[Necrotic lesion of the lip and cough with fever: cutaneous and pulmonary anthrax]. / Une lésion nécrotique de la lèvre et une toux fébrile chez un nourrisson marocain.

Anthrax disease is an anthropozoonosis caused by Bacillus anthracis. It appears in three clinical forms: pulmonary, intestinal, and cutaneous. We report a case of pulmonary and cutaneous anthrax in a one-year-old Moroccan infant.

[Characteristics of the children with epilepsy followed in the Marrakech University Hospital]. / Caractéristiques des enfants ayant une épilepsie suivis au CHU de Marrakech.

INTRODUCTION: Epilepsy is one of the most frequent neurological diseases in the pediatric population. Many epidemiological studies have been published, but with rather discordant results, because of methodological differences. In our context, epilepsy constitutes a public health problem. National epidemiological data are scarce. OBJECTIVES: To describe the characteristics of children with epilepsy, to analyze the risk factors and to assess the impact of the disease on schooling. METHODS: This was a retrospective study concerning 592 children attending the Mohammed VI university hospital center pediatric unit A outpatient clinic for epilepsy from August 2003 to December 2007. RESULTS: Epileptic syndromes were classified according to the criteria of the International League Against Epilepsy of 1989. Prevalence of epilepsy was 8.5%. Average age was 6 years 7 months. Age of seizure onset ranged from 2 months to 14 years. Male gender predominated. Antecedents were dominated by peri- and neonatal complications. Parental consanguinity and a family history of epilepsy were found in 19.2 and 11.6% of cases, respectively. Schooling was perturbed in more than one-third of the school-age children. Generalized seizures were most common (70.5%). Association with cerebral palsy was present in 18.6% of cases, with mental retardation in 4.7%. The epilepsy was idiopathic for 41% of the children, symptomatic for 39% and cryptogenic for 20%. Generalized epileptic syndromes were the most frequent, epilepsy absence (12%), Lennox-Gastaut syndrome (6%), West syndrome (5.5%) and myoclonic epilepsy (4%). The most common partial epileptic idiopathic syndrome was benign childhood epilepsy with centrotemporal spikes. Single-drug therapy was the rule for first intention treatment (96.8%). Sodium valproate was the antiepileptic drug most widely used (82%). Treatment led to resolution of the seizures in 76% of the children. CONCLUSION: Preventive measures should be reinforced in our context with a considerable proportion of children presenting neonatal risk factors. Efforts should be made to improve schooling for children with epilepsy.

Epidemiology and Clinical Features of Coronavirus Disease 2019 in Moroccan Children.

OBJECTIVE: This study aims to analyze the epidemiological and clinical features of coronavirus disease 19 (COVID-19) in a Moroccan pediatric population. METHODS: A retrospective study of a cohort of 74 children with RT-PCR confirmed COVID-19. We collected information on clinical and laboratory features of all children (age <18 years) admitted between 2 March, 2020 and 1 April, 2020. RESULTS: The mean (SD) age of the 74 children (40 girls) was 7 (1.5) years. The mean (SD) time from illness onset to diagnosis was 2 (1) days. 54 children were asymptomatic, while eight had fever, and five cases had cough. Recovery was after a mean (SD) of 12 (1) days. CONCLUSION: COVID-19 was mostly mild in the pediatric population in Morocco.

Late Treatment and Recurrence of Kawasaki Disease in a Moroccan Infant.

INTRODUCTION: While the diagnosis of typical form of Kawasaki disease (KD) is obvious, this multifaceted disease continues to surprise us. We report the case of a recurrent Kawasaki disease in an infant. CASE: At the age of 13 months, the infant was diagnosed with complete Kawasaki disease; he presented with prolonged fever, bilateral conjunctivitis, enanthem, exanthema, edema of the lower limb, peeling, and biological inflammatory syndrome. He was treated with intravenous immunoglobulin (IVIG) associated with a high dose of aspirin and then an antiplatelet dose with a good clinical-biological evolution. The echocardiography was normal. Seven months later, the patient was again admitted, in a similar picture: a prolonged fever evolving for 7 days, bilateral conjunctivitis, enanthem, cervical adenopathy of 1.5 cm/1 cm, scarlatiniform erythema, pruriginous of the trunk and limb, and peeling of the toes, with indurated edema of the hands and feet. The rest of the examination was normal except the irritability. The diagnosis of recurrent KD was made according the five criteria of the American Heart Association. The echocardiography was normal again. The infant received IVIG with good outcome. CONCLUSION: Despite its rarity, the possibility of recurrence of KD should be known by clinicians, so as not to delay the specific management of vasculitis whose stakes in terms of prevention of coronary artery lesions are well known. Our case confirms the possibility of this recurrence.

