Epidemiology of pertussis in Casablanca (Morocco): contribution of conventional and molecular diagnosis tools.

BACKGROUND: Pertussis, a vaccine preventable disease, is still responsible of significant morbidity and mortality around the world, mostly in newborns. The aim of the present study was (1) to introduce pertussis surveillance in the major pediatric hospital of Casablanca (2) to analyze the prevalence of pertussis among children under 14 years of age and their entourage in Casablanca, Morocco. METHODS: This is a prospective and non-case controlled study, including children suspected of Pertussis admitted at the Abderrahim Harouchi Pediatric Hospital in Casablanca, from January 2013 to June 2015. Nasopharyngeal samples were obtained for Bordetella spp. culture and Real time PCR detection (RT-PCR) with specific primers of Bordetella spp., B. pertussis, B. parapertussis and B. holmesii. The detection of Bordetella spp. was also performed in some household contacts of the children suspected of pertussis. RESULTS: During the 2.5-years period, a total of 282 samples were collected from hospitalized children (156) and in some of their contacts (126). Among 156 samples from the children (from whom 57% were under 2 month of age), Bordetella DNA was detected in 61% (96/156) by RT-PCR. Among these positive samples, 91.7% (88/96) corresponded to B. pertussis DNA. Furthermore, in 39.5% (38/96) of the Bordetella positive samples, B. holmesii DNA was also detected. B. parapertussis DNA was detected in only one sample (1/156). Out of the 156 samples collected from the hospitalized children, only 48 were tested by culture, and 4 B. pertussis were isolated (8.3%). Among the 126 samples from the contacts of the children, mostly mothers (115 cases), Bordetella DNA was detected in 47% (59/126), 90% (53/59) being B. pertussis DNA. Moreover, B. holmesii DNA was also detected in 18.6% (11/59) of the Bordetella positive samples, and coexistence of B. pertussis and B. holmesii DNA in 36.5% (35/96). Two B. pertussis were isolated by culture performed on 43 samples of the contacts of the children (4.6%). CONCLUSIONS: This study highlights the circulation of B. pertussis but also of B. holmesii in Casablanca-Morocco with a high proportion of co-infections B. holmesii/B. pertussis in infants and their mothers, indicate that infection of non-vaccinated infants could be more associated with young parents. Moreover, the RT- PCR provides a sensitive and specific diagnosis of B. pertussis infections and distinguishes it from other Bordetella species, and is therefore suitable for implementation in the diagnostic laboratory.

Clinical factors predictive of traumatic brain injuries in case of mild traumatic brain injury in children: case-control study.

BACKGROUND: Mild head injury (MHI) is very common in children and the problem is a lack of consensus criteria for the indication of a brain CT. OBJECTIVE: To determine predictors of cranio-cerebral lesions (CCL) in the case of MHI in children. METHODS: Case-control study over a period of 3 years. Included children aged 1 month to 15 years, were those admitted to the department of Pediatric Emergencies for MHI and had performed a brain CT. The principal outcome was the presence of traumatic brain injury. Statistical analysis focused on univariate and multivariate tests was done using SPSS version 16.0. RESULTS: We included 418 children. The median age was 6 years with a sex ratio of 2.24. The main mechanisms of trauma were the traffic accident. Cerebral CT proved to be abnormal in 191 children (45.7%). The main lesions found were the skull fractures, brain contusion and epidural hematoma. Predictors retained after logistic regression were the presence of an initial loss of consciousness regardless of its duration (p = 0.007), hematoma of the scalp (p = < 0.0001) and at least one clinical sign for a fracture of the skull base (p = 0.016). CONCLUSION: In case of MHI in children, the initial loss of consciousness, the presence of a hematoma of the scalp and the presence of at least one sign in favor of the skull base fracture seem most predictive of cranio-cerebral lesions.