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Biomedical subjects

A Bourrillon

Publications and source records attributed to A Bourrillon.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Cat scratch disease. Atypical forms].

First described by Robert Debré in 1950, cat scratch disease, usually observed in children and young adults (80% of the case occur in subjects under 18), is the principal cause of chronic benign lymph node enlargement. The Centers for Disease Control at Atlanta currently recognize Afipia felis and Rochalimaea henselae as the causal agents of cat scratch disease. Cats transmit the disease to humans by skin scratches or by licking open wounds. The bacilli can also be transmitted by dogs, monkeys, squirels or inert objects. The contaminating cats are usually young. There is no interhuman transmission. There are several uncommon manifestations of cat scratch disease which may misguide diagnosis. In atypical forms, the positive diagnosis of this benign disease can only be confirmed by serology or molecular biology techniques. In order to reduce the duration of the disease, antibiotic treatment is recommended in forms with systemic involvement and in atypical forms although there has been no proof of efficacy.

Cat-Scratch Disease↗
PubMed1996

[Cat scratch disease in immunocompetent children].

First cause of chronic benign lymphadenopathy, cat scratch disease occurs mainly in children and young adults. The nature of its bacterial agents is not definitely established, but Atlanta's CDC actually considers Afipia felis and Rochalimaea hensaela as the agents of the disease. It usually presents as chronic adenitis but there are severe forms of the disease with systemic manifestation. In such forms, new techniques such as serology and molecular biology are particularly useful for the diagnosis. The prognosis is always excellent and an antibiotic treatment is only recommended for systemic forms to reduce the duration of the disease.

Cat-Scratch Disease↗
PubMed1996

[Blau syndrome or familial form of sarcoidosis with onset during infancy].

INTRODUCTION: Blau syndrome is a granulomatous disease with dominant autosomal transmission. Skin, joint and ocular manifestations usually appear in childhood. CASE REPORTS: A father and his son had granulomatous disease with skin and joint manifestations beginning in childhood. Both patients had inflammatory polyarticular deformations of the small and medium sized joints with formation of synovial cysts. Skin manifestations were seen only in the son who presented diffuse micropapulous eruptions. Histology examination of the superficial and deep derma revealed an epithelioid granuloma without necrosis. DISCUSSION: Our case are similar to the syndrome described by Blau who recognized the familial nature of early onset sarcoidosis and probable autosomal dominant transmission together with joint deformation and development of synovial cysts without pulmonary involvement.

Age Factors↗
PubMed1996

Idiopathic disseminated bacillus Calmette-Guérin infection: a French national retrospective study.

OBJECTIVE: Disseminated bacillus Calmette-Guérin (BCG) infection after inoculation of live vaccine is considered to result from impaired immunity of the child. However, in half of the cases, regarded as idiopathic, no well-defined immunodeficiency condition can account for the infection. The objective of the present study is to report the prevalence, clinical features, associated infections, and outcomes of children with idiopathic disseminated BCG infection. DESIGN: National retrospective survey during the period from 1974 through 1994 in France. SETTING: All neonatology and pediatrics units in primary care and referral centers throughout France. PATIENTS: Data were collected from 595 (82%) of 721 units, 377 (93%) of 407 centers, and 320 (93%) of 345 cities. Selection criteria included BCG infection, dissemination to at least two areas beyond the inoculation site, and no well-defined immunodeficiency condition. Sixteen children (8 girls and 8 boys), born to families unrelated to each other but often consanguinous (5 of 16) or abroad (5 of 16). RESULTS: The minimal prevalence rate was estimated at 0.59 cases per 1 million vaccinated children born in France. Clinical features included fever and cachexia, disseminated BCG infection to lymph nodes (15 of 16), skin (13 of 16), soft tissues (11 of 16), lungs (11 of 16), spleen (11 of 16), liver (11 of 16), and bones (9 of 16). Eight children had associated or subsequent severe opportunistic infection (50%), with either nontyphi Salmonella enterica serotypes (7 of 16) or Mycobacterium abscessus (1 of 16). The outcome was poor: 8 children (50%) died; the cause of death was BCG infection for most children (7 of 8); 8 survived until the last follow-up (50%). CONCLUSIONS: Idiopathic disseminated BCG infection is a rare but severe complication of BCG vaccination. The infection probably results from an as yet unknown genetically determined immunodeficiency condition that affects the killing of intracellular bacteria such as BCG and Salmonella.

BCG Vaccine↗
PubMed1995

[Resistant pneumococci in pediatrics: therapeutic implications].

