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D Floret

Publications and source records attributed to D Floret.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Necrobacillosis and Lemierre's syndrome: case report].

UNLABELLED: Necrobacillosis (Fusobacterium necrophorum septicaemia) and Lemierre's syndrome (human necrobacillosis with cephalic origin) are not widely known by clinicians. CASE REPORT: We report the case of a 5-year-old girl, presenting with a Lemierre's syndrome consecutive to otitis media. Outcome was favourable under metronidazole and amoxicilline therapy for 6 weeks. CONCLUSION: Necrobacillosis remains a severe disease including peripheral abscesses (mainly in the lungs and the liver), often associated with thrombosis of the internal jugular vein in case of Lemierre's syndrome. Prolonged metronidazole and amoxicilline antibiotherapy allows nowadays a healthy outcome.

Amoxicillin↗
PubMed2003

[Pneumocystis carinii infections in a pediatric intensive care unit: a retrospective study 1980-2002].

OBJECTIVE: The objective of this study was to ascertain the clinical and epidemiological characteristics of Pneumocystis carinii pneumonia (PCP) cases admitted to the Pediatric Intensive Care Unit (PICU). PATIENTS AND METHODS: A retrospective study was carried out for the 10 PCP cases admitted to the PICU from 1980 to 2002. The variables studied were: age, sex, PRISM, underlying diseases, immunological status, clinical manifestations, radiology, response to therapy and clinical follow up. RESULTS: Age of the patients varied between 5 months and 15 years and 4 months and there were 7 females and 3 males. Underlying diseases included: AIDS (3 cases), renal transplant (2 cases), West syndrome (1 case), cancer (4 cases). All presented an acute respiratory failure and 8/10 needed mechanical ventilation (mean duration: 14 days). All were treated by trimethoprim-sulfamethoxazole and 6/10 received steroids. Only one child died. CONCLUSION: PCP is rare and affects mainly immunocompromised children who exhibit ARDS. Steroids treatment is now considered as an useful therapeutic adjuvant. A preventive treatment should be administered to children at risk.

Adolescent↗
PubMed2002

[Pneumococcal meningitis and resistant bacteria].

The emergence of resistance has imposed a modification of the protocols for the treatment of Streptococcus pneumoniae (S pneumoniae) bacterial meningitis. Amoxicillin is no longer adapted. As resistance to C3G appeared, a synergistic effect of an association C3G + vancomycine was demonstrated. Thus currently this association should be recommended in any case of meningitis supposedly due to S pneumoniae. The treatment is then modified according to the evolution and the minimal inhibition concentration (MIC) of the bacteria. The strains carrying a high level of resistance to cephalosporin (MIC > or = 4 micrograms ml-1) or tolerant to vancomycine may cause a therapeutic failure despite an increase of the dosage of cephalosporin. Rifampicin, fosfomycine, or imipenem (despite its risk of convulsions), may represent alternative options, as long as we do not have safe quinolones active on resistant strains of S. pneumoniae. Dexamethasone has been formerly implicated in the relapse of pneumococcal meningitis. Furthermore, its use is questionable since no evidence of a therapeutic benefit has been clearly demonstrated. As a consequence of the resistance phenomenon the management of S. pneumoniae meningitis must include particular measures: at least resistance to penicillin must be checked by the oxacilline disk and the MIC to C3G must be measured by E test; aCSF sample should be obtained between 36 and 48 hours following the beginning of the treatment to check its sterilization. All recent studies have shown a similar prognosis of meningitis due to resistant S. pneumoniae as compared to those due to sensitive strains. However, these data should be interpreted with caution since in these studies, pneumococcus resistant to cephalosporin (the real problem) are not separated from those only resistant to penicillin. Furthermore, presently, the incidence of strains highly resistant to cephalosporin is still low. The new conjugated vaccine against pneumococcus should change the situation if its ability to prevent the circulation of resistant strains is confirmed.

Adrenal Cortex Hormones↗
PubMed2001

[Current problems posed by staphylococcal infections in pediatric patients].

