[Burns by immersion in children and abuse]. / Brûlures par immersion chez l'enfant et maltraitance.

AIM OF THE STUDY: Ten percent of childhood burns could arise from maltreatment. While describing 6 severe cases of inflicted scalds by immersion in children, we expose our systematic diagnostic approach of abuse and confirm the serious nature of burn when they are inflicted. PATIENTS AND METHOD: The retrospective study concerned children hospitalized for scalds by immersion between 2013 and 2016 and for whom child abuse has been confirmed. Sex, age, burns description, needs of surgery, length of stay at hospital and protection plan set up were collected. RESULTS: Six cases of burns by immersion due to maltreatment were identified (5 boys, 1 girl) with a median age of 12 months. The average total burn surface area was 19%. Burns were of deep second and third degree and always symmetric. Every child underwent surgery at least once. Concern information was transferred for all of them. CONCLUSION: Teams taking care of children with burns must be trained to the difficult diagnostic of abuse or neglect so that early social interventions can be set up in case of maltreatment.

Antibiothérapie péri-opératoire et greffe de peau: état des lieux sur les prescriptions dans les centres français de traitement de la brûlure, vers une harmonisation des pratiques?

Most hospitals use protocols for surgical antibioprophylaxis (ABP). Despite SFB's 2009 recommendations promoting ABP in burn patients and stating the molecules to be used, wide variations exist within hospitals and among French hospitals, in cases of skin grafting and use of dermal substitutes. We contacted surgeons in 12 French Burn Centres (BCs) via email and questioned them about ABP in cases of skin grafting (thin and total) as well as in the use of dermal substitutes, in acute and sequelae settings. Eight BCs answered. In the acute phase, 3 BCs (37.5%) always use ABP in skin grafts, 2 (25%) use ABP on suspicion of wound infection and 3 (37.5%) never use ABP. When installing skin substitute, 5 BCs (62.5%) use ABP, one (12.5%) does so if the wound is suspected of being infected and 2 (25%) never use ABP. For sequelae, 5 BCs (62.5%) use ABP whatever the surgery, while 3 (37.5%) never use it. Infection onset after skin graft or use of dermal substitute is frequent. Our study shows wide variations in the use of ABP in these surgeries. A multi-centre evaluation of the implementation of SFB's 2009 recommendations and their role in preventing postoperative infections after skin grafting and skin substitute use, both in acute and sequelae phases, could help harmonize practices in BCs.

[Fillet flap for axillary reconstruction]. / Utilisation d'un membre banque pour le comblement d'une perte de substance axillaire.

INTRODUCTION: Among all complications that affect patients with neurofibromatosis, type I (NF1) are very aggressive malignant nerve sheath tumors (MPNSTs). Surgery is their first line therapy. CLINICAL CASE: We report the case of a non metastatic neurofibrosarcoma of the axillary area in a 22-year-old male with NF1. An interscapulothoracic resection was performed to resect the tumor and had sacrificed the homolateral latissimus dorsi pedicled myocutaneous flap. In this extreme and not codified situation, the coverage of the tissue loss was possible in the same time using a free flap harvested on the amputated limb (fillet flap). The free flap based on the humeral pedicle was composed of the entire skin and muscles of the amputated forearm. It was anastomosed on the subclavian vessels. Only a free flap was suitable in this tissue loss. The use of a fillet flap allows a wide and reliable coverage without donor site morbidity.

[Hand burns in children and Aquacel(®) Burn gloves, an alternative to prolonged hospital stays]. / Brûlures des mains de l'enfant et gants Aquacel(®) Burn, une alternative aux hospitalisations prolongées. À propos de 20 cas.