Pneumococci is the number one pathogen causing pneumonia and bacteraemia in children in France. After H. influenzae, it is the second most frequent cause of conjunctivitis and otitis as well as purulent meningitis in 3-month to 3-year-old children (a situation which will undoubtedly be modified by Hib H. influenzae b vaccinations). It also predominates in bronchial superinfections and occult bacteraemia. Penicillin G. has been given for pneumococci infections for years leading the development of resistant strains (20.1% of the strains isolated in France in 1992 were resistant to beta-lactamines. Other resistances include macrolides (44% of the strains), tetracyclins (28%), cotrimoxazol (32%), chloramphenicol (25%) and erythromycin-sulphisoxazol (20%). Thus no other family of oral antibiotics can be successfully substituted for beta-lactamines for routine treatment. Lifestyle and health care organization is a major factor of risk which could explain why the incidence of resistant strains is greater in high density urban populations or in countries were young children are cared for in groups. Therapeutic strategies for easily accessible localizations (septicaemias, pneumonia) can be easily established on the basis of minimal inhibiting concentrations, but for certain sites (otitis, meningitis) more problems are raised. For example, the probability of resistance to penicillin R in acute otitis has been estimated at 75% for children living in the Paris area. We therefore recommend amoxillin (150 to 200 mg/kg/day) or pristinamycin or possibly ceftriaxon (50 mg/kg/day during 3 days). Similar probabilistic strategies are established for purulent meningitis and other childhood pneumococci infections.

Age Factors↗
PubMed1995

[Treatment of febrile convulsions in infants].

Guidelines for the management of febrile seizures are presented. Intrarectal administration of diazepam (0.5 mg/kg) is the first line therapy for complex or prolonged seizures. Preventive treatment of recurrence is mainly indicated in case of complex seizures using either prolonged daily monotherapy, preferentially sodium valproate, or intermittent administration of diazepam during febrile illnesses.

Anticonvulsants↗
PubMed1994

[Treatment of Streptococcus pneumoiae meningitis in infants].

Due to a worldwide increasing number of cephalosporin resistant Streptococcus (S) pneumoniae strains, it appears necessary to modify the current treatment of pneumococcal meningitis. The authors recommend an initial antimicrobial regimen associating cefotaxime or ceftriaxone to vancomycin in any case of bacterial meningitis in which S pneumoniae appears to be involved (Gram positive cocci on direct examination of the CSF and/or presence of soluble bacterial antigen). There is also a need for a reappraisal of the duration of the treatment which, in any case, should not be shorter than 10 days. In the case of meningitis due to a penicillin resistant S pneumoniae, lumbar puncture must be repeated until sterilisation of the CSF.

Cefotaxime↗
PubMed1993

Lead encephalopathy mimicking a cerebellar tumor.

Encephalopathy is a rare but severe complication of lead poisoning, mainly due to cerebral edema. Usually diffuse, symptoms and signs are sometimes focal, suggesting a false diagnosis of tumor, particularly cerebellar tumor. We report such a case diagnosed by MR imaging in which early treatment for edema avoided neurosurgical exploration. Only six cases have been published since Biemond and Van Creveld's first report in 1939. Several data--clinical and experimental--providing specific involvement of cerebellum in lead poisoning are emphasized.

Cerebellar Diseases↗
PubMed1993

[Microangiopathic anemia following thrombopenic purpura].

BACKGROUND: Chronic relapsing microangiopathic hemolytic anemia is rare in children. This report describes a case associated with thrombocytopenia following idiopathic thrombocytopenic purpura. CASE REPORT: A 4 year-old girl was admitted for acute idiopathic thrombocytopenic purpura (platelet count: 12,000/mm3) without anemia or fragmented red cells. The patient was given intravenous gammaglobulins without success, followed by prednisone (2 mg/kg/day). The platelet count was normalized, but decreased when the treatment was discontinued. The patient developed acute intracranial hypertension at the age of 5 yr 8 mo, following two cerebral hematomas. The platelet count was 9,000/mm3. A second course of intravenous gammaglobulins and prednisone was unsuccessful, so a splenectomy was performed. One year later, the patient was admitted because of diffuse purpura, anemia and jaundice. Hematologic findings were: Hb 8.4 g/dl, reticulocytes 448,200/mm3, fragmented red cells 16%, platelets 15,000/mm3, WBC 22,400/mm3. Seroimmunologic investigation showed a high titer of antinuclear antibodies. Examination for viral etiology was negative. Intravenous gammaglobulins had a transient effect on platelets, reticulocytes and fragmented red cells. The patient was then given vincristine plus prednisone; they were only effective when high doses were used. A second intracerebral hemorrhage occurred when the patient was given low doses of drugs. After 3 other hematologic relapses, the vincristine was stopped without further complication. CONCLUSION: The criteria for systemic lupus erythematous were not satisfied, despite the presence of antinuclear antibodies. A congenital deficiency of an unidentified plasma factor that reverses microangiopathic hemolysis and thrombocytopenia was not demonstrated in this patient, who could not be given fresh frozen plasma.

