[Twin pregnancy and polymalformative syndrome by Enterovirus]. / Grossesse gémellaire et syndrome polymalformatif infectieux à Entérovirus.

Prenatal diagnosed congenital infection by Enterovirus is rarely described in the literature. A few casereports describe severe abnormalities observed by ultrasound that have led to spontaneous intrauterine demise or early death of the newborn. We report the case of a dichorionic diamniotic twin pregnancy. At 24 weeks of gestation, the second trimester ultrasound examination shows cardiac, brain and abdominal abnormalities in one of the fetuses. The other fetus has a normal appearance. "Standard" serological tests conducted on the mother are negative and amniocentesis reveals no genetic abnormality. After birth, Reverse Transcription Polymerase Chain Reaction (PCR) on samples of blood, ascites and stool reveals to be positive for Enterovirus in both newborns. Both are viable and exhibit severe brain abnormalities with severe neurological sequelae such as cerebral palsy, visual and hearing impairment. This case report illustrates the difficulty of prenatal diagnosis of congenital Enterovirus infection and informs about its possible neurological sequelae.

L'infection foetale précoce à Entérovirus (EV) est peu décrite dans la littérature. De rares cas rapportent de sévères anomalies vues à l'échographie qui conduisent à la mort foetale in utero ou au décès postnatal précoce. Nous présentons le cas d'une patiente présentant une grossesse gémellaire bichoriale biamniotique. L'échographie morphologique réalisée à 24 semaines d'aménorrhée révèle chez l'un des foetus des anomalies cardiaques, cérébrales et abdominales. Le second foetus présente un développement organique normal. Les sérologies «standards¼ réalisées chez la mère sont négatives et la ponction de liquide amniotique ne met pas en évidence d'anomalie génétique. A la naissance, une recherche d'Entérovirus par «Reverse Transcription Polymerase Chain Reaction¼ (RTPCR) se révèle positive pour les deux enfants. Ces derniers sont viables, mais présentent de sévères anomalies cérébrales causant des lourdes séquelles neurologiques. Ce cas clinique illustre la difficulté du diagnostic de l'infection congénitale à Entérovirus ainsi que ses conséquences potentielles.

[Kingella kingae bone and joint infections]. / Arthrites à Kingella kingae chez l'enfant : à propos de six cas.

We report six cases of children with probable or confirmed Kingella kingae bone and joint infections (BJI) and discuss the role of this pathogen in the pediatric population. The advent of Polymerase Chain Reaction (PCR) led to the recognition of the importance of Kingella kingae in several human diseases, particularly in BJI affecting children aged 6 to 48 months. Kingella kingae infections in children have most often a good prognosis provided that the diagnosis is discussed, appropriate diagnostic methods are performed and effective antibiotics are prescribed.

Nous rapportons 6 cas probables ou confirmés d'infections ostéoarticulaires (IOA) à Kingella kingae et proposons une revue de l'implication de ce pathogène en pédiatrie. L'avènement de la PCR (Polymerase Chain Reaction) a mis en lumière son rôle dans diverses maladies humaines, en particulier les IOA chez les enfants âgés de 6 à 48 mois. Le pronostic des infections à Kingella kingae chez l'enfant est le plus souvent bon, pour autant que le diagnostic soit évoqué, que les méthodes diagnostiques adéquates soient utilisées et qu'une antibiothérapie appropriée soit instaurée.

[Leptospirosis in a paperless migrant living in Brussels]. / Leptospirose sévère chez un migrant sans-papier résidant à Bruxelles.

We report the clinical history of a paperless migrant living in Belgium who contracted Weil's disease. This historical term refers to the severe form of leptospirosis, an ever more frequent tropical disease in Europe due to the growing globalization background. However, leptospirosis remains underdiagnosed. Actually, common clinical forms are neglected in outpatient medicine and the performance of available diagnostic tests is limited, especially when they are performed in severe, potentially life-threatening forms. In these cases of sepsis or even septic shock, the antibiotic treatment is most often empirical although fortunately adapted thanks to the large sensitivity of the spirochete.

