R Cohen

Université Paris-Est Créteil Val de Marne - Université Paris 12, Créteil, Île-de-France, France

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Publications (268)213.05 Total impact

  • Archives de Pédiatrie 12/2014; · 0.41 Impact Factor
  • Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie. 11/2014; 21 Suppl 2:S51-3.
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    ABSTRACT: The group A streptococcus (GAS) is the 5(th) responsible pathogen of invasive infections in children in France. These particularly severe diseases are dominated in children by soft tissue infection, isolated bacteremia but also osteoarthritis. Other complications are rare in France such as lung infections, necrotizing fasciitis (NF) and streptococcal toxic shock syndrome (STSS). More unusual localizations such as meningitis, neonatal infections, severe ear and throat and gastrointestinal infections and vascular disorders are also described. Based on published series, mortality ranging from 0-8 % of cases, is high but still lower than that observed in adults. Probabilistic antibiotherapy includes a β-lactam with anti-SGA but also anti-staphylococcal (predominantly methi-S in France) activity such as clavulanic acid- amoxicillin followed by amoxicillin as soon as identification of SGA is performed. The addition of an anti-toxin antibiotic such as clindamycin is recommended particularly in NF or STSS or clinical signs suggestive of toxin production by the SGA (rash, gastrointestinal signs, hemodynamic disorders). The use of intravenous polyvalent immunoglobulins must also be discussed in NF and STSS. In all cases surgery should be discussed. The prognosis of these potentially very severe infections is related to their early diagnosis and treatment. A better understanding of the pathophysiology of these infections may optimize their management but also their prevention.
    Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie. 11/2014; 21 Suppl 2:S87-92.
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    ABSTRACT: Group A streptococcal (GAS) meningitis in children are rare. The aim of this study was to analyze the clinical, biological and outcome data on GAS meningitis recorded in the Bacterial Meningitis (BM) French Surveillance Network (GPIP/ACTIV). From 2001 through 2012, 4,564 children suffering from proven bacterial meningitis were recorded in the data base. Among them, 0.7 % were GAS infections. The median age was 5.6 years. A history of community acquired infection before the onset of GAS meningitis was frequent. Apart from the identification of the bacterial species, GAS meningitis were clinically and biologically indistinguishable from meningitis caused by other pathogens notably S. pneumoniae. Case fatality rate was 8 %.
    Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie. 11/2014; 21 Suppl 2:S101-3.
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    ABSTRACT: The purpose of this study was to assess the performances of the group A streptococcus (GAS) rapid antigen diagnostic tests (RADTs) in extra-pharyngeal infections. Between October 2009 and June 2014, 368 patients (median age: 48 months) were enrolled. The pathologies involved were : 160 perineal infections (44 %), 69 blistering distal dactylitis (19 %), 55 cervical lymphadenitis (15 %), 31 crusty or bleeding rhinitis (8 %), and 53 other diseases (14 %). The sensitivity of GAS-RADT used was 96 % (95 % CI: 92-99 %), the specificity 81 % (95 % CI: 75- 86 %), the negative predictive value 97 % (CI 95 %: 93-99 %), and the positive predictive value 79 % (95 % CI: 73-85 %). Finally, positive and negative likelihood ratio were 5 (95 % CI: 4-7) and 0.05 (95 % CI: 0.02-0.11) respectively. The GAS-RADTs developed for pharyngitis have comparable performances in these settings and therefore can be used.
    Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie. 11/2014; 21 Suppl 2:S84-6.
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    ABSTRACT: Group A streptococcus (GAS) is the most frequently identified bacterium in children with acute pharyngitis. Clinical signs and symptoms cannot distinguish accurately between viral and GAS pharyngitis. Rapid antigen detection tests (RADTs) can identify GAS by an immunologic reaction within a few minutes. Compared to throat culture, most RADTs have a high specificity (around 95 %), allowing antibiotic prescribing on the basis of a positive RADT result. Similarly, the negative predictive value of RADTs seems sufficiently high (around 95 %) to ensure against the presence of GAS in case of a negative RADT result. Among several factors affecting RADT sensitivity, the training and expertise of the person performing the test and the quality of the throat swab specimen seem to be key determinants. Available evidence suggests that clinical prediction rules for the triage of children who should undergo GAS testing are not sufficiently accurate. Implementing RADTs into clinical practice has an important impact on antibiotic prescription rates, for a reduction of about 30 %. French guidelines that recommend using RADTs in all children above 3 years of age presenting with pharyngitis without backup culture of negative tests seem relevant in this context.
    Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie. 11/2014; 21 Suppl 2:S78-83.
  • E Grimprel, R Cohen
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    ABSTRACT: Management of common group A streptococcus (GAS) infections remains controversial. French recommendations advocate systematic treatment of streptococcal tonsillitis after confirmation by rapid diagnostic test. Oral amoxicillin twice daily for 6 days is the first-line treatment. Antibiotic prophylaxis is restricted to at-risk patients after contact with invasive GAS case. These recommendations take into consideration the prevention of complications, even if they are rare, the reduction of infectiousness and the reduction of the duration of symptoms. Different recommendations have been issued in other countries, particularly in Europe and are based on different considerations. These differences do not originate in the absence of demonstrative scientific studies but rather in societal considerations, themselves guided by the history of each different health system (and also judicial system). This is probably necessary to obtain physicians and public support. The French attitude reflects these considerations. However, its lack of enforcement needs to question about its origins.
    Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie. 11/2014; 21 Suppl 2:S107-12.
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    ABSTRACT: Blistering distal dactylitis is a distinct clinical entity, generally due to S. pyogenes, unfrequently reported. Characteristically, blistering distal dactylitis is described as a localized infection involving the distal phalanx of the digits, and it usually presents as a fluid-filled blister. Between October 2009 and June 2014, 69 children (median age: 60 months, extremes: 0,6-176) were enrolled. The sensitivity of GAS rapid antigen detection test was 97 % (CI 95 %: 83-100 %), the specificity was 76 % (CI 95 %: 60-89 %), the negative predictive value was 97 % (CI 95 %: 83-100 %), and the positive predictive value 76 % (CI 95 %: 60-89 %). All patients with a positive GAS rapid antigen test were treated with antibiotics (amoxicillin essentially) and cured without surgery.
    Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie. 11/2014; 21 Suppl 2:S93-6.
