Ostéomyélites aiguës de l’enfant drépanocytaire en zone tropicale : intérêt de l’utilisation des fluoroquinolones par voie oraleAcute osteomyelitis in children with sickle cell disease in a tropical country : benefit of the use of oral fluoroquinolones.

Aim. – This study was designed to assess the efficacy and the safety of fluoroquinolones in their compassionate use for acute osteomyelitis in children with sickle cell disease in a tropical country.Patients and methods. – This study was non comparative, including twelve children (eight SS, three SC and one SE°thalassemia) treated for acute osteomyelitis with oral ciprofloxacin or ofloxacin because of the following reasons : financial inability to afford conventional parenteral beta-lactams therapy (nine patients), refusal of hospitalization (two patients), and failure of conventional treatment (one patient).Results. – The mean age of patients was 9,5 ± 2,6 years. The long bones were the predominantly site. Salmonella species were present in 75 % of cases, followed by other enterobacteriaceae (16,7 %), and Staphylococcus aureus (8,3 %). Successful outcome occurred in all cases after three to four weeks of treatment and 45 days of plaster immobilization. Transient bilateral Achilles tendon tendinitis was noted in a five-year-old patient.Conclusion. – In economically developing countries, oral fluoroquinolones may be a therapeutic alternative for acute osteomyelitis in patients with sickle cell disease particularly in cases of financial hardship or failure with conventional therapy.     

Infections cutanées sévères à Streptococcus pyogenes chez l’enfant : résultats d’une enquête multicentriqueSevere cutaneous infections due to streptococcus pyogenes in children.

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, varicella 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.     

Chylothorax congénital et hypothyroïdie : à propos d’une observation

Congenital chylothorax, an uncommon disorder, is a therapeutic challenge without satisfactory results. When classical medical approaches fail (such as thoracosynthesis, total parenteral nutrition, and fasting followed by oral medium-chain triglycerides), some medical teams introduce somatostatin or octreotide in cases of recurring chylothorax. We report a case of recurring chylothorax treated with somatostatin at day 27 correlated with an unfortunate discovery of hypothyroidism on day 34. Clinical signs of chylothorax on somatostatin clearly improved with the introduction of levothyroxine. This article points out the relation between the two diseases based on a review of the literature.     

Dyspnée laryngée révélatrice d’une localisation cervicale d’hydatidose : à propos d’un casLaryngeal dyspnea with a hydatid etiology.

Hydatid cysts rarely present as a cervical tumor. We report a case of hydatid cyst of the neck in a child with multiple hydatid cysts in the liver, which was revealed by laryngeal dyspnea. Symptoms occurred in a six year-old country dweller, who presented with progressive laryngeal dyspnea. The chest radiographs showed extrinsic tracheal compression. A cervical ultrasonography showed a liquid filled mass evocative of hydatid cyst type 1. Explorative cervicotomy confirmed the diagnosis. The treatment was conservative after destruction of the parasite using a hypertonic saline solution. The immediate result was the disappearance of the laryngeal dyspnea.     

Mécanismes moléculaires du syndrome néphrotique idiopathiqueMolecular basis of idiopathic nephrotic syndrome.

Steroid-sensitive idiopathic nephrotic syndrome is a T-cell disorder associated with a functional renal impairment. The molecular mechanisms leading from the stimulation of the immune system to the clinical expression of the renal disease can be analyzed according to five biological events: 1) a Th2 activation of T-cells by interleukin-13; 2) a yet unidentified glomerular permeability factor from immune origin; 3) a molecular disorientation of slit diaphragms or glomerular basement membrane responsible for proteinuria; 4) a podocyte cytoskeleton rearrangement responsible for foot process effacement; and 5) renal avidity for sodium and edema formation resulting from a primary stimulation of tubular Na,K-ATPase and an increase of endothelial permeability.