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Biomedical subjects

A Labbé

Publications and source records attributed to A Labbé.

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

Prospective analysis of 61 cases of enteroviral meningitis: interest of systematic genome detection in cerebrospinal fluid irrespective of cytologic examination results.

BACKGROUND: Enteroviruses are the most commonly identified cause of viral meningitis. Detection of the enterovirus genome in cerebrospinal fluid (CSF) using reverse-transcription polymerase chain reaction (PCR) has proved to be useful in diagnosis and is more rapid and sensitive than viral cultures. In routine practice, cytologic examination results of CSF are obtained swiftly and PCR indication is performed as a second step. OBJECTIVES: The aim of this study was to determine, by analysis of complete data from CSF results for 61 cases of proven enteroviral meningitis, whether cytologic CSF findings can be used to establish viral etiology and to indicate if PCR assay should be performed. STUDY DESIGN: From a prospective study of children admitted during 1997 for suspected enterovirus meningitis in which PCR and viral cultures of CSF were systematically performed, we selected 61 patients with proven enterovirus meningitis. We compared global white cell count (WCC), relative percentage of lymphocytes/neutrophils, PCR and culture for enterovirus, patient age, and clinical data. RESULTS: 92% of patients (56/61) had positive PCR in CSF and in 48% (29/61) enterovirus was isolated in CSF. Nine patients (14.75%) had WCC<10/mm(3); eight of them had positive PCR and two had positive culture. There were comparable numbers of CSF with a predominance of lymphocytes (n=25) and CSF with a predominance of neutrophils (n=22), and of positive PCR and positive cultures of CSF in the two groups. Results were not influenced by the age of the patients. CONCLUSION: Irrespective of other CSF parameters, it seems difficult to dispense with PCR assay for enterovirus genome detection. It should be introduced as a true rapid routine test. Early reporting of a positive PCR result could result in a considerable saving in health resources.

Adolescent↗
PubMed2001

Experimental infection of specific pathogen free piglets with French strains of Streptococcus suis capsular type 2.

A standardized model of Streptococcus suis type 2 infection in specific-pathogen-free piglets, housed in high-security barns, was used to compare the virulence of 3 French field strains of S. suis serotype 2 isolated from tonsils of a healthy pig (strain 65) or from diseased pigs (meningitis, strain 166', or septicemia, strain 24). In one of the 2 trials, 7-week-old pigs, in 3 groups of 8, were inoculated intravenously with 2 x 10(8) colony-forming units of S. suis type 2. In each group, 1 uninfected animal was a sentinel. Eight animals were also used as negative control group. The experiment was repeated under similar conditions with strains 65 and 166'. Virulence differed markedly among these S. suis strains when clinical signs, zootechnical performances, lesions, and bacteriological data were analyzed. Strain 65 did not induce clinical signs in inoculated pigs. In contrast, pigs infected with the other 2 strains exhibited clinical signs and typical lesions of S. suis type 2 infections. Differences in virulence were also observed between the 2 virulent strains. Sentinel animals exhibited the same manifestations as those recorded in inoculated piglets. Results were similar in the second trial, indicating that under the present experimental conditions, results were reproducible. The standardized conditions described in this study could be a useful tool to further study about the S. suis infection.

Animals↗
PubMed2000

A nested PCR assay for the detection of Mycoplasma hyopneumoniae in tracheobronchiolar washings from pigs.

A nested polymerase chain reaction (PCR) was developed for the detection of Mycoplasma hyopneumoniae, the etiological agent of enzootic pneumonia, in tracheobronchiolar washings from live pigs. Two nested pairs of oligonucleotide primers were designed from the sequence of a specific DNA probe (I 141; accession number U02537). The primer combination was Hp1/Hp3 for the first step PCR while the nested primers (Hp4/Hp6) allowed amplification of a 706 bp fragment. All strains of M. hyopneumoniae tested in this study could be detected by the nested PCR. DNA from other bacterial species isolated from the respiratory tract of pigs or from other mycoplasmal species were not amplified. The detection limit was estimated to be 1 fg, corresponding approximately to one organism, while in the one step PCR previously described 4 x 10(2) organisms were required. The nested PCR was evaluated on 362 tracheobronchiolar lavages collected from pigs at 2, 4 and 6 months of age in eight herds chronically infected with M. hyopneumoniae. The nested PCR was compared to a blocking ELISA performed with sera collected from the same pigs at the same ages, and to an immunofluorescence test at slaughter on 65 lungs from 6-month old pigs. The comparison indicated that the nested PCR was significantly (p<0.05) more sensitive (157 positive results of 362 samples) than ELISA (118 positive results of 362 samples) for detection of M. hyopneumoniae infection. Nested PCR was also significantly more sensitive (54 positive results of 65 samples) than immunofluorescence (29 positive results of 65 samples) for detection of M. hyopneumoniae in pig lungs at slaughter. Moreover, the nested PCR was used to confirm the absence of the mollicute in a pig herd without any history of M. hyopneumoniae infection. Thus, nested PCR appears to be a useful test to assess M. hyopneumoniae infection on pig farms.

