Candida albicans colonizes the respiratory tract of patients with Cystic Fibrosis (CF). It compet... more Candida albicans colonizes the respiratory tract of patients with Cystic Fibrosis (CF). It competes with CF-associated pathogens, such as Pseudomonas aeruginosa and Staphylococcus aureus, and contributes to disease severity. We serially recovered 160 C. albicans clinical isolates over a period of 30 months from the sputum of 23 pediatric and 2 adult antifungal-naive CF patients at Children’s Hospital Tunis and characterized the genotype and phenotype of a subset of strains using multilocus sequence typing (MLST) and growth assays on multiple stress-, filamentous growth- and biofilm-inducing media. Out of 16 patients regularly sampled for at least 9 months, 8 and 4 were chronically and transiently colonized with C. albicans, respectively. MLST analyses of 56 strains originating from 15 patients indicated that each patient was colonized with a single strain, while 8 patients (53%) carried isolates from clade 4 known to be enriched with strains from Middle East-Africa. A subset of thes...
Pre-requis: Les convulsions febriles constituent un motif frequent d'hospitalisation. Leur pr... more Pre-requis: Les convulsions febriles constituent un motif frequent d'hospitalisation. Leur prise en charge demeure problematique. En effet, la pratique de la ponction lombaire est controversee. Selon l'Americain Academy of Pediatrics, la ponction lombaire est fortement recommandee en cas de convulsion febrile chez le nourrisson de moins de 1 an ; Cependant ce geste n'est pas denue de risque. But: Preciser la place de la ponction lombaire dans la prise en charge des convulsions febriles chez le nourrisson de moins de 12 mois en identifiant les facteurs predictifs de meningite et en repondant a la question suivante « chez quels nourrissons presentant une convulsion febrile avec un examen neurologique normal faut-il pratiquer la ponction lombaire ? ». Methodes: Eude retrospective realisee au service de medecine infantile B de l'Hopital d'Enfants de Tunis, portant sur les observations de convulsion febrile entre 3 mois et 12 mois durant une periode de huit ans ( 2000...
BACKGROUND Acute bronchiolitis management involves all pediatricians and primary care physicians.... more BACKGROUND Acute bronchiolitis management involves all pediatricians and primary care physicians. The national guidelines for bronchiolitis diagnosis and treatment were published in Tunisia to reduce excessive use of diagnostic tests and unify bronchiolitis management. OBJECTIVES We aimed to assess the real impact of the national guidelines on acute bronchiolitis management in Tunisia. METHODS We conducted an evaluative cross-sectional study. We randomly distributed anonymous questionnaires to physicians managing acute bronchiolitis during the period from 1st March 2014 to 30 November 2015. RESULTS We analyzed 140 questionnaires. Ninety-three interviewed physicians (66.4%) were advised of the latest national guidelines, half of them (33.6%) declared they didn't follow these guidelines. Real and complete guidelines adherence was observed in only 1.4% of interviewed physicians. According to bronchiolitis diagnosis, appropriate Chest X-rays and blood tests were requested respective...
Les tumeurs intra-rachidiennes de l'enfant sont relativement peu frequentes. La symptomatolog... more Les tumeurs intra-rachidiennes de l'enfant sont relativement peu frequentes. La symptomatologie clinique est polymorphe et souvent trompeuse. Les auteurs rapportent l'observation d'une fillette de 6 ans, hospitalisee pour boiterie, raideur rachidienne et amaigrissement., L'examen clinique trouve un effacement de la lordose lombaire, une raideur du rachis dorso-lombaire, un syndrome pyramidal faisant evoquer une atteinte medullaire. L'angio-IRM medullaire confirme le diagnostic d'une tumeur intra-durale extra-medullaire. L'examen anatomopathologique de la piece operatoire conclut a un meningiome. Les suites post operatoires sont simples.
BACKGROUND Influenza A (H1N1) is a contagious acute respiratory infection caused a pandemic in 20... more BACKGROUND Influenza A (H1N1) is a contagious acute respiratory infection caused a pandemic in 2009. The outcome was variable among populations. AIM To describe a clinical spectrum and the outcome of Tunisian children with pandemic H1N1/09 influenza virus. METHODS This is a retrospective, descriptive study of children with pandemic H1N1/09 influenza virus hospitalized in the children's hospital of tunis, between November 2009 and February 2010. The diagnosis was made on positive rapid test or PCR. RESULTS thirty two children were included. The median age was 12 months. The most frequently symptoms were: fever (87,5%), digestive disorders ( 59,4%) and dyspnea (15,6%). The mean length of stay was 3,8 days. The outcome was complicated by a bacterial infection (56,3%), and one death. CONCLUSION Mild form of H1N1/influenza virus is the most common presentation; however severe forms can be observed especially in infants.
