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P Reinert

Publications and source records attributed to P Reinert.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Severe cutaneous Streptococcus pyogenes infections in the child: results of a multicenter survey].

UNLABELLED: To assess pediatric cases of severe cutaneous infections due to Streptococcus pyogenes. Since the beginning of 1980, the incidence of cellulitis and necrotizing fasciitis due to S. pyogenes has increased in adults. Serotyping of obtained isolates are in most cases M1, M3 or M5 protein. PATIENTS AND METHOD: A retrospective (1990-2000) survey was carried out in pediatric hospital centers. RESULTS: Three cases of necrotizing fasciitis and 15 of cellulitis were observed. In 30% of the cases, vancella lesions were associated; in the other cases, minor wounds were the site of the infection. Bacteriologic diagnosis was made by local samples in 14 cases; blood cultures were positive in four cases. In 11 cases, initial intravenous treatment consisted of third generation cephalosporin, in six cases of penicillin M or G and in one case of fusidic acid. In the second time, penicillin M was perfused in the majority of the cases. Mean duration of intravenous antibiotics perfusion was 15 days. There were no sequelae or death in this survey. CONCLUSIONS: Despite this study had limited epidemiological characteristics, it confirms that these two infections are rare. The frequency is probably underestimated, due to the difficulty in performing a diagnosis. The major site of infection was the varicella lesion. These two infections are so similar that it is frequent to mistake one infection for the other. Nonsteroidal anti-inflammatory drugs and site of infections did not influence prognosis. The treatment of cellulitis is penicillinotherapy whereas in necrotizing fasciitis early major surgery is often correlated with the rate of survival.

Cellulitis↗
PubMed2001

[Epidemiology of purpura fulminans and early therapeutic recommendations].

Despite major advances in pediatrics intensive care, meningococcemia remains an important cause of mortality en France (10 to 30%). Parenteral antibiotic given immediately is associated with a substantial reduction in mortality. So the Conseil supérieur d'hygiène publique de France recommend that general practitioners should administer promptly, preferably intravenously, whenever purpura fulminans is suspected, ceftriaxone (i.m., i.v.), cefotaxime (i.v.) or Amoxicillin (i.m., i.v.).

Anti-Bacterial Agents↗
PubMed2000

[Marshall syndrome: results of a retrospective national survey].

Marshall's syndrome or periodic fever syndrome was first described in 1987 in the USA based on observations of 12 children under the age of five with periodic fever (> 38 degrees C) and accompanying aphtous stomatitis, pharyngitis, and cervical adenopathy (PFAPA). In 1998, a national retrospective study was carried out in France by the pediatric infectious pathology group, and a semeiological analysis was made of 22 cases. The main characteristics of Marshall's syndrome found in this patient population were in agreement with those reported in the literature. The onset of symptoms occurred between the age of 3 months and 12 years, with a mean age of 5 years; no geographical or ethnic predisposing factors were noted. The diagnosis of symptoms was subsequently established at an age ranging from 5 months to 16 years, with a mean age of 6.5 years. It was determined that following an initial phase of generalized clinical manifestations (asthenia, cranial neuritis, dysphagia, anorexia), the symptoms become stereotyped, with the sudden appearance of high fever (> 40 degrees C), shivering, aphtous stomatitis, pharyngitis, and cervical adenopathy. Other symptoms such as cranial neuritis, arthralgia, and abdominal pain may also be present (50% of cases in the present study), but due to their variability of appearance they are of lesser diagnostic value. The main characteristic of Marshall's syndrome is its periodic aspect; with fever occurring every 6 to 9 weeks, with a mean interval of 66 days before recurrence of fever compared to the shorter interval of 21 to 28 days reported in the literature. After excluding the presence of an infection, the differential diagnosis includes the following: familial Mediterranean fever, hyper IgD syndrome, and feverish neutropenia. During the periods of fever, an inflammatory syndrome with hyperleucocytosis and a marked increase in C-reactive protein (CRP) levels and sedimentation rate is observed. The most effective treatment seems to be the early administration of corticoids during the initial phase, prior to the appearance of more specific symptoms. The prognosis is excellent, with a progressive decrease in the incidence of periodic fever and an absence of complications. However, the etiology of Marshall's syndrome has not yet been determined.

