois. Pneumonie éosinophilique idiopathique aiguë chez une adolescente.

Acute idiopathic eosinophilic pneumonia is a very rare cause of interstitial lung disease in children. Pathophysiological mechanisms and etiology remain poorly understood. It manifests as a febrile dyspnea, progressively worsening. Chest X-ray, performed as first-line, shows bilateral infiltrates. The chest CT confirms a diffuse infiltrative pneumopathy and the bronchoalveolar lavage demonstrates the presence of alveolar hypereosinophilia. The exclusion of other causes of alveolar eosinophilia confirms the diagnosis. A ventilatory support is very often necessary. Systemic corticosteroids provides a spectacular clinical improvement, without recurrence.

La pneumonie éosinophilique idiopathique aiguë est une cause très rare de pneumopathie infiltrante diffuse de l'enfant. Le mécanisme physiopathologique et l'étiologie sont mal connus. Elle se manifeste par une dyspnée fébrile, s'aggravant progressivement. La radiographie thoracique, réalisée en première intention, montre des infiltrats bilatéraux. Le scanner thoracique confirme la pneumopathie infiltrante diffuse et le lavage broncho-alvéolaire démontre la présence d'une hyperéosinophilie alvéolaire. L'exclusion d'autres causes d'éosinophilie alvéolaire permet de confirmer le diagnostic. Un support ventilatoire est très souvent nécessaire. Une corticothérapie systémique permet une amélioration clinique spectaculaire, sans récidive.

[Infant respiratory distress revealing Jeune syndrome]. / Détresse respiratoire du nourrisson révélant un syndrome de Jeune.

Jeune syndrome (asphyxiating thoracic dystrophy) is a rare autosomal recessive osteochondrodysplasia with a variable degree of severity, clinically characterized by respiratory distress with a narrow chest and limb shortness. The reported incidence is one to five in 500,000 live births. Most patients develop severe respiratory failure during the first 2 years of life, leading to death in 60-80 % of cases. Survivors may suffer from renal, hepatic, or pancreatic complications. Expanding thoracic surgery can be used for severe cases. We describe the case of an 18-month-old boy who developed mild respiratory distress. The patient showed typical radiological features of Jeune syndrome: narrow thorax with short ribs and trident appearance of the pelvis. This case underscores the value of the right interpretation of the chest radiograph of the infant with a respiratory distress syndrome.

[Two case reports of meningococcemia. Review of the literature on chronic meningococcemia]. / À propos de deux cas de méningococcémie. Revue de la littérature sur la méningococcémie chronique.

INTRODUCTION: Neisseria meningitidis is a Gram-negative bacteria that can be highly pathogenic in humans and responsible for life-threatening and acute diseases. In a few cases, it can lead to an atypical form of sepsis-acute, subacute, or chronic-which, even if progression is slower, may carry the same risks for patients as conventional acute forms. CASES: Case 1 presented with recurrent fever, polyarthralgia, and generalized macular rash. Case 2 had fever for the previous 10days with neck pain and macular rash. Blood cultures were positive for group B meningococcus in both cases. Polymerase chain reaction (PCR) analysis for the same pathogen was also positive in the cerebrospinal fluid (CSF) of Case 2. Following intravenous antibiotic treatment, the progression was favorable in both cases. DISCUSSION: Chronic meningococcemia is characterized by a triad of clinical features, including a fever lasting for at least 1week, arthralgia, and a cutaneous rash. This condition evolves positively without any sequelae if treated properly. PCR and blood culture are two complimentary tools that support the diagnosis. CONCLUSION: Meningococcal infection can manifest in a variety of ways. Chronic meningococcemia diagnosis should be considered in a triad of prolonged fever, rash, and arthralgia. Better access to state-of-the-art techniques such as PCR is recommended in the future so as to provide optimal care of patients suffering from this condition.

[Spondylodiscitis in children: a review. A propos of two cases]. / La spondylodiscite chez l'enfant: a propos de deux observations.

Spondylodiscitis is defined as an infection of the intervertebral disc and the adjacent vertebral bodies. It represents, at the most, 2-4% of osteoarticular infections in children and its clinical presentation is often insidious. The specific condition of the young child (isolated discitis) is explained by some anatomical peculiarities. We report two cases of spondylodiscitis in children of different ages and review the pediatric characteristics, the role of imaging, the bacteriological diagnosis and the management of this disease.