Nous rapportons l'histoire clinique d'un sans-papier séjournant en Belgique atteint de maladie de Weil. Ce terme historique désigne la forme sévère de la leptospirose, une maladie tropicale dont l'incidence augmente en Europe, sur fond de mondialisation en essor. La leptospirose reste toutefois sous-diagnostiquée. En effet, les formes cliniques courantes sont négligées en médecine ambulatoire et la performance des tests diagnostiques disponibles est limitée, lorsqu'ils sont demandés face aux formes sévères, potentiellement mortelles. Dans ces cas de sepsis, voire de choc septique, le traitement antibiotique est donc le plus souvent empirique, tout en demeurant, heureusement, adapté de par la multisensibilité du spirochète.

[EARLY ENTEROVIRUS NEONATAL INFECTION: WHEN SHOULD WE THINK ABOUT IT?]. / INFECTION NÉONATALE PRÉCOCE À ENTÉROVIRUS : QUAND FAUT-IL Y PENSER? Cas cliniques et revue de la literature.

Enterovirus (EV) may cause a broad spectrum of clinical syndromes and even cause a sepsis-like picture. Although they are responsible for high morbidity and mortality rates, viral testing does not appear in the algorithms for the evaluation of neonatal infections. During the month of June 2013, we identified 3 cases of EV meningitis in our unit of neonatology. All three infants had fever during the first week of life and their clinical examination revealed an irritability. The EV infection was detected by Real-Time Polymerase Chain Reaction (RT-PCR) EV on the cerebrospinal fluid (CSF). Two of the patients also had a positive RT-PCR EV in the blood. The 3 newborns were discharged from the hospital after a few days with no adverse outcome. Our clinical observations and the literature review suggest that EV infections in neonates ought to be identified as soon as possible by an early RT-PCR EV on the blood, and on the CSF if a lumbar puncture is indicated. This could help reduce the administration of antibiotics and the length of hospital stay.

Herpes simplex virus reactivation and dental procedures.

OBJECTIVES: Dental extraction is reported to trigger recurrent herpes labialis (RHL). AIM: This aims to prospectively study the clinical occurrence of RHL and the oral herpes simplex virus type 1 (HSV-1) viral shedding before and 3 days after different dental procedures. MATERIALS AND METHODS: Oral HSV-1 DNA was measured by real-time PCR before and 3 days after dental procedures of the inferior dentition in 57 immunocompetent patients (mean age 32.4 years) who were selected and divided into four distinct subgroups (dental inspection without anesthesia, n = 19; dental filling under local anesthesia, n = 14; molar extraction under local anesthesia, n = 15; and molar extraction under general anesthesia, n = 9) and compared to 32 healthy controls (mean age 33 years). RESULTS: None of the patients suffered from RHL at day 3. Oral HSV-1 DNA was detected before and after procedure in 1.7 % (1/57) and 5.3 % (3/57), respectively [dental inspection without anesthesia, 5.3 % (1/19); molar extraction under local anesthesia, 6.7 % (1/15); and molar extraction under general anesthesia, 11 % (1/9)]. None of the controls presented RHL or detectable oral HSV-1 DNA. There was no statistically significant difference between the study groups and controls. CONCLUSION: Molar extraction increases the risk of oral HSV-1 shedding but not of RHL. Procedure-related nerve damage probably accounts for HSV reactivation. CLINICAL RELEVANCE: Antiviral prophylaxis for RHL is not routinely recommended for dental procedures, regardless of a prior history of RHL.

[Psittacosis without pulmonary symptoms at presentation]. / Le cas clinique du mois. Psittacose sans symptomatologie pulmonaire initiale.

We report the case of a woman who has a parrot fever disease. The first manifestations were headache, fever and flu-like muscle pain. The diagnostic was finally suspected by the anamnesis, which revealed that the patient lived with parrots, and confirmed by serological analysis. Pulmonary symptoms occurred only at a later stage, with the development of lesions showed by the chest CT Scan. The treatment was based on specific antibiotics, with the successful use of oral clarythromycin.

[New approaches to prenatal diagnosis of rhesus incompatibility]. / Nouvelles stratégies dans la prise en charge de l'allo-immunisation foeto-maternelle anti-RHD (Rhésus).

