Biomedical subjects
Publications and source records attributed to A Beaudoing.
An attack of malaria can be lethal; however, besides this classic form, clinical cases are less brutal, often with blood disorders, related to Plasmodium falciparum infection resistant to chloroquine. Because of the importance of chloroquinoresistance through the world, chemoprophylaxis is very difficult, and the fight against mosquitoes' bites is once again very important.
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Pharmacokinetic studies of 13 children treated with cyclosporine A (CyA) were retrospectively analysed (9 renal transplants, 1 combined liver-kidney transplant, 1 heart transplant; 2 were treated for a nephrotic syndrome). The patients were separated into 2 groups: patients 0-15 years (group 1), patients 15-18 years (group 2). In comparison with adults (group 3), children of the 2 groups required higher CyA doses, related either to body weight or to body surface area. CyA dosage was performed by high performance liquid chromatography on whole blood samples. Despite higher doses, trough CyA levels were lower in groups 1 and 2 compared with group 3. Nephrotoxicity occurred in the only 2 children treated with CyA doses higher than 10 mg/kg/d.
The authors report on a boy and his mother showing signs of hypoglycemia due to hypersensitivity to leucine that is related to a that dominant autosomal. The cyclic inheritance glycemia test shows hyperinsulism; oral as well as intravenous loading dose of leucine tests showed that this hyperinsulism is due to hypersensitivity to leucine. The clinical picture, outcome of the disease dietary and medical treatment with diazoxide, and the role of GIP in insulin secretion is discussed.
In a 9 month-old infant admitted to hospital for a fever with chilles, anaerobic blood cultures isolated Fusobacterium necrophorum. On the 5th day of intravenous treatment with amoxicillin and metronidazole clinical signs of mastoiditis, the likely source of the sepsis, became apparent. Septicemias with Fusobacterium necrophorum are usually observed in teenagers and young adults during an acute bout of tonsilitis. This type of infection is exceptional in infants and requires a careful search for a primary focus in facial cavities and in the base of the skull.
The diagnostic interest of the search for soluble bacterial antigens, using counter-current immunoelectrophoresis (CIE) has been evaluated in 109 children hospitalized with acute infection. In meningitis, CIE was well correlated with cerebrospinal fluid (CSF) culture and allowed a rapid diagnostic orientation in 82% of meningitis which were confirmed by classical bacteriology (CIE has to be performed using CSF and concentrated urine). False positive results were observed with type B meningococcus, especially on urine samples. In respiratory infections, the search for soluble antigens was of no interest except for focal pneumonitis; in that case, CIE was more frequently positive (35%) than blood culture (28%) and led to a 31% increase of correct diagnosis (CIE must be performed using concentrated urine). Serum and pleural fluid investigations were less sensitive. CIE was not useful in case of upper respiratory or nonfocal broncho-pulmonary infection, due to its very low efficiency.
In developed countries, Chlamydia trachomatis (CT) is found on the cervix of the uterus in 2-8% of pregnant women. Two thirds of neonates from infected mothers are contaminated at delivery at the level of ocular, respiratory and digestive mucosal surfaces. This infection is responsible for 40% of neonatal conjunctivitis and afebrile pneumonitis in the second and third month after birth. In older children and adolescents, CT is responsible for genital infections contracted by venereal contact. The treatment requires taking a macrolide orally for 15 days. Prevention requires the detection of high-risk women, and hygiene in sexual intercourse.
One case of Cutis marmorata telangiectatica congenita (CMTC) is reported with cutaneous signs, corporal asymmetry, macrocephaly and cerebral vascular malformation. This syndrome allows to recognize a particular type of CMTC and its relationship with other angiomatosis.
Among 199 cases of bronchopulmonary infection in children observed over a 2-year period, 22 cases (11%) were due to Mycoplasma pneumoniae. The diagnosis was based upon the complement fixation test on whole serum in half of the children and the research of specific IgM by complement fixation test on fractioned serum and/or indirect immunofluorescence on the others. The mean age of children with Mycoplasma pneumoniae was 6 years. The clinical and radiographic appearance of the affection was non specific, often similar to pneumococcal pneumonia.
A 9-year old country boy developed blepharitis with inflammation of the face and, 1 month later, eosinophilic meningitis with paralysis of 3 limbs and of an abducent nerve. Nuclear magnetic resonance imaging of the central nervous system disclosed a lesional signal beneath the floor of the 4th ventricle, which was compatible with the presence of a larva of fly. Treatment with thiabendazole was tried, and the clinical signs regressed. Six months later, an asymmetrical hydrocephalus due to obstruction of Monroe's foramen by an inflammatory granuloma was discovered. Human hypodermyasis, due to migration in tissues of larvae of flies, is not rare in cattle-breeding areas. Neuromeningeal disorders are observed in 12% of the cases, consisting of eosinophilic meningitis sometimes associated with neurological deficit or seizures. Such complications as intracerebral haematoma or meningeal haemorrhage may occur during the usually benign course of the disease.
Four cases of congenital toxoplasmosis with hydranencephaly are reported. The anatomic lesions are the consequence of ischemic necrosis and foetal hydrocephalus. The risk of such lesions is highest during the second trimester of pregnancy. The preventive steps against congenital toxoplasmosis are recalled.
Encephalitic illnesses with Epstein-Barr virus (EBV) only represent a small percentage of the causes of viral encephalitis. Clinical symptoms are not specific. Biological standards tests carry few elements of direction, only serologic test of infectious mononucleosis confirms the diagnostic of recent EBV infection. Previous observation shows that the initial study can present similarities with herpes simplex encephalitis, which forces the immediate start of treatment by Acyclovir.
A cardiac murmur was found in a newborn, after 12 hours of life. It was related to an intracardiac tumor, and we made the diagnosis of tuberous sclerosis. The same diagnosis was made in another patient, with a tumor diagnosed by obstetrical echography. In these two cases, seizures occurred rapidly during the evolution. In one case, the heredity was dominant, in the other one, it was a "de novo" mutation. It is unusual to diagnose tuberous sclerosis during the neonatal period, so we report these two cases.
The complications of varicella have been studied in 103 cases of hospitalized children. The patients have been divided into two groups: group I comprises 94 previously healthy children; group II is made up of 9 children who have been treated by corticotherapy for a long time. The frequency of the complications is not statistically different between the two groups. On the other hand, all the fatal complications are observed in group II (3 deaths out of 9 patients). This investigation is in accordance with published data which allows us to characterize a high risk population for life threatening varicella: patients with congenital or acquired cell immunity deficiency. This group requires special therapy: vaccination, specific immunoglobulins and acyclovir.
In a three years retrospective evaluation, the authors point out an important increase of hemophilus influenzae meningitis. This germ, who seem to be actually the first cause in infants bacterial meningitis, set the problem of his Ampicillin resistance (10-15% of cases). It is therefore necessary to change first treatment of these meningitis. Cefotaxime which has been prescribed to 50% of cases gives satisfactory results.
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Humoral immunity was studied in 40 children presenting with idiopathic nephrotic syndrome (INS), of which 30 with minimal supposed or proven glomerular changes (MGC) and 10 with focal and segmental hyalinosis (FSH). Such patients are capable of producing in vivo active antibodies, in response to viral or bacterial infections and after anti-poliomyelitis immunisation. They present with decreased immunoglobulins G and increased immunoglobulins M during exacerbation of the disease. These abnormalities often persist during remission as well as in patients off-therapy. IgE are often increased during periods or exacerbation as well as in remission. On the contrary, the number of B lymphocytes and their distribution according to surface Ig are normal.