Disseminated nocardiosis in a child with acute lymphoblastic leukemia]

Nocardiosis is a rare infectious disease in children. We report here a disseminated nocardiosis in a child with acute lymphoblastic leukemia. The patient presented prolonged febrile neutropenia and nodular pneumopathy. Based on the amplification of a 16S rDNA, a PCR assay detected Nocardia sp. in the patient's bronchoalveolar lavage (BAL) fluid. Culture of BAL samples yielded Nocardia nova colonies after 2 weeks of incubation. Hepatic, splenic, renal and cerebral localisations were detected on extension checkup. trimethoprime-sulfamethoxazole and amikacine were started given the results of PCR assay, with a good response. Improvement of the patient's general condition led to complete chemotherapy under ciprofloxacine and ceftriaxone treatment, without nocardiosis reactivation. Nocardiosis is a rare complication in children with acute lymphoblastic leukemia. trimethoprime-sulfamethoxazole prophylaxis is widely used to prevent Pneumocystis jiroveci infection in children with haematologic malignancies. As Nocardia species are usually sensible, trimethoprime-sulfamethoxazole could play a role in Nocardia prophylaxis in such population. In our patient, compliance with trimethoprime-sulfamethoxazole had been low. Nocardia species are relatively fastidious growth bacteria and are difficult to isolate with classical bacteriological techniques. Molecular methods are now available, with a good sensitivity and fast results allowing to start an appropriate antibiotherapy before culture results, as early treatment is a major prognosis factor in nocardiosis. Nocardia infection should be suspected in case of nodular pneumopathy in immunocompromised children. An extension checkup should be performed to detect secondary localisations.     

Acute self-limited colitis associated with Cryptosporidium in an immunocompetent patient

A case report of acute self-limiting colitis associated with enteric Cryptosporidium infection in an immunocompetent child is presented. This case broadens the spectrum of symptoms and manifestation of Cryptosporidium infection in a normal human host.     

Unusual lymphocytosis with systemic lupus erythematosus

A 15-year-old boy with systemic lupus erythematosus, who on a follow up visit complained of recurrent episodes of fever, easy fatiguability, and seizures. Investigations revealed lymphocytosis (95%), anemia, and a positive PCR for cytomegalovirus (CMV). Electron microscopy of the lymphocytes revealed intranuclear inclusion bodies supporting the diagnosis of CMV infection. The child was treated with ganciclovir and discharged. At discharge the child was afebrile. However, lymphocytosis persisted even after 9 months of discharge. Repeated screening for possible lymphoreticular malignancy was negative. It is likely that lymphocytosis in this child was due to persistence of CMV infection in host cells leading to continued provocation of the host immune system.     

Respiratory virus infection and airway hyperreactivity in children

A significant portion of infants and young children develop acute lower airway obstruction (wheezing) accompanying viral lower respiratory infections. These wheezing-associated respiratory illnesses, particularly bronchiolitis, are often associated with evidence of prolonged airway obstruction and airway hyperreactivity following the initial infection. The factors that determine the type of clinical infection that initially develops and long-term respiratory consequences of this infection are complex, including the genetic background of the child, the age at the time of infection, the respiratory virus involved, and environmental factors such as exposure to cigarette smoke. Several animal models have been developed to describe the pathophysiology of viral respiratory infection and have helped to define several potential mechanisms for the resulting airway obstruction. Data from these studies and studies in humans emphasize the importance of the immune system and of neural modulation of airway smooth muscle tone in determining the outcome of respiratory virus infection. These observations also help define the pivotal role of the airway epithelium in the regulation of airway smooth muscle tone and the host inflammatory response in the airway. Consequently, the interplay of host and environmental factors, as well as the relative importance of the different mechanisms potentially active in airway obstruction, determine the acute clinical outcome of infection for an individual child and the propensity of that child to develop recurrent episodes of wheezing (asthma).     

Successful elimination of an invasive Aspergillus nidulans lung infection by voriconazole after failure of a combination of caspofungin and liposomal amphotericin B in a boy with chronic granulomatous disease

Chronic granulomatous disease is an inherited defect in host defense mechanisms mainly affecting neutrophil function. Pulmonary infection with Aspergillus nidulans in a child with chronic granulomatous disease could not be eliminated by a combination of caspofungin and liposomal amphotericin B. Voriconazole was successful in clearing the infection.     