Despite generalisation of anti-D immunoprophylaxis, RhD allo-immunisation still remains the major cause of severe haemolytic disease of the fetus and of the newborn (HDFN). The routine follow up of pregnant women comprises: the ABO/D, Rh/Kell red cells typing and the search for irregular antibodies. In case of anti-D immunisation, the paternal Rh phenotype, when known, provides useful information regarding the probability for the fetus to have inherited the D antigen and thereby to be exposed to the risk of HDFN. The antibody titre, which is predictive of possible in vivo haemolysis, must be interpreted in the light of the previous obstetric history, and can lead to the decision of invasive amniocentesis. Then the measurement of the optical density (deltaOD450 nm) and the fetal RhD typing can be realised on amniotic fluid. New molecular techniques make it possible now to demonstrate the presence of fetal DNA in maternal plasma. These methods lying on non invasive procedures could advantageously be applied to the genotyping of fetal RHD during pregnancy. The present paper aims to discuss the predictive values of RHD fetal genotype in maternal plasma of RhD negative mothers. The ante-partum management of immunised pregnant women is reviewed in the light of this new molecular approach combined to Doppler ultrasonography of the fetal middle cerebral artery. This non invasive method for determining fetal RHD genotype could be systematically proposed to all RhD negative pregnant women for a better targeted prenatal follow-up and an increased efficacy of RhD prophylaxis.

[Prenatal determination of fetal RHD in maternal plasma: two-years experience of routine clinical use]. / Utilisation en routine clinique du génotypage foetal RHD sur plasma maternel: bilan de deux ans d'activité

OBJECTIVES: To evaluate the predictive value of RHD fetal genotype in maternal plasma of Rh D negative mothers after 10 weeks of gestation in a clinical use. MATERIAL AND METHOD: Prospective, comparative study between fetal RHD genotyping in maternal plasma, with amplification of exons 4,5,10 of the RHD gene, by real-time multiplex PCR, and Rh D serology at birth, in 218 pregnancy and their 223 babies, between November 2002 and 2004. RESULTS: Combining the amplification of three exons, the concordance rate of fetal Rh D genotyping in maternal plasma and baby phenotyping at delivery was 100%. Four women whose the babies were Rh D negative were positive for RHD exon 10 during pregnancy. This positivity was, in three cases, correlated with the presence of RHDpsi pseudogene and in last case, with a haplotype Cdes (r's). RHD genotyping was performed for five twin pregnancies. CONCLUSION: Multiplex PCR using maternal plasma provides perfect prenatal prediction of fetal RHD gene. These results confirm that this non invasive procedure is the preferred method for assessing Rh D fetal status in Rh negative mothers. Using this method for two years in routine practice has led us to modify our management scheme for sensitized Rh D-negative pregnant women.

External quality assessment for molecular detection of Bordetella pertussis in European laboratories.

Although the PCR for the detection of Bordetella pertussis is routinely performed in diagnostic laboratories, no quality assessment program has so far been described. We report on the results obtained with two external quality assessment proficiency panels sent to European laboratories. The first proficiency panel contained a series of dilutions of three previously characterized B. pertussis clinical isolates and two negative controls. No false-positive results were reported by six laboratories providing seven data sets. The reported limits of detection of the three B. pertussis strains varied between 4 and 4,000, 9 and 9,000, and 3 and 30,000 CFU/ml, respectively. The second proficiency panel, composed of a series of dilutions of reference strains of B. pertussis, B. holmesii, B. hinzii, and B. bronchiseptica, as well as negative controls, was sent to nine laboratories. One laboratory reported a negative result for a sample and reported a B. parapertussis-positive sample to be positive for B. pertussis. By using the B. pertussis-specific target gene pertactin, one laboratory detected B. pertussis with 100% specificity. All other laboratories, which used IS481-based assays, reported positive results for the samples containing B. holmesii and B. bronchiseptica, species that have occasionally been recovered from human respiratory samples. These data show that the choice of the target gene is particularly critical for the species specificity of B. pertussis PCR assays.

[Vulvovaginal candidiasis: prevalence of different Candida species in the Liege region]. / Prevalence des différentes espéces de Candida au niveau vaginal dans la région Liégeoise.

We calculated the prevalences of different yeast species isolated from more than 20,000 vulvovaginal specimens carried out at the CHR hospital in Liege. To assess the value of the observed relative frequencies, the culture results of 149 samples were confronted with those of a real-time PCR technique of fungal identification. With a prevalence close to 90%, Candida albicans remains the largely dominant species. In contrast with other teams, we observed no increase of the prevalences of Candida non-albicans species.

