Tropheryma whipplei associated with diarrhoea in young children.

Tropheryma whipplei was detected in preliminary studies in faeces of young children with diarrhoea and also in faeces of asymptomatic persons, not only in Europe but also in Africa. In this study, the link between this bacterium and the presence of acute diarrhoea was evaluated in a large group of children. From December 2009 to January 2013, rectal swabs collected from 3796 children in the emergency departments of university hospitals in Marseille, France, were analysed: 555 children (245 female and 310 male, from 6 days to 6 years old) with acute diarrhoea defined as at least three loose stools per day for <1 week and 3241 children (1444 female and 1797 male, from 22 days to 6 years old) without diarrhoea. Specific quantitative real-time PCR was performed to detect the presence of T. whipplei and of two enteric pathogens Clostridium difficile and Giardia duodenalis. Tropheryma whipplei was significantly more common in children with diarrhoea (22/555, 4%) than without (56/3241, 1.7%; p 0.001). Neither C. difficile nor G. duodenalis showed this association. For C. difficile, 39 of 531 (7.3%) children with diarrhoea were positive versus 184 of 3119 (5.9%) of children without diarrhoea (p 0.25). For G. duodenalis, 2 of 529 (0.37%) children with diarrhoea were positive versus 5 of 3119 (0.16%) children without diarrhoea (p 0.26). Tropheryma whipplei was found more commonly in autumn. Tropheryma whipplei is significantly associated with diarrhoea in children, suggesting that the bacterium may be a cause of acute diarrhoea.

"Soccer or emergency?" sporting event can lead to a decreased attendance in the pediatric emergency department.

AIM: Sporting events have been seen to be related to a decline in adult male visits in emergency departments. Studies about the influence of sporting events on pediatric emergency attendance are scarce and non-conclusive. In our institution there is a widely shared popular belief of the local pediatric emergency medical staff that there is a decrease in the attendance when the local soccer team (Olympique de Marseille) is playing. METHODS: We have collected data on attendance and orientation (medical or surgery) in the pediatric emergency unit (35,000 annual admission) for the Wednesdays, Saturdays and Sundays between July 1, 2008 and May 31, 2012 compassing 4 soccer seasons. We have also collected the date and the localization (at home or abroad) of all the games played by the city's soccer team for the four seasons. RESULTS: The study included 512 days (171 Saturdays and Sundays and 170 Wednesdays), 173 were match days and 339 were control days. After adjusting for day, month, and years, there was a 3.5% decrease of attendance during game days (P=0.007), which was higher for days of away games (4.7% decrease, P=0.012). For matches played at 9 p.m. for a 4 hour period (allowing for 1 hour before and 1 hour after the matches) the decrease was that of 8% (P=0.05) mostly for medicine admission. CONCLUSION: We observed that sporting events as soccer games can have a effect on the attendance rate in a children's emergency department. The underlying reason for this difference is not well understood.

[Relationship between precariousness, social coverage, and vaccine coverage: survey among children consulting in pediatric emergency departments in France]. / Précarité, couverture sociale et couverture vaccinale : enquête chez les enfants consultant aux urgences pédiatriques.

UNLABELLED: Poor children are more susceptible to infectious diseases. Routine medical follow-up is infrequent in these patients, sometimes resulting in immunization delays. The aim of this study was to correlate a number of socioeconomic factors related to poverty with vaccination coverage in children visiting a pediatric emergency ward. PATIENTS AND METHODS: Previous routine vaccinations and various socioeconomic features were prospectively recorded for children aged 9 months to 7 years visiting two public pediatric emergency departments in Marseilles (southern France) from 2009 to 2010. RESULTS: Three hundred and seventy-five children were included. Vaccination coverage was 87% for diphtheria, tetanus, poliomyelitis, Haemophilus influenzae type b infections and pertussis, 69% for tuberculosis (Bacillus Calmette-Guérin), 77% for measles, mumps and rubella, 74% for pneumococcal infections (conjugate vaccine), and 55% for hepatitis B. Socioeconomic factors related to poverty were significantly associated with delays in immunizations. Children not attending school (OR=2.5), having parents who were not fluent in French (OR=5.7), living in caravans or squatting (OR=11.5), or being recipients of the national medical assistance for foreigners (OR=12.8) had significant delays with diphtheria, tetanus, and poliomyelitis vaccines. The measles-mumps-rubella vaccine was also delayed in homeless children (OR=3.4). Children who were recipients of the national medical assistance for citizens were better vaccinated against tuberculosis and hepatitis B. CONCLUSION: Poor children living in southern France had significant delays in their routine immunizations, resulting in gaps in their protection. Every medical visit, even those conducted in an emergency ward, should identify children with immunization delays and offer a catch-up schedule if necessary.

[BCG and infants with a high risk of tuberculosis: a study of the vaccination rate in Marseille after suspension of the BCG requirement]. / BCG et nourrissons à risque de tuberculose : étude de couverture vaccinale à Marseille après la levée d'obligation.

