Invasive pneumococcal disease in children can reveal a primary immunodeficiency.

BACKGROUND: About 10% of pediatric patients with invasive pneumococcal disease (IPD) die from the disease. Some primary immunodeficiencies (PIDs) are known to confer predisposition to IPD. However, a systematic search for these PIDs has never been carried out in children presenting with IPD. METHODS: We prospectively identified pediatric cases of IPD requiring hospitalization between 2005 and 2011 in 28 pediatric wards throughout France. IPD was defined as a positive pneumococcal culture, polymerase chain reaction result, and/or soluble antigen detection at a normally sterile site. The immunological assessment included abdominal ultrasound, whole-blood counts and smears, determinations of plasma immunoglobulin and complement levels, and the evaluation of proinflammatory cytokines. RESULTS: We included 163 children with IPD (male-to-female ratio, 1.3; median age, 13 months). Seventeen children had recurrent IPD. Meningitis was the most frequent type of infection (87%); other infections included pleuropneumonitis, isolated bloodstream infection, osteomyelitis, endocarditis, and mastoiditis. One patient with recurrent meningitis had a congenital cerebrospinal fluid fistula. The results of immunological explorations were abnormal in 26 children (16%), and a PID was identified in 17 patients (10%), including 1 case of MyD88 deficiency, 3 of complement fraction C2 or C3 deficiencies, 1 of isolated congenital asplenia, and 2 of Bruton disease (X-linked agammaglobulinemia). The proportion of PIDs was much higher in children aged >2 years than in younger children (26% vs 3%; P < .001). CONCLUSIONS: Children with IPD should undergo immunological investigations, particularly those aged >2 years, as PIDs may be discovered in up to 26% of cases.

Short-term neurological outcome of children after surgery for brain tumors: incidence and characteristics in a pediatric intensive care unit.

PURPOSE: The main treatment for majority of pediatric brain tumors relies on surgery. In postoperative period, patients require monitoring in a pediatric intensive care unit (PICU). In this study, we analyzed the incidence of postoperative neurological complications and the outcome of neurological impairment in individual patients. PATIENTS AND METHODS: Our retrospective single-center study concerned all patients who were admitted to the PICU of the University Hospital of Angers between 2002 and 2008, after brain tumor resection. Population, perioperative data, and outcome through the stay in PICU have been analyzed. RESULTS: We reported 117 neurosurgical procedures. Majority of children (85.3%) were affected by neurological deficit before surgery: cranial nerve palsy and cerebellar syndrome were the most frequent impairment. In the first 2 days, neurological symptoms improved for 27 patients (23.7%), especially in children with preoperative cerebellar syndrome, convulsions, or endocrine disorders. Mean length of stay in PICU was correlated with the severity of neurological impairment (p = 0.006). Five children presented a transient mutism after surgery for infratentorial tumors (n = 5/54, 9.2%). Eight spontaneous cerebral spinal fluid leaks occurred precociously after surgery, and neurological infections complicated half of them. Neurological infections occurred in 12 patients (ten meningitis, one ventriculitis, and one brain abscess). One patient died after surgery. CONCLUSIONS: All these complications and their risk factors have to be systematically searched for in order to decrease postoperative morbidity of brain tumors in children. They justify neurosurgeons and anesthesiologists specialized in these pathologies.