Biomedical subjects
D Floret
Publications and source records attributed to D Floret.
-Vaccinations under interrogation: questions for a specialist.
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Cost of varicella in France: a study in day care centers.
To assess the cost of varicella in young children in France, a prospective study was done in day care centers. Children (1263), who were 3 months to 3 years old and attending day care, were followed over a varicella season. For every child who developed varicella (n = 200), detailed information was obtained by use of parental questionnaires. Questions concerned medical care, days missed from work for parents, and the need for extra baby-sitting. On average, each sick child had one consultation with a physician and received three medications. In half of the families (52%), at least 1 parent had to miss work an average of 4.5 days to care for a sick child. Total costs to society were estimated to be US$352 per family, with medical costs accounting for 22% of the cost. The average eventual cost to parents was $89 per family, including $80 of non-medical costs. This study emphasizes the important socioeconomic impact of varicella in the day care setting in France.
[Is it necessary to train generalists in urgent pediatric care? Experience with an inter-university curriculum of urgent care in pediatrics in the Rhone-Alps region].
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[Success and vicissitudes on organizing urgent care in pediatrics: presentation of a project of urgent pediatric medico-surgical care].
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[Febrile purpura in children].
The association of fever and purpura should first suggest the diagnosis of fulminant meningococcemia, owing to the severity of this condition. Compromise of peripheral circulation (cyanosis, prolonged refilling time) is important to consider, because normal blood pressure is usually observed at an early stage of a septic shock in children and particularly in young infants. When this hypothesis has been eliminated, other causes of febrile purpura can be considered: meningococcal meningitis; measles or other viral diseases; non infectious causes include mechanical purpura, Schönlein-Henoch's purpura and thrombocytopenia. In the frequent case where no cause has been found, the diagnosis of occult bacteriaemia should be considered, leading to parenteral administration of antibiotic following blood and cerebrospinal fluid cultures.
[Biological diagnosis of whooping cough: contribution of gene amplification].
An upsurge in pertussis infections, despite mandatory vaccination in France since 1966, has occurred again in developed countries due to progressive loss of vaccinal immunity and wider circulation of the causal bacterium, Bordetella pertussis. Unfortunately, the classical culture method is insufficiently sensitive and serology can only confirm diagnosis retrospectively. New techniques are needed for rapid diagnosis, and subsequent treatment and preventive measures. One new method, gene amplification using polymerase chain reaction (PCR), has been particularly useful in detecting Bordetella pertussis. PCR is highly specific and more sensitive than culture. It is thus quite useful in case of atypical clinical presentations and in previously treated or vaccinated patients. Less restrictions on sample transportation and preservation make PCR a technique which general practitioners can use for rapid easy diagnosis of pertussis.
[Clostridium perfringens meningitis with fatal outcome in a 3-week old infant].
BACKGROUND: Clostridium perfringens meningitis is a rare condition usually associated to skull injuries, surgery or gastro-intestinal disorders. CASE REPORT: A 21 day-old infant was admitted for the sudden worsening of a neonatal post-hemorrhagic hydrocephalus. Eighteen hours after admission, she developed a septic status with acute meningitis. A CT scan revealed the presence of intracerebral gas suggesting the responsibility of an anaerobic bacterium. The infant died within 24 hours from multiorgan failure, hemodynamic disorders, acute anemia with red urines. Clostridium perfringens was isolated both from the blood and CSF. CONCLUSIONS: The tissue alterations following meningeal hemorrhage may favor anaerobic growth. The presence of intracerebral gas is highly suggestive of the diagnosis. The prognosis is very poor.
[Virus-bacteria co-infections].
