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ABSTRACT: We report 2 cases of children with group A streptococcus pyogenes pleuropneumonia, in one child associated with Kawasaki disease and in the other with streptococcal toxic shock syndrome. These 2 features, with theoretically well-defined clinical and biological criteria, are difficult to differentiate in clinical practice, however, likely due to their pathophysiological links. In case of clinical doubt, an echocardiography needs to be performed to search for coronary involvement and treatment including intravenous immunoglobulins, and an antibiotic with an anti-toxin effect such as clindamycin has to be started early.
Archives de Pédiatrie 12/2011; 18(12):1310-4. · 0.30 Impact Factor
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ABSTRACT: Streptococcus pyogenes or group A streptococcus (GAS) is responsible for serious invasive infections with a risk of secondary infection in patients with more contact than in the general population. Regardless of clustering, few intrafamilial invasive infections have been reported despite a recent increase in the incidence of invasive GAS disease. We report the cases of two brothers, one a boy of 8.5 years with toxic shock syndrome with no bacteria identified and the second, 1 week later, his 14.5-year-old brother in hospital for sepsis due to GAS. The occurrence of a confirmed case of invasive GAS and a probable case within such a short period met the definition of clustered cases. Both brothers showed no risk factors for invasive disease and no gateway including skin was found. Antibiotic therapy was initiated in the family as recommended by the French Higher Council of Public Hygiene.
Archives de Pédiatrie 11/2011; 18(12):1305-9. · 0.30 Impact Factor
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ABSTRACT: Accidental drownings are severe and sometimes mortal events in children. Our study aims to better clarify the epidemiology and the respiratory complications of these accidents in our hospital. We led a retrospective study over 10 years concerning the children hospitalized for accidental drowning in our hospital centre. Age at the moment of the accident, sex, history of accident, hospitable care, thoracic imaging and neurological outcome of the children were studied. In total, 83 children were hospitalized (5 years on average, 70% being boys). The drowning especially took place in fresh water (71%), particularly in swimming pools (51.8%). Stages III and IV of drowning concerned 40.9% of the population. The coverage was the following one: admittance in ICU 57.8%, mechanical ventilation 34.9%, oxygen therapy 16.9%, antibiotics 87.9%. A normal chest x-ray was present in 45.7% of the cases. Drowning in fresh water, especially in contaminated fresh water (canal, WC, etc.), induced atelectasis (10.8%), whereas drowning in sea water induced diffuse infiltrates (8.4%). Aspiration pneumonia (33.7%) was present in both cases and a pulmonary oedema (6%) was only noticed during stage IV drowning. The secondary infections were rare (1 case was suspected and another probable). A child presented a secondary acute respiratory distress syndrome (1.2 %). Finally, 7 deaths (8.4%) and 1 case with severe neurological sequelae (1.2%) were noted. Accidental drowning causes important consequences in children. The long-term respiratory outcomes have not been properly studied. Prevention of such accidents is based on parental vigilance during their child's bathe.
Archives de Pédiatrie 11/2009; 17(1):14-8. · 0.30 Impact Factor
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ABSTRACT: Spontaneous pneumomediastinum is a rare entity in children, especially in young infants. We report the case of a 4-month-old infant with a massive spontaneous pneumomediastinum caused by acute viral bronchiolitis. Treatment including bed rest, codeine for its antitussive action, and nitrogen washout resolved the pneumomediastinum within 3 days. In the literature, cases of pneumomediastinum in very young infants are exceptional. To our knowledge, codeine has never been used in this situation. Nitrogen washout is also rarely used because of poorly demonstrated efficacy.
Archives de Pédiatrie 11/2008; 15(11):1652-5. · 0.30 Impact Factor
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ABSTRACT: Bronchiolitis obliterans following a bone marrow transplantation needs an early diagnosis for a better evolution. First signs are exercise dyspnea and hypoxemia. A walking test evaluating the tolerance for effort could have an interest in detecting such symptoms. We report a preliminary study of feasibility of the 3-minute step-test in children with a bone marrow transplantation.
Ten patients (5 boys, median 11.7 years, range 5.1-15.5 years) were included within at least 3 months away from a bone marrow transplantation. After clinical examination and realisation of pulmonary function tests, the test was to step up and down a single step which is 15 cm high, rhythmically (30 per minute) during 3 minutes. Heart rate and pulsed oxygen saturation were registered, dyspnea being assessed before and after the test by means of a visual analogue score and the fifteen-count breathlessness score.
All the children realised the 3-minute step-test successfully and with excellent tolerance. Only 1 child made an effort judged maximum. No hypoxemia caused by the effort was highlighted.
The 3-minute step-test is easy to achieve in a population of paediatric patients who have undergone a bone marrow transplantation. It could be a valuable tool in the respiratory follow up of these children.
Revue des Maladies Respiratoires 02/2008; 25(1):27-32. · 0.59 Impact Factor