AIM OF THE STUDY: Occlusive dressings for second-degree hand burns in children must prevent infection and promote healing. For good management of analgesia, these treatments often require children to be hospitalized. Our goal was to find an alternative to conventional care protocol that would reduce the number of dressings and therefore the length of hospitalization. We report our experience with the use of Aquacel(®) Burn. PATIENTS AND METHOD: Non-randomized monocentric prospective study was conducted from 2012 to 2014. The glove was used in the operating room within 72hours after the burn in children younger than 15 years old with isolated superficial to deep 2nd degree hand burns. Once the glove was perfectly stuck to the burn, the children could go back home. We saw them 10 to 12 days after the accident to be sure there was no indication of skin graft. RESULTS: Twenty gloves were used in 16 children aged from 16 months to 13 years. The average length of stay (ALOS) was five days to put the glove on and one day to remove it. Four hands were grafted. CONCLUSION: Once we get used to the product, Aquacel(®) Burn gloves have reduced the ALOS before skin graft in cases of isolated hand burns in children.

[A rare tumor of the median nerve in a young child: Intraneural perineurioma. About one clinical case]. / Une tumeur rare du nerf médian chez le jeune enfant : le périneuriome intraneural. À propos d'un cas clinique.

Intraneural perineurioma is a rare benign peripheral sheath tumor, which is most prevalent in adolescents and young adults. It is characterized by focal perineural cell proliferation infiltrating the endoneurium leading to the macroscopic aspect of hypertrophic nerve. It typically presents a loss of motor function in the involved nerve. We report the case of a 3-year-old boy presented with painless, subcutaneous mass on the palmar aspect of his right hand without loss of motor function. Imaging studies showed a large mass within the median nerve suggesting schwannoma. Surgical exploration was undertaken. The tumor could not be removed without leading to motor and sensitive loss. Neurolysis of the hypertrophic fascicles was performed. Microbiopsies ruled out malignant tumor and could make the diagnosis of intraneural perineurioma of the median nerve. An annual clinical follow-up has been decided in order to detect any functional trouble such as loss of motor function.

[Chronic radiodermatitis following coronaroplasty]. / Radiodermite chronique du dos après coronaroplastie.

We report the case of a 72-year-old patient sent by his dermatologist in January 2009 for a back burn. His medical history reported one coronarography and two coronaroplasties between September and October 2005. This enabled us to form the diagnosis of chronic radiodermatitis after coronaroplasty from literature data. The occurrence of chronic radiodermatitis of the back and axilla area after cardiac catheterization has been observed in many countries. It almost always occurred in patients who underwent difficult and long-acting procedures leading to high doses radiation. There is not always acute radiodermatitis. Lesions appear between three and 30 months after exposure or even later. They are well-defined four-sided centimetrics lesions going from simple radiodystrophy to ulceration such as late radionecrosis requiring surgical coverage procedure.

Improvement of the T-cell response to a non immunogenic peptide by its tandem association with a highly efficient T-helper peptide.

The 45-69 peptide, an helper T-cell epitope derived from the HIV nef protein is strongly immunogenic. A T-cell proliferative response was observed following immunization of Lou/M rats with 45-69 peptide administered in low dose and without any adjuvant. It is already known that the T-cell response to the 115-131 peptide of Sm28GST antigen, a protein of the parasite Schistosoma mansoni, requires the presence of a carrier of the use of peptidic constructs. We demonstrate here that a T-cell response against the 115-131 peptide can be obtained in the absence of adjuvant using peptidic constructs (115-45 and 45-115 peptides) resulting from tandem synthesis of 115-131 and 45-69 peptides. A covalent association of both peptides is necessary, since the coinjection of 45-69 and 115-131 peptides is not sufficient to induce a detectable anti-115-131 T-cell response. The mutual orientation between the respective tandem peptides (45-115 and 115-45) is critical for the T-cell response. These peptidic constructs possess distinct properties of antigenicity and immunogenicity but both allowed to reveal the existence of a specific T-cell response normally undetectable using 115-131 peptide alone. This immunopharmacological approach should be useful in the rational design and construction of vaccines.

Effect of a lipopeptidic formulation on macrophage activation and peptide presentation to T cells.