OBJECTIVES: The obligation for BCG vaccination, suspended in July 2007, was replaced by a vaccination targeting children with a high risk of tuberculosis. The purpose of this study was to assess the vaccination rate of infants living Marseilles and its suburbs who had criteria for BCG vaccination. MATERIAL AND METHODS: This observational study consisted in interviewing the parents of children born after the suspension of the obligatory BCG vaccination and admitted for a medical visit at the Pediatric Emergency Department of the Timone-Enfants University Hospital between 1 December 2008 and 31 March 2009. For each child, we noted the demographic data, the criteria for BCG eligibility, the vaccination status, and, when the child was not vaccinated but at risk for tuberculosis, the information received by the family on the vaccination. RESULTS: A total of 224 out of 271 eligible children were included (82.6%; mean age, 7.1 ± 4.9 months). One hundred and fifty-seven infants had at least one criterion for BCG vaccination; 116 of them were vaccinated (73.9%). The number of criteria for the vaccination did not influence the vaccine rate. Families of non-vaccinated high-risk children (n=41) had been informed about BCG in 39% of the cases. BCG was planned in 11 of these 41 infants. CONCLUSION: Eighteen months after suspension of the obligation for BCG vaccination, our results are encouraging but underline the need for improving information to families concerned by this new vaccination policy.

[Impact of a triage scale in a pediatric emergency department]. / Impact d'une grille de tri à l'accueil d'un service d'urgence pédiatrique.

UNLABELLED: The pediatric nursing staff of the emergency unit has established a list of items for the triage of patients which can be used by the registered nurses. This scale defined 3 stages of severity. OBJECTIVES: 1) to estimate the relevance of this list through the appraisal of the total time necessary to take care of the patients according to their severity stage, and the confrontation of the severity stage determined by the registered nurse and the severity stage determined by the paediatrician; 2) to determine a possible correlation between the severity stage and the rate of hospitalization. METHOD: This prospective study was carried out over a period of 1 month in winter for every child admitted in the pediatric emergency unit for medical reasons (traumatisms excluded). RESULTS: One thousand six hundred and fifty-six children have been included in the study. Among them, 136 have been classified stage I, 1020 stage II and 500 stage III. The children have been taken care of in an average period of 20 min for stage I, 32 min for stage II, 43 min for stage III. The coherence rate between the severity stage determined by the nurse and the severity rate determined by the paediatrician was good. The rate of sub-estimation was low (4,2%). Nevertheless the reception nurses tend to overestimate the stage of severity in 17,6% of the cases. The prediction rate for hospital admittance was good: 68,7% of children classified in stage 1 were admitted, 23,5% of children in stage 2 and only 1,6% of children in stage 3. CONCLUSION: Patients suffering from severe illnesses were taken care without injurious delay which was the main purpose of this list.

[Neonatal hyperthyroidism in a premature infant born to a mother with Grave's disease]. / Hyperthyroïdie néonatale chez un prématuré né de mère atteinte d'une maladie de Basedow.

BACKGROUND: Neonatal thyrotoxicosis is most commonly due to transplacental transfer of maternal thyroid-stimulating hormone receptor antibodies (TRAb). Bioassay of thyrotropin receptor antibodies may help to determine the risk for neonatal hyperthyroidism. CASE REPORT: Thyrotoxicosis developed in a premature infant born to a mother with Graves' disease, with a low level of TRAb by bioassay. The infant was treated with carbimazole for two months, until TRAb had disappeared. CONCLUSION: Bioassay TRAb is not always reliable for predicting the development of neonatal hyperthyroidism in infants born to mothers with Graves' disease. Thyroid function should be measured in all these neonates.

[Severe potassium dichromate poisoning after accidental nasal introduction]. / Intoxication grave au dichromate de potassium après introduction nasale accidentelle.

BACKGROUND: Nasal foreign body (NFB) is a common situation in pediatrics. Poisoning is a rare complication of NFB insertion. We report a case of acute potassium dichromate poisoning secondary to NFB insertion. CASE REPORT: Six days after insertion of a NFB, progressive occurrence of diarrhea, vomiting, nasal obstruction, acute renal failure, pancreatitis, hepatitis and drowsiness justified hospitalization of a 3-year-old girl in the pediatric intensive care unit. Acute potassium dichromate poisoning was confirmed by high plasma chromium level and by the spectrophotometric analysis of the crystal. Recovery was satisfactory with supportive treatment. An official survey allowed to discover that the crystal was freely sold and that its toxicity was unknown by dealers, while no information was given to the customers. CONCLUSION: Transmucosal absorption of toxics is an unusual severe potential hazard that should be evoked to allow a rapid management. After the discovery and withdrawal of a NFB, occurrence of systemic symptoms, even trivial, must make one suspect a poisoning. In this circumstance, analysis of the foreign body should be done, associated with toxicologic dosages. This case report illustrates that potassium dichromate poisoning is a severe medical condition and that its clinical presentation assume a large widespread of symptoms due to multiple organ involvement.