[Profile of bacterial resistance in pediatric urinary tract infections in 2014]. / Étude du profil des résistances bactériennes dans les pyélonéphrites de l'enfant en 2014.

In pediatric units, bacteria-producing extended-spectrum-betalactamase (ESBL) have an increasing prevalence among bacteria causing febrile urinary tract infections (UTIs). The purpose of this study was to evaluate the epidemiology of bacteria resistance patterns observed in UTIs, in order to assess the current antibiotic treatment protocols. This study is based upon a single-center retrospective chart review of the cytobacteriological urine cultures performed in UTIs between 1 January and 31 December 2014, in the medical pediatric unit of the Caen University Hospital. Out of the total of 219 cases of UTI, 26.9% were recurrences of UTI, 18.3% were infections in infants less than 3 months old, 21% of the patients suffered from underlying uropathy, and 16.4% of the patients had recently been exposed to antibiotics. In 80.3% of the cases, Escherichia coli was found, while Enterococcus faecalis was found in 5.6%. The antibiograms proved that 33.5% of the bacteria were sensitive. Half of E. coli were resistant to ampicillin, 4.9% to cefixime, 4.9% to ceftriaxone, 1.1% to gentamicin, and 27.8% to trimethoprim-sulfamethoxazole. Nine E. coli and one Enterobacter cloacae produced ESBL, accounting for 4.6% of the UTIs. We did not find any bacteria-producing high-level cephalosporinase. Cefixime resistance was statistically linked to ongoing antibiotic treatment (OR=5.98; 95% CI [1.44; 24.91], P=0.014) and underlying uropathy (OR=6.24; 95% CI [1.47; 26.42], P=0.013). Ceftriaxone resistance was statistically related to ongoing antibiotic treatment (OR=6.93; 95% CI [1.45; 33.13], P=0.015). These results argue in favor of maintaining intravenous ceftriaxone for probabilistic ambulatory treatment. However, in case of hospitalization, cefotaxime can replace ceftriaxone, due to its lower ecological impact. Moreover, it is necessary to continue monitoring bacterial resistance and regularly review our treatment protocols.

CYP24A1 Mutations in a Cohort of Hypercalcemic Patients: Evidence for a Recessive Trait.

CONTEXT: Loss-of-function mutations of CYP24A1 (which encodes the 25-OH-D3-24-hydroxylase) have recently been reported to cause hypercalcemia. OBJECTIVES: The aims of this study were: 1) to evaluate the frequency of CYP24A1 mutations in patients with medical history of hypercalcemia; 2) to show the clinical utility of a simultaneous assay of serum 25-hydroxyvitamin D3 (25-OH-D3) and 24,25-dihydroxyvitamin D3 (24,25-[OH]2D3) by liquid chromatography tandem mass spectrometry (LC-MS/MS); and 3) to investigate biochemical parameters in heterozygous gene carriers with CYP24A1 mutations. PATIENTS AND METHODS: We screened for CYP24A1 mutations in 72 patients with serum calcium levels > 2.6 mmol/L and PTH levels < 20 pg/mL and recruited 24 relatives after genetic counseling for subsequent investigations. Vitamin D metabolite concentrations were assessed in a subset of patients by LC-MS/MS and results expressed as a ratio (R) of 25-OH-D3:24,25-(OH)2D3. RESULTS: Twenty-five patients with hypercalcemia (35%) harbored CYP24A1 variations. Twenty (28%) had biallelic variations, mostly found in subjects with nephrocalcinosis or renal stones (19/20). Five patients, all neonates, were heterozygous, without renal disease. We describe 15 new variations leading to loss-of-function according to pathogenicity prediction programs, and we functionally characterized 5 of them in vitro. A dramatic increase of R, usually >80, was found in patients harboring biallelic mutations providing evidence in vivo for the loss of CYP24A1 activity. In contrast, R value remains <25 in patients without CYP24A1 mutations. Subjects carrying one mutant allele, hypercalcemic individuals, as well as gene-carrier relatives, had a detectable 24,25-(OH)2D3 level and R < 25, indicating normal 24-hydroxylase activity. CONCLUSION: CYP24A1 biallelic mutations are frequently found in patients presenting with hypercalcemia, low PTH, and renal disease. We confirm the accuracy and effectiveness of a novel blood test estimating the ratio between relevant vitamin D metabolites as a useful screening tool for CYP24A1 mutations. Haploinsufficiency is not associated with CYP24A1 deficiency.