Aeromonas hydrophilia tenosynovitis in an immunocompromised host

A case of Aeromonas hydrophilia tenosynovitis, in a child with aplastic anemia, reported here, reconfirms the need to consider this organism as a possible cause of infection in an immunocompromised host.     

Concomitant Candida epiglottitis and disseminated Varicella zoster virus infection associated with acute lymphoblastic leukemia

Acute epiglottitis by nonbacterial pathogens is an uncommon but life-threatening clinical entity. Herein, we report the concomitant occurrence of Candida epiglottitis and mucosal and visceral Varicella zoster virus infection in a child with acute lymphoblastic leukemia. Both infections were atypical in their presentation, occurred in a severely immunocompromised host, and required invasive procedures for diagnosis.     

Qu’accueille la famille d’accueil ?

Introduction

This study examines the reasons of failure of placement of children and adolescents in host family. It highlights what is repeated and what moves from the biological family to the host family and to the institution as well.

Method

The study was conducted about ten children and adolescents met in a house for children of social character. The tools used are interviews at admission and accompaniment and selected folders based on the primary endpoint of the failed investment in host family. For the analysis, we constructed a grid of reading in four areas: elements of the host family, the age of the child at the time of the placement, the reasons for the departure from the host family and significant elements of the child's history.

Results

The observation of the ten situations shows entanglement of past and current issues in biological and host family systems. It reveals the repetition of traumatic experiences in host families not yet symbolized in the biological family.

Analysis

The life of the child in host family is a background of manifest and latent violence. It is impacting the quality of the relationship and moves parental conflict to other institutional or family scenes. It appears that the host family welcomes not only the child to protect in accordance with its primary task but also hosts or is supposed to host the failures of supported previous history of any biological family.

Discussion

On another note, in addition of the complexity of affective links, it hosts an imaginary child, resonating with the imaginary child of biological parents. The host family rejects both the biological family and the child and thus rejects the real object of his mission to welcome and protect the child. This study shows that beyond the child, the foster family is the receptacle of the ghosts of family past and that far from rejecting the unbearable child, rupture reflects a difficulty to mourn the imaginary child.     

Ménétrier's disease and severe gastric ulcers associated with cytomegalovirus infection in an immunocompetent child: a case report

In pediatric patients, Ménétrier's disease is an uncommon clinical entity that has been rarely described only as sporadic cases, and the etiology is unclear. These patients usually have a self-limiting clinical course. Cytomegalovirus is an important pathogen in the immunocompromised host. However, cytomegalovirus infection can be detected in non-immunocompromised children. We discuss the possible role of cytomegalovirus infection in both Menetrier's disease and severe gastric ulcers in an immunocompetent child.     

Flaccid paralysis following oral poliomyelitis vaccination

This is the report of a four months old boy who developed a serous meningitis and flaccid paralysis of the left upper and lower extremity 17 days following the first immunisation with a trivalent life poliomyelitis vaccine. The patient recovered well within 2 months. Presently a mild functional disturbance and muscle wasting of the left leg can still be observed. An acute poliomyelitis can be due to a wild virus infection in an unimmunized child. Secondly an acute poliomyelitis can occur as vaccine associated poliomyelitis as it is reported in the immunocompromised host. As a third possibility the remutation of a poliomyelitis vaccine virus in a patient concomitantly infected with cytomegalovirus can be discussed. Our patient showed a normal humoral and cellular immunity. Virologic studies in our patient disclosed a wild poliomyelitis virus type III which was isolated from the stool. It cannot be clearly distinguished at the present time whether this wild virus is due to a remutation in the presence of a recent cytomegalovirus infection in our patient or due to a newly acquired wild virus infection.     

Does group A beta-hemolytic streptococcal infection increase risk for behavioral and neuropsychiatric symptoms in children?

