Virologic study of acute lower respiratory tract infections in children admitted to the paediatric department of Blida University Hospital, Algeria.

Acute lower respiratory tract infections (ALRTI) such as pneumonia and bronchiolitis are major causes of mortality and morbidity in children under 5 years of age. The main microbial agents responsible for ALRTI are either bacterial agents (Streptococcus pneumoniae, Haemophilus influenzae type b, Mycoplasma pneumoniae) or viruses (respiratory syncytial virus (RSV, also known as human orthopneumovirus), Myxovirus influenzae, Myxovirus parainfluenzae, adenovirus) [1]. More recently, other viruses (rhinovirus, metapneumovirus, coronavirus, bocavirus) have been implicated in ALRTI; their identification has been facilitated by new molecular biology techniques such as real-time PCR. To our knowledge, these emerging viruses have never been the subject of epidemiologic studies in our country.

Les infections aiguës des voies respiratoires comptent parmi les principales causes de morbidité et de mortalité chez les enfants. Elles se produisent dans le monde entier et constituent l'un des principaux fardeaux mondiaux des maladies chez les enfants. Le but de cette étude était de déterminer l'étiologie virale des infections respiratoires chez les enfants hospitalisés et âgés de moins de 02 ans.Sur une période d'un an, des aspirations nasales été effectuées chez 117 enfants âgés de 15 jours à 02 ans et hospitalisés pour une maladie respiratoire aiguë. Les échantillons prélevés ont été testés pour la présence de 12 virus respiratoires à l'aide d'une RT-PCR multiplex en temps réel. Des agents pathogènes ont été identifiés chez 97 enfants (82,9 %) et ont été fréquemment observés à l'automne et en hiver. Une co-infection a été observée dans 21,4 % des échantillons. Les pathogènes les plus fréquemment détectés étaient le Virus respiratoire syncytial (VRS, 47,9 %), le rhinovirus humain (hRV, 23,1 %), le métapneumovirus humain (hMPV, 22,2 %). Cette étude fournit des faits pertinents sur la circulation des virus respiratoires en Algérie et sur l'importance de l'utilisation de la PCR multiplexe comme outil intéressant pour la détection des virus. Un diagnostic précoce au moment de l'hospitalisation initiale peut réduire la propagation des virus dans les services de pédiatrie et améliorer la prise en charge.

Foreign body aspiration in children: experience from 2624 patients.

OBJECTIVES: The objective of this study is to analyze the epidemiological, clinical, radiological and endoscopic characteristics of pediatric foreign body aspiration in Algeria. METHODS: In this retrospective study, the results of 2624 children younger than 18 years admitted in our department for respiratory foreign body removal between 1989 and 2012, were presented. Most of them had an ambulatory rigid bronchoscopy. RESULTS: The children (62.34% males and 37.65% females) were aged 4 months to 18 years with 66% between 1 and 3 years. Choking was related in 65% of cases. The delay between aspiration and removal was 2-8 days in 65.8% and within 24 h in 9.2%. In the most cases, the children arrived with cough, laryngeal or bronchial signs and unilateral reduction of vesicular murmur. The examination was normal in 13%. The most common radiologic finding was pulmonary air trapping (40.7%). The aspirated bodies were organic in 66.7%, dominated by peanuts, while sunflower seeds, beans and ears of wheat were the most dangerous. In the other cases, they were metallic or plastic as pen caps and recently scarf pins. The endoscopic removal by rigid bronchoscopy was successful and complete in 97%. Cases with extraction failure (3%) limited to certain FBs, all of them inorganic were assigned to surgery. The complications related to the endoscopic procedure were 0.29% with a mortality of 0.26%. CONCLUSION: Foreign body aspiration is a real public health problem in Algeria. The best way to manage it is an early diagnosis and a rigid bronchoscopy removal under general anesthesia used by fully trained staff. The prevention of this domestic accident should consider the population lifestyle and cultural habits to be more effective.

A new large CFTR rearrangement illustrates the importance of searching for complex alleles.

The p.Val754Met variant, described in 1996 in a CF patient, has been considered a CF mutation. However, biochemical aspects, results of functional studies and, finally, the identification of a complex deletion removing exons 3 to 10 and 14b to 16 in cis of p.Val754Met in a CF patient, argue against a strong deleterious effect. An inventory through the French CF network of patients carrying p.Val754Met led to the registration of seven patients (CF: n=4; idiopathic chronic pancreatitis: n=3) and six healthy individuals, all heterozygous for the variation. Extensive CFTR gene analysis was carried out, including the search for large rearrangements and other possible mutations. The complex deletion, whose breakpoints are described here, was found only in the four CF patients, in association with the same haplotype. This data, added to the fact that the p.[Phe508del]+[Val754Met] genotype was found in a healthy individual, bring further arguments against the association of p.Val754Met with CF. We thus suggest looking for a possible complex allele whenever p.Val754Met is detected and considering it neutral regarding genetic counseling when found in isolation.