West Nile virus is currently one of the most widely distributed zoonotic arbovirus in the world, ... more West Nile virus is currently one of the most widely distributed zoonotic arbovirus in the world, progressing into epidemics in many countries. While most infected patients experience mild to no symptoms, thousands of West Nile virus-associated neuroinvasive cases, presenting as meningitis, encephalitis, or acute flaccid paralysis, have been reported, even in children. However, few neonatal cases have been described in literature. West Nile Virus neuroinvasive disease can lead to severe neurological disability or death, especially in infant. We report the first tunisian case of West Nile Virus meningoencephalitis in a newborn and its outcome.
La malformation adenomatoide congenitale du poumon est une malformation rare. L'âge et les ci... more La malformation adenomatoide congenitale du poumon est une malformation rare. L'âge et les circonstances du diagnostic sont variables. Nous rapportons l'observation d'une fillette de 6 ans qui est hospitalisee pour une pneumopathie recidivante. La radiographie du thorax montre une opacite du lobe inferieur gauche. L'IRM thoracique montre une volumineuse formation kystique avec un niveau liquide. L'enfant a ete opere avec des suites simples. L'analyse histologique de la piece operatoire conclut a une malformation adenomatoide kystique.
Prerequis: Les pneumopathies communautaires sont responsables d'une lourde morbidite infantil... more Prerequis: Les pneumopathies communautaires sont responsables d'une lourde morbidite infantile. Le diagnostic etiologique n'est pas toujours aise et le traitement reste probabiliste. But: Etudier les aspects cliniques et evolutifs des pneumopathies communautaires, rechercher les arguments cliniques, biologiques en faveur d'une orientation etiologique et de preciser la place des examens microbiologiques dans l'identification du germe. Methodes: Etude prospective sur une periode de 7 mois (1er decembre 2004 - 30 juin 2005) realisee au service de Medecine Infantile B de l'Hopital d'Enfants de Tunis. Ont ete inclus dans cette etude les enfants âges de 6 mois a 15 ans presentant une pneumopathie communautaire. Resultats: Trente neuf enfants ont ete inclus (20 garcons et 19 filles). L'âge moyen etait de 3 ans 3 mois. Le germe a ete identifie dans 41% des cas: un mycoplasme pneumoniae dans 7 cas, un pneumocoque et un hemophilus dans 4 cas chacun, et d'une co...
La pleuresie a meningocoque est rare chez l'enfant. Cette observation rapporte le cas d'u... more La pleuresie a meningocoque est rare chez l'enfant. Cette observation rapporte le cas d'une pleuresie purulente a meningocoque C chez un enfant de 3 ans. Le diagnostic a ete porte sur l'analyse bacteriologique du liquide de ponction pleurale. L'evolution etait favorable sous antibiotiques. La pleuresie a meningocoque doit etre suspectee meme en l'absence de signe de sepsis severe et de purpura.
Le pseudohypoaldosteronisme de type 1 (PHAI), denomme egalement resistance aux mineralocorticoide... more Le pseudohypoaldosteronisme de type 1 (PHAI), denomme egalement resistance aux mineralocorticoides, est une maladie rare caracterisee par son debut precoce et des manifestations severes associant un syndrome de perte de sel, une deshydratation et des troubles ioniques. Deux formes distinctes de la maladie ont ete individualisees: une forme systemique severe de transmission autosomique recessive et une forme localisee renale, moderee de transmission autosomique dominante ou sporadique. Nous rapportons l'observation d'un nourrisson âge de un mois et trois semaines atteint d'un pseudohypoaldosteronisme type 1 dans sa forme systemique.
BACKGROUND Due to the marked decline of maternal-fetal rhesus incompatibility, ABO alloimmunizati... more BACKGROUND Due to the marked decline of maternal-fetal rhesus incompatibility, ABO alloimmunization has become the leading cause of the newborn hemolytic disease. It is estimated that 15-25 % of all pregnancies are concerned by ABO incompatibility. AIM Neonatal blood group B seems to be more predisposing to acute hemolysis and severe hyperbilirubinemia. We propose to find if the newborn's blood group B represents a risk factor for severe hemolysis and/or severe hyperbilirubinemia. METHODS We conducted a comparative study in the pediatrics department "B" of the Children Hospital of Tunis. We collected retrospectively the medical files of the newborn hospitalized for ABO alloimmunization (January 2011 - March 2014), then we compared two groups, OA group with OA alloimmunization and OB group with OB alloimmunization. A significant threshold was fixed to 0.05. RESULTS We collected 98 cases of newborn ABO hemolytic disease. Both groups, OA and OB, were similar for the onset...
