[Clinical features of rotavirus infections: influence of child age on clinical manifestations]

The aim of the present study was to describe clinical features of rotavirus infections in children and to compare the observed symptoms according to the age of the patients. Clinical files of 278 rotavirus-positive children under 5 years of age were retrospectively examined. The presence of group A rotavirus antigens in stool samples collected from children was detected by direct sandwich enzyme-linked immuno-sorbent assay. Pearson's correlation tests were used to determine the relationship between each clinical sign noticed and patients' age. Among the 278 rotavirus-positive children, 93.9% presented with diarrhea, 79.1% vomiting, 71.6% fever, 37.4% respiratory troubles, and 33.1% neurological signs. Intravenous rehydration was needed for 59.7% of the children. The comparison of clinical signs according to the age showed that diarrhea [p = 0.001], vomiting [p = 0.007], fever [p = 0.045], respiratory troubles [p = 0.01] and dehydration [p<0.001] were significantly more frequent in infants of 1 to 24 months old. The severity of rotavirus illness seems to be directly influenced by child's age. Interestingly, infants of 1 to 5 years old often presented with disease as severe as babies of 6 to 24 months old

[Invasive infections neisseria meningitidis in children in Tunis: about 79 cases]

We conducted a retrospective study of meningococcal invasive diseases [MID] contracted in children in Tunis between January 1997 and January 2006. The purpose of this study is to specify the clinical, epidemiological, therapeutic and evolutionary features of these infections and to determine antimicrobial susceptibility and the antigenic formula of N. meningitidis isolates. During the study period, we have collected 79 cases of MID arising in children aged 3 days to 11 years. The majority of children's were less than of 4 years [57.3%]. We note a frequency of the MID in winter and in spring. The most frequent clinical shape was meningitis [53%]. Twenty one patients [26.6%] had a fulminant meningococcal disease. In our series, the rate of lethality was equal to 17.7%. Among the 46 meningococcal isolates, the most frequent serogroup was the B [73%] followed by C and A. A high heterogeneousness of the antigenic formulae was observed. The most frequent phenotype was NT: NST for the group B isolates and 4:P1.13 for the group C ones. N. meningitidis with reduced susceptibility to penicillin and to amoxicillin account for 54% and 10% of all isolates respectively. The cefotaxim and the rifampin were uniformly active

[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

[ anomalies des arcs aortiques etude de 7 cas]

Anomalies of the aortic arch and the great vessels emerging from the heart are rare. We report here seven cases: double aortic arch [three cases], compressive arterial brachiocephalic trunk [three cases] and retroesophageal right subclavian artery [one case]. The anomalies of the aortic arch were associated to cleft palate in one case and to Klippel Feil syndrome in an other case; this association was never been reported to the best of our knowledge. Surgical treatment was indicated in five cases and was performed in two cases with favourable outcome. One patient died

[Pseudohypoaldosteronism type I: systemic form]

Pseudohypoaldosteronism type 1 [PHA1] is a rare condition characterized by renal insensitivity to the action of mineralocorticoids. Patients manifest neonatal salt wasting, hyperkalemia, and metabolic acidosis despite elevated aldosterone levels. Autosomal recessive and dominant or renal forms of the disease have been described. In the recessive form, patients have salt wasting from the kidney, colon, sweat, and salivary glands; because of dramatic volume depletion, patients require massive sodium supplementation throughout life. We report a case of a one month and three weeks old who presented a systemic type 1 pseudohypoaldosteronism

[Cardiovascular disorders in Kawasaki disease: results of a Tunisian collaborative study]

Kawasaki disease [KD] is the first cause of cardiopathy acquired by children in developed countries. The aim of this study is to find out, in a precise way, the epidemiological, clinical and evolutionary aspects of the cardiovascular disorders in the Kawasaki disease and to determine their potential risk factors. It is a multicenter retrospective study conducted over the laps of 10 years [1007-2006] and which was a subject of interest for five hospital-university pediatrics services, during which the total of 29 observations of KD including 16 boys and 13 girls whose ages ranged between 6 months and 12 years [average age = 4 years] were analysed. The cardiovascular disorder was noticed in 11 cases [37, 93 per cent]. It consists in a myocarditis in 4 cases, a pericarditis in 1 cas and an endocarditis in 1 other case. The coronary artery problem [6 cases] from 54, 54 per cent of the cardiovascular disorders and 20, 68 per cent of the total number of patients. The diagnosis of the coronary disorders was made between 7 and 90 days [average 24 days]. Asai score was not correlated at the risk of appearance of coronary aneurysms. 5 patients out of 6 had received veinoglobulins and 3 of them before the 10[th] day of the disease evolution. The evolution was favourable in 4 cases who developed anevrysms under 8 mm. The 2 patients with multiple and huge anevrysms were complicated with a thrombosis and myocardial ischemia in 1 case and with stenosis of the left interventricular in the other. The cardiovascular disorder in the KD is dominated by the anevrysmal coronary disorder. This conditions the short term prognosis and causes the later complications