Upper airway obstruction and hemoptysis due to a leech infestation in a child.

This paper presents the case of a 12-year-old child who presented with an 8-day history of cough, respiratory distress, and hemoptysis. He was admitted first to the pediatric intensive care unit to reestablish hemodynamic and respiratory stability. The chest X-ray showed a bilateral alveolar-interstitial syndrome. Four hours after admission, he had a coughing fit, moderately abundant hemoptysis, and a leech appeared in his mouth, which was removed by the mother. Symptoms completely disappeared afterwards. Endoscopy and ear-throat-laryngeal examination done thereafter were normal. The presence of a leech in the larynx has been rarely described in children, but is not a rare cause of hemoptysis. Extraction is imperative and should be performed as soon as the diagnosis is made to avoid a fatal progression. Prevention remains the best treatment.

[Orbital and periorbital cellulitis in children. Epidemiological, clinical, therapeutic aspects and course]. / Cellulites orbitaires et péri-orbitaires de l'enfant. Profil épidémiologique, clinique, thérapeutique et évolutif.

Orbital cellulitis in children is a rare but potentially serious condition. The goal of this study is to analyze the epidemiological, clinical, therapeutic aspects and typical course of orbital and periorbital cellulitis in children, so as to propose a clinical management protocol adapted to our context. During the retrospective study period (2008-2014), 28 cases were hospitalized in the pediatric department at the Mohammed VI university medical center in Marrakech. Eighty-five percent of the cases were diagnosed as preseptal cellulitis, and 15% as retroseptal cellulitis. The age of the patients ranged from 6 months to 14 years with a mean age of 3 years. We report a female predominance with a prevalence of 58%. In our study, the most common cause is extension of infection from sinusitis. Clinically, fever was present in 19 patients (68%), eyelid edema was universal, proptosis and chemosis were noted in 2 cases, and ptosis in one patient. Bacteriological testing identified micro-organisms in 6 cases. Orbital computed tomography performed in 57% of the cases showed preseptal cellulitis in 12 cases, orbital cellulitis in one case, a subperiosteal abscess in 2 cases, and orbital abscess in one case. Medical treatment was based on amoxicillin-clavulanic acid or the combination of ceftriaxone, metronidazole±aminoglycoside. However, surgical drainage was necessary in 1 case. The outcome of all cases was favorable. Orbital cellulitis in children is usually preseptal, and amoxicillin-clavulanic acid is considered to be the standard empiric treatment.

[Acute disseminated encephalomyelitis after rabies vaccination: a case report]. / Encéphalomyélite aiguë disséminée post-vaccination antirabique: à propos d'un cas.

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system. It is a disease whose incidence is not precisely known. The presumed mechanism is demyelination of the immune-mediated central nervous system. There is no pathognomonic clinical presentation in ADEM. The combination of multifocal neurological disorders arising in the aftermath of an infection or vaccination should alert the clinician. We report a case of ADEM in an 8-year-old child occurring after antirabies vaccination. The diagnosis was made by nuclear magnetic resonance imaging (bilateral and multifocal lesions in the subcortical occipitoparietal and frontal left anterior white matter with involvement of U fibers) and a history of antirabies vaccination. The clinical course was marked by the appearance of motor and visual effects.

[An uncommon cause of delayed walking: idiopathic palmoplantar hidradenitis]. / Une cause inhabituelle de retard d'acquisition de la marche : l'hidradénite palmo-plantaire idiopathique.

