[Intoxication from accidental ingestion of cannabis: analysis of eight cases]. / À propos de 8 cas d'intoxication accidentelle au cannabis chez des nourrissons.

Consultations at pediatric emergency units for acute consciousness alterations is frequent. Miscellaneous causes include cranial trauma, meningoencephalitis, metabolic disorders, drugs, or other intoxications. We report here eight cases of infants who were brought to the emergency division due to acute consciousness failure after accidental ingestion of hashish, confirmed by urinary dosage of Δ9-tetrahydrocannabinol. This series of under 24-month-old infants only emphasizes the value of screening for cannabis in urine in cases of abnormal consciousness and/or abnormal behavior in an infant.

[A 2-month-old baby with Mediterranean spotted fever]. / Une fièvre boutonneuse méditerranéenne chez un nourrisson de 2 mois.

INTRODUCTION: Mediterranean spotted fever is an endemic rickettsiosis in southern France. We report here the case of a 2-month-old baby who developed rickettsiosis after a tick bite. CLINICAL FACT: A 2-month-old baby was hospitalized in the pediatric ward for fever with maculopapular rash extending to the palms and plantar surfaces and an eschar after a tick bite. Rickettsiosis serology examined after 48 h of fever was negative, but Rickettsia (spotted group) PCR taken from the lesion at the bite site was positive. A 1-week treatment with clarithromycin was started. Fever and rash disappeared 3 days after treatment initiation. DISCUSSION: Mediterranean spotted fever is endemic in southern France. It is, therefore, important to consider this diagnosis and search for tick bite signs or an eschar when a patient presents with fever and maculopapular rash. The treatment of choice consists in doxycycline or macrolides. CONCLUSION: Around the Mediterranean sea in particular, Mediterranean spotted fever should be considered as a possible cause of febrile disease with rash, to allow for a specific antibiotic treatment as fast as possible and to avoid dangerous complications, even though few cases have been reported below the age of 3 months.

Management of young children in contact with an adult with drug-resistant tuberculosis, France, 2004-2008.

SETTING: Drug-resistant tuberculosis (DR-TB) is increasing worldwide and may be a source of diagnostic and therapeutic problems in young exposed children. In France exposed children are systematically treated with 3-month isoniazid-rifampicin prophylaxis. OBJECTIVE: To describe the characteristics and management of children aged <2 years in contact with an adult case of DR-TB in France over a 5-year period (2004-2008). METHODS: Children were retrospectively identified by sending questionnaires to all the members of the Paediatric Infectious Diseases Group and the Paediatric Pulmonology Group of the French Paediatric Society. RESULTS: Ten children, all infants, in contact with an adult case of DR-TB were identified: six cases of DR-TB (mean age 4.6 months), one case of TB infection and three cases of exposure (mean age 3.1 months). The children were mainly in contact with poly- or multidrug-resistant TB. Time to initiation of appropriate treatment was 39 days for TB disease and 58 days for TB infection or exposure. One child with TB infection developed TB disease due to failure to adapt prophylaxis. Treatment was variable and centre-dependent. Short-term follow-up showed complete recovery of all children. CONCLUSION: Management of young children in contact with adult DR-TB requires rapid identification of the drug resistance profile. Molecular techniques should be used to reduce delays in initiating appropriate treatment.

Cyanosis revealing hepatopulmonary syndrome in a child with dyskeratosis congenita.

We report the case of a 5-year-old child with dyskeratosis congenita who presented cyanosis and dyspnea at exertion. He had severe hypoxemia with elevated alveolar-arterial oxygen gradient in the setting of liver disease. Technetium-99m-labeled macroaggregated albumin scan showed abnormally high uptake in the brain, confirming hepatopulmonary syndrome.

[Paravertebral streptococcal myositis complicated by an epidural abscess in a 5-year-old girl]. / Myosite paravertébrale à Streptococcus pyogenes A beta hémolytique compliquée d'un abcès épidural chez une enfant.

CASE REPORT: A 5-year-old girl was hospitalised for fever, abdominal and lumbar pain, associated with general impairment state and a whitlow. One of the blood cultures and CSF grew A beta haemolytic Streptococcus, muscular echography and MRI showed paravertebral myositis, which was complicated by an epidural abscess. The outcome was good with medical treatment alone. DISCUSSION: Streptococcal myositis is a rare and severe skeletal muscle infection caused by A beta haemolytic Streptococcus. It is characterized by a muscle necrosis, without abscess formation. It has to be distinguished from pyomyositis, usually caused by Staphylococcus aureus, where a muscle abscess occurs, which must be treated by surgical drainage and antibiotics. Prognosis of this infection is poorer than other muscle infections such as pyomyositis, with a high mortality rate. The diagnosis is difficult and often delayed. Practitioners should keep in mind this diagnosis, even if symptoms are non specific, in front of an undetermined infectious syndrome associated with pain, and make an echography or nuclear magnetic resonance imaging to confirm the diagnosis.