Acute gastroenteritis (AGE) are usually caused by viruses, especially Rotavirus and Norovirus. Among the bacterial causes, very few warrant antibiotic treatment, mainly Shigella, Vibrio cholerae, Campylobacter (only for severe cases, particularly in the initial phase) and severe cases of Salmonella infection. The antimicrobial treatments proposed in this guide follow the latest guidelines of the European Society of Pediatric Infectious Diseases and the European Society of Pediatric Gastroenterology and Nutrition. Azithromycin is the preferred antibiotic for infections due to Shigella and Campylobacter. Ceftriaxone and ciprofloxacin are recommended for salmonellosis when antibiotic treatment is indicated. In most cases, empirical treatment without bacteriological documentation should be avoided.

Gastroenteritis is usually due to viruses mainly Rotavirus and Norovirus. Among the bacterial causes, very few warrant systemic antibiotic treatment including Shigella, Vibrio cholerae, Campylobacter (only if diagnosed early) and severe cases of Salmonella infections. The antimicrobial treatments proposed in this guide are consistent with the latest recommendations of the European Society of Pediatric Infectious Diseases and the European Society of Pediatric Gastroenterology and Nutrition. Azithromycin is the preferred antibiotic for infections due to Shigella and Campylobacter. Ceftriaxone and ciprofloxpacin are recommended for Salmonella infections that must be treated. Empirical treatment without bacteriological documentation should be avoided Similary, the diagnosis of acute intestinal amebiasis must be proved by microscopic examination before prescribing metronidazole. (C) 2016 Elsevier Masson. All rights reserved.

L’ivermectine (IVM) est un médicament antiparasitaire, dérivé des avermectines, produit de fermentation d’un actinomycète, Streptomyces avermitilis. Sa structure est l’association de deux avermectines. L’IVM agit chez les invertébrés sur les canaux chlorures dépendants du glutamate et de l’acide gamma-aminobutyrique, bloquant ainsi la neurotransmission. Chez l’homme, plusieurs mécanismes de protection du cerveau existent dont la P-glycoprotéine située sur la face apicale des cellules endothéliales de la barrière hémato-encéphalique et codée par le gène MDR1. L’IVM est actuellement utilisée dans le traitement de masse de l’onchocercose, d’autres filarioses, de certaines nématodoses intestinales mais également dans la gale et plus rarement dans les pédiculoses résistantes. Les réactions secondaires décrites sont majoritairement liées au relargage d’un antigène parasitaire à l’origine d’une réaction inflammatoire. Les études réalisées chez l’enfant ou le nourrisson montrent une bonne tolérance de l’IVM. Cependant, son utilisation chez les nourrissons de moins de 15 kg est problématique compte tenu de l’absence d’autorisation de mise sur le marché dans cette tranche d’âge. Par ailleurs, le risque d’utilisation excessive et incontrôlée dans les pédiculoses de l’enfant impose une surveillance attentive.

Ivermectin is an antiparasitic drug, a derivate of avermectins, and a product of fermentation of an actinomycete, Streptomyces avermitilis. Its structure associates two avermectins. Ivermectin acts on the chloride-dependent channels of both glutamate and y-aminobutyric acid, interrupting neurotransmission in invertebrates. In humans, several mechanisms of brain protection exist, including P-glycoprotein, present on the apical face of endothelial cells of the blood-brain barrier and coded by the MDRI gene. Ivermectin is presently used in mass treatment of onchocerciasis, other filariasis, some intestinal nematode infections, but also in scabies, and more rarely in resistant head lice. The side effects described are related to the release of antigen and cause an inflammatory reaction. Studies conducted in children or infants have shown good tolerance of ivermectin. However, its use in infants who weigh less than 15 kg is a problem because of the absence of marketing authorization for this age group. However, the risk of excessive and uncontrolled use in head lice requires close surveillance. (C) 2015 Elsevier Masson SAS. All rights reserved.