A PEDIATRIC PATHOGEN: Staphylococci remain one of the most important pathogenic agents leading to community-acquired infection in children. Over the last decades, there has been an evolution in the localizations of these infections: dramatic pleuropulmonary staphylococcal infection in newborns has almost entirely disappeared in developed countries. Conversely, skin infections and soft tissue infections as well as bone and joint localizations are frequent. The severity of these bone and joint infections has however declined allowing less aggressive therapeutic regimens. One of the current problems is the risk of emergence of meticillin-resistant strains causing community-acquired infections. Such infections have been very rare in France but careful monitoring is nevertheless necessary. NOSOCOMIAL INFECTION: Staphylococci are however the leading cause of nosocomial infections in children, particularly in intensive care units. All localizations are concerned, especially catheter-related septicemia and pneumonia. There has been an increasing trend for Staphylococcus aureus and coagulase-negative staphylococci infections. Most of the strains isolated are meticillin-resistant. TOXINS: Staphylococcus aureus secretes toxins leading to specific diseases: enterotoxins cause food-poisoning and exofoliatines cause generalized exfoliation and bullous impetigo. Staphylococcal scarlatina is related to the shock provoked by staphylococcal toxins: TSST-1 and entrotoxins. Staphylococcal toxic shock syndrome is a relatively new entity more frequently observed in adults but which was initially described in children. The disease may develop during any staphylococcal infection, particularly after superinfection of a skin burn or varicella. MECHANISM OF ACTION OF TOXINS: Staphylococcal toxins act like superantigens, capable of provoking polyclonal activation of a large number of T cells. This leads to the release of an important quantity of cytokines that intervene in the pathogenesis of toxic diseases. This polyclonal activation has been observed in other pediatric diseases of unknown origin but in which the involvement of staphylococcal toxins can be suspected. There is solid evidence in favor of staphylococcal toxins in Kawasaki syndrome. Likewise, these toxins could be implicated in sudden death syndrome in infants and in acute exacerbations of atopic exzema.

Bacterial Toxins↗
PubMed2001

Role of cytomegalovirus infection in the incidence of viral acute respiratory infections in children attending day-care centers.

In a prospective study carried out in Lyon, France, the association between the excretion of cytomegalovirus (CMV) and the increasing frequency and severity of viral respiratory infections in children attending day-care centers was evaluated. Urine samples were collected in November 1992 (S1) and 4 months later in February 1993 (S4). A total of 246 children aged 6-12 months attending 29 day-care centers from 1 November to 28 February were screened for the excretion of CMV in urine. The diagnosis of viral acute respiratory infection was performed in the case of outbreaks only. Forty-eight (19.5%) children were both S1 and S4 positive for CMV, 30 (12.4%) became CMV positive (S1-/S4+), 4 (1.6%) became negative (S1+/S4-) and 164 (66.7%) remained negative. The percentage of children becoming CMV positive was significantly (P<0.001) higher in day-care centers where more than 40 children were enrolled. Nine outbreaks due to respiratory syncytial virus, rhinovirus and enterovirus were recorded in 8 of 29 (27.6%) day-care centers. Viral acute respiratory infections were significantly (P<0.05) more frequently recorded in day-care centers in which CMV and respiratory viruses cocirculated and were significantly (P<0.001) more frequently reported in CMV-infected children. These findings suggest that viral acute respiratory infections are significantly more likely to occur in CMV-infected children.

Acute Disease↗
PubMed2001

[Immunization for children treated for solid tumors: what are the guidelines?].

There is no agreement on immunization of children treated with chemotherapy (CT) for solid tumors. Based on a review of the literature, we have attempted to establish guidelines on this subject. Except for hepatitis B vaccine, there is no argument to support the use of vaccine during CT. After a standard CT, a 3-month washout period appears to be necessary before starting an immunization program for a child not previously vaccinated, or to proceed with the recommended booster injections for diphteria anatoxin, tetanus vaccine, poliomyelitis inactivated vaccine, pertussis vaccine, and haemophilus influenza type b vaccine if the child is less than 5 years old. For mumps, measles, and rubella live vaccines, a longer post-CT washout of 6 months is suggested for the initial immunization, or for a revaccination of a child proved to be negative for all three serologies. Following high-dose CT a minimal 12-months term and a normalization of the blood lymphocytes count is necessary before planning booster injections once having checked for antidiphteria, tetanic, polio, measles, mumps, rubella and +/- haemophilus antibody titles. We don't find any reason to recommend a systematic varicella immunization in pediatric oncology. Pneumococcal vaccine is recommended in case of asplenia. Any other vaccination (BCG, influenza, yellow fever) must be evaluated individually.

Age Factors↗
PubMed2001

[Pediatric deaths due to community-acquired bacterial infection. Survey of French pediatric intensive care units].