[Varicella vaccination]. / La vaccination contre la varicelle.

Varicella is a highly contagious disease due to varicella-zoster virus (VZV) belonging to the herpesvirus family. Following infection, the virus remains latent in neural ganglia, and upon subsequent reactivation VZV may cause zoster. While mostly a mild disorder in childhood, varicella tends to be more severe in adults. Healthy individuals may develop complications such as bacterial superinfections, pneumonia or encephalitis. Varicella may be fatal, especially in neonates and in immunocompromised persons. Control of varicella can be achieved only by widespread vaccination. The purpose of this review is to summarize the impact and the concerns of an universal varicella vaccination. The vaccines are based on the attenuated Oka-strain. The positive results of extensive safety, efficacy and cost-effectiveness analyses have warranted the introduction of these vaccines in the USA in 1995 and, more recently, in Australia and in Canada. However, European countries have some concerns. At low levels of coverage, there is a possible shift of the disease in older children and adults. At high levels of coverage, without natural exposure to the wild virus, the duration of the protection against varicella in vaccinated children could wane and zoster in elderly could increase. Recent reports suggest that a booster dose or a two doses regimen would be better for adequate immunisation in childhood. Vaccines combining measles, mumps, rubella and varicella are currently under studies and would warrant a high coverage.

[Risk of contamination by hepatitis C of endoscopes utilized in gastroenterology hospital service]. / Risques de contamination par le virus de l'hépatite C des endoscopes utilisés dans un service hospitalier de gastroentérologie.

UNLABELLED: Transmission of hepatitis C virus by gastrointestinal endoscopy has been suggested especially therapeutic procedures. The aim of this study was to investigate the frequency of contamination of the endoscopes by hepatitis C virus and to assess the efficacy of a semi-automatic disinfection procedure. METHODS: In 19 patients with chronic replicative hepatitis C, upper gastrointestinal endoscopy with different invasive procedures was performed. Cleaning and disinfection were carried out according to the recommendation of the belgian "Conseil Supérieur de l'Hygiène": cleaning with detergent solution, rinsing, disinfection with a disinfectant solution for 10 minutes and again rinsing. Before the procedure (T0), a blood sample was collected to detect the presence of hepatitis C virus RNA. Immediately after the endoscopic procedure, the operating channel of the endoscope was flushed with water and was sterilely collected (T1); after cleaning (T2) and after disinfection (T3, T3EC), the same procedure was repeated. The collected samples were analysed by PCR in order to detect hepatitis C virus RNA. RESULTS: All the samples were positive at T0. Virus C RNA was found in 10 out the 19 patients at T1 (53%). The results were negative in all the samples both after cleaning (T2) and disinfection (T3-T3 EC). CONCLUSIONS: Our study confirmed the presence of hepatitis C virus in the operating channel after invasive upper gastrointestinal endoscopy. The contamination rate of the endoscope is high. Our cleaning and disinfection procedure seems to be effective in regard of hepatitis C virus RNA clearance.

Bone mineral metabolism in the micropremie.

Environmental factors, nutritional supplies, hormonal status, diseases, and treatments appear to affect postnatal skeletal growth and mineralization in VLBW infants. Compared with their term counterparts, ELBW infants are at risk of postnatal growth deficiency and osteopenia at the time of hospital discharge. From recent data, DXA is becoming one of the reference techniques to evaluate mineral status, whole-body composition, and effects of dietary manipulations on weight gain composition and mineral accretion in preterm infants. Weight gain and length increases need to be evaluated carefully during the first weeks of life, in the intensive care unit and out of it, in the step down unit. Nutritional survey is required to improve the nutritional supply and to maximize linear growth. As the critical epoch of growth extends, during the first weeks or months after discharge, follow-up and nutritional support need to be provided during the first years to promote early catch-up growth and mineralization. Further studies need to determine precisely the most optimal feeding regimen during this period but also need to evaluate the long-term implications of such a policy on stature, peak bone mass, and general health at adulthood.

