[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

randomized, controlled trial of nebulized 5% hypertonic saline and mixed 5% hypertonic saline with epinephrine in bronchiolitis

Bronchiolitis is a public health problem in the word and in Tunisia. Nebulized hypertonic saline seems to have some benefits in bronchiolitis. The aim of this study is to evaluate the efficacy of nebulized 5% hypertonic saline alone or mixed with epinephrine in bronchiolitis as measured by improvement in clinical score, oxygen saturation or reduction in duration of hospitalization. This prospective, double blind, placebo controlled, randomized clinical trial was performed at Children's Hospital of Tunis from February 2012 to Mars 2012. A total of 94 patients less than 12 months of age with diagnosis of moderately severe bronchiolitis were enrolled and assigned to receive 5% nebulized hypertonic saline, mixed 5% hypertonic saline with standard epinephrine 0,1% or normal saline [placebo] at admission and every 4 hours during hospitalization. There were no significant difference between nebulized 5% hypertonic saline, mixed 5% hypertonic saline with epinephrine or normal saline at baseline, T30 min, T60 min, and T120 min after start study in Wang severity score, oxygen saturation in room air, rate respiratory and heart rate. There was no difference in duration of hospitalization. Nebulized 5% hypertonic saline or mixed 5% hypertonic saline with epinephrine are safety but does not appear effective in treating moderately ill infants with the first acute bronchiolitis

[Skin sensitization to aeroallergens in the child: cross-sectional study of 200 cases]

The prevalence of the allergic diseases increased considerably during the last decades. The clinical expression of allergy depends on the interaction of genetic and environmental factors. The aim of our study was to evaluate the prevalence of sensitizing to aeroallergens in the child and to determine the risk factors of sensitizing. We carried out a cross-sectional study relating to 200 pediatric patients of the Mahmoud El Matri hospital, aged from 3 to14 years. We performed skin prick test to 12 current aeroallergens. The prevalence of sensitizing to aeroallergens was 14%. Acarina [DP and/or DF] represented the allergens accused in the majority of the cases [96,4% of the cases]. The statistical analysis of the various risk factors of sensitizing showed that these factors were: the presence of a family atopy [p= 0,0034] particularly a maternal asthma [p< 0,001], the personal atopy specially an asthma, an allergic rhinitis or eczema atopic [p< 10-5], the short breast-feeding [p= 0,033] and the home humidity [p=0,0072]. Several risk factors reported in the literature did not seem to intervene in our study [the passive smoking, the urban dweling, the age of food diversification, infections at the low age]. The prevalence of sensitizing to aeroallergens is relatively high in our series. Many factors could explain the increase of the allergic diseases. Our study stresses the importance of the genetic, nutritional and environmental factors in the appearance of aeroallergens sensitization

Utility of lumbar puncture for febrile seizures among infants under one year old.

Febrile seizure is a frequent cause of hospitalization. Its management remains problematic According to the American Academy of Pediatrics, lumbar puncture, which is not devoid of risk, is strongly recommended in infants under 1 year. To define the utility of lumbar puncture in the management of febrile seizures in infants under 12 months and to identify risk factors of meningitis and to respond to this question: " lumbar puncure should be done in which infant with febrile seizure?" This retrospective study was conducted in the department of pediatrics B in the Children Hospital of Tunis on eight-year period [2000-2008]. In all statistical tests, significance level was set at 0.05. One hundred and six cases were collected during the period of study. Seizures related to bacterial meningitis were seen in 11 cases [10%]. We have separated two groups: GI infants presented bacterial meningitis, and G2 infants with febrile seizure. The comparison between the two groups G1 and G2 showed the following predictors factors of meningitis: age 5mm [p<0.001], recurrence of seizure in the same day[p=0,006], neurological abnormalities p<0.001], CRP>20 mg/1[p=0.03], hyponatremia

Marfan syndrome in a Triplo-X girl: a new association?