OBJECTIVE: To determine whether group A beta-hemolytic streptococcal infections increase the risk of developing symptoms characteristic of the diagnosis pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). DESIGN: Prospective cohort study. METHODS: Children (N = 814) aged 4 to 11 years seen for sore throat or well-child care in a large pediatric practice in Rochester, NY, were enrolled from October 2001 to June 2002 (group A beta-hemolytic streptococcal [GAS] infected, n = 411; GAS uninfected, n = 403, of whom 207 had a sore throat of presumed viral etiology and 196 were well children). Symptomatic children with GAS infection (n = 399) were treated with antibiotics. At baseline and 2 and 12 weeks following baseline, all parents completed a 20-item questionnaire about the presence/absence of recent PANDAS symptoms in their children, and capable children answered 10 items about worries, obsessions, and compulsions. The relative risk of developing a "mild PANDAS variant" (> or = 2 new PANDAS symptoms) by illness type (GAS positive, presumed viral, or well child) and by parent and child report was determined and adjusted for potential covariates. RESULTS: By parent report, ill children more frequently manifested several PANDAS symptoms at baseline than well children. However, neither new symptoms nor the risk of developing a mild PANDAS variant developed during the subsequent 12 weeks more commonly in children with GAS infection than in those with presumed viral illness or in well children by parent or child report. CONCLUSIONS: Ill children with GAS infection, treated for their GAS infection, were not at increased risk for developing PANDAS symptoms or a mild PANDAS variant compared with children with presumed viral illness or well children. The role of antibiotics in the prevention or treatment of PANDAS as well as the investigation of PANDAS in the asymptomatic, infectious host deserves future research.     

Management of the febrile child without a focus of infection in the era of universal pneumococcal immunization

Should strategies of management of invasive disease in the febrile child without focus of infection (occult bacteremia) be reconsidered in communities with universal immunization of infants with the conjugate vaccines for Haemophilus influenzae type b and Streptococcus pneumoniae (PCV7)? The incidence of occult bacteremia is likely to decrease with the virtual elimination of H. influenzae type b and vaccine serotype pneumococcal invasive diseases. The number of children with fever coming to physicians' offices, however, is unlikely to change. The challenge of distinguishing the febrile child with invasive bacterial disease who requires aggressive therapy from the febrile child who has a viral infection and requires only symptomatic therapy will persist. The bacteriology of invasive disease in infants and young children in 2002 will include pneumococcal serotypes not in PCV7; serotypes in PCV7 that occur in the unimmunized, partially immunized or fully immunized child (vaccine failures); Neisseria meningitidis; Salmonella spp., group A Streptococcus, Staphylococcus aureus and gram-negative enteric bacilli. Management plans published in the 1990s suggested an aggressive diagnostic approach to the febrile child 3 to 36 months old who was toxic or had a temperature of >39 degrees C. Diagnostic tests included white blood cell counts, cultures of blood and urine and chest radiograph and lumbar puncture as indicated by clinical signs and administration of parenteral ceftriaxone. Although PCV7 was extraordinarily effective in prevention of serotype-specific invasive pneumococcal disease in clinical trials, pediatricians need to know whether the results based on 38,000 enrollees will be maintained as millions of children are immunized. In addition questions about change in serotype of pneumococci causing invasive disease (serotype switching), herd immunity and durability of protection after immunization need to be answered. Until more experience is available to answer these questions, the febrile child without focus of infection should be managed without consideration of immunization with PCV7. Evaluation of the organism (serotype) and the host (acute and convalescent sera) should be undertaken for each case of invasive pneumococcal disease in this era of universal pneumococcal immunization.     

L-ASPARAGINASE TREATMENT OF ACUTE LEUKAEMIA IN CHILDREN

The results of asparaginase-prednisone therapy in children are reported. In 12 children with untreated acute lymphoblastic leukaemia 9 remissions were obtained, there were 2 failures and in one patient therapy had to be stopped because of an anaphylactic shock. One child with an acute myelocytic-granulocytic type of acute leukaemia did not respond. One child with an acute monocytic-monoblastic leukaemia was given asparaginase only. He responded very well. Four patients with a relapse of an acute myeloblastic leukaemia were treated: there were two failures, one child died too early from an infection to be evaluated. One child showed a very good reaction. Serious side-effects were few, the drugs gave many biochemical disturbances including a constant hypofibrino-genaemia, but these were well tolerated and reversible.     

Fever pathophysiology

Fever is a common reason for parents to bring their child to a phys ician for evaluation. F ever is often treated without regard to its underlying mechanism and potential role in the host response. In fact, fever is a complex dynamic process that is actively regulated by the thermoregulatory center within the central nervous system. In this article, the authors provide an overview of the physiology of thermoregulation, the pathogenesis of fever. and the potential role of fever and the febrile response in limiting infection.     