We studied a 45-69 lipopeptide obtained by N-terminal modification with a N epsilon-palmitoyl lysine residue of the 45-69 peptide derived from the nef protein of HIV. T cells from animals immunized intraperitoneally with 45-69 lipopeptide proliferated in vitro in the presence of 45-69 peptide while no response was obtained after intraperitoneal immunization with 45-69 peptide. The efficiency of the 45-69 lipopeptide is supported by the covalent association to the N epsilon-palmitoyl lysine moiety. The immunogenicity of the 45-69 lipopeptide or of the unmodified peptide is dependent on the route of immunization but is not related to a mitogenic effect on cells or to an increase of the peptide antigenicity. Moreover, only 45-69 lipopeptide induces the secretion of cytokines such as IL-1, IL-6 and TNF-alpha by peritoneal macrophages. Finally, the use of 45-69 lipopeptide permits the activation of highly purified T cells without the addition of antigen-presenting cells. These results have implications for the formulation of synthetic vaccines.

Improvement of the T-cell response to a non-immunogenic peptide by its tandem association with a highly efficient T-helper peptide.

The 45-69 peptide, an helper T-cell epitope derived from HIV nef protein, is strongly immunogenic. A T-cell proliferative response was observed following immunization of Lou/M rats with 45-69 peptide administered in low dose and without any adjuvant. It is already known that the T-cell response to the 115-131 peptide of Sm28GST antigen, a protein of the parasite Schistosoma mansoni, requires the presence of a carrier or the use of peptidic constructs. We demonstrate here that a T-cell response against the 115-131 peptide can be obtained in the absence of adjuvant using peptidic constructs (115-45 and 45-115 peptides) resulting from tandem synthesis of 115-131 and 45-69 peptides. A covalent association of both peptides is necessary, since the co-injection of 45-69 and 115-131 peptides is not sufficient to induce a detectable anti-115-131 T-cell response. The mutual orientation between the respective tandem peptides (45-115 and 115-45) is critical for the T-cell response. These peptidic constructs possess distinct properties of antigenicity and immunogenicity but both allowed to reveal the existence of a 115-131 specific T-cell response normally undetectable using 115-131 peptide alone. This immunopharmacological approach should be useful in the rational design and construction of vaccines.

La detección de IgA para diagnosticar las infecciones retrovíricas en el Caribe / IgA testing for diagnosis of retroviral infections in the Caribbean

En la isla caribeña de Guadalupe, donde hay una alta prevalencia de infección por el virus linfotrópico T humano del tipo 1 (HTLV-1), los métodos de diagnóstico dan lugar a muchos resultados positivos falsos que hay que verificar mediante pruebas adicionales largas y costosas. En el presente artículo se describe una manera simple de solucionar este problema. Consiste, primero, en extraer del suero de un paciente toda la IgG y sus inmunocomplejos circulantes (ICC) mediante un tratamiento con proteína G, para después detectar la presencia de IgA antivírica en el suero tratado usando las pruebas comerciales de ELISA y Western Blot con ligeras modificaciones

La detección de IgA para diagnosticar las infecciones retrovíricas en el Caribe / IgA testing for diagnosis of retroviral infections in the Caribbean

En la isla caribeña de Guadalupe, donde hay una alta prevalencia de infección por el virus linfotrópico T humano del tipo 1 (HTLV-1), los métodos de diagnóstico dan lugar a muchos resultados positivos falsos que hay que verificar mediante pruebas adicionales largas y costosas. En el presente artículo se describe una manera simple de solucionar este problema. Consiste, primero, en extraer del suero de un paciente toda la IgG y sus inmunocomplejos circulantes (ICC) mediante un tratamiento con proteína G, para después detectar la presencia de IgA antivírica en el suero tratado usando las pruebas comerciales de ELISA y Western Blot con ligeras modificaciones

Disponible en inglés en Bull Pan Am. Health Organ 25(3):201-06, 1991

IgA testing for diagnosis of retroviral infections in the Caribbean.

In Guadeloupe, a Caribbean island with a high prevalence of HTLV-I infected subjects, the percentage of false positive results for HIV IgG is high, requiring additional time and expense for confirmatory tests. This article describes a simple way of overcoming this problem. First, all IgG and IgG immune complexes are removed by protein G treatment, and then IgA enzyme-linked immunosorbent assay (ELISA) and the Western blot test are performed with minor modification of commercially available kits.