Triple X is a sex chromosomal abnormality that involves the presence of three sex chromosomes resulting in 47, XXX karyotype. Most patients suffering from this syndrome are usually mentally normal or subnormal with no gross malformation. To report an unusual association between Triple X and Marfan disease in a girl. A case of a triple X girl with craniofacial dysmorphy and skeletal anomalies, who did feat Marfan criteria by age, is presented. To the best of our knowledge this association has never been reported. Some clinical features are common between Triplo X and Marfan disease so a careful follow-up is needed and investigations should be performed in these patients because Marfan syndrome may be incomplete in early age

[Mediastinal tuberculosis mass in a three-month-old boy]

Mediastinal mass of tuberculous origin is exceedingly rare in infant. To report an exceedingly rare case of mediastinal mall of tuberculous origin. We report a three-month-old boy who presented a one month history of wheezing a persistent pneumopathy. Radiological investigations showed a large posterior mediastinal mass which infiltrates lungs. Thoracoscopic biopsy showed caseous necrosis with granuloma suggestive of tuberculosis. The outcome was favourable with antituberculous chemotherapy. Mediatinal mass of tuberculous origin should be considered in differential diagnosis of mediastinal masses in children; be suggested in mediastinal mass in children

[Congenital cutaneous candidiasis associated with respiratory distress in a full-term newborn]

Congenital candidiasis is rare occurring in most cases in premature and low birth weight new born. It can produce a spectrum of disease ranging from a diffuse skin eruption to a severe spectrum of disease with or without skin involvement. Amphotericin B is the first-line agent for the treatment of systemic disease. To describe a congenital candidiasis in a full-term new born. At birth, the newborn had a generalized, erythematous, papulovesicular eruption. He was treated by topic antifungal therapy. However, on the third day, he developed a systemic disease with respiratory distress and fever. Ear, skin swab and gastric aspirate grew to Candida albicans. The new born was given fluconazole for 10 days with favourable outcome. Early topic therapy did not prevent systemic spread of congenital cutaneous candidiasis in our case. Treatment with fluconazole, as the first- line agent, seems effective and safety

Unusual case of thiamine responsive megaloblastic anemia

Thiamine responsive megaloblastic anemia syndrome is a rare autosomal recessive disorder defined by the occurrence of megaloblastic anemia, diabetes mellitus, and neurosensoriel deafness, responding in varying degrees to thiamine treatment. Report an unusual case of this rare disorder. We report the case of a four-year-old boy who presented unusual features of thiamine- responsive megaloblastic anemia. In addition to the typical triad of the syndrome, he presented leuconeutropenia, hepatosplenomegalia, cardiac abnormalities including absent P waves, mitral and tricuspid insufficiency, retinitis pigmentosa, nystagmus, developmental delay and a brain Magnetic resonance imaging ischemic lesion. Lactate levels in serum and the lactate/ pyruvate ratio were increased. The mitochondrial mutation m.3243A > G located in MTTL1 gene encoding for transfer RNA leucine [tRNALeu[UUR]] was not found. Treatment with thiamine resulted in normalisation of the haemoglobin level, white cell count, and glucose and lactate levels. On three years follow up, the patient did not need insulinotherapy. These data sign the crucial role that thiamine plays for many cells and tissues and its importance in the activity of the respiratory chain

[ randomized, controlled trial of nebulized terbutaline in the first acute bronchiolitis in infant less than 12 months old]