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    ABSTRACT: Perineal diseases in children are usually caused by group A streptococcus (GAS). If the natural course of untreated cases is not known, it is well known that symptoms do not resolve spontaneously and can persist often for many months, until appropriate diagnosis and effective treatment are instituted. Furthermore, failures and recurrences after penicillin treatment are frequent. From 2009 to 2014, 165 perineal infections (median age: 48 months, extremes: 0.4-139) were enrolled by 15 pediatricians: 4 balanitis, 29 vulvo-vaginal diseases and 132 perianal infections. Painful defecation, anal fissures and macroscopic blood in stools were significantly more frequent in GAS perianal infections than negative GAS infections (p<0.01). The performance of GAS-rapid antigen test compared to the GAS culture was : sensitivity 97 % [CI 95 %: 89-100 %], specificity 76 % [CI 95 %: 66-84 %], negative predictive value 97 % [CI 95 %: 91-100 %], positive predictive value 71 % [CI 95 %: 60-80 %].
    Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie. 11/2014; 21 Suppl 2:S97-S100.
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    ABSTRACT: From 2009 to 2014, we enrolled prospectively 132 pediatric peri-anal infections. The association of painful defecation, anal fissures and macroscopic blood in stools were highly suggestive of GAS peri-anal infection (probability 83.3%). We found a high sensitivity of a group A streptococcal rapid diagnostic (98%) but relatively low specificity (72.8%).
    Clinical Infectious Diseases 10/2014; · 9.42 Impact Factor
  • Archives de pediatrie : organe officiel de la Societe francaise de pediatrie. 10/2014;
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    ABSTRACT: The French 2013 immunization schedule having a goal of simplification with comparable efficacy, has decreased the number of injections and removed the injection performed at three months of age in the general population. Apart from the prevention of invasive pneumococcal infections for which it is recommended to maintain three dose primary immunization, vaccination of premature is not addressed in this new calendar. Can the extremely preterm infants (<33weeks of gestational age) benefit from this new schedule or should we keep them in three injections schedule? The objective of this paper is to clarify this point through the data available in the literature. Children born prematurely and especially the "extremely premature" born before 33weeks are at high risk of infections, some of them are preventable by immunization. Although there is no clinical evidence, for pertussis, pneumococcus, Haemophilus influenzae b, hepatitis B, whatever the immunogenicity criteria, immunogenicity is significantly lower in preterm than in term newborn after 3 doses primary schedule. This lower immunogenicity raises concerns about the transition to two doses, about the ability to give short term protection and booster responses. Given these data, GPIP takes the position for maintaining a primary 3-dose vaccination at 2.3 and 4months for premature infants less than 33weeks.
    Archives de Pédiatrie 08/2014; · 0.41 Impact Factor
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    Archives de Pédiatrie 08/2014; 21(8):905. · 0.41 Impact Factor
  • Medecine et maladies infectieuses. 07/2014; 44(7):289-291.
  • Médecine et Maladies Infectieuses 07/2014; 44(7):289–291. · 0.91 Impact Factor
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    ABSTRACT: Staphylococcus aureus and Streptococcus pyogenes are the two main bacteria involved in skin infections in children. Mild infections like limited impetigo and furonculosis should preferentially be treated by topical antibiotics (mupirocine or fucidic acid). Empiric antimicrobial therapy of dermohypodermitis consists in amoxicillin-clavulanate through oral route (80mg/kg/d) or parenteral route (150mg/kg amoxicillin per d. in 3-4 doses) for complicated features: risk factors of extension of the infection, sepsis or fast evolution. Clindamycin (40mg/kg/d per d. in 3 doses) should be added to the beta-lactam treatment in case of toxinic shock, surgical necrotizing soft tissues or fasciitis infections.
    Archives de pediatrie : organe officiel de la Societe francaise de pediatrie. 06/2014;
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    ABSTRACT: For the past 20years, three vaccines against the three main bacterial species implicated in meningitis in children have been included in the French vaccine calendar: Haemophilus influenzae b in 1993, 7-valent pneumococcal conjugate vaccine (PCV7) in 2003 (replaced by 13-valent in 2010) and Neisseria meningitidis C in 2009. The French active surveillance network from the GPIP/ACTIV monitors the change in the epidemiological, clinical, and biological features of bacterial meningitis due to vaccine use.
    Archives de Pédiatrie 06/2014; · 0.41 Impact Factor
  • Archives de Pédiatrie 06/2014; · 0.41 Impact Factor
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    ABSTRACT: Recommendations for the use of diagnostic testing in low respiratory infection in children older than 3months were produced by the Groupe de Recherche sur les Avancées en Pneumo-Pédiatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP(2)A). The Haute Autorité de santé (HAS) methodology, based on formalized consensus, was used. A first panel of experts analyzed the English and French literature to provide a second panel of experts with recommendations to validate. Only the recommendations are presented here, but the full text is available on the SP(2)A website.
    Archives de Pédiatrie 03/2014; · 0.41 Impact Factor
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    ABSTRACT: Objectives We used data from the Groupe de pathologie infectieuse pédiatrique and Association clinique et thérapeutique infantile du Val-de-Marne (GPIP/ACTIV) National Survey of Bacterial Meningitis in children and the National Reference Center for Meningococci (CNRM) microbiological data to assess the potential impact of corticosteroids on the immediate management of invasive meningococcal disease (IMD) associated with different genotypes, including highly pro-inflammatory strains of the ST-11 clonal complex (genotype ST-11). Methods From 2001 to 2009, 259 pediatric wards and 168 microbiology laboratories distributed throughout France prospectively included all under-18-year-old patients with IMD (meningitis or purpura fulminans). The strains were sent to the CNRM for genotyping. We linked the ACTIV clinical data of IMD cases, where information on corticosteroid therapy was available, to strains isolated by the CRNM. Results A total of 1981 IMD cases were identified during the 8-year study, 805 cases (712 [88.5%] bacterial meningitis and 93 [11.5%] purpura fulminans) had steroid treatment data (33.8% received corticosteroids). The genotype of the strains was available for 410 patients (24.4% related to genotype ST-11; 100 patients). For all cases and regardless of the corticosteroids, mortality was significantly associated with the genotype ST-11 (OR = 2.39, 95% CI [1.29; 4.42], P = 0.004). For all cases and regardless of the genotypes of the isolates, mortality was also significantly higher for children with than without corticosteroid therapy (12.7% versus 4.5%, P < 0.001). However, this treatment had been prescribed more frequently in severe cases, including shock, PF, coma and/or mechanical ventilation. For children who did not receive corticosteroids, the mortality rate was significantly higher with genotype ST-11 compared to other genotypes (OR = 4.68 [1.91, 11.46], P = 0.001). This difference disappeared in children who received corticosteroids. Conclusion This study indicates that in the absence of corticosteroids, higher mortality in invasive meningococcal disease is associated with the ST-11 clonal complex strains. This suggests a possible positive effect of corticosteroid therapy depending on the genotype of the strain involved.
    Archives de Pédiatrie 03/2014; · 0.41 Impact Factor