INTRODUCTION: Idiopathic palmoplantar hidradenitis is an uncommon neutrophilic dermatosis, occurring in children and young adults. Its pathogenesis is incompletely understood. It is characterized by spontaneous resolution, but it can relapse in 50% of cases. We describe a case of a child with atypical idiopathic hidradenitis remarkable for its impact on his motor development. OBSERVATION: A 3-year-old boy was admitted to the pediatric unit for etiological assessment of delayed walking. Medullary MRI and TSH were normal. He was referred to a dermatologic consultation for recurrent and painful palmoplantar lesions, giving an equinus antalgic posture. Examination found erythematous tender plantar nodules. The palms were not affected. The exam was otherwise normal. Diagnosis of idiopathic plantar hidradenitis, pressure urticaria, and plantar erythema nodosum were discussed, leading to a skin biopsy. The histopathologic findings of nodular, neutrophilic infiltrates around the eccrine glands confirmed the diagnosis of idiopathic plantar hidradenitis. Anti-inflammatory treatment was given, followed by complete resolution of the lesions, but persistent equinus posture. COMMENTS: Idiopathic palmoplantar hidradenitis is an uncommon neutrophilic dermatosis, distinct from neutrophilic eccrine hidradenitis. It corresponds to neutrophilic infiltrates of the eccrine sweat glands. It is more frequently reported in children and young adults with no medical history. Its pathogenesis is not completely explained. The lesions are usually painful, hindering walking for a few days or even delaying it, as for our patient. These lesions typically involute, but they may recur in more than half of the cases. CONCLUSION: Through this observation, we highlight the atypical impact of idiopathic hidradenitis and the value of a dermatological examination in case of delayed walking.

[Moyamoya disease in children: a case report]. / Maladie de Moyamoya : à propos d'un cas pédiatrique.

Moyamoya is an angiogenic disorder and a rare cause of stroke. It is a progressive narrowing of cerebral arteries at the base of the brain involving the intracerebral portion of the internal carotid arteries, where it leads to development of collateral arteries, causing a "cigarette smoke" aspect. Ischemic events are more frequent in pediatric pathology, where hemorrhagic manifestations account for only 10%. The prognosis is severe, even worse than when onset of symptoms is earlier. We present the case of an 8-year-old child, who had presented recurrent hemiparesis since the age of 3 years; the brain CT scan and magnetic resonance imaging objectified injury sequelae. The MRA revealed stenosis of the internal carotid artery consistent with Moyamoya. In conclusion, the diagnosis of Moyamoya disease is now accessible to modern brain imaging techniques (MRI and MRA), easily achievable in children. The natural course of the disease involves the neurological and vital prognosis in young children, due to repeated ischemic attacks. Their identification would facilitate early diagnosis in order to treat neurosurgically, leading to a better neurological and cognitive prognosis.

[Survey on passive smoking in children in Agadir]. / Enquête sur le tabagisme passif chez l'enfant à Agadir.

INTRODUCTION: The aim of the study was to assess children's exposure to tobacco smoke at home, at school and in public places, to study its risks and to educate parents about the dangers of passive smoking. METHODS: This is a survey conducted in October 2007 among children enrolled in pre-school and primary school in the city of Agadir, Morocco. The data was gathered by a written questionnaire completed by parents at home. RESULTS: The survey covered 776 children. The response rate to the questionnaires was 88%. The father was a smoker in 28.9% of cases, against 0.7% for the mother. The prevalence of childhood exposure to tobacco was 34.1% at home, 36.4% in public places and 30.1% in schools. Concerning pregnant women, passive smoking and/or active was associated with a significantly increased risk of respiratory distress in newborn babies and hospitalisations in the neonatology department. In infant and child, involuntary inhalation of tobacco smoke involved an increased risk of sudden infant death syndrome and recurrent respiratory symptoms. However, its noxious effects were not found in the case of child asthma and tumour. CONCLUSION: Passive smoking is a real public health problem and smoking is a dangerous but also a preventable source of pollution.

[Epidemiology of urinary tract infection in children in Marrakech]. / Epidémiologie de l'infection urinaire chez l'enfant à Marrakech.

By its incidence, the polymorphism of its clinical presentation, its potential gravity, the difficulty of realization of urine culture in children, the frequency of the subjacent urologic abnormalities, the urinary tract infection (UTI) is an important problem in paediatrics. This work relates to a retrospective study carrying 121 episodes of UTI in 111 children taken care in paediatrics services of the Teaching Hospital Mohammed VI in Marrakech between March 2005 and March 2009. The age of our children varied between one month and 15 years with an average of 31 months, girls were more touched than boys with a sex ratio at 1.9. E. coli was the most common causative agent in our study (72 %), followed by Klebsiella in 14 % and Proteus in 5.8 % of cases. The study of antimicrobial susceptibility showed that the majority of the isolates were resistant to amoxicilline in 2/3 of cases. Third generation cephalosporins and aminosides kept their effectiveness on the majority of isolates (E. coli was susceptible to 3GC in 91.2 % and to gentamycin in 88 %). E. coli was sensible to the TSU in 54.4 % of cases.