Objective Respiratory viruses are the most important cause of lower respiratory tract infections ... more Objective Respiratory viruses are the most important cause of lower respiratory tract infections (LRTI) in children. Meteorological factors can influence viral outbreaks. The objective of this study was to determine the association between climate variables and respiratory virus detection. Methods Multicenter prospective 1-year surveillance was conducted among children hospitalized for LRTI in Tunisia. Nasopharyngeal aspirates were tested by direct immunofluorescence assay (DIFA) for the detection of respiratory syncytial virus (RSV); adenovirus (AdV); influenza virus (IFV) A and B; and parainfluenza virus 1, 2, and 3 (PIV1/2/3). Samples were further analyzed by reverse-transcription polymerase chain reaction for the detection of human metapneumovirus (hMPV). Monthly meteorological data were determined by consulting the National Institute of Meteorology and the World Weather Online Meteorological Company websites. Pearson's correlation tests were used to determine the statistica...
Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may com... more Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may compromise the prognosis of the child and the respiratory function in the long term. identify the predictive factors of respiratory sequelae of laryngotracheobronchial foreign body inhalation. This retrospective study was conducted in the children hospital of Tunis during a period of nine years (2000 - 2008). In all statistical tests, the significance level was set at 0.05. 60 children were included in the study. The average age was 24.9 +/- 3.4 months. 2 / 3 of the children were boys. The foreign body was plant in 80% of cases. The penetration syndrome was reported in 83.7% of cases. The average time of stay of foreign body was 14 days. The chest radiograph was abnormal in 77.4% of cases. Endoscopic extraction was performed in 59 cases and a pneumectomy was conducted in one child. 30 children were followed for an average of 23 months. 18 children had not respiratory sequelae (clinical, rad...
Candida albicans colonizes the respiratory tract of patients with Cystic Fibrosis (CF). It compet... more Candida albicans colonizes the respiratory tract of patients with Cystic Fibrosis (CF). It competes with CF-associated pathogens, such as Pseudomonas aeruginosa and Staphylococcus aureus, and contributes to disease severity. We serially recovered 160 C. albicans clinical isolates over a period of 30 months from the sputum of 23 pediatric and 2 adult antifungal-naive CF patients at Children’s Hospital Tunis and characterized the genotype and phenotype of a subset of strains using multilocus sequence typing (MLST) and growth assays on multiple stress-, filamentous growth- and biofilm-inducing media. Out of 16 patients regularly sampled for at least 9 months, 8 and 4 were chronically and transiently colonized with C. albicans, respectively. MLST analyses of 56 strains originating from 15 patients indicated that each patient was colonized with a single strain, while 8 patients (53%) carried isolates from clade 4 known to be enriched with strains from Middle East-Africa. A subset of thes...
Pre-requis: Les convulsions febriles constituent un motif frequent d'hospitalisation. Leur pr... more Pre-requis: Les convulsions febriles constituent un motif frequent d'hospitalisation. Leur prise en charge demeure problematique. En effet, la pratique de la ponction lombaire est controversee. Selon l'Americain Academy of Pediatrics, la ponction lombaire est fortement recommandee en cas de convulsion febrile chez le nourrisson de moins de 1 an ; Cependant ce geste n'est pas denue de risque. But: Preciser la place de la ponction lombaire dans la prise en charge des convulsions febriles chez le nourrisson de moins de 12 mois en identifiant les facteurs predictifs de meningite et en repondant a la question suivante « chez quels nourrissons presentant une convulsion febrile avec un examen neurologique normal faut-il pratiquer la ponction lombaire ? ». Methodes: Eude retrospective realisee au service de medecine infantile B de l'Hopital d'Enfants de Tunis, portant sur les observations de convulsion febrile entre 3 mois et 12 mois durant une periode de huit ans ( 2000...