Adolescent↗
PubMed2000

Epidemiology of pneumococcal infections in French children.

UNLABELLED: Since 1977, resistance to beta-lactams and other families of antibiotics among isolates of Streptococcus pneumoniae has increased alarmingly worldwide. France is particularly affected by this phenomenon; in 1997 the French National Reference Centre for Pneumococci reported that 44% of S. pneumoniae strains were penicillin non-susceptible (PNSS). Furthermore, resistance to macrolides (53%) and sulphonamides (37%) was comparable; in addition, >50% of PNSS had a high level of resistance to penicillin and were multiresistant. The highest frequency of resistance is observed in children, particularly those with acute otitis media (AOM). CONCLUSION: The clinical consequences of increasing antibiotic resistance are evident for meningitis and AOM, prompting clinicians to consider alternative agents such as high-dose cefotaxime (300 mg/ kg/d) or ceftriaxone (100mg/kg/d) plus vancomycin (60 mg/kg/d) for meningitis, and high-dose amoxicillin (> 80 mg/kg/d) or ceftriaxone (50 mg/kg/d) for AOM.

Acute Disease↗
PubMed2000

Use of the forced oscillation technique to assess airway obstruction and reversibility in children.

The forced oscillation technique (FOT) is particularly attractive in a pediatric setting as it requires only passive cooperation from the child. We assessed the sensitivity and specificity of this method for detecting airway obstruction and its reversibility in 313 children (3 to 16 yr of age) with asthma or chronic nocturnal cough. Baseline and post-bronchodilator (n = 251) resistance were measured (R(0)) with the FOT. Baseline R(0) was normalized for height and weight [R(0)(SD)]. In children able to perform forced expiratory maneuvers (n = 181), R(0)(SD) was independently correlated with FEV(1) (p < 0.02) and maximal expiratory flow at 50% (MEF(50)) (p < 0.004). The optimal R(0)(SD) cutoff value given by receiver operating characteristic (ROC) curves to discriminate between children with baseline FEV(1) < 80% or >/= 80% of predicted values yielded 84% sensitivity and 73% specificity. Post-bronchodilator changes in R(0)(SD) [DeltaR(0)(SD)] were mostly correlated to changes in MEF(50). The optimal DeltaR(0)(SD) cutoff value to discriminate between children with the presence or absence of significant reversibility in FEV(1) yielded 69% sensitivity and 78% specificity. In children unable to perform forced expiratory maneuvers (n = 132), this DeltaR(0)(SD) cutoff clearly identified a subgroup of young children with high R(0) values at baseline, that returned to normal after bronchodilation. We conclude that FOT measurements allow reliable evaluation of bronchial obstruction and its reversibility in asthmatic children over 3 yr old.

Administration, Inhalation↗
PubMed2000

Characterization of inflammatory reaction in upper airways of cystic fibrosis patients.

Inflammatory cell populations have not been yet precisely evaluated in cystic fibrosis (CF) airways. We intended to characterize morphological modifications, inflammatory cell infiltration and cell proliferation in nasal tissues obtained from 15 CF patients and from 6 non-CF patients with nasal polyposis. Morphological analysis showed an intense inflammatory infiltration in CF and non-CF tissues with only few modifications in the epithelium from CF tissues. Inflammatory cell populations characterized by specific immunolabeling were quantified, showing a predominance of macrophages and T- and B-lymphocytes and only moderate numbers of neutrophils in CF tissues; in non-CF polyps, lymphocytes and eosinophils were abundant. Proliferating cell percentages quantified after proliferating cell nuclear antigen immunolabeling were 5.3+/-4.1% (mean +/- SD) in CF polyps and 3.1+/-1.2% in non-CF polyps in epithelium but were very low in lamina propria. Intense inflammation in nasal tissues from CF patients is therefore dominated by macrophages and lymphocytes rather than by neutrophils. While morphology is preserved, proliferation is high in epithelium from CF polyps. These findings should be regarded in the future for a better understanding of inflammation in CF airway disease.