Group A rotavirus (RVA) is the leading cause of acute gastroenteritis in young children worldwide. A prospective surveillance network has been set up to investigate the virological and clinical features of RVA infections and to detect the emergence of potentially epidemic strains in France. From 2009 to 2014, RVA-positive stool samples were collected from 4800 children <5 years old attending the paediatric emergency units of 16 large hospitals. Rotaviruses were then genotyped by RT-PCR with regard to their outer capsid proteins VP4 and VP7. Genotyping of 4708 RVA showed that G1P[8] strains (62.2%) were predominant. The incidence of G9P[8] (11.5%), G3P[8] (10.4%) and G2P[4] (6.6%) strains varied considerably, whereas G4P[8] (2.7%) strains were circulating mostly locally. Of note, G12P[8] (1.6%) strains emerged during the seasons 2011–12 and 2012–13 with 4.1% and 3.0% prevalence, respectively. Overall, 40 possible zoonotic reassortants, such as G6 (33.3%) and G8 (15.4%) strains, were detected, and were mostly associated with P[6] (67.5%). Analysis of clinical records of 624 hospitalized children and severity scores from 282 of them showed no difference in clinical manifestations or severity in relation to the genotype. The relative stability of RVA genotypes currently co-circulating and the large predominance of P[8] type strains may ensure vaccine effectiveness in France. The surveillance will continue to monitor the emergence of new reassortants that might not respond to current vaccines, all the more so as all genotypes can cause severe infections in infants.

BACKGROUND:Retrospective studies and case-reports have suggested the possible role of various viruses in the pathogenesis of the Kawasaki disease. OBJECTIVES:To determine prospectively the incidence of Kawasaki diseases associated with a recent bocavirus infection in the course of a year. STUDY DESIGN:Thirty-two children with Kawasaki disease were enrolled in a 13 months prospective study to assess the frequency of human bocavirus type 1 infections. Seasonal shedding of virus, markers of recent infection such as viraemia, viral load, and serum interferon alpha were analyzed. RESULTS:Three of 32 (9%) children had HBoV-DNA in the serum suggesting a recent infection. HBoV-DNA was detected in naso-pharyngeal aspiration of 7/32 (21.8%) children with Kawasaki Disease and six of them (18%) had an increased viral load. No common respiratory viruses were isolated from the 32 patients with the exception of one adenovirus. The seven bocaviruses were identified during the winter-spring season. In addition, 4 of 7 of Kawasaki disease patients shedding bocavirus had detectable interferon alpha in the blood, indicating a possible active or recent viral infection. CONCLUSIONS:This study shows that a recent bocavirus infection is concomitant with the onset of some cases of Kawasaki disease. Bocavirus may be a cofactor in the pathogenesis of this disease as previously reported for other infectious agents.

Montrer qu’une corticothérapie avant le diagnostic de leucémie aiguë lymphoblastique (LAL) peut entraîner des difficultés dans la prise en charge de la maladie.Étude rétrospective de 2005 à 2011, multicentrique sur 11 enfants ayant reçu une corticothérapie orale à la dose de 0,6 à 3,3 mg/kg/j d’équivalent prednisolone pendant 2 à 15 jours dans les deux mois précédant le diagnostic de LAL.Quatre enfants s’étaient présentés avec une pancytopénie fébrile, dont 2 avec un sepsis sévère et un myélogramme initial ne permettant pas le diagnostic en temps utile. L’un d’entre eux avait souffert d’un syndrome de lyse brutale et séjourné à deux reprises en réanimation. Une atteinte méningée avait été observée chez 2 adolescents ayant une LAL-T, avec des lésions cutanées pour l’un, une leucostase cérébrale et pulmonaire, avec insuffisance rénale et coagulation intravasculaire disséminée (CIVD) pour l’autre. Une enfant était décédée d’un choc septique lors de l’induction d’une LAL-T corticorésistante. Quatre enfants n’avaient présenté aucune complication pendant l’induction. Une corticorésistance avait été notée chez 5 enfants, alors que la réponse aux corticoïdes n’était pas évaluable chez 3 autres enfants. Trois allogreffes de moelle avaient été réalisées : la première pour une rechute méningée précoce et les 2 autres pour des LAL-T réfractaires à l’induction.Les corticoïdes peuvent être à l’origine d’un retard à la prise en charge de la LAL et semblent majorer les complications initiales, voire favoriser des atteintes diffuses ainsi qu’une corticorésistance ultérieure. La prudence est donc requise quant à leur prescription notamment devant des tableaux cliniques infectieux peu spécifiques, pour lesquels une numération formule sanguine (NFS) est particulièrement recommandée.The aim of this study was to show that steroid therapy taken before the diagnosis of acute lymphoblastic leukemia (ALL) can alter the management of the disease.We conducted a multicenter retrospective study on 11 children treated between 2005 and 2011, who received oral steroids ranging from 0.6 to 3.3 mg/kg/day prednisolone equivalent for a duration of 2 to 15 days during the 2 months prior to diagnosis of ALL.Four children had febrile pancytopenia. Among them, 2 had severe infections and a noncontributive bone marrow aspiration. One of them presented a severe tumoral lysis syndrome and was hospitalized twice in the intensive care unit. Two teenagers had central nervous system involvement at diagnosis of T-ALL, 1 having associated cutaneous locations, the second one showing pulmonary and central nervous system (CNS) leukostasis with renal failure and disseminated intravascular coagulation. One child died of septic shock during the induction phase of steroid-resistant T-ALL. Four children had no complications during the induction phase. Steroid resistance occurred in 5 cases and steroid sensitivity could not be evaluated in 3 cases. Three allogeneic bone marrow transplants were performed: the first one because of early CNS relapse, the 2 others because of initial treatment resistance.Steroids can induce a delay in the management of ALL and seem to favor initial complications, and possibly increase diffuse locations as well as steroid resistance. Their prescription needs to be carefully managed, especially for uncharacteristic infectious symptoms. Then a complete blood count should be done.