PIP: Researchers wanted to determine whether they could do a more specific ELISA HIV test directed at IgA rather than IgG antibodies. So they 1st used streptococcal protein G to remove IgG from serum samples of 10 follow up patients from Guadeloupe who previously tested positive via ELISA for HIV-1/2 IgG and HTLV-I IgG. They did this to test sera for IgA. The protein G treatment resulted in a 99.9% reduction in the IgG concentration (12.21.7 mg/ml to .007-.017 mg/ml). After IgG depletion, the researchers noted no ELISA positive samples for HIV-1/2 or HTLV-I IgG. In fact, all the values were well below the cutoff levels. This result indicated that streptococcal protein G treatment followed by IgA ELISA is more specific than testing for IgG. The sera of 8 patients tested negative for HIV-1/2 IgA, but all tested positive for HTLV-1 IgA. This result showed that IgA may be more useful than IgG for also confirming retroviral infections. The sera of 2 patients were 44% and 27% above the cutoff level indicating that these patients had HIV-1/2 IgA antibodies. The researchers observed that protein G treatment suppressed all HIV-1/2 and HTLV-I IgG Western blot reactivity which confirmed the effectiveness of protein G treatment. Further the HIV IgG bands in the 8 false positive sera did not materialize at all suggesting that the IgG reactivity observed was most likely nonspecific. These results indicated that nonspecific HIV-1/2 IgG caused the false positive HIV-1/2 IgG ELISA results. In conclusion, in Caribbean countries where HTLV-1 infection can be as high as 13%, the more specific HIV IgA ELISA test should be used since its use saves time and money. Further it can do generalized testing for HTLV antibodies.

IgA testing for diagnosis of retroviral infections in the Caribbean

In Guadeloupe, a Caribbean island with a high prevalence of HTLV-I infected subjects, the percentage of false positive results for HIV IgG is high, requiring additional time and expense for confirmatory tests. This article describes a simple way of overcoming this problem. First, all IgG and IgG immune complexes are removed by protein G treatment, and then IgA enzyme-linked immudosorbent assay (ELISA) and the Western blot test are performed with minor modification of commercially available kits

IgA testing for diagnosis of retroviral infections in the Caribbean

In Guadeloupe, a Caribbean island with a high prevalence of HTLV-I infected subjects, the percentage of false positive results for HIV IgG is high, requiring additional time and expense for confirmatory tests. This article describes a simple way of overcoming this problem. First, all IgG and IgG immune complexes are removed by protein G treatment, and then IgA enzyme-linked immudosorbent assay (ELISA) and the Western blot test are performed with minor modification of commercially available kits

Available in spanish in Bol. Oficina Sanit. Panam 112(1):12-18, 1992

[Antigens of Toxoplasma gondii with a diagnostic and potential immunoprophylactic value: new strategies of identification]. / Antigènes de Toxoplasma gondii d'intérêt diagnostique et immunoprophylactique potentiel: nouvelles stratégies d'identification.

Toxoplasma gondii is an ubiquitous protozoan parasite which induces severe pathology in in utero infected children and in immunosuppressed patients (particularly in the case of AIDS). Previous work that focused on toxoplasma somatic antigens failed to demonstrate an efficient protection against highly virulent T. gondii strains. The authors therefore first studied the role of parasite excreted-secreted (ES) antigens in the immune response. They describe here the preparation of excreted-secreted antigens in cell-free medium from tachyzoites, the intracellular proliferative stage present during acute infection. Major ES antigens have Mr of 108 K, 97 K, 86 K, 57 K, 42 K, 39 K, 28.5 K, 27 K and 21 K. The protective role of ES antigens has been demonstrated using congenitally athymic (Nu/Nu) rats that are highly sensitive to T. gondii infection (+/+ Fischer rats are resistant). The humoral and cellular components of this protection have been studied by the passive transfer either of sera or of T lymphocytes from ES-immunized +/+ Fischer rats into Nu/Nu rats. Adoptive transfers were carried out 24 hours before infection with the highly virulent T. gondii RH strain. Based on the concept of concomitant immunity, the authors have characterized antigens from tachyzoites and bradyzoites (the encysted stage persisting during chronic infection) which share common epitopes. Four tachyzoite antigens, P63, GP43, P39 and GP 28.5 have been shown by immunoprecipitation to cross-react with bradyzoite antigens. Two monoclonal antibodies raised against ES antigens permitted to demonstrate the localization of the 28.5 K and 27 K antigens inside the dense granules of tachyzoites and bradyzoites.(ABSTRACT TRUNCATED AT 250 WORDS)

