[Pneumococcal meningitis: clinical features and prognostic factors]

Despite advances in antibiotic therapy strategies and pediatric intensive care, prognosis of Streptococcus pneumoniae meningitis remains very poor. To determine epidemiological and clinical features of pneumococcal meningitis and the factors associated with hospital mortality and neurologic sequelae. We conducted a retrospective study of 21 cases of childhood pneumococcal meningitis admitted in the department B of the Children hospital of Tunis during a 9-year-period. Twenty one children were included in this study. The mean of age was 22 months. 10 children had presented seizures before admission and one was admitted in coma. The direct examination of the cerebrospinal fluid was positive in 85 per cent soluble antigens were positive in 66 per cent and the culture was positive in 100 per cent. Immediate complication were notified in 9 cases and neurosensorial sequelae in 6 cases. Pneumococcal meningitis is a serious disease with a high rate morbidity and mortality then, we suggest introducing pneumococcal vaccine

[Neonatal infection and streptococcus pneumonae meningitis]

Streprococccus pneumoniae is a major cause of morbidity and mortality in childhood infectious disease; however, it is unusual in the neonatal infection. We report the case of a newborn, admitted in our department to manage respiratory distress. One the clinical examination, he presented hypothermia, polypnea and hypotonia. The blood and cerebrospinal fluid cultures were positive for Streptococcus pneumoniae. Brain imaging showed a hydrocephalus. He received cefotaxim and vancomycin for 56 days

[Laryngotracheobronchial foreign body in children: predictive factors of respiratory sequelae]

Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may compromise the prognosis of the child and the respiratory function in the long term. Aim: identify the predictive factors of respiratory sequelae of laryngotracheobronchial foreign body inhalation. This retrospective study was conducted in the children hospital of Tunis during a period of nine years [2000 - 2008]. In all statistical tests, the significance level was set at 0.05. 60 children were included in the study. The average age was 24.9 +/- 3.4 months. 2 / 3 of the children were boys. The foreign body was plant in 80% of cases. The penetration syndrome was reported in 83.7% of cases. The average time of stay of foreign body was 14 days. The chest radiograph was abnormal in 77.4% of cases. Endoscopic extraction was performed in 59 cases and a pneumectomy was conducted in one child. 30 children were followed for an average of 23 months. 18 children had not respiratory sequelae [clinical, radiological and scintigraphic]. 10 children had respiratory sequelae [clinical and radiological and/or scintigraphic] at the last follow-up and four patients developed bronchial dilatation. Respiratory sequelae were correlated with the stay period of the foreign body exceeding 84H. Neither age, nor sex, nor the nature of foreign body or its location, nor the presence of radiological opacity at the initial radiograph, were predictive factors of respiratory sequelae. The inhalation of foreign body is a serious accident affecting essentially male infants. Clinical, radiological and scintigraphic follow up is mandatory

Neonatal cholestasis as the presenting feature of cystic fibrosis

Neonatal cholestasis as the presenting feature of cystic fibrosis is rare. We reported a 2 and half months infant who presented neonatal cholestasis since 27 days of life. The punch biopsy of the liver showed signs of cholestasis. Serological tests revealed CMV infection; sweat test showed elevated chloride and confirm the diagnosis of cystic fibrosis. This patient developed a pulmonary pseudomonas infection. The outcome was fatal. Several etiologies may be involved in neonatal cholestasis and the presence of one does not preclude the other