Early neonatal infection caused by Streptococcus pneumonias: report of 3 cases

S pneumoniae is a rare cause [1-8%] of maternofetal infection causing an important morbi-mortality in the newborn and the mother. To report 3 cases of early neonatal infection due to S pneumonia. Three cases of early neonatal infection due to S pneumoniae are reported. The three newborns were at term or near term babies with a vaginal delivery in two cases and a caesarean section in one case. They presented severe symptoms, with a progressive onset after birth, leading to hypoxemic pneumonia in one case and to septic shock in two newborns associated with meningitis in one case. S pneumoniae was isolated in the blood culture in two patients with positive soluble antigens in the cerebrospinal fluid in one case and positive peripheral bacteriological swabs in the other case. In the third case, S pneumoniae was isolated in the tracheal sample of the newborn and his mother. S pneumoniae was sensitive to ampicillin in two patients and of decreased sensitivity to ampicillin in one patient. The clinical course was favourable in the three patients after hospitalization in the intensive care unit. Early neonatal infections caused by S pneumonia are rare and are an important cause of morbi-mortality in the newborn and the mother

Management of purpura fulminans about 21 cases: diagnostic delay and therapeutic problems

To evaluate the diagnostic delay and therapeutic insufficiencies delay before the transfer in ICU of the children admitted in the ICU of the children's hospital of Tunis with a purpura fulminans [PF] A retrospective, descriptive study, of children with PF referred between January 2000 and January 2006 to a the paediatric intensive care unit [PICU] of the children's hospital of Tunis. The PF diagnosis was retained in any child presenting a feverish purpura and circulatory insufficiency signs. The optimal diagnostic and therapeutic charge taking was defined in three levels: parental, the first line doctors, and the hospital doctors. The symptoms' duration and the various treatments which were lavished to the patients were taken from the medical observations of the patients transferred in our PICU. Twenty one observations were collected. Twelve patients [57,1%] were addressed by a doctor exerting in a dispensary or by a free practicing doctor, 5 patients [23,8%] were transferred from a regional hospital and 4 children [19,1%] directly consulted the children hospital of Tunis urgencies .delayed parental recognitionoccured in 11 children. The PF diagnosis was not evoked by the first line doctor in 62%. Eleven [52,4%] of the children with meningococcal disease were seen but not admitted by a doctor in the 48 hours before admission. Apart from 2 patients [9,5%] who were hospitalized in reanimation directly of the urgencies, all the other patients forwarded by a general pediatry service. In general pediatry, the PF diagnosis was not evoked in 3 cases [15.8%], 31,6% of patients had unnecessary a lumbar punctures and shock was not recognised or treated in 26,3%. Twelve patients [52,2%] died. The duration of hospitalization in general pediatry is significantly higher among deceased patients [5,5 +/- 6,6 hours] than among the surviving patients [2,6 +/- 1,5 hours]; p<0,5. Suboptimal treatement in PF is due to failure of parents, general practioners and hospital doctors to recognise specific features of the illness. Improvement in outcome could be achieved by public education and better training of clinicians in recognition, resuscitation, and stabilisation of seriously ill children