Chronic respiratory failure due to toxic epidermal necrosis in a 10 year old girl.

Toxic epidermal necrosis is a severe mucocutaneous disease with a high mortality rate. A third of the patients surviving the acute phase will develop pulmonary complications. The most frequent complication is bronchiolitis obliterans. Despite well-conducted treatment, in most cases, lung injury often leads to chronic respiratory failure. We describe here the case of a young patient that presented a toxic epidermal necrosis at the age of 3 years. Poor therapeutic compliance result in chronic respiratory failure and after 7 years of follow-up, pulmonary transplant remains the only long-term alternative. Close monitoring of respiratory symptoms in the course of toxic epidermal necrosis, intense treatment as soon as they appear and a long-term follow-up are essential to postpone chronic respiratory failure.

Removal of an unusual bronchial foreign body: rigid or flexible bronchoscopy?

Foreign body inhalation is an emergency in pediatric medicine, particularly in children before the age of 3 years. Whereas clinical assessment and chest X-ray usually guide the diagnosis, rigid bronchoscopy still remains the gold standard in terms of management of foreign body inhalation. However, flexible fibroscopy can also be quite useful in certain situations. This is illustrated by the following case of a young girl with foreign body inhalation in which flexible fibroscopy was the only way of removing the foreign object.

[Clinical case of the month. Left recurrent neck abscess revealing a fourth branchial cleft fistula]. / Le cas clinique du mois. Abcès cervical gauche récidivant révélateur d'une fistule de la quatrième fente branchiale.

The fourth branchial cleft fistula, which can be the origin of a recurrent left neck abscess, is a rare congenital malformation. Its diagnosis can be difficult. A ten-year-old girl presented with a left painful swelling of the neck. At ultrasonography and tomodensitometry, the diagnosis of thyroglossal cyst was suspected. Antibiotics were prescribed before surgical resection. The intervention was successful and the peroperative macroscopic aspect of the lesion suggested a dermoid cyst. Four months later, the same symptoms reappeared with fever. An intravenous antibiotic therapy was started while a magnetic resonance imaging demonstrated a possible aero-digestive tract fistula. Two days later, the patient developed an aero-cutaneous fistula. Oral antibiotics were started. Five months later, the girl came back for a second recurrence. A few days after her admission, she developed again an aero-cutaneous fistula. The diagnosis of surinfected fourth cleft fistula was made. An antibiotic therapy was started until the second intervention. After discussion about embryology, we describe the physiopathology, the differential diagnosis and the management of a fourth branchial cleft fistula causing recurrent left neck abscess.

[Osteoid osteoma in children: 5 cases treated with electrocoagulation]. / L'ostéome ostéoïde de l'enfant : à propos de 5 cas traités par électrocoagulation.

Osteoid osteoma is a benign bone tumor. Its diagnosis is often delayed despite typical symptoms: severe pain mainly situated on the lower limbs and characteristically worse at night. Once diagnosed, an antalgic treatment by aspirin is well known to be very effective in relieving pain. Osteoid osteoma will resolve spontaneously. If symptoms persist despite the use of aspirin, surgery can be performed to remove the tumor. Percutaneous electrocoagulation can be performed instead of surgical resection as a less invasive procedure. The success rate of surgery and percutaneous electrocoagulation is comparable. We reviewed the cases of 5 patients who were hospitalized in our institution for percutaneous electrocoagulation of an osteoid osteoma. We compared them to the literature.

External validation of the bacterial meningitis score in children hospitalized with meningitis.

UNLABELLED: The Bacterial Meningitis Score (BMS) is considered as the rule with the highest sensitivity to safely distinguish between aseptic and bacterial meningitis (BM). OBJECTIVE: The objective of our study was to evaluate the performance of the score and its usefulness for the clinician. METHOD: Retrospective analysis of two Belgian academic hospitals-based cohort studies. All consecutive children aged 29 days to 18 years admitted for acute meningitis between January 1996 and December 2008 was eligible. The BMS (risk of bacterial meningitis if seizure, positive cerebrospinal fluid (CSF) Gram staining, CSF protein level (3) 80 mg/dl, CSF neutrophil count 1,000/ mm3 or blood neutrophil count > or = 10,000/mm3) was applied to all patients with meningitis defined by CSF pleocytosis > 8 WBC/mm3. RESULTS: 174 patients were included in the final analysis of whom 26 (15%) had BM. Of the 93 patients categorized as having with no risk for BM (BMS score = 0), 2 patients had BM, one of which had petechial rash (negative predictive value 97.8%). BMS had a sensitivity of 92.3%. Risk of BM was significantly related to the BMS score: 6/147 (4%) patients with BMS < or = 1 had BM compared to 20/27 (74%) patients with BMS > 1. CONCLUSIONS: Our study reports a lower sensitivity of the BMS than observed in previous validation studies. We suggest to include the BMS in a decision tree aiming to optimize the ordering of laboratory investigations including viral and bacterial PCR testing in any child with CSF pleocytosis.