Protective role of IgE in immunocompromised rat toxoplasmosis.

In contrast to euthymic adult Fischer rats, immunocompromised Nu/Nu animals develop a lethal infection when inoculated with the RH strain of the protozoan Toxoplasma gondii. However, a significant period of survival is obtained when Nu/Nu rats are passively transferred with sera from 28-day infected Fischer +/+ (euthymic) animals. Specific IgE are involved since IgE-depleted sera are unable to afford such a protection. Only excreted/secreted Ag or living tachyzoites are able to induce a significant protective IgE response in intact animals. In addition, platelets or, to a lesser extent, eosinophil-rich populations from Toxoplasma infected or excreted-secreted Ag-immunized euthymic animals bear surface IgE and are cytotoxic for the parasite in vitro. Also, adoptive transfer of immune platelets confers a significant degree of protection to Toxoplasma-infected Nu/Nu animals. Our results clearly show the key role of Ag present in both living parasites and excreted-secreted Ag to induce, in this model, a protective IgE response. In addition, as in other parasitic infections, platelets and probably eosinophils are the effector cells involved in controlling parasitic dissemination during Toxoplasma infection in immunocompromised rats.

Killer cells in human cutaneous leishmaniasis.

In French Guiana, American cutaneous leishmaniasis is localized in the skin. The host response appears to be effective since few extra- or intracellular organisms can be found in tissue lesions, and we never observed any cutaneous dissemination or visceral involvement. However, this response is not fully effective since lesions may last for months. By using immunoperoxidase techniques and monoclonal antibodies directed against various cell populations, we examined the local immune response in skin biopsies. We found a high percentage of cells with the K/NK phenotype, a variable but usually high percentage of cells with the T cell phenotype bearing TAC receptors, and moderate numbers of monocytes and B cells. These results suggest that K/NK cells could play a role in the local control of parasite dissemination.

[Changes in immunologic and biochemical functions after a mission to a tropical forest]. / Modification des fonctions immunologiques et biochimiques après une mission en forêt tropicale.

A biochemical and immunological survey of a selected military group has been performed, before and after a jungle raid. Biochemical (total proteins, albumin, proteins electrophoresis, transferrin, haptoglobin, ceruloplasmin, orosomucoid, alpha-1 antitrypsin and alpha-2 macroglobin) and immunological (Ig G., Ig A., C 3c, C 4, specific antibodies against Leishmania) analysis of sera have been studied as well as the level of cellular immunity (Multitest scoring, macrophage cytotoxicity, interleukin-1 and prostaglandin E-2, macrophage production). The results show some modifications as a consequence of the work in tropical forest, particularly the tendency to some cellular immunity deficiency. This can be linked to several factors: nutritional balance, cutaneous infections, sustained physical activity and excessive sweating.

Macrophage function in patients with American cutaneous leishmaniasis: in vitro cytotoxicity and interleukin-1 production.

Monocyte-derived blood macrophages of untreated patients with Leishmania braziliensis or Leishmania mexicana amazonensis infections show anomalies in their nonspecific immune functions. Their ability to kill HeLa cells or to produce interleukin-1 in vitro in response to lipopolysaccharide plus Candida albicans is lower than controls indicating that acquired or innate macrophage deficiencies may be involved in the course of the disease.