[VRS bronchiolitis with severe hyponatremia leading to acute seizures: a report of three cases]. / Convulsions hyponatrémiques et bronchiolite à VRS : à propos de 3 cas.

Acute bronchiolitis due to respiratory syncytial virus (RSV) can present with extrapulmonary manifestations, notably severe hyponatremia. Hyponatremia is caused by excess secretion of antidiuretic hormone and can be exacerbated by intravenous infusion of hypotonic solutions. We report three cases of infants admitted for acute bronchiolitis and hyponatremia leading to acute seizures. We describe how hyponatremia was corrected and analyze the management aspects that might have worsened the magnitude of hyponatremia. We underline the basic principles of water and electrolyte management of bronchiolitis.

[Orbital bone infarction in a child with homozygous sickle cell disease]. / Crise vaso-occlusive orbitaire chez un enfant drépanocytaire.

Vaso-occlusive crises are the most common complication of sickle cell disease. Orbital bone infarction is an unusual manifestation of sickling disorders. It is suspected in patients with acute painful periorbital swelling. Orbital compression syndrome with possible optic nerve injury is a rare but serious complication; therefore, this diagnosis should be considered. Orbital infarction can be difficult to distinguish from osteomyelitis or skin infections. Imaging can be helpful in differentiating infection from infarction. We report a case of orbital bone infarction in a 14-year-old boy with sickle cell disease. Under medical treatment, the clinical course resolved with no sequelae.

[Surveillance of Haemophilus Influenzae meningitis in children in France, 2001-2006]. / Surveillance des méningites à Haemophilus Influenzae de l'enfant en France, 2001-2006.

BACKGROUND: The implementation of Haemophilus influenzae b (Hib) vaccination program in France in 1993 resulted in a rapid and dramatic decrease of the Hib meningitis incidence in children. The aim of our study was to describe the residual Haemophilus influenzae (Hi) meningitis in the French paediatric population between 2001 and 2006. METHODS: The French Paediatric Infectious Diseases Group set up an active surveillance network to analyze the clinical and biological features of bacterial meningitis. We used these data to retrospectively study the risk factors, signs and symptoms, vaccination status, cerebrospinal fluid analysis, treatment and case fatality rate of Hi meningitis. RESULTS: Among the 2539 cases of bacterial meningitis reported in France between 2001 and 2006, 69 (2.7 %) were due to Hi. A mean number of 11.5 cases of Hi meningitis was reported annually (minimum 6, maximum 16). Among Hi meningitis cases, 36 strains were of serotype b, 8 were capsulated but not b (6 f, 1 e and 1 unknown serotype), 20 strains were not capsulated, and 5 were non studied. The mean age of the children was 30.3 months (median 13.8 months, range 3.3 months to 14.5 years). 41 % of children with Hib meningitis did not received any anti-Hib vaccine and 41 % did not followed the French recommendations for Hib vaccine. CONCLUSION: Hi meningitis still occurs, and more than half is due to the b serotype. Among Hib cases, 14 % did not recieved any anti-Hib vaccine and 15 % received an incomplete vaccination schedule. Increase of vaccine coverage and use of an earlier booster dose at the age of 12 months could further improve the epidemiology of Hib meningitis. The immunity of children with Hib meningitis should be systematically studied in order to improve the comprehension of the pathophysiology of vaccine failure.

[Human herpesvirus 6 encephalitis after bone marrow transplantation]. / Un cas d'encéphalite à herpès virus humain de type 6 après transplantation de moelle osseuse.

Human herpesvirus 6 (HHV-6) encephalitis may induce neurological sequelae and death; the diagnosis is difficult because of an initially poor symptomatology and of the absence of specific biochemical, electric and radiological signs. We report on a 7-year-old boy with relapsed acute lymphoblastic leukaemia, who developed HHV-6 encephalitis after bone marrow transplantation; the patient recovered after treatment with ganciclovir.