We aimed to elucidate the mechanism underlying the anti-dyslipidemic effect of compound-T3, a farnesoid X receptor antagonist, by investigating its effects on hepatic lipid metabolism in non-human primates. We administered lipid-lowering drugs for 7 days to cynomolgus monkeys receiving a high-fat diet, and subsequently measured the levels of lipid parameters in plasma, feces, and hepatic tissue fluids. Compound-T3 (0.3 and 3 mg/kg p.o.) significantly decreased the plasma levels of non-high-density lipoprotein (non-HDL) cholesterol and apolipoprotein B in a dose-dependent manner. It also decreased the mRNA levels of hepatic small heterodimer partner-1, induced the mRNA expression of hepatic cholesterol 7α-hydroxylase, reduced hepatic cholesterol and triglyceride levels, increased fecal bile acid excretion, and upregulated the expression of hepatic low-density lipoprotein (LDL) receptor. Furthermore, compound-T3 significantly increased plasma HDL cholesterol and apolipoprotein A-I levels. The mRNA expression levels of hepatic apolipoprotein A-I tended to increase after compound-T3 treatment. Compound-T3 also induced accumulation of hepatic bile acids and decreased the mRNA expression levels of the hepatic bile acid export pump. The effects of cholestyramine (300 mg/kg p.o.) on the plasma and hepatic lipid parameters were similar to those of compound-T3, and it increased fecal bile acid levels without causing accumulation of hepatic bile acids. These findings suggest that LDL receptor-mediated hepatic LDL incorporation due to cholesterol catabolism catalyzed by cholesterol 7α-hydroxylase decreases plasma non-HDL cholesterol levels. Upregulation of hepatic apolipoprotein A-I mRNA expression may partially contribute to the increase in HDL cholesterol levels mediated by compound-T3.