Animals↗
PubMed2000

[Acute myocarditis in children. Study of 11 clinical cases].

The diagnosis of acute myocarditis in children is based on histological criteria. Often viral in origin, it results in acute left ventricular dysfunction, the clinical manifestations of which are very variable. The potential severity of the disease is maximal in its initial phase, justifying rapid and intensive treatment. Long-term outcome is relatively good although there is a risk of chronic left ventricular dysfunction. This retrospective study is based on 11 cases of acute myocarditis admitted to the paediatric unit of Clermont-Ferrand University Hospital between February 1989 and March 1999. The initial symptoms were non-specific. Echocardiography was the key diagnostic procedure. Half of the patients had severe cardiac failure requiring admission to the intensive care unit. Four cases presented with a severe complication: two embolic events, one syncopal atrioventricular block and one cardiac arrest. The cardiac treatment was classical (digitalis, diuretics, angiotensin converting enzyme inhibitors, anticoagulants). The aetiology was established in 3 cases (toxoplasmosis, haemolytic and uraemic syndrome, Kawasaki) and a viral cause was suspected in 6 other cases (adenovirus in 3 cases, herpes virus, RSV and enterovirus in 1 case). There were no deaths in the acute phase. The long-term outcome was globally good: complete regression in 8 cases, 1 chronic left ventricular dysfunction and 2 late deaths due to intractable cardiac failure. This short series illustrates the often misleading presentation of acute myocarditis in childhood, the value of systematic investigation in the hope of a specific treatment becoming available in the near future for the often viral aetiology.

Acute Disease↗
PubMed2000

[Asthma in children].

Asthma is the most common chronic condition in paediatrics. Nowadays the prevalence is of multi-factorial origin. Clinical symptoms in children are often deceptive (isolated cough, winter bronchitis, caused by effort) often to the point of delaying diagnosis. This depends on a network of clinical arguments established by indispensable complementary investigations (thoracic plate and exploration of respiratory function). Search for atopy is systematic whatever the age of the child. Therapeutic care includes educative programmes for both children and their parents. Basal treatment is necessary when the asthma is persistent. Recourse must be made to drugs of which the type and dosage vary according to the state of development. Inhaled corticosteroid is often indicated for a prolonged period. Indications for specific desensitization are now well codified. The concern cases where the allergy has a significant impact on the development of the asthma. Individualised reception plans give a better integration of asthmatic children into school.

Adolescent↗
PubMed1999

[The value of procalcitonin in neonatal infections].

UNLABELLED: The value of procalcitonin (PCT) measurement is not presently completely assessed for the diagnosis of neonatal infections. PATIENTS AND METHODS: This parameter was assessed in a prospective study in the neonatal intensive care unit of Clermont-Ferrand Hospital (France) in comparison to C-reactive protein. All newborn infants admitted before 24 h of life (day 0) in the neonatal intensive care unit were included in the study. Newborns (102) were assigned to one of four groups: group 1: non-infected newborns (n = 41); group 2: possibly infected newborns (n = 33); group 3: probably infected newborns (n = 10); group 4: confirmed infections (n = 18 bacterial or fungal infections). C-reactive protein and PCT were determined in the sera at D0, D1, D3 and D8. We determined the optimal cutoff value of PCT using the Receiver Operating Characteristic curves (R.O.C.). RESULTS: The cutoff value is 1.5 ng/mL at D0 and 10 ng/mL at D1. PCT cutoff value is significantly higher at D1 because of a significant PCT peak on the first day of life independent of any infectious stimulus. Our study shows that at D0 and D1 infected newborn infants had significantly higher mean PCT and C-reactive protein values than non infected newborn infants. C-reactive protein has a better specificity but PCT has better sensitivity and negative predictive value. CONCLUSION: PCT seems to be an interesting marker of neonatal infections especially during the first 24 h of life even though the mechanism of PCT synthesis remains unclear.