[Nontuberculous mycobacterial epitrochlear adenitis]. / Adénite épitrochléenne à mycobactérie non tuberculeuse.

We report the case of a 2-year-old girl referred for unilateral epitrochlear lymphadenitis caused by Mycobacterium avium. Adenitis is the most frequent presentation of non tuberculous mycobacteria in children. Typical locations are the cervical, submandibular, axillar, inguinal, mediastinal, and parotid regions. To our knowledge, this is the first observation of an epitrochlear location. The diagnosis was made by evidencing the causal bacterium but also by the exclusion of other causes such as Bartonella henselae and Mycobacterium tuberculosis infections. Treatment is based on surgical excision, which provides a cure rate of 90%. Macrolides are reserved for extended lesions and/or relapsing lesions despite surgical management.

Psychological, social and school implications of asthma: a comparison of Belgian French-speaking children having asthma with healthy children.

The present study aimed to explore the psychosocial implications of asthma among Belgian French-speaking children. Ninety-nine parents of children having asthma (Mage=11.40, SD=2.35) and 102 parents of children without asthma (Mage=11.25, SD=.81) participated in the study. Parents filled in the Child Behaviour Checklist and a demographic questionnaire. Results showed that children having asthma were assessed by their parents as having more internalizing, social and attention problems and as having less competence in doing activities (e.g., sports, hobbies, jobs) than their healthy peers. Significant differences also appeared between genders for attention problems, anxiety/depression, activities, social and school competences, indicating that boys were more vulnerable to psychological and social difficulties than girls but they had better school competences than girls. Finally, results showed no difference for psychological, social, and school adjustment between children who controlled and partly controlled their asthma. These findings emphasize the importance of screening children who would be at risk for having psychosocial problems and developing multidisciplinary interventions for children with asthma and for their families.

[A clinical case of spontaneous involution of systemic cat scratch disease]. / Involution spontanée d'une forme systémique de maladie par griffade de chat: à propos d'un cas.

Typical Cat-scratch disease (CSD) manifests as regional lymphadenopathy following cat scratch and sometimes associated with mild fever. There is a lot of atypical manifestations and some of those have systemic involvement. Hepatosplenic CSD is a systemic presentation associating fever of unknown origin with nodules in the liver and/or the spleen. Ultrasound abdominal examination shows nodules (3-30 mm) in the spleen and/or in the liver. Diagnostic is based on serology for B henselae (always IgG + and sometimes IgM +), or polymerase chain reaction (PCR) on the liver to test for the presence of B henselae. Hepatosplenic CSD is rare and therefore underdiagnosed. There is no consensus about the treatment but most of the authors suggest to treat with rifampicine. We report a case of a 4-years-old girl presenting with fever of unknown origin (FUO), high inflammatory markers with normal leukocytosis and hepatosplenic nodules. The diagnosis of CSD was made retrospectively. Evolution was favourable even though no specific antibiotic treatment for Bartonella henselae was administrated.

[Dengue shock syndrome]. / Le cas clinique du mois. A propos d' une fièvre "importée.

Célia, 21 month-old child, presented to our pediatric clinic a few months ago with a fever of unknown origin after a stay in St-Domingue with her parents. Complementary investigations led to a diagnosis of Dengue Fever. The condition, not very frequent and thus not well known in our countries, represents a major world health problem especially because of the global failure of prophylactic measures. If the disease is self-limited in most cases, severe form can occur, with significant mortality and morbidity. Delay in diagnosis and treatment of these severe cases is often fatal.

[Limp with fever in adolescent: about 2 cases of pyomyositis]. / Boiterie fébrile chez l'adolescent: à propos de 2 observations de pyomyosite.