BACKGROUND Acute bronchiolitis management involves all pediatricians and primary care physicians.... more BACKGROUND Acute bronchiolitis management involves all pediatricians and primary care physicians. The national guidelines for bronchiolitis diagnosis and treatment were published in Tunisia to reduce excessive use of diagnostic tests and unify bronchiolitis management. OBJECTIVES We aimed to assess the real impact of the national guidelines on acute bronchiolitis management in Tunisia. METHODS We conducted an evaluative cross-sectional study. We randomly distributed anonymous questionnaires to physicians managing acute bronchiolitis during the period from 1st March 2014 to 30 November 2015. RESULTS We analyzed 140 questionnaires. Ninety-three interviewed physicians (66.4%) were advised of the latest national guidelines, half of them (33.6%) declared they didn't follow these guidelines. Real and complete guidelines adherence was observed in only 1.4% of interviewed physicians. According to bronchiolitis diagnosis, appropriate Chest X-rays and blood tests were requested respective...
Les tumeurs intra-rachidiennes de l'enfant sont relativement peu frequentes. La symptomatolog... more Les tumeurs intra-rachidiennes de l'enfant sont relativement peu frequentes. La symptomatologie clinique est polymorphe et souvent trompeuse. Les auteurs rapportent l'observation d'une fillette de 6 ans, hospitalisee pour boiterie, raideur rachidienne et amaigrissement., L'examen clinique trouve un effacement de la lordose lombaire, une raideur du rachis dorso-lombaire, un syndrome pyramidal faisant evoquer une atteinte medullaire. L'angio-IRM medullaire confirme le diagnostic d'une tumeur intra-durale extra-medullaire. L'examen anatomopathologique de la piece operatoire conclut a un meningiome. Les suites post operatoires sont simples.
BACKGROUND Influenza A (H1N1) is a contagious acute respiratory infection caused a pandemic in 20... more BACKGROUND Influenza A (H1N1) is a contagious acute respiratory infection caused a pandemic in 2009. The outcome was variable among populations. AIM To describe a clinical spectrum and the outcome of Tunisian children with pandemic H1N1/09 influenza virus. METHODS This is a retrospective, descriptive study of children with pandemic H1N1/09 influenza virus hospitalized in the children's hospital of tunis, between November 2009 and February 2010. The diagnosis was made on positive rapid test or PCR. RESULTS thirty two children were included. The median age was 12 months. The most frequently symptoms were: fever (87,5%), digestive disorders ( 59,4%) and dyspnea (15,6%). The mean length of stay was 3,8 days. The outcome was complicated by a bacterial infection (56,3%), and one death. CONCLUSION Mild form of H1N1/influenza virus is the most common presentation; however severe forms can be observed especially in infants.
West Nile virus is currently one of the most widely distributed zoonotic arbovirus in the world, ... more West Nile virus is currently one of the most widely distributed zoonotic arbovirus in the world, progressing into epidemics in many countries. While most infected patients experience mild to no symptoms, thousands of West Nile virus-associated neuroinvasive cases, presenting as meningitis, encephalitis, or acute flaccid paralysis, have been reported, even in children. However, few neonatal cases have been described in literature. West Nile Virus neuroinvasive disease can lead to severe neurological disability or death, especially in infant. We report the first tunisian case of West Nile Virus meningoencephalitis in a newborn and its outcome.
La malformation adenomatoide congenitale du poumon est une malformation rare. L'âge et les ci... more La malformation adenomatoide congenitale du poumon est une malformation rare. L'âge et les circonstances du diagnostic sont variables. Nous rapportons l'observation d'une fillette de 6 ans qui est hospitalisee pour une pneumopathie recidivante. La radiographie du thorax montre une opacite du lobe inferieur gauche. L'IRM thoracique montre une volumineuse formation kystique avec un niveau liquide. L'enfant a ete opere avec des suites simples. L'analyse histologique de la piece operatoire conclut a une malformation adenomatoide kystique.
Prerequis: Les pneumopathies communautaires sont responsables d'une lourde morbidite infantil... more Prerequis: Les pneumopathies communautaires sont responsables d'une lourde morbidite infantile. Le diagnostic etiologique n'est pas toujours aise et le traitement reste probabiliste. But: Etudier les aspects cliniques et evolutifs des pneumopathies communautaires, rechercher les arguments cliniques, biologiques en faveur d'une orientation etiologique et de preciser la place des examens microbiologiques dans l'identification du germe. Methodes: Etude prospective sur une periode de 7 mois (1er decembre 2004 - 30 juin 2005) realisee au service de Medecine Infantile B de l'Hopital d'Enfants de Tunis. Ont ete inclus dans cette etude les enfants âges de 6 mois a 15 ans presentant une pneumopathie communautaire. Resultats: Trente neuf enfants ont ete inclus (20 garcons et 19 filles). L'âge moyen etait de 3 ans 3 mois. Le germe a ete identifie dans 41% des cas: un mycoplasme pneumoniae dans 7 cas, un pneumocoque et un hemophilus dans 4 cas chacun, et d'une co...