Bacterial Infections↗
PubMed1999

An outbreak due to echovirus type 30 in a neonatal unit in France in 1997: usefulness of PCR diagnosis.

Between February and August 1997, 53 patients with enterovirus meningitis were hospitalized in Clermont-Ferrand, France. All but one were children. Echovirus type 30 was involved in 70% of cases with identified serotype. The outbreak ceased on August 8. Two months later, a neonate was admitted to the neonatal unit with an echovirus type 30 meningitis thought to be acquired at delivery. Twenty days later a nosocomial outbreak of echovirus type 30 involving five neonates occurred. Two of them presented with meningitis and two with febrile seizure; One was asymptomatic. The retrospective examination of the maternal sera in a neutralization test, using the index case strain as a source of antigen, showed that none of the neonates was passively immunized before hospitalization. The use of genome detection in cerebrospinal fluid allowed rapid diagnosis and infection was contained by re-inforcing hygiene measures. Prospective examination of stools in the neonatal and paediatric units showed no further occurrences of the disease. No sporadic case was observed in the general population. Hence, nosocomial infections can occur a long time after an outbreak in the general population; rapid diagnosis with molecular tools is useful both for a definite diagnosis in patients already hospitalized, and to act as a rapid alert, even in intervals between seasonal outbreaks.

Adult↗
PubMed1999

[Management of severe acute asthma in children in pediatric urgent and intensive care units].

Mortality in cases of severe asthma attacks in children is evaluated at 1%. During initial medical care, repeated evaluation of clinical and para-clinical severity criteria constitutes the main therapeutic guide. Emergency care treatment is based mainly on oxygen therapy, bronchodilatory therapy by discontinuous inhalation, and general corticotherapy. Intravenous theophylline treatment is controversial. The response after a few hours should allow a decision to be made [1] to follow up with outpatient treatment (rapid marked improvement), [2] to continue the hospital treatment (stabilization), or [3] to transfer to intensive care (worsening, exhaustion). In the intensive care unit, the treatment is based on continuous intravenous administration of beta 2 mimetics in addition to the above therapies. The objective is to avoid resorting to assisted ventilation. When this proves necessary, it must not be detrimental; controlled alveolar hypoventilation allows dynamic hyper-inflation linked to ventilation to be reduced. Prevention of relapse is indispensable. This requires hospitalization in a specialized care unit after discharge from intensive care.

Adrenal Cortex Hormones↗
PubMed1997

Non-infectious interstitial alveolitis and foreign body pulmonary vasculitis in a child treated for acute lymphoblastic leukemia.

We report a case of a 14-month-old girl who was treated for acute lymphoblastic leukemia but died from interstitial alveolitis associated with foreign body vasculitis. This respiratory complication arose 3 months after an allogenic bone marrow transplant. No infectious agents (bacteria, virus, or parasite) were isolated from bronchial or lung tissue samples. Respiratory complications after chemotherapy are reviewed as well as the potential origin of the intravascular foreign body.

Antineoplastic Agents↗
PubMed1997

[Severe streptococcal complications in varicella].

BACKGROUND: An increase in the incidence of group A beta hemolytic streptococcal (GABHS) infections in children has been recently noted with a frequent association with varicella. CASE REPORTS: Two children, 3 and 4.5 years old, developed varicella. The first one was febrile and presented a phlyctene on his left foot. Few hours after his admission, he presented a septic shock; GABHS was isolated from blood. Despite immediate adapted antibiotherapy, he developed a right tibial osteomyelitis with abscess. The second child also developed varicella and was hospitalized because of fever, bad general condition, right cervical adenitis and edema on the left wrist. Edema rapidly extended to the hand and upper arm. One purulent lesion was noted on the upper arm from whom Staphylococcus aureus and GABHS were isolated. Blood samples were sterile. The clinical course was favorable with adapted antibiotherapy. A cutaneous desquamation was observed on the 9th day and we concluded that it was a GABHS cellulitis. CONCLUSION: These two cases confirm the recent report of increase in GABHS infections associated with varicella. Such complications must be looked for in patients with varicella remaining abnormally febrile and/or presenting unusual manifestations.

Chickenpox↗