A retrospective survey has been conducted in the Pediatric Intensive Care Units (PICUs) affiliated to the Groupe Francophone d'Urgence et de Réanimation Pédiatrique over two years (1999 and 2000). The purpose was to determine the number of children aged from 10 days to 18 years who died from community acquired bacterial infections and to compare the data to those obtained from official surveys (statistics of death from the Institut National de la Santé et de la Recherche Médicale) and from the Institut National de Veille Sanitaire as well as from punctual studies. Thirty two (60%) PICUs have participated and 100 cases of children without known risk factors, dead from community acquired documented bacterial infection have been considered for analysis (36 in 1999, 54 in 2000). Infants aged between 10 days and 2 months represent 1/3 of the fatalities. Neisseria meningitidis is the first pathogen responsible for death (34% including 10 not documented cases of purpura fulminans). B group is predominant (14/24) compared to the C group (6 cases). A lethal infection due to W135 group occurred in 2 infants in 2000. Streptococcus pneumoniae is the second pathogen responsible for death (28%). None of the cases were due to antibiotic resistant pneumococcus. Bordetella pertussis is surprisingly the third pathogen responsible for death (13%), all of them being younger than 2 months. Pertussis is the first cause of death in infants aged 10 days-2 months. An important increase was observed between 1999 (3 cases) and 2000 (10 cases). Meningitis is the first disease responsible for death (42%): 26 are related to pneumococcus, 5 to meningococcus and 6 to group B streptococcus. Purpura fulminans is the second cause (30%), due mainly to group B meningococcus (11 cases). Group C meningococcus accounts for 6 cases only. One case is related to pneumococcus. Lung infections are a rare cause of death (5 cases) and particularly staphylococcal pleuro pneumonia seems to be no longer a significative cause of fatality. Toxic shock syndrome is an emergent disease responsible for 5 death (2 staphylococcal, 3 streptococcal). These data fit with those provided by the Institut National de Veille Sanitaire with respect to meningococcal infections and the Renacoq network with respect to pertussis, as well as the data provided by a previous GPIP survey on pneumococcal meningitis. However, the data provided by INSERM seem not to be relevant. In spite of the bias due to a retrospective study and the lack of exhaustivity, this survey provides data which could help decision making with respect to new vaccines against pneumococcus.

Bacterial Infections↗
PubMed2001

[Severe staphylococcal pneumonia in children].

Between 1986 and 1999, 8 cases of severe pneumonia due Staphylococcus aureus strains producing the Panton and Valentine leukotoxin (PVL) were referred to the French reference centre for staphylococcal toxaemia. All but one patient were children and to determine the clinical features of these pneumonia we conducted a prospective surveillance during 1999. Staphylococcal pneumonia was defined according to usual standards. All the strains were tested for the gene coding PVL, the cases associated with PVL positive strains were considered as study group. Nosocomial pneumonia were excluded. 52 cases were referred and 16 were PVL positive. These pneumonia occurred in younger patients (median age = 14.8 vs. 70.1) which were previously healthy (40% of underlying disease in control) Remarkable features were the presence of viral infection in the preceding day (75% vs. 9%), the frequency of shock (81% vs. 53%), respiratory distress (75% vs. 53%) and hemoptysia (38% vs. 3%). Leucopenia was present in 79% of cases. Mortality was higher in the PVL group (75% vs. 47%). Severe staphylococcal pneumonia with shock, leucopenia, hemoptysia and high mortality rate have been previously described in children and young adults. We established the relationship between this syndrome and the PVL production by S. aureus. We believe that viral infection constitute the prerequisite altering the respiratory epithelium which secondary allows S. aureus invasion. The necrotizing action of the PVL leads to the massive haemorrhagic necrotic pneumonia. Staphylococcal necrotizing pneumonia is a new entity which frequency is probably underestimated. Further studies are needed to determinate the prognosis factors, the role of S. aureus carriage and of viral infections. The description of this new syndrome could lead to changes in the management of staphylococcal pneumonia in children.

Carrier State↗
PubMed2001

[Clinical aspects of streptococcal and staphylococcal toxinic diseases].

