[Nosocomial cavernous sinus thrombophlebitis due to multidrug-resistant Staphylococcus aureus. A pediatric case report]. / Thrombophlébite du sinus caverneux nosocomiale àStaphylococcus aureus multirésistant. À propos d'un cas.

Cavernous sinus thrombophlebitis is a serious disease. We report herein a case seen in a 9-year-old boy hospitalized for an acute pneumopathy. Clinical signs were made of a diffuse edema of the upper two-thirds of the face, eyelid edema, chemosis, exophthalmia, meningeal syndrome, and infections syndromes associated with alteration of consciousness. A CT scan revealed a heterogenous enhancement and enlargement of the left cavernous sinus and homogenous opacity of the sphenoidal sinuses. Therapeutic management was complicated due to allergy to ß-lactams and the multidrug resistance of Staphylococcus aureus.

Thrombus intracardiaque avec ischemie aigue et thrombophlebite des membres inferieurs lors d'une cardiomyopathie du peripartum

La cardiomyopathie du peripartum est une cardiomyopathie dilatee survenant dans le dernier trimestre de la grossesse ou dans les cinq ou six mois suivants l'accouchement. Elle est caracterisee par une dysfonction ventriculaire gauche diagnostiquee a l'echocardiographie bidimensionnelle (fraction d'ejection 45); sans aucune autre etiologie de la defaillance cardiaque. Nous rapportons dans cette etude un cas associant un thrombus intracardiaque; une ishemie aigue du membre inferieur et une thrombophlebite

[Bladder fistula of an ovarian dermoid cyst]. / Une fistulisation vésicale d'un kyste dermoïde de l'ovaire.

We report a case of right ovarian dermoid cyst fistulized in the bladder and revealed by recurrence urinary infections. The diagnostic has not been conformed but 5 years after the urinary first manifestations. The cystoscopy has been a cardinal importance but the right seat of the lesion has been determined only during laparotomy. This unusual complication of ovarian dermoid cyst must call the practitioner's attention to urinary symptoms with a pelvic tumour. Moreover, the left ovary agenesis and the young patient's age have constrained the surgeon to preservative method. The functional efficiency of this method has been proved by the periods recovery, 5 months later.

[Bilharzian meningomyeloradiculopathy in children]. / La méningo-myélo-radiculite bilharzienne chez l'enfant.

Child meningomyeloradiculitis is a rare complication form of schistosomiasis, even in hyperendemic area. Its diagnosis is very difficult, especially if there are not history or signs of Schistosoma mansoni or hematobium infections. It must be evocated in case of acute flask paralysis occurring in children living in Schistosoma infections endemic area. The authors report a 14-year-old boy's case and suggest etiopathogeny of the disease.

[Acute flaccid paralysis after drug injection: a case report in the pediatric service of the Befelatanana Hospital Center in Antananarivo]. / Paralysie flasque aiguë post-injectionnelle de médicament chez l'enfant: à propos d'un cas observé au Service de Pédiatrie du Centre Hospitalier de Befelatanana-Antananarivo.

In the framework of the poliomyelitis program eradication, the World Health Organization suggests two markers to survey the circulation of the poliovirus: notification of all cases of acute flask paralysis (AFP) and etiological research of these AFP from two stool samples. The authors reported the case of a AFP, occurring after a polio vaccination in a 5-year-old boy who had later an acute rhinopharyngitis treated by antibiotics and quinine intramuscular injections. A left lower limb AFP justified his hospitalisation. The isolation of a Sabin type 3 poliovirus was a pitfall because clinical and complementary investigations demonstrate a peripheral neuromuscular paralysis. This demonstrative case shows the need for health staff to be trained to perform correctly an usual act like intramuscular drug injections.

[Diagnostic pitfalls in childhood acute obstructive dyspnea]. / Pièges diagnostiques d'une dyspnée aiguë obstructive de l'enfant.