Adolescent↗
PubMed2000

Multicentric study of the effect of milk fermented by Lactobacillus casei on the incidence of diarrhoea.

The aim of this study was to determine if supplementation of healthy children with milk fermented by yogurt cultures and Lactobacillus casei strain DN-114 001 could affect the incidence of acute diarrhoea when compared with traditional yogurt. The study was a multicentre, randomised, double-blind trial, conducted over four months, on 928 children aged, at inclusion, 6-24 months. The study consisted of two periods: supplementation and observation. Subjects were supplemented daily with 100 g of one of the two dairy products being tested: standard yogurt and milk fermented by yogurt cultures and Lactobacillus casei (10(8) cfu/ml). Frequency or duration of any diarrhoea episode was evaluated. As far as frequency was concerned there was a statistically significant difference between the groups, the incidence of diarrhoea being significantly reduced by supplementation with L. casei fermented milk (15.9%) compared with yogurt (22%) (p = 0.03). These results suggest an additional benefit of L. casei in acute diarrhoea in children compared with standard yogurt.

Acute Disease↗
PubMed1999

[Leigh syndrome and leukodystrophy due to partial succinate dehydrogenase deficiency: regression with riboflavin].

UNLABELLED: Succinate dehydrogenase (SDH) deficiency is rare. Clinical manifestations can appear in infancy with a marked impairment of psychomotor development with pyramidal signs and extrapyramidal rigidity. CASE REPORT: A 10-month-old boy developed severe neurological features, evoking a Leigh syndrome; magnetic resonance imaging showed features of leukodystrophy. A deficiency in the complex II respiratory chain (succinate dehydrogenase [SDH]) was shown. The course was remarkable by the regression of neurological impairment under treatment by riboflavin. The delay of psychomotor development, mainly involving language, was moderate at the age of 5 years. CONCLUSION: The relatively good prognosis of this patient, despite severe initial neurological impairment, may be due to the partial enzyme deficiency and/or riboflavin administration.

Basal Ganglia Diseases↗
PubMed1999

Interest of colchicine for the treatment of cystic fibrosis patients. Preliminary report.

Cystic fibrosis (CF) lung disease is characterized by persistent inflammation. Antiinflammatory drugs, such as corticosteroids and ibuprofen, have proved to slow the decline of pulmonary function although their use is limited because of frequent adverse events. We hypothesized that colchicine could be an alternative treatment because of its antiinflammatory properties and upregulatory effect on cystic fibrosis transmembrane regulator (CFTR) closely related proteins. We herein present results obtained in an open study of eight CF children treated with colchicine for at least 6 months. Clinical status was better in all patients and respiratory function tests significantly improved in five. Median duration of antibiotherapy decreased significantly. These preliminary results support our hypothesis of a beneficial effect of colchicine in CF patients and stress the need for a controlled therapeutic trial.

Adolescent↗
PubMed1999

MEFV-Gene analysis in armenian patients with Familial Mediterranean fever: diagnostic value and unfavorable renal prognosis of the M694V homozygous genotype-genetic and therapeutic implications.

Familial Mediterranean fever (FMF) is a recessively inherited disorder that is common in patients of Armenian ancestry. To date, its diagnosis, which can be made only retrospectively, is one of exclusion, based entirely on nonspecific clinical signs that result from serosal inflammation and that may lead to unnecessary surgery. Renal amyloidosis, prevented by colchicine, is the most severe complication of FMF, a disorder associated with mutations in the MEFV gene. To evaluate the diagnostic and prognostic value of MEFV-gene analysis, we investigated 90 Armenian FMF patients from 77 unrelated families that were not selected through genetic-linkage analysis. Eight mutations, one of which (R408Q) is new, were found to account for 93% of the 163 independent FMF alleles, with both FMF alleles identified in 89% of the patients. In several instances, family studies provided molecular evidence for pseudodominant transmission and incomplete penetrance of the disease phenotype. The M694V homozygous genotype was found to be associated with a higher prevalence of renal amyloidosis and arthritis, compared with other genotypes (P=.0002 and P=.006, respectively). The demonstration of both the diagnostic and prognostic value of MEFV analysis and particular modes of inheritance should lead to new ways for management of FMF-including genetic counseling and therapeutic decisions in affected families.

