[Imported malaria in children in France]. / Paludisme d'importation de l'enfant en France.

UNLABELLED: Among the European countries, France is the most affected by imported malaria. The aim of this study was to take stock of the situation of imported malaria in children in France. METHODS: Attacks of malaria in children less than 15-year-old which have been notified to Centre National de Référence des Maladies d'Importation (CNRMI) were reviewed retrospectively between 1995 and 1997 and 1995 and 1998 for severe malaria. RESULTS: Over a period of 3 years, 1256 malaria attacks were notified in children including 90.9% without signs of severity. The mean age was 7 years. Sex ratio was 1.19. About 44.5% were French. Most of the cases were acquired in Africa. Plasmodium falciparum was involved in 79.2% of the cases. About 61.8% of children have been under prophylaxis but only 37.9% admit good compliance. Chemoprophylaxis was frequently inadequate. Halofantrine was prescribed for 76% of these children. Over a 4-year period, 51 children were notified as severe malaria attacks. Among them, 17 had severe malaria as defined by the World Health Organisation criteria. Most of these patients (73%) were treated by quinine by intravenous route. Two children died. CONCLUSION: Paediatric malaria is not rare in France. Only the improvement of prophylaxis could decrease the incidence of malaria in France.

A secondary respiratory chain defect in a patient with Fanconi-Bickel syndrome.

A North African boy, the son of consanguineous parents, presented at 8 years of age with hypophosphataemic rickets due to De Toni-Debré-Fanconi syndrome. Hepatomegaly and abnormalities of carbohydrate metabolism were suggestive of Fanconi-Bickel syndrome. This was confirmed by the detection of a mutation within GLUT2, the gene encoding the liver-type facilitative glucose transporter. The study of the respiratory chain revealed a deficiency of complexes I, III and IV in muscle. Mechanisms responsible for an impairment ofmitochondrial function, which we interpret as a secondary phenomenon, are discussed.

[Severe cutaneous Streptococcus pyogenes infections in the child: results of a multicenter survey]. / Infections cutanées sévères à Streptococcus pyogenes chez l'enfant: résultats d'une enquête multicentrique.

UNLABELLED: To assess pediatric cases of severe cutaneous infections due to Streptococcus pyogenes. Since the beginning of 1980, the incidence of cellulitis and necrotizing fasciitis due to S. pyogenes has increased in adults. Serotyping of obtained isolates are in most cases M1, M3 or M5 protein. PATIENTS AND METHOD: A retrospective (1990-2000) survey was carried out in pediatric hospital centers. RESULTS: Three cases of necrotizing fasciitis and 15 of cellulitis were observed. In 30% of the cases, vancella lesions were associated; in the other cases, minor wounds were the site of the infection. Bacteriologic diagnosis was made by local samples in 14 cases; blood cultures were positive in four cases. In 11 cases, initial intravenous treatment consisted of third generation cephalosporin, in six cases of penicillin M or G and in one case of fusidic acid. In the second time, penicillin M was perfused in the majority of the cases. Mean duration of intravenous antibiotics perfusion was 15 days. There were no sequelae or death in this survey. CONCLUSIONS: Despite this study had limited epidemiological characteristics, it confirms that these two infections are rare. The frequency is probably underestimated, due to the difficulty in performing a diagnosis. The major site of infection was the varicella lesion. These two infections are so similar that it is frequent to mistake one infection for the other. Nonsteroidal anti-inflammatory drugs and site of infections did not influence prognosis. The treatment of cellulitis is penicillinotherapy whereas in necrotizing fasciitis early major surgery is often correlated with the rate of survival.

-Vaccination against hepatitis A-. / Vaccination contre l'hépatite A.

A pediatric form of hepatitis A vaccine is available with an immunization schedule of three injections within one year followed by booster injections every 10 years. This schedule gives a marked elevation of protecting antibodies and has a good protective effect against the symptomatic forms of hepatitis A. The vaccine is administered intramuscularly in the deltoid and is usually well tolerated. Major changes have occurred in the epidemiology of hepatitis A in France in the last decades. While many children were affected 20 years ago, hepatitis A is nowadays essentially observed in adolescents and young adults, although there remain symptomatic cases, with very few fulminating cases, among children. Considering the low risk of symptomatic cases, the usefulness of a systematic immunization against hepatitis A in children is questionable, with the exception of polytransfused children and handicapped children living in community. For the travelling children, hepatitis A immunization must be decided according to the travel conditions and the epidemiology of hepatitis A in the visited country.

Metabolism of quinine in children with global malnutrition.