[Acetaminophen (paracetamol) causing renal failure: report on 3 pediatric cases]. / Insuffisance rénale secondaire à une intoxication au paracétamol: à propos de 3 cas.

Renal failure secondary to acetaminophen poisoning is rare and occurs in approximately 1-2 % of patients with acetaminophen overdose. The pathophysiology is still being debated, and renal acetaminophen toxicity consists of acute tubular necrosis, without complication if treated promptly. Renal involvement can sometimes occur without prior liver disease, and early renal manifestations usually occur between the 2nd and 7th day after the acute acetaminophen poisoning. While therapy is exclusively symptomatic, sometimes serious metabolic complications can be observed. The monitoring of renal function should therefore be considered as an integral part of the management of children with acute, severe acetaminophen intoxication. We report 3 cases of adolescents who presented with acute renal failure as a result of voluntary drug intoxication with acetaminophen. One of these 3 girls developed severe renal injury without elevated hepatic transaminases. None of the 3 girls' renal function required hemodialysis, but one of the 3 patients had metabolic complications after her acetaminophen poisoning.

[Two uncommon extrapulmonary forms of Mycoplasma pneumoniae infection]. / Infections extrapulmonaires àMycoplasma pneumoniae : atteintes neurologique et rénale.

Mycoplasma pneumonia is the second most frequent bacterium in pneumonia and the leading intracellular type. M. pneumoniae pulmonary infection is characterized by a slower onset profile and a lower biological inflammatory picture than pneumococcal infection. Both upper and lower respiratory tracts are often affected and sometimes a Kawasaki-like syndrome can be associated, with conjunctivitis or cheilitis. Extrapulmonary forms of the disease can occur, whether or not it is associated with pulmonary infection. We report two cases: in the first case, a renal form of M. pneumoniae disease developed in a 6-year-old girl, with membranous proliferative glomerulonephritis expressed as a picture of impure nephritic syndrome with decreased serum complement concentration, following an upper respiratory infection. Diagnosis was obtained by means of a kidney biopsy. The second case occurred in an 8-year-old girl who expressed, after a respiratory tract infection, neurological symptoms such as ocular flutter, perception disorder, and ataxia. This onset is typical of post-infectious rhombencephalitis. Biological investigations and imaging were normal. In both cases, M. pneumoniae infection was diagnosed on the basis of immunoglobulin M-positive serology. Direct exploration of the bacterium was negative, due to its fragility and delayed diagnostic hypothesis. Several forms of M. pneumoniae infection are either the direct effect of the bacterium or are secondary to a cross-immunological reaction. As its frequency is increasing, M. pneumoniae infection should be raised as a cause of atypical, less well-known extrapulmonary forms of the disease.

[Hemolytic and uremic syndrome and maternal-fetal Escherichia coli K1 infection]. / Syndrome hémolytique et urémique au décours d'une infection materno-fœtale àEscherichia coli K1.

Hemolytic uremic syndrome (HUS) is primarily a disease of infancy and early childhood. In its classic form, it is preceded by a prodrome of Escherichia coli-mediated bloody mucoid diarrhea. Typical HUS is commonly related to an infection by shiga-toxin producing E. coli. Stool cultures may detect this bacteria or its toxin, and PCRs can detect the shiga-toxin virulence genes. Atypical cases of HUS are mainly related to abnormalities of the alternative complement pathway and mutations of H, I, or B factors. Some atypical cases of HUS may also be related to von Willebrand factor or vitamin B12 metabolism abnormalities. A number of HUS cases related to invasive pneumococcal infections (pneumonia or meningitis) have been reported. We report a case of HUS associated with a bacterial E. coli K1 infection in a newborn baby, with a good clinical outcome: there was no need for dialysis and normal renal function was quickly regained. The workup did not favor a toxinic origin or an abnormality on the alternative complement pathway.