Diagnosis of an acute obstructive dyspnea is very difficult because there are many possible causes. The authors reported the case of a 3.5-year-old boy with an atopic status who presented iterative asthma attacks which evolute to severity in spite of an appropriate therapy. Then suffocation occurred with a serious infectious context. The cause of the disease was diagnosed by respiratory tract endoscopic exam which allowed to detect a laryngeal papillomatis. The surgical extraction of this tumour cured the patient. Physiopathology of acute obstructive dyspnea in child was discussed. Upper airway obstructions are separated from lower pulmonary diseases. Two syndromes are very difficult to separate among upper airway obstructions: spasmodic laryngitis and subglottal laryngitis. They are considered in fact as different outward signs of the same disease: subglottal laryngitis is the infectious evolutive form of a spasmodic laryngitis in which atopic status exists. Laryngeal papillomatosis would be a favourising factor of infection. The authors conclude that respiratory tract endoscopic exam is very important to diagnose childhood acute obstructive dyspnea.

[Evaluation of the management of tuberculosis in children in Madagascar. Results of a multicentric study]. / Evaluation de la prise en charge de la tuberculose infantile à Madagascar. Résultats d'une étude multicentrique.

In Madagascar, tuberculosis remains an important cause of morbidity and letality with a Risk of Annual Tubercular Infection about 1% in 1996 in spite of a vaccination rate of 82.6% and tubercular drugs free of charge. In 1995, the National Tubercular Control Program detected 7,000 cases of pulmonary tuberculosis and expected more than 12,000 cases per year. This study was carried out in order to review the management and the treatment of the child tuberculosis in Madagascar. This retrospective study was conducted in four pediatric units of the General hospital of Befelatanana (A and B), Ambohimiandra Hospital and Regional Hospital Centre of Toliara for a twenty four months period from January 1997 to December 1998. All the less than 15-year-old children medical files were consulted. 214 cases were suspected of tuberculosis. 133 of them were treated upon clinical presumption basis and/or radiological exams (33 bacteriological and/or histopathological exams were only realized). 56% of the cases were vaccinated by BCG vaccine. Respiratory diseases with fever motive 46% of hospitalization. The majority of these children are living in poor conditions and 38% of them had malnutrition. Were found as clinical manifestations: 47% of pulmonary tuberculosis (among them 20% were smear-positive pulmonary tuberculosis), 12% had ganglionar tuberculosis, 10% peritoneal tuberculosis, 8% a tubercular meningitis, 5% a Pott-disease and 2% a miliary-disease. Mortality increases with suffocation. 18% of cases died, especially infants and in tubercular meningitis. The authors conclude that management and treatment of tuberculosis need an early diagnosis. But the diagnosis is difficult in front of non specific clinical manifestations in children and due to lack of means and national agreement which settle up diagnosis and therapy. A scoring system based upon clinical signs in agreement with complementary medical tests is desirable.

[Study of idiopathic thrombopenic purpura in two pediatric services of Antananarivo city]. / Etude du purpura thrombopénique idiopathique dans deux services pédiatriques de la ville d'Antananarivo.

Idiopathic thrombocytopenic purpura (ITP), haematologic disease affecting the only blood platelets, is an acquired disease. It appears as cutaneous and mucosal bleedings preceded by a feverish syndrome. Cerebral haemorrhage is possible but very rare. If the disease occurs frequently in Europe and in the United States of America, there is a lack of data in Africa and in Madagascar. In order to fill this gap, the authors carried out retrospective and prospective studies in two paediatric units of Antananarivo for 32 months. They reported 4 cases of PTI of which clinical signs were moderate. As therapy, corticosteroids were used and were efficiency. It is desirable to settle a program allowing to survey sick children.

[Value of C-Reactive Protein (CRP) in childhood fever conditions]. / Intérêt de la C-Reactive Protein (CRP) dans les affections fébriles de l'enfant.