La gale, en recrudescence ces dernières années, a posé des problèmes thérapeutiques, principalement lors des retraits répétés du benzoate de benzyle. L’objectif de cette étude était de décrire les pratiques de prescription d’experts du traitement de la gale chez l’enfant.Une enquête nationale a été réalisée, entre décembre 2014 et mars 2015, au moyen d’un questionnaire standardisé reprenant différentes situations cliniques de gale et les molécules utilisées préférentiellement selon les âges. Le questionnaire a été diffusé aux membres du groupe de recherche clinique de la Société française de dermatologie pédiatrique.Sur 38 experts interrogés, 20 ont répondu. Pour une gale typique, l’ivermectine per os était prescrite en première intention par 55 % des experts chez les enfants de 6 ans, par 15 % chez les enfants de 2 ans et par 5 % chez un nourrisson de 3 mois. L’ivermectine était davantage prescrite après échec de traitements antérieurs, en cas de peau lésée ou impétiginisée, en cas de précarité, et surtout en cas de gale profuse hyperkératosique. Trente-cinq pour cent des dermatologues ne posaient pas de restriction à sa prescription en fonction du poids ou de l’âge. Des variations étaient également observées dans ses modalités d’administration. L’esdépalléthrine restait le traitement local préférentiellement prescrit (38 % de l’ensemble des topiques prescrits), sauf chez l’enfant asthmatique, alors que la perméthrine était le topique le moins prescrit.Ce travail confirme l’hétérogénéité de nos pratiques. Des recommandations formalisées d’experts sont attendues, notamment concernant la place de l’ivermectine chez le nourrisson.Scabies has been on the rise in France in recent years and has posed therapeutic problems, mainly due to the withdrawal of benzyl benzoate. The objective of this study was to describe prescribing practices for scabies in children.A national survey was conducted by means of a standardized questionnaire covering various clinical situations of scabies and the drugs used preferentially according to age, which was sent out between December 2014 and March 2015 to members of the clinical research group of the French Society of Paediatric Dermatology.Of the 38 experts contacted, 20 replied. For a typical case of scabies, 55% of the experts initially prescribed oral ivermectin for children aged 6 years, 15% prescribed ivermectin in children aged 2 years, and 5% in infants aged 3 months. Ivermectin was more widely prescribed after failure of prior treatment or recurrence of scabies, on skin lesions or impetigo, if precarious, especially for profuse hyperkeratotic scabies. A total of 35% of the experts reported no prescribing restrictions with regard to patient age or weight. Discrepancies were observed concerning the mode of administration and the time between consecutive doses. Esdepallethrin remained the preferred local treatment among the experts (38% of all topical prescriptions) except in asthmatic children, while permethrin was the least-prescribed topical agent.This study confirms the heterogeneity of our practices. Formal expert recommendations are awaited, particularly concerning the use of ivermectin in infants.

L'émergence de bactéries multirésistantes aboutissant à des impasses thérapeutiques fait de la bonne gestion des antibiotiques une priorité internationale de santé publique. L'utilisation des antibiotiques dans un but de prévention (antibioprophylaxie) doit donc être raisonnée et guidée par les preuves. Les mesures d'antibioprophylaxie doivent toujours s'accompagner de mesure de prévention des infections (vaccination quand cela est indiqué, respect strict des règles d'hygiène). Il existe deux grandes catégories d'antibioprophylaxie : l'antibioprophylaxie chirurgicale et l'antibioprophylaxie médicale. La première a montré son efficacité pour la prévention des infections de sites opératoires dans des situations bien définies. Elle repose sur le principe d'obtention d'une concentration d'antibiotique suffisante au site d'incision pour éviter que les bactéries présentes pénètrent dans le site opératoire et y prolifèrent. Le choix de l'antibiothérapie varie en fonction des sites opératoires et du type de chirurgie. L'antibioprophylaxie chirurgicale ne concerne pas la chirurgie de site infecté et doit être limitée dans le temps avec, le plus souvent, une seule injection périopératoire et toujours d'une durée maximale de 48 heures. L'antibiothérapie médicale peut être indiquée dans certaines situations très bien définies comme certaines situations d'immunodépression (asplénie, déficit de l'immunité cellulaire sévère), la postexposition à des infections invasives (méningococcémie, coqueluche, infection invasive à streptocoque du groupe A, morsure) ou à des situations à risques (certains gestes invasifs chez des patients porteurs de cardiopathies à risques). L'indication de l'antibioprophylaxie urinaire est de plus en plus restreinte au vu de la balance bénéfice/risque et doit toujours être discutée avec un spécialiste.

Consultation of child traveler has two main objectives: to assess of health risk related to the child's health status and history and also the risk related to travel environment; to counsel and prescribe preventive measure to reduce these travel health risks. The evaluation is based on physical examination and a detailed interview including personal history and information regarding the regions of proposed travel. Up to date knowledge of the epidemiology of visited sites, preventive measures and presumptive treatment is required. Essential health recommendations include, in case of exposure, prevention of malaria, arthropod borned diseases and vaccine preventable diseases. For all destinations advice regarding prevention of diarrhea, accident risks and aggravation of preexisting chronic diseases is needed. Universal primary prevention counselling is valuable for all travellers regardless of their age. In the case of children, special attention must be given to food and water hygiene, sun and heat exposure, swimming risks and transports security measures. Evaluation of risk and health education take time and often several visits are needed to complete the immunization schedule before departure.

