[Cytomegalovirus pneumopathies in pediatric intensive care units]. / Pneumopathies à cytomégalovirus en réanimation pédiatrique.

BACKGROUND: Cytomegalovirus (CMV) infection can result in major complications in immunocompromised infants and children. CMV pneumonia may be difficult to diagnose and the true pathogenic role of the virus in the disease is not always clear. This report describes a cohort of 20 children who suffered from CMV pneumonia. POPULATIONS AND METHODS: Twenty children aged 1 month to 11 years 10 months were admitted to our intensive care unit between 1981 and 1990 because of pneumonia with evidence of CMV infection. They were classified into three groups: group I (cases 1-10) with hemopathy or cancer, group II (cases 11-14) with AIDS, and group III (cases 15-20): non immunodeficient or immunosuppressed children. CMV infection was diagnosed after isolation of CMV from bronchoalveolar lavage (BAL) fluid (15 patients), lung biopsy revealing intranuclear inclusions or CMV antigens, or CMV-positive cultures (four patients), CMV-positive urine cultures (one patient). RESULTS: Clinical manifestations and X-rays findings were unspecific; interstitial pneumonia was found only in immunodeficient patients. CMV pneumonia was diagnosed only in two patients on post mortem examination. Concomitant pneumocystis carinii was found on BAL in two patients (group I) and two others (group II). Thirteen patients required ventilation. Eleven patients were given ganciclovir for 2 or 3 weeks; one of them was given a single dose. This treatment was well tolerated. Mortality was 90% in group I, 100% in group II and 33% in group III. CONCLUSION: Ganciclovir did not appear to benefit the immunocompromised patients with CMV pneumonia. Future treatment should include hyperimmune CMV immunoglobulins plus ganciclovir. Careful hand washing is important for all those caring for these patients to prevent contamination as is the use of CMV-negative blood products.

[Late recurrence of supra- and infra-tentorial medulloblastoma]. / Rechute tardive sus- et sous-tentorielle d'un médulloblastome.

BACKGROUND: The vital outcome for treated medulloblastoma in children is generally positive provided there is no evidence of recurrence 18 months after initial surgery and radiotherapy. Late recurrences have, however, been reported. CASE REPORT: A medulloblastoma in the posterior fossa of a 10 year-old-boy was treated by almost complete surgical excision, radiotherapy and chemotherapy. One year later, the CT scan was normal but, 4 years after surgery, it showed supra-and infratentorial tumors. Progressive hydrocephaly required a ventriculoperitoneal shunt. 9 years after the initial surgery, progressive neurological degradation and the presence of cells in the CSF were treated by several courses of chemotherapy, with subsequent improvement of the neurological condition. This boy is in a stabilized condition 11 years after the discovery of the tumor. CONCLUSION: The first symptomatic recurrence of medulloblastoma was late, more than seven years after surgery. This recurrence was supra-and infratentorial and responded to non intensive chemotherapy.

[Isolated Candida albicans meningitis after treatment of B lymphoma]. / Méningite à Candida albicans isolée au décours du traitement d'un lymphome B.

A case of candida meningitis occurring in a child treated for a lymphoma is reported. Diagnosis was made with Candida albicans culture in the CSF. Blood cultures were negative. Cerebral CT scan was normal. No other localization was found. The child was successfully treated by amphotericin B (initially with 5-fluorocytosin). Fluconazole was continued orally later on. This case is noteworthy by the absence of other localization, the favourable evolution and its occurrence in childhood. The therapeutic attitude and prevention are discussed.

Alloimmune neonatal neutropenia.

In three neonates, the diagnosis of anti-NA1 alloimmune neutropenia related to maternal immunization against fetal polymorphonuclear leukocytes (PMN) antigens was achieved by serum antibody screening and PMN phenotyping. All the children were small for date and exhibited bacterial infection within days 2-13. Neutropenia persisted until days 20-50. High-dose intravenous immunoglobulin G (IVIgG) was ineffective. In one case, NA1-negative PMN collected from a normal donor were infused because of infection after thoracic surgery and resulted in a sharp but transient increase in PMN counts with resolution of infection. The natural history and the management of alloimmune neonatal neutropenia are discussed.

Recurrent enterocolitis-like symptoms as the possible presenting manifestations of neonatal Brucella melitensis infection.

A premature infant had three episodes of enterocolitis-like symptoms during the first three months of life. Brucella melitensis was isolated in a prolonged blood culture on day 85. The clinical manifestations disappeared under treatment and did not recur. A maternofetal transmission is suggested in this case. The importance of prolonged blood cultures when brucellosis is epidemiologically suspected is emphasized.

[Role of azlocillin in the treatment of Pseudomonas aeruginosa otitis in children]. / Place de l'azlocilline dans le traitement des otites à pyocyanique de l'enfant.

From May, 1978 to October, 1983, 88 children with otitis due to Pseudomonas aeruginosa were seen at Paediatric Unit E.N.T. consultation of the University Hospital of Tours. Epidemiologically, it is worth mentioning that the majority of these infections was not of nosocomial origin: 56 children were infected outside the hospital and 26 during their stay in hospital; 3 neonates were referred directly from the Maternity Unit. Most strains of Ps. aeruginosa, with various serotypes, were sensitive to azlocillin. Twenty-four children received a systemic treatment required by their local or general condition. Azlocillin was used in 24 cases on the basis of positive sensitivity tests and was occasionally combined with topical treatment using antiseptics or the antibiotic itself. Or the 3 failures observed, 2 were due to acquired resistance to azlocillin and 1 to chronic otitis. An incomplete result was obtained in a case of otitis externa caused by a strain of intermediate sensitivity. The remaining 19 cases were cured, including 3 neonates with otitis externa or media, 1 child with otitis externa, 1 with combined otitis externa and media, 10 with otitis media, usually protracted, 2 with mastoiditis medically cured and 1 with superinfection following mastoidectomy for cholesteatoma. Secretions dried up within 3 to 4 days and treatment was discontinued after clinical cure was obtained in 9 to 19 days. Fever, which was present in 7 cases, abated within 2 to 8 days. The only relapse that occurred, one month after treatment of an otitis media, responded to a second course of azlocillin.