C-Reactive Protein (CRP) measurement is used to orientate the diagnosis of an inflammation especially in childhood febrish diseases. A retrospective study was carried out at the pediatric service of the General hospital of Befelatanana in Antananarivo for 48 months (1997-1998). The population of this study was continued of 361 patients taken from 714 febrish children. 384 CRP were performed. The initial CRP measurement allowed to differentiate 152 presumed bacterial infections: 49 respiratory tract infections, 62 in neurological pathology, 10 in digestive pathology, 19 in otorhinolaryngology pathology, 12 in urinary pathology, and 153 presumed viral infections: 86 respiratory tract infections, 29 in neurological pathology, 12 in digestive pathology, 26 in otorhinolaryngology pathology. There was a right correlation of CRP values and leukocyte levels in presumed bacterial infections. Specificity and sensibility of the test applied in different child febrish diseases were satisfactory. CRP measurement is easy and rapid to perform. It is useful and seems to be the appropriate method to diagnose childhood febrish diseases in countries where facilities are insufficient and financial possibilities limited.

[Congenital afibrinogenemia complicated by spontaneous cerebral hemorrhages: a case report]. / Afibrinogénémie congénitale compliquée d'hémorrhagies cérébrales spontanées: à propos d'un cas.

Congenital afibrinogenemia is a rare autosomal recessive disease caused by markedly reduced or absent synthesis of fibrinogen. Consanguinity is common in affected family. Clinical manifestations range to minimal or moderate bleeding to catastrophic haemorrhage. Bleedings are often post-traumatic, sometimes spontaneous. Diagnosis is established by laboratory tests presenting trace or absence of fibrinogen. Substitutive treatment with fibrinogen concentrates or fresh frozen plasma is used. The authors reported the case of a 41-year-old male with congenital afibrinogenemia with fatal spontaneous cerebral haemorrhage. Diagnosis was made upon history, bleeding history, clinical examination, blood coagulation tests and radiography. Cerebral haemorrhage must be suspected in any patient presenting blood coagulation disorders with bleeding history. Drug therapy must be installed immediately and continued before obtention of specific radiology images which are often late in relation to clinical signs.

[Evaluation of the use of antibiotics in the hospital pediatric milieu]. / Evaluation de l'utilisation des antibiotiques en milieu hospitalier pédiatrique.

Excessive and inappropriate use of antibiotics is a world-wide serious problem because it contributes to the development and the spreading of antibiotic resistance. The authors carried out a study for one year by 1998, in order to evaluate antibiotic prescriptions in three childhood diseases: respiratory, digestive and neurological diseases. Patients hospitalized at the unit paediatric of the General hospital of Befelatanana are 0 month to 15 years old. Three antibiotic families were frequently used: cotrimoxazole, penicillins derivatives and aminoglycosides. Results of this study noted that antibiotic precriptions were irrational. Some factors may give explanations to these facts: the insufficiency of biological labs, but also expensive costs of exams. It is desirable that all paediatricians can gather in order to draw up clinical protocols and to assess them by a multicentric survey. Further results may be used as reference for empirical or probabilist antibiotic prescriptions of which efficacy will be checked by an experienced lab.

[Costs directly related to acute lower respiratory tract infections in the pediatric hospital milieu]. / Coût direct lié aux infections respiratoires aiguës basses en milieu hospitalier pédiatrique.

The purpose of this retrospective study carried out by 1997 in two paediatric units of Antananarivo: paediatric unit of the General hospital of Befelatanana (Marfan) and paediatric unit of the Hospital Center of Soavinandriana (CI), was to evaluate direct service costs for an hospitalization of a child affected by lower acute airway diseases. In the first unit, there is partial charge, in the second, there is full charge. Direct services were continued by complementary tests, therapy and meals. The length of the hospitalization changes according to the cause and the severity of diseases. Average direct service costs were of 19 and 38 US$ respectively. Maximum direct service costs were of 77 and 154 US$ respectively. Amounts of direct service costs were crippled especially by inappropriate use of antibiotics.