La pleuresie a meningocoque est rare chez l'enfant. Cette observation rapporte le cas d'u... more La pleuresie a meningocoque est rare chez l'enfant. Cette observation rapporte le cas d'une pleuresie purulente a meningocoque C chez un enfant de 3 ans. Le diagnostic a ete porte sur l'analyse bacteriologique du liquide de ponction pleurale. L'evolution etait favorable sous antibiotiques. La pleuresie a meningocoque doit etre suspectee meme en l'absence de signe de sepsis severe et de purpura.
Le pseudohypoaldosteronisme de type 1 (PHAI), denomme egalement resistance aux mineralocorticoide... more Le pseudohypoaldosteronisme de type 1 (PHAI), denomme egalement resistance aux mineralocorticoides, est une maladie rare caracterisee par son debut precoce et des manifestations severes associant un syndrome de perte de sel, une deshydratation et des troubles ioniques. Deux formes distinctes de la maladie ont ete individualisees: une forme systemique severe de transmission autosomique recessive et une forme localisee renale, moderee de transmission autosomique dominante ou sporadique. Nous rapportons l'observation d'un nourrisson âge de un mois et trois semaines atteint d'un pseudohypoaldosteronisme type 1 dans sa forme systemique.
BACKGROUND Due to the marked decline of maternal-fetal rhesus incompatibility, ABO alloimmunizati... more BACKGROUND Due to the marked decline of maternal-fetal rhesus incompatibility, ABO alloimmunization has become the leading cause of the newborn hemolytic disease. It is estimated that 15-25 % of all pregnancies are concerned by ABO incompatibility. AIM Neonatal blood group B seems to be more predisposing to acute hemolysis and severe hyperbilirubinemia. We propose to find if the newborn's blood group B represents a risk factor for severe hemolysis and/or severe hyperbilirubinemia. METHODS We conducted a comparative study in the pediatrics department "B" of the Children Hospital of Tunis. We collected retrospectively the medical files of the newborn hospitalized for ABO alloimmunization (January 2011 - March 2014), then we compared two groups, OA group with OA alloimmunization and OB group with OB alloimmunization. A significant threshold was fixed to 0.05. RESULTS We collected 98 cases of newborn ABO hemolytic disease. Both groups, OA and OB, were similar for the onset...
Objective Respiratory viruses are the most important cause of lower respiratory tract infections ... more Objective Respiratory viruses are the most important cause of lower respiratory tract infections (LRTI) in children. Meteorological factors can influence viral outbreaks. The objective of this study was to determine the association between climate variables and respiratory virus detection. Methods Multicenter prospective 1-year surveillance was conducted among children hospitalized for LRTI in Tunisia. Nasopharyngeal aspirates were tested by direct immunofluorescence assay (DIFA) for the detection of respiratory syncytial virus (RSV); adenovirus (AdV); influenza virus (IFV) A and B; and parainfluenza virus 1, 2, and 3 (PIV1/2/3). Samples were further analyzed by reverse-transcription polymerase chain reaction for the detection of human metapneumovirus (hMPV). Monthly meteorological data were determined by consulting the National Institute of Meteorology and the World Weather Online Meteorological Company websites. Pearson's correlation tests were used to determine the statistica...
Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may com... more Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may compromise the prognosis of the child and the respiratory function in the long term. identify the predictive factors of respiratory sequelae of laryngotracheobronchial foreign body inhalation. This retrospective study was conducted in the children hospital of Tunis during a period of nine years (2000 - 2008). In all statistical tests, the significance level was set at 0.05. 60 children were included in the study. The average age was 24.9 +/- 3.4 months. 2 / 3 of the children were boys. The foreign body was plant in 80% of cases. The penetration syndrome was reported in 83.7% of cases. The average time of stay of foreign body was 14 days. The chest radiograph was abnormal in 77.4% of cases. Endoscopic extraction was performed in 59 cases and a pneumectomy was conducted in one child. 30 children were followed for an average of 23 months. 18 children had not respiratory sequelae (clinical, rad...
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