[Legionella pneumonia in an immunocompetent child]. / La légionellose chez l'enfant immunocompétent: a propos d'un cas.

We report a case of Legionella pneumonia in an immunocompetent child. Legionella pneumonia is a rare pathology among children, and even rarer when they are immuno-competent; a few cases have been reported in the literature. This is explained by the fact that infection occurs primarily to immuno-suppressed patients. Legionella bacteria are not systematically sought for in front of child's atypical pneumonia, contrary to Mycoplasma or Chlamydiae. In addition, a number of cases are probably not even noticed because either not serious (Pontiac fever), spontaneously cured, or cured with macrolides prescribed in the case of suspected pneumonia with Mycoplasma.

Engineering concepts for inflatable Mars surface greenhouses.

A major challenge of designing a bioregenerative life support system for Mars is the reduction of the mass, volume, power, thermal and crew-time requirements. Structural mass of the greenhouse could be saved by operating the greenhouse at low atmospheric pressure. This paper investigates the feasibility of this concept. The method of equivalent system mass is used to compare greenhouses operated at high atmospheric pressure to greenhouses operated at low pressure for three different lighting methods: natural, artificial and hybrid lighting.

[Home environment and acute propylene glycol intoxication in a two-year old. An unusual case report]. / Environnement domestique et intoxication aiguë au propylène glycol chez un nourrisson de deux ans. A propos d'une observation inhabituelle.

BACKGROUND: Acute propylene glycol intoxication in a two-year-old toddler underlines the potentially serious toxicity in children of this chemical agent present as a diluent in many drugs and environmental products such as cosmetics, diapers, cleansing towels, despite a common consideration of safety and lack of toxicity. CASE REPORT: A two-years-old boy previously healthy was found in the morning by his parents in his cradle, lethargic, responsive only to sharp pain. On admission, vital signs were: temperature 38.5 degrees C, lethargy, polypnea; propylene glycol intoxication through disposable cleansing towels chewing was ascertained by anamnesis and blood urine analyses which revealed metabolic acidosis and serum propylene glycol peak. CONCLUSION: Environmental acute propylene glycol intoxication must be considered and searched for in front of a metabolic acidosis case of unknown origin in children.

[Haemophilus influenzae bacterial meningitis: residual risk; case report]. / Méningite bactérienne à Haemophilus influenzae: le risque résiduel; à propos d'un cas.

UNLABELLED: Bacterial meningitis due to Haemophilus influenzae has become a rare, albeit not exceptional occurrence since generalized vaccination against that pathogen was instated, concerning as well incapsulated b and non-b Haemophilus influenzae strains, as non-incapsulated strains. CASE REPORT: A 19-month-old fully immunized infant was referred to our hospital for bacterial meningitis. CSF analysis elicited biotype III, non-incapsulated Haemophilus influenzae. CONCLUSION: Generalizing Haemophilus influenzae preventive inoculation has revolutionized the epidemiology of bacterial meningitis; however, a residual risk exists, which deserves to be taken into account.

[Pseudotumoral presentation of cat scratch disease]. / Maladie des griffes du chat de présentation pseudotumorale.

BACKGROUND: A frequent cause of chronic benign lymphadenopathy, cat-scratch disease (CSD) occurs mainly in children and young adults. Bartonella henselae is the agent responsible for CSD. The most common symptoms of the disease are regional lymphadenopathy and fever. Atypical forms occur in about 10% of patients; among them, CSD may initially present as a tumor. CASE REPORT: A 4-year-old child developed a 'tumor' of the arm with fever. The values of white blood cell count and CRP were normal. Ultrasonography, MRI and arteriography did not contribute to the diagnosis, which was established on histologic examination and serologic test for infection with B. henselae. The outcome was favorable with antibiotic treatment. CONCLUSION: In case of tumor of the limbs, cat-scratch disease should be searched for.

[Osteogenesis imperfecta: a new, early therapeutic approach with biphosphonates. A case report]. / Ostéogenèse imparfaite: une nouvelle approche thérapeutique précoce par les biphosphonates. A propos d'une observation.

