[A homogeneous series of 210 cases of congenital toxoplasmosis in 0 to 11-month-old infants detected prospectively].
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Biomedical subjects
Publications and source records attributed to G Tournier.
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The systematic serological examination of 174 infants aged between 0 and 12 months in a paediatric pneumology unit over a period of 12 months revealed that 59 infants (33%) had antibodies and that at least 15 (8.6%) were infected. Based on the experience gained in this department and on data from the literature, the authors recall the clinical and laboratory features of Chlamydia trachomatis interstitial pneumonia in infants, its treatment, pathophysiology and epidemiology.
100 cases of bronchial foreign body seen over a period of 4 years represent 1.2% of the admissions of a paediatric pneumology unit; 73% of the children were aged between 6 months and 3 years. The foreign body was vegetable in 61% of cases (a peanut in 44% of cases). The time between the inhalation and the endoscopic diagnosis was greater than 7 days in 70% of cases and greater than 30 days in 37% of cases. Removal of the foreign body was possible in all but one case. In particular, the authors studied the pneumological implications of a foreign body: the value of a quantitative bacteriological study of the bronchial secretions, which was significant in 43% of cases, and detection of the sequelae by prospective clinical and functional surveillance with a follow-up of 3 to 24 months. After 6 months, persistent radiological abnormalities were found in 40% of cases, perfusion disorders were found in 35% and ventilation disorders were found in 64%. A surgical operation was performed in 7 cases: one case of bronchotomy for extraction of the foreign body and 6 cases of parenchymal excision, including 2 total pneumonectomy for a destroyed lung. These were no death. The pathophysiology of the complications of functional disorders and of dilatation of the bronchi is discussed in the context of the experience gained from this series.
A 4 1/2 month-old infant presented with severe alveolo-interstitial pneumonitis needing intubation and mechanical ventilation. Legionella pneumophila infection was established by a significant increase in antibody titers. The clinical picture was consistent with that of legionnaires' disease. No immune defect could be proven.
The present study relates to 39 children, 24 boys and 15 girls, aged 1 to 17 (mean age, 6 1/2 years) suffering from chronic airflow obstruction without muco-viscidosis. The search for a ciliary anomaly was motivated either by the coexistence of situs inversus (group I: 12 cases) or by the negative or scanty aetiological history (group II: 27 cases). The investigation of the cilia consists of a study of ciliary motility and an ultrastructural study of biopsy specimens using the electron microscope. Groups I and II were similar as regards severity of disease, assessed by the incidence of bronchiectasis and chronic hypoxia at rest; a higher incidence of neonatal respiratory distress was noted in group I (7 cases against 4 in group II). Ciliary immotility was particularly noted in group I (7 cases) and one case of weak motility in group II. The major ultrastructural anomalies of the axonemal complex were seen as well in both groups I and II; it was noted that all the structures may be totally or partially missing with the exception of the peripheral microtubules. The discussion centred on three points: 1. In the first analysis, the discordance between the existance of major ultrastructural anomalies of the axonemal complex, a priori incompatible with the conservation of ciliary motility on light microscopy; the link seems to lie in the percentage of cilia affected, the existence of ciliary dyskinesia and finally the disorientation of the basal corpuscles. 2. The immunologic abnormalities sometimes associated with a syndrome of ciliary immotility: that is the anomalies of leucokyte migration under the control of microtubular structures in the peri-centriolar region. 3. The practical consequences. Current treatment rests on daily respiratory physiotherapy and antibiotics adapted for cases of superinfection; also there are drugs stimulating ciliary activity perhaps by the effect on their residual motility; some substances carrying ATP and ATP-ase may re-establish ciliary motility anulled by the absence of dynein arms; also the observations of major ultrastructural abnormalities ought to lead to better genetic counselling than at present, where the mode or modes of transmission are uncertain.
Chlamydia trachomatis now has an important place in infantile respiratory pathology. In neonates, it is transmitted in utero, which explains one quarter of the cases of interstitial pneumonia seen during the first months of life. In children, the number of carriers of antibodies increases with age and may be more than 40 p. cent by the age of 7 years. The mode of contamination and the pathological significance remain uncertain in this age group. Chlamydia trachomatis can be a cause of pneumonia in immuno-depressed patients. A survey conducted in a Paediatric Respiratory Medicine Unit showed that 22 p. cent of patients were carriers of the antibody and at least 7.8 p. cent were infected.
Twenty children aged between 5 and 16 suffering from severe asthma were treated with long acting oral theophylline. The minimum duration of treatment was three months and the maximum 12 months. Clinical, pharmacokinetic and pulmonary function studies were made. With a mean dose of 8.75 mg/kg, morning and evening, the theophylline blood levels on the 4th day of treatment (4 hours after the morning dose) were 12.3 +/- 4.36 mg/l. Those taken 4 hours after the evening dose 9.41 +/- 3.75 mg/l, suggesting a circadian rhythm for theophylline blood levels. The importance if fever is stressed in relationship to blood levels, which were increased by 67-100% with fevers of 38.5-39 degrees C. Treatment was very beneficial in 53% of cases. Respiratory function studies were performed in 13 children. After 4 days of treatment there was a significant decrease in airflow obstruction and hypoxemia However, despite carefully adjusted treatment, functional disturbances persisted, in particular hyperinflation.
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Control of breathing at rest was studied in 14 children (4-16 years old) with interstitial lung disease (ILD). Four of them were tested several times. Breathing pattern and the mouth occlusion pressure (P0.1) were measured. Results in ILD children were compared to values in healthy children previously reported. Respiratory frequency and minute ventilation were increased (P less than 0.02). Inspiratory time (TI) was shortened (P less than 0.001), the shortening in TI being significantly related to the increase in lung elastance (EL). The ratio of TI to the total duration of the respiratory cycle (TI/TTOT) was lowered (P less than 0.01). Tidal volume (VT) both in ml and normalized for body weight (BW) was normal. P0.1 was higher than predicted. The increase in P0.1 was significantly related to change in arterial O2 pressure (PaO2) which was reduced in 10 cases. There was a significant relationship between the increase in P0.1 and in EL. The increase in mean inspiratory flow (VTBW/TI) was related to the increase in EL. But VTBW/TI was not increased as much as P0.1. Consequently the effective inspiratory impedance was enhanced. This high effective inspiratory impedance was related to the increased lung elastance.
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The early onset of the disease (between the 13th and 15th days of life) and its long duration in 2 out of 3 cases, the absence of infectious symptoms and the efficacy of erythromycin treatment were characteristic features. The diagnosis was confirmed by positive (greater than 1/32th) serological tests in both infants and parents. Chlamydia trachomatis lung infection should be suspected in infants presenting, during the first weeks of life, with cough and dyspnoea unaccompanied by fever, radiological evidence of interstitial pneumonia, blood eosinophilia and raised immunoglobulin levels. The disease results from intranatal contamination and might represent, in France as in the U.S.A., an important percentage of respiratory infections occurring during the early months of life.