Staphylococcus aureus and Streptococcus pyogenes produce a lot of toxins, some of them responsible for specific diseases. Staphylococcal food poisoning is due to ingestion of enterotoxin containing food. Seven toxins have been isolated so far. Generalized exfoliative syndrome is related to exfoliatin. Young children are particularly affected. The disease consists in a cutaneous exfoliation usually limited with a favourable outcome. The mucus membranes are not involved. The nose or pharynx are the most usual portal of entry. Staphylococcus aureus is not grown from the bullae. Severe extensive forms have been observed particularly in neonates (Ritter's disease). Bullous impetigo is also due to exfoliatin. It consists in the presence of a restricted number of cloudy bullae, from which staphylococcus can be grown. It is a mild disease with a favourable outcome within a few days. Scarlet fever is related to the streptococcal erythrogenic toxins. The classic form of the disease is presently rare. This disease may be related to staphylococcus as a complication of arthritis, osteomyelitis or wound super-infection. Bacteremia is usual. Staphylococcal scarlet fever is not related to exfoliatin as previously believed, but to enterotoxins or TSST-1, so it seems to be an abortive form of toxic shock syndrome. Toxic shock syndrome is defined as a multi organ failure syndrome with a rapid onset, fever, rash followed by desquamation, vomiting and diarrhea, hypotension, conjunctivitis and strawberry tongue. The disease is related to an infection or colonisation with a toxin (TSST-1) producing strain of Staphylococcus aureus. Enterotoxins (mainly C) may be involved. The disease may occur in childhood, sometimes after superinfection of varicella. The mortality is low (5%) and mainly due to ARDS or cardiac problems. Erythrogenic toxins produced by Streptococcus pyogenes are involved in a streptococcal form of toxic shock syndrome with a quite similar presentation. In most cases however, a cutaneous or soft tissue infection is at the origin. Necrotizing fasciitis complicating varicella is a classic cause in children. Bacteremia is often observed. The mortality rate is as high as 60%. The streptococcal strains involved in north america use to produce the toxin erythrogenic A, the european cases seem to be more related to strains secreting the B toxin with a dysregulation of the mechanisms which control the secretion of the toxin. Staphylococcus strains producing the Panton and Valentine leucocidin are responsible for chronic or relapsing furonculosis and above all for a very severe necrotizing pneumonia observed in children and young adults presenting as an acute respiratory distress syndrome with leucopenia, hemoptysis and shock carrying a heavy mortality rate. Besides these specific diseases, staphylococcal and streptococcal toxins may be involved in some syndromes of unknown origin, in which the intervention of superantigens seems very likely. Kawasaki syndrome is among them as strains producing staphylococcal and streptococcal toxins have been grown from patients with Kawasaki syndrome. In the same way, the intervention of toxins is suspected in the determination of sudden infant death syndrome and atopic eczema.

Bacterial Toxins↗
PubMed2001

Postoperative infectious complications in paediatric liver transplantation: a study of 48 transplants.

We studied, retrospectively, postoperative infectious complications following paediatric liver transplantation at a single university centre. The objectives were to characterize the epidemiology of infection and to determine the associated risk factors during the early postoperative period, either the first postoperative month or the entire duration of paediatric intensive care unit (PICU) stay. Forty-eight liver transplants were performed on 46 patients. Sixty-three infections occurred in 32 patients who underwent 34 liver transplantations (1.36 infection/patient); 47 were bacterial, 6 fungal and 10 viral. The most common sites of infection were bloodstream (36.5%) and abdomen (30%). Gram-positive bacteria (78%) predominated over gram-negative bacteria (22%). Initial analysis revealed infection risk factors to be age <1 year, body weight <10 kg, extrahepatic biliary atresia, intraoperative transfusion > 160 ml x kg(-1), mechanical ventilation > 8 days and PICU stay > 19 days. After stratified analysis, the main risk factor for infection was low body weight of the recipient.

Adolescent↗
PubMed2000

Abdominal expansion using a polytetrafluoroethylene prosthesis in the treatment of Pepper syndrome.

The authors report three cases of stage IV-S neuroblastoma in infants aged 4, 6, and 8 weeks, who despite chemo- and radiotherapy required surgical intervention to urgently relieve major thoracoabdominal compression secondary to massive hepatomegaly. The results were successful, with abdominal expansion being achieved by the introduction of a polytetrafluoroethylene prosthesis, which was removed during the 2nd, 3rd and 7th postoperative month, respectively, after tumor regression. Two children were in complete remission 32 and 38 months later, the 3rd died after 16 months of tumor progression.

Adrenal Gland Neoplasms↗
PubMed2000

[Perianal streptococcal dermatitis].

BACKGROUND: Pediatric perianal streptococcal dermatitis (PSD) is a well-defined clinical entity. However, its highly uniform presentation remains surprisingly unrecognized by many practitioners 33 years after its first description. CASE REPORT: A seven-year-old girl had a three-week history of perianal and vulva redness with well-defined margins. Functional symptoms associated perirectal tenderness and pain during defecation, which was responsible for constipation. At onset she also presented with a sore throat, which resolved spontaneously, and she had been complaining for a few days about a perioral impetigo. She received mycostatin unsuccessfully for an alleged candidiasis. Positive cultures for group A beta-hemolytic streptococci from both perirectal and perioral swabs confirmed the diagnosis of PSD. Therapy with amoxicillin (50 mg/kg/d) was prescribed for ten days. Perianal lesions were cleared by day 2. CONCLUSION: Since PSD can masquerade as candidiasis, psoriasis, seborrheic dermatitis, inflammatory bowel disease or even sexual abuse, it remains an underdiagnosed entity. This situation leads to delayed diagnosis and treatment which in turn might increase the frequency of secondary complications related to streptococcal infections (i.e., post-streptococcal acute nephritis and rheumatism, guttate psoriasis, etc.).

Amoxicillin↗