Despite the common clinical practice, the available evidence on the efficacy of bronchodilators therapy for bronchiolitis is conflicting. The aim of this study is to evaluate the efficacy of nebulized terbutaline in bronchiolitis as measured by improvement in clinical score, oxygen saturation or reduction in duration of hospitalization. This prospective, double blind, placebo controlled, randomized clinical trial was performed at Children's Hospital of Tunis from December 2004 to April 2006. A total of 35 patients less than 12 months of age with diagnosis of moderately severe bronchiolitis were enrolled and assigned to receive nebulized terbutaline or normal saline placebo at admission [TO], at 30 minutes after admission [T30] and every four hours during a study period. Outcome measurements included: Respiratory Distress Assessment Instrument [RDAI] score, respiratory rate, oxygen saturation, heart rate and the duration of hospitalization. There were no significant difference between terbutaline and placebo at baseline, T30 min, T60 min, and T120 min after start study in RDAI score, oxygen saturation in room air, rate respiratory and heart rate. There was no difference in duration of hospitalization. Nebulized terbutaline therapy does not appear effective in treating moderately ill infants with the first acute bronchiolitis

[Community acquired pneumonia in children]

Community acquired pneumonia is responsible for a high morbidity in children. The etiological diagnosis is not always easy and treatment remains probabilistic. To analysis clinical patterns and the outcome of community acquired pneumonia and to find arguments in favour of its origin. A prospective analysis of the files of 39 children [20 boys, 19 girls] hospitalized between [1 December 2004-30 June 2005] for community acquired pneumonia was performed. Included children whad between 6 months ad 15 years-old. The mean age was of 3 years and three months. Germ was identified in 41%of cases: Mycoplasma pneumoniae was the most important germ found in9 cases, pneumococcus was found in 4 cases and hemophilus in four cases. Coinfection pneumococcus and mycoplasma were found in two cases. None virus was identified. We have separated two groups: bacterial pneumonia and pneomoniae without definite etiology. Fat cough was associated to bacterial pneumonia mycoplasma pneomoniae was significantly associated with high fever and dry cough. We haven't found any others associations between clinical, biological or radiological patterns and the two groups of pneumonia. C-reactive protein more than 66 mg/I has sensitivity of 77%, specificity of 73.3%, positive predictive value of 46.7 99 of and negative predictive value of 91.7%. The outcome was favourable in all cases. Theses results showed the necessity to improve our microbiological methods to identify infectious agents of pneumonia. Mycoplasma pneumonia seems to be a frequent germ in preschool children

Infantile onest of cockayne syndrome without photosensitivity in a Tunisian Girl

Cockayne syndrome is a rare autosomal recessive disorder with dwarfism, mental retardation, and otherwise clinically heterogeneous features. Classically, the onset of Cockayne syndrome starts in the second year of life. The failure of RNA synthesis to recover to normal rates after UV-C irradiation provides a useful diagnostic test and the clinical feature that correlates most strongly with defective RNA synthesis is photosensitivity. To report an unusual case of Cockayne Syndrome. A case of a five-year-old girl with Cockayne with an onset in early infancy the girl and without photosensitivity is presented. The diagnosis was confirmed by the failure of RNA synthesis to recover to normal rate after UV-C irradiation. The patient died at the age of 6 of pneumonia. Although rare, Cockayne syndrome may be presented without photosensitivity and had an early onset

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

kyste hydatique du poumon chez l'enfant a propos de 54 cas

The purpose of this retrospective study is to clarify the clinical, radiological and evolutionary aspects of the hydatid cyst of the lung. Over a period of 9 years [January, 1983 - December, 2001], we brought together in the pediatric service B of Children's hospital of Tunis, 54 cases of hydatid cyst of the lung. The average age is of 7 years 3 months [extremes 2 and 14 years], and the sex- ratio of 1, 16. 61% of the children are of rural origin. Bronchpulmonary infection is the most frequent circumstance of discovery [72% of cases], hemoptysis is revealing in 37% of cases. Discovery is fortuitous in 7% of cases. The radiography of the chest is of a big diagnostic contribution. The radiological aspects obtained are: a homogeneous opaqueness [61%], a diverse opaqueness [26%], an image of lung abscess [22%], an aspect of floating membrane [4%], a pleural effusion [9%], and an opaqueness with growing gas [4%]. Chest echography was contributory in 77% of cases. 74% of the children were operated without complications. The others were lost