[Non-tuberculous mycobacterial cervical adenitis in children: 2 cases]. / Deux cas d'adénite cervicale à mycobactéries non tuberculeuses chez l'enfant.

BACKGROUND: Cervical lymphadenitis is the most common manifestation of infection with nontuberculous mycobacteria (NTM) in immunocompetent children. Nevertheless, it is poorly known by dermatologists. Its incidence, which is currently increasing since the cessation of BCG vaccination in 2007, raises several issues regarding its pathophysiology, diagnosis and management. PATIENTS AND METHODS: We report two cases of NTM adenitis: one in a 2-year-old girl vaccinated with BCG and one in an unvaccinated 22-month-old boy, in whom a misleading presentation led to delayed diagnosis. The condition progressed to fistula formation and the diagnosis was finally made on systematic cultures of lymph node samples. The time to diagnosis was 2 and 4months, respectively. The girl was treated with erythromycin for 3 weeks and with clarithromycin for 3 weeks; the boy received clarithromycin for 7 weeks and underwent complete surgical excision. DISCUSSION: NTM adenitis preferentially affects girls under 4 years and occurs more frequently in winter and spring. First, the other differential diagnoses, including tuberculosis, must be ruled out by chest radiography. The diagnosis is oriented by the clinical picture, a positive TST and resistance to conventional antibiotics. However, it is only certified by systematic culture or PCR of lymph node biopsies, with screening for atypical mycobacteria being specified. The decrease in child protection by BCG vaccination coincides with the current increase in NTM infections, of which the most frequent is Mycobacterium avium complex (MAC) for cervical adenitis. The reference treatment is surgery. However, alternative treatments (incomplete excision, antibiotics, watchful waiting, etc.) should be considered where surgery fails or there is excessive risk of injury to a branch of the facial nerve. CONCLUSION: Atypical mycobacterial adenitis in immunocompetent children has become an increasingly common infection since the abandonment of BCG vaccination. Improved knowledge of this disease would result in complete surgical excision at an early stage with a lower rate of aesthetic sequelae.

Effect of intense swimming training on rhinitis in high-level competitive swimmers.

BACKGROUND: Rhinitis is commonly reported by swimmers. Seasonal allergic rhinitis may impair athletes' performance and quality of life (QOL). No data are currently available on the changes of nasal symptoms during and after a swimming season. We aimed to determine in competitive swimmers: (1) the prevalence of rhinitis and its impact on their QOL during an intense training programme, (2) the changes in nasal symptoms and QOL after a resting period and (3) the relationship between rhinitis and airway hyperresponsiveness (AHR). METHODS: Thirty-nine swimmers and 30 healthy controls answered the Rhinitis Quality of Life Questionnaire (RQLQ) and scored nasal symptoms on a seven-point Likert scale during the week preceding their visit. Subjects had allergy skin prick tests and a methacholine challenge. Peak nasal inspiratory flows were also measured. The athletes performed these tests during an intense training period (V1), outside the pollen season and after at least 2 weeks without swimming (V2). RESULTS: At V1, rhinitis symptoms were reported by 74% of swimmers and 40% of controls (P<0.01). Eighty-four percent of swimmers and 72% of controls were atopic (NS). RQLQ score was higher in swimmers compared with controls at V1 (27.3+/-28.5 vs. 9.5+/-12.7, respectively, P<0.005). The presence of AHR during training did not correlate with the presence of rhinitis symptoms. At V2, the nasal symptoms and RQLQ scores were similar in swimmers and controls. CONCLUSION: Intense swimming training is associated with an increase in nasal symptoms and impairment in QOL in most competitive swimmers. Such an increase is not related to seasonal allergen exposure in atopic athletes and probably results from chlorine derivative exposure.

Asthma, airway inflammation and epithelial damage in swimmers and cold-air athletes.

Endurance athletes show an increased prevalence of airway hyperresponsiveness. The aim of the present study was to evaluate the long-term effects of training on airway responsiveness, inflammation and epithelial damage in swimmers and cold-air athletes. In total, 64 elite athletes (32 swimmers and 32 cold-air athletes), 32 mild asthmatic subjects and 32 healthy controls underwent allergy skin prick testing, methacholine challenge and induced sputum analysis. Overall, 69% of swimmers and 28% of cold-air athletes had airway hyperresponsiveness. Sputum neutrophil count correlated with the number of training hours per week in both swimmers and cold-air athletes. Eosinophil counts were higher in swimmers than in healthy subjects, although they were lower than in asthmatic subjects, and correlated with airway hyperresponsiveness in swimmers only. The eosinophil count in cold-air athletes was similar to that in healthy subjects. Bronchial epithelial cell count was not correlated with airway hyperresponsiveness but was significantly increased in swimmers, compared with healthy and asthmatic controls. In conclusion, the present authors observed significant airway inflammation only in competitive athletes with airway hyperresponsiveness. However, the majority of elite athletes showed evidence of bronchial epithelial damage that could possibly contribute to the development of airway hyperresponsiveness.

New state mosquito records for Vermont including a checklist of the mosquito fauna.

Collections of mosquitoes in Vermont during 1980 and 1989 have resulted in 9 new state records, including species of Psorophora and Wyeomyia for the first time. A checklist of all species occurring in the state is also given.

Tick (Acari: Ixodidae) infestation at two rural, seasonal camps in Maine and Vermont.

In July 2008, owners of seasonal camps in Vermont and Maine were exposed to large numbers of questing ticks after opening their camps for the season. Examination of collected specimens revealed that the camp in Vermont was infested with Ixodes cookei Packard, and the camp in Maine was infested with Ixodes marxi Banks. In both instances, numerous tick bites were reported by residents. Both camps were also occupied by wildlife during the off-season, primarily squirrels (Maine) and skunks (Vermont). Subsequent samples from the Vermont site were tested for the presence of Powassan encephalitis virus, though no viral activity was detected.

[Laparoscopy: tubal sterilization: 1000 cases and general evaluation of the method]. / Laparoscopie: stérilisation tubaire: étude de 1000 cas et évaluation globale de la méthode

PIP: 1000 cases of laparoscopic tubal cauterization performed between January 1970 and December 1972 are reviewed. The number of cases rose d ramatically during that 3-year period. The average age of the patients was 35 years and the average parity was almost 4 children. The requirements to authorize the operation were initially very strict, but subsequently became much more liberal: the overall rate of elective sterilization was 72.2%. The complications reported ranged from minor to serious: 6 laparotomies were required, of which 2 were to control hemorrhages in the uterus and 4 to correct ideal perforations. A 7th la parotomy was necessary in order to perform the sterilization, because the laparoscope was unable to penetrate a curtain of adhesions. The effectiveness of the method is excellent, since only 3 pregnancies were reported, of which 2 were in progress at the time of surgery and only 1 was a true failure, resulting from the coil cauterization of only 1 tube.^ieng