[Semi-invasive necrotic aspergillosis in a child with cystic fibrosis]

INTRODUCTION

Aspergillosis colonisation in cystic fibrosis (CF), usually due to Aspergillus fumigatus (AF), classically presents as allergic bronchopulmonary aspergillosis. However, aspergillus infection can produce a range of manifestations: from minor colonization to an invasive infection.

CASE REPORT

A 14-year-old CF patient, chronically colonized with Staphylococcus aureus and Pseudomonas aeruginosa, presented with acute right-sided chest pain, a moderate fever and no modification of the sputum. The chest X-ray showed a 5 cm round opacity. Laboratory parameters were WBC 24,500 G/l, CRP 27 mg/l, Total IgE 1527 UI/l, Specific Aspergillus fumigatus IgE 31 UI/l. Bronchoscopy revealed external compression of the middle lobe bronchus with mucopurulent secretions coming from apical segment of the lower lobe. Bronchoalveolar lavage revealed the presence of pseudomonas aeruginosa 103 CFA/ml, staph aureus 107 CFA/ml and one colony of AF. Chest CT scan showed a large necrotic mass with an air-fluid level located in the apical segment of the right lower lobe. Initial therapy with itraconazole and corticosteroid was replaced by voriconazole, caspofungin, metronidazole and linezolide. Treatment was well tolerated and after 8 weeks the chest X-ray appearances had returned to normal.

CONCLUSIONS

The possible diagnoses and therapeutic options are discussed. Conventional antifungal treatment with amphotericin B is limited by nephrotoxicity. These newer antifungal agents appear to be effective and well-tolerated.

[Smoking and the adolescent. An inquiry into motivation and knowledge of the effects of tobacco]

INTRODUCTION

The nicotinism at the teenagers is a concern of public health. The objective of our prospective and descriptive investigation was to better include/understand the nicotinic practices of the teenagers.

METHODS

A questionnaire was distributed to the children from 12 to 16 years presenting at the Paediatric emergency department of Le Havre from September 2003 on May 2004. The items collected related to the practices and knowledge on the nicotinism.

RESULTS

Hundred answers were collected at teenagers with an average age 14 years. We found 35% of smokers. Among smokers, the average age of the beginning of the nicotinism is at 12,2 years. The girls smoke significantly more than the boys (42% versus 22%, p<0.01). Sex ratio is 2,8 (26 girls and 9 boys). The degree of dependence was evaluated by the score of Fagerström. Half of the questioned teenagers are fairly with strongly dependent (score > 5), in spite of a daily consumption of 5 cigarettes on average. The consumption of other "drugs" was announced at 51.5% of the smokers. On the 100 teenagers, 7 stopped smoking, but 3 think of smoking a day again. The teenagers of single-parent family or separate smoke significantly more than if the parents are in couple (58.3% versus 41.6, p<0.01). The class of third represented the peak of making of contact with the tobacco.

CONCLUSION

The tobacco at the teenagers is a control at the risk justifying the continuation of the actions of prevention by the whole of the doctors.

[Extra-pulmonary tuberculosis in childhood]

Extra-pulmonary tuberculosis (EPT) accounts for around 25% of cases of the disease, and around 20% in children. In Pott's disease and other forms of bone and joint involvement (globally 10-15% of EPT cases), modern imaging techniques like MRI scan have improved diagnosis and follow-up of treatment outcomes. Tuberculous meningitis has not disappeared even in BCG vaccinated children and remains a severe form of the disease. Techniques like the polymerase chain reaction and MRI contribute to an early diagnosis and controversy persists regarding the role of corticosteroid therapy in the treatment strategy. Other localisations are rare in children, including tuberculosis of the urogenital tract, infection of the digestive tract or pericarditis.