Influenza is the best known model of bacterial-viral co-infection. Epidemics of influenza result in an increased hospital admission rate for bacterial pneumonia due to pneumococcus, Haemophilus influenzae and Staphylococcus aureus. Similarly, an increased incidence of meningococcal diseases, particularly severe forms, follows the influenza outbreaks, with a two week delay. Though the precise mechanism is not known, the depression of host's phagocytes bactericidal activity by the influenza virus seems to be involved. An increased incidence of invasive group A beta hemolytic streptococcal infections, particularly necrotizing fasciitis and toxic shock syndrome, is also observed in relation with chickenpox. The reason for this association is unclear and appears not to be limited to the disruption of the cutaneous barrier which leads to the cutaneous infections in this disease. Bacterial-viral co-infection is not a justification for a systematic antibiotic prescription in viral diseases. Severe bacterial disease will be best prevented through viral immunization, thus encouraging the development of viral vaccines and immunization campaigns.
Toxin involvement in staphylococcal scalded skin syndrome.
The production of staphylococcal exfoliative toxin A (ETA) and toxin B (ETB), toxic shock syndrome toxin (TSST-1), and enterotoxins A-E was analyzed in 60 Staphylococcus aureus strains isolated from children with scalded skin syndrome (15 with generalized exfoliative syndrome, 28 with bullous impetigo, and 17 with staphylococcal scarlet fever). All strains isolated from patients with generalized exfoliative syndrome or bullous impetigo produced ETA and/or ETB and caused a Nikolsky's sign when injected subcutaneously into newborn mice. In contrast, exfoliative toxin was detected in an S. aureus strain from only one of 17 case of staphylococcal scarlet fever; the 16 other S. aureus strains produced TSST-1 and/or an enterotoxin. In conclusion, enterotoxins or TSST-1 are more frequently associated with staphylococcal scarlet fever than are exfoliative toxins. Hence staphylococcal scarlet fever may well represent an abortive form of toxic shock syndrome rather than a milder form of staphylococcal scalded skin syndrome.
[Cutaneous Kaposi disease disclosing acquired immunodeficiency syndrome in a child].
INTRODUCTION: Kaposi's sarcoma associated with acquired immunodeficiency syndrome is uncommon in children and cutaneous localizations are rare. We report a case of pediatric cutaneous Kaposi's sarcoma that revealed a human immunodeficiency virus infection. OBSERVATION: An 8-years-old girl native of the Ivory Coast, with normal statural and psychomotor development, presented cutaneous Kaposi's sarcoma after varicella. The serodiagnosis was positive for type 1 human immunodeficiency virus and CD4 lymphocytes count was 9/mm3. A tonsil localization of Kaposi's sarcoma occurred and bleomycin was a short time effective. A relapse of cutaneous Kaposi's sarcoma with digestive, pulmonary and neurological symptoms was transitorily controlled by the association prednisone-vinblastine-doxorubicin, but death occurred with recurrence of pharyngeal Kaposi's sarcoma. DISCUSSION: The review of literature shows that in pediatric acquired immunodeficiency syndrome, failure to thrive, encephalopathy and opportunistic infections are common. On the other hand, Kaposi's sarcoma is unusual and cutaneous localizations are especially observed when the contamination is postnatal and late. In our case the contamination is presumed perinatal and the human immunodeficiency virus infection was asymptomatic until 8 years old. Kaposi's sarcoma was the cause of the most presenting symptoms and of death, without demonstrated opportunistic infections.
[Story of antifreeze].
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[Haemophilus influenzae meningitis following vaccination. Consequence or coincidence?].
BACKGROUND: The introduction of vaccines against Haemophilus influenzae type b (Hib) has had a substantial impact on Hib infections. Their use has established their excellent safety profiles but occasional adverse effects have been reported. CASE REPORT: A 4 month-old infant was admitted for a severe form of Hib meningitis with septicemia whose first manifestations developed 3 hours after the first immunization with a conjugate vaccine against Hib (PRP-T). The outcome was good without any sequelae. DISCUSSION: A dramatic decrease in serum antibodies due to antigen-antibody reaction during the first days after immunization has been reported; this mechanism and some epidemiological data could favor the hypothesis that the vaccine is responsible for the infection, at least the unconjugated vaccines. CONCLUSION: Any fever occurring in the immediate post-immunization period must alert the possibility of a Hib infection.
[Role of macrolides in the treatment of respiratory tract infections in children].
