Biomedical subjects
Publications and source records attributed to J Gaudelus.
Vaccination of children who are allergic or assumed allergic to eggs still creates concern and complication for both the doctor and the patient. These concerns are based on a 1985 circular which has always been liberally interpreted and not well understood. Further analysis of the circular and a review of recent literature show, that most of the time, no special precautions need to be taken before vaccination of children with egg allergy.
PURPOSE: To describe the vaccine practice of general practitioners and paediatricians for the 0-24-month-old infants and their deviations to the official recommendations. RESULTS: One thousand three hundred and fifty-five practitioners, 46 +/- 8-year-old took part in the survey. Among them 42.7% were general practitioners and 57.3% were paediatrician. Only one third of them, strictly complied with the official vaccination recommendation (33.1%). This percentage was higher for the general practitioners (43.4%) than for the paediatricians (25.5% P < 0.001). When practitioners adapted the vaccination program, their modifications essentially concerned the first administration of the DTCP Hib vaccine, which was delayed of 1 or 2 months. Some vaccines were specifically concerned by the modifications. The ROR was delayed and the vaccination coverage reached only 75% at 18 months. General practitioners adapted the vaccination calendar more often than paediatricians (16.9 vs. 9.0%: P < 0.05). The B Hepatitis vaccination schedule was the most frequently adapted one by general practitioners as well as paediatricians to deal with multiple injections (53.5%), and the age of the infants (39.1%). CONCLUSION: The availability of hexavalent vaccination containing B Hepatitis should contribute to increase the vaccination coverage of the population against B Hepatitis and could allow an antipneumococcal vaccination through an heptavalent vaccine without increasing the number of injections. On the other hand, general practitioners and paediatricians must actively contribute to increase the ROR vaccination coverage.
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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.
Streptococcus pneumoniae is the leading cause of community acquired infections. We conducted a 5 years retrospective study to assessed mortality of pneumococcal infections in children in the area of Paris. Regarding the provided answers, the mortality rate is 0.3/100.000/year in the 0-15 years old children. The majority of them are toddlers. Only 30% of cases occurred in high-risk children. Meningitis was the main cause of death. Pneumococcal resistance to antibiotics did not appear as a risk factor of mortality.
We report on a 38-day-old infant who developed pleuropneumonia due to a Staphylococcus aureus strain responsible for familial furunculosis, which was acquired by maternal breast-feeding. All isolates from the infant and parents were genetically related by randomly amplified polymorphic DNA analysis and produced Panton-Valentine leukocidin.
BACKGROUND: Myasthenia gravis, an autoimmune disease of young women, is due to the dysfunction of neuromuscular transmission. The newborn of a myasthenic mother inconstantly presents a transitory neonatal myasthenic syndrome. Maternal aggravation, or even myasthenic crisis with respiratory failure, can occur in the first three months post-partum. CASE REPORT: Mrs. S., para two without appreciable medical history, delivered normally a boy weighing 4 kg with an Apgar score of 10/10. At 3 h of life the newborn was admitted to the neonatal care unit for grunting and axial hypotonia. Diagnoses of maternal-fetal infection and fetal distress were excluded. The dissociated pattern of neurological disorders (refusal to drink, axial hypotonia, hypomimia, but good contact and normal alertness) led to search for neuromuscular causes or poison. Myasthenia gravis was then considered and confirmed by maternal electromyography, allowing the diagnosis of transient neonatal myasthenia gravis and early diagnosis and treatment of the maternal myasthenic crisis in a specialized care unit. The outcome of both mother and child was favorable under treatment. CONCLUSION: Lack of maternal myasthenia gravis history should not result in excluding the diagnosis of transitory neonatal myasthenia gravis when evocative neonatal neurological signs are present. The symptomatology in the newborn may indeed reveal maternal myasthenia gravis, allowing an early diagnosis in both the mother and the newborn.
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.
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Sexual abuse against children is common. Both medical and social workers must understand the conditions which suggest the possibility of sexual abuse. To protect children from further abuse and prevent future psychological sequellae, it is necessary to make a multidisciplinary assessment, which is usually followed by referral to justice or to the children's protective services. Legislation concerning medical confidentiality must be well-known and understood by physicians. If the child is left in his family, supportive measures may help him and his family to modify interrelations. If he is sent away from his family, to a foster home or to a foster family, it is very important to maintain the bonds between the child and his family.
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Most of childhood urinary tract infections come through ascending way. Fecal microflora is the usual source of the bacterial strains. Infection facilitating factors are bacterial virulence which increase bacterial attachment to the urinary tract, adhesins and toxins, mostly studied in Escherichia coli, and host factors (receptors availability, acquired or congenital urinary tract abnormalities). Prophylactic treatment in childhood urinary tract infection is indicated in case of obstructed uropathy before surgery, vesico-ureteral reflux without surgical management, recurrent cystitis. It includes hygiene, treatment of a possible uninhibited bladder, and antimicrobial prophylaxy. Few antimicrobial agents have been studied for efficiency and long term tolerance in children. Nitrofurantoin and cotrimoxazole are the most currently used. Subinhibitory concentrations, about 20% of the curative treatment dosage of lower urinary tract infection are effective on bacterial attachment and lessen the frequency of infections. They can be given once a day in the evening.
We report one case of a de-novo complex chromosomal rearrangement (CCR), t(1;5;13)ins(14;13), in an abnormal 19-month-old boy. Clinical features associated were a mild facial dysmorphy and a psychomotor retardation. Parental ages were, respectively, 29 years for the mother and 60 years for the father. We point out the usefulness of fluorescence in-situ hybridization in elucidating CCRs, and discuss the possible correlation between the existence of a chromosomal aberration and advanced paternal age.
Kawasaki disease or mucocutaneous lymph-node syndrome has been described in Japan in 1967. Diagnostic criteria are clinical. The diagnosis must be evoked when a child less than 5-year-old has fever lasting for 5 days or more, particularly if associated with conjonctivitis, cheilitis, rash, or adenomegaly. Kawasaki disease is a vasculitis and can lead to lesions of the coronary arteries which are more frequent in younger infants. Intravenous gammaglobulins (in the first 10 days) lower the frequency of coronary lesions. Aetiology is still unknown but recent advances support the hypothesis that bacterial superantigens are involved.
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