[Subdural empyemas complicating listeria monocytoenes meningitis in an immunocompetent infant]

Empyemas complicating Listeria monocytogenes meningitis is a rare event in immunocompetent children, beyond the neonatal period. We report a case of Listeria monocytogenes meningitis in a 15-month-old-girl. Magnetic resonance imaging showed subdural empyemas. Specific treatment was established with ampicillin for six weeks. The outcome was favourable

[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

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

A severe illness of a congenital cytomegalovirus infection

Congenital cytomegalovirus [CMV] infection occurs in about 1 per cent of newborns and 10 per cent of them exhibit symptomatic infection. Nervous system damage influences prognosis and newborns management. We report the case of a newborn with a s6vere and progressive congenital CMV infection. He was admitted because of petechiae and thrombocytopenia. Investigations of the newborn showed a bilateral optic atrophy, severe nervous system damage with hydrocephalus, enormous periventricular pseudocysts and cerebellum hypoplasia. No brain calcifications were found. Diagnosis relied on blood CMV viral load measurement in both the newborn and his mother. The newborn received Ganciclovir. Hydrocephalus progressed and required ventriculoperitoneal shunt placement. This case illustrates that pseudocysts and progressive hydrocephalus must suggest CMV congenital infection even not associated to brain calcifications. Nervous system damage is serious in congenital CMV infection and requires a systematic screening during pregnancy

[Pleural effusion with pneumonia caused by Neisseria meningitidis C: a case report]

Pleural effusion with pneumonia is an uncommon manifestation of Neisseria meningitidis infection. We report the case of a 3-year-old child who presented a one week fever and abdominal pain. Chest X ray showed pleural effusion with lung condensation. The outcome was favourable with antibiotics

[Acute poisoning in the pediatric service at the infant hospital of Tunis. report of 325 cases]

We reported a retrospective study concerning 325 cases of acute poisoning in the pediatric service at the infant hospital of Tunis during a period of one year from 1 January to 31 December. The aim of this report is to evaluated the epidemiologic, clinical and evolutive aspects. They were 194 boys and 131 girls. 60 per cent of the infants are aged under 3 years. The chemical products occupied the first place with 153 infants [49.7 per cent], the inhalation of petroleum represented 62 cases, the water of javel 58 cases. The medicines occupied the second place with 128 infants [39 per cent]. The evolution was favourable in 277 infants [85 per cent]. 12 patients [3.6 per cent] are presented a pneumonia after inhalation of petroleum. In 4 patients [1.2 per cent], we constated a caustic oesophagitis. One case of death was occurred in a patient with medicinal polypoisoning.The prevention stays the better way to fight this phenomenon

[ dyschondrosteosis case]

Dyschondrosteosis is a general disease with a dominant transmission. It is of late discovery ever in the birth. Most frequent at the girl. Clinically it associate an incapacity staturale moderate and deformation of members with the infringement elective of the average segment of the front arm and leg. The gene incriminate in the genese of the disease is the SHOX gene. Its exist in the pseudo-autosomic commun region of chromosom X and Y in X pter-p. 22-3 and Y pter-p. 11-2.. The nature of the disorder is a mutation or a deletion infringement. Prognosis is favorable not justifying mostly any treatment. The radial osteotomy is indicate in case of confusion functional. We bring back an observation of a dyschondrosteosis case

[Triplo X: about an observation]

Triplo X is a gonosomal disorder. The incidence in the new-born population is approximately 1 per 1000 female infants. The origin of the extra X are scanty although it seems to be mostly maternal. It result from a non disjunction at meiotic division. There is not a special dysmorphie face; we found a large size, mental retardation with difficulty of training of the language. Fertility present in many cases. The diagnostic is carried by the survey of the caryotype. We bring back an observation of triplo X case