Is there still a place for serum galactomannan in the diagnosis of invasive aspergillosis in children at high risk and under antifungal prophylaxis?

BACKGROUND: The performance of serum galactomannan (GM) for the diagnosis of invasive aspergillosis (IA) has been studied mainly in adults. Paediatric data are scarce and based on small and heterogeneous cohorts. OBJECTIVE: To evaluate the performance of serum GM for the diagnosis of IA in a paediatric oncologic population at high risk of IA and to clarify the impact of antifungal prophylaxis on this test. METHODS: We performed a retrospective study from January 2014 to December 2020 in the paediatric oncologic haematologic department of the University Hospital of Bordeaux. The diagnosis of IA was made using the recommendations of the EORTC and the MSGERC. RESULTS: Among the 329 periods at high risk of IA in 222 patients, the prevalence of IA was 1.8% (3 proven and 3 probable IA). In the total population, the sensitivity, and the positive predictive value (PPV) were respectively 50% and 17.6%. Under antifungal prophylaxis, the sensitivity and PPV dropped, respectively, to 33.3% and 14.3%. In this group, the post-test probability of IA was 2% for a negative serum GM and only 14%. CONCLUSION: In this large cohort of children at high risk of IA, the incidence of IA is low and the diagnostic performance of GM is poor, especially in the case of mould-active prophylaxis. Screening should be targeted rather than systematic and should be reserved for patients at highest risk for IA without mould-active prophylaxis. Combination with other tests such as Aspergillus PCR would increase the accuracy of GM in screening setting.

Neonatal salt wasting syndrome: Aldosterone synthase deficiency caused by a new splicing variant in CYP11B2.

Aldosterone synthase deficiency (ASD) is a rare autosomal recessive disorder involving isolated aldosterone deficiency without any compromise of other adrenal hormones. This condition manifests mainly in the neonatal period and in infants as a salt wasting syndrome with vomiting and failure to thrive. Due to its potentially life-threatening effects, ASD requires a careful and early diagnosis based on appropriate hormonal investigations in order to initiate adequate management: rehydration as well as salt and fludrocortisone supplementation. Genetic analysis of the CYP11B2 gene will confirm ASD in most cases. We report the case of a newborn with a typical clinical presentation associated with some uncommon phenotypic features (hyperhidrosis, liver injury). Furthermore, our patient carries a new CYP11B2 splicing variant to be added to the approximately 60 pathogenic or likely pathogenic variants already reported.

Neonatal toxic shock syndrome-like exanthematous disease: A French case series.

Neonatal toxic shock syndrome-like exanthematous disease (NTED) was first described in Japan in the 1990s. It results from the secretion of superantigenic toxins by Staphylococcus aureus. Diagnostic criteria include generalized macular erythema and at least one of the following three features: fever (>38°C), thrombocytopenia (<150,000/mm3 ), low positive C reactive protein (10-50 mg/L) in the absence of another known disease process. We herein describe four cases from France, involving both MSSA and "Geraldine" MRSA. This report aims to bring this underdiagnosed disease to the attention of pediatricians and infectious disease specialists, to improve the management of affected newborns.

When Stridor is Not Croup: A Case Report.

BACKGROUND: Croup is one of the most common causes of acute respiratory disorder in children. It presents as acute laryngeal symptoms in the context of viral infection. Treatment consists of systemic steroids and aerosolized adrenaline, after which the symptoms must resolve rapidly. There are many differential diagnoses, including neurological causes. In these cases, clinical presentation is atypical and the outcome can be less favorable. CASE REPORT: We present the cases of three children who presented with stridor, which was initially treated as croup but eventually turned out to have a neurological origin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians need to be aware of the differential diagnoses of croup. We suggest a few key points to help emergency physicians manage these patients, including adequate use of monitoring and nasofibroscopy. Early identification is a key element in the effective management of certain rapidly progressive neurological diseases.

The Effects of Eccentric Training on Biceps Femoris Architecture and Strength: A Systematic Review With Meta-Analysis.

OBJECTIVE: To determine the effects of an eccentric hamstrings strength-training program, performed for at least 4 weeks by healthy adults, on muscle architecture and eccentric strength. DATA SOURCES: A systematic search was performed up to October 2018 in the following electronic databases: PubMed, PEDro, CINAHL and SPORTDiscus. Combinations of the following search terms were used: eccentric strength training, eccentric loading, nordic hamstring, hamstring strength, fascicle length, pennation angle, muscle thickness, muscle architecture, biceps femoris long head, biceps femoris, and hamstring muscles. STUDY SELECTION: Included articles were randomized controlled trials that allowed comparisons between isolated eccentric strength training of the biceps femoris muscle and other programs. DATA EXTRACTION: Data from the included studies were extracted by 2 independent reviewers. These data included the study design, participant characteristics, inclusion and exclusion criteria of clinical studies, exercise and intervention characteristics, outcome measures, and the main results of the study. When meta-analysis was possible, we performed quantitative analysis. Ten randomized controlled trials were included. DATA SYNTHESIS: Limited to moderate evidence indicated that eccentric strength training was associated with an increase in fascicle length (mean difference [MD] = 1.97; 95% confidence interval [CI] = 1.48, 2.46), an increase in muscle thickness (MD = 0.10; 95% CI = 0.06, 0.13), and a decrease in pennation angle (MD = 2.36; 95% CI = 1.61, 3.11). Conflicted to moderate evidence indicated that eccentric hamstrings strength was increased after eccentric strength training compared with concentric strength training (standardized mean difference [SMD] = 1.06; 95% CI = 0.26, 1.86), usual level of activity (SMD = 2.72; 95% CI = 1.68, 3.77), and static stretching (SMD = 0.39; 95% CI = -0.97, 1.75). CONCLUSIONS: In healthy adults, an eccentric strength-training program produced architectural adaptations on the long head of the biceps femoris muscle and increased eccentric hamstrings strength.