Macrolides are antibiotics with high intracellular concentrations. They have a bacteriostatic activity but are also bactericides for concentrations five times greater than the minimal inhibitory concentration, concentrations in which they reach in the respiratory tract. They are usually active on Streptococcus, Neisseria, Moraxella catarrhalis, Listeria monocytogenes, Bordetella pertussis, Pasteurella multocida, Chlamydia, Mycoplasma pneumoniae, Legionella pneumophila and Helicobacter pylori. They have few secondary effects, some in relation with drug interactions. Their main indications are bronchopulmonary infections due to Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachomatis and Legionella pneumophila. They are also useful in whooping cough allowing the eradication of Bordetella pertussis in the rhinopharynx, thus limiting the dissemination of the infection in children. In amygdalitis and pharyngitis, macrolides are a good substitute in the case of allergy to penicillin. New generation of macrolides (roxithromycine, clarithromycine, dirithromycine, azithromycine) might open other interesting therapeutic perspectives.
Management of subglottic haemangioma.
Between 1980 and 1993, 10 infants underwent endoscopic treatment and/or open surgical excision of a subglottic haemangioma. Of the eight children treated with the laser, four showed simple evolution following a single laser treatment, one required repeated laser treatments and two needed tracheotomy despite repeated laser treatments. The last three children developed moderate subglottic stenosis. Laser treatment was followed by open surgical excision in one child. Two children underwent primary surgical excision, allowing extubation between 8 and 10 days post-operatively. After a period in which we systematically treated subglottic haemangiomas with the laser, these findings have led us to employ open surgery in children with large subglottic haemangiomas or when airway obstruction requires a tracheostomy.
[Acute infectious myocarditis in children. Apropos of 2 series from Lyon].
Acute infectious myocarditis in childhood has a very poor initial outcome, but the long-term outlook is relatively good for the survivors. This retrospective study was based on cases of acute myocarditis admitted to two hospital departments with different modes of recruitment. Firstly, a polyvalent paediatric intensive care unit where 12 children (mean age 12 months) were admitted during the acute phase of myocarditis. The initial symptoms were non-specific and misleading, the diagnosis being established at autopsy in 9 cases. Only 4 children presented with typical cardiac failure. The clinical signs were hepatomegaly, sinus tachycardia, cardiomegaly, ECG ST-T wave changes and biological signs of multiple organ failure. Left ventricular function was very poor with a fractional shortening of only 17%. The causal agent was usually viral. The clinical course was marked by a high early mortality (11/26, 42%) within 23 hours of hospital admission. Secondly, a paediatric cardiology unit where 81 children (mean age 15 months) were followed up after acute infectious myocarditis. Thirteen cases were taken from our first series and were included for long-term follow-up; 76.5% had premonitory signs of infection and 71% were in cardiac failure, Classes III or IV, during the hospital admission. The causal agent was identified in 30 cases (37%) and was usually a virus (22 cases). Treatment was classical (association of digitalis, diuretics, angiotensin converting enzyme inhibitors, anticoagulants and beta-sympathomimetics when necessary).(ABSTRACT TRUNCATED AT 250 WORDS)
Liver transplantation in end-stage biliary cirrhosis in infants weighing less than 12 kilograms.
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[Surveillance of children with liver transplantation].
The benefit of liver transplantation in children with end-stage liver disease is now well established. About 80% of the children are alive 5 years after liver transplantation. These good results are obtained not only because of the improvements of the surgical techniques, but also secondary to the reffinements of the follow-up of the patients. In the intensive care unit, clinical, biological and radiological cares must be permanent, allowing graft function assessment, correction of the haemodynamic disturbances, initiation of specific therapies and the research of any complication which must be promptly treated. The main surgical complications are intraperitoneal haemorrhage, biliary and vascular failures. Bacterial and viral infections, rejection represent frequent medical complications. Following the discharge from the intensive care unit, the children are checked daily until patient and graft conditions reach normal status. As time goes, the risk of complications is decreasing, but does not disappear, underlying the need for regular and long follow-up. In almost children, liver transplantation offers normal growth and scooling.