Acute Disease↗
PubMed1993

[Treatment of primary tuberculosis in children].

The increased prevalence of tuberculosis during the past years incites to a rigorous attitude in screening and treatment of primary tuberculosis. The authors underlines the importance of the prevention by BCG vaccination and of careful screening using correctly performed Mantoux test. The treatment of primary tuberculosis is different whether it is latent (tuberculin positive children without evidence of disease) or patent (with clinical or radiological signs, mycobacterium tuberculosis identification). For latent tuberculosis a two drugs therapy with isoniazid an rifampicine during 6 months is recommended. For patent tuberculosis the author recommands a four drugs therapy (isoniazide, rifampicine, ethambutol, pyrazinamide) for 2 months (3 months in case of hematogenous dissemination with acute miliary or meningitis) followed by a two drugs regimen (isoniazide, rifampicine) for 4 to 9 months. Corticosteroids are indicated when atelectasis resulting from bronchial obstruction is present.

Adrenal Cortex Hormones↗
PubMed1993

[Congenital myasthenia with esophageal involvement].

BACKGROUND: Mild disorders associated with persistent neonatal myasthenia gravis may not be recognized for several months. Esophageal dysfunction in this type of myasthenia has never been studied. CASE REPORT: A gastroesophageal reflux was diagnosed during the first weeks of life in a girl; she was not treated. At 8 month-old, she was admitted for febrile convulsions; the pyrexia was due to urinary tract infection by Escherichia coli. 4 days later, the infant displayed weakness of the eyelids and extraocular muscles. The proximal muscles of the arms were also weak. Neostigmine, 0.3 mg subcutaneously, completely removed the symptoms in a few minutes. Neuromuscular transmission tests showed a progressive decrease in eyelid muscle response on repetitive stimulation of the nerve, with a pattern of post-synaptic defects that was corrected by edrophonium chloride injection. Neither the girl nor her mother had acetylcholine receptor antibodies. Overnight monitoring of the distal esophagus pH showed numerous episodes of acid reflux, essentially after the meal. Manometry disclosed abnormalities of both the striated and smooth muscles of the esophagus that were corrected with neostigmine. The girl was given neostigmine and was in good condition one year later. CONCLUSION: Myasthenia could worsen and/or trigger a gastroesophageal reflux by decreasing esophageal clearance and lower esophageal sphincter pressure.

Female↗
PubMed1993

[Analysis of emergency recruitment in a pediatric hospital. Effect on the organization of available care].

BACKGROUND: The increasing demand on the emergency wards of pediatric hospitals raise the question of whether the services delivered are adequate for the explicit and implicit needs of outpatients. POPULATION AND METHODS: The files of all the 334 children consulting at the medical emergency ward of Robert-Debré hospital in Paris between April 19 and April 26, 1989 were analyzed. Socio-demographic data, reasons for visit and final diagnosis were collected. Each outpatient was assigned to one of 3 categories: 1) severe emergency; 2) simple emergency; 3) consultation. Further data on the events leading to the visit were obtained by a second survey covering 213 children seen between May 11 and May 14, 1991 from 8 hrs to 20 hrs. RESULTS: The mean age of the 334 children in the first survey was 3.2 years. Half of the mothers were unemployed. Half of the families was of foreign extraction. 3.4% of the children had no social insurance. Ten percent of the patients were frequent users of the emergency ward. Infectious diseases were the most prevalent reason for visit. Severe emergencies were 28%, simple emergencies 44% and consultations 28%. Among the 213 children of the second survey, half of the families had seen (43%) or attempted to see (7%) a physician outside the hospital before coming to the emergency ward. CONCLUSION: The needs of the children could best be met by performing a true medico-social examination at the medical emergency ward, enhancing access for children and revitalizing a partnership with the community to provide continuous care for those children in need of it.

Child, Preschool↗