Publication Stats

979 Citations
213.05 Total Impact Points


  • 2014
    • Université Paris-Est Créteil Val de Marne - Université Paris 12
      Créteil, Île-de-France, France
  • 1987–2014
    • Centre Hospitalier Intercommunal Creteil
      Créteil, Île-de-France, France
  • 2013
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 2008–2013
    • Hôpital Jean-Verdier – Hôpitaux Universitaires Paris-Seine-Saint-Denis
      Bondy, Île-de-France, France
    • Centre Hospitalier de Versailles
      Versailles, Île-de-France, France
    • Hôpital Saint-Vincent-de-Paul – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
  • 2010
    • Infectious Diseases Society Of America
      Arlington, Virginia, United States
  • 2008–2009
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
  • 2007
    • Hôpital Universitaire Robert Debré
      • Service de Pédiatrie Générale
      Lutetia Parisorum, Île-de-France, France
  • 2004
    • Kaiser Permanente
      Oakland, California, United States
  • 2000
    • Hôpital Louis-Mourier – Hôpitaux Universitaires Paris Nord Val de Seine
      Colombes, Île-de-France, France
  • 1999
    • African Center for Technology Studies
      Nairoba, Nairobi Area, Kenya
  • 1996
    • CHU de Lyon - Hôpital de la Croix-Rousse
      Lyons, Rhône-Alpes, France
  • 1994
    • Computational Hydraulics Int.
      Guelph, Ontario, Canada