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Biomedical subjects

Joël Gaudelus

Publications and source records attributed to Joël Gaudelus.

8 recordsLinked to original sources
PubMed2006

Herpes simplex encephalitis: diagnostic problems and late relapse.

A 5-year-old female presented with prolonged afebrile right-sided focal seizures, right brachio-facial paralysis, and dysarthria; consciousness was not altered. Fever appeared 20 hours after onset of neurological symptoms. At admission (day 1) cerebral computerized tomography and cerebrospinal fluid (CSF) analyses were normal including undetectable alpha-interferon (alpha-IFN) and negative herpes simplex virus (HSV) polymerase chain reaction (PCR). Acyclovir was started at a dosage of 60mg/kg/day for 21 days and neurological symptoms improved. Cerebral magnetic resonance imaging (MRI) showed lesions in the left thalamus and left parietal lobe. On day 8, CSF contained an elevated leukocyte count with a predominance of lymphocytes, but alpha-IFN and HSV DNA were still undetectable. Delayed intrathecal synthesis of specific anti-HSV antibodies was found on day 26 and confirmed herpes simplex encephalitis (HSE) diagnosis. Twenty months after this episode, the patient presented with a febrile meningeal syndrome. PCR detected HSV DNA in CSF and cerebral imaging showed a new left temporal lesion. At relapse onset, intrathecal synthesis of specific anti-HSV antibodies had disappeared. Acyclovir was started at a dosage of 60mg/kg/day for 21 days and neurological status improved. At discharge, neurological examination showed right hemiparesis and bucco-facial dyspraxia. Diagnostic problems of HSE diagnosis in children are highlighted. It is suggested that the premature disappearance of intrathecal synthesis of a specific anti-HSV antibody might play a permissive role in the resurgence of cerebral viral replication.

Acyclovir↗
PubMed2006

Tuberculosis in adolescents: A French retrospective study of 52 cases.

BACKGROUND: The only available data about tuberculosis (TB) among adolescents date back to the 1980s, although the incidence of tuberculosis has been increasing in this age group. METHODS: Medical records were reviewed for all adolescents aged 12 to 18 years hospitalized with the diagnosis of TB in Avicenne/Jean Verdier Teaching hospital (Seine-Saint-Denis, suburb of Paris) between September 2000 and December 2004. RESULTS: Of the 52 patients identified, 52% were female. Median age at diagnosis was 15 years (range, 12-18 years). The proportion of adolescents known to be born abroad was 90%. Diagnoses resulted from the examination of a sick child in 79% of cases, a case contact investigation of an adult suspected of having TB in 19% and routine tuberculin skin test in 2%. Twenty-seven of 52 patients (52%) had isolated pulmonary disease. Sixteen patients (31%) had pulmonary and extrapulmonary TB and 8 cases (17%) had exclusively extrapulmonary disease. The site of extrapulmonary TB included pleural (n = 8), meningitis (n = 4), lymph node (n = 4), peritoneal (n = 5), osteoarticular (n = 3) and genitourinary (n = 1). TB was confirmed by the isolation of Mycobacterium tuberculosis from sputum (n = 21), gastric aspirate (n = 8), bone (n = 1) or cerebrospinal fluid (n = 2). No case had a relapse or recurrence of disease in median 3.2 years of follow up. CONCLUSIONS: Our results indicate that demographic and clinical characteristics of adolescents with TB differed from adults and children. A specific approach to the prevention and treatment of TB in adolescents is absolutely necessary.

Adolescent↗
PubMed2003

[New pneumococcal vaccine].

Streptococcus Pneumoniae is the main pathogen bacteria responsible for invasive diseases (bacteremia, meningitis) in children less than 2 years of age. The new conjugate heptavalent pneumococcal vaccine (7 polysaccharide serotypes 4, 6B, 9V, 14, 18C, 19F, 23F conjugated with the CRP 197 protein derived from diphteria anatoxin) is a great advance. This vaccine is well tolerated, immunogenic and efficient in infant. His efficacy in invasive pneumococcal diseases is more than 95%. The reduction of pneumonia (with 2.5 cm X-Ray opacity) was 32.2% in the first year of age and 23.4% in the two first years in the vaccinated group. The efficacy in acute otitis media is poor French indications of this vaccine, limited to infants under 2 years of age with further risk factor, might be extended to all the infants under 2 years of age.

France↗
PubMed2002

[Tuberculosis in children].

Children tuberculosis accounts for 5.5% of the declared cases of tuberculosis in France. Tuberculosis in children is always due to recent contamination from an adult. Survey of tuberculosis in children is a good indicator of the Koch's bacillus spread. Age is an important risk factor for an infected child to develop tuberculous disease. Estimated risk is 43% under 1 year of age, 24% between 1 and 5 years of age, 16% in teenagers. The risk to develop severe disease (miliary, meningitis) is higher in infants. Teenagers may have a rapidly evolutive form. Diagnosis of tuberculosis in children is difficult. One has to keep in mind this diagnosis which must be assessed by tuberculin skin test, radiologic exams and bacteriological sampling. The proof of tuberculosis is rare in children: direct examination of gastric fluid is positive only in 20% of cases or less; culture is positive only in 50% of cases or less. Infection and disease have to be treated in children. The search of the index case is mandatory.

Adolescent↗