UNLABELLED: Management of type III osteogenesis imperfecta (O.I.) (brittle bone disease) is primarily supportive; early introduction of cyclic intravenous pamidronate administration in children younger than 2 years of age is an innovative and promising therapeutic approach. CASE REPORT: We present the case of a 6-month-old infant, whose preliminary data have already been partly published, with severe type III O.I. referred because of aching and crumbling from multiple fractures. Cyclic intravenous disodic pamidronate administration improved the clinical status (fracture incidence, pain, growth curve) and biological status (bone density, osseous alkaline phosphatases, urinary desoxypiridoline excretion), allowing a remarkable recovery. CONCLUSION: Biphosphonates are a new and innovative therapeutic agent in O.I. Clinical safety, easy administration, and overall efficacy are likely to extend their use in severe type III O.I. from the very first months of life, the time of best efficacy.

[Macrolides and Pseudomonas aeruginosa infection]. / Macrolides et infection à Pseudomonas aeruginosa.

Several unique effects of subinhibitory concentrations of C14 and C15 macrolides on Pseudomonas aeruginosa infection are described in vitro: P. aeruginosa virulence factors inhibition, bacterial biofilm disruption, P. glycoprotein expression upregulation, anti-inflammatory and immunoregulatory effects. Clinical trials in vivo are warranted to assess the potential usefulness of macrolides for treatment of chronic infections caused by P. aeruginosa.

[Cardiac involvement during classic hemolytic uremic syndrome]. / Atteinte cardiaque au cours du syndrome hémolytique et urémique typique.

BACKGROUND: Cardiac involvement rarely occurs in classic hemolytic uremic syndrome (HUS); it is often fatal. CASE REPORTS: The first patient, a 21-month-old boy, developed classic HUS with acute renal failure. Peritoneal dialysis was performed for 20 days. On the 10th day of dialysis, myocardial infarction occurred, probably related to coronary thrombus. The patient was given heparin and antibiotics because of an unexplained fever. The outcome was favorable despite antero-apical cardiac necrosis, and moderated chronic renal failure. The second patient, a 24-month-old girl, also showed a classic HUS, which required peritoneal dialysis for 10 days. Dilated cardiomyopathy with cardiac failure appeared on the 4th day of dialysis, not related to the volume overload and metabolic consequences of the acute renal failure, such as systemic hypertension or ineffective dialysis. On the 5th day of dialysis neurological involvement appeared. Neurological, cardiac and renal outcome was favorable. The third patient, a 25-month-old girl, developed a classical HUS, requiring peritoneal dialysis for 25 days. No cardiac insult appeared during the acute phase of the disease. After dialysis, the child had chronic renal failure (creatinine clearance: 15 mL/min/1.73 m2). Dilated cardiomyopathy appeared 3 months later, without definite etiology. The outcome was favorable with digoxin treatment. CONCLUSION: A cardiac involvement should also be searched for in the acute phase of HUS and several months later.

[Secondary kidney amyloidosis and mucoviscidosis]. / Amylose rénale secondaire et mucoviscidose.

BACKGROUND: Due to the improvement in cystic fibrosis management, life expectancy has risen; on the other hand, longer survival has led to new complications, including secondary renal amyloidosis, which has been so far very uncommonly reported. CASE REPORTS: Secondary nephropathic amyloidosis was seen in two 25-year and 22-year-old adults with cystic fibrosis. Both had developed recurrent pulmonary infections due to Pseudomonas aeruginosa over several years. One patient died after 2 years of progressive kidney failure. CONCLUSION: Severe renal insufficiency due to secondary amyloidosis may complicate the course of cystic fibrosis and become the main prognosis factor in adults.

[Initial imaging in pediatric urinary tract infection]. / Imagerie de première intention dans l'infection urinaire de l'enfant.

First step imaging investigations in urinary tract infections in children rely upon conventional sonography, and, when available. Power Doppler sonography. Enhanced computerised tomography (CT) and dimercaptosuccinic acid (DMSA) scintigraphy are complementary investigations in difficult cases. Contrast cystourethrogram has always to be performed. Intravenous pyelography is no longer used as a first step imaging technique.