Isabelle Claudet

Publications (55) View all

• Article: Risk factors for high-grade envenomations after French viper bites in children.

  Isabelle Claudet, Céline Maréchal, Emmanuel Gurrera, Laurie Cordier, Raphaele Honorat, Erick Grouteau
  [show abstract] [hide abstract]
  ABSTRACT: Viper bites and subsequent evolution to severe envenomations are more frequent in children. The aims of this study were to describe the clinical, biological, and therapeutic characteristics of children bitten by vipers in France and to identify risk factors associated with severe envenomations. A retrospective study was conducted between 2001 and 2009 in the pediatric emergency department of a tertiary-level children hospital. Collected data were age and sex of children; day and time of admission; day, time, and circumstances of the accident; snake identification; bite location; envenomation severity; presence of fang marks; prehospital care; use of specific immunotherapy and associated treatments; length of stay; and hospital course. Fifty-eight children were included (43 boys, 15 girls). The mean age was 7.8 ± 4.1 years. Bites were most often located on the lower extremities (77%). The classification of envenomation was: 83% low grade (absence or minor envenomation) and 17% high-grade (moderate to severe envenomations). All high-grade envenomations received specific immunotherapy (Viperfav). Being bitten on an upper extremity (P < 0.001), during the afternoon (P = 0.025), feeling violent pain (P = 0.037), and high initial glucose level (P = 0.016) were associated with a significant risk of high-grade envenomation. In the multivariate analysis, 3 factors remained significant: upper-extremity location (relative risk [RR], 60.5 [3.5-1040]; P = 0.005), immediate violent pain (RR, 21.5 [1.3-364.5]; P = 0.03), and female sex (RR, 17.5 [0.9-320.3]; P = 0.053). A certain number of criteria seem related to more significant risk of progression to high-grade envenomation. Bites to the upper extremities should be carefully observed because of the risk of evolution to a high-grade envenomation.
  Pediatric emergency care 06/2012; 28(7):650-4. · 0.92 Impact Factor
• Article: Influenza A(H1N1)-associated ischemic stroke in a 9-month-old child.

  Raphaele Honorat, Camille Tison, Annick Sevely, Emmanuel Cheuret, Yves Chaix, Isabelle Claudet
  [show abstract] [hide abstract]
  ABSTRACT: This study aimed to report a rare clinical course of pandemic influenza A(H1N1) infection, ischemic stroke, in a 9 month-old child. A 9-month-old girl with no previous medical problem presented to our pediatric emergency department with high fever (39°C/102°F) lasting for 48 hours. Soon after admission, she started generalized tonic-clonic seizures that ceased after 2 injections of diazepam. Six hours later, she presented 2 short episodes of partial clonic seizures of the right arm followed by monoplegia. Lumbar puncture was normal. Noncontrast computed tomographic imaging of the brain was performed and revealed an acute infarct in the left middle cerebral artery territory with no mass effect. Electroencephalogram revealed important slowing in the left hemisphere. A magnetic resonance imaging was performed the next day and confirmed an ischemic stroke in the left posterior middle cerebral artery region. Nasal swab polymerase chain reaction was positive for influenza A(H1N1) and polymerase chain reaction detection negative in cerebrospinal fluid. She fully recovered her right-arm function on day 3 and was discharged on day 10 without sequelae. Seasonal influenza is known to cause neurological complications in children. Influenza increases the stroke risk especially in adults at high risk. This is a rare event in childhood, and we believe this is the first report associated with H1N1 new variant. Acute viral infection, notably influenza, is associated with increased susceptibility to stroke, and vaccination against influenza may reduce the risk of stroke.
  Pediatric emergency care 04/2012; 28(4):368-9. · 0.92 Impact Factor
• Article: [What treatment of isolated fever in the child?].

  Cécile Debuisson, Isabelle Claudet
  La Revue du praticien 04/2012; 62(4):534.
• Article: Response.

  Isabelle Claudet
  Pediatric Neurology 03/2012; 46(3):199. · 1.52 Impact Factor
• Article: Serotonin syndrome induced by tramadol intoxication in an 8-month-old infant.

  Céline Maréchal, Raphaele Honorat, Isabelle Claudet
  [show abstract] [hide abstract]
  ABSTRACT: Severe cases of pediatric tramadol intoxication are rarely reported. We report on serotonin syndrome after tramadol intoxication. An 8-month-old girl developed extreme agitation after accidentally ingesting a tablet of her father's medication (Monocrixo LP (Thérabel Lucien Pharma, Levallois Perret, France), 200 mg tramadol). Unable to sleep, she was admitted the next morning to our Pediatric Emergency Department after an episode of epistaxis. Vital signs were significant for sinus tachycardia and a neurologic examination revealed intermediately reactive pupils, agitation alternating with drowsiness with a Glasgow Coma Scale of 10, and increased lower-limb reflexes. Within 24 hours, she developed hyperthermia and high blood pressure. She did not experience seizures. Neurologic and cardiovascular effects resolved on day 2. Tramadol serum plasma levels confirmed the intoxication (680 μg/L). She was discharged on day 5 with no sequelae. Serotonin syndrome was described in adults when tramadol was associated with selective serotonin-reuptake inhibitors in contexts of therapy or intoxication. Our patient developed moderate serotonin syndrome. The clinical presentation was unusual compared with previous pediatric cases of tramadol intoxication, in which opioid effects and seizures were usually predominant. This case illustrates that serotonin syndrome can occur in children intoxicated with tramadol.
  Pediatric Neurology 01/2011; 44(1):72-4. · 1.52 Impact Factor