[Community-acquired pleuropneumonia in children: bacteriological and therapeutic challenges]

Background: Community-acquired pleuropneumonia [CPP] is a common complication of pneumonia in children. It is serious given its high morbidity and significant mortality

Aim: To study clinical and paraclinical features of CPP in children and to establish a common therapeutic strategy

Methods: Our retrospective study included patients who were hospitalized for CPP between 2004 and 2012. All data were collected from patients' medical files. Statistical analysis was made by Epi-Info 6

Results: One hundred and sixty four patients were registered. The mean age was 32 months [15 days - 14.5 years]. The hospital incidence of CPP doubled between 2004 and 2012. The symptomatology was dominated by fever [93.9%], cough [56.7%] and dyspnea [48.1%]. The pleural effusion was frequently moderately abundant and loculated. Pleural sample, performed in 53.6% of cases, was the most beneficial bacteriological examination [p=10-6 ]. The bacteriological confirmation was attained in 44.5% of cases with the predominance of Staphylococcus aureus [59%] followed by Streptococcus pneumoniae [26%]. The S. aureus occurred basically in most young infants [p=0.04] and was responsible for the most severe cases [p=0.01]. The CPP management included heterogeneous intravenous antibiotics associated with a pleural drainage in 40% of cases. The quarter of our patients were transferred to an intensive care unit. Six patients died

Conclusion: The bacteriological confirmation is difficult. Pleural aspiration is the key tool. S. aureus is the first microorganism followed by S. pneumoniae. A therapeutic strategy is proposed based on large spectrum intravenous antibiotics. The pleural drainage indication is limited

[Pediatric Crohn's disease in Tunisia]

Crohn's disease occur mainly in adults. However, pediatric onset forms are not rare and have many characteristics.To study clinical, diagnostic, therapeutic and evolutive characteristics of crohn's disease in tunisian children. Retrospective multicenter study conducted in 10 pediatric departments on a period of 10 years [2000-2008]. 43 children were included. The sex-ratio was 1.68. The mean age at the onset of the symptoms was 11 +/- 2.3 years [5-16 years]. The age of onset was inferior to 10 years in 25% of the children. The delay before management was superior to 1 year in 25% of cases. The initial symptoms were dominated by diarrhea [95%]. Perineal manifestations were present at diagnosis in 30% of children and extra-digestive manifestations in 53%. Ileocolonic localization was the most frequent [46%]. The initial disease flare was moderate in 83% of cases. The treatment was medical in 77% of cases, nutritional and medical in 18.5%. Maintenance therapy was instituted in 86% of cases and consisted essentiallay in azathioprin [62%]. The mean follow-up was 3 years and 4 months. 60% of the children had at least one acute flare. During evolution, 7% of children had anoperineal surgery and 11% an intestinal resection. Crohn's disease seems rare in Tunisia. The time of diagnosis is often delayed. The management is based on immunosuppressive therapy and nutritional support

Extra pulmonary tuberculosis in children: a study of 41 cases

Extrapulmonary tuberculosis accounts for up o one third of all cases of tuberculosis and children show a higher predisposition to the development of extra-pulmonary tuberculosis. To review the clinical features of the extrapulmonary tuberculosis in children. Forty one children with extrapulmonary tuberculosis followed in the Children Hospital of Tunis between January 1995 and December 2007 were reviewed. Extrapulmonary tuberculosis constitutes 57.9%of all cases of tuberculosis. Male to female ratio was 0.7 and the mean age was 75 years. The most commonly involved sites were the peripheral lymphadenitis [14 cases] followed by abdominal [11 cases], central nervous system [7 cases], osteoarticular [5 cases] and multifocal [4 cases]. A positive family history of active tuberculosis was detected in 22.5%of the cases. Diagnosis delay was 4.7 months. Sequelae observed during the follow up were: neurosensory in 5 cases, and vertebral deformation in 1 case. Extrapulmonary tuberculosis represents an important fraction of tuberculosis in our study. The most common form is lymph nodes localization followed by abdominal and central system nervous forms. Neurosensory sequelae were frequent in central system nervous tuberculosis

[Aetiologies and outcome of bronchiectasis in children: a study of 41 patients]

Bronchiectasis remains an important cause of chronic suppurative lung disease in the developing world. This study is to describe the epidemiological characteristics, clinical features, underlying aetiologies and Outcome of bronchiectasis in the paediatric hospital of Tunis. A retrospective study of 41 children with bronchiectasis was conducted between January 1994 and December 2006. Diagnosis was made in patients with clinical suspicion of bronchiectasis associated with abnormalities on chest X ray [n=37] and/or on high resolution computed tomography [HRCT] [n=36]. Mean age at diagnosis was 5 years 9 months; [range: 6 months-14 years]. Persistent cough and bronchorhea were the most common symptoms. Fourteen patients [34%] had dyspnoea on first presentation, 11 of them [26.8%] had chest deformation and/or finger clubbing. Haemoptysis was noted in only two cases. Mean time to diagnosis from symptom onset was 2.7 years [range: 2 months- 4 years]. The underlying aetiologies were identified in 52% of patients. Cystic fibrosis [17%], previous pneumonic illness [9.7%], primary ciliary dyskinesia [9.7%] and immunodeficiency [9.7%] were the most common causes. After a mean follow-up of 6.6 years, the annual lower respiratory infection rate decreased from 7.2 +/- 3 to 3.1 +/- 2.6 [p<0.05], Twenty one point nine per cent of patients had chronic respiratory failure and five patients required surgery. Delays diagnosis of bronchiectasis remains important in our country. Congenital and indeterminate aetiologies are the most common forms. Prognosis is poor with a high prevalence of chronic respiratory failure

[Chronic septic granulomatosis in children revealed by invasive pulmonary aspergillosis]

Chronic granulomatosis disease [GCD] is a hereditary abnormality of phagocytic cells, frequently revealed by invasive pulmonary Aspergillosis. The authors report the case of 8 year old girl investigates for hypotrophia, recurrent lung disease and hemoptysia. She was treated for pulmonary tuberculosis because of biological inflammatory syndrome, right alveolar, opacity and positive tuberculin skin test. The course was marked by the development of a thoracic wall mass. Anti- aspergillus serology was positive; culture of the thoracic mass puncture and bronchoalveolar lavage isolated fumigatus Aspergillus. GCD was suggested and confirmed by the NBT test