[Pneumocystis carinii pneumonia in a child without immunodepression]. / Pneumonie à Pneumocystis carinii chez un enfant non immunodéprimé.

We report the case of a 5 1/2 month baby with an atypical pneumonia. The PCR revealed a Pneumocystis carinii pneumonia. The complementary approach failed to show any immunosuppression. We will discuss the aetiology, physiopathology and treatment of Pneumocystis carnii pneumonia, particularly in cases without immunosuppression. We will also recall the importance of this disease in AIDS.

[Meningococcemia, recrudescence, diagnosis and treatment]. / Méningococcémie: recrudescence, diagnostic et traitement.

Meningococcemia is a severe Gram negative septicemia whose mortality may be as high as 30%. It occurs more frequently in children but the proportion of teenagers is increasing in Belgium. During the past decade, a slow but sustained rise in the incidence of this illness has been noted, with a predominance of the serogroup B. We describe the symptoms, which often are poor in the early stage, the different therapies, most of them being still under investigation, and the chemoprophylaxis. Without being alarmist, the diagnosis must be considered in any child with cutaneous rash, even atypical and tachycardia.

[Gestational diabetes: prognostic significance for the infant]. / Diabète gestationnel: signification pronostique pour l'enfant.

Gestational diabetes, even if it seems to induce far less foetal complications than classical type 1 or type 2 diabetes mellitus, may be deleterious for the child. We will successively consider the complications that could affect the child during gestation, during the neonatal period and during adult life. These consequences for the offspring require optimal screening and management of gestational diabetes mellitus.

[Pompe disease or type 2 glycogenosis]. / La maladie de pompe ou glycogénose de type 2.

We report the case of a rapidly progressing respiratory failure of a three-month old infant, who shows a cardiomyopathy with left ventricule hypertrophy leading to a Pompe's disease diagnosis. This type 2 glycogenosis will be confirmed by the enzymatic study of the hepatocytes. It is a genetic pathology associated with a deficient activity of the acid maltase resulting in a intralysosomial accumulation of glycogen. The most generally responsible mutations are: delta 18 et delta 525. Prognosis is quite bad with a progressive deterioration of the heart, brain and muscular functions causing death at around 4 to 8 months. Type 2 glycogenosis may be diagnosed before birth through enzymatic study of a material collected through an amniocentesis or a biopsy on chorionic villi, and through DNA analysis. Curative treatment is still under study, but two main research orientations are being developed: genic therapy using viral vector and the correction of the enzymatic deficiency thanks to the synthesis of alpha glucosidase modified to specially get affixed to the heart and muscular cells. Both techniques have already show some encouraging results even though the clinical applications are not presently valid yet.

[Medico-surgical management of childhood cardiopathy: results of the Liège experience]. / Prise en charge médico-chirurgicale des enfants cardiopathes: résultats de l'expérience liégeoise.

OBJECTIVE: Evaluation of the results obtained in the management of congenital heart diseases in Liège. MATERIAL AND METHODS: We evaluated the results, the mortality and the morbidity of diagnostic and interventional cardiac catheterization, and of the cardiac surgery in the 123 cardiac children who were referred to us during the three first years of operation of our medico-surgical team. RESULTS: 89 children underwent a catheterization, including 12 therapeutic interventions, whereas 68 were operated. In the two domains, the results are completely comparable with those of the established centers. CONCLUSIONS: The widening of the activity of paediatric cardiology and the creation of an activity of pediatric cardiac surgery in Liège appeared important to us for the quality of management of the cardiac children. This goal could be reached only if our results were comparable with those of the literature. The bet seems to be held. The ultimate objective is to contribute by an adequate policy of management to the quality of life and the health of the cardiac children.

[Drug clinics. Drug of the month. A new measles-rubella-mumps vaccine (Priorix)]. / Pharma-clinics. Le médicament du mois. Un nouveau vaccin rougeole, rubéole, oreillons (Priorix).

A novel measles-mumps-rubella vaccine (Priorix) has been marketed by SmithKline Beecham. It contains live attenuated virus with measles and mumps strains slightly different from those present in MMR VAX (Pasteur Merieux MSD). The indications and contraindications are similar for both vaccines. Immunogenicity is also equivalent as well as general reactogenicity. By contrast local symptoms were reported significantly less frequently after Priorix.