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Biomedical subjects

F Dubos

Publications and source records attributed to F Dubos.

At least 19 recordsLinked to original sources
PubMed2006

[Bracelet localisation of chickenpox: a case of atypical varicella].

We report on a 3-year-old child with bracelet localisation of chickenpox. Varicella with unusual clinical aspects and course is known as atypical varicella; it is characterized by its unique clinical features, unusual distribution, or a prolonged course. In case of atypical varicella, clinical diagnosis can be difficult. Pre-existing factors have been reported such as immunocompromised status, sun exposition, local injury and pre-existing rash.

Chickenpox↗
PubMed2006

[Evaluation of the antibiotic prescription in a paediatric intensive care unit].

UNLABELLED: The antibiotic prescription in intensive care units is frequent using often broad-spectrum antibiotics; its quality has never been evaluated in paediatric intensive care units. OBJECTIVES: To describe the modalities of antibiotic prescriptions in a paediatric intensive care unit and confront them to the literature guidelines and bacteriological data. METHODS: From January 1st to March 31st 2005, 52 consecutive prescriptions regarding 45 children, with a total of 47 hospitalisations were prospectively analysed. RESULTS: Confirmed diagnosis of bacterial infection was retained for 50 of the 52 patients: community acquired infection in 35 cases (70%) and a nosocomial infection in 15 cases. Ten children died during the antibiotic treatment (22%), with 5 deaths related to the infection (11%). Monotherapy represented 56% of the prescriptions of antibiotics. The initial antibiotic treatment was empirical in 42 of 52 cases (81%). The empirical prescriptions were documented afterward in 48% of cases. One or more microorganisms were isolated for 60% of the initial prescriptions. Misuses in antibiotic doses (in excess [10%] or by insufficiency [13%]), number of daily administration (4%), and way of administration and/or length of treatment were observed. Seventy-seven percent of the initial prescriptions seemed to be adapted to the identified or suspected bacteria, but only 63% adequate to recommendations. CONCLUSION: Almost 2/3rd of the antibiotic prescriptions were adequate to the recommendations. The implementation of standardized and specific protocols should contribute to improve the quality of these prescriptions.

Anti-Bacterial Agents↗
PubMed2006

[Severity assessment of acute diarrhoea].

Clinician should recognize any life-threatening causes of diarrhoea, such as intussusceptions, surgical abdomen, and haemolytic uraemic syndrome. The following clinical features should alert: abdominal pain with tenderness, with or without guarding, pallor, jaundice, oligo-anuria, bloody diarrhoea, systemically unwell out of proportion to the level of dehydration, shock. The risk of dehydration is related to age (highest in young infants<6 months), and frequency of watery stools (>8/day) and vomiting (>2/day before 1 year and >4/day after 1 year), but these historical points have a moderate sensitivity. The severity of dehydration is rarely estimated with accuracy in terms of weight loss (third sector with full colon, absence of accurate baseline pre-dehydration weight). Combinations of examination signs perform markedly better than any individual sign in predicting dehydration (poor rate agreement, clinically unhelpful likelihood ratio). The presence of at least three signs better correlate with dehydration. Laboratory tests are not helpful. New studies are mandatory to validate severity scoring systems.

Acute Disease↗
PubMed2006

Epidemiology of hospital admissions for paediatric varicella infections: a one-year prospective survey in the pre-vaccine era.

To evaluate the epidemiology of hospital admissions for varicella in children, a 1-year prospective multicentre study was done in Northern France in the pre-varicella vaccine era. The 405 children aged <16 years seen at local hospitals for varicella or herpes zoster were included. Among them, 143 who had varicella and resided in the district were admitted. Admission incidence rates were 28/100000 children aged <16 years (149/100000 infants aged <1 year, 69/100000 children aged 1-4 years, and 2/100000 children aged 5-15 years). Most admissions (57%) were related to complications, usually skin infection (47%). Independent risk factors for admission were place of residence outside the district [adjusted odds ratio (aOR) 8.7], complication at admission (aOR 5.8), recurrent fever (aOR 4.5), recent varicella in a sibling (aOR 4.0), and previous physician visit for the same condition (aOR 2.0).

Adolescent↗
PubMed2006

Clinical decision rules to distinguish between bacterial and aseptic meningitis.