The authors report on 2 cases of limp with fever in adolescents, which developed after vigorous physical activity and were due to pyomyositis. Clinical, biological and radiological findings of the disorder are reviewed. Treatment is discussed. Early diagnosis and treatment are crucial for good prognosis.

Early skin sensitization to aeroallergens.

BACKGROUND: Early detection of aeroallergen sensitization is important as a prognosis factor but may be more difficult in young children. OBJECTIVE: We sought to demonstrate that skin sensitization to aeroallergens was present in a selected group of 0-2-year-old children and that it was associated with environmental exposure and a family history of allergic disease. METHODS: Data on exposure and history were extracted from the files of 824 children seen in the asthma clinic and who were skin tested to a panel of aero- and food allergens. RESULTS: Forty percent of our children demonstrated atopy, 28% were sensitized to aeroallergens, the majority of which to house dust mite. Higher sensitization rates were found in children with large weals to histamine (P<0.001) and in those who slept with soft toys [odds ratio (OR) 1.45, 95% confidence interval (CI) 1.02-2.08]. With a definition of sensitization including the size of the weal to histamine, there was a negative association with a personal history of eczema only (OR 0.66, 95% CI 0.45-0.99). There was no gender-dependent effect and no association with day-care attendance. CONCLUSION: This is one of the largest studies to evaluate skin testing in a selected population of young children. We found a high prevalence of sensitization to aeroallergens, which was associated with exposure to soft toys. Further follow-up of this population will allow assessment of the predictive value of this sensitization.

[Pet turtle and septicemia: what is the relationship?]. / Tortue d'eau et septicémie chez un nourrisson de 4 mois: quel rapport ?

We report the case of a four months old girl who suffered from a Salmonella pomona's septicemia. The source of contamination was the pet turtle recently acquired by her parents. If the pet turtle-associated salmonellosis is still rare in our country, the high rate of carriage of this germ by these exotic pets and the potential severity of the human disease justify an epidemiological survey. People with immature or weakened immune systems should avoid contact with reptiles.

Optimal assessment of the ability of children with recurrent respiratory tract infections to produce anti-polysaccharide antibodies.

Specific anti-polysaccharide antibody deficiency (SPAD) is an immune disorder. Diagnostic criteria have not yet been defined clearly. One hundred and seventy-six children evaluated for recurrent respiratory tract infections were analysed retrospectively. For each subject, specific anti-pneumococcal antibodies had been measured with two enzyme-linked immunosorbent assays (ELISAs), one overall assay (OA) using the 23-valent pneumococcal polysaccharide vaccine (23-PPSV) as detecting antigen and the other purified pneumococcal polysaccharide serotypes (serotype-specific assay, SSA) (serotypes 14, 19F and 23F). Antibody levels were measured before (n = 176) and after (n = 93) immunization with the 23-PPSV. Before immunization, low titres were found for 138 of 176 patients (78%) with OA, compared to 20 of 176 patients (11%) with the SSA. We found a significant correlation between OA and SSA results. After immunization, 88% (71 of 81) of the patients considered as responders in the OA test were also responders in the SSA; 93% (71 of 76) of the patients classified as responders according to the SSA were also responders in the OA. SPAD was diagnosed in 8% (seven of 93) of patients on the basis of the absence of response in both tests. Thus, we propose to use OA as a screening test for SPAD before 23-PPSV immunization. After immunization, SSA should be used only in case of a low response in OA. Only the absence of or a very low antibody response detected by both tests should be used as a diagnostic criterion for SPAD.

[Necrotizing pneumonia in children: apropos of 4 cases]. / Pneumonie nécrosante de l'enfant: à propos de 4 cas.

OBJECTIVES: To describe the necrotizing pneumonia in children, a severe affection which prevalence seems to increase; to review literature. PATIENTS AND METHODS: We report 4 cases of necrotizing pneumonia: symptoms, agents, diagnostic tools, treatment and long term evolution. RESULTS: In 2 cases, pneumatoceles could be seen at chest X-ray. Two patients presented a deficiency of anti-pneumococcal antibodies. Three needed insertion of a pleural chest tube of whom 1 had a resection of a small piece of necrotic lung. Duration of hospitalisation is longer than in uncomplicated pneumonias. CONCLUSION: Necrotizing pneumonia is a severe affection. Diagnosis has to be made by lung CT. Long term evolution is excellent in pediatric population with serious management at hospital.