Long-term therapy with aerosolized ribavirin for parainfluenza 3 virus respiratory tract infection in an infant with severe combined immunodeficiency

Abstract:  We report the case of an infant with severe combined immunodeficiency who was presented with PIV3 infection. Aerosolized ribavirin was administered for 10 months until the child gained a functional immune system through an allogeneic hematopoietic stem cell transplant and cleared PIV3 infection. No adverse effect was observed in the child and in healthcare personnel, with a follow-up of three years. Despite the burden of aerosolized administration, early and prolonged administration of aerosolized ribavirin was feasible, well tolerated, and safe for the patient and the caregivers. This is a case report and no definite conclusions can be drawn. However, our experience suggests that prolonged aerosolized ribavirin administration should be considered for the treatment of PIV3 infection in the context of primary immunodeficiency, where there is no currently available alternative treatment, until a functional immune system is gained.     

Herpes simplex infection in the newborn infant

A case of neonatal Herpes simplex infection is being described, which was diagnosed clinically as well as serologically. It concerns a child, which was born after 35 weeks of gestation. Two days after the delivery the mother showed typically efflorescences of Herpes simplex infection in the abdominal region. On the fifth day after birth the child showed a vesico-bullous exanthema beginning on the head and spreading out on breast and back. On day 14th a serious sepsis-like pattern of the disease with respiratory insufficiency and encephalitic symptoms could be seen. Treatment with Vidarabinphosphat and Acyclovir-Natrium was without definite success. At the age of five months the child showed a pseudobulbar-paralysis with tetra-spasticity. The cranial computer-tomography demonstrated a distinct hydrocephalus e vacuo and the electroencephalography registered only sporadic brain activity.     

Epstein-Barr virus related opsoclonus-myoclonus-ataxia does not rule out the presence of occult neuroblastic tumors

Opsoclonus-myoclonus-ataxia (OMA) secondary to Epstein-Barr virus (EBV) infection has only been described in three pediatric patients. Previous reports suggested that evidence for a recent EBV infection in the absence of an occult neoplasm would predict a favorable prognosis for OMA as well as no tumor development. We present the case of a 20-month-old child with OMA associated with a microbiologically documented acute EBV infection and an occult thoracic ganglioneuroblastoma diagnosed 5 months later.     

Early child growth: how do nutrition and infection interact?

It is well known that the relationship between child nutrition and infection is bidirectional, i.e. frequent illness can impair nutritional status and poor nutrition can increase the risk of infection. What is less clear is whether infection reduces the effectiveness of nutrition interventions or, vice versa, whether malnutrition lessens the impact of infection control strategies. The objective of this paper is to review the evidence regarding this interaction between nutrition and infection with respect to child growth in low-income populations. Even when there are no obvious symptoms, physiological conditions associated with infections can impair growth by suppressing appetite, impairing absorption of nutrients, increasing nutrient losses and diverting nutrients away from growth. However, there is little direct evidence that nutrition interventions are less effective when infection is common; more research is needed on this question. On the other hand, evidence from four intervention trials suggests that the adverse effects of certain infections (e.g. diarrhoea) on growth can be reduced or eliminated by improving nutrition. Interventions that combine improved nutrition with prevention and control of infections are likely to be most effective for enhancing child growth and development.     

Thrombotic Thrombocytopenic Purpura as the Cause of Death in an HIV-Positive Child

A case of fatal thrombotic thrombocytopenic purpura (TTP) in a pediatric patient with HIV infection is reported. The diagnosis was made at autopsy based on the presence of platelet microthrombi in multiple organs, including the cardiac conduction system. The disease presented atypically with hemorrhagic manifestations, thrombocytopenia, and hemolytic anemia, without significant accompanying neurologic and renal abnormalities. Autoimmune-based thrombocytopenia has been well documented in the presence of HIV infection in both the adult and the pediatric population. We believe this to be the first reported case of TTP in an HIV-positive child.     

Recurrent Mycoplasma pneumoniae infection in a human immunodeficiency virus-positive child

Mycoplasma pneumoniae is a frequent cause of community-acquired respiratory infections, especially in young children and adolescents. The significance of M. pneumoniae infection in HIV-positive patients, particularly children, is not well described. This report describes an HIV-positive female child with recurrent B-cell lymphoma and recurrent or relapsing pulmonary infections with M. Pneumoniae.