Adolescent↗
PubMed1998

Role of bilirubin in the regulation of the total peroxyl radical trapping antioxidant activity of plasma in sickle cell disease.

Alpha-tocopherol and bilirubin antioxidant properties were evaluated in sickle cell disease. The total peroxyl radical trapping antioxidant activity of plasma (TRAP) was measured with a polarographic method using hemin as oxidative stress initiator. The TRAP was not correlated with plasma alpha-tocopherol concentration. The TRAP was correlated with plasma total bilirubin concentration [TRAP = 8.1 (total bilirubin) +363.7 (r = 0.67)] and the correlation was even better with the sum (alpha-tocopherol + total bilirubin) plasma concentration [TRAP = 9.1(alpha-tocopherol + total bilirubin)+ 170.5(r = 0.77)]. The alpha-tocopherol contribution in the antioxidant capacity of plasma was significant but bilirubin level acted as the limiting factor of plasma antioxidant capacity in sickle cell anemia. This result can be explained by the antioxidant property of bilirubin but also by coantioxidant activity towards oxidized alpha-tocopherol.

Anemia, Sickle Cell↗
PubMed1998

[Immunization schedule in the European Union].

All nations that are part of the European Union share the same aim for the control and eradication of vaccine-preventable diseases. However, there are differences in child immunization strategies and schedules between nations, depending upon health care systems, immunization habits and epidemiology of infectious diseases. All nations immunize children against diphtheria, tetanus, poliomyelitis, measles, rubella and mumps. Immunization against pertussis, Haemophilus influenzae, hepatitis B and tuberculosis are not systematically applied.

Adolescent↗
PubMed1998

[Plea for an evaluation of beta hemolytic streptococcal tonsillitis: from diagnosis to treatment].

There is no justification to maintain a systematic antibiotic treatment of all tonsillitis as currently practiced in France. Indeed, it is today possible to exclude the streptococcal origin of tonsillitis with a fair probability using a rapid diagnosis test. It is therefore mandatory that these tests are made available to the French practitioner. Additionally, alternatives to the classical 10-day penicillin V treatment of streptococcal tonsillitis must be seriously considered: shorter duration treatment with oral cephalosporins, macrolides or amoxicillin have proved to be as efficient and of lower cost; they are also probably safer due to a better compliance related to the shorter duration.

Child↗
PubMed1998

[Exploration of 112 children suspected of amoxicillin allergy. Indications and efficacy of oral provocation test].

BACKGROUND: One to 10% of treatments using betalactams, particularly synthetic penicillin, are complicated by allergic reactions, usually cutaneous, and not easily imputable to immunologic sensitization in children. PATIENTS AND METHODS: The aim of this study was to identify, using cutaneous and biological tests, those from a group of 112 children suspected of amoxicillin allergy (evidenced by rash) who were actually sensitized, and to confirm the absence of allergy in others by an oral provocation test (OPT) associated to a long-term survey. The cutaneous tests were made by prick test and intra-dermo reaction (IDR) with Allergopen and with amoxicillin or amoxicillin + clavulanic acid. The biological tests included examination for penicillin and amoxicillin antibodies by using various techniques including enzyme-linked immunosorbent assay (ELISA) immunoglobulin G (IgG) and IgE, FARR, radioallergo sorbent test (RAST) and a histaminoliberation. When these tests were negative, an OPT with the suspected antibiotic was subsequently performed. RESULTS: Thirty-nine children (36.4%) confidently presented at least one positive cutaneous test (38 Allergopen, ten amoxicillin); 25 biological tests were positive (16 ELISA IgE, one ELISA IgG and eight histaminolibarations), seven times with negative cutaneous test. Forty-five children were judged to be sensitized to amoxicillin, with only one who subsequently took amoxicillin again. Among the 67 others, 52 received an OPT, six of them with moderate cutaneous reactions. Fifty-one (45.5%) children were allergic and 46 (41%) were allowed to take amoxicillin again; 17 did, one of them with a benign cutaneous reaction. CONCLUSION: Efficacy and safety of this type of investigation seems clear; it will have to be confirmed by other studies.

Adolescent↗