BACKGROUND: Clinical decision rules have been derived to distinguish between bacterial and aseptic meningitis in the emergency room to avoid unnecessary antibiotic treatments and hospitalisations. AIMS: To evaluate the reproducibility and to compare the diagnostic performance of five clinical decision rules. METHODS: All children hospitalised for bacterial meningitis between 1995 and 2004 or aseptic meningitis between 2000 and 2004 have been included in a retrospective cohort study. Sensitivity and specificity were calculated by applying each rule to the patients. The best rule was a priori defined as the one yielding 100% sensitivity for bacterial meningitis, the highest specificity, and the greatest simplicity for a bedside application. RESULTS: Among the 166 patients included, 20 had bacterial meningitis and 146 had aseptic meningitis. Although three rules achieved 100% sensitivity (95% CI 84-100), one had a significantly lower specificity (13%, 95% CI 8-19) than those of the other two rules (57%, 95% CI 48-65; and 66%, 95% CI 57-73), which were not statistically different. The ease of manual computation of the rule developed by Nigrovic et al (a simple list of five items: seizure, blood neutrophil count, cerebrospinal fluid (CSF) Gram stain, CSF protein, CSF neutrophil count) was higher than the one developed by Bonsu and Harper. CONCLUSION: On our population, the rule derived by Nigrovic et al had the best balance between accuracy and simplicity of manual computation and could help to avoid two thirds of unnecessary antibiotic treatments and hospitalisations.

Adolescent↗
PubMed2004

[Assessment of out-patient treatment of varicella in children].

BACKGROUND: Varicella, an almost compulsory affection in children, is complicated in 2% of cases. Some treatments such as powders and non-steroidial anti-inflammatories (NSAIs) may favorise or worsen infectious complications. OBJECTIVE: To assess out-patient prescriptions in children presenting with varicella. METHODS: Three methods were used. Collection of the out-patient prescriptions in children (n=122) subsequently presenting with varicella in one of the hospitals in the North of France conducted from January to May 2003. A telephone survey was made among 50 general practitioners in the same area in March 2003. This collected not only the prescription of the last case reported, but also the intended prescriptions when confronted with a simulated case of the disease. RESULTS: Powders were prescribed in 44 to 54% of cases, NSAIs in 14 to 16%, aspirin in 2 to 4%, and oral acyclovir in 4%. The three assessment methods did not reveal any differences in the prescription of antibiotics, more frequent in the children subsequently visiting the hospital (25 vs. 6%), and the prescriptions of paracetamol. Only 38% of the prescriptions during clinical cases corresponded to the guidelines. CONCLUSION: It is crucial that practitioners be informed on the treatment of varicella and the risks of severe cutaneous surinfections enhanced by certain prescriptions.

Ambulatory Care↗
PubMed2004

[Interferon alpha production in the serum of very young infants after viral infections].

UNLABELLED: IFN-alpha detection is useful in some clinical circumstances, but its use has never been validated in young infants with viral infections. OBJECTIVE: The authors wanted to determine it there was any difference in the assessment of IFN-alpha production between infants under or over six months of age. PATIENTS AND METHOD: A series of 233 children with identified common viral infections who had been assessed for IFN-alpha production was retrospectively analyzed. The viral infections were enteroviral meningitis (n =103), respiratory syncytial virus infections (n =60), and rotavirus gastroenteritis (n =70). Data collected from the group of infants under six months of age (n =105) was compared to that of the older children (n =128). Qualitative and quantitative values of interferon-alpha were determined for each group. RESULTS: Interferon-alpha was detected in very young infants (81.9% of cases) as often as in the older age group (80.3% of cases), for any of the three viral infections (P =0.3-0.63). The mean level of interferon-alpha production detected was not lower in the youngest group, and even higher in the group under six months of age with enteroviral meningitis. CONCLUSION: Interferon-alpha detection in very young infants is efficient and may be useful to differentiate between viral and bacterial infection particularly when the etiological diagnosis appears uncertain.

Age Factors↗
PubMed2003

[Mefloquine treatment in infants and children with Plasmodium falciparum malaria: an efficient and well tolerated treatment].

OBJECTIVES: The aim of this study was to evaluate the efficacy and tolerance of mefloquine treatment in children, especially in infants of less than 15 kg, in an endemic area of malaria (French Guiana). METHOD: This 5-years (1996-2000) retrospective study included 61 children aged 6 months to 16 years who had been treated with mefloquine for acute Plasmodium falciparum malaria. Twenty-six of these children weighted less than 15 kg. The efficiency of the treatment was evaluated using clinical and parasitic data that had been validated according to the criteria of the World Health Organization (WHO). Tolerance was compared with the data in the medical literature. RESULTS: None of the 59 patients who were given the treatment correctly presented signs of early therapeutic failure as defined by the WHO. Apyrexia was obtained in 48 h on average (CI 95%: 39-57; median: 36 h). The mean time required to obtain negative parasitism was 91 h (CI 95%: 80-101; median: 96 h) among the 51 patients in whom this was measured. Mild side effects were observed in 27.8% of the cases affecting mainly the digestive system. No differences were observed regarding efficacy or tolerance for children who weighed less than 15 kg. CONCLUSION: Mefloquine represents an efficient treatment for acute uncomplicated P. falciparum malaria in children and is well-tolerated even in infants.

Adolescent↗
PubMed2003

[Efficacy and tolerance of mefloquine in the treatment of infants and children with Plasmodium falciparum malaria].

