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Biomedical subjects

Y Gillet

Publications and source records attributed to Y Gillet.

14 recordsLinked to original sources
PubMed2005

[Experience of Handicap International in providing humanitarian relief in region near Aceh, Indonesia from March 1 to 27, 2005].

This report describes the experience of the author in March 2005 during the relief efforts deployed in the region near Aceh, Indonesia (North Sumatra) by Handicap International, one of the 400 NGO that provided humanitarian aid following the tsunami disaster that struck Southeast Asia on December 26, 2004. Working in Banda Aceh and Meulaboh, the author was confronted with the extent of the devastation both in terms of property damage and human suffering. Clinical cases were often severe and rarely encountered in industrialized countries. The tsunami worsened the already poor sanitary conditions: rundown care facilities, poorly trained health care personnel, tropical disease, poor hygiene, and AVP.

Delivery of Health Care↗
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

[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↗
PubMed2000

[Bacterial meningitis in infants 1 to 8 weeks old].

Bacterial meningitis in the newborn and infant remains a serious problem, with a mortality rate of 24% and a morbidity rate ranging from 30 to 50%. This retrospective study conducted between January 1982 and December 1997, aims to characterize the epidemiology of bacterial meningitis in infants less than 60 days of age. Thirty-five infants between 6 and 60 days of age, hospitalized for bacterial meningitis in the pediatric units of Edouard-Herriot Hospital in Lyon, France, were included. The clinical presentation was not specific for most cases, hyperthermia being the most common symptom (97%). Neurological symptoms such as bulging fontanelle or nuchal rigidity were present in 30% and 8% of the cases, respectively. The four predominant meningeal pathogens were: group B streptococcus (36%), Escherichia coli (28%), meningogoccus (8.6%) and Staphylococcus aureus (8.6%). This study emphasizes the importance of prompt diagnosis, including CSF evaluation, and antimicrobial therapy in infants less than 2 months of age presenting an isolated fever.

Anti-Bacterial Agents↗
PubMed2000

[Liver transplantation in infants and children. Evaluation of the first 40 cases (March 1991-March 1997)].

BACKGROUND: Liver transplantation (LT) is the treatment of end-stage liver disease in children. We report our experience with LT using grafts from living related (LRD) and cadaver donors (CD). POPULATION: From March 1991 to March 1997, 40 children and infants received a total of 42 liver grafts. A reduced-size liver was used in 28 cases. We studied pre-transplantation status, survival rate, and medical and surgical complications in these patients. RESULTS: The survival rate in our series was respectively 85 and 80% at 1 and 7 years after LT. Low weight infants required a prolonged ventilatory assistance. Five of the six deaths noticed during the first three months after LT occurred in children weighing less than 12 kg. One year after LT, no significant difference in the incidence of rejection was found, neither between low-weight children and the others, nor between patients transplanted from CD or LRD. Biliary tract stricture was the major surgical complication. CONCLUSION: This series consisted of a majority of low-weight children. The survival rate in the patients weighting less than 12 kg is lower than in the others. This may be explained by the nutritional status of these patients and early postsurgical complications. The use of grafts from living donors offers more flexibility since the operation is performed electively, but it did not seem to modify the incidence of acute rejections and surgical complications.

Adolescent↗
PubMed1998

-Prevention of respiratory syncytial virus infection-.

Respiratory syncytial virus (RSV) is responsible for annual outbreaks of severe respiratory disease among infants. Its prevention has been considered for many years but the first vaccination trials resulted in diseases of increased severity. New vaccines are in progress with promising results, although their efficacy in the presence of maternal antibodies, and their tolerance in very young babies, remain to be demonstrated. Concerning passive immunization, intravenous anti-RSV immunoglobulins have been successfully tested in children at risk of severe bronchiolitis; however this prophylaxis is not applicable to healthy children. The use of local immunization with intranasal monoclonal antibodies is under study. While waiting for a safe and efficient immunization against RSV, prevention of nosocomial infections by cohorting and handwashing is recommended.

Administration, Intranasal↗
PubMed1997

[Febrile purpura in children].

The association of fever and purpura should first suggest the diagnosis of fulminant meningococcemia, owing to the severity of this condition. Compromise of peripheral circulation (cyanosis, prolonged refilling time) is important to consider, because normal blood pressure is usually observed at an early stage of a septic shock in children and particularly in young infants. When this hypothesis has been eliminated, other causes of febrile purpura can be considered: meningococcal meningitis; measles or other viral diseases; non infectious causes include mechanical purpura, Schönlein-Henoch's purpura and thrombocytopenia. In the frequent case where no cause has been found, the diagnosis of occult bacteriaemia should be considered, leading to parenteral administration of antibiotic following blood and cerebrospinal fluid cultures.

Chickenpox↗
PubMed1997

Toxin involvement in staphylococcal scalded skin syndrome.

The production of staphylococcal exfoliative toxin A (ETA) and toxin B (ETB), toxic shock syndrome toxin (TSST-1), and enterotoxins A-E was analyzed in 60 Staphylococcus aureus strains isolated from children with scalded skin syndrome (15 with generalized exfoliative syndrome, 28 with bullous impetigo, and 17 with staphylococcal scarlet fever). All strains isolated from patients with generalized exfoliative syndrome or bullous impetigo produced ETA and/or ETB and caused a Nikolsky's sign when injected subcutaneously into newborn mice. In contrast, exfoliative toxin was detected in an S. aureus strain from only one of 17 case of staphylococcal scarlet fever; the 16 other S. aureus strains produced TSST-1 and/or an enterotoxin. In conclusion, enterotoxins or TSST-1 are more frequently associated with staphylococcal scarlet fever than are exfoliative toxins. Hence staphylococcal scarlet fever may well represent an abortive form of toxic shock syndrome rather than a milder form of staphylococcal scalded skin syndrome.

Animals↗