Background: Recent data about hepatitis A virus (HAV) seroprevalence in industrialized countries and the impact of travels to endemic areas are sparse or absent, particularly for children.Objective: To determine the impact of travel to endemic areas on HAV seroprevalence and estimate the overall HAV seroprevalence in children in France. To identify risk factors for positive HAV serologic results.Study design: This prospective multicentre cross-sectional seroprevalence study took place in eight paediatric emergency units throughout France. Children 1-16 years of age following all inclusion and exclusion criteria were included. Demographic, socioeconomic, and travel data were prospectively collected with a standardized questionnaire before measurement of specific HAV antibodies. HAV seroprevalence was determined and its association with diverse variables assessed by univariate and multivariate analyses.Results: 430 children were included, of whom 116 had travelled to endemic areas. The HAV seroprevalence in the overall population was 5% (95% CI, 3-7) and was higher among the travellers (12% [95% CI, 6-18]) than among the others (2% [95% CI, 0-3]), OR = 7.0 [95% CI, 2.6-18.8]. Risk factors identified for positive serologic results for HAV were travel to an endemic area > 7 days (adjusted OR [aOR] = 4.3 [95% CI, 1.5-12]), age of 14-16 years (aOR = 7.7 [95% CI, 1.6-38.3]) and mother's birth in an endemic area (aOR = 5.2 [95% CI, 1.8-14.8]).Conclusion: Statistical evidence showed that travel to endemic areas and parents' place of birth both play a role in HAV serologic results in children with a significant difference of HAV seroprevalence between traveller and non-traveller children in France. (C) 2012 Elsevier B.V. All rights reserved.

Escherichia coli is both a gastrointestinal tract commensal and a major pathogen. In recent years, E. coli is under lire from the news due to a better understanding of pathogenic factors, outbreaks of infections caused by enterohaemorrhagic strains, and last Inn not least, the worrying development of antibiotic resistance. Due to the absence of new compounds active against these strains, producing extended-spectrum beta-lactamases (ESBL) and frequently multiresistant to other antibiotics. their emergence will pose therapeutic problems for practitioners of all pediatric specialties. The gold standard treatment for severe infections due to ESBL-E. coli family is the penem classe. The frequent use of penems promotes the emergence of strains resistant to carbapenems. Sparing carbapenems should be a clear objective for non life-threatening infect ions. (C) 2012 Elsevier Masson SAS. All rights reserved.

Les politiques vaccinales anti-méningococciques varient beaucoup selon les pays, sans que les différences épidémiologiques ne soient très importantes. Les pays européens, le Canada, l’Australie et le Brésil conseillent en routine la vaccination avec le vaccin méningocoque C conjugué, mais l’âge varie, primo-vaccination avant un an ou pendant la deuxième année de vie, rappel ou non, et rattrapage jusqu’à la fin de l’adolescence ou non. Les États-Unis vaccinent avec le vaccin quadrivalent conjugué ACYW135 à 10 ans avec un rappel 5 ans plus tard car le sérotype Y est largement présent. Enfin, la première campagne de vaccination avec un vaccin A conjugué a débuté dans plusieurs pays de la ceinture des méningites en Afrique.

In European Country, Canada, Australia and Brazil immunization program with conjugate meningococcal C, including universal vaccination of infants or toddlers, with a catch-up program up to 19) in several areas, have been successful in reducing disease incidence through direct and indirect protection. In USA, quadrivalent conjugate vaccines targeting serogroups ACYW135 are used in programs of adolescent immunization at 10 and 15 years because serotype Y is frequent. A mass immunization campaign against serogroupe A disease with a conjugate vaccine is beginning in African belt of meningitis. Polysaccharide vaccines A, C or ACYW135 are used in travelers but quadrivalent conjugate vaccine, with larger targets, gives higher titers after booster and must be preferred. Some questions are pending: immunize before or after one year of age, a booster dose in adolescence and the routine use of quadrivalent conjugate vaccine in Europe if the incidence of serotype Y is growing. (c) 2012 Elsevier Masson SAS. All rights reserved.