Malnutrition and malaria are two important public health problems in Africa. Quinine is one of the major treatments of chloroquine-resistant malaria. Although some authors have shown that quinine clearance is decreased in kwashiorkor, this type of malnutrition is caused by protein deficiency that differs from global protein-energy malnutrition. In rats, hepatic metabolism of many drugs is decreased in protein deficiency and increased in global food restriction. Several studies have found that human hepatic metabolism of many drugs is decreased in kwashiorkor, but, as yet, no study has focused on human global energy-protein malnutrition. Thus, as quinine is a drug with a narrow therapeutic index, we compared the pharmacokinetics of quinine in two groups. One group included children with global malnutrition and the other was a control group of children with normal nutrition. Volume of distribution and plasma concentrations of unbound quinine did not differ between children with global malnutrition and children with normal nutritional status. Clearance was significantly faster, half-life shorter, and concentrations, 12 h after the beginning of treatment, lower in malnourished children compared with control subjects. The ratio between area under the curve of hydroxyquinine (metabolite of quinine in man) and area under the curve of quinine was significantly increased in malnourished children and correlated with mid-arm/ head circumference ratio (marker of malnutrition in children). Thus, as metabolism of quinine is increased in children with global malnutrition, we suggest that the administration interval should be reduced in these children to obtain the same plasma concentrations of quinine found in normally nourished children. A safe and effective dosing strategy is postulated.

[Comparative study of nebulized sambutol against placebo in the acute phase of bronchiolitis in 33 infants aged 1 to 6 months]. / Etude comparative des nébulisations de salbutamol contre placebo à la phase aiguë d'une bronchiolite chez 33 nourrissons de 1 à 6 mois.

BACKGROUND: The therapeutic role of bronchodilators in bronchiolitis remains controversial. The aim of this study is to evaluate the safety and the clinical response to nebulized salbutamol in infants with mild acute bronchiolitis. PATIENTS AND METHODS: Thirty-three infants, aged 1 month to 5 months and 22 days (mean: 92.4 days) were included in the study. Patients received either nebulized salbutamol (0.15 mg/kg per dose: 16 infants) or a placebo (normal saline aerosol: 17 infants), delivered by an oxygen propellent, three times at intervals of 1 hour, as part of a double-blind randomized trial. Effect of treatment was evaluated by measuring respiratory and heart rate, clinical scores based on the degree of retraction and wheezing, and oxygen saturation. Clinical assessment was repeated 30 minutes after each nebulization. A nasopharyngeal swab was obtained for detection of respiratory syncytial virus (VRS) antigens by immunofluorescence assay in all patients. RESULTS: Patients in the salbutamol group exhibited significantly greater improvement in respiratory rate (P = 0.01), accessory muscle score (P < 0.001) and wheezing score (P < 0.001). There was no significant difference in oxygen saturation between both groups. Infants treated with salbutamol exhibited a non-significant increase in heart rate after the three sprays; no other adverse effects were noted. VRS was identified in 78% of the children tested. CONCLUSIONS: Salbutamol is safe and effective in relieving the respiratory distress of young infants with acute bronchiolitis. Our study confirms previous observations that infants younger than six months of age respond as well as older children when given three doses of nebulized salbutamol. Responders could not be differentiated from non responders by personal or family histories of atopy and VRS isolation. A longitudinal study could establish a correlation between response to bronchodilator therapy and later development of asthma.

Comparative study of human expertise and an expert system: application to the diagnosis of child's meningitis.

We present a general method of statistical evaluation for expert systems, applied to a system for the diagnosis of child's meningitis. Fifty difficult clinical cases of child's meningitis were submitted to the system, to seven senior specialists and to seven young physicians. Multidimensional analysis of the diagnosis of the infection category reveals that the two groups of physicians separate naturally and that the system is located among the group of experts. The study of the agreement of the microbiological diagnosis and therapeutic advice shows that the advice of the two groups of physicians is significantly different and that the advice of the system is significantly closer to that of the experts. This result is confirmed by the study of therapeutic errors. This type of study allows one to classify the performance of the system among physicians having different levels of expertise without referring to an objective solution.

[Disclosure by neurologic signs of right subclavian aneurysm. Post-traumatic aneurysm?]. / Révélation par des signes neurologiques d'un anévrysme de la sous-clavière droite.

BACKGROUND: Aneurysms of the subclavian artery are rare in childhood and may be due to traumatic, infectious or congenital causes. CASE REPORT: A 15 year-old boy presented with a sudden left visual disturbance plus decreased muscle strength and paresthesias of the left arm; these manifestations disappeared within 15 minutes. His neurological examination on admission was normal. The right arm radial pulse was weak and the blood pressures of the right and left arms were significantly different. Doppler showed a right subclavian artery aneurysm containing several clots, that was confirmed by angiography. There were no signs of inflammation or indication of autoimmune disease. This aneurysm might have been caused by trauma as the patient had had a violent cervical traumatism after a diving accident 2 years earlier. The aneurysm was surgically removed and the right vertebral artery arising from it was reimplanted. Histological examination of the aneurysm gave no evidence of etiology. The post-surgical MRI showed no brain abnormaly. CONCLUSIONS: This aneurysm is probably of post-traumatic origin. The cerebral disturbance could be due to embolism or transient ischemia; the latter is more compatible with the normal NMR.