[Pneumococcal meningitis: clinical features and prognostic factors]

Despite advances in antibiotic therapy strategies and pediatric intensive care, prognosis of Streptococcus pneumoniae meningitis remains very poor. To determine epidemiological and clinical features of pneumococcal meningitis and the factors associated with hospital mortality and neurologic sequelae. We conducted a retrospective study of 21 cases of childhood pneumococcal meningitis admitted in the department B of the Children hospital of Tunis during a 9-year-period. Twenty one children were included in this study. The mean of age was 22 months. 10 children had presented seizures before admission and one was admitted in coma. The direct examination of the cerebrospinal fluid was positive in 85 per cent soluble antigens were positive in 66 per cent and the culture was positive in 100 per cent. Immediate complication were notified in 9 cases and neurosensorial sequelae in 6 cases. Pneumococcal meningitis is a serious disease with a high rate morbidity and mortality then, we suggest introducing pneumococcal vaccine

[Neonatal infection and streptococcus pneumonae meningitis]

Streprococccus pneumoniae is a major cause of morbidity and mortality in childhood infectious disease; however, it is unusual in the neonatal infection. We report the case of a newborn, admitted in our department to manage respiratory distress. One the clinical examination, he presented hypothermia, polypnea and hypotonia. The blood and cerebrospinal fluid cultures were positive for Streptococcus pneumoniae. Brain imaging showed a hydrocephalus. He received cefotaxim and vancomycin for 56 days

A severe illness of a congenital cytomegalovirus infection

Congenital cytomegalovirus [CMV] infection occurs in about 1 per cent of newborns and 10 per cent of them exhibit symptomatic infection. Nervous system damage influences prognosis and newborns management. We report the case of a newborn with a s6vere and progressive congenital CMV infection. He was admitted because of petechiae and thrombocytopenia. Investigations of the newborn showed a bilateral optic atrophy, severe nervous system damage with hydrocephalus, enormous periventricular pseudocysts and cerebellum hypoplasia. No brain calcifications were found. Diagnosis relied on blood CMV viral load measurement in both the newborn and his mother. The newborn received Ganciclovir. Hydrocephalus progressed and required ventriculoperitoneal shunt placement. This case illustrates that pseudocysts and progressive hydrocephalus must suggest CMV congenital infection even not associated to brain calcifications. Nervous system damage is serious in congenital CMV infection and requires a systematic screening during pregnancy

[Prenatal gastrointestinal bleeding caused by oesophagitis]

Upper gastrointestinal tract bleeding in the neonate is usually related to gastritis and esophagitis. Fewer cases of prenatal gastrointestinal tract bleeding diagnosis are reported, showing that gastric peptic lesions can occur in the prenatal period. We report a case of a prenatal oesophagitis revealed at 35 weeks of gestation by the presence of bloody amniotic fluid that was confirmed by endoscopy at birth

[Kawasaki disease. About 9 cases]

To analyze epidemiologic, clinical and evolutive profile of Kawasaki disease, we studied retrospectively 9 cases of children with Kawasaki disease fulfilled during ten years [1994 - 2003]. It is about 8 boys and 1 girl, aged from 4 months to 9 years [mean age at 3 years].5 patients fulfilled at least 5 major criterias of The illness and the four others presented an incomplete form We noted cardiac manifestations in 3 patients, neuromeningeal, renal and digestive symptoms in 5 cases for each one, articular in 2 cases and pulmonary in 1 case. Biologic inflammatory syndrome is present in all cases and high rate of platelets has been found in 6 cases/9. Aspirin with anti inflammatory dose has been instituted in 8 cases / 9. Intravenous immunoglobulin has been administrated in 6 cases /9. Cardiac manifestations have disappeared completely in the 3 cases. The outcome has been favorable for all cases. In conclusion, Kawasaki disease is unknown rather rare, incomplete or atypic forms are frequents and source of diagnostic delay. Early treatment permit to improve the prognosis of this disease