A comparison of human metapneumovirus and respiratory syncytial virus WHO-defined severe pneumonia in Moroccan children.

Acute respiratory infections remain the principal cause of morbidity and mortality in Moroccan children. Besides bacterial infections, respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are prominent among other viruses due to their high prevalence and association with severe clinical episodes. We aimed to describe and compare RSV- and hMPV-associated cases of WHO-defined severe pneumonia in a paediatric population admitted to Morocco's reference hospital. Children aged 2-59 months admitted to the Hôpital d'Enfants de Rabat, Morocco meeting WHO-defined severe pneumonia criteria were recruited during 14 months and thoroughly investigated to ascertain a definitive diagnosis. Viral prevalence of RSV, hMPV and other viruses causing respiratory symptoms was investigated in nasopharyngeal aspirate samples through the use of molecular methods. Of the 683 children recruited and included in the final analysis, 61/683 (8·9%) and 124/683 (18·2%) were infected with hMPV and RSV, respectively. Besides a borderline significant tendency for higher age in hMPV cases, patients infected with either of the viruses behaved similarly in terms of demographics, patient history, past morbidity and comorbidity, vaccination history, socioeconomic background and family environment. Clinical presentation on arrival was also similar for both viruses, but hMPV cases were associated with more severity than RSV cases, had a higher risk of intensive care need, and received antibiotic treatment more frequently. RSV and hMPV are common and potentially life-threatening causes of WHO-defined pneumonia in Moroccan children. Both viruses show indistinctive clinical symptomatology, but in Moroccan children, hMPV was associated with a more severe evolution.

[Mycoplasma pneumoniae encephalitis associated with basal ganglia necrosis]. / Encéphalite aiguë des noyaux gris centraux àMycoplasma pneumoniae.

INTRODUCTION: Severe central nervous system diseases, such as encephalitis, have been reported in association with Mycoplasma pneumoniae infections. CASE REPORT: A previously healthy 5-year-old boy presented with an atypical pneumonia; he rapidly developed encephalitis revealed by lethargy, generalized status epilepticus. MRI showed abnormal signals in the basal ganglia, typical of bilateral striatal necrosis. Serologic tests for M. pneumoniae were positive, the child recovered almost completely. CONCLUSION: M. pneumoniae infection should be considered in all cases of acute encephalopathy; yet the pathogenesis of the disorder is unknown and the treatment uncertain.

[Absence of a relationship between obesity and asthma in prepubertal Moroccan children]. / Absence de relation entre obésité et asthme dans une population d'enfants prépubères marocains.

Obesity and asthma are both public health problems that have been increasing for several years. This increase suggests that there may be a connection between these two pathologies. The aim of this study was to examine the relationship between obesity and asthma by measuring the prevalence of obesity in asthmatic children compared with a control population, by analysing the impact of obesity on the severity of the asthma, and by examining the relationship between obesity and atopy. The study was based on 100 children aged from 4 to 16 years in whom the diagnosis of asthma was confirmed; obesity being defined as a body mass index greater than the 97th percentile. The prevalence of obesity in these patients was 14%. Obesity was not a factor in the severity of the asthma as 14.5% of the severe asthmatics were obese compared with 18.75% of the mild and moderate asthmatics. 13% of the atopic subjects were obese compared with 13% of the non-atopics. Obesity does not constitute, therefore, a risk factor for asthma and does not contribute to the severity of the disease. In addition there is no relationship between obesity and atopy.

[Flexible bronchoscopy in children. Experience at French centers of pediatric pneumology]. / La fibroscopie bronchique chez l'enfant. Expertise des centres français de pneumologie pédiatrique.

INTRODUCTION: Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS: In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS: Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS: This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.