Étudier les aspects épidémiologiques, cliniques, bactériologiques et évolutifs des méningites bactériennes néonatales et analyser les facteurs de mauvais pronostic de cette affection.Analyse rétrospective de 44 cas de méningite bactérienne néonatale observés dans un service de pédiatrie entre janvier 1996 et décembre 2010. Ont été inclus les nouveau-nés d’âge inférieur à 29 j, hospitalisés pour une méningite bactérienne retenue sur la présence d’une bactérie dans le liquide céphalorachidien (LCR) ou une pléiocytose supérieure à 50 éléments blancs/mm3 avec une prédominance des polynucléaires neutrophiles et une protéinorachie supérieure à 1,2 g/L.La prévalence des méningites bactériennes néonatales a été de 0,49 pour 1000 naissances vivantes. Les enfants étaient des prématurés dans 20,4 % des cas et de faible poids de naissance dans 13,6 % des cas. Les principaux signes à l’admission avaient été la fièvre (43,2 %), le refus de téter (20,4 %), des convulsions (18,2 %) et une détresse respiratoire (13,6 %). La culture du LCR avait été positive dans 36,4 % des cas et le streptocoque du groupe B avait été le plus fréquemment isolé (62,5 %) suivi par Escherichia coli (12,5 %). L’association céfotaxime-ampicilline-gentamicine avait été utilisée en première intention dans tous les cas. L’ofloxacine avait été associée à l’antibiothérapie initiale pendant les 5 premiers jours dans 20,4 % des cas. Le taux de mortalité avait été de 15,9 % et le taux des séquelles neurosensorielles chez les survivants était de 21,6 %. La prématurité, le faible poids de naissance, l’état de choc, la détresse respiratoire et une pléiocytose inférieure à 500 éléments blancs/mm3 étaient les principaux facteurs de mauvais pronostic. L’adjonction de l’ofloxacine à l’antibiothérapie initiale était associée à une diminution du taux de séquelles neurosensorielles chez les survivants (11 % vs 25 %, p = 0,042).Cette étude souligne la gravité des méningites bactériennes néonatales avec des taux de mortalité et de séquelles neurosensorielles élevés surtout chez les prématurés et les faibles poids de naissance. Un diagnostic précoce et une antibiothérapie efficace sont nécessaires pour améliorer le pronostic.To study the epidemiological, clinical, and bacteriological aspects as well as the outcome of neonatal bacterial meningitis and analyze the factors of poor prognosis of this condition.We report a retrospective analysis of 44 cases of neonatal bacterial meningitis hospitalized in the pediatric unit of Tahar Sfar Hospital in Mahdia, Tunisia, between January 1996 and December 2010. Inclusion criteria were infants less than 29 days of age who were hospitalized for bacterial meningitis diagnosed on either the presence of bacteria in cerebrospinal fluid or with more than 50 cells/mm3, predominance of neutrophils, and the protein level greater than 1.2 g/l. Clinical data were obtained through the analysis of patient files. Statistical analysis was based on the Chi2 test, and P-values less than 0.05 were considered statistically significant.The incidence of neonatal bacterial meningitis was 0.49 per 1000 live births. The patients were premature in 20.4 % and low birth weight in 13.6 % of cases. The clinical presentation was not specific for most cases. The main signs at admission were hyperthermia (43.2 %), refusal to nurse (20.4 %), seizures (18.2 %), and respiratory distress (13.6 %). The cerebrospinal fluid culture was positive in 36.4 % of cases. The group B streptococcus was the most frequently isolated (62.5 %) followed by Escherichia coli (12.5 %). The association of cefotaxime-ampicillin-gentamicin was used as the first treatment in all cases. Ofloxacin was associated with initial antibiotic therapy during the first 5 days in 20.4 % of cases. The mortality rate was 15.9 % and the rate of neurological sequelae in survivors was 21.6 %. Prematurity, low birth weight, shock, respiratory distress, and pleocytosis of less than 500 cells/mm3 were the main factors of a poor prognosis. The addition of ofloxacin to the initial antibiotic therapy was associated with a decreased rate of neurological sequelae in survivors (11 % vs. 25 %, P = 0.042).This study emphasizes the severity of neonatal bacterial meningitis with high rates of mortality and neurological sequelae, especially in premature and low birth weight infants. An early diagnosis and effective antibiotic therapy is needed to improve the prognosis.