UNLABELLED: Only a limited number of treatments are available for use in young children with malaria. OBJECTIVES: The aim of this study was to evaluate the efficacy and tolerance of mefloquine treatment in children, especially in infants of less than 15 kg, in an endemic area of malaria (French Guiana). METHOD: This five-years (1996-2000) retrospective study included 61 children aged six months to 16 years who have been treated with mefloquine for acute P. falciparum malaria. Twenty-six of these children weighted less than 15 kg. The efficiency of the treatment was evaluated using clinical and parasitic data that had been validated according to the criteria of the World Health Organization (WHO). Tolerance was compared with the data in the medical literature. RESULTS: None of the 59 patients who were given the treatment correctly presented signs of early therapeutic failure as defined by the WHO. Apyrexia was obtained in 47.8 h on average (CI 95%: 39-57; median: 36 h). The mean time required to obtain negative parasitism was 90.8 h (CI 95%: 80-101; median: 96 h) among the 51 patients in whom this was measured. Mild side effects were observed in 27.8% of the cases affecting mainly the digestive system. No differences were observed regarding efficacy or tolerance for children who weighed less than 15 kg. CONCLUSION: Mefloquine represents an efficient treatment for acute uncomplicated P. falciparum malaria in children and is well tolerated even in infants.

Adolescent↗
PubMed2000

[Acute bronchiolitis in infants].

Bronchiolitis is the most common disease of the respiratory tract during the first year of life, and occurs in annual epidemics in winter. The etiology is viral, and respiratory syncytial virus (RSV) is the commonest agent. Respiratory symptoms remain generally mild, and treatment just supportive and at home. Certain infants are at high risk of severe illness (age less than 3 months, preterm birth, neonatal respiratory disease, bronchopulmonary dysplasia, underlying chronic diseases), and require hospitalisation. Most treatments are of unproved (corticosteroids), or limited benefit (inhaled bronchodilators, antibiotics). Chest physiotherapy is indicated in case of bronchial secretion. Vaccine are not now available, but prophylaxis with human RSV immunoglobulin or monoclonal antibodies has to be considered for children at increased risk for severe disease.

Acute Disease↗
PubMed1987

Effect of various diets on toxin production by two strains of Clostridium difficile in gnotobiotic mice.

When axenic mice fed a commercial diet were monoassociated with two toxigenic strains of Clostridium difficile, 100% of them died 3 days after inoculation and both enterotoxin and cytotoxin were produced in their intestinal tract. However, when axenic mice were fed various semisynthetic diets before C. difficile challenge, some of them survived and their fecal cytotoxin and enterotoxin productions were highly reduced, whereas the C. difficile population level did not decrease to a great extent. Thus, gnotobiotic mice associated with C. difficile were a good model for the study of modulation by the dietary regimen of intestinal cytotoxin and enterotoxin production.

Animals↗
PubMed1986

Relationships between rotavirus diarrhea and intestinal microflora establishment in conventional and gnotobiotic mice.

Intestinal microflora did not play a role in the intensity or course of EDIM rotavirus-induced diarrhea, since similar results were observed in axenic and conventional mice. In conventional mice, rotavirus-induced diarrhea did not modify the establishment of Lactobacillus spp. and Escherichia coli before weaning. The consequences of diarrhea on the establishment of strictly anaerobic bacteria after weaning were studied through the measurement of two bacterial functions, the microbial barrier effect against E. coli and the development of the immunoglobulin A intestinal immune system. These two bacterial functions were expressed in a similar way in diarrheic and control mice. In young gnotobiotic mice inoculated with Clostridium perfringens or C. difficile, rotavirus infection led to an earlier development of both strains, as compared with controls. This effect was more pronounced with C. difficile. These results suggest that rotavirus infections might enhance opportunistic bacterial infections.

Animals↗
PubMed1986

Prevention of Clostridium difficile induced mortality in gnotobiotic mice by Saccharomyces boulardii.

Oral preventive treatment of gnotobiotic mice by Saccharomyces boulardii significantly decreased mortality following Clostridium difficile infection. A single S. boulardii ingestion protected 16% of mice, whereas 56% were protected when S. boulardii was given continuously in the drinking water. No direct antagonistic effect of the yeast on C. difficile numbers was detected, whereas a modulation of fecal cytotoxin production was demonstrated.

Animals↗
PubMed1985

Modulation of cytotoxin production by Clostridium difficile in the intestinal tracts of gnotobiotic mice inoculated with various human intestinal bacteria.

Gnotobiotic mice died 2 days after inoculation of a cytotoxigenic Clostridium difficile strain. Protection occurred when mice were previously inoculated with a strain of Escherichia coli or Bifidobacterium bifidum. Intestinal cytotoxin production was highly reduced in the surviving mice, whereas the C. difficile population level did not decrease to a great extent.

Adult↗